Evaluation Of The Volume,Morphology And Composition Of Benign Prostatic Hyperplasia Transition Zone Using Multiparametric MRI:A Correlation With The IPSS

Objective To investigate the correlation between the application of multiparametric MRI(mp-MRI)to evaluate the volume,morphology and composition of benign prostatic hyperplasia(BPH)and the International Prostate Symptom Score(IPSS).Methods A retrospective analysis of 210 patients with Benign Prostatic Hyperplasia(BPH)confirmed by surgical pathology,who underwent conventional MRI with Diffusion Weighted Imaging(DWI)examinations and the IPSS questionnaire scores,and were divided into mild(group 1),moderate(group 2),and severe(group 3)according to the IPSS score.Those who were part of the Diffusion Tensor Imaging(DTI)cohort underwent DTI examinations and were divided into mild to moderate(group 4)and severe(group 5)according to their IPSS scores.The evaluation indicators included prostate volumetric parameters [the total prostate volume(TPV),transition zone volume(TZV),and transition zone index(TZI,TZI=TZV/TPV)],prostate morphological parameters [the intravesical prostatic protrusion(IPP),prostatic urethra angle(PUA),presumed circle area ratio(PCAR)and peripheral zone thickness(PZ thickness)] and prostate compositional parameters [the fractional anisotropy(FA)values,apparent diffusion coefficient(ADC),and mean signal intensity of T2WI(mean-SI-T2WI)].The Pearson(r)correlation coefficient,one-way analysis of variance(ANOVA),receiver operator characteristic curve(ROC)and multiple linear regression analysis were used and regression models were constructed to investigate the correlation between each clinical index and each MRI quantitative parameter and IPSS in the included subjects and their effectiveness.Results Ⅰ.Correlation between prostate volume parameters and IPSS Between the three groups of the total cohort(group 1,group 2,and group3): TPV(r = 0.350,P < 0.001),TZV(r = 0.374,P < 0.001),and TZI(r = 0.383,P< 0.001)all had a mildly significant positive correlation with IPSS.Ⅱ.Correlation between prostate morphological parameters and IPSS Between the three groups of the total cohort(group 1,group 2,and group3): there was no correlation between PUA and IPP and IPSS(P > 0.05);there was a moderately significant positive correlation between PCAR(r = 0.481,P <0.001)and IPSS;and there was a mildly significant negative correlation between PZ thickness(r =-0.227,P = 0.001)and IPSS.Ⅲ.Correlation between prostate texture parameters and IPSS Between the three groups of the total cohort(group 1,group 2,group 3):mean-SI-T2WI(r =-0.626,P < 0.001)showed a significant negative correlation with IPSS;mean ADC(r =-0.198,P < 0.001)showed a mildly significant negative correlation with IPSS.Between DTI groups(group 4 and group 5): the mean value of FA showed a mildly significant positive correlation with IPSS(P < 0.05).Based on multiple linear regression analysis in the total cohort,the impact of the mean-SI-T2WI and TZI on the IPSS were statistically significant(P<0.05),and the regression equation established with the analysis[IPSS=37.932+10.15×TZI+(-0.090)×(mean-SI-T2WI)] was statistically significant(F=87.374,P <0.001).Conclusions Mp-MRI could be used to evaluate the volume and morphology of BPH.In particular,the mean SI-T2WI,ADC value and FA value could be used to describe the internal composition of the prostate,which is an objective and accurate imaging method for comprehensive assessment of BPH.