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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 838-842. doi: 10.19723/j.issn.1671-167X.2023.05.010

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Application of dynamic contrast enhanced status in multiparametric magnetic resonance imaging for prostatic cancer with PI-RADS 4 lesion

Chang-wei YUAN,De-run LI,Zhi-hua LI,Yi LIU,Gang-zhi SHAN,Xue-song LI*(),Li-qun ZHOU   

  1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
  • Received:2023-03-07 Online:2023-10-18 Published:2023-10-09
  • Contact: Xue-song LI E-mail:pineneedle@sina.com

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Abstract:

Objective: To evaluate the diagnostic value of dynamic contrast enhanced (DCE) of multiparametric magnetic resonance imaging (mpMRI) for prostate imaging reporting and data system (PI-RADS) 4 lesion in prostate peripheral zone. Methods: The clinical data of patients with PI-RADS 4 lesion in prostate peripheral zone who underwent prostate biopsy from January 2018 to September 2021 in Peking University First Hospital were retrospectively included. According to DCE status, the patients were divided into the conventional group (4 points for diffusion-weighted imaging) and the comprehensive group (3 points for diffusion-weighted imaging + 1 point for DCE positive). Pearson's chi-square test or Fisher's exact test for comparison was conducted between prostate cancer and non-cancer patients. Univariate and multivariate Logistic regression were performed to analyze the correlation of positive biopsy with age, total prostate specific antigen (PSA), free PSA/total PSA (f/tPSA), prostate volume (PV), PSA density (PSAD) and DCE status. Results: Among the 267 prostate biopsy patients, 217 cases were diagnosed as prostatic cancer (81.27%) and 50 cases were non-cancer (18.73%). Statistical analysis between the prostatic cancer group and the non-cancer group showed that there were significant differences in age, tPSA, PV and PSAD (all P < 0.05), but no significant differences in f/tPSA between the two groups. About different PI-RADS 4 lesion groups, the conventional group and the comprehensive group showed significant difference in biopsy results (P=0.001), and the conventional group had a higher positive rate. The PV of comprehensive group was larger than that of the conventional group. Among the prostate cancer patients diagnosed by biopsy, statistical analysis between the conventional group and comprehensive group showed that there were not significant differences in International Society of Urological Pathology (ISUP) grade and distinguishing clinically significant prostate cancer (all P > 0.05). Logistic univariate analysis showed that the diagnosis of prostate cancer was related to age, tPSA, f/tPSA, PV and DCE group status (all P < 0.05). Multivariate analysis showed that age, tPSA, PV and DCE group status (all P < 0.05) were independent risk factors for the diagnosis of prostatic cancer. Conclusion: tPSA, f/tPSA, PV and PSAD are the indicators to improve the diagnosis of prostatic cancer with PI-RADS 4 lesion in peripheral zone lesions. DCE status is worth considering, so that we can select patients for biopsy more accurately, reduce the rate of missed diagnosis of prostate cancer as well as avoid unnecessary prostate puncture.

Key words: Prostatic neoplasms, Magnetic resonance imaging, Dynamic contrast enhanced, Prostate imaging reporting and data system, Biopsy

CLC Number: 

  • R737.25

Table 1

Clinical characteristics of patients undergoing prostate biopsy"

Items Total (n=267) Prostate cancer group (n=217) Non-cancer group (n=50) P value
Age/years, ${\bar x}$±s 68.57±8.48 69.97±7.76 62.46±8.84 < 0.001
tPSA/(ng/mL), M (P25, P75) 9.26 (6.31, 13.23) 9.61 (6.59, 13.40) 7.23 (5.25, 12.93) 0.016
f/tPSA, ${\bar x}$±s 0.14±0.06 0.13±0.06 0.15±0.07 0.057
PV/mL, ${\bar x}$±s 53.12±33.16 48.55±28.85 72.98±42.47 < 0.001
PSAD/(ng/mL2), M (P25, P75) 0.20 (0.13, 0.36) 0.24 (0.14, 0.38) 0.12 (0.09, 0.18) < 0.001
DCE, n(%) 0.001
  Comprehensive group 117 (43.8) 85 (72.6) 32 (27.4)
  Conventional group 150 (56.2) 132 (88.0) 18 (12.0)

Table 2

The clinical and pathological characteristic of patient in comprehensive and conventional group"

Items Comprehensive group (n=117) Conventional group (n=150) P value
Age/years, ${\bar x}$±s 68.80±8.80 68.26±8.07 0.610
tPSA/(ng/mL), M (P25, P75) 9.30 (6.15, 14.29) 9.21 (6.46, 12.86) 0.923
f/tPSA, ${\bar x}$±s 0.14±0.06 0.14±0.06 0.955
PV/mL, ${\bar x}$±s 55.98±37.27 50.89±29.50 0.596
PSAD/(ng/mL2), M (P25, P75) 0.19 (0.11, 0.37) 0.20 (0.14, 0.35) 0.535

Table 3

The pathological results of prostate cancer patients in comprehensive and conventional group (n=217)"

Items Comprehensive group (n=85) Conventional group (n=132) P value
ISUP, n(%) 0.346
  1 14 (48.3) 15 (51.7)
  2 27 (34.2) 52 (65.8)
  3 15 (33.3) 30 (66.7)
  4 13 (39.4) 20 (60.6)
  5 16 (51.6) 15 (48.4)
csPCa, n(%) 0.310
   Yes 71 (37.8) 117 (62.2)
   No 14 (48.3) 15 (51.7)

Table 4

Univariate and multivariate Logistic regression analysis of predicting prostate cancer"

Items Univariate analysis Multivariate analysis
OR 95%CI P value OR 95%CI P value
Age 1.12 1.07-1.17 < 0.001 1.22 1.42-1.31 < 0.001
tPSA/(ng/mL)
  ＜4 1 1
  4-10 3.11 1.00-9.72 0.050 8.47 1.88-38.20 0.005
  >10 and ≤20 3.65 1.10-12.06 0.030 10.69 2.11-54.08 0.004
  ＞20 9.00 1.50-53.86 0.020 142.55 8.05-2 523.13 0.001
f/tPSA 0.01 0.00-0.87 0.043 0.031 0.00-71.84 0.379
PV 0.98 0.97-0.99 < 0.001 0.96 0.96-0.98 < 0.001
DCE status 0.36 0.19-0.69 0.002 0.29 0.13-0.66 0.003
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