ArticleFrontiers in oncology2026
A prospective comparison of the diagnostic performance of a high b-value diffusion-weighted image-guided score versus PI-RADS v2.1 for transition zone prostate cancer.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: The objective of this study is to evaluate the diagnostic accuracy of transition zone (TZ) scoring guided by diffusion-weighted imaging (DWI) with different b-values versus TZ lesion scoring under the current PI-RADS v2.1 standard for diagnosing transition zone prostate cancer (TZPCa). Methods: This prospective study enrolled 345 men with suspected prostate cancer (PCa). Following standardized multi-parametric magnetic resonance imaging (mpMRI), all patients underwent cognitive fusion-guided targeted biopsy and systematic biopsy, ultimately enrolling 50 patients with TZPCa and 121 patients with benign prostatic hyperplasia (BPH). DWI sequences were acquired with b-values of 50, 800, 1500, 2500, and 3000 s/mm². Three contrast groups were established for comparison with conventional PI-RADS v2.1 TZ scoring: DWI-TZ group: b=50, 800, 1500 s/mm²; h-DWI-TZ group: b=50, 800, 2500 s/mm²; uh-DWI-TZ group: b=50, 800, 3000 s/mm². Scoring procedure: Each radiologist first scored TZ lesions using standard b-values (50, 800, 1500) according to PI-RADS v2.1 criteria. After a 4-week interval, DWI-guided TZ scoring was performed on images from the three distinct b-value groups. The procedure for each group was identical: first, identify suspicious lesions on DWI/ADC images; then correlate these with T2WI images; finally, score TZ lesions according to PI-RADS v2.1 criteria. All scoring was performed independently by two radiologists. Results: When PI-RADS ≥ 3 was employed as the positive criterion, both the high b-value (h-DWI-TZ) and ultra-high b-value (uh-DWI-TZ) sequences exhibited significantly higher diagnostic sensitivity (0.855 and 0.823, respectively) and specificity (both 0.863) in comparison to conventional DWI sequences (sensitivity 0.677, specificity 0.630; p < 0.05 for both). Conversely, the standard high b-value (DWI-TZ) sequence demonstrated no statistically significant difference from the conventional sequence. When the threshold was elevated to PI-RADS score ≥4, the h-DWI-TZ sequence exhibited significantly superior specificity (0.967 vs. 0.874) and positive predictive value (PPV, 0.902 vs. 0.630) in comparison to the conventional sequence (both p<0.001). In addition, the h-DWI-TZ sequence exhibited markedly superior interobserver agreement (κ-value: 0.689 vs. 0.272, p<0.001). Conclusions: Diffusion-weighted imaging with high and ultra-high b-values guided TZ scoring enhances diagnostic accuracy for TZPCa.
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