MP03-12 ACCURACY OF MULTIPARAMETRIC MR IMAGING WITH PI-RADS V2 ASSESSMENT IN DETECTING INFILTRATIONS OF THE NEUROVASCULAR BUNDLES PRIOR TO PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening I1 Apr 2017MP03-12 ACCURACY OF MULTIPARAMETRIC MR IMAGING WITH PI-RADS V2 ASSESSMENT IN DETECTING INFILTRATIONS OF THE NEUROVASCULAR BUNDLES PRIOR TO PROSTATECTOMY Markus Sauer, Julius Weinrich, Georg Salomon, Pierre Tennstedt, Gerhard Adam, and Dirk Beyersdorff Markus SauerMarkus Sauer More articles by this author , Julius WeinrichJulius Weinrich More articles by this author , Georg SalomonGeorg Salomon More articles by this author , Pierre TennstedtPierre Tennstedt More articles by this author , Gerhard AdamGerhard Adam More articles by this author , and Dirk BeyersdorffDirk Beyersdorff More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.129AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate mpMRI-based assessments of neurovascular bundle (NVB) infiltration and to determine the value of PI-RADS V2 scores for the prediction of NVB-infiltration before prostatectomy. METHODS Our institutional review board approved the study. 198 patients underwent standardized mpMRI at 3T prior to surgery, including high resolution T2w-TSE-imaging in 3 planes, T1-w-TSE, DWI with ADC map, PD-TSE and Gd-DCE with post-processing of images. Assessment for NVB-infiltration was made for each side of each prostate (n=396). Maximum PI-RADS-V2 scores were determined for the posterolateral areas adjacent to the NVB (n=396). MRI-findings were correlated to pathologic analysis as reference standard, where NVB-infiltration was defined as tumor invasion into the NVB or extraprostatic expansion (EPE) in the posterolateral area adjacent to the NVB. RESULTS Overall T-staging accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mpMRI were 78.3%, 644 %, 892 %, 82.4% and 76.2%, respectively. In 396 cases infiltration of the NVB was predicted with 89.4%, 75.2%, 94.0%, 80.2% and 92.1% overall accuracy, sensitivity, specificity, PPV and NPV, respectively. By correlating 365 maximum PIRADS-V2 scores to the pathology of adjacent NVBs, infiltration was demonstrated in 13 NVBs despite low likelihood of cancer presence (PI-RADS 1 or 2 scores), amounting to 14% false negative predictions. CONCLUSIONS mpMRI-based assessment of NVB-infiltration should be acknowledged when nerve sparing surgery is considered. However, areas without tumor suspicion (PI-RADS 1 or 2) might demonstrate NVB-infiltration in pathology causing false negative predictions. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e24 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Markus Sauer More articles by this author Julius Weinrich More articles by this author Georg Salomon More articles by this author Pierre Tennstedt More articles by this author Gerhard Adam More articles by this author Dirk Beyersdorff More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...