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Combined MRI and MR Spectroscopy of the Prostate Before Radical Prostatectomy

Axel Wetter1, Tobias A. Engl2, Darius Nadjmabadi1, Klaus Fliessbach3, Thomas Lehnert1, Jessen Gurung1, Wolf-Dietrich Beecken2 and Thomas J. Vogl1

1 Institute for Diagnostic and Interventional Radiology, University of Frankfurt, Theodor-Stern-Kai 7, 60389 Frankurt, Germany.
2 Department of Urology, University of Frankfurt, Frankfurt, Germany.
3 Department of Epileptology, University of Bonn, Bonn, Germany.


Figure 1
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  		Fig. 1A —70-year-old man with histopathologically proven T3a prostate cancer with prostate-specific antigen level of 10 ng/mL and Gleason score of 6 (3 + 3). Tumor extended over four spectroscopic slices. Patient had total number of 31 tumor voxels and 7.75 voxels per slice. Note: Endorectal coil is rotated to left, but tumor is clearly visible because it is located on same side. Transverse (A) and coronal (B) T2-weighted MR image from fast spin-echo sequence showing hypointense lesion (circle) of left peripheral zone with obliteration of retroprostatic angle.

 

Figure 2
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  		Fig. 1B —70-year-old man with histopathologically proven T3a prostate cancer with prostate-specific antigen level of 10 ng/mL and Gleason score of 6 (3 + 3). Tumor extended over four spectroscopic slices. Patient had total number of 31 tumor voxels and 7.75 voxels per slice. Note: Endorectal coil is rotated to left, but tumor is clearly visible because it is located on same side. Transverse (A) and coronal (B) T2-weighted MR image from fast spin-echo sequence showing hypointense lesion (circle) of left peripheral zone with obliteration of retroprostatic angle.

 

Figure 3
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  		Fig. 1C —70-year-old man with histopathologically proven T3a prostate cancer with prostate-specific antigen level of 10 ng/mL and Gleason score of 6 (3 + 3). Tumor extended over four spectroscopic slices. Patient had total number of 31 tumor voxels and 7.75 voxels per slice. Note: Endorectal coil is rotated to left, but tumor is clearly visible because it is located on same side. Tumor voxel from center of lesion showing pathologic ratio of (choline + creatine) / citrate (rectangle denotes E).

 

Figure 4
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  		Fig. 1D —70-year-old man with histopathologically proven T3a prostate cancer with prostate-specific antigen level of 10 ng/mL and Gleason score of 6 (3 + 3). Tumor extended over four spectroscopic slices. Patient had total number of 31 tumor voxels and 7.75 voxels per slice. Note: Endorectal coil is rotated to left, but tumor is clearly visible because it is located on same side. Tumor voxel from center of lesion showing pathologic ratio of (choline + creatine) / citrate (rectangle denotes E).

 

Figure 5
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  		Fig. 1E —70-year-old man with histopathologically proven T3a prostate cancer with prostate-specific antigen level of 10 ng/mL and Gleason score of 6 (3 + 3). Tumor extended over four spectroscopic slices. Patient had total number of 31 tumor voxels and 7.75 voxels per slice. Note: Endorectal coil is rotated to left, but tumor is clearly visible because it is located on same side. Overlaid spectral grid covering tumorous lesion with voxels of nominal size of 0.45 cm3. Volume of interest (white) is close around prostate. Voxels covering tumorous lesion have pathologic metabolite ratio with high choline and low citrate value.

 

Figure 6
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  		Fig. 2A —58-year-old man with histopathologically proven T3a prostate cancer with prostate-specific antigen level of 7.7 ng/mL and Gleason score of 6 (2 + 4). Spectroscopy showed no tumor voxels despite histologically proven prostate carcinoma. Transverse (A) and coronal (B) T2-weighted MR image from fast spin-echo sequence showing hypointense lesion (circles 1 and 2) of both peripheral zones.

 

Figure 7
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  		Fig. 2B —58-year-old man with histopathologically proven T3a prostate cancer with prostate-specific antigen level of 7.7 ng/mL and Gleason score of 6 (2 + 4). Spectroscopy showed no tumor voxels despite histologically proven prostate carcinoma. Transverse (A) and coronal (B) T2-weighted MR image from fast spin-echo sequence showing hypointense lesion (circles 1 and 2) of both peripheral zones.

 

Figure 8
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  		Fig. 2C —58-year-old man with histopathologically proven T3a prostate cancer with prostate-specific antigen level of 7.7 ng/mL and Gleason score of 6 (2 + 4). Spectroscopy showed no tumor voxels despite histologically proven prostate carcinoma. Overlaid spectral grid and voxels covering suspicious lesions showing normal metabolite levels with high citrate and low choline values.

 

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