Andrew B Rosenkrantz1, Nainesh Parikh2, Andrea S Kierans2, Max Xiangtian Kong3, James S Babb2, Samir S Taneja4, Justin M Ream2. 1. Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016. Electronic address: Andrew.Rosenkrantz@nyumc.org. 2. Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016. 3. Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York. 4. Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York.
Abstract
RATIONALE AND OBJECTIVES: The aim of this study was to assess prostate cancer detection using a broad range of computed b-values up to 5000 s/mm(2). MATERIALS AND METHODS: This retrospective Health Insurance Portability and Accountability Act-compliant study was approved by an institutional review board with consent waiver. Forty-nine patients (63 ± 8 years) underwent 3T prostate magnetic resonance imaging before prostatectomy. Examinations included diffusion-weighted imaging (DWI) with b-values of 50 and 1000 s/mm(2). Seven computed DWI image sets (b-values: 1000, 1500, 2000, 2500, 3000, 4000, and 5000 s/mm(2)) were generated by mono-exponential fit. Two blinded radiologists (R1 [attending], R2 [fellow]) independently evaluated diffusion weighted image sets for image quality and dominant lesion location. A separate unblinded radiologist placed regions of interest to measure tumor-to-peripheral zone (PZ) contrast. Pathologic findings from prostatectomy served as reference standard. Measures were compared between b-values using the Jonckheere-Terpstra trend test, Spearman correlation coefficient, and generalized estimating equations based on logistic regression for correlated data. RESULTS: As b-value increased, tumor-to-PZ contrast and benign prostate suppression for both readers increased (r = +0.65 to +0.71, P ≤ 0.001), whereas anatomic clarity, visualization of the capsule, and visualization of peripheral-transition zone edge decreased (r = -0.69 to -0.75, P ≤ 0.003). Sensitivity for tumor was highest for R1 at b1500-3000 (84%-88%) and for R2 at b1500-2500 (70%-76%). Sensitivities for both pathologic outcomes were lower for both readers at both b1000 and the highest computed b-values. Sensitivity for Gleason >6 tumor was highest for R1 at b1500-3000 (90%-93%) and for R2 at 1500-2500 (78%-80%). The positive predictive value for tumor for R1 was similar from b1000 to 4000 (93%-98%) and for R2 was similar from b1500 to 4000 (88%-94%). CONCLUSIONS: Computed b-values in the range of 1500-2500 s/mm(2) (but not higher) were optimal for prostate cancer detection; b-values of 1000 or 3000-5000 exhibited overall lower performance.
RATIONALE AND OBJECTIVES: The aim of this study was to assess prostate cancer detection using a broad range of computed b-values up to 5000 s/mm(2). MATERIALS AND METHODS: This retrospective Health Insurance Portability and Accountability Act-compliant study was approved by an institutional review board with consent waiver. Forty-nine patients (63 ± 8 years) underwent 3T prostate magnetic resonance imaging before prostatectomy. Examinations included diffusion-weighted imaging (DWI) with b-values of 50 and 1000 s/mm(2). Seven computed DWI image sets (b-values: 1000, 1500, 2000, 2500, 3000, 4000, and 5000 s/mm(2)) were generated by mono-exponential fit. Two blinded radiologists (R1 [attending], R2 [fellow]) independently evaluated diffusion weighted image sets for image quality and dominant lesion location. A separate unblinded radiologist placed regions of interest to measure tumor-to-peripheral zone (PZ) contrast. Pathologic findings from prostatectomy served as reference standard. Measures were compared between b-values using the Jonckheere-Terpstra trend test, Spearman correlation coefficient, and generalized estimating equations based on logistic regression for correlated data. RESULTS: As b-value increased, tumor-to-PZ contrast and benign prostate suppression for both readers increased (r = +0.65 to +0.71, P ≤ 0.001), whereas anatomic clarity, visualization of the capsule, and visualization of peripheral-transition zone edge decreased (r = -0.69 to -0.75, P ≤ 0.003). Sensitivity for tumor was highest for R1 at b1500-3000 (84%-88%) and for R2 at b1500-2500 (70%-76%). Sensitivities for both pathologic outcomes were lower for both readers at both b1000 and the highest computed b-values. Sensitivity for Gleason >6 tumor was highest for R1 at b1500-3000 (90%-93%) and for R2 at 1500-2500 (78%-80%). The positive predictive value for tumor for R1 was similar from b1000 to 4000 (93%-98%) and for R2 was similar from b1500 to 4000 (88%-94%). CONCLUSIONS: Computed b-values in the range of 1500-2500 s/mm(2) (but not higher) were optimal for prostate cancer detection; b-values of 1000 or 3000-5000 exhibited overall lower performance.
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