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Incremental Value of Multiplanar Cross-Referencing for Prostate Cancer Staging with Endorectal MRI

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Rm. C-278, New York, NY 10021.
² Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
³ Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —53-year-old man with clinical stage T1c prostate carcinoma with Gleason score of 3 + 3 and prostate-specific antigen level of 11.9 ng/mL. MRI without PACS cross-referencing indicated possible extracapsular extension (ECE) at right base and possible right seminal vesicle invasion (SVI) (scores of 3 and 3, respectively). However, MRI with PACS cross-referencing indicated definite ECE and definite SVI (scores of 5 and 5, respectively). Axial T2-weighted image shows point of interest (crosshairs) selected by reviewer in low-signal-intensity area using cross-referencing tool. Irregular nodularity is seen in right seminal vesicle (arrowhead), indicating seminal vesicle invasion.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —53-year-old man with clinical stage T1c prostate carcinoma with Gleason score of 3 + 3 and prostate-specific antigen level of 11.9 ng/mL. MRI without PACS cross-referencing indicated possible extracapsular extension (ECE) at right base and possible right seminal vesicle invasion (SVI) (scores of 3 and 3, respectively). However, MRI with PACS cross-referencing indicated definite ECE and definite SVI (scores of 5 and 5, respectively). T2-weighted coronal MR image with cross-referencing shows ECE (arrow) at right base and right seminal vesicle invasion (arrowheads). Crosshairs indicate point of interest identified by cross-referencing tool. Relationship between seminal vesicle and central zone is shown clearly.

View larger version (172K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —53-year-old man with clinical stage T1c prostate carcinoma with Gleason score of 3 + 3 and prostate-specific antigen level of 11.9 ng/mL. MRI without PACS cross-referencing indicated possible extracapsular extension (ECE) at right base and possible right seminal vesicle invasion (SVI) (scores of 3 and 3, respectively). However, MRI with PACS cross-referencing indicated definite ECE and definite SVI (scores of 5 and 5, respectively). Sagittal T2-weighted MR image shows right seminal vesicle invasion (arrowheads). Crosshairs indicate point of interest identified by cross-referencing tool.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —53-year-old man with clinical stage T1c prostate carcinoma with Gleason score of 3 + 3 and prostate-specific antigen level of 11.9 ng/mL. MRI without PACS cross-referencing indicated possible extracapsular extension (ECE) at right base and possible right seminal vesicle invasion (SVI) (scores of 3 and 3, respectively). However, MRI with PACS cross-referencing indicated definite ECE and definite SVI (scores of 5 and 5, respectively). Histologic photograph shows whole-mount sections that confirm presence of ECE (red) at right base and right seminal vesicle invasion (blue). RSV = right seminal vesicle.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —63-year-old man with clinical stage T1c prostate carcinoma with Gleason score of 4 + 4, prostate-specific antigen level of 12.9 ng/mL. MRI without PACS cross-referencing indicated possible extracapsular extension (ECE) at left base and possible left seminal vesicle invasion (SVI) (scores of 3 and 3, respectively). However, cross-referenced MR images (A-C) indicated no ECE and no SVI (scores of 1 and 1, respectively). Axial T2-weighted MR image shows point of interest (crosshairs) identified by cross-referencing tool.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —63-year-old man with clinical stage T1c prostate carcinoma with Gleason score of 4 + 4, prostate-specific antigen level of 12.9 ng/mL. MRI without PACS cross-referencing indicated possible extracapsular extension (ECE) at left base and possible left seminal vesicle invasion (SVI) (scores of 3 and 3, respectively). However, cross-referenced MR images (A-C) indicated no ECE and no SVI (scores of 1 and 1, respectively). Coronal T2-weighted MR image shows interface (arrow) between seminal vesicle and central zone of prostate. Crosshairs indicate point of interest identified by cross-referencing tool.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —63-year-old man with clinical stage T1c prostate carcinoma with Gleason score of 4 + 4, prostate-specific antigen level of 12.9 ng/mL. MRI without PACS cross-referencing indicated possible extracapsular extension (ECE) at left base and possible left seminal vesicle invasion (SVI) (scores of 3 and 3, respectively). However, cross-referenced MR images (A-C) indicated no ECE and no SVI (scores of 1 and 1, respectively). Sagittal T2-weighted image with cross-referencing shows point of interest selected by reviewer (crosshairs).

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —63-year-old man with clinical stage T1c prostate carcinoma with Gleason score of 4 + 4, prostate-specific antigen level of 12.9 ng/mL. MRI without PACS cross-referencing indicated possible extracapsular extension (ECE) at left base and possible left seminal vesicle invasion (SVI) (scores of 3 and 3, respectively). However, cross-referenced MR images (A-C) indicated no ECE and no SVI (scores of 1 and 1, respectively). Histopathologic photograph shows whole-mount sections confirming absence of extracapsular extension and seminal vesicle invasion at left base. RSV = right seminal vesicle, LSV = left seminal vesicle.

View larger version (23K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Graph shows results of receiver operating characteristic analysis for detection of extracapsular extension with MRI alone and MRI with PACS cross-referencing. R1 = reviewer 1, R2 = reviewer 2, MRI = MRI alone, PACS = MRI with PACS cross-referencing, AUC = area under curve.

View larger version (21K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Graph shows results of receiver operating characteristic analysis for detection of seminal vesicle invasion with MRI with PACS cross-referencing and MRI alone. R1 = reviewer 1; R2 = reviewer 2; MRI = MRI alone; PACS = MRI with PACS cross-referencing, AUC = area under curve.

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