European Radiology

, Volume 30, Issue 1, pp 26–37 | Cite as

Prediction of extraprostatic extension on multi-parametric magnetic resonance imaging in patients with anterior prostate cancer

  • Hyungwoo Ahn
  • Sung Il HwangEmail author
  • Hak Jong Lee
  • Hyoung Sim Suh
  • Gheeyoung Choe
  • Seok-Soo Byun
  • Sung Kyu Hong
  • Sangchul Lee
  • Joongyub Lee



To validate how established markers of extraprostatic extension (EPE) are applied to anterior prostate cancers (APCs), and to investigate other novel markers if available.


Among 614 histopathologically confirmed APCs from 2011 to 2016, 221 lesions with PiRADS (verion 2) scores ≥ 4 on 3-T multi-parametric MRI were analyzed retrospectively. Two radiologists independently assessed capsular morphology qualitatively with 5-point scale (normal, thinning, bulging, loss, extracapsular disease), and capsule contact length (arc), tumor dimension, and their ratio (arc-dimension ratio) quantitatively. Reproducibility in measurement was assessed with κ and intra-class correlation coefficients (ICCs). Logistic regression analysis was done to find meaningful indicators of EPE. Diagnostic performance of markers was compared to one another with generalized linear model and multi-reader multi-case ROC analysis.


Reproducibility was moderate to substantial (κ 0.45–0.73) for qualitative, and moderate to almost perfect (ICC 0.50–0.87) for quantitative features of EPE. Capsular morphology (odds ratio [OR] 1.818), capsule contact length (OR 1.115), tumor dimension (OR 1.035), and arc-dimension ratio (OR 1.846) were independently associated with EPE (p ≤ 0.019). Capsular bulging and capsule contact length of 10 mm as thresholds of EPE demonstrated sensitivity/specificity of 0.58/0.85 and 0.77/0.68, respectively. Capsule contact length yielded greatest AUC (0.784), followed by capsular morphology (0.778), arc-dimension ratio (0.749), and tumor dimension (0.741). Diagnostic performance of capsular morphology, capsule contact length, and arc-dimension ratio was comparable in predicting EPE.


Existing markers of EPE applicable regardless of locations of tumors apply similarly to APCs. Arc-dimension ratio may be a novel marker of EPE of APCs.

Key Points

• Existing imaging markers of extraprostatic extension (EPE) which have been applied regardless of locations of tumors are reflected similarly to anterior prostate cancers (APCs).

• Measuring tumor dimension without capsular assessment may result in insufficient pre-operative prediction of EPE of APCs.

• Arc-dimension ratio (capsule contact length divided by tumor dimension) exhibited highest OR and comparable performance to existing features in predicting EPE of APCs.


Prostatic neoplasms Adenocarcinoma Neoplasm staging Magnetic resonance imaging 



Apparent diffusion coefficient


Anterior fibromuscular stroma


Anterior prostate cancer


Area under the curve


Extraprostatic extension


Gleason score


Intra-class correlation coefficient


Magnetic resonance imaging


Multi-reader, multi-case


Odds ratio


Partial AUC


Prostate Imaging Reporting and Data System


Prostate-specific antigen


Receiver operating characteristic


Radical prostatectomy





This study was presented in the annual meeting of European Congress of Radiology of 2018.


This work was supported by the National Research Foundation funded by the Ministry of Science, Information and Communications Technology, Republic of Korea (Grant No. NRF-2013R1A1A2011398).

This work was supported by the Seoul National University Bundang Hospital Research Fund (Grant No. 11-2010-008).

Compliance with ethical standards


The scientific guarantor of this publication is Hak Jong Lee.

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

Joongyub Lee kindly 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.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologySeoul National University Bundang HospitalSeongnam-siSouth Korea
  2. 2.Department of PathologySeoul National University Bundang HospitalSeongnam-siSouth Korea
  3. 3.Department of UrologySeoul National University Bundang HospitalSeongnam-siSouth Korea
  4. 4.Department of Prevention and Management, School of MedicineInha University HospitalIncheonSouth Korea

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