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Prostate heterogeneity correlates with clinical features on multiparametric MRI

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Abstract

Background

Prostate heterogeneity on multi-parametric MRI (mpMRI) may confound image interpretation by obscuring lesions; systematic biopsy may have a role in this context.

Purpose

To determine if prostate heterogeneity (1) correlates with clinical risk factors for prostate cancer and (2) associates with higher-grade tumor in systematic biopsy (SB), compared with MRI-directed target biopsy (MDTB), i.e., SB > MDTB, thus providing a rationale for combined biopsy.

Methods

IRB-approved retrospective study included men who underwent mpMRI, SB, and MDTB between 2015 and 2017. Regions of interest were applied to the entire transition zone (TZ) and peripheral zone (PZ) on T2-weighted imaging (T2WI), apparent diffusion coefficient maps (ADC), and early dynamic contrast-enhanced (DCE) images on the midgland slice. Mean signal intensities and standard deviation (SD) of each zone were calculated. SD served as a measure of heterogeneity. Spearman’s rank correlation analysis of clinical and imaging variables was performed. Univariate logistic regression was used to determine if any imaging variable associated with SB > MDTB.

Results

93 patients were included. Significant correlations included age and TZ ADC heterogeneity (rho = 0.34, p = 0.013), PSA density, and mean TZ ADC (rho = − 0.29, p = 0.049). PZ T2WI heterogeneity correlated with PZ ADC heterogeneity (rho = 0.48, p < 0.001). PZ DCE heterogeneity correlated with TZ DCE heterogeneity (rho = 0.46, p < 0.001). TZ ADC heterogeneity was associated with SB > MDTB prior to multiple comparison correction (p = 0.032). p value after correction was 0.24.

Conclusion

TZ ADC heterogeneity correlated with age and may reflect prostatic hyperplasia and/or prostate cancer. PZ heterogeneity, possibly a measure of prostatitis, correlated with TZ hyperplasia and/or inflammation. TZ ADC heterogeneity was associated with SB > MDTB with p value of < 0.05 prior to multiple correction; future investigation is needed to further elucidate significance of ADC heterogeneity in prostate imaging.

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Funding

Weill Cornell Medicine is the recipient of an in-kind research grant from Siemens Healthineers.

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Authors and Affiliations

  1. Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA

    Christine Chen & Daniel J. Margolis

  2. Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA

    Zihan Yang & Elizabeth Sweeney

  3. New York, USA

    Stefanie J. Hectors

  4. Department of Urology, Weill Cornell Medicine, New York, NY, USA

    Jim C. Hu

Authors
  1. Christine Chen
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  2. Zihan Yang
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  3. Elizabeth Sweeney
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  4. Stefanie J. Hectors
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Correspondence to Christine Chen.

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Chen, C., Yang, Z., Sweeney, E. et al. Prostate heterogeneity correlates with clinical features on multiparametric MRI. Abdom Radiol 46, 5369–5376 (2021). https://doi.org/10.1007/s00261-021-03221-6

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  • DOI: https://doi.org/10.1007/s00261-021-03221-6

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