Abstract
Objectives: Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) is a promising non-invasive imaging technique to detect and grade prostate cancer (PCa). However, the results regarding the diagnostic performance of IVIM-DWI in the characterization and classification of PCa have been inconsistent among published studies. This meta-analysis was performed to summarize the diagnostic performance of IVIM-DWI in the differential diagnosis of PCa from non-cancerous tissues and to stratify the tumor Gleason grades in PCa.Materials and Methods: Studies concerning the differential diagnosis of prostate lesions using IVIM-DWI were systemically searched in PubMed, Embase, and Web of Science without time limitation. Review Manager 5.3 was used to calculate the standardized mean difference (SMD) and 95% confidence intervals of the apparent diffusion coefficient (ADC), tissue diffusivity (D), pseudodiffusivity (D*), and perfusion fraction (f). Stata 12.0 was used to pool the sensitivity, specificity, and area under the curve (AUC), as well as publication bias and heterogeneity. Fagan's nomogram was used to predict the post-test probabilities.Results: Twenty studies with 854 patients confirmed with PCa were included. Most of the included studies showed a low to unclear risk of bias and low concerns regarding applicability. PCa showed a significantly lower ADC (SMD = −2.34; P < 0.001) and D values (SMD = −1.86; P < 0.001) and a higher D* value (SMD = 0.29; P = 0.01) than non-cancerous tissues, but no difference was noted with the f value (SMD = −0.16; P = 0.50). Low-grade PCa showed higher ADC (SMD = 0.63; P < 0.001) and D values (SMD = 0.80; P < 0.001) than the high-grade lesions. ADC showed comparable diagnostic performance (sensitivity = 86%; specificity = 86%; AUC = 0.87) but higher post-test probabilities (60, 53, 36, and 36% for ADC, D, D*, and f values, respectively) compared with the D (sensitivity = 82%; specificity = 82%; AUC = 0.85), D* (sensitivity = 70%; specificity = 70%; AUC = 0.75), and f values (sensitivity = 73%; specificity = 68%; AUC = 0.76).Conclusion: IVIM parameters are adequate to differentiate PCa from non-cancerous tissues with good diagnostic performance but are not superior to the ADC value. Diffusion coefficients can further stratify the tumor Gleason grades in PCa.
Highlights
Prostate cancer (PCa) remains the most frequently diagnosed cancer and is the second leading cause of cancer death among men in the United States in 2020 (1)
The apparent diffusion coefficient (ADC) value may overlap between PCa and non-cancerous tissues because benign prostatic hyperplasia shows increased cellularity, and ADC is mixed with microcirculation perfusion within the capillaries
The results showed that the Intravoxel incoherent motion (IVIM) model has good diagnostic performance but was not superior to the monoexponential ADC value overall
Summary
Prostate cancer (PCa) remains the most frequently diagnosed cancer and is the second leading cause of cancer death among men in the United States in 2020 (1). Diagnosis of PCa and stratification of tumor grades are important for risk assessment and management strategies. PCa patients with high Gleason scores usually accept radical prostatectomy and radiation therapy, whereas patients with low-risk cancer are optimal for active surveillance instead of immediate intervention, in older men (2). Reported that multiparametric magnetic resonance imaging (MRI) improved the accuracy of PCa detection and local staging (3). The diffusion-weighted imaging (DWI)-derived apparent diffusion coefficient (ADC) has become a valuable quantitative parameter to detect and grade PCa (4). The ADC value may overlap between PCa and non-cancerous tissues because benign prostatic hyperplasia shows increased cellularity, and ADC is mixed with microcirculation perfusion within the capillaries
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