الفهرس 
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Abstract
SUMMARY
Prostate cancer is one of the most frequent cancers affecting male populations with considerably high mortality and morbidity. Nowadays with the use of mp-MRI accurate diagnosis and grading of prostatic cancer have become increasingly popular.
The ADC value of DWI provides quantitative information on prostate tumor characteristics and increases the accuracy of DWI analysis in detecting and localizing PCa.
However, because absolute ADC values depend on the selected b- value, the most accurate method of measuring the ADC value is still being discussed. Besides, although ADC value can estimate tumor aggressiveness, there is still a large overlap between ADCs of different tumors with the same GS.
The purpose of the study was to investigate the usefulness of the ADC map value and ADC ratio on DWI-MRI in Prostate Cancer Grading and Correlation with the Gleason score.
This was a diagnostic accuracy study conducted at Beni-Suef University Hospital on 40 patients with known cancer prostate, their ages ranged from 62 to 82 years with a mean ± SD of 71.73±6.30 years.
The mean ADC value of normal tissue was 1.558 ± 0.294 (1.00 - 2.08) × 10−3 mm2/sec, and of the lesion was 0.592 ± 0.144 (0.340 - 0.940) × 10−3 mm2/sec. Based on these measurements, the mean ADC ratio among the studied patients was 0.380 ± 0.127.
The histopathological analysis reported that most of the cases (67.5%) had a GS of more than 7 (3+4) and only 13 (32.5%) had a GS of less than or equal to 7. The mean GS was 7.45 ± 1.04 ranging from 6 to 9. In
addition, There were 13 (32.5%) patients of grade groups 1 and 2, and 27 (67.5%) patients had a higher grade group more than 2.
There were significant linear negative correlations between ADC value in the lesion and ADC ratio with both GS and tumor grade groups (p<0.001 for all).
In order to assess the diagnostic performance of ADC value and ADC ratio in diagnosing prostate tumors, ROC curve analyses were performed.
At a cut-off ≤0.62 and ≤0.59, the ROC curve indicated a significant role of ADC value in the lesion in the prediction of high malignant lesions [GS = more than 7 (3+4)] with sensitivity 78.12%, specificity 87.50%, PPV 96.2%, and NPV 50.0% and of malignant lesions [grade group ≤ 2] with sensitivity 85.19%, specificity 92.31%, PPV 75.0%, and NPV 75.0%, respectively.
At a cut-off ≤0.43 and ≤0.41, the ROC curve indicated a significant role of ADC ration in the prediction of high malignant lesions [GS = more than 7 (3±4)] with sensitivity 93.75%, specificity 87.50%, PPV 96.8% and NPV 77.80% and of malignant lesions [grade group ≤ 2] with sensitivity 92.59%, specificity 76.92%, PPV 89.3% and NPV 83.3%, respectively.
Our results reveal higher diagnostic accuracy and more promising results of ADC ratio in comparison to the ADC value
Linear regression analysis showed a highly significant role of ADC ratio in the prediction of tumor grade group and GS.
There was a significant decrease in both ADC value and ADC ratio in the high-grade prostate tumor compared to the lower-grade tumor.