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European Radiology

, Volume 29, Issue 3, pp 1133–1143 | Cite as

Diagnosis of transition zone prostate cancer using T2-weighted (T2W) MRI: comparison of subjective features and quantitative shape analysis

  • Satheesh Krishna
  • Nicola SchiedaEmail author
  • Matthew DF McInnes
  • Trevor A. Flood
  • Rebecca E. Thornhill
Urogenital
  • 180 Downloads

Abstract

Purpose

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.

Results

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).

Conclusion

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.

Key points

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.

Keywords

Prostate Benign prostatic hyperplasia Prostate cancer Magnetic resonance imaging Medical imaging 

Abbreviations

AS

Active surveillance

AUC

Area under the curve

BPH

Benign prostatic hyperplasia

DCE

Dynamic contrast enhanced

DICOM

Digital Imaging and Communications in Medicine

DWI

Diffusion weighted imaging

GU

Urogenital

IQR

Interquartile range

MRI

Magnetic resonance imaging

PACS

Picture archiving and communication system

PCa

Prostate cancer

PI-RADS v2

Prostate Imaging Reporting and Data System – version 2

PZ

Peripheral zone

ROC

Receiver-operator characteristic

RP

Radical prostatectomy

T2W

T2 weighted

TRUS

Trans-rectal ultrasound

TZ

Transition zone

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Satheesh Krishna
    • 1
  • Nicola Schieda
    • 2
    Email author
  • Matthew DF McInnes
    • 1
  • Trevor A. Flood
    • 3
  • Rebecca E. Thornhill
    • 1
  1. 1.Department of Medical ImagingThe Ottawa Hospital, The University of OttawaOttawaCanada
  2. 2.The Ottawa Hospital, The University of OttawaOttawaCanada
  3. 3.Department of Anatomical PathologyThe Ottawa Hospital, The University of OttawaOttawaCanada

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