To evaluate if diffusion tensor Imaging (DTI) is able to detect changes of periprostatic neurovascular fibers (PNFs) before and after radical prostatectomy (RP), and if these changes are related to post-surgical urinary incontinence and erectile dysfunction.
22 patients (mean age 62.6 years) with biopsy-proven prostate cancer underwent 1.5-T DTI before and after radical prostatectomy (RP). The number, fractional anisotropy (FA) values and length of PNFs before and after RP were compared using Student's t-test. Each patient filled out two questionnaires before and after RP, one for the evaluation of urinary continence (ICIQ-SF) and one for the evaluation of erectile function (IIEF-5). The ratios of the number, FA values and length of PNFs before and after RP (DTI B-A RATIOs) and the ratios between the scores obtained before and after RP for both ICIQ-SF and IIEF-2 (ICIQ-SF B-A RATIOs and IIEF-2 B-A RATIOs) were calculated to perform the Kendall's Tau Test between them.
There was a statistically significant decrease of the number of PNFs after RP at base, mid gland, and apex (p<0.01) and of FA values at mid gland (p<0.05), with positive statistically significant correlation between the DTI B-A RATIOs of the number of PNFs and IIEF-2 B-A RATIOs (p<0.05, ρ=0.47).
DTI was able to detect that the decrease of the number of the PNFs after RP was statistically related to the post-surgical erectile dysfunction (p< 0.05). Advances in knowledge: This work demonstrates that: - 1.5 T MRI Diffusion Tensor Imaging is able to detect the decrease of the number and of the Fractional Anisotropy of periprostatic neurovascular fibers after prostatectomy; - the decrease of the number of periprostatic neurovascular fibers after prostatectomy is related with the post-surgical erectile dysfunction; - 1.5 T MRI Diffusion Tensor Imaging has demonstrated to be a reproducible technique in detecting the changes of the periprostatic neurovascular fibers induced by radical prostatectomy (RP), with high interobserver agreement.
The British journal of radiology. 2018 Feb 01 [Epub ahead of print]
Valerio Di Paola, Adam Cybulski, Salvatore Belluardo, Francesca Cavicchioli, Riccardo Manfredi, Roberto Pozzi Mucelli
1 Università Cattolica del Sacro Cuore di Roma, Roma, Italy., 2 Università di Verona, Verona, Italy., 3 Ospedale Civile Maggiore di Borgo Trento - Verona, Italy., 4 Ospedale Sacro Cuore Don Calabria di Negrar, Negrar, Italy.