Evaluation of the contribution of perfusion MRİ in diagnosis of prostate cancer by multiparametric MRİ

Purpose: To obtain the quantitative perfusion MR data in the lesions determined according to Prostate Imaging Reporting and Data System version 2 (PIRADS v2) manual and to evaluate the contribution of these data in the diagnosis of cancer in patients with suspected prostate cancer. Materials and Methods: This prospective study was carried out with the permission of the protocol of Malatya İnönü University Scientific Research and Publication Ethics Board 2018/66. Between January 2018 and March 2019, 76 lesions of 56 patients with clinical findings and PSA were suspected for prostate cancer were included in the study. All patients underwent multiparametric prostate magnetic resonance imaging (MPPMRG) for medical indication. Images of the patients were evaluated according to Prostate Imaging Reporting and Data System version 2 (PIRADS v2) manual by 2 radiologists who did not know the histopathology results. Intensity measurements were performed on ADC images obtained with high b values. Perfusion MR maps were created from tkms images according to tofts model. On the maps, reference measurements were made from the lesions and radiologically benign areas. Gleason scores were determined by histopathological sampling. Correlation between Ktrans, Kep, Ve, iAUC and ADC signals obtained from perfusion MR images with Gleason and PIRADS scores were evaluated. Findings: The mean age of the patients included in the study was 64.02 (44-86), the mean value of tPSA was 20.11 (2.21-517.61) ng / ml, and the mean prostate volume was 68.79 (18-186) ml. ADC signal intensity obtained by the high b value of the lesions located in the peripheral zone, the Ktrans, Kep, Ve and iAUC values obtained from the volume of interest (VOI) obtained in the perfusion MR maps were found to be statistically significant (p <0.05). In the analyzes, the Ktrans cut-off value of the peripheral zone lesions was 0.218, the specificity was 52%, and the sensitivity was 75%; iAUC cut-off value was 0.209, specificity was 81.3% and sensitivity was 85.7%. Result: Evaluation of The perfusion MR parameters obtained from DkMR images with PIRADS scores increase the coherence of the lesions with histopathology results. Our study shows that the perfusion MR parameters are quantitative criteria that can be used to characterize prostate gland peripheral zone lesions as benign or cancer. Further studies with larger patient series having prostatectomy or MR fusion biopsy are needed to obtain more accurete histopathological results to confirm these data. Keywords: Multiparametric MRI, Perfusion MRI, Ktrans, Prostate cancer, PIRAD