Histogram Analysis Of Diffusion Kurtosis Imaging For The Diagnostic Value And Invasive Evaluation In Prostate Cancer

Objective To investigate diagnostic performance of diffusion kurtosis imaging histogram analysis in detecting prostate cancer（PCa）and assessing aggressiveness of prostate cancer.Methods 110 patients were retrospectively enrolled who were clinically suspected of prostate disease and underwent MRI examination in our hospital from January 2017 to June2020.Diagnosed by TRUS or surgery,57 cases were in the benign prostatic hyperplasia group and 53 cases were in the prostate cancer group,including 12 cases of low-grade cancer（LG）（Gleason score≤6）and 41 cases of high-grade cancer（HG）（Gleason score≥7）.All patients underwent MRI examination before TEUS or surgery,the sequence included:T1WI,T2WI,DWI,and DKI.Use Firevoxel software to delineate the region of interest（ROI）in the DKI and DWI sequence images,and measure the histogram parameters of DKI（Dapp,Kapp）and ADC value,including the mean,median,max,min,10th,25th,50th,75th,90th percentile,kurtosis and skewness.Intraclass correlation coefficient（ICC）was used to analyze the repeatability of data measurement.The independent sample t-test was used to evaluate the differences in the measurement parameters between BPH and PCa,and between LG and HG.The receiver operating characteristic curve（ROC）was used to analyze the differential diagnosis of statistically significant parameters.Spearman rank correlation analysis showed the correlation between each parameter and GS.Results Except for D_app-max,K_app-min,ADC_max,kurtosis and skewness of D_app,K_app,and ADC,other parameters had good inter-observer reliability,with ICC 0.672-0.935.Mean,median,min,10th,25th,50th,_a75th,90th of Dapp,and mean,median,min,max,10th,25th,50th,75th,90th of ADC in BPH group were significantly higher than those in PCa group（P<0.001）.Mean,median,max,min,10th,25th,50th,75th and 90th of K_appin BPH group were significantly lower than those in PCa group（P<0.001）.Mean,median,min,10th,25th,50th,75th,90th of D_appand ADC in HG were significantly lower than in LG（P<0.05）.Mean,median,max,min,25th,50th,75th and 90th of K_appin HG were significantly higher than those in LG（P<0.05）.D_app-10thand K_app-90thhad better diagnostic efficiency to differentiate BPH and PCa than ADC_10th（AUC=0.968,0.970,0.959）,with no significant difference statistically（P=0.2581,0.5183）.The combined diagnostic efficiency of D_app-10thand K_app-90thwas higher（AUC=0.972）,and there was no statistically significant difference with ADC_10th（P=0.3319）.D_app-10th,K_app-90thhad better diagnostic efficiency（AUC=0.837,0.797）than ADC_10th（AUC=0.776）in the differential diagnosis of LG and HG,with no significant difference statistically（P=0.3648,0.5025）.The combined diagnostic efficiency of D_app-10thand K_app-90thwas higher than the above parameters（AUC=0.850）,and there was no statistically significant difference with ADC_10th（P=0.0731）.D_appand ADC parameters were negatively correlated with Gleason score,and K_appparameters were positively correlated with Gleason score.K_app-90thhad a good correlation with Gleason score（r=0.619,P<0.05）.Conclusion Histogram analysis of DKI can help to diagnose prostate cancer,assess the aggressiveness of prostate cancer,and contribute to clinical treatment.