title: Length of capsular contact on prostate MRI as a predictor of extracapsular extension: which is the most optimal sequence?
abstract: Background Length of capsular contact (LCC) is a promising biomarker for predicting extracapsular extension (ECE), but the most optimal magnetic resonance imaging (MRI) sequence for measuring LCC is yet to be determined. Purpose To evaluate LCC using different MRI sequences for determining ECE in prostate cancer. Material and Methods A total of 185 patients underwent prostate MRI followed by radical prostatectomy. LCC was measured separately on T2-weighted (T2W) images, apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced (DCE) MRI. LCCs (LCCT2, LCCADC, LCCDCE, and LCCmax[greatest value of 3 LCCs]) were compared between sequences using Wilcoxon signed rank test and was tested for determining ECE using the Mann-Whitney U test, ROC curve analysis, and logistic regression analysis. Results There were no significant differences among LCCs ( P = 0.333-0.837). All LCCs were significantly greater in patients with ECE ( P < 0.001). The optimal threshold value for predicting ECE was >14, >13, >12, and >14 mm for LCCT2, LCCADC, LCCDCE, and LCCmax, respectively. LCCmaxyielded the highest area under the curve (0.895) which was significantly greater than that by LCCADC(0.858, P = 0.030). Otherwise, there were no significant difference between LCCs ( P = 0.052-0.985). At univariate analysis, age, clinical stage, PSA, Gleason score, and all LCCs were significantly associated with ECE ( P < 0.001-0.040). At multivariate analysis, GS ( P ≤ 0.008) and all LCCs ( P < 0.001) were independently predictive factors. Conclusion LCC measured on any sequence was significantly different in patients with and without ECE and was independently associated with the presence of ECE. Although LCCmaxshowed the greatest ability to predict ECE, there was relatively equivalent performance among different MRI sequences.
authors.affiliation: 1 Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Sungmin
authors.initials: S
authors.lastname: Woo
authors.affiliation: 1 Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Sang Youn
authors.initials: SY
authors.lastname: Kim
authors.affiliation: 1 Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.|2 Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea.
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Cho
authors.affiliation: 1 Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.|2 Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea.
authors.forename: Seung Hyup
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000368:Aged; D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media
keywords: Prostate cancer; extracapsular extension; length of capsular contact; magnetic resonance imaging