Seminal vesicle invasion in prostate cancer: evaluation by using multiparametric endorectal MR imaging.

PURPOSE To retrospectively evaluate the diagnostic performance of multiparametric endorectal magnetic resonance (MR) imaging, including T2-weighted, diffusion-weighted (DW), and dynamic contrast material-enhanced (DCE) MR techniques, for the diagnosis of seminal vesicle invasion (SVI) and to determine the incremental value of DW MR and DCE MR images. MATERIALS AND METHODS This retrospective HIPAA-compliant study was approved by the institutional review board, with a waiver of informed consent. The study included 131 patients (mean age, 68 years; range, 43-75 years) who underwent endorectal MR imaging before radical prostatectomy between January 2007 and April 2010. Two radiologists (A: experienced, B: less experienced) estimated the likelihood of SVI by using a five-point ordinal scale in three image-viewing settings: T2-weighted images alone; T2-weighted and DW MR images; and T2-weighted, DW MR, and DCE MR images. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated. Confidence intervals estimated with bootstrapping and the McNemar test or Fisher exact test were used to compare sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS Of the 131 patients, 23 (17.6%) had SVI identified after surgery. Review of T2-weighted MR images alone resulted in high specificity (93.1% and 93.6%, for radiologists A and B, respectively) and high negative predictive value (94.8% and 94.0%) but moderate sensitivity (59% and 52%) and positive predictive value (52% and 50%). Review of T2-weighted and DW MR images significantly improved specificity (96.6% [P = .02] and 98.3% [P = .003]) and positive predictive value (70% [P < .05] and 79% [P < .05]) without significantly improving AUC. Additional review of DCE MR images did not yield further incremental improvement. CONCLUSION Additional review of DW MR images improves specificity and positive predictive value in SVI detection compared with reviewing T2-weighted images alone. Addition of DCE MR images to this combination, however, does not provide incremental value for diagnosis of SVI.

[1]  I. Menchi,et al.  Local staging of prostate carcinoma with endorectal coil MRI: correlation with whole-mount radical prostatectomy specimens , 2004, European Radiology.

[2]  J Alfred Witjes,et al.  Staging prostate cancer with dynamic contrast-enhanced endorectal MR imaging prior to radical prostatectomy: experienced versus less experienced readers. , 2005, Radiology.

[3]  T Okada,et al.  Dynamic endorectal magnetic resonance imaging for local staging and detection of neurovascular bundle involvement of prostate cancer: correlation with histopathologic results. , 2001, Urology.

[4]  B. Delahunt,et al.  International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes , 2011, Modern Pathology.

[5]  P. Dettmar,et al.  Limited value of endorectal magnetic resonance imaging and transrectal ultrasonography in the staging of clinically localized prostate cancer , 2001, BJU international.

[6]  C. Tempany,et al.  MR imaging in adenocarcinoma of the prostate: interobserver variation and efficacy for determining stage C disease. , 1992, AJR. American journal of roentgenology.

[7]  G. Chodak,et al.  An analysis of risk factors for biochemical progression in patients with seminal vesicle invasion: validation of Kattan's nomogram in a pathological subgroup , 2004, BJU international.

[8]  Michael W Kattan,et al.  Cancer control with radical prostatectomy alone in 1,000 consecutive patients. , 2002, The Journal of urology.

[9]  Michael W Kattan,et al.  A nomogram to predict seminal vesicle invasion by the extent and location of cancer in systematic biopsy results. , 2003, The Journal of urology.

[10]  P. Carroll,et al.  Carcinoma of the prostate gland: MR imaging with pelvic phased-array coils versus integrated endorectal--pelvic phased-array coils. , 1994, Radiology.

[11]  H. Yin,et al.  Seminal vesicle invasion in prostate cancer: prediction with combined T2-weighted and diffusion-weighted MR imaging , 2009, European Radiology.

[12]  K. Taari,et al.  Magnetic resonance imaging of clinically localized prostatic cancer. , 1998, The Journal of urology.

[13]  K. Taari,et al.  Endorectal magnetic resonance imaging of prostatic cancer: comparison between fat-suppressed T2-weighted fast spin echo and three-dimensional dual-echo, steady-state sequences , 2001, European Radiology.

[14]  O. Halvorsen,et al.  MRI with an endorectal coil for staging of clinically localised prostate cancer prior to radical prostatectomy , 1999, European Radiology.

[15]  P. Scardino,et al.  The Mechanisms and Prognostic Significance of Seminal Vesicle Involvement by Prostate Cancer , 1993, The American journal of surgical pathology.

[16]  Local Staging of Prostatic Carcinoma: Comparison of Transrectal Sonography and Endorectal MR Imaging , 1996 .

[17]  B. K. Park,et al.  Diffusion‐weighted MR imaging for the evaluation of seminal vesicle invasion in prostate cancer: Initial results , 2008, Journal of magnetic resonance imaging : JMRI.

[18]  M. Kattan,et al.  Prediction of organ-confined prostate cancer: incremental value of MR imaging and MR spectroscopic imaging to staging nomograms. , 2006, Radiology.

[19]  Thomas Hambrock,et al.  Prostate cancer: multiparametric MR imaging for detection, localization, and staging. , 2011, Radiology.

[20]  Victor Reuter,et al.  Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. , 2003, The Journal of urology.

[21]  R. Stephenson,et al.  Isolated seminal vesicle invasion imparts better outcomes after radical retropubic prostatectomy for clinically localized prostate cancer: prognostic stratification of pt3b disease by nodal and margin status. , 2005, Urology.

[22]  H. Thaler,et al.  Endo-rectal coil magnetic resonance imaging in clinically localized prostate cancer: is it accurate? , 1996, The Journal of urology.

[23]  Michael W Kattan,et al.  Prediction of seminal vesicle invasion in prostate cancer: incremental value of adding endorectal MR imaging to the Kattan nomogram. , 2007, Radiology.

[24]  O. Hélénon,et al.  Endorectal color doppler sonography and endorectal MR imaging features of nonpalpable prostate cancer: correlation with radical prostatectomy findings. , 2000, AJR. American journal of roentgenology.

[25]  K. Berbaum,et al.  Receiver operating characteristic rating analysis. Generalization to the population of readers and patients with the jackknife method. , 1992, Investigative radiology.

[26]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[27]  G. Chodak,et al.  Should the therapeutic approach to prostate cancer with seminal vesicle invasion be reviewed: Improving functional results without diminishing oncological outcome? , 2004, BJU international.

[28]  H. Hricak,et al.  Endorectal MR imaging in the evaluation of seminal vesicle invasion: diagnostic accuracy and multivariate feature analysis. , 2006, Radiology.

[29]  D. Bostwick,et al.  Prediction of capsular perforation and seminal vesicle invasion in prostate cancer. , 1996, The Journal of urology.

[30]  H. Hricak,et al.  Incremental value of multiplanar cross-referencing for prostate cancer staging with endorectal MRI. , 2007, AJR. American journal of roentgenology.

[31]  C. Metz,et al.  "Proper" Binormal ROC Curves: Theory and Maximum-Likelihood Estimation. , 1999, Journal of mathematical psychology.

[32]  P. Carroll,et al.  Prostate cancer: effect of postbiopsy hemorrhage on interpretation of MR images. , 1995, Radiology.

[33]  A. Zlotta,et al.  Prostate specific antigen density of the transition zone for predicting pathological stage of localized prostate cancer in patients with serum prostate specific antigen less than 10 ng./ml. , 1998, The Journal of urology.

[34]  O. Hélénon,et al.  Extraprostatic spread of clinically localized prostate cancer: factors predictive of pT3 tumor and of positive endorectal MR imaging examination results. , 2002, Radiology.

[35]  Jelle O. Barentsz,et al.  Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis , 2002, European Radiology.

[36]  David Hinkley,et al.  Bootstrap Methods: Another Look at the Jackknife , 2008 .

[37]  R. Sutherland,et al.  Prognostic significance of preoperative factors in localized prostate carcinoma treated with radical prostatectomy , 2003, Cancer.