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Prospective comparison of T2w-MRI and dynamic-contrast-enhanced MRI, 3D-MR spectroscopic imaging or diffusion-weighted MRI in repeat TRUS-guided biopsies

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Abstract

Objectives

To compare T2-weighted MRI and functional MRI techniques in guiding repeat prostate biopsies.

Methods

Sixty-eight patients with a history of negative biopsies, negative digital rectal examination and elevated PSA were imaged before repeat biopsies. Dichotomous criteria were used with visual validation of T2-weighted MRI, dynamic contrast-enhanced MRI and literature-derived cut-offs for 3D-spectroscopy MRI (choline-creatine-to-citrate ratio >0.86) and diffusion-weighted imaging (ADC × 103 mm2/s < 1.24). For each segment and MRI technique, results were rendered as being suspicious/non-suspicious for malignancy. Sextant biopsies, transition zone biopsies and at least two additional biopsies of suspicious areas were taken.

Results

In the peripheral zones, 105/408 segments and in the transition zones 19/136 segments were suspicious according to at least one MRI technique. A total of 28/68 (41.2%) patients were found to have cancer. Diffusion-weighted imaging exhibited the highest positive predictive value (0.52) compared with T2-weighted MRI (0.29), dynamic contrast-enhanced MRI (0.33) and 3D-spectroscopy MRI (0.25). Logistic regression showed the probability of cancer in a segment increasing 12-fold when T2-weighted and diffusion-weighted imaging MRI were both suspicious (63.4%) compared with both being non-suspicious (5.2%).

Conclusion

The proposed system of analysis and reporting could prove clinically relevant in the decision whether to repeat targeted biopsies.

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Authors and Affiliations

  1. Department of Radiology, Clinique Pasteur, 45, avenue de Lombez, 31300, Toulouse, France

    Daniel Portalez

  2. Department of Urology, Hôpital de Rangueil, 1, avenue Jean Poulhès, TSA 50032-31059, Toulouse Cedex 9, France

    Gautier Rollin, Patrick Mouly, Frédéric Jonca & Bernard Malavaud

  3. Department of Urology, Clinique Saint Jean, 20, Route de Revel, 31400, Toulouse, France

    Pierre Leandri

  4. Department of Urology, Clinique Pasteur, 45, avenue de Lombez, 31300, Toulouse, France

    Benjamin Elman

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  1. Daniel Portalez
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  2. Gautier Rollin
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  3. Pierre Leandri
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  4. Benjamin Elman
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Correspondence to Bernard Malavaud.

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Portalez, D., Rollin, G., Leandri, P. et al. Prospective comparison of T2w-MRI and dynamic-contrast-enhanced MRI, 3D-MR spectroscopic imaging or diffusion-weighted MRI in repeat TRUS-guided biopsies. Eur Radiol 20, 2781–2790 (2010). https://doi.org/10.1007/s00330-010-1868-6

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  • DOI: https://doi.org/10.1007/s00330-010-1868-6

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