Performance characteristics of MR imaging in the evaluation of clinically low-risk prostate cancer: A prospective study Journal Article


Authors: Vargas, H.; Akin, O.; Shukla-Dave, A.; Zhang, J.; Zakian, K. L.; Zheng, J.; Kanao, K.; Goldman, D. A.; Moskowitz, C. S.; Reuter, V. E.; Eastham, J. A.; Scardino, P. T.; Hricak, H.
Article Title: Performance characteristics of MR imaging in the evaluation of clinically low-risk prostate cancer: A prospective study
Abstract: Purpose: To prospectively evaluate diagnostic performance of T2- weighted magnetic resonance (MR) imaging and MR spectroscopic imaging in detecting lesions stratified by pathologic volume and Gleason score in men with clinically determined low-risk prostate cancer. Materials and Methods: The institutional review board approved this prospective, HIPAA-compliant study. Written informed consent was obtained from 183 men with clinically low-risk prostate cancer (cT1-cT2a, Gleason score ≤ 6 at biopsy, prostatespecific antigen [PSA] level < 10 ng/mL [10 mg/L]) undergoing MR imaging before prostatectomy. By using a scale of 1-5 (score 1, definitely no tumor; score 5, definitely tumor), two radiologists independently scored likelihood of tumor per sextant on T2-weighted images. Two spectroscopists jointly recorded locations of lesions with metabolic features consistent with tumor on MR spectroscopic images. Whole-mount step-section histopathologic analysis constituted the reference standard. Diagnostic performance at sextant level (T2-weighted imaging) and detection sensitivities (T2-weighted imaging and MR spectroscopic imaging) for lesions of 0.5 cm3 or larger were calculated. Results: For T2-weighted imaging, areas under the receiver operating characteristic curves for sextant-level detection were 0.77 (reader 1) and 0.82 (reader 2). For lesions of ≥0.5 cm 3 and <1 cm 3, sensitivities were significantly lower when the lesion Gleason score was ≤6 (0.44 [reader 1] and 0.61 [reader 2]) rather than when the Gleason score was ≥7 (0.73, P = .02 [reader 1]; and 0.84, P = .05 [reader 2]). For lesions of ≥1 cm 3, lesion Gleason score did not significantly affect sensitivity (0.83 [reader 1] and 1.00 [reader 2] for Gleason score ≤ 6 vs 0.82 and 0.92 for Gleason score ≥ 7; P ≥ .07). MR spectroscopic imaging sensitivity was low and was not significantly affected by pathologic lesion volume or Gleason score. Conclusion: In men with clinically low-risk prostate cancer, detection of lesions of <1 cm 3 with T2-weighted imaging is significantly dependent on lesion Gleason score; detection of lesions of ≥1 cm 3 is significantly better than detection of smaller lesions and is not affected by lesion Gleason score. The role of MR spectroscopic imaging alone in this population is limited. © RSNA, 2012.
Keywords: adult; child; controlled study; human tissue; school child; aged; middle aged; major clinical study; cancer risk; preoperative care; nuclear magnetic resonance imaging; diagnostic accuracy; prospective study; sensitivity and specificity; prospective studies; prostate specific antigen; reproducibility of results; image interpretation, computer-assisted; risk factors; prostate cancer; gleason score; prostatic neoplasms; image enhancement; prostatectomy; prostate biopsy; cancer size; nuclear magnetic resonance spectroscopy; intermethod comparison; rating scale; performance; predictive value; receiver operating characteristic; diagnostic test accuracy study; tissue metabolism
Journal Title: Radiology
Volume: 265
Issue: 2
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2012-11-01
Start Page: 478
End Page: 487
Language: English
DOI: 10.1148/radiol.12120041
PROVIDER: scopus
PMCID: PMC3480819
PUBMED: 22952382
DOI/URL:
Notes: --- - "Export Date: 3 December 2012" - "CODEN: RADLA" - "Source: Scopus"
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MSK Authors
  1. Junting Zheng
    133 Zheng
  2. Peter T Scardino
    621 Scardino
  3. Chaya S. Moskowitz
    173 Moskowitz
  4. Jingbo Zhang
    34 Zhang
  5. Hedvig Hricak
    333 Hricak
  6. James Eastham
    427 Eastham
  7. Amita Dave
    80 Dave
  8. Kristen L Zakian
    74 Zakian
  9. Kento Kanao
    4 Kanao
  10. Victor Reuter
    922 Reuter
  11. Oguz Akin
    179 Akin
  12. Debra Alyssa Goldman
    97 Goldman