Combined morphological, [1H]-MR spectroscopic and contrast-enhanced imaging of human prostate cancer with a 3-Tesla scanner: preliminary experience.

PURPOSE: The objective of this study was to explore the feasibility of combined morphological magnetic resonance imaging (MRI), [(1)H]magnetic resonance spectroscopic imaging (MRSI) and quantitative dynamic contrast-enhanced MRI (DCE-MRI) of human prostate cancer at 3 Tesla using a pelvic phased-array coil. MATERIALS AND METHODS: MRI, MRSI and DCE-MRI with a 3-Tesla whole-body scanner were performed in 30 patients with biopsy-proven prostate cancer before radical prostatectomy. High-resolution T2-weighted turbo spin echo (TSE) images were evaluated for visualisation of the peripheral zone, central gland, visibility of the cancer lesion, prostatic capsule delineation and overall image quality according to a five-point scale. Relative levels of the prostate metabolites citrate, choline and creatine were determined in cancer and in the normal peripheral zone (PZ) and central gland (CG). Spectra were also evaluated for the separation of the signal of citrate, choline and creatine and suppression of lipid and water signals. Time-intensity curves were obtained for prostatic cancer and healthy PZ and CG from DCE-MRI. Finally, time of arrival, time to peak, maximum enhancement and wash-in rate in cancer, normal PZ and CG were calculated. RESULTS: The high signal-to-noise ratio (SNR) at 3 Tesla provided T2-weighted TSE images with excellent anatomical detail (in-plane voxel size of 0.22 x 0.22 mm) and good T2 contrast. The increased spectral resolution was sufficient to separate the choline and creatine resonances and allow delineation of the four peaks of citrate resonance. The (choline + creatine)/citrate ratio was elevated in cancer in comparison with PZ and CG (p<0.001). Dynamic contrast-enhanced images showed good temporal resolution. All parameters obtained from DCE-MRI showed a statistically significant (P<0.05) difference between cancer tissue and normal PZ and CG. Wash-in rate and (choline+creatine)/citrate ratio were significantly correlated (r=0.713, P=0.001) in PZ cancer, whereas the correlation was not significant (r=0.617, P=0.06) in CG and in PZ (r=0.530, P=0.08). CONCLUSIONS: It is possible to perform MRI of prostate cancer at 3 Tesla using a pelvic phased-array coil with high spatial, temporal and spectral resolution. The combination of vascular information from DCE-MRI and metabolic data from MRSI has excellent potential for improved accuracy in delineating and staging prostate carcinoma. These results suggest that high magnetic field strengths offer the possibility of studying prostate cancer without use of an endorectal coil.

In vivo measurement of the apparent diffusion coefficient in normal and malignant prostatic tissue using thin-slice echo-planar imaging.

PURPOSE: Diffusion is a physical process based on the random movement of water molecules, known as Brownian movement. Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that provides information on such biophysical properties of tissues as density, cell organisation and microstructure, which influence the diffusion of water molecules. The aim of this study was to evaluate the ability of MRI to obtain information on the diffusion of water molecules in normal and malignant prostate tissues. MATERIALS AND METHODS: Ten volunteers and 19 patients with prostate lesions diagnosed by transrectal ultrasound (TRUS) were enrolled in our study. Morphological imaging was obtained with T2-weighted turbo spin-echo (TSE) sequences with and without fat suppression [spectral presaturation with inversion recovery (SPIR)] and an axial dynamic T1-weighted SPIR fast-field echo (FFE) sequence during intravenous administration of contrast material. DWI was obtained with a high-spatial-resolution single-shot spin-echo echo planar imaging (EPI) inversion recovery (IR) sequence. The apparent diffusion coefficient (ADC) maps were analysed by positioning an 8-pixel region of interest (ROI) over different zones of the prostate, and the focal lesion when present. The tumour was confirmed by a TRUS-guided needle biopsy taken within 1 month of the MRI examination. RESULTS: The mean ADC value of the central zones (1,512.07+/-124.85x10(-3) mm2/s) was significantly lower than the mean ADC of the peripheral zones (1,984.11+/-226.23x10(-3) mm2/s) (p<0.01). The mean ADC value of tumours (958.97+/-168.98x10(-3) mm2/s) was significantly lower than the mean values of normal peripheral zones (p<0.01). CONCLUSIONS: Our preliminary results indicate that DWI is useful for characterising tissue in the different regions of the prostate gland and in distinguishing normal from cancerous tissues, given its ability to detect early changes in the structural organisation of prostate tissue.

Integrated multislice CT and Tc-99m Sestamibi SPECT-CT evaluation of solitary pulmonary nodules.

PURPOSE: The purpose of this study was to evaluate efficacy of multislice computed tomography (MSCT) and single photon emission computed tomography (SPECT)-CT with Tc-99m Sestamibi in the assessment of solitary pulmonary nodules of uncertain significance. Scintigraphy was performed using a 'hybrid' g-camera that allows simultaneous acquisition of SPECT and CT images, with interesting results in diagnostic oncology. MATERIALS AND METHODS: Between September 2003 and August 2004, 23 patients with a solitary pulmonary nodule detected on CT underwent SPECT-CT using Tc-99m Sestamibi as a radiotracer. Nodules with positive scintigraphy were immediately subjected to biopsy or surgical resection. Nodules with negative scintigraphy were followed up after 3-4 months by MSCT with automatic segmentation software (Advanced Lung Analysis, ALA) and histological characterisation. RESULTS: Of the 23 nodules (size range 0.8-2 cm) discovered with MSCT, 11 showed intense uptake of Tc-99m Sestamibi. Ten lesions were true positive: seven adenocarcinomas, one squamous cell carcinoma, one large cell carcinoma and one metastasis. The only false positive was histologically classified as a large cell granuloma. Twelve lesions had negative scintigraphy: five fibrous lesions, three hamartomas, three granulomas and one adenocarcinoma (false negative). Benign nodules without tracer uptake underwent another CT scan 3-4 months later, which confirmed stability of the nodule size. Correlation of Sestamibi SPECT with histology showed sensitivity (Se) of 90.9 %, specificity (Sp) of 91.6 %, diagnostic accuracy of 91.3 %, positive predictive value (PPV) of 90.9% and negative predictive value (NPV) of 91.6 %. CONCLUSIONS: The integrated use of MSCT and Tc-99m Sestamibi SPECT-CT could be very useful in the management of solitary pulmonary nodules (SPNs). In particular, in our preliminary study, scintigraphy provided significant diagnostic information to differentiate benign from suspicious pulmonary nodules. The use of scintigraphy could be helpful to anticipate histological assessment and surgical treatment of SPNs identified at CT.

Magnetic resonance imaging of the prostate with spectroscopic imaging using a surface coil. Initial clinical experience.

PURPOSE: The purpose of this study was to evaluate the diagnostic ability of proton magnetic resonance spectroscopic imaging (MRSI) in the detection and localisation of prostate cancer, prospectively compared with histopathologic findings. MATERIALS AND METHODS: Magnetic resonance imaging (MRI) and MRSI were performed on 39 patients with prostate-specific antigen (PSA) levels greater than 4 ng/ml and suspicious findings at trans-rectal ultrasound (TRUS). All patients underwent a TRUS ten-core biopsy within 30 days according to a subdivision of the prostate into octants. All studies were interpreted by a dedicated radiologist who reported the areas of interest as normal, equivocal or suspicious on MRI. At MRSI, cancer was defined as possible if the ratio of choline plus creatine to citrate exceeded mean normal peripheral zone values by two standard deviations (SD) or as definite if that ratio exceeded the normal value by three SD. MRI and MRSI findings were spatially correlated with findings obtained from individual biopsy sites. RESULTS: MRI and MRSI alone had sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in the detection of prostate cancer equal to 85%, 75%; 53%, 89%; 65%, 88%; 77%, 74%; and 69%, 79%, respectively. These values were 70%, 89%, 88%, 74% and 79% when MRI and MRSI were combined. Site-by-site analysis of MRI and MRSI findings and biopsy results yielded no significant correlation. CONCLUSIONS: The combination of MRSI and MRI provides a significantly higher specificity in the detection of tumours as compared with MRI alone and can be recommended as a problem-solving modality before biopsy in patients with high PSA levels and suspicious TRUS.

MR spectroscopy of prostate cancer. Initial clinical experience.

Aim of the study was to evaluate the effectiveness of proton MR Spectroscopic (MRS) imaging in the detection and localization of prostate cancer, prospectively compared with histopathologic findings. Magnetic Resonance (MR) and MRS imaging were performed in 65 patients with high levels of prostate-specific antigen (PSA) and suspicious areas at the transrectal ultrasound (TRUS). At MR areas of interest were reported as normal, equivocal or suspicious. At MRS imaging, cancer was diagnosed as "possible" if the ratio of choline plus creatine to citrate exceeded 2 SDs above mean normal peripheral zone values or as "definite" if the ratio exceeded 3 SDs. All patients underwent a TRUS 10-core biopsy within 30 days of the imaging study. MR alone showed sensitivity, specificity, positive predictive values, negative predictive values and accuracy for detection of prostate cancer of 85%, 76%, 53%, 91% and 65%, respectively, whereas MRS alone showed 89%, 77%, 78%, 69% and 83%, respectively. These values were 71%, 90%, 89%, 74% and 80% when the prostate was evaluated combining MR and MRS. The addition of MRS to the MR imaging provides a higher specificity in tumour detection and can be recommended as a problem-solving modality for patients with elevated PSA levels and suspicious TRUS before biopsy.