Prostate cancer: prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging.

PURPOSE To determine if the addition of three-dimensional (3D) proton magnetic resonance (MR) spectroscopic imaging to endorectal MR imaging helps diagnose extracapsular extension (ECE) of prostate cancer. MATERIALS AND METHODS Endorectal MR imaging and 3D MR spectroscopic imaging were performed in 53 patients with prostate cancer before radical prostatectomy. MR imaging studies were evaluated by two independent readers unaware of histopathologic findings. The presence of ECE was graded on a five-point scale. At 3D MR spectroscopic imaging, cancer was diagnosed if the ratio of choline plus creatine to citrate was 2 or more SDs above normal. The accuracy of MR imaging alone was compared with that of combined MR imaging and 3D MR spectroscopic imaging, with use of the step-section histopathologic results as the standard of reference. RESULTS For the less experienced reader, the addition of 3D MR spectroscopic imaging to MR imaging significantly improved accuracy (area under the receiver operating characteristic curve [Az] = 0.75 vs Az = 0.62, P < .05). For the more experienced reader, the addition improved accuracy but not significantly (Az = 0.86 vs Az = 0.78). The addition also reduced interobserver variability (Az = 0.86 vs Az = 0.75). CONCLUSION 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.

[1]  T. Stamey,et al.  Morphometric and clinical studies on 68 consecutive radical prostatectomies. , 1988, The Journal of urology.

[2]  P H Bland,et al.  Carcinoma of the prostate: MR images obtained with body coils do not accurately reflect tumor volume. , 1991, AJR. American journal of roentgenology.

[3]  P. Carroll,et al.  Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24-0.7-cm3) spatial resolution. , 1996, Radiology.

[4]  D. Mitchell,et al.  Prostate carcinoma: assessment of diagnostic criteria for capsular penetration on endorectal coil MR images. , 1994, Radiology.

[5]  D. Bostwick,et al.  The volume of prostate cancer in the biopsy specimen cannot reliably predict the quantity of cancer in the radical prostatectomy specimen on an individual basis. , 1995, The Journal of urology.

[6]  M D Schnall,et al.  Cost-effectiveness of endorectal magnetic resonance imaging for the staging of prostate cancer. , 1996, Academic radiology.

[7]  R. Herfkens,et al.  Determining the volume of prostatic carcinoma: value of MR imaging with an external-array coil. , 1993, AJR. American journal of roentgenology.

[8]  J R Thornbury,et al.  Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. , 1996, AJR. American journal of roentgenology.

[9]  P. Carroll,et al.  Prostate cancer: metabolic response to cryosurgery as detected with 3D H-1 MR spectroscopic imaging. , 1996, Radiology.

[10]  M. Hafermann,et al.  Adjuvant radiotherapy following radical prostatectomy: results and complications. , 1986, The Journal of urology.

[11]  H M Pollack,et al.  Use of endorectal surface coil magnetic resonance imaging for local staging of prostate cancer. , 1993, The Journal of urology.

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

[13]  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.

[14]  M. Schnall,et al.  MR imaging of mucinous adenocarcinoma of the prostate. , 1992, Journal of computer assisted tomography.

[15]  J A Swets,et al.  Staging prostate cancer with MR imaging: a combined radiologist-computer system. , 1997, Radiology.

[16]  C. Tempany,et al.  Invasion of the neurovascular bundle by prostate cancer: evaluation with MR imaging. , 1991, Radiology.

[17]  R Alagappan,et al.  Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. , 1997, Radiology.

[18]  R E Lenkinski,et al.  Prostate cancer: local staging with endorectal surface coil MR imaging. , 1991, Radiology.

[19]  T. Stamey,et al.  PATTERNS OF PROGRESSION IN PROSTATE CANCER , 1986, The Lancet.

[20]  R. Gibbons,et al.  Total prostatectomy for clinically localized prostatic cancer: long-term results. , 1989, The Journal of urology.

[21]  S. F. Quinn,et al.  MR imaging of prostate cancer with an endorectal surface coil technique: correlation with whole-mount specimens. , 1994, Radiology.

[22]  P. Walsh,et al.  Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term followup. , 1993, The Journal of urology.

[23]  J. Kurhanewicz,et al.  Improved water and lipid suppression for 3D PRESS CSI using rf band selective inversion with gradient dephasing (basing) , 1997, Magnetic resonance in medicine.

[24]  D. Bostwick,et al.  Staging of early prostate cancer: a proposed tumor volume-based prognostic index. , 1993, Urology.

[25]  A. Schned,et al.  Staging of prostate cancer with endorectal MR imaging: lessons from a learning curve. , 1995, Radiographics : a review publication of the Radiological Society of North America, Inc.

[26]  M. Terris,et al.  Estimation of prostate cancer volume by transrectal ultrasound imaging. , 1992, The Journal of urology.

[27]  R. Thisted,et al.  Results of conservative management of clinically localized prostate cancer. , 1994, The New England journal of medicine.

[28]  C. Gatsonis,et al.  Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer. Results of a multi-institutional cooperative trial. , 1990, The New England journal of medicine.

[29]  C. Langlotz,et al.  Staging of prostatic cancer: accuracy of MR imaging. , 1995, Radiology.

[30]  P. Carroll,et al.  Local staging of prostatic carcinoma: comparison of transrectal sonography and endorectal MR imaging. , 1996, AJR. American journal of roentgenology.

[31]  P. Carroll,et al.  Hormonal ablation of prostatic cancer: effects on prostate morphology, tumor detection, and staging by endorectal coil MR imaging. , 1996, AJR. American journal of roentgenology.

[32]  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.

[33]  J Kurhanewicz,et al.  Citrate as an in vivo marker to discriminate prostate cancer from benign prostatic hyperplasia and normal prostate peripheral zone: detection via localized proton spectroscopy. , 1995, Urology.

[34]  T. Stamey,et al.  Capsular Penetration in Prostate Cancer. Significance for Natural History and Treatment , 1990, The American journal of surgical pathology.

[35]  W. Whitmore,et al.  The role of neoadjuvant hormonal manipulation in localized prostatic cancer , 1993, Cancer.

[36]  O Hélénon,et al.  Local staging of prostate cancer by endorectal MRI using fast spin-echo sequences: prospective correlation with pathological findings after radical prostatectomy. , 1996, British journal of urology.

[37]  J Kurhanewicz,et al.  Localizing prostate cancer in the presence of postbiopsy changes on MR images: role of proton MR spectroscopic imaging. , 1998, Radiology.

[38]  C W Piccoli,et al.  Staging of prostate cancer: results of Radiology Diagnostic Oncology Group project comparison of three MR imaging techniques. , 1994, Radiology.

[39]  W. Catalona,et al.  Clinical stage B prostate carcinoma: staging with MR imaging. , 1987, Radiology.

[40]  L. Kivisaari,et al.  Computerized tomography and transrectal ultrasound in the assessment of local extension of prostatic cancer before radical retropubic prostatectomy. , 1987, The Journal of urology.

[41]  R E Lenkinski,et al.  Current role of MR imaging in the staging of adenocarcinoma of the prostate. , 1993, Radiology.