Endorectal Magnetic Resonance Imaging and Spectroscopy for the Detection of Tumor Foci in Men With Prior Negative Transrectal Ultrasound Prostate Biopsy

Yuen, John Shyi Peng; Thng, Choon Hua; Tan, Puay‐Hoon; Khin, Lay Wai; Phee, Soo Jay; Xiao, Di; Lau, Weber Kam Onn; Ng, Wan Sing; Cheng, Christopher

doi:10.1097/01.ju.0000118380.90871.ef

Cited by 140 publications

(109 citation statements)

References 11 publications

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“…Beyersdorff et al 26 exhibited that T2-weighed e-MRI has increased diagnostic performance with a sensitivity of 83%. Yuen et al 27 exhibited a sensitivity and specificity of 82.1 and 100%, with a PCa detection rate of 29.2%. Hara et al 28 using dce-MRI achieved a sensitivity of 93% and a specificity of 96% in a group of 90 patients.…”

Section: Discussionmentioning

confidence: 99%

Prostate cancer detection using an extended prostate biopsy schema in combination with additional targeted cores from suspicious images in conventional and functional endorectal magnetic resonance imaging of the prostate

Engelhard

Zugor

et al. 2009

Prostate Cancer Prostatic Dis

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The purpose of this study is to report our method in detecting prostate cancer (PCa) using an 18-core transrectal ultrasound (TRUS) prostate biopsy (PB) schema, in combination with additional targeted cores from suspicious images in conventional (e-cMRI) and functional (e-fMRI) endorectal magnetic resonance imaging (e-MRI) of the prostate. From 2004 to 2008, 260 consecutive patients with a clinical suspicion of PCa underwent PB and were prospectively studied. e-cMRI and e-fMRI was performed in all patients before PB. The patients were divided into two groups (A and B) according to the results of their radiological findings (group A ¼ suspicious findings, group B ¼ non-suspicious findings). After the images were processed, an 18-core TRUS-guided PB was performed. When a patient exhibited a suspicious site on e-cMRI and e-fMRI images, three additional targeted PBs were obtained from that site. In group A, 17.5% of PCa was detected by the 18-core PB and 56.5% of PCa was detected by the targeted cores. The overall PCa detection rate (18 þ targeted cores) was 73.9%. The overall specificity was 73.9%. In group B, overall false-positive detection rate reached 19.2%, with the overall sensitivity being 80.8%. The method described above is not only practical but also a promising modality in PCa detection. As seen, PCa was optimally detected when combining the 18-core and targeted-core PB schema together. Non-suspicious images do not rule out the probability of PCa, thus justifying a PB in these patients as well.

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Section: Discussionmentioning

confidence: 99%

Prostate cancer detection using an extended prostate biopsy schema in combination with additional targeted cores from suspicious images in conventional and functional endorectal magnetic resonance imaging of the prostate

Engelhard

Zugor

et al. 2009

Prostate Cancer Prostatic Dis

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“…Though such imaging sequences are considered sensitive for prostate cancer detection, they lack specificity and are generally used for staging purposes. In efforts to improve the specificity of MR prostate examinations, both gadolinium based dynamic contrast studies (11)(12)(13) and magnetic resonance spectroscopy (MRS) studies (10,(14)(15)(16)(17)(18)(19)(20) are being evaluated. Similarly, quantitative T2-mapping and diffusion imaging have been suggested as potential candidates for improving the specificity of prostate MR examinations (21)(22)(23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

Biexponential characterization of prostate tissue water diffusion decay curves over an extended b-factor range

Mulkern

Barnes

Haker

et al. 2006

Magnetic Resonance Imaging

121

135

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Detailed measurements of water diffusion within the prostate over an extended b-factor range were performed to assess whether the standard assumption of monoexponential signal decay is appropriate in this organ. From nine men undergoing prostate MR staging exams at 1.5 T, a single 10 mm thick axial slice was scanned with a line scan diffusion imaging (LSDI) sequence in which 14 equally spaced b-factors from 5 to 3500 s/mm 2 were sampled along three orthogonal diffusion sensitization directions in 6 minutes. Due to the combination of long scan time and limited volume coverage associated with the multi-b-factor, multi-directional sampling, the slice was chosen online from the available T2-weighted axial images with the specific goal of enabling the sampling of presumed noncancerous regions of interest (ROI's) within the central gland (CG) and peripheral zone (PZ). Histology from pre-scan biopsy (N = 9) and post-surgical resection (N = 4) was subsequently employed to help confirm that the ROIs sampled were non-cancerous. The CG ROIs were characterized from the T2-weighted images as primarily mixtures of glandular and stromal benign prostatic hyperplasia (BPH) which is prevalent in this population. The water signal decays with bfactor from all ROI's were clearly non-monoexponential and better served with bi-vs monoexponential fits, as tested using λ 2 based F-test analyses. Fits to biexponential decay functions yielded inter-subject fast diffusion component fractions on the order of 0.73 ± 0.08 for both CG and PZ ROIs, fast diffusion coefficients of 2.68 ± 0.39 and 2.52 ± 0.38 μm 2 /ms and slow diffusion coefficients of 0.44 ± 0.16 and 0.23 ± 0.16 um 2 /ms for CG and PZ ROI's, respectively. The difference between the slow diffusion coefficients within CG and PZ was statistically significant as assessed with a Mann-Whitney non-parametric test (P < 0.05). We conclude that a monoexponential model for water diffusion decay in prostate tissue is inadequate when a large range of b-factors is sampled and that biexponential analyses are better suited for characterizing prostate diffusion decay curves.

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“…Men with persistently elevated serum PSA levels after a negative first random TRUS-guided prostate biopsy represent a great diagnostic challenge for urologists (10). The fact that additional rounds of conventional random biopsies do not improve the cancer detection rate in this group of patients shows the high false-negative rates of the current random biopsy technique (10)(11)(12)(13). On the basis of these outcomes there is a need for a more sensitive and accurate imaging modality to direct biopsy and to detect prostate cancer.…”

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confidence: 99%

Value of Magnetic Resonance Spectroscopy Imaging and Dynamic Contrast-Enhanced Imaging for Detecting Prostate Cancer Foci in Men With Prior Negative Biopsy

Sciarra

Panebianco

Ciccariello

et al. 2010

Clinical Cancer Research

144

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Purpose: This study aimed to prospectively analyze the role of magnetic resonance spectroscopy imaging (MRSI) and dynamic-contrast enhancement magnetic resonance (DCEMR) in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen levels (in the range of ≥4 ng/mL to <10 ng/mL) and prior negative random trans-rectal ultrasound (TRUS)-guided biopsy.Experimental Design: This was a prospective randomized single-center study. One hundred and eighty eligible cases were included in the study. Patients in group A were submitted to a second random prostate biopsy, whereas patients in group B were submitted to a 1 H-MRSI-DCEMR examination and samples targeted on suspicious areas were associated to the random biopsy.Results: At the second biopsy, a prostate adenocarcinoma histologic diagnosis was found in 22 of 90 cases (24.4%) in group A and in 41 of 90 cases (45.5%) in group B (P = 0.01). On a patient-by-patient basis, MRSI had 92.3% sensitivity, 88.2% specificity, 85.7% positive predictive value (PPV), 93.7% negative predictive value (NPV), and 90% accuracy; DCEMR had 84.6 % sensitivity, 82.3% specificity, 78.5% PPV, 87.5% NPV, and 83.3% accuracy; and the association MRSI plus DCEMR had 92.6% sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV, and 90.7% accuracy, for predicting prostate cancer detection.Conclusions: The combination of MRSI and DCEMR showed the potential to guide biopsy to cancer foci in patients with previously negative TRUS biopsy. To avoid a potential bias, represented from having taken more samples in group B (mean of cores, 12.17) than in group A (10 cores), in the future a MRSI/ DCEMR directed biopsy could be prospectively compared with a saturation biopsy procedure. Clin Cancer Res; 16(6); 1875-83. ©2010 AACR.At present, suspicion of prostate adenocarcinoma is mainly based on three tests: digital rectal examination, prostate-specific antigen (PSA), and trans-rectal ultrasound (TRUS), and is confirmed by TRUS-guided biopsies. The latter is recognized by urologists as the first choice in the diagnosis of prostate pathologies (1). All three modern imaging modalities, namely, computer tomography, ultrasonography, and magnetic resonance (MR), have been considered to have limitations in the diagnosis of prostate adenocarcinoma. Recently some studies (2-5) revealed the high diagnostic accuracy of combined proton 1H-magnetic resonance spectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced imaging magnetic resonance (DCEMR) in the management of prostate cancer. The advantage of MRSI is that the spectroscopic analysis provides metabolic information regarding prostatic tissue by displaying the relative concentrations of chemical compounds within contiguous small volumes of interest (voxels). In the prostate the substances analyzed by MRSI are citrate, creatine, and choline. For practical purposes, prostate adenocarcinoma can be distinguished from healthy peripheral zone tissue on the basis of the (choline + creatine)/citrate ratio (5-7). Normal per...

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Endorectal Magnetic Resonance Imaging and Spectroscopy for the Detection of Tumor Foci in Men With Prior Negative Transrectal Ultrasound Prostate Biopsy

Abstract: MRI and MRSI have the potential to identify cancer foci and direct TRUS in patients with a previous negative TRUS biopsy. Further, larger studies are required to quantify the amount of benefit.

Cited by 140 publications

References 11 publications

Prostate cancer detection using an extended prostate biopsy schema in combination with additional targeted cores from suspicious images in conventional and functional endorectal magnetic resonance imaging of the prostate

Prostate cancer detection using an extended prostate biopsy schema in combination with additional targeted cores from suspicious images in conventional and functional endorectal magnetic resonance imaging of the prostate

Biexponential characterization of prostate tissue water diffusion decay curves over an extended b-factor range

Value of Magnetic Resonance Spectroscopy Imaging and Dynamic Contrast-Enhanced Imaging for Detecting Prostate Cancer Foci in Men With Prior Negative Biopsy

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