Performance of Ultrafast DCE-MRI for Diagnosis of Prostate Cancer

Rationale and Objectives

This study aimed to test high temporal resolution dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for different zones of the prostate and evaluate its performance in the diagnosis of prostate cancer (PCa). Determine whether the addition of ultrafast DCE-MRI improves the performance of multiparametric MRI.

Materials and Methods

Patients ( n = 20) with pathologically confirmed PCa underwent preoperative 3T MRI with T2-weighted, diffusion-weighted, and high temporal resolution (~2.2 seconds) DCE-MRI using gadoterate meglumine (Guerbet, Bloomington, IN) without an endorectal coil. DCE-MRI data were analyzed by fitting signal intensity with an empirical mathematical model to obtain parameters: percent signal enhancement, enhancement rate (α), washout rate (β), initial enhancement slope, and enhancement start time along with apparent diffusion coefficient (ADC) and T2 values. Regions of interests were placed on sites of prostatectomy verified malignancy ( n = 46) and normal tissue ( n = 71) from different zones.

Results

Cancer (α = 6.45 ± 4.71 s −1 , β = 0.067 ± 0.042 s −1 , slope = 3.78 ± 1.90 s −1 ) showed significantly ( P < .05) faster signal enhancement and washout rates than normal tissue (α = 3.0 ± 2.1 s −1 , β = 0.034 ± 0.050 s −1 , slope = 1.9 ± 1.4 s −1 ), but showed similar percentage signal enhancement and enhancement start time. Receiver operating characteristic analysis showed area under the curve for DCE parameters was comparable to ADC and T2 in the peripheral (DCE 0.67–0.82, ADC 0.80, T2 0.89) and transition zones (DCE 0.61–0.72, ADC 0.69, T2 0.75), but higher in the central zone (DCE 0.79–0.88, ADC 0.45, T2 0.45) and anterior fibromuscular stroma (DCE 0.86–0.89, ADC 0.35, T2 0.12). Importantly, combining DCE with ADC and T2 increased area under the curve by ~30%, further improving the diagnostic accuracy of PCa detection.

Conclusion

Quantitative parameters from empirical mathematical model fits to ultrafast DCE-MRI improve diagnosis of PCa. DCE-MRI with higher temporal resolution may capture clinically useful information for PCa diagnosis that would be missed by low temporal resolution DCE-MRI. This new information could improve the performance of multiparametric MRI in PCa detection.

Introduction

Prostate cancer (PCa) is the most common non-cutaneous cancer among men in the United States, with more than 200,000 men diagnosed with PCa yearly . Magnetic resonance imaging (MRI) is increasingly used in the detection and local staging of PCa. Dynamic contrast-enhanced (DCE) MRI is a valuable tool for clinical detection and diagnosis of PCa and for evaluating response of therapy . DCE-MRI along with T2-weighted (T2W) and diffusion-weighted imaging (DWI) is a key component of multiparametric MRI (mpMRI) of the prostate. The addition of DCE-MRI to T2W and DWI improves the diagnostic accuracy in PCa detection .

In the recent Prostate Imaging-Reporting and Data System (PI-RADS) version 2 consensus guidelines , DCE is designated as secondary to DWI and T2W imaging. A temporal resolution higher than 10–15 seconds per image is recommended for clinical use . However, the full potential of DCE-MRI may not be reached and, in particular, the details of the contrast uptake kinetics may not be captured when data are acquired with relatively low temporal resolution. An investigation of the effect of temporal resolution on diagnostic performance of DCE-MRI in PCa detection showed higher temporal resolution leads to increased diagnostic performance . Recent studies looking at high temporal resolution (<10 seconds) DCE in the prostate showed that signal enhancement during the first 30–40 seconds after contrast media injection is very sparse, and that therefore, PCa can be detected more accurately at very early times after injection .

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Materials and Methods

Study Patients

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MRI

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Table 1

MR Imaging Parameters

Imaging Sequence Pulse Sequence FOV (mm) Scan Matrix Size Resolution (mm) TE (ms) TR (ms) Slice Thickness (mm) Flip Angle (°) Axial T2WI SE-TSE 200 256 × 256 0.8 × 0.8 38,88,138, 188,238,288 8200 3 90 DWI \* SE-EPI 220 150 × 150 1.5 × 1.5 75 4700 3 90 Ultrafast DCE † T1-FFE 200 160 × 160 1.25 × 1.25 1.4 3.8 3 10

EPI, echo planar imaging; FFE, fast field echo; FOV, field of view; SE, spin echo; TE, echo time; TR, repetition time; TSE, turbo spin echo.

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Semiquantitative MR Image Analysis

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STE=S0exp(−TE/T2), S

exp

(

−

)

where S TE is the signal measured at each TE, and S 0 is the extrapolated signal at TE = 0 ms.

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Sb=SSEexp(−b.ADC), S

exp

(

−

)

where b or b -value is the diffusion-weighting factor, S b is the attenuated spin-echo signal measured at each b -value, and S SE is the maximum spin-echo signal without diffusion attenuation ( b = 0).

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PSE(t)=S(t)−S0S0×100 P

(

)

(

)

−

100

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PSE(t)=A(1−e−αt)e−βt PSE

(

)

(

−

)

−

where A is the amplitude of PSE, α is the signal enhancement or uptake rate (sec −1 ), and β is the washout rate (sec −1 ).

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Statistical Analysis

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Results

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Performance of T2 and ADC Values

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DCE-MRI Characteristics of Normal Prostate and PCa

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Table 2

Summary of Quantitative mpMRI Parameters

mpMRI Quantitative Metric Cancer Normal Tissue Peripheral Zone Transition Zone Central Zone Anterior Fibromuscular Stroma ADC

(µm 2 /ms) 1.15 ± 0.411.55 ± 0.35 1.15 ± 0.32 0.96 ± 0.25 0.87 ± 0.37 T2

(ms) 108.7 ± 30.0192.8 ± 69.2 118.5 ± 32.0 102.8 ± 20.872.1 ± 20.1 MIP

(%/s) 160.6 ± 41.7 133.4 ± 46.3 159.0 ± 41.0 134.8 ± 46.3 129.9 ± 56.0 α

(%/s) 6.45 ± 4.713.18 ± 2.00 4.28 ± 2.342.60 ± 1.672.17 ± 1.85 β

(%/s) 0.067 ± 0.042 0.043 ± 0.044 0.066 ± 0.0350.019 ± 0.0610.010 ± 0.039 slope

(%/s) 3.78 ± 1.901.94 ± 1.69 2.98 ± 1.491.62 ± 0.701.23 ± 1.23 Start point

(s) 35.9 ± 7.6 30.9 ± 7.7 34.4 ± 7.3 33.6 ± 9.3 34.1 ± 8.3 TOA

(s) 37.6 ± 7.5 33.7 ± 8.1 36.3 ± 7.7 36.0 ± 10.2 39.6 ± 13.5n 46 18 16 18 19

Magnetic resonance imaging (MRI) parameters that were found to be significantly different ( P < .01) from cancer using analysis of variance (ANOVA) with post hoc Tukey honest significance test (HSD) test are displayed in bold.

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Correlation of Quantitative mpMRI Parameters with Gleason Score

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Diagnosis of PCa Using mpMRI with Ultrafast DCE-MRI

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Table 3

Results of ROC Analysis Between Prostate Cancer and Normal Tissue From Different Prostate Zones

α β Slope ADC T2 ADC + T2 ADC + T2 + DCE α Entire prostate † 0.770 \* 0.719 \* 0.800 \* 0.550 0.522 0.601 0.765 \* PZ 0.739 \* 0.667 \* 0.819 \* 0.803 \* 0.891 \* 0.902 \* 0.922 \* TZ 0.689 \* 0.605 0.715 \* 0.693 \* 0.745 \* 0.767 \* 0.797 \* CZ 0.824 \* 0.792 \* 0.878 \* 0.446 ‡ 0.454 ‡ — — AFMS 0.871 \* 0.864 \* 0.885 \* 0.351 ‡ 0.116 \* , ‡ — —

ADC, apparent diffusion coefficient; AFMS, anterior fibromuscular stroma; CZ, central zone; DCE, dynamic contrast-enhanced; PZ, peripheral zone; ROC, receiver operating characteristic; TZ, transition zone.

Area under the curve (95% confidence interval).

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Discussion

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Conclusion

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Acknowledgment

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Performance of Ultrafast DCE-MRI for Diagnosis of Prostate Cancer

Rationale and Objectives

Materials and Methods

Results

Conclusion

Introduction

Materials and Methods

Study Patients

MRI

Semiquantitative MR Image Analysis

Statistical Analysis

Results

Performance of T2 and ADC Values

DCE-MRI Characteristics of Normal Prostate and PCa

Correlation of Quantitative mpMRI Parameters with Gleason Score

Diagnosis of PCa Using mpMRI with Ultrafast DCE-MRI

Discussion

Conclusion

Acknowledgment

References

Further Reading

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