Investig Magn Reson Imaging.  2020 Sep;24(3):132-140. 10.13104/imri.2020.24.3.132.

Comparison of Standard and Specialized Readings in Routine Practice for the Assessment of Extraprostatic Extension of Prostate Cancer on MRI after Biopsy

  • 1Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea


To retrospectively determine whether specialized magnetic resonance imaging (MRI) reading performed by an experienced radiologist affected the successful assessment of extraprostatic extension (EPE) in the presence of biopsyrelated hemorrhage after prostate biopsy.
Materials and Methods
Two hundred consecutive patients with biopsy-proven prostate cancer underwent MRI. General radiologist and subspecialized radiologist readings were unpaired and reviewed in random order by a radiologist who was blinded to patients’ clinical details and histopathologic data. The extent of hemorrhage was assessed on T1-weighted (T1W) MRI using a 1-4 scale, and the likelihood of EPE was assessed for each of the four categories. Histopathologic specimens served as the reference standard. The area under the curve (AUC) of the standard reading was compared to that of the specialized reading.
Post-biopsy hemorrhage was subjectively graded as ≥ 3 in 101 patients (50.5%) by standard reading, and in 100 patients (50.0%) by specialized reading. The standard and specialized readings disagreed for 40 (20.7%) of the patients (kappa [κ] = 0.35; 95% CI, 0.14-0.48). Of these, specialized reading was the correct interpretation for 21 patients (52.5%). The sensitivity (75% vs. 44%; P = 0.002) and area under the receiver operating characteristics (AUROC) (0.83 vs. 0.67; P = 0.008) of the specialized readings were significantly higher than those of the standard readings, while there was no significant difference in specificity (84% vs. 87%; P = 0.434).
The reinterpretation of MRI by experienced radiologists significantly improves the diagnosis of EPE in prostate cancer in the presence of post-biopsy hemorrhage.


Prostatic neoplasms; Extraprostatic extension; Magnetic resonance imaging; Biopsy
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