Value of 3D-presumed circular area ratio in MRI assessment of benign prostatic hyperplasia

To quantitatively assess morphological alterations in benign prostatic hyperplasia (BPH) using MRI-based three-dimensional presumed circular area ratio (3D-PCAR), and to explore its correlation with International Prostate Symptom Score (IPSS). A total of 335 patients with pathologically confirmed BPH who underwent preoperative prostate MRI and completed IPSS questionnaire were retrospectively analyzed. MRI-derived volume parameters included total prostate volume (TPV), transition zone volume (TZV), and transition zone index (TZI, TZI = TZV / TPV); morphological parameters included intravesical prostatic protrusion (IPP), PCAR (axial, coronal, and sagittal), and peripheral zone thickness (PZ-thickness). Correlations between MRI-derived parameters and total IPSS, IPSS storage sub-score (IPSS-ss) and IPSS voiding sub-score (IPSS-vs) were analyzed using Pearson correlation, one-way analysis of variance (ANOVA) and multivariable regression. All MRI parameters showed significant correlations with IPSS scores (all p < 0.05). Positive correlations with IPSS were observed for IPP, TPV, TZV, TZI, and PCAR ( r = 0.18–0.59), whereas PZ-thickness showed negative correlations ( r = − 0.18 to − 0.24). Among the evaluated MRI-derived parameters, PCAR measurements in all three planes demonstrated moderate-to-strong correlations with IPSS (axial r = 0.485, 0.474, 0.405; coronal r = 0.592, 0.553, 0.524; sagittal r = 0.545, 0.508, 0.484, all p < 0.001) and remained significant predictors of IPSS in multivariable analyses ( p < 0.05). 3D-PCAR reflects prostate sphericity and correlates with symptom severity in BPH, demonstrating potential as a novel non-invasive imaging biomarker for evaluating intraprostatic pressure and urinary symptoms.