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MRI Techniques for Prediction of Local Tumor Progression After High-Intensity Focused Ultrasonic Ablation of Prostate Cancer

Chan Kyo Kim1, Byung Kwan Park1, Hyun Moo Lee2, Sam Soo Kim3 and EunJu Kim4

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea 135-710.
2 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
3 Department of Radiology, Kangwon National University School of Medicine, Kangwon-do, South Korea.
4 Department of MRI, DIS Business Group, Philips Healthcare Korea, Seoul, South Korea.


Figure 1
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  		Fig. 1A —66-year-old man with local tumor progression of prostate cancer in left lobe (prostate-specific antigen level, 2.38 ng/mL; Gleason sum score, 8). Axial T2-weighted turbo spin-echo MR image shows focal area (arrow) of low signal intensity in left lobe.

 

Figure 2
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  		Fig. 1B —66-year-old man with local tumor progression of prostate cancer in left lobe (prostate-specific antigen level, 2.38 ng/mL; Gleason sum score, 8). Axial apparent diffusion coefficient map image corresponding to A shows focal low-signal-intensity lesion (arrow) relative to noncancerous prostate tissue.

 

Figure 3
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  		Fig. 1C —66-year-old man with local tumor progression of prostate cancer in left lobe (prostate-specific antigen level, 2.38 ng/mL; Gleason sum score, 8). Parametric images of wash-in rate (C), maximal enhancement (D), and time-to-peak (E) show color-coded area (arrow) corresponding to site in A and representing possibility of local tumor progression. In this case, T2-weighted MRI with diffusion-weighted imaging was equivalent to dynamic contrast-enhanced parametric imaging.

 

Figure 4
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  		Fig. 1D —66-year-old man with local tumor progression of prostate cancer in left lobe (prostate-specific antigen level, 2.38 ng/mL; Gleason sum score, 8). Parametric images of wash-in rate (C), maximal enhancement (D), and time-to-peak (E) show color-coded area (arrow) corresponding to site in A and representing possibility of local tumor progression. In this case, T2-weighted MRI with diffusion-weighted imaging was equivalent to dynamic contrast-enhanced parametric imaging.

 

Figure 5
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  		Fig. 1E —66-year-old man with local tumor progression of prostate cancer in left lobe (prostate-specific antigen level, 2.38 ng/mL; Gleason sum score, 8). Parametric images of wash-in rate (C), maximal enhancement (D), and time-to-peak (E) show color-coded area (arrow) corresponding to site in A and representing possibility of local tumor progression. In this case, T2-weighted MRI with diffusion-weighted imaging was equivalent to dynamic contrast-enhanced parametric imaging.

 

Figure 6
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  		Fig. 2A —69-year-old man with local tumor progression of prostate cancer involving both lobes (prostate-specific antigen level, 4.31 ng/mL; Gleason sum score, 7). Axial T2-weighted turbo spin-echo MR image shows slightly low signal intensity (arrows) in both lobes.

 

Figure 7
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  		Fig. 2B —69-year-old man with local tumor progression of prostate cancer involving both lobes (prostate-specific antigen level, 4.31 ng/mL; Gleason sum score, 7). Axial apparent diffusion coefficient map image shows slightly low signal intensity (arrows) in site corresponding to A. Both readers interpreted lesion as noncancerous tissue.

 

Figure 8
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  		Fig. 2C —69-year-old man with local tumor progression of prostate cancer involving both lobes (prostate-specific antigen level, 4.31 ng/mL; Gleason sum score, 7). Parametric images of wash-in rate (C), maximal enhancement (D), maximal relative enhancement (E), and time-to-peak (F) show color-coded area (arrows) in site corresponding to A, representing possibility of local tumor progression. In this case, dynamic contrast-enhanced parametric images were superior to T2-weighted MRI with diffusion-weighted imaging.

 

Figure 9
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  		Fig. 2D —69-year-old man with local tumor progression of prostate cancer involving both lobes (prostate-specific antigen level, 4.31 ng/mL; Gleason sum score, 7). Parametric images of wash-in rate (C), maximal enhancement (D), maximal relative enhancement (E), and time-to-peak (F) show color-coded area (arrows) in site corresponding to A, representing possibility of local tumor progression. In this case, dynamic contrast-enhanced parametric images were superior to T2-weighted MRI with diffusion-weighted imaging.

 

Figure 10
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  		Fig. 2E —69-year-old man with local tumor progression of prostate cancer involving both lobes (prostate-specific antigen level, 4.31 ng/mL; Gleason sum score, 7). Parametric images of wash-in rate (C), maximal enhancement (D), maximal relative enhancement (E), and time-to-peak (F) show color-coded area (arrows) in site corresponding to A, representing possibility of local tumor progression. In this case, dynamic contrast-enhanced parametric images were superior to T2-weighted MRI with diffusion-weighted imaging.

 

Figure 11
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  		Fig. 2F —69-year-old man with local tumor progression of prostate cancer involving both lobes (prostate-specific antigen level, 4.31 ng/mL; Gleason sum score, 7). Parametric images of wash-in rate (C), maximal enhancement (D), maximal relative enhancement (E), and time-to-peak (F) show color-coded area (arrows) in site corresponding to A, representing possibility of local tumor progression. In this case, dynamic contrast-enhanced parametric images were superior to T2-weighted MRI with diffusion-weighted imaging.

 

Figure 12
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  		Fig. 3A —73-year-old man with false-positive findings on dynamic contrast-enhanced parametric imaging (prostate-specific antigen level, 1.89 ng/mL). Axial T2-weighted turbo spin-echo (A) and apparent diffusion coefficient map (B) images show slightly diffuse low signal intensity (arrows) in both lobes. Finding is suggestive of noncancerous tissue.

 

Figure 13
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  		Fig. 3B —73-year-old man with false-positive findings on dynamic contrast-enhanced parametric imaging (prostate-specific antigen level, 1.89 ng/mL). Axial T2-weighted turbo spin-echo (A) and apparent diffusion coefficient map (B) images show slightly diffuse low signal intensity (arrows) in both lobes. Finding is suggestive of noncancerous tissue.

 

Figure 14
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  		Fig. 3C —73-year-old man with false-positive findings on dynamic contrast-enhanced parametric imaging (prostate-specific antigen level, 1.89 ng/mL). Parametric images of maximal enhancement (C), maximal relative enhancement (D), and washout rate (E) show color-coded area (arrowheads) in site corresponding to A and representing possibility of local tumor progression. Findings at transrectal sonographically guided prostate biopsy showed benign prostate gland and stroma without cancer foci. In this case, T2-weighted MRI with diffusion-weighted imaging was superior to dynamic contrast-enhanced parametric imaging.

 

Figure 15
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  		Fig. 3D —73-year-old man with false-positive findings on dynamic contrast-enhanced parametric imaging (prostate-specific antigen level, 1.89 ng/mL). Parametric images of maximal enhancement (C), maximal relative enhancement (D), and washout rate (E) show color-coded area (arrowheads) in site corresponding to A and representing possibility of local tumor progression. Findings at transrectal sonographically guided prostate biopsy showed benign prostate gland and stroma without cancer foci. In this case, T2-weighted MRI with diffusion-weighted imaging was superior to dynamic contrast-enhanced parametric imaging.

 

Figure 16
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  		Fig. 3E —73-year-old man with false-positive findings on dynamic contrast-enhanced parametric imaging (prostate-specific antigen level, 1.89 ng/mL). Parametric images of maximal enhancement (C), maximal relative enhancement (D), and washout rate (E) show color-coded area (arrowheads) in site corresponding to A and representing possibility of local tumor progression. Findings at transrectal sonographically guided prostate biopsy showed benign prostate gland and stroma without cancer foci. In this case, T2-weighted MRI with diffusion-weighted imaging was superior to dynamic contrast-enhanced parametric imaging.

 

Figure 17
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  		Fig. 4 —Receiver operating characteristic curves show results of interpretation of dynamic contrast-enhanced MRI (DCE-MRI) and T2-weighted MRI with diffusion-weighted imaging (DWI) by two readers. No statistical difference between DCE-MRI and T2-weighted MRI with DWI for two readers was evident for prediction of local tumor progression of prostate cancer after high-intensity focused ultrasonic ablation. Az = area under the receiver operating characteristic curve.

 

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