Prostate MRI with dynamic contrast enhancement (DCE) is controversial with growing interest in noncontrast (NC) MRI. Decision curve analyses performed on data from two contemporary studies identified ranges of high grade cancer probability thresholds at which DCE had the highest net benefit. DCE MRI has the most benefit in moderate or moderate-high risk threshold ranges, thought to vary based on the study differences in disease prevalence, reference standard, and the presence or absence of additional DCE reconstruction images. The risk ranges in which NC versus DCE MRI optimize net benefit may help inform the best clinical use of prostate MRI.
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