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. 2022 Mar;55(3):842-853.
doi: 10.1002/jmri.27895. Epub 2021 Sep 18.

Prostate Cancer Diffusion-Weighted Magnetic Resonance Imaging: Does the Choice of Diffusion-Weighting Level Matter?

Stephan E Maier  1   2 , Jonas Wallström  1   3 , Fredrik Langkilde  1   3 , Jens Johansson  1 , Stefan Kuczera  1 , Jonas Hugosson  4   5 , Mikael Hellström  1   3
Affiliations

Prostate Cancer Diffusion-Weighted Magnetic Resonance Imaging: Does the Choice of Diffusion-Weighting Level Matter?

Stephan E Maier et al. J Magn Reson Imaging. 2022 Mar.

Abstract

Background: Diffusion-weighted magnetic resonance imaging plays an important role in multiparametric assessment of prostate lesions. The derived apparent diffusion coefficient (ADC) could be a useful quantitative biomarker for malignant growth, but lacks acceptance because of low reproducibility.

Purpose: To investigate the impact of the choice of diffusion-weighting levels (b-values) on contrast-to-noise ratio and quantitative measures in prostate diffusion-weighted MRI.

Study type: Retrospective and simulation based on published data.

Subjects: Patient cohort (21 men with Prostate Imaging-Reporting and Data System (PI-RADS) version 2 score ≥3) from a single-center study.

Field strength/sequence: 3 T/diffusion-weighted imaging with single-shot echo-planar imaging.

Assessment: Both clinical data and simulations based on previously acquired data were used to quantify the influence of b-value choice in normal peripheral zone (PZ) and PZ tumor lesions. For clinical data, ADC was determined for different combinations of b-values. Contrast-to-noise ratio and quantitative diffusion measures were simulated for a wide range of b-values.

Statistical tests: Tissue ADC and the lesion-to-normal tissue ADC ratios of different b-value combinations were compared with paired two-tailed Student's t-tests. A P-value <0.05 was considered statistically significant.

Results: Findings about b-value dependence derived from clinical data and from simulations agreed with each other. Provided measurement was limited to two b-values, simulation-derived optimal b-value choices coincided with PI-RADSv2 recommendations. For two-point measurements, ADC decreased by 15% when the maximum b-value increased from 1000 to 1500 seconds/mm2 , but corresponding lesion-to-normal tissue ADC ratio showed no significant change (P = 0.86 for acquired data). Simulations with three or more measurement points produced ADCs that declined by only 8% over this range of maximum b-value. Corresponding ADC ratios declined between 2.6% (three points) and 3.8% (21 points). Simulations also revealed an ADC reduction of about 19% with the shorter echo and diffusion time evaluated.

Data conclusion: The comprehensive assessment of b-value dependence permits better formulation of protocol and analysis recommendations for obtaining reproducible results in prostate cancer diffusion-weighted MRI.

Level of evidence: 4 TECHNICAL EFFICACY: Stage 2.

Keywords: apparent diffusion coefficient; apparent diffusion coefficient ratio; b-value; diffusion; kurtosis; prostate peripheral zone.

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References

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    1. Feng Z, Min X, Wang L, et al. Effects of echo time on IVIM quantification of the normal prostate. Sci Rep 2018;8:2572. https://doi.org/10.1038/s41598-018-19150-2.
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