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Combined T2-Weighted and Diffusion-Weighted MRI for Localization of Prostate Cancer

¹ Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network and Mount Sinai Hospital, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada.
² Department of Pathology and Laboratory Medicine, Princess Margaret Hospital, University Health Network, University of Toronto, ON, Canada.
³ Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, ON, Canada.
⁴ Department of Biostatistics, Princess Margaret Hospital, University Health Network, University of Toronto, ON, Canada.
⁵ Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, ON, Canada.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Receiver operator characteristic (ROC) curves for detection of prostate cancer on T2-weighted imaging alone (dashed line) and combined T2 and diffusion-weighted imaging (DWI) (solid line). For whole prostate, area under ROC curve (Az) was significantly higher (p = 0.006) for T2 plus DWI (Az = 0.87) than for T2 imaging alone (Az = 0.8).

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Receiver operator characteristic (ROC) curves for detection of prostate cancer on T2-weighted imaging alone (dashed line) and combined T2 and diffusion-weighted imaging (DWI) (solid line). For peripheral zone, Az was significantly higher (p = 0.004) for T2 plus DWI (Az = 0.89) than for T2 imaging alone (Az = 0.81).

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1c —Receiver operator characteristic (ROC) curves for detection of prostate cancer on T2-weighted imaging alone (dashed line) and combined T2 and diffusion-weighted imaging (DWI) (solid line). Test performance was poor for transition zone, with T2 imaging alone (Az = 0.79) and T2 plus DWI (Az = 0.78) showing similar results.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Tumors seen on apparent diffusion coefficient (ADC) map and not on T2-weighted images in 46-year-old man with prostate tumor. Prostate-specific antigen was 9.9 ng/mL and Gleason score was 7. T2-weighted image shows generalized decrease in signal in peripheral zone and no focal mass on left side; this region was scored as 2, possible cancer.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Tumors seen on apparent diffusion coefficient (ADC) map and not on T2-weighted images in 46-year-old man with prostate tumor. Prostate-specific antigen was 9.9 ng/mL and Gleason score was 7. ADC map calculated from diffusion-weighted images at b values of 0 and 600 s/mm2 shown at window width of 1,650 x 10-6 mm2/s and level of 1,675 x 10-6 mm2/s reveals clear focal mass in left peripheral zone (arrow); this region was scored as 4, definite cancer.

View larger version (81K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Tumors seen on apparent diffusion coefficient (ADC) map and not on T2-weighted images in 46-year-old man with prostate tumor. Prostate-specific antigen was 9.9 ng/mL and Gleason score was 7. Photomicrograph of pathologic specimen shows Gleason score of 7 (3 + 4) tumor (outlined areas). ED = ejaculatory duct.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Definite prostate cancer seen on apparent diffusion coefficient (ADC) map but poorly seen on T2 images in 66-year-old man. Prostate-specific antigen was 3.2 ng/mL and Gleason score was 7 (3 + 4). T2-weighted image shows mild loss of signal at left and right posterolateral aspects of peripheral zone (arrows). These regions were scored as 2, possible cancer.

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Definite prostate cancer seen on apparent diffusion coefficient (ADC) map but poorly seen on T2 images in 66-year-old man. Prostate-specific antigen was 3.2 ng/mL and Gleason score was 7 (3 + 4). ADC map calculated from diffusion-weighted images at b values of 0 and 600 s/mm2 shown at window width of 1,650 x 10-6 mm2/s and level of 1,675 x 10-6 mm2/s shows focal area of decreased signal corresponding to one of two areas seen on T2 images in left posterolateral peripheral zone (arrow). This area was characterized as 4, definite cancer.

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Definite prostate cancer seen on apparent diffusion coefficient (ADC) map but poorly seen on T2 images in 66-year-old man. Prostate-specific antigen was 3.2 ng/mL and Gleason score was 7 (3 + 4). Photomicrograph of pathologic specimen shows Gleason score of 7 (3 + 4) tumor (outlined areas). ED = ejaculatory duct.

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