Imaging Prostate Cancer

Department of Radiology and Biomedical Imaging, University of California San Francisco, 350 Parnassus Avenue, Suite 307, San Francisco, CA 94143, USA.
Radiologic Clinics of North America (Impact Factor: 1.83). 11/2012; 50(6):1043-59. DOI: 10.1016/j.rcl.2012.08.001
Source: PubMed

ABSTRACT This article reviews the anatomy of the prostate gland, magnetic resonance (MR) imaging techniques, and the role MR imaging in the setting of prostate cancer. Sequences discussed include T2-weighted MR imaging, proton ((1)H) MR spectroscopic imaging, diffusion-weighted MR imaging, and dynamic contrast-enhanced MR imaging. MR imaging can be applied as an adjuvant tool to establish the diagnosis, localize, determine the extent, and estimate the aggressiveness of prostate cancers. The role of transrectal ultrasonography, computed tomography, and radionuclide scans is also briefly discussed.

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    ABSTRACT: PurposeTo demonstrate the utility of a robotic needle-guidance template device as compared to a manual template for in-bore 3T transperineal magnetic resonance imaging (MRI)-guided prostate biopsy.Materials and Methods This two-arm mixed retrospective-prospective study included 99 cases of targeted transperineal prostate biopsies. The biopsy needles were aimed at suspicious foci noted on multiparametric 3T MRI using manual template (historical control) as compared with a robotic template. The following data were obtained: the accuracy of average and closest needle placement to the focus, histologic yield, percentage of cancer volume in positive core samples, complication rate, and time to complete the procedure.ResultsIn all, 56 cases were performed using the manual template and 43 cases were performed using the robotic template. The mean accuracy of the best needle placement attempt was higher in the robotic group (2.39 mm) than the manual group (3.71 mm, P < 0.027). The mean core procedure time was shorter in the robotic (90.82 min) than the manual group (100.63 min, P < 0.030). Percentage of cancer volume in positive core samples was higher in the robotic group (P < 0.001). Cancer yields and complication rates were not statistically different between the two subgroups (P = 0.557 and P = 0.172, respectively).Conclusion The robotic needle-guidance template helps accurate placement of biopsy needles in MRI-guided core biopsy of prostate cancer.J. Magn. Reson. Imaging 2014. © 2014 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 09/2014; DOI:10.1002/jmri.24770 · 2.79 Impact Factor
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    ABSTRACT: Prostate cancer (PCa) is the most common non-cutaneous malignancy among men in the United States and the second leading cause of cancer-related death. Multi-parametric magnetic resonance imaging (mpMRI) has gained recent popularity to characterize PCa. Acoustic Radiation Force Impulse (ARFI) imaging has the potential to aid PCa diagnosis and management by using tissue stiffness to evaluate prostate zonal anatomy and lesions. MR and B-mode/ARFI in vivo imaging datasets were compared with one another and with gross pathology measurements made immediately after radical prostatectomy. Images were manually segmented in 3D Slicer to delineate the central gland (CG) and prostate capsule, and 3D models were rendered to evaluate zonal anatomy dimensions and volumes. Both imaging modalities showed good correlation between estimated organ volume and gross pathologic weights. Ultrasound and MR total prostate volumes were well correlated (R (2) = 0.77), but B-mode images yielded prostate volumes that were larger (16.82% ± 22.45%) than MR images, due to overestimation of the lateral dimension (18.4% ± 13.9%), with less significant differences in the other dimensions (7.4% ± 17.6%, anterior-to-posterior, and -10.8% ± 13.9%, apex-to-base). ARFI and MR CG volumes were also well correlated (R (2) = 0.85). CG volume differences were attributed to ARFI underestimation of the apex-to-base axis (-28.8% ± 9.4%) and ARFI overestimation of the lateral dimension (21.5% ± 14.3%). B-mode/ARFI imaging yielded prostate volumes and dimensions that were well correlated with MR T2-weighted image (T2WI) estimates, with biases in the lateral dimension due to poor contrast caused by extraprostatic fat. B-mode combined with ARFI imaging is a promising low-cost, portable, real-time modality that can complement mpMRI for PCa diagnosis, treatment planning, and management.
    Ultrasonic Imaging 07/2014; DOI:10.1177/0161734614542177 · 1.16 Impact Factor
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    ABSTRACT: To evaluate the utilization of functional imaging tests in multiparametric (mp)-MRI of the prostate in routine practice and to assess whether education improves usage. With research ethics board approval, 254 patients underwent mp-MRI [diffusion-weighted imaging (DWI) and dynamic contrast enhancement (DCE)] over a 1-year period at a single tertiary-care referral centre for prostate disease. All studies were reported by fellowship-trained abdominal radiologists. To determine to what extent parametric tests were used, radiology reports were searched for terms indicating usage of DWI/DCE and studies were reviewed to determine whether post-processing of DCE was performed. Midway through the study, an internal continuing medical education (CME) programme was instituted (consisting of lectures, electronic reading material, intra- and inter-departmental prostate rounds) and a standardized reporting template was introduced. Utilization of functional imaging was compared between radiologists by years of experience and by number of examinations interpreted, by study indication, and before and after CME. Overall, both DWI and DCE were used in 50.7% of examinations. DWI (67.3%) was more frequently used than DCE (56.3%). DCE contrast curves were generated in 33.5% of studies, and quantitative analysis was performed in only one patient. Use of parametric tests was higher after CME (60.6% versus 40.4%), p = 0.009. There was no correlation between the use of parametric tests and years of experience, (p = 0.94), and there was no association with the number of examinations interpreted (p = 0.19-0.97). There was no association between the use of parametric tests and study indication, (p = 0.16); however, contrast curves were produced more frequently in non-staging studies, (p = 0.027). Parametric tests were underutilized in routine practice. DWI was used more commonly than DCE. CME was associated with increased utilization of mp-MRI. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
    Clinical Radiology 01/2015; 70(4). DOI:10.1016/j.crad.2014.12.001 · 1.66 Impact Factor