title: Detection of prostate cancer with magnetic resonance imaging: optimization of T1-weighted, T2-weighted, dynamic-enhanced T1-weighted, diffusion-weighted imaging apparent diffusion coefficient mapping sequences and MR spectroscopy, correlated with biopsy and histopathological findings.
abstract: OBJECTIVE
  The aim of this study was to optimize and predict the most efficient magnetic resonance imaging (MRI) sequences; T1-weighted (T1W), T2-weighted (T2W), dynamic contrast-enhanced (DCE) T1W, diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) mapping sequences and proton MR spectroscopy (H-MRS) for the detection of prostate cancer.
  
  
  METHODS
  After institutional review board approval and informed consent taken from all the patients, 40 patients with prostate cancer were included in this research. Two readers independently evaluated the results of T1W, T2W, DCE T1W, and DWI-ADC mapping sequences and proton H-MRS for the depiction of prostate cancer. Reference standard was the transrectal ultrasonography-guided biopsy and the surgical histopathological results. Statistical analysis was assessed by the Fisher exact t test, Wilcoxon signed rank test, variance analysis test with kappa (κ) values and receiver operating characteristics (ROC) curve for ADC values, choline (Cho)/citrate (Cit) and Cho+creatine (Cre)/Cit ratios for each observer.
  
  
  RESULTS
  Based on both readers' results, sensitivity declined to 31% and specificity to 75% for the T1W sequence, sensitivity declined to 43% and specificity to 67% for the DCE T1W sequence, sensitivity declined to 46% and specificity to 68% for the T2W sequence, sensitivity declined to 29% and specificity to 82% for the DWI-ADC mapping; and specificity was 49% for the Cho/Cit and Cho+Cre/Cit ratios, sensitivity was 69% for the Cho/Cit ratio, and sensitivity was 70% for the Cho+Cre/Cit ratio for H-MRS. The T2W sequence and H-MRS presented significant statistical differences for the depiction of prostatic cancer (P < 0.05), the most efficient sequence to detect prostatic cancer was H-MRS: Cho+Cre/Cit and Cho/Cit ratios.
  
  
  CONCLUSIONS
  Instead of using either sequences alone owing to low sensitivity and specificity rates, combined use of MRI techniques could easily improve the detection and staging of prostate cancer.
authors.affiliation: Radiology Department, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Aydin
authors.forename: Volkan
authors.initials: V
authors.lastname: Kizilgöz
authors.forename: Idil Güneş
authors.initials: IG
authors.lastname: Tatar
authors.forename: Cağri
authors.initials: C
authors.lastname: Damar
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Ugan
authors.forename: Irem
authors.initials: I
authors.lastname: Paker
authors.forename: Baki
authors.initials: B
authors.lastname: Hekimoğlu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000378:metabolism; D001706:Biopsy; D002794:Choline / Q000378:metabolism; D019343:Citric Acid / Q000378:metabolism; D003287:Contrast Media; D003401:Creatine / Q000378:metabolism; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009942:Organometallic Compounds; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D018084:Ultrasonography, Interventional
chemical_list: D014408:Biomarkers, Tumor; D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D019343:Citric Acid; D017430:Prostate-Specific Antigen; D003401:Creatine; D002794:Choline