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Magnetic resonance imaging in prostate cancer: the value of apparent diffusion coefficients for identifying malignant nodules

Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK

Correspondence: Dr N M deSouza, Clinical Magnetic Resonance Research Group, MRI Unit, Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK

The aim of this work was to determine the potential of diffusion weighted magnetic resonance imaging (DW-MRI) for identifying prostate cancer by comparing apparent diffusion coefficients (ADCs) from malignant peripheral zone (PZ) nodules with values from the non-malignant PZ and the predominantly benign central gland (CG). 33 patients with elevated prostate specific antigen (PSA) aged 52–78 years (30 patients with biopsy proven prostate cancer) underwent endorectal MRI with T₂ weighted and echo planar diffusion weighting (b = 0 mm² s^–1, 300 mm² s^–1, 500 mm² s^–1 and 800 mm² s^–1) sequences. ADCs were measured from 30 malignant PZ nodules (identified on T₂ weighting and positive biopsy; median region of interest (ROI) size 41 mm²), 33 CG regions (predominantly benign nodules; median ROI size 218 mm²) and 18 non-malignant PZ regions (ipsilateral biopsies all benign; median ROI size 54.5 mm²). ADCs were (mean±standard deviation (SD); mm² s^–1): malignant PZ nodules 1.30±0.30x10^–3, CG 1.46±0.14x10^–3 and non-malignant PZ 1.71±0.16x10^–3. Differences between all three groups were statistically significant (p = 0.01 malignant PZ vs CG; p = 0.0001 malignant PZ vs non-malignant PZ and p = 0.0001 CG vs non-malignant PZ). Using receiver operating characteristic curves, cut-off values of 1.39x10^–3 mm² s^–1 differentiated malignant PZ nodules from predominantly benign CG (sensitivity 60%, specificity 76%) and of 1.6x10^–3 mm² s^–1 identified malignant from non-malignant PZ (sensitivity 86.7%, specificity 72.2%). These results suggest that DW-MRI has the potential to increase the specificity of prostate cancer detection because ADCs are significantly lower in malignant compared with non-malignant prostate tissue.

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