Prostate MRI Transitional Zone Volume Predicts BPH Enucleation Volume Better than Alternative Modalities

Area of Science:

• Urology
• Medical Imaging
• Surgical Planning

Background:

• Benign prostate hyperplasia (BPH) guidelines rely on volume-based interventions.
• The accuracy of various imaging modalities in correlating to treated BPH volume is not well-established.

Purpose of the Study:

• To compare the accuracy of preoperative ultrasound, CT, MRI, and MRI-TZ in predicting BPH enucleation weight.
• To determine which imaging modality best correlates with surgical BPH volume.

Main Methods:

• Retrospective review of 95 patients undergoing BPH enucleation with preoperative imaging (TRUS, CT, MRI).
• Measurement of total prostate volumes (CT, MRI, TRUS) and MRI-transitional zone (TZ) volume.
• Comparison of imaging volumes to enucleated pathology weight using ANOVA and Tukey's test.

Main Results:

• MRI-TZ volume showed the highest accuracy in predicting enucleation volume (p < 0.001).
• Median differences between imaging and enucleation volumes were 46 cc (TRUS), 51 cc (CT), 53 cc (MRI), and 14 cc (MRI-TZ).
• MRI-TZ was significantly more accurate than CT, MRI, and TRUS (p < 0.03).

Conclusions:

• Transitional zone volume on MRI is the most accurate predictor of BPH enucleation volume.
• Total prostate volume measurements from CT, TRUS, and MRI are less accurate than MRI-TZ.
• Utilizing MRI-TZ volume can improve patient stratification for BPH treatment.