The Clinical Value Of 3.0T Magnetic Resonance Diffusion Kurtosis Imaging In Prostate Cancer Diagnosis

Purpose: To evaluate the different features in parameters of diffusion kurtosis imaging(DKI)between prostate cancer,benign prostatic hyperplasia(BPH)(stromal and nonstromal hyperplasia),and benign peripheral zone(PZ),to provide the evidence for diagnosing prostate cancer by this technique.Materials and Methods: To retrospective analysis 48 patients which performed conventional MRI and DKI exams in Air Force General Hospital.With pathologically confirmed 39 patients(14 were underwent radical prostatectomy,25 were determined by the results of TRUS-guided biopsy),with age 74.8±6.7.16 patients with prostate cancer(18 foci of prostate cancer),23 patients with BPH(14 stromal and 28 nonstromal hyperplasia),37 benign PZ.All patients were undertook axial T1WI?three-segment T2WI?axial T2WI-FS?axial DWI and DKI,DWI with 2 b value(0,1000s/mm2),DKI was applied diffusion gradients in 15 different spatial with 3 bvalues(0,1000,2000 s/mm2).For each focus,the mean value of the parameters of DWI(ADC)and DKI(MK,Ka,Kr,FA,MD,Da,Dr)values were measured.Regions of interest(ROIs)were drawn manually within all histopathologically verified lesion of every patient,as well as in the prostate cancer,BPH(stromal and nonstromal hyperplasia)and benign PZ.ROIs were chosen to be as large as possible,which should consistent more than 2/3 from the lesions.The parameters of DKI and ADC were compared using one-way analysis of variance(AVOVA)with patients as a random effect,Post hoc Turkey honestly significant difference(HSD)test for pairwise comparisons were used to determine whether there was any significant difference between prostate cancer,BPH and benign PZ.In addition,receiver operating characteristic(ROC)analyses were performed to evaluate the diagnostic performance of the parameters to discriminate prostate cancer from benign PZ.p values less than 0.05 were considered to indicate a significant difference.Results: There is a significant difference in the parameters of DKI(MK,Ka,Kr,FA,MD,Da,Dr)and ADC between prostate cancer,BPH and benign PZ(F=33.477,p =0.000<0.001;F=27.461,p =0.000<0.001;F=24.348,p =0.000<0.001,F=13.949,p =0.000<0.001;F=25.403,p =0.000<0.001;F=32.522,p =0.000<0.001;F=25.062,p =0.000<0.001;F=18.843,p =0.000<0.001,respectively).The parameters of DKI and ADC all showed significant difference between prostate cancer and benign PZ(MK p =0.000<0.001,Ka p =0.000<0.001,Kr p =0.000<0.001,MD p=0.000<0.001,Da p =0.000<0.001,Dr p =0.000<0.001,FA p =0.000<0.001,ADC p=0.000<0.001);MK showed significant difference between prostate cancer and stromal BPH(p =0.01<0.05);MK,Ka,Kr,MD,Da,Dr and ADC showed significant difference between prostate cancer and nonstromal BPH(MK p =0.000<0.001,Ka p =0.000<0.001,Kr p =0.000<0.001,FA p =0.01<0.05,MD p =0.000<0.001,Da p =0.000<0.001,Dr p =0.000<0.001,ADC p =0.000<0.001).On the ROC analyses,the AUC of DKI parameters and ADC were all higher than 0.9(MK AUC=0.992,Ka AUC=0.980,Kr AUC=0.968,FA AUC=0.865,MD AUC=0.968,Da AUC=0.972,Dr AUC=0.948,ADC AUC=0.948),MD,Da and Dr showed the highest sensitivity among all parameters,on the other hand,MD,Da and Dr showed the highest specificity of cancer detection.Conclusion:DKI is the most useful technique in diagnostic differentiation of prostate cancer from BPH and benign PZ.DKI plays a significant role in localized and diagnosing prostate.