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Jia G, Abaza R, Williams JD, Zynger DL, Zhou J, Shah ZK, Patel M, Sammet S, Wei L, Bahnson RR, Knopp MV. Amide proton transfer MR imaging of prostate cancer: a preliminary study. J Magn Reson Imaging 2011; 33:647-54. [PMID: 21563248 DOI: 10.1002/jmri.22480] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the capability of amide proton transfer (APT) MR imaging for detection of prostate cancer that typically shows a higher tumor cell proliferation rate and cellular density leading to an MRI-detectable overall elevated mobile protein level in higher grade tumors. MATERIALS AND METHODS Twelve patients with biopsy-proven prostate cancer were imaged on a 3 Tesla MR imaging system before prostatectomy. APT-MR images were acquired by means of a single-slice single-shot turbo spin echo sequence with a saturation prepulse preparation using 33 different frequency offsets (-8 to 8 ppm, interval 0.5 ppm). For quantification we used the APT ratio (APTR) based on the asymmetry of the magnetization transfer ratio at 3.5 ppm in respect to the water signal. Tumor and peripheral zone benign regions of interest (ROIs) were delineated based on whole mount pathology slides after prostatectomy. RESULTS APTR in prostate cancer ROIs was 5.8% ± 3.2%, significantly higher than that in the peripheral zone benign regions (0.3% ± 3.2%, P = 0.002). CONCLUSION APT-MR imaging is feasible in prostate cancer detection and has the potential to discriminate between cancer and noncancer tissues.
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Affiliation(s)
- Guang Jia
- Department of Radiology and Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, Ohio 43210, USA
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Boutier R, Girouin N, Cheikh AB, Belot A, Rabilloud M, Gelet A, Chapelon JY, Rouvière O. Location of residual cancer after transrectal high-intensity focused ultrasound ablation for clinically localized prostate cancer. BJU Int 2011; 108:1776-81. [PMID: 21711432 DOI: 10.1111/j.1464-410x.2011.10251.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED What's known on the subject ? and What does the study add? Transrectal High-Intensity Focused Ultrasound (HIFU) ablation has been used as a minimally invasive treatment for localized prostate cancer for 15 years. Five-year disease-free survival rates of 66-78% have been reported, challenging the results of external-beam radiation therapy. Usually, a 6-mm safety margin is used in the apex to preserve the urinary sphincter and potency. The influence of this 6-mm margin on the results of the treatment has never been assessed. This retrospective study of a cohort of 99 patients who underwent systematic biopsy 3-6 months after HIFU ablation for prostate cancer (with a 6-mm safety margin in the apex) shows that post-HIFU residual cancer is found more frequently in the apex. Therefore, new strategies improving the prostate destruction at the apex while preserving the urinary continence need to be found. OBJECTIVE • To evaluate whether the location (apex/midgland/base) of prostate cancer influences the risk of incomplete transrectal high-intensity focused ultrasonography (HIFU) ablation. PATIENTS AND METHODS • We retrospectively studied 99 patients who underwent prostate cancer HIFU ablation (Ablatherm; EDAP, Vaulx-en-Velin, France) with a 6-mm safety margin at the apex, and had systematic biopsies 3-6 months after treatment. • Locations of positive pre- and post-HIFU sextants were compared. • The present study included two analyses. First, sextants negative before and positive after treatment were recoded as positive/positive, hypothesizing that cancer had been missed at pretreatment biopsy. Second, patients with such sextants were excluded. RESULTS • Pre-HIFU biopsies found cancer in all patients and in 215/594 sextants (36.2%); 55 (25.6%) positive sextants were in the apex, 86 (40%) in the midgland and 74 (34.4%) in the base. • After treatment, residual cancer was found in 36 patients (36.4%) and 50 sextants (8.4%); 30 (60%) positive sextants were in the apex, 12 (24%) in the midgland and eight (16%) in the base. • Both statistical analyses found that the locations of the positive sextants before and after HIFU ablation were significantly different (P < 0.001), with a higher proportion of positive apical sextants after treatment. • At the first analysis, the mean (95% confidence interval) probability for a sextant to remain positive after HIFU ablation was 8.8% (3.5-20.3%) in the base, 12.7% (5.8-25.9%) in the midgland and 41.7% (27.2-57.89%) in the apex. • At the second analysis, these same probabilities were 5.9% (1.9-17%), 9.9% (3.9-23.2%) and 27.3% (13.7-47%), respectively. CONCLUSION • When a 6-mm apical safety margin is used, residual cancer after HIFU ablation is found significantly more frequently in the apex.
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Affiliation(s)
- Romain Boutier
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
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Yakar D, Schouten MG, Bosboom DGH, Barentsz JO, Scheenen TWJ, Fütterer JJ. Feasibility of a pneumatically actuated MR-compatible robot for transrectal prostate biopsy guidance. Radiology 2011; 260:241-7. [PMID: 21406625 DOI: 10.1148/radiol.11101106] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess the feasibility of using a remote-controlled, pneumatically actuated magnetic resonance (MR)-compatible robotic device to aid transrectal biopsy of the prostate performed with real-time 3-T MR imaging guidance. MATERIALS AND METHODS This prospective study was approved by the ethics review board, and written informed consent was obtained from all patients. Twelve consecutive men who were clinically suspected of having prostate cancer and had a history of at least one transrectal ultrasonography (US)-guided prostate biopsy with negative results underwent diagnostic multiparametric MR imaging of the prostate. Two radiologists in consensus identified cancer-suspicious regions (CSRs) in 10 patients. These regions were subsequently targeted with the robot for MR imaging-guided prostate biopsy. To direct the needle guide toward the CSRs, the MR-compatible robotic device was remote controlled at the MR console by means of a controller and a graphical user interface for real-time MR imaging guidance of the needle guide. The ability to reach the CSRs with the robot for biopsy was analyzed. RESULTS A total of 17 CSRs were detected in 10 patients at the diagnostic MR examinations. These regions were targeted for MR imaging-guided robot-assisted prostate biopsy. Thirteen (76%) of the 17 CSRs could be reached with the robot for biopsy. Biopsy of the remaining four CSRs was performed without use of the robot. CONCLUSION It is feasible to perform transrectal prostate biopsy with real-time 3-T MR imaging guidance with the aid of a remote-controlled, pneumatically actuated MR-compatible robotic device.
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Affiliation(s)
- Derya Yakar
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands.
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Pinto F, Totaro A, Calarco A, Sacco E, Volpe A, Racioppi M, D’Addessi A, Gulino G, Bassi P. Imaging in Prostate Cancer Diagnosis: Present Role and Future Perspectives. Urol Int 2011; 86:373-82. [DOI: 10.1159/000324515] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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A Clinically Relevant Approach to Imaging Prostate Cancer:Review. AJR Am J Roentgenol 2011; 196:S1-10 Quiz S11-4. [DOI: 10.2214/ajr.09.7196] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nishida K, Yuen S, Kamoi K, Yamada K, Akazawa K, Ito H, Okihara K, Kawauchi A, Miki T, Nishimura T. Incremental value of T2-weighted and diffusion-weighted MRI for prediction of biochemical recurrence after radical prostatectomy in clinically localized prostate cancer. Acta Radiol 2011; 52:120-6. [PMID: 21498337 DOI: 10.1258/ar.2010.100293] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND For men with clinically localized prostate cancer and candidates to receive radical prostatectomy (RP) a main concern is a cancer recurrence after treatment. Although previous studies have demonstrated the diagnostic utility of diffusion-weighted imaging (DWI) for prostate cancer, the prognostic value of pretreatment DWI has not been investigated yet. PURPOSE To investigate the incremental value of MRI-based T staging using DWI and T2-weighted imaging (T2WI) as compared with the clinical parameters in prediction of biochemical recurrence (BCR) after RP for clinically localized prostate cancer. MATERIAL AND METHODS Sixty MR examinations, obtained before RP between April 2002 and March 2009, were retrospectively reviewed using T2WI alone, DWI alone, or T2WI + DWI for T staging according to the 2002 American Joint Committee on Cancer guidelines. The relationship between MRI stage and BCR was evaluated using Kaplan-Meier survival estimates. Multivariate analysis and receiver operating characteristics (ROC) curve analysis were used to investigate the incremental value over the standard clinical variables in prediction of BCR. RESULTS As of August 2009, 12 (20%) patients had BCR. Based on T2WI + DWI, both T3a (compared to OC disease) and T2 (compared to T1c) showed significantly higher BCR rates (p=0.047 and 0.025, respectively). Multivariate analysis and area under ROC curve analysis confirmed the additional value of MRI staging to the conventional clinical variables in prediction of BCR. CONCLUSION The combination of T2WI and DWI on performing pretreatment MRI helped predict BCR after RP in clinically localized prostate cancer.
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Affiliation(s)
- Kaori Nishida
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Sachiko Yuen
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Kazumi Kamoi
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Kentaro Akazawa
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | | | - Koji Okihara
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Akihiro Kawauchi
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Tsuneharu Miki
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
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Ultra-high-b-value diffusion-weighted MR imaging for the detection of prostate cancer: evaluation in 201 cases with histopathological correlation. Eur Radiol 2010; 21:188-96. [DOI: 10.1007/s00330-010-1883-7] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 05/03/2010] [Accepted: 05/31/2010] [Indexed: 10/19/2022]
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D’Agostino F, Dell’Aia P, Quattrocchi C, Del Vescovo R, Setola R, Grasso R, Beomonte Zobel B. Differentiation of normal and neoplastic bone tissue in dynamic gadolinium-enhanced magnetic resonance imaging: validation of a semiautomated technique. Radiol Med 2010; 115:804-14. [DOI: 10.1007/s11547-010-0572-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 12/08/2009] [Indexed: 11/30/2022]
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Bouchelouche K, Turkbey B, Choyke P, Capala J. Imaging prostate cancer: an update on positron emission tomography and magnetic resonance imaging. Curr Urol Rep 2010; 11:180-90. [PMID: 20425625 PMCID: PMC3407670 DOI: 10.1007/s11934-010-0105-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prostate cancer is a common cancer in men and continues to be a major health problem. Imaging plays an essential role in the clinical management of patients. An important goal for prostate cancer imaging is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. Developments in imaging technologies, specifically magnetic resonance imaging (MRI) and positron emission tomography (PET)/computed tomography (CT), have improved the detection rate of prostate cancer. MRI has improved lesion detection and local staging. Furthermore, MRI allows functional assessment with techniques such as diffusion-weighted MRI, MR spectroscopy, and dynamic contrast-enhanced MRI. The most common PET radiotracer, (18)F-fluorodeoxyglucose, is not very useful in prostate cancer. However, in recent years other PET tracers have improved the accuracy of PET/CT imaging of prostate cancer. Among these, choline (labeled with (18)F or (11)C), (11)C-acetate, and (18)F-fluoride have demonstrated promising results, and other new radiopharmaceuticals are currently under evaluation in preclinical and clinical studies.
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Affiliation(s)
- Kirsten Bouchelouche
- PET & Cyclotron Unit, PET 3982, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Chaussy CG, Thüroff S. Robot-Assisted High-Intensity Focused Ultrasound in Focal Therapy of Prostate Cancer. J Endourol 2010; 24:843-7. [DOI: 10.1089/end.2009.0439] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sauvain JL, Palascak P, Gomez W, Nader N, Bremon JM, Bloqueau P, Jung L, Maniere P, Papavero R, Rhomer P. [MRI and prostatic cancer: measurements of kinetic perfusion parameters of gadolinium with a computerized-aided diagnostic tool (CAD)]. Prog Urol 2010; 20:121-9. [PMID: 20142053 DOI: 10.1016/j.purol.2009.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 05/11/2009] [Accepted: 06/08/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess with a CAD in the peripheral (ZP) and transitional (ZT) zones the areas with modifications of the kinetic parameter Kep (ratio of exchanges between vascular compartment and extravascular extracellular spaces) in prostatic cancers with DCE MRI before radical prostatectomy. METHODS Forty-two consecutive patients (mean age 67 years, mean PSA: 8.9 ng/ml) with a prostatic cancer proved after a set of 12 biopsies underwent, before radical prostatectomy, a dynamic MRI (1.5T) with a surface coil after injection of gadolinium. We look with a CAD for foci of voxels with an abnormal Kep in ZP and/or in ZT. Foci of abnormal voxels computerized were compared with histological results of radical prostatectomies: prostates were shared in 12 sectors (six peripheral and six central) and a total of 504 sectors were studied. The links between prostatic capsule and foci of voxels with elevated Kep were systematically evaluated. The location and the local extension of the various cancerous foci were estimated. A comparison with the results of the T2W and T1 DCE MRI sequences without use of the CAD was made. RESULTS Eighty-eight percent of investigated patients revealed at least a cancerous focus associated with a group of pathological voxels. Hundred and seventy-eight of the 504 investigated prostatic sectors revealed a cancerous lesion after radical prostatectomy (RP) and 116 a focus of voxels with a pathological Kep being linked to 71 isolated lesions, some of them filling several sectors (47 peripheral and 24 transitional). The automatic research with the software of foci of voxels with a parameter Kep more than 2,2 per minute to detect a cancerous lesion had a sensitivity by sector less than the reading without CAD (69% in ZP and 58% in ZT against respectively, 85 and 66% (p<0.01) but seemed more specific: 98% in PZ and 95% in ZT against respectively, 80 and 82% (p<0.01). After RP, 16 cancers were classified Pt2, 10 Pt2R+ and 16 Pt3. The CAD had a better accuracy (74%) than T2W MRI (60%) to look for an extracapsular extension (EPE) or a risk of positive margins: 86% of extraprostatic extension and 60% of positive margins were near a focus of pathological voxels. CONCLUSIONS CAD allowed a computerized qualitative and quantitative study of DCE MRI. It identified and localized with a good specificity the significant foci. A focus of voxels with elevated Kep against the capsule increased significantly the risk of an extraprostatic extension or a positive margin after radical prostatectomy.
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Affiliation(s)
- J-L Sauvain
- Centre d'imagerie médicale, 6, passage Jules-Didier, 70000 Vesoul, France.
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62
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Kim JK, Jang YJ, Cho G. Multidisciplinary functional MR imaging for prostate cancer. Korean J Radiol 2010; 10:535-51. [PMID: 19885309 PMCID: PMC2770824 DOI: 10.3348/kjr.2009.10.6.535] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 07/03/2009] [Indexed: 12/30/2022] Open
Abstract
Various functional magnetic resonance (MR) imaging techniques are used for evaluating prostate cancer including diffusion-weighted imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy. These techniques provide unique information that is helpful to differentiate prostate cancer from non-cancerous tissue and have been proven to improve the diagnostic performance of MRI not only for cancer detection, but also for staging, post-treatment monitoring, and guiding prostate biopsies. However, each functional MR imaging technique also has inherent challenges. Therefore, in order to make accurate diagnoses, it is important to comprehensively understand their advantages and limitations, histologic background related with image findings, and their clinical relevance for evaluating prostate cancer. This article will review the basic principles and clinical significance of functional MR imaging for evaluating prostate cancer.
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Affiliation(s)
- Jeong Kon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
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63
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Realtime TRUS/MRI Fusion Targeted-Biopsy for Prostate Cancer: A Clinical Demonstration of Increased Positive Biopsy Rates. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/978-3-642-15989-3_7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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64
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Schmuecking M, Boltze C, Geyer H, Salz H, Schilling B, Wendt TG, Kloetzer KH, Marx C. Dynamic MRI and CAD vs. Choline MRS: Where is the detection level for a lesion characterisation in prostate cancer? Int J Radiat Biol 2009; 85:814-24. [DOI: 10.1080/09553000903090027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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65
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Rouvière O, Girouin N, Glas L, Ben Cheikh A, Gelet A, Mège-Lechevallier F, Rabilloud M, Chapelon JY, Lyonnet D. Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI. Eur Radiol 2009; 20:48-55. [PMID: 19690866 DOI: 10.1007/s00330-009-1520-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 06/07/2009] [Indexed: 12/14/2022]
Abstract
The objective was to evaluate T2-weighted (T2w) and dynamic contrast-enhanced (DCE) MRI in detecting local cancer recurrences after prostate high-intensity focused ultrasound (HIFU) ablation. Fifty-nine patients with biochemical recurrence after prostate HIFU ablation underwent T2-weighted and DCE MRI before transrectal biopsy. For each patient, biopsies were performed by two operators: operator 1 (blinded to MR results) performed random and colour Doppler-guided biopsies ("routine biopsies"); operator 2 obtained up to three cores per suspicious lesion on MRI ("targeted biopsies"). Seventy-seven suspicious lesions were detected on DCE images (n = 52), T2w images (n = 2) or both (n = 23). Forty patients and 41 MR lesions were positive at biopsy. Of the 36 remaining MR lesions, 20 contained viable benign glands. Targeted biopsy detected more cancers than routine biopsy (36 versus 27 patients, p = 0.0523). The mean percentages of positive cores per patient and of tumour invasion of the cores were significantly higher for targeted biopsies (p < 0.0001). The odds ratios of the probability of finding viable cancer and viable prostate tissue (benign or malignant) at targeted versus routine biopsy were respectively 3.35 (95% CI 3.05-3.64) and 1.38 (95% CI 1.13-1.63). MRI combining T2-weighted and DCE images is a promising method for guiding post-HIFU biopsy towards areas containing recurrent cancer and viable prostate tissue.
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Affiliation(s)
- Olivier Rouvière
- Department of Urinary and Vascular Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon 69437, France.
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McMahon CJ, Bloch BN, Lenkinski RE, Rofsky NM. Dynamic contrast-enhanced MR imaging in the evaluation of patients with prostate cancer. Magn Reson Imaging Clin N Am 2009; 17:363-83. [PMID: 19406364 DOI: 10.1016/j.mric.2009.01.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Prostate cancer is a common tumor among men, with increasing diagnosis at an earlier stage and a lower volume of disease because of screening with prostate-specific antigen (PSA). The need for imaging of the prostate stems from a desire to optimize treatment strategy on a patient and tumor-specific level. The major goals of prostate imaging are (1) staging of known cancer, (2) determination of tumor aggressiveness, (3) diagnosis of cancer in patients who have elevated PSA but a negative biopsy, (4) treatment planning, and (5) the evaluation of therapy response. This article concentrates on the role of dynamic contrast-enhanced MR imaging in the evaluation of patients who have prostate cancer and how it might be used to help achieve the above goals. Various dynamic contrast enhancement approaches (quantitative/semiquantitative/qualitative, high temporal versus high spatial resolution) are summarized with reference to the relevant strengths and compromises of each approach.
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Affiliation(s)
- Colm J McMahon
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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68
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Diffusion-weighted imaging with apparent diffusion coefficient mapping and spectroscopy in prostate cancer. Top Magn Reson Imaging 2009; 19:261-72. [PMID: 19512848 DOI: 10.1097/rmr.0b013e3181aa6b50] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Prostate cancer is a major health problem, and the exploration of noninvasive imaging methods that have the potential to improve specificity while maintaining high sensitivity is still critically needed. Tissue changes induced by tumor growth can be visualized by magnetic resonance imaging (MRI) methods. Current MRI methods include conventional T2-weighted imaging, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping and magnetic resonance spectroscopy (MRS). Techniques such as DWI/ADC provide functional information about the behavior of water molecules in tissue; MRS can provide biochemical information about the presence or absence of certain metabolites, such as choline, creatine, and citrate. Finally, vascular parameters can be investigated using dynamic contrast-enhanced MRI. Moreover, with whole-body MRI and DWI, metastatic disease can be evaluated in 1 session and may provide a way to monitor treatment. Therefore, when combining these various methods, a multiparametric data set can be built to assist in the detection, localization, assessment of prostate cancer aggressiveness, and tumor staging. Such a comprehensive approach offers more power to evaluate prostate disease than any single measure alone. In this article, we focus on the role of DWI/ADC and MRS in the detection and characterization using both in vivo and ex vivo imaging of prostate pathology.
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69
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Turpen R, Rosser CJ. Focal therapy for prostate cancer: revolution or evolution? BMC Urol 2009; 9:2. [PMID: 19386137 PMCID: PMC2679056 DOI: 10.1186/1471-2490-9-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 04/23/2009] [Indexed: 01/27/2023] Open
Abstract
The face of prostate cancer has been dramatically changed since the late 1980s when PSA was introduced as a clinical screening tool. More men are diagnosed with small foci of cancers instead of the advanced disease evident prior to PSA screening. Treatment options for these smaller tumors consist of expectant management, radiation therapy (brachytherapy and external beam radiotherapy) and surgery (cryosurgical ablation and radical prostatectomy). In the highly select patient, cancer specific survival employing any of these treatment options is excellent, however morbidity from these interventions are significant. Thus, the idea of treating only the cancer within the prostate and sparing the non-cancerous tissue in the prostate is quite appealing, yet controversial. Moving forward if we are to embrace the focal treatment of prostate cancer we must: be able to accurately identify index lesions within the prostate, image cancers within the prostate and methodically study the litany of focal therapeutic options available.
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Affiliation(s)
- Ryan Turpen
- Department of Urology, University of Florida, Gainesville, Florida, USA.
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Turkbey B, Pinto PA, Choyke PL. Imaging techniques for prostate cancer: implications for focal therapy. Nat Rev Urol 2009; 6:191-203. [PMID: 19352394 PMCID: PMC3520096 DOI: 10.1038/nrurol.2009.27] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The multifocal nature of prostate cancer has necessitated whole-gland therapy in the past; however, since the widespread use of PSA screening, patients frequently present with less-advanced disease. Many men with localized disease wish to avoid the adverse effects of whole-gland therapy; therefore, focal therapy for prostate cancer is being considered as a treatment option. For focal treatment to be viable, accurate imaging is required for diagnosis, staging, and monitoring of treatment. Developments in MRI and PET have brought more attention to prostate imaging and the possibility of improving the accuracy of focal therapy. In this Review, we discuss the advantages and disadvantages of conventional methods for imaging the prostate, new developments for targeted imaging, and the possible role of image-guided biopsy and therapy for localized prostate cancer.
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Affiliation(s)
- Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1088, USA
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Zelhof B, Lowry M, Rodrigues G, Kraus S, Turnbull L. Description of magnetic resonance imaging-derived enhancement variables in pathologically confirmed prostate cancer and normal peripheral zone regions. BJU Int 2009; 104:621-7. [PMID: 19281464 DOI: 10.1111/j.1464-410x.2009.08457.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the use of a semiquantitative analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) to produce indices for enhancement curves that might enable differentiation between malignant prostatic lesions and normal peripheral zone (PZ). PATIENTS AND METHODS Fifty-two patients scheduled for radical prostatectomy underwent DCE-MRI before surgery using a 3 T scanner. The DCE images were used to generate variables from changes in signal intensity for pathologically confirmed malignant areas and the normal PZ, using whole-mounted pathology specimens as a reference to delineate regions of interest (ROI). These variables included maximum enhancement index (MaxEI), time to MaxEI at 30 s, the initial and final slopes of signal intensity change, and the area under curve. A threshold value for each DCE variable was identified, and the sensitivity and specificity were obtained. RESULTS Malignant lesions had a 56% higher MaxEI than normal PZ and took half the time to reach MaxEI (P<0.001). Hence, at 30 s, cancer lesions have double the mean (sd) EI than normal PZ, of 2.22 (1.04) vs 1.04 (0.51), respectively. Tumours showed significant washout of contrast medium, which was reflected in the final slope of the curve being negative, as opposed to positive for normal PZ. The combined data of DCE variables, using a logistic regression test, gave a mean (95% confidence interval) sensitivity and specificity of 89 (81-96)% and 90 (83-97)%, respectively. CONCLUSION This technique provides good discrimination of malignant lesions that might enable accurate localisation of the lesion. It is a simple, semiquantitive, noninvasive method that reflects the unusual vascular characteristics of newly formed microvessels and the changes in the interstitium that occur in prostate cancer.
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Affiliation(s)
- Bashar Zelhof
- Centre for MR Investigations, University of Hull, and Department of Pathology, Hull & East Yorkshire NHS Trust, Castle Hill Hospital, Hull, Yorks, UK.
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Functional magnetic resonance imaging in prostate cancer. Eur Urol 2009; 55:801-14. [PMID: 19185981 DOI: 10.1016/j.eururo.2009.01.027] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 01/13/2009] [Indexed: 01/12/2023]
Abstract
CONTEXT Magnetic resonance imaging (MRI) combined with magnetic resonance spectroscopy imaging (MRSI), dynamic contrast-enhanced MRI, and diffusion-weighted MRI emerged as promising tests in the diagnosis of prostate cancer, and they show encouraging results. OBJECTIVE This review emphasizes different functional MRI techniques in the diagnosis of prostate cancer and includes information about their clinical value and usefulness. EVIDENCE ACQUISITION The authors searched the Medline, Embase, and Cochrane Library databases. There were no language restrictions. The last search was performed in October 2008. EVIDENCE SYNTHESIS The combination of conventional MRI with functional MRI techniques is more reliable for differentiating benign and malignant prostate tissues than any other diagnostic procedure. At present, no guideline is available that outlines which technique is best in a specific clinical situation. It also remains uncertain whether improved spatial resolution and signal-to-noise ratio of 3-T MRI will improve diagnostic performance. CONCLUSIONS A limited number of small studies suggest that functional MRI may improve the diagnosis and staging of prostate cancer. This finding needs further confirmation in larger studies, and cost-effectiveness needs to be established.
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73
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Lim HK, Kim JK, Kim KA, Cho KS. Prostate Cancer: Apparent Diffusion Coefficient Map with T2-weighted Images for Detection—A Multireader Study. Radiology 2009; 250:145-51. [DOI: 10.1148/radiol.2501080207] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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74
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Magnetic resonance imaging of prostate cancer. Prostate Cancer 2008. [DOI: 10.1017/cbo9780511551994.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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75
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Cornud F, Villers A, Mongiat-Artus P, Rebillard X, Soulie M. Imagerie par résonance magnétique et cancer de la prostate. Prog Urol 2008; 18:621-33. [DOI: 10.1016/j.purol.2008.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 05/24/2008] [Accepted: 06/23/2008] [Indexed: 10/21/2022]
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76
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Kim JH, Kim JK, Park BW, Kim N, Cho KS. Apparent diffusion coefficient: Prostate cancer versus noncancerous tissue according to anatomical region. J Magn Reson Imaging 2008; 28:1173-9. [DOI: 10.1002/jmri.21513] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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77
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Zelhof B, Pickles M, Liney G, Gibbs P, Rodrigues G, Kraus S, Turnbull L. Correlation of diffusion-weighted magnetic resonance data with cellularity in prostate cancer. BJU Int 2008; 103:883-8. [PMID: 19007373 DOI: 10.1111/j.1464-410x.2008.08130.x] [Citation(s) in RCA: 200] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the relationship between the apparent diffusion coefficient (ADC) on magnetic resonance imaging (MRI) and cell density (CD) obtained from radical prostatectomy (RP) specimens. PATIENTS AND METHODS In all, 36 patients with prostate cancer were recruited; T2-weighted and diffusion-weighted MRI was obtained axially using a 3.0 T scanner. Patients then proceeded to RP; the prostate was whole-mounted and sectioned axially. Slices (3 microm) were cut from the surface of each section and stained with haematoxylin and eosin (H&E). Five randomly positioned areas from the tumour and normal peripheral zone (PZ) were examined by light microscopy at x 200, then digitally photographed and analysed to obtain automatic CD. ADC values were determined from the MRI data using the H&E slides as a reference. ADC and CD values were measured in both malignant lesions and the PZ, and the correlation between ADC and CD assessed. RESULTS ADC values were lower (P <or= 0.001) in regions pathologically determined as tumour, with a mean (sd) of 1.45 (0.26) x 10(-3) mm(2)/s, vs normal PZ, of 1.90 (0.33) x 10(-3) mm(2)/s. Similarly, the mean CD over the five fields was higher (P <or= 0.001) in tumour than in normal PZ, with values of 18.89 (4.93)% vs 9.22 (3.23)%. There was a significant correlation between the ADC values and CD (r = -0.50, P < 0.001) regardless of tissue type. CD values were high in cancer which had lower ADC values than normal PZ. CONCLUSIONS ADC values were correlated successfully with CD; this information cannot be obtained with conventional MRI and is useful in characterizing prostate cancer.
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Affiliation(s)
- Bashar Zelhof
- University of Hull, Centrre for MR Investigations, UK.
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78
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Evaluation of T2-weighted and dynamic contrast-enhanced MRI in localizing prostate cancer before repeat biopsy. Eur Radiol 2008; 19:770-8. [DOI: 10.1007/s00330-008-1190-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 07/31/2008] [Accepted: 09/08/2008] [Indexed: 11/27/2022]
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79
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Lemaitre L, Rouvière O, Penna-Renard R, Villers A, Puech P. L’IRM du cancer de la prostate : un changement de paradigme. ACTA ACUST UNITED AC 2008; 89:1053-64. [DOI: 10.1016/s0221-0363(08)73909-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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80
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Jagannathan NR, Kumar V, Kumar R, Thulkar S. Role of magnetic resonance methods in the evaluation of prostate cancer: an Indian perspective. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2008; 21:393-407. [DOI: 10.1007/s10334-008-0122-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 06/19/2008] [Accepted: 06/23/2008] [Indexed: 01/30/2023]
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81
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MRI Techniques for Prediction of Local Tumor Progression After High-Intensity Focused Ultrasonic Ablation of Prostate Cancer. AJR Am J Roentgenol 2008; 190:1180-6. [PMID: 18430829 DOI: 10.2214/ajr.07.2924] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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82
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Détection par IRM des récidives locales du cancer de prostate après traitement par ultrasons focalisés de haute intensité (HIFU) transrectaux : étude préliminaire. ACTA ACUST UNITED AC 2008; 89:571-7. [DOI: 10.1016/s0221-0363(08)71483-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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83
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Value of Diffusion-Weighted Imaging for the Prediction of Prostate Cancer Location at 3T Using a Phased-Array Coil. Invest Radiol 2007; 42:842-7. [DOI: 10.1097/rli.0b013e3181461d21] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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Ocak I, Bernardo M, Metzger G, Barrett T, Pinto P, Albert PS, Choyke PL. Dynamic contrast-enhanced MRI of prostate cancer at 3 T: a study of pharmacokinetic parameters. AJR Am J Roentgenol 2007; 189:849. [PMID: 17885055 DOI: 10.2214/ajr.06.1329] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objectives of our study were to determine whether dynamic contrast-enhanced MRI performed at 3 T and analyzed using a pharmacokinetic model improves the diagnostic performance of MRI for the detection of prostate cancer compared with conventional T2-weighted imaging, and to determine which pharmacokinetic parameters are useful in diagnosing prostate cancer. SUBJECTS AND METHODS This prospective study included 50 consecutive patients with biopsy-proven prostate cancer who underwent imaging of the prostate on a 3-T scanner with a combination of a sensitivity-encoding (SENSE) cardiac coil and an endorectal coil. Scans were obtained at least 5 weeks after biopsy. T2-weighted turbo spin-echo images were obtained in three planes, and dynamic contrast-enhanced images were acquired during a single-dose bolus injection of gadopentetate dimeglumine (0.1 mmol/kg). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated for T2-weighted and dynamic contrast-enhanced MRI. The following pharmacokinetic modeling parameters were determined and compared for cancer, inflammation, and healthy peripheral zone: K(trans) (forward volume transfer constant), k(ep) (reverse reflux rate constant between extracellular space and plasma), v(e) (the fractional volume of extracellular space per unit volume of tissue), and the area under the gadolinium concentration curve (AUGC) in the first 90 seconds after injection. RESULTS Pathologically confirmed cancers in the peripheral zone of the prostate were characterized by their low signal intensity on T2-weighted scans and by their early enhancement, early washout, or both on dynamic contrast-enhanced MR images. The overall sensitivity, specificity, PPV, and NPV of T2-weighted imaging were 94%, 37%, 50%, and 89%, respectively. The sensitivity, specificity, PPV, and NPV of dynamic contrast-enhanced MRI were 73%, 88%, 75%, and 75%, respectively. K(trans), k(ep), and AUGC were significantly higher (p < 0.001) in cancer than in normal peripheral zone. The ve parameter was not significantly associated with prostate cancer. CONCLUSION MRI of the prostate performed at 3 T using an endorectal coil produces high-quality T2-weighted images; however, specificity for prostate cancer is improved by also performing dynamic contrast-enhanced MRI and using pharmacokinetic parameters, particularly K(trans) and k(ep), for analysis. These results are comparable to published results at 1.5 T.
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Affiliation(s)
- Iclal Ocak
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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85
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Kundra V, Silverman PM, Matin SF, Choi H. Imaging in Oncology from The University of Texas M. D. Anderson Cancer Center: Diagnosis, Staging, and Surveillance of Prostate Cancer. AJR Am J Roentgenol 2007; 189:830-44. [PMID: 17885053 DOI: 10.2214/ajr.07.2011] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this article is to discuss the epidemiology, risk factors, and presentation of prostate cancer. After reviewing the prostate anatomy, the article will show how imaging plays an important role in establishing the diagnosis, staging, and monitoring the therapeutic response in prostate cancer, with a focus on adenocarcinomas. CONCLUSION Imaging studies, in the appropriate laboratory and clinical context, contribute essential information that enhances the capacity to provide individualized risk stratification, a suitable treatment strategy, and monitoring for the patient with prostate cancer.
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Affiliation(s)
- Vikas Kundra
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Box 57, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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86
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Aigner F, Pallwein L, Pelzer A, Schaefer G, Bartsch G, Nedden DZ, Frauscher F. Value of magnetic resonance imaging in prostate cancer diagnosis. World J Urol 2007; 25:351-9. [PMID: 17569054 DOI: 10.1007/s00345-007-0187-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 05/15/2007] [Indexed: 10/23/2022] Open
Abstract
MRI has shown its potential in prostate cancer (PCa) imaging. MRI is able to demonstrate zonal anatomy with excellent contrast resolution. Furthermore it can detect PCa dependent not only on tumor-size, histological grading, PSA levels, but also on technical equipment and reader's experience. Non-palpable PCas in the inner and outer gland can be detected by this technique. Another potential is that MRI is helpful for tumor staging and treatment planning as well as response evaluation. Besides the morphological information, MRI can give functional information based on metabolic evaluation with proton magnetic resonance spectroscopy and of tumor angiogenesis based on dynamic contrast-material enhanced MRI and diffusion-weighted imaging. In addition MRI can be used for targeted prostate biopsies; however, the clinical practicability is questionable. Furthermore many data about the value of MRI for PCa diagnosis are based on transrectal ultrasound (TRUS) biopsy findings. Since there is lack of accuracy in fusing MRI images with TRUS images these limit the results of MRI for cancer diagnosis. However, in the future MRI may play an additional role in planning and monitoring minimally invasive PCa therapies. Although, MRI of the prostate seems to be useful, nevertheless this method remains expensive and lacks availability regarding the oncoming requirements.
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Affiliation(s)
- Friedrich Aigner
- Department of Radiology II, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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87
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Kim CK, Park BK, Han JJ, Kang TW, Lee HM. Diffusion-Weighted Imaging of the Prostate at 3 T for Differentiation of Malignant and Benign Tissue in Transition and Peripheral Zones. J Comput Assist Tomogr 2007; 31:449-54. [PMID: 17538295 DOI: 10.1097/01.rct.0000243456.00437.59] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate prospectively the use of apparent diffusion coefficients (ADCs) for the differentiation of malignant and benign tissue in the transition (TZ) and peripheral (PZ) zones of the prostate diffusion-weighted imaging (DWI) at 3 T magnetic resonance imaging (MRI) using a phased-array coil. METHODS The DWI at 3-T MRI was performed on a total of 35 patients before radical prostatectomy. A single-shot echo-planar imaging DWI technique with b = 0 and b = 1000 s/mm2 was used. The ADC values were measured in both benign and malignant tissues in the PZ and TZ using regions of interest. Differences between PZ and TZ ADC values were estimated using a paired Student t test. Presumed ADC cutoff values in the PZ and TZ for the diagnosis of cancer were assessed by receiver operating characteristic analysis. RESULTS The ADC values of malignant tissues were significantly lower than those of benign tissues in the PZ and TZ (P < 0.001; 1.32 +/- 0.24 x 10(-3) mm2/s vs 1.97 +/- 0.25 x 10(-3) mm2/s, and 1.37 +/- 0.29 x 10(-3) mm2/s vs 1.79 +/- 0.19 x 10(-3) mm2/s, respectively). For tumor diagnosis, cutoff values of 1.67 x 10(-3) mm2/s (PZ) and 1.61 x 10(-3) mm2/s (TZ) resulted in sensitivities and specificities of 94% and 91% and 90% and 84%, respectively. CONCLUSIONS The DWI of the prostate at 3T MRI using a phased-array coil was useful for the differentiation of malignant and benign tissues in the TZ and PZ.
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Affiliation(s)
- Chan Kyo Kim
- Departments of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Inan N, Arslan A, Akansel G, Anik Y, Balci NC, Demirci A. Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses. Eur J Radiol 2007; 65:154-62. [PMID: 17466481 DOI: 10.1016/j.ejrad.2007.03.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2006] [Revised: 01/13/2007] [Accepted: 03/12/2007] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the value of dynamic MR imaging in the differential diagnosis of adrenal adenomas and malignant tumors, especially in cases with atypical adenomas. MATERIALS AND METHODS Sixty-four masses (48 adenomas, 16 malignant tumors) were included in this prospective study. Signal loss of masses was evaluated using chemical shift MR imaging. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, with the acquisition starting simultaneously with i.v. contrast administration (0-100 s) followed by a T1-weighted FFE sequence in the late phase (5th minute). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained according to the SIs on the 0th, 25th, 50th 75th and 100th second. Also, the wash-in rate, maximum relative enhancement, time-to-peak, and wash-out of contrast at 100 s of masses in both groups were calculated. The statistical significance was determined by Mann-Whitney U test. To evaluate the diagnostic performance of the quantitative tests, receiver operating characteristic (ROC) analysis was performed. RESULTS Chemical shift MR imaging was able to differentiate 44 out of 48 adenomas (91.7%) from non-adenomas. The 4 adenomas (8.3%) which could not be differentiated from non-adenomas by this technique did not exhibit signal loss on out-of-phase images. With a cut-off value of 30, SI indices of adenomas had a sensitivity of 93.8%, specificity of 100% and a positive predictive value of 100%. On visual evaluation of dynamic MR imaging, early phase contrast enhancement patterns were homogeneous in 75% and punctate in 20,83% of the adenomas; while patchy in 56.25% and peripheral in 25% of the malignant tumors. On the late phase images 58.33% of the adenomas showed peripheral ring-shaped enhancement and 10.41% showed heterogeneous enhancement. All of the malignant masses showed heterogeneous enhancement. At the 25th second, the SIs and wash-in rates of the adenomas were significantly higher than those of the malignant masses (p=0.010). Time-to-peak enhancement of the malignant masses was significantly longer than that of the adenomas. With a cut-off value of 52.85 s, the time-to-peak enhancement had 87.5% sensitivity and 80% specificity. CONCLUSION Chemical shift MR has a high sensitivity and specificity in the differential diagnosis of adenomas and malignant adrenal masses. However, taking into consideration only the atypical adenomas, chemical shift MRI is of no diagnostic value. Although the diagnostic value of dynamic MRI is lower than chemical shift MRI, in the atypical cases contrast enhancement patterns and time-to-peak and wash-in rates derived from SI-time curve of dynamic MRI give are contributory to the results of chemical shift MRI.
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Affiliation(s)
- Nagihan Inan
- Department of Radiology, School of Medicine, University of Kocaeli, 41380 Umuttepe, Kocaeli, Turkey.
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Choi YJ, Kim JK, Kim N, Kim KW, Choi EK, Cho KS. Functional MR Imaging of Prostate Cancer. Radiographics 2007; 27:63-75; discussion 75-7. [PMID: 17234999 DOI: 10.1148/rg.271065078] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
T2-weighted magnetic resonance (MR) imaging has been widely used for pretreatment work-up for prostate cancer, but its accuracy for the detection and localization of prostate cancer is unsatisfactory. To improve the utility of MR imaging for diagnostic evaluation, various other techniques may be used. Dynamic contrast material-enhanced MR imaging allows an assessment of parameters that are useful for differentiating cancer from normal tissue. The advantages of this technique include the direct depiction of tumor vascularity and, possibly, obviation of an endorectal coil; however, there also are disadvantages, such as limited visibility of cancer in the transitional zone. Diffusion-weighted imaging demonstrates the restriction of diffusion and the reduction of apparent diffusion coefficient values in cancerous tissue. This technique allows short acquisition time and provides high contrast resolution between cancer and normal tissue, but individual variability in apparent diffusion coefficient values may erode diagnostic performance. The accuracy of MR spectroscopy, which depicts a higher ratio of choline and creatine to citrate in cancerous tissue than in normal tissue, is generally accepted. The technique also allows detection of prostate cancer in the transitional zone. However, it requires a long acquisition time, does not directly depict the periprostatic area, and frequently is affected by artifacts. Thus, a comprehensive evaluation in which both functional and anatomic MR imaging techniques are used with an understanding of their particular advantages and disadvantages may help improve the accuracy of MR for detection and localization of prostate cancer.
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Affiliation(s)
- Young Jun Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poong-nap-dong, Songpa-gu, Seoul 138-736, South Korea
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90
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91
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Hou P, De EJB, Kramer LA, Westney OL. Dynamic contrast-enhanced MRI study of male pelvic perfusion at 3T: Preliminary clinical report. J Magn Reson Imaging 2007; 25:160-9. [PMID: 17173309 DOI: 10.1002/jmri.20813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To detect male pelvic perfusion in patients with coronary artery disease (CAD) vs. controls by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) at 3T. MATERIALS AND METHODS Eighteen male patients were studied with T1-weighted (T1W) DCE-MRI to measure perfusion, phase-contrast (PC) imaging to measure bulk flow, and contrast-enhanced (CE)-MRA to detect stenosis. Regions of interest (ROIs) in prostate, corpus cavernosal, and spongiosal tissues were analyzed. Two-compartment pharmacokinetic modeling was employed to fit the signal enhancement. Perfusion parameters were analyzed by curve-fitting and utilized to compare the CAD and control groups. Validated questionnaires measuring urinary and erectile function were used to evaluate pelvic symptomatology in both groups. RESULTS Mean perfusion analysis confirmed weaker and slower enhancement in CAD patients vs. controls despite equivalent cardiac output values. The mean maximum enhancement was 26.33 +/- 0.12 (controls) vs. 22.38 +/- 0.44 (CAD) for prostate. The mean wash-in rate in units of minute(-1) was 62.10 +/- 1.74 (controls) vs. 34.44 +/- 1.08 (CAD) for prostate, 16.68 +/- 0.72 (controls) vs. 8.04 +/- 0.36 (CAD) for spongiosal, and 8.34 +/- 0.54 (controls) vs. 3.48 +/- 0.24 (CAD) for cavernosal tissues (all with P < 0.0001). CONCLUSION This preliminary study demonstrates that perfusion parameters differ between CAD and control patients, and the findings mirror the differences in pelvic symptoms in these groups.
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Affiliation(s)
- Ping Hou
- Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Texas 77030, USA.
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Morakkabati-Spitz N, Bastian PJ, Meissner A, Träber F, Gieseke J, Schild HH, Müller SC. MR-Techniken zur nicht-invasiven Diagnostik des Prostatakarzinoms. Urologe A 2006; 45:702-5. [PMID: 16788787 DOI: 10.1007/s00120-006-1063-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The diagnosis of prostate cancer is suggested on the basis of an elevated PSA level, abnormal digital exam, and abnormal transrectal ultrasound. US-guided biopsy is used to confirm the diagnosis, but up to 30% of prostate cancer may be missed with this approach. Meanwhile MR imaging and proton MR spectroscopy have emerged as the most sensitive additional tools for the noninvasive evaluation of prostate cancer. This article reviews the clinical indications for MRI of the prostate and summarizes new techniques such as high field strength (3 tesla) and dynamic contrast-enhanced MRI.
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Affiliation(s)
- N Morakkabati-Spitz
- Radiologische Klinik, Klinikum, Rheinische Friedrich-Wilhelms Universität, Sigmund-Freud-Strasse 25, 53105, Bonn.
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