Diagnostic Value of Intravoxel Incoherent Motion Parameters in Differentiating and Grading Prostate Cancer

Abstract

Objective: To evaluate the value of intravoxel incoherent motion (IVIM) parameters in differentiating prostate cancer (PCa) and predicting PCa grading. Material and Methods: Sixty-eight patients (21 prostatitis, 19 benign prostatic hyperplasia, 27 PCa) were enrolled in this methodological research. In addition to routine multiparametric magnetic resonance imaging (Mp-MRI), IVIM sequence including 15 different b values ranging from 0 to 1200 s/mm2 was taken. Apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f) parameters were obtained based on the measurements made from all b values. According to the Kolmogorov-Smirnov test, all data were normally distributed. The differences of these parameters in detecting prostate lesions and grading PCa were analyzed by t test, and correlation with PCa grade was determined by Pearson’s correlation test. ROC analysis was performed to evaluate the diagnostic performance of the parameters. Linear discriminant analysis was performed to investigate the additional value of the IVIM sequence to Mp-MRI. Results: With the addition of IVIM parameters to routine Mp-MRI; the sensitivity, specificity, and accuracy rates increased from 87%, 92%, and 90% to 92%, 95%, and 94%, respectively. All of parameters showed good diagnostic performance in differentiating PCa from healthy prostate tissue (p<0.0001 for each). While ADC and D were significantly lower in PCa compared with benign lesions (p<0.0001 for both); there were no statistically differences in D* and f (p=0.603 and p=0.454, respectively). IVIM parameters were not successful in differentiating low and moderate/high grade PCa (p=0.314, p=0.413, p=0.619 and p=0.628, respectively). Conclusion: IVIM parameters are useful in distinguishing PCa from healthy tissue and increase the diagnostic performance of conventional Mp-MRI.

Keywords

• prostate cancer
• pseudo-diffusion coefficient
• intravoxel incoherent motion
• apparent diffusion coefficient
• multiparametric magnetic resonance imaging

Prostat Kanserinin Saptanması ve Derecelendirilmesinde Voksel İçi Tutarsız Hareket (IVIM) Parametrelerinin Tanısal Değeri

Abstract

Amaç: Voksel içi tutarsız hareket (IVIM) parametrelerinin, prostat kanseri (PK) ile normal prostat dokusu ve benign prostat lezyonlarından ayırmadaki başarısını ve PK’yi derecelendirmedeki yararını saptamak. Gereç ve Yöntemler: Bu metodolojik araştırmaya 1,5 T cihaz kullanılarak prostata yönelik yapılan çok parametreli manyetik rezonans görüntüleme (Mp-MRG)’si ve doku tanısı olan toplam 68 hasta (21 prostatit, 19 benign prostat hiperplazisi, 27 PK) dahil edildi. Rutin Mp-MRG’ye, 0 ile 1200 s/mm2 arasında değişen 15 farklı b değeri içeren IVIM sekansı eklendi. Tüm b değerlerinden yapılan ölçümler baz alınarak; görünür difüzyon katsayısı (ADC), gerçek difüzyon katsayısı (D), kan akışıyla ilişkili yalancı difüzyon katsayısı (D*) ve perfüzyon fraksiyonu (f) parametreleri elde edildi. Kolmogorov-Smirnov testine göre tüm veriler normal dağılım göstermekte idi. Bu parametrelerin prostat lezyonlarını saptamadaki ve PK derecelendirmesindeki farklılıkları t testi ile analiz edildi, PK derecesi ile korelasyonu Pearson korelasyon testi ile saptandı. Parametrelerin tanısal performansını değerlendirmek için ROC analizi yapıldı. IVIM sekansının Mp-MRG’ye ek katkısının araştırılması amaçlı lineer diskriminant analizi (LDA) kullanıldı. Bulgular: ADC, D, D* ve f parametrelerinin rutin Mp-MRG’ye eklenmesi ile duyarlılık, özgüllük ve doğruluk oranları sırası ile %87, %92 ve %90’dan %92, %95 ve %94’e yükseldi. Bu dört parametre de PK ile sağlıklı prostat dokusunu ayırmada faydalı idi (her biri için p<0,0001). ADC ve D parametreleri PK’yi benign lezyonlardan ayırt etmede başarılı iken (ikisi için de p<0,0001); D* ve f parametreleri başarısız idi (sırasıyla p=0,603 ve p=0,454). ADC, D, D* ve f parametrelerinin düşük ve orta/yüksek dereceli PK’yi ayırmadaki yararı istatiksel olarak anlamlı bulunmadı (sırasıyla p=0,314; p=0,413; p=0,619 ve p=0,628). Sonuç: IVIM parametrelerinin PK’yi normal dokudan ayırmada başarılı olduğu ve rutin Mp-MRG’ye ek katkı sunduğu görülmüştür.

Keywords

• prostat kanseri
• yalancı-difüzyon katsayısı
• voksel içi tutarsız hareket
• görünür difüzyon katsayısı
• multiparametrik manyetik rezonans görüntüleme

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