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KMID : 1037120200380030370
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The World Journal of Men′s Health
2020 Volume.38 No. 3 p.370 ~ p.376
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Usefulness of Bi-Parametric Magnetic Resonance Imaging with b=1,800 s/mm2 Diffusion-Weighted Imaging for Diagnosing Clinically Significant Prostate Cancer
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Lee Seung-Soo
Lee Dong-Hoon
Song Won-Hoon
Nam Jong-Kil
Han Ji-Yeon
Lee Hyun-Jung
Kim Tae-Un
Park Sung-Woo
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Abstract
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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.
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KEYWORD
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Diagnostic imaging, Image-guided biopsy, Magnetic resonance imaging, Prostatic neoplasms
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