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Background <p>Accurate diagnosis of peripheral zone prostate cancer is challenging. The Prostate Imaging–Reporting and Data System (PI-RADS v2.1) is widely used but remains subjective and often requires contrast agents. Synthetic MRI (SyMRI) generates quantitative T1 and T2 relaxation maps rapidly and without contrast. This study assessed the diagnostic performance of SyMRI compared with PI-RADS v2.1.</p> Methods <p>In this retrospective single-center study, 70 men with suspected prostate cancer underwent both multi-parametric MRI and SyMRI, followed by histopathological confirmation. Quantitative T1, T2, and proton density values were extracted from SyMRI, and two radiologists independently assigned PI-RADS v2.1 scores. Diagnostic accuracy was evaluated using ROC analysis with pathology as the reference standard.</p> Results <p>Malignant lesions showed significantly reduced T1 (median 1230 ms vs. 1997 ms, <i>p</i> &lt; 0.01) and T2 values (79 ms vs. 132 ms, <i>p</i> &lt; 0.01) compared with benign lesions, while proton density was not different. Optimal thresholds of 1495 ms (T1) and 90.6 ms (T2) achieved sensitivities of 92.5% and specificities of 80.0% and 90.0%, respectively. AUC values were 0.868 for T1, 0.952 for T2, and 0.663 for PI-RADS alone. The combined use of T1, T2, and PI-RADS yielded the highest diagnostic accuracy (AUC = 0.993).</p> Conclusion <p>Quantitative SyMRI provides reproducible, contrast-free biomarkers that significantly enhance detection of peripheral zone prostate cancer beyond PI-RADS v2.1. Incorporating T1 and T2 mapping into clinical MRI protocols may improve early diagnosis, reduce dependence on contrast agents, and potentially lower unnecessary biopsy rates. Given the modest sample size and the absence of a priori power analysis, these findings should be interpreted as exploratory and validated in larger, prospective cohorts.</p>

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Quantitative synthetic MRI improves peripheral zone prostate cancer detection beyond PI-RADS v2.1

  • 期刊论文

  • 发表日期：

    2025年11月24日

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  • Yueyue Wang,
  • Hui Sun,
  • Haoran Feng,
  • Chunhua Xia

摘要

Background

Accurate diagnosis of peripheral zone prostate cancer is challenging. The Prostate Imaging–Reporting and Data System (PI-RADS v2.1) is widely used but remains subjective and often requires contrast agents. Synthetic MRI (SyMRI) generates quantitative T1 and T2 relaxation maps rapidly and without contrast. This study assessed the diagnostic performance of SyMRI compared with PI-RADS v2.1.

Methods

In this retrospective single-center study, 70 men with suspected prostate cancer underwent both multi-parametric MRI and SyMRI, followed by histopathological confirmation. Quantitative T1, T2, and proton density values were extracted from SyMRI, and two radiologists independently assigned PI-RADS v2.1 scores. Diagnostic accuracy was evaluated using ROC analysis with pathology as the reference standard.

Results

Malignant lesions showed significantly reduced T1 (median 1230 ms vs. 1997 ms, p < 0.01) and T2 values (79 ms vs. 132 ms, p < 0.01) compared with benign lesions, while proton density was not different. Optimal thresholds of 1495 ms (T1) and 90.6 ms (T2) achieved sensitivities of 92.5% and specificities of 80.0% and 90.0%, respectively. AUC values were 0.868 for T1, 0.952 for T2, and 0.663 for PI-RADS alone. The combined use of T1, T2, and PI-RADS yielded the highest diagnostic accuracy (AUC = 0.993).

Conclusion

Quantitative SyMRI provides reproducible, contrast-free biomarkers that significantly enhance detection of peripheral zone prostate cancer beyond PI-RADS v2.1. Incorporating T1 and T2 mapping into clinical MRI protocols may improve early diagnosis, reduce dependence on contrast agents, and potentially lower unnecessary biopsy rates. Given the modest sample size and the absence of a priori power analysis, these findings should be interpreted as exploratory and validated in larger, prospective cohorts.