Length of capsular contact on prostate MRI as a predictor of extracapsular extension: which is the most optimal sequence?

Abstract

Background

Length of capsular contact (LCC) is a promising biomarker for predicting extracapsular extension (ECE), but the most optimal magnetic resonance imaging (MRI) sequence for measuring LCC is yet to be determined.

Purpose

To evaluate LCC using different MRI sequences for determining ECE in prostate cancer.

Material and Methods

A total of 185 patients underwent prostate MRI followed by radical prostatectomy. LCC was measured separately on T2-weighted (T2W) images, apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced (DCE) MRI. LCCs (LCC_T2, LCC_ADC, LCC_DCE, and LCC_max [greatest value of 3 LCCs]) were compared between sequences using Wilcoxon signed rank test and was tested for determining ECE using the Mann–Whitney U test, ROC curve analysis, and logistic regression analysis.

Results

There were no significant differences among LCCs (P = 0.333–0.837). All LCCs were significantly greater in patients with ECE (P < 0.001). The optimal threshold value for predicting ECE was >14, >13, >12, and >14 mm for LCC_T2, LCC_ADC, LCC_DCE, and LCC_max, respectively. LCC_max yielded the highest area under the curve (0.895) which was significantly greater than that by LCC_ADC (0.858, P = 0.030). Otherwise, there were no significant difference between LCCs (P = 0.052–0.985). At univariate analysis, age, clinical stage, PSA, Gleason score, and all LCCs were significantly associated with ECE (P < 0.001–0.040). At multivariate analysis, GS (P ≤ 0.008) and all LCCs (P < 0.001) were independently predictive factors.

Conclusion

LCC measured on any sequence was significantly different in patients with and without ECE and was independently associated with the presence of ECE. Although LCC_max showed the greatest ability to predict ECE, there was relatively equivalent performance among different MRI sequences.

Keywords

Prostate cancer extracapsular extension magnetic resonance imaging length of capsular contact

Get full access to this article

View all access options for this article.

References

Bill-Axelson

Holmberg

Ruutu

. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2011; 364: 1708–1717.

Hricak

Wang

Wei

. The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy. Cancer 2004; 100: 2655–2663.

Ploussard

Agamy

Alenda

. Impact of positive surgical margins on prostate-specific antigen failure after radical prostatectomy in adjuvant treatment-naive patients. BJU Int 2011; 107: 1748–1754.

Godoy

Tareen

Lepor

. Site of positive surgical margins influences biochemical recurrence after radical prostatectomy. BJU Int 2009; 104: 1610–1614.

Engelbrecht

Jager

Laheij

. Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis. Eur Radiol 2002; 12: 2294–2302.

Hricak

Alagappan

. Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. Radiology 1997; 202: 697–702.

Rosenkrantz

Shanbhogue

Wang

. Length of capsular contact for diagnosing extraprostatic extension on prostate MRI: Assessment at an optimal threshold. J Magn Reson Imaging 2015; 43: 990–997.

Baco

Rud

Vlatkovic

. Predictive value of magnetic resonance imaging determined tumor contact length for extracapsular extension of prostate cancer. J Urol 2015; 193: 466–472.

Ukimura

Troncoso

Ramirez

. Prostate cancer staging: correlation between ultrasound determined tumor contact length and pathologically confirmed extraprostatic extension. J Urol 1998; 159: 1251–1259.

10.

Villers

Puech

Mouton

. Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol 2006; 176: 2432–2437.

11.

Bratan

Melodelima

Souchon

. How accurate is multiparametric MR imaging in evaluation of prostate cancer volume? Radiology 2015; 275: 144–154.

12.

Qayyum

Coakley

. Organ-confined prostate cancer: effect of prior transrectal biopsy on endorectal MRI and MR spectroscopic imaging. Am J Roentgenol 2004; 183: 1079–1083.

13.

Lee

ETY

. A simplified B-spline computation routine. Computing 1982; 29: 365–371.

14.

Samaratunga

Montironi

True

. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling. Mod Pathol 2011; 24: 6–15.

15.

Hosseinzadeh

Schwarz

. Endorectal diffusion-weighted imaging in prostate cancer to differentiate malignant and benign peripheral zone tissue. J Magn Reson Imaging 2004; 20: 654–661.

16.

Scheidler

Hricak

. Prostate cancer: prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. Radiology 1999; 213: 481–488.

17.

Rosenkrantz

Chandarana

Gilet

. Prostate cancer: utility of diffusion-weighted imaging as a marker of side-specific risk of extracapsular extension. J Magn Reson Imaging 2013; 38: 312–319.

18.

Woo

Cho

Kim

. Extracapsular extension in prostate cancer: added value of diffusion-weighted MRI in patients with equivocal findings on T2-weighted imaging. Am J Roentgenol 2015; 204: W168–175.

19.

Kim

Park

. Diffusion-weighted MRI as a predictor of extracapsular extension in prostate cancer. Am J Roentgenol 2014; 202: W270–276.

20.

Hambrock

Somford

Huisman

. Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer. Radiology 2011; 259: 453–461.

21.

Verma

Rajesh

Morales

. Assessment of aggressiveness of prostate cancer: correlation of apparent diffusion coefficient with histologic grade after radical prostatectomy. Am J Roentgenol 2011; 196: 374–381.

22.

Wang

Deng

. Feasibility study of 3-T DWI of the prostate: readout-segmented versus single-shot echo-planar imaging. Am J Roentgenol 2015; 205: 70–76.

23.

Korn

Kurhanewicz

Banerjee

. Reduced-FOV excitation decreases susceptibility artifact in diffusion-weighted MRI with endorectal coil for prostate cancer detection. Magn Reson Imaging 2015; 33: 56–62.

24.

Vargas

Hotker

Goldman

. Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol 2016; 26: 1606–1612.

25.

Barrett

Turkbey

Choyke

. PI-RADS version 2: what you need to know. Clin Radiol 2015; 70: 1165–1176.

26.

Haffner

Lemaitre

Puech

. Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int 2011; 108: E171–178.

27.

Sharif-Afshar

Feng

Koopman

. Impact of post prostate biopsy hemorrhage on multiparametric magnetic resonance imaging. Can J Urol 2015; 22: 7698–7702.

28.

Ball

Partin

Epstein

. Extent of extraprostatic extension independently influences biochemical recurrence-free survival: evidence for further pT3 subclassification. Urology 2015; 85: 161–164.