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01-05-2018 | Oncology

Diffusion-weighted imaging of the prostate: should we use quantitative metrics to better characterize focal lesions originating in the peripheral zone?

Authors: Thibaut Pierre, Francois Cornud, Loïc Colléter, Frédéric Beuvon, Frantz Foissac, Nicolas B. Delongchamps, Paul Legmann

Published in: European Radiology | Issue 5/2018

Abstract

Purpose

To compare inter-reader concordance and accuracy of qualitative diffusion-weighted (DW) PIRADSv2.0 score with those of quantitative DW-MRI for the diagnosis of peripheral zone prostate cancer.

Materials and methods

Two radiologists independently assigned a DW-MRI-PIRADS score to 92 PZ-foci, in 74 patients (64.3±5.6 years old; median PSA level: 8 ng/ml, normal DRE in 70 men). A standardised ADCmean and nine ADC-derived parameters were measured, including ADCratios with the whole-prostate (WP-ADCratio) or the mirror-PZ (mirror-ADCratio) as reference areas. Surgical histology and MRI-TRUS fusion-biopsy were the reference for tumours and benign foci, respectively. Inter-reader agreement was assessed by the Cohen-kappa-coefficient and the intraclass correlation coefficient (ICC). Univariate-multivariate regressions determined the most predictive factor for cancer.

Results

Fifty lesions were malignant. Inter-reader concordance was fair for qualitative assessment, but excellent for quantitative assessment for all quantitative variables. At univariate analysis, ADCmean, WP-ADCratio and WL-ADCmean performed equally, but significantly better than the mirror-ADCratio (p<0.001). At multivariate analysis, the only independent variable significantly associated with malignancy was the whole-prostate-ADCratio. At a cut-off value of 0.68, sensitivity was 94–90 % and specificity was 60–38 % for readers 1 and 2, respectively.

Conclusion

The whole-prostate-ADCratio improved the qualitative inter-reader concordance and characterisation of focal PZ-lesions.

Key Points

• Inter-reader concordance of DW PI-RADSv2.0 score for PZ lesions was only fair.

• Using a standardised ADCmean measurement and derived DW-quantitative parameters, concordance was excellent.

• The whole-prostate ADCratio performed significantly better than the mirror-ADCratio for cancer detection.

• At a cut-off of 0.68, sensitivity values of WP-ADCratio were 94–90 %.

• The whole-prostate ADCratio may circumvent variations of ADC metrics across centres.

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Title: Diffusion-weighted imaging of the prostate: should we use quantitative metrics to better characterize focal lesions originating in the peripheral zone?
Authors: Thibaut Pierre
Francois Cornud
Loïc Colléter
Frédéric Beuvon
Frantz Foissac
Nicolas B. Delongchamps
Paul Legmann
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 5/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-5107-2

At a glance: The STEP trials

Springer Medicine

Diffusion-weighted imaging of the prostate: should we use quantitative metrics to better characterize focal lesions originating in the peripheral zone?

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

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