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Dynamic Contrast-Enhanced MRI of Prostate Cancer at 3 T: A Study of Pharmacokinetic Parameters

¹ Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892.
² Present address: Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213-2582.
³ NCI Molecular Imaging Program and Research Technology Program, SAIC-Frederick, Inc., Frederick, MD.
⁴ Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN.
⁵ Urologic Oncology Branch, National Cancer Institute, Bethesda, MD.
⁶ Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Utility of color map in identifying tumor in 52-year-old man with diffuse chronic prostatitis (prostate-specific antigen level = 4.7 ng/mL, Gleason score = 7). Transverse high-resolution T2-weighted turbo spin-echo MR image shows diffuse low signal intensity within entire peripheral zone.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Utility of color map in identifying tumor in 52-year-old man with diffuse chronic prostatitis (prostate-specific antigen level = 4.7 ng/mL, Gleason score = 7). Transverse 3D fast-field echo T1-weighted images before (B) and after (C) contrast injection show early signal enhancement in tumor on left anterior peripheral zone.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Utility of color map in identifying tumor in 52-year-old man with diffuse chronic prostatitis (prostate-specific antigen level = 4.7 ng/mL, Gleason score = 7). Transverse 3D fast-field echo T1-weighted images before (B) and after (C) contrast injection show early signal enhancement in tumor on left anterior peripheral zone.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Utility of color map in identifying tumor in 52-year-old man with diffuse chronic prostatitis (prostate-specific antigen level = 4.7 ng/mL, Gleason score = 7). Pixel-by-pixel pharmacokinetic analysis was performed in region of interest (ROI) enclosed by white curve. kep (reverse reflux rate constant between extracellular space and plasma) map overlaid on T2-weighted image localizes lesion to left anterior peripheral zone.

View larger version (23K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Utility of color map in identifying tumor in 52-year-old man with diffuse chronic prostatitis (prostate-specific antigen level = 4.7 ng/mL, Gleason score = 7). Comparison of gadopentetate dimeglumine concentration–versus–time curves obtained from right (E) and left (F) sides of peripheral zone, specified by green and red ROIs in (C), respectively, indicate that wash-in and washout processes were more rapid in tumor.

View larger version (17K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —Utility of color map in identifying tumor in 52-year-old man with diffuse chronic prostatitis (prostate-specific antigen level = 4.7 ng/mL, Gleason score = 7). Comparison of gadopentetate dimeglumine concentration–versus–time curves obtained from right (E) and left (F) sides of peripheral zone, specified by green and red ROIs in (C), respectively, indicate that wash-in and washout processes were more rapid in tumor.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Prostatitis and hemorrhage masking prostate cancer in right apex in 59-year-old man with Gleason score of 6 and prostate-specific antigen level of 4.5 ng/mL. Biopsy was performed 8 weeks before MRI. Transverse T2-weighted image shows diffuse low signal intensity in entire peripheral zone due to prostatitis and hemorrhage.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Prostatitis and hemorrhage masking prostate cancer in right apex in 59-year-old man with Gleason score of 6 and prostate-specific antigen level of 4.5 ng/mL. Biopsy was performed 8 weeks before MRI. Unenhanced transverse 3D fast-field echo T1-weighted image shows diffuse hemorrhage in peripheral zone.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Prostatitis and hemorrhage masking prostate cancer in right apex in 59-year-old man with Gleason score of 6 and prostate-specific antigen level of 4.5 ng/mL. Biopsy was performed 8 weeks before MRI. On this MR image obtained after contrast agent injection, tumor cannot be differentiated from hemorrhagic regions.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Prostatitis and hemorrhage masking prostate cancer in right apex in 59-year-old man with Gleason score of 6 and prostate-specific antigen level of 4.5 ng/mL. Biopsy was performed 8 weeks before MRI. kep (reverse reflux rate constant between extracellular space and plasma [min–1]) map also fails to delineate tumor.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Prostate cancer depicted on T2-weighted and dynamic contrast-enhanced MRI in 56-year-old man with prostate-specific antigen level of 4.8 ng/mL and histologically proven prostate cancer with Gleason score of 7. Transverse T2-weighted turbo spin-echo image shows low signal intensity in right apical peripheral zone.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Prostate cancer depicted on T2-weighted and dynamic contrast-enhanced MRI in 56-year-old man with prostate-specific antigen level of 4.8 ng/mL and histologically proven prostate cancer with Gleason score of 7. Three-dimensional fast-field echo T1-weighted images before (B) and after (C) contrast agent injection show earlier signal enhancement in tumor.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Prostate cancer depicted on T2-weighted and dynamic contrast-enhanced MRI in 56-year-old man with prostate-specific antigen level of 4.8 ng/mL and histologically proven prostate cancer with Gleason score of 7. Three-dimensional fast-field echo T1-weighted images before (B) and after (C) contrast agent injection show earlier signal enhancement in tumor.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Prostate cancer depicted on T2-weighted and dynamic contrast-enhanced MRI in 56-year-old man with prostate-specific antigen level of 4.8 ng/mL and histologically proven prostate cancer with Gleason score of 7. Fusion of transverse T2-weighted image with color-encoded Ktrans (forward volume transfer constant) map delineates tumor area.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Prostate cancer depicted on both T2-weighted and dynamic contrast-enhanced MR images of 60-year-old man with prostate-specific antigen level of 7 ng/mL and tumor on left peripheral zone with Gleason score of 7. Transverse high-resolution turbo spin-echo T2-weighted image shows homogeneous low signal intensity on left peripheral zone.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Prostate cancer depicted on both T2-weighted and dynamic contrast-enhanced MR images of 60-year-old man with prostate-specific antigen level of 7 ng/mL and tumor on left peripheral zone with Gleason score of 7. Three-dimensional fast-field echo T1-weighted images before (B) and after (C) contrast agent injection show earlier signal enhancement in tumor on left peripheral zone.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Prostate cancer depicted on both T2-weighted and dynamic contrast-enhanced MR images of 60-year-old man with prostate-specific antigen level of 7 ng/mL and tumor on left peripheral zone with Gleason score of 7. Three-dimensional fast-field echo T1-weighted images before (B) and after (C) contrast agent injection show earlier signal enhancement in tumor on left peripheral zone.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Prostate cancer depicted on both T2-weighted and dynamic contrast-enhanced MR images of 60-year-old man with prostate-specific antigen level of 7 ng/mL and tumor on left peripheral zone with Gleason score of 7. Fusion of transverse T2-weighted image with color-encoded kep (reverse reflux rate constant between extracellular space and plasma) map detects tumor.

View larger version (7K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Diagram shows receiver operating characteristic (ROC) curve obtained by combining T2-weighted images with Ktrans (forward volume transfer constant), kep (reverse reflux rate constant between extracellular space and plasma), and AUGC (area under the gadolinium concentration curve in the first 90 seconds after injection) parameters computed from dynamic contrast-enhanced MRI. ROC curve shows diagnostic performance of generalized estimating equations and logistic regression predictor. Analysis of combination of these parameters yielded 80% specificity and 75% sensitivity; this corresponds to single point on estimated ROC curve.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —65-year-old man with prostate-specific antigen level of 8 ng/mL and histologically proven prostate cancer in left base with Gleason score of 6. Normal enhancement within peripheral zone masks small prostate cancer. Coronal (A) and transverse (B) T2-weighted turbo spin-echo images show normal-appearing peripheral zone and no evidence of hemorrhage.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —65-year-old man with prostate-specific antigen level of 8 ng/mL and histologically proven prostate cancer in left base with Gleason score of 6. Normal enhancement within peripheral zone masks small prostate cancer. Coronal (A) and transverse (B) T2-weighted turbo spin-echo images show normal-appearing peripheral zone and no evidence of hemorrhage.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —65-year-old man with prostate-specific antigen level of 8 ng/mL and histologically proven prostate cancer in left base with Gleason score of 6. Normal enhancement within peripheral zone masks small prostate cancer. Three-dimensional fast-field echo T1-weighted image obtained after contrast agent injection shows homogeneous enhancement in entire peripheral zone.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —65-year-old man with prostate-specific antigen level of 8 ng/mL and histologically proven prostate cancer in left base with Gleason score of 6. Normal enhancement within peripheral zone masks small prostate cancer. Fusion of T2-weighted transverse image with color-encoded Ktrans (forward volume transfer constant) map is also normal.

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