Clinical significance of MRI-DWI and PWI scans in identifying benign prostatic hyperplasia and prostate cancer

To investigate the importance of magnetic resonance diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) for distinguishing between prostate cancer (PCa) and prostate hyperplasia (BPH). A total of 78 patients with prostate disorders and 20 individuals without prostate disorders (control group) treated between June 2020 and June 2023 were examined. Among them, 30 were pathologically diagnosed with BPH and 48 with PCa. (Magnetic Resonance Imaging-diffusion weighted imaging) MRI-DWI and PWI parameters, specifically the apparent diffusion coefficient (ADC), maximum slope of perfusion curve (SSmax) and quasi-T2 relaxation rate (∆R2*peak), were compared among the three groups. Microvessel density (MVD) of vascular endothelial growth factor (VEGF) and PCa were quantified through immunohistochemistry. No statistically significant differences were observed in ADC values within the transition zone of the prostate among the control group, BPH and PCa patients (p > 0.05), while significant differences in ADC values were observed within the peripheral zone of the three groups (p < 0.05). The ADC and T2 values of BPH lesions were significantly higher than those of PCa tissue (p < 0.05). Moreover, SSmax and ∆R2*peak values were significantly different in BPH lesions (p < 0.05). MVD levels were significantly lower in BPH lesions compared to PCa lesions, and the positive expression rate of VEGF was also significantly lower in BPH lesions (p < 0.05). Correlation analysis revealed a positive association between SSmax and ∆R2*peak levels in PCa lesions and their MVD and VEGF levels (p < 0.05). Both MRI-PWI and DWI imaging demonstrate substantial value in distinguishing between PCa and BPH. Furthermore, a significant correlation was observed between PWI scan parameters, such as SSmax, ∆R2*peak and VEGF and MVD levels in tumor tissues, offering a promising non-invasive option for assessing tumor neovascularization.

Prostate cancer; Magnetic resonance perfusion-weighted imaging; Diffusion-weighted imaging; Tumor angiogenesis

[1] Achard V, Putora PM, Omlin A, Zilli T, Fischer S. Metastatic prostate cancer: treatment options. Oncology. 2022; 100: 48–59.

[2] Vietri MT, D'Elia G, Caliendo G, Resse M, Casamassimi A, Passariello L, et al. Hereditary prostate cancer: genes related, target therapy and prevention. International Journal of Molecular Sciences. 2021; 22: 3753.

[3] Rosellini M, Santoni M, Mollica V, Rizzo A, Cimadamore A, Scarpelli M, et al. Treating prostate cancer by antibody-drug conjugates. International Journal of Molecular Sciences. 2021; 22: 1551.

[4] Shi C, Ge P, Zhao Y, Huang G. Diffusion-weighted imaging combined with perfusion-weighted imaging under segmentation algorithm in the diagnosis of melanoma. Contrast Media & Molecular Imaging. 2022; 2022: 1–9.

[5] Nagendran A, McConnell JF. Diffusion- and perfusion-weighted imaging characteristics of an intracranial abscess in a cat. Journal of Small Animal Practice. 2021; 62: 714.

[6] Huang TH, Lai MC, Chen YS, Huang CW. Brain imaging in epilepsy-focus on diffusion-weighted imaging. Diagnostics. 2022; 12: 2602.

[7] Dakowicz D, Zajkowska M, Mroczko B. Relationship between VEGF family members, their receptors and cell death in the neoplastic transformation of colorectal cancer. International Journal of Molecular Sciences. 2022; 23: 3375.

[8] Saponaro C, Malfettone A, Ranieri G, Danza K, Simone G, Paradiso A, et al. VEGF, HIF-1 alpha expression and MVD as an angiogenic network in familial breast cancer. PLOS ONE. 2013; 8: e53070.

[9] Bennani-Baiti B, Pinker K, Zimmermann M, Helbich TH, Baltzer PA, Clauser P, et al. Non-invasive assessment of hypoxia and neovascularization with MRI for identification of aggressive breast cancer. Cancers. 2020; 12: 2024.

[10] Harmankaya I, Yurut-Caloglu V, Tastekin E, Turkkau G, Caloglu M, Uzal C. Prognostic importance of microvessel density, VEGF expression and perineural invasion in laryngeal cancer treated with adjuvant radiotherapy. Indian Journal of Pathology and Microbiology. 2022; 65: 521–526.

[11] Gagliardi T, Adejolu M, DeSouza NM. Diffusion-weighted magnetic resonance imaging in ovarian cancer: exploiting strengths and understanding limitations. Journal of Clinical Medicine. 2022; 11: 1524.

[12] Gong X, Tao Y, Wang R, Liu N, Huang X, Zheng J, et al. Application of diffusion weighted imaging in prostate cancer bone metastasis: detection and therapy evaluation. Anti-Cancer Agents in Medicinal Chemistry. 2021; 21: 1950–1956.

[13] Yoshida S, Takahara T, Arita Y, Sakaino S, Katahira K, Fujii Y. Whole‐body diffusion‐weighted magnetic resonance imaging: diagnosis and follow up of prostate cancer and beyond. International Journal of Urology. 2021; 28: 502–513.

[14] Connolly M, Srinivasan A. Diffusion-weighted imaging in head and neck cancer: technique, limitations, and applications. Magnetic Resonance Imaging Clinics of North America. 2018; 26: 121–133.

[15] Ueno YR, Tamada T, Takahashi S, Tanaka U, Sofue K, Kanda T, et al. Computed diffusion-weighted imaging in prostate cancer: basics, advantages, cautions, and future prospects. Korean Journal of Radiology. 2018; 19: 832.

[16] De Perrot T, Sadjo Zoua C, Glessgen CG, Botsikas D, Berchtold L, Salomir R, et al. Diffusion-weighted MRI in the genitourinary system. Journal of Clinical Medicine. 2022; 11: 1921.

[17] McGarry SD, Brehler M, Bukowy JD, Lowman AK, Bobholz SA, Duenweg SR, et al. Multi-site concordance of diffusion-weighted imaging quantification for assessing prostate cancer aggressiveness. Journal of Magnetic Resonance Imaging. 2022; 55: 1745–1758.

[18] Shukla G, Alexander GS, Bakas S, Nikam R, Talekar K, Palmer JD, et al. Advanced magnetic resonance imaging in glioblastoma: a review. Chinese Clinical Oncology. 2017; 6: 40.

[19] Delvecchio G, Gritti D, Squarcina L, Brambilla P. Neurovascular alterations in bipolar disorder: a review of perfusion weighted magnetic resonance imaging studies. Journal of Affective Disorders. 2022; 316: 254–272.

[20] Pons-Escoda A, Smits M. Dynamic-susceptibility-contrast perfusion-weighted-imaging (DSC-PWI) in brain tumors: a brief up-to-date overview for clinical neuroradiologists. European Radiology. 2023; 33: 8026–8030.

[21] Tamada T, Ueda Y, Ueno Y, Kojima Y, Kido A, Yamamoto A. Diffusion-weighted imaging in prostate cancer. MAGMA. 2022; 35: 533–547.

[22] Maier SE, Wallstrom J, Langkilde F, Johansson J, Kuczera S, Hugosson J, et al. Prostate cancer diffusion-weighted magnetic resonance imaging: does the choice of diffusion-weighting level matter? Journal of Magnetic Resonance Imaging. 2022; 55: 842–853.

[23] Ueda T, Ohno Y, Yamamoto K, Murayama K, Ikedo M, Yui M, et al. Deep Learning reconstruction of diffusion-weighted MRI improves image quality for prostatic imaging. Radiology. 2022; 303: 373–381.

[24] Ueno Y, Tamada T, Sofue K, Murakami T. Diffusion and quantification of diffusion of prostate cancer. The British Journal of Radiology. 2022; 95: 20210653.

[25] Tanaka O, Maejima R, Yama E, Taniguchi T, Ono K, Makita C, et al. Radiotherapy for prostate cancer: effect of gold fiducial markers on diffusion‐weighted magnetic resonance imaging. Asia-Pacific Journal of Clinical Oncology. 2021; 17: 79–83.

[26] Kikuchi K, Hiwatashi A, Togao O, Yamashita K, Kamei R, Kitajima M, et al. Usefulness of perfusion- and diffusion-weighted imaging to differentiate between pilocytic astrocytomas and high-grade gliomas: a multicenter study in Japan. Neuroradiology. 2018; 60: 391–401.

[27] Friismose AI, Markovic L, Nguyen N, Gerke O, Schulz MK, Mussmann BR. Amide proton transfer-weighted MRI in the clinical setting—correlation with dynamic susceptibility contrast perfusion in the post-treatment imaging of adult glioma patients at 3T. Radiography. 2022; 28: 95–101.

[28] Yang X, Xing Z, She D, Lin Y, Zhang H, Su Y, et al. Grading of IDH-mutant astrocytoma using diffusion, susceptibility and perfusion-weighted imaging. BMC Medical Imaging. 2022; 22: 105.

[29] Tomić TT, Gustavsson H, Wang W, Jennbacken K, Welén K, Damber J. Castration resistant prostate cancer is associated with increased blood vessel stabilization and elevated levels of VEGF and Ang-2. The Prostate. 2012; 72: 705–712.

[30] Jin Cho W, Pyo J. Immunohistochemical analysis of the impact of ischemic change in benign prostatic hyperplasia. Pathology—Research and Practice. 2020; 216: 152694.