title: Correlation of proton MR spectroscopic imaging with gleason score based on step-section pathologic analysis after radical prostatectomy.
abstract: OBJECTIVE
  To determine whether hydrogen 1 magnetic resonance (MR) spectroscopic imaging can be used to predict aggressiveness of prostate cancer.
  
  
  METHODS
  All patients gave informed consent according to an institutionally approved research protocol. A total of 123 patients (median age, 58 years; age range, 40-74 years) who underwent endorectal MR imaging and MR spectroscopic imaging between January 2000 and December 2002 were included. MR imaging and spectroscopy were performed by using combined pelvic phased-array and endorectal probe. Water and lipids were suppressed, and phase-encoded data were acquired with 6.2-mm resolution. Voxels in the peripheral zone were considered suspicious for cancer if (Cho + Cr)/Cit was at least two standard deviations above the normal level, where Cho represents choline-containing compounds, Cr represents creatine and phosphocreatine, and Cit represents citrate. Correlation between metabolite ratio and four Gleason score groups identified at step-section pathologic evaluation (3 + 3, 3 + 4, 4 + 3, and > or =4 + 4) was assessed with generalized estimating equations.
  
  
  RESULTS
  Data from 94 patients were included. Pathologic evaluation was used to identify 239 lesions. Overall sensitivity of MR spectroscopic imaging was 56% for tumor detection, increasing from 44% in lesions with Gleason score of 3 + 3 to 89% in lesions with Gleason score greater than or equal to 4 + 4. There was a trend toward increasing (Cho + Cr)/Cit with increasing Gleason score in lesions identified correctly with MR spectroscopic imaging. Tumor volume assessed with MR spectroscopic imaging increased with increasing Gleason score.
  
  
  CONCLUSIONS
  MR spectroscopic imaging measurement of prostate tumor (Cho + Cr)/Cit and tumor volume correlate with pathologic Gleason score. There is overlap between MR spectroscopic imaging parameters at various Gleason score levels, which may reflect methodologic and physiologic variations. MR spectroscopic imaging has potential in noninvasive assessment of prostate cancer aggressiveness.
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. zakiank@mskcc.org
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Zakian
authors.forename: Kanishka
authors.initials: K
authors.lastname: Sircar
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
authors.forename: Hui-Ni
authors.initials: HN
authors.lastname: Chen
authors.forename: Amita
authors.initials: A
authors.lastname: Shukla-Dave
authors.forename: Steven
authors.initials: S
authors.lastname: Eberhardt
authors.forename: Manickam
authors.initials: M
authors.lastname: Muruganandham
authors.forename: Lanie
authors.initials: L
authors.lastname: Ebora
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Jason A
authors.initials: JA
authors.lastname: Koutcher
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery*; D011522:Protons; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted
chemical_list: D011522:Protons