title: 3T multiparametric MRI of the prostate: Does intravoxel incoherent motion diffusion imaging have a role in the detection and stratification of prostate cancer in the peripheral zone?
abstract: OBJECTIVE
  To evaluate the potential added value of the intravoxel incoherent motion model to conventional multiparametric magnetic resonance protocol in order to differentiate between healthy and neoplastic prostate tissue in the peripheral zone.
  
  
  METHODS
  Mono-exponential and bi-exponential fits were used to calculate ADC and IVIM parameters in 53 patients with peripheral zone biopsy proved tumor. Inferential statistics analysis was performed on T2, ADC and IVIM parameters (D, D*, f) comparing healthy and neoplastic tissues. Linear discriminant analysis was performed for the conventional parameters (T2 and ADC), the IVIM parameters (molecular diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (f) and the combined T2-weighted imaging/DWI and IVIM parameters (T2, ADC, D, D* and f). A correlation with Gleason scores was achieved.
  
  
  RESULTS
  The values of T2, ADC and D were significantly lower in cancerous tissues (2749.82 ± 1324.67 ms, 0.76 ± 0.27 × 10(-3)mm(2)/s and 0.99 ± 0.38 × 10(-3)mm(2)/s respectively) compared to those found in the healthy tissues (3750.70 ± 1735.37 ms, 1.39 ± 0.48 × 10(-3)mm(2)/s and 1.77 ± 0.36 × 10(-3)mm(2)/s respectively); D* parameter was significantly increased in neoplastic compared to healthy tissue (15.56 ± 12.91 × 10(-3)mm(2)/s and 10.25 ± 10.52 × 10(-3)mm(2)/s respectively). The specificity, sensitivity and accuracy of the T2-weighted imaging/DWI and IVIM parameters were 100, 96 and 98%, respectively, compare to 88, 92 and 90% and 96, 92 and 94 for T2-weighted imaging/ADC and IVIM alone.
  
  
  CONCLUSIONS
  IVIM parameters increase the specificity and sensitivity in the evaluation of peripheral zone prostate cancer. A statistical difference between low grade tumors and high grade tumors has been demostrated in that ADC, D and D* dataset; in particular, D has been found to have the highest significativity.
authors.affiliation: Dept. of Radiological Sciences, Oncology & Pathology-Sapienza University of Rome, V.le Regina Elena, 324, 00161 Roma, Italy.
authors.forename: Mariacristina
authors.initials: M
authors.lastname: Valerio
authors.affiliation: Dept. of Radiological Sciences, Oncology & Pathology-Sapienza University of Rome, V.le Regina Elena, 324, 00161 Roma, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Zini
authors.affiliation: Dept. of Radiological Sciences, Oncology & Pathology-Sapienza University of Rome, V.le Regina Elena, 324, 00161 Roma, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Fierro
authors.affiliation: Dept. of Radiological Sciences, Oncology & Pathology-Sapienza University of Rome, V.le Regina Elena, 324, 00161 Roma, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Giura
authors.affiliation: Dept. of Radiological Sciences, Oncology & Pathology-Sapienza University of Rome, V.le Regina Elena, 324, 00161 Roma, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Colarieti
authors.affiliation: Environment and Health Dept., Istituto Superiore di Sanità, Rome, V.le Regina Elena, 299, 00161 Roma, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giuliani
authors.affiliation: Dept. of Radiological Sciences, Oncology & Pathology-Sapienza University of Rome, V.le Regina Elena, 324, 00161 Roma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Laghi
authors.affiliation: Dept. of Radiological Sciences, Oncology & Pathology-Sapienza University of Rome, V.le Regina Elena, 324, 00161 Roma, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.affiliation: Dept. of Radiological Sciences, Oncology & Pathology-Sapienza University of Rome, V.le Regina Elena, 324, 00161 Roma, Italy. Electronic address: valeria.panebianco@uniroma1.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Panebianco
mesh_terms: D001706:Biopsy / Q000379:methods; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D016002:Discriminant Analysis; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009038:Motion; D060787:Neoplasm Grading; D010477:Perfusion; D011446:Prospective Studies; D011467:Prostate / Q000033:anatomy & histology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Diffusion weighted imaging; Gleason score; Intravoxel incoherent motion; Multiparametric magnetic resonance imaging; Peripheral zone; Prostate cancer