Usefulness of a Combined Approach of T1-Weighted, T2-Weighted, Dynamic Contrast-Enhanced, and Diffusion-Weighted Imaging in Prostate Cancer

Abstract

PurposeWe evaluated the value of a combined approach of T1-weighted (T1W) imaging, T2-weighted (T2W) imaging, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and diffusion-weighted imaging (DWI) for the detection of prostate cancer and extracapsular extension (ECE) in patients with prostate cancer by using pathologic data after radical prostatectomy.Materials and MethodsFrom April 2009 to December 2011, 126 patients who underwent radical prostatectomy and prostate MRI for prostate cancer were analyzed retrospectively. The MRI findings were compared with the pathologic findings of the radical prostatectomy specimens in each patient. The sensitivity, specificity, and accuracy of the detection of prostate cancer and extracapsular extension were analyzed.ResultsThe prostate cancer detection rate by use of T1W and T2W imaging, DCE-MRI, and their combination was 65.1%, 69.0%, and 80.2%, respectively (p=0.023). The detection rate using T1W and T2W imaging, DCE-MRI, DWI, and their combination was 57.7%, 65.4%, 67.3%, and 80.8%, respectively (p=0.086). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combination MRI (T1W, T2W, and DCE-MRI) for ECE were 46.4%, 91.4%, 83.9%, and 68.1%, respectively. The sensitivity of combination MRI (T1W, T2W, and DCE-MRI) for ECE tended to increase as the prostate-specific antigen level rose (p=0.010). The sensitivity, specificity, PPV, and NPV of combination MRI (T1W, T2W, DCE-MRI, and DWI) for ECE were 65.0%, 87.5%, 76.5%, and 80.0%, respectively.ConclusionsA combined approach of T1W, T2W, and DCE-MRI with DWI demonstrated an accurate detection rate of prostate cancer. Also, combination approaches showed a high specificity for predicting ECE, although sensitivity was relatively lower. Therefore, these methods are reliable for predicting prostate cancer. However, a new protocol is necessary to enhance the sensitivity for predicting ECE.

Apparent diffusion coefficient in the evaluation of side-specific extracapsular extension in prostate cancer: Development and external validation of a nomogram of clinical use

“…a At mpMRI (multiparametric magnetic resonance imaging). This result is in line to previous studies [10][11][12][18][19][20], suggesting that this nomogram could be of help to confirm results from standard T2-WI, which is currently recognized as the most accurate sequence to detect macroscopic ECE.…”

“…Although T2-WI has some limitations (long acquisition times and susceptibility to motion artefacts), with the possibility of an impaired image quality, ADC from DWI is associated with high sensitivity to detect ECE [10][11][12][18][19][20].…”

“…Adding DWI to T2-WI protocols improved sensitivity and specificity to predict ECE [10][11][12], as DWI provides a strong and easily visible contrast of tumor (higher signal intensity) with low ADC values. Moreover, there is evidence that tumor ADC-and the ratio between pathological and normal ADC-correlate inversely with Gleason grade, representing possible predictors of ECE [13].…”

Pelvic Lymph Node Metastases in Prostate Cancer: Preoperative Detection With Dynamic Contrast-Enhanced Magnetic Resonance Imaging Compared With Postoperative Pathologic Result of Pelvic Lymph Node Dissection

“…8 There are several guidelines from the European Association In detecting lymph node metastasis, mp-MRI showed a high specificity of 91%-97% but a low sensitivity of 14%-36%. 10,11,27 Hövels et al 12 20 .…”

“…They concluded that nodal imaging studies should only be recommended for patients having a probability of 45% or higher for LNI. Min et al 11 We stratified the cohorts into 3 groups according to the number of LNE: no significant LNE group, one LNE group, and more than 2 LNE group. Each group was graded as 0, 1, and…”