Transition Zone Prostate Cancer: Metabolic Characteristics at<sup>1</sup>H MR Spectroscopic Imaging—Initial Results

Zakian, Kristen L.; Eberhardt, Steven C.; Hricak, Hedvig; Shukla–Dave, Amita; Kleinman, Shanon; Muruganandham, Manickam; Sircar, Kanishka; Kattan, Michael W.; Reuter, Victor E.; Scardino, Peter T.; Koutcher, Jason A.

doi:10.1148/radiol.2291021383

Cited by 159 publications

(112 citation statements)

References 52 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…The spectroscopist was blinded to all clinical and surgical-pathologic findings except the fact that all patients were considered to have clinical stage T1c prostate cancer. Voxels in the peripheral (14,15,18,19) and transition (20) zones of the prostate gland were judged to be suspicious on the basis of established metabolic criteria, without reference to the MR findings. Subsequently, the radiologists reviewed the MR spectroscopic imaging results and, with knowledge of the MR imaging scores, assigned new scores for the presence of tumor, extracapsular extension, seminal vesicle invasion, and adjacent organ invasion on the basis of combined endorectal MR imaging-MR spectroscopic imaging data and by using the same five-point scale.…”

Section: Genitourinary Imaging: Mr Evaluation Of Clinical Stage T1c Pmentioning

confidence: 99%

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Zhang¹,

Hricak²,

Shukla–Dave³

et al. 2009

Radiology

Self Cite

View full text Add to dashboard Cite

Purpose:To assess the diagnostic accuracy of endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for prediction of the pathologic stage of prostate cancer and the presence of clinically nonimportant disease in patients with clinical stage T1c prostate cancer. Materials and Methods:The institutional review board approved-and waived the informed patient consent requirement for-this HIPAAcompliant study involving 158 patients (median age, 58 years; age range, 40 -76 years) who had clinical stage T1c prostate cancer, had not been treated preoperatively, and underwent combined 1.5-T endorectal MR imaging-MR spectroscopic imaging between January 2003 and March 2004 before undergoing radical prostatectomy. On the MR images and combined endorectal MR-MR spectroscopic images, two radiologists retrospectively and independently rated the likelihood of cancer in 12 prostate regions and the likelihoods of extracapsular extension (ECE), seminal vesicle invasion (SVI), and adjacent organ invasion by using a five-point scale, and they determined the probability of clinically nonimportant prostate cancer by using a four-point scale. Whole-mount step-section pathology maps were used for imaging-pathologic analysis correlation. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) were estimated nonparametrically for assessment of reader accuracy. Results:At surgical-pathologic analysis, one (0.6%) patient had no cancer; 124 (78%) patients, organ-confined (stage pT2) disease; 29 (18%) patients, ECE (stage pT3a); two (1%) patients, SVI (stage pT3b); and two (1%) patients, bladder neck invasion (stage pT4). Forty-six (29%) patients had a total tumor volume of less than 0.5 cm 3 . With combined MR imaging-MR spectroscopic imaging, the two readers achieved 80% accuracy in disease staging and AUCs of 0.62 and 0.71 for the prediction of clinically nonimportant cancer. Conclusion:Clinical Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.I n American men, prostate cancer continues to be the most common cancer and the second leading cause of noncutaneous cancer-related mortality (1). The American Cancer Society estimated that in 2009, 192 280 new cases of prostate cancer would be diagnosed and 27 360 deaths would occur owing to this disease in the United States (1). Serum prostate-specific antigen (PSA) screening has led to a dramatic decrease in prostate cancer stage at the time of diagnosis, and stage T1c is now the most commonly diagnosed clinical stage (2).According to the TNM classification system, T1c prostate cancers are malignancies identified with needle biopsy (performed, for example, because of an elevated PSA level) that are not detectable at digital rectal examination or imaging (usually transrectal ultrasonography [US]) (3). In a study conducted by Humphrey et al (4), 78 of 100 consecutive patients who underwent rad...

show abstract

Section: Genitourinary Imaging: Mr Evaluation Of Clinical Stage T1c Pmentioning

confidence: 99%

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Zhang¹,

Hricak²,

Shukla–Dave³

et al. 2009

Radiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…The usable voxels were classified as follows: (a) nondiagnostic voxels, voxels with nondiagnostic levels of metabolites; (b) Cit voxels, voxels with diagnostic levels of Cit; and (c) Cho voxels, voxels with nondiagnostic levels of Cit and diagnostic levels of Cho. On the basis of published data in untreated and hormone-treated gland (9)(10)(11)(12)14,15,18,19), Cit voxels with a (Cho + Cr)/Cit ratio of 0.5 or more and all Cho voxels were considered suspicious (criteria) for tumor in the peripheral zone. To calculate the (Cho + Cr)/Cit ratio in Cit voxels with nondiagnostic levels of Cho and/or Cr, the levels of these metabolites were assigned a value equivalent to the noise standard deviation.…”

Section: Endorectal Mr Imaging and Mr Spectroscopymentioning

confidence: 99%

Prostate Cancer: Correlation of MR Imaging and MR Spectroscopy with Pathologic Findings after Radiation Therapy–Initial Experience

Pucar¹,

Shukla–Dave²,

Hricak³

et al. 2005

Radiology

Self Cite

188

113

View full text Add to dashboard Cite

PURPOSE:To prospectively evaluate magnetic resonance (MR) imaging and MR spectroscopy for depiction of local prostate cancer recurrence after external-beam radiation therapy, with stepsection 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.

show abstract

“…The described MR techniques are feasible using existing technology. Clinical MRSI is routinely applied (35,36) and quantitative MRSI of 5-FU pharmacokinetics in patients has been described previously (37) on available 1.5 T MR scanners. The current availability of higher field strength magnets for clinical studies (3-9 T) affords the opportunity for improved sensitivity in MRSI.…”

mentioning

confidence: 99%

Imaging Transgene Activity In vivo

Gade¹,

Koutcher

Spees³

et al. 2008

Cancer Research

Self Cite

View full text Add to dashboard Cite

The successful translation of gene therapy for clinical application will require the assessment of transgene activity as a measure of the biological function of a therapeutic transgene. Although current imaging permits the noninvasive detection of transgene expression, the critical need for quantitative imaging of the action of the expressed transgene has not been met. In vivo magnetic resonance spectroscopic imaging (MRSI) was applied to quantitatively delineate both the concentration and activity of a cytosine deaminase-uracil phosphoribosyltransferase (CD-UPRT) fusion enzyme expressed from a transgene. MRSI enabled the generation of anatomically accurate maps of the intratumoral heterogeneity in fusion enzyme activity. We observed an excellent association between the CD-UPRT concentration and activity and the percentage of CD-UPRT + cells. Moreover, the regional levels of UPRT activity, as measured by imaging, correlated well with the biological affect of the enzyme. This study presents a translational imaging paradigm for precise, in vivo measurements of transgene activity with potential applications in both preclinical and clinical settings. [Cancer Res 2008;68(8):2878-84]

show abstract

Transition Zone Prostate Cancer: Metabolic Characteristics at¹H MR Spectroscopic Imaging—Initial Results

Abstract: TZ cancer has a metabolic profile that is different from that of benign TZ tissue; however, the broad range of metabolite ratios observed in TZ cancer precludes the use of a single ratio to differentiate TZ cancer from benign TZ tissue.

Cited by 159 publications

References 52 publications

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Prostate Cancer: Correlation of MR Imaging and MR Spectroscopy with Pathologic Findings after Radiation Therapy–Initial Experience

Imaging Transgene Activity In vivo

Contact Info

Product

Resources

About

Transition Zone Prostate Cancer: Metabolic Characteristics at1H MR Spectroscopic Imaging—Initial Results

Abstract: TZ cancer has a metabolic profile that is different from that of benign TZ tissue; however, the broad range of metabolite ratios observed in TZ cancer precludes the use of a single ratio to differentiate TZ cancer from benign TZ tissue.

Cited by 159 publications

References 52 publications

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Prostate Cancer: Correlation of MR Imaging and MR Spectroscopy with Pathologic Findings after Radiation Therapy–Initial Experience

Imaging Transgene Activity In vivo

Contact Info

Product

Resources

About

Transition Zone Prostate Cancer: Metabolic Characteristics at¹H MR Spectroscopic Imaging—Initial Results