European Radiology

, Volume 29, Issue 3, pp 1133–1143 | Cite as

Diagnosis of transition zone prostate cancer using T2-weighted (T2W) MRI: comparison of subjective features and quantitative shape analysis

  • Satheesh Krishna
  • Nicola SchiedaEmail author
  • Matthew DF McInnes
  • Trevor A. Flood
  • Rebecca E. Thornhill



To assess T2-weighted (T2W) MRI to differentiate transition zone (TZ) prostate cancer (PCa) from benign prostatic hyperplasia (BPH).

Materials and methods

With IRB approval, 22 consecutive TZ PCa were retrospectively compared with 30 consecutive BPH (15 stromal, 15 glandular) nodules diagnosed using radical prostatectomy MRI maps. Two blinded radiologists (R1/R2) subjectively assessed the shape (round/oval vs. lenticular) and margin (circumscribed vs. blurred/indistinct) and for a T2W hypointense rim. Both radiologists segmented lesions extracting quantitative shape features (circularity, convexity and topology/skeletal branching). Statistical tests were performed using chi-square (subjective features), Mann-Whitney U (quantitative features), Cohen’s kappa/Bland-Altman and receiver-operator characteristic analysis.


There were differences in the subjective analysis of the shape, margin and absence of a T2W-rim comparing TZ PCa with BPH (p < 0.0001) with moderate to almost perfect agreement [kappa = 0.56 (shape), 0.72 (margin), 0.97 (T2W-rim)]. Area under the curve (AUC ± standard error) for diagnosis of TZ PCas was shape = 0.88 ± 0.05, margin = 0.89 ± 0.04, and T2W-rim = 0.91 ± 0.04. Shape, judged subjectively, was specific (100%/94% R1/R2) with low-to-moderate sensitivity (55%/88% R1/R2). Circularity and convexity differed between groups (p < 0.001) with no difference in topology/skeletal branches (p = 0.31). Agreement in measurements was substantial for significant quantitative variables and AUC ± SE, sensitivity and specificity for diagnosis of TZ PCa were: circularity = 0.98 ± 0.01, 90%/96%; convexity = 0.85 ± 0.06, 68%/97%. AUCs for circularity were higher than for subjective analysis (p = 0.01 and 0.26).


Subjective analysis of T2W-MRI accurately diagnoses TZ PCa with high accuracy also demonstrated for quantitative shape analysis, which may be useful for future radiogenomic analysis of transition zone tumors.

Key points

Presence of a complete T2-weighted hypointense circumscribed rim accurately diagnoses BPH.

Round shape accurately diagnoses BPH and can be assessed quantitatively using circularity.

Lenticular shape accurately diagnoses TZ PCa and can be assessed quantitatively using convexity.


Prostate Benign prostatic hyperplasia Prostate cancer Magnetic resonance imaging Medical imaging 



Active surveillance


Area under the curve


Benign prostatic hyperplasia


Dynamic contrast enhanced


Digital Imaging and Communications in Medicine


Diffusion weighted imaging




Interquartile range


Magnetic resonance imaging


Picture archiving and communication system


Prostate cancer


Prostate Imaging Reporting and Data System – version 2


Peripheral zone


Receiver-operator characteristic


Radical prostatectomy


T2 weighted


Trans-rectal ultrasound


Transition zone



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Nicola Schieda, MD FRCP(C).

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this article. One of the authors, Dr. Rebecca E. Thornhill, provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case-control study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Satheesh Krishna
    • 1
  • Nicola Schieda
    • 2
    Email author
  • Matthew DF McInnes
    • 1
  • Trevor A. Flood
    • 3
  • Rebecca E. Thornhill
    • 1
  1. 1.Department of Medical ImagingThe Ottawa Hospital, The University of OttawaOttawaCanada
  2. 2.The Ottawa Hospital, The University of OttawaOttawaCanada
  3. 3.Department of Anatomical PathologyThe Ottawa Hospital, The University of OttawaOttawaCanada

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