Endorectal MR Imaging and MR Spectroscopic Imaging for Locally Recurrent Prostate

Male Tract



Fergus V. Coakley, MD ; Hui Seong Teh, MBBS2 ; Aliya Qayyum, MBBS ; Mark G. Swanson, PhD ; Ying Lu, PhD ; Mack Roach III, MD ; Barby Pickett, MSc ; Katsuto Shinohara, MD ; Daniel B. Vigneron, PhD ; John Kurhanewicz, PhD

1 From the Departments of Radiology (F.V.C., H.S.T., A.Q., M.G.S., D.B.V., J.K.), Epidemiology and Biostatistics (Y.L.), Radiation Oncology (M.R., B.P.), and Urology (K.S.), University of California San Francisco, 505 Parnassus Ave, Box 0628, M-372, San Francisco, CA 94143-0628. Received December 22, 2003; revision requested February 26, 2004; revision received March 8; accepted April 1. Supported by NIH grants CA79980 and CA59897.

PURPOSE: To evaluate endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for the depiction of locally recurrent prostate cancer after external beam radiation therapy.

MATERIALS AND METHODS: Endorectal MR imaging and MR spectroscopic imaging were performed in 21 patients with biochemical failure after external beam radiation therapy for prostate cancer. Two readers independently and retrospectively reviewed MR images and rated the likelihood of recurrent tumor on a five-point scale. Spectroscopic voxels were considered suspicious for malignancy if the choline level was elevated and citrate was absent. Receiver operating characteristic curve analysis was used to assess cancer detection in each side of the prostate with endorectal MR imaging and spectroscopic imaging at different thresholds based on the scores assigned by the two readers and on the number of suspicious voxels in each hemiprostate, respectively. The presence or absence of cancer at subsequent transrectal biopsy was used as the standard of reference.

RESULTS: Biopsy demonstrated locally recurrent prostate cancer in nine hemiprostates in six patients. The area under the receiver operating characteristic curve for the detection of locally recurrent cancer with MR imaging was 0.49 and 0.51 for readers 1 and 2, respectively. By using the number of suspicious voxels to define different diagnostic thresholds, the area under the receiver operating characteristic curve for MR spectroscopic imaging was significantly (P < .005) higher, at 0.81. In particular, the presence of three or more suspicious voxels in a hemiprostate showed a sensitivity and specificity of 89% and 82%, respectively, for the diagnosis of local recurrence. Seven hemiprostates demonstrated complete metabolic atrophy at spectroscopic imaging and only postirradiation atrophy at biopsy.

CONCLUSION: Preliminary data suggest that MR spectroscopic imaging, but not endorectal MR imaging, may be of value for the depiction of locally recurrent prostate cancer after radiation therapy.