Evaluation of the most optimal multiparametric magnetic resonance imaging sequence for determining pathological length of capsular contact. Issue 112 (March 2019)

• Record Type: Journal Article
• Authors: Onay, Aslıhan; Vural, Metin; Armutlu, Ayse; Ozel Yıldız, Sevda; Kiremit, Murat Can; Esen, Tarık; Bakır, Barıs
• Is Part Of: European journal of radiology. Issue 112(2019)
• Page Start: 192
• Page End: 199
• Publication Date: 2019-03
• Subjects: Prostate cancer -- Multi-parametric prostate MRI -- Extracapsular extension -- Length of capsular contact; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2019.01.020
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: The contact between prostate tumor and capsule is a useful parameter for assessing the extra prostatic extension (EPE) with Mp-MRI. The length of capsular contact (LCC) based on T2WI and DCE-MRI show fair accuracy with good inter-reader reproducibility in EPE diagnosis. The LCC based on T2WI, ADC map and DCE-MRI show strong correlation with pathological LCC. The LCC based on DCE-MRI has greatest correlation with pathological LCC and show highest accuracy in predicting pathological LCC. The performance of LCC was similar when using T2WI or DCE-MRI for clinical EPE assessment. Abstract: Objectives: To assess the most optimal multi-parametric magnetic resonance imaging sequence (Mp-MRI) in determining pathological length of capsular contact (LCC) for the diagnosis of prostate cancer extraprostatic extension (EPE). Methods: 105 patients with prostate cancer who underwent Mp-MRI of prostate prior to radical prostatectomy were enrolled in this retrospective study. LCC was determined from T2-weighted images (T2WI), Apparent Diffusion Coefficient (ADC) map, dynamic contrast-enhanced MRI (DCE-MRI) separately by two blinded radiologists. The LCCs in patients with and without EPE were compared with Mann Whitney-U test. The relationship between pathological LCC and the LCC that was measured from each Mp-MRI sequences were calculated by using Spearman test. The ability of all individual Mp-MRI sequences in determining pathological LCC was calculated by drawing receiver operator characteristic (ROC) curves. The diagnostic accuracy of LCC based on each MRI sequences for EPE diagnosis was also calculated with ROC curve analysis. Results: The patients with EPE had longer median LCC than patients without EPE for each Mp-MRI sequences and for both readers. In addition, the LCC showed a broader overlapping between patients with and without EPE on ADC map (reader-1, p = 0.01; reader-2, p = 0.01) when compared with T2WI (reader-1, p = 0.002; reader-2, p = 0.001) and DCE-MRI (reader-1, p = 0.001; reader-2, p = 0.001). LCC based on DCE-MRI showed the strongest correlation with pathological LCC. The area under the curve (AUC) based on LCC was higher when using the DCE-MRI (reader-1: 0.874, p = 0.030; reader-2: 0.862, p = 0.02) than when using T2WI and ADC map in predicting pathological LCC for both readers. While the LCC based on ADC map showed poor diagnostic accuracy, LCC based on T2WI and DCE-MRI had fair diagnostic accuracy for EPE diagnosis. Conclusion: The contact between prostate tumor and capsule seems to be a useful and objective parameter for evaluating the EPE of prostate cancer with Mp-MRI. More specifically, LCC based on DCE-MRI has highest correlation with pathological LCC and has better ability to predict pathological LCC when compared with other Mp-MRI sequences. However, the performance of LCC based on T2WI and DCE-MRI was similar for EPE diagnosis. It seems measurement of LCC from DCE-MRI and measurement of LCC from T2WI does not show any difference in clinical EPE assessment.