New RESOLVE-Based Diffusional Kurtosis Imaging in MRI-Visible Prostate Cancer: Effect of Reduced b Value on Image Quality and Diagnostic Effectiveness

Objective: The purpose of this article was to investigate whether a new readout segmentation of long variable echo-trains (RESOLVE)-based diffusional kurtosis imaging (DKI) with reduced b value technique can affect image quality and diagnostic effectiveness in MRI-visible prostate cancer (PCA).

Subjects and methods: Prostatic RESOLVE DKI (0-1400 s/mm2) was prospectively performed for 12 volunteers. The optimal protocol was then performed in 108 MRI-visible PCAs to determine whether it can compete against a preferred b-value set (0-2000 s/mm(2)) regarding image quality and diagnostic effectiveness. Images were interpreted by two independent radiologists using the prostate imaging reporting and data system (PI-RADS). Readers' concordance and diagnostic effectiveness were tested with the Fleiss kappa and area under the ROC curve (Az) analyses.

Results: A b value of 1400 s/mm(2) generated a larger apparent diffusion coefficient of gaussian distribution (Dapp) (1.35 ± 0.31 vs 1.30 ± 0.30 mm(2)/s; p < 0.001) and apparent kurtosis coefficient (Kapp) (1.11 ± 0.26 vs 1.00 ± 0.21; p < 0.001) in PCA than did a b value of 2000 s/mm(2). Interreader agreement using PI-RADS was relatively low when Dapp and Kapp maps were excluded from image interpretations (κ = 0.39-0.41 vs κ = 0.66-0.68 with Dapp and Kapp maps). Interreader agreement in staging PCA was relatively high (κ > 0.80) and was not influenced by reducing the b value. The power of Dapp and Kapp to differentiate PCA from normal tissue (Az = 0.97-0.98), tissue with a Gleason score less than or equal to 3 + 4 from tissue with a Gleason score greater than 3 + 4 (Az = 0.77-0.82), and PCA stage lower than pT3 from stage pT3 and higher PCA (Az = 0.70-0.75) was not significantly degraded by reducing the b value.

Conclusion: We found that b values significantly influenced image quality, PI-RADS score, and DKI outputs but did not degrade the diagnostic effectiveness of DKI parameters to detect and classify PCA.