Emanuele Casciani, Presenter: Nothing to Disclose

Elisabetta Polettini MD, Abstract Co-Author: Nothing to Disclose

Vito Pansadoro, Abstract Co-Author: Nothing to Disclose

Luca Bertini MD, Abstract Co-Author: Nothing to Disclose

Stefano Caprasecca, Abstract Co-Author: Nothing to Disclose

Gianfranco Gualdi, Abstract Co-Author: Nothing to Disclose

To establish the additional value of MR Spectroscopy (MRS 3D CSI - Magnetic Resonance Spectroscopy 3D Chemical Shift Imaging) to endorectal MR in the diagnosis and grading of prostate cancer.

MR and MRS 3D CSI were performed in 70 Patients with suspicion of prostatic cancer on the basis of endorectal exploration and/or on transrectal ultrasound and/or on high PSA levels. All the examinations were performed with 1,5 T scan using an endorectal coil. We acquired axial and coronal FSE T2-weighted sequences, axial T1 weighted SE and spectroscopic sequences PRESS 3D CSI (Point Resolved Spectroscopy 3D Chemical Shift Imaging) localized on the axial T2 images thus including only the peripheral zone of the prostate, excluding the periprostatic fat. MR examinations have been evaluated by two Radiologist blind of the clinical data, the transrectal ultrasound findings, the PSA levels and of the histological findings. MR and MRS 3D CSI findings were compared with histological specimens obtained from radical prostatectomy.

The histologic examination revealed adenocarcinoma in 46 cases, prostatitis in 3 cases and no alterations in the remaining 21 cases. By using MR morphologic evaluation alone we reported a sensibility of 76%, a specificity of 53%, an accuracy of 70%, a PPV of 81% and a NPV of 47%. By combining MR and MRS 3D CSI we obtained a sensibility of 95%, a specificity of 81%, an accuracy of 91%, a PPV of 92% and a NPV of 87%. An elevated concentration of choline was found either in the tumors with low Gleason score (21 cases) and in the tumors with high Gleason score (25 cases); instead we found marked reduction (n=12) or absence (n=5) of the concentration of citrate only in the tumors with high Gleason score, while we found normal citrate levels in remaining tumurs with low Gleason score.

The MRS 3D CSI has improved the reliability of the endorectal MR in the diagnosis and localization of prostatic cancer. Moreover MRS 3D CSI has demonstrated a linear correlation with cancer grade.

Casciani, E, Polettini, E, Pansadoro, V, Bertini, L, Caprasecca, S, Gualdi, G, Prostate Cancer: Evaluation with Endorectal MR Imaging and Three-dimensional Proton MR Spectroscopic Imaging.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4418425.html