RESUMO
OBJECTIVE: To investigate the relationship between the apparent diffusion coefficient (ADC) histogram parameters based on the whole tumor and the pathological grade and lymph node metastasis (LNM) of PCa. METHODS: This retrospective study included 82 cases of PCa confirmed pathologically and subjected to MRI preoperatively. We obtained a series of ADC histogram parameters, such as ADCmean, ADCmedian, ADC25%, ADC75%, entropy, and histogram width, by processing the ADC images via the Firevoxel Post-Processing and the SPSS24 software. We compared the parameters between the high-risk and low- or moderate-risk groups as well as between the LNM-positive and LNM-negative groups of the patients, and analyzed the diagnostic performance of the parameters with statistically significant differences. RESULTS: The high-risk group, compared with the low- or moderate-risk one, showed a significantly lower ADCmean (ï¼»590 ± 120ï¼½ vs ï¼»837 ± 142ï¼½ ×10ï¼6 mm2/s, P < 0.01), ADCmedian (ï¼»560 ± 117ï¼½ vs ï¼»804 ± 139ï¼½ ×10ï¼6 mm2/s, P < 0.01), ADC25% (ï¼»446.5 ± 98ï¼½ vs ï¼»717 ± 118ï¼½ ×10ï¼6 mm2/, P < 0.01) and ADC75% (ï¼»667 ± 132ï¼½ vs ï¼»931 ± 167ï¼½ ×10ï¼6 mm2/s, P < 0.01). The ADCmean manifested the highest diagnostic performance, with an AUC of 0.907, a sensitivity of 0.933 and a specificity of 0.796. No statistically significant difference was found between the high-risk and the low- or moderate-risk one in entropy (3.58 ± 0.39 vs 3.63 ± 0.42, P = 0.238) or the histogram width (ï¼»540 ± 73ï¼½ vs ï¼»520 ± 65ï¼½ ×10ï¼6 mm2/s, P = 0.086). Both entropy and the histogram width were remarkably higher in the LNM-positive than in the LNM-negative group (3.95 ± 0.41 vs 3.12 ± 0.45, P < 0.01; ï¼»578 ± 59ï¼½ vs ï¼»455 ± 68ï¼½ ×10ï¼6 mm2/s, P < 0.01), and the former had an even higher diagnostic performance, with an AUC of 0.836, a sensitivity of 0.887 and a specificity of 0.781. There were no statistically significant differences between the LNM-positive and LNM-negative groups in the ADCmean (ï¼»768 ± 135ï¼½ vs ï¼»790±128ï¼½ ×10ï¼6 mm2/s, P = 0.402), ADCmedian (ï¼»759 ± 110ï¼½ vs ï¼»775 ± 121ï¼½ ×10ï¼6 mm2/s, P = 0.225), ADC25% (ï¼»643 ± 91ï¼½ vs ï¼»657 ± 89ï¼½ ×10ï¼6 mm2/s, P = 0.654) or ADC75% (ï¼»895 ± 127ï¼½ vs ï¼»872 ± 129ï¼½ ×10ï¼6 mm2/s, P = 0.926). CONCLUSIONS: ADC histogram parameters are related to pathological grade and LNM of PCa, and the analysis of the ADC histogram based on the whole tumor has an important value for preoperative evaluation and prognostic estimation of the malignancy.