Volume 62, Issue 6, Pages 986-996 (December 2012) Validation of the European Society of Urogenital Radiology Scoring System for Prostate Cancer Diagnosis on Multiparametric Magnetic Resonance Imaging in a Cohort of Repeat Biopsy Patients  Daniel Portalez, Pierre Mozer, François Cornud, Raphaëlle Renard-Penna, Vincent Misrai, Matthieu Thoulouzan, Bernard Malavaud  European Urology  Volume 62, Issue 6, Pages 986-996 (December 2012) DOI: 10.1016/j.eururo.2012.06.044 Copyright © 2012 Terms and Conditions

Fig. 1 Target definition and elastic surface registration, axial representations of the prostate, are presented in the first column. (a) T2-weighted magnetic resonance imaging (MRI), diffusion-weighted imaging MRI, and dynamic contrast-enhanced MRI demonstrate a European Society of Urogenital Radiology score sum (ESUR-S) of 13 lesion in the anterior aspect of the right transition zone that is highlighted by a yellow tag in the first column. (b) Surface reconstruction from MRI; the prostate volume is contoured in the axial, sagittal, and coronal T2-weighted MRI acquisitions. (c) Surface reconstruction of three-dimensional transrectal ultrasonography (3D TRUS). (d) Elastic surface registration by means of an algorithm that controls the prostate constraints driven by changes in the patient’s positioning, deformations in rectal wall, or displacement of the prostate. After registration, the MRI-suspicious areas highlighted by colored tags could alternatively be displayed within MRI- or 3D TRUS–registered volumes. European Urology 2012 62, 986-996DOI: (10.1016/j.eururo.2012.06.044) Copyright © 2012 Terms and Conditions

Fig. 2 Postprocedure analysis of the European Society of Urogenital Radiology (ESUR) characteristics of multiparametric magnetic resonance imaging (mpMRI) Digital Imaging and Communications in Medicine archives; for clarity’s sake, only the pictures pertaining to the target are presented. (a,b) Tagging of a suspicious focus in the right peripheral zone. (c,d) Transfer to the three-dimensional transrectal ultrasonography (3D TRUS) model by elastic surface registration ([c] T2-weighted magnetic resonance imaging; [inset] 3D TRUS). (e) Recording of the spatial location of the cores by repeating 3D TRUS with the needle left in place. (f) Reverse transfer to the mpMRI model. The actual ESUR characteristics of the site sampled by the cores was determined after the procedure by comparison with the initial mpMRI Digital Imaging and Communications in Medicine archives (a). European Urology 2012 62, 986-996DOI: (10.1016/j.eururo.2012.06.044) Copyright © 2012 Terms and Conditions

Fig. 3 Absolute number of cores taken and proportion positive for cancer (in parentheses) per sector. Random systematic cores are in red (n=1125), and targeted cores are in blue (n=399). L=left; R=right. European Urology 2012 62, 986-996DOI: (10.1016/j.eururo.2012.06.044) Copyright © 2012 Terms and Conditions

Fig. 4 Proportion of cores positive for cancer according to T2-weighted (T2w) magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI) MRI, and dynamic contrast-enhanced (DCE) MRI European Society of Urogenital Radiology (ESUR) score sum. The number of cores taken for each condition is presented in parentheses. European Urology 2012 62, 986-996DOI: (10.1016/j.eururo.2012.06.044) Copyright © 2012 Terms and Conditions

Fig. 5 Proportion of cores positive for cancer according to the European Society of Urogenital Radiology score sum (ESUR-S), the ESUR-S in five increments, and the five classes of the Likert scale. European Urology 2012 62, 986-996DOI: (10.1016/j.eururo.2012.06.044) Copyright © 2012 Terms and Conditions

Fig. 6 Receiver operating characteristic curves for (A) the European Society of Urogenital Radiology (ESUR) score sum and (B) the Likert scale. CI=confidence interval. European Urology 2012 62, 986-996DOI: (10.1016/j.eururo.2012.06.044) Copyright © 2012 Terms and Conditions