Diagnosis of transition zone prostate cancer using T2-weighted (T2W) MRI: comparison of subjective features and quantitative shape analysis
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To assess T2-weighted (T2W) MRI to differentiate transition zone (TZ) prostate cancer (PCa) from benign prostatic hyperplasia (BPH).
Materials and methods
With IRB approval, 22 consecutive TZ PCa were retrospectively compared with 30 consecutive BPH (15 stromal, 15 glandular) nodules diagnosed using radical prostatectomy MRI maps. Two blinded radiologists (R1/R2) subjectively assessed the shape (round/oval vs. lenticular) and margin (circumscribed vs. blurred/indistinct) and for a T2W hypointense rim. Both radiologists segmented lesions extracting quantitative shape features (circularity, convexity and topology/skeletal branching). Statistical tests were performed using chi-square (subjective features), Mann-Whitney U (quantitative features), Cohen’s kappa/Bland-Altman and receiver-operator characteristic analysis.
There were differences in the subjective analysis of the shape, margin and absence of a T2W-rim comparing TZ PCa with BPH (p < 0.0001) with moderate to almost perfect agreement [kappa = 0.56 (shape), 0.72 (margin), 0.97 (T2W-rim)]. Area under the curve (AUC ± standard error) for diagnosis of TZ PCas was shape = 0.88 ± 0.05, margin = 0.89 ± 0.04, and T2W-rim = 0.91 ± 0.04. Shape, judged subjectively, was specific (100%/94% R1/R2) with low-to-moderate sensitivity (55%/88% R1/R2). Circularity and convexity differed between groups (p < 0.001) with no difference in topology/skeletal branches (p = 0.31). Agreement in measurements was substantial for significant quantitative variables and AUC ± SE, sensitivity and specificity for diagnosis of TZ PCa were: circularity = 0.98 ± 0.01, 90%/96%; convexity = 0.85 ± 0.06, 68%/97%. AUCs for circularity were higher than for subjective analysis (p = 0.01 and 0.26).
Subjective analysis of T2W-MRI accurately diagnoses TZ PCa with high accuracy also demonstrated for quantitative shape analysis, which may be useful for future radiogenomic analysis of transition zone tumors.
• Presence of a complete T2-weighted hypointense circumscribed rim accurately diagnoses BPH.
• Round shape accurately diagnoses BPH and can be assessed quantitatively using circularity.
• Lenticular shape accurately diagnoses TZ PCa and can be assessed quantitatively using convexity.
KeywordsProstate Benign prostatic hyperplasia Prostate cancer Magnetic resonance imaging Medical imaging
Area under the curve
Benign prostatic hyperplasia
Dynamic contrast enhanced
Digital Imaging and Communications in Medicine
Diffusion weighted imaging
Magnetic resonance imaging
Picture archiving and communication system
- PI-RADS v2
Prostate Imaging Reporting and Data System – version 2
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Nicola Schieda, MD FRCP(C).
Conflict of interest
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.
Statistics and biometry
No complex statistical methods were necessary for this article. One of the authors, Dr. Rebecca E. Thornhill, provided statistical advice for this manuscript.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• case-control study
• performed at one institution
- 10.Abd-Alazeez M, Ahmed HU, Arya M et al (2014) The accuracy of multiparametric MRI in men with negative biopsy and elevated PSA level--can it rule out clinically significant prostate cancer? Urol Oncol 32(45):e17–e22Google Scholar
- 22.Niu XK, Chen ZF, Chen L, Li J, Peng T, Li X (2017) Clinical application of biparametric MRI texture analysis for detection and evaluation of high-grade prostate cancer in zone-specific regions. AJR Am J Roentgenol 210:549–556Google Scholar
- 26.Amin MB, Lin DW, Gore JL et al (2014) The critical role of the pathologist in determining eligibility for active surveillance as a management option in patients with prostate cancer: consensus statement with recommendations supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation. Arch Pathol Lab Med 138:1387–1405CrossRefGoogle Scholar
- 28.Krishna S, Lim CS, McInnes MDF et al (2017) Evaluation of MRI for diagnosis of extraprostatic extension in prostate cancer. J Magn Reson Imaging. https://doi.org/10.1002/jmri.25729
- 40.Dinh AH, Melodelima C, Souchon R et al (2018) Characterization of prostate cancer with Gleason score of at least 7 by using quantitative multiparametric MR imaging: validation of a computer-aided diagnosis system in patients referred for prostate biopsy. Radiology. https://doi.org/10.1148/radiol.2017171265