3205
Role of quantification of relaxation time from synthetic MRI in diagnosis and grading of prostate cancer1Department of Radiology, Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China, 2MR Research, GE Healthcare, Beijing, China
Synopsis
This study aims to investigate the value of quantitative relaxation time derived from synthetic MRI (SyMRI) in the diagnosis and grading of prostate cancer (PCa). The results of this study showed that the diagnostic efficiencies of SyMRI in distinguishing PCa from most benign prostate lesions and different Gleason grades of PCa were similar to that of DWI, and the combined index of SyMRI and DWI can obtain higher diagnostic efficiencies. In addition, SyMRI has the advantages of short scanning time, unified parameters and simple operation, so it has a good prospect of clinical application.
Introduction
MRI is recognized as the best non-invasive imaging method to diagnose PCa clinically, and the Prostate Imaging Reporting And Data System (PI-RADS) was introduced for multiparametric MRI standardized scans. However, the signal intensity of conventional MRI is influenced by scanner types and acquisition parameters, and a direct comparison between absolute signal intensities is meaningless, which leads to the evaluation of MRI mainly depends on the comparison between the lesion and surrounding tissues in the same slice. Synthetic MRI (SyMRI) is a new MR quantitative technology based on quantification of relaxation times and proton density by multi-echo acquisitions of a saturation-recovery using turbo spin-echo readout (QRAPMASTER) method, which can not only quickly quantify the values of T1, T2 and PD, but also can obtain multiple synthetic contrast-weighted images within a single 5 min scan simultaneously. At present, it has been applied in a variety of diseases and shows good diagnostic effects. Since there are only two reports on the study of PCa using Sy MRI, and no published study has distinguished between PCa and prostatitis using SyMRI, our study aims to furtherly investigate the diagnostic value of SyMRI in the diagnosis and grading of PCa.Material and Methods
Patients 38 patients suspected of PCa due to PSA elevation were prospectively recruited, and 54 patients with clinically diagnosed benign prostatic hyperplasia were also randomly recruited, both of them underwent routine and SyMRI.MR imaging acquisition The MRI was performed on a 3T scanner (SIGNA Pioneer, GE Healthcare, Milwaukee, WI, USA). Conventional MRI sequences include T1-weighted imaging (T1WI), T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI); SyMRI sequences include T1WI and T2WI, and quantitative parameter maps are generated by MAGiC software of the scanner console.
Imaging data analysis and processing Two radiologists delineated regions of interest (ROIs). For PCa lesions and prostatitis lesions with puncture results, the ROI of each layer of image was outlined according to the biopsy site recorded by ultrasound puncture and the signal characteristics of T2WI and DWI; for prostatitis lesions without puncture results, ROIs were outlined according to the signal characteristics of low signal on T2WI and diffusion restriction on DWI; for glandular hyperplasia (GH) and stromal hyperplasia (SH), ROIs were outlined according to the signal characteristics on T2WI, GH and SH show well-defined, homogeneous hyper- and hypointense nodules, respectively; for the normal PZ area, ROIs were outlined according to the high signal characteristics on T2WI. ROIs were drawn to exclude hemorrhage, necrosis and calcification.
Statistical analysis The comparison of the data was analyzed by unpaired t test and the Wilcoxon rank sum test between two groups. The Kruskal–Wallis test was used for multiple group comparison. Receiver operating characteristic (ROC) curve and the The DeLong test were used to assess the diagnostic efficiencies of the different parameters.
Results
In the peripheral zone lesions, T1, T2, ADCmean, ADCmin and PD values in PCa were lower than those in normal prostate tissue (P < 0.05), the first four values have better AUCs (the area under the curve) than PD value (P < 0.05); the ADCmin of PCa was lower than that of prostatitis (P < 0.05), and none of the other parameters were statistically significant between two groups; T1, T2, ADCmean, ADCmin and PD values in prostatitis were lower than those in normal prostate tissue (P < 0.05), they all have higher AUCs, and the first three values have better AUCs than that of the last two(P < 0.05). In the transitional zone lesions, T2, ADCmean, ADCmin and PD values of PCa were lower than those of GH, and the T1 value of PCa was higher than that of GH (P < 0.05), the first four values have better AUCs than PD value (P < 0.05); ADCmean and ADCmin values of PCa were lower than those of SH (P < 0.05), and both of them have higher AUCs; T1, T2, ADCmean, ADCmin and PD values in SH were lower than those in GH (P < 0.05), the first four values have better AUCs than PD value (P < 0.05). In the comparison of Gleason grade of PCa, ADCmean, ADCmin and T2 values of HG PCa were lower than those of LG PCa, and the T1 value were higher than that of LG PCa (P < 0.05), they all have higher AUCs.Discussion
Our study aims to investigate the diagnostic value of SyMRI in the diagnosis and grading of PCa. ROC curve analysis showed that the diagnostic efficiencies of SyMRI in distinguishing PCa from most benign prostate lesions and different Gleason grades of PCa were similar to that of DWI, the diagnostic efficiencies of SyMRI in distinguishing PCa from prostatitis and SH were not superior to DWI, and the combined index of SyMRI and DWI can obtain higher diagnostic efficiencies. At the same time, SyMRI has the advantages of short scanning time, unified parameters and simple operation. It could become a useful adjunct for MRI diagnosis and grading of PCa.Conclusion
SyMRI is helpful to the diagnosis and grading of PCa, and has the advantages of short scanning time, unified parameters and simple operation. Therefore, it has a good prospect of clinical application.Acknowledgements
No acknowledgement found.References
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