Transition Zone Prostate Cancer: Quantitative Synthetic MR Imaging and Diffusion-Weighted Imaging in Tumour Detection

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Distinguishing transition zone (TZ) prostate cancer (PCa) from benign prostatic hyperplasia (BPH) using multiparametric MRI presents diagnostic challenges.
• The comparative effectiveness of synthetic MRI (Sy-MRI) parameters and apparent diffusion coefficient (ADC) in this differentiation remains unclear.

Purpose of the Study:

• To assess the diagnostic utility of Sy-MRI parameters (T1, T2, PD) and ADC in differentiating TZ PCa from BPH.
• To compare the performance of these imaging parameters in a cohort of patients with suspected prostate cancer.

Main Methods:

• Retrospective analysis of 261 patients (89 PCa, 172 BPH) who underwent preoperative MRI, including DWI and Sy-MRI.
• Independent radiologists defined regions of interest (ROIs) on ADC, T1, T2, and PD maps to extract quantitative imaging values.
• Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis and the DeLong test.

Main Results:

• T1, T2, and ADC values were significantly lower in PCa compared to BPH (p ≤ 0.001).
• Proton density (PD) values did not show a significant difference between PCa and BPH (p = 0.073).
• ADC exhibited the highest diagnostic performance (AUC = 0.996), significantly outperforming T1 (AUC = 0.928) and T2 (AUC = 0.907) (p < 0.001).

Conclusions:

• Sy-MRI-derived T1 and T2 values offer valuable assistance in differentiating PCa from BPH in the transition zone.
• Apparent diffusion coefficient (ADC) remains the most effective imaging biomarker for distinguishing between PCa and BPH, particularly in intermediate- to high-risk tumors.