Characterization of low-intensity lesions in the peripheral zone of prostate on pre-biopsy endorectal coil MR imaging

Abstract. The aim of this study was to determine which morphological features of low-intensity lesions in the peripheral zone of the prostate are predictable of prostate cancer on pre-biopsy T2-weighted integrated endorectal phased-array MR images. The MR examinations were performed in 69 consecutive patients with elevated level of prostate-specific antigen (>4 ng/ml) and/or a positive digital rectal examination before transperineal 12-site biopsy. Two radiologists evaluated presence of lesions, their morphological features, and possibility of malignancy in divided into four sections of the peripheral zone. Imaging analysis findings were compared with biopsy results. Discriminative features were selected by stepwise logistic regression. Descriptive statistics and receiver operating characteristics (ROC) curves were also calculated. Sixty-eight benign lesions and 23 malignant lesions were found. Wedge shape and diffuse extensions without mass effect were significantly associated with benignity (P=0.0105 and 0.002, respectively). Lesion size was significantly associated with malignancy (P=0.0001). For evaluating probability of malignancy for lesions, regression model showed a comparable accuracy with the total impression for the readers in ROC analysis (Az 0.9095 vs 0.9266, respectively). Wedge shape, diffuse extension without mass effect, and size are the morphological features of low-intensity lesions in the peripheral zone on pre-biopsy T2-weighted MR images that give the best prediction of malignancy.

[1]  J R Thornbury,et al.  Dynamic TurboFLASH subtraction technique for contrast-enhanced MR imaging of the prostate: correlation with histopathologic results. , 1997, Radiology.

[2]  P. Scardino,et al.  A comparison of the morphological features of cancer arising in the transition zone and in the peripheral zone of the prostate. , 1991, The Journal of urology.

[3]  J. Vilanova,et al.  The value of endorectal MR imaging to predict positive biopsies in clinically intermediate-risk prostate cancer patients , 2001, European Radiology.

[4]  P. Carroll,et al.  Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging--clinicopathologic study. , 1999, Radiology.

[5]  D. Bostwick,et al.  Staging of prostate cancer. , 1994, Seminars in surgical oncology.

[6]  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.

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

[8]  R E Lenkinski,et al.  Prostate: MR imaging with an endorectal surface coil. , 1989, Radiology.

[9]  C. Tempany.  MR staging of prostate cancer. How we can improve our accuracy with decisions aids and optimal techniques. , 1996, Magnetic resonance imaging clinics of North America.

[10]  Hironobu Nakamura,et al.  Transition Zone Biopsy in the Detection of Prostate Cancer , 2000, European Urology.

[11]  L Axel,et al.  Prostatic carcinoma and benign prostatic hyperplasia: correlation of high-resolution MR and histopathologic findings. , 1989, Radiology.

[12]  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.

[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]  P H Bland,et al.  Prostate cancer: correlation of MR images with tissue optical density at pathologic examination. , 1991, Radiology.

[15]  K. Taari,et al.  Magnetic resonance imaging of prostatic cancer: Does detection vary between high and low gleason score tumors? , 2000, The Prostate.

[16]  G. Murphy,et al.  The national cancer data base report on prostate cancer , 1995 .

[17]  D P Dearnaley,et al.  Dynamic contrast enhanced MRI of prostate cancer: correlation with morphology and tumour stage, histological grade and PSA. , 2000, Clinical radiology.

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

[19]  C. Langlotz.  Benefits and costs of MR imaging of prostate cancer. , 1996, Magnetic Resonance Imaging Clinics of North America.

[20]  J. Martin,et al.  Inflatable surface coil for MR imaging of the prostate. , 1988, Radiology.

[21]  M. R. W. Engelbrecht,et al.  MR imaging of the male pelvis , 1999, European Radiology.

[22]  M. Rifkin,et al.  MR imaging characteristics of noncancerous lesions of the prostate , 1992, Journal of magnetic resonance imaging : JMRI.

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

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

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

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

[27]  B. Yankaskas,et al.  Diagnosis of prostatic carcinoma: value of random transrectal sonographically guided biopsies. , 1993, AJR. American journal of roentgenology.

[28]  J Kurhanewicz,et al.  Prostate cancer: prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. , 1999, Radiology.