Problems of Social Hygiene, Public Health and History of MedicineProblems of Social Hygiene, Public Health and History of Medicine0869-866X2412-2106Joint-Stock Company Chicot15310.32687/0869-866X-2019-27-si1-559-564Научная статьяMultiparametric magnetic resonance imaging markers of clinically significant prostate cancerGoncharukD. A.gonch.urology@yandex.ruVelievE. I.-LoranO. B.-PaklinaO. V.-SetdikovaG. R.-ShabuninI. V.-SokolovE. A.-Russian Medical Academy of Continuing Professional Education (RMACPE)S. P. Botkin City Clinical HospitalPatero Clinic Medical Diagnostic Center151220192755956406042021Copyright © 2019,2019Authors aimed to assess the correlation between the apparent diffusion coefficient (ADC of the tumor, ADC ratio) and final grade group (GG) after radical prostatectomy (RP), and to determine the threshold values of ADC for detecting clinically significant prostate cancer (PC) with subsequent evaluation in a prospective group. 118 patients with PC were included in the retrospective group. These patients underwent RP from 2012 to 2017 with preoperative 3 Tesla multiparametric MRI (mpMRT) with contrast enhancement in a single center. After analyzing all the MRI studies, the average values of tumor ADC and benign tissue ADC were calculated using the maps of ADC. The prospective part of the study included 60 patients with completed pre-biopsy mpMRI and subsequent RP from January 2018 to March 2019. The prospective part of the study demonstrated the effectiveness of applying the obtained diffusion coefficient thresholds. When used as a criterion for determining clinically significant prostate cancer (GG > 6), threshold value of ADC ratio had sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 84%, 91%, 87%, 94% and 78% respectively.clinically significant prostate cancergrade groupsmagnetic resonance imagingapparent diffusion coefficientклинически значимый рак предстательной железыгрейд-группамультипараметрическая магнитно-резонансная томографияизмеряемый коэффициент диффузии[Epstein J. I., Allsbrook W. C., Amin M. B., Egevad L. L. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am. J. Surg. Pathol. 2005;29:1228-42.][Ahmed H. U., Arya M., Freeman A., et al. Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy? Lancet Oncol. 2012;13(11):e509-17.][Musunuru H. B., Yamamoto T., Klotz L., et al. Active surveillance for intermediate risk prostate cancer: survival outcomes in the Sunnybrook experience. J. Urol. 2016;196(6):1651-8.][Epstein J. I., Zelefsky M. J., Sjoberg D. D., et al. A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur. Urol. 2016;69(3):428-35.][Epstein J. I., Feng Z., Trock B. J., Pierorazio P. M. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur. Urol. 2012;61:1019-24.][Oto A., Kayhan A., Jiang Y., et al. Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology. 2010;257:715-23.][Litjens G. J. S., Hambrock T., Hulsbergen-van de Kaa C., Barentsz J. O., Huisman H. J. Interpatient variation in normal peripheral zone apparent diffusion coefficient: effect on the prediction of prostate cancer aggressiveness. Radiology. 2012;265:260-6.][Verma S., Rajesh A., Morales H., et al. Assessment of aggressiveness of prostate cancer: correlation of apparent diffusion coefficient with histologic grade after radical prostatectomy. AJR. Am. J. Roentgenol. 2011;196:374-81.][Hambrock T., Somford D. M., Huisman H. J., et al. Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer. Radiology. 2011;259:453-61.][Vargas H. A., Akin O., Franiel T., et al. Diffusion-weighted endorectal MR imaging at 3 T for prostate cancer: tumor detection and assessment of aggressiveness. Radiology. 2011;259:775-84.][Jung S. II, Donati O. F., Vargas H. A., 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.][Barentsz J. O., Richenberg J., Clements R., et al. ESUR prostate MR guidelines 2012. Eur Radiol. 2012;22:746-57.][Kim C. K., Park B. K., Kim B. High-b-value diffusion-weighted imaging at 3 T to detect prostate cancer: comparisons between b values of 1,000 and 2,000 s/mm2. AJR. Am. J. Roentgenol. 2010;194:W33-7.][Zelhof B., Pickles M., Liney G., et al. Correlation of diffusion-weighted magnetic resonance data with cellularity in prostate cancer. BJU Int. 2009;103:883-8.][Gibbs P., Liney G. P., Pickles M. D., Zelhof B., Rodrigues G., Turnbull L. W. Correlation of ADC and T2 measurements with cell density in prostate cancer at 3.0 Tesla. Invest. Radiol. 2009;44:572-6.][Simpkin C. J., Morgan V. A., Giles S. L., Riches S. F., Parker C., de Souza N. M. Relationship between T2 relaxation and apparent diffusion coefficient in malignant and non-malignant prostate regions and the effect of peripheral zone fractional volume. Br. J. Radiol. 2013;86:20120469.][Kim J. H., Kim J. K., Park B.-W., Kim N., Cho K.-S. Apparent diffusion coefficient: prostate cancer versus noncancerous tissue according to anatomical region. J. Magn. Reson. Imaging. 2008;28:1173-9.][Thormer G., Otto J., Horn L.-C., et al. Non-invasive estimation of prostate cancer aggressiveness using diffusion-weighted MRI and 3D proton MR spectroscopy at 3.0 T. Acta Radiol. 2014 [Epub ahead of print].][Lebovici A., Sfrangeu S. A., Feier D., et al. Evaluation of the normal-todiseased apparent diffusion coefficient ratio as an indicator of prostate cancer aggressiveness. BMC Med. Imaging. 2014;14:15.][Rosenkrantz A. B., Kopec M., Kong X., et al. Prostate cancer vs. postbiopsy hemorrhage: diagnosis with T2- and diffusion-weighted imaging. J. Magn. Reson. Imaging. 2010;31:1387-94.][Langer D. L., van der Kwast T. H., Evans A. J., et al. Intermixed normal tissue within prostate cancer: effect on MR imaging measurements of apparent diffusion coefficient and T2-sparse versus dense cancers. Radiology. 2008;249:900-8.][Merret C., et al. Magnet before the Needle: Commentary on MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis (PRECISION Trial). Urology. 2018.][Henderson D. R., et al. Nine-year Follow-up for a Study of Diffusion-weighted Magnetic Resonance Imaging in a Prospective Prostate Cancer Active Surveillance Cohort. Eur Urol. 2015. doi: 10.1016/ j.eururo.2015.10.010]