Fusion of Magnetic Resonance Imaging and Real-Time Elastography to Visualize Prostate Cancer: A Prospective Analysis using Whole Mount Sections after Radical Prostatectomy.
OBJECTIVE
To determine whether the fusion of multiparametric magnetic resonance imaging (MRI) with transrectal real-time elastography (RTE) improves the visualization of PCa lesions compared to MRI alone.


METHODS
In a prospective setting, 45 patients with biopsy-proven PCa received prostate MRI prior to radical prostatectomy (RP). T2 and diffusion-weighted imaging (T2WI/DW-MRI) and, if applicable, dynamic contrast-enhanced sequences (T2WI/DW/DCE-MRI) were used to perform MRI/RTE fusion. The probability of PCa on MRI was graded according to the PI-RADS score for 12 different prostate sectors per patient. MRI images were fused with RTE to stratify suspicious from non-suspicious sectors. Imaging results were compared to whole mount sections using nonparametrical receiver operating characteristic curves and the area under these curves (AUC).


RESULTS
41 of 45 patients were eligible for final analyses. Histopathology confirmed PCa in 261 (53%) of 492 prostate sectors. MRI alone provided an AUC of 0.62 (T2WI/DW-MRI) and 0.65 (T2WI/DW/DCE-MRI) to predict PCa and was meaningfully enhanced to 0.75 (T2WI/DW-MRI) and 0.74 (T2WI/DW/DCE-MRI) using MRI/RTE fusion. Sole MRI showed a sensitivity and specificity of 57.9% and 61% with the best results for ventral prostate sectors whereas RTE was superior in dorsal and apical sectors. MRI/RTE fusion improved sensitivity and specificity to 65.9% and 75.3%, respectively. Additional use of DCE sequences showed a sensitivity and specificity of 65% and 55.7% for MRI and 72.1% and 66% for MRI/RTE fusion.


CONCLUSIONS
MRI/RTE fusion provides improved PCa visualization by combining the strength of both imaging techniques in regard to prostate zonal anatomy and thereby might improve future biopsy-guided PCa detection.
Urology, Ruhr-University Bochum, Marienhospital Herne, Germany.
M
M
Brock
Urology, Ruhr-University Bochum, Marienhospital Herne, Germany.
F
F
Roghmann
Radiology, Ruhr-University Bochum, Marienhospital Herne, Germany.
C
C
Sonntag
Pathology, Ruhr-University Bochum, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Bochum, Germany.
F
F
Sommerer
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
Z
Z
Tian
Urology, Ruhr-University Bochum, Marienhospital Herne, Germany.
B
B
Löppenberg
Urology, Ruhr-University Bochum, Marienhospital Herne, Germany.
R J
RJ
Palisaar
Urology, Ruhr-University Bochum, Marienhospital Herne, Germany.
J
J
Noldus
Urology, Ruhr-University Bochum, Marienhospital Herne, Germany.
J
J
Hanske
Urology, Ruhr-University Bochum, Marienhospital Herne, Germany.
C
C
von Bodman
D000368:Aged; D003199:Computer Systems; D004867:Equipment Design; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000295:instrumentation*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D017430:Prostate-Specific Antigen