Assessing the Role of Bi- and Multi-Parametric MRI in Prostate Cancer-A Regional Study

Abstract

Prostate MRI is a key diagnostic tool for prostate cancer (PCa), with current guidelines recommending multi-parametric MRI (mpMRI), which includes T2-weighted (T2W), diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. However, biparametric MRI (bpMRI), which omits DCE, is suggested to reduce scan time, cost, and potential contrast-related side effects. Limited research exists comparing bpMRI’s efficacy against mpMRI for detecting clinically significant prostate cancer (CsPCa) using the Prostate Imaging and Reporting Data System (PI-RADS v2.1).To compare the diagnostic performance of bpMRI and mpMRI for prostatic carcinoma and CsPCa detection. This study retrospectively evaluated 115 males over 40 years with elevated prostate-specific antigen (PSA) levels (≥15 ng/ml) who underwent mpMRI and had histopathological results. Two radiologists independently assessed suspected PCa lesions, assigning PI-RADS categories for bpMRI (report one) and mpMRI (report two). The reference standard was histopathological biopsy with Gleason scoring. Among 101 patients with suspected PCa, CsPCa was diagnosed in 45 cases using mpMRI, 39 with bpMRI, and 14 with DCE alone. The PI-RADS grading system showed strong agreement (kappa = 0.82) for bpMRI and near-perfect agreement (kappa = 0.912) for mpMRI. Sensitivity was slightly higher for mpMRI (98.4%) than bpMRI (96.7%) with (P < 0.001), while bpMRI demonstrated higher specificity (75.8% vs. 66.8%, P < 0.001) the detection rates of CsPCa for bpMRI and mpMRI were 51.50% and 53.40% respectively. The study concludes that bpMRI is non-inferior to mpMRI in CsPCa detection, making it a viable alternative while DCE remains valuable for PCa lesion detection.