Urologic Oncology: Seminars and Original Investigations 34 (2016) 255.e7–255.e13 Original article Comparison of prostate cancer detection at 3-T MRI with and without an endorectal coil: A prospective, paired-patient study Daniel N. Costa, M.D. a, * , Qing Yuan, Ph.D. b , Yin Xi, Ph.D. b , Neil M. Rofsky, M.D. a , Robert E. Lenkinski, Ph.D. a , Yair Lotan, M.D. c , Claus G. Roehrborn, M.D. c , Franto Francis, M.D. d , Debbie Travalini, PA-C b , Ivan Pedrosa, M.D. a a Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX b Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX c Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX d Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX Received 29 December 2015; received in revised form 2 February 2016; accepted 6 February 2016 Abstract Objectives: To compare the sensitivity of 2 different non–endorectal coil strategies vs. endorectal coil (ERC) magnetic resonance imaging (MRI) for detection of prostate cancer (PCa). Methods: In this prospective, single-center, paired-patient, paired-reader study, 49 men with a clinical indication for MRI underwent non-ERC (phased-array coil only) T2-weighted imaging and diffusion-weighted imaging followed by the same sequences using both ERC and phased-array coils (ERC Protocol). Patients were randomized into 1 of 2 arms: standard non-ERC protocol and augmented non-ERC protocol. Lesions with Likert score Z 3 were defined as suspicious for cancer. Radical prostatectomy specimen or combined systematic plus targeted biopsies served as the standard of reference. Cancers were stratified into risk groups according to the National Comprehensive Cancer Network guidelines. Generalized estimating equations with Bonferroni correction were used for comparisons. The level of reader confidence was inferred by the Likert scores assigned to index lesions. Results: The ERC protocol provided sensitivity (78%) superior to MRI without ERC for PCa detection, both with a standard (43%) (P o 0.0001) or augmented (60%) (P o 0.01) protocol. The ERC MRI missed less-intermediate or high-risk index lesions (4%) than standard non-ERC (42%) (P ¼ 0.02) and augmented non-ERC MRI (25%), although the latter did not reach significance (P ¼ 0.09). The ERC improved radiologist confidence for the detection of PCa (average Likert score ¼ 4.2  1.4) compared to standard (2.3  2.3) and augmented (2.9  2.1) non-ERC (P ¼ 0.001). Conclusions: The use of combined ERC and pelvic phased-array coil for T2-weighted imaging and diffusion-weighted imaging provides superior sensitivity for the detection of PCa compared to an examination performed without the ERC. r 2016 Elsevier Inc. All rights reserved. Keywords: Prostate cancer; Imaging; MRI; Detection; Endorectal coil 1. Introduction The role of magnetic resonance imaging (MRI) of the prostate is rapidly evolving [1]. Initially, an imaging technique only used sparingly and predominantly for staging in academic centers, multiparametric MRI (mpMRI) is now utilized more broadly for a range of indications, including detection of areas suspicious for prostate cancer (PCa) before targeted biopsy [2], and in a wide variety of practice settings. When imaging the prostate gland, as in most MRI applications, it is desirable to obtain images with an optimized signal-to-noise ratio (SNR) within a reasonable acquisition time. Initially, the only way to practically achieve this in prostate examinations was by employing an endorectal coil (ERC), prompting its use as a standard of care [3,4]. http://dx.doi.org/10.1016/j.urolonc.2016.02.009 1078-1439/r 2016 Elsevier Inc. All rights reserved. Abbreviations: ACR, American College of Radiology; AUC, area under the receiver operating characteristic curve; DWI, diffusion-weighted imaging; ERC, endorectal coil; ESUR, European Society of Uroradiology; mpMRI, multiparametric magnetic resonance imaging; NCCN, National Comprehensive Cancer Network; PCa, prostate cancer; PI-RADS, prostate imaging-reporting and data system; T2WI, T2-weighted imaging. * Corresponding author. Tel.: þ1-214-648-7738; fax: þ1-214-648-7783. E-mail address: daniel.costa@utsouthwestern.edu (D.N. Costa).