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Multiparametric Magnetic Resonance Imaging Characterization of Prostate Lesions in the Active Surveillance Population: Incremental Value of Magnetic Resonance Imaging for Prediction of Disease Reclassification

Bonekamp, David MD, PhD,*; Bonekamp, Susanne DVM, PhD,*; Mullins, Jeffrey K. MD,; Epstein, Jonathan I. MD,; Carter, H. Ballentine MD,; Macura, Katarzyna J. MD, PhD*

Journal of Computer Assisted Tomography:
doi: 10.1097/RCT.0b013e31829ae20a
Genitourinary Imaging

Objective: This study aimed to characterize prostate lesions by multiparametric magnetic resonance imaging (MRI) in active surveillance (AS) and examine the incremental predictive value of MRI in comparison with clinical parameters for disease reclassification.

Methods: Blinded imaging review of 3-T endorectal mMRI from 50 consecutive men was performed. Multiparametric MRI biomarkers and morphological parameters and the predictive value of a suspicious MR lesion of 10 mm or greater for clinical or histopathologic disease reclassification were assessed.

Results: Nine patients were reclassified as AS noneligible during follow-up. Morphological parameters, magnetic resonance spectroscopic imaging, and dynamic contrast-enhanced MRI were associated with disease reclassification. Multiparametric MRI best predicted disease reclassification in patients who did not meet clinical AS enrollment criteria and had a suspicious lesion 10 mm or greater, followed by patients with a suspicious lesion of 10 mm or greater. Not meeting enrollment criteria alone was not a significant predictor of disease reclassification.

Conclusions: Multiparametric MRI demonstrates incremental predictive value when used in combination with clinical AS enrollment criteria and supports the assessment of eligibility for AS.

Author Information

From the *Russell H. Morgan Department of Radiology, †James Buchanan Brady Urological Institute, and ‡Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.

Received for publication March 23, 2013; accepted May 6, 2013.

Reprints: David Bonekamp, MD, PhD, Russell H. Morgan Department of Radiology, Johns Hopkins Medical Institutions, 600 N. Wolfe St, Park Bldg, 3rd floor, Room 367, Baltimore, MD 21287 (e-mail:

D. B. has no conflicts of interest to disclose. K. J. M. received grant support from Siemens AG. H. B. C. received funding from the Prostate Cancer Foundation.

© 2013 by Lippincott Williams & Wilkins