Korean J Radiol.  2013 Apr;14(2):222-232. 10.3348/kjr.2013.14.2.222.

Biexponential Apparent Diffusion Coefficients Values in the Prostate: Comparison among Normal Tissue, Prostate Cancer, Benign Prostatic Hyperplasia and Prostatitis

• Liu X
• Peng W
• Zhou L
• Wang H

• KMID: 1482781
• DOI: http://doi.org/10.3348/kjr.2013.14.2.222

Abstract

OBJECTIVE
To investigate the biexponential apparent diffusion parameters of diverse prostate tissues and compare them with monoexponential apparent diffusion coefficient (ADC) value in the efficacy to discriminate prostate cancer from benign lesions.
MATERIALS AND METHODS
Eleven healthy volunteers and 61 patients underwent a conventional (b-factors 0, 1000 s/mm2) and a 10 b-factor (0 to 3000 s/mm2) diffusion-weighted imaging (DWI). The monoexponential ADC value and biexponential parameters of fast ADC (ADCf), fraction of ADCf (f), slow ADC (ADCs) value for 29 prostate cancer, 28 benign prostatic hyperplasia (BPH), 24 prostatitis lesions and normal tissue were calculated and compared. Receiver operating characteristic analysis was performed to determine the sensitivity, specificity and optimal cut-off points.
RESULTS
Prostate cancer had lower ADC, ADCf, f, and ADCs than all other tissues (p < 0.01). Prostatitis exhibited a lower ADC, ADCf, ADCs and f than the peripheral zone tissue (p < 0.01), and BPH showed a lower ADC and ADCf than the central gland tissue (p < 0.01). The ADCf demonstrated a comparable accuracy with ADC in differentiating cancer from BPH [area under the curve (AUC) 0.93 vs. 0.92] and prostatitis AUC 0.98 vs. 0.99) (both p > 0.05), but the AUC of f and ADCs in differentiating cancer from BPH (0.73 and 0.81) and prostatitis (0.88 and 0.91) were significantly lower than ADC (all p < 0.05).
CONCLUSION
The biexponential DWI appears to provide additional parameters for tissue characterization in prostate, and ADCf helps to yield comparable accuracy with ADC in differentiating cancer from benign lesions.

Keyword

Magnetic resonance imaging; Diffusion weighted imaging; Prostate; Biexponential decay

MeSH Terms

Adult
Aged
Aged, 80 and over
Analysis of Variance
Biopsy
Diagnosis, Differential
*Diffusion Magnetic Resonance Imaging
Humans
Male
Middle Aged
Prospective Studies
Prostate-Specific Antigen/blood
Prostatectomy
Prostatic Hyperplasia/*diagnosis
Prostatic Neoplasms/*diagnosis/surgery
Prostatitis/*diagnosis
ROC Curve
Sensitivity and Specificity
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Signal of prostate cancer and normal tissue on DWI images at different b values and corresponding mono- and biexponential parameter maps. A. Prostate cancer (Gleason score 4 + 4 = 8) involving right PZ and right CG (arrow) on T2-weighted image. B. Example ROIs on b = 0 s/mm2 image for cancer (right), CG (middle), PZ tissue (left) and noise (posterior) from one cancer patient. C. Corresponding semi-log plots show typical signal decay vs. b-factor for PZ, CG and cancer. Signal of both PZ and CG tissue decline rapidly at b values from 0-2400 s/mm2, and relatively slower at higher values, while signal from cancerous tissue decreases in more linear fashion. PZ = peripheral zone, CG = central gland, ROI = regions of interest D-G. In ADCf, f, ADCs and ADC value maps with T2-weighted image as background, cancer tissue was notably different from normal tissue. ADCf, f ADCs, ADC values of cancer (1.78 × 10-3 mm2/s, 45.4%, 0.41 × 10-3 mm2/s, 0.68 × 10-3 mm2/s) calculated from ROIs were lower than PZ (3.65 × 10-3 mm2/s, 60.2%, 1.71 × 10-3 mm2/s, 1.53 × 10-3 mm2/s) and CG (3.5 × 10-3 mm2/s, 51.9%, 0.63 × 10-3 mm2/s, 1.30 × 10-3 mm2/s). ADC = apparent diffusion coefficient, PZ = peripheral zone, CG = central gland, ROI = regions of interest

• 

  Fig. 2 Signal of prostate BPH and normal tissue on DWI images at different b values and corresponding mono- and biexponential parameter maps. A. Prostate glandular BPH in right CG (arrow) on T2-weighted image. B, C. Example ROIs on b = 0 s/mm2 image for BPH (right), normal CG (middle), PZ tissue (left) and noise (posterior) from same patient, and corresponding semi-log plots show typical signal decay vs. b-factor for BPH and normal tissue. Three tissues showed similar tendency of signal decay, although decay of BPH was slightly slower than normal tissue. D-G. ADCf, f ADCs and ADC maps with T2-weighted image as background. ADCf, f, ADCs and ADC values of BPH (2.51 × 10-3 mm2/s, 54.4%, 0.84 × 10-3 mm2/s, 0.97 × 10-3 mm2/s) calculated from ROIs were lower than PZ (3.63 × 10-3 mm2/s, 78.2%, 1.17 × 10-3 mm2/s, 2.03 × 10-3 mm2/s) and CG (4.09 × 10-3 mm2/s, 59%, 1.36 × 10-3 mm2/s, 1.44 × 10-3 mm2/s). ADC = apparent diffusion coefficient, PZ = peripheral zone, CG = central gland, ROI = regions of interest, BPH = benign prostatic hyperplasia

• 

  Fig. 3 Box graph of ADCf, f and ADCs value for prostate cancer, BPH, prostatitis and normal tissue. Means of ADCf (A), f (B) and ADCs (C) for different tissues. Note significant differences between cancer and other tissues in all value (*). (◆) means extremum value of the data. Prostatitis showed lower ADCf, ADCs and smaller f than PZ, while BPH exhibited lower ADCf, but similar ADCs and f compared with CG. ADC = apparent diffusion coefficient, PZ = peripheral zone, CG = central gland

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