• World journal of urology · Apr 2019

    Comparative Study

    Comparison of multiparametric and biparametric MRI of the prostate: are gadolinium-based contrast agents needed for routine examinations?

    • Daniel Junker, Fabian Steinkohl, Veronika Fritz, Jasmin Bektic, Theodoros Tokas, Friedrich Aigner, HerrmannThomas R WTRWTraining and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.Department of Urology, Klinik für Urologie, Spital Thurgau AG, Frauenfeld, Switzerland., Michael Rieger, and Udo Nagele.
    • Department of Radiology, Community Hospital Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria. daniel.junker@tirol-kliniken.at.
    • World J Urol. 2019 Apr 1; 37 (4): 691-699.

    PurposeTo investigate, if and how omitting gadolinium-based contrast agents (GBCA) and dynamic contrast-enhanced imaging (DCE) influences diagnostic accuracy and tumor detection rates of prostate MRI.MethodsIn this retrospective study, 236 patients were included. The results of biparametric (bpMRI) and multiparametric magnetic resonance imaging (mpMRI) were compared using the PI-RADS version 2 scoring system. The distribution of lesions to PIRADS score levels, tumor detection rates, diagnostic accuracy and RoC analysis were calculated and compared to the results of histopathological analysis or 5-year follow-up for benign findings.ResultsOmitting DCE changed PI-RADS scores in 9.75% of patients, increasing the number of PI-RADS 3 scores by 8.89% when compared to mpMRI. No change of more than one score level was observed. BpMRI did not show significant differences in diagnostic accuracy or tumor detection rates. (AuC of 0.914 vs 0.917 in ROC analysis). Of 135 prostate carcinomas (PCa), 94.07% were scored identically, and 5.93% were downgraded only from PI-RADS 4 to PI-RADS 3 by bpMRI. All of them were low-grade PCa with Gleason Score 6 or 7a. No changes were observed for PCa ≥ 7b.ConclusionOmitting DCE did not lead to significant differences in diagnostic accuracy or tumor detection rates when using the PI-RADS 2 scoring system. According to these data, it seems reasonable to use a biparametric approach for initial routine prostate MRI. This could decrease examination time and reduce costs without significantly lowering the diagnostic accuracy.

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