Abstract
Aim. To compare the diagnostic performance of diffusion weighted imaging (DWI) using b-values of 1000 s/mm2 and 2000 s/mm2 at 3 Tesla (T) for the evaluation of clinically significant prostate cancer. Matherials and Methods. Seventy-eight prostate cancer patients underwent a 3T MRI scan followed by radical prostatectomy. DWI was performed using b-values of 0, 1000, and 2000 s/mm2 and qualitatively analysed by two radiologists. ADC maps were obtained at b-values of 1000 and 2000 s/mm2 and quantitatively analyzed in consensus. Results. For diagnosis of 78 prostate cancers the accuracy of DWI for the young reader was significantly greater at b = 2000 s/mm2 for the peripheral zone (PZ) but not for the transitional zone (TZ). For the experienced reader, DWI did not show significant differences in accuracy between b-values of 1000 and 2000 s/mm2. The quantitative analysis in the PZ and TZ was substantially superimposable between the two b-values, albeit with a higher accuracy with a b-value of 2000 s/mm2. Conclusions. With a b-value of 2000 s/mm2 at 3T both readers differentiated clinical significant cancer from benign tissue; higher b-values can be helpful for the less experienced readers.
Highlights
Because the greater part of these 2 tumors were located in both zones occupied by the peripheral zone (PZ), they were defined as PZ cancer
The aim of our study was to standardize DW-MRI protocol, as regards the b-value, for the qualitative and quantitative evaluation of prostate cancer in common clinical practice without contrast agent administration. It is widely debated in literature which could be the best b-value for prostate cancer detection in order to highlight the tumor tissue, reducing the signal from benign prostate tissue, in order to obtain good quality ADC maps for better measurements and visual imaging interpretations [6] without increasing the acquisition time or reduce the signal-to-noise ratio
diffusion weighted imaging (DWI) sequences are included in the standard multiparametric magnetic resonance imaging (mp-MRI) protocol of the prostate for both detection and local staging [7,8,9]
Summary
Prostatic adenocarcinoma is the most common cancer in men and the second leading cause of cancer deaths [1]. many patients suffering from prostate cancer die with prostate cancer and not because of prostate cancer itself.The standard of care is to achieve an early diagnosis in patients with clinically significant prostate cancer (e.g., Gleason score ≥ 3 + 3).Largest series concerning prostate cancer screening by use of PSA have shown no significant effect on the reduction of mortality [2, 3].Clinically significant prostate cancer detection using transrectal ultrasound (TRUS) is not easy.In a recent study from Spajic et al on prostate TRUS examination in a large cohort of patients affected with prostate cancer, 60.6% of cancerous lesions were hypoechoic, 31.8% were isoechoic, and 7.6% hyperechoic, which is about 40% of TRUS prostate cancer missing detection [4]. Prostatic adenocarcinoma is the most common cancer in men and the second leading cause of cancer deaths [1]. Many patients suffering from prostate cancer die with prostate cancer and not because of prostate cancer itself. The standard of care is to achieve an early diagnosis in patients with clinically significant prostate cancer (e.g., Gleason score ≥ 3 + 3). Significant prostate cancer detection using transrectal ultrasound (TRUS) is not easy. In a recent study from Spajic et al on prostate TRUS examination in a large cohort of patients affected with prostate cancer, 60.6% of cancerous lesions were hypoechoic, 31.8% were isoechoic, and 7.6% hyperechoic, which is about 40% of TRUS prostate cancer missing detection [4]
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