Feasibility of multiparametric prostate magnetic resonance imaging in the detection of cancer distribution: histopathological correlation with prostatectomy specimens

Abstract

PurposeTo prevent overtreatment, it is very important to diagnose the precise distribution and characteristics of all cancer lesions, including small daughter tumors. The purpose of this study was to evaluate the efficacy of T2-weighted magnetic resonance imaging (T2W), diffusion-weighted magnetic resonance imaging (DWI), magnetic resonance spectroscopy (1H-MRS), and prostate biopsy (PBx) in the detection of intraprostatic cancer distribution.MethodsAll patients underwent T2W, DWI, 1H-MRS, and PBx followed by radical prostatectomy (RP). Individual prostates were divided into 12 segmental regions, each of which was examined for the presence or absence of malignancy on the basis of T2W, DWI, 1H-MRS, and PBx, respectively. These results were compared with the histopathological findings for RP specimens.ResultsWe included 54 consecutive patients with biopsy-proven prostate cancer (mean age, 62.7 years; median prostate-specific antigen level, 5.7 ng/mL) in this study. We could detect cancer in 247 of 540 evaluable lesions. The area under the receiver operator characteristic curve analysis yielded a higher value for DWI (0.68) than for T2W (0.65), 1H-MRS (0.54), or PBx (0.56). In 180 cancerous regions of RP specimens with false-negative PBx results, T2W+DWI had the highest positive rate (53.3%) compared with that of each sequence alone, including T2W (45.6%), DWI (41.1%), and 1H-MRS (30.0%).ConclusionsMultiparametric magnetic resonance imaging (T2W, 1H-MRS, DWI) enables the detection of prostate cancer distribution with reasonable sensitivity and specificity. T2W+DWI was particularly effective in detecting cancer distribution with false-negative PBx results.

Diffusion Weighted Imaging in Magnetic Resonance Imaging for Prostate Cancer Diagnosis: Current Efficiency as a Standalone Sequence for an Unenhanced MRI Experience - a Pilot Study

“…Our results are different from those of Kitamura et al who found lower sensitivity rates for DWI (51%) and a higher specificity (89%). However, their results were also influenced by the quantitative interpretation (ADC) and the ADC maps [4]. Concerning the ADC values, our results are in accordance with those obtained by deCobelli et al who also demonstrated a stratified decrease in ADC values in accordance to the increase in Gleason scoring for malignant lesions [9].…”

“…We analyzed the data using the EpiInfo v 7.1.4.0 (Centers for Disease Control and Prevention, Atlanta, USA) and the IBM-SPSS V19.0 demo (SPSS Inc, an IBM company) software. After dichotomization of the initial PI-RADS classification as benign (1, 2) and malignant (3,4,5), clinical efficiency indicators (sensitivity, specificity, positive and negative likelihood ratio) were calculated for qualitative DWI, referring to the gold standard. ADC values were analyzed according to the final diagnosis.…”

“…DCE has more of an orientating role, being used mainly when in doubt [2].The use of intravenous gadolinium in DCE can have its setbacks, mainly in the chronic renal failure patients where, for uncertain reasons, there is a risk for a severe disease called Nephrogenic Systemic Fibrosis [3].A potential solution could be the use of sequences as standalone techniques for asuperior native non-contrast -enhanced MpMRI. The main candidate is DWI, with its assessment of water diffusion (and thus cellularity) and also its pre-disposition to artifacts (by movement or eddy currents) requiring special examination techniques like the use of an endorectal coil for 1.5 T scanners [4,5]. However, this can cause discomfort for the patient, increase movement artifacts and influence interpretation.…”

Is dynamic contrast enhancement still necessary in multiparametric magnetic resonance for diagnosis of prostate cancer: a systematic review and meta-analysis

“…Belgium, Japan, Finland, Austria, United States, Brazil, Italy, Spain and Turkey respectively. Among them 15 were (8,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) prospective studies and 30 were retrospective studies. The publication period of these studies was from 2005 to 2018.…”

Current role of multiparametric magnetic resonance imaging in the management of prostate cancer

“…In terms of comparing preoperative mp-MRI with postoperative histopathology, Styles et al [ 23 ] from Melbourne demonstrated (n=38) that analyzing T2WI and DWI in combination was the best strategy for detecting localized PC with a reported sensitivity of 85% for cancers with a volume >0.5 mL. Kitamura et al [ 24 ] (n=54) examined cancer distribution in men who underwent mp-MRI of the prostate (T2, DWI, MRS) and prostate biopsy followed by radical prostatectomy. The prostate was divided into 12 segments, each of which was examined for malignancy on the basis of T2WI, DWI, and MRS.…”