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Prostate Cancer: Identification with Combined Diffusion-weighted MR Imaging and 3D ¹H MR Spectroscopic Imaging—Correlation with Pathologic Findings¹

¹ From the Departments of Medical Physics (Y.M., A.S., K.L.Z., J.A.K.), Radiology (Y.M., A.S., H.H., J.Z., K.L.Z., J.A.K.), Pathology (S.W.F., G.I., V.E.R.), Epidemiology and Biostatistics (C.S.M., N.M.I.), and Urology (K.T.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10021. Received February 22, 2007; revision requested April 26; revision received June 15; final version accepted July 23. Supported by National Institutes of Health grant R01 CA76423. Address correspondence to Y.M. (e-mail: mazahery{at}mskcc.org).

Purpose: To retrospectively measure the mean apparent diffusion coefficient (ADC) with diffusion-weighted magnetic resonance (MR) imaging and the mean metabolic ratio (MET) with three-dimensional (3D) hydrogen 1 (¹H) MR spectroscopic imaging in regions of interest (ROIs) drawn over benign and malignant peripheral zone (PZ) prostatic tissue and to assess ADC, MET, and combined ADC and MET for identifying malignant ROIs, with whole-mount histopathologic examination as the reference standard.

Materials and Methods: The institutional review board approved this HIPAA-compliant retrospective study and issued a waiver of informed consent. From among 61 consecutive patients with prostate cancer, 38 men (median age, 61 years; range, 42–72 years) who underwent 1.5-T endorectal MR imaging before radical prostatectomy and who fulfilled all inclusion criteria of no prior hormonal or radiation treatment and at least one PZ lesion (volume, >0.1 cm³) at whole-mount pathologic examination were included. ADC maps were generated from diffusion-weighted MR imaging data, and MET maps of (choline plus polyamine plus creatine)/citrate were calculated from 3D ¹H MR spectroscopic imaging data. ROIs in the PZ identified by matching pathologic slides with T2-weighted images were overlaid on MET and ADC maps. Areas under the receiver operating characteristic curves (AUCs) were used to evaluate accuracy.

Results: The mean ADC ± standard deviation, (1.39 ± 0.23) x 10^–3 mm²/sec, and mean MET (0.92 ± 0.32) for malignant ROIs differed significantly from the mean ADC, (1.69 ± 0.24) x 10^–3 mm²/sec, and mean MET (0.73 ± 0.18) for benign ROIs (P < .001 for both). In distinguishing malignant ROIs, combined ADC and MET (AUC = 0.85) performed significantly better than MET alone (AUC = 0.74; P = .005) and was also better than ADC alone (AUC = 0.81), although the difference was not statistically significant (P = .09).

Conclusion: The combination of ADC and MET performs significantly better than MET for differentiating between benign and malignant ROIs in the PZ.

© RSNA, 2008

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