Morphologic perfusion patterns and PI-RADSv2.1 in transition zone prostate cancer

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Prostate cancer detection in the transition zone (TZ) using multiparametric MRI (mpMRI) remains challenging.
• Accurate characterization of TZ prostate cancer is crucial for effective diagnosis and treatment planning.

Purpose of the Study:

• To evaluate the diagnostic utility of morphologic perfusion patterns in TZ prostate cancer.
• To assess if these patterns improve the performance of the PI-RADSv2.1 scoring system.

Main Methods:

• Two radiologists assessed MRI perfusion patterns (asymmetry, signal strength, homogeneity) in consensus from 321 biopsy cores in 141 patients.
• Perfusion patterns were evaluated on early-phase images alongside T2w images and biopsy traces.
• Receiver operating characteristic (ROC) curves were analyzed for PI-RADSv2.1 and the proposed perfusion pattern criteria.

Main Results:

• A logistic regression model incorporating PI-RADSv2.1 and perfusion patterns showed significantly improved model fit (Likelihood Ratio Test, p < .001).
• The combined model achieved an Area Under the Curve (AUC) of 0.96, compared to 0.92 for PI-RADSv2.1 alone.
• Evaluation of homogeneity in early-enhancement images demonstrated comparable performance to conventional dynamic contrast-enhanced (DCE) parameters (AUC 0.84 vs. 0.83).

Conclusions:

• Morphologic perfusion patterns significantly enhance the diagnostic performance of PI-RADSv2.1 for TZ prostate cancer.
• These findings suggest that incorporating perfusion pattern analysis can improve the accuracy of mpMRI in detecting transition zone prostate cancer.