Dynamic contrast-enhanced MR evaluation of prostate cancer before and after endorectal high-intensity focused ultrasound

La risonanza magnetica perfusionale nella valutazione dell’adenocarcinoma della prostata prima e dopo HIFU transrettale

Abstract

Purpose

The authors sought to determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging in the evaluation of prostate cancer before and after transrectal high-intensity focused ultrasound (HIFU) treatment.

Materials and methods

We analysed 25 patients with prostate cancer. The prostate-specific antigen (PSA) value was evaluated 1, 4 and 6 months after treatment. DCE-MR imaging was performed the day prior to and 1, 4 and 6 months after HIFU treatment. Transrectal prostate biopsies were obtained at the time of diagnosis and 6 months after treatment.

Results

Before treatment, intraglandular lesions were considered to be potential sites of neoplasm and subsequently confirmed as sites of prostate adenocarcinoma in all 25 patients based on prostatespecific antigen (PSA) values and histological examinations (rho=1; p<0.001). Using histology as the gold standard, DCE-MR imaging displayed 100% sensitivity, 100% specificity, 100% positive predictive value and 100% negative predictive value before treatment. After HIFU treatment, DCE-MR imaging showed 100% sensitivity and 96% specificity.

Conclusions

DCE-MR imaging can be used to visualise prostate adenocarcinoma. Several morphological and postgadolinium modifications in the follow-up DCE-MR images after HIFU treatment were also observed.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare, per mezzo di un’analisi quantitativa, la performance diagnostica della risonanza magnetica perfusionale (RM-P) nell’adenocarcinoma della prostata prima e dopo il trattamento transrettale con ultrasuoni focalizzati ad alta intensità (HIFU).

Materiali e metodi

Abbiamo analizzato 25 pazienti affetti da neoplasia della prostata. Il dosaggio dell’antigene prostatico specifico (PSA) è avvenuto ad intervalli regolari di 1 mese, 4 mesi e 6 mesi successivi al trattamento. La RM-P veniva effettuata il giorno prima dell’HIFU e ad 1 mese, 4 mesi e 6 mesi dopo il trattamento. Le biopsie prostatiche sono state effettuate al momento della diagnosi e 6 mesi dopo il trattamento.

Risultati

Prima del trattamento, le lesioni intra-ghiandolari ipointense nelle sequenze pesate in T2 ed iperintense nelle sequenze post-contrastografiche pesate in T1 sono state interpretate come sospette per localizzazione di neoplasia per poi essere state confermate, come sede di adenocarcinoma prostatico, con il PSA e con l’esame istologico in tutti e 25 i pazienti (rho=1 e p<0,001). Prima del trattamento, la RM-P, considerando gold standard il dato istologico, mostra sensibilità=100%, specificità=100%, valore predittivo positivo (VPP)=100% ed valore predittivo negativo (VPN)=100%; dopo il trattamento HIFU, presenta sensibilità=100% ed specificità=96%.

Conclusioni

La RM-P può essere impiegata come ottimo strumento per la visualizzazione dell’adenocarcinoma della prostata. Abbiamo, inoltre, osservato diverse modificazioni morfo-strutturali e post-contrastografiche ai controlli RM-P successivi al trattamento HIFU.

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Correspondence to R. Del Vescovo.

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Del Vescovo, R., Pisanti, F., Russo, V. et al. Dynamic contrast-enhanced MR evaluation of prostate cancer before and after endorectal high-intensity focused ultrasound. Radiol med 118, 851–862 (2013). https://doi.org/10.1007/s11547-012-0876-9

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Keywords

  • MRI
  • Prostate cancer
  • HIFU
  • D-CE-MR
  • DYCHO

Parole chiave RM

  • Carcinoma della prostata
  • HIFU
  • RM-P
  • DYCHO