Abdominal Radiology

, Volume 44, Issue 1, pp 279–285 | Cite as

Predictive role of PI-RADSv2 and ADC parameters in differentiating Gleason pattern 3 + 4 and 4 + 3 prostate cancer

  • Francesco AlessandrinoEmail author
  • Mehdi Taghipour
  • Elmira Hassanzadeh
  • Alireza Ziaei
  • Mark Vangel
  • Andriy Fedorov
  • Clare M. Tempany
  • Fiona M. Fennessy



To compare the predictive roles of qualitative (PI-RADSv2) and quantitative assessment (ADC metrics), in differentiating Gleason pattern (GP) 3 + 4 from the more aggressive GP 4 + 3 prostate cancer (PCa) using radical prostatectomy (RP) specimen as the reference standard.


We retrospectively identified treatment-naïve peripheral (PZ) and transitional zone (TZ) Gleason Score 7 PCa patients who underwent multiparametric 3T prostate MRI (DWI with b value of 0,1400 and where unavailable, 0,500) and subsequent RP from 2011 to 2015. For each lesion identified on MRI, a PI-RADSv2 score was assigned by a radiologist blinded to pathology data. A PI-RADSv2 score ≤ 3 was defined as “low risk,” a PI-RADSv2 score ≥ 4 as “high risk” for clinically significant PCa. Mean tumor ADC (ADCT), ADC of adjacent normal tissue (ADCN), and ADCratio (ADCT/ADCN) were calculated. Stepwise regression analysis using tumor location, ADCT and ADCratio, b value, low vs. high PI-RADSv2 score was performed to differentiate GP 3 + 4 from 4 + 3.


119 out of 645 cases initially identified met eligibility requirements. 76 lesions were GP 3 + 4, 43 were 4 + 3. ADCratio was significantly different between the two GP groups (p = 0.001). PI-RADSv2 score (“low” vs. “high”) was not significantly different between the two GP groups (p = 0.17). Regression analysis selected ADCT (p = 0.03) and ADCratio (p = 0.0007) as best predictors to differentiate GP 4 + 3 from 3 + 4. Estimated sensitivity, specificity, and accuracy of the predictive model in differentiating GP 4 + 3 from 3 + 4 were 37, 82, and 66%, respectively.


ADC metrics could differentiate GP 3 + 4 from 4 + 3 PCa with high specificity and moderate accuracy while PI-RADSv2, did not differentiate between these patterns.


Prostate cancer Magnetic resonance imaging Diffusion-weighted imaging Apparent diffusion coefficient PI-RADSv2 Gleason score 


Compliance with ethical standards


National Institute of Health—National Cancer Institute: U01 CA151261; R25 CA089017; NIH P41EB 015898.

Conflict of interest

Francesco Alessandrino, Mehdi Taghipour, Elmira Hassanzadeh, Alireza Ziaei, and Mark Vangel declare they have no conflict of interest. Andriy Fedorov received the following grants from Institute of Health—National Cancer Institute: U01 CA151261; NIH P41EB 015898. Clare M Tempany received the following grants from Institute of Health—National Cancer Institute: R25 CA089017; NIH P41EB 015898. Fiona M Fennessy received the following grants from Institute of Health—National Cancer Institute: U01 CA151261; R25 CA089017; NIH P41EB 015898.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Imaging, Dana Farber Cancer InstituteHarvard Medical SchoolBostonUSA
  3. 3.Department of RadiologyUniversity of Illinois at ChicagoChicagoUSA

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