Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: Can ADC values contribute to assess the aggressiveness of prostate cancer?

Purpose. To determine association between apparent diffusion coefficient value on diffusion-weighted imaging and Gleason score in patients with prostate cancer. Methods. This retrospective case series was conducted at Radiology Department of Aga Khan University between June 2009 and June 2011. 28 patients with biopsy-proven prostate cancer were included who underwent ultrasound guided sextant prostate biopsy and MRI. MRI images were analyzed on diagnostic console and regions of interest were drawn. Data were entered and analyzed on SPSS 20.0. ADC values were compared with Gleason score using one-way ANOVA test. Results. In 28 patients, 168 quadrants were biopsied and 106 quadrants were positive for malignancy. 89 lesions with proven malignancy showed diffusion restriction. The mean ADC value for disease with a Gleason score of 6 was 935 mm2/s (SD=248.4 mm2/s); Gleason score of 7 was 837 mm2/s (SD=208.5 mm2/s); Gleason score of 8 was 614 mm2/s (SD=108 mm2/s); and Gleason score of 9 was 571 mm2/s (SD=82 mm2/s). Inverse relationship was observed between Gleason score and mean ADC values. Conclusion. DWI and specifically quantitative ADC values may help differentiate between low-risk (Gleason score, 6), intermediate-risk (Gleason score, 7), and high-risk (Gleason score 8 and 9) prostate cancers, indirectly determining the aggressiveness of the disease.

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Differentiation of prostate cancer and stromal hyperplasia in the transition zone with histogram analysis of the apparent diffusion coefficient

Acta Radiologica ◽

10.1177/0284185117698861 ◽

2017 ◽

Vol 58 (12) ◽

pp. 1528-1534 ◽

Cited By ~ 4

Author(s):

Liu Xiaohang ◽

Zhou Bingni ◽

Zhou Liangping ◽

Peng Weijun ◽

Yang Xiaoqun ◽

...

Keyword(s):

Prostate Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Transition Zone ◽

B Value ◽

Histogram Analysis ◽

Apparent Diffusion ◽

Adc Values ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Background Prostate cancer and stromal hyperplasia (SH) in the transition zone (TZ) are difficult to discriminate by conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI). Purpose To investigate the apparent diffusion coefficient (ADC) of prostate cancer and SH in the TZ with histogram analysis and the ability of ADC metrics to differentiate between these two tissues. Material and Methods Thirty-three cancer and 29 SH lesions in the TZ of 54 patients undergoing preoperative DWI (b-value 0, 1000 s/mm2) were analyzed. All the lesions on the MR images were localized based on histopathologic correlations. The 10th, 25th, and 50th percentiles, and the mean ADC values were calculated for the two tissues and compared. The efficiencies of the 10th, 25th, and 50th ADC percentiles in differentiating the two tissues were compared with that of the mean ADC with receiver operating characteristic (ROC) analysis. Results The 10th, 25th, and 50th percentiles and mean ADC values (×10−3 mm2/s) were 0.86 ± 0.15, 0.89 ± 0.16, 0.94 ± 0.16, and 1.03 ± 0.17 in SH and 0.64 ± 0.12, 0.69 ± 0.12, 0.72 ± 0.16, and 0.83 ± 0.15 in TZ cancer, respectively. The parameters were all significantly lower in cancer than SH. The 10th ADC percentile yielded an area under the ROC curve (AUC) of 0.87 for the differentiation of carcinomas from SH, which was higher than the mean ADC (0.80) ( P < 0.05), and the AUCs of the 25th (0.82) and 50th (0.83) percentiles exhibited no differences from those of the mean ADC ( P > 0.05). Conclusion Histogram analysis of ADC values may potentially improve the differentiation of prostate cancer from SH in the TZ.

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Clinical utility of the normalized apparent diffusion coefficient for preoperative evaluation of the aggressiveness of prostate cancer

Japanese Journal of Radiology ◽

10.1007/s11604-014-0367-0 ◽

2014 ◽

Vol 32 (12) ◽

pp. 685-691 ◽

Cited By ~ 14

Author(s):

Ryo Itatani ◽

Tomohiro Namimoto ◽

Akira Yoshimura ◽

Kazuhiro Katahira ◽

Seiichiro Noda ◽

...

Keyword(s):

Prostate Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Clinical Utility ◽

Preoperative Evaluation ◽

Apparent Diffusion

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Do apparent diffusion coefficient (ADC) values obtained using high b-values with a 3-T MRI correlate better than a transrectal ultrasound (TRUS)-guided biopsy with true Gleason scores obtained from radical prostatectomy specimens for patients with prostate cancer?

European Journal of Radiology ◽

10.1016/j.ejrad.2013.02.021 ◽

2013 ◽

Vol 82 (8) ◽

pp. 1219-1226 ◽

Cited By ~ 27

Author(s):

Kazuhiro Kitajima ◽

Satoru Takahashi ◽

Yoshiko Ueno ◽

Hideaki Miyake ◽

Masato Fujisawa ◽

...

Keyword(s):

Prostate Cancer ◽

Diffusion Coefficient ◽

Radical Prostatectomy ◽

Apparent Diffusion Coefficient ◽

Transrectal Ultrasound ◽

B Values ◽

Guided Biopsy ◽

Apparent Diffusion ◽

Adc Values ◽

Better Than

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Changes in prostate apparent diffusion coefficient values during radiotherapy after neoadjuvant hormones

Therapeutic Advances in Urology ◽

10.1177/1756287218798748 ◽

2018 ◽

Vol 10 (12) ◽

pp. 359-364

Author(s):

Andrew McPartlin ◽

Lucy Kershaw ◽

Alan McWilliam ◽

Marcus Ben Taylor ◽

Clare Hodgson ◽

...

Keyword(s):

Prostate Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Gleason Score ◽

Prostate Gland ◽

Specific Antigen ◽

Predictive Tool ◽

Significant Difference ◽

Apparent Diffusion ◽

Adc Values

Background: Changes in prostate cancer apparent diffusion coefficient (ADC) derived from diffusion-weighted magnetic resonance imaging (MRI) provide a noninvasive method for assessing radiotherapy response. This may be attenuated by neoadjuvant hormone therapy (NA-HT). We investigate ADC values measured before, during and after external beam radiotherapy (EBRT) following NA-HT. Methods: Patients with ⩾T2c biopsy-proven prostate cancer receiving 3 months of NA-HT plus definitive radiotherapy were prospectively identified. All underwent ADC-MRI scans in the week before EBRT, in the third week of EBRT and 8 weeks after its completion. Imaging was performed at 1.5 T. The tumour, peripheral zone (PZ) and central zone (CZ) of the prostate gland were identified and median ADC calculated for each region and time point. Results: Between September and December 2014, 15 patients were enrolled (median age 68.3, range 57–78) with a median Gleason score of 7 (6–9) and prostate-specific antigen (PSA) at diagnosis 14 (3–197) ng/ml. Median period of NA-HT prior to first imaging was 96 days (69–115). All patients completed treatment. Median follow up was 25 months (7–34), with one patient relapsing in this time. Thirteen patients completed all imaging as intended, one withdrew after one scan and another missed the final imaging. PZ and CZ could not be identified in one patient. Median tumour ADC before, during and post radiotherapy was 1.24 × 10−3 mm2/s (interquartile range 0.16 × 10−3 mm2/s), 1.31 × 10−3 mm2/s (0.22 × 10−3 mm2/s), then 1.32 × 10−3 mm2/s (0.13 × 10−3 mm2/s) respectively ( p > 0.05). There was no significant difference between median tumour and PZ or CZ ADC at any point. Gleason score did not correlate with ADC values. Conclusions: Differences in ADC parameters of normal and malignant tissue during EBRT appear attenuated by prior NA-HT. The use of changes in ADC as a predictive tool in this group may have limited utility.

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Apparent diffusion coefficient values are superior to transrectal ultrasound-guided prostate biopsy for the assessment of prostate cancer aggressiveness

Acta Radiologica ◽

10.1177/0284185116639764 ◽

2016 ◽

Vol 58 (2) ◽

pp. 232-239 ◽

Cited By ~ 4

Author(s):

Chunmei Li ◽

Min Chen ◽

Jianye Wang ◽

Xuan Wang ◽

Wei Zhang ◽

...

Keyword(s):

Prostate Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Transrectal Ultrasound ◽

Risk Scores ◽

High Grade ◽

Clinical Risk ◽

Cancer Aggressiveness ◽

Apparent Diffusion ◽

Adc Values

Background Few studies have focused on comparing the utility of diffusion-weighted imaging (DWI) and transrectal ultrasound (TRUS)-guided biopsy in predicting prostate cancer aggressiveness. Whether apparent diffusion coefficient (ADC) values can provide more information than TRUS-guided biopsy should be confirmed. Purpose To retrospectively assess the utility of ADC values in predicting prostate cancer aggressiveness, compared to the TRUS-guided prostate biopsy Gleason score (GS). Material and Methods The DW images of 54 patients with biopsy-proven prostate cancer were obtained using 1.5-T magnetic resonance (MR). The mean ADC values of cancerous areas and biopsy GS were correlated with prostatectomy GS and D’Amico clinical risk scores, respectively. Meanwhile, the utility of ADC values in identifying high-grade prostate cancer (with Gleason 4 and/or 5 components in prostatectomy) in patients with a biopsy GS ≤ 3 + 3 = 6 was also evaluated. Results A significant negative correlation was found between mean ADC values of cancerous areas and the prostatectomy GS ( P < 0.001) and D’Amico clinical risk scores ( P < 0.001). No significant correlation was found between biopsy GS and prostatectomy GS ( P = 0.140) and D’Amico clinical risk scores ( P = 0.342). Patients harboring Gleason 4 and/or 5 components in prostatectomy had significantly lower ADC values than those harboring no Gleason 4 and/or 5 components ( P = 0.004). Conclusion The ADC values of cancerous areas in the prostate are a better indicator than the biopsy GS in predicting prostate cancer aggressiveness. Moreover, the use of ADC values can help identify the presence of high-grade tumor in patients with a Gleason score ≤ 3 + 3 = 6 during biopsy.

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Synthetic apparent diffusion coefficient for high b-value diffusion weighted MRI in Prostate

10.1101/19008201 ◽

2019 ◽

Author(s):

Prativa Sahoo ◽

Russell Rockne ◽

Jung Alexander ◽

Pradeep K Gupta ◽

Rakesh K Gupta

Keyword(s):

Prostate Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

B Value ◽

T Test ◽

B Values ◽

Apparent Diffusion ◽

Adc Values ◽

Malignant Lesions ◽

Log Linear

AbstractPurposeIt has been reported that diffusion weighted imaging (DWI) with ultrahigh b-value increases the diagnostic power of prostate cancer. DWI imaging with higher b-values is challenging as it commonly suffers from low signal to noise ratio (SNR), distortion and longer scan time. The aim of our study was to develop a technique for quantification of apparent diffusion coefficient (ADC) for higher b-values from lower b-value DW images.Materials and MethodsFifteen patient (7 malignant, 8 benign) with prostate cancer were included in this study retrospectively with the institutional ethical committee approval. All images were acquired at 3T MR scanner. The ADC values were calculated using mono-exponential model. Synthetic ADC (sADC) for higher b-value were computed using a log-linear model. Contrast ratio (CR) between prostate lesion and normal tissue on synthetic DWI (sDWI) was computed and compared with original DWI and ADC images.ResultsNo significant difference was observed between actual ADC and sADC for b-2000 in all prostate lesions. However; CR increased significantly (p=0.002, paired t-test) in sDWI as compared to DWI. Malignant lesions showed significantly lower sADC as compared to benign lesion (p=0.0116, independent t-test). Mean (±standard deviation) of sADC of malignant lesions was 0.601±0.06 and for benign lesions was 0.92 ± 0.09 (10−3mm2/s).Discussion / ConclusionOur initial investigation suggests that the ADC values corresponding to higher b-value can be computed using log-linear relationship derived from lower b-values (b≤1000). Our method might help clinician to decide the optimal b-value for prostate lesion identification.

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Discrimination between clinical significant and insignificant prostate cancer with Apparent diffusion coefficient – A systematic review and meta analysis

10.21203/rs.3.rs-16729/v1 ◽

2020 ◽

Author(s):

Hans-Jonas Meyer ◽

Andreas Wienke ◽

Alexey Surov

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Gleason Score ◽

Adc Value ◽

Apparent Diffusion ◽

Adc Values ◽

Clinically Significant ◽

Insignificant Prostate Cancer

Abstract Background Multiparametric MRI has become a corner stone in diagnosis of prostate cancer (PC). Diffusion weighted imaging and the apparent diffusion coefficient (ADC) can be used to reflect tumor microstructure. The present analysis sought to compare ADC values of clinically insignificant with clinical significant PC based upon a large patient sample. Methods MEDLINE library and SCOPUS databases were screened for the associations between ADC and Gleason score in PC up to May 2019. The primary endpoint of the systematic review was the ADC value of PC groups according to Gleason score. In total 27 studies were suitable for the analysis and included into the present study. The included studies comprised a total of 1633 lesions. Results Clinically relevant PCs (Gleason score 7 and higher) were diagnosed in 1078 cases (66.0%) and insignificant PCs (Gleason score 5 and 6) in 555 cases (34.0%). The pooled mean ADC value of the clinically significant PC was 0.86x10-3 mm2/s [95% CI 0.83-0.90] and the pooled mean value of insignificant PC was 1.1 x10-3 mm2/s [95% CI 1.03-1.18]. Clinical significant PC showed lower ADC values compared to non-significant PC. The pooled ADC values of clinically insignificant PCs were no lower than 0.75 ×10-3 mm2/s. This value may be proposed as a threshold for distinguishing clinically significant from insignificant PCs. Conclusions We evaluated the published literature comparing clinical insignificant with clinically prostate cancer in regard of the Apparent diffusion coefficient values derived from magnetic resonance imaging. We identified that the clinically insignificant prostate cancer have lower ADC values than clinically significant, which may aid in tumor noninvasive tumor characterization in clinical routine.

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Impact of mandated prospectively reported apparent diffusion coefficient values on the rates of positivity for clinically significant prostate cancer by PI-RADS score

Acta Radiologica ◽

10.1177/0284185120915617 ◽

2020 ◽

pp. 028418512091561

Author(s):

Hiram Shaish ◽

Randy Casals ◽

Firas Ahmed ◽

Jasnit Makkar ◽

Sven Wenske

Keyword(s):

Prostate Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Chi Square ◽

Apparent Diffusion Coefficient Values ◽

Apparent Diffusion ◽

Adc Values ◽

Clinically Significant ◽

Magnetic Resonance Imaging Mri ◽

The Impact

Background Prior research has shown that retrospectively measured apparent diffusion coefficient (ADC) of prostate magnetic resonance imaging (MRI) lesions is associated with clinically significant prostate cancer (csPCa) on targeted biopsy suggesting that ADC should be measured and reported prospectively. Purpose To assess the impact of mandatory prospective measurement of ADC on the rates of positivity across PI-RADS scores for csPCa. Material and Methods Consecutive patients who underwent ultrasound (US)-MRI fusion prostate biopsy from August 2018 to July 2019 and who had prospectively reported ADC were compared to control patients who did not. Rates of positivity by PI-RADS category were computed and compared using Chi-square. Multivariable regression was performed. Results In total, 126 patients (median age 65 years) with 165 prostate lesions (19, 51, 70, and 25 PI-RADS 2, 3, 4, and 5, respectively) and prospectively reported ADC values were compared to 113 control patients (median age 66 years) with 157 prostate lesions (17, 42, 64, and 34 PI-RADS 2, 3, 4, and 5, respectively). Rates of positivity across PI-RADS scores were similar between the two cohorts; 11%, 25%, 55%, and 76% and 0%, 21%, 56%, and 62% for PI-RADS 2, 3, 4, and 5 in the test and control cohorts, respectively (Chi-square P = 0.78). Multivariate logistic regression showed no significant association between the presence of prospectively measured ADC and csPCa (odds ratio 1.1, 95% confidence interval 0.7–1.7, P = 0.82). Conclusion Prospective ADC measurement may not impact PI-RADS category assignments or positivity rates for csPCa under current guidelines. Future versions of PI-RADS may need to incorporate ADC into scoring rules to realize their potential.

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