Abstract
Purpose
To evaluate the role of DTI (with fibretracking) and T2-weighted imaging (T2-WI) used together for predicting extra-capsular extension in patients with localized prostate cancer.
Method and materials
Thirty-six patients with biopsy-proven diagnosis of prostatic neoplasia performed MRI and underwent radical prostatectomy. Histopathological analysis showed ECE in 15/36 and capsule sparing in 21/36. By means of T2-WI, ECE was evaluated in a qualitative manner, according to PI-RADS v.2 (two groups with low and high risk of ECE); sensitivity and specificity were calculated for both groups. We performed a quantitative analysis on two tractographic parameters, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) and computed the ratio between the lesion quadrant and its contralateral (L/H ratio). We compared L/H ratios of patients with and without ECE; ROC analyses were performed to determinate ECE cut-off values of tractographic parameters. These cut-off values were used in association with T2-WI to reassess patients and to evaluate whether specificity and sensitivity of ECE detection change.
Results
T2-WI showed a sensitivity of 80% and a specificity of 71% in detection of ECE. Tractography displayed a significant difference in L/H ratio for FA and ADC between patients with and without ECE. The simultaneous use of T2-WI and tractography revealed high sensitivity (100%) on patients with low suspect of ECE (on T2-WI) and high specificity (83%) on patients with high suspect of ECE (on T2-WI).
Conclusion
The morphologic component of T2-weighted imaging and functional aspect of DTI should be interpreted together to more successfully assess the presence of ECE.
Similar content being viewed by others
References
Woo S et al (2015) Extracapsular extension in prostate cancer: added value of diffusion-weighted MRI in patients with equivocal findings on T2-weighted imaging. AJR Am J Roentgenol 204(2):W168–W175
Bill-Axelson A et al (2011) Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 364(18):1708–1717
Panebianco V et al (2013) In vivo 3D neuroanatomical evaluation of periprostatic nerve plexus with 3T-MR Diffusion Tensor Imaging. Eur J Radiol 82(10):1677–1682
Hricak H et al (2004) The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy. Cancer 100(12):2655–2663
Ploussard G et al (2011) Impact of positive surgical margins on prostate-specific antigen failure after radical prostatectomy in adjuvant treatment-naive patients. BJU Int 107(11):1748–1754
Godoy G, Tareen BU, Lepor H (2009) Site of positive surgical margins influences biochemical recurrence after radical prostatectomy. BJU Int 104(11):1610–1614
Yu KK et al (1997) Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. Radiology 202(3):697–702
Outwater EK et al (1994) Prostate carcinoma: assessment of diagnostic criteria for capsular penetration on endorectal coil MR images. Radiology 193(2):333–339
Erbetta A et al (2009) Diffusion tensor imaging shows different topographic involvement of the thalamus in progressive supranuclear palsy and corticobasal degeneration. AJNR Am J Neuroradiol 30(8):1482–1487
Farrell JA et al (2007) Effects of signal-to-noise ratio on the accuracy and reproducibility of diffusion tensor imaging-derived fractional anisotropy, mean diffusivity, and principal eigenvector measurements at 1.5 T. J Magn Reson Imaging 26(3):756–767
Di Paola V et al (2018) Evaluation of periprostatic neurovascular fibers before and after radical prostatectomy by means of 1.5 T MRI diffusion tensor imaging. Br J Radiol 91(1085):20170318
Finley DS et al (2012) Diffusion tensor magnetic resonance tractography of the prostate: feasibility for mapping periprostatic fibers. Urology 80(1):219–223
Srigley et al (2009) Protocol for the examination of specimens from patients with carcinoma of the prostate gland. Arch Pathol Lab Med 133:1568–1576
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standards
This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Cybulski, A.J., Catania, M., Brancato, S. et al. Added value of MRI tractography of peri-prostatic nerve plexus to conventional T2-WI in detection of extra-capsular extension of prostatic cancer. Radiol med 124, 946–954 (2019). https://doi.org/10.1007/s11547-019-01047-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-019-01047-3