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array:24 [ "pii" => "S217351071730040X" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2017.06.003" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "964" "copyright" => "SERAM" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2017;59:313-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 51 "formatos" => array:2 [ "HTML" => 39 "PDF" => 12 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0033833817300425" "issn" => "00338338" "doi" => "10.1016/j.rx.2017.03.003" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "964" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2017;59:313-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 510 "formatos" => array:2 [ "HTML" => 152 "PDF" => 358 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Predicción de la extensión extracapsular en el cáncer de próstata mediante la longitud del contacto tumoral y el coeficiente de difusión aparente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "320" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Predicting extracapsular involvement in prostate cancer through the tumor contact length and the apparent diffusion coefficient" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1155 "Ancho" => 2333 "Tamanyo" => 256004 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Paciente de 65 años de edad con cáncer de próstata Gleason 8 (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4), localizado en la zona periférica anterior del tercio medio izquierdo. A) Imagen axial en T2, en la cual la línea roja representa la medición de la longitud del contacto tumoral con la cápsula, que es de 26,5<span class="elsevierStyleHsp" style=""></span>mm. B) Imagen axial del mapa de coeficiente de difusión aparente (b 800) con un valor de 0,798<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span> mm<span class="elsevierStyleSup">2</span>/s. Esta lesión presentó extensión extracapsular microscópica en el análisis de patología.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.F. Granja, C.M. Pedraza, D.C. Flórez, J.A. Romero, M.A. Palau, D.A. Aguirre" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.F." "apellidos" => "Granja" ] 1 => array:2 [ "nombre" => "C.M." "apellidos" => "Pedraza" ] 2 => array:2 [ "nombre" => "D.C." "apellidos" => "Flórez" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Romero" ] 4 => array:2 [ "nombre" => "M.A." "apellidos" => "Palau" ] 5 => array:2 [ "nombre" => "D.A." "apellidos" => "Aguirre" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217351071730040X" "doi" => "10.1016/j.rxeng.2017.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351071730040X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817300425?idApp=UINPBA00004N" "url" => "/00338338/0000005900000004/v1_201707050009/S0033833817300425/v1_201707050009/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173510717300381" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2017.06.001" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "963" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2017;59:321-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 95 "formatos" => array:2 [ "HTML" => 88 "PDF" => 7 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Usefulness of multidetector computed tomography before and after pulmonary vein isolation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "328" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la tomografía computarizada multidetector en la evaluación previa y el seguimiento de los pacientes sometidos a ablación de venas pulmonares" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2264 "Ancho" => 1626 "Tamanyo" => 247397 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Measurement of severity and length of two (2) pulmonary vein stenoses. (A) Significant stenosis (70 per cent of the vein reference diameter) of 15<span class="elsevierStyleHsp" style=""></span>mm in length in the SRPV (superior right pulmonary vein). (B) Moderate stenosis (60 per cent) of 18.7<span class="elsevierStyleHsp" style=""></span>mm in length in the SRPV (superior right pulmonary vein).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Revilla Orodea, I. Sánchez Lite, J.C. Gallego Beuth, T. Sevilla Ruiz, M.G. Sandín Fuentes, I.J. Amat Santos, J.A. San Román Calvar" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Revilla Orodea" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Sánchez Lite" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Gallego Beuth" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Sevilla Ruiz" ] 4 => array:2 [ "nombre" => "M.G." "apellidos" => "Sandín Fuentes" ] 5 => array:2 [ "nombre" => "I.J." "apellidos" => "Amat Santos" ] 6 => array:2 [ "nombre" => "J.A." "apellidos" => "San Román Calvar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833817300413" "doi" => "10.1016/j.rx.2017.03.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817300413?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510717300381?idApp=UINPBA00004N" "url" => "/21735107/0000005900000004/v1_201707120030/S2173510717300381/v1_201707120030/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510717300411" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2017.06.004" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "966" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2017;59:306-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 36 "formatos" => array:2 [ "HTML" => 26 "PDF" => 10 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Report</span>" "titulo" => "Dual-energy computed tomography for the detection of focal liver lesions" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "312" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tomografía computada de doble energía para la detección de lesiones focales hepáticas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 872 "Ancho" => 2834 "Tamanyo" => 212747 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Illustrative example of one avascular focal liver lesion assessed using one dual-energy CT scan during the portal phase. Comparative study among virtual spectral monochromatic imaging at 40<span class="elsevierStyleHsp" style=""></span>keV (A); polychromatic imaging; and (B) virtual spectral monochromatic imaging at 70<span class="elsevierStyleHsp" style=""></span>keV (C). The right lobe of the liver shows two (2) small simple adjacent cysts that are visible in the three (3) images (black arrow). Located immediately anterior to these cysts we can see one subtle hypoattenuated lesion that is only visible in the monochromatic image at 40<span class="elsevierStyleHsp" style=""></span>keV (white arrow in B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "K.N. Lago, J. Vallejos, C. Capuñay, E. Salas, E. Reynoso, J.B. Carpio, P.M. Carrascosa" "autores" => array:7 [ 0 => array:2 [ "nombre" => "K.N." "apellidos" => "Lago" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Vallejos" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Capuñay" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Salas" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Reynoso" ] 5 => array:2 [ "nombre" => "J.B." "apellidos" => "Carpio" ] 6 => array:2 [ "nombre" => "P.M." "apellidos" => "Carrascosa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833817300449" "doi" => "10.1016/j.rx.2017.03.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817300449?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510717300411?idApp=UINPBA00004N" "url" => "/21735107/0000005900000004/v1_201707120030/S2173510717300411/v1_201707120030/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Report</span>" "titulo" => "Predicting extracapsular involvement in prostate cancer through the tumor contact length and the apparent diffusion coefficient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "320" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.F. Granja, C.M. Pedraza, D.C. Flórez, J.A. Romero, M.A. Palau, D.A. Aguirre" "autores" => array:6 [ 0 => array:3 [ "nombre" => "M.F." "apellidos" => "Granja" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "C.M." "apellidos" => "Pedraza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "D.C." "apellidos" => "Flórez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.A." "apellidos" => "Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "M.A." "apellidos" => "Palau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:4 [ "nombre" => "D.A." "apellidos" => "Aguirre" "email" => array:1 [ 0 => "aguirreda@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Radiología e Imágenes Diagnósticas, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Patología y Laboratorio Clínico, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Predicción de la extensión extracapsular en el cáncer de próstata mediante la longitud del contacto tumoral y el coeficiente de difusión aparente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1155 "Ancho" => 2333 "Tamanyo" => 256004 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sixty-five year old-patient with Gleason 8 prostate cancer (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4) located in the peripheral area of the middle third of the left side. (A) Axial T2-weighted image showing one red line as the measurement of tumor contact length with a 26.5<span class="elsevierStyleHsp" style=""></span>mm capsule. (B) Axial image of the apparent diffusion coefficient map (b 800) with a value of 0.798<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s. This injury showed microscopic extracapsular spread in the pathology report.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Prostate cancer is the second most common type of cancer in males worldwide (15 per cent) and the fifth cause of cancer mortality among this population (6.6 per cent).<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> In Colombia, the panorama is not any different and it is the second most common cause of cancer in men, with an incidence of 46.5 per 100,000 inhabitants and a mortality rate of 12.6 per 100,000 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Both choosing treatment and the prognosis of patients with prostate cancer depend on the presence of extracapsular spread (ECS). For the cases of localized prostate cancer, the radical prostatectomy is the treatment of choice, with high rates of survival.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Patients with localized prostate cancer undergo clinical staging of the risks based upon what decisions are made when it comes to management (radical prostatectomy with or without adjuvant therapy), ECS risk prediction and possible chemical relapse after the prostatectomy–reported in up to 15–40 per cent of the cases.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4–7</span></a> This staging is performed based on the prostate-specific antigen (PSA), rectal examination, and Gleason grading group.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> Gleason's grading system is based on the sum of the two (2) most prevalent patterns of growth of biopsied tissue, and this score is used to make a five (5) group-grade classification (1: ≤6; 2: 3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7; 3: 4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7; 4: 8; and 5: 9 and 10), where group-grade 1 is low risk, while groups-grades 4 through 5 are high risk.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Unfortunately, with the use of these clinical parameters we find a 59 per cent substaging,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> with presence of microscopic ECS in 20–50 per cent of the surgical pieces initially classified as localized prostate cancer.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12,13</span></a> This is why it is recommended to perform one wide surgical resection including the neurovascular bundle that may lead to erectile dysfunction as a possible complication.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> This is the reason why determining the ECS is essential to be able to achieve better surgical outcomes with a lower comorbidity rate and better oncological outomes.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The multiparametric magnetic resonance imaging (mp-MRI) is the best imaging modality for the tumor staging of this neoplasm. It uses anatomical sequences (T1 and T2-weighted images) and functional sequences (diffusion and dynamics after the administration of contrast). For the diagnosis of ECS we normally use T2-weighted imaging conventional criteria<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">16,17</span></a>; this is how, in the year 2011, the European Society of Urogenital Radiology established the PI-RADS criteria and determined the score for the prediction of extracapsular involvement (1–5 points) using T2-weighted sequences. These criteria assess the following parameters: capsular contact (1 point); capsular irregularity (3 points); neurovascular bundle thickening (4 points); bulging or capsular loss (4 points); and overt extracapsular spread (5 points). Scores ≥4 regard the presence of ECS as likely.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> In 2015, the PI-RADS criteria (versión 2) were updated, no changes to these ECS criteria were made, but the DWI sequences-appararent diffusion coefficient (ADC) map and tumor contact length (TCL) with the capsule were mentioned as important factors in the prediction of ECS.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In the medical literature we found great variability in the values of sensitivity and specificity when using these conventional criteria (T2-weighted sequences). One meta-analysis from 2015 showed low sensitivity–53 per cent (95 per cent confidence interval [95 per cent CI]: 44–63 per cent), and high specificity–91 per cent (95 per cent CI: 88–93 per cent).<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In view of the clinical substaging and wide variability of sensitivity and specificity with the use of T2-weighted imaging conventional criteria for the preoperative diagnosis of ESC, during the last years new quantitative markers for mp-MRI have been studied like the TCL and the quantitative values of the ADC map. There are few studies in the medical literature and these imaging markers have only been assessed independently.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Therefore, the goal of this study is to assess the diagnostic performance of the quantification of TCL and ADC map, both separately and together, for the prediction of microscopic ESC in patients with prostate cancer using the radial prostatectomy specimen as the standard of reference.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><p id="par0045" class="elsevierStylePara elsevierViewall">We conducted one diagnostic test study with a retrospective review of the clinical histories of patients with confirmed diagnoses of moderate and high-risk prostate cancer treated with radical prostatectomy in a reference center on prostatic diseases from May, 2011 to December, 2013. The study was approved by the institutional research ethics committee which did not deem it necessary to obtain prior written informed consent given the observational and retrospective nature of the study.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0050" class="elsevierStylePara elsevierViewall">All patients with prostate cancer treated at the institution with radical prostatectomy who also underwent mp-MRIs during their preoperative assessment were included in the study.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The following patients were excluded from the study: 1) patients with prior prostate cancers who had already received radiotherapy or hormone replacement therapy; 2) patients with overt signs of ECS in the T2-weighted sequences; 3) patients whose mp-MRIs did not show affectation of the prostatic capsule tumor; and 4) patients whose images showed technical artifacts that would not allow a precise estimation of the values of the ADC map.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Imaging modality</span><p id="par0060" class="elsevierStylePara elsevierViewall">All patients underwent one prostate mp-MRI using one 1.5<span class="elsevierStyleHsp" style=""></span>T, Signa Excite HDxT superonductor machine (GE Medical Systems<span class="elsevierStyleSup">®</span>, Milwaukee, Wisconsin, USA) with pelvic antenna (16 channel phase array). We included high resolution T1-weighted images (axial cut, TR/TE, 500/11.48, cut thickness/gap 3<span class="elsevierStyleHsp" style=""></span>mm/0<span class="elsevierStyleHsp" style=""></span>mm, FOV 240<span class="elsevierStyleHsp" style=""></span>mm and matrix 256<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>256), T1-weighted images (axial, sagittal and coronal cuts, TR/TE 4300/61, cut thickness/gap: 3<span class="elsevierStyleHsp" style=""></span>mm/0<span class="elsevierStyleHsp" style=""></span>mm, FOV: 180<span class="elsevierStyleHsp" style=""></span>mm and matrix 256<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>256), dynamic sequences after the administration of contrast (axial cut, TR/TE 3.3/1.5, cut thickness: 3<span class="elsevierStyleHsp" style=""></span>mm, FOV:180<span class="elsevierStyleHsp" style=""></span>mm and matrix 256<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>192) and diffusion weighted imaging (DWI)-ADC map (axial cut, values b200, b500, b800<span class="elsevierStyleHsp" style=""></span>s/mm<span class="elsevierStyleSup">2</span>, TR/TE, 4725/91, cut thickness: 3<span class="elsevierStyleHsp" style=""></span>mm, FOV: 280<span class="elsevierStyleHsp" style=""></span>mm and matrix 256<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>256).</p><p id="par0065" class="elsevierStylePara elsevierViewall">One radiologist identified the disease-induced target lesion and then proceeded to locate it in the T2-weighted images and ADC b800. Using the Advantage WorkStation (GE Medical Systems<span class="elsevierStyleSup">®</span>, Milwaukee, Wisconsin, USA) the ADC values were assessed using one region of interest (ROI) from the injury reported, while the ADC b800 value and standard deviation were obtained too. Also the TCL of the injury with larger surface of contact to the capsule seen in the axial T2-weighted images was measured in millimeters using one digitized metric function of the working station (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Anatomopathological study</span><p id="par0070" class="elsevierStylePara elsevierViewall">After the radical prostatectomy, one pathologist with twelve years of experience in genitourinary diseases conducted one detailed study of the surgical piece using the following protocol: 3<span class="elsevierStyleHsp" style=""></span>mm cut sections were obtained, first in the axial plane, then in the sagittal plane and eventually in apex-to-base quadrants. Three (3)<span class="elsevierStyleHsp" style=""></span>μm cuts were performed and hematoxylin–eosin staining was used. The ESC was defined as the presence of cancer cells outside the prostatic capsule, then we determined if the ESC was focal/microscopic (radial spread <0.5<span class="elsevierStyleHsp" style=""></span>mm), or overt/macroscopic (when exceeding such spread). In some studies of the actual medical literature, focal ESC are defined as the identification of cancer cells beyond the capsule in a radial spread <0.5<span class="elsevierStyleHsp" style=""></span>mm, and in other studies <2<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20,21</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Also, the Gleason score ranges were determined based on the most prevalent growth patterns in the surgical piece categorizing it within one of the five (5) groups-grades established by the medical literature.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">For the analysis of information the following softwares were used: STATA 13<span class="elsevierStyleSup">®</span> (Stata Inc, College Station, Texas, USA) and SPSS 21<span class="elsevierStyleSup">®</span> (SPSS, Chicago, Illinois, USA). One univariate analysis was conducted in order to establish the relative frequencies of categorical variables. The measurements of central tendency and dispersion of quantitative variables, including the age of the patients, the PSA, and the ADC and TCL values in patients classified into Gleason categories were taken. One bivariate analysis was conducted in order to assess the existing correlation using the Student's t test and eventually establish the differences between the measurements of ADC and TCL values in patients with and without ESC.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The operative characteristics of ADC maps and TCL were determined using the microscopic ESC described in pathology reports as a reference. Using the area under the ROC curve, the optimal cut-off points could be established.</p><p id="par0090" class="elsevierStylePara elsevierViewall">One logistics regression analysis model was designed using as independent variables the values of ADC and TCL, and as the dependant variable the ESC defined using the specimen of pathology as a reference. The analysis of the ROC curves was conducted in order to assess the operative performance of the prediction model for microscopic ESCs. <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 values were considered statistically significant.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">In the total sample of 92 patients the average age was 61 years old (39–78 years old), the average value of the PSA, 9.25<span class="elsevierStyleHsp" style=""></span>ng/ml (4.9 and 12<span class="elsevierStyleHsp" style=""></span>ng/ml) and most patients (66 per cent) scored 7 in the Gleason grading system (groups-grades 2 and 3) as <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">When comparing ADC values and Gleason scores, we found that patients with Gleason group-grade 3 (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3) showed the most negative ADC values, with an average of 0.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.24<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s, followed in descending order, by the ADC values that corresponded to scores from groups-grades 4 and 5, with an average of 0.85<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.18<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s and 0.88<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.27<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s, respectively. One significant difference was identified (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03) between the ADC values of Gleason group-grade 2 (3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4) and Gleason group-grade 3 (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3), with values of 1.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.31<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s and 0.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.24<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s, respectively (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">When assessing the average TCL and Gleason scores we found the lowest value in Gleason group-grade 1 (17.15<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.00<span class="elsevierStyleHsp" style=""></span>mm), and the highest value in Gleason group-grade 5 (27.09<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.80<span class="elsevierStyleHsp" style=""></span>mm); however, we did not find any significant differences in these values like <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows.</p><p id="par0110" class="elsevierStylePara elsevierViewall">When assessing the ADC values for the prediction of microscopic ESCs three (3) cut-off points were considered (0.59, 0.87, and 0.9<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s) and the area under the curve (AUC) was identified at 72 per cent of the cut-off point 0.87<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Similarly, for that cut-off point (0.87<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s) the sensitivity and specificity for the prediction of microscopic ESCs were 83 per cent and 61 per cent, respectively, which was statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.014). Similarly, we confirmed that with a cut-off point of 17.5<span class="elsevierStyleHsp" style=""></span>mm for the TCL, the AUC for the prediction of microscopic ESC is larger (74 per cent), and when comparing it to 20<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> cut-off point, a much smaller AUC of 61 per cent was found. With the 17.5<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> cut-off point we identified high sensitivity (91 per cent) and specificity (57 per cent)–also statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">We did not find any significant differences in ADC values between patients with microscopic ESCs (average: 0.82; standard deviation [SD]: 0.26<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s) and those without microscopic ESCs (average: 0.94; DE: 0.29<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.11), but we could identify significant differences in the TLC values between patients with microscopic ESCs (average: 23.48; DE: 6.96<span class="elsevierStyleHsp" style=""></span>mm) and those without microscopic ESCs (average: 18.4; SD: 9.68<span class="elsevierStyleHsp" style=""></span>mm) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03). However, when conducting one binominal logistics regression analysis we confirmed that when it comes to ADC values, one cut-off point of 0.87<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s is a predictor of microscopic ESC with statistically significant results (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02) (coefficient: 1.89; 95 per cent confidence interval [95 per cent IC]: 0.27<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.52); when it comes to TLC values, one cut-off point of 17.5<span class="elsevierStyleHsp" style=""></span>mm is also a predictor of microscopic ESC with statistically significant results (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.037) (coefficient: 2.26; 95 per cent IC: 0.13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.39).</p><p id="par0120" class="elsevierStylePara elsevierViewall">When combining the cut-off points of ADC (0.87<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s) and TLC (17.5<span class="elsevierStyleHsp" style=""></span>mm) values, one AUC larger than the one found independently was obtained: of 77 per cent (77 per cent sensitivity; 61 per cent specificity). However when these cut-off points were assessed together using one logistics regression model, the AUC reached 82 per cent. These values were statistically significant with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001, like <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> and <a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a> show.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The election of treatment and prognosis of patients with prostate cancer depend on the presence or absence of ESC, being the radical prostatectomy reserved for patients with localized prostate cancer (without ESC). Currently, preoperative diagnoses using clinical criteria only in moderate and high-risk prostate cancers show 59 per cent substaging,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> while, postoperatively, in 20–50 per cent of the cases findings of microscopic ESCs have been reported.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12,13</span></a> Even the use of mp-MRI conventional criteria (T2-weighted images) for the diagnosis of ESC has shown great variability in the sensitivity and specificity of different studies. One meta-analysis (30 studies) showed low sensitivity (53 per cent) (95 per cent CI: 44–63 per cent), and high specificity (91 per cent) (95 per cent CI: 88–93 per cent).<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> Other studies have shown greater variability, with sensitivities ranging from 13 per cent to 95 per cent and specificities ranging from 49 per cent to 97 per cent.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> The diagnosis of microscopic (focal) ESCs using T2-weighted imaging conventional criteria is much lower than the diagnosis of established or macroscopic ESCs (50 per cent <span class="elsevierStyleItalic">vs</span> 69 per cent)<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a>; this is why it is very important to improve the preoperative diagnosis in the local staging of these patients when using new mp-MRI quantitative tools.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In this study two (2) quantitative criteria for the prediction of microscopic ECS, TCL, and quantification of the ADC map were assessed, since we have been able to see that adding these quantitative measures to T2-weighted imaging conventional criteria improves the diagnosis of ECS as recent studies have confirmed.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20–22,25</span></a> This is why in the update of the 2015 PI-RADS criteria (version 2) it has been included that the use of TCL and the quantification of the ADC map may be used as good predictors of ECS.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In this study significant differences were found in the TCL averages between patients with and without microscopic ECS (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03), but not in the ADC averages (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.11). The optimal cut-off point for the ADC value was 0.87<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s, with an AUC of 72 per cent (83 per cent sensitivity; 61 per cent specificity) while the optimal cut-off point for the TCL was 17.5<span class="elsevierStyleHsp" style=""></span>mm, with an AUC of 74 per cent (91 per cent sensitivity; 57 per cent specificity)–both statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.014 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007, respectively).</p><p id="par0140" class="elsevierStylePara elsevierViewall">The results from our study are similar to those from the medical literature. Baco et al.’s study<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> (111 patients, 1.5<span class="elsevierStyleHsp" style=""></span>T machine and pelvic antenna) found a similar cut-off point for the TCL (20<span class="elsevierStyleHsp" style=""></span>mm), with AUCs of 88 per cent (79 per cent sensitivity; 85 per cent specificity). However, in another study conducted by Rosenkrantz et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> (90 patients, 3<span class="elsevierStyleHsp" style=""></span>T machine and pelvic antenna), the cut-off point for the TCL (6<span class="elsevierStyleHsp" style=""></span>mm) was lower than the cut-off point from our study and also lower than Baco et al.’s study,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> with AUCs of 81.3 per cent (80.4–89.1 per cent sensitivity; 73.1–74.6 per cent specificity)<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a>–a finding that seems hard to replicate in a clinical setting yet despite the differences reported in the image acquisition machines. The reasons for these different cut-off points for the TCL are not quite clear.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The ADC values are also similar to the ones reported in the medical literature. In a study conducted by Woo et al.,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> one cut-off point of 0.893<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s presents a 75 per cent ADC (92 per cent sensitivity; 55 per cent specificity). Another study conducted by Chong et al.,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> confirmed similar ADC values with an average 0.883<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.18<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s, with significant differences (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) between patients with ECS (0.729<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.15<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s) and those without ECS (0.985<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.23<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s).</p><p id="par0150" class="elsevierStylePara elsevierViewall">When comparing the characteristics of this study with other studies from the aforementioned medical literature we realized that the studies are similar. They were all retrospective studies. When it comes to the number of patients, this study included 92 patients while other studies ranged from 69 to 117 patients. Similarly, in these studies the pelvic antenna was used the same way it was used in this study. When it comes to the mp-MRI used, Baco et al.’s study<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> also used a 1.5<span class="elsevierStyleHsp" style=""></span>T MRI scanner while the other three (3) studies used a 3<span class="elsevierStyleHsp" style=""></span>T MRI scanner.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20,25,26</span></a> The benefits derived from using 3<span class="elsevierStyleHsp" style=""></span>T MRI scanners instead of 1.5<span class="elsevierStyleHsp" style=""></span>T MRI scanner, and the pelvic antenna instead of the endorectal antenna have been widely discussed. The last PI-RADS consensus from 2015 (versión 2) claimed that although the 3<span class="elsevierStyleHsp" style=""></span>T MRI scanner is superior to the 1.5<span class="elsevierStyleHsp" style=""></span>T MRI scanner, both machines provide an adequate diagnosis when used with the appropriate optimized parameters. Nevertheless, the systematic use of the endorectal antenna is not recommended but it is suggested in 1.5<span class="elsevierStyleHsp" style=""></span>T MRI scanners for image quality enhancement.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">No studies assessing these quantitative criteria have ever been published (TCL<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>ADC). In this study we found that the sum of both criteria improved the AUC (77 per cent), and that the use of one logistics regression model improved the AUC even more (to 82 per cent), which is a larger (and statistically significant) percentage than the AUCs obtained using each criterion separately.</p><p id="par0160" class="elsevierStylePara elsevierViewall">With the evidence presented it may be deemed possible to use ADC and TCL for their systematic measurement in mp-MRIs in patients with prostate cancer for a better preoperative staging and more precise surgical planning in an effort to reduce local and postoperative side effects such as erectile dysfunction and incontinence.</p><p id="par0165" class="elsevierStylePara elsevierViewall">As a strong point here we have to say that we did not find any studies in the medical literature assessing TCL or ADC values as quantitative values for the prediction of microscopic ECS, so in this regard, our study would be the first one to make correlations between these parameters.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Some of the limitations of this study are that it is retrospective and that the number of patients was low. Future research should include larger populations and prospective studies; also image assessment should be performed by more than just one radiologist.</p><p id="par0175" class="elsevierStylePara elsevierViewall">We think that the results coming from this study allow us to apply new quantitative criteria in mp-MRIs for the diagnosis of ECS, in particular ECS microscopic affectation, for a better surgical planning and prognosis of these patients with moderate and high-risk prostate cancers.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of people and animals</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed abide by the ethics and regulations of the Human Research Committee, the World Health Organization and the Declaration of Helsinki.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols from their centres on the disclosure of data from patients.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have obtained prior written informed consent from the aforementioned patients. This document belongs to the corresponding author.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors</span><p id="par0195" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0200" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study: DCFC, DAA.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0205" class="elsevierStylePara elsevierViewall">Study idea: MFGS, CMPA, DCFC, DAA and JR.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0210" class="elsevierStylePara elsevierViewall">Study design: MFGS, CMPA, DCFC and DAA.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0215" class="elsevierStylePara elsevierViewall">Data mining: DCFC, DAA, JR and MP.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0220" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: MFGS, DAA and CMPA.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0225" class="elsevierStylePara elsevierViewall">Statistical analysis: MFGS, DAA and CMPA.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0230" class="elsevierStylePara elsevierViewall">Reference: DAA.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0235" class="elsevierStylePara elsevierViewall">Writing: MFGS, CMPA, DCFC, DAA, JR and MP.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0240" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks: MFGS, CMPA, DCFC, DAA, JR and MP.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10.</span><p id="par0245" class="elsevierStylePara elsevierViewall">Approval of final version: MFGS, CMPA, DCFC, DAA, JR and MP.</p></li></ul></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0250" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres866571" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec855853" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres866570" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec855852" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Imaging modality" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Anatomopathological study" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Authors" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-24" "fechaAceptado" => "2017-03-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec855853" "palabras" => array:4 [ 0 => "Prostate cancer" 1 => "Magnetic resonance imaging" 2 => "Prostatectomy" 3 => "Diffusion sequences" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec855852" "palabras" => array:4 [ 0 => "Cáncer de próstata" 1 => "Resonancia magnética" 2 => "Prostatectomía" 3 => "Secuencias de difusión" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the diagnostic performance of the length of the tumor contact with the capsule (LTC) and the apparent diffusion coefficient (ADC) map in the prediction of microscopic extracapsular extension in patients with prostate cancer who are candidates for radical prostatectomy.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We used receiver operating curves to retrospectively study the diagnostic performance of the ADC map and the LTC as predictors of microscopic extracapsular extension in 92 patients with prostate cancer and moderate to high risk who were examined between May 2011 and December 2013.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The optimal cutoff for the ADC map was 0.87<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s, which yielded an area under the ROC curve of 72% (95% <span class="elsevierStyleSmallCaps">CI</span>: 57%–86%), corresponding to a sensitivity of 83% and a specificity of 61%. The optimal cutoff for the LTC was 17.5<span class="elsevierStyleHsp" style=""></span>mm, which yielded an area under the ROC curve of 74% (95% CI: 61%–87%), corresponding to a sensitivity of 91% and a specificity of 57%. Combining the two criteria improved the diagnostic performance, yielding an area under the ROC curve of 77% (95% CI: 62%–92%), corresponding to a sensitivity of 77% and a specificity of 61%. We elaborated a logistic regression model, obtaining an area under the ROC curve of 82% (95% CI: 73%–93%).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Using quantitative measures improves the diagnostic accuracy of multiparametric magnetic resonance imaging in the staging of prostate cancer. The values of the ADC and LTC were predictors of microscopic extracapsular extension, and the best results were obtained when both values were used in combination.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar el rendimiento diagnóstico de la longitud del contacto tumoral con la cápsula (LCT) y la cuantificación del mapa del coeficiente de difusión aparente (ADC) en la predicción de la extensión extracapsular (EEC) microscópica en pacientes con cáncer de próstata candidatos a prostatectomía radical.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio retrospectivo de prueba diagnóstica con curvas receptor-operador (ROC) evaluando el rendimiento diagnóstico del valor de ADC y LCT como predictores de EEC microscópica en 92 pacientes con cáncer de próstata de moderado y alto riesgo, entre mayo de 2011 y diciembre de 2013.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El punto de corte óptimo para el valor del mapa de ADC fue de 0,87 × 10<span class="elsevierStyleSup">−3</span> mm<span class="elsevierStyleSup">2</span>/s, con un área bajo la curva ROC del 72% (intervalo de confianza del 95% [IC95%]: 57-86%), una sensibilidad del 83% y una especificidad del 61%. Para la LCT, el punto de corte óptimo fue de 17,5<span class="elsevierStyleHsp" style=""></span>mm, con un área bajo la curva ROC del 74% (IC95%: 61-87%), una sensibilidad del 91% y una especificidad del 57%. Empleando ambos criterios, el rendimiento diagnóstico mejoró con un área bajo la curva ROC del 77% (IC95%: 62-92%), una sensibilidad del 77% y una especificidad del 61%. Se calculó un modelo de regresión logística y se obtuvo un área bajo la curva ROC del 82% (IC95%: 73-93%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El uso de criterios cuantitativos mejora la exactitud diagnóstica de la resonancia magnética multiparamétrica en la estadificación del cáncer de próstata. Se encontró que los valores de ADC y de LCT son predictores de EEC microscópica, y que se obtienen mejores resultados si se usan de manera conjunta.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Granja MF, Pedraza CM, Flórez DC, Romero JA, Palau MA, Aguirre DA. Predicción de la extensión extracapsular en el cáncer de próstata mediante la longitud del contacto tumoral y el coeficiente de difusión aparente. Radiología. 2017;59:313–320.</p>" ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1157 "Ancho" => 2333 "Tamanyo" => 246877 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Fifty-one year old-patient with Gleason 8 prostate cancer (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4), located in the peripheral area of the middle third of the left side. (A) Axial T2-weighted image showing one red line as the measurement of tumor contact length with a 19.7<span class="elsevierStyleHsp" style=""></span>mm capsule. (B) Axial image of the apparent diffusion coefficient map (b 800) with a value of 0.645<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s. This injury showed microscopic extracapsular spread in the pathology report.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1155 "Ancho" => 2333 "Tamanyo" => 256004 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sixty-five year old-patient with Gleason 8 prostate cancer (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4) located in the peripheral area of the middle third of the left side. (A) Axial T2-weighted image showing one red line as the measurement of tumor contact length with a 26.5<span class="elsevierStyleHsp" style=""></span>mm capsule. (B) Axial image of the apparent diffusion coefficient map (b 800) with a value of 0.798<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s. This injury showed microscopic extracapsular spread in the pathology report.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1099 "Ancho" => 1651 "Tamanyo" => 77026 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ROC curves to predict extracapsular spread using different cut-off points of the quantitative values of the apparent diffusion coefficient map.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1199 "Ancho" => 1548 "Tamanyo" => 86180 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ROC curves to predict extracapsular spread using different cut-off points of the quantitative values of the tumor contact length with the capsule.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1099 "Ancho" => 1627 "Tamanyo" => 100516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ROC curves to predict extracapsular spread using optimal cut-off points obtained for the quantitative values of the apparent diffusion coefficient map and tumor contact length with the capsule, use of both criteria, and estimated logistics regression model.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">SD: standard deviation; PSA: prostate-specific antigen.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age (years), average</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">PSA at the moment of diagnosis (ng/ml), average</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.25<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Group-grade (Gleason) based on surgical specimen (No.</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">92), n (per cent)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 1 (≤6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (9.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 2 (3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34(36.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 3 (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27(29.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 5 (≥9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (10.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1457465.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics of patients.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">ADC: apparent diffusion coefficient; SD: standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gleason grade (No.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>92) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Group-grade (Gleason 1</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Gleason 2)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">ADC (10</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">−3</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">/s), average</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 1 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.19<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 2 (3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.01<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 3 (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.24<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 5 (≥9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.85<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Group-grade (Gleason 1</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Gleason 2)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Tumor contact length (mm), average</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 1 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.15<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 2 (3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 3 (4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.50<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group-grade 5 (≥9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.09<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.80 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1457467.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The difference between the average values of ADC for Gleason scores 3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4 and Gleason scores 4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3 is statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Distribution of the apparent diffusion coefficient and tumor contact length according to Gleason's grading system.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">AUC: area under the curve; ADC: apparent diffusion coefficient; 95 per cent CI: 95 per cent confidence interval.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AUC (95 per cent CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity/Specificity (per cent) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">ADC value (10</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">−3</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">/s)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.54 (0.35–0.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16/91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.72 (0.57–0.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83/61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.014<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70 (0.55–0.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83/57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.025<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Tumor contact length (mm)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.61 (0.44–0.78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58/65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.203 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>17.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.74 (0.61–0.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91/57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1457468.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The AUC estimator is statistically significant.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Receiver–operator characteristics and areas under the curve for the diagnosis of microscopic extracapsular spread.</p>" ] ] 8 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">AUC: area under the curve; ADC: apparent diffusion coefficient; 95 per cent CI: 95 per cent confidence interval.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Model \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AUC (95 per cent CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Logistics regression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.828 (0.726–0.929) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ADC value ≤8.7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s and TCL ≥17.5<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.774 (0.622–0.925) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1457466.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Estimator with significance level of 0.05.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Receiver–operator characteristics and areas under the curve for the diagnosis of microscopic extracapsular spread using one logistics regression model and the presence of an apparent diffusion coefficient ≤0.87<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>/s and a tumor contact length ≥17.5<span class="elsevierStyleHsp" style=""></span>mm.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global incidence and mortality for prostate cancer: analysis of temporal patterns and trends in 36 countries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. 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