Prostate Cancer: Prediction of Extracapsular Extension with Endorectal MR Imaging and Three-dimensional Proton MR Spectroscopic Imaging

Yu, Kyle K.; Scheidler, J.; Hricak, Hedvig; Vigneron, Daniel B.; Zaloudek, Charles; Males, Ryan G.; Nelson, Sarah J.; Carroll, Peter R.; Kurhanewicz, John

doi:10.1148/radiology.213.2.r99nv26481

Cited by 323 publications

(194 citation statements)

References 42 publications

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“…This result may have been related to the experience levels of the two readers, which were roughly equivalent: Both readers had read more than 1000 prostate MR studies before taking part in this investigation. Previous study investigators have found that using MR spectroscopic imaging increases reader confidence and significantly improves reader performance in the interpretation of MR imagesespecially that of less experienced readers (33)(34)(35).…”

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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“…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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“…One recent study reported an overall staging accuracy of 93% and 56% for two different readers within the same study (28). Although inter-reader variability can be due to differences in reader experience and subjectivity, the addition of objective metabolic criteria provided by MRSI has been demonstrated to decrease this inter-reader variability (29).…”

Section: Morphologic Identification Of Prostate Cancer-mrimentioning

confidence: 99%

“…This study was based on prior histopathologic studies that demonstrated that tumor volume was a significant predictor of extracapsular extension (ECE) of prostate cancer (75,76). It was found that tumor volume per lobe estimated by MRSI was significantly (P Ͻ 0.01) higher in patients with ECE (2.14 Ϯ 2.3 cm 3 ) than in patients without ECE (0.98 Ϯ 1.1 cm 3 ) (29). Moreover the addition of an MRSI estimate of tumor volume to high-specificity MRI findings for ECE (74) improved the diagnostic accuracy and decreased the inter-observer variability of MRI in the diagnosis of extracapsular extension of prostate cancer (Fig.…”

Section: Improved Prostate Cancer Staging Using Combined Mri/mrsimentioning

confidence: 99%

Combined magnetic resonance imaging and spectroscopic imaging approach to molecular imaging of prostate cancer

Kurhanewicz

Swanson

Nelson

et al. 2002

Magnetic Resonance Imaging

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Magnetic resonance spectroscopic imaging (MRSI) provides a noninvasive method of detecting small molecular markers (historically the metabolites choline and citrate) within the cytosol and extracellular spaces of the prostate, and is performed in conjunction with high-resolution anatomic imaging. Recent studies in pre-prostatectomy patients have indicated that the metabolic information provided by MRSI combined with the anatomical information provided by MRI can significantly improve the assessment of cancer location and extent within the prostate, extracapsular spread, and cancer aggressiveness. Additionally, pre-and post-therapy studies have demonstrated the potential of MRI/MRSI to provide a direct measure of the presence and spatial extent of prostate cancer after therapy, a measure of the time course of response, and information concerning the mechanism of therapeutic response. In addition to detecting metabolic biomarkers of disease behavior and therapeutic response, MRI/MRSI guidance can improve tissue selection for ex vivo analysis. High-resolution magic angle spinning ( 1 H HR-MAS) spectroscopy provides a full chemical analysis of MRI/MRSI-targeted tissues prior to pathologic and immunohistochemical analyses of the same tissue. Preliminary 1 H HR-MAS spectroscopy studies have already identified unique spectral patterns for healthy glandular and stromal tissues and prostate cancer, determined the composition of the composite in vivo choline peak, and identified the polyamine spermine as a new metabolic marker of prostate cancer. The addition of imaging sequences that provide other functional information within the same exam (dynamic contrast uptake imaging and diffusion-weighted imaging) have also demonstrated the potential to further increase the accuracy of prostate cancer detection and characterization.

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Prostate Cancer: Prediction of Extracapsular Extension with Endorectal MR Imaging and Three-dimensional Proton MR Spectroscopic Imaging

Abstract: The addition of 3D MR spectroscopic imaging to MR imaging improves accuracy for less experienced readers and reduces interobserver variability in the diagnosis of ECE of prostate cancer.

Cited by 323 publications

References 42 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

Combined magnetic resonance imaging and spectroscopic imaging approach to molecular imaging of prostate cancer

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