title: Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging.
abstract: OBJECTIVE
  To analyze the diffusion and perfusion parameters of central gland (CG) prostate cancer, stromal hyperplasia (SH), and glandular hyperplasia (GH) and to determine the role of these parameters in the differentiation of CG cancer from benign CG hyperplasia.
  
  
  METHODS
  In this institutional review board-approved (with waiver of informed consent), HIPAA-compliant study, 38 foci of carcinoma, 38 SH nodules, and 38 GH nodules in the CG were analyzed in 49 patients (26 with CG carcinoma) who underwent preoperative endorectal magnetic resonance (MR) imaging and radical prostatectomy. All carcinomas and hyperplastic foci on MR images were localized on the basis of histopathologic correlation. The apparent diffusion coefficient (ADC), the contrast agent transfer rate between blood and tissue (K(trans)), and extravascular extracellular fractional volume values for all carcinoma, SH, and GH foci were calculated. The mean, standard deviation, 95% confidence interval (CI), and range of each parameter were calculated. Receiver operating characteristic (ROC) and multivariate logistic regression analyses were performed for differentiation of CG cancer from SH and GH foci.
  
  
  RESULTS
  The average ADCs (× 10(-3) mm(2)/sec) were 1.05 (95% CI: 0.97, 1.11), 1.27 (95% CI: 1.20, 1.33), and 1.73 (95% CI: 1.64, 1.83), respectively, in CG carcinoma, SH foci, and GH foci and differed significantly, yielding areas under the ROC curve (AUCs) of 0.99 and 0.78, respectively, for differentiation of carcinoma from GH and SH. Perfusion parameters were similar in CG carcinomas and SH foci, with K(trans) yielding the greatest AUCs (0.75 and 0.58, respectively). Adding K(trans) to ADC in ROC analysis to differentiate CG carcinoma from SH increased sensitivity from 38% to 57% at 90% specificity without noticeably increasing the AUC (0.79).
  
  
  CONCLUSIONS
  ADCs differ significantly between CG carcinoma, SH, and GH, and the use of them can improve the differentiation of CG cancer from SH and GH. Combining K(trans) with ADC can potentially improve the detection of CG cancer.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100021/-/DC1.
authors.affiliation: Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637, USA. aoto@radiology.bsd.uchicago.edu
authors.forename: Aytekin
authors.initials: A
authors.lastname: Oto
authors.forename: Arda
authors.initials: A
authors.lastname: Kayhan
authors.forename: Yulei
authors.initials: Y
authors.lastname: Jiang
authors.forename: Maria
authors.initials: M
authors.lastname: Tretiakova
authors.forename: Cheng
authors.initials: C
authors.lastname: Yang
authors.forename: Tatjana
authors.initials: T
authors.lastname: Antic
authors.forename: Farid
authors.initials: F
authors.lastname: Dahi
authors.forename: Arieh L
authors.initials: AL
authors.lastname: Shalhav
authors.forename: Gregory
authors.initials: G
authors.lastname: Karczmar
authors.forename: Walter M
authors.initials: WM
authors.lastname: Stadler
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011470:Prostatic Hyperplasia / Q000473:pathology* / Q000601:surgery; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve