Role of Multi-Parametric Magnetic Resonance Imaging (MRI) in Assessment of Malignant Prostatic Lesions

Abstract

Background: carcinoma of the prostate is an important health problem. It is the one of the most frequently diagnosed solid malignant tumor among men. Multi-parametric MRI of the prostate has been increasingly used as an imaging technique through the last years. Objective: our study aimed to evaluate the sensitivity of multiparametric magnetic resonance (MR) imaging in detection of cancer prostate, using the Prostate Imaging Reporting and Data System (PIRADS) version 2.0. Patients and Methods: thirty patients were enrolled in the study. All patients with elevated PSA values greater than 4 ng/ml underwent sextant TRUS guided biopsies. MRI examination was done either prior to the TRUS biopsy or at least 3 weeks after the TRUS biopsy. Results: the application of PI-RADS version 2 has significantly improved the diagnostic performance in detection of clinically significant cancer. Considering PIRADS score greater than 3 as a strong indicator for malignancy, the sensitivity of PI-RADS version 2 was 80% for detection of malignant lesions in general (significant and insignificant). Moreover, our study revealed an 88% sensitivity and 33% specificity of mp-MRI in detection of clinically significant cancer prostate (with PIRADS score 4 or more for clinically significant caner that have a Gleason score 7 or more, or extraprostatic extension), with a significant p value <0. 001. Conclusion: as a preoperative imaging tool, use of PI-RADS version 2 helps to diagnose clinically significant prostate cancer, considering PI-RADS scores of 4 and 5 to be associated with the presence of clinically significant cancer.