Role of diffusion weighted MR imaging in differentiating benign from malignant prostate lesions

Sachin ., Kirti Chaturvedy, R. N. Gehlot, Prateek Sihag, Suman Kumari, Anil Kumar Jangir, Mohit Jakhar, Ravindra Purohit, Tejinder Pal Singh


Background: The purpose of the study was to determine the diagnostic accuracy of diffusion weighted MR imaging and to propose a cut off ADC value in differentiating benign from malignant prostatic lesions considering histopathology as gold standard.

Methods: It is a descriptive type of observational study done on 40 patients with clinical suspicion of prostate carcinoma and elevated PSA level more than 4ng/ml. The patients underwent Multiparametric prostate MRI and ADC values were calculated using ADC maps.

Results: Of the 40 cases included in the study histopathology revealed a diagnosis of abscess (1), chronic prostatitis (2), BPH with chronic prostatitis (4), BPH (12), and malignancy (21). The mean and standard deviation (SD) of ADC values for the abscess (0.59), CP (0.83+0.16), BPH with CP (0.94+0.22), BPH (1.14+0.14) and malignancy (0.72+0.15) (x10-3mm2/s) were found in our study. The mean ADC value of malignant lesion was lower (0.727+0.149) as compare to benign lesion (1.034+0.216) and this difference was found to be statistically significant with p<0.001. By using ROC curve, ADC cut off value was calculated as 0.92 x 10-3mm2/s and sensitivity, specificity at this cut off value of ADC were 95.24% and 73.68% respectively. The PPV, NPV, diagnostic accuracy of at this cut off value of ADC were 80%, 93.33%, 85% respectively.

Conclusions: Our study shows that DWI with ADC calculation helps in differentiation of Benign from Malignant prostatic lesions with high accuracy and this quantitative analysis should be incorporated in routine MRI evaluation of prostatic lesions


Apparent diffusion coefficient, Diffusion weighted imaging, Magnetic resonance imaging, Prostate carcinoma

Full Text:



Jacobs MA, Ouwerkerk R, Petrowski K, Macura KJ. Diffusion-weighted imaging with apparent diffusion coefficient mapping and spectroscopy in prostate cancer. Top Magn Reson Imaging. 2008;19(6):261-72.

Chodak GW, Keller P, Schoenberg HW. Assessment of screening for prostate cancer using the digital rectal examination. J Urol. 1989;141(5):1136-38.

Claus FG, Hricak H, Hattery RR. Pretreatment evaluation of prostate cancer: role of MR imaging and H1 MR spectroscopy. Radiographics. 2004;24 Suppl1:S167-80.

Lim HK, Kim JK, Kim KA, Cho KS. Prostate cancer: apparent diffusion coefficient map with T2WI for detection-a multi reader study. Radiol. 2009;250(1):145-51.

Choi YJ, Kim JK, Kim N, Kim KW, Choi Ek, Cho KS. Functional MR imaging of prostate cancer. Radiographics. 2007;27:63-75.

Yagci AB, Özari N, Aybek Z, Düzcan E. The value of diffusion-weighted MRI for prostate cancer detection and localization. Diagnostic Inter Radiol. 2011 Jun 1;17(2):130.

Verma S, Rajesh A. A clinically relevant approach to imaging prostate cancer: review. Am J Roentgenol. 2011;196 (3Suppl.) [s1-s1].

Hosseinzadeh K, Schwarz SD. Endorectal diffusion-weighted imaging in prostate cancer to differentiate malignant and benign peripheral zone tissue. J Magn Reson Imaging. 2004;20(4):654-61.

Esen M, Onur MR, Akpolat N, Orhan I, Kocakoc E. Utility of ADC measurement on diffusion-weighted MRI in differentiation of prostate cancer, normal prostate and prostatitis. Quant Imaging Med Surg. 2013;3(4):210-6.

Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging-Reporting and Data System: 2015, Version 2. Eur Urol. 2016;69(1):16-40.

Barentsz JO, Weinreb JC, Verma S, Thoeny HC, tempany CM, Shtern F, et al. Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol. 2016;69(1):41-9.

Petraliaa G, Thoeny HC. DW-MRI of the urogenital tract: applications in oncology. Cancer Imaging. 2010;10(1A):S112-23.

Lee CH, Akin-Olugbade O, Kirschenbaum A. Overview of prostate anatomy, histology, and pathology. Endocrinol Metabol Clin. 2011 Sep 1;40(3):565-75.

Anunobi CC, Akinde OR, Elesha SO, Daramola AO, Tijani KH, Ojewala RW. Prostate diseases in Lagos, Nigeria: a histologic study with tPSA correlation. Nigerian Postgrad Med J. 2011;18(2):98-104.

ABRAR BM, Mubarak M, IQBAL KJ. Histopathological lesions in transrectal ultrasound guided biopsies of prostate in patients with raised serum prostate specific antigen: a preliminary report. J Nephro-Urol. 2011;3(3):186-90.

Jagannathan D, Indiran V. Accuracy of diffusion weighted images and MR spectroscopy in prostate lesions-our experience with endorectal coil on 1.5 T MRI. JCDR. 2017 May;11(5):TC10.

Emad-Eldin S, Halim M, Metwally LI, Abdel-Aziz RM. Diffusion-weighted MR imaging and ADC measurement in normal prostate, benign prostatic hyperplasia and prostate carcinoma. Egyptian J Radiol Nuclear Med. 2014 Jun 1;45(2):535-42.

Liu X, Peng W, Zhou L, Wang H. Biexponential apparent diffusion coefficients values in the prostate: comparison among normal tissue, prostate cancer, benign prostatic hyperplasia and prostatitis. Korean J Radiol. 2013;14(2):222-32.

AbdelMaboud NM, Elsaid HH, Aboubeih EA. The role of diffusion-weighted MRI in evaluation of prostate cancer. Egypt J Radiol Nuc Med. 2014;45:231-6.

Tanimoto A, Nakashima J, Kohno H, Shinmoto H, Kuribayashi S. Prostate cancer screening: the clinical value of diffusion weighted imaging and dynamic MR imaging in combination with T2-weighted imaging. J Magn Reson Imaging. 2007;25:146-52.

Ren J, Huang X, Wang H, Liu H, Ren F, Zhang Z, et al. Prostatic abscess and seminal vesicle abscess: MRI findings and quantitative analysis of apparent diffusion coefficient values. Radiol Infectious Dis. 2015 Jun 1;2(1):27-32.

Nagayama M, Watanabe Y, Terai A, Araki T, Notohara K, Okumura A, et al. Determination of the cutoff level of apparent diffusion coefficient values for detection of prostate cancer. Jap J Radiol. 2011 Aug 1;29(7):488.

Lojanapiwat B, Anutrakulchai W, Chongruksut W, Udomphot C. Correlation and diagnostic performance of PSA level with diagnosis, aggressiveness and bone metastasis of prostate cancer in clinical practice. Prostate Int. Sep 2014;2(3):133-9.