Utility of T2-weighted MRI texture analysis in assessment of peripheral zone prostate cancer aggressiveness: a single-arm, multicenter study
Gabriel A. Nketiah, Mattijs Elschot, Tom W. J. Scheenen, Marnix C. Maas, Tone F. Bathen, Kirsten M. Selnæs, Ulrike Attenberger, Pascal Baltzer, Tone F. Bathen, Jurgen J. Fütterer, Masoom A. Haider, Thomas H. Helbich, Berthold Kiefer, Marnix C. Maas, Katarzyna J. Macura, Daniel Margolis, Anwar R. Padhani, Stephen H. Polanec, Marleen Praet, Tom W. J. Scheenen, Stefan O. Schoenberg, Kirsten M. Selnæs, Theodorus van der Kwast, Geert Villeirs, Trond Viset, Heninrich von Busch
Abstract
Abstract T 2 -weighted (T 2 W) MRI provides high spatial resolution and tissue-specific contrast, but it is predominantly used for qualitative evaluation of prostate anatomy and anomalies. This retrospective multicenter study evaluated the potential of T 2 W image-derived textural features for quantitative assessment of peripheral zone prostate cancer (PCa) aggressiveness. A standardized preoperative multiparametric MRI was performed on 87 PCa patients across 6 institutions. T 2 W intensity and apparent diffusion coefficient (ADC) histogram, and T 2 W textural features were computed from tumor volumes annotated based on whole-mount histology. Spearman correlations were used to evaluate association between textural features and PCa grade groups (i.e. 1–5). Feature utility in differentiating and classifying low-(grade group 1) vs. intermediate/high-(grade group ≥ 2) aggressive cancers was evaluated using Mann–Whitney U-tests, and a support vector machine classifier employing “hold-one-institution-out” cross-validation scheme, respectively. Textural features indicating image homogeneity and disorder/complexity correlated significantly ( p < 0.05) with PCa grade groups. In the intermediate/high-aggressive cancers, textural homogeneity and disorder/complexity were significantly lower and higher, respectively, compared to the low-aggressive cancers. The mean classification accuracy across the centers was highest for the combined ADC and T 2 W intensity-textural features (84%) compared to ADC histogram (75%), T 2 W histogram (72%), T 2 W textural (72%) features alone or T 2 W histogram and texture (77%), T 2 W and ADC histogram (79%) combined. Texture analysis of T 2 W images provides quantitative information or features that are associated with peripheral zone PCa aggressiveness and can augment their classification.