Table 1.
Magnetic resonance imaging acquisition parameters.
Table 2.
Evaluation of each magnetic resonance imaging sequence according to the Prostate Imaging Reporting and Data System score.
Fig 1.
Diagram showing 12 cores systematic transrectal biopsy locations.
Table 3.
Patient characteristics.
Fig 2.
ROC curves for diagnosis in peripheral zone (A) and transition zone (B).
Table 4.
Estimates of sensitivity, specificity, accuracy, positive predictive value and negative predictive value per modality for both peripheral zone and transition zone.
Table 5.
Modality wise areas under the curves (AUCs) for both peripheral zone and transition zone.
Fig 3.
Images from a 55 yr old male patient with total prostate-specific antigen (PSA) 3.41 ng/ml and free PSA 0.247ng/ml. Systematic transrectal biopsy confirmed. prostate cancer (Gleason score 4 + 3 = 7).
(A) High-solution T2-weighted imaging shows low signal intensity area in the left boundary region of the transition zone (TZ) and peripheral zone (PZ); (B–D) On ultrahigh b-value diffusion-weighted imaging (DWI) (b = 1000, 2000, 3000 s/mm2), lesions on the left showed significantly higher signal nodules. Increase in b-values reduced normal tissue signal intensity, but not signals from prostate cancer tissue; (E–G) With conventional and ultrahigh b-value DWI (b = 1000, 2000, 3000 s/mm2), apparent diffusion coefficient map (ADC), and organization of lesions on the left and normal ADC values were significantly different; lesion ADC values decreased with increase in b-value. Key: ADC—apparent diffusion coefficient; DWI—diffusion-weighted imaging; PSA—prostate-specific antigen; PZ—peripheral zone; TZ—transition zone.
Fig 4.
Images from a 79 yr old male patient with total PSA 6.1 ng/ml. Systematic transrectal biopsy confirmed prostate hyperplasia and prostatitis.
(A) High-solution T2-weighted imaging shows low signal lesions on bilateral peripheral zone; (B–D) On conventional and ultrahigh b-value diffusion-weighted imaging (b = 1000, 2000, 3000 s/mm2), bilateral PZ lesions showed slightly higher signal nodules. Intensity of lesion signals decreased with increase in b-value, whereas the intensity of normal tissue signals reduced significantly. Key: PSA—Prostate specific antigen; PZ—Peripheral zone.
Fig 5.
Images of a 68 yr old male patient with total PSA 10.5 ng/ml and free PSA 1.66 ng/ml. Systematic transrectal biopsy confirmed PCa (Gleason score 4 + 3 = 7).
(A) High-solution T2-weighted imaging shows low signal intensity area in the right TZ, and PI-RADS score of 2 due to subtle mass effect; (B) PI-RADS score of 3 on DWI with b-value 1000 s/mm2. The cancer is ambiguous because of high signal intensity from surrounding parenchyma; (C, D) PI-RADS score of 5 on ultrahigh DWI with b-value 2000, 3000 s/mm2. High signal intensity areas in the right portion of the TZ are clearly visible. Key: PSA—Prostate specific antigen; PCa—prostate cancer; TZ—transition zone; DWI—diffusion-weighted imaging; PI-RADS—Prostate Imaging Reporting and Data System.