Joan C. Vilanova MD, Presenter: Nothing to Disclose

Josep Comet, Abstract Co-Author: Nothing to Disclose

Joaquim Barcelo MD, Abstract Co-Author: Nothing to Disclose

Miguel Villalon MD, Abstract Co-Author: Nothing to Disclose

Joan Areal, Abstract Co-Author: Nothing to Disclose

Albert Maroto MS, Abstract Co-Author: Nothing to Disclose

To evaluate the role of magnetic resonance spectroscopic imaging (MRSI) in prostate cancer detection for the transition and peripheral zone in patients with elevated PSA levels and negative biopsy results for prostate cancer; and analyze the metabolic changes between prostate cancer and BPH in each zonal area

Endorectal MR and 3D MRSI were performed in 27 patients with elevated PSA levels with previous negative biopsy results for prostate cancer. Patients had PSA levels >4ng/ml but progressively higher . All studies were performed on a 1.5 Tesla GE Signa MR using an endorectal coil in combination with an ADT torso coil. MRSI consisted of point resolved spectroscopy (PRESS) voxel excitation with 3D phase encoding (16x8x8) of the whole prostate. The Choline+Creatine/Citrate (CC/Ci) ratio and the Choline/Creatine (Ch/Cr) ratio were evaluated in each voxel. A transrectal sextant biopsy was performed after the endorectal MR exam with additional biopsies in the transitional zone and in the area/s suspected by MR imaging

10 patients (37%) had positive results for prostate cancer, 4 in the transitional zone and 6 in the peripheral gland. The overall accuracy, sensitivity and specificity of tumor detection, using MRSI in the transition zone was 85%, 75% and 87% respectively. The CC/Ci ratio and Ch/Cr ratio for cancer voxels (2.13+/-1.21, 3.51+/-1.32) were significantly different from the ratios in the voxels with BPH (0.79+/-0.32, 1.32+/-0.38 respectively) (p<0.01) in the transitional zone. For the peripheral gland the CC/Ci ratio and Ch/Cr ratio for cancer voxels (1.81+/-1.01, 2.53+/-1.12) were significantly different from the ratios in the voxels of the normal gland(0.53+/-0.31, 1.02+/-0.32 respectively) (p<0.01). Accuracy, sensitivity and specificity for tumor detection was 92%, 83% and 95% respectively, for the peripheral gland

The combination of MR imaging and MRSI may be of benefit for patients with previous negative biopsies and increasing PSA levels. Assessment of this patient population on MRSI should include the entire gland, transitional and peripheral zone as the benign and malignant prostatic tissues might be differentiated and located on 3D MRSI

J.C.V.,J.B.,M.V.,J.C.,J.A.,A.M.: This work was supported in part by the Catalan Agency for Health Technology Assessment and Research - AATM- Spain. Grant # 006/30/02.

Vilanova, J, Comet, J, Barcelo, J, Villalon, M, Areal, J, Maroto, A, The Value of MR Spectroscopic Imaging for Prostate Cancer Detection in the Peripheral and Transitional Zone in Patients with Elevated PSA and Negative Biopsy.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405716.html