Jeevan Shah1, Roger Bourne2, Geoffrey Watson3, and Andre Bongers1
1The University of New South Wales, Sydney, Australia, 2The University of Sydney, Sydney, Australia, 3Royal Prince Alfred Hospital, Sydney, Australia
Synopsis
This study investigates mapping
of Surface-to-Volume (S/V) ratios from short diffusion time derived ADC maps to
detect and characterize prostate cancer. ADC was mapped using a cos-OGSE DWI (fosc=50-200Hz)
in one unfixed prostate (Gleason 4+4). Using a previously established model, S/V
and free cytosol diffusivity (D0) maps were estimated by fitting the
temporal behaviour of ADC. S/V and D0 were able to clearly and
significantly separate the cancer and normal peripheral zone as indicated by a
t-test and ROC curves. The geometrical nature of S/V may provide additional
information to better characterize prostate cancer independent from diffusion
related parameters.
Introduction
Mapping of restricted diffusion at short diffusion
times shows promise to improve diagnostic sensitivity of DWI and it has been
demonstrated that the selectivity of OGSE methods to this range may facilitate the
detection of subtle subcellular changes that occur in the progression or
treatment of cancer1,2. OGSE based diffusion spectroscopy also
facilitates the extraction of interesting quantities such as
surface-to-volume-ratio (S/V)3,4
that separate tissue topology from diffusion related parameters. These
methods have a merit to become a powerful tool for tissue microstructure characterization
and clinical diagnosis. In this study we investigate the value of mapping S/V
ratios using OGSE for the detection of prostate cancer in unfixed radical
prostatectomy samples using high resolution, high SNR pre-clinical MR data.Methods
An unfixed specimen from radical prostatectomy, histologically diagnosed with prostate cancer Gleason Score (4+4), was
prepared as described in Bourne et al.5 and imaged on a BioSpec Avance III 94/20 system equipped
with BGA-12S HP gradients (Gmax=660mT/m, dG/dtmax=4570Tm/s)
and 72-mm quad-RF-coil. Multiple DWI experiments were performed using an
in-house developed cos-OGSE sequence2 at 7 different oscillation
frequencies (50Hz-200Hz, Δf=25Hz) with 3 directions, 4 b-values
(200,400,600)+b0. General imaging parameters: TE=90ms, TR=2200ms, FoV:
4.5×4.5 cm, Matrix: 64×64, resolution: 700×700µm. Slice thickness: 2mm+2mm
gap, 7 slices, 2 averages. Tacq=42min. ADC maps were
calculated for each oscillation frequency by mono-exponential fitting S = S0×exp(-ADC×b)
to the geometric mean of the DWIs. The temporal ADC maps were normalized to the
free water diffusion coefficient of a reference
tube that was inserted into the urethra (D0=2.2mm2/ms, at 22°C) and fitted using the following model3:
$$$D_{g}(t)=D_{0}\left(1-\frac{c^{\prime}}{d}\left(\frac{S}{V}\right)\sqrt{D_{0}\Delta_{\mathrm{eff}}}\right)$$$ where $$$c^{\prime}=\frac{4\pi\cdot C\left(2N^{\frac{1}{2}}\right)+3\cdot S\left(2N^{\frac{1}{2}}\right)}{2\sqrt{2}\pi N},\Delta_{\mathrm{eff}}=\frac{9}{64f_{\mathrm{osc}}}$$$
N,f – OGSE number of periods and frequency; C,S –
Cosine and Sine Fresnel Functions
In the fits for S/V and D0 quantification only frequencies
50Hz-175Hz were included as a small signal drop in the highest frequency was
found, which can likely be attributed to limitations in our gradient system. After imaging and fixation, the prostate sample was
sliced in exact alignment to the MRI for histological region
determination. Mean values were statistically
compared in cancer and peripheral zone ROIs and ROC for cancer detection was
calculated
Results
Fig.1 shows the D0 and S/V maps from the central
slice of our ex-vivo prostectomy sample (c,d) together with the delineation of
the Gleason 4+4 classified cancer region on the pathology section (a) and
region definition on the T2w image (b). ADC vs sqrt(Δeff(t)) plots of the normalized
ROI means are shown with the fitted model in Fig.2. Average D0 and S/V
values were found to be D0,cancer=1.16μm2/ms,
D0,peri=1.43μm2/ms and S/Vcancer=1.14μm-1, S/Vperi=0.63μm-1 in
cancerous and normal peripheral zone tissue, respectively. Both mean ROI D0
and S/V are significantly (P<0.001) different between cancer and normal peripheral
zone tissue (Fig.3). Sensitivity and specificity for cancer detection is shown
in the ROC curves in Fig.4.
The AUC(S/V)=0.86 and AUC(D0)=0.91 demonstrate a relatively
clear separation between cancer and normal tissue in both maps. For comparison Fig.4 also presents
corresponding ROC curves for cancer delineation directly from the ADC maps of
OGSE at 175Hz (Δeff=1.4ms) and PGSE (Δeff=20ms). AUC values are comparable to those of
the more advanced parameters. Due to the small sample size further samples will
have to be investigated to establish a firmer statistical basis.Discussion
In our study we
found a significant increase of S/V in prostate cancer (Gleason 4+4) relative
to the normal peripheral zone. This correlates well with the clinical finding that epithelial cells
proliferate and occupy a greater partial volume of tissue when cancer progresses.
In our limited dataset it was possible to robustly delineate the cancer region
on both, S/V and D0 maps. ROC analysis showed that S/V and D0
yield similar cancer discrimination ability as direct delineation on (OGSE and
PGSE) ADC maps. As S/V directly reflects a purely geometric/topographic tissue
property independent of any diffusion related parameters we anticipate that
this surrogate marker may add valuable information to improve the
characterization of microstructural changes during cancer progression and
treatmentAcknowledgements
The authors would like to thank the facilities, scientific and
technical assistance of the National Imaging Facility (NIF) at the UNSW Mark
Wainwright Analytical Centre, Biological Imaging Resources Laboratory MRI
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