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. 2010 Apr;255(1):89-99.
doi: 10.1148/radiol.09090475.

Prostate cancer: value of multiparametric MR imaging at 3 T for detection--histopathologic correlation

Baris Turkbey  1 , Peter A Pinto, Haresh Mani, Marcelino Bernardo, Yuxi Pang, Yolanda L McKinney, Kiranpreet Khurana, Gregory C Ravizzini, Paul S Albert, Maria J Merino, Peter L Choyke
Affiliations

Prostate cancer: value of multiparametric MR imaging at 3 T for detection--histopathologic correlation

Baris Turkbey et al. Radiology. 2010 Apr.

Abstract

Purpose: To determine utility of multiparametric imaging performed at 3 T for detection of prostate cancer by using T2-weighted magnetic resonance (MR) imaging, MR spectroscopy, and dynamic contrast material-enhanced MR imaging, with whole-mount pathologic findings as reference standard.

Materials and methods: This prospectively designed, HIPAA-compliant, single-institution study was approved by the local institutional review board. Seventy consecutive patients (mean age, 60.4 years; mean prostate-specific antigen level, 5.47 ng/mL [5.47 microg/L]; range, 1-19.9 ng/mL [1-19.9 microg/L]) were included; informed consent was obtained from each patient. All patients had biopsy-proved prostate cancer, with a median Gleason score of 7 (range, 6-9). Images were obtained by using a combination of six-channel cardiac and endorectal coils. MR imaging and pathologic findings were evaluated independently and blinded and then correlated with histopathologic findings by using side-by-side comparison. Analyses were conducted with a raw stringent approach and an alternative neighboring method, which accounted for surgical deformation, shrinkage, and nonuniform slicing factors in pathologic specimens. Generalized estimating equations (GEEs) were used to estimate the predictive value of region-specific, pathologically determined cancer for all three modalities. This approach accounts for the correlation among multiple regions in the same individual.

Results: For T2-weighted MR imaging, sensitivity and specificity values obtained with stringent approach were 0.42 (95% confidence interval [CI]: 0.36, 0.47) and 0.83 (95% CI: 0.81, 0.86), and for the alternative neighboring approach, sensitivity and specificity values were 0.73 (95% CI: 0.67, 0.78) and 0.89 (95% CI: 0.85, 0.93), respectively. The combined diagnostic accuracy of T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy for peripheral zone tumors was examined by calculating their predictive value with different combinations of techniques; T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy provided significant independent and additive predictive value when GEEs were used (P < .001, P = .02, P = .002, respectively).

Conclusion: Multiparametric MR imaging (T2-weighted MR imaging, MR spectroscopy, dynamic contrast-enhanced MR imaging) of the prostate at 3 T enables tumor detection, with reasonable sensitivity and specificity values.

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Figures

Figure 1:
Figure 1:
Flowchart of patient population in current study. DCE MRI = dynamic contrast-enhanced MR imaging, MRS = MR spectroscopy, T2W = T2-weighted MR imaging.
Figure 2:
Figure 2:
Illustration demonstrates neighboring approach used for MR imaging and whole-mount step-section histopathologic correlation among regions of prostate (1–30). Region 14 at left mid PZ neighbors with regions 7, 8, 13, 19, and 20, which are also localized at consecutive ipsilateral PZs, whereas region 11 at right apex to mid TZ neighbors with regions 5, 6, 12, 17, and 18, which are localized at consecutive TZs.
Figure 3a:
Figure 3a:
Prostate cancer in 58-year-old man. (a) Axial and (b) sagittal T2-weighted MR images demonstrate a low-signal-intensity lesion (arrow) in left mid PZ suspicious for cancer. (c) MR spectra demonstrate increased ratio of choline (cho) to citrate (cit) in left mid PZ lesion (∗) when compared with normal right side. (d) Raw dynamic contrast-enhanced MR image and (e) Ktrans and (f) kep maps help localize tumor (arrow). (g) Histopathologic slide at mid prostate level confirms presence of tumor (Gleason score, 7), with extracapsular extension (red line) detected on MR images. A = anterior, L = left, P = posterior, R = right.
Figure 3b:
Figure 3b:
Prostate cancer in 58-year-old man. (a) Axial and (b) sagittal T2-weighted MR images demonstrate a low-signal-intensity lesion (arrow) in left mid PZ suspicious for cancer. (c) MR spectra demonstrate increased ratio of choline (cho) to citrate (cit) in left mid PZ lesion (∗) when compared with normal right side. (d) Raw dynamic contrast-enhanced MR image and (e) Ktrans and (f) kep maps help localize tumor (arrow). (g) Histopathologic slide at mid prostate level confirms presence of tumor (Gleason score, 7), with extracapsular extension (red line) detected on MR images. A = anterior, L = left, P = posterior, R = right.
Figure 3c:
Figure 3c:
Prostate cancer in 58-year-old man. (a) Axial and (b) sagittal T2-weighted MR images demonstrate a low-signal-intensity lesion (arrow) in left mid PZ suspicious for cancer. (c) MR spectra demonstrate increased ratio of choline (cho) to citrate (cit) in left mid PZ lesion (∗) when compared with normal right side. (d) Raw dynamic contrast-enhanced MR image and (e) Ktrans and (f) kep maps help localize tumor (arrow). (g) Histopathologic slide at mid prostate level confirms presence of tumor (Gleason score, 7), with extracapsular extension (red line) detected on MR images. A = anterior, L = left, P = posterior, R = right.
Figure 3d:
Figure 3d:
Prostate cancer in 58-year-old man. (a) Axial and (b) sagittal T2-weighted MR images demonstrate a low-signal-intensity lesion (arrow) in left mid PZ suspicious for cancer. (c) MR spectra demonstrate increased ratio of choline (cho) to citrate (cit) in left mid PZ lesion (∗) when compared with normal right side. (d) Raw dynamic contrast-enhanced MR image and (e) Ktrans and (f) kep maps help localize tumor (arrow). (g) Histopathologic slide at mid prostate level confirms presence of tumor (Gleason score, 7), with extracapsular extension (red line) detected on MR images. A = anterior, L = left, P = posterior, R = right.
Figure 3e:
Figure 3e:
Prostate cancer in 58-year-old man. (a) Axial and (b) sagittal T2-weighted MR images demonstrate a low-signal-intensity lesion (arrow) in left mid PZ suspicious for cancer. (c) MR spectra demonstrate increased ratio of choline (cho) to citrate (cit) in left mid PZ lesion (∗) when compared with normal right side. (d) Raw dynamic contrast-enhanced MR image and (e) Ktrans and (f) kep maps help localize tumor (arrow). (g) Histopathologic slide at mid prostate level confirms presence of tumor (Gleason score, 7), with extracapsular extension (red line) detected on MR images. A = anterior, L = left, P = posterior, R = right.
Figure 3f:
Figure 3f:
Prostate cancer in 58-year-old man. (a) Axial and (b) sagittal T2-weighted MR images demonstrate a low-signal-intensity lesion (arrow) in left mid PZ suspicious for cancer. (c) MR spectra demonstrate increased ratio of choline (cho) to citrate (cit) in left mid PZ lesion (∗) when compared with normal right side. (d) Raw dynamic contrast-enhanced MR image and (e) Ktrans and (f) kep maps help localize tumor (arrow). (g) Histopathologic slide at mid prostate level confirms presence of tumor (Gleason score, 7), with extracapsular extension (red line) detected on MR images. A = anterior, L = left, P = posterior, R = right.
Figure 3g:
Figure 3g:
Prostate cancer in 58-year-old man. (a) Axial and (b) sagittal T2-weighted MR images demonstrate a low-signal-intensity lesion (arrow) in left mid PZ suspicious for cancer. (c) MR spectra demonstrate increased ratio of choline (cho) to citrate (cit) in left mid PZ lesion (∗) when compared with normal right side. (d) Raw dynamic contrast-enhanced MR image and (e) Ktrans and (f) kep maps help localize tumor (arrow). (g) Histopathologic slide at mid prostate level confirms presence of tumor (Gleason score, 7), with extracapsular extension (red line) detected on MR images. A = anterior, L = left, P = posterior, R = right.
Figure 4a:
Figure 4a:
Prostate cancer in 62-year-old man. (a) Axial T2-weighted MR image demonstrates a low-signal-intensity focus (arrow) at right apex mid PZ suspicious for prostate cancer. (b) Raw dynamic contrast-enhanced MR image and (c) Ktrans and (d) kep maps help localize tumor (arrow). (e) Histopathologic slide at apex mid prostate level confirms presence of tumor (Gleason score, 8) more anteriorly (red line), secondary to distortion and shrinkage of specimen. Keys are same as for Figure 3.
Figure 4b:
Figure 4b:
Prostate cancer in 62-year-old man. (a) Axial T2-weighted MR image demonstrates a low-signal-intensity focus (arrow) at right apex mid PZ suspicious for prostate cancer. (b) Raw dynamic contrast-enhanced MR image and (c) Ktrans and (d) kep maps help localize tumor (arrow). (e) Histopathologic slide at apex mid prostate level confirms presence of tumor (Gleason score, 8) more anteriorly (red line), secondary to distortion and shrinkage of specimen. Keys are same as for Figure 3.
Figure 4c:
Figure 4c:
Prostate cancer in 62-year-old man. (a) Axial T2-weighted MR image demonstrates a low-signal-intensity focus (arrow) at right apex mid PZ suspicious for prostate cancer. (b) Raw dynamic contrast-enhanced MR image and (c) Ktrans and (d) kep maps help localize tumor (arrow). (e) Histopathologic slide at apex mid prostate level confirms presence of tumor (Gleason score, 8) more anteriorly (red line), secondary to distortion and shrinkage of specimen. Keys are same as for Figure 3.
Figure 4d:
Figure 4d:
Prostate cancer in 62-year-old man. (a) Axial T2-weighted MR image demonstrates a low-signal-intensity focus (arrow) at right apex mid PZ suspicious for prostate cancer. (b) Raw dynamic contrast-enhanced MR image and (c) Ktrans and (d) kep maps help localize tumor (arrow). (e) Histopathologic slide at apex mid prostate level confirms presence of tumor (Gleason score, 8) more anteriorly (red line), secondary to distortion and shrinkage of specimen. Keys are same as for Figure 3.
Figure 4e:
Figure 4e:
Prostate cancer in 62-year-old man. (a) Axial T2-weighted MR image demonstrates a low-signal-intensity focus (arrow) at right apex mid PZ suspicious for prostate cancer. (b) Raw dynamic contrast-enhanced MR image and (c) Ktrans and (d) kep maps help localize tumor (arrow). (e) Histopathologic slide at apex mid prostate level confirms presence of tumor (Gleason score, 8) more anteriorly (red line), secondary to distortion and shrinkage of specimen. Keys are same as for Figure 3.
Figure 5:
Figure 5:
Predictive value of T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy for tumor detection in PZ. Graph shows probability of pathologically determined cancer in a region as a function of different region-specific imaging results. Predictor was developed by using GEE with a logistic link and independence working correlation structure. Predictor was estimated as Pcan = exp(−1.20 + 0.81T2 + 0.73D + 0.93S)/1 + exp(−1.20 + 0.81T2 + 0.73D + 0.93S), where Pcan is probability of cancer, T2 is T2-weighted MR imaging, D is dynamic contrast-enhanced MR imaging, and S is MR spectroscopy. Bars show ±1 standard deviation in these estimated probabilities, which were obtained by using the delta method. Keys are the same as for Figure 1.
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