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Open Access Highly Accessed Research article

Evaluation of the normal-to-diseased apparent diffusion coefficient ratio as an indicator of prostate cancer aggressiveness

Andrei Lebovici1, Silviu A Sfrangeu1, Diana Feier1*, Cosmin Caraiani2, Ciprian Lucan3, Mihai Suciu3, Florin Elec3, Gheorghita Iacob4 and Mircea Buruian5

Author Affiliations

1 Radiology Department, Emergency County Hospital, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

2 Department of Imaging, Regional Institute of Gastroenterology and Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

3 Department of Urology, Clinical Institute of Urology and Kidney Transplant, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

4 Department of Pathology, Clinical Institute of Urology and Kidney Transplant, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

5 Department of Radiology, County Emergency Hospital Mures, University of Medicine and Pharmacy, Targu-Mures, Romania

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BMC Medical Imaging 2014, 14:15  doi:10.1186/1471-2342-14-15

Published: 10 May 2014

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.

Keywords:
Prostate cancer; Diffusion-weighted magnetic resonance imaging; Neoplasm grading