Three-dimensional 1H-magnetic resonance spectroscopy of the prostate in clinical practice: technique and results in patients with elevated prostate-specific antigen and negative or no previous prostate biopsies

Abstract

To assess the benefit of routinely used three-dimensional 1H-spectroscopy of the prostate combined with magnetic resonance imaging in patients with elevated prostate-specific antigen (PSA) levels and negative or no previous prostate biopsies. Fifty-four patients were examined with our combined imaging protocol, which consisted of transversal, coronal and sagittal T2-weighted fast spin echo sequences. For spectroscopy, we used a three-dimensional chemical shift imaging spin echo (3D-CSI-SE) sequence. The study population consisted of patients with elevated PSA levels and histologically proven prostate carcinoma and patients with elevated PSA levels and negative or no previous prostate biopsies. Examination time was 31 min, a time feasible for routine use. Eighty-eight tumour voxels and 67 control voxels of 27 patients with histologically proven prostate carcinoma were analysed. Ratios of (choline + creatine)/citrate [(Cho + Crea)/Cit] below 0.6 were classified as normal and above 0.6 as pathological. Applying this classification to 20 patients with tumour-suspicious lesions of the prostate and negative or no previous prostate biopsies, we could obtain a sensitivity and specificity for tumour detection of 100% and 69%, respectively. Our combined imaging protocol is feasible for routine use and can add valuable information for the diagnostic management of patients with negative or no previous prostate biopsies.

Transrectal ultrasound‐guided biopsy of prostate voxels identified as suspicious of malignancy on three‐dimensional 1H MR spectroscopic imaging in patients with abnormal digital rectal examination or raised prostate specific antigen level of 4–10 ng/ml

“…They achieved combined MRI/MRSI sensitivity and specificity of 100 and 70.6%, respectively. Further studies (28)(29)(30) reported sensitivity of voxel-directed biopsy from 73.3 to 100% and specificity of 44 to 96.3%. In these studies (27)(28)(29)(30) the MRI/MRSI targeted TRUS-guided biopsy was carried out on patients who had negative biopsies but with persistently increased PSA value (in the range 4-40 ng/ ml).…”

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

“…MRI of the prostate is not routinely used in the initial diagnosis of prostate adenocarcinoma, but rather for staging (22).…”

“…The positive findings of our study showed the potential of these qualitative criteria. On the contrary, Wetter et al (22) in their analysis, on the basis of the choline + creatine/citrate ratio, defined three categories: normal if below 0.6; borderline from 0.6 to 1.1, and pathologic for above 1.1. Amsellem et al (11) reported a significant reduction in the specificity and PPV of MRSI when reducing the threshold of the ratio from 0.8 to 0.75, due to the increase of MRSI FP findings.…”

MR-compatible assistance system for punction in a high-field system: device and feasibility of transgluteal biopsies of the prostate gland

“…In particular the role of MR-imaging in the detection of prostate cancer is increasing. Magnetic resonance imaging and proton MR spectroscopy have been gaining acceptance as tools in noninvasive evaluation techniques of prostate anatomic and biologic tumor features [14][15][16][17][18][19][20][21]. Based upon these advantages MRI has great potential to provide accurate image guidance for percutaneous interventions of the prostate gland.…”