Apparent Diffusion Coefficient Values as a Complementary Tool in Prostate Gland Disease: Retrospective Evaluation of Apparent Diffusion Coefficient Values with Pathological Data Guided by PI-RADSv2.1

Abstract

Objective: This retrospective study reveals whether a lesion is a benign pathological process or malignant by measuring apparent diffusion coefficient (ADC) values following prostate imaging reporting and diagnostic system version 2.1 (PI-RADSv2.1) guide on multiparametric magnetic resonance imaging (MpMRI) examinations. Furthermore, this study aims to determine the cut-off ADC values (ADCv) that may exist to help identify and distinguish between benign and the malignant lesions. Additionally, the paper evaluates whether there is a correlation between malignant lesions' International Society of Urological Pathology (ISUP) score and ADCv, and whether ADCv provide information about prostate cancer (PCa) aggressiveness without requiring invasive procedures.Materials and Methods: The study group consised of 243 patients. The lesions were diagnosed using transrectal ultrasound-guided cognitive MRI fusion. MpMRI images before the biopsy were evaluated according to PI-RADSv2.1 guideline by a radiologist. Three groups, benign prostatic tissue, prostatitis, and PCa were obtained according to the histopathological results.Results: When the cut-off value for ADC was 780x10-3, sensitivity was 80%. When the cut-off value was taken as 668x10-3, the sensitivity and specificity were 72% and 62%, respectively. When the cut-off ADCv was taken as 647x10-3, the sensitivity was 83% and the specificity was 48.5%. ADCv varied significantly depending on the ISUP groups (p=0.003). It was determined that the ISUP 1 group was significantly higher compared to other groups. ADC group mean values were not significantly different between groups 2, 3, 4, and 5.Conclusion: ADCv may be a suitable tool for estimating PCa aggressiveness, and it shows a significant potential to improve the diagnostic accuracy.