IVIM Parameters on MRI Could Predict ISUP Risk Groups of Prostate Cancers on Radical Prostatectomy

PURPOSE: To elucidate the usefulness of intravoxel incoherent motion (IVIM)/apparent diffusion coefficient (ADC) parameters in preoperative risk stratification using International Society of Urological Pathology (ISUP) grades. MATERIALS AND METHODS: Forty-five prostate cancer (PCa) patients undergoing radical prostatectomy (RP) after prostate multiparametric magnetic resonance imaging (mpMRI) were included. The ISUP grades were categorized into low-risk (I-II) and high-risk (III-V) groups, and the concordance between the preoperative and postoperative grades was analyzed. The largest region of interest (ROI) of the dominant tumor on each IVIM/ADC image was delineated to obtain its histogram values (i.e., minimum, mean, and kurtosis) of diffusivity (D), pseudodiffusivity (D*), perfusion fraction (PF), and ADC. Multivariable logistic regression analysis of the IVIM/ADC parameters without and with preoperative ISUP grades were performed to identify predictors for the postoperative high-risk group. RESULTS: Thirty-two (71.1%) of 45 patients had concordant preoperative and postoperative ISUP grades. D(mean), D*(kurtosis), PF(kurtosis), ADC(min), and ADC(mean) were significantly associated with the postoperative ISUP risk group (all p < 0.05). D(mean) and D*(kurtosis) (model I, both p < 0.05) could predict the postoperative ISUP high-risk group with an area under the curve (AUC) of 0.842 and a 95% confidence interval (CI) of 0.726–0.958. The addition of D*(kurtosis) to the preoperative ISUP grade (model II) may enhance prediction performance, with an AUC of 0.907 (95% CI 0.822–0.992). CONCLUSIONS: The postoperative ISUP risk group could be predicted by D(mean) and D*(kurtosis) from mpMRI, especially D*(kurtosis). Obtaining the biexponential IVIM parameters is important for better risk stratification for PCa.