Evaluation of different mathematical models and different b-value ranges of diffusion weighted imaging in peripheral zone prostate cancer detection using b-value up to 4500 s/mm2

Objectives To evaluate the diagnostic performance of different mathematical models and different b value ranges of diffusion-weighted imaging (DWI) in peripheral zone prostate cancer (PZ PCa) detection. Methods Fifty-six patients with histologically proven PZ PCa who underwent DWI-magnetic resonance imaging (MRI) using 21 b-values (0-4500 s/mm(2)) were included. The mean signal intensities of the regions of interest (ROls) placed in benign PZs and cancerous tissues on DWI images were fitted using mono-exponential, bi-exponential, stretched-exponential, and kurtosis models. The b -values were divided into four ranges: 0-1000, 0-2000, 0-3200, and 0-4500 s/mm2, grouped as A, B, C, and D, respectively. ADC, <D>, D*, f, DDC, a, D-app, and K-app were estimated for each group. The adjusted coefficient of determination (R-2) was calculated to measure goodness-of-fit. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of the parameters. Results All parameters except D* showed significant differences between cancerous tissues and benign PZs in each group. The area under the curve values (AUCs) of ADC were comparable in groups C and D (p = 0.980) and were significantly higher than those in groups A and B (p<0.05 for all). The AUCs of ADC and Kapp in groups B and C were similar (p = 0.07 and p = 0.954), and were significantly higher than the other parameters (p<0.001 for all). The AUCs of ADC in group D was slightly higher than Kapp (p = 0.002), and both were significantly higher than the other parameters (p<0.001 for all). Conclusions ADC derived from conventional mono-exponential high b-value (3200 s/mm(2)) models is an optimal parameter for PZ PCa detection.