The clinical utility of prostate cancer heterogeneity using texture analysis of multiparametric MRI

  • Maira Hameed
  • Balaji Ganeshan
  • Joshua Shur
  • Subhabrata Mukherjee
  • Asim Afaq
  • Deepak BaturaEmail author
Urology - Original Paper



To determine if multiparametric MRI (mpMRI) derived filtration-histogram based texture analysis (TA) can differentiate between different Gleason scores (GS) and the D’Amico risk in prostate cancer.


We retrospectively studied patients whose pre-operative 1.5T mpMRI had shown a visible tumour and who subsequently underwent radical prostatectomy (RP). Guided by tumour location from the histopathology report, we drew a region of interest around the dominant visible lesion on a single axial slice on the T2, Apparent Diffusion Coefficient (ADC) map and early arterial phase post-contrast T1 image. We then performed TA with a filtration-histogram software (TexRAD -Feedback Medical Ltd, Cambridge, UK). We correlated GS and D’Amico risk with texture using the Spearman’s rank correlation test.


We had 26 RP patients with an MR-visible tumour. Mean of positive pixels (MPP) on ADC showed a significant negative correlation with GS at coarse texture scales. MPP showed a significant negative correlation with GS without filtration and with medium filtration. MRI contrast texture without filtration showed a significant, negative correlation with D’Amico score. MR T2 texture showed a significant, negative correlation with the D’Amico risk, particularly at textures without filtration, medium texture scales and coarse texture scales.


ADC map mpMRI TA correlated negatively with GS, and T2 and post-contrast images with the D’Amico risk score. These associations may allow for better assessment of disease prognosis and a non-invasive method of follow-up for patients on surveillance. Further, identifying clinically significant prostate cancer is essential to reduce harm from over-diagnosis and over-treatment.


Prostatic neoplasms Radical prostatectomy Neoplasm grading Prostate-specific antigen Magnetic resonance imaging Image enhancement Texture analysis 


Author contributions

AA: study conceptualisation. BG: MR image analysis (guidance), statistics and inputs to the manuscript. DB: Study conceptualisation, clinical data collection, manuscript revisions. JS: MR image analysis and manuscript revisions. MH: Initial draft, bibliography and manuscript revisions. SM: Clinical data collection and validation. Control of data and final manuscript approval were undertaken by the last author (study-guarantor).


BG and AA work at University College London Hospital/University College London (UCLH/UCL), which received a proportion of the funding from the UK’s Department of Health’s National Institute of Health Research, Biomedical Research Centre’s funding scheme. AA has also received funding from the London North West Healthcare Charitable Fund and the UCL Experimental Cancer Medicine Centre.

Compliance with ethical standards

Conflict of interest

BG is a Director of Feedback Medical Ltd ( and Shareholder of Feedback Plc, Cambridge (which wholly owns Feedback Medical Ltd.), a UK-based medical imaging software company and manufacturer of TexRAD texture analysis research software used in this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of RadiologyImperial College Healthcare NHS TrustLondonUK
  2. 2.Institute of Nuclear MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
  3. 3.Joint Department of Medical ImagingUniversity Health NetworkTorontoCanada
  4. 4.Department of UrologyDartford and Gravesham NHS TrustDartfordUK
  5. 5.Department of UrologyLondon North West University Healthcare NHS TrustLondonUK

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