Prostate cancer: correlation of intravoxel incoherent motion MR parameters with Gleason score



      To evaluate the potential of intravoxel incoherent motion (IVIM) imaging to predict histological prognostic parameters by investigating whether IVIM parameters correlate with Gleason score.

      Materials and methods

      The institutional review board approved this retrospective study, and informed consent was waived. A total of 41 patients with histologically proven prostate cancer who underwent prostate MRI using a 3 T MRI machine were included. For eight diffusion-weighted imaging b-values (0, 10, 20, 50, 100, 200, 500, and 800 s/mm2), a spin-echo echo-planar imaging sequence was performed. D, f, D, and ADCfit values were compared among three groups of patients with prostate cancer: Gleason score 6 (n=9), 7 (n=16), or 8 or higher (n=16). Receiver operating characteristic (ROC) curves were generated for D, f, D, and ADCfit to assess the ability of each parameter to distinguish cancers with low Gleason scores from cancers with intermediate or high Gleason scores.


      Pearson's coefficient analysis revealed significant negative correlations between Gleason score and ADCfit (r=−0.490, P=.001) and Gleason score and D values (r=−0.514, P=.001). Gleason score was poorly correlated with f (r=0.168, P=.292) and D values (r=−0.108, P=.500). The ADCfit and D values of prostate cancers with Gleason scores 7 or ≥8 were significantly lower than values for prostate cancers with Gleason score 6 (P<.05). ROC curves were constructed to assess the ability of IVIM parameters to discriminate prostate cancers with Gleason score 6 from cancers with Gleason scores 7 or ≥8. Areas under the curve were 0.671 to 0.974. ADCfit and D yielded the highest Az value (0.960–0.956), whereas f yielded the lowest Az value (0.633).


      The pure molecular diffusion parameter, D, was the IVIM parameter that best discriminated prostate cancers with low Gleason scores from prostate cancers with intermediate or high Gleason scores.


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        • Jemal A
        • Center MM
        • DeSantis C
        • Ward EM
        Global patterns of cancer incidence and mortality rates and trends.
        Cancer Epidemiol Biomark Prev. 2010; 19: 1893-1907
        • Herman CM
        • Kattan MW
        • Ohori M
        • Scardino PT
        • Wheeler TM
        Primary Gleason pattern as a predictor of disease progression in Gleason score 7 prostate cancer: a multivariate analysis of 823 men treated with radical prostatectomy.
        Am J Surg Pathol. 2001; 25: 657-660
        • Cookson MS
        • Fleshner NE
        • Soloway SM
        • Fair WR
        Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications.
        J Urol. 1997; 157: 559-562
        • Divrik RT
        • Eroglu A
        • Sahin A
        • Zorlu F
        • Ozen H
        Increasing the number of biopsies increases the concordance of Gleason scores of needle biopsies and prostatectomy specimens.
        Urol Oncol. 2007; 25: 376-382
        • Tamada T
        • Sone T
        • Jo Y
        • Toshimitsu S
        • Yamashita T
        • Yamamoto A
        • et al.
        Apparent diffusion coefficient values in peripheral and transition zones of the prostate: comparison between normal and malignant prostatic tissues and correlation with histologic grade.
        J Magn Reson Imaging. 2008; 28: 720-726
        • Hambrock T
        • Somford DM
        • Huisman HJ
        • van Oort I
        • Witjes JA
        • CA H-vdK
        • et al.
        Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer.
        Radiology. 2011; 259: 453-461
        • Peng Y
        • Jiang Y
        • Yang C
        • Brown JB
        • Antic T
        • Sethi I
        • et al.
        Quantitative analysis of multiparametric prostate MR images: differentiation between prostate cancer and normal tissue and correlation with Gleason score–a computer-aided diagnosis development study.
        Radiology. 2013; 267: 787-796
        • Woodfield CA
        • Tung GA
        • Grand DJ
        • Pezzullo JA
        • Machan JT
        • JF R
        2nd Diffusion-weighted MRI of peripheral zone prostate cancer: comparison of tumor apparent diffusion coefficient with Gleason score and percentage of tumor on core biopsy.
        AJR Am J Roentgenol. 2010; 194: W316-W322
        • Nagarajan R
        • Margolis D
        • Raman S
        • Sarma MK
        • Sheng K
        • King CR
        • et al.
        MR spectroscopic imaging and diffusion-weighted imaging of prostate cancer with Gleason scores.
        J Magn Reson Imaging. 2012; 36: 697-703
        • Verma S
        • Rajesh A
        • Morales H
        • Lemen L
        • Bills G
        • Delworth M
        • et al.
        Assessment of aggressiveness of prostate cancer: correlation of apparent diffusion coefficient with histologic grade after radical prostatectomy.
        AJR Am J Roentgenol. 2011; 196: 374-381
        • Itou Y
        • Nakanishi K
        • Narumi Y
        • Nishizawa Y
        • Tsukuma H
        Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: can ADC values contribute to assess the aggressiveness of prostate cancer?.
        J Magn Reson Imaging. 2011; 33: 167-172
        • Peng Y
        • Jiang Y
        • Antic T
        • Giger ML
        • Eggener SE
        • Oto A
        Validation of quantitative analysis of multiparametric prostate MR images for prostate cancer detection and aggressiveness assessment: a cross-imager study.
        Radiology. 2014; 271: 461-471
        • Vargas HA
        • Akin O
        • Franiel T
        • Mazaheri Y
        • Zheng J
        • Moskowitz C
        • et al.
        Diffusion-weighted endorectal MR imaging at 3 T for prostate cancer: tumor detection and assessment of aggressiveness.
        Radiology. 2011; 259: 775-784
        • Jung SI
        • Donati OF
        • Vargas HA
        • Goldman D
        • Hricak H
        • Akin O
        Transition zone prostate cancer: incremental value of diffusion-weighted endorectal MR imaging in tumor detection and assessment of aggressiveness.
        Radiology. 2013; 269: 493-503
        • Oto A
        • Yang C
        • Kayhan A
        • Tretiakova M
        • Antic T
        • Schmid-Tannwald C
        • et al.
        Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis.
        AJR Am J Roentgenol. 2011; 197: 1382-1390
        • Le Bihan D
        • Breton E
        • Lallemand D
        • Aubin ML
        • Vignaud J
        • Jeantet ML
        Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging.
        Radiology. 1988; 168: 497-505
        • Le Bihan D
        • Turner R
        • MacFall JR
        Effects of intravoxel incoherent motions (IVIM) in steady-state free precession (SSFP) imaging: application to molecular diffusion imaging.
        Magn Reson Med. 1989; 10: 324-337
        • Turner R
        • Le Bian D
        • Maier J
        • Vavrek R
        • Hedges LK
        • Pekar J
        Echo-planar imaging of intravoxel incoherent motions.
        Radiology. 1990; 177: 407-414
        • Dixon WT
        Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging: a modest proposal with tremendous potential.
        Radiology. 1988; 168: 566-567
        • Shinmoto H
        • Tamura C
        • Soga S
        • Shiomi E
        • Yoshihara N
        • Kaji T
        • et al.
        An intravoxel incoherent motion diffusion-weighted imaging study of prostate cancer.
        AJR Am J Roentgenol. 2012; 199: W496-W500
        • Pang Y
        • Turkbey B
        • Bernardo M
        • Kruecker J
        • Kadoury S
        • Merino ML
        • et al.
        Intravoxel incoherent motion MR imaging for prostate cancer: an evaluation of perfusion fraction and diffusion coefficient derived from different b-value combinations.
        Magn Reson Med. 2013; 69: 553-562
        • Döpfert J
        • Lemke A
        • Weidner A
        • Schad LR
        Investigation of prostate cancer using diffusion-weighted intravoxel incoherent motion imaging.
        Magn Reson Imaging. 2011; 29: 1053-1058
        • Kuru TH
        • Roethke MC
        • Stieltjes B
        • Maier-Hein K
        • Schlemmer HP
        • Hadaschik BA
        • et al.
        Intravoxel incoherent motion (IVIM) diffusion imaging in prostate cancer - what does it add?.
        J Comput Assist Tomogr. 2014; 38: 558-564
        • Zhang YD
        • Wang Q
        • Wu CJ
        • Wang XN
        • Zhang J
        • Liu H
        • et al.
        The histogram analysis of diffusion-weighted intravoxel incoherent motion (IVIM) imaging for differentiating the Gleason grade of prostate cancer.
        Eur Radiol. 2015; 25: 994-1004
        • Gibbs P
        • Liney GP
        • Pickles MD
        • Zelhof B
        • Rodrigues G
        • Turnbull LW
        Correlation of ADC and T2 measurements with cell density in prostate cancer at 3.0 tesla.
        Investig Radiol. 2009; 44: 572-576
        • Wang XZ
        • Wang B
        • Gao ZQ
        • Liu JG
        • Liu ZQ
        • Niu QL
        • et al.
        Diffusion-weighted imaging of prostate cancer: correlation between apparent diffusion coefficient values and tumor proliferation.
        J Magn Reson Imaging. 2009; 29: 1360-1366
        • Langer DL
        • van der Kwast TH
        • Evans AJ
        • Plotkin A
        • Trachtenberg J
        • Wilson BC
        • et al.
        Prostate tissue composition and MR meaurements: investigating the relationships between ADC, T2, K-trans, v(e), and corresponding histologic features.
        Radiology. 2010; 255: 485-494
        • Huellener MW
        • Mattei A
        • Ross S
        • Butea-Bocu M
        • Vosbeck J
        • Pauli C
        • et al.
        Integrated CT-perfusion shows no meaningful correlation with PSA and presurgical Gleason score in patients with early prostate cancer.
        Clin Imaging. 2014; 38: 850-857
        • Vos EK
        • Litjens GJ
        • Kobus T
        • Hambrock T
        • Hulsbergen-van de Kaa CA
        • Barentsz JO
        • et al.
        Assessment of prostate cancer aggressiveness using dynamic contrast-enhanced magnetic resonance imaging at 3 T.
        Eur Urol. 2013; 64: 448-455
        • Moradi M
        • Salcudean SE
        • Chang SD
        • Jones EC
        • Buchan N
        • Casey RG
        • et al.
        Multiparametric MRI maps for detection and grading of dominant prostate tumors.
        J Magn Reson Imaging. 2012; 35: 1403-1413
        • Padhani AR
        • Miles KA
        Multiparametric imaging of tumor response to therapy.
        Radiology. 2010; 256: 348-364
        • Cornud F
        • Delongchamps NB
        • Mozer P
        • Beuvon F
        • Schull A
        • Muradyan N
        • et al.
        Value of multiparametric MRI in the work-up of prostate cancer.
        Curr Urol Rep. 2012; 13: 82-92
        • Langer DL
        • van der Kwast TH
        • Evans AJ
        • Trachtenberg J
        • Wilson BC
        • Haider MA
        Prostate cancer detection with multiparametric MRI; logistic regression analysis of quantitative T2, diffusion-weighted imaging, and dynamic contrast-enhanced MRI.
        J Magn Reson Imaging. 2009; 30: 327-334
        • Koh DM
        • Collins DJ
        • Orton MR
        Intravoxel incoherent motion on body diffusion-weighted MRI: reality and challenges.
        AJR Am J Roentgenol. 2011; 196: 1351-1381