UROGENITAL Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology Lars Boesen & Elizaveta Chabanova & Vibeke Løgager & Ingegerd Balslev & Kari Mikines & Henrik S. Thomsen Received: 10 September 2014 /Revised: 23 October 2014 /Accepted: 24 November 2014 # European Society of Radiology 2014 Abstract Objectives To evaluate the diagnostic performance of preop- erative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tu- mour stage (T-stage) and prediction of ECE at final pathology. Materials and Methods Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was per- formed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cT MRI ), an ECE risk score, and suspi- cion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy re- sults were standard reference. Results Histopathology and cT MRI showed a spearman rho correlation of 0.658 (p <0.001) and a weighted kappa=0.585 [CI 0.44;0.73](reader A). ECE was present in 31/87 (36 %) patients. ECE risk-scoring showed an AUC of 0.65–0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %–74 % and 77 %-88 % for the readers, respectively. Conclusions Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate can- cer clinical tumour stage and ECE at final pathology. Key Points • Multiparametric MRI is an accurate diagnostic technique for preoperative prostate cancer staging • ECE risk scoring predicts extracapsular tumour extension at final pathology • ECE risk scoring shows an AUC of 0.86 on the ROC-curve • ECE risk scoring shows a moderate inter-reader agreement (K=0.45) • Multiparametric MRI provides essential knowledge for op- timal clinical management Keywords Prostate cancer . Magnetic resonance imaging . Tumour staging . Guidelines . Scoring methods Abbreviations DRE Digital rectal examination TRUS Transrectal ultrasound PCa Prostate cancer EPE Extraprostatic tumour extension RP Radical prostatectomy cT Clinical tumour stage NVB Neurovascular bundle MRI Magnetic resonance imaging Mp-MRI Multiparametric MRI PIRADS Prostate imaging reporting and data system L. Boesen (*) : K. Mikines Department of Urology, Herlev University Hospital, Herlev Ringvej 75, Herlev 2730, Denmark e-mail: lars.boesen@dadlnet.dk K. Mikines e-mail: kari.mikines@regionh.dk E. Chabanova : V. Løgager : H. S. Thomsen Department of Radiology, Herlev University Hospital, Herlev Ringvej 75, Herlev 2730, Denmark E. Chabanova e-mail: elizaveta.chabanova@regionh.dk V. Løgager e-mail: vibeke.loegager@regionh.dk H. S. Thomsen e-mail: henrik.thomsen@regionh.dk I. Balslev Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, Herlev 2730, Denmark e-mail: ingegerd.balslev@regionh.dk Eur Radiol DOI 10.1007/s00330-014-3543-9