The value of diffusion-weighted MRI for prostate cancer detection and localization.
OBJECTIVE
The aim of this study was to evaluate the role of prebiopsy T2-weighted imaging (T2WI), quantitative diffusion-weighted imaging (DWI), and the combination of these magnetic resonance (MR) techniques (T2WI+DWI) in the detection and localization of peripheral zone prostate cancer.


METHODS
T2WI and DWI (b value = 800 s/mm2) with an endorectal coil at 1.5 T were performed prospectively in 43 consecutive male patients with suspicion of prostate cancer before a systematic 12-core prostate biopsy. The peripheral zone of the prostate was evaluated after dividing it into sextants (n = 258). Minimum apparent diffusion coefficient (ADC) values of each sextant in the peripheral zone were measured. Two core biopsies were obtained from each sextant under transrectal ultrasound guidance.


RESULTS
The mean minimum ADC values of the malignant sextants were significantly lower than that of noncancerous tissue, with a significant negative correlation between the ADC value and the Gleason score. The sensitivity, specificity, and area under the receiver operating characteristic curve for the detection and localization of prostate cancer within the peripheral zone were 71%, 77%, and 0.741 for T2WI alone; 84%, 82%, and 0.830 for quantitative DWI alone; and 81%, 92%, and 0.863 for T2WI+DWI, respectively. The use of quantitative DWI, alone or combined with T2WI, improved diagnostic performance in prostate cancer detection and localization compared with T2WI alone (P = 0.020 and P = 0.001, respectively).


CONCLUSIONS
Prebiopsy DWI is valuable in detecting, localizing, and grading prostate cancer within the peripheral zone, and the lowest ADC values can indicate the regions to be biopsied.
Yağci
Ahmet Baki
AB
Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey. bakiyagci@yahoo.com
Ozari
Nurgül
N
Aybek
Zafer
Z
Düzcan
Ender
E
D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000473:pathology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity