MR-guided prostatic biopsy at 3T: the role of PI-RADS-score: a histopahologic-radiologic correlation

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1 MR-guided prostatic biopsy at 3T: the role of PI-RADS-score: a histopahologic-radiologic correlation Poster No.: B-0969 Congress: ECR 2015 Type: Scientific Paper Authors: A. Malich; Nordhausen/DE Keywords: Oncology, Interventional non-vascular, Computer applications, MR-Diffusion/Perfusion, CAD, Image manipulation / Reconstruction, Biopsy, Diagnostic procedure, Computer Applications-Detection, diagnosis, Neoplasia, Cancer, Image verification DOI: /ecr2015/B-0969 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 28

2 Purpose PCA is the most common cancer for men in Europe. Current gold standard for verification is ultrasound guided biopsy of the prostate gland. Relevance of multiparametric MRIanalysis is increasing so the MR-guided biopsies do. Study aimed to verify the diagnostic potential of recently established PIRADS-score compared to the histopathological outcome of MR-guided biopsy at 3T. A comparison of imaging and histopathological outcome was done at 3T-based MRguided prostate biopsies to verify the diagnostic relevance of T2w vs. DWI/ADC vs. dynamic analysis in the multiparametric analysis of prostate lesions. Images for this section: Fig. 1: Cover page Page 2 of 28

3 Fig. 2: Introduction: current situation Page 3 of 28

4 Fig. 3: Scope Page 4 of 28

5 Methods and materials 189 prostatic lesions were histologically verified by MR-guided biopsy (3T Philips Ingenia). Indication for biopsy was an inconclusive ultrasound guided biopsy and a suspicious multiparametric MRI. T2w was obtained in 3 dimension; dynamic analysis (overall duration >5min, single dynamic scan of the entire gland <13s) was analyzed by CAD (Confirma and DynaCAD). DWI/ADC were calculated using B-values up to Lesions with PIRADS 4 or 5 were biopsied. PIRADS-schgeme of all single analyses were matched to the histopathological outcome. Related slides explain the principle of PIRADS as well as the endorectally performed MR-guided biopsy step by step. Images for this section: Fig. 4: PIRADS-Score: T2, peripheral zone Page 5 of 28

6 Fig. 5: PIRADS-Score: T2: central zone Page 6 of 28

7 Fig. 6: PIRADS-Score: DWI/ADC Page 7 of 28

8 Fig. 8: PIRADS: Contrast uptake 1 Page 8 of 28

9 Fig. 9: PIRADS: Contrast uptake 2 Page 9 of 28

10 Fig. 10: Patients Page 10 of 28

11 Fig. 7: Dynamic presets of the used CAD-system Page 11 of 28

12 Fig. 11: Preparation for biopsy Page 12 of 28

13 Fig. 12: MR-guided biopsy Step 1 Page 13 of 28

14 Fig. 13: MR-guided biopsy Step 2 Page 14 of 28

15 Fig. 14: MR-guided biopsy step 3 Page 15 of 28

16 Fig. 15: MR-guided biopsy step 4 Page 16 of 28

17 Fig. 16: MR-guided biopsy step 5 Page 17 of 28

18 Fig. 17: MR-guided biopsy step 6 Page 18 of 28

19 Fig. 18: MR-guided biopsy step 7 Page 19 of 28

20 Results 71/189 lesions were proven invasive-malignant and 14/189 lesions as ASAP. 39/189 lesions were verified as prostatitis, 31/189 as hyperplasia, 29/189 as atrophic prostatic tissue or other benign prostatic pathology. In 5/189 biopsies paraglandular tissue was found. No complication occurred at all. 24% of the histologically verified lesions were located in the central zone. T2w finding was scored as 4 or 5 points in 159 cases (sens: 50.9%; spec: 86.7%); sensitivity and specificity of DWI/ADC-calculation was 60.4%; spec: 63.4% and for dynamic analysis 50.4% and 60.5%, resp. Images for this section: Fig. 19: Post biopsy: Outcome Page 20 of 28

21 Fig. 20: HIstopathology Page 21 of 28

22 Fig. 21: Comparison T2w vs. histopathology Page 22 of 28

23 Fig. 22: Comparison: ADC/DWI to histology Page 23 of 28

24 Fig. 23: Comparison: Dynamic Analysis vs. histopathology Page 24 of 28

25 Fig. 24: Complications Page 25 of 28

26 Conclusion MR-guided prostate biopsy is a safe and useful intervention especially after inconclusive ultrasound guided biopsy of the prostate gland. PI-RADS-scoring according to T2w-data is more accurate for determination of malignancy, multiparametric analysis is, however essential to improve the specificity especially of the central zone. The semiquantitative CAD-based scoring of prostate lesions is less accurate and less specific. Further parameters such as slope or amount of peak uptake as well as Kep might be helpful to improve diagnostic potential of dynamic prostate MRI. Images for this section: Fig. 25: Conclusion Page 26 of 28

27 Fig. 26: Thank you for your interest, for further Details please contact me via: Page 27 of 28

28 Personal information It would be a pleasure to get in contact with you. Thynk you for your interest. Please contact me as follows: Prof. Dr. med. habil Ansgar Malich Dr.-R.-Koch-Str Nordhausen Institute of Radiology Sueharz-HOspital Nordhausen Germany ansgar.malich@shk-ndh.de fon: References given in the slides. For more detailed information feel free to get in touch with me. Page 28 of 28

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