Prostatic peripheral zone thickness: what is normal on magnetic resonance imaging?

Abstract

To report the precision of a technique of measuring the PZ thickness on T2-weighted MRI and report normal parameters in patients with normal-sized prostates. We also wanted to establish the mean and second standard deviations (2SD) above and below the mean as criteria for abnormally narrow or expanded PZ thickness. Of the initial 1566 consecutive cohort referred for evaluation for carcinoma based on elevated PSA (prostate specific antibody) or DRE (digital rectal examination), 132 separate subjects with normal-sized prostates were selected for this study. Mean age was 58.2years (15-82). Median serum PSA was 6.2ng/mL (range 0.3-145). Most were asymptomatic for lower urinary tract symptoms (LUTS). Inclusion criteria in this study required technically adequate T2-weighted MRI and total prostatic volume (TPV) ≤ 25cc. Exclusion criteria included post-prostatic surgical and radiation patients, patients having had medical management or minimally invasive therapy for BPH, those being treated for prostatitis. Patients with suspected tumor expanding or obscuring measurement boundaries were also not considered. Transition zone (TZ) and peripheral zone (PZ) volumes were determined using the prolate ellipsoid model. Posterolateral measurement of the PZ was obtained at the axial level of maximal transverse diameter of the prostate on a line drawn from the outer boundary of the TZ to the inner boundary of the external prostatic capsule (EPC). The data were normally distributed. Therefore, it was analyzed using the 2-sided student t-test and Pearson product correlation statistic. Mean pooled (composite) measurement for the posterolateral PZ (PLPZ) was 10mm (CI 9.5-10.5mm) with SD of 2.87mm. Means were statistically the same for the 2 observers (p = 0.75). Pearson correlation between the two observers was 0.63. In a prostate ≤ 25cc volume , the posterolateral PZ should be no thicker than 15.8mm and averages 10.0mm when measured in the maximal axial plane on MRI. These norms were independent of age or use of endorectal coil. The technique measurement demonstrated clinically useful precision.