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Published on: March 21, 2025
Intravoxel Incoherent Motion (IVIM) Diffusion Weighted Imaging (DWI) in the Periferic Prostate Cancer Detection and
Filippo Pesapane1, Francesca Patella2, Enrico Maria Fumarola2
1Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy. filippopesapane@gmail.com.
Abstract:
The aim of this study was to compare the Intravoxel Incoherent Motion (IVIM) parameters between healthy Peripheral Zone (PZ), Benign Prostatic Hyperplasia (BPH) and Prostate Cancer (PCa) and compare them to assess whether there was correlation with Gleason Score (GS) grading system. Thirty-one patients with suspect of PCa underwent 1.5T Multi-Parametric Magnetic Resonance Imaging (MP-MRI) with endorectal coil with a protocol including T2WI, DWI using 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, 1000 s/mm2) and DCE. Monoexponential and IVIM model fits were used to calculate both apparent diffusion coefficient (ADC) and the following IVIM parameters: molecular diffusion coefficient (D), perfusion-related diffusion coefficient (D*) and perfusion fraction (f). The ADC and D values were significantly lower in the PCa (0.70 ± 0.16 × 10-3 mm2/s and 0.88 ± 0.31 × 10-3 mm2/s) compared to those found in the PZ (1.22 ± 0.20 × 10-3 mm2/s and 1.78 ± 0.34 × 10-3 mm2/s) and in the BPH (1.53 ± 0.23 × 10-3 mm2/s and 1.11 ± 0.28 × 10-3 mm2/s). The D* parameter was significantly increased in the PCa (5.35 ± 5.12 × 10-3 mm2/s) compare to the healthy PZ (3.02 ± 2.86 × 10-3 mm2/s), instead there was not significantly difference in the PCa compare to the BPH (5.61 ± 6.77 × 10-3 mm2/s). The f was statistically lower in the PCa (9.01 ± 5.20%) compared to PZ (10.57 ± 9.30%), but not significantly different between PCa and BPH (9.29 ± 7.29%). The specificity, sensitivity and accuracy of T2WI associated with DWI and IVIM were higher (100, 98 and 99%, respectively) than for T2WI/DWI and IVIM alone (89, 92 and 90%, respectively). Only for ADC was found a statistical difference between low- and intermediate-/high-grade tumors. Adding IVIM to the MP-MRI could increase the diagnostic performance to detect clinically relevant PCa. ADC values have been found to have a rule to discriminate PCa reliably from normal areas and differed significantly in low- and intermediate-/high-grade PCa. In contrast, IVIM parameters were unable to distinguish between the different GS.
Insights
Intravoxel Incoherent Motion (IVIM) parameters, alongside standard MRI, improve prostate cancer detection. While ADC values differentiate tumor grades, IVIM parameters show potential for enhanced diagnostic accuracy in prostate cancer assessment.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate cancer (PCa) diagnosis relies on imaging, but differentiating benign conditions and tumor grades remains challenging.
- Multi-parametric Magnetic Resonance Imaging (MP-MRI) offers detailed tissue characterization.
- Intravoxel Incoherent Motion (IVIM) imaging provides insights into tissue microstructure and microcirculation.
Purpose of the Study:
- To compare IVIM parameters in healthy peripheral zone (PZ), benign prostatic hyperplasia (BPH), and PCa.
- To assess the correlation of IVIM parameters with Gleason Score (GS) grading.
- To evaluate the diagnostic performance of IVIM combined with MP-MRI for PCa detection.
Main Methods:
- Thirty-one patients with suspected PCa underwent 1.5T MP-MRI with an endorectal coil.
- A protocol including T2WI, DWI with 10 b-values, and DCE was used.
- Monoexponential and IVIM models were applied to calculate ADC, D, D*, and f parameters.
Main Results:
- ADC and D values were significantly lower in PCa compared to PZ and BPH.
- D* was significantly increased in PCa versus PZ, but not significantly different from BPH.
- The combination of T2WI, DWI, and IVIM achieved higher diagnostic accuracy (99%) than T2WI/DWI or IVIM alone.
- ADC values showed a statistical difference between low- and intermediate-/high-grade tumors.
Conclusions:
- Adding IVIM to MP-MRI enhances diagnostic performance for clinically relevant PCa.
- ADC values reliably discriminate PCa from normal tissue and correlate with tumor grade.
- IVIM parameters alone were not sufficient to distinguish between different Gleason Scores.
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