Document Type : Original Article
Zagazig University Faculty of Medicine Urology Department
Background: MRI is widely used now in prostatic lesions for guiding the diagnostic sample, staging and for active surveillance. Despite the widespread use of MRI, the variability in performing prostate MRI across practices remains challenging. PI-RADS has increasingly become an important part of prostate cancer diagnostics. We aimed to compare the accuracy of using T2 and DW-MRI separately in discriminating prostatic nodule and compare them when using total PIRADS according to PI-RADS-v2 using mp-MRI at 1.5. A prospective study included 120 male patients with clinically suspected prostate cancer. In each prostate lesion, PI-RADS score (from 1 - 5) was given for each prostatic nodule according to T2-WI, then according to DWI. Finally, we reported the overall PI-RADS score of each patient according to V2.
The validity of T2WI imaging alone in diagnosis of prostate cancer was 88.5% sensitivity, 72 % specificity, 81.6% accuracy, 81.5 % predictive value of positivity (PVP) and 81.8% predictive value of negativity (PVN). The validity of DWI imaging was 90% sensitivity, 70% specificity, 81.6% accuracy, 80.7 % PVP and 83.3 % PVN. Total PIRADS v2 scoring revealed an increase in Sensitivity, Specificity, Accuracy, PVP and PVN in diagnosis of prostatic focal lesions reaching 94.2 %, 76 %, 86.6%, 84.6% and 90.4 % respectively
T2WI and DWI have nearly similar accuracy in discriminating benign and malignant prostatic lesions with considerable raising in the accuracy when using total PIRAD V2 in diagnosing peripheral and transitional zones prostatic lesions.