Better lesion conspicuity translates into improved prostate cancer detection: comparison of non-parallel-transmission-zoomed-DWI with conventional-DWI

Purpose To compare advanced non-parallel transmission zoomed diffusion-weighted imaging (nonPTX zoom-DWI) to conventional DWI (conv-DWI) for the assessment of prostate cancer (PCa). Methods This retrospective study included 98 patients who underwent conv-DWI, nonPTX zoom-DWI, and T2-weighted imaging of the prostate. The image qualities of the two DWI sets, including the distortion of the prostate and the existence of artifacts, were evaluated. To compare the overall PCa and clinically important PCa (ciPCa) detection ability between the sets, lesions were scored using the Prostate Imaging Reporting and Data System (PI-RADS) version 2. Apparent diffusion coefficient (ADC) values of the lesions were also measured and compared. The Mann–Whitney U test was used to compare continuous variables, and the χ 2 test was used to compare categorical variables. Two-sided P values of < 0.05 were considered significant. Results Non-PTX zoom-DWI yielded significantly better image quality and image analysis reproducibility than conv-DWI (all P < 0.001). Compared with conv-ADC, nonPTX zoom-ADC showed slightly better detection performance for overall PCa (AUC: 0.827 vs. 0.797; P = 0.55) and ciPCa (AUC: 0.822 vs. 0.749; P = 0.58). At a PI-RADS score of 4 as the cutoff value for PCa prediction, nonPTX zoom-DWI showed significantly higher diagnostic efficiency for overall PCa detection (sensitivity: 87.9% vs. 72.4%; specificity: 87.5% vs. 77.5%; both P < 0.05) and ciPCa detection (sensitivity: 86.3% vs. 74.5%; specificity: 72.3% vs. 63.8%; both P ≤ 0.001). Conclusion Non-PTX zoom-DWI yields better image quality and higher PCa detection performance than Conv-DWI. Graphic Abstract