Focal nodular enhancement on DCE MRI of the prostatectomy bed: radiologic-pathologic correlations and prognostic value

• Published in: European radiology 2023-04, Vol.33 (4), p.2985-2994
• Main Authors: Park, Mi Yeon, Park, Kye Jin, Kim, Mi-Hyun, Kim, Jeong Kon
• Format: Article
• Language: English
• Subjects: Antigens; Cancer surgery; Cancer therapies; Diagnostic Radiology; Humans; Imaging; Impact prediction; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Male; Margins of Excision; Medical prognosis; Medicine; Medicine & Public Health; Metastasis; Neoplasm Grading; Neoplasm Recurrence, Local - pathology; Neuroradiology; Prognosis; Prostate cancer; Prostate-Specific Antigen; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - surgery; Radiation therapy; Radiology; Regression analysis; Retrospective Studies; Tumors; Ultrasound; Urogenital; Urological surgery
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-022-09241-0

Objectives To determine the concordance of dynamic contrast-enhanced (DCE) imaging findings with clinico-pathologic characteristics and their prognostic impact for predicting biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) for prostate cancer. Methods This retrospective study included patients who underwent MRI within 1 year after RP between November 2019 and October 2020. DCE findings and their concordance with the presence and location of positive surgical margin (PSM) were assessed using RP specimens. Kaplan–Meier and logistic regression analyses were used to evaluate the prognostic impact of DCE findings for BCR. Results Among the 272 men (mean age ± standard deviation, 66.6 ± 7.4 years), focal nodular enhancement was more frequently observed in those with PSM compared to those with negative margin (85.4% versus 14.6%; p < 0.001). The sites of focal nodular enhancement were 72.9% (35/48) concordant with the PSM locations. Focal nodular enhancement was associated with a higher Gleason score, higher preoperative PSA (≥ 10 ng/mL), higher Gleason grade at the surgical margin, and non-limited margin involvement ( p = 0.002, 0.006, 0.032, and 0.001, respectively). In patients without BCR at the time of MRI, focal nodular enhancement was associated with a shorter time to BCR ( p < 0.001) and a significant factor predicting 1-year BCR in both univariate (odds ratio = 8.4 [95% CI: 2.5–28.3]; p = 0.001) and multivariate (odds ratio = 5.49 [1.56–19.3]; p = 0.008) analyses. Conclusions Focal nodular enhancement on post-prostatectomy MRI was associated with adverse clinico-pathologic characteristics of high risk for recurrence and can be a predictor for 1-year BCR in patients undergoing RP. Key Points • Focal nodular enhancement (PI-RR DCE score ≥ 4) was 72.9% (35/48) concordant with the site of positive resection margin by radiologic-histologic correlation. • Focal nodular enhancement (PI-RR DCE score ≥ 4) was associated with higher Gleason score ( ≥ 8), preoperative PSA ( > 10 ng/mL), and Gleason grade 4 or 5 at the surgical margin and non-limited margin involvement (p ≤ 0.032). • In patients without BCR at the time of MRI, focal nodular enhancement was a significant factor predicting 1-year BCR (odds ratio = 5.49; 95% CI: 1.56–19.3; p = 0.008).