title: Endorectal 3D T2-weighted 1mm-slice thickness MRI for prostate cancer staging at 1.5Tesla: should we reconsider the indirects signs of extracapsular extension according to the D'Amico tumor risk criteria?
abstract: OBJECTIVE
  To evaluate the accuracy of a 3D-endorectal 1mm-thick slices MRI acquisition for local staging of low, intermediate and high D'Amico risk prostate cancer (PCa).
  
  
  METHODS
  178 consecutive patients underwent a multiparametric MRI protocol prior to radical prostatectomy (RP). T2W images were acquired with the 3D sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) sequence (5mn acquisition time). Direct and indirect MRI signs of extracapsular extension (ECE) were evaluated to predict the pT stage. The likelihood of SVI (seminal vesicle invasion) was also assessed.
  
  
  RESULTS
  Histology showed ECE and SVI in 38 (21%) and 12 (7%) cases, respectively. MRI sensitivity and specificity to detect ECE were 55 and 96% if direct signs of ECE were used and 84 and 89% (p<0.05), if both direct and indirect signs were combined. D'Amico criteria did not influence MRI performance. Sensitivity and specificity for SVI detection were 83% and 99%.
  
  
  CONCLUSIONS
  3D data sets acquired with the SPACE sequence provides a high accuracy for local staging of prostate cancer. The use of indirect signs of ECE may be recommended in low D'Amico risk tumors to optimise patient selection for active surveillance or focal therapy.
authors.affiliation: Department of Radiology, Hôpital Cochin, Université Paris Descartes, France; IRM Paris 16, 46-48 rue Chardon-Lagache, 75116 Paris, France. frcornud@imagerie-tourville.com
authors.forename: F
authors.initials: F
authors.lastname: Cornud
authors.forename: M
authors.initials: M
authors.lastname: Rouanne
authors.forename: F
authors.initials: F
authors.lastname: Beuvon
authors.forename: D
authors.initials: D
authors.lastname: Eiss
authors.forename: T
authors.initials: T
authors.lastname: Flam
authors.forename: M
authors.initials: M
authors.lastname: Liberatore
authors.forename: M
authors.initials: M
authors.lastname: Zerbib
authors.forename: N B
authors.initials: NB
authors.lastname: Delongchamps
mesh_terms: D000368:Aged; D005602:France / Q000453:epidemiology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D012007:Rectum / Q000473:pathology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity