International urology and nephrology · 2026
Zone-specific diagnostic performance of synthetic MRI quantitative parameters, ADC, and PSA density for clinically significant prostate cancer: comparison with PI-RADS v2.1.
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Liu Yanan, Liu Xinai, Zhang He, Liu Bo, Sun Hongmei, Wang Tongming
Аннотация
BACKGROUND: The diagnostic performance of synthetic magnetic resonance imaging-derived quantitative tissue parameters relative to Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) remains incompletely understood. This study evaluated the zone-specific diagnostic performance of magnetic resonance image compilation (MAGiC)-derived T1, T2, and proton density (PD), apparent diffusion coefficient (ADC), and prostate-specific antigen density (PSAD) for clinically significant prostate cancer (csPCa).
METHODS: This retrospective diagnostic accuracy study included 141 treatment-naïve patients with 141 MRI-visible index lesions and histopathologic confirmation. Sixty-three lesions were located in the peripheral zone (PZ) and 78 in the transition zone (TZ). Two radiologists independently assigned PI-RADS v2.1 categories. T1, T2, PD, and ADC were measured using a three-slice region-of-interest approach. Zone-specific logistic regression models combining T1, T2, ADC, and PSAD were evaluated by receiver operating characteristic analysis. Ridge-penalized regression was used to generate predicted probabilities for the TZ models.
RESULTS: The cohort included 52 csPCa and 89 clinically insignificant lesions. T1, T2, and ADC were lower in csPCa in both zones (all P < 0.001), whereas PD did not differ. ADC showed the highest individual AUC in the PZ (0.881) and TZ (0.878). The T1 + T2 + ADC model showed higher apparent AUCs than PI-RADS v2.1 in the PZ (0.947 vs 0.799; P = 0.002) and TZ (0.961 vs 0.803; P = 0.013). Adding PSAD increased the AUCs to 0.961 and 0.963, but the increments were not significant (P = 0.329 and P = 0.700). PI-RADS agreement was substantial, and quantitative measurements showed good-to-excellent reproducibility.
CONCLUSIONS: MAGiC-derived T1 and T2 measurements combined with ADC showed promising zone-specific discrimination of csPCa and higher apparent performance than PI-RADS v2.1. External validation and assessment of calibration and clinical utility are required before implementation.
METHODS: This retrospective diagnostic accuracy study included 141 treatment-naïve patients with 141 MRI-visible index lesions and histopathologic confirmation. Sixty-three lesions were located in the peripheral zone (PZ) and 78 in the transition zone (TZ). Two radiologists independently assigned PI-RADS v2.1 categories. T1, T2, PD, and ADC were measured using a three-slice region-of-interest approach. Zone-specific logistic regression models combining T1, T2, ADC, and PSAD were evaluated by receiver operating characteristic analysis. Ridge-penalized regression was used to generate predicted probabilities for the TZ models.
RESULTS: The cohort included 52 csPCa and 89 clinically insignificant lesions. T1, T2, and ADC were lower in csPCa in both zones (all P < 0.001), whereas PD did not differ. ADC showed the highest individual AUC in the PZ (0.881) and TZ (0.878). The T1 + T2 + ADC model showed higher apparent AUCs than PI-RADS v2.1 in the PZ (0.947 vs 0.799; P = 0.002) and TZ (0.961 vs 0.803; P = 0.013). Adding PSAD increased the AUCs to 0.961 and 0.963, but the increments were not significant (P = 0.329 and P = 0.700). PI-RADS agreement was substantial, and quantitative measurements showed good-to-excellent reproducibility.
CONCLUSIONS: MAGiC-derived T1 and T2 measurements combined with ADC showed promising zone-specific discrimination of csPCa and higher apparent performance than PI-RADS v2.1. External validation and assessment of calibration and clinical utility are required before implementation.