Susceptibility weighted imaging: a new tool in the diagnosis of prostate cancer and detection of prostatic calcification

Abstract

Background: Susceptibility weighted imaging (SWI) is a new MRI technique which has been proved very useful in the diagnosis of brain diseases, but few study was performed on its value in prostatic diseases. The aim of the present study was to investigate the value of SWI in distinguishing prostate cancer from benign prostatic hyperplasia and detecting prostatic calcification.

Methodology/principal findings: 23 patients with prostate cancer and 53 patients with benign prostatic hyperplasia proved by prostate biopsy were scanned on a 3.0T MR and a 16-row CT scanner. High-resolution SWI, conventional MRI and CT were performed on all patients. The MRI and CT findings, especially SWI, were analyzed and compared. The analyses revealed that 19 out of 23 patients with prostate cancer presented hemorrhage within tumor area on SWI. However, in 53 patients with benign prostatic hyperplasia, hemorrhage was detected only in 1 patient in prostate by SWI. When comparing SWI, conventional MRI and CT in detecting prostate cancer hemorrhage, out of the 19 patients with prostate cancer who had prostatic hemorrhage detected by SWI, the prostatic hemorrhage was detected in only 7 patients by using conventional MRI, and none was detected by CT. In addition, CT demonstrated calcifications in 22 patients which were all detected by SWI whereas only 3 were detected by conventional MRI. Compared to CT, SWI showed 100% in the diagnostic sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) in detecting calcifications in prostate but conventional MRI demonstrated 13.6% in sensitivity, 100% in specificity, 75% in accuracy, 100% in PPV and 74% in NPV.

Conclusions: More apparent prostate hemorrhages were detected on SWI than on conventional MRI or CT. SWI may provide valuable information for the differential diagnosis between prostate cancer and prostatic hyperplasia. Filtered phase images can identify prostatic calcifications as well as CT.

Figure 1. A 64-year-old man with prostate cancer in peripheral zone of the prostate.

Heterogeneous signal on conventional T1WI (A) and T2WI (B) (arrows) indicates tumor hemorrhage. No hemorrhage is demonstrated on CT (C). The tumor hemorrhage was also seen with SWI (D) and filtered phase image (E) (arrows). Histopathologic examination confirmed the diagnosis of prostate cancer (F).

Figure 2. A 55-year-old man with prostate cancer in central zone of the prostate.

No tumor hemorrhage is demonstrated on conventional T1WI (A), T2WI (B) and CT (C), but low signal within tumor on SWI (D) and filtered phase image (E) (arrows) indicates tumor hemorrhage. Histopathologic examination confirmed the diagnosis of prostate cancer (F).

Figure 3. A 66-year-old man with prostate cancer in peripheral zone of the prostate.

Low signal on conventional T1WI (A) and T2WI (B) (arrows) indicates tumor hemorrhage. No hemorrhage is demonstrated on CT (C). The tumor hemorrhage was also seen with SWI (D) and filtered phase image (E) (arrows). The images in second row come from another slice of the same patient. No prostatic calcification is demonstrated on conventional T1WI (F) and T2WI (G), but dot-like high density on CT (H), low signal on SWI (I) and high signal on filtered phase image (J) (arrows) indicates calcificaiton.

Figure 4. A 62-year-old man with benign prostatic hyperplasia.

No prostatic calcification is demonstrated on conventional T1WI (A) and T2WI (B), but dot-like high density on CT (C), low signal on SWI (D) and high signal on filtered phase image (E) (arrows) indicates calcificaiton.