Detectability of low and intermediate or high risk prostate cancer with combined T2-weighted and diffusion-weighted MRI

AbstractObjectivesTo evaluate the incremental value of diffusion-weighted imaging (DWI) in combination with T2-weighted imaging to detect low (Gleason score, ≤ 6) and intermediate or high risk (Gleason score, ≥ 7) prostate cancer.MethodsFifty-one patients who underwent MRI before prostatectomy were evaluated. Two readers independently scored the probability of tumour in eight regions of prostate on T2-weighted images (T2WI) and T2WI combined with apparent diffusion coefficient (ADC) maps. Data were divided into two groups—low risk and intermediate or high risk prostate cancer—and correlated with histopathological results. Diagnostic performance parameters, areas under the receiver-operating characteristic curve (AUCs) and interreader agreement were calculated.ResultsFor both readers, AUCs of combined T2WI and ADC maps were greater than those of T2WI in intermediate or high risk (reader 1, 0.887 vs. 0.859; reader 2, 0.732 vs 0.662, P < 0.05) prostate cancers, but not in low risk (reader 1, 0.719 vs 0.725; reader 2, 0.685 vs. 0.680, P > 0.05) prostate cancers. Weighted κ value of combined T2WI and ADC maps was 0.689.ConclusionsThe addition of DWI to T2-weighted imaging improves the accuracy of detecting intermediate or high risk prostate cancers, but not for low risk prostate cancer detection.Key Points• Gleason scores influence diagnostic performance of MRI for prostate cancer detection. • Addition of DWI does not improve low risk prostate cancer detection. • Combined T2WI and DWI may help select intermediate or high risk patients.

[1]  Peter L Choyke,et al.  Imaging prostate cancer: a multidisciplinary perspective. , 2007, Radiology.

[2]  Silvia D. Chang,et al.  Combined diffusion‐weighted and dynamic contrast‐enhanced MRI for prostate cancer diagnosis—Correlation with biopsy and histopathology , 2006, Journal of magnetic resonance imaging : JMRI.

[3]  Katsuyuki Nakanishi,et al.  Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: Can ADC values contribute to assess the aggressiveness of prostate cancer? , 2011, Journal of magnetic resonance imaging : JMRI.

[4]  Jelle O. Barentsz,et al.  Prostate MRI: diffusion-weighted imaging at 1.5T correlates better with prostatectomy Gleason grades than TRUS-guided biopsies in peripheral zone tumours , 2012, European Radiology.

[5]  A. Evans,et al.  Prostate tissue composition and MR measurements: investigating the relationships between ADC, T2, K(trans), v(e), and corresponding histologic features. , 2010, Radiology.

[6]  J. Babb,et al.  Prostate cancer: Utility of fusion of T2‐weighted and high b‐value diffusion‐weighted images for peripheral zone tumor detection and localization , 2011, Journal of magnetic resonance imaging : JMRI.

[7]  Hiroshi Honda,et al.  Usefulness of apparent diffusion coefficient map in diagnosing prostate carcinoma: Correlation with stepwise histopathology , 2008, Journal of magnetic resonance imaging : JMRI.

[8]  B. K. Park,et al.  Diffusion-Weighted Imaging of the Prostate at 3 T for Differentiation of Malignant and Benign Tissue in Transition and Peripheral Zones: Preliminary Results , 2007, Journal of computer assisted tomography.

[9]  M. Gleave,et al.  Upgrade in Gleason score between prostate biopsies and pathology following radical prostatectomy significantly impacts upon the risk of biochemical recurrence , 2011, BJU international.

[10]  H. Hricak,et al.  MR imaging and MR spectroscopic imaging in the pre-treatment evaluation of prostate cancer. , 2005, The British journal of radiology.

[11]  Masoom A Haider,et al.  Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. , 2007, AJR. American journal of roentgenology.

[12]  Bostwick Dg,et al.  Predictive factors in prostate cancer: current concepts from the 1999 College of American Pathologists Conference on Solid Tumor Prognostic Factors and the 1999 World Health Organization Second International Consultation on Prostate Cancer. , 1999 .

[13]  I. Tuerk,et al.  Comparing the Gleason prostate biopsy and Gleason prostatectomy grading system: the Lahey Clinic Medical Center experience and an international meta-analysis. , 2008, European urology.

[14]  Fernando J. Kim,et al.  Is apparent diffusion coefficient associated with clinical risk scores for prostate cancers that are visible on 3-T MR images? , 2011 .

[15]  N. deSouza,et al.  MAGNETIC RESONANCE IMAGING IN PROSTATE CANCER : VALUE OF APPARENT DIFFUSION COEFFICIENTS FOR IDENTIFYING MALIGNANT NODULES , 2010 .

[16]  M. Kattan,et al.  Correlation of proton MR spectroscopic imaging with gleason score based on step-section pathologic analysis after radical prostatectomy. , 2005, Radiology.

[17]  L. Turnbull,et al.  Diffusion‐weighted imaging of normal and malignant prostate tissue at 3.0T , 2006, Journal of magnetic resonance imaging : JMRI.

[18]  Olivier Rouvière,et al.  Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria: is it reasonable? , 2007, European Radiology.

[19]  L. Klotz.  Active surveillance for prostate cancer: for whom? , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  Y. Yamashita,et al.  Ultra-high-b-value diffusion-weighted MR imaging for the detection of prostate cancer: evaluation in 201 cases with histopathological correlation , 2010, European Radiology.

[21]  Cher Heng Tan,et al.  Diffusion weighted imaging in prostate cancer , 2011, European Radiology.

[22]  Katsuyoshi Ito,et al.  Apparent diffusion coefficient values in peripheral and transition zones of the prostate: Comparison between normal and malignant prostatic tissues and correlation with histologic grade , 2008, Journal of magnetic resonance imaging : JMRI.

[23]  J. Machan,et al.  Diffusion-weighted MRI of peripheral zone prostate cancer: comparison of tumor apparent diffusion coefficient with Gleason score and percentage of tumor on core biopsy. , 2010, AJR. American journal of roentgenology.

[24]  D. Portalez,et al.  Prospective comparison of T2w-MRI and dynamic-contrast-enhanced MRI, 3D-MR spectroscopic imaging or diffusion-weighted MRI in repeat TRUS-guided biopsies , 2010, European Radiology.

[25]  Kyung Ah Kim,et al.  Prostate cancer: apparent diffusion coefficient map with T2-weighted images for detection--a multireader study. , 2009, Radiology.

[26]  Bernd Hamm,et al.  Dynamic contrast-enhanced magnetic resonance imaging and pharmacokinetic models in prostate cancer , 2011, European Radiology.

[27]  L. Turnbull,et al.  Diffusion Imaging of the Prostate at 3.0 Tesla , 2006, Investigative radiology.

[28]  Yousef Mazaheri,et al.  Diffusion-weighted endorectal MR imaging at 3 T for prostate cancer: tumor detection and assessment of aggressiveness. , 2011, Radiology.

[29]  A. Oto,et al.  Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis. , 2011, AJR. American journal of roentgenology.

[30]  Clare Allen,et al.  Is it time to consider a role for MRI before prostate biopsy? , 2009, Nature Reviews Clinical Oncology.

[31]  D. Dearnaley,et al.  A study of diffusion-weighted magnetic resonance imaging in men with untreated localised prostate cancer on active surveillance. , 2009, European urology.