Diffusion Is Directional: Innovative Diffusion Tensor Imaging to Improve Prostate Cancer Detection
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. mpMRI Acquisition
2.3. mpMRI Analysis
2.4. DTI Acquisition
2.5. DTI Image Processing and Analysis
2.6. Pathology
2.7. Statistical Analysis
3. Results
3.1. Patients
3.2. DTI Metrics
3.3. Diagnostic Accuracy
3.4. ROC Curve Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All | NC | PCa | Significance * | |
---|---|---|---|---|
n = 42 | n = 26 | n = 16 | ||
Age, median [IQR] | 61.7 [54.4–68.4] | 61.5 [51.1–65.4] | 63.3 [55.5–71.0] | p = 0.21 |
PSA (ng/mL), median [IQR] | 4.8 [1.3–10.7] | 2.3 [1.0–6.8] | 7.8 [4.2–11.2] | p = 0.29 |
Prostate volume by MRI (mL), median [IQR] | 49.5 [34.8–70.0] | 47.0 [33.2–69.0] | 51.0 [35.0–91.0] | p = 0.26 |
PSA density (ng/mL/mL), median [IQR] | 0.064 [0.035–0.158] | 0.055 [0.026–0.125] | 0.108 [0.056–0.218] | p = 0.11 |
Suspicious DRE | 16% | 16% | 16% | p = 1 |
Family History of prostate and related cancers | 26% | 30% | 19% | p = 0.39 |
PCa: n (%) | ||||
Gleason 6 (3 + 3) | 8 (50%) | |||
Gleason 7 (3 + 4) | 5 (31%) | |||
Gleason 7 (4 + 3) | 0 | |||
Gleason 8 (4 + 4) | 1 (6%) | |||
Gleason 9 (4 + 5) | 2 (13%) | |||
Lesion in peripheral zone | 11 (69%) | |||
Lesion in central gland | 5 (31%) |
Parameter | Peripheral Zone | Central Gland * | Mean Difference | 2-Tailed Significance | Significance (Bonferroni-Corrected) | |
---|---|---|---|---|---|---|
DTI: | λ1, | 2.34 ± 0.25 | 2.03 ± 0.12 | 0.315 | <0.0001 | <0.0001 |
λ2 | 1.87 ± 0.26 | 1.51 ± 0.13 | 0.357 | <0.0001 | <0.0001 | |
λ3 | 1.39 ± 0.30 | 1.00 ± 0.14 | 0.382 | <0.0001 | <0.0001 | |
MD | 1.91 ± 0.27 | 1.52 ± 0.12 | 0.351 | <0.0001 | <0.0001 | |
MA | 0.95 ± 0.11 | 1.01 ± 0.09 | −0.067 | 0.007 | 0.15 | |
FA | 0.27 ± 0.06 | 0.34 ± 0.04 | −0.076 | <0.0001 | <0.0001 | |
DWI: | ADC | 2.33 ± 0.06 | 2.15 ± 0.03 | 0.177 | 0.076 | 1.0 |
(a) Peripheral Zone | ||||||
Parameter | Normal | PCa | Mean Difference | 2-Tailed Significance | Significance (Bonferroni-Corrected) | |
DTI: | λ1 | 2.34 ± 0.25 | 1.66 ± 0.30 | 0.684 | <0.0001 | <0.0001 |
λ2 | 1.87 ± 0.26 | 1.23 ± 0.28 | 0.64 | <0.0001 | <0.0001 | |
λ3 | 1.39 ± 0.30 | 0.78 ± 0.26 | 0.61 | <0.0001 | <0.0001 | |
MD | 1.91 ± 0.27 | 1.22 ± 0.28 | 0.644 | <0.0001 | <0.0001 | |
MA | 0.95 ± 0.11 | 0.87 ± 0.10 | 0.074 | 0.027 | 0.57 | |
FA | 0.27 ± 0.06 | 0.38 ± 0.06 | −0.104 | <0.0001 | <0.0001 | |
DWI: | ADC | 2.33 ± 0.06 | 1.50 ± 0.04 | 0.083 | <0.0001 | <0.0001 |
(b) Central Gland | ||||||
Parameter | Normal | PCa | Mean Difference | 2-Tailed Significance | Significance (Bonferroni-Corrected) | |
DTI: | λ1, | 2.03 ± 0.12 | 1.26 ± 0.13 | 0.768 | <0.0001 | <0.0001 |
λ2 | 1.51 ± 0.13 | 0.85 ± 0.05 | 0.663 | <0.0001 | <0.0001 | |
λ3 | 1.00 ± 0.14 | 0.46 ± 0.07 | 0.545 | <0.0001 | <0.0001 | |
MD | 1.52 ± 0.12 | 0.85 ± 0.04 | 0.663 | <0.0001 | <0.0001 | |
MA | 1.01 ± 0.09 | 0.80 ± 0.18 | 0.21 | 0.0003 | 0.0063 | |
FA | 0.34 ± 0.04 | 0.45 ± 0.08 | −0.111 | 0.078 | 1.0 | |
DWI: | ADC | 2.15 ± 0.03 | 1.35 ± 0.03 | 0.08 | <0.0001 | <0.0001 |
a. DTI Likert score 2 and 3 were considered as DTI-positive | ||||||
Pathology | ||||||
Pos | Neg | sensitivity | 87.5% | [71.3–100%] | ||
DTI Pos | 14 | 4 | 18 | specificity | 84.6% | [70.7–98.5%] |
DTI Neg | 2 | 22 | 24 | PPV | 77.8% | [58.6–97.0%] |
16 | 26 | 42 | NPV | 91.7% | [80.6–100%] | |
b. mpMRI PI-RADS2 3, 4 and 5 lesions on mpMRI were considered as mpMRI-positive | ||||||
Pathology | ||||||
Pos | Neg | sensitivity | 87.5% | [71.3–100%] | ||
mpMRI Pos | 14 | 16 | 30 | specificity | 38.5% | [19.8–57.2%] |
mpMRI Neg | 2 | 10 | 12 | PPV | 46.7% | [28.8–64.5%] |
16 | 26 | 42 | NPV | 83.3% | [62.3–100%] | |
c. DTI Likert score 3 on DTI was considered as DTI-positive | ||||||
Pathology | ||||||
Pos | Neg | sensitivity | 81.3% | [62.1–100%] | ||
DTI Pos | 13 | 1 | 14 | specificity | 96.2% | [88.8–100%] |
DTI Neg | 3 | 25 | 28 | PPV | 92.9% | [79.4–100%] |
16 | 26 | 42 | NPV | 89.3% | [77.8–100%] | |
d. mpMRI PI-RADS2 4 and 5 lesions on mpMRI were considered as mpMRI-positive | ||||||
Pathology | ||||||
Pos | Neg | sensitivity | 62.5% | [38.8–86.2%] | ||
mpMRI P | 10 | 8 | 18 | specificity | 69.2% | [51.5–87.0%] |
mpMRI N | 6 | 18 | 24 | PPV | 55.6% | [32.6–78.5%] |
16 | 26 | 42 | NPV | 75.0% | [57.7–92.3%] |
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Shenhar, C.; Degani, H.; Ber, Y.; Baniel, J.; Tamir, S.; Benjaminov, O.; Rosen, P.; Furman-Haran, E.; Margel, D. Diffusion Is Directional: Innovative Diffusion Tensor Imaging to Improve Prostate Cancer Detection. Diagnostics 2021, 11, 563. https://doi.org/10.3390/diagnostics11030563
Shenhar C, Degani H, Ber Y, Baniel J, Tamir S, Benjaminov O, Rosen P, Furman-Haran E, Margel D. Diffusion Is Directional: Innovative Diffusion Tensor Imaging to Improve Prostate Cancer Detection. Diagnostics. 2021; 11(3):563. https://doi.org/10.3390/diagnostics11030563
Chicago/Turabian StyleShenhar, Chen, Hadassa Degani, Yaara Ber, Jack Baniel, Shlomit Tamir, Ofer Benjaminov, Philip Rosen, Edna Furman-Haran, and David Margel. 2021. "Diffusion Is Directional: Innovative Diffusion Tensor Imaging to Improve Prostate Cancer Detection" Diagnostics 11, no. 3: 563. https://doi.org/10.3390/diagnostics11030563