Mass-like peripheral zone enhancement on CT is predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer

• Published in: Abdominal imaging 2015-03, Vol.40 (3), p.560-570
• Main Authors: Glazer, D. I., Davenport, M. S., Khalatbari, S., Cohan, R. H., Ellis, J. H., Caoili, E. M., Stein, E. B., Childress, J. C., Masch, W. R., Brown, J. M., Mollard, B. J., Montgomery, J. S., Palapattu, G. S., Francis, I. R.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Clinical Competence; Gastroenterology; Hepatology; Humans; Image Interpretation, Computer-Assisted; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Radiographic Image Enhancement; Radiology; Tomography, X-Ray Computed
• ISSN: 0942-8925; 2366-004X; 1432-0509; 2366-0058
• DOI: 10.1007/s00261-014-0233-7

Purpose To determine whether focal peripheral zone enhancement on routine venous-phase CT is predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer. Materials and methods IRB approval was obtained and informed consent waived for this HIPAA-compliant retrospective study. Forty-three patients with higher-grade prostate cancer (≥Gleason 4 + 3) and 96 with histology-confirmed lower-grade (≤Gleason 3 + 4 [ n  = 47]) or absent ( n  = 49) prostate cancer imaged with venous-phase CT comprised the study population. CT images were reviewed by ten blinded radiologists (5 attendings, 5 residents) who scored peripheral zone enhancement on a scale of 1 (benign) to 5 (malignant). Mass-like peripheral zone enhancement was considered malignant. Likelihood ratios (LR) and specificities were calculated. Multivariate conditional logistic regression analyses were conducted. Results Scores of “5” were strongly predictive of higher-grade prostate cancer (pooled LR+ 9.6 [95% CI 5.8–15.8]) with rare false positives (pooled specificity: 0.98 [942/960, 95% CI 0.98–0.99]; all 10 readers had specificity ≥95%). Attending scores of “5” were more predictive than resident scores of “5” (LR+: 14.7 [95% CI 5.8–37.2] vs. 7.6 [95% CI 4.2–13.7]) with similar specificity (0.99 [475/480, 95% CI 0.98–1.00] vs. 0.97 [467/480, 95% CI 0.96–0.99]). Significant predictors of an assigned score of “5” included presence of a peripheral zone mass ( p