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Updated: Jun 22, 2026
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Diffusion weighted image-guided transitional zone scoring in the detection of transitional zone prostate cancer:
Myoung Seok Lee1, Jeong Hwan Park2, Sang Youn Kim3
1Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Purpose:
To compare the performance of diffusion-weighted imaging-guided transitional zone (TZ) lesion scoring on T2-weighted imaging (DWI-guided TZ scoring) to conventional PI-RADS TZ scoring.
Methods:
Forty patients carried transition zone prostate cancer (TZPCa), and 40 patients had benign prostatic hyperplasia without TZPCa. A lesion-base, one-to-one correlation between the pathologic mapping sheet and the corresponding MR imaging was conducted by consensus between the genitourinary-specialized radiologist and pathologist. DWI-guided TZ scoring was defined as evaluating the DWI/apparent diffusion coefficient (ADC) images first, identifying the suspicious foci, then correlating the foci with the T2-weighted imaging, and finally assigning the PI-RADS score based on PI-RADS v2.1. Three other radiologists independently recorded the PI-RADS v2.1 scoring for TZ and the DWI-guided TZ scoring, with a time interval of 4 weeks.
Results:
When a PI-RADS score of ≥ 3 was considered a positive lesion, the specificity, PPV, NPV and sensitivity between the DWI-guided TZ scoring and conventional PI-RADS TZ scoring were 0.896 vs. 0.542 (p < .001), 0.764 vs. 0.439 (p < .001), 0.853 vs. 0.759 (p = .001), and 0.687 vs. 0.676 (p = .836), respectively. When PI-RADS scores ≥ 4 was considered cancer-positive, the specificity and PPV were also higher when applying DWI-guided TZ scoring (0.986 vs. 0.944, p = .007; 0.943 vs. 0.810, p = .009, respectively); however, the sensitivity and NPV were not statistically different (0.468 vs. 0.468, p = .998; 0.785 vs. 0.776, p = .537, respectively). The interobserver agreement presented as κ-value was higher in DWI-guided TZ scoring (0.584) than in conventional PI-RADS TZ scoring (0.155) (p = .003).
Conclusions:
DWI-guided TZ scoring improves the interobserver agreement, specificity, and predictive value without impairing the sensitivity.
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