Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging.
OBJECTIVE
To prospectively determine the accuracies of T2-weighted magnetic resonance (MR) imaging, dynamic contrast material-enhanced MR imaging, and quantitative three-dimensional (3D) proton MR spectroscopic imaging of the entire prostate for prostate cancer localization, with whole-mount histopathologic section findings as the reference standard.


METHODS
This study was approved by the institutional review board, and informed consent was obtained from all patients. Thirty-four consecutive men with a mean age of 60 years and a mean prostate-specific antigen level of 8 ng/mL were examined. The median biopsy Gleason score was 6. T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and 3D MR spectroscopic imaging were performed, and on the basis of the image data, two readers with different levels of experience recorded the location of the suspicious peripheral zone and central gland tumor nodules on each of 14 standardized regions of interest (ROIs) in the prostate. The degree of diagnostic confidence for each ROI was recorded on a five-point scale. Localization accuracy and ROI-based receiver operating characteristic (ROC) curves were calculated.


RESULTS
For both readers, areas under the ROC curve for T2-weighted MR, dynamic contrast-enhanced MR, and 3D MR spectroscopic imaging were 0.68, 0.91, and 0.80, respectively. Reader accuracy in tumor localization with dynamic contrast-enhanced imaging was significantly better than that with quantitative spectroscopic imaging (P < .01). Reader accuracy in tumor localization with both dynamic contrast-enhanced imaging and spectroscopic imaging was significantly better than that with T2-weighted imaging (P < .01).


CONCLUSIONS
Compared with use of T2-weighted MR imaging, use of dynamic contrast-enhanced MR imaging and 3D MR spectroscopic imaging facilitated significantly improved accuracy in prostate cancer localization.
Fütterer
Jurgen J
JJ
Department of Radiology, Radboud University Nijmegen Medical Center, Geert Grooteplein zuid 10, NL 6500 HB, Nijmegen, the Netherlands. J.Futterer@rad.umcn.nl
Heijmink
Stijn W T P J
SW
Scheenen
Tom W J
TW
Veltman
Jeroen
J
Huisman
Henkjan J
HJ
Vos
Pieter
P
Hulsbergen-Van de Kaa
Christina A
CA
Witjes
J Alfred
JA
Krabbe
Paul F M
PF
Heerschap
Arend
A
Barentsz
Jelle O
JO
D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*; D012372:ROC Curve; D015203:Reproducibility of Results
D003287:Contrast Media; D019786:Gadolinium DTPA