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Observational Study
. 2018 Nov;43(11):3117-3124.
doi: 10.1007/s00261-018-1598-9.

3T multiparametric MR imaging, PIRADSv2-based detection of index prostate cancer lesions in the transition zone and the peripheral zone using whole mount histopathology as reference standard

Nazanin Hajarol Asvadi  1 , Sohrab Afshari Mirak  2 , Amirhossein Mohammadian Bajgiran  1 , Pooria Khoshnoodi  1 , Pornphan Wibulpolprasert  3 , Daniel Margolis  4 , Anthony Sisk  5 , Robert E Reiter  6 , Steven S Raman  1   6
Affiliations
Observational Study

3T multiparametric MR imaging, PIRADSv2-based detection of index prostate cancer lesions in the transition zone and the peripheral zone using whole mount histopathology as reference standard

Nazanin Hajarol Asvadi et al. Abdom Radiol (NY). 2018 Nov.

Abstract

Purpose: To evaluate 3T mpMRI characteristics of transition zone and peripheral zone index prostate cancer lesions stratified by Gleason Score and PI-RADSv2 with whole mount histopathology correlation.

Methods: An institution review board-approved, HIPAA-compliant single-arm observational study of 425 consecutive men with 3T mpMRI prior to radical prostatectomy from December 2009 to October 2016 was performed. A genitourinary radiologist and a genitourinary pathologist matched all lesions detected on whole mount histopathology with lesions concordant for size and location on 3T mpMRI. Differences in clinical, MRI parameters, and histopathology between transition zone and peripheral zone were determined and analyzed with χ2 and Mann-Whitney U test. AUC was measured.

Results: 3T mpMRI detected 248/323 (76.7%) index lesions in peripheral zone and 75/323 (23.2%) in transition zone. Transition zone prostate cancer had higher median prostate-specific antigen (p = 0.001), larger tumor on 3T mpMRI (p = 0.001), lower proportions of PI-RADSv2 category 4 and 5 (p < 0.001), and lower pathological stage (p = 0.055) compared to peripheral zone prostate cancer. No significant differences were detected in prostate-specific antigen density, preoperative biopsy, and pathology Gleason Scores. After adjusting for significant variables from univariate analysis including prostate volume, tumor volume, prostate-specific antigen, PI-RADSv2 category, AUC for predicting clinically significant tumor in transition zone and peripheral zone were 0.80 and 0.72, respectively (p = 0.36).

Conclusions: The diagnostic performance of PI-RADSv2 for clinically significant transition and peripheral zone prostate cancer was similar. However, there was a lower portion of PI-RADSv2 4 and 5 lesions in transition zone compared to peripheral zone.

Keywords: Gleason score; Multiparametric magnetic resonance imaging; PI-RADSv2; Prostate cancer.

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Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Multiparametric 3T MRI in a 58-year-old man with a history biopsy-proven PCa with PI-RADSv2 score of 5. (a) Axial T2-weighted MR image show transition zone lesion with 2.92 cm3 (b) DWI shows focal high intensity (c ) ADC map shows focal low intensity (d) DCE curve shows early and intense enhancement with washout. (e) Wholemount histopathology with maximum tumor diameter of 2.5 cm, GS 4+4 and tumor stage T2C (f) PI-RADSv2 sector map
Fig. 2
Fig. 2
Multiparametric 3T MRI in a 66-year-old man with a history biopsy-proven PCa with PI-RADSv2 score of 4. (a) Axial T2-weighted MR image show peripheral zone lesion with 0.26 cm3 (b) DWI shows focal high intensity (c ) ADC map shows focal low intensity (d) DCE curve shows early and intense enhancement with immediate washout (e) Wholemount histopathology with maximum tumor diameter of 2 cm, GS 3+4 and tumor stage T2 (f) PI-RADSv2 sector map
Fig. 3
Fig. 3
Scatterplot and correlation analysis for pathology prostate weight and MRI prostate volume
Fig. 4
Fig. 4
AUC for PI-RADSv2 detection of TZ and PZ PCa on 3T mpMRI after adjusting for significant variables
See this image and copyright information in PMC

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