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Figure 2a: Patient 21. (a) Transverse T2-weighted MR image (fast spin-echo sequence, 5000/102) with 3D MR spectral grid and corresponding 3D MR spectroscopic spectra of midgland: MR image shows wide area of low signal intensity in posterior peripheral zone of gland, bilateral with capsular irregularity; 3D MR spectroscopic spectra shows low citrate content and high choline peak in corresponding voxels (mean CC/C ratio = 1.81 on right side, 1.64 on left). (b) Corresponding PET/CT fusion images show pathologic uptake of ¹¹C-choline extending outside rim of gland in posterior right side (maximum SUV = 7); on left side of posterior gland, another area of focal uptake of ¹¹C-choline (maximum SUV = 5.9) is depicted; in anterior transitional zone, lower ¹¹C-choline focal uptake (maximum SUV = 4.9) is depicted. Black arrow = cursor. (c) Corresponding histologic specimen shows bilateral posterior adenocarcinoma (T3bN1MX, Gleason score = 4 + 3) with infiltration of anterior transition zone and bilateral extracapsular extension (*). (Hematoxylin-eosin stain; original magnification, x1.)