Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI

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Diffusion-weighted MRI (DW-MRI) is a sensitive technique that depends on the b value and apparent diffusion coefficient (ADC) value for the diagnosis of PCa. The main objective of this study was to determine the optimal b-value and apparent diffusion coefficient (ADC) value in DW-MRI for the diagnosis of prostate cancer. Methods A prospective study including 26 male participants were conducted. MRI examinations were performed with T2 fat saturation sequences, and Diffusion weighted imaging (DWI) sequences with b-values (800, 1000, 1500, and 2000 mm2/s) were used, and the corresponding ADC maps were calculated. Qualitative and quantitative analyses were conducted. Results According to the present study, a b-value of 0,1500 mm2/s exhibited the highest Signal-to-Noise Ratio (SNR), and Signal Intensity Ratio (SIR). Area Under the Curve (AUC) for 0,1500 mm2/s was 0.80, indicating a high diagnostic accuracy for prostate cancer. Conclusion DWI with a b-value of 1500 mm2/s provides good diagnostic accuracy for differential diagnosis of prostate lesions. DWI is a crucial sequence in multiparametric MRI of the prostate and offers detailed information that enhances the accuracy of prostate cancer diagnosis and management. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-155/v4", "name": "Enhancing prostate cancer detection: The role of b-value and apparent..." } } ] } Home Browse Enhancing prostate cancer detection: The role of b-value and apparent... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Goveas B, Dkhar W, Kadavigere R et al. Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.12688/f1000research.161128.4 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] Brian Goveas 1 , Winniecia Dkhar https://orcid.org/0000-0001-5963-3230 1 , Rajagopal Kadavigere https://orcid.org/0000-0003-3486-8740 2 , [...] Kaushik Nayak 1 , Abhimanyu Pradhan https://orcid.org/0000-0002-2910-5338 1 , Anand Venugopal 2 , Praveen Shastry 3 , Neil Barnes Abraham 1 Brian Goveas 1 , Winniecia Dkhar https://orcid.org/0000-0001-5963-3230 1 , [...] Rajagopal Kadavigere https://orcid.org/0000-0003-3486-8740 2 , Kaushik Nayak 1 , Abhimanyu Pradhan https://orcid.org/0000-0002-2910-5338 1 , Anand Venugopal 2 , Praveen Shastry 3 , Neil Barnes Abraham 1 PUBLISHED 19 Sep 2025 Author details Author details 1 Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Radiodiagnosis and Imaging, Katsurba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Radiodiagnosis, Manipal HealthMap, Manipal, Karnataka, 576104, India Brian Goveas Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Visualization, Writing – Original Draft Preparation Winniecia Dkhar Roles: Conceptualization, Formal Analysis, Investigation, Project Administration, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Rajagopal Kadavigere Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation Kaushik Nayak Roles: Data Curation, Formal Analysis, Investigation, Software, Validation, Writing – Original Draft Preparation Abhimanyu Pradhan Roles: Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Visualization, Writing – Original Draft Preparation Anand Venugopal Roles: Conceptualization, Investigation, Project Administration, Supervision, Visualization Praveen Shastry Roles: Formal Analysis, Investigation, Methodology, Visualization Neil Barnes Abraham Roles: Data Curation, Formal Analysis, Methodology, Software, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. This article is included in the Oncology gateway. Abstract Background Magnetic Resonance Imaging (MRI) is a highly effective tool for the detection of prostate cancer (PCa). Diffusion-weighted MRI (DW-MRI) is a sensitive technique that depends on the b value and apparent diffusion coefficient (ADC) value for the diagnosis of PCa. The main objective of this study was to determine the optimal b-value and apparent diffusion coefficient (ADC) value in DW-MRI for the diagnosis of prostate cancer. Methods A prospective study including 26 male participants were conducted. MRI examinations were performed with T2 fat saturation sequences, and Diffusion weighted imaging (DWI) sequences with b-values (800, 1000, 1500, and 2000 mm 2 /s) were used, and the corresponding ADC maps were calculated. Qualitative and quantitative analyses were conducted. Results According to the present study, a b-value of 0,1500 mm 2 /s exhibited the highest Signal-to-Noise Ratio (SNR), and Signal Intensity Ratio (SIR). Area Under the Curve (AUC) for 0,1500 mm 2 /s was 0.80, indicating a high diagnostic accuracy for prostate cancer. Conclusion DWI with a b-value of 1500 mm 2 /s provides good diagnostic accuracy for differential diagnosis of prostate lesions. DWI is a crucial sequence in multiparametric MRI of the prostate and offers detailed information that enhances the accuracy of prostate cancer diagnosis and management. READ ALL READ LESS Keywords Prostate Cancer, Magnetic Resonance Imaging, Diffusion Weighted Imaging Corresponding Author(s) Winniecia Dkhar ( [email protected] ) Rajagopal Kadavigere ( [email protected] ) Close Corresponding authors: Winniecia Dkhar, Rajagopal Kadavigere Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Goveas B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Goveas B, Dkhar W, Kadavigere R et al. Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.12688/f1000research.161128.4 ) First published: 04 Feb 2025, 14 :155 ( https://doi.org/10.12688/f1000research.161128.1 ) Latest published: 19 Sep 2025, 14 :155 ( https://doi.org/10.12688/f1000research.161128.4 ) Revised Amendments from Version 3 In this revised version of our article, several important modifications have been made in response to reviewer feedback and to enhance the clarity and accuracy of our findings. First, we have removed the Contrast-to-Noise Ratio (CNR) parameter from Table 3. In this revised version of our article, several important modifications have been made in response to reviewer feedback and to enhance the clarity and accuracy of our findings. First, we have removed the Contrast-to-Noise Ratio (CNR) parameter from Table 3. See the authors' detailed response to the review by Jaseemudheen MM READ REVIEWER RESPONSES Introduction Prostate cancer (PCa) is a significant global health concern and the second-most common cancer among men in several regions of India. 1 MRI is a highly effective tool for the detection, treatment planning, and follow-up of prostate cancer (PCa), but its acceptance is not universal. Diffusion-weighted MRI (DW-MRI) can determine the distribution of water in tissues as well as the extracellular space and cell density within the tissues. 2 Diffusion-weighted imaging is sensitive to the movement of water molecules at the diffusion scale, where it focuses on the Brownian movement of water molecules and has a three-dimensional process that quantifies the diffusion index. This index reflects the apparent mean diffusivity, commonly referred to as the Apparent Diffusion Coefficient (ADC), which estimates the extent of diffusion along three orthogonal directions. 3 The sensitivity of this sequences depends upon the factor which is known as b-value. Diffusion weighted imaging (DWI) sequence is sensitive to prostate lesion detection, which can be adjusted by manipulating an extrinsic parameter known as the b-value. Higher b-values produce a stronger diffusion-weighted signal but result in a lower signal-to-noise ratio (SNR), whereas lower b-values are influenced by perfusion, which affects the sensitivity of diffusion sequences. 4 Despite its well-established diagnostic status in oncology, DWI presents challenges in its clinical application for evaluating prostate cancer owing to technical limitations and a lack of standardized protocols. This technique utilizes Echo Planar Imaging (EPI), which allows the rapid acquisition of images without the need for contrast agents. 5 , 6 DWI has been used for prostate imaging in several previous studies; however, its sensitivity and specificity have varied, which is likely the result of variations in technical parameters, such as the selection of b values, strength of the magnetic gradient, and methods for calculating ADC values in the region of interest. 7 , 8 The current literature lacks research on the optimal b-values and ADC values for prostate cancer screening and diagnosis. Establishing a single optimal b-value is crucial for reducing motion artifacts and time. Diffusion-weighted imaging (DWI) is particularly valuable for patients who are unable to undergo contrast-enhanced studies and may enhance the positive predictive value (PPV) for detecting prostate lesions. Thus, further investigations are essential to establish a standardized protocol. The main objective of the present study was to determine the diagnostic accuracy of the optimal b-value and ADC value of DWI for the detection of prostate cancer. Methods Ethical approval for this prospective study was obtained from the Institutional Ethics Committee (IEC 126/2023) of Kasturba Hospital, Manipal, India, for data collection, on 4/05/2023. All participants were fully informed about the study’s objectives and procedures. Written informed consent was obtained in compliance with the ethical principles set forth in the Declaration of Helsinki. This study was registered in the Clinical Trial Registry of India (CTRI). Subjects The study included 26 male subjects age group–35-75 years (mean±SD, 58±2 years) who had a confirmed diagnosis of prostate cancer on ultrasonography and were then recruited for MRI. Subjects who had undergone prostate surgery, chemotherapy, or radiotherapy were excluded. MRI techniques MRI examinations were performed with a Philips Achieva© 1.5Tesla MRI - (Philips, Netherlands) and United Imaging uMR ® 780uCS 3.0 Tesla - Tesla MRI (Shanghai United Imaging, China). A 12-channel pelvic phased-array coil is used. The examination protocol consists of a conventional pulse sequence - Axial T2W (Philips-Repetition Time (TR)/Echo Time (TE): 2494/100 ms, slice thickness: 3.5 mm, matrix, 224 × 199; Number of Excitations (NEX), 2; United-TR/TE, 4800/115 ms; slice thickness, 3 mm; matrix, 224 × 199; NEX, 2) for lesion localization and lesion size measurement, and DW sequence (Philips TR/TE: 5193/72 ms, flip angle: 90°, slice thickness: 4 mm, matrix: 108 × 86, signal averages: 1.011, United-TR/TE: 4520/73 ms, flip angle: 90°, slice thickness: 4 mm, matrix: 108 × 86, signal averages: 1.011) with a combination of four b-values (b- 800,1000,1500 and 2000 mm 2 /s). The diffusion series was then registered before generating the corresponding ADC maps for each b-value ( Table 1 ). Table 1. MRI sequence parameters for Philips Achieva 1.5T and United Imaging uMR 3.0T scanners. Parameter Philips 1.5T – DWI Philips 1.5T – T2 FS United Imaging 3T – DWI United Imaging 3T – T2 FS Slice Thickness 4 mm 3.5 mm 3 mm 3 mm TR (ms) 5193 2494 4520 4800 TE (ms) 72 100 73 115 b-values (s/mm 2 ) 0, 500, 1000, 1500, 2000 – 0, 50, 800, 1500, 2000 – Matrix 108 × 86 224 × 199 108 × 86 224 × 199 Fast Imaging Mode EPI – EPI – Signal Average/NEX 1.011 2 1.011 2 DWI Directions 15 – 15 – Flip Angle 90° 90° 90° 90° Fat Suppression SPIR SPIR SPIR SPIR Image analysis Qualitative and quantitative approaches were integrated in this study to provide a comprehensive assessment of image analysis. Qualitative analysis can provide context and insight, whereas quantitative analysis can offer precise and reproducible measurements. Qualitative image analysis was performed in the T2 FS sequence for localization and measurement of the lesion size in its maximum dimension in centimetres. The two radiologists, each with more than 10 years of experience, were blinded and analysed the DWI images at all different b-values. The image quality was assessed using a 5-point Likert scale, in which 1 represents unacceptable image quality, 2 = suboptimal, 3 = average, 4 = acceptable, and 5 = excellent, based on subjective SNR. 9 Quantitative analysis was conducted by measuring the signal intensity of the lesion, normal glandular tissue, and background noise, by placing the ROI on the acquired images. The SI values were used to compute the signal to intensity ratio (SIR) using the formula SIR= signal intensity of lesion/signal intensity of background noise. The ADC values of the prostate lesions were calculated by drawing three ROIs within the lesion or tumor and three within the normal tissue; these values were averaged for each b-value across the ROIs. Histopathology reports were collected for all patients as part of the investigation. Statistical analysis Data analysis was conducted using Statistical Package for Social Science (SPSS) version 16.0. 10 The inter-rate reliability of qualitative items (i.e., image quality) was determined using the kappa statistic. 11 Descriptive statistics were analyzed to determine the Mean and Standard Deviation of the ADC values of the prostate lesions. To determine the ADC cut-off value, receiver operating characteristic (ROC) curves were used, and the area under the curve (AUC) was used to calculate the sensitivities, specificities, and positive predictive values (PPV) of the multiple b values to determine the threshold ADC values. Youden’s index (J) was used to evaluate the diagnostic performance level (optimal b value) for the detection and differential diagnosis of diseases. Results A total of 26 subjects were included in this study, 20 of whom had malignant lesions and 6 of which were benign lesions. To evaluate the image quality of DWI with different b values, both subjective and quantitative evaluations were conducted. Table 2 illustrates the subjective SNR based on the differences between the signal intensity in the region of interest and background tissue. The Kappa values for b value of 800, 1000, 1500, and 2000 mm 2 /s were 0.77, 0.75, 0.64, and 0.64, respectively, which indicates moderate agreement across all b-values. To distinguish lesions from normal tissue, Kappa values varied from 0.78, 0.75, 0.77, and 0.79 for b-values of 800,1000,1500, and 2000, respectively. In the zone of the prostate, b = 1500 mm 2 /s exhibited a higher inter reading agreement with a Kappa value of 0.79 compared with other b values. In addition, it was noted that the Geometric Distortion for b values 800 & 2000 mm 2 /s had a higher inter reading agreement, with Kappa values of 0.9 and 0.93 as compared to the other b values. A quantitative analysis of the SIR and SNR in Table 3 . Compared to other b-values, the b-value of 1500 mm 2 /s showed excellent signal intensity with minimal noise and excellent contrast differentiation between the lesions and normal tissue. Table 4 presents a quantitative analysis of the ADC values for prostatic lesions and normal tissues, including the b-values (800,1000,1500,2000 mm 2 /s). The mean ADC values for normal tissues were 1.402±0.20 mm 2 /s, 1.606±0.18 mm 2 /s, 1.416±0.15 mm 2 /s, and 1.25±0.20 mm 2 /s for b-values of 800, 1000, 1500, and 2000 mm 2 /s, respectively. It was noted that the mean ADC values for benign lesions were 0.708 ± 0.14 mm 2 /s, 0.839 ± 0.15 mm 2 /s, 0.665 ± 0.15 mm 2 /s, and 0.59 ± 0.19 mm 2 /s for the corresponding b-values. Similarly, the mean ADC values of malignant lesions were 0.524 ± 0.03 mm 2 /s, 0.79 ± 0.014 mm 2 /s, 0.52 ± 0.16 mm 2 /s, and 0.48 ± 0.09 mm 2 /s, respectively. Therefore, the ADC value at b-1500 mm 2 /s was statistically significant for differentiating benign from malignant lesions. In this analysis, it was found that the mean ADC values decreased as the b-value increased, with malignant lesions exhibiting consistently lower ADC values. For a b-value of 800 mm 2 /s, the ADC cut-off threshold value was 0.481 × 10 -3 mm 2 /s which yielded 90.9 sensitivity and 83.3%; for a b-value of 1000 mm 2 /s, the ADC cut-off threshold value was 0.510 × 10 -3 mm 2 /s with 90.9% sensitivity and 79% specificity; for a b-value of 1500 mm 2 /s, the ADC cut-off threshold value was 0.389 × 10 -3 mm 2 /s with 94% sensitivity and 87% specificity; and for a b-value of 2000 mm 2 /s the ADC cut-off threshold value was 0.351 × 10 -3 mm 2 /s with 77% sensitivity and 88% specificity. Table 2. The Kappa value of the subjective assessment of prostate lesions on a DWI. b value (mm 2 /s) Criteria 1 Subjective SNR Criteria 2 Lesion V/s tissue differentiation Criteria 3 Zonal Anatomy Criteria 4 Geometric Distortion 0,800 0.77 0.78 0.77 0.9 0,1000 0.75 0.75 0.74 0.81 0,1500 0.64 0.77 0.79 0.74 0,2000 0.64 0.79 0.78 0.93 Table 3. Quantitative assessment of Signal Intensity Ratio (SIR) and Signal to Noise Ratio (SNR) of the prostate lesion on diffusion weighted images with respect to multiple b-values. b value (mm 2 /s) Image Criteria’s Signal Intensity Ratio Signal to Noise Ratio 0,800 1.86±0.540 6.31±2.251 0,1000 1.63±0.423 4.24±1.632 0,1500 1.51±0.630 6.99±2.749 0,2000 2.46±0.763 5.19±2.891 Table 4. Mean and Range of ADC values of Benign, Malignant and Normal Prostate tissues at multiple b value in MR Diffusion Weighted Imaging. b value (mm 2 /s) Prostate Tissue ADC Mean ± SD p-value 0, 800 Normal Tissue 1.402 ± 0.20 >0.05 Benign 0.708 ± 0.14 Malignant 0.524 ± 0.03 0, 1000 Normal Tissue 1.606 ± 0.18 >0.05 Benign 0.839 ± 0.15 Malignant 0.79 ± 0.014 0, 1500 Normal Tissue 1.416 ± 0.15 0.05 Benign 0.59 ± 0.19 Malignant 0.48 ± 0.09 Based on the Receiver Operating Characteristic (ROC) curve ( Figure 1 ), the area under the curve (AUC) was 0.90, 0.71, 0.80, and 0.64 for b-values of 800, 1000, 1500, and 2000 mm²/s, respectively as shown in Table 5 . To distinguish between benign and malignant prostate lesions, the AUC was significantly larger for b-values of 800 and 1500 mm 2 /s. Additionally, the prime threshold points and the diagnostic power of each b value were ascertained by analyzing the ADC readings at various cut-off points. Figure 1. Receiver Operating Characteristic (ROC) curves derived from ADC values in differential diagnosis of benign from malignant lesions for b value of (a). 0,800 mm 2 /s; (b). 0, 1000 mm 2 /s; (c). 0, 1500 mm 2 /s; and (d). 0, 2000 mm 2 /s. Table 5. Cut off Threshold value, Sensitivity, Specificity at multiple b-value for distinguishing between Benign and Malignant Prostate Lesions at different b values. b value (mm 2 /s) AUC ADC- Cut Off X 10 –3 mm 2 /s Mean SD Sensitivity (%) Specificity (%) 0, 800 0.90 0.481 90.9 83.3 0, 1000 0.71 0.510 90.9 79 0, 1500 0.80 0.389 94 87 0, 2000 0.64 0.351 77 88 Discussion MRI is an extensively accepted diagnostic tool for assessing prostate tissues and anomalies. DWI has a significant potential for assessing the structural properties of tissues and characterizing lesions. The effective diagnosis of a lesion requires its detection, and the b-value in DWI is a crucial factor in determining lesion conspicuity. In the present study, we observed that b-1500 mm 2 /s had the highest SNR and SIR, in comparison to the other b values. Despite the intermediate kappa values across b-values, the high SNR and SIR suggest that b-1500 mm 2 /s has superior image quality, indicating that the sensitivity of the diffusion weighted imaging is heavily influenced by the b-value. Hence, selecting a smaller b-value results in considerable signal attenuation owing to the high mobility of water molecules. We observed that increasing the b-value decreased the SNR of the image, which is consistent with the findings of previous studies. 12 A recent study demonstrated the significance of b-values in the detection of prostate lesions in DWI sequences. We found that b-values of 0 and 1500 mm 2 /s yielded optimal image quality. However, in the study reported by Kitajima et al., 11 noted that b1000 mm 2 /s had a better SNR (48.7 ± 13.5 and 33.2 ± 7.9 for cancerous and non-cancerous tissue) compared to b2000 mm 2 /s. In contrast, Nagayama et al. 8 determined that b800 offers a higher SNR and fewer artifacts when compared with higher b-values for the mapping of ADCs. In the study by Rezaeian et al., 12 b 1200 mm 2 /s was found to be an effective differential diagnosis technique owing to its low b-value, which allows DW images to show both extravascular molecular diffusion and perfusion characteristics, thus reducing the diagnostic accuracy of ADC values in distinguishing prostate cancer from healthy tissue. In a similar study, Rosenkranz et al. 13 indicated that prostate cancer diagnosis is most effective, with a b-value between 1500 and 2000 mm 2 /s. In contrast, the higher b-values (3000-5000 mm 2 /s) demonstrated inferior performance owing to inadequate or excessive signal suppression, resulting in poor anatomical clarity. According to Seung Soo Lee et al. 14 conducted a study comparing b1000 with b1800 and found that b1800 had improved accuracy and detection rates for lesions. In addition, we observed an increase in the accuracy rate for lesions classified as PI-RADS 4 or 5. As recommended by Chandarana et al., 15 multiparametric prostate MRI protocols should incorporate DWI sequences with b-values greater than 1000 mm 2 /s for the effective differentiation of normal tissue from lesions, both benign and malignant, in which, according to our study, the optimal b-value is 0,1500 mm 2 /sec. Based on the quantitative analysis of ADC values for b-values of 800, 1000, 1500, and 2000 mm 2 /s obtained in the present study, it was shown that the b1500 ADC value is optimal for the differential diagnosis of prostate lesions ( Figure 2 ). For b value of 0,1500 mm 2 /s, the mean ADC values were 1.416 ± 0.15 mm 2 /s for normal tissue, 0.665 ± 0.15 mm 2 /s for benign lesions, and 0.52 ± 0.16 mm 2 /s for malignant lesions, with the threshold cut off ADC value of 0.389 × 10 −3 mm 2 /s, with of 94% sensitivity and 87%specificity. It was also found that for normal tissue, benign and malignant ADC values decreased with increasing b values, which may be due to perfusion or diffusion, as reported by Abbas Rezaeian et al. 12 Figure 2. A 72-year-old male patient with difficulty urinating, the biochemistry revealed a PSA level of 58 mg/dl. Following a biopsy, the patient was diagnosed with prostatic acinar adenocarcinoma with a Gleason score of (4+3) = 7. For further investigation, the patient was referred for MRI Prostate. (a) Axial T2 fat suppression sequence showed a lesion with a length of 20.1mm, clearly delineating its boundaries. (b) The DWI with b value of 1500 mm 2 /s demonstrated values of 0.511×10 -3 mm 2 /s with decreased SNR. The study by Amol Madanlal et al. 13 found that the with ADC values for malignant lesions were significantly lower (0.75 ± 0.19) compared to benign lesions (1.14 ± 0.14), with high sensitivity of 82.98%, specificity of 89.47%, and a positive predictive value of 95.12% in the differentiation between benign and malignant lesions with b value of 1000 mm 2 /s. Kazuhiro Kitajima et al 14 reported an ADC cut-off value of 1.14 × 10 −3 mm 2 /s with a b-value of 1000 mm 2 /s, in which malignant tissues exhibited significantly lower ADC values of 0.82 ± 0.27 mm 2 /s compared to benign tissues with 1.69 ± 0.23 mm 2 /s. Abbas Rezaeian et al, 15 reported the ADC for the malignant lesions to be 0.87 ±0.13 mm 2 /s and for benign lesion 1.43±0.12 mm 2 /s, with the ADC cut-off value of 0.94 × 10 −3 mm 2 /s at a b-value of 1200 mm 2 /s, achieving 90.2% sensitivity, 92.6% specificity, and 91% overall accuracy indicating good diagnostic sequences for differential diagnosis of prostate lesions. Masako Nagayama et al, 12 reported mean ADC values of 1.00 ± 0.22 mm 2 /s for malignant lesions and 1.56 ± 0.14 mm 2 /s for benign lesions, with a threshold cutoff value of 1.35 × 10 −3 mm 2 /s, yielding sensitivity, specificity, and accuracy of 88%, 96%, and 93%, respectively. In addition, significant changes in ADC values may be attributed to necrosis or marked fibrosis, which may affect water diffusion or restriction. According to our analysis, there were slight differences in the threshold cut-off value in all previous studies, which could be attributed to different methods of calculating the qualitative ADC values, small sample sizes, and stages of cancer, in which more in-depth research needs to be conducted. We observed that MRI strength did not influence ADC values in the differential diagnosis of prostate cancer. In contrast, a higher magnetic field strength of 3T provided better image quality, owing to improvements in SNR. Significant changes in ADC values can occur because of necrosis or marked fibrosis, which affects water diffusion or restriction. The most notable benefit of DWI is that it can be easily integrated into screening protocols for high-risk populations, and when contrast-enhanced imaging is contraindicated, DWI is more reliable than T1- and T2-weighted imaging for the detection of prostate cancer. DWI can quantitatively characterize tumors (ADC value); therefore, it can be used as an alternative to invasive procedures, such as biopsies, which can cause incontinence, erectile dysfunction, infection, and septic shock. This study has some limitations, including a small sample size and the absence of an endorectal coil, which could have enhanced image quality and improved prostate cancer localization using a dedicated coil. Future studies should increase sample sizes to improve the generalizability of findings and enhance statistical power. The utilization of an endorectal coil in MRI protocols may optimize the signal-to-noise ratio and spatial resolution, thereby improving the accuracy of prostate lesion detection. Furthermore, standardizing b-values across institutions and integrating multiparametric MRI with advanced machine learning algorithms could enhance diagnostic precision and support automated prostate cancer classification. Conclusion Diffusion-weighted sequencing (DWI) in magnetic resonance imaging (MRI) is a valuable tool for both qualitative and quantitative evaluation of prostate pathology. According to our study, the optimal b-value for the detection and differential diagnosis of prostate lesions was 0,1500 mm 2 /s. This sequence has the potential to enhance the positive predictive value of prostate cancer screening, and because it requires a short scan time and is highly sensitive, it can be used as a screening tool for high-risk populations. Standardization of b-value will allow for improved inter-study comparisons of the diagnostic accuracy of diffusion-weighted MR prostate imaging. Normalized ADC values can assist in the differential diagnosis of prostate lesions and tumors. Overall, DWI is a crucial sequence in multiparametric MRI (mpMRI) of the prostate, offering detailed information that enhances the accuracy of prostate cancer diagnosis and management. Ethics and consent Ethical approval for this prospective study was obtained from the Institutional Ethics Committee (IEC 126/2023) of Kasturba Hospital, Manipal, India, on 4/05/2023. This study was registered in the Clinical Trial Registry of India (CTRI) and approval was received on the 09 th of June 2023, in which data collection was started on the 15 th of June 2023. All participants were fully informed about the study’s objectives and procedures. Written informed consent was obtained in compliance with the ethical principles set forth in the Declaration of Helsinki. Data availability Underlying data Figshare: Annotated data set, https://doi.org/10.6084/m9.figshare.28219067.v2 . 16 This project contains the following underlying data: • The data consist of the qualitative and quantitative values of DWI Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Laddha A, Thomas A, Nair DC: Outcomes of standard 12-core transrectal ultrasound-guided prostate biopsy in biopsy naive Indian men -single center experience. Indian J. Urol. 2020; 36 (3): 179–183. Publisher Full Text 2. Tan CH, Wang J, Kundra V: Diffusion weighted imaging in prostate cancer. Eur. Radiol. 2011 Mar; 21 (3): 593–603. Publisher Full Text 3. Tamada T, Ueda Y, Ueno Y, et al. : Diffusion-weighted imaging in prostate cancer. Magnetic Resonance Materials in Physics, Biology and Medicine. 2022; Vol. 35 : p. 533–547. Springer Science and Business Media Deutschland GmbH. Publisher Full Text 4. Dkhar W, Kadavigere R, Mustaffa SP: Quantitative Evaluation for Differential Diagnosis of Breast Lesions in Diffusion-Weighted MR Imaging. Health Technol (Berl). 2021 Nov 1; 11 (6): 1269–1275. Publisher Full Text 5. Maurer MH, Heverhagen JT: Diffusion weighted imaging of the prostate-principles, application, and advances. Transl. Androl. Urol. 2017; 6 : 490–498. AME Publishing Company. PubMed Abstract | Publisher Full Text | Free Full Text 6. Fennessy FM, Maier SE: Quantitative diffusion MRI in prostate cancer: Image quality, what we can measure and how it improves clinical assessment. Eur. J. Radiol. 2023; 167 : 111066. Elsevier Ireland Ltd. PubMed Abstract | Publisher Full Text | Free Full Text 7. Rezaeian A, Ostovari M, Hoseini-Ghahfarokhi M, et al. : Diffusion-weighted magnetic resonance imaging at 1.5 T for peripheral zone prostate cancer: the influence of the b-value combination on the diagnostic performance of apparent diffusion coefficient. Pol. J. Radiol. 2022 Jan 1; 87 : 215–219. Publisher Full Text 8. Nagayama M, Watanabe Y, Terai A, et al. : Determination of the cutoff level of apparent diffusion coefficient values for detection of prostate cancer. Jpn. J. Radiol. 2011 Aug; 29 (7): 488–494. PubMed Abstract | Publisher Full Text 9. Dkhar W, Kadavigere R, Paruthikunnan SM: Image Quality Analysis for Optimization of b-value in Diffusion Weighted MRI of Breast. Malays. J. Med. Health Sci. 2020; 16 . 10. IBM SPSS Statistics 28 Brief Guide This edition applies to version 28, release 0, modification 0 of IBM ® SPSS ® Statistics and to all subsequent releases and modifications until otherwise indicated in new editions. 11. Chris ©, Reviewer K, Marshall E: community project encouraging academics to share statistics support resources All stcp resources are released under a Creative Commons licence. Reference Source 12. Nagayama M, Watanabe Y, Terai A, et al. : Determination of the cutoff level of apparent diffusion coefficient values for detection of prostate cancer. Jpn. J. Radiol. 2011 Aug; 29 (7): 488–494. PubMed Abstract | Publisher Full Text 13. Lahoti AM, Lakhotiya AR, Ingole SM, et al. : Role and application of diffusion-weighted imaging in evaluation of prostate cancer. Indian J. Med. Paediatr. Oncol. 2018 Jul 1; 39 (3): 349–354. Publisher Full Text 14. Kitajima K, Kaji Y, Kuroda K, et al. : High b-value DiŠusion-weighted Imaging in Normal and Malignant Peripheral Zone Tissue of the Prostate: EŠect of Signal-to-Noise Ratio. Magn. Reson. Med. Sci. 2008; 7 : 93–99. PubMed Abstract | Publisher Full Text 15. Rezaeian A, Ostovari M, Hoseini-Ghahfarokhi M, et al. : Diffusion-weighted magnetic resonance imaging at 1.5 T for peripheral zone prostate cancer: the influence of the b-value combination on the diagnostic performance of apparent diffusion coefficient. Pol. J. Radiol. 2022 Jan 1; 87 : e215–e219. PubMed Abstract | Publisher Full Text 16. Dkhar W: Qualitative Data Quantitative Data. [Dataset]. figshare. 2025. Publisher Full Text Comments on this article Comments (0) Version 4 VERSION 4 PUBLISHED 04 Feb 2025 ADD YOUR COMMENT Comment Author details Author details 1 Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Radiodiagnosis and Imaging, Katsurba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Radiodiagnosis, Manipal HealthMap, Manipal, Karnataka, 576104, India Brian Goveas Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Visualization, Writing – Original Draft Preparation Winniecia Dkhar Roles: Conceptualization, Formal Analysis, Investigation, Project Administration, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Rajagopal Kadavigere Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation Kaushik Nayak Roles: Data Curation, Formal Analysis, Investigation, Software, Validation, Writing – Original Draft Preparation Abhimanyu Pradhan Roles: Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Visualization, Writing – Original Draft Preparation Anand Venugopal Roles: Conceptualization, Investigation, Project Administration, Supervision, Visualization Praveen Shastry Roles: Formal Analysis, Investigation, Methodology, Visualization Neil Barnes Abraham Roles: Data Curation, Formal Analysis, Methodology, Software, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (4) version 4 Revised Published: 19 Sep 2025, 14:155 https://doi.org/10.12688/f1000research.161128.4 version 3 Revised Published: 10 Sep 2025, 14:155 https://doi.org/10.12688/f1000research.161128.3 version 2 Revised Published: 06 Mar 2025, 14:155 https://doi.org/10.12688/f1000research.161128.2 version 1 Published: 04 Feb 2025, 14:155 https://doi.org/10.12688/f1000research.161128.1 Copyright © 2025 Goveas B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Goveas B, Dkhar W, Kadavigere R et al. Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.12688/f1000research.161128.4 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 4 VERSION 4 PUBLISHED 19 Sep 2025 Revised Views 0 Cite How to cite this report: MM J. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.188480.r415648 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v4#referee-response-415648 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Oct 2025 Jaseemudheen MM , K.S. Hegde Medical Academy, NITTE, Mangalore, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.188480.r415648 I appreciate the thorough and careful revisions made to the manuscript. The authors have responded to all queries with clarity and have thoughtfully addressed the concerns raised in the previous round of review. The removal of the CNR parameter has ... Continue reading READ ALL I appreciate the thorough and careful revisions made to the manuscript. The authors have responded to all queries with clarity and have thoughtfully addressed the concerns raised in the previous round of review. The removal of the CNR parameter has improved the consistency and readability of the results, and the additional explanations provided have enhanced the overall clarity of the manuscript. The study is well-structured, the methodology is sound, and the findings contribute valuable insights to the field. I am satisfied with the revisions and recommend the manuscript for indexing. Competing Interests: No competing interests were disclosed. Reviewer Expertise: MRI, CT, Radiation safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT MM J. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.188480.r415648 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v4#referee-response-415648 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 3 VERSION 3 PUBLISHED 10 Sep 2025 Revised Views 0 Cite How to cite this report: MM J. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.187913.r413119 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v3#referee-response-413119 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Sep 2025 Jaseemudheen MM , K.S. Hegde Medical Academy, NITTE, Mangalore, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.187913.r413119 I appreciate the thorough effort made in revising the manuscript and in addressing the earlier queries with clarity. The additional explanations have improved the overall readability of the work. However, regarding Table 3, the CNR values show pronounced skewness, with ... Continue reading READ ALL I appreciate the thorough effort made in revising the manuscript and in addressing the earlier queries with clarity. The additional explanations have improved the overall readability of the work. However, regarding Table 3, the CNR values show pronounced skewness, with disproportionately large standard deviations in some cases exceeding the mean. This appears to result from combining data acquired on two different MRI machines, which may render the reported measure less meaningful in its current form. To avoid potential misinterpretation, you may consider either: (i) removing this parameter from Table 3 , or (ii) presenting the values separately for each scanner , so that the variability is more transparently represented. Competing Interests: No competing interests were disclosed. Reviewer Expertise: MRI, CT, Radiation safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT MM J. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.187913.r413119 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v3#referee-response-413119 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 06 Mar 2025 Revised Views 0 Cite How to cite this report: MM J. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.178777.r408413 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v2#referee-response-408413 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Sep 2025 Jaseemudheen MM , K.S. Hegde Medical Academy, NITTE, Mangalore, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.178777.r408413 This is a well-conducted and clearly written study addressing an important aspect of prostate MRI optimization. The authors have presented their methods and results in detail, and the findings contribute valuable insights into the role of b-values and ADC in ... Continue reading READ ALL This is a well-conducted and clearly written study addressing an important aspect of prostate MRI optimization. The authors have presented their methods and results in detail, and the findings contribute valuable insights into the role of b-values and ADC in differentiating prostate lesions. The discussion is comprehensive and relates well to prior literature Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Methods: Clarify whether all patients were imaged on both scanners (Philips 1.5T and United Imaging 3T) or divided between them, since field strength could influence results (Not ADC but other factors). Consistently expand abbreviations at first mention (e.g., SI- Signal Intensity, NEX- Number of Excitations). In Table 2 , the reported CNR values show disproportionately large standard deviations, in some cases exceeding the mean, which raises concerns about calculation accuracy or data consistency. Please recheck the CNR computations and clarify whether these represent SD or another measure of variability (e.g., variance). Consider alternative representation (e.g., median ± IQR) if the data are highly skewed. In Table 3 , while mean ADC values are presented for normal, benign, and malignant tissues across different b-values, a pairwise comparison (e.g., benign vs malignant, malignant vs normal, benign vs normal- In an additional Table) would strengthen the statistical analysis and clarify which differences are statistically significant. Please consider including appropriate pairwise comparison tests with correction for multiple testing (post-hoc pairwise tests) Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: MRI, CT, Radiation safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT MM J. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.178777.r408413 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v2#referee-response-408413 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 12 Sep 2025 Winniecia Dkhar , Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India 12 Sep 2025 Author Response 1) Reviewer Comments:- Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Author Response:- We thank the reviewer for this suggestion. The ... Continue reading 1) Reviewer Comments:- Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Author Response:- We thank the reviewer for this suggestion. The MRI Technique section has been revised, and the scanner and sequence details are now presented in Table 1 for clarity and readability. 2) Reviewer Comments:- Methods: Clarify whether all patients were imaged on both scanners (Philips 1.5T and United Imaging 3T) or divided between them, since field strength could influence results (Not ADC but other factors). Author Response:- We thank the reviewer for this valuable comment. We have clarified this point in the revised Methods section. Patients were imaged on either the Philips Achieva 1.5T or the United Imaging uMR 3.0T scanner, depending on availability. Each patient underwent MRI on a single scanner only, and no patient was imaged on both systems. 3) Reviewer Comments:- Consistently expand abbreviations at first mention (e.g., SI- Signal Intensity, NEX- Number of Excitations). Author Response:- We thank the reviewer for this observation. All abbreviations have now been expanded at their first mention in the manuscript. 4) Reviewer Comments:- In Table 2 , the reported CNR values show disproportionately large standard deviations, in some cases exceeding the mean, which raises concerns about calculation accuracy or data consistency. Please recheck the CNR computations and clarify whether these represent SD or another measure of variability (e.g., variance). Consider alternative representation (e.g., median ± IQR) if the data are highly skewed. Author Response:- We thank the reviewer for this comment. All values in Table 2, including SIR, SNR, and CNR, were calculated as mean ± standard deviation (SD) . The data were not skewed, and no alternative representation was necessary. 5) Reviewer Comments:- In Table 3 , while mean ADC values are presented for normal, benign, and malignant tissues across different b-values, a pairwise comparison (e.g., benign vs malignant, malignant vs normal, benign vs normal- In an additional Table) would strengthen the statistical analysis and clarify which differences are statistically significant. Please consider including appropriate pairwise comparison tests with correction for multiple testing (post-hoc pairwise tests) Author Response:- We thank the reviewer for this suggestion. In this study, the primary objective was to report mean ADC values and ranges for normal, benign, and malignant prostate tissues at multiple b-values. Due to the relatively small sample size in the benign group performing pairwise statistical comparisons may not provide robust or reliable results. Therefore, we have reported the overall trends without post-hoc pairwise analysis, which we believe is appropriate given the exploratory nature of this study. 1) Reviewer Comments:- Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Author Response:- We thank the reviewer for this suggestion. The MRI Technique section has been revised, and the scanner and sequence details are now presented in Table 1 for clarity and readability. 2) Reviewer Comments:- Methods: Clarify whether all patients were imaged on both scanners (Philips 1.5T and United Imaging 3T) or divided between them, since field strength could influence results (Not ADC but other factors). Author Response:- We thank the reviewer for this valuable comment. We have clarified this point in the revised Methods section. Patients were imaged on either the Philips Achieva 1.5T or the United Imaging uMR 3.0T scanner, depending on availability. Each patient underwent MRI on a single scanner only, and no patient was imaged on both systems. 3) Reviewer Comments:- Consistently expand abbreviations at first mention (e.g., SI- Signal Intensity, NEX- Number of Excitations). Author Response:- We thank the reviewer for this observation. All abbreviations have now been expanded at their first mention in the manuscript. 4) Reviewer Comments:- In Table 2 , the reported CNR values show disproportionately large standard deviations, in some cases exceeding the mean, which raises concerns about calculation accuracy or data consistency. Please recheck the CNR computations and clarify whether these represent SD or another measure of variability (e.g., variance). Consider alternative representation (e.g., median ± IQR) if the data are highly skewed. Author Response:- We thank the reviewer for this comment. All values in Table 2, including SIR, SNR, and CNR, were calculated as mean ± standard deviation (SD) . The data were not skewed, and no alternative representation was necessary. 5) Reviewer Comments:- In Table 3 , while mean ADC values are presented for normal, benign, and malignant tissues across different b-values, a pairwise comparison (e.g., benign vs malignant, malignant vs normal, benign vs normal- In an additional Table) would strengthen the statistical analysis and clarify which differences are statistically significant. Please consider including appropriate pairwise comparison tests with correction for multiple testing (post-hoc pairwise tests) Author Response:- We thank the reviewer for this suggestion. In this study, the primary objective was to report mean ADC values and ranges for normal, benign, and malignant prostate tissues at multiple b-values. Due to the relatively small sample size in the benign group performing pairwise statistical comparisons may not provide robust or reliable results. Therefore, we have reported the overall trends without post-hoc pairwise analysis, which we believe is appropriate given the exploratory nature of this study. Competing Interests: NIl Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 12 Sep 2025 Winniecia Dkhar , Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India 12 Sep 2025 Author Response 1) Reviewer Comments:- Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Author Response:- We thank the reviewer for this suggestion. The ... Continue reading 1) Reviewer Comments:- Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Author Response:- We thank the reviewer for this suggestion. The MRI Technique section has been revised, and the scanner and sequence details are now presented in Table 1 for clarity and readability. 2) Reviewer Comments:- Methods: Clarify whether all patients were imaged on both scanners (Philips 1.5T and United Imaging 3T) or divided between them, since field strength could influence results (Not ADC but other factors). Author Response:- We thank the reviewer for this valuable comment. We have clarified this point in the revised Methods section. Patients were imaged on either the Philips Achieva 1.5T or the United Imaging uMR 3.0T scanner, depending on availability. Each patient underwent MRI on a single scanner only, and no patient was imaged on both systems. 3) Reviewer Comments:- Consistently expand abbreviations at first mention (e.g., SI- Signal Intensity, NEX- Number of Excitations). Author Response:- We thank the reviewer for this observation. All abbreviations have now been expanded at their first mention in the manuscript. 4) Reviewer Comments:- In Table 2 , the reported CNR values show disproportionately large standard deviations, in some cases exceeding the mean, which raises concerns about calculation accuracy or data consistency. Please recheck the CNR computations and clarify whether these represent SD or another measure of variability (e.g., variance). Consider alternative representation (e.g., median ± IQR) if the data are highly skewed. Author Response:- We thank the reviewer for this comment. All values in Table 2, including SIR, SNR, and CNR, were calculated as mean ± standard deviation (SD) . The data were not skewed, and no alternative representation was necessary. 5) Reviewer Comments:- In Table 3 , while mean ADC values are presented for normal, benign, and malignant tissues across different b-values, a pairwise comparison (e.g., benign vs malignant, malignant vs normal, benign vs normal- In an additional Table) would strengthen the statistical analysis and clarify which differences are statistically significant. Please consider including appropriate pairwise comparison tests with correction for multiple testing (post-hoc pairwise tests) Author Response:- We thank the reviewer for this suggestion. In this study, the primary objective was to report mean ADC values and ranges for normal, benign, and malignant prostate tissues at multiple b-values. Due to the relatively small sample size in the benign group performing pairwise statistical comparisons may not provide robust or reliable results. Therefore, we have reported the overall trends without post-hoc pairwise analysis, which we believe is appropriate given the exploratory nature of this study. 1) Reviewer Comments:- Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Author Response:- We thank the reviewer for this suggestion. The MRI Technique section has been revised, and the scanner and sequence details are now presented in Table 1 for clarity and readability. 2) Reviewer Comments:- Methods: Clarify whether all patients were imaged on both scanners (Philips 1.5T and United Imaging 3T) or divided between them, since field strength could influence results (Not ADC but other factors). Author Response:- We thank the reviewer for this valuable comment. We have clarified this point in the revised Methods section. Patients were imaged on either the Philips Achieva 1.5T or the United Imaging uMR 3.0T scanner, depending on availability. Each patient underwent MRI on a single scanner only, and no patient was imaged on both systems. 3) Reviewer Comments:- Consistently expand abbreviations at first mention (e.g., SI- Signal Intensity, NEX- Number of Excitations). Author Response:- We thank the reviewer for this observation. All abbreviations have now been expanded at their first mention in the manuscript. 4) Reviewer Comments:- In Table 2 , the reported CNR values show disproportionately large standard deviations, in some cases exceeding the mean, which raises concerns about calculation accuracy or data consistency. Please recheck the CNR computations and clarify whether these represent SD or another measure of variability (e.g., variance). Consider alternative representation (e.g., median ± IQR) if the data are highly skewed. Author Response:- We thank the reviewer for this comment. All values in Table 2, including SIR, SNR, and CNR, were calculated as mean ± standard deviation (SD) . The data were not skewed, and no alternative representation was necessary. 5) Reviewer Comments:- In Table 3 , while mean ADC values are presented for normal, benign, and malignant tissues across different b-values, a pairwise comparison (e.g., benign vs malignant, malignant vs normal, benign vs normal- In an additional Table) would strengthen the statistical analysis and clarify which differences are statistically significant. Please consider including appropriate pairwise comparison tests with correction for multiple testing (post-hoc pairwise tests) Author Response:- We thank the reviewer for this suggestion. In this study, the primary objective was to report mean ADC values and ranges for normal, benign, and malignant prostate tissues at multiple b-values. Due to the relatively small sample size in the benign group performing pairwise statistical comparisons may not provide robust or reliable results. Therefore, we have reported the overall trends without post-hoc pairwise analysis, which we believe is appropriate given the exploratory nature of this study. Competing Interests: NIl Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Debnath M. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.178777.r369839 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v2#referee-response-369839 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Apr 2025 Manna Debnath , Bapubhai Desaibhai Patel Institute of Paramedical Sciences, Charotar University of Science and Technology, Changa, Gujarat, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.178777.r369839 The authors have carefully reviewed and corrected the manuscript based on the suggestions provided. All ... Continue reading READ ALL The authors have carefully reviewed and corrected the manuscript based on the suggestions provided. All the corrections made by the authors are satisfactory. The manuscript is now ready for indexing. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Medical Imaging Technology_MRI I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Debnath M. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.178777.r369839 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v2#referee-response-369839 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 04 Feb 2025 Views 0 Cite How to cite this report: Debnath M. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.177120.r365942 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v1#referee-response-365942 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Feb 2025 Manna Debnath , Bapubhai Desaibhai Patel Institute of Paramedical Sciences, Charotar University of Science and Technology, Changa, Gujarat, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.177120.r365942 1. The abstract is well written, highlighting this research article's overall summary. 2. Is there any Indian study published on prostate cancer detection using DWI? If so, please cite the study in the Introduction section and provide a detailed ... Continue reading READ ALL 1. The abstract is well written, highlighting this research article's overall summary. 2. Is there any Indian study published on prostate cancer detection using DWI? If so, please cite the study in the Introduction section and provide a detailed overview of the Indian perspective. 3. Page no. 3, in the MRI techniques section, 2 nd last line, please correct the sentence as with a combination of five b-values (b=0, 800,1000,1500 and 2000 mm2/s). 4. Page no. 3, in the Image analysis section, 2 nd paragraph, expand SI. Most probably it is Signal Intensity. 5. On page 4, in the Results section, first paragraph, the sentence 'The mean ADC values for benign lesions were 0.708 × 0.149 mm²/s, 0.839 × 0.15 mm²/s, 0.665 × 0.15 mm²/s, and 0.59 × 0.19 mm²/s for the corresponding b-values' should be corrected to use the '±' sign instead of '×', as the author has reported mean and standard deviation (SD). Additionally, in the b = 800 mm²/s value, the SD is written as 0.149 in the text but 0.14 in Table 3. Please ensure uniform decimal formatting throughout the paper to avoid reader confusion. 6. In the very next line of page 4, in the Results section, the sentence 'In a similar manner, the mean ADC values of malignant lesions were 0.4949 mm²/s, 0.014 mm²/s, 0.52 mm²/s, and 0.48 mm²/s, respectively.' contains discrepancies between the data reported in the text and the values presented in Table 3. Please rectify these inconsistencies to ensure accuracy. 7. The discussion and conclusion are well written. However, I suggest adding 2–3 lines on future recommendations that could guide further research on prostate imaging using MRI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Medical Imaging Technology_MRI I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Debnath M. Reviewer Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.177120.r365942 ) The direct URL for this report is: https://f1000research.com/articles/14-155/v1#referee-response-365942 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 4 VERSION 4 PUBLISHED 04 Feb 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 4 (revision) 19 Sep 25 read Version 3 (revision) 10 Sep 25 read Version 2 (revision) 06 Mar 25 read read Version 1 04 Feb 25 read Manna Debnath , Bapubhai Desaibhai Patel Institute of Paramedical Sciences, Charotar University of Science and Technology, Changa, India Jaseemudheen MM , K.S. Hegde Medical Academy, NITTE, Mangalore, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 MM J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Oct 2025 | for Version 4 Jaseemudheen MM , K.S. Hegde Medical Academy, NITTE, Mangalore, India 0 Views copyright © 2025 MM J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I appreciate the thorough and careful revisions made to the manuscript. The authors have responded to all queries with clarity and have thoughtfully addressed the concerns raised in the previous round of review. The removal of the CNR parameter has improved the consistency and readability of the results, and the additional explanations provided have enhanced the overall clarity of the manuscript. The study is well-structured, the methodology is sound, and the findings contribute valuable insights to the field. I am satisfied with the revisions and recommend the manuscript for indexing. Competing Interests No competing interests were disclosed. Reviewer Expertise MRI, CT, Radiation safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) MM J. Peer Review Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.188480.r415648) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-155/v4#referee-response-415648 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 MM J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Sep 2025 | for Version 3 Jaseemudheen MM , K.S. Hegde Medical Academy, NITTE, Mangalore, India 0 Views copyright © 2025 MM J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I appreciate the thorough effort made in revising the manuscript and in addressing the earlier queries with clarity. The additional explanations have improved the overall readability of the work. However, regarding Table 3, the CNR values show pronounced skewness, with disproportionately large standard deviations in some cases exceeding the mean. This appears to result from combining data acquired on two different MRI machines, which may render the reported measure less meaningful in its current form. To avoid potential misinterpretation, you may consider either: (i) removing this parameter from Table 3 , or (ii) presenting the values separately for each scanner , so that the variability is more transparently represented. Competing Interests No competing interests were disclosed. Reviewer Expertise MRI, CT, Radiation safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) MM J. Peer Review Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.187913.r413119) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-155/v3#referee-response-413119 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 MM J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Sep 2025 | for Version 2 Jaseemudheen MM , K.S. Hegde Medical Academy, NITTE, Mangalore, India 0 Views copyright © 2025 MM J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a well-conducted and clearly written study addressing an important aspect of prostate MRI optimization. The authors have presented their methods and results in detail, and the findings contribute valuable insights into the role of b-values and ADC in differentiating prostate lesions. The discussion is comprehensive and relates well to prior literature Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Methods: Clarify whether all patients were imaged on both scanners (Philips 1.5T and United Imaging 3T) or divided between them, since field strength could influence results (Not ADC but other factors). Consistently expand abbreviations at first mention (e.g., SI- Signal Intensity, NEX- Number of Excitations). In Table 2 , the reported CNR values show disproportionately large standard deviations, in some cases exceeding the mean, which raises concerns about calculation accuracy or data consistency. Please recheck the CNR computations and clarify whether these represent SD or another measure of variability (e.g., variance). Consider alternative representation (e.g., median ± IQR) if the data are highly skewed. In Table 3 , while mean ADC values are presented for normal, benign, and malignant tissues across different b-values, a pairwise comparison (e.g., benign vs malignant, malignant vs normal, benign vs normal- In an additional Table) would strengthen the statistical analysis and clarify which differences are statistically significant. Please consider including appropriate pairwise comparison tests with correction for multiple testing (post-hoc pairwise tests) Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise MRI, CT, Radiation safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 12 Sep 2025 Winniecia Dkhar, Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India 1) Reviewer Comments:- Section- MRI Technique: Presenting scanner details (Separately for both scanners), in a clear protocol table, will improve readability. Author Response:- We thank the reviewer for this suggestion. The MRI Technique section has been revised, and the scanner and sequence details are now presented in Table 1 for clarity and readability. 2) Reviewer Comments:- Methods: Clarify whether all patients were imaged on both scanners (Philips 1.5T and United Imaging 3T) or divided between them, since field strength could influence results (Not ADC but other factors). Author Response:- We thank the reviewer for this valuable comment. We have clarified this point in the revised Methods section. Patients were imaged on either the Philips Achieva 1.5T or the United Imaging uMR 3.0T scanner, depending on availability. Each patient underwent MRI on a single scanner only, and no patient was imaged on both systems. 3) Reviewer Comments:- Consistently expand abbreviations at first mention (e.g., SI- Signal Intensity, NEX- Number of Excitations). Author Response:- We thank the reviewer for this observation. All abbreviations have now been expanded at their first mention in the manuscript. 4) Reviewer Comments:- In Table 2 , the reported CNR values show disproportionately large standard deviations, in some cases exceeding the mean, which raises concerns about calculation accuracy or data consistency. Please recheck the CNR computations and clarify whether these represent SD or another measure of variability (e.g., variance). Consider alternative representation (e.g., median ± IQR) if the data are highly skewed. Author Response:- We thank the reviewer for this comment. All values in Table 2, including SIR, SNR, and CNR, were calculated as mean ± standard deviation (SD) . The data were not skewed, and no alternative representation was necessary. 5) Reviewer Comments:- In Table 3 , while mean ADC values are presented for normal, benign, and malignant tissues across different b-values, a pairwise comparison (e.g., benign vs malignant, malignant vs normal, benign vs normal- In an additional Table) would strengthen the statistical analysis and clarify which differences are statistically significant. Please consider including appropriate pairwise comparison tests with correction for multiple testing (post-hoc pairwise tests) Author Response:- We thank the reviewer for this suggestion. In this study, the primary objective was to report mean ADC values and ranges for normal, benign, and malignant prostate tissues at multiple b-values. Due to the relatively small sample size in the benign group performing pairwise statistical comparisons may not provide robust or reliable results. Therefore, we have reported the overall trends without post-hoc pairwise analysis, which we believe is appropriate given the exploratory nature of this study. View more View less Competing Interests NIl reply Respond Report a concern MM J. Peer Review Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.178777.r408413) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-155/v2#referee-response-408413 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Debnath M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Apr 2025 | for Version 2 Manna Debnath , Bapubhai Desaibhai Patel Institute of Paramedical Sciences, Charotar University of Science and Technology, Changa, Gujarat, India 0 Views copyright © 2025 Debnath M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have carefully reviewed and corrected the manuscript based on the suggestions provided. All the corrections made by the authors are satisfactory. The manuscript is now ready for indexing. Competing Interests No competing interests were disclosed. Reviewer Expertise Medical Imaging Technology_MRI I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Debnath M. Peer Review Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.178777.r369839) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-155/v2#referee-response-369839 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Debnath M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Feb 2025 | for Version 1 Manna Debnath , Bapubhai Desaibhai Patel Institute of Paramedical Sciences, Charotar University of Science and Technology, Changa, Gujarat, India 0 Views copyright © 2025 Debnath M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. The abstract is well written, highlighting this research article's overall summary. 2. Is there any Indian study published on prostate cancer detection using DWI? If so, please cite the study in the Introduction section and provide a detailed overview of the Indian perspective. 3. Page no. 3, in the MRI techniques section, 2 nd last line, please correct the sentence as with a combination of five b-values (b=0, 800,1000,1500 and 2000 mm2/s). 4. Page no. 3, in the Image analysis section, 2 nd paragraph, expand SI. Most probably it is Signal Intensity. 5. On page 4, in the Results section, first paragraph, the sentence 'The mean ADC values for benign lesions were 0.708 × 0.149 mm²/s, 0.839 × 0.15 mm²/s, 0.665 × 0.15 mm²/s, and 0.59 × 0.19 mm²/s for the corresponding b-values' should be corrected to use the '±' sign instead of '×', as the author has reported mean and standard deviation (SD). Additionally, in the b = 800 mm²/s value, the SD is written as 0.149 in the text but 0.14 in Table 3. Please ensure uniform decimal formatting throughout the paper to avoid reader confusion. 6. In the very next line of page 4, in the Results section, the sentence 'In a similar manner, the mean ADC values of malignant lesions were 0.4949 mm²/s, 0.014 mm²/s, 0.52 mm²/s, and 0.48 mm²/s, respectively.' contains discrepancies between the data reported in the text and the values presented in Table 3. Please rectify these inconsistencies to ensure accuracy. 7. The discussion and conclusion are well written. However, I suggest adding 2–3 lines on future recommendations that could guide further research on prostate imaging using MRI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Medical Imaging Technology_MRI I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Debnath M. Peer Review Report For: Enhancing prostate cancer detection: The role of b-value and apparent diffusion coefficient in DWI [version 4; peer review: 2 approved] . F1000Research 2025, 14 :155 ( https://doi.org/10.5256/f1000research.177120.r365942) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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