Correlation of apparent diffusion coefficient ratio on 3.0 T MRI with prostate cancer Gleason score

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Highlights

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ADC _ratio is a reliable and reproducible tool in quantification of diffusion restriction for clinically significant PCa foci.
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Comparing an experienced and a new MRI reader, Inter-reader reliability in the calculation of ADC _ratio was excellent.
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ADC _ratio has potential to replace the current practice of visual analysis of ADC _tumour reduction, and provide an objective tool.

Abstract

Introduction

The purpose was to investigate the usefulness of ADC _ratio on Diffusion MRI to discriminate between benign and malignant lesions of Prostate.

Methods

Images of patients who underwent in-gantry MRI guided prostate lesion biopsy were retrospectively analyzed. Prostate Cancers with 20% or more Gleason score (GS) pattern 3 + 3 = 6 in each core or any volume of higher Gleason score pattern were included. ADC _ratio was calculated by two reviewers for each lesion. The ADC _ratio was calculated for each lesion by dividing the lowest ADC value in a lesion and highest ADC value in normal prostate in peripheral zone (PZ). ADC _ratio values were compared with the biopsy result. Data was analysed using independent samples T-test, Spearman correlation, intra-class correlation coefficient (ICC) and Receiver operating characteristic (ROC) curve.

Results

45 lesions in 33 patients were analyzed. 12 lesions were in transitional zone (TZ) and 33 in perpheral zone PZ. All lesions demonstrated an ADC _ratio of 0.45 or lower. GS demonstrated a negative correlation with both the ADC value and ADC _ratio. However, ADC _ratio (p < 0.001) demonstrated a stronger correlation compared to ADC value alone (p = 0.014). There was no significant statistical difference between GS 3 + 4 and GS 4 + 3 mean ADC _tumour value (p = 0.167). However when using ADC _ratio, there was a significant difference (p = 0.032). ROC curve analysis demonstrated an area under the curve of 0.83 using ADC _ratio and 0.76 when using ADC _tumour value when discriminating Gleason 6 from Gleason ≥7 tumours. Inter-observer reliability in the calculation of ADC ratios was excellent, with ICC of 0.964.

Conclusion

ADC _ratio is a reliable and reproducible tool in quantification of diffusion restriction for clinically significant prostate cancer foci.

Related collections

Most cited references 16

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Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer.

Diederik Somford, Thomas Hambrock, J. Barentsz … (2011)

To retrospectively determine the relationship between apparent diffusion coefficients (ADCs) obtained with 3.0-T diffusion-weighted (DW) magnetic resonance (MR) imaging and Gleason grades in peripheral zone prostate cancer. The requirement to obtain institutional review board approval was waived. Fifty-one patients with prostate cancer underwent MR imaging before prostatectomy, including DW MR imaging with b values of 0, 50, 500, and 800 sec/mm(2). In prostatectomy specimens, separate slice-by-slice determinations of Gleason grade groups were performed according to primary, secondary, and tertiary Gleason grades. In addition, tumors were classified into qualitative grade groups (low-, intermediate-, or high-grade tumors). ADC maps were aligned to step-sections and regions of interest annotated for each tumor slice. The median ADC of tumors was related to qualitative grade groups with linear mixed-model regression analysis. The accuracy of the median ADC in the most aggressive tumor component in the differentiation of low- from combined intermediate- and high-grade tumors was summarized by using the area under the receiver operating characteristic (ROC) curve (A(z)). In 51 prostatectomy specimens, 62 different tumors and 251 step-section tumor lesions were identified. The median ADC in the tumors showed a negative relationship with Gleason grade group, and differences among the three qualitative grade groups were statistically significant (P < .001). Overall, with an increase of one qualitative grade group, the median ADC (±standard deviation) decreased 0.18 × 10(-3) mm(2)/sec ± 0.02. Low-, intermediate-, and high-grade tumors had a median ADC of 1.30 × 10(-3) mm(2)/sec ± 0.30, 1.07 × 10(-3) mm(2)/sec ± 0.30, and 0.94 × 10(-3) mm(2)/sec ± 0.30, respectively. ROC analysis showed a discriminatory performance of A(z) = 0.90 in discerning low-grade from combined intermediate- and high-grade lesions. ADCs at 3.0 T showed an inverse relationship to Gleason grades in peripheral zone prostate cancer. A high discriminatory performance was achieved in the differentiation of low-, intermediate-, and high-grade cancer. RSNA, 2011

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Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3?

Jennifer R Stark, Sven Perner, Meir J Stampfer … (2009)

PURPOSE Gleason grading is an important predictor of prostate cancer (PCa) outcomes. Studies using surrogate PCa end points suggest outcomes for Gleason score (GS) 7 cancers vary according to the predominance of pattern 4. These studies have influenced clinical practice, but it is unclear if rates of PCa mortality differ for 3 + 4 and 4 + 3 tumors. Using PCa mortality as the primary end point, we compared outcomes in Gleason 3 + 4 and 4 + 3 cancers, and the predictive ability of GS from a standardized review versus original scoring. PATIENTS AND METHODS Three study pathologists conducted a blinded standardized review of 693 prostatectomy and 119 biopsy specimens to assign primary and secondary Gleason patterns. Tumor specimens were from PCa patients diagnosed between 1984 and 2004 from the Physicians' Health Study and Health Professionals Follow-Up Study. Lethal PCa (n = 53) was defined as development of bony metastases or PCa death. Hazard ratios (HR) were estimated according to original GS and standardized GS. We compared the discrimination of standardized and original grading with C-statistics from models of 10-year survival. Results For prostatectomy specimens, 4 + 3 cancers were associated with a three-fold increase in lethal PCa compared with 3 + 4 cancers (95% CI, 1.1 to 8.6). The discrimination of models of standardized scores from prostatectomy (C-statistic, 0.86) and biopsy (C-statistic, 0.85) were improved compared to models of original scores (prostatectomy C-statistic, 0.82; biopsy C-statistic, 0.72). CONCLUSION Ignoring the predominance of Gleason pattern 4 in GS 7 cancers may conceal important prognostic information. A standardized review of GS can improve prediction of PCa survival.

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Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study.

Flavie Bratan, Emilie Niaf, Christelle MelodeLima … (2013)

To assess factors influencing prostate cancer detection on multiparametric (T2-weighted, diffusion-weighted, and dynamic contrast-enhanced) MRI.

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All references

Author and article information

Contributors

Tarun Pankaj Jain

Journal

Journal ID (nlm-ta): Eur J Radiol Open

Journal ID (iso-abbrev): Eur J Radiol Open

Title: European Journal of Radiology Open

Publisher: Elsevier

ISSN (Electronic): 2352-0477

Publication date PMC-release: 30 March 2018

Publication date Collection: 2018

Publication date (Electronic): 30 March 2018

Volume: 5

Pages: 58-63

Affiliations

[a ]Department of Urology, The Canberra Hospital, Garran, ACT, Australia

[b ]Universal Medical Imaging, Canberra, Calvary Hospital, Bruce, Australia

[c ]Australian National University, Canberra, ACT, Australia

[d ]The Canberra Hospital, Garran, ACT, 2606, Australia

Author notes

[* ]Corresponding author at: Universal Medical Imaging, 1/110 Giles street, Kingston, ACT, 2604, Australia. tarun.jain@ 123456act.gov.au

Article

Publisher ID: S2352-0477(18)30014-5

DOI: 10.1016/j.ejro.2018.03.002

PMC ID: 5910169

PubMed ID: 29687050

SO-VID: 2d0c3436-7158-4d9e-904e-0d1fec91a51a

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).