title: [Accuracy of endorectal Magnetic Resonance Imaging (MRI) and Dynamic Contrast Enhanced-MRI (DCE-MRI) in the preoperative local staging of prostate cancer].
abstract: BACKGROUND
  The proper management of newly diagnosed prostate cancer (PCa) requires the choice of the appropriate treatment plan. A crucial factor is the accurate evaluation of the tumor local extension. The Magnetic Resonance Imaging (MRI) plays an important role in the local staging of prostate cancer, although its use in clinical practice is widely debated. Therefore, the purpose of our study was to evaluate the diagnostic accuracy of T2-weighted MR imaging in association with DCE-MRI, performed using an endorectal coil, in preoperative local staging of patients with prostate cancer, by using the histopathologic findings as the reference standard.
  
  
  METHODS
  From April 2010 to May 2011, 65 patients (mean age, 65 years; range, 51-77 years) with clinical localized PCa, underwent radical prostatectomy at our institution, performed by 2 experienced surgeons. All patients were prospectively evaluated with eMRI in association with DCE-MRI prior to radical prostatectomy. In all patients MRI was performed at least 6 weeks after biopsy and within 2 weeks before Radical Prostatectomy (RP). Histologic analysis was our diagnostic "gold standard". To ensure that the histopathological findings matched with MR images, the assessment of radiological images and the RP specimens were performed dividing the prostate in 14 regions.
  
  
  RESULTS
  First, we performed a "per-patient" analysis, considering the entire prostate as a single region. Then, we performed a "per-emigland" analysis, finally a "per-region" analysis. The sensitivity, specificity, PPV, NPV and AUC in predicting ECE in the analysis "per-emigland" were respectively 66.7, 95.7, 66.7, 95.7, 0.824. The evaluation of SVI reported similar results: 62.5, 97.5, 62.5, 97.5, 0.797. DCE-MRI did not improve the diagnostic accuracy of T1-T2-weighted MR images in the evaluation of ECE or SVI.
  
  
  CONCLUSIONS
  T1-, T2-weighted MRI adds important information regarding the preoperative local staging of PCa. DCE-MRI does not improve the diagnostic accuracy of MRI in the local staging of PCa.
authors.affiliation: UO Urologia Martorana, Università di Bologna, Policlinico S. Orsola Malpighi, Italy. alessandrobaccos@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Baccos
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Ziv
authors.initials: Z
authors.lastname: Zukerman
authors.forename: Fiorenza
authors.initials: F
authors.lastname: Busato
authors.forename: Caterina
authors.initials: C
authors.lastname: Gaudiano
authors.forename: Eugenio
authors.initials: E
authors.lastname: Salizzoni
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Fiorentino
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D019540:Area Under Curve; D001706:Biopsy; D003287:Contrast Media; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012007:Rectum; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media