Background: We tested the feasibility of a simple method for assessment of prostate cancer (PCa) aggressiveness\nusing diffusion-weighted magnetic resonance imaging (MRI) to calculate apparent diffusion coefficient (ADC) ratios\nbetween prostate cancer and healthy prostatic tissue.\nMethods: The requirement for institutional review board approval was waived. A set of 20 standardized core\ntransperineal saturation biopsy specimens served as the reference standard for placement of regions of interest on\nADC maps in tumorous and normal prostatic tissue of 22 men with PCa (median Gleason score: 7; range, 6ââ?¬â??9). A\ntotal of 128 positive sectors were included for evaluation. Two diagnostic ratios were computed between tumor\nADCs and normal sector ADCs: the ADC peripheral ratio (the ratio between tumor ADC and normal peripheral zone\ntissue, ADC-PR), and the ADC central ratio (the ratio between tumor ADC and normal central zone tissue, ADC-CR).\nThe performance of the two ratios in detecting high-risk tumor foci (Gleason 8 and 9) was assessed using the area\nunder the receiver operating characteristic curve (AUC).\nResults: Both ADC ratios presented significantly lower values in high-risk tumors (0.48 Ã?± 0.13 for ADC-CR and 0.40 Ã?±\n0.09 for ADC-PR) compared with low-risk tumors (0.66 Ã?± 0.17 for ADC-CR and 0.54 Ã?± 0.09 for ADC-PR) (p < 0.001) and\nhad better diagnostic performance (ADC-CR AUC = 0.77, sensitivity = 82.2%, specificity = 66.7% and ADC-PR\nAUC = 0.90, sensitivity = 93.7%, specificity = 80%) than stand-alone tumor ADCs (AUC of 0.75, sensitivity = 72.7%,\nspecificity = 70.6%) for identifying high-risk lesions.\nConclusions: The ADC ratio as an intrapatient-normalized diagnostic tool may be better in detecting high-grade\nlesions compared with analysis based on tumor ADCs alone, and may reduce the rate of biopsies.
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