title: Seminal vesicle invasion in prostate cancer: evaluation by using multiparametric endorectal MR imaging.
abstract: OBJECTIVE
  To retrospectively evaluate the diagnostic performance of multiparametric endorectal magnetic resonance (MR) imaging, including T2-weighted, diffusion-weighted (DW), and dynamic contrast material-enhanced (DCE) MR techniques, for the diagnosis of seminal vesicle invasion (SVI) and to determine the incremental value of DW MR and DCE MR images.
  
  
  METHODS
  This retrospective HIPAA-compliant study was approved by the institutional review board, with a waiver of informed consent. The study included 131 patients (mean age, 68 years; range, 43-75 years) who underwent endorectal MR imaging before radical prostatectomy between January 2007 and April 2010. Two radiologists (A: experienced, B: less experienced) estimated the likelihood of SVI by using a five-point ordinal scale in three image-viewing settings: T2-weighted images alone; T2-weighted and DW MR images; and T2-weighted, DW MR, and DCE MR images. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated. Confidence intervals estimated with bootstrapping and the McNemar test or Fisher exact test were used to compare sensitivity, specificity, positive predictive value, and negative predictive value.
  
  
  RESULTS
  Of the 131 patients, 23 (17.6%) had SVI identified after surgery. Review of T2-weighted MR images alone resulted in high specificity (93.1% and 93.6%, for radiologists A and B, respectively) and high negative predictive value (94.8% and 94.0%) but moderate sensitivity (59% and 52%) and positive predictive value (52% and 50%). Review of T2-weighted and DW MR images significantly improved specificity (96.6% [P = .02] and 98.3% [P = .003]) and positive predictive value (70% [P < .05] and 79% [P < .05]) without significantly improving AUC. Additional review of DCE MR images did not yield further incremental improvement.
  
  
  CONCLUSIONS
  Additional review of DW MR images improves specificity and positive predictive value in SVI detection compared with reviewing T2-weighted images alone. Addition of DCE MR images to this combination, however, does not provide incremental value for diagnosis of SVI.
authors: Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637, USA.
authors: Fatma Nur
authors: FN
authors: Soylu
authors: Yahui
authors: Y
authors: Peng
authors: Yulei
authors: Y
authors: Jiang
authors: Shiyang
authors: S
authors: Wang
authors: Christine
authors: C
authors: Schmid-Tannwald
authors: Ila
authors: I
authors: Sethi
authors: Scott
authors: S
authors: Eggener
authors: Tatjana
authors: T
authors: Antic
authors: Aytekin
authors: A
authors: Oto
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D012007:Rectum; D012189:Retrospective Studies; D012669:Seminal Vesicles / Q000473:pathology*; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA