Reproducibility of Apparent Diffusion Coefficient and Restriction Spectrum Imaging Restriction Score in the Prostate Across MRI Sessions, Vendors, and Acquisition Settings: a Prospective Study

BackgroundDiffusion-weighted MRI is central to prostate cancer detection, but apparent diffusion coefficient (ADC) has limited reproducibility across scanners and sites. Restriction Spectrum Imaging restriction score maximum value (RSIrs-max) may provide a more reproducible biomarker. PurposeTo evaluate cross-session reproducibility of within-lesion mean ADC and RSIrs-max on prostate MRI, including same-vendor and cross-vendor comparisons, and in unfavorable-histology prostate cancer (uhPC) and different interpolation settings. Materials and MethodsIn this prospective study, participants with suspected or known prostate cancer enrolled from August 2022 to January 2026 underwent two MRI examinations including an RSI protocol. MRI-visible lesions were contoured on T2-weighted MRI; in participants with multiple lesions, the index lesion was selected. Mean ADC and RSIrs-max were measured within MRI-visible lesions. Analyses included all visible lesions, same-vendor and cross-vendor subgroups, participants with uhPC, and 20 participants with scans reconstructed with and without zero-filled interpolation (a setting with different defaults across vendors). Pearson correlation coefficients with 10,000 bootstrap resamples were used to estimate 95% confidence intervals. ResultsSixty-one male participants (median age, 69 years [IQR, 63-74]) were evaluated; 58 of 61 (95%) had MRI-visible lesions, and 26 of 58 (45%) had uhPC. For all MRI-visible lesions, correlations were 0.55 (95% CI: 0.23-0.76) for mean ADC and 0.83 (95% CI: 0.72-0.90) for RSIrs-max. In same-vendor scans, correlations were 0.76 (95% CI: 0.27-0.95) and 0.88 (95% CI: 0.72-0.96); in cross-vendor scans, they were 0.31 (95% CI: -0.07-0.62) and 0.79 (95% CI: 0.65-0.89), respectively. In uhPC, correlations were 0.42 (95% CI: -0.02-0.83) for mean ADC and 0.90 (95% CI: 0.77-0.96) for RSIrs-max. With inconsistent versus consistent interpolation, RSIrs-max correlation increased from 0.73 (95% CI: 0.48-0.89) to 0.89 (95% CI: 0.78-0.96). ConclusionADC showed limited reproducibility, particularly across vendors. RSIrs-max has stronger between-session reproducibility across same-vendor, cross-vendor, uhPC, and interpolation analyses.