Prostate Cancer: Differentiation of Central Gland Cancer from Benign Prostatic Hyperplasia by Using Diffusion-weighted and Dynamic Contrast-enhanced MR Imaging

Abstract

Purpose:To analyze the diffusion and perfusion parameters of central gland (CG) prostate cancer, stromal hyperplasia (SH), and glandular hyperplasia (GH) and to determine the role of these parameters in the differentiation of CG cancer from benign CG hyperplasia. Materials and Methods:In this institutional review board-approved (with waiver of informed consent), HIPAA-compliant study, 38 foci of carcinoma, 38 SH nodules, and 38 GH nodules in the CG were analyzed in 49 patients (26 with CG carcinoma) who underwent preoperative endorectal magnetic resonance (MR) imaging and radical prostatectomy. All carcinomas and hyperplastic foci on MR images were localized on the basis of histopathologic correlation. The apparent diffusion coeffi cient (ADC), the contrast agent transfer rate between blood and tissue (K trans ), and extravascular extracellular fractional volume values for all carcinoma, SH, and GH foci were calculated. The mean, standard deviation, 95% confi dence interval (CI), and range of each parameter were calculated. Receiver operating characteristic (ROC) and multivariate logistic regression analyses were performed for differentiation of CG cancer from SH and GH foci. Results:The average ADCs ( 3 10 2 3 mm 2 /sec) were 1.05 (95% CI: 0.97, 1.11), 1.27 (95% CI: 1.20, 1.33), and 1.73 (95% CI: 1.64, 1.83), respectively, in CG carcinoma, SH foci, and GH foci and differed signifi cantly, yielding areas under the ROC curve (AUCs) of 0.99 and 0.78, respectively, for differentiation of carcinoma from GH and SH. Perfusion parameters were similar in CG carcinomas and SH foci, with K trans yielding the greatest AUCs (0.75 and 0.58, respectively). Adding K trans to ADC in ROC analysis to differentiate CG carcinoma from SH increased sensitivity from 38% to 57% at 90% specifi city without noticeably increasing the AUC (0.79). Conclusion:ADCs differ signifi cantly between CG carcinoma, SH, and GH, and the use of them can improve the differentiation of CG cancer from SH and GH. Combining K trans with ADC can potentially improve the detection of CG cancer.

Multiparametric Magnetic Resonance Imaging of Prostate Cancer: Association of Quantitative Magnetic Resonance Parameters with Histopathologic Findings

“…K trans was not highly effective in the differentiation of tumor from normal tissue in our study. This observation agrees with the literature (39,40). However, we found a moderate correlation between K trans and GS, and K trans was moderately effective in the differentiation of low and high-grade tumors.…”

Three-dimensional proton magnetic resonance spectroscopy and diffusion-weighted imaging in the differentiation of incidental prostate carcinoma from benign prostate hyperplasia

“…The group of 9 patients with IPCa had the following characteristics: i) PSA levels were increased slightly compared with those with BPH; and ii) tumors had low Gleason scores and they were mostly well-or moderately differentiated carcinomas. Cancer in the CG of the prostate exhibits the following features: Homogeneous low signal intensity on T2WI, lack of capsule, ill-defined margins, increased CC/C value, high signal intensity on DWI and decreased ADC value (2,3,8,12,23). In the present study, the T1WI and T2WI findings for the 9 patients with IPCa were similar to those with BPH, and did not exhibit any apparently cancerous areas.…”

“…The results of prior studies (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) indicate that the apparent diffusion coefficient (ADC) value of malignant regions was lower than that of the benign regions, and the [choline (Cho) + creatine (Cre)]/citrate (Cit) (CC/C) value of the former was higher than the latter.…”

Biparametric MRI of the prostate

“…In TZ different but morphologically similar entities (e.g. post-inflammatory or post-biopsy scars, atrophic changes, prostatitis, granulomatous prostatitis, intraepithelial neoplasia (PIN) or post-treatment lesions and often benign prostatic hyperplasia [BPH]) [32][33][34] that appear as focal hypointense areas, may mimic PCa.…”