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Published online before print September 11, 2006, 10.1148/radiol.2412051866
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Prostate Cancer Localization with Dynamic Contrast-enhanced MR Imaging and Proton MR Spectroscopic Imaging1

Jurgen J. Fütterer, MD, PhD, Stijn W. T. P. J. Heijmink, MD, Tom W. J. Scheenen, PhD, Jeroen Veltman, MD, Henkjan J. Huisman, PhD, Pieter Vos, MSc, Christina A. Hulsbergen–Van de Kaa, MD, PhD, J. Alfred Witjes, MD, PhD, Paul F. M. Krabbe, PhD, Arend Heerschap, PhD and Jelle O. Barentsz, MD, PhD

1 From the Departments of Radiology (J.J.F., S.W.T.P.J.H., T.W.J.S., J.V., H.J.H., P.V., A.H., J.O.B.), Pathology (C.A.H.), Urology (J.A.W.), and Medical Technology Assessment (P.F.M.K.), Radboud University Nijmegen Medical Center, Geert Grooteplein zuid 10, NL 6500 HB, Nijmegen, the Netherlands. Received November 15, 2005; revision requested January 5, 2006; revision received March 21; accepted May 2; final version accepted May 19. Supported by the Dutch Cancer Society. Address correspondence to J.J.F. (e-mail: J.Futterer{at}rad.umcn.nl).


Figure 1
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  		Figure 1: Flow chart of the study profile based on recommended standards for reporting diagnostic accuracy (34). DCE-MRI = dynamic contrast-enhanced MR imaging, MRSI = MR spectroscopic imaging.

 

Figure 2
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  		Figure 2a: MR images and corresponding histopathologic section of prostate of 71-year-old man with prostate cancer (prostate-specific antigen level, 16.4 ng/mL; Gleason sum score, 6). (a) Transverse T2-weighted multiple-spin-echo image (4200/132) of prostate. (b–d) Pharmacokinetic maps of calculated Ktrans (b), kep (c), and washout (d), overlaid on T2-weighted image. (e) Overlay of volume of interest, MR spectroscopic matrix, and spectra on T2-weighted image, with spectra of eight voxels outlined in detail (right). Voxels in inset (right) show markedly reduced citrate (Ci) signal and increased choline-creatine (Cho+Cr)-to-citrate ratio in central gland of prostate (red box). Cho = choline. (f) Whole-mount histopathologic section at corresponding level shows tumor (T, outlined in blue) occupying almost entire left prostate lobe, including central gland. The tumor can be identified on both pharmacokinetic (b–d, circled in red) and spectroscopic (e, voxels with deviating metabolite ratios, in red box) maps.

 

Figure 2
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  		Figure 2b: MR images and corresponding histopathologic section of prostate of 71-year-old man with prostate cancer (prostate-specific antigen level, 16.4 ng/mL; Gleason sum score, 6). (a) Transverse T2-weighted multiple-spin-echo image (4200/132) of prostate. (b–d) Pharmacokinetic maps of calculated Ktrans (b), kep (c), and washout (d), overlaid on T2-weighted image. (e) Overlay of volume of interest, MR spectroscopic matrix, and spectra on T2-weighted image, with spectra of eight voxels outlined in detail (right). Voxels in inset (right) show markedly reduced citrate (Ci) signal and increased choline-creatine (Cho+Cr)-to-citrate ratio in central gland of prostate (red box). Cho = choline. (f) Whole-mount histopathologic section at corresponding level shows tumor (T, outlined in blue) occupying almost entire left prostate lobe, including central gland. The tumor can be identified on both pharmacokinetic (b–d, circled in red) and spectroscopic (e, voxels with deviating metabolite ratios, in red box) maps.

 

Figure 2
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  		Figure 2c: MR images and corresponding histopathologic section of prostate of 71-year-old man with prostate cancer (prostate-specific antigen level, 16.4 ng/mL; Gleason sum score, 6). (a) Transverse T2-weighted multiple-spin-echo image (4200/132) of prostate. (b–d) Pharmacokinetic maps of calculated Ktrans (b), kep (c), and washout (d), overlaid on T2-weighted image. (e) Overlay of volume of interest, MR spectroscopic matrix, and spectra on T2-weighted image, with spectra of eight voxels outlined in detail (right). Voxels in inset (right) show markedly reduced citrate (Ci) signal and increased choline-creatine (Cho+Cr)-to-citrate ratio in central gland of prostate (red box). Cho = choline. (f) Whole-mount histopathologic section at corresponding level shows tumor (T, outlined in blue) occupying almost entire left prostate lobe, including central gland. The tumor can be identified on both pharmacokinetic (b–d, circled in red) and spectroscopic (e, voxels with deviating metabolite ratios, in red box) maps.

 

Figure 2
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  		Figure 2d: MR images and corresponding histopathologic section of prostate of 71-year-old man with prostate cancer (prostate-specific antigen level, 16.4 ng/mL; Gleason sum score, 6). (a) Transverse T2-weighted multiple-spin-echo image (4200/132) of prostate. (b–d) Pharmacokinetic maps of calculated Ktrans (b), kep (c), and washout (d), overlaid on T2-weighted image. (e) Overlay of volume of interest, MR spectroscopic matrix, and spectra on T2-weighted image, with spectra of eight voxels outlined in detail (right). Voxels in inset (right) show markedly reduced citrate (Ci) signal and increased choline-creatine (Cho+Cr)-to-citrate ratio in central gland of prostate (red box). Cho = choline. (f) Whole-mount histopathologic section at corresponding level shows tumor (T, outlined in blue) occupying almost entire left prostate lobe, including central gland. The tumor can be identified on both pharmacokinetic (b–d, circled in red) and spectroscopic (e, voxels with deviating metabolite ratios, in red box) maps.

 

Figure 2
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  		Figure 2e: MR images and corresponding histopathologic section of prostate of 71-year-old man with prostate cancer (prostate-specific antigen level, 16.4 ng/mL; Gleason sum score, 6). (a) Transverse T2-weighted multiple-spin-echo image (4200/132) of prostate. (b–d) Pharmacokinetic maps of calculated Ktrans (b), kep (c), and washout (d), overlaid on T2-weighted image. (e) Overlay of volume of interest, MR spectroscopic matrix, and spectra on T2-weighted image, with spectra of eight voxels outlined in detail (right). Voxels in inset (right) show markedly reduced citrate (Ci) signal and increased choline-creatine (Cho+Cr)-to-citrate ratio in central gland of prostate (red box). Cho = choline. (f) Whole-mount histopathologic section at corresponding level shows tumor (T, outlined in blue) occupying almost entire left prostate lobe, including central gland. The tumor can be identified on both pharmacokinetic (b–d, circled in red) and spectroscopic (e, voxels with deviating metabolite ratios, in red box) maps.

 

Figure 2
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  		Figure 2f: MR images and corresponding histopathologic section of prostate of 71-year-old man with prostate cancer (prostate-specific antigen level, 16.4 ng/mL; Gleason sum score, 6). (a) Transverse T2-weighted multiple-spin-echo image (4200/132) of prostate. (b–d) Pharmacokinetic maps of calculated Ktrans (b), kep (c), and washout (d), overlaid on T2-weighted image. (e) Overlay of volume of interest, MR spectroscopic matrix, and spectra on T2-weighted image, with spectra of eight voxels outlined in detail (right). Voxels in inset (right) show markedly reduced citrate (Ci) signal and increased choline-creatine (Cho+Cr)-to-citrate ratio in central gland of prostate (red box). Cho = choline. (f) Whole-mount histopathologic section at corresponding level shows tumor (T, outlined in blue) occupying almost entire left prostate lobe, including central gland. The tumor can be identified on both pharmacokinetic (b–d, circled in red) and spectroscopic (e, voxels with deviating metabolite ratios, in red box) maps.

 

Figure 3
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  		Figure 3: ROI-ROC curves show Az values for dynamic MR parameters and MPKS for localization of prostate tumors with volumes of 0.5 cm3 or greater. MPKS yielded significantly greater Az compared with individual dynamic MR parameters (P < .01). V = ve.

 

Figure 4
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  		Figure 4a: (a, b) ROI-ROC curves show Az values for T2-weighted imaging (T2), MR spectroscopic imaging (MRS), MPKS at dynamic imaging, and dynamic and MR spectroscopic imaging combined (PKMRS) for prostate cancer localization in peripheral zone (a) and central gland (b). For both peripheral zone and central gland tumor localization, Az was significantly greater with MPKS than with MR spectroscopic imaging (P < .01), and both dynamic and MR spectroscopic imaging enabled significantly better tumor localization than did T2-weighted imaging.

 

Figure 4
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  		Figure 4b: (a, b) ROI-ROC curves show Az values for T2-weighted imaging (T2), MR spectroscopic imaging (MRS), MPKS at dynamic imaging, and dynamic and MR spectroscopic imaging combined (PKMRS) for prostate cancer localization in peripheral zone (a) and central gland (b). For both peripheral zone and central gland tumor localization, Az was significantly greater with MPKS than with MR spectroscopic imaging (P < .01), and both dynamic and MR spectroscopic imaging enabled significantly better tumor localization than did T2-weighted imaging.

 




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