title: Prostatic biopsy directed with endorectal MR spectroscopic imaging findings in patients with elevated prostate specific antigen levels and prior negative biopsy findings: early experience.
abstract: OBJECTIVE
  To prospectively evaluate the accuracy of transrectal ultrasonography (US)-guided biopsy directed with magnetic resonance (MR) spectroscopic imaging in patients with an elevated prostate specific antigen (PSA) level and negative findings at prior biopsy by using subsequent biopsy results as the reference standard.
  
  
  METHODS
  The committee on human research approved this study, and written informed consent was obtained. MR imaging and MR spectroscopic imaging were performed in 42 men (age range, 45-75 years; average age, 63.3 years; median age, 65 years) with negative findings at two or more prostatic biopsies and at digital rectal examination. MR spectroscopic data were rated on a scale of 1 (benign) to 5 (malignant) on the basis of standardized metabolic criteria. Abnormal voxels were overlaid on the corresponding transverse transrectal US images and used to perform voxel-guided biopsy of the prostate. All patients subsequently received an extended-pattern biopsy scheme.
  
  
  RESULTS
  Thirty-one of 42 patients demonstrated metabolic abnormalities that were suspicious for cancer (voxels with scores > or = 4). Eleven patients with negative MR spectroscopic imaging results also had negative biopsy findings. Cancer was detected in 17 (55%) of 31 men with positive MR spectroscopic imaging findings (voxels with scores > or = 4) with a sensitivity of 100%, specificity of 44%, positive predictive value of 55%, negative predictive value of 100%, and accuracy of 67%. In men with at least one spectroscopic voxel with a score of 5 (12 of 17 men), the sensitivity, specificity, positive and negative predictive values, and accuracy were 71%, 84%, 75%, 81%, and 79%, respectively.
  
  
  CONCLUSIONS
  Metabolic data from MR spectroscopic imaging can be transferred to transrectal US images and used to sample regions of cancer in men with rising PSA levels and negative findings at prior biopsy with good accuracy.
authors.affiliation: Department of Radiology, Vera Cruz Hospital, Av Andrade Neves 707, Campinas SP, 13013-161, Brazil. aprando@mpc.com.br
authors.forename: Adilson
authors.initials: A
authors.lastname: Prando
authors.forename: John
authors.initials: J
authors.lastname: Kurhanewicz
authors.forename: Alexandre P
authors.initials: AP
authors.lastname: Borges
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Oliveira
authors.forename: Eduardo
authors.initials: E
authors.lastname: Figueiredo
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D016009:Chi-Square Distribution; D019160:Endosonography / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology*; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional
chemical_list: D017430:Prostate-Specific Antigen