Prostate cancer

Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy - Initial experience

Darko Pucar, Amita Shukla-Dave, Hedvig Hricak, Chaya S. Moskowitz, Kentaro Kuroiwa, Semra Olgac, Lanie E. Ebora, Peter T. Scardino, Jason A. Koutcher, Kristen L. Zakian

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To prospectively evaluate magnetic resonance (MR) imaging and MR spectroscopy for depiction of local prostate cancer recurrence after external-beam radiation therapy, with step-section pathologic findings as the standard of reference. MATERIALS AND METHODS: Study received institutional approval, and written informed consent was obtained. Study was compliant with Health Insurance Portability and Accountability Act. Sextant biopsy, digital rectal examination, MR imaging, MR spectroscopy, and salvage radical prostatectomy with step-section pathologic examination were performed in nine patients with increasing prostate-specific antigen levels after external-beam radiation therapy. MR imaging criterion for tumor was a focal nodular region of reduced signal intensity at T2-weighted imaging. MR spectroscopic criteria for tumor were voxels with choline (Cho) plus creatine (Cr) to citrate (Cit) ratio ([Cho + Cr]/Cit) of at least 0.5 or voxels with detectable Cho and no Cit in the peripheral zone. Sensitivity and specificity of sextant biopsy, digital rectal examination, MR imaging, and MR spectroscopy were determined by using a prostate sextant as the unit of analysis. For feature analysis, MR imaging and MR spectroscopic findings were correlated with step-section pathologic findings. RESULTS: MR imaging and MR spectroscopy showed estimated sensitivities of 68% and 77%, respectively, while sensitivities of biopsy and digital rectal examination were 48% and 16%, respectively. MR spectroscopy appears to be less specific (78%) than the other three tests, each of which had a specificity higher than 90%. MR spectroscopic feature analysis showed that a metabolically altered benign gland could be falsely identified as tumor by using MR spectroscopic criteria; further analysis of MR spectroscopic features did not lead to improved MR spectroscopic criteria for recurrent tumor. CONCLUSION: In summary, MR imaging and MR spectroscopy may be more sensitive than sextant biopsy and digital rectal examination for sextant localization of cancer recurrence after external-beam radiation therapy.

Original languageEnglish (US)
Pages (from-to)545-553
Number of pages9
JournalRadiology
Volume236
Issue number2
DOIs
StatePublished - Aug 1 2005

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Prostatic Neoplasms
Magnetic Resonance Spectroscopy
Radiotherapy
Magnetic Resonance Imaging
Digital Rectal Examination
Choline
Biopsy
Creatine
Neoplasms
Recurrence
Social Responsibility
Health Insurance
Prostate-Specific Antigen
Prostatectomy
Informed Consent
Citric Acid
Prostate
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Pucar, D., Shukla-Dave, A., Hricak, H., Moskowitz, C. S., Kuroiwa, K., Olgac, S., ... Zakian, K. L. (2005). Prostate cancer: Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy - Initial experience. Radiology, 236(2), 545-553. https://doi.org/10.1148/radiol.2362040739

Prostate cancer : Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy - Initial experience. / Pucar, Darko; Shukla-Dave, Amita; Hricak, Hedvig; Moskowitz, Chaya S.; Kuroiwa, Kentaro; Olgac, Semra; Ebora, Lanie E.; Scardino, Peter T.; Koutcher, Jason A.; Zakian, Kristen L.

In: Radiology, Vol. 236, No. 2, 01.08.2005, p. 545-553.

Research output: Contribution to journalArticle

Pucar, D, Shukla-Dave, A, Hricak, H, Moskowitz, CS, Kuroiwa, K, Olgac, S, Ebora, LE, Scardino, PT, Koutcher, JA & Zakian, KL 2005, 'Prostate cancer: Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy - Initial experience', Radiology, vol. 236, no. 2, pp. 545-553. https://doi.org/10.1148/radiol.2362040739
Pucar, Darko ; Shukla-Dave, Amita ; Hricak, Hedvig ; Moskowitz, Chaya S. ; Kuroiwa, Kentaro ; Olgac, Semra ; Ebora, Lanie E. ; Scardino, Peter T. ; Koutcher, Jason A. ; Zakian, Kristen L. / Prostate cancer : Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy - Initial experience. In: Radiology. 2005 ; Vol. 236, No. 2. pp. 545-553.
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abstract = "PURPOSE: To prospectively evaluate magnetic resonance (MR) imaging and MR spectroscopy for depiction of local prostate cancer recurrence after external-beam radiation therapy, with step-section pathologic findings as the standard of reference. MATERIALS AND METHODS: Study received institutional approval, and written informed consent was obtained. Study was compliant with Health Insurance Portability and Accountability Act. Sextant biopsy, digital rectal examination, MR imaging, MR spectroscopy, and salvage radical prostatectomy with step-section pathologic examination were performed in nine patients with increasing prostate-specific antigen levels after external-beam radiation therapy. MR imaging criterion for tumor was a focal nodular region of reduced signal intensity at T2-weighted imaging. MR spectroscopic criteria for tumor were voxels with choline (Cho) plus creatine (Cr) to citrate (Cit) ratio ([Cho + Cr]/Cit) of at least 0.5 or voxels with detectable Cho and no Cit in the peripheral zone. Sensitivity and specificity of sextant biopsy, digital rectal examination, MR imaging, and MR spectroscopy were determined by using a prostate sextant as the unit of analysis. For feature analysis, MR imaging and MR spectroscopic findings were correlated with step-section pathologic findings. RESULTS: MR imaging and MR spectroscopy showed estimated sensitivities of 68{\%} and 77{\%}, respectively, while sensitivities of biopsy and digital rectal examination were 48{\%} and 16{\%}, respectively. MR spectroscopy appears to be less specific (78{\%}) than the other three tests, each of which had a specificity higher than 90{\%}. MR spectroscopic feature analysis showed that a metabolically altered benign gland could be falsely identified as tumor by using MR spectroscopic criteria; further analysis of MR spectroscopic features did not lead to improved MR spectroscopic criteria for recurrent tumor. CONCLUSION: In summary, MR imaging and MR spectroscopy may be more sensitive than sextant biopsy and digital rectal examination for sextant localization of cancer recurrence after external-beam radiation therapy.",
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AU - Pucar, Darko

AU - Shukla-Dave, Amita

AU - Hricak, Hedvig

AU - Moskowitz, Chaya S.

AU - Kuroiwa, Kentaro

AU - Olgac, Semra

AU - Ebora, Lanie E.

AU - Scardino, Peter T.

AU - Koutcher, Jason A.

AU - Zakian, Kristen L.

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N2 - PURPOSE: To prospectively evaluate magnetic resonance (MR) imaging and MR spectroscopy for depiction of local prostate cancer recurrence after external-beam radiation therapy, with step-section pathologic findings as the standard of reference. MATERIALS AND METHODS: Study received institutional approval, and written informed consent was obtained. Study was compliant with Health Insurance Portability and Accountability Act. Sextant biopsy, digital rectal examination, MR imaging, MR spectroscopy, and salvage radical prostatectomy with step-section pathologic examination were performed in nine patients with increasing prostate-specific antigen levels after external-beam radiation therapy. MR imaging criterion for tumor was a focal nodular region of reduced signal intensity at T2-weighted imaging. MR spectroscopic criteria for tumor were voxels with choline (Cho) plus creatine (Cr) to citrate (Cit) ratio ([Cho + Cr]/Cit) of at least 0.5 or voxels with detectable Cho and no Cit in the peripheral zone. Sensitivity and specificity of sextant biopsy, digital rectal examination, MR imaging, and MR spectroscopy were determined by using a prostate sextant as the unit of analysis. For feature analysis, MR imaging and MR spectroscopic findings were correlated with step-section pathologic findings. RESULTS: MR imaging and MR spectroscopy showed estimated sensitivities of 68% and 77%, respectively, while sensitivities of biopsy and digital rectal examination were 48% and 16%, respectively. MR spectroscopy appears to be less specific (78%) than the other three tests, each of which had a specificity higher than 90%. MR spectroscopic feature analysis showed that a metabolically altered benign gland could be falsely identified as tumor by using MR spectroscopic criteria; further analysis of MR spectroscopic features did not lead to improved MR spectroscopic criteria for recurrent tumor. CONCLUSION: In summary, MR imaging and MR spectroscopy may be more sensitive than sextant biopsy and digital rectal examination for sextant localization of cancer recurrence after external-beam radiation therapy.

AB - PURPOSE: To prospectively evaluate magnetic resonance (MR) imaging and MR spectroscopy for depiction of local prostate cancer recurrence after external-beam radiation therapy, with step-section pathologic findings as the standard of reference. MATERIALS AND METHODS: Study received institutional approval, and written informed consent was obtained. Study was compliant with Health Insurance Portability and Accountability Act. Sextant biopsy, digital rectal examination, MR imaging, MR spectroscopy, and salvage radical prostatectomy with step-section pathologic examination were performed in nine patients with increasing prostate-specific antigen levels after external-beam radiation therapy. MR imaging criterion for tumor was a focal nodular region of reduced signal intensity at T2-weighted imaging. MR spectroscopic criteria for tumor were voxels with choline (Cho) plus creatine (Cr) to citrate (Cit) ratio ([Cho + Cr]/Cit) of at least 0.5 or voxels with detectable Cho and no Cit in the peripheral zone. Sensitivity and specificity of sextant biopsy, digital rectal examination, MR imaging, and MR spectroscopy were determined by using a prostate sextant as the unit of analysis. For feature analysis, MR imaging and MR spectroscopic findings were correlated with step-section pathologic findings. RESULTS: MR imaging and MR spectroscopy showed estimated sensitivities of 68% and 77%, respectively, while sensitivities of biopsy and digital rectal examination were 48% and 16%, respectively. MR spectroscopy appears to be less specific (78%) than the other three tests, each of which had a specificity higher than 90%. MR spectroscopic feature analysis showed that a metabolically altered benign gland could be falsely identified as tumor by using MR spectroscopic criteria; further analysis of MR spectroscopic features did not lead to improved MR spectroscopic criteria for recurrent tumor. CONCLUSION: In summary, MR imaging and MR spectroscopy may be more sensitive than sextant biopsy and digital rectal examination for sextant localization of cancer recurrence after external-beam radiation therapy.

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