Kobilnyk Y. The value of multiparametric and biparametric MRI in the differential diagnosis of prostate cancer

The dissertation is devoted to the problems of application of multiparametric MRI (mpMRI) and biparametric MRI (bpMRI) and imaging markers based on them for detection and differential diagnosis of prostate cancer (PCa). To solve these problems, the aim of the study was to improve the effectiveness of diagnosis and treatment of patients with prostate cancer through the use of multiparametric and biparametric MRI and their imaging markers. The study was performed on the basis of a comprehensive clinical, laboratory and instrumental examination, retrospective and prospective analysis of MRI images and histological data of 210 patients with prostate pathology, who were in inpatient or outpatient treatment in the urology department of the Lviv Regional Clinical Hospital of Lviv Regional Council and / or were examined at the Medical Centers "Euroclinic" (Lviv, Ivano- Frankivsk, Uzhhorod) for the period from 2017 to 2022. Of these, 178 men suspected of having PCa with no history of 5-alpha reductase inhibitors administration, among whom the analysis of histological findings from puncture biopsy revealed the following distribution of diagnoses: PCa was found in 102 (57.3%) ) patients (mean age - 0.83 ± 5.96 years), benign prostatic hyperplasia (BPH) - in 70 (39.3%) patients (mean age - 0.71 ± 6.25 years) and chronic prostatitis (CP) - in 6 (3.4%) patients (mean age - 62.0 ± 8.49 years). In addition, the study included 20 patients with histologically verified PCa (mean age - 61.11 ± 4.78 years) and 12 patients with BPH (mean age - 59.97 ± 7.45 years), who before inclusion in studies were treated with the drug of group of 5-alpha reductase inhibitors - finasteride. As a group of normal control an MRI data of 15 healthy volunteers was used (mean age - 33, 24 ± 2.75 years). Depending on the clinical T-stage, 122 cases of PCa were distributed as follows: T1c - 5 (4.1%) patients, T2a - 42 (34.4%) patients, T2b - 34 (27.9%) patients, T2c - 22 (18.0%) patients, T3a - 9 (7.4%) patients, T3b - 10 (8.2%) patients. Clinical signs of metastatically affected pelvic lymph nodes (cN1) were observed in 16 (13.1%) patients. Clinical features of metastatic pelvic bone lesions (cM1) were determined in 12 (9.8%) patients. In order to study the effectiveness of multiparametric and biparametric MRI in the detection of prostate cancer, all patients (main group) were divided into 5 subgroups according to the score obtained by the PI-RADS system based on mpMRI data. In addition, an alternative division of the same patients (comparison group) into subgroups according to the PI-RADS score was performed, however, based on the evaluation of the images of the abbreviated bpMRI protocol. For examination of patients, we used laboratory research methods, as well as instrumental: transrectal ultrasound examination, magnetic resonance imaging with intravenous contrast enhancement of the pelvic organs (magnetic field strength - 1.5 T), CT or chest radiography, puncture transrectal biopsy under ultrasound control. To evaluate MRI images according to the PI-RADS system, the classification of version 2.1 was used. Based on diffusion-weighted images (DWI) MRI maps were generated from which their quantitative parameter was calculated - apparent diffusion coefficient (ADC), which was used as a measure of diffusion of healthy and affected tissues.