Diffusion-tensor MRI at 3 T: differentiation of central gland prostate cancer from benign prostatic hyperplasia.

OBJECTIVE The purpose of this article is to retrospectively evaluate the utility of diffusion-tensor imaging (DTI) at 3 T in differentiating central gland prostate cancer from benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Eighty consecutive patients (57 with central gland cancer and 23 without central gland cancer) were included in this study. All patients underwent T2-weighted imaging and DTI at 3 T, followed by surgery. For predicting central gland cancer, experienced and less-experienced radiologists independently analyzed T2-weighted imaging and combined T2-weighted imaging and DTI, respectively. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured for central gland cancers and BPH foci of stromal and glandular hyperplasia. Statistical analyses were performed using McNemar test, linear mixed model, receiver operating characteristic (ROC), and kappa statistics. RESULTS For predicting central gland cancers, the area under the curve (Az) of combined T2-weighted imaging and DTI for the experienced (0.915) and less-experienced reader (0.753) was superior to that of T2-weighted imaging (0.723 vs 0.664; p<0.001). The mean ADC and FA values were 0.77×10(-3) mm2/s and 0.35, respectively, for central gland cancers, 1.22×10(-3) mm2/s and 0.26, respectively, for stromal hyperplasia foci, and 1.59×10(-3) mm2/s and 0.21, respectively, for glandular hyperplasia foci, and the values differed significantly. For differentiating central gland cancer from stromal hyperplasia foci and glandular hyperplasia foci, Az values of ADC versus FA were 0.989 and 1.0 versus 0.818 and 0.916, respectively, and the difference was statistically different. CONCLUSION DTI at 3 T is useful for distinguishing central gland cancers from BPH foci, with significantly different ADC and FA values. Furthermore, ADC showed greater diagnostic accuracy than FA in differentiating central gland cancers from stromal and glandular hyperplasia foci.

[1]  R. McKinstry,et al.  Diffusion tensor imaging and tractography of human brain development. , 2006, Neuroimaging clinics of North America.

[2]  Guglielmo Manenti,et al.  Diffusion Tensor Magnetic Resonance Imaging of Prostate Cancer , 2007, Investigative radiology.

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

[4]  Xuna Zhao,et al.  Diffusion tensor imaging of prostate at 3.0 Tesla , 2011, Acta radiologica.

[5]  P. Boesiger,et al.  High-resolution diffusion tensor imaging of prostate cancer using a reduced FOV technique. , 2011, European journal of radiology.

[6]  B. Bloch,et al.  Prediction of prostate cancer extracapsular extension with high spatial resolution dynamic contrast-enhanced 3-T MRI , 2012, European Radiology.

[7]  Diffusion tensor imaging of normal prostate at 3 T: effect of number of diffusion-encoding directions on quantitation and image quality. , 2012, The British journal of radiology.

[8]  Takeo Ishigaki,et al.  Differentiation of noncancerous tissue and cancer lesions by apparent diffusion coefficient values in transition and peripheral zones of the prostate , 2005, Journal of magnetic resonance imaging : JMRI.

[9]  Glyn Johnson,et al.  Diffusion-tensor MR imaging of intracranial neoplasia and associated peritumoral edema: introduction of the tumor infiltration index. , 2004, Radiology.

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

[11]  M. Kattan,et al.  Transition zone prostate cancer: metabolic characteristics at 1H MR spectroscopic imaging--initial results. , 2003, Radiology.

[12]  D. Margolis,et al.  Diffusion tensor magnetic resonance tractography of the prostate: feasibility for mapping periprostatic fibers. , 2012, Urology.

[13]  J. Fütterer,et al.  ESUR prostate MR guidelines 2012 , 2012, European Radiology.

[14]  E. Melhem,et al.  Diffusion-tensor MR imaging and tractography: exploring brain microstructure and connectivity. , 2007, Radiology.

[15]  M Hedehus,et al.  Diffusion-tensor MR imaging at 1.5 and 3.0 T: initial observations. , 2001, Radiology.

[16]  Aytekin Oto,et al.  Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging. , 2010, Radiology.

[17]  Susumu Mori,et al.  Diffusion-tensor MR imaging and fiber tractography: a new method of describing aberrant fiber connections in developmental CNS anomalies. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

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

[19]  R. Henry,et al.  Diffusion Tensor MR Imaging and Fiber Tractography: Technical Considerations , 2008, American Journal of Neuroradiology.

[20]  Riwa Kishimoto,et al.  ADC value and diffusion tensor imaging of prostate cancer: Changes in carbon‐ion radiotherapy , 2008, Journal of magnetic resonance imaging : JMRI.

[21]  John Kurhanewicz,et al.  Dynamic contrast-enhanced MRI and MR diffusion imaging to distinguish between glandular and stromal prostatic tissues. , 2008, Magnetic resonance imaging.

[22]  Evis Sala,et al.  Transition zone prostate cancers: features, detection, localization, and staging at endorectal MR imaging. , 2006, Radiology.

[23]  Byung Kwan Park,et al.  Value of Diffusion-Weighted Imaging for the Prediction of Prostate Cancer Location at 3T Using a Phased-Array Coil: Preliminary Results , 2007, Investigative radiology.

[24]  L. White,et al.  Evaluation of diffusion tensor imaging and fiber tractography of the median nerve: preliminary results on intrasubject variability and precision of measurements. , 2010, AJR. American journal of roentgenology.

[25]  K. Sugimura,et al.  Benign prostatic hyperplasia: value of MR imaging for determining histologic type. , 1994, Radiology.

[26]  R. Cohen,et al.  Transition zone carcinoma of the prostate gland: a common indolent tumour type that occasionally manifests aggressive behaviour , 2003, Pathology.

[27]  K. Shinohara,et al.  Prospective evaluation of systematic sextant transition zone biopsies in large prostates for cancer detection. , 1998, Urology.

[28]  Michael Phillips,et al.  Central zone carcinoma of the prostate gland: a distinct tumor type with poor prognostic features. , 2008, The Journal of urology.

[29]  T. Stamey,et al.  Zonal Distribution of Prostatic Adenocarcinoma: Correlation with Histologic Pattern and Direction of Spread , 1988, The American journal of surgical pathology.

[30]  Henkjan J Huisman,et al.  Discrimination of prostate cancer from normal peripheral zone and central gland tissue by using dynamic contrast-enhanced MR imaging. , 2003, Radiology.

[31]  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.

[32]  R C McKinstry,et al.  Evaluating pediatric brain tumor cellularity with diffusion-tensor imaging. , 2001, AJR. American journal of roentgenology.

[33]  I. Yamada,et al.  Diagnostic possibility of diffusion tensor imaging for the evaluation of myometrial invasion in endometrial cancer: An ex vivo study , 2011, Journal of magnetic resonance imaging : JMRI.

[34]  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.

[35]  A. Uluğ,et al.  Diagnostic utility of DTI in prostate cancer. , 2011, European journal of radiology.

[36]  P. Scardino,et al.  A comparison of the morphological features of cancer arising in the transition zone and in the peripheral zone of the prostate. , 1991, The Journal of urology.

[37]  D. Le Bihan,et al.  Diffusion tensor imaging: Concepts and applications , 2001, Journal of magnetic resonance imaging : JMRI.

[38]  P. P. Iu,et al.  ESUR prostate MR guidelines. , 2013, European radiology.