Document Detail


Value of endorectal MRI and MRS in patients with elevated prostate-specific antigen levels and previous negative biopsies to localize peripheral zone tumours.
MedLine Citation:
PMID:  18625351     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To evaluate prospectively the role of endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in detecting peripheral zone tumour in patients with total prostate-specific antigen (PSA) values>or=4 ng/ml and one or more negative transrectal ultrasound (TRUS) biopsy rounds. MATERIAL AND METHODS: Fifty-four consecutive men (mean age 65.4+/-5.2 years, mean total PSA 10.8+/-7.5 ng/ml), underwent a combined MRI-MRS examination with endorectal coil. MRI included transverse, coronal, and sagittal T2-weighted and transverse T1-weighted fast spin-echo sequences. MRS data were acquired using a double spin-echo point resolved spectroscopy (PRESS) sequence. A 10-site scheme was adopted to evaluate the prostate peripheral zone. A peripheral prostatic site was classified as suspicious if low intensity signal was present on T2-weighted images and/or if the choline+creatine/citrate ratio was >0.86. Following MRI-MRS all patients were submitted to a standard 10-core biopsy scheme to which from one to three supplementary samples were added from suspicious MRI and/or MRS sites. In per-patient analysis findings were considered true-positive if biopsy positive patients were classified as suspicious, irrespectively of lesion site indication. RESULTS: Prostate cancer (PC) was detected in 17 of 54 patients (31.5%); median Gleason score was 6 (range 4-8). On a per-patient basis sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were respectively 100, 64.9, 56.7, 100, and 75.9% for MRI; 82.2, 70.3, 57.7, 92.9, and 75.9% for MRS; and 100, 51.4, 48.6, 100, and 66.7% for combined MRI-MRS. In all the 17 PC patients, combined MRI-MRS correctly indicated the sites harbouring cancer, whereas both MRI and MRS gave erroneous indications in two patients. CONCLUSION: The results of the present study show that MRI alone might be able to select negative patients in whom further biopsies are unnecessary. The combination of MRI and MRS might be able to drive biopsies in suspicious sites and increase the cancer detection rate. Further studies are required to confirm these data.
Authors:
S Cirillo; M Petracchini; P Della Monica; T Gallo; V Tartaglia; E Vestita; U Ferrando; D Regge
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Clinical radiology     Volume:  63     ISSN:  1365-229X     ISO Abbreviation:  Clin Radiol     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-15     Completed Date:  2008-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1306016     Medline TA:  Clin Radiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  871-9     Citation Subset:  IM    
Affiliation:
Unit of Radiology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy. stefano.cirillo@ircc.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Biopsy
Epidemiologic Methods
False Negative Reactions
Humans
Image Interpretation, Computer-Assisted / methods
Magnetic Resonance Imaging / methods
Magnetic Resonance Spectroscopy / methods
Male
Middle Aged
Patient Selection
Prostate-Specific Antigen / blood*
Prostatic Neoplasms / diagnosis*,  pathology
Chemical
Reg. No./Substance:
EC 3.4.21.77/Prostate-Specific Antigen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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