Detection of prostate cancer

Utility of diffusion-weighted MR imaging and 3D MR spectroscopic imaging

Ghada K. Gouhar, Tamer F. Taha, Mohamed N. Allam

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Purpose: To prospectively compare the mean ADC generated from DWI, the mean choline + creatine/citrate ratio generated from 3D MRS and the combined mean ADC and mean choline + creatine/citrate ratio in the detection of prostate cancer, and to correlate between the choline + creatine/citrate ratio and the aggressiveness of malignancy determined by Gleason score, with histopathological examination of the excised gland as the reference standard. Patients and methods: Forty-six patients with biopsy-proved cancer underwent pre-operative MRI at 1.5 T. Axial T1, axial, coronal and sagittal T2-weighted, diffusion-weighted and 3D MRS using a point-resolved spectroscopic sequence (PRESS) were acquired. The mean ADC, mean choline + creatine/citrate ratio and combined parameters for malignant lesions are correlated with the pathological results. For each malignant lesion choline + creatine/citrate ratio was correlated with the aggressiveness of malignancy determined by Gleason score. Receiver operating characteristic (ROC) curves were used to determine sensitivity, and specificity of the studied parameters, and Kappa measures of agreement were calculated for prostate cancer detection. Results: The mean ADC for tumor tissue was 1.0 ± 0.22 × 10-3 mm2/s (mean ± SD), and was significantly lower than that for non-tumor tissue 1.44 ± 0.28 × 10-3 mm2/s (p < 0.001). For MRS study the mean (choline + creatine)/citrate ratio in tumor tissue was 1.98 ± 1.0, and was significantly higher than that for non-tumor tissue, 0.72 ± 0.39 (p < 0.001). By combining both ADC values and (choline + creatine)/citrate ratio for differentiating malignant from non-malignant tissues a receiver operating characteristic analysis (ROC) curve showed Area under curve (AUC = 0.93) and was significantly higher than either (choline + creatine)/citrate ratio alone (AUC = 0.86) (p < 0.001) or ADC value alone (AUC = 0.89) (p < 0.001). There is an increasing (choline + creatine)/citrate ratio with increasing Gleason score, however, there is overlap between groups. A greater sensitivity of MRS for tumor detection 85% and 92% was present for tumors with Gleason score 4 + 3 and ≥4 + 4, respectively, while for tumors with Gleason score 3 + 3 the sensitivity was 63%. Conclusion: The combination of ADC and (choline + creatine)/citrate ratio is better than each parameter alone in differentiating between tumor and non-tumor prostatic tissue, also MR spectroscopic imaging findings of prostate tumor (Cho + Cr)/Cit ratio correlate with pathologic Gleason score. The combined parameters offer a promising non-invasive method for the diagnostic workup of prostate cancer.

Original languageEnglish
Pages (from-to)429-439
Number of pages11
JournalEgyptian Journal of Radiology and Nuclear Medicine
Volume41
Issue number3
DOIs
Publication statusPublished - 1 Sep 2010

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Creatine
Choline
Prostatic Neoplasms
Neoplasm Grading
Neoplasms
Area Under Curve
ROC Curve
Prostate
Biopsy
Sensitivity and Specificity

Keywords

  • Cancer
  • Diffusion
  • MR
  • Prostate
  • Spectroscopy

Cite this

@article{f4a2380ed49d4f148c8b315816b84c82,
title = "Detection of prostate cancer: Utility of diffusion-weighted MR imaging and 3D MR spectroscopic imaging",
abstract = "Purpose: To prospectively compare the mean ADC generated from DWI, the mean choline + creatine/citrate ratio generated from 3D MRS and the combined mean ADC and mean choline + creatine/citrate ratio in the detection of prostate cancer, and to correlate between the choline + creatine/citrate ratio and the aggressiveness of malignancy determined by Gleason score, with histopathological examination of the excised gland as the reference standard. Patients and methods: Forty-six patients with biopsy-proved cancer underwent pre-operative MRI at 1.5 T. Axial T1, axial, coronal and sagittal T2-weighted, diffusion-weighted and 3D MRS using a point-resolved spectroscopic sequence (PRESS) were acquired. The mean ADC, mean choline + creatine/citrate ratio and combined parameters for malignant lesions are correlated with the pathological results. For each malignant lesion choline + creatine/citrate ratio was correlated with the aggressiveness of malignancy determined by Gleason score. Receiver operating characteristic (ROC) curves were used to determine sensitivity, and specificity of the studied parameters, and Kappa measures of agreement were calculated for prostate cancer detection. Results: The mean ADC for tumor tissue was 1.0 ± 0.22 × 10-3 mm2/s (mean ± SD), and was significantly lower than that for non-tumor tissue 1.44 ± 0.28 × 10-3 mm2/s (p < 0.001). For MRS study the mean (choline + creatine)/citrate ratio in tumor tissue was 1.98 ± 1.0, and was significantly higher than that for non-tumor tissue, 0.72 ± 0.39 (p < 0.001). By combining both ADC values and (choline + creatine)/citrate ratio for differentiating malignant from non-malignant tissues a receiver operating characteristic analysis (ROC) curve showed Area under curve (AUC = 0.93) and was significantly higher than either (choline + creatine)/citrate ratio alone (AUC = 0.86) (p < 0.001) or ADC value alone (AUC = 0.89) (p < 0.001). There is an increasing (choline + creatine)/citrate ratio with increasing Gleason score, however, there is overlap between groups. A greater sensitivity of MRS for tumor detection 85{\%} and 92{\%} was present for tumors with Gleason score 4 + 3 and ≥4 + 4, respectively, while for tumors with Gleason score 3 + 3 the sensitivity was 63{\%}. Conclusion: The combination of ADC and (choline + creatine)/citrate ratio is better than each parameter alone in differentiating between tumor and non-tumor prostatic tissue, also MR spectroscopic imaging findings of prostate tumor (Cho + Cr)/Cit ratio correlate with pathologic Gleason score. The combined parameters offer a promising non-invasive method for the diagnostic workup of prostate cancer.",
keywords = "Cancer, Diffusion, MR, Prostate, Spectroscopy",
author = "Gouhar, {Ghada K.} and Taha, {Tamer F.} and Allam, {Mohamed N.}",
year = "2010",
month = "9",
day = "1",
doi = "10.1016/j.ejrnm.2010.08.004",
language = "English",
volume = "41",
pages = "429--439",
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issn = "0378-603X",
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}

Detection of prostate cancer : Utility of diffusion-weighted MR imaging and 3D MR spectroscopic imaging. / Gouhar, Ghada K.; Taha, Tamer F.; Allam, Mohamed N.

In: Egyptian Journal of Radiology and Nuclear Medicine, Vol. 41, No. 3, 01.09.2010, p. 429-439.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Detection of prostate cancer

T2 - Utility of diffusion-weighted MR imaging and 3D MR spectroscopic imaging

AU - Gouhar, Ghada K.

AU - Taha, Tamer F.

AU - Allam, Mohamed N.

PY - 2010/9/1

Y1 - 2010/9/1

N2 - Purpose: To prospectively compare the mean ADC generated from DWI, the mean choline + creatine/citrate ratio generated from 3D MRS and the combined mean ADC and mean choline + creatine/citrate ratio in the detection of prostate cancer, and to correlate between the choline + creatine/citrate ratio and the aggressiveness of malignancy determined by Gleason score, with histopathological examination of the excised gland as the reference standard. Patients and methods: Forty-six patients with biopsy-proved cancer underwent pre-operative MRI at 1.5 T. Axial T1, axial, coronal and sagittal T2-weighted, diffusion-weighted and 3D MRS using a point-resolved spectroscopic sequence (PRESS) were acquired. The mean ADC, mean choline + creatine/citrate ratio and combined parameters for malignant lesions are correlated with the pathological results. For each malignant lesion choline + creatine/citrate ratio was correlated with the aggressiveness of malignancy determined by Gleason score. Receiver operating characteristic (ROC) curves were used to determine sensitivity, and specificity of the studied parameters, and Kappa measures of agreement were calculated for prostate cancer detection. Results: The mean ADC for tumor tissue was 1.0 ± 0.22 × 10-3 mm2/s (mean ± SD), and was significantly lower than that for non-tumor tissue 1.44 ± 0.28 × 10-3 mm2/s (p < 0.001). For MRS study the mean (choline + creatine)/citrate ratio in tumor tissue was 1.98 ± 1.0, and was significantly higher than that for non-tumor tissue, 0.72 ± 0.39 (p < 0.001). By combining both ADC values and (choline + creatine)/citrate ratio for differentiating malignant from non-malignant tissues a receiver operating characteristic analysis (ROC) curve showed Area under curve (AUC = 0.93) and was significantly higher than either (choline + creatine)/citrate ratio alone (AUC = 0.86) (p < 0.001) or ADC value alone (AUC = 0.89) (p < 0.001). There is an increasing (choline + creatine)/citrate ratio with increasing Gleason score, however, there is overlap between groups. A greater sensitivity of MRS for tumor detection 85% and 92% was present for tumors with Gleason score 4 + 3 and ≥4 + 4, respectively, while for tumors with Gleason score 3 + 3 the sensitivity was 63%. Conclusion: The combination of ADC and (choline + creatine)/citrate ratio is better than each parameter alone in differentiating between tumor and non-tumor prostatic tissue, also MR spectroscopic imaging findings of prostate tumor (Cho + Cr)/Cit ratio correlate with pathologic Gleason score. The combined parameters offer a promising non-invasive method for the diagnostic workup of prostate cancer.

AB - Purpose: To prospectively compare the mean ADC generated from DWI, the mean choline + creatine/citrate ratio generated from 3D MRS and the combined mean ADC and mean choline + creatine/citrate ratio in the detection of prostate cancer, and to correlate between the choline + creatine/citrate ratio and the aggressiveness of malignancy determined by Gleason score, with histopathological examination of the excised gland as the reference standard. Patients and methods: Forty-six patients with biopsy-proved cancer underwent pre-operative MRI at 1.5 T. Axial T1, axial, coronal and sagittal T2-weighted, diffusion-weighted and 3D MRS using a point-resolved spectroscopic sequence (PRESS) were acquired. The mean ADC, mean choline + creatine/citrate ratio and combined parameters for malignant lesions are correlated with the pathological results. For each malignant lesion choline + creatine/citrate ratio was correlated with the aggressiveness of malignancy determined by Gleason score. Receiver operating characteristic (ROC) curves were used to determine sensitivity, and specificity of the studied parameters, and Kappa measures of agreement were calculated for prostate cancer detection. Results: The mean ADC for tumor tissue was 1.0 ± 0.22 × 10-3 mm2/s (mean ± SD), and was significantly lower than that for non-tumor tissue 1.44 ± 0.28 × 10-3 mm2/s (p < 0.001). For MRS study the mean (choline + creatine)/citrate ratio in tumor tissue was 1.98 ± 1.0, and was significantly higher than that for non-tumor tissue, 0.72 ± 0.39 (p < 0.001). By combining both ADC values and (choline + creatine)/citrate ratio for differentiating malignant from non-malignant tissues a receiver operating characteristic analysis (ROC) curve showed Area under curve (AUC = 0.93) and was significantly higher than either (choline + creatine)/citrate ratio alone (AUC = 0.86) (p < 0.001) or ADC value alone (AUC = 0.89) (p < 0.001). There is an increasing (choline + creatine)/citrate ratio with increasing Gleason score, however, there is overlap between groups. A greater sensitivity of MRS for tumor detection 85% and 92% was present for tumors with Gleason score 4 + 3 and ≥4 + 4, respectively, while for tumors with Gleason score 3 + 3 the sensitivity was 63%. Conclusion: The combination of ADC and (choline + creatine)/citrate ratio is better than each parameter alone in differentiating between tumor and non-tumor prostatic tissue, also MR spectroscopic imaging findings of prostate tumor (Cho + Cr)/Cit ratio correlate with pathologic Gleason score. The combined parameters offer a promising non-invasive method for the diagnostic workup of prostate cancer.

KW - Cancer

KW - Diffusion

KW - MR

KW - Prostate

KW - Spectroscopy

UR - http://www.scopus.com/inward/record.url?scp=78650006995&partnerID=8YFLogxK

U2 - 10.1016/j.ejrnm.2010.08.004

DO - 10.1016/j.ejrnm.2010.08.004

M3 - Article

VL - 41

SP - 429

EP - 439

JO - Egyptian Journal of Radiology and Nuclear Medicine

JF - Egyptian Journal of Radiology and Nuclear Medicine

SN - 0378-603X

IS - 3

ER -