Prostate Cancer: Accurate Determination of Extracapsular Extension with High-Spatial-Resolution Dynamic Contrast-enhanced and T2-weighted MR Imaging—Initial Results

Bloch, B; Furman‐Haran, Edna; Helbich, Thomas H.; Lenkinski, Robert E.; Degani, Hadassa; Kratzik, Christian; Susani, Martin; Haitel, Andrea; Jaromi, Silvia; Ngo, Long; Rofsky, Neil M.

doi:10.1148/radiol.2451061502

Cited by 211 publications

(130 citation statements)

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“…The incorporation of other MR techniques, such as dynamic perfusion or diffusion-weighted imaging, can further improve the performance of MR examinations in the detection and staging of prostate cancer (36)(37)(38)(39). It would be of clinical interest in the future to investigate whether multiparametric examinations in which all of these state-of-the-art techniques are combined can yield superior diagnostic information for stratifying patients with clinical stage T1c prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Zhang¹,

Hricak²,

Shukla–Dave³

et al. 2009

Radiology

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Purpose:To assess the diagnostic accuracy of endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for prediction of the pathologic stage of prostate cancer and the presence of clinically nonimportant disease in patients with clinical stage T1c prostate cancer. Materials and Methods:The institutional review board approved-and waived the informed patient consent requirement for-this HIPAAcompliant study involving 158 patients (median age, 58 years; age range, 40 -76 years) who had clinical stage T1c prostate cancer, had not been treated preoperatively, and underwent combined 1.5-T endorectal MR imaging-MR spectroscopic imaging between January 2003 and March 2004 before undergoing radical prostatectomy. On the MR images and combined endorectal MR-MR spectroscopic images, two radiologists retrospectively and independently rated the likelihood of cancer in 12 prostate regions and the likelihoods of extracapsular extension (ECE), seminal vesicle invasion (SVI), and adjacent organ invasion by using a five-point scale, and they determined the probability of clinically nonimportant prostate cancer by using a four-point scale. Whole-mount step-section pathology maps were used for imaging-pathologic analysis correlation. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) were estimated nonparametrically for assessment of reader accuracy. Results:At surgical-pathologic analysis, one (0.6%) patient had no cancer; 124 (78%) patients, organ-confined (stage pT2) disease; 29 (18%) patients, ECE (stage pT3a); two (1%) patients, SVI (stage pT3b); and two (1%) patients, bladder neck invasion (stage pT4). Forty-six (29%) patients had a total tumor volume of less than 0.5 cm 3 . With combined MR imaging-MR spectroscopic imaging, the two readers achieved 80% accuracy in disease staging and AUCs of 0.62 and 0.71 for the prediction of clinically nonimportant cancer. Conclusion:Clinical Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.I n American men, prostate cancer continues to be the most common cancer and the second leading cause of noncutaneous cancer-related mortality (1). The American Cancer Society estimated that in 2009, 192 280 new cases of prostate cancer would be diagnosed and 27 360 deaths would occur owing to this disease in the United States (1). Serum prostate-specific antigen (PSA) screening has led to a dramatic decrease in prostate cancer stage at the time of diagnosis, and stage T1c is now the most commonly diagnosed clinical stage (2).According to the TNM classification system, T1c prostate cancers are malignancies identified with needle biopsy (performed, for example, because of an elevated PSA level) that are not detectable at digital rectal examination or imaging (usually transrectal ultrasonography [US]) (3). In a study conducted by Humphrey et al (4), 78 of 100 consecutive patients who underwent rad...

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Section: Discussionmentioning

confidence: 99%

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Zhang¹,

Hricak²,

Shukla–Dave³

et al. 2009

Radiology

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“…Adding functional parameters to T2WI may improve this. One study reported that adding DCEI to T2WI for T-staging resulted in a sensitivity of 86% and specificity of 95% for detecting EPE [112]. Another study failed to validate these findings [113], however, and two studies reported that combining MRS and T2WI failed to improve accuracy over T2WI alone in staging [114,115].…”

Section: Mri In T-staging Treatment Selection and Planningmentioning

confidence: 99%

The role of magnetic resonance imaging in the diagnosis and management of prostate cancer

et al. 2013

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Background• The diagnosis of prostate cancer has long been plagued by the absence of an imaging tool that reliably detects and localises significant tumours. Recent evidence suggests that multi-parametric MRI could improve the accuracy of diagnostic assessment in prostate cancer. This review serves as a background to a recent USANZ position statement. It aims to provide an overview of MRI techniques and to critically review the published literature on the clinical application of MRI in prostate cancer. Technical Aspects• The combination of anatomical (T2-weighted) MRI with at least two of the three functional MRI parameterswhich include diffusion-weighted imaging, dynamic contrast-enhanced imaging and spectroscopy -will detect greater than 90% of significant (moderate to high risk) tumours; however MRI is less reliable at detecting tumours that are small (<0.5 cc), low grade (Gleason score 6) or in the transitional zone. The higher anatomical resolution provided by 3-Tesla magnets and endorectal coils may improve the accuracy, particularly in primary tumour staging.

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“…The incremental value of high spatial resolution DCE MRI was shown recently [77]. This imaging strategy acquires higher-resolution images with smaller voxel sizes than has been possible with prior MR technology and more comprehensive tissue sampling compared to other pre-surgical assessments.…”

Section: Mri Of the Prostate At Beth Israel Deaconess Medical Center mentioning

confidence: 99%

The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: The Beth Israel Deaconess Medical Center (BIDMC) approach

Bloch

Lenkinski

Rofsky

2008

CBM

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Management decisions for patients with prostate cancer present a dilemma for both patients and their clinicians because prostate cancers demonstrate a wide range in biologic activity, with the majority of cases not leading to a prostate cancer related death. Furthermore, the current treatment options have significant side effects, such as incontinence, rectal injury and impotence. Key elements for guiding appropriate treatment include: distinction of organ-confined disease from extracapsular extension (ECE); and determination of tumor volume and tumor grade, none of which have been satisfactorily accomplished in today's pre-treatment paradigm. Magnetic resonance imaging (MRI) has the capability to assess prostate tissue, both functionally and morphologically. MRI as a staging tool has not shown enough consistency or sufficient accuracy for widespread adoption in clinical practice; yet, recent technical developments in MRI have yielded improved results. At our institution we have combined the use of new endorectal 3 Tesla MRI technology, T2-weighted, and high spatial resolution dynamic-contrast enhanced (DCE) MRI to non-invasively assess the prostate with higher signal-to-noise ratio and spatial resolution than previously achieved. This approach allows assessment of prostate-tissue morphology and kinetics, thus providing a non-invasive tool for tumor detection and staging and, consequently, directing biopsy and treatment specifically to diseased areas for a pre-treatment evaluation that can assist in the rational selection of patients for appropriate prostate cancer therapy.

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Prostate Cancer: Accurate Determination of Extracapsular Extension with High-Spatial-Resolution Dynamic Contrast-enhanced and T2-weighted MR Imaging—Initial Results

Abstract: The combination of high-spatial-resolution dynamic contrast-enhanced MR imaging and T2-weighted MR imaging yields improved assessment of ECE and better results for prostate cancer staging compared with either technique independently.

Cited by 211 publications

References 53 publications

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

The role of magnetic resonance imaging in the diagnosis and management of prostate cancer

The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: The Beth Israel Deaconess Medical Center (BIDMC) approach

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