Combining Magnetic Resonance Diffusion-Weighted Imaging with Prostate-Specific Antigen to Differentiate Between Malignant and Benign Prostate Lesions

Abstract

Background We aimed to develop a combined model of quantitative parameters derived from 3 different magnetic resonance imaging (MRI) diffusion models and laboratory data related to prostate-specific antigen (PSA) for differentiating between prostate cancer (PCa) and benign lesions. Material/Methods Eighty-four patients pathologically confirmed as having PCa or benign disease were enrolled. All patients underwent multiparametric MRI before biopsy, added intravoxel incoherent motion (IVIM) imaging, and diffusion kurtosis imaging (DKI). The following data were collected: quantitative parameters of diffusion-weighted imaging (DWI), IVIM, and DKI, preoperative total PSA, free/total PSA ratio, and PSA density (PSAD) values. A combined logistic regression model was established by above MRI quantitative parameters and PSA data to diagnose PCa. The Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) was used to assess the lesions for comparison. Results Thirty-two patients had PCa and 52 patients had benign lesions. In multivariate logistic regression analysis, only apparent diffusion coefficient (ADC) and PSAD were significant variables ( P <0.05) and were thus retained in the model. The area under curve value of the combined model (0.911) was higher than that of ADC, PSAD, and PI-RADS v2 (0.887, 0.861, and 0.859, respectively) in univariate analysis, but without any statistically significant differences. The combined model generated greater clinical benefit than the independent application of ADC, PSAD, and PI-RADS v2. Conclusions ADC and PSAD were the 2 most important metrics for distinguishing PCa from benign lesions. The combined model of ADC and PSAD demonstrated satisfactory discrimination and improved clinical net benefit.

Study on the Diagnostic Value of Contrast-Enhanced Ultrasound and Magnetic Resonance Imaging in Prostate Cancer

“…PSA is considered as the commonly clinical indicator in the examination of prostate malignant tumor. PSA was also usually performed as a marker in the screening and assessment of treatment effect in prostate malignant tumor [ 6 ]. Previous research studies found that increased PSA levels were closely associated with the clinical phase of prostate malignant tumor and the higher PSA concentration indicated the worse damage of surrounding tissues and malignant degree [ 17 ].…”

“…However, using MRI alone has some limitations. It was reported that could MRI only find morphological information and was not able to obtain the internal microstructure of tumor tissues, resulting in difficult evaluation for the risk of prostate tumors [ 6 ]. Another study showed that diffusion-weighted MRI could well manifest the tissue of tumor with abundant vascularity; however, the diagnostic role for prostate malignant tumor was debated [ 7 ].…”