Clinical Prostate Cancer

Friday 16 May 2014

Rajakumar Nagarajan¹, Zohaib Iqbal¹, Brian Burns¹, Neil Wilson¹, Manoj K Sarma¹, Daniel A Margolis¹, Robert E Reiter², Steven S Raman¹, and M.Albert Thomas^1
1Radiological Sciences, University of California Los Angeles, LOS ANGELES, CA, United States, ²Urology, University of California Los Angeles, LOS ANGELES, CA, United States

Prostate cancer is a difficult disease to correctly diagnose and patients often undergo a painful and uncomfortable biopsy. The non-uniformly undersampled (NUS) four-dimensional (4D) echo-planar J-resolved spectroscopic imaging (EP-JRESI) study aims to establish data fidelity after non-linear reconstruction and to detect more metabolites than the currently used one-dimensional (1D) spectral based MR spectroscopic imaging method. The maximum entropy (MaxEnt) and total variation (TV) methods were used for the reconstruction of the NUS 4D EP-JRESI data. There was an excellent correlation between the two methods (TV and MaxEnt). These methods may help clinicians with an improved diagnosis and on deciding on the best course of treatment for the patient.

Palamadai N Venkatasubramanian¹, George Iordanescu¹, Kristian Novakovic², Jennifer Doll³, Charles Brendler², and Alice M Wyrwicz^1
1Radiology, NorthShore University HealthSystem, Evanston, IL, United States, ²Surgery, NorthShore University HealthSystem, Evanston, IL, United States, ³Biomedical Sciences, University of Wisconsin at Milwaukee, Milwaukee, WI, United States

Using ex vivo MR spectroscopy we detected alterations in the fatty acid composition of periprostatic adipose tissue from obese prostate cancer patients, relative to their subcutaneous adipose tissue. The altered periprostatic adipose composition was found to have predictive potential for a pathological criterion for aggressive prostate cancer, namely, extracapsular extension. Our results suggest that in vivo MR spectroscopy may have potential for developing a noninvasive biomarker for aggressive prostate cancer.

Marnix C. Maas¹, Eline K. Vos¹, Mark J. van Uden¹, Stephan Orzada^2,3, Andreas K. Bitz^2,4, Miriam W. Lagemaat¹, and Tom W.J. Scheenen^1,2
1Radiology, Radboud University Medical Center, Nijmegen, Netherlands, ²Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany, ³Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany,⁴Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

Increasing the magnetic field strength to 7T can lead to improved quality of prostate imaging and ¹H-MRSI, and offers potential for use of new biomarkers in ³¹P-MRSI. 7T abdominal imaging faces challenges including strong RF inhomogeneity, high SAR and increased sensitivity to off-resonance effects. Here we present the first steps towards a fully multiparametric MRI protocol for prostate at 7T, including high-resolution T2w, DWI and ¹H-MRSI. We show that excellent image quality in T2w and DWI with b-values up to 800 s/mm² and high quality spectra can be achieved in less than 60 minutes in 2 prostate cancer patients.

Raquel Perez-Lopez^1,2, Matthew D. Blacklegde¹, David Lorente^1,2, Ulrike Naumann¹, Joaquin Mateo^1,2, Thian Yiliang², Zaki Ahmad², David J. Collins¹, Martin O. Leach¹, Gerhardt Attard^1,2, Johann S. de Bono^1,2, Dow-Mu Koh^1,2, and Nina Tunariu^1,2
1The Institute of Cancer Research, Sutton, Surrey, United Kingdom, ²The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom

We conducted a study in patients with metastatic castration-resistant prostate cancer (mCRPC) and bone metastases, to evaluate if parameters derived from DWI (volume of bone disease and ADC values distribution in the bone metastases) confer prognostic information for overall survival. Whole body DW-MRI from 33 patients with mCRPC and bone involvement were analyzed and data were correlated with clinical variables. Our results show that the volume of bone disease assessed by DWI, and more so the volume of disease with ADC values between 750-1450 μm2/s, are a strong prognostic biomarker for overall survival in mCRPC and correlate with clinically relevant variables.

Matthias C. Roethke¹, Tristan Kuder², Timur H. Kuru³, Boris Hadaschik³, Michael Fenchel¹, Frederik Laun², and Bram Stieltjes^1
1Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany, ²Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany, ³Urology, University Hospital Heidelberg, Germany

Diffusion weighted imaging is established in state-of-the-art MRI of prostate cancer (PCa). In addition to the classic monoexponential diffusion fit, diffusional kurtosis and may contain additional information about tissue structure. Thus, aim of the study was to investigate the additional value of kurtosis imaging in patients with PCa. 3 Tesla MRI was performed in 55 patients with biopsy-proven PCa. Using a ROI- and pixel-based quantitative evaluation, we found significant difference between PCa and benign tissue using both kurtosis derived parameters and standard ADC. However, considering lesion detection and grading, there was no benefit of kurtosis imaging compared to standard ADC.

Christopher Nguyen^1,2, Zhaoyang Fan¹, Ali Afshar³, Yibin Xie^1,2, Rola Saouaf⁴, Hyung Kim³, and Debiao Li^1,2
1Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States, ²Bioengineering, University of California Los Angeles, Los Angeles, CA, United States, ³Surgery, Urology Division, Cedars-Sinai Medical Center, Los Angeles, CA, United States, ⁴Radiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States

We developed a novel 3D diffusion-prepared multi-shot balanced steady-state free precession technique capable of improved spatial resolution, image quality, and lesion contrast-to-noise ratio compared with single-shot diffusion-weighted echo planar imaging (SS DW EPI), while maintaining quantitative estimation of trace apparent diffusion coefficient. Because of these technical advances, the proposed technique yielded significantly better sensitivity, PPV, NPV, and AUC in detecting biopsy-confirmed lesions compared with SS DW EPI in a small group of prostate cancer patients undergoing active surveillance (AS-PC). By improving lesion detection, the proposed technique may allow DW MRI to potentially monitor low-risk prostate cancer lesions in AS-PC.

Eline K. Vos¹, Thiele Kobus¹, Geert Litjens¹, Thomas Hambrock¹, Christina Hulsbergen-van de Kaa², Marnix Maas¹, and Tom Scheenen^1
1Radiology, Radboud university medical center, Nijmegen, Gelderland, Netherlands, ²Pathology, Radboud university medical center, Nijmegen, Gelderland, Netherlands

Multiparametric MRI (mpMRI) was evaluated for the assessment of prostate cancer aggressiveness. For the peripheral zone only the ADC calculated from DWI should be used in combination with anatomical T2-weighted imaging. In the transition zone, both pharmacokinetic parameters (Ktrans and Kep) derived from DCE-MRI and metabolite ratios (CC/C and C/C) from MRSI may be useful additions to T2-weighted imaging and DWI for the discrimination of indolent versus significant PCa

Arash Latifoltojar¹, Nikos Dikaios², Ashley Ridout³, Caroline Moore⁴, Rowland Illing⁵, Alex Kirkham⁶, Clare Allen⁵, Stuart Taylor², Steve Halligan², David Atkinson², Mark Emberton³, and Shonit Punwani^2
1Centre for Medical Imaging, University College London, London, London, United Kingdom, ²Centre for Medical Imaging, University College London, London, United Kingdom, ³Urology, University College London Hospital, London, United Kingdom, ⁴Urology, University College London, London, United Kingdom, ⁵Radiology, University College London Hospital, London, United Kingdom, ⁶Radiology, university College London Hospital, London, United Kingdom

Patients with raised PSA traditionally have transrectal ultrasound guided biopsy (TRUS) performed prior to a pelvic MRI for the assessment of confirmed prostate cancer. However this approach may complicate the interpretation of MRI and cause unnecessary delay in patient management. In this work, the temporal changes in MRI quantitative derived parameters following biopsy is assessed.

Sarah Alessi¹, Paul Summers¹, Ara Alconchel Pilar¹, Sara Raimondi¹, Gennaro Musi¹, Salvatore L Renne¹, Deliu V Matei¹, Giuseppe Renne¹, Ottavio De Cobelli^1,2, Barbara A Jereczek-Fossa^1,2, Massimo Bellomi^1,2, and Giuseppe Petralia^1
1European Institute of Oncology, Milan, MI, Italy, ²University of Milan, Milan, MI, Italy

To investigate whether Prostate Imaging Reporting And Data System (PI-RADS) score and Gleason score (GS) are associated, 298 consecutive biopsy-proven prostate cancer patients underwent multiparametric magnetic resonance imaging of the prostate. Each lesion was given a PI-RADS score and assessed for location, size and probability of extra-prostatic disease. The highest PI-RADS score reported for each patient was compared with the GS of final histology. Patients with a PI-RADS scores of 4 and 5 had respectively more than three and 13-times higher probabilities of having a GS≥7 than patients with PI-RADS≤3. The highest PI-RADS score and Gleason score were strongly associated in our cohort.

Ivan Jambor¹, Timo Liimatainen², Harri Merisaari³, Pekka Taimen⁴, Peter Boström⁵, Heikki Minn³, Hannu Aronen¹, and Marko Pesola^1
1Departement of Diagnostic Radiology, University of Turku, Turku, Finland, ²Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, Kuopio, Finland, ³Turku PET centre, University of Turku, Turku, Finland, ⁴Department of Pathology, University of Turku, Turku, Finland, ⁵Department of Surgery, Turku University Hospital, Turku, Finland

Twenty-seven patients with histologically confirmed prostate cancer underwent two repeated 3T MRI examinations consisting of T_RAFF, T₁ and T₂mapping. Rotating frame imaging (RAFF, and continuous wave T₁) of PCa was feasible using clinical 3T MRI scanner and demonstrated robust repeatability. Both T_RAFF and T₁ of PCa differed significantly from similar value of normal peripheral zone.