Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Peripheral Zone Prostate Cancer Detection

Main Article Content

Pornphan Wibulpolprasert Sasiprapa Rongthong Sith Phongkitkarun Panas Chalermsanyakorn


Background: Multiparametric magnetic resonance imaging (mp-MRI) has emerged as the best noninvasive imaging modality for prostate cancer detection, grading, staging, and targeted biopsy guidance. Validate performance of mp-MRI for peripheral zone prostate cancer detection is important for clinical implication.

Objective: To determine the accuracy of T2-weighted (T2W) imaging, diffusion-weighted imaging (DWI), three dimensional (3D) magnetic resonance spectroscopic (MRS) and dynamic contrast-enhanced imaging (DCE) in peripheral zone prostate cancer detection.

Methods: The retrospective study included 38 patients who has undergone pre-operative endorectal MRI from March 2006, to March 2010. The correlation of T2W, DWI, MRS and DCE in differentiation between tumor and non-tumor areas were analyzed by using Pearson's chi-square test or Fisher’s exact test. The receiver operating characteristic (ROC) analysis was use to evaluate the distinguishing ability of T2W, DWI, MRS, DCE, and the combinations in tumor detection.

Results: In 76 lesions from 38 patients, the area under the ROC curve (AUC) for tumor detection was 0.86 (T2W), 0.86 (DWI), 0.95 (MRS), and 0.61 (DCE). Combination of T2W+DWI, T2W+MRS, T2W+DCE achieved an AUC of 0.86, 0.92, and 0.80, respectively. There is no statistically significant difference in AUC between combination of T2W+DWI (0.86), and combination of T2W+DWI+DCE (0.82), T2W+DWI+MRS (0.81), or T2W+DWI+MRS+DCE (0.78).

Conclusions: DWI is the most useful complementary sequence to conventional anatomical T2W imaging for prostate cancer foci identification. The 3D-MRS and DCE images may be use as confirmation tools in peripheral zone prostate cancer detection.



Article Details

How to Cite
Wibulpolprasert, P., Rongthong, S., Phongkitkarun, S., & Chalermsanyakorn, P. (2018). Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Peripheral Zone Prostate Cancer Detection. Ramathibodi Medical Journal, 41(3), 1-12. https://doi.org/10.14456/rmj.2018.31
Original Articles


1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5-29. doi:10.3322/caac.21254.

2. Rosenkrantz AB, Deng FM, Kim S, et al. Prostate cancer: multiparametric MRI for index lesion localization--a multiple-reader study. AJR Am J Roentgenol. 2012;199(4):830-837. doi:10.2214/AJR.11.8446.

3. Wetter A, Engl TA, Nadjmabadi D, et al. Combined MRI and MR spectroscopy of the prostate before radical prostatectomy. AJR Am J Roentgenol. 2006;187(3):724-730. doi:10.2214/AJR.05.0642.

4. Hricak H. MR imaging and MR spectroscopic imaging in the pre-treatment evaluation of prostate cancer. Br J Radiol. 2005;78: S103–S111. doi:10.1259/bjr/11253478.

5. Caivano R, Cirillo P, Balestra A, et al. Prostate cancer in magnetic resonance imaging: diagnostic utilities of spectroscopic sequences. J Med Imaging Radiat Oncol. 2012;56(6):606-616. doi:10.1111/j.1754-9485.2012.02449.x.

6. Barentsz JO, Weinreb JC, Verma S, et al. Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol. 2016;69(1):41-49. doi:10.1016/j.eururo.2015.08.038.

7. Hambrock T, Somford DM, Huisman HJ, et al. Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer. Radiology. 2011;259(2):453-461. doi:10.1148/radiol.11091409.

8. Rosenkrantz AB, Mannelli L, Kong X, et al. Prostate cancer: utility of fusion of T2-weighted and high b-value diffusion-weighted images for peripheral zone tumor detection and localization. J Magn Reson Imaging. 2011;34(1):95-100. doi:10.1002/jmri.22598.

9. Haider MA, van der Kwast TH, Tanguay J, et al. Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. AJR Am J Roentgenol. 2007;189(2):323-328.

10. Lim HK, Kim JK, Kim KA, Cho KS. Prostate cancer: apparent diffusion coefficient map with T2-weighted images for detection--a multireader study. Radiology. 2009;250(1):145-51. doi:10.1148/radiol.2501080207.

11. Wibulpolprasert P, Phongkitkarun S, Chalermsanyakorn P. Clinical applications of diffusion-weighted-MRI in prostate cancer. J Med Assoc Thai. 2013;96(8):967-975.

12. Nagarajan R, Margolis D, Raman S, et al. Correlation of Gleason scores with diffusion-weighted imaging findings of prostate cancer. Adv Urol. 2012;2012:374805. doi:10.1155/2012/374805.

13. Mucci LA, Powolny A, Giovannucci E, et al. Prospective study of prostate tumor angiogenesis and cancer-specific mortality in the health professionals follow-up study. J Clin Oncol. 2009;27(33):5627-5633. doi:10.1200/JCO.2008.20.8876.

14. Ogura K, Maekawa S, Okubo K, et al. Dynamic endorectal magnetic resonance imaging for local staging and detection of neurovascular bundle involvement of prostate cancer: correlation with histopathologic results. Urology. 2001;57(4):721-726.

15. Jackson AS, Reinsberg SA, Sohaib SA, et al. Dynamic contrast-enhanced MRI for prostate cancer localization. Br J Radiol. 2009;82(974):148-156. doi:10.1259/bjr/89518905.

16. Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS prostate imaging - reporting and data system: 2015, version 2. Eur Urol. 2016;69(1):16-40. doi:10.1016/j.eururo.2015.08.052.

17. Jung JA, Coakley FV, Vigneron DB, et al. Prostate depiction at endorectal MR spectroscopic imaging: investigation of a standardized evaluation system. Radiology. 2004;233(3):701-708. doi:10.1148/radiol.2333030672.

18. Johnson LM, Turkbey B, Figg WD, Choyke PL. Multiparametric MRI in prostate cancer management. Nat Rev Clin Oncol. 2014;11(6):346-353. doi:10.1038/nrclinonc.2014.69.

19. Ito H, Kamoi K, Yokoyama K, Yamada K, Nishimura T. Visualization of prostate cancer using dynamic contrast-enhanced MRI: comparison with transrectal power Doppler ultrasound. Br J Radiol. 2003;76(909):617-624. doi:10.1259/bjr/52526261.

20. Scherr MK, Seitz M, Muller-Lisse UG, Ingrisch M, Reiser MF, Muller-Lisse UL. MR-perfusion (MRP) and diffusion-weighted imaging (DWI) in prostate cancer: quantitative and model-based gadobenate dimeglumine MRP parameters in detection of prostate cancer. Eur J Radiol. 2010;76(3):359-366. doi:10.1016/j.ejrad.2010.04.023.

21.Malayeri AA, El Khouli RH, Zaheer A, et al. Principles and applications of diffusion-weighted imaging in cancer detection, staging, and treatment follow-up. Radiographics. 2011;31(6):1773-1791. doi:10.1148/rg.316115515.

22. Bonekamp D, Jacobs MA, El-Khouli R, Stoianovici D, Macura KJ. Advancements in MR imaging of the prostate: from diagnosis to interventions. Radiographics. 2011;31(3):677-703. doi:10.1148/rg.313105139.

23. Pickles MD, Gibbs P, Sreenivas M, Turnbull LW. Diffusion-weighted imaging of normal and malignant prostate tissue at 3.0T. J Magn Reson Imaging. 2006;23(2):130-134. doi:10.1002/jmri.20477.

24. Kumar V, Jagannathan NR, Kumar R, et al. Apparent diffusion coefficient of the prostate in men prior to biopsy: determination of a cut-off value to predict malignancy of the peripheral zone. NMR Biomed. 2007;20(5):505-511. doi:10.1002/nbm.1114.

25. desouza NM, Reinsberg SA, Scurr ED, Brewster JM, Payne GS. Magnetic resonance imaging in prostate cancer: the value of apparent diffusion coefficients for identifying malignant nodules. Br J Radiol. 2007;80(950):90-95. doi:10.1259/bjr/24232319.

26. Tan CH, Wei W, Johnson V, Kundra V. Diffusion-weighted MRI in the detection of prostate cancer: meta-analysis. AJR Am J Roentgenol. 2012;199(4):822-829. doi:10.2214/AJR.11.7805.

27. Ghai S, Haider MA. Multiparametric-MRI in diagnosis of prostate cancer. Indian J Urol. 2015;31(3):194-201. doi:10.4103/0970-1591.159606.

28. Osugi K, Tanimoto A, Nakashima J, et al. What is the most effective tool for detecting prostate cancer using a standard MR scanner? Magn Reson Med Sci. 2013;12(4):271-280. doi:10.2463/mrms.2012-0054.

29. Bhatia C, Phongkitkarun S, Booranapitaksonti D, Kochakarn W, Chaleumsanyakorn P. Diagnostic accuracy of MRI/MRSI for patients with persistently high PSA levels and negative TRUS-guided biopsy results. J Med Assoc Thai. 2007;90(7):1391-1399.

30. Martin Noguerol T, Sanchez-Gonzalez J, Martinez Barbero JP, Garcia-Figueiras R, Baleato-Gonzalez S, Luna A. Clinical imaging of tumor metabolism with 1H magnetic resonance spectroscopy. Magn Reson Imaging Clin N Am. 2016;24(1):57-86. doi:10.1016/j.mric.2015.09.002.

31. Schimmoller L, Quentin M, Arsov C, et al. MR-sequences for prostate cancer diagnostics: validation based on the PI-RADS scoring system and targeted MR-guided in-bore biopsy. Eur Radiol. 2014;24(10):2582-9. doi:10.1007/s00330-014-3276-9.

Most read articles by the same author(s)