Endorectal coil MRI and MR-spectroscopic imaging in patients with elevated serum prostate specific antigen with negative trus transrectal ultrasound guided biopsy

Abstract

Background:The aim of this study was to see the efficacy of endorectal coil MRI and MR spectroscopic imaging in patients with elevated serum PSA and negative transrectal ultrasonography (TRUS)-guided biopsy.Materials and Methods:This study was conducted on 87 patients presented with: • Elevated prostatic specific antigen levels >5 ng/ml • Symptoms and signs of prostatic carcinoma • Patients with negative TRUS-guided biopsy • Suspicious lesion on TRU. All the patients were subjected to TRUS and followed by TRUS-guided biopsy of the lesion identified on endorectal coil MRI and MR-Spectroscopy. TRUS-guided biopsy of prostate was done with a Siemens Sonoline Adana Scanner. The scanning was performed by mechanical probe 5-7.5 MHz.Results:Out of 87 patients, 43 (49.4%) had hypointense lesion, 11 (12.6%) had hyperintense lesion. Out of 87 patients, MR-spectroscopy showed peak choline-creatine in 74 patients. Normal citrate peak was seen in 13 patients. Patients who had choline-creatine peak, among them 28 (37.8%) had peak in left peripheral zone, 23 (31.1%) had peak in the right peripheral zone, 2 (2.7%) had peak in the central zone, 17 had (23%) peak bilaterally. Four patients (5.4%) had peaks in right and central zones. The difference was statistically significant (P < 0.001).Conclusion:Prostatic biopsy directed with endorectal coil MRI and MR-spectroscopic imaging findings in patients with elevated serum PSA and prior negative biopsy, improves the early diagnosis of prostatic carcinoma and accurate localization of prostate cancer within the gland.

Multiparametric MRI in prostate cancer management

“…One useful application of MRSI is in the detection of cancer in patients with rising PSA levels and prior negative biopsy. Ganie et al 73 performed MRSI in 87 patients with PSA >5 ng/ml and prior transrectal ultrasound (TRUS)-guided biopsy, and found that the addition of MRSI to conventional endorectal coil MRI improved detection of cancerous lesions, with a sensitivity of 87.3% and a specificity of 81.3%. A study by Kobus et al 74 examined the use of MRSI alone versus MRSI plus DW–MRI at 3T in 54 patients with biopsy-proven cancer before undergoing prostatectomy.…”

Practical aspects of prostate MRI: hardware and software considerations, protocols, and patient preparation

“…The 1H-MRSI acquisition has evolved from singlevoxel spectroscopy to 3D 1H-MRSI that is typically acquired using phase encoding in all three directions but is time consuming. Improvements in pulse sequence design have enabled the acquisition of metabolic information from the entire prostate at high resolution within less than 10 min with voxel sizes ranging from 0.2 to 0.5 cm 3 , making 1H-MRSI a clinically feasible technique [139,140]. These include using flyback echo-planar readout gradients to improve efficiency and robustness to errors and non-uniform undersampling, and compressed sensing to accelerate the acquisition [141,142].…”