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Diagnosis of Prostate Cancer in Patients with an Elevated Prostate-Specific Antigen Level: Role of Endorectal MRI and MR Spectroscopic Imaging

¹ All authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Rm. M-372, Box 0628, San Francisco, CA 94143-0628.

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Empiric receiver operating characteristic (ROC) curves for MRI alone (solid line) and for combined MRI and MR spectroscopic imaging (MRSI) (dotted and dashed line). Areas under ROC curves (AUCs) are 0.70 for MRI alone and 0.63 for combined MRI and MRSI (no significant difference; p = 0.32). Comparison of AUCs is based on DeLong, DeLong, and Clarke-Pearson [29] method. Dotted line = test of no value (50/50 chance of being correct).

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Axial T2-weighted MR image through midgland of prostate in 68-year-old man with prostate-specific antigen value of 6.4 ng/mL and negative findings on one prior biopsy. No focal T2 signal abnormality is visible, but two (asterisks) of four highlighted MR spectroscopic imaging (MRSI) voxels show moderate choline elevation (spectral peaks labeled 1 for choline, 2 for creatine, and 3 for citrate), which is suspicious for malignancy. Cancer was found in right hemigland on subsequent biopsy. Although addition of MRSI to MRI was helpful in diagnosis of prostate cancer in this case, our study showed no overall incremental benefit.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Axial T2-weighted MR image through midgland of prostate in 50-year-old man with prostate-specific antigen value of 6.9 ng/mL and no prior biopsy. Indistinct focus of reduced T2 signal intensity is seen in left midgland, and four corresponding MR spectroscopic imaging (MRSI) voxels all show marked choline elevation (spectral peaks labeled 1 for choline, 2 for creatine, and 3 for citrate). MRI and MRSI findings were considered likely due to malignancy, but all biopsy cores in left hemigland showed only prostatitis. Inflammation may be confounding variable in interpreting MRI and MRSI in patients with prostate cancer, although number of patients with inflammation in our study was insufficient to allow meaningful analysis of this variable.

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