3T MRI in prostate cancer evaluation with DWI, ADC and MR spectroscopy

Congress:

ECR 2012

Poster Number:

C-2124

Type:

Scientific Paper

Keywords:

Oncology, Abdomen, MR, Imaging sequences, Image compression, Neoplasia

Authors:

I. P. KOTECHA¹, A. Kohli², D. Rajput², L. Gosar², A. Dhapare², A. Bherwani³, M. Singh²; ¹MUMBAI, MAHARASHTRA/IN, ²Mumbai/IN, ³400077/IN

DOI:

10.1594/ecr2012/C-2124

DOI-Link:

https://dx.doi.org/10.1594/ecr2012/C-2124

Fig. 1: Schematic diagram showing normal zonal anatomy of prostate. PUT -...

Fig. 2: T1WI axial showing post biopsy hemorrhage as hyperintense focus (arrow) in the...

Fig. 5: T2WI axial showing a suspicious hypointense nodule (green arrow) in the...

Fig. 4: T2WI coronal showing normal zonal anatomy of prostate - uniformly distincitly...

Purpose

Prostate cancer is one of the most frequently diagnosed cancer in men. Diagnosis currently is based on TRUS biopsy, however which has its own pitfalls. Patients with a high Gleason's score have a detrimental prognosis. Non invasive identification of these patients is essential to avoid unnecessary surgery and guide adjuvant therapy. Hence the purpose of this study is to evaluate the feasibility of 3T MRI in multiparametric evaluation of prostate cancer and identify patients in whom adjuvant therapy rather than surgical approach is required.

Methods and Materials

25 patients with a high PSA level (10-100 ng/ml ) and those with rising PSA levels were evaluated on a 3T Magnatom Verio scanner with phased array body coil. These patients subsequently underwent TRUS guided biopsy of prostate and were proven as having prostate cancer Technical parameters: FOV - 16 x 16 cm, larger FOV to look for lymph nodal spread Matrix - 256 x 256 Slice thickness - 4 mm with an interslice gap of 1 mm Sequences: T1WI axial for evaluating involvement of...

Results

T2WI and ADC drop on DWI are the most sensitive sequences for detection and localisation of prostate cancer within the peripheral zone. 84 % of patients on T2WI showed hypointense nodule within the peripheral zone, which turned out to be positive on biopsy as well. 80 % of the patients revealed ADC values lesser than 1251 x 10 -6 on DWI with corresponding bright signal on b=800 images. ADC values below 600 x 10 -6 were associatede with higher Gleason's score of 8 or more.

Conclusion

T2WI when combined with diffusion weighted imaging in the most sensitive sequence for identification of prostate cancer nodule and further guide biopsy. Extracapsular extension and neurovascualr bundle involvment can be reliably diagnosed on T2WI. DCE and MRS cannot be always used to confidently detect prostate cancer.

References

State of the Art: Multiparametric MRI of prostate cancer,Radiology: volume 261: number 1-October 2011 Genitourinary imaging: Prostate cancer: Relationship between ADC and Gleason grade,Radiology: volume 259: number 2-May 2011 Genitourinary imaging: Prostate cancer: corelation of ADC and clinical risk, Radiology: volume 258: number 2-February 2011 DWI at 3T for the evaluation of prostate cancer,AJR:194, June 2010 3T MRI of prostate cancer, APPLIED RADIOLOGY January-February 2009 DCE MRI in the evaluation of patients with prostate cancer, Magn Reson Imaging Clin N Am 17 (2009) 363-383 Diffusion...