Biparametric Prostate MRI: Diagnostic Performance, Estimated Additional Cost of DCE, and Gadolinium Avoidance

Biparametric MRI, which excludes dynamic contrast-enhanced imaging, may reduce the resources required for prostate MRI. This exploratory study assessed biparametric MRI findings against biopsy histopathology in a selected cohort and described differences from the original clinical multiparametric MRI readings. A retrospective convenience sample of 89 prostate MRI examinations with an available biparametric reassessment after removal of dynamic contrast-enhanced sequences was identified. Four patients without a classifiable histopathological diagnosis were excluded, leaving 85 patients for analysis. All had undergone biopsy following a suspicious clinical multiparametric MRI report. Two experienced radiologists each reviewed a portion of the biparametric MRI examinations while blinded to histopathology and the original multiparametric MRI report. Clinically significant prostate cancer, defined as Gleason score ≥3 + 4 (Grade Group ≥ 2), was the primary outcome. PI-RADS > 3 was considered positive. Prostate cancer was detected in 47 of 85 patients (55.3%), including 34 (40.0%) with clinically significant disease. Biparametric MRI classified 33 of 34 clinically significant cancers as PI-RADS > 3, corresponding to a sensitivity of 97.1% (95% CI, 85.1–99.5%). The corresponding sensitivity of the original clinical multiparametric MRI readings was 91.2% (95% CI, 77.0–97.0%; exploratory paired comparison, p = 0.50). Omitting dynamic contrast-enhanced imaging was estimated to reduce examination time, administered gadolinium, and the use of contrast-related materials and staff capacity under local workflow assumptions. In this selected biopsy cohort, biparametric MRI classified 33 of 34 clinically significant cancers as PI-RADS > 3. The comparison with the original multiparametric MRI readings was exploratory and cannot establish equivalence or non-inferiority. Avoiding dynamic contrast-enhanced imaging may reduce contrast administration and resource use, although the economic estimates are specific to the local workflow and environmental release was not measured.