Abstract
Introduction
Prostatic ductal adenocarcinoma (DCa) is an aggressive variant. The purpose of this study was to determine if T2 signal intensity (SI) differs from conventional adenocarcinoma (CCa).
Materials and methods
A retrospective study of patients who underwent preoperative MRI and prostatectomy between 2009 and 2012 was performed. T2 SI ratios (SIR) for tumour (T) to obturator internus muscle (M) and normal peripheral zone (PZ) were compared. Two radiologists evaluated the central gland/PZ to detect tumours and compared diagnostic accuracy.
Results
T2 SIR for DCa were 3.60 (T/M), 0.66 (T/PZ); 2.68 (T/M), 0.47 (T/PZ) for Gleason 9; 2.50 (T/M), 0.47 (T/PZ) for Gleason 7/8 and 3.95 (T/M), 0.73 (T/PZ) for Gleason 6 tumours. There was a difference in T2 T/M and T/PZ SIR between DCa and Gleason 9 (p = 0.003, p = 0.004) and Gleason 7/8 (p = 0.006, p = 0.002), but no difference in SIR between DCa and Gleason 6 tumours. The sensitivity for tumour detection was 0–27 % for DCa, 64–82 % for Gleason 9, 44–88 % for Gleason 7–8 and 0–20 % for Gleason 6. There was a difference in the sensitivity of detecting Gleason 9 and 7/8 tumours when compared to DCa (p = 0.004, p = 0.001).
Conclusions
DCa resembles Gleason score 6 tumour at T2-weighted MRI, which underestimates tumour grade and renders the tumour occult.
Key Points
• Prostatic ductal adenocarcinoma is aggressive, resembling endometrial carcinoma at histopathology.
• Prostatic ductal adenocarcinoma resembles Gleason score 6 tumour at T2-weighted MRI.
• MRI grading may underestimate ductal adenocarcinoma based on increased T2 signal.
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Acknowledgments
The scientific guarantor of this publication is Nicola Schieda. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Dr. Anne Tsampalieros MD kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, case-control study, performed at one institution.
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Schieda, N., Coffey, N., Gulavita, P. et al. Prostatic ductal adenocarcinoma: an aggressive tumour variant unrecognized on T2 weighted magnetic resonance imaging (MRI). Eur Radiol 24, 1349–1356 (2014). https://doi.org/10.1007/s00330-014-3150-9
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DOI: https://doi.org/10.1007/s00330-014-3150-9