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(Radiology. 1999;213:473-480.)
© RSNA, 1999

Genitourinary Imaging

Prostate Cancer: Localization with Three-dimensional Proton MR Spectroscopic Imaging-Clinicopathologic Study1

Juergen Scheidler, MD, Hedvig Hricak, MD, PhD, Daniel B. Vigneron, PhD, Kyle K. Yu, MD, Dahlia L. Sokolov, BS, L. Royal Huang, BS, Charles J. Zaloudek, MD, Sarah J. Nelson, PhD, Peter R. Carroll, MD and John Kurhanewicz, PhD

1 From the Departments of Radiology (J.S., H.H., D.B.V., K.K.Y., D.L.S., L.R.H., 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. From the 1997 RSNA scientific assembly. Received April 23, 1998; revision requested July 2; final revision received February 24, 1999; accepted June 8. J.S. supported by the Deutsche Forschungsgemeinschaft. J.K. supported by grants RO1-59897 and R29-64667 from the National Institutes of Health. K.K.Y. supported by a GE-AUR Radiology Research Academic Fellowship. Address reprint requests to J.K. (e-mail: johnk @mrsc.ucsf.edu).

PURPOSE: To assess the efficacy of combined magnetic resonance (MR) imaging and three-dimensional (3D) proton MR spectroscopic imaging in the detection and localization of prostate cancer.

MATERIALS AND METHODS: MR imaging and 3D MR spectroscopic imaging examinations were performed in 53 patients with biopsy-proved prostate cancer and subsequent radical prostatectomy with step-section histopathologic examination. The prostate was divided into sextants. At MR imaging, the presence or absence of cancer in the peripheral zone of each sextant was assessed independently by two readers (readers 1 and 2) unaware of the findings at 3D MR spectroscopic imaging and histopathologic examination. At 3D MR spectroscopic imaging, cancer was diagnosed as possible if the ratio of choline plus creatine to citrate exceeded 2 SD above population norms or as definite if that ratio exceeded 3 SDs above the norm.

RESULTS: On the basis of sextants, sensitivity and specificity, respectively, for MR imaging were 77% and 61% (reader 1) and 81% and 46% (reader 2) with moderate interreader agreement ({kappa} = 0.43). The 3D MR spectroscopic imaging diagnosis of definite cancer had significantly higher specificity (75%, P < .05) but lower sensitivity (63%, P < .05). Receiver operating characteristic analysis showed significantly (P < .001) improved tumor localization for both readers when 3D MR spectroscopic imaging was added to MR imaging. High specificity (up to 91%) was obtained when combined MR imaging and 3D MR spectroscopic imaging indicated cancer, whereas high sensitivity (up to 95%) was obtained when either test alone indicated a positive result.

CONCLUSION: The addition of 3D MR spectroscopic imaging to MR imaging provides better detection and localization of prostate cancer in a sextant of the prostate than does use of MR imaging alone.

Index terms: Magnetic resonance (MR), spectroscopy, 844.12145 • Magnetic resonance (MR), three-dimensional, 844.12149 • Prostate, hyperplasia, 844.316 • Prostate, MR, 844.12141, 844.12145 • Prostate, neoplasms, 844.32


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