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Pathologic Characterization of Human Prostate Tissue with Proton MR Spectroscopy¹

¹ From the Institute for Magnetic Resonance Research and Department of Magnetic Resonance in Medicine, University of Sydney, Block 3 Level 3, Royal North Shore Hospital, St Leonard’s, New South Wales, 2065, Australia. Received November 9, 2001; revision requested January 23, 2002; final revision received November 1; accepted January 2, 2003. Supported by Australian NH&MRC grant no. 991337. Address correspondence to C.M. (e-mail: caro@imrr.usyd.edu.au).

View larger version (24K): [in a new window]   Figure 1. One-dimensional 1H MR spectra of prostate biopsy specimens obtained at 8.5 T (256 acquisitions). A, Adenocarcinoma with 50% of the specimen involved. B, Adenocarcinoma with 5% of the specimen involved. C, Stromal BPH (95% stromal, 5% glandular). D, Glandular BPH (85% glandular, 15% stromal). The distinction between the abnormalities and tissue types are the result of variations of the creatine (3.0 ppm), choline (3.2 ppm), lipid (1.3 ppm), and lysine (1.7 ppm) resonances. See Table 1 for assignments. Acly = acetyl residues; Chol = choline; Cit = citrate; Cre = creatine; Glu/Gln = glutamate, glutamine; Ile = isoleucine; Lac = lactate; Leu = leucine; Lip = lipid; Lys = lysine; PA = spermine, spermidine, polyamines; Thr = threonine; Val = valine.

View larger version (24K): [in a new window]   Figure 2. Two-directional plot of MR spectroscopic ratios of tissue specimens reported to contain adenocarcinoma and those reported to contain BPH from patients without cancer elsewhere in the prostate gland. The choline-creatine ratio (3.2:3.0 ppm) is plotted on the y axis; the lipid-lysine ratio (1.3:1.7 ppm), on the x axis. Diagnosis was determined with routine histologic analysis of the tissue specimen analyzed with MR spectroscopy. There is a clear distinction between the two abnormalities. = adenocarcinoma, = BPH but no cancer elsewhere in prostate.

View larger version (29K): [in a new window]   Figure 3. Added to the information presented in Figure 2 are the data from patients with histologically identified BPH but also with cancer elsewhere in the prostate. Marked on the two-directional plots are numbers 1-3; these are the specimens in which the histologic results were corrected after serial slicing and examination. Yellow diamond = BPH but no cancer elsewhere, green square = histologically corrected after serial sectioning, red triangle = BPH and cancer elsewhere in the prostate, blue circle = adenocarcinoma.

View larger version (79K): [in a new window]   Figure 4. A, 1H MR spectrum from tissue histologically identified as adenocarcinoma. B, 1H MR spectrum from tissue histologically identified as glandular BPH from the same patient as in A. Histologic slides of each of these specimens are shown under the spectra. The MR spectra are similar, and both indicate malignancy, yet results of a routine hospital histologic examination indicate that specimen B is glandular BPH. (Hematoxylin-eosin stain; original magnification, x150.)