Dynamic contrast-enhanced magnetic resonance imaging for risk stratification in patients with prostate cancer

Hyungin Park; Seung Ho Kim; Joo Yeon Kim

doi:10.21037/qims-21-455

Dynamic contrast-enhanced magnetic resonance imaging for risk stratification in patients with prostate cancer

Quant Imaging Med Surg. 2022 Jan;12(1):742-751. doi: 10.21037/qims-21-455.

Authors

Hyungin Park¹, Seung Ho Kim¹, Joo Yeon Kim²

Affiliations

¹ Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-gu, Busan, Korea.
² Department of Pathology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-gu, Busan, Korea.

Abstract

Background: To investigate the usefulness of perfusion parameters derived from dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) of patients diagnosed as prostate cancer (PCa) in differentiating clinically significant cancer [CSC, Gleason score (GS) ≥7] from non-CSC (GS 6).

Methods: A total of 94 patients diagnosed between August 2018 and September 2020 as PCa by radical prostatectomy were included in this retrospective study (mean age: 68.7 years, range, 47-83 years). All of the patients had undergone DCE-MRI on a single 3T-MR scanner. Whole-tumor volume was measured by reviewing a pathologic topographic map as a reference standard. The quantitative DCE perfusion parameters, including volume transfer constant (K^trans), rate constant (k_ep), extracellular extravascular space (EES) volume fraction (v_e), plasma volume fraction (v_p) and area of region of interest (ROI) were calculated under an extended Tofts model. A receiver operating characteristic (ROC) curve analysis by pair-wise comparison was performed to compare the diagnostic performances of the perfusion parameters.

Results: The study population comprised GS 6 (n=17), GS 7 (n=57), GS 8 (n=9) and GS 9 (n=11) cases. Among the perfusion parameters, v_e differed significantly between CSC (0.238±0.095) and non-CSC (0.300±0.126) (P=0.0308). Area under the curve (AUC) was 0.643 (95% CI, 0.538-0.739), and a maximum accuracy of 64%, a sensitivity of 66%, and a specificity of 53% were estimated. Area of ROI also differed significantly between CSC (201.89±163.87 mm²) and non-CSC (84.99±85.82 mm²) (P=0.0054). AUC was 0.807 (95% CI, 0.713-0.881), and maximum accuracy, sensitivity, and specificity were 81%, 82%, and 76%, respectively.

Conclusions: Size of the tumor and interstitial space volume fraction are significant parameters in differentiating aggressiveness in PCa.

Keywords: Gleason score (GS); Perfusion; dynamic contrast-enhanced (DCE); magnetic resonance imaging (MRI); prostate cancer (PCa).