title: Endorectal MR imaging and MR spectroscopic imaging for locally recurrent prostate cancer after external beam radiation therapy: preliminary experience.
abstract: OBJECTIVE
  To evaluate endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for the depiction of locally recurrent prostate cancer after external beam radiation therapy.
  
  
  METHODS
  Endorectal MR imaging and MR spectroscopic imaging were performed in 21 patients with biochemical failure after external beam radiation therapy for prostate cancer. Two readers independently and retrospectively reviewed MR images and rated the likelihood of recurrent tumor on a five-point scale. Spectroscopic voxels were considered suspicious for malignancy if the choline level was elevated and citrate was absent. Receiver operating characteristic curve analysis was used to assess cancer detection in each side of the prostate with endorectal MR imaging and spectroscopic imaging at different thresholds based on the scores assigned by the two readers and on the number of suspicious voxels in each hemiprostate, respectively. The presence or absence of cancer at subsequent transrectal biopsy was used as the standard of reference.
  
  
  RESULTS
  Biopsy demonstrated locally recurrent prostate cancer in nine hemiprostates in six patients. The area under the receiver operating characteristic curve for the detection of locally recurrent cancer with MR imaging was 0.49 and 0.51 for readers 1 and 2, respectively. By using the number of suspicious voxels to define different diagnostic thresholds, the area under the receiver operating characteristic curve for MR spectroscopic imaging was significantly (P < .005) higher, at 0.81. In particular, the presence of three or more suspicious voxels in a hemiprostate showed a sensitivity and specificity of 89% and 82%, respectively, for the diagnosis of local recurrence. Seven hemiprostates demonstrated complete metabolic atrophy at spectroscopic imaging and only postirradiation atrophy at biopsy.
  
  
  CONCLUSIONS
  Preliminary data suggest that MR spectroscopic imaging, but not endorectal MR imaging, may be of value for the depiction of locally recurrent prostate cancer after radiation therapy.
authors.affiliation: Department of Radiology, University of California San Francisco, 505 Parnassus Ave, Box 0628, M-372, San Francisco, CA 94143-0628, USA. fergus.coakley@radiology.ucsf.edu.
authors.forename: Fergus V
authors.initials: FV
authors.lastname: Coakley
authors.forename: Hui Seong
authors.initials: HS
authors.lastname: Teh
authors.forename: Aliya
authors.initials: A
authors.lastname: Qayyum
authors.forename: Mark G
authors.initials: MG
authors.lastname: Swanson
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Mack
authors.initials: M
authors.lastname: Roach
authors.forename: Barby
authors.initials: B
authors.lastname: Pickett
authors.forename: Katsuto
authors.initials: K
authors.lastname: Shinohara
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Vigneron
authors.forename: John
authors.initials: J
authors.lastname: Kurhanewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy*; D012007:Rectum; D012680:Sensitivity and Specificity