Application Of DKI,IVIM And DTI In Prognostic Gleason Group

PurposeDiffusion kurtosis imaging(DKI),Introvoxel incoherent motion(IVIM),Diffusion tensor imaging(DTI)and Magnetic resonance imaging(MRI)were used to predict the prognostic Gleason Group of prostate cancer.Materials and methods177 Patients with abnormal PSA and digital rectal examination from December 2018 to December 2019 in the Second Affiliated Hospital of Dalian Medical University were collected.Routine MR,DKI,IVIM and DTI images were collected by a 3.0-T MRI scanner(Discovery 750W;GE Medical Systems)with an 8-channel phase-controlled body front circle coil.Pathological tissues were obtained by magnetic resonance imaging-Transrectal ultrasound fusion image targeted biopsy technique and stained with Hematoxylin-eosin staining and basal cell labeling.According to the Prognostic Gleason Group(PGG)proposed by the International Society of Urological Pathology in 2014,the PGG was divided into two groups:the good prognosis group(PGG≤2)and the poor prognosis group(PGG>2).A total of 115 cases of prostate cancer were collected,including 24 cases of PGG 1,16 cases of PGG 2,28 cases of PGG 3,19 cases of PGG 4and 28 cases of PGG 5.There were 40 cases in the good prognosis group(PGG≤2)and75 cases in the poor prognosis group(PGG>2).All images were transferred to a workstation(Advantage Workstation 4.6;GE Medical Systems)which obtains DKI related parameters:mean kurtosis(MK),axial kurtosis(Ka),radial kurtosis(Kr),mean diffusivity(MD),axial diffusivity(Da),radial diffusivity(Dr),IVIM related parameters:standard apparent diffusion coefficient(standard ADC),pure molecular diffusion(D),pseudo diffusion coefficient(D~*),perfusion fraction(f),distributed diffusion coefficient(DDC)and water molecular diffusion heterogeneity index(a)value and DTI related parameter:fractional anisotropy(FA)value in target lesions.Statistical analyses were performed using IBM SPSS software(version 21.0,IBM,Chicago,IL).Correlations between the prognostic Gleason Group and related parameters’values of DKI,IVIM and DTI were accessed using Spearman’s rank correlation.The independent sample t test was used to compare the statistical differences among the two groups.For parameters with statistical differences,receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy between the good prognosis group and the poor prognosis group.The corresponding sensitivity,specificity and critical value were calculated.Results1.In DKI,IVIM and DTI,MK,Ka,Kr and FA values were positively correlated with the prognostic Gleason Group(r=0.451,0.558,0.295,0.253,P=0.000,0.000,0.001,0.006),while MD,Da,Dr,standard ADC,D and DDC values were negatively correlated with the prognostic Gleason Group(r=-0.661,-0.549,-0.514,-0.506,-0.569,-0.385,all P=0.000).However,D*,f and a values were not correlated with the prognostic Gleason Group(P=0.706,0.038,0.545).2.MK,Ka,Kr and FA values in the poor prognosis group were higher than those in the good prognosis group with statistically different(P=0.001,0.001,0.011,0.001).MD,Da,Dr,standard ADC,D and DDC values in the poor prognosis group were lower than those in the good prognosis group,and the differences were statistically significant(all P=0.001).D*,f and a values in the poor prognosis group were higher than those in the good prognosis group,but there was no statistical difference(P=0.461,0.053,0.704).3.Among DKI,IVIM and DTI related parameters,MD value was the best parameter to distinguish between the good prognosis group and poor prognosis group,which had the highest diagnosis efficiency(AUC:0.845,sensitivity:0.875,specificity:0.680,Cut off value:0.855).Conclusion1.DKI,IVIM and DTI have clinical application value in predicting the Prognostic Gleason Group of prostate cancer.2.Among DKI,IVIM and DTI related parameters,MK,Ka,Kr,MD,Da,Dr,standard ADC,D,DDC,FA values can be used to distinguish poor prognosis group and the good prognosis group.MD value had the best diagnostic performance in differentiating the poor prognosis group and the good prognosis group.