title: High-grade prostatic intraepithelial neoplasia in patients with prostate cancer: MR and MR spectroscopic imaging features--initial experience.
abstract: OBJECTIVE
  To retrospectively determine the magnetic resonance (MR) and MR spectroscopic imaging features of high-grade prostatic intraepithelial neoplasia (HGPIN) in patients with prostate cancer.
  
  
  METHODS
  Approval of the committee on human research was obtained, with a waiver of consent for this HIPAA-compliant study. Endorectal MR imaging and MR spectroscopic imaging were performed in 48 men (mean age, 59 years; range, 47-75 years) prior to radical prostatectomy for prostate cancer. T2-weighted signal intensity and metabolic ratios of peripheral zone HGPIN foci of 6 mm or greater in diameter were recorded by two readers with knowledge of step-section histopathologic findings using areas of confirmed normal and cancerous peripheral zone tissue for comparison. A random effects statistical model was used to compare metabolic ratios from normal, HGPIN, and cancer voxels.
  
  
  RESULTS
  A total of 123 peripheral zone HGPIN foci with a mean diameter of 3 mm (range, 1-28 mm) were identified in 37 (77%) patients, but only 20 foci in 14 patients had a diameter of 6 mm or greater. Six foci were excluded, yielding 14 large HGPIN lesions from 11 patients in the final statistical analysis. The larger HGPIN foci were not associated with any focal reduction in T2-weighted signal intensity but demonstrated metabolic findings intermediate between normal and cancerous tissue; the mean ratios of choline (Cho) to creatine (Cr) for normal, HGPIN, and cancer were 0.92, 1.75, and 1.99, respectively, (P < .01), and the corresponding ratios of Cho plus Cr to citrate were 0.34, 0.50, and 0.78 (P < .01).
  
  
  CONCLUSIONS
  HGPIN is metabolically intermediate between normal peripheral zone tissue and prostate cancer at MR spectroscopic imaging but does not manifest any MR imaging abnormality and is rarely of sufficient size to cause substantial error in evaluation of peripheral zone tumor extent in patients with prostate cancer.
authors.affiliation: Department of Radiology, University of California, San Francisco, Box 0628, M-372, 505 Parnassus Ave, San Francisco, CA 94143-0628, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Hom
authors.forename: Fergus V
authors.initials: FV
authors.lastname: Coakley
authors.forename: Jeffry P
authors.initials: JP
authors.lastname: Simko
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Aliya
authors.initials: A
authors.lastname: Qayyum
authors.forename: Antonio C A
authors.initials: AC
authors.lastname: Westphalen
authors.forename: Lars D
authors.initials: LD
authors.lastname: Schmitt
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.forename: John
authors.initials: J
authors.lastname: Kurhanewicz
mesh_terms: D000368:Aged; D002467:Cell Nucleus / Q000648:ultrastructure; D053145:Cell Nucleus Size; D002794:Choline / Q000032:analysis; D019343:Citric Acid / Q000032:analysis; D015331:Cohort Studies; D003401:Creatine / Q000032:analysis; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology* / Q000601:surgery; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D019343:Citric Acid; D003401:Creatine; D002794:Choline