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)

• Published in: Radiologia medica 2010-12, Vol.115 (8), p.1314-1329
• Main Authors: Panebianco, V., Sciarra, A., Ciccariello, M., Lisi, D., Bernardo, S., Cattarino, S., Gentile, V., Passariello, R.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Aged; Biopsy, Needle; Contrast Media; Diagnostic Radiology; Humans; Image Interpretation, Computer-Assisted; Imaging; Interventional Radiology; Logistic Models; Magnetic Resonance Imaging - methods; Magnetic Resonance Spectroscopy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Organometallic Compounds; Predictive Value of Tests; Prospective Studies; Prostate-Specific Antigen - analysis; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Radiologia Uro-Genitale; Radiology; ROC Curve; Sensitivity and Specificity; Ultrasonography, Interventional; Ultrasound; Uro-Genital Radiology
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-010-0575-3

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 [ 1 H]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.