| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Genitourinary Imaging |
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).
 |
Abstract |
|---|
 TOP Abstract IntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
|---|
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 (
= 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
|
Introduction |
|---|
|
TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
|---|
Surgery and radiation therapy represent the mainstays of prostate cancer treatment. The emerging concept of patient-specific localized tumor therapy aims to improve patient outcome by maintaining treatment efficacy while reducing treatment-associated morbidity. In this context, the accurate localization of prostate cancer within the prostate gland is becoming increasingly important, as it can affect surgical and radiation treatment planning and can guide the extent of cryosurgery. Furthermore, the choice of a watchful waiting strategy can be assisted with knowledge of tumor size and growth. The development of patient-specific therapy is limited by the inability of current diagnostic techniques to differentiate aggressive from indolent cancer and to accurately localize and stage this disease.
Transrectal US is widely used for guidance of prostate gland biopsy, but sensitivity and specificity are low in the localization of prostate cancer. Magnetic resonance (MR) imaging has a significantly higher sensitivity for tumor detection than does transrectal US but, like transrectal US, has low specificity (5–10). The addition of metabolic information from three-dimensional (3D) MR spectroscopic imaging to morphologic data from MR imaging may allow more specific diagnosis and localization of prostate cancer. MR spectroscopy has been used to obtain metabolic data from tumors in situ (11,12). Recent technical developments have allowed the application of localized three-dimensional proton 3D MR spectroscopic imaging to the in vivo evaluation of the human prostate (13). With use of 3D MR spectroscopic imaging, significantly higher choline levels and significantly lower citrate levels were observed in regions of cancer compared with areas of benign prostatic hypertrophy and normal prostatic tissue. The ratio of these metabolites (choline to citrate) in regions of cancer appears not to overlap with ratios in the normal peripheral zone, which suggests that 3D MR spectroscopic imaging combined with MR imaging may improve tumor detection and localization compared to those with MR imaging alone (13). Feasibility and technical development of prostatic 3D MR spectroscopic imaging have been reported (13), but the efficacy of 3D MR spectroscopic imaging in prostate cancer detection or combined results with MR imaging and 3D MR spectroscopic imaging data in the detection or localization of prostate cancer have not been described, to our knowledge.
The purpose of this study was to assess the effectiveness of combined 3D MR spectroscopic imaging and MR imaging for tumor detection and localization with results at step-section histopathologic examination as the standard of reference.
|
MATERIALS AND METHODS |
|---|
|
TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
|---|
Mean patient age was 60.2 years ± 7.1 (SD). Mean preoperative prostate-specific antigen was 8.2 ng/mL ± 5.0. The mean interval between the MR examination and radical retropubic prostatectomy was 28.4 days ± 23.0 (range, 1–86 days).
MR Imaging Technique
MR imaging was performed with a 1.5-T MR imaging system (Signa; GE Medical Systems, Milwaukee, Wis). The endorectal coil (Medrad, Pittsburgh, Pa) was connected to the pelvic phased-array coil, and combined images were obtained. After acquisition of a sagittal T2-weighted fast spin-echo localizer image to check coil position, transverse T2-weighted fast spin-echo images were obtained from below the apex of the prostate to above the seminal vesicles with the following parameters: repetition time msec/echo time msec (effective) of 4,000–5,000/102, 3-mm section thickness, no intersection gap, three signals acquired, 14-cm field of view, 256 x 192 matrix, no phase wrap. Transverse T1-weighted images (500–700/12, 4-mm-thick sections, 1-mm section gap, two signals acquired, 14-cm field of view, 256 x 192 matrix, no phase wrap) were then obtained from below the apex of the prostate to the level of the aortic bifurcation to assess for sites of postbiopsy bleeding and pelvic lymphadenopathy. All images were analytically corrected for the reception profile of the endorectal and pelvic phased-array coils (15). The total examination time, including patient positioning, coil placement, MR imaging, and 3D MR spectroscopic imaging, was typically 50–60 minutes.
Three-dimensional MR Spectroscopic Imaging Protocol
The 3D MR spectroscopic imaging technique has been previously described in detail (13,16,17). In brief, from the high-spatial-resolution transverse T2-weighted images, a spectroscopic volume was selected with the point-resolved spectroscopic, or PRESS, technique to encompass as much of the prostate as possible, while excluding periprostatic fat. The echo delay of the point-resolved spectroscopic sequence (130 msec) was optimized for the quantitative detection of both citrate and choline. The position of the selected volume and the accuracy of localization were evaluated by means of MR imaging. A 3D MR spectroscopic imaging data set was acquired with a spatial resolution of 0.24–0.70 cm3. Studies were performed with 1,000/130, a spectral width of 1,250 Hz, 512 points, 8 x 8 x 8 phase-encoding steps with two signals or 16 x 8 x 8 with one signal acquired per phase-encoding step, yielding 512 or 1,024 proton MR spectra, respectively, of which between 40 and 332 were from within the prostate, depending on gland size and spatial resolution. Technical improvements during the study resulted in improved craniocaudal coverage of the peripheral zone of the prostate gland, which was increased from 20%–50% to 70%–100%. For this study, 3D MR spectroscopic imaging provided peripheral zone coverage of less than 25% in one patient, 25.0%–49.9% in 17 patients, 50.0%–74.9% in 23 patients, and 75%–100% in 12 patients.
MR Image Analysis
All images were interpreted retrospectively by two independent readers (H.H., K.K.Y.) unaware of clinical, 3D MR spectroscopic imaging, and histopathologic findings. Both readers knew that all patients had biopsy-proved prostate cancer. Reader 1 was more experienced than reader 2 and had interpreted at least twice the number of prostatic studies (at least 500 over the preceding 5 years).
To allow for direct comparison between MR imaging and 3D MR spectroscopic imaging, MR image evaluation was performed on only sections covered at 3D MR spectroscopic imaging. The presence of cancer, identified as an area of low signal intensity within the peripheral zone on T2-weighted images, was recorded for each section by each of the two readers independently and entered on a standardized form developed for this study. For each examination, the likelihood of tumor presence was estimated with a 5-point rating scale: 1, normal tissue; 2, probably normal tissue; 3, possible cancer; 4, probable cancer; 5, definite cancer. For calculation of sensitivity and specificity, these results were dichotomized so that cancer was diagnosed for scores 4 and 5 and was not diagnosed for scores 1–3.
Three-dimensional MR Spectroscopic Imaging Data Processing
All 3D MR spectroscopic imaging data were transferred off-line and processed on an UltraSparc workstation (Sun Microsystems, Mountain View, Calif) with software developed for 3D MR spectroscopic imaging studies. The spectral data sets were apodized with a 2-Hz Lorentzian function and were Fourier transformed in the time domain and three spatial domains. After frequency, phase, and baseline correction (16), the integral areas for the choline, creatine, and citrate resonances were calculated (13,16). In addition to the peak parameters, the quantification algorithm was also used to estimate random noise and, hence, the accuracy of the estimates of peak metabolite areas. To discriminate between cancer and normal prostatic tissue in the peripheral zone, we calculated the peak area ratios of choline plus creatine to citrate and citrate to normal citrate for each voxel (13). These ratios and the signal-to-noise ratios for choline and citrate were reported as the mean plus or minus SD. Possible cancer was defined as voxels with a ratio of choline plus creatine to citrate of greater than 2 SD above normal (>0.75) or a twofold decrease in citrate over normal citrate as determined in a previous study (13). Definite cancer was identified when the ratio of choline plus creatine to citrate was greater than 3 SD above normal (>0.86). Voxels with a ratio of choline plus creatine to citrate of less than 0.75 were considered normal peripheral zone tissue. To enable receiver-operating-characteristic (ROC) analysis, the same rating scale used for MR imaging was used for 3D MR spectroscopic imaging.
To correlate metabolic data with anatomy and histopathologic findings within the same study, data were displayed by plotting proton spectral arrays on the corresponding transverse T2-weighted images. The 3D MR spectroscopic imaging phase-encoding grid and the outline of the selected volume were superimposed on the T2-weighted images. The use of the same gradients and the same patient position within a study allowed alignment of MR imaging and 3D MR spectroscopic imaging data.
Histopathologic Review
After surgical resection, the prostate gland was coated with India ink and fixed in 10% buffered formaldehyde. The gland was transversely sectioned at 3–4-mm intervals in a plane perpendicular to the long axis (base to apex) of the gland. Presence, location, and extent of cancer was determined and entered on standardized histopathologic forms with diagrams that corresponded to the MR imaging data forms.
Mean surgical histopathologic Gleason score was 5.3 ± 1.0 (range, 4–10). Unilateral disease was present in 14 patients, and bilateral multifocal cancer was present in 39 (74%). At histopathologic analysis, 38 of 53 patients (72%) had disease confined to the gland (stage pT2a, five patients; stage pT2b, four patients; stage pT2c, 29 patients). Twelve patients had unilateral extracapsular extension (stage pT3a), one patient had bilateral extracapsular extension (stage pT3b), and two patients had seminal vesicle invasion (stage pT3c).
Correlation of MR Imaging and 3D MR Spectroscopic Imaging Findings with Histopathologic Findings
One of the authors (J.S.), who was not a reader of either MR imaging or 3D MR spectroscopic imaging data, assembled all of the images for interpretation, maintained the database of histopathologic information, and correlated MR imaging and 3D MR spectroscopic imaging findings with the results at histopathologic examination. The correlation was performed on a section-by-section basis. However, the definition of matching sections was complicated by differences in technique. In particular, the angle at which the histopathologic sections were cut often differed from the angle at which imaging was performed (difference of 5°–20°). The size and shape of the prostate may also change as a result of tissue shrinkage during fixation. MR and 3D MR spectroscopic images were acquired with 3-mm section thickness without gap, whereas histopathologic slices were 5-mm thick and made every 3–4 mm. To correct for these differences in sectioning technique, a tumor site on MR or 3D MR spectroscopic images was considered to match the histopathologic site if the tumor was present in the peripheral zone of the same sextant of the prostate (right or left base, right or left middle gland, right or left apex) within a range of one section (craniocaudal distance, ±3–4 mm). In addition, the tumor had to be in the same anterior or posterior location. Sections through the bladder neck and proximal prostatic urethra were considered the prostatic base, whereas the prostatic apex was defined on the basis of the doughnut-like appearance of the distal prostatic urethra. The remainder of the prostate was considered the middle gland. Data analysis included evaluation of the ability of MR imaging and 3D MR spectroscopic imaging to localize tumor to a sextant or side of the prostate.
Statistical Analysis
Descriptive statistics included sensitivity and specificity with their corresponding 95% CIs and positive and negative predictive values for each test. The McNemar test was used to determine whether there were any statistically significant (P < .05) differences in diagnostic accuracy between MR imaging and 3D MR spectroscopic imaging for both readers. Complementarity of MR imaging and 3D MR spectroscopic imaging results was assessed by calculating the 95% CIs for the probability that 3D MR spectroscopic imaging can depict or exclude additional tumor sites compared with findings at MR imaging (18). ROC analysis was used to compare the results at MR imaging to those with the combination of MR imaging and 3D MR spectroscopic imaging. Results of MR imaging and 3D MR spectroscopic imaging were combined by adding the MR imaging result (scores 1-5 in the rating scale) to the 3D MR spectroscopic imaging ratings (scores 1, 3, and 5 in the rating scale). The method of Hanley and McNeil was used for the paired testing of significance of difference in area under the ROC curve (Az) (19). Interreader agreement on MR image interpretation was quantified with statistics, with less than 0.4 considered poor agreement, between 0.40 and 0.75 considered good agreement, and greater than 0.75 considered excellent agreement.
|
RESULTS |
|---|
|
TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
|---|
Tables 1 and 2 summarize the results of MR imaging and 3D MR spectroscopic imaging on a sextant-by-sextant basis (Table 1) and for tumor lateralization (Table 2). Although there were no significant differences in diagnostic accuracy between readers 1 and 2 with MR imaging, ROC analysis revealed significantly (P < .01) better performance of reader 1 (Az = 0.73) compared with reader 2 (Az = 0.68) (Fig 1). Interreader agreement for tumor detection was moderate ( = 0.43). When the MR imaging results of readers 1 and 2 were compared to their results with 3D MR spectroscopic imaging for definite cancer, there was a trend toward higher sensitivity with MR imaging (both readers) and higher specificity with 3D MR spectroscopic imaging. Figures 2 and 3 show sample MR images with the corre- sponding 3D MR spectroscopic imaging results and histopathologic sections. Lowering of the threshold for cancer detection with 3D MR spectroscopic imaging (possible cancer) resulted in efficacy data similar to those with MR imaging.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
A false-positive diagnosis of tumor was made with 3D MR spectroscopic imaging in five prostatic lobes. In three cases, the false-positive diagnosis was obtained in early studies with larger voxels, which led to contamination of the spectra from periurethral and central gland tissue. In one case, a single 0.24-cm3 voxel was positive in a lobe in which no cancer was found at histopathologic examination. In the remaining case, no apparent explanation for the false-positive result could be found.
Complementary Role of MR Imaging and 3D MR Spectroscopic Imaging
For ROC analysis of combined MR imaging and 3D MR spectroscopic imaging, results with MR imaging were added to the results with 3D MR spectroscopic imaging, which provided approximately equally weighting for both MR imaging and 3D MR spectroscopic imaging. ROC curves with combined MR imaging and 3D MR spectroscopic imaging are shown in Figure 1. ROC analysis demonstrated that the addition of 3D MR spectroscopic imaging data to MR imaging data improved Az to 0.80 (reader 1) and 0.77 (reader 2), which is significantly increased compared to results with MR imaging alone (Az = 0.73 for reader 1 and Az = 0.68 for reader 2, P < .001 for both readers).
Descriptive statistical data with combined MR imaging and 3D MR spectroscopic imaging are summarized in Table 3. Compared with MR imaging alone, detection of cancer with combined MR imaging and 3D MR spectroscopic imaging (possible or definite cancer) resulted in significantly higher specificity but lower sensitivity, whereas detection of cancer with either MR imaging or 3D MR spectroscopic imaging alone resulted in significantly higher sensitivity but lower specificity. The combination of MR imaging and 3D MR spectroscopic imaging findings that was most predictive of cancer in a sextant (positive predictive value, 89%–92%) was the detection of cancer with both MR imaging and 3D MR spectroscopic imaging (>3 SDs, definite cancer). The combination that was most useful for excluding the presence of cancer in a sextant (negative predictive value, 74%–82%) was the absence of cancer with either MR imaging or 3D MR spectroscopic imaging (>2 SDs, definite or possible cancer).
|
|
DISCUSSION |
|---|
|
TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
|---|
Current diagnostic strategies have limitations in tumor detection and localization. Transrectal US fails to depict as many as 8%–30% of lesions palpable at digital rectal examination. Transrectal US also has a high false-positive rate in cancer evaluation because only 20% of hypoechoic lesions (US finding most indicative of cancer) are malignant (35,36). MR imaging with a combined endorectal and phased-array coil has demonstrated a high sensitivity (91%) but low specificity (27%) in tumor lateralization (5). Initial reports about 3D MR spectroscopic imaging show that the ability of this technique to distinguish between cancer, benign prostatic hypertrophy, and normal prostatic tissue suggests that the addition of 3D MR spectroscopic imaging to clinical MR imaging may increase the specificity of MR imaging in tumor detection and localization (13,37). In this study, we evaluated this hypothesis by correlating results with MR imaging, 3D MR spectroscopic imaging, or both to those with step-section histopathologic examination in patients who underwent prostatectomy.
Data points on the ROC curve indicated a significantly better performance with combined MR imaging and 3D MR spectroscopic imaging than with MR imaging alone. With use of various combinations of MR imaging and 3D MR spectroscopic imaging, a point on the ROC curve can be chosen that provides either high sensitivity or high specificity depending on clinical requirements. Three-dimensional MR spectroscopic imaging demonstrated a significantly higher specificity in tumor localization than did MR imaging. A positive result with combined MR imaging and 3D MR spectroscopic imaging (>3 SDs) indicated the presence of tumor with high probability (positive predictive value, 89%–92%), whereas a negative result (>2 SDs) excluded the presence of cancer with high probability (negative predictive value, 74%–82%).
Findings in the preliminary study by Vigneron et al (38) suggest that small, low-grade tumors may be undetected with 3D MR spectroscopic imaging because the severity of metabolite alteration correlates with tumor aggressiveness. High-grade cancers (Gleason scores 7 and 8) revealed highly elevated choline resonances, whereas lower grade tumors (Gleason scores 4 and 5) showed slightly elevated choline levels only (38). Other reasons for wrong 3D MR spectroscopic imaging results in our pilot study, such as box placement errors and spectral contamination in large voxels, can now be avoided. The experience gained with 3D MR spectroscopic imaging has led to standardization of the technique and important progress in the development of 3D MR spectroscopic imaging as a clinically useful tool. During the period of this study, technical developments resulted in improved spatial resolution (from 0.7 to 0.24 cm3), complete gland coverage, and reduction in total examination time (for both MR imaging and 3D MR spectroscopic imaging).
In conclusion, findings in this study demonstrate the potential usefulness of combined morphologic and metabolic information about prostate cancer in clinical practice and provide an analysis of this new method. Our findings show that the addition of 3D MR spectroscopic imaging to MR imaging provides better detection and localization of prostate cancer in a sextant of the prostate, with sensitivity and specificity higher than those with MR imaging alone.
|
Footnotes |
|---|
Abbreviations: Az = area under the receiver operating characteristic curve ROC = receiver operating characteristic 3D = three-dimensional
Author contributions: Guarantor of integrity of entire study, H.H.; study concepts and design, H.H., J.S., J.K.; definition of intellectual content, H.H., J.K.; literature research, J.S.; clinical studies, J.S., P.R.C.; data acquisition, J.S., H.H., D.B.V., D.L.S., L.R.H., C.J.Z., S.J.N., J.K.; data analysis, J.S., K.K.Y.; statistical analysis, J.S., K.K.Y.; manuscript preparation, J.S., K.K.Y., H.H.; manuscript editing, K.K.Y., H.H.; manuscript review, D.B.V., P.R.C., J.K., S.J.N.
|
References |
|---|
|
TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
|---|
Related Article
This article has been cited by other articles:
|
|
 |
|
  G. J. Kelloff, P. Choyke, D. S. Coffey, and for The Prostate Cancer Imaging Working Group Challenges in Clinical Prostate Cancer: Role of Imaging Am. J. Roentgenol., June 1, 2009; 192(6): 1455 - 1470. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Turkbey, P. S. Albert, K. Kurdziel, and P. L. Choyke Imaging Localized Prostate Cancer: Current Approaches and New Developments Am. J. Roentgenol., June 1, 2009; 192(6): 1471 - 1480. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Weinreb, J. D. Blume, F. V. Coakley, T. M. Wheeler, J. B. Cormack, C. K. Sotto, H. Cho, A. Kawashima, C. M. Tempany-Afdhal, K. J. Macura, et al. Prostate Cancer: Sextant Localization at MR Imaging and MR Spectroscopic Imaging before Prostatectomy--Results of ACRIN Prospective Multi-institutional Clinicopathologic Study Radiology, April 1, 2009; 251(1): 122 - 133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Spratlin, N. J. Serkova, and S. G. Eckhardt Clinical Applications of Metabolomics in Oncology: A Review Clin. Cancer Res., January 15, 2009; 15(2): 431 - 440. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Langer, T. H. van der Kwast, A. J. Evans, L. Sun, M. J. Yaffe, J. Trachtenberg, and M. A. Haider Intermixed Normal Tissue within Prostate Cancer: Effect on MR Imaging Measurements of Apparent Diffusion Coefficient and T2--Sparse versus Dense Cancers Radiology, December 1, 2008; 249(3): 900 - 908. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Albers, R. Bok, A. P. Chen, C. H. Cunningham, M. L. Zierhut, V. Y. Zhang, S. J. Kohler, J. Tropp, R. E. Hurd, Y.-F. Yen, et al. Hyperpolarized 13C Lactate, Pyruvate, and Alanine: Noninvasive Biomarkers for Prostate Cancer Detection and Grading Cancer Res., October 15, 2008; 68(20): 8607 - 8615. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Plathow and W. A. Weber Tumor Cell Metabolism Imaging J. Nucl. Med., June 1, 2008; 49(Suppl_2): 43S - 63S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Choi and J. Ma Use of Perfluorocarbon Compound in the Endorectal Coil to Improve MR Spectroscopy of the Prostate Am. J. Roentgenol., April 1, 2008; 190(4): 1055 - 1059. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. McKenna, F. V. Coakley, A. C. Westphalen, S. Zhao, Y. Lu, E. M. Webb, B. Pickett, M. Roach III, and J. Kurhanewicz Prostate Cancer: Role of Pretreatment MR in Predicting Outcome after External-Beam Radiation Therapy--Initial Experience Radiology, April 1, 2008; 247(1): 141 - 146. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Mazaheri, A. Shukla-Dave, H. Hricak, S. W. Fine, J. Zhang, G. Inurrigarro, C. S. Moskowitz, N. M. Ishill, V. E. Reuter, K. Touijer, et al. Prostate Cancer: Identification with Combined Diffusion-weighted MR Imaging and 3D 1H MR Spectroscopic Imaging--Correlation with Pathologic Findings Radiology, February 1, 2008; 246(2): 480 - 488. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. Westphalen, F. V. Coakley, A. Qayyum, M. Swanson, J. P. Simko, Y. Lu, S. Zhao, P. R. Carroll, B. M. Yeh, and J. Kurhanewicz Peripheral Zone Prostate Cancer: Accuracy of Different Interpretative Approaches with MR and MR Spectroscopic Imaging Radiology, December 1, 2007; 246(1): 177 - 184. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Shukla-Dave, H. Hricak, C. Moskowitz, N. Ishill, O. Akin, K. Kuroiwa, J. Spector, M. Kumar, V. E. Reuter, J. A. Koutcher, et al. Detection of Prostate Cancer with MR Spectroscopic Imaging: An Expanded Paradigm Incorporating Polyamines Radiology, November 1, 2007; 245(2): 499 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Kundra, P. M. Silverman, S. F. Matin, and H. Choi Imaging in Oncology from The University of Texas M. D. Anderson Cancer Center: Diagnosis, Staging, and Surveillance of Prostate Cancer Am. J. Roentgenol., October 1, 2007; 189(4): 830 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. N. Bloch, E. Furman-Haran, T. H. Helbich, R. E. Lenkinski, H. Degani, C. Kratzik, M. Susani, A. Haitel, S. Jaromi, L. Ngo, et al. Prostate Cancer: Accurate Determination of Extracapsular Extension with High-Spatial-Resolution Dynamic Contrast-enhanced and T2-weighted MR Imaging Initial Results Radiology, October 1, 2007; 245(1): 176 - 185. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Testa, R. Schiavina, R. Lodi, E. Salizzoni, B. Corti, M. Farsad, J. Kurhanewicz, F. Manferrari, E. Brunocilla, C. Tonon, et al. Prostate Cancer: Sextant Localization with MR Imaging, MR Spectroscopy, and 11C-Choline PET/CT Radiology, September 1, 2007; 244(3): 797 - 806. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Haider, T. H. van der Kwast, J. Tanguay, A. J. Evans, A.-T. Hashmi, G. Lockwood, and J. Trachtenberg Combined T2-Weighted and Diffusion-Weighted MRI for Localization of Prostate Cancer Am. J. Roentgenol., August 1, 2007; 189(2): 323 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Hricak, P. L. Choyke, S. C. Eberhardt, S. A. Leibel, and P. T. Scardino Imaging Prostate Cancer: A Multidisciplinary Perspective Radiology, April 1, 2007; 243(1): 28 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. G. Costouros, F. V. Coakley, A. C. Westphalen, A. Qayyum, B. M. Yeh, B. N. Joe, and J. Kurhanewicz Diagnosis of Prostate Cancer in Patients with an Elevated Prostate-Specific Antigen Level: Role of Endorectal MRI and MR Spectroscopic Imaging Am. J. Roentgenol., March 1, 2007; 188(3): 812 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Graser, A. Heuck, B. Sommer, J. Massmann, J. Scheidler, M. Reiser, and U. Mueller-Lisse Per-Sextant Localization and Staging of Prostate Cancer: Correlation of Imaging Findings with Whole-Mount Step Section Histopathology Am. J. Roentgenol., January 1, 2007; 188(1): 84 - 90. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Reinsberg, G. S. Payne, S. F. Riches, S. Ashley, J. M. Brewster, V. A. Morgan, and N. M. deSouza Combined Use of Diffusion-Weighted MRI and 1H MR Spectroscopy to Increase Accuracy in Prostate Cancer Detection Am. J. Roentgenol., January 1, 2007; 188(1): 91 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. J. Choi, J. K. Kim, N. Kim, K. W. Kim, E. K. Choi, and K.-S. Cho Functional MR Imaging of Prostate Cancer RadioGraphics, January 1, 2007; 27(1): 63 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Futterer, S. W. T. P. J. Heijmink, T. W. J. Scheenen, J. Veltman, H. J. Huisman, P. Vos, C. A. H.-V. de Kaa, J. A. Witjes, P. F. M. Krabbe, A. Heerschap, et al. Prostate Cancer Localization with Dynamic Contrast-enhanced MR Imaging and Proton MR Spectroscopic Imaging Radiology, November 1, 2006; 241(2): 449 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Wetter, T. A. Engl, D. Nadjmabadi, K. Fliessbach, T. Lehnert, J. Gurung, W.-D. Beecken, and T. J. Vogl Combined MRI and MR spectroscopy of the prostate before radical prostatectomy. Am. J. Roentgenol., September 1, 2006; 187(3): 724 - 730. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G S Payne and M O Leach Applications of magnetic resonance spectroscopy in radiotherapy treatment planning Br. J. Radiol., September 1, 2006; 79(Special_Issue_1): S16 - S26. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. N. Reske, N. M. Blumstein, B. Neumaier, H.-W. Gottfried, F. Finsterbusch, D. Kocot, P. Moller, G. Glatting, and S. Perner Imaging Prostate Cancer with 11C-Choline PET/CT J. Nucl. Med., August 1, 2006; 47(8): 1249 - 1254. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-Y. Chen, C.-W. Li, Y.-T. Kuo, T.-S. Jaw, D.-K. Wu, J.-C. Jao, J.-S. Hsu, and G.-C. Liu Early Response of Hepatocellular Carcinoma to Transcatheter Arterial Chemoembolization: Choline Levels and MR Diffusion Constants--Initial Experience Radiology, May 1, 2006; 239(2): 448 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Sala, S. C. Eberhardt, O. Akin, C. S. Moskowitz, C. N. Onyebuchi, K. Kuroiwa, N. Ishill, M. J. Zelefsky, J. A. Eastham, and H. Hricak Endorectal MR Imaging before Salvage Prostatectomy: Tumor Localization and Staging Radiology, January 1, 2006; 238(1): 176 - 183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Hricak MR imaging and MR spectroscopic imaging in the pre-treatment evaluation of prostate cancer Br. J. Radiol., October 1, 2005; 78(Special_Issue_2): S103 - S111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Prando, J. Kurhanewicz, A. P. Borges, E. M. Oliveira Jr, and E. Figueiredo Prostatic Biopsy Directed with Endorectal MR Spectroscopic Imaging Findings in Patients with Elevated Prostate Specific Antigen Levels and Prior Negative Biopsy Findings: Early Experience Radiology, September 1, 2005; 236(3): 903 - 910. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Pucar, A. Shukla-Dave, H. Hricak, C. S. Moskowitz, K. Kuroiwa, S. Olgac, L. E. Ebora, P. T. Scardino, J. A. Koutcher, and K. L. Zakian Prostate Cancer: Correlation of MR Imaging and MR Spectroscopy with Pathologic Findings after Radiation Therapy-Initial Experience Radiology, August 1, 2005; 236(2): 545 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Huisman, J. J. Futterer, E. N. J. T. van Lin, A. Welmers, T. W. J. Scheenen, J. A. van Dalen, A. G. Visser, J. A. Witjes, and J. O. Barentsz Prostate Cancer: Precision of Integrating Functional MR Imaging with Radiation Therapy Treatment by Using Fiducial Gold Markers Radiology, July 1, 2005; 236(1): 311 - 317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Aberle, C. Chiles, C. Gatsonis, B. J. Hillman, C. D. Johnson, B. L. McClennan, D. G. Mitchell, E. D. Pisano, M. D. Schnall, and A. G. Sorensen Imaging and Cancer: Research Strategy of the American College of Radiology Imaging Network Radiology, June 1, 2005; 235(3): 741 - 751. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. L. Zakian, K. Sircar, H. Hricak, H.-N. Chen, A. Shukla-Dave, S. Eberhardt, M. Muruganandham, L. Ebora, M. W. Kattan, V. E. Reuter, et al. Correlation of Proton MR Spectroscopic Imaging with Gleason Score Based on Step-Section Pathologic Analysis after Radical Prostatectomy Radiology, March 1, 2005; 234(3): 804 - 814. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Beyersdorff, A. Winkel, B. Hamm, S. Lenk, S. A. Loening, and M. Taupitz MR Imaging-guided Prostate Biopsy with a Closed MR Unit at 1.5 T: Initial Results Radiology, February 1, 2005; 234(2): 576 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Jung, F. V. Coakley, D. B. Vigneron, M. G. Swanson, A. Qayyum, V. Weinberg, K. D. Jones, P. R. Carroll, and J. Kurhanewicz Prostate Depiction at Endorectal MR Spectroscopic Imaging: Investigation of a Standardized Evaluation System Radiology, December 1, 2004; 233(3): 701 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. V. Coakley, H. S. Teh, A. Qayyum, M. G. Swanson, Y. Lu, M. Roach III, B. Pickett, K. Shinohara, D. B. Vigneron, and J. Kurhanewicz Endorectal MR Imaging and MR Spectroscopic Imaging for Locally Recurrent Prostate Cancer after External Beam Radiation Therapy: Preliminary Experience Radiology, November 1, 2004; 233(2): 441 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. G. Claus, H. Hricak, and R. R. Hattery Pretreatment Evaluation of Prostate Cancer: Role of MR Imaging and 1H MR Spectroscopy RadioGraphics, October 1, 2004; 24(suppl_1): S167 - S180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Wang, M. Mullerad, H.-N. Chen, S. C. Eberhardt, M. W. Kattan, P. T. Scardino, and H. Hricak Prostate Cancer: Incremental Value of Endorectal MR Imaging Findings for Prediction of Extracapsular Extension Radiology, July 1, 2004; 232(1): 133 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Shukla-Dave, H. Hricak, S. C. Eberhardt, S. Olgac, M. Muruganandham, P. T. Scardino, V. E. Reuter, J. A. Koutcher, and K. L. Zakian Chronic Prostatitis: MR Imaging and 1H MR Spectroscopic Imaging Findings--Initial Observations Radiology, June 1, 2004; 231(3): 717 - 724. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Dhingsa, A. Qayyum, F. V. Coakley, Y. Lu, K. D. Jones, M. G. Swanson, P. R. Carroll, H. Hricak, and J. Kurhanewicz Prostate Cancer Localization with Endorectal MR Imaging and MR Spectroscopic Imaging: Effect of Clinical Data on Reader Accuracy Radiology, January 1, 2004; 230(1): 215 - 220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. L. Zakian, S. Eberhardt, H. Hricak, A. Shukla-Dave, S. Kleinman, M. Muruganandham, K. Sircar, M. W. Kattan, V. E. Reuter, P. T. Scardino, et al. Transition Zone Prostate Cancer: Metabolic Characteristics at H MR Spectroscopic Imaging--Initial Results Radiology, October 1, 2003; 229(1): 241 - 247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Swindle, S. McCredie, P. Russell, U. Himmelreich, M. Khadra, C. Lean, and C. Mountford Pathologic Characterization of Human Prostate Tissue with Proton MR Spectroscopy Radiology, July 1, 2003; 228(1): 144 - 151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Beyersdorff, M. Taupitz, B. Winkelmann, T. Fischer, S. Lenk, S. A. Loening, and B. Hamm Patients with a History of Elevated Prostate-Specific Antigen Levels and Negative Transrectal US-guided Quadrant or Sextant Biopsy Results: Value of MR Imaging Radiology, September 1, 2002; 224(3): 701 - 706. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. R. DeGrado, S. W. Baldwin, S. Wang, M. D. Orr, R. P. Liao, H. S. Friedman, R. Reiman, D. T. Price, and R. E. Coleman Synthesis and Evaluation of 18F-Labeled Choline Analogs as Oncologic PET Tracers J. Nucl. Med., December 1, 2001; 42(12): 1805 - 1814. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Thornbury, D. K. Ornstein, P. L. Choyke, C. P. Langlotz, and J. C. Weinreb Prostate Cancer: What Is the Future Role for Imaging? Am. J. Roentgenol., January 1, 2001; 176(1): 17 - 22. [Full Text]
|
|
|
|
|
|
S. M. Larson Molecular Imaging in Oncology: The Diagnostic Imaging "Revolution" Clin. Cancer Res., June 1, 2000; 6(6): 2125 - 2125. [Full Text]
|
|
|
|
|
|
T. R. DeGrado, R. E. Coleman, S. Wang, S. W. Baldwin, M. D. Orr, C. N. Robertson, T. J. Polascik, and D. T. Price Synthesis and Evaluation of 18F-labeled Choline as an Oncologic Tracer for Positron Emission Tomography: Initial Findings in Prostate Cancer Cancer Res., January 1, 2000; 61(1): 110 - 117. [Abstract] [Full Text]
|
|
|
|
|
|
U. G. Mueller-Lisse, D. B. Vigneron, H. Hricak, M. G. Swanson, P. R. Carroll, A. Bessette, J. Scheidler, A. Srivastava, R. G. Males, I. Cha, et al. Localized Prostate Cancer: Effect of Hormone Deprivation Therapy Measured by Using Combined Three-dimensional 1H MR Spectroscopy and MR Imaging: Clinicopathologic Case-controlled Study Radiology, November 1, 2001; 221(2): 380 - 390. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| RADIOLOGY | RADIOGRAPHICS | RSNA JOURNALS ONLINE |
