title: Prostate cancer: utility of fusion of T2-weighted and high b-value diffusion-weighted images for peripheral zone tumor detection and localization.
abstract: OBJECTIVE
  To retrospectively assess the utility of fusion of T2-weighted images (T2WI) and high b-value diffusion-weighted images (DWI) for prostate cancer detection and localization.
  
  
  METHODS
  In this IRB-approved HIPAA-compliant study, 42 patients with prostate cancer underwent MRI including multiplanar T2WI and axial DWI before prostatectomy. Two independent radiologists first assessed multiplanar T2WI and axial DWI(b-1000) images and recorded whether tumor was present in each sextant. Axial T2WI was then fused with axial DWI(b-1000) images, and the radiologists re-evaluated each sextant for tumor. Accuracy was compared using generalized estimating equations based on a binary logistic regression model.
  
  
  RESULTS
  The accuracy, sensitivity, specificity, PPV, and NPV for tumor detection on a sextant-basis using separate and fused image sets was 65.1%, 50.8%, 78.0%, 67.8%, and 63.6% and 71.0%, 60.8%, 80.3%, 73.7%, and 69.3%, respectively, for reader 1, and 54.0%, 42.5%, 64.4%, 52.0%, and 55.2%, and 61.1%, 56.7%, 65.2%, 59.6%, and 62.3%, respectively, for reader 2. The improvements in accuracy, sensitivity, and NPV using fused images were statistically significant for both readers, as was the improvement in PPV for reader 2 (P ranging from <0.0001 to 0.041). With either separate or fused images, there was greater sensitivity for tumors of higher grade or larger size (P ranging from <0.001 to 0.099).
  
  
  CONCLUSIONS
  Fusion of T2WI and high b-value DWI resulted in significant improvements in sensitivity and accuracy for tumor detection on a sextant-basis, with similar specificity.
authors.affiliation: Department of Radiology, NYU Langone Medical Center, TCH-HW202, New York, New York 10016, USA. rosena23@nyumc.org
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mannelli
authors.forename: Xiangtian
authors.initials: X
authors.lastname: Kong
authors.forename: Ben E
authors.initials: BE
authors.lastname: Niver
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Berkman
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Jonathan
authors.initials: J
authors.lastname: Melamed
authors.forename: Samir S
authors.initials: SS
authors.lastname: Taneja
mesh_terms: D001706:Biopsy; D003952:Diagnostic Imaging / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008495:Medical Oncology / Q000379:methods; D017430:Prostate-Specific Antigen / Q000096:biosynthesis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen