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Objective value of the apparent diffusion coefficient (ADC) map from ultrahigh b-value diffusion-weighted imaging
Kun Zhang1, Zhengming Chen1, Chen Zhang1
1Department of Radiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China.
Background:
Accurate risk stratification of prostate cancer (PCa) is crucial for clinical management. Although diffusion-weighted imaging (DWI) is widely used in PCa evaluation, the value of high and ultrahigh b-values remains under investigation. This study aimed to explore the predictive value of ultrahigh b-value DWI for the Gleason score of PCa patients.
Methods:
This study gathered a total of 78 patients and acquired T2-weighted imaging (T2WI), conventional DWI (0, 1,000 s/mm2), and ultrahigh b-value DWI (0, 2,000, and 3,000 s/mm2) from each patient. Using reference biopsy as the gold standard, the apparent diffusion coefficient (ADC) of DWI images at different b-values was analyzed. On the basis of regression analysis at various b-values and receiver operating characteristic (ROC) curves, the 3,000 s/mm2 ultrahigh b-value DWI demonstrated greater diagnostic performance in assessing the differentiation of PCa.
Results:
A total of 154 biopsy-confirmed lesions (102 cancerous lesions and 52 noncancer lesions) were analyzed. Ultrahigh b-value DWI (b=2,000 and 3,000 s/mm2) demonstrated significant differences in ADC values between PCa and noncancerous tissues (P<0.05): at b=2,000 s/mm2, the PCa ADC was 0.740±0.173 ×10-3 mm2/s vs. the non-PCa ADC was 0.949±0.176 ×10-3 mm2/s, whereas at b=3,000 s/mm2, the PCa ADC decreased to 0.581±0.130 vs. the non-PCa ADC was 0.748±0.179 ×10-3 mm2/s, with no overlap between groups. Both b-values showed inverse correlations between the ADC values and Gleason scores (b=2,000: r=-0.401, R2=0.161; b=3,000: r=-0.489, R2=0.240), with stronger linearity at higher b-values. Risk stratification revealed distinct ADC values between the low-risk (0.926±0.125 ×10-3 mm2/s at b=2,000; 0.726±0.097 ×10-3 mm2/s at b=3,000) and intermediate/high-risk groups (P<0.05), although no significant differences existed between the intermediate- and high-risk groups (P>0.05). ROC analysis for differentiating Gleason <7 vs. ≥7 lesions revealed greater diagnostic accuracy at b=3,000 [area under the curve (AUC) =0.908, cutoff =0.615 ×10-3 mm2/s, sensitivity 83.12%, specificity 92%] than at b=2,000 (AUC =0.893, cutoff =0.799 ×10-3 mm2/s, sensitivity 81.82%, specificity 88%).
Conclusions:
Ultrahigh b-value DWI with quantitative ADC measurements can be an effective indicator for evaluating the differentiation of PCa. It has important value for the clinical prediction of Gleason scores and prognosis assessment.
