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@ARTICLE{Wang:167183,
      author       = {X. Wang$^*$ and T. Hielscher$^*$ and J. P. Radtke$^*$ and
                      M. Görtz and V. Schütz and T. A. Kuder$^*$ and R.
                      Gnirs$^*$ and C. Schwab and A. Stenzinger and M.
                      Hohenfellner and H.-P. Schlemmer$^*$ and D. Bonekamp$^*$},
      title        = {{C}omparison of single-scanner single-protocol quantitative
                      {ADC} measurements to {ADC} ratios to detect clinically
                      significant prostate cancer.},
      journal      = {European journal of radiology},
      volume       = {136},
      issn         = {0720-048X},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2021-00174},
      pages        = {109538},
      year         = {2021},
      note         = {#EA:E010#LA:E010#},
      abstract     = {Mean ADC has high predictive value for the presence of
                      clinically significant prostate cancer (sPC). Measurement
                      variability is introduced by different scanners, protocols,
                      intra-and inter-patient variation. Internal calibration by
                      ADC ratios can address such fluctuations however can
                      potentially lower the biological value of quantitative ADC
                      determination by being sensitive to deviations in reference
                      tissue signal.To better understand the predictive value of
                      quantitative ADC measurements in comparison to internal
                      reference ratios when measured in a single scanner, single
                      protocol setup.284 consecutive patients who underwent 3 T
                      MRI on a single scanner followed by MRI-transrectal
                      ultrasound fusion biopsy were included. A board-certified
                      radiologist retrospectively reviewed all MRIs blinded to
                      clinical information and placed regions of interest (ROI) on
                      all focal lesions and the following reference regions:
                      normal-appearing peripheral zone (PZNL) and transition zone
                      (TZNL), the urinary bladder (BLA), and right and left
                      internal obturator muscle (RIOM, LIOM). ROI-based mean ADC
                      and ADC ratios to the reference regions were compared
                      regarding their ability to predict the aggressiveness of
                      prostate cancer. Spearman's rank correlation coefficient was
                      used to estimate the correlation between ADC parameters,
                      Gleason score (GS) and ADC ratios. The primary endpoint was
                      presence of sPC, defined as a GS ≥ 3 + 4. Univariable and
                      multivariable logistic regression models were constructed to
                      predict sPC. Receiver operating characteristics curves (ROC)
                      were used for visualization; DeLong test was used to
                      evaluate the differences of the area under the curve (AUC).
                      Bias-corrected AUC values and corresponding 95 $\%-CI$ were
                      calculated using bootstrapping with 100 bootstrap
                      samples.After exclusion of patients who received prior
                      treatment, 259 patients were included in the final cohort of
                      which 220 harbored 351 MR lesions. Mean ADC and ADC ratios
                      demonstrated a negative correlation with the GS. Mean ADC
                      had the strongest correlation with ρ of -0.34, followed by
                      ADCratioPZNL (ρ=-0.32). All ADC parameters except
                      ADCratioLIOM (p = 0.07) were associated with sPC p<0.05).
                      Mean ADC and ADCratioPZNL had the highest ROC AUC of all
                      parameters (0.68). Multivariable models with mean ADC
                      improve predictive performance.A highly standardized
                      single-scanner mean ADC measurement could not be improved
                      upon using any of the single ADC ratio parameters or
                      combinations of these parameters in predicting the
                      aggressiveness of prostate cancer.},
      keywords     = {Apparent diffusion coefficient (Other) / Gleason score
                      (Other) / Multiparametric MRI (Other) / Prostate cancer
                      (Other)},
      cin          = {E010 / C060 / E020 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)E010-20160331 / I:(DE-He78)C060-20160331 /
                      I:(DE-He78)E020-20160331 / I:(DE-He78)HD01-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:33482592},
      doi          = {10.1016/j.ejrad.2021.109538},
      url          = {https://inrepo02.dkfz.de/record/167183},
}