4D perfusion CT of prostate cancer for image-guided radiotherapy planning: A proof of concept study

Autoři: Lucian Beer aff001;  Stephan H. Polanec aff001;  Pascal A. T. Baltzer aff001;  Georg Schatzl aff003;  Dietmar Georg aff004;  Christian Schestak aff001;  Anja Dutschke aff001;  Harald Herrmann aff004;  Peter Mazal aff006;  Alexander K. Brendel aff006;  Shahrokh F. Shariat aff003;  Helmut Ringl aff001;  Thomas H. Helbich aff001;  Paul Apfaltrer aff001
Působiště autorů: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria aff001;  Department of Radiology and Cancer Research UK Cambridge Center, Cambridge, United Kingdom aff002;  Department of Urology, Medical University of Vienna, Vienna, Austria aff003;  Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria aff004;  Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University Vienna, Austria aff005;  Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria aff006;  Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany aff007
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225673



Advanced forms of prostate cancer (PCa) radiotherapy with either external beam therapy or brachytherapy delivery techniques aim for a focal boost and thus require accurate lesion localization and lesion segmentation for subsequent treatment planning. This study prospectively evaluated dynamic contrast-enhanced computed tomography (DCE-CT) for the detection of prostate cancer lesions in the peripheral zone (PZ) using qualitative and quantitative image analysis compared to multiparametric magnet resonance imaging (mpMRI) of the prostate.


With local ethics committee approval, 14 patients (mean age, 67 years; range, 57–78 years; PSA, mean 8.1 ng/ml; range, 3.5–26.0) underwent DCE-CT, as well as mpMRI of the prostate, including standard T2, diffusion-weighted imaging (DWI), and DCE-MRI sequences followed by transrectal in-bore MRI-guided prostate biopsy. Maximum intensity projections (MIP) and DCE-CT perfusion parameters (CTP) were compared between healthy and malignant tissue. Two radiologists independently rated image quality and the tumor lesion delineation quality of PCa using a five-point ordinal scale. MIP and CTP were compared using visual grading characteristics (VGC) and receiver operating characteristics (ROC)/area under the curve (AUC) analysis.


The PCa detection rate ranged between 57 to 79% for the two readers for DCE-CT and was 92% for DCE-MRI. DCE-CT perfusion parameters in PCa tissue in the PZ were significantly different compared to regular prostate tissue and benign lesions. Image quality and lesion visibility were comparable between DCE-CT and DCE-MRI (VGC: AUC 0.612 and 0.651, p>0.05).


Our preliminary results suggest that it is feasible to use DCE-CT for identification and visualization, and subsequent segmentation for focal radiotherapy approaches to PCa.

Klíčová slova:

Biopsy – Cancer treatment – Computed axial tomography – Lesions – Magnetic resonance imaging – Prostate cancer – Prostate gland – Radiation therapy


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