Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection

Sisto Perdonà, Giuseppe Di Lorenzo, Riccardo Autorino, Carlo Buonerba, Marco De Sio, Sergio Venanzio Setola, Roberta Fusco, Francesco Michele Ronza, Michele Caraglia, Matteo Ferro, Antonella Petrillo

Research output: Contribution to journalArticle

Abstract

The use of magnetic resonance spectroscopy imaging (MRSI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) have emerged as a valid diagnostic tools for prostate cancer (CaP).Men with PSA levels below 10 ng/ml were enrolled in a prospective cohort study and underwent combined MRSI and DCE-MRI and transrectal ultrasound-guided prostate biopsy. Imaging was performed using a 1.5 T MR scanner (Symphony TIM; Siemens, Erlangen, Germany) with an endorectal coil (Medrad; Pittsburg, PA), inflated with 60 cc of air. Three-dimensional magnetic resonance spectroscopic data were acquired by using water and a lipid-suppressed double-spin-echo point-resolved spectroscopy sequence, which was optimized for quantitative detection of both choline and citrate. Dynamic contrast-enhanced MRI sequences were obtained with 3D T1-weighted FLASH images before and during rapid bolus administration of intravenous paramagnetic contrast medium gadoteric acid. Specificity, sensitivity, positive predictive value, negative predictive value, and accuracy were computed considering patients, each of the 2 lobes, each of the 6 sextants, and each 12th part of the prostate gland as single measurements. Overall, 106 patients were included in the analysis. Median age was 65.9 years (range, 61.2-70.5 years) and median PSA level at study entry was 7.1 ng/ml (range, 2.5-9.9). CaP was detected at biopsy in 24 patients (22.6 % of the population) with a median Gleason score of 8 (range 4-10). Diagnostic accuracy of combined MRSI and DCE-MRI was 85%, sensitivity was 71%, and specificity was 48%, considering patients as single measurements, with a negative predictive value of 91%, but a positive predictive value of only 19%. Positive predictive value of the examination improved to 25% for patients who repeated biopsy. Although this study confirms the potential usefulness of MRI for the diagnosis of CaP, the positive predictive value obtained was unacceptably low due to the high number of false positives recorded. Nevertheless, the high negative predictive value of the examination may serve to avoid unnecessary biopsies. Future research should be directed at assessing the value of combining MRI-based techniques with novel biochemical markers for the diagnosis of CaP in patients with low PSA levels.

Original languageEnglish
Pages (from-to)761-765
Number of pages5
JournalUrologic Oncology: Seminars and Original Investigations
Volume31
Issue number6
DOIs
Publication statusPublished - Aug 2013

Fingerprint

Prostatic Neoplasms
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
Biopsy
Prostate
Neoplasm Grading
Choline
Intravenous Administration
Contrast Media
Germany
Spectrum Analysis
Cohort Studies
Biomarkers
Air
Prospective Studies
Lipids
Sensitivity and Specificity
Acids
Water
Population

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection. / Perdonà, Sisto; Di Lorenzo, Giuseppe; Autorino, Riccardo; Buonerba, Carlo; De Sio, Marco; Setola, Sergio Venanzio; Fusco, Roberta; Ronza, Francesco Michele; Caraglia, Michele; Ferro, Matteo; Petrillo, Antonella.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 31, No. 6, 08.2013, p. 761-765.

Research output: Contribution to journalArticle

Perdonà, Sisto ; Di Lorenzo, Giuseppe ; Autorino, Riccardo ; Buonerba, Carlo ; De Sio, Marco ; Setola, Sergio Venanzio ; Fusco, Roberta ; Ronza, Francesco Michele ; Caraglia, Michele ; Ferro, Matteo ; Petrillo, Antonella. / Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection. In: Urologic Oncology: Seminars and Original Investigations. 2013 ; Vol. 31, No. 6. pp. 761-765.
@article{fae4e56469a94114bc290585c657480c,
title = "Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection",
abstract = "The use of magnetic resonance spectroscopy imaging (MRSI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) have emerged as a valid diagnostic tools for prostate cancer (CaP).Men with PSA levels below 10 ng/ml were enrolled in a prospective cohort study and underwent combined MRSI and DCE-MRI and transrectal ultrasound-guided prostate biopsy. Imaging was performed using a 1.5 T MR scanner (Symphony TIM; Siemens, Erlangen, Germany) with an endorectal coil (Medrad; Pittsburg, PA), inflated with 60 cc of air. Three-dimensional magnetic resonance spectroscopic data were acquired by using water and a lipid-suppressed double-spin-echo point-resolved spectroscopy sequence, which was optimized for quantitative detection of both choline and citrate. Dynamic contrast-enhanced MRI sequences were obtained with 3D T1-weighted FLASH images before and during rapid bolus administration of intravenous paramagnetic contrast medium gadoteric acid. Specificity, sensitivity, positive predictive value, negative predictive value, and accuracy were computed considering patients, each of the 2 lobes, each of the 6 sextants, and each 12th part of the prostate gland as single measurements. Overall, 106 patients were included in the analysis. Median age was 65.9 years (range, 61.2-70.5 years) and median PSA level at study entry was 7.1 ng/ml (range, 2.5-9.9). CaP was detected at biopsy in 24 patients (22.6 {\%} of the population) with a median Gleason score of 8 (range 4-10). Diagnostic accuracy of combined MRSI and DCE-MRI was 85{\%}, sensitivity was 71{\%}, and specificity was 48{\%}, considering patients as single measurements, with a negative predictive value of 91{\%}, but a positive predictive value of only 19{\%}. Positive predictive value of the examination improved to 25{\%} for patients who repeated biopsy. Although this study confirms the potential usefulness of MRI for the diagnosis of CaP, the positive predictive value obtained was unacceptably low due to the high number of false positives recorded. Nevertheless, the high negative predictive value of the examination may serve to avoid unnecessary biopsies. Future research should be directed at assessing the value of combining MRI-based techniques with novel biochemical markers for the diagnosis of CaP in patients with low PSA levels.",
author = "Sisto Perdon{\`a} and {Di Lorenzo}, Giuseppe and Riccardo Autorino and Carlo Buonerba and {De Sio}, Marco and Setola, {Sergio Venanzio} and Roberta Fusco and Ronza, {Francesco Michele} and Michele Caraglia and Matteo Ferro and Antonella Petrillo",
year = "2013",
month = "8",
doi = "10.1016/j.urolonc.2011.07.010",
language = "English",
volume = "31",
pages = "761--765",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection

AU - Perdonà, Sisto

AU - Di Lorenzo, Giuseppe

AU - Autorino, Riccardo

AU - Buonerba, Carlo

AU - De Sio, Marco

AU - Setola, Sergio Venanzio

AU - Fusco, Roberta

AU - Ronza, Francesco Michele

AU - Caraglia, Michele

AU - Ferro, Matteo

AU - Petrillo, Antonella

PY - 2013/8

Y1 - 2013/8

N2 - The use of magnetic resonance spectroscopy imaging (MRSI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) have emerged as a valid diagnostic tools for prostate cancer (CaP).Men with PSA levels below 10 ng/ml were enrolled in a prospective cohort study and underwent combined MRSI and DCE-MRI and transrectal ultrasound-guided prostate biopsy. Imaging was performed using a 1.5 T MR scanner (Symphony TIM; Siemens, Erlangen, Germany) with an endorectal coil (Medrad; Pittsburg, PA), inflated with 60 cc of air. Three-dimensional magnetic resonance spectroscopic data were acquired by using water and a lipid-suppressed double-spin-echo point-resolved spectroscopy sequence, which was optimized for quantitative detection of both choline and citrate. Dynamic contrast-enhanced MRI sequences were obtained with 3D T1-weighted FLASH images before and during rapid bolus administration of intravenous paramagnetic contrast medium gadoteric acid. Specificity, sensitivity, positive predictive value, negative predictive value, and accuracy were computed considering patients, each of the 2 lobes, each of the 6 sextants, and each 12th part of the prostate gland as single measurements. Overall, 106 patients were included in the analysis. Median age was 65.9 years (range, 61.2-70.5 years) and median PSA level at study entry was 7.1 ng/ml (range, 2.5-9.9). CaP was detected at biopsy in 24 patients (22.6 % of the population) with a median Gleason score of 8 (range 4-10). Diagnostic accuracy of combined MRSI and DCE-MRI was 85%, sensitivity was 71%, and specificity was 48%, considering patients as single measurements, with a negative predictive value of 91%, but a positive predictive value of only 19%. Positive predictive value of the examination improved to 25% for patients who repeated biopsy. Although this study confirms the potential usefulness of MRI for the diagnosis of CaP, the positive predictive value obtained was unacceptably low due to the high number of false positives recorded. Nevertheless, the high negative predictive value of the examination may serve to avoid unnecessary biopsies. Future research should be directed at assessing the value of combining MRI-based techniques with novel biochemical markers for the diagnosis of CaP in patients with low PSA levels.

AB - The use of magnetic resonance spectroscopy imaging (MRSI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) have emerged as a valid diagnostic tools for prostate cancer (CaP).Men with PSA levels below 10 ng/ml were enrolled in a prospective cohort study and underwent combined MRSI and DCE-MRI and transrectal ultrasound-guided prostate biopsy. Imaging was performed using a 1.5 T MR scanner (Symphony TIM; Siemens, Erlangen, Germany) with an endorectal coil (Medrad; Pittsburg, PA), inflated with 60 cc of air. Three-dimensional magnetic resonance spectroscopic data were acquired by using water and a lipid-suppressed double-spin-echo point-resolved spectroscopy sequence, which was optimized for quantitative detection of both choline and citrate. Dynamic contrast-enhanced MRI sequences were obtained with 3D T1-weighted FLASH images before and during rapid bolus administration of intravenous paramagnetic contrast medium gadoteric acid. Specificity, sensitivity, positive predictive value, negative predictive value, and accuracy were computed considering patients, each of the 2 lobes, each of the 6 sextants, and each 12th part of the prostate gland as single measurements. Overall, 106 patients were included in the analysis. Median age was 65.9 years (range, 61.2-70.5 years) and median PSA level at study entry was 7.1 ng/ml (range, 2.5-9.9). CaP was detected at biopsy in 24 patients (22.6 % of the population) with a median Gleason score of 8 (range 4-10). Diagnostic accuracy of combined MRSI and DCE-MRI was 85%, sensitivity was 71%, and specificity was 48%, considering patients as single measurements, with a negative predictive value of 91%, but a positive predictive value of only 19%. Positive predictive value of the examination improved to 25% for patients who repeated biopsy. Although this study confirms the potential usefulness of MRI for the diagnosis of CaP, the positive predictive value obtained was unacceptably low due to the high number of false positives recorded. Nevertheless, the high negative predictive value of the examination may serve to avoid unnecessary biopsies. Future research should be directed at assessing the value of combining MRI-based techniques with novel biochemical markers for the diagnosis of CaP in patients with low PSA levels.

UR - http://www.scopus.com/inward/record.url?scp=84880697728&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84880697728&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2011.07.010

DO - 10.1016/j.urolonc.2011.07.010

M3 - Article

C2 - 21906966

AN - SCOPUS:84880697728

VL - 31

SP - 761

EP - 765

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 6

ER -