title: Assessment of biologic aggressiveness of prostate cancer: correlation of MR signal intensity with Gleason grade after radical prostatectomy.
abstract: OBJECTIVE
  To retrospectively investigate whether the signal intensity (SI) of prostate cancer on T2-weighted magnetic resonance (MR) images correlates with the Gleason grade at whole-mount step-section pathologic evaluation after radical prostatectomy.
  
  
  METHODS
  The institutional review board approved and issued a waiver of informed consent for this HIPAA-compliant study of 74 patients (median age, 57.5 years; range, 32-72 years) who underwent endorectal MR imaging before radical prostatectomy, with subsequent whole-mount step-section pathologic evaluation, between January 2001 and July 2004. Inclusion criteria were that they had: no prior treatment; at least one lesion of uniform Gleason grade 3 or 4 or with Gleason grade 5 components, with a bidimensional diameter product of 20 mm2 or greater; no high SI on T1-weighted MR images indicative of postbiopsy changes; and an interval of more than 4 weeks between biopsy and MR imaging. SI of prostate tumors, nontumor prostatic tissue, and internal obturator muscles was measured on uncorrected and corrected T2-weighted MR images. Correlations between Gleason grades and SI ratios were assessed by using generalized estimating equations. SI ratios in peripheral zone (PZ) and transition zone (TZ) lesions of the same Gleason grade were compared with an unpaired t test.
  
  
  RESULTS
  Seventy-nine Gleason grade 3, eight Gleason grade 4, and four mixed Gleason grades 4 and 5 lesions identified at pathologic evaluation were analyzed. Gleason grade correlated significantly with tumor-muscle SI ratio for PZ tumors on corrected and uncorrected images (P = .006 and <.001, respectively). Higher Gleason grades were associated with lower tumor-muscle SI ratios. Nontumor-muscle SI ratios did not correlate with patients' Gleason grades. Tumor-muscle SI ratios were lower in TZ than in PZ tumors (P < .001).
  
  
  CONCLUSIONS
  Higher Gleason grades were associated with lower tumor-muscle SI ratios on T2-weighted MR images. SI evaluation on T2-weighted MR images may facilitate noninvasive assessment of prostate cancer aggressiveness.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Rm C-278, New York, NY 10021, USA. wang6@mskcc.org
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.forename: Yousef
authors.initials: Y
authors.lastname: Mazaheri
authors.forename: Jingbo
authors.initials: J
authors.lastname: Zhang
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Ishill
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kuroiwa
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies