Comparrison of multiparametric magnetic resonance immaging of the prostate with Tesla magnetic field, with transrectal ultrasound-guided prostate biopsy
Authors:
Alžběta Šobrová 1; Viktor Eret 1; Olga Dolejšová 1; Jiří Ferda 2; Jan Kastner 2; Ondřej Hes 3; Kristýna Pivovarčíková 3; Milan Hora 1
Authors‘ workplace:
Urologická klinika LF UK a FN, Plzeň
1; Klinika zobrazovacích metod LF UK a FN, Plzeň
2; Šiklův patologicko-anatomický ústav LF UK a FN, Plzeň
3
Published in:
Ces Urol 2014; 18(3): 225-233
Category:
Original article
Overview
Aim:
Modern magnetic resonance immaging (MRI) with 3 Tesla (T) magnetic field opens new possibilities in the diagnostics of prostate cancer. The aim of this study is to compare the results of 3 T MRI of the prostate with the results of transrectal ultrasound (TRUS)-guided biopsy of the prostate and to determine the role of 3 T MRI in the diagnostics of prostate cancer.
Material and methods:
In the period from 4/2011 to 4/2013 (1st period) 354 men were evaluated using 3T MRI of the prostate. One hundered ninety two of them (54.2%) underwent MRI before TRUS biopsy of the prostate (pacients with a clinical suspicion of prostate cancer), the remaining 162 participants (45.8%) underwent MRI after TRUS biopsy (patients with at least one negative biopsy and ongoing suspicion of prostate cancer, or those requiring staging before radical prostatectomy). To determine potential developments in the outcome 2 years after beginning of the study, we evaluated control group of 162 men in the period from 5/2013 to 12/2013 (2nd period). One hundered nineteen patients (73.5%) underwent MRI before TRUS biopsy, the remaining 43 (26.5%) underwent MRI after TRUS biopsy. The protocol of 3T MRI included triplane T2 weighted MRI, MR spectroscopy, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Suspect results (according to either biopsy or MRI) were considered positive.
Results:
The mean age was 65.4 years (41–82), mean PSA 16.03 ng/ml (1.41–523) in the 1st period and 11.5 ng/ml (2.02–75) in the 2nd period. Sensitivity of MRI was 87.6% and 81.4% in the 1st and 2nd period respectively. Specificity was 56.5% and 68.4% in 1st and 2nd period respectively. Differences between results in patients with MRI before and after biopsy were apparent mainly in specificity which was 46.7% before vs. 70.7% after (in the 1st period) and 62.9% before vs. 92.9% after (in the 2nd period). The most experienced radiologist achieved sensitivity of 83.9% and specificity of 85%, the secon most experienced radiologist achieved sensitivity 71.4% and specificity 50%.
Conclusion:
In the 1st period our study showed a relatively high sensitivity (87.56%) and low specificity (56.52%) of 3T MRI of the prostate in the diagnostics of prostate cancer. In the 2nd period the sensitivity had slightly decreased to 81.4%, and contrary to that specificity had increased to 68.4%. Significant relationship between the experience of radiologist and success rate of MRI diagnosis was detected. The reason for low specificity is not necessarily the failure of MRI but it can be the inability to detect cancer using prostate biopsy. In cases where the biopsy is performed after MRI we focus on cancer loci described on MRI. In cases where the cancer has been verified by biopsy, we use MRI results to select an optimal treatment.
Key words:
3 T MRI of the prostate, prostate cancer, TRUS biopsy.
Sources
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Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2014 Issue 3
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