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Bildgebung beim Prostatakarzinom

State of the Art

Imaging in prostate cancer

State of the art

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Im Rahmen der Magnetresonanztomographie (MRT) kann die Prostata mit dem besten Weichgewebskontrast und der höchsten räumlichen Auflösung aller bildgebenden Verfahren beurteilt werden. Gleichzeitig können zusätzlich zur rein anatomisch-morphologischen Information auch funktionelle Parameter, wie Gewebedurchblutung (Perfusion), -stoffwechsel (MR-Spektroskopie, MRS) und Zelldichte (diffusionsgewichtete Bildgebung, DWI) bestimmt werden.

Material und Methoden

Zahlreiche Studien belegen bereits den Stellenwert der MRT in der Lokalisation von Karzinomherden bei Patienten mit steigender Konzentration des prostataspezifischen Antigens (PSA) und stattgehabter Negativbiopsie. Insbesondere in der Drüsenperipherie, der häufigsten Manifestationsstelle eines PCa, erlaubt die kombinierte Analyse morphologischer und funktioneller Parameter, den PCa-Fokus von mit einer Prostatitis einhergehenden Veränderungen spezifisch zu differenzieren. Neben der Primärdiagnostik findet die MRT ihren wertvollen Einsatz auch in der präoperativen Beurteilung evtl. vorliegenden extrakapsulären Wachstums/Samenblasenbefalls und nach z. B. erfolgter Radiatio in der Rezidivsituation oder bei biochemischem Rezidiv nach radikaler Prostatektomie.

Schlussfolgerungen

Damit stellt die sog. multiparametrische (mMRT) ein sehr leistungsfähiges Verfahren für die Diagnose des PCa dar.

Abstract

Background

Magnetic resonance imaging (MRI) offers the best soft tissue contrast and the highest spatial resolution of the prostate gland among all clinical imaging modalities available at present. Besides morphological information functional parameters can also be assessed by perfusion and diffusion weighted imaging (DWI) as well as MR spectroscopy.

Materials and methods

Numerous studies have already proven the value of MRI in patients with increasing prostate-specific antigen (PSA) levels after negative biopsy results. Multiparametric MRI, consisting of morphological T2-weighted images as well as functional techniques improves the accuracy of the examination, allowing a more specific diagnosis even in the presence of other prostatic diseases, such as benign prostate hyperplasia or prostatitis. Besides detection of primary prostate cancer, MRI has also proven to be of value for the assessment of extracapsular involvement prior to surgery as well as for follow-up after radiation therapy.

Conclusions

The MRI technique has become a valuable tool which is superior to digital rectal evaluation and transrectal ultrasound for the detection and localization of prostate cancer.

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Literatur

  1. Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757

    Article  PubMed  Google Scholar 

  2. Beer AJ, Eiber M, Souvatzoglou M et al (2011) Restricted water diffusibility as measured by diffusion-weighted MR imaging and choline uptake in (11)C-choline PET/CT are correlated in pelvic lymph nodes in patients with prostate cancer. Mol Imaging Biol 13:352–361

    Article  PubMed  Google Scholar 

  3. Bittencourt LK, Matos C, Coutinho AC Jr (2011) Diffusion-weighted magnetic resonance imaging in the upper abdomen: technical issues and clinical applications. Magn Reson Imaging Clin N Am 19:111–131

    Article  PubMed  Google Scholar 

  4. Bloch BN, Furman-Haran E, Helbich TH et al (2007) Prostate cancer: accurate determination of extracapsular extension with high-spatial-resolution dynamic contrast-enhanced and T2-weighted MR imaging – initial results. Radiology 245:176–185

    Article  PubMed  Google Scholar 

  5. Chen Z, Penet M-F, Nimmagadda S et al (2011) Theranostic imaging of metastatic prostate cancer. Proc Intl Soc Mag Reson Med 19:448

    Google Scholar 

  6. Cornfeld DM, Weinreb JC (2007) MR imaging of the prostate: 1.5 T versus 3 T. Magn Reson Imaging Clin N Am 15:433–448

    Article  PubMed  Google Scholar 

  7. Delongchamps NB, Peyromaure M, Schull A et al (2013) Prebiopsy magnetic resonance imaging and prostate cancer detection: comparison of random and targeted biopsies. J Urol 189:493–499

    Article  PubMed  Google Scholar 

  8. Desouza NM, Riches SF, Vanas NJ et al (2008) Diffusion-weighted magnetic resonance imaging: a potential non-invasive marker of tumour aggressiveness in localized prostate cancer. Clin Radiol 63:774–782

    Article  PubMed  CAS  Google Scholar 

  9. Deutsche Gesellschaft für Urologie (2011) Prostatakarzinom: Früherkennung, Diagnose und Therapie der verschiedenen Stadien.. AWMF-Register: Nummer 043-022OL. http://awmf.org

  10. Doo KW, Sung DJ, Park BJ et al (2012) Detectability of low and intermediate or high risk prostate cancer with combined T2-weighted and diffusion-weighted MRI. Eur Radiol 22:1812–1819

    Article  PubMed  Google Scholar 

  11. Franiel T, Stephan C, Erbersdobler A et al (2011) Areas suspicious for prostate cancer: MR-guided biopsy in patients with at least one transrectal US-guided biopsy with a negative finding – multiparametric MR imaging for detection and biopsy planning. Radiology 259:162–172

    Article  PubMed  Google Scholar 

  12. Fueger BJ, Helbich TH, Schernthaner M et al (2011) Diagnose importance of multiparametric magnetic resonance tomography for prostate cancer. Radiologe 51:947–954

    Article  PubMed  CAS  Google Scholar 

  13. Futterer JJ, Engelbrecht MR, Jager GJ et al (2007) Prostate cancer: comparison of local staging accuracy of pelvic phased-array coil alone versus integrated endorectal-pelvic phased-array coils. Local staging accuracy of prostate cancer using endorectal coil MR imaging. Eur Radiol 17:1055–1065

    Article  PubMed  Google Scholar 

  14. Futterer JJ, Heijmink SW, Scheenen TW et al (2006) Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 241:449–458

    Article  PubMed  Google Scholar 

  15. Ganswindt U, Schilling D, Muller AC et al (2011) Distribution of prostate sentinel nodes: a SPECT-derived anatomic atlas. Int J Radiat Oncol Biol Phys 79:1364–1372

    Article  PubMed  Google Scholar 

  16. Haider MA, Van Der Kwast TH, Tanguay J et al (2007) Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. AJR Am J Roentgenol 189:323–328

    Article  PubMed  Google Scholar 

  17. Heesakkers RA, Hovels AM, Jager GJ et al (2008) MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol 9:850–856

    Article  PubMed  CAS  Google Scholar 

  18. Heidenreich A, Bellmunt J, Bolla M et al (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71

    Article  PubMed  Google Scholar 

  19. Hovels AM, Heesakkers RA, Adang EM et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63:387–395

    Article  PubMed  CAS  Google Scholar 

  20. Itou Y, Nakanishi K, Narumi Y et al (2011) Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: can ADC values contribute to assess the aggressiveness of prostate cancer? J Magn Reson Imaging 33:167–172

    Article  PubMed  Google Scholar 

  21. Mazaheri Y, Hricak H, Fine SW et al (2009) Prostate tumor volume measurement with combined T2-weighted imaging and diffusion-weighted MR: correlation with pathologic tumor volume. Radiology 252:449–457

    Article  PubMed  Google Scholar 

  22. Meijer HJ, Fortuin AS, Van Lin EN et al (2013) Geographical distribution of lymph node metastases on MR lymphography in prostate cancer patients. Radiother Oncol 106:59–63

    Article  PubMed  Google Scholar 

  23. Mullerad M, Hricak H, Kuroiwa K et al (2005) Comparison of endorectal magnetic resonance imaging, guided prostate biopsy and digital rectal examination in the preoperative anatomical localization of prostate cancer. J Urol 174:2158–2163

    Article  PubMed  Google Scholar 

  24. Outwater EK, Petersen RO, Siegelman ES et al (1994) Prostate carcinoma: assessment of diagnostic criteria for capsular penetration on endorectal coil MR images. Radiology 193:333–339

    PubMed  CAS  Google Scholar 

  25. Padhani AR, Harvey CJ, Cosgrove DO (2005) Angiogenesis imaging in the management of prostate cancer. Nat Clin Pract Urol 2:596–607

    Article  PubMed  Google Scholar 

  26. Ren J, Huan Y, Wang H et al (2008) Diffusion-weighted imaging in normal prostate and differential diagnosis of prostate diseases. Abdom Imaging 33:724–728

    Article  PubMed  Google Scholar 

  27. Rischke HC, Schafer AO, Nestle U et al (2012) Detection of local recurrent prostate cancer after radical prostatectomy in terms of salvage radiotherapy using dynamic contrast enhanced-MRI without endorectal coil. Radiat Oncol 7:185

    Article  PubMed  CAS  Google Scholar 

  28. Sato C, Naganawa S, Nakamura T et al (2005) Differentiation of noncancerous tissue and cancer lesions by apparent diffusion coefficient values in transition and peripheral zones of the prostate. J Magn Reson Imaging 21:258–262

    Article  PubMed  Google Scholar 

  29. Schouten MG, Nagel NA, HambrockT et al (2011) Apparent diffusion coefficient values during magnetic resonance-guided biopsy of the prostate: correlation with histological results. Proc Intl Soc Mag Reson Med 19:1052

    Google Scholar 

  30. Selnaes KM, Heerschap A, Jensen LR et al (2012) Peripheral zone prostate cancer localization by multiparametric magnetic resonance at 3 T: unbiased cancer identification by matching to histopathology. Invest Radiol 47:624–633

    Article  PubMed  Google Scholar 

  31. Tamada T, Sone T, Jo Y et al (2008) Apparent diffusion coefficient values in peripheral and transition zones of the prostate: comparison between normal and malignant prostatic tissues and correlation with histologic grade. J Magn Reson Imaging 28:720–726

    Article  PubMed  Google Scholar 

  32. Turkbey B, Mani H, Shah V et al (2011) Multiparametric 3 T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol 186:1818–1824

    Article  PubMed  Google Scholar 

  33. Turkbey B, Pinto PA, Mani H et al (2010) Prostate cancer: value of multiparametric MR imaging at 3 T for detection – histopathologic correlation. Radiology 255:89–99

    Article  PubMed  Google Scholar 

  34. Turkbey B, Shah VP, Pang Y et al (2011) Is apparent diffusion coefficient associated with clinical risk scores for prostate cancers that are visible on 3-T MR images? Radiology 258:488–495

    Article  PubMed  Google Scholar 

  35. Weidner AM, Van Lin EN, Dinter DJ et al (2011) Ferumoxtran-10 MR lymphography for target definition and follow-up in a patient undergoing image-guided, dose-escalated radiotherapy of lymph nodes upon PSA relapse. Strahlenther Onkol 187:206–212

    Article  PubMed  Google Scholar 

  36. Westphalen AC, Coakley FV, Roach M III et al (2010) Locally recurrent prostate cancer after external beam radiation therapy: diagnostic performance of 1.5-T endorectal MR imaging and MR spectroscopic imaging for detection. Radiology 256:485–492

    Article  PubMed  Google Scholar 

  37. Xylinas E, Yates DR, Renard-Penna R et al (2011) Role of pelvic phased array magnetic resonance imaging in staging of prostate cancer specifically in patients diagnosed with clinically locally advanced tumours by digital rectal examination. World J Urol. DOI 10.1007/s00345-011-0811-z

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. U.I. Attenberger weist für sich und seine Koautoren auf folgende Beziehungen hin: Attenberger: Consultant Bayer HealthCare, Institutional Research Agreement Siemens Healthcare.

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Authors and Affiliations

  1. Institut für Klinische Radiologie und Nuklearmedizin – IKRN, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    U.I. Attenberger MD, S.O. Schoenberg, A. Weidner, M. Sertdemir & D. Hausmann

  2. Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Klinikum der Universität München – Campus Großhadern, München, Deutschland

    M. Niyazi

  3. CDPI Clinics-Abdominal and Pelvic Imaging, Rio de Janeiro Federal University, Rio de Janeiro, Brazil

    L.K. Bittencourt

  4. Klinik für Strahlentherapie und Radioonkologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland

    D. Buergy

Authors
  1. U.I. Attenberger MD
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  2. S.O. Schoenberg
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  3. A. Weidner
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  4. M. Niyazi
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  5. L.K. Bittencourt
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  6. D. Buergy
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  7. M. Sertdemir
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  8. D. Hausmann
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Correspondence to U.I. Attenberger MD.

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Attenberger, U., Schoenberg, S., Weidner, A. et al. Bildgebung beim Prostatakarzinom. Onkologe 19, 747–755 (2013). https://doi.org/10.1007/s00761-013-2484-2

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  • DOI: https://doi.org/10.1007/s00761-013-2484-2

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