Journal
RADIOLOGIA MEDICA
Volume 124, Issue 10, Pages 946-954Publisher
SPRINGER-VERLAG ITALIA SRL
DOI: 10.1007/s11547-019-01047-3
Keywords
Prostate cancer; Extra-capsular extension; DTI; Tractography; Staging
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Purpose To evaluate the role of DTI (with fibretracking) and T2-weighted imaging (T2-WI) used together for predicting extra-capsular extension in patients with localized prostate cancer. Method and materials Thirty-six patients with biopsy-proven diagnosis of prostatic neoplasia performed MRI and underwent radical prostatectomy. Histopathological analysis showed ECE in 15/36 and capsule sparing in 21/36. By means of T2-WI, ECE was evaluated in a qualitative manner, according to PI-RADS v.2 (two groups with low and high risk of ECE); sensitivity and specificity were calculated for both groups. We performed a quantitative analysis on two tractographic parameters, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) and computed the ratio between the lesion quadrant and its contralateral (L/H ratio). We compared L/H ratios of patients with and without ECE; ROC analyses were performed to determinate ECE cut-off values of tractographic parameters. These cut-off values were used in association with T2-WI to reassess patients and to evaluate whether specificity and sensitivity of ECE detection change. Results T2-WI showed a sensitivity of 80% and a specificity of 71% in detection of ECE. Tractography displayed a significant difference in L/H ratio for FA and ADC between patients with and without ECE. The simultaneous use of T2-WI and tractography revealed high sensitivity (100%) on patients with low suspect of ECE (on T2-WI) and high specificity (83%) on patients with high suspect of ECE (on T2-WI). Conclusion The morphologic component of T2-weighted imaging and functional aspect of DTI should be interpreted together to more successfully assess the presence of ECE.
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