Imaging in Oncology from The University of Texas M. D. Anderson Cancer Center: Diagnosis, Staging, and Surveillance of Prostate Cancer
Vikas Kundra1,2,
Paul M. Silverman1,
Surena F. Matin3 and
Haesun Choi1
1 Department of Radiology, The University of Texas M. D. Anderson Cancer Center,
Box 57, 1515 Holcombe Blvd., Houston, TX 77030.
2 Department of Experimental Diagnostic Imaging, The University of Texas M. D.
Anderson Cancer Center, Houston, TX 77030.
3 Department of Urology, The University of Texas M. D. Anderson Cancer Center,
Houston, TX 77030.
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Fig. 1B —Prostate anatomy. Drawings show axial views of prostate near
level of base (A), middle portion (B), and apex (C) of gland corresponding to
lines labeled A, B, and C in A. Asterisks indicate urethra; short
arrows indicate ejaculatory ducts.
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Fig. 2A —Organ-confined prostate cancer (TNM stage T2) in 73-year-old
man. Axial T2-weighted MR image (A) shows prostate carcinoma presenting
as focal low-signal area in peripheral zone on left (arrow) and
having isointense signal on T1-weighted image (B). Peripheral zone
(arrowheads) is normally high signal and central zone
(diamond) is often heterogeneous because of benign prostatic
hyperplasia on T2-weighted sequences. Note that the transition and central
zones cannot be distinguished and are termed central zone or central gland on
MR images. Central gland and peripheral zone are isointense on T1-weighted
sequences.
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Fig. 2B —Organ-confined prostate cancer (TNM stage T2) in 73-year-old
man. Axial T2-weighted MR image (A) shows prostate carcinoma presenting
as focal low-signal area in peripheral zone on left (arrow) and
having isointense signal on T1-weighted image (B). Peripheral zone
(arrowheads) is normally high signal and central zone
(diamond) is often heterogeneous because of benign prostatic
hyperplasia on T2-weighted sequences. Note that the transition and central
zones cannot be distinguished and are termed central zone or central gland on
MR images. Central gland and peripheral zone are isointense on T1-weighted
sequences.
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Fig. 3 —Extracapsular extension of prostate cancer (TNM stage T3) in
65-year-old man. Axial MR image shows extraprostatic extension of prostate
carcinoma presenting as low-signal area in peripheral zone and extending
beyond prostatic capsule at 7-o'clock position, resulting in irregular bulge
(arrow). On this T2-weighted image, prominent periprostatic vessels
(arrowheads) are also seen.
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Fig. 4 —Invasion into adjacent organs (TNM stage T4) in 72-year-old
man. Axial CT scan shows invasion of prostate cancer into rectum
(arrow). Foley catheter (black arrowhead) and rectal tube
(white arrowhead) are also seen.
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Fig. 6 —Bone metastases in 70-year-old man. Bone scintigraphy using
99mTc-MDP (methylene diphosphate) shows multiple focal areas of
increased uptake throughout bones, consistent with multiple bone metastases
from prostate cancer. Above-knee amputation is seen.
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Fig. 9 —Neurovascular bundle invasion in 65-year-old man. Axial
T2-weighted MR image shows left-sided extraprostatic extension and
neurovascular bundle invasion (long arrow). Fat plane
(short arrow) is seen between prostate and uninvolved
neurovascular bundle (arrowhead) on right.
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Fig. 10B —Hemorrhage in 70-year-old man. Hemorrhage (arrows)
is seen as increased signal in peripheral zone on T1-weighted (A) and
as decreased signal on T2-weighted (B) axial MR images. Biopsy of
prostate was performed 5 weeks before MRI. In general, it is preferable to
perform MRI at least 6 weeks after prostate biopsy to allow resolution of
hemorrhage.
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Fig. 11 —MR spectroscopy in 65-year-old man. Axial T2-weighted MR
image shows prostate cancer presenting as low signal in peripheral zone on
left (single arrow). Grid over prostate marks location where spectra
were acquired. Increased choline (long arrows) and decreased
citrate (short arrows) peaks are noted in boxes
corresponding to region of decreased T2 signal. Spectrum suggesting prostate
cancer is magnified on right. Normal spectrum with low choline and high
citrate is magnified on left. Choline and creatine peaks are close and are
usually difficult to separate on spectra.
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Fig. 12B —Hemorrhage in 60-year-old man. Hemorrhage (arrows)
is seen as increased signal in seminal vesicles on T1-weighted (A) and
as increased signal on T2-weighted (B) axial MR images. Biopsy of
prostate was performed 5 weeks before MRI.
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Fig. 14 —Adrenal metastasis in 60-year-old man. Axial CT scan shows
prostate cancer metastasis (arrow) to left adrenal gland. Rarely,
prostate cancer metastases involve solid organs such as lung, liver, pleura,
and adrenal glands.
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Fig. 15B —Focal bone metastasis in 72-year-old man. Prostate cancer
metastasis to sacrum results in increased uptake (arrow, A) of
99mTc MDP (methylene diphosphate) on bone scan (A) and
appears as sclerosis (arrows, B) on CT scan (B).
Radiopharmaceutical injection site is seen on bone scan (arrowhead,
A).
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Fig. 16A —Diffuse bone metastases in 75-year-old man. Prostate cancer
metastases throughout skeleton result in "superscan" with
relatively normal-appearing bones but poor visualization of kidneys
(arrows) on 99mTc MDP (methylene diphosphate) bone
scintigraphy. Right renal pelvis (arrowhead) is seen because of
obstruction of ureter.
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Fig. 17A —Diffuse bone metastases in 68-year-old man. On frontal
(A) and lateral (B) radiographs, prostate cancer metastases
throughout skeleton appear as focal and diffuse areas of sclerosis
(arrows indicate some examples). Sternotomy wires are present.
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Fig. 17B —Diffuse bone metastases in 68-year-old man. On frontal
(A) and lateral (B) radiographs, prostate cancer metastases
throughout skeleton appear as focal and diffuse areas of sclerosis
(arrows indicate some examples). Sternotomy wires are present.
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Fig. 18A —Bone metastasis with epidural extension in 78-year-old man
Prostate cancer metatasis to thoracic vertebral body (short arrow)
has low signal admixed with mild increased signal on T2-weighted image
(A), low signal on T1-weighted image (B), and mild enhancement
on fat-suppressed T1-weighted image with IV contrast material (C).
Metatasis has epidural component (long arrow) that compresses spinal
cord and appears isointense on T2-weighted image (A), hypointense on
T1-weighted image (B), and enhances (C).
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Fig. 18B —Bone metastasis with epidural extension in 78-year-old man
Prostate cancer metatasis to thoracic vertebral body (short arrow)
has low signal admixed with mild increased signal on T2-weighted image
(A), low signal on T1-weighted image (B), and mild enhancement
on fat-suppressed T1-weighted image with IV contrast material (C).
Metatasis has epidural component (long arrow) that compresses spinal
cord and appears isointense on T2-weighted image (A), hypointense on
T1-weighted image (B), and enhances (C).
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Fig. 18C —Bone metastasis with epidural extension in 78-year-old man
Prostate cancer metatasis to thoracic vertebral body (short arrow)
has low signal admixed with mild increased signal on T2-weighted image
(A), low signal on T1-weighted image (B), and mild enhancement
on fat-suppressed T1-weighted image with IV contrast material (C).
Metatasis has epidural component (long arrow) that compresses spinal
cord and appears isointense on T2-weighted image (A), hypointense on
T1-weighted image (B), and enhances (C).
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Fig. 19A —Local recurrence in 61-year-old man. Local prostate cancer
recurrence (arrows) shows increased signal on T2-weighted image
(A), isointense signal on T1-weighted image (B), and enhancement
on contrast-enhanced T1-weighted image (C).
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Fig. 19B —Local recurrence in 61-year-old man. Local prostate cancer
recurrence (arrows) shows increased signal on T2-weighted image
(A), isointense signal on T1-weighted image (B), and enhancement
on contrast-enhanced T1-weighted image (C).
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Fig. 19C —Local recurrence in 61-year-old man. Local prostate cancer
recurrence (arrows) shows increased signal on T2-weighted image
(A), isointense signal on T1-weighted image (B), and enhancement
on contrast-enhanced T1-weighted image (C).
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Copyright © 2007 by the American Roentgen Ray Society.
