Prostate Cancer: Feasibility and Preliminary Experience of a Diffusional Kurtosis Model for Detection and Assessment of Aggressiveness of Peripheral Zone Cancer

Purpose: To assess the feasibility of diffusional kurtosis (DK) imaging for distinguishing benign from malignant regions, as well as low-from high-grade malignant regions, within the peripheral zone (PZ) of the prostate in comparison with standard diffusion-weighted (DW) imaging. Materials and Methods: The institutional review board approved this retrospective HIPAA-compliant study and waived informed consent. Forty-seven patients with prostate cancer underwent 3-T magnetic resonance imaging by using a pelvic phased-array coil and DW imaging (maximum b value, 2000 sec/mm(2)). Parametric maps were obtained for apparent diffusion coefficient (ADC); the metric DK (K), which represents non-Gaussian diffusion behavior; and corrected diffusion (D) that accounts for this non-Gaussianity. Two radiologists reviewed these maps and measured ADC, D, and K in sextants positive for cancer at biopsy. Data were analyzed by using mixed-model analysis of variance and receiver operating characteristic curves. Results: Seventy sextants exhibited a Gleason score of 6; 51 exhibited a Gleason score of 7 or 8. K was significantly greater in cancerous sextants than in benign PZ (0.96 +/- 0.24 vs 0.57 +/- 0.07, P < .001), as well as in cancerous sextants with higher rather than lower Gleason score (1.05 +/- 0.26 vs 0.89 +/- 0.20, P < .001). K showed significantly greater sensitivity for differentiating cancerous sextants from benign PZ than ADC or D (93.3% vs 78.5% and 83.5%, respectively; P < .001), with equal specificity (95.7%, P < .99). K exhibited significantly greater sensitivity for differentiating sextants with low-and high-grade cancer than ADC or D (68.6% vs 51.0% and 49.0%, respectively; P < .004) but with decreased specificity (70.0% vs 81.4% and 82.9%, respectively; P <= .023). K had significantly greater area under the curve for differentiating sextants with low-and high-grade cancer than ADC (0.70 vs 0.62, P =.010). Relative contrast between cancerous sextants and benign PZ was significantly greater for D or K than ADC (0.25 +/- 0.14 and 0.24 +/- 0.13, respectively, vs 0.18 +/- 0.10; P < .001). Conclusion: Preliminary findings suggest increased value for DK imaging compared with standard DW imaging in prostate cancer assessment. (C) RSNA, 2012