Diagnostic accuracy of multiparametric magnetic resonance imaging with histopathological correlation in detecting prostate cancer using current prostate imaging-reporting and data system scoring system

Background: Prostate cancer (PCa) is the second most commonly diagnosed malignancy in men worldwide. Accurate pre-biopsy characterization of prostatic lesions remains a clinical challenge. Multiparametric magnetic resonance imaging (mpMRI), interpreted using Prostate Imaging-Reporting and Data System (PI-RADS) v2.1, has emerged as a valuable noninvasive diagnostic tool. This study evaluates the diagnostic performance of mpMRI with histopathological correlation in detecting clinically significant PCa at a tertiary care center in India. Materials and Methods: A prospective observational study was conducted on 63 male patients undergoing pre-biopsy mpMRI on a 1.5-T GE Signa HDxT system. Sequences included T2-weighted imaging, diffusion-weighted imaging with apparent diffusion coefficient (ADC) mapping, and dynamic contrast-enhancement (DCE) imaging. Lesions were scored using PI-RADS v2.1. Histopathological examination served as the gold standard. Diagnostic performance metrics were calculated. Results: Among 63 patients, 42 (65.6%) had adenocarcinoma, and 21 (32.8%) had benign pathology. Using PI-RADS 3–5 as positive, mpMRI showed 100% sensitivity, 47.6% specificity, 79.2% positive predictive value, 100% negative predictive value (NPV), and 82.53% accuracy. ADC hypointensity and lesion margin demonstrated the highest sensitivity (100%), while DCE showed the highest specificity (45.45%). PI-RADS 4 had 100% malignancy risk; PI-RADS 5 had 75%. Conclusion: mpMRI with PI-RADS v2.1 is a highly sensitive modality with excellent NPV, enabling reliable exclusion of significant malignancy and supporting its role in guiding biopsy decisions.