Value of the hemorrhage exclusion sign on T1-weighted prostate MR images for the detection of prostate cancer Journal Article


Authors: Barrett, T.; Vargas, H. A.; Akin, O.; Goldman, D. A.; Hricak, H.
Article Title: Value of the hemorrhage exclusion sign on T1-weighted prostate MR images for the detection of prostate cancer
Abstract: Purpose: To retrospectively determine the prevalence and positive predictive value (PPV) of the hemorrhage exclusion sign on T1-weighted magnetic resonance (MR) images in conjunction with findings on T2-weighted images in the detection of prostate cancer, with use of whole-mount step-section pathologic specimens from prostatectomy as the reference standard. Materials and Methods: The institutional review board approved this retrospective study, which was compliant with HIPAA, and the requirement to obtain informed consent was waived. Two hundred ninety-two patients with biopsy-proved prostate cancer underwent endorectal MR imaging followed by prostatectomy. The hemorrhage exclusion sign was defined as the presence of a well-defined area of low signal intensity surrounded by areas of high signal intensity on T1-weighted images. Two readers independently assessed the presence and extent of postbiopsy changes and the hemorrhage exclusion sign. The presence of a corresponding area of homogeneous low signal intensity on T2-weighted images was also recorded. The prevalence and PPV of the hemorrhage exclusion sign were calculated. Results: Readers 1 and 2 found postbiopsy changes in the peripheral zone in 184 (63%) and 189 (64.7%) of the 292 patients, respectively. In these patients, the hemorrhage exclusion sign was observed in 39 of 184 patients (21.2%) by reader 1 and 36 of 189 patients (19.0%) by reader 2. A corresponding area of homogeneous low signal intensity was seen on T2-weighted images in the same location as the hemorrhage exclusion sign in 23 of 39 patients (59%) by reader 1 and 19 of 36 patients (53%) by reader 2. The PPV of the hemorrhage exclusion sign alone was 56% (22 of 39 patients) for reader 1 and 50% (18 of 36 patients) for reader 2 but increased to 96% (22 of 23 patients) and 95% (18 of 19 patients) when the sign was identified in an area of homogeneous low signal intensity on T2-weighted images. Conclusion: Postbiopsy change is a known pitfall in the interpretation of T2-weighted images. The authors have shown that a potential benefit of postbiopsy change is the presence of excluded hemorrhage, which, in conjunction with a corresponding area of homogeneous low signal intensity at T2-weighted imaging, is highly accurate for cancer identification. © RSNA, 2012.
Keywords: adult; human tissue; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; histopathology; cancer localization; nuclear magnetic resonance imaging; magnetic resonance imaging; cancer grading; diagnostic accuracy; image analysis; image interpretation, computer-assisted; prevalence; tumor biopsy; retrospective study; biopsy; prostate cancer; postoperative complications; gleason score; prostatic neoplasms; disease severity; prostatectomy; prostate biopsy; cancer size; predictive value of tests; prostate hypertrophy; signal detection; image display; predictive value; hemorrhage
Journal Title: Radiology
Volume: 263
Issue: 3
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2012-06-01
Start Page: 751
End Page: 757
Language: English
DOI: 10.1148/radiol.12112100
PROVIDER: scopus
PMCID: PMC3359512
PUBMED: 22474673
DOI/URL:
Notes: --- - "Export Date: 2 July 2012" - "CODEN: RADLA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Hedvig Hricak
    333 Hricak
  2. Oguz Akin
    179 Akin
  3. Debra Alyssa Goldman
    97 Goldman