A Cox regression multivariate analysis was done to determine the clinical and pathological indicators that predict for prostate specific antigen (PSA) failure in 347 patients who underwent radical prostatectomy for clinically localized prostate cancer between 1989 and 1993. In the patient subgroups (PSA less than 20 ng./ml. and biopsy Gleason sum 5 to 7 or PSA more than 10 to 20 ng./ml. and biopsy Gleason sum 2 to 4) not classifiable into those at high and low risk for postoperative PSA failure using PSA and biopsy Gleason sum, the status of the seminal vesicles and prostatic capsule on endo-rectal coil magnetic resonance imaging (MRI) allowed for this categorization. Specifically, 2-year actuarial PSA failure rates were 84% versus 23% in patients with and without seminal vesicle invasion, respectively, on MRI (p < 0.0001) and 58% versus 21% in those with and without extracapsular extension, respectively (p = 0.0001). In patients with extracapsular extension but without pathological involvement of the seminal vesicle(s) or poorly differentiated tumors (pathological Gleason sum 8 to 10), the 2-year actuarial PSA failure rates were 50% (margin positive), 28% (margin negative with established extracapsular disease) and 9% (margin negative with focal microscopic extracapsular disease). Therefore, endo-rectal coil MRI showing seminal vesicle invasion or extracapsular extension when the PSA level is less than 20 ng./ml. and the biopsy Gleason sum is 5 to 7 or the PSA level is more than 10 but less than 20 ng./ml. and the biopsy Gleason sum is 2 to 4 predicted for PSA failure. In patients with extracapsular extension who had pathological Gleason sum less than 8 disease with uninvolved seminal vesicles, the margin status and extent of extracapsular disease predicted for PSA failure.

An endorectal surface coil has been developed to obtain high-resolution magnetic resonance images of the prostate. The probe consists of a surface coil mounted on the inner surface of a balloon. The balloon is concave to ensure tight seating against the prostate. The coil has been used in 15 patients with biopsy-proved prostatic carcinoma and in two healthy volunteers. The axial images were obtained with a 12-16-cm field of view and a 3-mm section thickness. Compared with images obtained with a body coil, the surface coil images better demonstrate prostatic anatomy and pathologic conditions.

To increase the accuracy of local staging of rectal carcinomas at magnetic resonance (MR) imaging, the authors placed on endorectal coil mounted on a balloon in a position adjacent to the lesion. Use of such a local coil resulted in increased signal-to-noise ratio compared with use of a body coil; higher-resolution images were obtained because the field of view was decreased. The depth of wall invasion by rectal carcinoma was correctly staged with endorectal MR imaging in 11 of 12 patients. In the detection of perirectal adenopathy, use of MR enabled correct identification of positive perirectal nodes in four of seven patients (57%). There were no false-positive diagnoses of perirectal adenopathy at MR. Endorectal MR imaging is an evolving and promising technique for the local staging of rectal carcinomas, but further studies are needed to demonstrate its efficacy.

The purpose of this study was to compare the diagnostic information provided by a combination of two-dimensional and three-dimensional (3D) time-of-flight (TOF) techniques with that provided by non-breath-hold 3D spoiled gradient-echo gadolinium-enhanced MR angiography. MATERIALS AND METHODS. Fifty patients suspected of having extracranial atherosclerotic carotid artery disease were examined with all three imaging techniques using a 1.5-T MR imaging system. Three observers independently and retrospectively measured the degree of stenosis according to the North American Symptomatic Carotid Endarterectomy Trial criteria.

A Cox regression multivariate analysis was done to determine the clinical and pathological indicators that predict for prostate specific antigen (PSA) failure in 347 patients who underwent radical prostatectomy for clinically localized prostate cancer between 1989 and 1993. In the patient subgroups (PSA less than 20 ng./ml. and biopsy Gleason sum 5 to 7 or PSA more than 10 to 20 ng./ml. and biopsy Gleason sum 2 to 4) not classifiable into those at high and low risk for postoperative PSA failure using PSA and biopsy Gleason sum, the status of the seminal vesicles and prostatic capsule on endo-rectal coil magnetic resonance imaging (MRI) allowed for this categorization. Specifically, 2-year actuarial PSA failure rates were 84% versus 23% in patients with and without seminal vesicle invasion, respectively, on MRI (p < 0.0001) and 58% versus 21% in those with and without extracapsular extension, respectively (p = 0.0001). In patients with extracapsular extension but without pathological involvement of the seminal vesicle(s) or poorly differentiated tumors (pathological Gleason sum 8 to 10), the 2-year actuarial PSA failure rates were 50% (margin positive), 28% (margin negative with established extracapsular disease) and 9% (margin negative with focal microscopic extracapsular disease). Therefore, endo-rectal coil MRI showing seminal vesicle invasion or extracapsular extension when the PSA level is less than 20 ng./ml. and the biopsy Gleason sum is 5 to 7 or the PSA level is more than 10 but less than 20 ng./ml. and the biopsy Gleason sum is 2 to 4 predicted for PSA failure. In patients with extracapsular extension who had pathological Gleason sum less than 8 disease with uninvolved seminal vesicles, the margin status and extent of extracapsular disease predicted for PSA failure.