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Combined morphological, [1H]-MR spectroscopic and contrast-enhanced imaging of human prostate cancer with a 3-Tesla scanner: preliminary experience

Imaging combinato morfologico, spettroscopico e dinamico post-contrastografico del cancro prostatico con apparecchiatura di risonanza magnetica a 3 Tesla: esperienza preliminare

  • Uro-Genital Radiology/Radiologia Uro-Genitale
  • Published:
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Abstract

Purpose

The objective of this study was to explore the feasibility of combined morphological magnetic resonance imaging (MRI), [1H]magnetic resonance spectroscopic imaging (MRSI) and quantitative dynamic contrast-enhanced MRI (DCE-MRI) of human prostate cancer at 3 Tesla using a pelvic phased-array coil.

Materials and methods

MRI, MRSI and DCE-MRI with a 3-Tesla whole-body scanner were performed in 30 patients with biopsy-proven prostate cancer before radical prostatectomy. High-resolution T2-weighted turbo spin echo (TSE) images were evaluated for visualisation of the peripheral zone, central gland, visibility of the cancer lesion, prostatic capsule delineation and overall image quality according to a five-point scale. Relative levels of the prostate metabolites citrate, choline and creatine were determined in cancer and in the normal peripheral zone (PZ) and central gland (CG). Spectra were also evaluated for the separation of the signal of citrate, choline and creatine and suppression of lipid and water signals. Time-intensity curves were obtained for prostatic cancer and healthy PZ and CG from DCE-MRI. Finally, time of arrival, time to peak, maximum enhancement and wash-in rate in cancer, normal PZ and CG were calculated.

Results

The high signal-to-noise ratio (SNR) at 3 Tesla provided T2-weighted TSE images with excellent anatomical detail (in-plane voxel size of 0.22×0.22 mm) and good T2 contrast. The increased spectral resolution was sufficient to separate the choline and creatine resonances and allow delineation of the four peaks of citrate resonance. The (choline + creatine)/citrate ratio was elevated in cancer in comparison with PZ and CG (p<0.001). Dynamic contrast-enhanced images showed good temporal resolution. All parameters obtained from DCE-MRI showed a statistically significant (P<0.05) difference between cancer tissue and normal PZ and CG. Wash-in rate and (choline+creatine)/citrate ratio were significantly correlated (r=0.713, P=0.001) in PZ cancer, whereas the correlation was not significant (r=0.617, P=0.06) in CG and in PZ (r=0.530, P=0.08).

Conclusions

It is possible to perform MRI of prostate cancer at 3 Tesla using a pelvic phased-array coil with high spatial, temporal and spectral resolution. The combination of vascular information from DCE-MRI and metabolic data from MRSI has excellent potential for improved accuracy in delineating and staging prostate carcinoma. These results suggest that high magnetic field strengths offer the possibility of studying prostate cancer without use of an endorectal coil.

Riassunto

Obiettivo

Esplorare la possibilità di effettuare uno studio combinato di risonanza magnetica del cancro prostatico di tipo morfologico (MRI), spettroscopico dell’idrogeno (MRSI) e dinamico postcontrastografico (DCE-MRI) a 3 Tesla utilizzando una bobina pelvica phased-array.

Materiali e metodi

Trenta pazienti con cancro prostatico dimostrato alla biopsia sono stati sottoposti a MRI, MRSI e DCE-MRI con apparecchiatura a 3 Tesla prima della prostatectomia radicale. Le immagini T2 pesate ad alta risoluzione sono state valutate in base ad una scala di 5 punti per la visualizzazione della zona periferica, della ghiandola centrale, della lesione tumorale, per la delineazione della capsula prostatica e per la qualità complessiva dell’immagine. Sono stati determinati i valori relativi dei metaboliti prostatici citrato, colina e creatina nel cancro, nella zona periferica normale (PZ) e nella ghiandola centrale (CG). Gli spettri sono stati anche valutati per la separazione del segnale del citrato, della colina e della creatina e la soppressione del segnale derivante dall’acqua e dai lipidi. Dai dati del DCE-MRI sono state generate curve intensità-tempo in corrispondenza del cancro, della PZ e della CG. Infine sono stati calcolati per il cancro, la PZ normale e la CG il time of arrival, time to peak, maximum enhancement e il wash in rate.

Risultati

L’elevato rapporto segnale-rumore (SNR) a 3 Tesla ha permesso di ottenere immagini TSE T2 pesate con un eccellente dettaglio anatomico (dimensioni in piano del voxel di 0,22×0,22 mm) e buon contrasto T2. L’incrementata risoluzione spettrale è risultata sufficiente a separare la risonanza della colina e della creatina e ha permesso di delineare i 4 picchi della risonanza del citrato. Il rapporto (colina+creatina)/citrato è risultato più elevato nel cancro rispetto a quello individuato nella PZ e nella CG (p<0,001). Le immagini dell’acquisizione dinamica post-contrastografica hanno mostrato una buona risoluzione temporale. Tutti i parametri ottenuti dal DCE-MRI hanno mostrato una differenza statisticamente significativa (p<0,05) tra tessuto neoplastico e PZ normale e CG. Il wash in rate e il rapporto (colina+creatina)/citrato sono risultati significativamente correlati (r=0,713, p=0,001) nel cancro nella zona periferica, mentre la correlazione non è risultata significativa nella CG (r=0,617, p=0,06) e nella PZ (r=0,530, p=0,08).

Conclusioni

È possibile effettuare uno studio di risonanza magnetica del cancro prostatico a 3 Tesla con elevata risoluzione spaziale, temporale e spettrale utilizzando una bobina pelvica phased-array. La combinazione delle informazioni derivanti dal DCE-MRI e dai dati spettroscopici ha eccellenti possibilità di incrementare l’accuratezza nella definizione e stadiazione del cancro prostatico. Questi risultati suggeriscono come campi i magnetici ad elevata intensità offrano la possibilità di studiare il cancro prostatico senza l’uso di una bobina endorettale.

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Università di Roma, Policlinico “Tor Vergata”, Viale Oxford 81, 00133, Roma, Italy

    M. Carlani, S. Mancino & G. Simonetti

  2. Dipartimento di Biopatologia e Diagnostica per Immagini, Cattedra di Anatomia ed Istologia Patologica, Università di Roma, Policlinico “Tor Vergata”, Viale Oxford 81, 00133, Roma, Italy

    E. Bonanno

  3. Cattedra di Urologia, Università di Roma, Policlinico “Tor Vergata”, Viale Oxford 81, 00133, Roma, Italy

    E. Finazzi Agrò

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  1. M. Carlani
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  2. S. Mancino
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  4. E. Finazzi Agrò
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  5. G. Simonetti
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Correspondence to M. Carlani.

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Carlani, M., Mancino, S., Bonanno, E. et al. Combined morphological, [1H]-MR spectroscopic and contrast-enhanced imaging of human prostate cancer with a 3-Tesla scanner: preliminary experience. Radiol med 113, 670–688 (2008). https://doi.org/10.1007/s11547-008-0271-8

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  • DOI: https://doi.org/10.1007/s11547-008-0271-8

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