World J Mens Health.  2020 Jul;38(3):370-376. 10.5534/wjmh.190079.

Usefulness of Bi-Parametric Magnetic Resonance Imaging with b=1,800 s/mm2 Diffusion-Weighted Imaging for Diagnosing Clinically Significant Prostate Cancer

Affiliations
  • 1Departments of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 2Departments of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 3Departments of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 4Departments of Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Abstract

Purpose
This study was conducted to compare the accuracy of bi-parametric magnetic resonance imaging (bpMRI) with high b-value (b=1,000 s/mm2, b1000) diffusion-weighted imaging (DWI) to that of bpMRI with ultra-high b-value (b=1,800 s/mm2, b1800) DWI to detect clinically significant prostate cancer (csPCa).
Materials and Methods
A total of 408 patients with suspected PCa were evaluated by bpMRI prior to biopsy. One reader retrospectively reviewed all images for confirmation of Prostate Imaging–Reporting and Data System (PI-RADS) score. Cognitive magnetic resonance/ultrasound fusion target biopsy was done for all visible lesions (PI-RADS 3–5). Systematic biopsy was done for all cases. The csPCa detection rates were compared according to the bpMRI protocol (with/without b1800 DWI) or PI-RADS score. The accuracy of PI-RADS score was estimated using receiver operating characteristics curve. The signal intensity (SI) ratio (visible lesion/surrounding background) was evaluated.
Results
Among 164 men confirmed having PCa, 102 had csPCa (Gleason score≥7). Proportions of PI-RADS score 1–2/3/4/5 without b1800 DWI (n=133) and with b1800 DWI (n=275) were 19.5%/57.9%/15.8%/6.8% and 21.1%/48.7%/22.2%/8.0%, respectively. csPCa detection rates with/without b1800 DWI were 27.6%/19.5% (p=0.048), respectively. Areas under the curve of PI-RADS grading with/without b1800 DWI for csPCa detection were 0.885 and 0.705, respectively. The SI ratio in b1800 DWI was higher than that in b1000 DWI (p<0.001).
Conclusions
Adding b1800 DWI to bpMRI protocol improved the diagnostic accuracy and detection rate of csPCa. The higher SI ratio (lesion/background) in b1800 DWI enabled clearer identification of lesions.

Keyword

Diagnostic imaging; Image-guided biopsy; Magnetic resonance imaging; Prostatic neoplasms
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