title: Magnetic resonance spectroscopy of the malignant prostate gland after radiotherapy: a histopathologic study of diagnostic validity.
abstract: OBJECTIVE
  Accurate spatial representation of tumor clearance after conformal radiotherapy is an endpoint of clinical importance. Magnetic resonance spectroscopy (MRS) can diagnose malignancy in the untreated prostate gland through measurements of cellular metabolites. In this study we sought to describe spectral metabolic changes in prostatic tissue after radiotherapy and validate a multivariate analytic strategy (based on MRS) that could identify viable tumor.
  
  
  METHODS
  Transrectal ultrasound-guided prostate biopsies from 35 patients were obtained 18-36 months after external beam radiotherapy. One hundred sixteen tissue specimens were subjected to 1H MRS, submitted to histopathology, and analyzed for correlation with a multivariate strategy specifically developed for biomedical spectra.
  
  
  RESULTS
  The sensitivity and specificity of MRS in identifying a malignant biopsy were 88.9% and 92% respectively, with an overall classification accuracy of 91.4%. The diagnostic spectral regions identified by our algorithm included those due to choline, creatine, glutamine, and lipid. Citrate, an important discriminating resonance in the untreated prostate gland, was invisible in all spectra, regardless of histology.
  
  
  CONCLUSIONS
  Although the spectral features of prostate tissue markedly change after radiotherapy, MRS combined with multivariate methods of analysis can accurately identify histologically malignant biopsies. MRS shows promise as a modality that could integrate three-dimensional measures of tumor response.
authors.affiliation: Department of Radiation Oncology, University of Manitoba, Winnipeg, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Menard
authors.forename: I C
authors.initials: IC
authors.lastname: Smith
authors.forename: R L
authors.initials: RL
authors.lastname: Somorjai
authors.forename: L
authors.initials: L
authors.lastname: Leboldus
authors.forename: R
authors.initials: R
authors.lastname: Patel
authors.forename: C
authors.initials: C
authors.lastname: Littman
authors.forename: S J
authors.initials: SJ
authors.lastname: Robertson
authors.forename: T
authors.initials: T
authors.lastname: Bezabeh
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity