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. 2010 Dec;257(3):715-23.
doi: 10.1148/radiol.10100021. Epub 2010 Sep 15.

Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging

Aytekin Oto  1 , Arda Kayhan, Yulei Jiang, Maria Tretiakova, Cheng Yang, Tatjana Antic, Farid Dahi, Arieh L Shalhav, Gregory Karczmar, Walter M Stadler
Affiliations

Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging

Aytekin Oto et al. Radiology. 2010 Dec.

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 coefficient (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% confidence 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 (× 10(-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 significantly, 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% specificity without noticeably increasing the AUC (0.79).

Conclusion: ADCs differ significantly 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.

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100021/-/DC1.

PubMed Disclaimer

Conflict of interest statement

Authors stated no financial relationship to disclose.

Figures

Figure 1a:
Figure 1a:
Images in 76-year-old man with CG carcinoma with a Gleason score of 9 (5 + 4). (a) T2-weighted fast SE axial MR image shows ill-defined, hypointense carcinoma focus (arrows) occupying most of the left side of the CG and extending to the midline. The carcinoma (arrows) is dark on (b) ADC map, demonstrating restricted diffusion (measured ADC of the carcinoma = 0.73 × 10−3 mm2/sec). (c) Ktrans map color overlain on T2-weighted MR image reveals increased Ktrans values over the areas corresponding to the carcinoma (arrows) (measured Ktrans of the carcinoma = 0.13/min). (d) Histopathologic slide from the prostatectomy specimen shows the cancer (arrows) on the left side of the CG. (Hematoxylin-eosin stain.)
Figure 1b:
Figure 1b:
Images in 76-year-old man with CG carcinoma with a Gleason score of 9 (5 + 4). (a) T2-weighted fast SE axial MR image shows ill-defined, hypointense carcinoma focus (arrows) occupying most of the left side of the CG and extending to the midline. The carcinoma (arrows) is dark on (b) ADC map, demonstrating restricted diffusion (measured ADC of the carcinoma = 0.73 × 10−3 mm2/sec). (c) Ktrans map color overlain on T2-weighted MR image reveals increased Ktrans values over the areas corresponding to the carcinoma (arrows) (measured Ktrans of the carcinoma = 0.13/min). (d) Histopathologic slide from the prostatectomy specimen shows the cancer (arrows) on the left side of the CG. (Hematoxylin-eosin stain.)
Figure 1c:
Figure 1c:
Images in 76-year-old man with CG carcinoma with a Gleason score of 9 (5 + 4). (a) T2-weighted fast SE axial MR image shows ill-defined, hypointense carcinoma focus (arrows) occupying most of the left side of the CG and extending to the midline. The carcinoma (arrows) is dark on (b) ADC map, demonstrating restricted diffusion (measured ADC of the carcinoma = 0.73 × 10−3 mm2/sec). (c) Ktrans map color overlain on T2-weighted MR image reveals increased Ktrans values over the areas corresponding to the carcinoma (arrows) (measured Ktrans of the carcinoma = 0.13/min). (d) Histopathologic slide from the prostatectomy specimen shows the cancer (arrows) on the left side of the CG. (Hematoxylin-eosin stain.)
Figure 1d:
Figure 1d:
Images in 76-year-old man with CG carcinoma with a Gleason score of 9 (5 + 4). (a) T2-weighted fast SE axial MR image shows ill-defined, hypointense carcinoma focus (arrows) occupying most of the left side of the CG and extending to the midline. The carcinoma (arrows) is dark on (b) ADC map, demonstrating restricted diffusion (measured ADC of the carcinoma = 0.73 × 10−3 mm2/sec). (c) Ktrans map color overlain on T2-weighted MR image reveals increased Ktrans values over the areas corresponding to the carcinoma (arrows) (measured Ktrans of the carcinoma = 0.13/min). (d) Histopathologic slide from the prostatectomy specimen shows the cancer (arrows) on the left side of the CG. (Hematoxylin-eosin stain.)
Figure 2a:
Figure 2a:
Images in 64-year-old man with an SH nodule on the right side of the CG. (a) Axial T2-weighted fast SE MR image shows a round, well-defined, homogeneously hypointense nodule (arrows) representing SH. The nodule (arrows) can be detected on (b) a DW image (b = 1000 sec/mm2) but cannot be delineated on (c) an ADC map (ADC of nodule = 1.33 × 10−3 mm2/sec). (d) Fused Ktrans map and T2-weighted image reveals increased Ktrans throughout the SH nodule (arrow). (e) On the histopathologic slide (hematoxylin-eosin stain), the predominantly stromal component of the nodule (white arrow) is noted. Incidentally noted is a mixed glandular and stromal nodule (arrowhead in d and black arrow in e) on the left side of the CG that demonstrates similar Ktrans features.
Figure 2b:
Figure 2b:
Images in 64-year-old man with an SH nodule on the right side of the CG. (a) Axial T2-weighted fast SE MR image shows a round, well-defined, homogeneously hypointense nodule (arrows) representing SH. The nodule (arrows) can be detected on (b) a DW image (b = 1000 sec/mm2) but cannot be delineated on (c) an ADC map (ADC of nodule = 1.33 × 10−3 mm2/sec). (d) Fused Ktrans map and T2-weighted image reveals increased Ktrans throughout the SH nodule (arrow). (e) On the histopathologic slide (hematoxylin-eosin stain), the predominantly stromal component of the nodule (white arrow) is noted. Incidentally noted is a mixed glandular and stromal nodule (arrowhead in d and black arrow in e) on the left side of the CG that demonstrates similar Ktrans features.
Figure 2c:
Figure 2c:
Images in 64-year-old man with an SH nodule on the right side of the CG. (a) Axial T2-weighted fast SE MR image shows a round, well-defined, homogeneously hypointense nodule (arrows) representing SH. The nodule (arrows) can be detected on (b) a DW image (b = 1000 sec/mm2) but cannot be delineated on (c) an ADC map (ADC of nodule = 1.33 × 10−3 mm2/sec). (d) Fused Ktrans map and T2-weighted image reveals increased Ktrans throughout the SH nodule (arrow). (e) On the histopathologic slide (hematoxylin-eosin stain), the predominantly stromal component of the nodule (white arrow) is noted. Incidentally noted is a mixed glandular and stromal nodule (arrowhead in d and black arrow in e) on the left side of the CG that demonstrates similar Ktrans features.
Figure 2d:
Figure 2d:
Images in 64-year-old man with an SH nodule on the right side of the CG. (a) Axial T2-weighted fast SE MR image shows a round, well-defined, homogeneously hypointense nodule (arrows) representing SH. The nodule (arrows) can be detected on (b) a DW image (b = 1000 sec/mm2) but cannot be delineated on (c) an ADC map (ADC of nodule = 1.33 × 10−3 mm2/sec). (d) Fused Ktrans map and T2-weighted image reveals increased Ktrans throughout the SH nodule (arrow). (e) On the histopathologic slide (hematoxylin-eosin stain), the predominantly stromal component of the nodule (white arrow) is noted. Incidentally noted is a mixed glandular and stromal nodule (arrowhead in d and black arrow in e) on the left side of the CG that demonstrates similar Ktrans features.
Figure 2e:
Figure 2e:
Images in 64-year-old man with an SH nodule on the right side of the CG. (a) Axial T2-weighted fast SE MR image shows a round, well-defined, homogeneously hypointense nodule (arrows) representing SH. The nodule (arrows) can be detected on (b) a DW image (b = 1000 sec/mm2) but cannot be delineated on (c) an ADC map (ADC of nodule = 1.33 × 10−3 mm2/sec). (d) Fused Ktrans map and T2-weighted image reveals increased Ktrans throughout the SH nodule (arrow). (e) On the histopathologic slide (hematoxylin-eosin stain), the predominantly stromal component of the nodule (white arrow) is noted. Incidentally noted is a mixed glandular and stromal nodule (arrowhead in d and black arrow in e) on the left side of the CG that demonstrates similar Ktrans features.
Figure 3a:
Figure 3a:
Images in 67-year-old man with a GH nodule on the left side of the CG. (a) Axial T2-weighted fast SE MR image shows the well-defined, hyperintense nodule (white arrow) in the CG. (b) The GH nodule (white arrow) is bright on ADC map (ADC = 1.89 × 10−3 mm2/sec) and does not show any restricted diffusion. (c) Fused Ktrans map and T2-weighted image reveals an area of decreased Ktrans corresponding to the location of the GH nodule (white arrow). Incidentally noted is cancer (black arrow) on the left posterior side of the PZ on all images. (d) Histopathologic slide from the prostatectomy specimen reveals the GH on the left side of the CG (white arrow) and the cancer in the left PZ (black arrow). (Hematoxylin-eosin stain.)
Figure 3b:
Figure 3b:
Images in 67-year-old man with a GH nodule on the left side of the CG. (a) Axial T2-weighted fast SE MR image shows the well-defined, hyperintense nodule (white arrow) in the CG. (b) The GH nodule (white arrow) is bright on ADC map (ADC = 1.89 × 10−3 mm2/sec) and does not show any restricted diffusion. (c) Fused Ktrans map and T2-weighted image reveals an area of decreased Ktrans corresponding to the location of the GH nodule (white arrow). Incidentally noted is cancer (black arrow) on the left posterior side of the PZ on all images. (d) Histopathologic slide from the prostatectomy specimen reveals the GH on the left side of the CG (white arrow) and the cancer in the left PZ (black arrow). (Hematoxylin-eosin stain.)
Figure 3c:
Figure 3c:
Images in 67-year-old man with a GH nodule on the left side of the CG. (a) Axial T2-weighted fast SE MR image shows the well-defined, hyperintense nodule (white arrow) in the CG. (b) The GH nodule (white arrow) is bright on ADC map (ADC = 1.89 × 10−3 mm2/sec) and does not show any restricted diffusion. (c) Fused Ktrans map and T2-weighted image reveals an area of decreased Ktrans corresponding to the location of the GH nodule (white arrow). Incidentally noted is cancer (black arrow) on the left posterior side of the PZ on all images. (d) Histopathologic slide from the prostatectomy specimen reveals the GH on the left side of the CG (white arrow) and the cancer in the left PZ (black arrow). (Hematoxylin-eosin stain.)
Figure 3d:
Figure 3d:
Images in 67-year-old man with a GH nodule on the left side of the CG. (a) Axial T2-weighted fast SE MR image shows the well-defined, hyperintense nodule (white arrow) in the CG. (b) The GH nodule (white arrow) is bright on ADC map (ADC = 1.89 × 10−3 mm2/sec) and does not show any restricted diffusion. (c) Fused Ktrans map and T2-weighted image reveals an area of decreased Ktrans corresponding to the location of the GH nodule (white arrow). Incidentally noted is cancer (black arrow) on the left posterior side of the PZ on all images. (d) Histopathologic slide from the prostatectomy specimen reveals the GH on the left side of the CG (white arrow) and the cancer in the left PZ (black arrow). (Hematoxylin-eosin stain.)
Figure 4:
Figure 4:
Scatterplot of ADCs for CG carcinoma, SH foci, and GH foci. Data points = individual ADCs, horizontal lines = average ADCs and associated 95% confidence intervals.
Figure 5:
Figure 5:
ROC curves of diffusion and perfusion parameters in the differentiation of CG carcinomas. Left: CG carcinomas versus SH foci. Right: CG carcinomas versus GH foci.
See this image and copyright information in PMC

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