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Quantitative assessment of prostate cancer using an individualized apparent diffusion coefficient intensity scale: a
Michele Scialpi1, Giuseppe Nazareno Antogiovanni1, Francesco Bianconi2
1Division of Radiology I Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Quantitative Imaging in Medicine and Surgery
|August 12, 2026
Summary
An individualized apparent diffusion coefficient (ADC) scale effectively differentiates prostate cancer (PCa) from benign lesions in S-PI-RADS 4 cases. This method shows high specificity, potentially reducing unnecessary biopsies in prostate cancer diagnosis.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Distinguishing prostate cancer (PCa) from benign lesions in simplified Prostate Imaging Reporting and Data System (S-PI-RADS) 4 categories on biparametric magnetic resonance imaging (bpMRI) remains a clinical challenge.
- Accurate differentiation is crucial for appropriate patient management and avoiding unnecessary invasive procedures.
Purpose of the Study:
- To evaluate the diagnostic performance of an individualized apparent diffusion coefficient (ADC) signal intensity (SI) scale for differentiating PCa from benign S-PI-RADS 4 lesions on bpMRI.
- To assess the potential of this quantitative measure to improve diagnostic accuracy and reduce unnecessary biopsies.
Main Methods:
- A retrospective study included 102 patients with biopsy-confirmed PCa and 79 with benign lesions presenting as S-PI-RADS 4 on bpMRI.
- An individualized ADC SI scale was created using bladder and femoral head ADC values to normalize lesion ADC intensity.
- Key metrics calculated included midpoint ADC (ADC_mean) and percentage difference (PD) between ADC_mean and lesion ADC (ADC_lesion).
- Diagnostic performance was assessed using Mann-Whitney U tests and receiver operating characteristic (ROC) analysis.
Main Results:
- Prostate cancer lesions exhibited significantly lower ADC values and higher PDs compared to benign lesions (P<0.001).
- ROC analysis of PD demonstrated an area under the curve (AUC) of 0.798.
- A PD cut-off of 14.67% achieved 73.5% sensitivity and 94.9% specificity for PCa detection.
- High intra-reader repeatability (ICC 0.92-0.94) and robustness of PD values were observed.
Conclusions:
- The individualized ADC SI scale offers a patient-specific quantitative method for effectively distinguishing malignant from benign S-PI-RADS 4 prostate lesions.
- This approach complements visual bpMRI assessment, providing high specificity and the potential to decrease unnecessary prostate biopsies.
- Further prospective studies are recommended to confirm the clinical utility of this diagnostic tool.
