Impact of Arterial Input Function Selection on the Accuracy of Dynamic Contrast-Enhanced MRI Quantitative Analysis for the Diagnosis of Clinically Significant Prostate Cancer

Purpose: Using a limited temporal resolution dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) dataset to assess the impact of the arterial input function (AIF) choice on the transfer constant (K-trans) to distinguish prostate carcinoma (PCa) from benign tissue. Materials and Methods: Thirty-eight patients with clinically important peripheral PCa (>= 0.5 cc) were retrospectively studied. These patients underwent 1.5T multiparametric prostate MR with PCa and benign regions of interest (ROIs) selected using a visual registration with morphometric reconstruction obtained from radical prostatectomy. Using three pharmacokinetic (PK) analysis software programs, the mean K-trans of ROIs was computed using three AIFs: an individual AIF (IndAIF) and two literature population average AIFs of Weinmann (W-AIF) and of Fritz-Hansen (FH-AIF). A pairwise comparison of the area under the receiver operating characteristic curves (AUROCC) obtained with different AIFs was performed. Results: AUROCCs obtained with W-AIF (ranging from 0.801 to 0.843) were significantly higher than FH-AIF (ranging from 0.698 to 0.780, 0.002 <= P <= 0.045) and similar to or higher than Ind-AIF (ranging from 0.591 to 0.839, 0.014 <= P <= 0.9). Ind-AIF and FH-AIF provided similar AUROCC (0.34 <= P <= 0.81). The pairwise correlation of K-trans values was moderate to very strong when comparing W-AIF with FH-AIF (the Spearman's correlation coefficients [SCCs] ranged from 0.55 to 0.93) and very weak to moderate when comparing W-AIF with Ind-AIF (the SCCs ranged from 0.018 to 0.59) or FH-AIF with Ind-AIF (the SCCs ranged from 0.30 to 0.51). Conclusion: W-AIF yielded a higher performance than FH-AIF and a similar or higher performance than Ind-AIF in distinguishing PCa from benign tissue.