Prostate cancer aggressiveness: Assessment with whole-lesion histogram analysis of the apparent diffusion coefficient Journal Article


Authors: Donati, O. F.; Mazaheri, Y.; Afaq, A.; Vargas, H. A.; Zheng, J.; Moskowitz, C. S.; Hricak, H.; Akin, O.
Article Title: Prostate cancer aggressiveness: Assessment with whole-lesion histogram analysis of the apparent diffusion coefficient
Abstract: Purpose: To evaluate the relationship between prostate cancer aggressiveness and histogram-derived apparent diffusion coefficient (ADC) parameters obtained from whole-lesion assessment of diffusion-weighted magnetic resonance (MR) imaging of the prostate and to determine which ADC metric may help best differentiate low-grade from intermediate- or high-grade prostate cancer lesions. Materials and Methods: The institutional review board approved this retrospective HIPAA-compliant study of 131 men (median age, 60 years) who underwent diffusion-weighted MR imaging before prostatectomy for prostate cancer. Clinically significant tumors (tumor volume > 0.5 mL) were identified at whole-mount step-section histopathologic examination, and Gleason scores of the tumors were recorded. A volume of interest was drawn around each significant tumor on ADC maps. The mean, median, and 10th and 25th percentile ADCs were determined from the whole-lesion histogram and correlated with the Gleason score by using the Spearman correlation coefficient (ρ). The ability of each parameter to help differentiate tumors with a Gleason score of 6 from those with a Gleason score of at least 7 was assessed by using the area under the receiver operating characteristic curve (Az). Results: In total, 116 clinically significant lesions (89 in the peripheral zone, 27 in the transition zone) were identified in 85 of the 131 patients (65%). Forty-six patients did not have a clinically significant lesion. For mean ADC, median ADC, 10th percentile ADC, and 25th percentile ADC, the Spearman r values for correlation with Gleason score were -0.31, -0.30, -0.36, and -0.35, respectively, whereas the Az values for differentiating lesions with a Gleason score of 6 from those with a Gleason score of at least 7 were 0.704, 0.692, 0.758, and 0.723, respectively. The Az of 10th percentile ADC was significantly higher than that of the mean ADC for all lesions and peripheral zone lesions (P = .0001). Conclusion: When whole-lesion histograms were used to derive ADC parameters, 10th percentile ADC correlated with Gleason score better than did other ADC parameters, suggesting that 10th percentile ADC may prove to be optimal for differentiating low-grade from intermediate- or high-grade prostate cancer with diffusion-weighted MR imaging. © RSNA, 2013.
Keywords: adult; controlled study; human tissue; aged; major clinical study; histopathology; nuclear magnetic resonance imaging; outcome assessment; cancer grading; diagnostic accuracy; disease association; image analysis; tumor volume; tumor differentiation; diagnostic imaging; retrospective study; prostate cancer; gleason score; diffusion coefficient; histogram; diagnostic test accuracy study; apparent diffusion coefficient; human; male; priority journal; article
Journal Title: Radiology
Volume: 271
Issue: 1
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2014-04-01
Start Page: 143
End Page: 152
Language: English
DOI: 10.1148/radiol.13130973
PROVIDER: scopus
PUBMED: 24475824
DOI/URL:
Notes: Export Date: 1 May 2014 -- CODEN: RADLA -- Source: Scopus
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Citation Impact
MSK Authors
  1. Junting Zheng
    187 Zheng
  2. Chaya S. Moskowitz
    251 Moskowitz
  3. Hedvig Hricak
    405 Hricak
  4. Oguz Akin
    254 Akin
  5. Asim Ahmed Afaq
    13 Afaq
  6. Olivio Fabrizio Manolo Donati
    17 Donati