Faculty Collaboration Database

Multiparametric MRI Features and Pathologic Outcome of Wedge-Shaped Lesions in the Peripheral Zone on T2-Weighted Images of the Prostate. AJR Am J Roentgenol 2019 Jan;212(1):124-129

Date

11/08/2018

Pubmed ID

30403532

Pubmed Central ID

PMC6437777

DOI

10.2214/AJR.18.19742

Scopus ID

2-s2.0-85058902292 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

OBJECTIVE: This study investigates the multiparametric MRI (mpMRI) characteristics and pathologic outcome of wedge-shaped lesions observed on T2-weighted images.

MATERIALS AND METHODS: Seventy-six patients with histologically confirmed prostate cancer underwent preoperative 3-T MRI before undergoing radical prostatectomy. Two radiologists worked in consensus to mark wedge-shaped regions of hypointensity on T2-weighted images and assess their appearance on apparent diffusion coefficient (ADC) maps (to determine the degree of hypointensity) and dynamic contrast-enhanced (DCE) MRI (DCE-MRI) (to assess whether they showed early enhancement). The pathologic outcome of wedge-shaped lesions was assessed by matching MR images with whole-mount histologic specimens retrospectively. The difference in quantitative ADC values between malignant and benign wedge-shaped lesions was assessed using a t test.

RESULTS: Thirty-five wedge-shaped regions were identified, 12 (34%) of which were found be malignant. Most malignant wedge-shaped regions were highly hypointense (10/12; 83%) on ADC maps and showed early enhancement on DCE-MRI (7/12; 58%). However, benign wedge-shaped lesions were predominantly mildly hypointense (13/23; 57%) on ADC maps and showed no early enhancement (15/23; 65%). Histologic correlates of the benign wedge-shaped regions showed prostatitis (acute inflammation [7/23; 30%] or chronic inflammation [9/23; 39%]), hemosiderin-laden macrophages (6/23; 26%), prominent blood vessels (7/23; 30%), intraluminal blood (6/23; 26%), and nonspecific atrophy (6/23; 26%). The mean (± SD) quantitative ADC value of malignant wedge-shaped regions (1.13 ± 0.11 μm²/ms) was significantly lower (p = 0.0001) than that of benign wedge-shaped regions (1.52 ± 0.27 μm²/ms).

CONCLUSION: This study shows that a greater percentage of wedge-shaped features are malignant than was previously thought. Of importance, mpMRI (specifically, ADC maps) can distinguish between malignant and benign wedge-shaped features.

Author List

Chatterjee A, Tokdemir S, Gallan AJ, Yousuf A, Antic T, Karczmar GS, Oto A

Author

Alexander J. Gallan MD Assistant Professor in the Pathology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Contrast Media
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging
Humans
Image Enhancement
Imaging, Three-Dimensional
Magnetic Resonance Imaging
Male
Middle Aged
Prostatectomy
Prostatic Neoplasms
Retrospective Studies