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Conventional MRI Capabilities in the Diagnosis of Prostate Cancer in the Transition Zone

¹ Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho chuo-ku, Kobe, Hyogo, Japan 650-0017.
² Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
³ Division of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan.

OBJECTIVES. Our objectives were to evaluate the diagnostic capabilities of conventional MRI for the accurate detection of prostate cancer within the transition zone and to compare the results with histopathologic examination results.

MATERIALS AND METHODS. One hundred sixteen prostate specimens with prostate cancer were consecutively obtained. Axial, sagittal, and coronal T2- and T1-weighted MR images with gadopentetate dimeglumine were independently reviewed by two radiologists. The diagnostic base criteria of the MR images were determined for detecting transition zone cancer as follows: lesions with A, uniform low intensity on T2-weighted images; B, homogeneous gadolinium enhancement; and C, irregular margins both on gadolinium-enhanced and T2-weighted images. Wilcoxon's rank sum and chi-square tests and receiver operating characteristic curves were used. Differences of less than 0.05 were considered significant.

RESULTS. Eighty-six lesions in the transition zone were analyzed. Histopathologic analysis showed 53 cancers and 33 benign lesions. The diagnostic sensitivity, specificity, and accuracy for cancer were 50%, 51%, and 51%, respectively with criteria A; 68%, 75%, and 71% with criteria B; and 60%, 72%, and 65% with criteria C. When base criteria were combined into criteria A-B, A-C, and B-C and then further divided into three subgroups, accuracy was found to be highest when the lesion satisfied any two criteria from A, B, and C than those of base criteria, combination criteria, and the other two subgroups.

CONCLUSION. The addition of gadolinium-enhanced MRI to T2-weighted imaging provides better accuracy for detecting cancerous transition zone lesions than the use of T2-weighted imaging alone.

Keywords: cancer • MRI • prostate

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