The Evaluation Of New DWI Technologies And Biparametric PI-RADS V2 For The Diagnostic Value Of Clinical Significant Prostate Cancer Based On Targeted Biopsy

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The Diagnosis Value of PI-RADS V2 Combined with MRI-TRUS Fusion Targeted Biopsy for Clinical Significant Prostate CancerObjective To evaluate the application of transperineal targeted prostate biopsy using multiparametric magnetic resonance imaging(mpMRI)-transrectal ultrasound fusion in the diagnosis of clinical significant prostate cancer.Methods A prospectively analysis was performed in 168 patients with suspected prostate cancer from September 2015 to June 2013.Suspicious areas on mpMRI were defined and graded using PI-RADS score.All the patients had the transrectal ultrasound-guided systematic(TRUS)biopsy,108 patients with PI-RADS V2 scores(?)=3 had additional MRI-TRUS targeted biopsies.The detection rate of TRUS biopsy and suspicious MRI targeted biopsy in PCa and clinical significant cancer were tested by x2 test on the results of MRI-TRUS fusion guided biopsy.Results Initially,all of the 168 patients underwent TRUS biopsy.106 cases in whom PI-RADS V2 scores(?)3 had MRI-TRUS fusion guided biopsy to confirm their diagnosis.Prostate cancer was detected in 86 of 168 patients(51.19%,86/168),82(48.81%,82/168)were not prostate cancer.78(46.43%,78/168)cases of PCa were detected by TRUS biopsy,and 63(58.33%,63/168)cases of PCa were detected by MRI-TRUS fusion guided biopsy,the difference was statistical significant between TRUS biopsy and MRI-TRUS fusion guided biopsy(x2=3.73,p=0.035).The 168 patients were biopsied a total of 2300 cores,including TRUS biopsy 2016 cores and MRI-TRUS fusion targeted biopsy 284 cores.Additionally,the detection rate for per cores for MRI-TRUS fusion targeted biopsy(51.76%,147/284)were significantly better than for TRUS biopsy cores(19.64%,396/2016)(x2=142.38,p<0.05),Among patients with a positive biopsy for PCa,the biopsy cores for conventional TRUS biopsy was 1032 comparing to 214 cores for MRI-TRUS biopsy,the suspicious MRI-TRUS fusion targeted biopsy(68.69%,147/214)detected more prostate cancers which there had statistical differences compared with TRUS biopsy(38.37%,396/1032)(x2=66.27,p<0.05).Additionally,MRI-TRUS fusion targeted biopsy[69.74%(106/152)]detected more significant cancer cores than TRUS biopsy[54.50%(351/644)](x2=11.67,p<0.05).Conclusions MRI-TRUS fusion biopsy increases positive rate markedly and improves the detection rate of clinical significant PCa in comparison with TRUS biopsy.Part ? The Comparative Study of Diagnostic Performance of new DWI Technologies(IVIM,DKI models)for Prostate Cancer in Transtion ZoneObjective To explore the clinical value of intravoxel incoherent motion(IVIM)and diffusion kurtosis imaging(DKI)quantitative parameters in the differential diagnosis of benign and malignant lesions of the prostate in transitional zone(TZ)and the identification of clinical significant prostate cancer and no clinical significant lesions,and to analyze its association with Gleason score(GS)of prostate cancer.Methods A retrospective analysis was conducted on clinical data of 55 patients lesions was pathologically confirmed to be located in the prostate transition zone by MRI-TRUS targeted fusion biopsy and TRUS biopsy,and all cases were examined for prostate DWI,IVIM,and DKI before biopsy.Each lesion was outlined the 3D ROI,and measured the quantitative parameters of ADC values,IVIM and DKI models.Parameters were post processed by IVIM models for quantitation of perfusion fraction f,diffusivity D and pseudo-diffusivity D*and DKI models for the mean apparent diffusion for Gaussian distribution(MD),apparent kurtosis coefficient(MK)and fractional anisotropy(FA).Data satisfying the normal distribution assumption were subjected to independent sample t-test.Conversely,data not satisfying the assumption were analyzed using the Mann-Whitney U test.Receiver operating characteristic analysis was performed for IVIM and DKI parameters.AUC were compared using the Z-test.The correlations between the quantitative parameters and Gleason score were assessed with Spearman correlation.Results Among the 55 patients,there were 27 cases of PCa(36 focus)in transitional zone and 28 cases of BPH(40 focus).Twenty-seven cases of PCa in TZ with age of 58-81 yeas(mean 69±1.54 years)and a mean PSA level of 22.13±6.93ng/ml.BPH with of 51-80 years(mean 63±1.47 years)and a mean PSA level of 12.90±1.13 ng/ml were confirmed.The ADC and D of IVIM differed significantly between PCa and BHP in TZ(p<0.05,p=0.007),ADC exhibited a higher area under the curve(AUC,0.863)compared with D with area under the curve(AUC,0.833),however,the difference is not significant(p=0.8706).The difference between D*and f is not significant(p>0.05).Values of MD,MK and FA of DKI models were significantly different(p<0.05,p=0.01,p<0.05).The highest classification accuracy was achieved by the mean MD(AUC,0.742).The AUC is 0.892 of the combination of mean ADC and D,0.884 of combination of mean ADC and MD,the AUC(0.897)of the combination of ADC,D and MD significant higher than any two combined parameters(p=0.1316,p=0.3867,p=0.2537).In the group of GS(?)7 and BPH+(GS=6),ADC and D of IVIM model showed a significance difference(p<0.05,p=0.017),ADC got a higher AUC(0.826);the difference of D*and f is not significant(p>0.05).All the parameters of DKI models are significant different from the two groups,MD got a higher AUC than others(AUC,0.742).The AUC is 0.851 of the combination of mean ADC and D,0.846 of combination of mean ADC and MD,the AUC(0.856)of the combination of ADC,D and MD significant higher than any two combined parameters(p=0.2348,p=0.4133;p=0.3353).ADC and MD showed relatively higher negativity correlations(r=-0.586,r=-0.489)with GS of PCa in TZ.Conclusion The IVIM and DKI models can be used to differentially diagnose the diagnosis of prostate cancer in TZ and clinically significant prostate cancer.However,the diagnostic performances did not perform better than the traditional ADC.It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD respectively.Part ? The Diagnostic Evaluation of PI-RADS V2 based on Abbreviated Biparametric MRI for Clinical Significant Prostate CancerObjective To evaluate the diagnostic efficacy of PI-RADS V2 based on biparametric MRI(bpMRI)and multiparametric magnetic resonance imaging(mpMRI)for prostate diseases and to determine the detection value of PI-RADS V2 based on bpMRI for clinically significant prostate cancer.And to analyze the consistency of PI-RADS V2 based on bpMRI among different radiologists.Methods All 333 patients with suspicious lesions were performed mpMRI including full multi parametric contrast-enhanced MR imaging at 3.0T(high-spatial-resolution structural imaging in several planes,diffusion-weighted imaging,and dynamic contrast-enhanced MR imaging).Two radiologists(9 years and 4 years prostate MRI reading experience)scored the T2WI sequence cross-sectional and DWI sequences in the mpMRI sequence of all cases in strict accordance with the PI-RADS V2 scoring standard without knowing the patient's clinical data and pathology results,which is bpMRI;And then graded using Standard PI-RADS V2 scores for all mpMRI sequences after two weeks.Between-reader agreement of all PI-RADS V2 scores of two radiologist were investigated.All cases were scored by the author based on mpMRI-based PI-RADS V2 before biopsy.The patients with suspicious tumors PI-RADS V2 assessment category of?3 were selected for MRI-TRUS targeted biopsy within two weeks after MRI.The other patients with PI-RADS V2 assessment category of land 2 were selected for TRUS biopsy.The receiver operating characteristic curves were obtained by PI-RADS V2 scores based on bpMRI and mpMRI sequences,to record the AUC,accuracy,sensitivity,specificity,positive predictive value and negative predictive value.The diagnostic efficacy of bpMRI and mpMRI for prostate disease was evaluated by MRI-TRUS targeted biopsy and TRUS biopsy.Results A total of 333 men,aged 67.77 years±9.27(median PSA,11.21ng/mL),median age 68 years(30-89 years old)were included.A cohort of 333 patients was performed including 162 PCa(including 150 clinically significant and 12 non-clinically significant PCa)and 171 non-PCa.bpMRI helped detect PCa in 131 men and clinically significant PCa in 126 men;mpMRI helped detect PCa in 138 men and clinically significant PCa in 127 men;Between-reader agreement of bpMRI and the mpMRI of two radiologists was substantial(k=0.678 and 0.660).The area under the curve of PI-RADS V2 score based on bpMRI and mpMRI for the diagnosis of benign and malignant prostate lesions was 0.869 and 0.889 respectively,and the difference was not statistically significant(P=0.0638);The accuracy of bpMRI in the diagnosis of benign and malignant prostate diseases is 81.68%(272/333),the sensitivity is 80.86%(131/162),the specificity is 82.46%(141/171),the positive predictive value is 81.37%(131/161),and the negative predictive value is 81.98%(141/172);The accuracy of mpMRI score in the diagnosis of benign and malignant prostate lesions was 84.98%(283/333),the sensitivity was 85.18%(138/162),the specificity was 84.80%(145/171),the positive predictive value was 84.15%(138/164)and the predicted value is 85.8%(145/169).The area under the curve of PI-RADS V2 score based on bpMRI and mpMRI for the diagnosis of clinically significant prostate cancer was 0.879 and 0.890,and the difference was not statistically significant(P=0.1685);The diagnostic accuracy of bpMRI for clinically significant prostate cancer was 84.38%(281/333),the sensitivity was 92.42%(122/132),the specificity was 79.10%(159/201),the positive predictive value was 74.39%(122/164),and the negative predictive value was 94.08%(159/169);The diagnostic accuracy of mpMRI was 85.59%(285/333),the sensitivity was 93.94%(124/132),the specificity was 80.10%(161/201),the positive predictive value was 75.61%(124/164),and the negative predictive value was 95.27%(161/169).Conclusion BpMRI can effectively detect clinical significant prostate cancer;bpMRI is similar to mpMRI in the diagnosis of prostate cancer,and can significantly shorten the acquisition and interpretation time and avoid the potential risk of DCE injection of contrast agent.