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Clinical Article
Application of MRI apparent diffusion coefficient in identifying prognostic risk stratification of prostate cancer
YI Nuo  WANG Yajing  WANG Peng  LIU Hao  ZHOU Wenzhen  YIN Xindao  WANG Liwei 

Cite this article as: Yi N, Wang YJ, Wang P, et al. Application of MRI apparent diffusion coefficient in identifying prognostic risk stratification of prostate cancer[J]. Chin J Magn Reson Imaging, 2022, 13(12): 104-110. DOI:10.12015/issn.1674-8034.2022.12.018.

[Abstract] Objective To assess the diagnostic performance of the apparent diffusion coefficient (ADC) of biparametric magnetic resonance imaging (bpMRI) in the identification of prostate cancer (PCa), performing the International Society of Urological Pathology (ISUP) grading group (GG) for PCa and comparing the diagnostic ability of minimum apparent diffusion coefficient (ADCmin) and mean apparent diffusion coefficient (ADCmean).Materials and Methods The bpMRI images and data of 91 patients were retrospectively analyzed, the ADCmin and ADCmean of the main lesions were calculated, and the receiver operating characteristic (ROC) curve was drawn to determine the diagnostic cut-off of ADC. The area under the curve (AUC) was calculated to analyze the diagnostic performance of ADC for PCa. The differences of ADC between benign and malignant lesions were compared, and the differences between low-risk, intermediate-and high-risk lesions were compared according to risk stratification. Correlations between ADC and ISUP GG were analyzed using Spearman analysis.Results Of the 91 patients, 48 had PCa (52.7%), and 43 had benign lesions (47.3%). The medians of ADCmin and ADCmean in PCa group were significantly lower than those in benign lesions group, and there was significant difference between benign lesions and malignant lesions (P<0.05). The median ADCmin and ADCmean of intermediate and high-risk PCa (ihPCa) were significantly lower than those of benign and low-risk groups, and the differences were significant (P<0.05). Taking 0.49×10-3 mm2/s (b=2000) as the diagnostic cut-off value, the specificity, positive predictive value, Youden index, and AUC of ADCmin in diagnosing ihPCa were 88%, 84%, 68%, and 0.87, respectively. Taking 0.64×10-3 mm2/s (b=2000) as the diagnostic cut-off value, the specificity, positive predictive value, Youden index, and AUC of ADCmean for diagnosing ihPCa were 85%, 78%, 59%, 0.83, respectively. The values of ADCmin and ADCmean were negatively correlated with ISUP GG values (ρ=-0.661, P<0.01).Conclusions As the ADC value decreases, the prognosis risk of PCa increases. The ADC parameters of bpMRI have relatively high specificity and PPV in the diagnosis of ihPCa and the diagnostic performance of ADCmin is better than that of ADCmean. The ADC parameters of bpMRI can be used to non-invasively assess the risk stratification related to the prognosis of PCa, providing an effective tool for risk prediction and individualized treatment of PCa patients, and suggesting that radiologists can focus more on ADCmin in diagnosis.
[Keywords] prostate cancer;benign prostatic hyperplasia;magnetic resonance imaging;biparametric magnetic resonance imaging;apparent diffusion coefficient;risk stratification

YI Nuo   WANG Yajing   WANG Peng   LIU Hao   ZHOU Wenzhen   YIN Xindao   WANG Liwei*  

Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China

Wang LW, E-mail:

Conflicts of interest   None.

Received  2022-07-07
Accepted  2022-11-29
DOI: 10.12015/issn.1674-8034.2022.12.018
Cite this article as: Yi N, Wang YJ, Wang P, et al. Application of MRI apparent diffusion coefficient in identifying prognostic risk stratification of prostate cancer[J]. Chin J Magn Reson Imaging, 2022, 13(12): 104-110. DOI:10.12015/issn.1674-8034.2022.12.018.

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