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(Radiology. 1999;213:481-488.)
© RSNA, 1999

Genitourinary Imaging

Prostate Cancer: Prediction of Extracapsular Extension with Endorectal MR Imaging and Three-dimensional Proton MR Spectroscopic Imaging1

Kyle K. Yu, MD, Juergen Scheidler, MD, Hedvig Hricak, MD, PhD, Daniel B. Vigneron, PhD, Charles J. Zaloudek, MD, Ryan G. Males, PhD, Sarah J. Nelson, PhD, Peter R. Carroll, MD and John Kurhanewicz, PhD

1 From the Departments of Radiology (K.K.Y., J.S., H.H., D.B.V., R.G.M., S.J.N., J.K.), Pathology (C.J.Z.), and Urology (P.R.C.), University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628. Received June 23, 1998; revision requested August 8; final revision received February 3, 1999; accepted June 8. K.K.Y. supported by a GE-AUR Radiology Research Academic Fellowship. J.S. supported by the Deutsche Forschungsgemeinschaft. J.K. supported by grants RO1-59897 and R29-64667 from the National Institutes of Health. Address reprint requests to H.H. (e-mail: Hedvig.Hricak@radiology.ucsf.edu).

PURPOSE: To determine if the addition of three-dimensional (3D) proton magnetic resonance (MR) spectroscopic imaging to endorectal MR imaging helps diagnose extracapsular extension (ECE) of prostate cancer.

MATERIALS AND METHODS: Endorectal MR imaging and 3D MR spectroscopic imaging were performed in 53 patients with prostate cancer before radical prostatectomy. MR imaging studies were evaluated by two independent readers unaware of histopathologic findings. The presence of ECE was graded on a five-point scale. At 3D MR spectroscopic imaging, cancer was diagnosed if the ratio of choline plus creatine to citrate was 2 or more SDs above normal. The accuracy of MR imaging alone was compared with that of combined MR imaging and 3D MR spectroscopic imaging, with use of the step-section histopathologic results as the standard of reference.

RESULTS: For the less experienced reader, the addition of 3D MR spectroscopic imaging to MR imaging significantly improved accuracy (area under the receiver operating characteristic curve [Az] = 0.75 vs Az = 0.62, P < .05). For the more experienced reader, the addition improved accuracy but not significantly (Az = 0.86 vs Az = 0.78). The addition also reduced interobserver variability (Az = 0.86 vs Az = 0.75).

CONCLUSION: The addition of 3D MR spectroscopic imaging to MR imaging improves accuracy for less experienced readers and reduces interobserver variability in the diagnosis of ECE of prostate cancer.

Index terms: Diagnostic radiology, observer performance • Magnetic resonance (MR), spectroscopy, three-dimensional, 844.12145 • Prostate, MR, 844.12141, 844.12145 • Prostate, neoplasms, 844.32 • Receiver operating characteristic (ROC) curve


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Radiology 1999 213: 473-480. [Abstract] [Full Text] [PDF]



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