title: Multiparametric MR can identify high grade prostatic intraepithelial neoplasia (HGPIN) lesions and predict future detection of prostate cancer in men with a negative initial prostate biopsy.
abstract: This study aims to determine the pre-biopsy diffusion-weighted imaging (DWI) and magnetic resonance spectroscopic imaging (MRSI) characteristics of patients with high-grade prostatic intraepithelial neoplasia (HGPIN) and perform follow-up studies in these patients to assess the clinical implications.
  
  
  
  One hundred sixteen men with prostate specific antigen between 4 and 10ng/ml underwent pre-biopsy MR examinations. Nine of them had HGPIN lesions without concomitant prostate cancer (PCa) on biopsy. Apparent diffusion coefficient (ADC) and metabolite ratio [Citrate/(Choline+Creatine)] were calculated and these 9 patients were followed to determine the clinical outcomes.
  
  
  
  Mean ADC for HGPIN foci was 1.01±0.16×10(-3)mm(2)/s while for the normal peripheral zone it was 1.69±0.25×10(-3)mm(2)/s (p<0.005). Mean metabolite ratio for voxels in the HGPIN region of initial biopsy was 0.24±0.16 while for the normal peripheral zone the value was 2.66±1.57 (p<0.005). Four of 5 patients who were available for follow-up were detected to have prostate cancer on repeat biopsy. No significant change in metabolite ratio and PSA was observed while ADC showed further reduction on follow-up.
  
  
  
  HGPIN foci have ADC and metabolite ratio values similar to adenocarcinoma prostate, indicating that such patients have a high likelihood of developing cancer. DWI may help identify such men who may be candidates for close follow-up.
authors.affiliation: Department of NMR and MRI Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Durgesh Kumar
authors.initials: DK
authors.lastname: Dwivedi
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Girdhar Singh
authors.initials: GS
authors.lastname: Bora
authors.affiliation: Department of Radio-diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Radio-diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Siddhartha Datta
authors.initials: SD
authors.lastname: Gupta
authors.affiliation: Department of NMR and MRI Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India. Electronic address: jagan1954@hotmail.com.
authors.forename: Naranamangalam R
authors.initials: NR
authors.lastname: Jagannathan
mesh_terms: D000368:Aged; D001706:Biopsy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D019048:Prostatic Intraepithelial Neoplasia / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: Diffusion-weighted imaging; Follow-up; High-grade prostatic intraepithelial neoplasia; Magnetic resonance spectroscopic imaging; Prostate cancer