title: In vivo assessment of prostate cancer aggressiveness using magnetic resonance spectroscopic imaging at 3 T with an endorectal coil.
abstract: BACKGROUND
  One of the most important clinical challenges in prostate cancer (PCa) management is an in vivo assessment of cancer aggressiveness.
  
  
  OBJECTIVE
  To validate the performance of magnetic resonance (MR) spectroscopic imaging (MRSI) of the prostate at 3 T for the purpose of assessing tumour aggressiveness based on the ratio of choline plus creatine to citrate (Cho+Cr/Cit) and of choline to creatine (Cho/Cr), using the Gleason score of the radical prostatectomy (RP) specimen as the gold standard.
  
  
  METHODS
  A total of 43 biopsy-proven PCa patients with 53 clinically relevant tumour foci were retrospectively included in this study.
  
  
  METHODS
  Patients underwent MR imaging and MRSI examination followed by RP. From MRSI, all spectroscopy voxels containing tumour were selected by a radiologist guided by the prostatectomy histopathology map only. For each tumour, two spectroscopists determined the maximum Cho+Cr/Cit, Cho/Cr, and malignancy rating using a standardised threshold approach, incorporating both metabolic ratios. The maximum Cho+Cr/Cit, Cho/Cr, and malignancy ratings showed a relation to tumour aggressiveness and so were used to differentiate among tumour aggressiveness classes.
  
  
  CONCLUSIONS
  The maximum Cho+Cr/Cit ratio, maximum Cho/Cr ratio, and malignancy rating of a standardised threshold approach separated low-grade from higher-grade tumours, with areas under the receiver operating characteristic (ROC) curves of 0.70, 0.74, and 0.78, respectively.
  
  
  CONCLUSIONS
  MRSI offers possibilities for an in vivo, noninvasive assessment of PCa aggressiveness. The combination of the different metabolite ratios was used with promising results for discrimination among different aggressiveness classes.
authors.affiliation: Department of Radiology (667), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. T.Kobus@rad.umcn.nl
authors.forename: Thiele
authors.initials: T
authors.lastname: Kobus
authors.forename: Thomas
authors.initials: T
authors.lastname: Hambrock
authors.forename: Christina A
authors.initials: CA
authors.lastname: Hulsbergen-van de Kaa
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wright
authors.forename: Jelle O
authors.initials: JO
authors.lastname: Barentsz
authors.forename: Arend
authors.initials: A
authors.lastname: Heerschap
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Scheenen
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy; D002794:Choline / Q000032:analysis*; D019343:Citric Acid / Q000032:analysis*; D003401:Creatine / Q000032:analysis*; D004867:Equipment Design; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy / Q000295:instrumentation* / Q000592:standards; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D019343:Citric Acid; D003401:Creatine; D002794:Choline