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Effects of dynamic contrast enhancement on transition zone prostate cancer in Prostate Imaging Reporting and Data System Version 2.1

Jiahui Zhang
Jiahui Zhang
, 
Lili Xu
Lili Xu
, 
Gumuyang Zhang
Gumuyang Zhang
, 
Xiaoxiao Zhang
Xiaoxiao Zhang
, 
Xin Bai
Xin Bai
, 
Hao Sun
Hao Sun
 et 
Zhengyu Jin
Zhengyu Jin
   | 20 janv. 2023
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Article Category: Research Article
Publié en ligne: 20 janv. 2023
Pages: 42 - 50
Reçu: 09 oct. 2022
Accepté: 18 nov. 2022
DOI: https://doi.org/10.2478/raon-2023-0007
© 2023 Jiahui Zhang, Lili Xu, Gumuyang Zhang, Xiaoxiao Zhang, Xin Bai, Hao Sun, Zhengyu Jin, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Flowchart showing the patient recruitment process.
Flowchart showing the patient recruitment process.

Figure 2

Images from a 62-year-old male patient with a total prostate-specific antigen (PSA) of 7.66 ng/mL. (A) Axial T2-weighted imaging (T2WI) showed focal hypointensity on the right lobe of the prostate in the transitional zone with a blurred margin and a T2WI score of 3. (B) Diffusion-weighted imaging (DWI) showed a slight increase in lesion signal. (C) Reduced corresponding apparent diffusion coefficient (ADC) value with a score of 3. (D) dynamic contrast-enhancement (DCE) showed obvious enhancement in the early stage of the lesion, thus indicating that the DCE score was positive. Scores were 3, 4, and 4 based on T2WI + DWI, T2WI + DCE, and T2WI + DWI + DCE, respectively. The lesion was confirmed to be clinically significant transitional-zone prostate cancer (cs-tzPCa) based on biopsy (Gleason score of 5 + 4).
Images from a 62-year-old male patient with a total prostate-specific antigen (PSA) of 7.66 ng/mL. (A) Axial T2-weighted imaging (T2WI) showed focal hypointensity on the right lobe of the prostate in the transitional zone with a blurred margin and a T2WI score of 3. (B) Diffusion-weighted imaging (DWI) showed a slight increase in lesion signal. (C) Reduced corresponding apparent diffusion coefficient (ADC) value with a score of 3. (D) dynamic contrast-enhancement (DCE) showed obvious enhancement in the early stage of the lesion, thus indicating that the DCE score was positive. Scores were 3, 4, and 4 based on T2WI + DWI, T2WI + DCE, and T2WI + DWI + DCE, respectively. The lesion was confirmed to be clinically significant transitional-zone prostate cancer (cs-tzPCa) based on biopsy (Gleason score of 5 + 4).

Figure 3

Histograms showing cancer detection rates of tzPCa based on the T2-weighted imaging (T2WI) + diffusion-weighted imaging (DWI), T2WI + dynamic contrast-enhancement (DCE), and T2WI + DWI + DCE.
Histograms showing cancer detection rates of tzPCa based on the T2-weighted imaging (T2WI) + diffusion-weighted imaging (DWI), T2WI + dynamic contrast-enhancement (DCE), and T2WI + DWI + DCE.

Figure 4

Histograms showing cancer detection rates of cs-tzPCa based on the T2-weighted imaging (T2WI) + diffusion-weighted imaging (DWI), T2WI + dynamic contrast-enhancement (DCE), and T2WI + DWI + DCE.
Histograms showing cancer detection rates of cs-tzPCa based on the T2-weighted imaging (T2WI) + diffusion-weighted imaging (DWI), T2WI + dynamic contrast-enhancement (DCE), and T2WI + DWI + DCE.

Sequence parameters for prostate MRI

Parameters T2WI DWI DCE
Sequence FRFSE SE-EPI 3D-GRE
TR/TE (ms) 4137/86 4200/90 4.3/1.3
Flip angle 110° 90° 12°
Echo train length 32 1 N/A
FOV (mm × mm) 270 × 270 360 × 360 400 × 400
Matrix size 288 × 192 128 × 96 320 × 192
Slice thickness (mm) 3.0 3.0 3.0
Other b values = 0, 50, 100, 150, 200, 500, 800, 1000, 1500, 2000 sec/mm2 Temporal resolution > 10s, total scan time of 5 min

Comparison of diagnostic efficacy of three sequence combinations in tzPCa

tzPCa (n =203) Non-tzPCa (n=222) Sensitivity (%) Specificity (%) PPV (%) NPV(%) Accuracy (%) AUC (95% CI)
T2WI + DWI ≥ 4 (n=191) > 4 (n=234) 161 42 30 192 79.3 86.5 84.3 82.1 83.1 0.863 (0.827–0.894)
T2WI + DCE ≥ 4 (n=243) > 4 (n=182) 172 31 71 151 84.7 68.0 70.8 83.0 76.0 0.868 (0.832 + 0.899)
T2WI + DWI + DCE ≥ 4 (n=244) > 4 (n=181) 174 29 70 152 85.7 68.5 71.3 84.0 76.7 0.863 (0.827 + 0.895)
aP 0.001 > 0.001 NA NA 0.002 0.424
bP > 0.001 > 0.001 NA NA > 0.001 0.968
cP 0.500 1.000 NA NA 0.250 0.369

Comparison of diagnostic efficacy of three sequence combinations in cs-tzPCa

cs-tzPCa (n=146) Free cs-tzPCa (n=279) Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%) AUC (95%CI)
T2WI + DWI ≥ 4 (n=191) > 4 (n=234) 121 25 70 209 82.9 74.9 63.4 89.3 77.6 0.840 (0.802–0.874)
T2WI + DCE ≥ 4 (n=243) > 4 (n=182) 129 17 114 165 88.4 59.1 53.1 90.7 69.2 0.833 (0.795–0.868)
T2WI + DWI + DCE ≥ 4 (n=244) > 4 (n=181) 131 15 113 166 89.7 59.5 53.7 91.7 69.9 0.824 (0.785–0.869)
aP 0.008 > 0.001 NA NA > 0.001 0.430
bP 0.002 > 0.001 NA NA > 0.001 0.101
cP 0.500 1.000 NA NA 0.250 0.193

Scoring criteria of transition zone prostate for three sequence combinations

Scoring Criteria
T2WI DWI DCE T2WI + DWI T2WI + DCE T2WI + DWI + DCE
1 1~5 − 1 1 1
1 1~5 + 1 2 2
2 1~3 − 2 2 2
2 1~3 + 2 3 3
2 4~5 − 3 2 3
2 4~5 + 3 3 4
3 1~4 − 3 3 3
3 1~4 + 3 4 4
3 5 − 4 3 4
3 5 + 4 4 5
4 1~5 − 4 4 4
4 1~5 + 4 5 5
5 1~5 − 5 5 5
5 1~5 + 5 5 5

Clinicopathological data of patients included in this study

Clinicopathological data Patients
Age (year), Mean ± SD 66 ± 9.0
T-PSA (ng/ml), Median (Upper and lower quartiles) 9.4 (6.3 + 15.4)
tzPCa, n (%) 203 (48%)
Non-tzPCa, n (%) 222 (52%)
cs-tzPCa, n (%) 146 (34%)
Free cs-tzPCa, n (%) 279 (66%)
Tumor size (mm), Median (Upper and lower quartiles) 12.7 (9.1 + 22.5)
GS, n (%)
3 + 3 57 (28%)
3 + 4 56 (28%)
4 + 3 24 (12%)
3 + 5 3 (1.5%)
4 + 4 18 (8.9%)
4 + 5 28 (13.8%)
5 + 3 1 (0.5%)
5 + 4 13 (6.4%)
5 + 5 3 (1.5%)
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