An inter-centre statistical scale standardisation for quantitatively evaluating prostate tissue on T2-weighted MRI

  • Neda GholizadehEmail author
  • Todsaporn Fuangrod
  • Peter B. Greer
  • Peter Lau
  • Saadallah Ramadan
  • John Simpson
Scientific Paper


Magnetic resonance images (MRI) require intensity standardisation if they are used for the purpose of quantitative analysis as inherent variations in image intensity levels between different image sets are manifest due to technical factors. One approach is to standardise the image intensity values using a statistically applied biological reference tissue. The aim of this study is to compare the performance of differing candidate biological reference tissues for standardising T2WI intensity distributions. Fifty-one prostate cancer patients across two centres with different scanners were evaluated using the percentage interpatient coefficient of variation (%interCV) for four different biological references; femoral bone marrow, ischioanal fossa, obturator-internus muscle and bladder urine. The tissue with the highest reproducibility (lowest %interCV) in both centres was used for intensity standardisation of prostate T2WI using three different statistical measures (mean, Z-score, median + Interquartile Range). The performance of different standardisation methods was evaluated from the assessment of image intensity histograms and the percentage normalised root mean square error (%NRSME) of the healthy peripheral zone tissue. Ischioanal fossa as a reference tissue demonstrated the highest reproducibility with %interCV of 18.9 for centre1 and 11.2 for centre2. Using ischioanal fossa for statistical intensity standardisation and the median + Interquartile Range method demonstrated the lowest %NRMSE across centres for healthy peripheral zone tissues. This study demonstrates ischioanal fossa as a preferred reference tissue for standardising intensity values from T2WI of the prostate. Subsequent image standardisation using the median + Interquartile Range intensity of the reference tissue demonstrated a robust and reliable standardisation method for quantitative image assessment.


Standardisation MRI T2WI Quantitative imaging Prostate cancer CV NRMSE 



The authors gratefully acknowledge the funding support provided by the Hunter Cancer Research Alliance (HCRA). N. Gholizadeh gratefully appreciates the UNIPRS scholarship awarded to her by the University of Newcastle, Australia.

Author contributions

The authors’ responsibilities were as follows- Greer, Ramadan, Simpson: designed the research, protocol and project development, data acquisition and edited manuscript; Lau: prostate segmentation; Gholizadeh, Fuangrod, Ramadan: data analysis and wrote manuscript; Simpson: conducted the research and had primary responsibility for the final content of the manuscript.


This study was funded by the Hunter Cancer Research Alliance (HCRA).

Compliance with ethical standards

Conflict of interest

All authors read and approved the final manuscript. None of the authors had a conflict of interest.

Ethical approval

Ethics approval for the study protocol was obtained from the local area heath ethics committee. This study was conducted under Hunter New England Imaging (HNEI) approval at Calvary Mater Newcastle, Australia.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Australasian College of Physical Scientists and Engineers in Medicine 2019

Authors and Affiliations

  • Neda Gholizadeh
    • 1
    Email author
  • Todsaporn Fuangrod
    • 2
  • Peter B. Greer
    • 3
    • 4
  • Peter Lau
    • 5
    • 6
  • Saadallah Ramadan
    • 1
    • 5
  • John Simpson
    • 3
    • 4
  1. 1.School of Health SciencesUniversity of NewcastleCallaghanAustralia
  2. 2.School of Medicine and Public Health, HRH Princess Chulabhorn College of Medical ScienceChulabhorn Royal AcademyBangkokThailand
  3. 3.Department of Radiation OncologyCalvary Mater NewcastleNewcastleAustralia
  4. 4.School of Physics and MathematicsUniversity Of NewcastleCallaghan, NewcastleAustralia
  5. 5.Imaging CentreHunter Medical Research Institute (HMRI)New Lambton HeightsAustralia
  6. 6.Department of RadiologyCalvary Mater NewcastleNewcastleAustralia

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