Quantitative Analysis of Multiparametric Prostate MR Images: Differentiation between Prostate Cancer and Normal Tissue and Correlation with Gleason Score-A Computer-aided Diagnosis Development Study

Purpose: To evaluate the potential utility of a number of parameters obtained at T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced multiparametric magnetic resonance (MR) imaging for computer-aided diagnosis (CAD) of prostate cancer and assessment of cancer aggressiveness. Materials and Methods: In this institutional review board-approved HIPAA-compliant study, multiparametric MR images were acquired with an endorectal coil in 48 patients with prostate cancer (median age, 62.5 years; age range, 44-73 years) who subsequently underwent prostatectomy. A radiologist and a pathologist identified 104 regions of interest (ROIs) (61 cancer ROIs, 43 normal ROIs) based on correlation of histologic and MR findings. The 10th percentile and average apparent diffusion coefficient (ADC) values, T2-weighted signal intensity histogram skewness, and Tofts K-trans were analyzed, both individually and combined, via linear discriminant analysis, with receiver operating characteristic curve analysis with area under the curve (AUC) as figure of merit, to distinguish cancer foci from normal foci. Spearman rank-order correlation (r) was calculated between cancer foci Gleason score (GS) and image features. Results: AUC (maximum likelihood estimate +/- standard error) values in the differentiation of prostate cancer from normal foci of 10th percentile ADC, average ADC, T2weighted skewness, and K-trans were 0.92 +/- 0.03, 0.89 +/- 0.03, 0.86 +/- 0.04, and 0.69 +/- 0.04, respectively. The combination of 10th percentile ADC, average ADC, and T2-weighted skewness yielded an AUC value for the same task of 0.95 +/- 0.02. GS correlated moderately with 10th percentile ADC (rho = 20.34, P = .008), average ADC (rho = 20.30, P = .02), and K-trans (rho = 0.38, P = .004). Conclusion: The combination of 10th percentile ADC, average ADC, and T2-weighted skewness with CAD is promising in the differentiation of prostate cancer from normal tissue. ADC image features and K-trans moderately correlate with GS.