Evaluation of the accuracy of dynamic contrast enhanced MRI in the diagnosis of invasive prostate neoplasm using pathological findings

Background: Prostate cancer is the most common malignancy in men and the second leading cause of death in all countries of the world. The exact mechanism of prostate cancer is not known. On the other hand, early detection of prostate cancer can lead to a complete cure. Several clinical experiments including Digital Rectum Examination (DRE), biochemistry such as Prostate Specific Antigen (PSA), and pathology such as Trans Rectal Ultra Sonography (TRUS) are used to assess the size and spread of prostate cancer. In this study, the relationship between mean serum PSA and Gleason score as a standard method in patients with prostate cancer was compared using the parameters extracted from DCE MRI. Methods: This applied-fundamental study was performed on 90 patients with prostate cancer, according to McDonald's criteria who were referred to Shafa Imaging Center in Isfahan, from March 2020 to October 2020. Quantitative analysis is based on modeling the change of concentration of the contrast agent using pharmacokinetic modeling techniques. The pathologist then determined the Gleason score using anatomical landmarks (such as prostate urethra) in the same areas suspected of being cancerous. Existing commercial software captures DCE-MRI data and creates parametric maps such as Ktrans and Kep maps that can be used for diagnostic purposes. Results: Kep and Ktrans maps showed a significant difference between healthy and cancerous tissue. Kep and Ktrans in prostate cancer were significantly higher than in healthy tissue (P<0.05). Pearson correlation coefficient was used to investigate the relationship between DCE-MRI parameters and histopathological findings. No significant relationship was observed between Gleason score and DCE MRI parameters. Conclusion: DCE MRI parameters significantly improve the accurate diagnosis of prostate cancer and are useful and effective for diagnosis, management, and evaluation of men with prostate cancer, but should not be considered as a substitute for tissue biopsy.