title: Evaluation of the normal-to-diseased apparent diffusion coefficient ratio as an indicator of prostate cancer aggressiveness.
abstract: BACKGROUND
  We tested the feasibility of a simple method for assessment of prostate cancer (PCa) aggressiveness using diffusion-weighted magnetic resonance imaging (MRI) to calculate apparent diffusion coefficient (ADC) ratios between prostate cancer and healthy prostatic tissue.
  
  
  METHODS
  The requirement for institutional review board approval was waived. A set of 20 standardized core transperineal saturation biopsy specimens served as the reference standard for placement of regions of interest on ADC maps in tumorous and normal prostatic tissue of 22 men with PCa (median Gleason score: 7; range, 6-9). A total of 128 positive sectors were included for evaluation. Two diagnostic ratios were computed between tumor ADCs and normal sector ADCs: the ADC peripheral ratio (the ratio between tumor ADC and normal peripheral zone tissue, ADC-PR), and the ADC central ratio (the ratio between tumor ADC and normal central zone tissue, ADC-CR). The performance of the two ratios in detecting high-risk tumor foci (Gleason 8 and 9) was assessed using the area under the receiver operating characteristic curve (AUC).
  
  
  RESULTS
  Both ADC ratios presented significantly lower values in high-risk tumors (0.48 ± 0.13 for ADC-CR and 0.40 ± 0.09 for ADC-PR) compared with low-risk tumors (0.66 ± 0.17 for ADC-CR and 0.54 ± 0.09 for ADC-PR) (p < 0.001) and had better diagnostic performance (ADC-CR AUC = 0.77, sensitivity = 82.2%, specificity = 66.7% and ADC-PR AUC = 0.90, sensitivity = 93.7%, specificity = 80%) than stand-alone tumor ADCs (AUC of 0.75, sensitivity = 72.7%, specificity = 70.6%) for identifying high-risk lesions.
  
  
  CONCLUSIONS
  The ADC ratio as an intrapatient-normalized diagnostic tool may be better in detecting high-grade lesions compared with analysis based on tumor ADCs alone, and may reduce the rate of biopsies.
authors.forename: Andrei
authors.initials: A
authors.lastname: Lebovici
authors.forename: Silviu A
authors.initials: SA
authors.lastname: Sfrangeu
authors.affiliation: Radiology Department, Emergency County Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. diana.feier@gmail.com.
authors.forename: Diana
authors.initials: D
authors.lastname: Feier
authors.forename: Cosmin
authors.initials: C
authors.lastname: Caraiani
authors.forename: Ciprian
authors.initials: C
authors.lastname: Lucan
authors.forename: Mihai
authors.initials: M
authors.lastname: Suciu
authors.forename: Florin
authors.initials: F
authors.lastname: Elec
authors.forename: Gheorghita
authors.initials: G
authors.lastname: Iacob
authors.forename: Mircea
authors.initials: M
authors.lastname: Buruian
mesh_terms: D000368:Aged; D001706:Biopsy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D011859:Radiography; D012189:Retrospective Studies