| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Genitourinary Imaging |
1 From the Departments of Urology (M.M., M.W.K., P.T.S.) and Radiology (H.H., L.W., H.N.C.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021. Received August 6, 2003; revision requested September 18; revision received December 19; accepted January 13, 2004. Supported by National Institutes of Health grant R01 CA76423. Address correspondence to H.H. (e-mail: muellnea@mskcc.org).
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
MATERIALS AND METHODS: In this cohort study, 344 consecutive patients with biopsy-proved prostate cancer underwent endorectal MR imaging followed by surgery. Likelihood of ECE described in MR imaging reports was compared with clinical predictor variables. ECE was determined from the final pathologic report on specimens resected at surgery. Readers of MR images were classified into genitourinary MR imaging radiologists (n = 4) and general body MR imaging radiologists (n = 6). For data analysis, Wilcoxon rank sum and 
2 tests, as well as receiver operating characteristic (ROC) curves and univariate and multivariate logistic regression analyses, were used. A difference with P < .05 was considered significant.
RESULTS: Univariate analysis results demonstrated that all predictors except clinical stage were significantly associated with detection of ECE in both groups of readers (P < .05). In the genitourinary MR imaging radiologist group of patients, area under the ROC curve for endorectal MR imaging findings (0.833) was larger than areas under the curves for all other predictors (0.566–0.701). In the general body MR imaging radiologist group of patients, area under the ROC curve for endorectal MR imaging findings (0.646) was not larger than areas under the curves for all other predictors (0.582–0.793). Results of multivariate analysis of two models, one with all predictors and another with all predictors except endorectal MR imaging findings, demonstrated a significant increase in area under the ROC curve with endorectal MR images interpreted by genitourinary MR imaging radiologists (P = .019 and .31, respectively).
CONCLUSION: Endorectal MR imaging findings are significant predictors for detection of ECE when MR images are interpreted by genitourinary radiologists experienced with MR imaging of the prostate.
© RSNA, 2004
Index terms: Diagnostic radiology, observer performance • Magnetic resonance (MR), coils, 844.121411, 844.121419 • Magnetic resonance (MR), spectroscopy, 844.12145 • Prostate, biopsy, 844.1261 • Receiver operating characteristic (ROC) curve
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
Presurgical variables commonly used for the prediction of pathologic stage of prostate cancer are prostate-specific antigen (PSA) level, Gleason score, and clinical tumor stage (evaluated with findings at digital rectal examination and transrectal ultrasonography) (1–3). Nomographic models have been created to help physicians predict the final pathologic stage of the tumor and the risk of cancer recurrence within 5 years on the basis of the patient’s individual parameters (1–3). These nomograms provide a statistical prediction but lack anatomic data that can assist in intervention aimed to control local disease. Therefore, the quest for a better diagnostic test that would enable physicians to differentiate between advanced and localized disease and improve treatment planning led to the evaluation of the role of endorectal magnetic resonance (MR) imaging in the localization and the staging of prostate cancer. Researchers in early studies reported inter- and intraobserver variability, as well as inconsistency in the accuracy of diagnoses determined with MR imaging findings (4–8). Data in these reports in part may explain why 20 years after the introduction of MR imaging to clinical practice, referring physicians tend to regard this modality as having limited value for evaluation of patients with prostate cancer (9).
The aim of our study was to determine whether the predictive value of endorectal MR imaging findings in the detection of ECE is significantly affected by the reader’s subspecialty experience.
|
MATERIALS AND METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
Imaging and Image Interpretation
Endorectal MR imaging and hydrogen 1 MR spectroscopic imaging were performed with a 1.5-T whole-body MR imaging unit (Signa Horizon; GE Medical Systems, Milwaukee, Wis). The examination was performed with patients in the supine position. A body coil was used for excitation, and a pelvic phased-array coil (GE Medical Systems) combined with a commercially available balloon-covered expandable endorectal coil (Medrad, Pittsburgh, Pa) was used for signal reception. Transverse T1-weighted and spin-echo MR images were obtained from the aortic bifurcation to the symphysis pubis with the following parameters: repetition time msec/echo time msec, 700/8; section thickness, 5 mm; intersection gap, 1 mm; field of view, 24 cm; matrix, 256 x 192; and frequency direction, transverse (to prevent obstruction of the pelvic node from endorectal coil motion artifact). One signal was acquired.
Transverse and coronal thin-section high-spatial-resolution T2-weighted fast spin-echo MR images of the prostate and seminal vesicle were obtained with the following parameters: 5,000/96 (effective); echo train length, 16; section thickness, 3 mm; intersection gap, 0 mm; field of view, 14 cm; matrix, 256 x 192; frequency direction, anteroposterior (to prevent obstruction of the prostate from endorectal coil motion artifact); and number of signals acquired, three.
MR spectroscopic imaging was performed by using point-resolved spectroscopic voxel excitation (11), band-selective inversion with gradient dephasing water and lipid suppression (12), and spatial encoding with chemical shift imaging (13) at 6.25-mm resolution in all three dimensions (left-right, anterior-posterior, superior-inferior dimensions). Parameters were 1,000/130, and imaging time was 17 minutes.
Data processing was performed at a workstation (Sun Ultra 10; Sun Microsystems, Mountain View, Calif) and included 2-Hz Lorentzian spectral apodization; four-dimensional Fourier transform; and automated frequency, phase, and baseline correction (14). Spectral data were zero filled to 3.1-mm resolution in the superior-inferior dimension and overlaid on corresponding transverse T2-weighted MR images. Peak areas were calculated by using numeric integration. To provide a noise measurement, we calculated the SD of the MR signal intensity in a region of the spectrum containing only noise. Metabolite peak areas were then normalized with respect to the noise SD to yield an approximate signal-to-noise ratio.
MR images were interpreted by 10 MR imaging radiologists (four genitourinary MR imaging radiologists and six general body MR imaging radiologists), including one of the authors (H.H.), during their regular clinical assignment to the MR imaging service. All readers were trained in body MR imaging (seven had an MR imaging fellowship and the others had been involved with MR imaging since it was introduced to clinical practice), but the genitourinary MR imaging radiologists had extensive experience in genitourinary imaging and more than 3 years of experience in prostate imaging. They regularly attended urology grand rounds and prostate tumor board conferences and were involved in the field academically. Experience in interpretation of MR images ranged from 4 to 15 years since fellowship for the genitourinary MR imaging radiologists and from 6 to 10 years since fellowship for the general body MR imaging radiologists.
In 344 patients, MR images in 163 patients were evaluated by the genitourinary MR imaging radiologists and those in the remaining 181 patients were evaluated by the general body MR imaging radiologists. There was no initial meeting or training to establish the diagnostic criteria for ECE on endorectal MR images. Rather, radiologists made their determinations on the basis of their own continuing medical training and knowledge of previously described MR imaging features of ECE. The diagnostic criteria used by the radiologists included irregular capsular bulge, periprostatic fat infiltration, obliteration of the rectoprostatic angle, and asymmetry or direct involvement of the neurovascular bundles (15). All readers had access to MR spectroscopic imaging data when available, but such data were not always used. In addition, all readers had access to the patients’ medical records, including PSA level and biopsy findings. On the basis of the radiologists’ written reports, one observer (L.W.) retrospectively scored the likelihood of ECE with a five-point scale as follows: score 1, no ECE; score 2, probably no ECE (cannot be ruled out though there is no clear evidence of it); score 3, possible ECE (a lesion is suspected of demonstrating ECE); score 4, probable ECE (a lesion is highly suspected of demonstrating ECE); score 5, definite ECE.
Clinical Data and Reference Standards
Presurgical clinical data, as well as pathologic reports at biopsy were evaluated for PSA level, Gleason score, greatest percentage of cancer in all core biopsy specimens, percentage of cancer-positive core specimens in all core biopsy specimens (the number of cancer-positive core specimens divided by the total number of core biopsy specimens), presence of perineural invasion (PNI), and clinical stage of tumor. The greatest percentage of cancer was determined in each patient by examining each core biopsy specimen and dividing the length of the core specimen tissue with cancer by the whole core specimen length; the core specimen with the highest percentage of cancer defined the patient’s greatest percentage of cancer. This parameter has been previously described by Rubin et al (16) and Bismar et al (17). Results from the final pathologic report following surgery were used to determine ECE. ECE was defined as the presence of tumor cells outside the prostate capsule. All 344 patients had undergone radical prostatectomy.
Specimens removed at radical prostatectomy were examined by the institutional pathology department, with methods previously described by Yossepowitch et al (18). Biopsy was performed at our institution, or biopsy findings were reviewed by our pathologists.
Statistical Analysis
The Wilcoxon rank sum test was used to compare the presurgical continuous predictor variables of the two groups of patients (one composed of patients whose MR images were interpreted by general body MR imaging radiologists and the other composed of patients whose MR images were interpreted by genitourinary MR imaging radiologists). Hereafter, these groups will be referred to as the general body radiologist group and the genitourinary radiologist group, respectively. The 2 test was used to evaluate the differences between the categorical predictor variables of the two groups, as well as to evaluate the difference between the percentages of the two groups in regard to the number of final pathologic specimens that showed ECE. Predictor variables that we tested included PSA level, Gleason score, greatest percentage of cancer in all core biopsy specimens, percentage of cancer-positive core specimens in all core biopsy specimens, presence of PNI, and clinical stage of tumor, as well as the probability of ECE as scored retrospectively on the basis of findings in endorectal MR imaging reports. We calculated the area under the receiver operating characteristic (ROC) curve for each variable in the univariate regression analysis for the prediction of ECE. To determine the predictive value of endorectal MR imaging findings, we used multivariate regression analysis. Two models were constructed: One model included all the clinical variables with endorectal MR imaging findings, and the other model included only the clinical variables without endorectal MR imaging findings. Jackknife-predicted probabilities of ECE for models with and without endorectal MR imaging findings were used to construct the ROC curves. P values were bias corrected by using the bootstrap method. A difference with P < .05 was considered significant.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
|
|
|
|
|
|
|
|
|
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
Birkmeyer (20) estimated that for cardiovascular surgical procedures, such as coronary artery bypass grafting and abdominal aortic aneurysm repair, the mortality rates in patients treated by high-volume medical providers are 20%–50% lower than the mortality rates in those treated by low-volume providers. The association between patient volume and patient outcome does not stop at the cardiothoracic surgical ward. Researchers in studies (19) about the evaluation of cancer treatment demonstrated that patient volume can affect morbidity, local cancer recurrence, long-term survival, and mortality for a variety of cancer-related surgical procedures.
Investigators in several studies (21–23) have examined the relationship between patient volume and patient outcome with respect to the hospital or surgeon in patients who were undergoing radical prostatectomy. Findings in many of the studies indicated an inverse relationship between patient volume and mortality, morbidity, short- and long-term complications, and length of hospitalization (21–23). Not only surgeons succumb to the influences of experience and subspecialty training. When Gleason scores determined by pathologists were evaluated for accuracy, it was found that the pathologist’s subspecialty influenced the disease grade. Gleason scores determined by general pathologists displayed only moderate interobserver reproducibility (
= 0.435), whereas Gleason scores determined by genitourinary pathologists showed improved interobserver agreement ( = 0.56–0.70) (24,25).
With consideration of these findings, it is not surprising that the accuracy of endorectal MR imaging findings and of MR image interpretation is related to radiologists’ experience and subspecialty training (7,8,26–30). It has been demonstrated that endorectal MR imaging evaluations performed by experienced radiologists (those with more years of experience in interpretation of endorectal MR images of the prostate) have less interobserver variability and are more accurate than evaluations performed by inexperienced radiologists (31). Since the early reports about interobserver variability of MR imaging findings (6), both MR imaging technology and radiologists’ skills have improved substantially. Yu et al (15) demonstrated that the combined use of endorectal MR imaging and MR spectroscopic imaging decreased interobserver variability and, for less experienced radiologists, significantly improved the detection of ECE in patients with prostate cancer.
Interobserver variability was not assessed in our study because interpretation of endorectal MR images was performed as part of the routine clinical service, and therefore only one radiologist interpreted the images for each case. For our data analysis, the ten MR imaging radiologists were classified as either genitourinary MR imaging radiologists or general body MR imaging radiologists. All of the readers were trained in body MR imaging (seven had an MR imaging fellowship and the others had been involved with MR imaging since it was introduced to clinical practice), but the genitourinary MR imaging radiologists had extensive experience in genitourinary imaging and more than 3 years of experience in prostate imaging. They regularly attended urology grand rounds and prostate tumor board conferences and were involved academically in the field.
Results of our study demonstrated that in the genitourinary radiologist group endorectal MR imaging findings displayed a combination of sensitivity and specificity that was superior to that of all other predictors tested. In the general body radiologist group, however, the combination of sensitivity and specificity of endorectal MR imaging findings was similar to that of the clinical predictors. Univariate analysis results revealed that most of the variables tested were significantly associated with findings of ECE. Results of multivariate analysis for assessment of two models of variables (one with and one without endorectal MR imaging findings) for their strength in the prediction of ECE demonstrated that in the genitourinary radiologist group a model with endorectal MR imaging findings had a greater area under the ROC curve than did a model without endorectal MR imaging findings (area under the ROC curve = 0.854 and 0.760, respectively; P = .019). In the general body radiologist group, however, the model with endorectal MR imaging findings did not have a significantly greater area under the ROC curve than did the model without endorectal MR imaging findings (area under the ROC curve = 0.813 and 0.788, respectively; P = .31). Nevertheless, endorectal MR imaging findings were significant predictors of ECE in both groups of patients.
As stated by Kattan (32), predictors should not be judged by their P value but rather by their ability to improve an existing set of clinically used variables. This argument applies to the evaluation of an expensive test such as endorectal MR imaging. Given the high incidence of prostate cancer, the cost of endorectal MR imaging might burden the health care system with additional expenses unless it results in fewer unnecessary surgeries or improves treatment planning and outcomes (33). D’Amico et al (34) concluded that although MR imaging findings added significant predictive value (ie, prediction of the risk of development of biochemical failure following radical prostatectomy in 20% of patients), the added predictive value of findings with this modality was not great enough to justify its routine use. Recently, it was suggested that treatment decisions should not be altered as a result of endorectal MR imaging findings (35).
One limitation of our study was that the contribution of MR spectroscopic imaging findings to the final MR imaging reports could not be assessed. MR spectroscopic technology was introduced at our institution in 2000, and radiologists experienced a steep learning curve in the acquisition and interpretation of MR spectroscopic imaging data during the past 4 years. Although MR spectroscopic imaging findings were accessible at the time of interpretation of endorectal MR imaging findings, readers did not always consult them, and therefore the degree of influence of MR spectroscopic imaging findings on reader impressions could not be quantified. Other limitations resulted from the fact that the study was designed to assess the value of endorectal MR image readings as used in clinical practice; accordingly, the readers were not blinded to clinical data such as PSA level and biopsy results, and as mentioned before, only one reader evaluated images in each case once so that we were unable to assess interobserver and intraobserver variability.
With consideration of the foregoing data, results of this study demonstrate that endorectal MR imaging findings add significant value in the diagnosis of ECE in patients with prostate cancer when MR images are interpreted by radiologists with experience in MR imaging of the prostate. In light of these results, it is easy to understand why referring physicians have experienced frustration about the use of MR image readings for the evaluation of prostate cancer. Nevertheless, advances in technology and in the expertise of radiologists dedicated to the genitourinary field suggest that endorectal MR imaging could play an increasingly useful role in the treatment of patients with prostate cancer.
In conclusion, results of this study demonstrate that endorectal MR imaging findings can be significant predictors for ECE in patients with prostate cancer, after controlling for PSA level, Gleason score, greatest percentage of cancer in all core biopsy specimens, percentage of cancer-positive core specimens in all core biopsy specimens, PNI, and clinical stage of tumor. A comparison of the ROC curves drawn from the results of readings performed by genitourinary MR imaging radiologists and general body MR imaging radiologists showed that endorectal MR imaging findings added value to all other predictor variables only when MR images were interpreted by genitourinary MR imaging radiologists.
|
FOOTNOTES |
|---|
Abbreviations: ECE = extracapsular extension, PNI = perineural invasion, PSA = prostate-specific antigen, ROC = receiver operating characteristic
Author contributions: Guarantors of integrity of entire study, H.H., M.M.; study concepts, H.H., M.M., M.W.K.; study design, M.W.K., H.H., P.T.S.; literature research, L.W., M.M.; clinical studies, P.T.S., M.W.K., H.N.C., L.W.; data acquisition, L.W., M.M., H.N.C.; data analysis/interpretation, H.N.C., M.W.K., M.M., L.W.; statistical analysis, H.N.C., M.W.K.; manuscript preparation, H.H., M.M.; manuscript definition of intellectual content, editing, and final version approval, H.H., P.T.S., M.W.K.; manuscript revision/review, M.M., L.W., H.N.C.
|
REFERENCES |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
This article has been cited by other articles:
|
|
 |
|
  A. Shukla-Dave, H. Hricak, N. Ishill, C. S. Moskowitz, M. Drobnjak, V. E. Reuter, K. L. Zakian, P. T. Scardino, and C. Cordon-Cardo Prediction of Prostate Cancer Recurrence Using Magnetic Resonance Imaging and Molecular Profiles Clin. Cancer Res., June 1, 2009; 15(11): 3842 - 3849. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Shukla-Dave, H. Hricak, N. M. Ishill, C. S. Moskowitz, M. Drobnjak, V. E. Reuter, K. L. Zakian, P. T. Scardino, and C. Cordon-Cardo Correlation of MR Imaging and MR Spectroscopic Imaging Findings with Ki-67, Phospho-Akt, and Androgen Receptor Expression in Prostate Cancer Radiology, March 1, 2009; 250(3): 803 - 812. [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]
|
|
|
|
 |
|
 S. Kawakami, I. Fukui, J. Yonese, Y. Okubo, S. Yamamoto, T. Tsukamoto, and Y. Ishikawa Antegrade Radical Retropubic Prostatectomy with Preliminary Ligation of Vascular Pedicles in 614 Consecutive Patients Jpn. J. Clin. Oncol., July 1, 2007; 37(7): 528 - 533. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. W. T. P. J. Heijmink, J. J. Futterer, T. Hambrock, S. Takahashi, T. W. J. Scheenen, H. J. Huisman, C. A. Hulsbergen-Van de Kaa, B. C. Knipscheer, L. A. L. M. Kiemeney, J. A. Witjes, et al. Prostate Cancer: Body-Array versus Endorectal Coil MR Imaging at 3 T--Comparison of Image Quality, Localization, and Staging Performance Radiology, July 1, 2007; 244(1): 184 - 195. [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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
L. Wang, J. Zhang, L. H. Schwartz, H. Eisenberg, N. M. Ishill, C. S. Moskowitz, P. Scardino, and H. Hricak Incremental Value of Multiplanar Cross-Referencing for Prostate Cancer Staging with Endorectal MRI Am. J. Roentgenol., January 1, 2007; 188(1): 99 - 104. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Wang, H. Hricak, M. W. Kattan, H. N. Chen, K. Kuroiwa, H. F. Eisenberg, and P. T. Scardino Prediction of Seminal Vesicle Invasion in Prostate Cancer: Incremental Value of Adding Endorectal MR Imaging to the Kattan Nomogram Radiology, December 1, 2006; 242(1): 182 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Wang, H. Hricak, M. W. Kattan, L. H. Schwartz, S. C. Eberhardt, H.-N. Chen, and P. T. Scardino Combined endorectal and phased-array MRI in the prediction of pelvic lymph node metastasis in prostate cancer. Am. J. Roentgenol., March 1, 2006; 186(3): 743 - 748. [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]
|
|
|
|
|
|
L. Wang, H. Hricak, M. W. Kattan, H.-N. Chen, P. T. Scardino, and K. Kuroiwa Prediction of Organ-confined Prostate Cancer: Incremental Value of MR Imaging and MR Spectroscopic Imaging to Staging Nomograms Radiology, December 12, 2005; (2005) 2382041905. [Abstract] [Full Text]
|
|
|
|
|
|
J. J. Futterer, S. W. T. P. J. Heijmink, T. W. J. Scheenen, G. J. Jager, C. A. Hulsbergen-Van de Kaa, J. A. Witjes, and J. O. Barentsz Prostate Cancer: Local Staging at 3-T Endorectal MR Imaging--Early Experience Radiology, December 1, 2005; 238(1): 184 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Futterer, M. R. Engelbrecht, H. J. Huisman, G. J. Jager, C. A. Hulsbergen-van De Kaa, J. A. Witjes, and J. O. Barentsz Staging Prostate Cancer with Dynamic Contrast-enhanced Endorectal MR Imaging prior to Radical Prostatectomy: Experienced versus Less Experienced Readers Radiology, November 1, 2005; 237(2): 541 - 549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Beyersdorff, K. Taymoorian, T. Knosel, D. Schnorr, R. Felix, B. Hamm, and H. Bruhn MRI of Prostate Cancer at 1.5 and 3.0 T: Comparison of Image Quality in Tumor Detection and Staging Am. J. Roentgenol., November 1, 2005; 185(5): 1214 - 1220. [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]
|
|
|
|
 |
|
 H. Schoder, H. W.D. Yeung, and S. M. Larson CT in PET/CT: Essential Features of Interpretation J. Nucl. Med., August 1, 2005; 46(8): 1249 - 1251. [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]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| RADIOLOGY | RADIOGRAPHICS | RSNA JOURNALS ONLINE |
