Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24-0.7-cm3) spatial resolution.
OBJECTIVE
To evaluate if three-dimensional hydrogen-1 magnetic resonance spectroscopic imaging (3D MRSI) when combined with a clinical MR imaging examination could discriminate prostatic adenocarcinoma from normal prostatic zonal anatomy and benign prostatic hyperplasia (BPH) on the basis of observable metabolite levels.


METHODS
Combined phased-array, endorectal MR imaging and 3D MRSI was performed in nine young healthy volunteers, five patients with BPH, and 85 patients with prostate cancer and BPH. Volume MR imaging and 3D MRSI data were analytically corrected for the reception profile of the endorectal and pelvic phased-array coils, aligned with the MR imaging data, and compared with postoperative pathologic histology findings.


RESULTS
Statistically significant variations in metabolite levels with prostatic zonal anatomy, age, and pathologic condition were detected with a 3D MRSI examination added to a clinical MR imaging examination. Significantly higher choline levels and significantly lower citrate levels were observed in regions of cancer compared with BPH and normal peripheral zone tissues. The ratio (choline + creatine/citrate) in regions of cancer (2.1 +/- 1.3 [standard deviation]) had no overlap with normal peripheral zone values and minimal overlap with BPH values (0.61 +/- 0.21). An estimate of the spatial extent of prostate cancer was determined by generating metabolite images in which this metabolite ratio significantly exceeded normal peripheral zone values in multiple contiguous sections.


CONCLUSIONS
These results suggest that a 3D MRSI examination added to a clinical MR imaging examination may help define the presence and spatial extent of prostate cancer.
Kurhanewicz
J
J
Department of Radiology, University of California, San Francisco 94143-0738, USA.
Vigneron
D B
DB
Hricak
H
H
Narayan
P
P
Carroll
P
P
Nelson
S J
SJ
D000230:Adenocarcinoma / Q000175:diagnosis / Q000378:metabolism; D000328:Adult; D000368:Aged; D002794:Choline / Q000032:analysis; D002951:Citrates / Q000032:analysis; D019343:Citric Acid; D003401:Creatine / Q000032:analysis; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000033:anatomy & histology / Q000737:chemistry / Q000473:pathology; D011470:Prostatic Hyperplasia / Q000175:diagnosis* / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism
D002951:Citrates; D019343:Citric Acid; D003401:Creatine; D002794:Choline