Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria:: is it reasonable?

The purpose of this study was to evaluate the accuracy of prostate cancer localization with simple visual diagnostic criteria using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). A total of 46 consecutive patients with biopsy-proven prostate cancer underwent prostate 1.5 T MRI with pelvic phased-array coils before prostatectomy. Besides the usual T2-weighted sequences, a 30-s DCE sequence was acquired three times after gadoterate injection. On DCE images, all early enhancing lesions of the peripheral zone were considered malignant. In the central gland, only early enhancing lesions appearing homogeneous or invading the peripheral zone were considered malignant. Three readers specified the presence of cancer in 20 prostate sectors and the location of distinct tumors. Results were compared with histology; p < 0.05 was considered significant. For localization of cancer in the sectors, DCE imaging had a significantly higher sensitivity [logistic regression, odds ratio (OR): 3.9, p < 0.0001] and a slightly but significantly lower specificity (OR: 0.57, p < 0.0001). Of the tumors > 0.3 cc, 50-60% and 78-81% were correctly depicted with T2-weighted and DCE imaging, respectively. For both techniques, the depiction rate of tumors > 0.3 cc was significantly influenced by the Gleason score (most Gleason <= 6 tumors were overlooked), but not by the tumor volume. Conclusion: DCE-MRI using pelvic phased-array coils and simple visual diagnostic criteria is more sensitive for tumor localization than T2-weighted imaging.