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Multiparametric And Ex-vivo Mr Imaging In Diagnosis Of Prostate Cancer: Preliminary Results From A Prospective Trial In Patients Undergoing Robotic Prostatectomy
Li-Ming Su, Katarzyna Macura*
Johns Hopkins Hospital, Baltimore, MD
Introduction: Various multiparametric approaches to MR imaging of the prostate have been investigated. This study assessed the diagnostic accuracy of endorectal MR imaging at 1.5 T with a multiparametric protocol (standard T2W sequences for morphological assessment, diffusion weighted imaging (DWI), spectroscopy (MRSI), and dynamic contrast enhanced MR imaging (DCE-MRI)) all performed in the same patient population.
Methods:
Endorectal MR imaging was performed on 1.5T GE Signa Excite and included T2W images, DWI, MRSI and DCE-MRI. 48 prostate sextants were evaluated in eight consecutive patients who all underwent robotic prostatectomy. Tumor localization was mapped on diagrams corresponding to pathology sections and was subsequently co-registered with in-vivo MRI through the use of ex-vivo MRI of the prostate specimen as an intermediate step for the correlation between pathology specimen tumor mapping and pre-operative in-vivo MRI.
Results:
Pre-operative biopsy revealed only 16 of 30 tumor nodules (53%), with significant misregistration of tumor localization per sextant: non-matched 20 of 30 (67%), matched 10 of 30 (33%). In per nodule/sextant analysis, diagnostic accuracy for multiparametric MRI was as shown in Table 1.
Conclusions:
MRSI and DCE-MRI demonstrate the highest specificity and PPV, while T2W and MRSI had the highest sensitivity in detecting prostate cancer. These results will aid in developing multiparametric models for prediction of malignancy.
Table 1. Diagnostic accuracy for T2W, MRSI, DWI, DCE-MRI in the studied sample. | Parameter | T2W, focal nodule-like dark signal | MRSI, voxels with choline+creatine/citrate > 0.68 [2] | DWI, ADC < 1.30 * (0.99±2SD [3]) | DCE-MRI, increased rate and degree of enhancement >100% from baseline | | # Sextants | 48 | 30 | 42 | 48 | | Sensitivity | 80.64 (62-92) | 70 (45-88) | 61.53 (40-79) | 53.33 (34-71) | | Specificity | 47.05 (22-72) | 100 (69-100) | 62.5 (35-84) | 100 (81-100) | | PPV | 73.52 (55-87) | 100 (76-100) | 72.72 (49-89) | 100 (79-100) | | NPV | 57.14 (28-82) | 62.5 (35-84) | 50 (27-72) | 56.25 (37-73) |
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