1. Usefulness of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging in the diagnosis of prostate transition-zone cancer
- Author
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Mikio Igawa, Akihiko Wada, Koji Uchida, Takeshi Yoshizako, Masahiro Sumura, Nobue Uchida, Takafumi Hayashi, and Hajime Kitagaki
- Subjects
Gadolinium DTPA ,Male ,medicine.medical_treatment ,Contrast Media ,Adenocarcinoma ,Sensitivity and Specificity ,Prostate cancer ,Imaging, Three-Dimensional ,Predictive Value of Tests ,Prostate ,medicine ,Humans ,Effective diffusion coefficient ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Aged, 80 and over ,Observer Variation ,Prostatectomy ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Prostatic Neoplasms ,Reproducibility of Results ,Cancer ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,Diffusion Magnetic Resonance Imaging ,medicine.anatomical_structure ,Prostate surgery ,business ,Nuclear medicine ,Diffusion MRI - Abstract
Background: Conventional T2-weighted (T2-WI) magnetic resonance imaging (MRI) has poor sensitivity for prostate transition-zone (TZ) cancer detection. Purpose: To retrospectively evaluate the clinical value of diffusion-weighted MRI (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI) in combination with T2-WI for the diagnosis of TZ cancer. Material and Methods: Twenty-six TZ cancers in 23 patients with at least one tumor (tumor size >10 mm) located predominantly in the TZ were included in the study. Sixteen peripheral-zone (PZ) cancers in 12 patients with PZ cancer but without TZ cancer (control group) were selected by step-section pathologic maps. All patients underwent MRI and radical prostatectomy. MRI was obtained by a 1.5T superconducting system with a phased-array coil. Imaging sequences were T2-WI with fat saturation (FST2-WI), DW-MRI (single-shot echoplanar image, b=0 and 1000 s/mm2, apparent diffusion coefficient [ADC] map findings), and DCE-MRI (3D fast spoiled gradient recalled [SPGR], contrast medium [0.2 mmol/kg], total injection time 5 s, image acquisition 30, 60, and 90 s). Sensitivity, specificity, accuracy, and positive predictive value (PPV) for the diagnosis of TZ cancer were evaluated in four protocols: A) FST2-WI alone, B) FST2-WI plus DW-MRI, C) FST2-WI plus DCE-MRI, D) FST2-WI plus DW-MRI plus DCE-MRI. Results: Sensitivity, specificity, accuracy, and PPV in protocol A (FST2-WI alone) were 61.5%, 68.8%, 64.3%, and 76.2%, respectively. FST2-WI plus DW-MRI (protocol B) improved the sensitivity, specificity, accuracy, and PPV. In FST2-WI plus DW-MRI plus DCE-MRI (protocol D), the number of true-negative lesions increased and false-positive lesions decreased, and the sensitivity, specificity, accuracy, and PPV were 69.2%, 93.8%, 78.6%, and 94.7%, respectively. There was a significant difference between protocols A and D ( P Conclusion: Adding DW-MRI to FST2-WI in the diagnosis of prostate TZ cancer increased the diagnostic accuracy. The addition of DCE-MRI may be an option to improve the specificity and PPV of diagnosing TZ cancer with FST2-WI and DW-MRI.
- Published
- 2008
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