Impact of qualitative, semi-quantitative, and quantitative analyses of dynamic contrast-enhanced magnet resonance imaging on prostate cancer detection

Dynamic contrast enhanced imaging (DCE) as an integral part of multiparametric prostate magnet resonance imaging (mpMRI) can be evaluated using qualitative, semi-quantitative, or quantitative assessment methods. Aim of this study is to analyze the clinical benefits of these evaluations of DCE regarding clinically significant prostate cancer (csPCa) detection and grading. 209 DCE data sets of 103 consecutive patients with mpMRI (T2, DWI, and DCE) and subsequent MRI-(in-bore)-biopsy were retrospectively analyzed. Qualitative DCE evaluation according to PI-RADS v2.1, semi-quantitative (curve type; DCE score according to PI-RADS v1), and quantitative Tofts analyses (K(trans), k(ep,) and v(e)) as well as PI-RADS v1 and v2.1 overall classification of 209 lesions (92 PCa, 117 benign lesions) were performed. Of each DCE assessment method, cancer detection, discrimination of csPCa, and localization were assessed and compared to histopathology findings. All DCE analyses (p<0.01–0.05), except v(e) (p = 0.02), showed significantly different results for PCa and benign lesions in the peripheral zone (PZ) with area under the curve (AUC) values of up to 0.92 for PI-RADS v2.1 overall classification. In the transition zone (TZ) only the qualitative DCE evalulation within PI-RADS (v1 and v2.1) could distinguish between PCa and benign lesions (p<0.01; AUC = 0.95). None of the DCE parameters could differentiate csPCa from non-significant (ns) PCa (p ≥ 0.1). Qualitative analysis of DCE within mpMRI according to PI-RADS version 2.1 showed excellent results regarding (cs)PCa detection. Semi-quantitative and quantitative parameters provided no additional improvements. DCE alone wasn’t able to discriminate csPCa from nsPCa.