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

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), rate constant (k), extracellular extravascular space (EES) volume fraction (v), plasma volume fraction (v) 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 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 mm) and non-CSC (84.99±85.82 mm) (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.