MRI-based analysis of different clinically significant prostate cancer detection rate of prostate imaging reporting and data system score 4 in the peripheral zone.PURPOSE

MRI
To compare the clinically significant prostate cancer (csPCa) detection rate between diffusion-weighted imaging (DWI) 4 and DWI 3 with positive dynamic contrast-enhanced (DCE) (hereinafter called 'DWI 3/DCE+') lesions in the peripheral zone (PZ) and to explore the diagnostic performance of targeted biopsy (TB) or systematic biopsy (SB) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions.


 The chi-square test was used to compare the csPCa detection rates between DWI 4 and DWI 3/DCE+ lesions.  Patients with DWI 4 lesions had higher csPCa detection rate than those with DWI 3/DCE+ lesions when using TB + SB, TB, and SB, and the differences were significant for TB + SB (72.22 vs. 54.84%, p = 0.015) or SB (65.97 vs. 46.77%, p = 0.010).  For DWI 3/DCE+ patients whose prostate-specific antigen levels ranged from 4 to 10 ng/mL, TB alone showed the highest negative predictive value (95% Cl 78.12-100).


 DWI 4 tends to have worse results than DWI 3/DCE+.  TB has great diagnostic performances in DWI 3/DCE+ patients, especially for those prostate-specific antigen ranging from 4 to 10 ng/mL.
DWI
To compare the clinically significant prostate cancer (csPCa) detection rate between diffusion-weighted imaging (DWI) 4 and DWI 3 with positive dynamic contrast-enhanced (DCE) (hereinafter called 'DWI 3/DCE+') lesions in the peripheral zone (PZ) and to explore the diagnostic performance of targeted biopsy (TB) or systematic biopsy (SB) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions.


 The chi-square test was used to compare the csPCa detection rates between DWI 4 and DWI 3/DCE+ lesions.  Patients with DWI 4 lesions had higher csPCa detection rate than those with DWI 3/DCE+ lesions when using TB + SB, TB, and SB, and the differences were significant for TB + SB (72.22 vs. 54.84%, p = 0.015) or SB (65.97 vs. 46.77%, p = 0.010).  For DWI 3/DCE+ patients whose prostate-specific antigen levels ranged from 4 to 10 ng/mL, TB alone showed the highest negative predictive value (95% Cl 78.12-100).


 DWI 4 tends to have worse results than DWI 3/DCE+.  TB has great diagnostic performances in DWI 3/DCE+ patients, especially for those prostate-specific antigen ranging from 4 to 10 ng/mL.
DCE
To compare the clinically significant prostate cancer (csPCa) detection rate between diffusion-weighted imaging (DWI) 4 and DWI 3 with positive dynamic contrast-enhanced (DCE) (hereinafter called 'DWI 3/DCE+') lesions in the peripheral zone (PZ) and to explore the diagnostic performance of targeted biopsy (TB) or systematic biopsy (SB) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions.


 All patients subsequently underwent combined magnetic resonance imaging/ultrasound fusion-guided TB and ultrasound-guided 12-core SB.  Based on the TB + SB results as a standard reference, we analyzed the sensitivity, negative predictive value, and diagnostic accuracy of TB alone or SB alone.


 Patients with DWI 4 lesions had higher csPCa detection rate than those with DWI 3/DCE+ lesions when using TB + SB, TB, and SB, and the differences were significant for TB + SB (72.22 vs. 54.84%, p = 0.015) or SB (65.97 vs. 46.77%, p = 0.010).  For DWI 3/DCE+ patients whose prostate-specific antigen levels ranged from 4 to 10 ng/mL, TB alone showed the highest negative predictive value (95% Cl 78.12-100).


 TB has great diagnostic performances in DWI 3/DCE+ patients, especially for those prostate-specific antigen ranging from 4 to 10 ng/mL.
TB
To compare the clinically significant prostate cancer (csPCa) detection rate between diffusion-weighted imaging (DWI) 4 and DWI 3 with positive dynamic contrast-enhanced (DCE) (hereinafter called 'DWI 3/DCE+') lesions in the peripheral zone (PZ) and to explore the diagnostic performance of targeted biopsy (TB) or systematic biopsy (SB) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions.


 All patients subsequently underwent combined magnetic resonance imaging/ultrasound fusion-guided TB and ultrasound-guided 12-core SB.  The chi-square test was used to compare the csPCa detection rates between DWI 4 and DWI 3/DCE+ lesions.  Based on the TB + SB results as a standard reference, we analyzed the sensitivity, negative predictive value, and diagnostic accuracy of TB alone or SB alone.


 Patients with DWI 4 lesions had higher csPCa detection rate than those with DWI 3/DCE+ lesions when using TB + SB, TB, and SB, and the differences were significant for TB + SB (72.22 vs. 54.84%, p = 0.015) or SB (65.97 vs. 46.77%, p = 0.010). 
SB
To compare the clinically significant prostate cancer (csPCa) detection rate between diffusion-weighted imaging (DWI) 4 and DWI 3 with positive dynamic contrast-enhanced (DCE) (hereinafter called 'DWI 3/DCE+') lesions in the peripheral zone (PZ) and to explore the diagnostic performance of targeted biopsy (TB) or systematic biopsy (SB) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions.


 We retrospectively enrolled 206 patients who underwent multiparametric magnetic resonance imaging and had at least one PI-RADS 4 lesion in the PZ. 
PI-RADS