Diagnostic performance of biparametric versus multiparametric MRI for prostate cancer: a noninferiority, confirmatory observer study.

Authors

Xingyu Fang, Jialin Li, Wei Lv, Lin Liu, Jing Feng, Li Liu, Feng Pan, Yijun Zhang

Published in

Frontiers in oncology. Volume 16. Pages 1808035. Epub Jun 03, 2026.

Abstract

This study aimed to assess the noninferiority of biparametric MRI (bpMRI) compared to multiparametric MRI (mpMRI) using Prostate Imaging Reporting and Data System (PI-RADS) in diagnosing prostate cancer (PCa). Additionally, we compared diagnostic performance of bpMRI and mpMRI between expert and non-expert readers.
A total of 319 men with abnormal serum prostate-specific antigen (PSA) were included in the study and underwent mpMRI examinations. Two expert readers and two non-expert readers sequentially assessed bpMRI and mpMRI using the PI-RADS scoring system, respectively. The noninferiority of bpMRI versus mpMRI was evaluated using the area under the receiver operating characteristic curve (AUROC) alongside the sensitivity and specificity at a threshold of PI-RADS 3. The diagnostic performance and inter-observer agreement of bpMRI and mpMRI were compared between expert and non-expert readers.
The prevalence of clinically significant PCa (csPCa) was 55.5% (177/319), bpMRI showed noninferior diagnostic performance to mpMRI in AUROC (0.896 [95% CI, 0.879-0.943] vs 0.911 [95% CI, 0.861-0.931]; difference of -1.5% [95% CI, -3.1% to 0.1%], p < 0.001), alongside sensitivity (92.8 [95% CI, 90.1-95.6] vs 93.8 [95% CI, 91.2-96.6]; difference of -1.0% [95% CI, -2.0% to 0.0%], p < 0.001) and specificity (69.4 [95% CI, 63.6-73.9] vs 73.1[95% CI, 67.1-76.9]; difference of -3.5% [95% CI, -6.1% to -1.4%], p < 0.01) at a threshold of PI-RADS 3. In bpMRI interpretation, specificity showed significant differences among readers (P = 0.001); expert readers (32.7%, 209/638) and non-expert readers (37.0%, 236/638) showed significant differences in PI-RADS 3 (P = 0.01) and moderate agreement (0.64 [0.53-0.71]).
The diagnostic performance of bpMRI in detecting csPCa was noninferior to that of mpMRI in a selected high-risk cohort of men with abnormal serum PSA. Limited additional benefits of DCE were observed for non-expert readers. Specialized system training of PI-RADS for non-experts or diagnosis under the supervision of expert radiologists might be better alternatives.

PMID:
42318473
Bibliographic data and abstract were imported from PubMed on 19 Jun 2026.

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