title: Multi-parametric MR imaging of the anterior fibromuscular stroma and its differentiation from prostate cancer.
abstract: To describe MP-MRI features of the normal anterior fibromuscular stroma (AFMS) and identify MR imaging findings that can differentiate it from anterior prostate cancer.
  
  
  
  We reviewed MP-MR images and histopathology of patients who underwent pre-operative MRI and prostatectomy between October 2012 and August 2014. Thirty-seven patients with anterior prostate cancer larger than 5 mm and 40 patients with no anterior cancer were included in this study. After correlation with histology and MR images, the size, symmetry, T2, DWI characteristics, and enhancement pattern of normal AFMS and anterior prostate cancer were compared.
  
  
  
  Normal AFMS was hypointense and symmetric on T2-weighted images (37/40, 93%), whereas anterior prostate cancers, while also hypointense on T2-weighted images, were predominantly asymmetric (6/37, 16%) (P < 0.001). On high b-value DWI, AFMS was predominantly hypointense (36/40, 90%), whereas anterior prostate cancers were predominantly hyperintense (30/37, 81%) compared to the normal peripheral zone (P < 0.001). The mean ADC and tenth percentile ADC values of anterior prostate cancers were lower than normal AFMS (7.14 vs. 8.33 (10-4mm2/s), P < 0.01) and (5.73 vs. 6.95 (10-4mm2/s), P < 0.01), respectively. On DCE-MR images, AFMS demonstrated a type 1 enhancement curve (35/39, 90%), whereas anterior prostate cancers demonstrated only either a type 3 (23/37, 62%) or type 2 enhancement curve (14/37, 38%) (P < 0.001).
  
  
  
  Symmetric T2 appearance, hypointense high b-value DWI signal, relatively higher ADC values, and Type 1 enhancement pattern of the AFMS can be helpful in its differentiation from anterior prostate cancers.
authors.affiliation: Department of Radiology, University of Chicago, 5841 S. Maryland Avenue MC 2026, Chicago, IL, 60637, USA.|Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: Emily
authors.initials: E
authors.lastname: Ward
authors.affiliation: Department of Radiology, University of Chicago, 5841 S. Maryland Avenue MC 2026, Chicago, IL, 60637, USA. mike.baad@gmail.com.
authors.forename: Michael
authors.identifier: 0000-0002-1068-9134
authors.initials: M
authors.lastname: Baad
authors.affiliation: Department of Radiology, University of Chicago, 5841 S. Maryland Avenue MC 2026, Chicago, IL, 60637, USA.|School of Electronic and Information Engineering, Beijing Jiaotong University, 3 Shangyuancun, Haidian District, Beijing, 100044, China.
authors.forename: Yahui
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Department of Radiology, University of Chicago, 5841 S. Maryland Avenue MC 2026, Chicago, IL, 60637, USA.
authors.forename: Ambereen
authors.initials: A
authors.lastname: Yousuf
authors.affiliation: Department of Radiology, University of Chicago, 5841 S. Maryland Avenue MC 2026, Chicago, IL, 60637, USA.
authors.forename: Shiyang
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Pathology, University of Chicago, 5841 S. Maryland Avenue MC 6101, Chicago, IL, 60637, USA.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Antic
authors.affiliation: Department of Radiology, University of Chicago, 5841 S. Maryland Avenue MC 2026, Chicago, IL, 60637, USA.
authors.forename: Aytekin
authors.initials: A
authors.lastname: Oto
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
keywords: Anterior fibromuscular stroma; Anterior prostate; Prostate MRI; Prostate cancer