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Role of magnetic resonance spectroscopic imaging ([1H]MRSI) and dynamic contrast-enhanced MRI (DCE-MRI) in identifying prostate cancer foci in patients with negative biopsy and high levels of prostate-specific antigen (PSA)

Ruolo della risonanza magnetica con spettroscopia (1H-MRSI) e con studio dinamico (DCEMR) nell’identificazione dei foci di adenocarcinoma prostatico in pazienti con biopsia negativa ed elevati valori di antigene prostatico specifico (PSA)

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

Purpose

The purpose of this study was to evaluate the role of magnetic resonance spectroscopic imaging (MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in detecting tumour foci in patients with elevated prostate-specific antigen (PSA) and negative transrectal ultrasonography (TRUS)-guided biopsy.

Materials and methods

This prospective randomised trial was conducted on 150 patients who underwent [1H]MRSI and DCE-MRI and targeted biopsies of suspicious areas on MRI associated with random biopsies.

Results

After the second biopsy, the diagnosis of prostate adenocarcinoma was made in 64/150 cases. On a perpatient basis, MRSI had 82.8% sensitivity, 91.8% specificity, 88.3% positive predictive value (PPV), 87.8% negative predictive value (NPV) and 85.7% diagnostic accuracy. The sensitivity, specificity, PPV, NPV and accuracy for DCE-MRI was 76.5%, 89.5%, 84.5%, 83.7% and 82%, respectively. The combination of MRSI and DCE-MRI yielded 93.7% sensitivity, 90.7% specificity, 88.2% PPV, 95.1% NPV and 90.9% accuracy in detecting prostate carcinoma.

Conclusions

The combined study with [1H]MRSI and DCE-MRI showed promising results in guiding the biopsy of cancer foci in patients with an initial negative TRUS-guided biopsy.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare il ruolo della risonanza magnetica (RM) con spettroscopia (MRSI) e studio dinamico (DCEMR) nell’individuazione di foci tumorali in pazienti con elevati valori di antigene prostatico specifico (PSA) e biopsia prostatica guidata tramite TRUS (trans-rectal-ultrasound)-guidata negativa.

Materiali e metodi

Lo studio è stato di tipo prospettico randomizzato. Abbiamo esaminato 150 pazienti. Tutti sono stati sottoposti ad esame di 1H-MRSI e DCEMR ed a prelievi mirati nelle zone sospette alla RM, associate a biopsie random.

Risultati

Dopo la seconda biopsia, la diagnosi di adenocarcinoma prostatico è stata effettuata in 64/150 casi. Nella nostra popolazione, su una base patient by patient, l’MRSI ha mostrato i seguenti valori: sensibilità 82,8%; specificità 91,8%; valore predittivo positivo (PPV) 88,3%; valore predittivo negativo (NPV) 87,8%; accuratezza 85,7%. La DCEMR ha mostrato i seguenti valori: sensibilità 76,5%; specificità 89,5%; PPV 84,5%; NPV 83,7%; accuratezza 82%. L’associazione delle due metodiche, MRSI e DCEMR, aumenta la sensibilità (93,7%), la specificità (90,7%), il PPV (88,2%), il PNV (95,1%) e l’accuratezza (90,9%) nel predire l’individuazione del carcinoma prostatico se paragonata alla sola metodica MRSI o DCEMR.

Conclusioni

Lo studio combinato ha mostrato risultati promettenti nella guida alla biopsia dei foci tumorali in pazienti con prima biopsia TRUS-guidata negativa.

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Authors and Affiliations

  1. Department of Radiologial Sciences, Policlinico Umberto I, University “Sapienza”, Viale Regina Elena 324, 00161, Rome, Italy

    V. Panebianco, D. Lisi, S. Bernardo & R. Passariello

  2. Department of Urology, Policlinico Umberto I, University “Sapienza” of Rome, Rome, Italy

    A. Sciarra, M. Ciccariello, S. Cattarino & V. Gentile

Authors
  1. V. Panebianco
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  2. A. Sciarra
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  3. M. Ciccariello
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  4. D. Lisi
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  5. S. Bernardo
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  6. S. Cattarino
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  7. V. Gentile
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  8. R. Passariello
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Correspondence to V. Panebianco.

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Panebianco, V., Sciarra, A., Ciccariello, M. et al. Role of magnetic resonance spectroscopic imaging ([1H]MRSI) and dynamic contrast-enhanced MRI (DCE-MRI) in identifying prostate cancer foci in patients with negative biopsy and high levels of prostate-specific antigen (PSA). Radiol med 115, 1314–1329 (2010). https://doi.org/10.1007/s11547-010-0575-3

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  • DOI: https://doi.org/10.1007/s11547-010-0575-3

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