[Clinical value of native and contrast enhanced MRI in staging prostatic carcinoma before planned radical prostatectomy]. / Klinischer Stellenwert der nativen und KM-unterstützten MRT im Staging des Prostatakarzinoms vor geplanter radikaler Prostatektomie.

PURPOSE: To assess the clinical value of MRI with and without contrast agent in the staging of prostatic carcinoma. Relevance for surgical management. METHODS: 60 patients with carcinoma proven by biopsy or suspected prostatic carcinoma were evaluated with MRI. The examinations were performed in a 1.5 T (Philips ACS-NT Gyroscan) imager with multiplanar orientations before and after intravenous application of 0.1 mmol/kg/bw Gadodiamide (Omniscan-Nycomed/Amersham). The gold standard was histology after radical prostatectomy and in case of non-operability the consensual final staging. RESULTS: Compared to histology MRI revealed a sensitivity of 75% and a specificity of 82% in the differentiation of locally advanced carcinoma (T 3/4). Including the non-surgical cases MRI showed a sensitivity of 82.5% and a specificity of 86%. Interindividual analysis showed no difference in diagnostic accuracy between the non-enhanced and the contrast-enhanced techniques. In 23% of cases (n = 14) MRI induced changes in patient management. CONCLUSIONS: MRI is an accurate procedure in the local staging of prostatic carcinoma. In combination with clinical findings, PSA, and grading scores MRI has a significant influence on treatment selection. Contrast agent administration does not seem to increase the diagnostic accuracy significantly.