Adding ASL Perfusion to PI-RADS Boosts Prostate Cancer Detection Accuracy

Combining arterial spin labeling (ASL) perfusion with PI-RADS v2.1 scoring raised AUC from 0.916 (PI-RADS alone) to 0.965 for clinically significant prostate cancer detection in 133 biopsy-confirmed patients — but findings await external validation.

• Retrospective single-center diagnostic-accuracy study; 133 of 233 suspected prostate cancer patients had pathologically confirmed lesions and formed the analytic cohort; internal validation used bootstrap resampling only.
• ASL-derived maximum prostate blood flow (PBF-max) achieved AUC 0.872 alone and correlated with PI-RADS v2.1 score (r = 0.62); tPSA and prostate volume were also independent risk factors incorporated into the nomogram.
• Key limitation: retrospective design, single center, modest n, and no external or prospective validation — generalizability remains unproven.

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