Imaging prostate cancer.
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: To investigate the usefulness of Apparent Diffusion Coefficients (ADC) in predicting prostatectomy Gleason Grades (pGG) and Scores (GS), compared with ultrasound-guided biopsy Gleason Grades (bGG). Twenty-four patients with biopsy-proven prostate cancer were included in the study. Diffusion-weighted images were obtained using 1.5-T MR with a pelvic phased-array coil. Median ADC values (b0,500,1000 s/mm²) were measured at the most suspicious areas in the peripheral zone. The relationship between ADC values and pGG or GS was assessed using Pearson's coefficient. The relationship between bGG and pGG or GS was also evaluated. Receiver operating characteristic (ROC) curve analysis was performed to assess the performance of each method on a qualitative level. A significant negative correlation was found between mean ADCs of suspicious lesions and their pGG (r = -0.55; p < 0.01) and GS (r = -0.63; p < 0.01). No significant correlation was found between bGG and pGG (r = 0.042; p > 0.05) or GS (r = 0.048; p > 0.05). ROC analysis revealed a discriminatory performance of AUC = 0.82 for ADC and AUC = 0.46 for bGG in discerning low-grade from intermediate/high-grade lesions. The ADC values of suspicious areas in the peripheral zone perform better than bGG in the correlation with prostate cancer aggressiveness, although with considerable intra-subject heterogeneity. • Prostate cancer aggressiveness is probably underestimated and undersampled by routine ultrasound-guided biopsies. • Diffusion-weighted MR images show good linear correlation with prostate cancer aggressiveness. • DWI information may be used to improve risk-assessment in prostate cancer.European Radiology 09/2011; 22(2):468-75. · 4.34 Impact Factor
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ABSTRACT: We report the findings of a transperineal magnetic resonance image (MRI) guided biopsy of the prostate in a man with increasing prostate specific antigen who was not a candidate for a transrectal ultrasound guided biopsy. Using an open configuration 0.5 Tesla MRI scanner and pelvic coil, a random sextant sample was obtained under real time MRI guidance from the peripheral zone of the prostate gland as well as a single core from each MRI defined lesion. The patient had previously undergone proctocolectomy for ulcerative colitis and, therefore, was not a candidate for transrectal ultrasound guided biopsy. Prior attempts to make the diagnosis of prostate cancer using a transurethral approach were unsuccessful. The random sextant samples contained benign prostatic hyperplasia, whereas Gleason grade 3 + 3 = 6 adenocarcinoma was confirmed in 15% and 25% of the 2 cores obtained from the MRI targeted specimens of 2 defined lesions. The procedure was well tolerated by the patient. Transperineal MRI guided biopsy is a new technique that may be useful in detecting prostate cancer in men with increasing prostate specific antigen who are not candidates for transrectal ultrasound guided biopsy.The Journal of Urology 09/2000; 164(2):385-7. · 3.75 Impact Factor
- European Urology 03/2011; 59(3):365-9. · 10.48 Impact Factor