Assessment of Prostate Cancer Aggressiveness Using Dynamic Contrast-enhanced Magnetic Resonance Imaging at 3 T

• Published in: European urology Vol. 64; no. 3; pp. 448 - 455
• Main Authors: Vos, Eline K., Litjens, Geert J.S., Kobus, Thiele, Hambrock, Thomas, Kaa, Christina A. Hulsbergen-van de, Barentsz, Jelle O., Huisman, Henkjan J., Scheenen, Tom W.J.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.09.2013; Elsevier
• Subjects: Area Under Curve; Biological and medical sciences; Contrast Media - pharmacokinetics; Dynamic contrast-enhanced MRI; Gynecology. Andrology. Obstetrics; Humans; Magnetic Resonance Imaging; Male; Male genital diseases; Medical sciences; Meglumine - pharmacokinetics; Neoplasm Grading; Nephrology. Urinary tract diseases; Organometallic Compounds - pharmacokinetics; Pharmacokinetic modeling; Predictive Value of Tests; Prognosis; Prostate cancer; Prostate cancer aggressiveness; Prostatectomy; Prostatic Neoplasms - metabolism; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Reproducibility of Results; Retrospective Studies; ROC Curve; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; Validation study; Dynamic contrast-enhanced MRI; Pharmacokinetic modeling; Prostate cancer; Prostate cancer aggressiveness; Validation study; Validation; Nephrology; Urinary system disease; Prostate disease; Malignancy; Malignant tumor; Nuclear magnetic resonance imaging; Modeling; Urology; Dynamics; Medical imagery; Pharmacokinetics; Male genital diseases; Cancer; Aggressiveness
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2013.05.045

A challenge in the diagnosis of prostate cancer (PCa) is the accurate assessment of aggressiveness. To validate the performance of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate at 3 tesla (T) for the assessment of PCa aggressiveness, with prostatectomy specimens as the reference standard. A total of 45 patients with PCa scheduled for prostatectomy were included. This study was approved by the institutional review board; the need for informed consent was waived. Subjects underwent a clinical MRI protocol including DCE-MRI. Blinded to DCE-images, PCa was indicated on T2-weighted images based on histopathology results from prostatectomy specimens with the use of anatomical landmarks for the precise localization of the tumor. PCa was classified as low-, intermediate-, or high-grade, according to Gleason score. DCE-images were used as an overlay on T2-weighted images; mean and quartile values from semi-quantitative and pharmacokinetic model parameters were extracted per tumor region. Statistical analysis included Spearman's ρ, the Kruskal-Wallis test, and a receiver operating characteristics (ROC) analysis. Significant differences were seen for the mean and 75th percentile (p75) values of wash-in (p = 0.024 and p = 0.017, respectively), mean wash-out (p = 0.044), and p75 of transfer constant (Ktrans) (p = 0.035), all between low-grade and high-grade PCa in the peripheral zone. ROC analysis revealed the best discriminating performance between low-grade versus intermediate-grade plus high-grade PCa in the peripheral zone for p75 of wash-in, Ktrans, and rate constant (Kep) (area under the curve: 0.72). Due to a limited number of tumors in the transition zone, a definitive conclusion for this region of the prostate could not be drawn. Quantitative parameters (Ktrans and Kep) and semi-quantitative parameters (wash-in and wash-out) derived from DCE-MRI at 3 T have the potential to assess the aggressiveness of PCa in the peripheral zone. P75 of wash-in, Ktrans, and Kep offer the best possibility to discriminate low-grade from intermediate-grade plus high-grade PCa. Quantitative (transfer constant and rate constant) and semi-quantitative (wash-in and wash-out) parameters derived from dynamic contrast-enhanced magnetic resonance imaging have the potential to assess prostate cancer aggressiveness in the peripheral zone. These results are promising for selecting patients for active surveillance and thus preventing overtreatment.