Correlation of Proton MR Spectroscopic Imaging with Gleason Score Based on Step-Section Pathologic Analysis after Radical Prostatectomy1

Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Radiology (Impact Factor: 6.87). 03/2005; 234(3):804-14. DOI: 10.1148/radiol.2343040363
Source: PubMed


To determine whether hydrogen 1 magnetic resonance (MR) spectroscopic imaging can be used to predict aggressiveness of prostate cancer.
All patients gave informed consent according to an institutionally approved research protocol. A total of 123 patients (median age, 58 years; age range, 40-74 years) who underwent endorectal MR imaging and MR spectroscopic imaging between January 2000 and December 2002 were included. MR imaging and spectroscopy were performed by using combined pelvic phased-array and endorectal probe. Water and lipids were suppressed, and phase-encoded data were acquired with 6.2-mm resolution. Voxels in the peripheral zone were considered suspicious for cancer if (Cho + Cr)/Cit was at least two standard deviations above the normal level, where Cho represents choline-containing compounds, Cr represents creatine and phosphocreatine, and Cit represents citrate. Correlation between metabolite ratio and four Gleason score groups identified at step-section pathologic evaluation (3 + 3, 3 + 4, 4 + 3, and > or =4 + 4) was assessed with generalized estimating equations.
Data from 94 patients were included. Pathologic evaluation was used to identify 239 lesions. Overall sensitivity of MR spectroscopic imaging was 56% for tumor detection, increasing from 44% in lesions with Gleason score of 3 + 3 to 89% in lesions with Gleason score greater than or equal to 4 + 4. There was a trend toward increasing (Cho + Cr)/Cit with increasing Gleason score in lesions identified correctly with MR spectroscopic imaging. Tumor volume assessed with MR spectroscopic imaging increased with increasing Gleason score.
MR spectroscopic imaging measurement of prostate tumor (Cho + Cr)/Cit and tumor volume correlate with pathologic Gleason score. There is overlap between MR spectroscopic imaging parameters at various Gleason score levels, which may reflect methodologic and physiologic variations. MR spectroscopic imaging has potential in noninvasive assessment of prostate cancer aggressiveness.

Download full-text


Available from: Steven C Eberhardt,
  • Source
    • "J. Yuan, W. Qiu, M. Rajchl and A. Fenster are with the Robarts Research Institute, University of Western Ontario, London, ON, Canada N6A 5K8. C. Romagnoli is with the Department of Medical Imaging, University of Western Ontario, London, ON, Canada N6A 5K8. of prostate cancers because of its high sensitivity and specificity for detecting early stage prostate cancer [3]. Reports have shown that T2-weighted MR imaging combined with an endorectal coil can achieve a high degree of accuracy in diagnosing prostate cancer of between 60% -96% [4] [5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study, we proposed an efficient non-rigid magnetic resonance (MR) to transrectal ultrasound (TRUS) deformable registration method in order to improve the accuracy of targeting suspicious regions during a three dimensional (3D) TRUS guided prostate biopsy. The proposed deformable registration approach employs the multi-channel modality independent neighborhood descriptor (MIND) as the local similarity feature across the two modalities of MR and TRUS, and a novel and efficient duality-based convex optimization-based algorithmic scheme was introduced to extract the deformations and align the two MIND descriptors. The registration accuracy was evaluated using 20 patient images by calculating the TRE using manually identified corresponding intrinsic fiducials in the whole gland and peripheral zone. Additional performance metrics (Dice similarity coefficient (DSC), mean absolute surface distance (MAD), and maximum absolute surface distance (MAXD)) were also calculated by comparing the MR and TRUS manually segmented prostate surfaces in the registered images. Experimental results showed that the proposed method yielded an overall median TRE of 1.76 mm. The results obtained in terms of DSC showed an average of 80.8±7.8% for the apex of the prostate, 92.0±3.4% for the mid-gland, 81.7 ± 6.4% for the base and 85.7 ± 4.7% for the whole gland. The surface distance calculations showed an overall average of 1.84±0.52 mm for MAD and 6.90±2.07 mm for MAXD.
    IEEE Transactions on Medical Imaging 11/2014; 34(5). DOI:10.1109/TMI.2014.2375207 · 3.39 Impact Factor
  • Source
    • "PET tends to underestimate the area of neoplasmatic growth in the prostate and has only a 70% specificity in the estimation of the clinical stage of the disease, and should not be used in routine clinical settings [19]. Most imagining procedures are highly operator–depended, and have their limitations, such as post–biopsy hemorrhages or inflammatory changes which can lead to false clinical staging [20, 21]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction The main treatment methods of prostate carcinoma are surgery and radiation therapy, both having serious side effects. Because of these side effects, the idea of organ preserving therapy emerged. Rationale to perform focal therapy is to preserve the prostate gland, along with potency and continence, offering good cancer control with appropriate treatment. The idea of gland sparing therapy is quite controversial. Presently, EAU Guidelines propose focal therapy as experimental in the treatment of prostate carcinoma. Material and methods The aim of the study was to asses how many patients could be qualified for focal therapy, according to post prostatectomy pathological findings. 720 patients suspected of prostate cancer were biopsied. In 324 patients, prostate carcinoma was revealed, of which 81 were subjected to radical prostatectomy. Pre and post–operative pathological results were analyzed, according to possible qualification for focal treatment. Results According to the clinical evaluation of all the patients referred to the treatment, 25% could be assumed to have unifocal disease and could be qualified to the focal treatment. Post–operative evaluation revealed pT2b cancer in 5%, pT2c disease in 65%, and pT3a–pT4a disease in 20% of these patients. Cancer was unilateral (pT2a–b) in only 15% of cases, and was suitable for focal treatment (small disease not extending to whole lobe– pT2a disease) in only 10%. Conclusions It seems that with the use of current methods, proper T–staging of the disease and amount of neoplasmatic tissue inside the gland can not be reached with great certainty. In our opinion, focal therapy should not be used in patients with ≤pT2b and high risk disease. For them, radical treatment (surgery or radiation therapy) should be recommended. For the rest of the patients, with low risk disease, keeping in mind the large scale of possible overtreatment, active surveillance is a valid treatment option. Focal therapy can be an interesting therapeutic proposition for a small group of patients with pT2a cancer, but it is not possible to select them with big certainty with current methods of imaging medicine.
    08/2014; 67(3):235-41. DOI:10.5173/ceju.2014.03.art5
  • Source
    • "Elastography, tissue characterisation imaging modalities and contrast-enhanced ultrasound have shown variable degrees of success in the identification of clinically significant cancer [58–62], although the imaging modality that has attracted the most interest is multi-parametric magnetic resonance imaging (MP-MRI), which uses functional parameters (dynamic contrast-enhanced, diffusion-weighted or magnetic resonance spectroscopy) and anatomical parameters (T2-weighted imaging) and has shown a sensitivity, specificity and negative predictive value of 86, 94 and 95%, respectively, for the identification of tumours greater than 0.5 ml, when compared against radical prostatectomy specimens [63,64]. Evidence suggests that Apparent diffusion coefficient (ADC) values in diffusion-weighted imaging and metabolite ratios in spectroscopy may correlate to the aggressiveness of the cancer [65–67]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Focal therapy is an emerging treatment modality for localised prostate cancer that aims to reduce the morbidity seen with radical therapy, while maintaining cancer control. Focal therapy treatment strategies minimise damage to non-cancerous tissue, with priority given to the sparing of key structures such as the neurovascular bundles, external sphincter, bladder neck and rectum. There are a number of ablative technologies that can deliver energy to destroy cancer cells as part of a focal therapy strategy. The most widely investigated are cryotherapy and high-intensity focussed ultrasound. Existing radical therapies, such as brachytherapy and external beam radiotherapy, also have the potential to be applied in a focal manner. The functional outcomes of focal therapy from several phase I and II trials have been encouraging, with low rates of urinary incontinence and erectile dysfunction. Robust medium- and long-term cancer control outcomes are currently lacking. Controversies in focal therapy remain, notably treatment paradigms based on the index lesion hypothesis, appropriate patient selection for focal therapy and how the efficacy of focal therapy should be assessed. This review articles discusses the current status of focal therapy, highlighting controversies and emerging strategies that can influence treatment outcomes for the future.
    Clinical Oncology 06/2013; 25(8). DOI:10.1016/j.clon.2013.05.002 · 3.40 Impact Factor
Show more