Dynamic contrast-enhanced case-control analysis in 3T MRI of prostate cancer can help to characterize tumor aggressiveness

• Curve types showed no statistical association with healthy/tumor peripheral areas.
• Ktrans, ve, upslope and AUC showed significant differences in controls vs. tumors.
• The global diagnostic performance of standard MRI perfusion parameters is poor.
• Normalized Ktrans, upslope and AUC had good diagnostic accuracy for tumor grading.

PurposeThe aim of this work is to establish normality and tumor tissue ranges for perfusion parameters from dynamic contrast-enhanced (DCE) MR of the peripheral prostate at 3T and to compare the diagnostic performance of quantitative and semi-quantitative parameters.Materials and methodsThirty-six patients with prostate carcinomas (18 Gleason-6, 15 Gleason-7, and 3 Gleason-8) and 33 healthy subjects were included. Image analysis workflow comprised four steps: manual segmentation of whole prostate and lesions, series registration, voxelwise T1 mapping and calculation of pharmacokinetic and semi-quantitative parameters.ResultsKtrans, ve, upslope and AUC60 showed statistically significant differences between healthy peripheral areas and tumors. Curve type showed no association with healthy/tumor peripheral areas (chi-square = 0.702). Areas under the ROC curves were 0.64 (95% CI: 0.54–0.75), 0.70 (0.60–0.80), 0.62 (0.51–0.72) and 0.63 (0.52–0.74) for Ktrans, ve, upslope and AUC60, respectively. The optimal cutoff values were: Ktrans = 0.21 min−1 (sensitivity = 0.61, specificity = 0.64), ve = 0.36 (0.63, 0.71), upslope = 0.59 (0.59, 0.59) and AUC60 = 2.4 (0.63, 0.64). Significant differences were found between Gleason scores 6 and 7 for normalized Ktrans, upslope and AUC60, with good diagnostic accuracy (area under ROC curve 0.80, 95% CI: 0.60–1.00).ConclusionQuantitative (Ktrans and ve) and semi-quantitative (upslope and AUC60) perfusion parameters showed significant differences between tumors and control areas in the peripheral prostate. Normalized Ktrans, upslope and AUC60 values might characterize tumor aggressiveness.