title: Prostate cancer: identification with combined diffusion-weighted MR imaging and 3D 1H MR spectroscopic imaging--correlation with pathologic findings.
abstract: OBJECTIVE
  To retrospectively measure the mean apparent diffusion coefficient (ADC) with diffusion-weighted magnetic resonance (MR) imaging and the mean metabolic ratio (MET) with three-dimensional (3D) hydrogen 1 ((1)H) MR spectroscopic imaging in regions of interest (ROIs) drawn over benign and malignant peripheral zone (PZ) prostatic tissue and to assess ADC, MET, and combined ADC and MET for identifying malignant ROIs, with whole-mount histopathologic examination as the reference standard.
  
  
  METHODS
  The institutional review board approved this HIPAA-compliant retrospective study and issued a waiver of informed consent. From among 61 consecutive patients with prostate cancer, 38 men (median age, 61 years; range, 42-72 years) who underwent 1.5-T endorectal MR imaging before radical prostatectomy and who fulfilled all inclusion criteria of no prior hormonal or radiation treatment and at least one PZ lesion (volume, >0.1 cm(3)) at whole-mount pathologic examination were included. ADC maps were generated from diffusion-weighted MR imaging data, and MET maps of (choline plus polyamine plus creatine)/citrate were calculated from 3D (1)H MR spectroscopic imaging data. ROIs in the PZ identified by matching pathologic slides with T2-weighted images were overlaid on MET and ADC maps. Areas under the receiver operating characteristic curves (AUCs) were used to evaluate accuracy.
  
  
  RESULTS
  The mean ADC +/- standard deviation, (1.39 +/- 0.23) x 10(-3) mm(2)/sec, and mean MET (0.92 +/- 0.32) for malignant ROIs differed significantly from the mean ADC, (1.69 +/- 0.24) x 10(-3) mm(2)/sec, and mean MET (0.73 +/- 0.18) for benign ROIs (P < .001 for both). In distinguishing malignant ROIs, combined ADC and MET (AUC = 0.85) performed significantly better than MET alone (AUC = 0.74; P = .005) and was also better than ADC alone (AUC = 0.81), although the difference was not statistically significant (P = .09).
  
  
  CONCLUSIONS
  The combination of ADC and MET performs significantly better than MET for differentiating between benign and malignant ROIs in the PZ.
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10021, USA. mazahery@mskcc.org
authors.forename: Yousef
authors.initials: Y
authors.lastname: Mazaheri
authors.forename: Amita
authors.initials: A
authors.lastname: Shukla-Dave
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
authors.forename: Samson W
authors.initials: SW
authors.lastname: Fine
authors.forename: Jingbo
authors.initials: J
authors.lastname: Zhang
authors.forename: Gloria
authors.initials: G
authors.lastname: Inurrigarro
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Ishill
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
authors.forename: Karim
authors.initials: K
authors.lastname: Touijer
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Zakian
authors.forename: Jason A
authors.initials: JA
authors.lastname: Koutcher
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D011522:Protons; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic
chemical_list: D014408:Biomarkers, Tumor; D011522:Protons