title: Prostate cancer: feasibility and preliminary experience of a diffusional kurtosis model for detection and assessment of aggressiveness of peripheral zone cancer.
abstract: OBJECTIVE
  To assess the feasibility of diffusional kurtosis (DK) imaging for distinguishing benign from malignant regions, as well as low- from high-grade malignant regions, within the peripheral zone (PZ) of the prostate in comparison with standard diffusion-weighted (DW) imaging.
  
  
  METHODS
  The institutional review board approved this retrospective HIPAA-compliant study and waived informed consent. Forty-seven patients with prostate cancer underwent 3-T magnetic resonance imaging by using a pelvic phased-array coil and DW imaging (maximum b value, 2000 sec/mm2). Parametric maps were obtained for apparent diffusion coefficient (ADC); the metric DK (K), which represents non-Gaussian diffusion behavior; and corrected diffusion (D) that accounts for this non-Gaussianity. Two radiologists reviewed these maps and measured ADC, D, and K in sextants positive for cancer at biopsy. Data were analyzed by using mixed-model analysis of variance and receiver operating characteristic curves.
  
  
  RESULTS
  Seventy sextants exhibited a Gleason score of 6; 51 exhibited a Gleason score of 7 or 8. K was significantly greater in cancerous sextants than in benign PZ (0.96±0.24 vs 0.57±0.07, P<.001), as well as in cancerous sextants with higher rather than lower Gleason score (1.05±0.26 vs 0.89±0.20, P<.001). K showed significantly greater sensitivity for differentiating cancerous sextants from benign PZ than ADC or D (93.3% vs 78.5% and 83.5%, respectively; P<.001), with equal specificity (95.7%, P>.99). K exhibited significantly greater sensitivity for differentiating sextants with low- and high-grade cancer than ADC or D (68.6% vs 51.0% and 49.0%, respectively; P≤.004) but with decreased specificity (70.0% vs 81.4% and 82.9%, respectively; P≤.023). K had significantly greater area under the curve for differentiating sextants with low- and high-grade cancer than ADC (0.70 vs 0.62, P=.010). Relative contrast between cancerous sextants and benign PZ was significantly greater for D or K than ADC (0.25±0.14 and 0.24±0.13, respectively, vs 0.18±0.10; P<.001).
  
  
  CONCLUSIONS
  Preliminary findings suggest increased value for DK imaging compared with standard DW imaging in prostate cancer assessment.
authors.affiliation: Department of Radiology, New York University Langone Medical Center, 550 First Ave, TCH-HW202, New York, NY 10016, USA. Andrew.Rosenkrantz@nyumc.org
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.forename: Eric E
authors.initials: EE
authors.lastname: Sigmund
authors.forename: Glyn
authors.initials: G
authors.lastname: Johnson
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Thais C
authors.initials: TC
authors.lastname: Mussi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Melamed
authors.forename: Samir S
authors.initials: SS
authors.lastname: Taneja
authors.forename: Vivian S
authors.initials: VS
authors.lastname: Lee
authors.forename: Jens H
authors.initials: JH
authors.lastname: Jensen
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001499:Bayes Theorem; D001706:Biopsy; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012372:ROC Curve; D012189:Retrospective Studies