ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2019 April;71(2):154-60

DOI: 10.23736/S0393-2249.18.03065-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Role of apparent diffusion coefficient values in prostate diseases characterization on diffusion-weighted magnetic resonance imaging

Giuseppe SALVAGGIO ¹ ✉, Mauro CALAMIA ¹, Pierpaolo PURPURA ¹, Tommaso V. BARTOLOTTA ¹, Dario PICONE ¹, Nino DISPENSA ², Claudio LUNETTA ¹, Alberto BRUNO ¹, Ludovica RASO ¹, Leonardo SALVAGGIO ³, Giuseppe LO RE ¹, Massimo GALIA ¹, Alchiede SIMONATO ², Massimo MIDIRI ¹, Roberto LAGALLA ¹

¹ Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy; ² Unit of Urology, Department of Surgery, Oncology, and Stomatology, University of Palermo, Palermo, Italy; ³ Facolty of Medicine and Surgery, University of Palermo, Palermo, Italy

BACKGROUND: To evaluate if normal and pathological prostate tissue can be distinguished by using apparent diffusion coefficient (ADC) values on magnetic resonance imaging (MRI) and to understand if it is possible to differentiate among pathological prostate tissues using ADC values.
METHODS: Our population consisted in 81 patients (mean age 65.4 years) in which 84 suspicious areas were identified. Regions of interest were placed over suspicious areas, detected on MRI, and over areas with normal appearance, and ADC values were recorded. Statistical differences between ADC values of suspicious and normal areas were evaluated. Histopathological diagnosis, obtained from targeted biopsy using MRI-US fusion biopsies in 39 patients and from prostatectomy in 42 patients, were correlated to ADC values.
RESULTS: Histopathological diagnosis revealed 58 cases of prostate cancer (PCa), 19 patients with indolent PCa (Gleason Score ≤6) and 39 patients with clinically significant PCa (Gleason Score ≥7), 16 of high-grade prostatic intraepithelial neoplasia (HG-PIN) and 10 of atypical small acinar proliferation (ASAP). Significant statistical differences between mean ADC values of normal prostate tissue versus PCa (P<0.00001), HG-PIN (P<0.00001) and ASAP (P<0.00001) were found. Significant differences were observed between mean ADC values of PCa versus HG-PIN (P<0.00001) and ASAP (P<0.00001) with many overlapping values. Differences between mean ADC values of HG-PIN versus ASAP (P=0.015) were not significant. Significant differences of ADC values were also observed between patients with indolent and clinically significant PCa (P<0.00001).
CONCLUSIONS: ADC values allow differentiation between normal and pathological prostate tissue and between indolent and clinically significant PCa but do not allow a definite differentiation between PCa, HG-PIN, and ASAP.

KEY WORDS: Prostate; Diffusion magnetic resonance imaging; Magnetic resonance imaging