Diagnostic evaluation of magnetization transfer and diffusion kurtosis imaging for prostate cancer detection in a re-biopsy population

• Published in: European radiology Vol. 28; no. 8; pp. 3141 - 3150
• Main Authors: Barrett, Tristan, McLean, Mary, Priest, Andrew N., Lawrence, Edward M., Patterson, Andrew J., Koo, Brendan C., Patterson, Ilse, Warren, Anne Y., Doble, Andrew, Gnanapragasam, Vincent J., Kastner, Christof, Gallagher, Ferdia A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2018; Springer Nature B.V
• Subjects: Aged; Benign; Biopsy; Cancer; Diagnostic Radiology; Diagnostic systems; Diffusion; Diffusion coefficient; Diffusion Magnetic Resonance Imaging - methods; Diffusion Tensor Imaging - methods; Humans; Image Interpretation, Computer-Assisted - methods; Image-Guided Biopsy - methods; Imaging; Internal Medicine; Interventional Radiology; Kurtosis; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Magnetization; Male; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Prospective Studies; Prostate cancer; Prostatic Neoplasms - pathology; Quality; Radiology; Retreatment; ROC Curve; Tumors; Ultrasound; Urogenital; Diffusion-weighted imaging; Magnetisation transfer imaging; MRI; Prostate; Diffusion kurtosis imaging
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-5169-1

Objective To evaluate diffusion kurtosis imaging (DKI) and magnetisation transfer imaging (MTI) compared to standard MRI for prostate cancer assessment in a re-biopsy population. Methods Thirty-patients were imaged at 3 T including DKI (K app and D app ) with b-values 150/450/800/1150/1500 s/mm 2 and MTI performed with and without MT saturation. Patients underwent transperineal biopsy based on prospectively defined MRI targets. Receiver-operating characteristic (ROC) analyses assessed the parameters and Wilcoxon-signed ranked test assessed relationships between metrics. Results Twenty patients had ≥ 1 core positive for cancer in a total of 26 MRI targets (Gleason 3+3 in 8, 3+4 in 12, ≥ 4+3 in 6): 13 peripheral (PZ) and 13 transition zone (TZ). The apparent diffusion coefficient (ADC) and D app were significantly lower and the K app and MT ratio (MTR) significantly higher in tumour versus benign tissue (all p ≤ 0.005); ROC values 0.767-1.000. Normal TZ had: lower ADC and D app and higher K app and MTR compared to normal PZ. MTR showed a moderate correlation to K app ( r = 0.570) and D app ( r = -0.537) in normal tissue but a poor correlation in tumours. No parameter separated low-grade (Gleason 3+3) from high-grade (≥ 3+4) disease for either PZ ( p = 0.414-0.825) or TZ ( p = 0.148-0.825). Conclusion ADC, D app , K app and MTR all distinguished benign tissue from tumour, but none reliably differentiated low- from high-grade disease. Key Points • MTR was significantly higher in PZ and TZ tumours versus normal tissue • K app was significantly lower and D app higher for PZ and TZ tumours • There was no incremental value for DKI/MTI over mono-exponential ADC parameters • No parameter could consistently differentiate low-grade (Gleason 3+3) from high-grade (≥ 3+4) disease • Divergent MTR/DKI values in TZ tumours suggests they offer different functional information