The Role of Dynamic Contrast Enhanced Magnetic Resonance Imaging in Evaluating Prostate Adenocarcinoma: A Partially-Blinded Retrospective Study of a Prostatectomy Patient Cohort With Whole Gland Histopathology Correlation and Application of PI-RADS or TNM Staging

Background: Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in the current Prostate Imaging-Reporting and Data System version 2.1 (PI-RADS v2.1) is considered optional, with primary scoring based on T2-weighted imaging (T2WI) and diffusion weighted imaging (DWI). Our study is designed to assess the relative contribution of DCE MRI in a patient-cohort with whole mount prostate histopathology and spatially-mapped prostate adenocarcinoma (PCa) for reference.

Methods: We performed a partially-blinded retrospective review of 47 prostatectomy patients with recent multi-parametric MRI (mpMRI). Scans included T2WI, DWI with apparent diffusion coefficient (ADC) mapping, and DCE imaging. Lesion conspicuity was scored on a 10-point scale with ≥ 6 considered "positive," and image quality was assessed on a 4-point scale for each sequence. The diagnostic contribution of DCE images was evaluated on a 4-point scale. The mpMRI studies were assigned PI-RADS scores and tumor, node, metastasis (TNM) T-stage with blinded comparison to spatially-mapped whole-mount pathology. Results were compared to the prospective clinical reports, which used standardized PI-RADS templates that emphasize T2WI, DWI and ADC.

Results: Per lesion sensitivity for PCa was 93.5%, 82.6%, 63.0%, and 58.7% on T2WI, DCE, ADC and DWI, respectively. Mean lesion conspicuity was 8.5, 7.9, 6.2, and 6.1, on T2W, DCE, ADC and DWI, respectively. The higher values on T2WI and DCE imaging were not significantly different from each other but were both significantly different from DWI and ADC (p < 0.001). DCE scans were determined to have a marked diagnostic contribution in 83% of patients, with the most common diagnostic yield being detection of contralateral peripheral zone tumor or delineating presence/absence of extra-prostatic extension (EPE), contributing to more accurate PCa staging by PI-RADS or TNM, as compared to histopathology.

Conclusion: We demonstrate that DCE may contribute to lesion detection and local staging as compared to T2WI plus DWI-ADC alone and that lesion conspicuity using DCE is markedly improved as compared to DWI-ADC. These findings support modification of PI-RADS v2.1 to include use of DCE acquisitions and that a TNM staging is feasible on mpMRI as compared to surgical pathology.