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Localized Prostate Cancer: Effect of Hormone Deprivation Therapy Measured by Using Combined Three-dimensional ¹H MR Spectroscopy and MR Imaging: Clinicopathologic Case-controlled Study¹

¹ From the Departments of Radiology (U.G.M.L., D.B.V., H.H., M.G.S., A.B., J.S., A.S., R.G.M., J.K.), Urology (P.R.C.), and Pathology (I.C.), University of California–San Francisco, Magnetic Resonance Science Center, 1 Irving St, Suite AC-109, San Francisco, CA 94143-1290. Received September 26, 2000; revision requested November 12; revision received March 22, 2001; accepted April 11. Supported in part by grants NIH R01-59897 and NIH R29-64667 and the Association for the Cure of Cancer of the Prostate Foundation. Address correspondence to J.K. (e-mail: johnk@mrsc.ucsf.edu).

PURPOSE: To determine the accuracy of combined magnetic resonance (MR) imaging and three-dimensional (3D) proton MR spectroscopic imaging in localizing prostate cancer to a sextant of the gland in patients receiving hormone deprivation therapy.

MATERIALS AND METHODS: Combined MR imaging/3D MR spectroscopic imaging examinations were performed in 16 hormone-treated patients and 48 nontreated matched control patients before radical prostatectomy and step-section histopathologic analysis. At MR imaging, cancer presence within the peripheral zone was assessed on a per sextant basis by two readers. At 3D MR spectroscopic imaging, cancer was identified by using (choline plus creatine)–to-citrate ratios at cutoff values of 2 and 3 SDs above mean normal peripheral zone values. Data were compared by using receiver operating characteristic analysis.

RESULTS: There was no significant difference in the ability of combined MR imaging/3D MR spectroscopic imaging to localize prostate cancer in treated versus control patients. For MR imaging alone, the sensitivity and specificity were 91% and 48% (reader 1) and 75% and 60% (reader 2) in treated patients versus 79% and 60% (reader 1) and 84% and 43% (reader 2) in control patients. For 3D MR spectroscopic imaging alone (>3 SDs cutoff), higher specificity (treated, 80%; controls, 73%) but lower sensitivity (treated, 56%; controls, 53%) was attained. In treated patients, high sensitivity or specificity (up to 92%) was achieved when either or both modalities indicated cancer.

CONCLUSION: When performed within 4 months after initiating hormone deprivation therapy, combined MR imaging/3D MR spectroscopic imaging had the same accuracy in localizing prostate cancer as in nontreated patients.

Index terms: Magnetic resonance (MR), spectroscopy, 844.12145 • Prostate, MR, 844.121411, 844.121415, 844.12145 • Prostate neoplasms, 844.32

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