Michael Meier-Schroers1, Guido Kukuk2, Karsten Wolter3, Georges Decker4, Stefan Fischer5, Christian Marx6, Frank Traeber7, Alois Martin Sprinkart8, Wolfgang Block9, Hans Heinz Schild10, Winfried Willinek11. 1. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: michael.meier@ukb.uni-bonn.de. 2. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: guido.kukuk@ukb.uni-bonn.de. 3. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: karsten.wolter@ukb.uni-bonn.de. 4. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: georges.decker@ukb.uni-bonn.de. 5. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: stefan.fischer@ukb.uni-bonn.de. 6. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: christian.marx@ukb.uni-bonn.de. 7. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: frank.traeber@ukb.uni-bonn.de. 8. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: sprinkart@uni-bonn.de. 9. Department of Radiology, University of Bonn, Sigmund-Freud-Str 25, 53127 Bonn, Germany. 10. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: hans.schild@ukb.uni-bonn.de. 11. Department of Radiology, Neuroradiology, Sonography and Nuclear Medicine, Hospital of the Barmherzige Brüder Trier, Nordallee 1, 54292 Trier, Germany. Electronic address: w.willinek@bk-trier.de.
Abstract
PURPOSE: To determine if prostate cancer (PCa) and prostatitis can be differentiated by using PI-RADS. MATERIALS AND METHODS: 3T MR images of 68 patients with 85 cancer suspicious lesions were analyzed. The findings were correlated with histopathology. T2w imaging (T2WI), diffusion weighted imaging (DWI), dynamic contrast enhancement (DCE), and MR-Spectroscopy (MRS) were acquired. Every lesion was given a single PI-RADS score for each parameter, as well as a sum score and a PI-RADS v2 score. Furthermore, T2-morphology, ADC-value, perfusion type, citrate/choline-level, and localization were evaluated. RESULTS: 44 of 85 lesions showed PCa (51.8%), 21 chronic prostatitis (24.7%), and 20 other benign tissue such as hyperplasia or fibromuscular tissue (23.5%). The single PI-RADS score for T2WI, DWI, DCE, as well as the aggregated score including and not including MRS, and the PI-RADS v2-score were all significantly higher for PCa than for prostatitis or other tissue (p<0.001). The single PI-RADS score for MRS and the PI-RADS sum score including MRS were significantly higher for prostatitis than for other tissue (p=0.029 and p=0.020), whereas the other parameters were not different. Prostatitis usually presented borderline pathological PI-RADS scores, showed restricted diffusion with ADC≥900mm(2)/s in 100% of cases, was more often indistinctly hypointense on T2WI (66.7%), and localized in the transitional zone (57.1%). An ADC≥900mm(2)/s achieved the highest predictive value for prostatitis (AUC=0.859). CONCLUSION: Prostatitis can be differentiated from PCa using PI-RADS, since all available parameters are more distinct in cases of cancer. However, there is significant overlap between prostatitis and other benign findings, thus PI-RADS is only suitable to a limited extent for the primary assessment of prostatitis. Restricted diffusion with ADC≥900mm(2)/s is believed to be a good indicator for prostatitis. MRS can help to distinguish between prostatitis and other tissue.
PURPOSE: To determine if prostate cancer (PCa) and prostatitis can be differentiated by using PI-RADS. MATERIALS AND METHODS: 3T MR images of 68 patients with 85 cancer suspicious lesions were analyzed. The findings were correlated with histopathology. T2w imaging (T2WI), diffusion weighted imaging (DWI), dynamic contrast enhancement (DCE), and MR-Spectroscopy (MRS) were acquired. Every lesion was given a single PI-RADS score for each parameter, as well as a sum score and a PI-RADS v2 score. Furthermore, T2-morphology, ADC-value, perfusion type, citrate/choline-level, and localization were evaluated. RESULTS: 44 of 85 lesions showed PCa (51.8%), 21 chronic prostatitis (24.7%), and 20 other benign tissue such as hyperplasia or fibromuscular tissue (23.5%). The single PI-RADS score for T2WI, DWI, DCE, as well as the aggregated score including and not including MRS, and the PI-RADS v2-score were all significantly higher for PCa than for prostatitis or other tissue (p<0.001). The single PI-RADS score for MRS and the PI-RADS sum score including MRS were significantly higher for prostatitis than for other tissue (p=0.029 and p=0.020), whereas the other parameters were not different. Prostatitis usually presented borderline pathological PI-RADS scores, showed restricted diffusion with ADC≥900mm(2)/s in 100% of cases, was more often indistinctly hypointense on T2WI (66.7%), and localized in the transitional zone (57.1%). An ADC≥900mm(2)/s achieved the highest predictive value for prostatitis (AUC=0.859). CONCLUSION:Prostatitis can be differentiated from PCa using PI-RADS, since all available parameters are more distinct in cases of cancer. However, there is significant overlap between prostatitis and other benign findings, thus PI-RADS is only suitable to a limited extent for the primary assessment of prostatitis. Restricted diffusion with ADC≥900mm(2)/s is believed to be a good indicator for prostatitis. MRS can help to distinguish between prostatitis and other tissue.
Authors: Sascha Merat; Theresa Blümlein; Markus Klarhöfer; Dominik Nickel; Gad Singer; Frank G Zöllner; Stefan O Schoenberg; Rahel A Kubik-Huch; Daniel Hausmann; Lukas Hefermehl Journal: Diagnostics (Basel) Date: 2021-03-30