Multiparametric-MRI in diagnosis of prostate cancer

Sangeet Ghai, Masoom A Haider, Sangeet Ghai, Masoom A Haider

Abstract

Multiparametric-magnetic resonance imaging (mp-MRI) has shown promising results in diagnosis, localization, risk stratification and staging of clinically significant prostate cancer. It has also opened up opportunities for focal treatment of prostate cancer. Combinations of T2-weighted imaging, diffusion imaging, perfusion (dynamic contrast-enhanced imaging) and spectroscopic imaging have been used in mp-MRI assessment of prostate cancer, but T2 morphologic assessment and functional assessment by diffusion imaging remains the mainstay for prostate cancer diagnosis on mp-MRI. Because assessment on mp-MRI can be subjective, use of the newly developed standardized reporting Prostate Imaging and Reporting Archiving Data System scoring system and education of specialist radiologists are essential for accurate interpretation. This review focuses on the present status of mp-MRI in prostate cancer and its evolving role in the management of prostate cancer.

Keywords: Diffusion imaging; MRI-guided biopsy; functional imaging; multiparametric-MRI; prostate cancer.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
A 55-year-old man with Gleason 7 (4 + 3) prostate cancer. (a) Axial T2-weighted image (T2WI) shows the normal hyperintense T2 signal in the peripheral zone (white arrow) from the high water content with cancer (black arrow) appearing as an area of low signal on T2WI. (b) Apparent diffusion coefficient map at the same level showing low signal from the restricted diffusion at the site of cancer (arrow)
Figure 2
Figure 2
Transition zone tumor. A 54-year-old male with biopsy-confirmed Gleason 8 prostate carcinoma. The T2-weighted image showing a typical “erased charcoal” (arrow) appearance in the transition zone
Figure 3
Figure 3
Extracapsular extension of tumor. A 64-year-old male with biopsy-confirmed Gleason 7 (3 + 4) prostate carcinoma. Axial T2-weighted image obtained with the endorectal coil shows the low signal tumor in the left peripheral zone with minimal extension along the left neurovascular bundle (arrow)
Figure 4
Figure 4
Residual tumor following focal therapy. Dynamic contrast-enhanced axial subtraction image 6 months following focal therapy shows a nodular area of enhancement at the margin of the treatment. Magnetic resonance-directed fusion biopsy of the area was performed, which revealed Gleason 6 disease

References

    1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.
    1. Chou R, Croswell JM, Dana T, Bougatsos C, Blazina I, Fu R, et al. Screening for prostate cancer: A review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:762–71.
    1. Panebianco V, Barchetti F, Sciarra A, Ciardi A, Indino EL, Papalia R, et al. Multiparametric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: A randomized study. Urol Oncol. 2015;33:17.e1–7.
    1. Schimmöller L, Quentin M, Arsov C, Hiester A, Buchbender C, Rabenalt R, et al. MR-sequences for prostate cancer diagnostics: Validation based on the PI-RADS scoring system and targeted MR-guided in-bore biopsy. Eur Radiol. 2014;24:2582–9.
    1. Petrillo A, Fusco R, Setola SV, Ronza FM, Granata V, Petrillo M, et al. Multiparametric MRI for prostate cancer detection: Performance in patients with prostate-specific antigen values between 2.5 and 10 ng/mL. J Magn Reson Imaging. 2014;39:1206–12.
    1. Penzkofer T, Tempany-Afdhal CM. Prostate cancer detection and diagnosis: The role of MR and its comparison with other diagnostic modalities - A radiologist's perspective. NMR Biomed. 2014;27:3–15.
    1. Park SY, Kim CK, Park BK, Kwon GY. Comparison of apparent diffusion coefficient calculation between two-point and multipoint B value analyses in prostate cancer and benign prostate tissue at 3 T: Preliminary experience. AJR Am J Roentgenol. 2014;203:W287–94.
    1. Manenti G, Nezzo M, Chegai F, Vasili E, Bonanno E, Simonetti G. DWI of prostate cancer: Optimal b-Value in clinical practice. Prostate Cancer. 2014;2014:868269.
    1. Nowak J, Malzahn U, Baur AD, Reichelt U, Franiel T, Hamm B, et al. The value of ADC, T2 signal intensity, and a combination of both parameters to assess Gleason score and primary Gleason grades in patients with known prostate cancer. Acta Radiol. 2014 Epub ahead of print.
    1. Marcus DM, Rossi PJ, Nour SG, Jani AB. The impact of multiparametric pelvic magnetic resonance imaging on risk stratification in patients with localized prostate cancer. Urology. 2014;84:132–7.
    1. Lawrence EM, Gallagher FA, Barrett T, Warren AY, Priest AN, Goldman DA, et al. Preoperative 3-T diffusion-weighted MRI for the qualitative and quantitative assessment of extracapsular extension in patients with intermediate- or high-risk prostate cancer. AJR Am J Roentgenol. 2014;203:W280–6.
    1. Jie C, Rongbo L, Ping T. The value of diffusion-weighted imaging in the detection of prostate cancer: A meta-analysis. Eur Radiol. 2014;24:1929–41.
    1. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al. European Society of Urogenital Radiology. ESUR prostate MR guidelines 2012. Eur Radiol. 2012;22:746–57.
    1. Shah ZK, Elias SN, Abaza R, Zynger DL, DeRenne LA, Knopp MV, et al. Performance comparison of 1.5-T endorectal coil MRI with 3-T nonendorectal coil MRI in patients with prostate cancer. Acad Radiol. 2015;22:467–74.
    1. Choi YJ, Kim JK, Kim N, Kim KW, Choi EK, Cho KS. Functional MR imaging of prostate cancer. Radiographics. 2007;27:63–77.
    1. Rosenkrantz AB, Lim RP, Haghighi M, Somberg MB, Babb JS, Taneja SS. Comparison of interreader reproducibility of the prostate imaging reporting and data system and likert scales for evaluation of multiparametric prostate MRI. AJR Am J Roentgenol. 2013;201:W612–8.
    1. Hoeks CM, Vos EK, Bomers JG, Barentsz JO, Hulsbergen-van de Kaa CA, Scheenen TW. Diffusion-weighted magnetic resonance imaging in the prostate transition zone: Histopathological validation using magnetic resonance-guided biopsy specimens. Invest Radiol. 2013;48:693–701.
    1. Oto A, Kayhan A, Jiang Y, Tretiakova M, Yang C, Antic T, et al. Prostate cancer: Differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology. 2010;257:715–23.
    1. Hoeks CM, Hambrock T, Yakar D, Hulsbergen-van de Kaa CA, Feuth T, Witjes JA, et al. Transition zone prostate cancer: Detection and localization with 3-T multiparametric MR imaging. Radiology. 2013;266:207–17.
    1. Wang L, Mazaheri Y, Zhang J, Ishill NM, Kuroiwa K, Hricak H. Assessment of biologic aggressiveness of prostate cancer: Correlation of MR signal intensity with Gleason grade after radical prostatectomy. Radiology. 2008;246:168–76.
    1. Hoeks CM, Barentsz JO, Hambrock T, Yakar D, Somford DM, Heijmink SW, et al. Prostate cancer: Multiparametric MR imaging for detection, localization, and staging. Radiology. 2011;261:46–66.
    1. Kitajima K, Takahashi S, Ueno Y, Yoshikawa T, Ohno Y, Obara M, et al. Clinical utility of apparent diffusion coefficient values obtained using high b-value when diagnosing prostate cancer using 3 tesla MRI: Comparison between ultra-high b-value (2000 s/mm2) and standard high b-value (1000 s/mm2) J Magn Reson Imaging. 2012;36:198–205.
    1. Hambrock T, Somford DM, Huisman HJ, van Oort IM, Witjes JA, Hulsbergen-van de Kaa CA, et al. Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer. Radiology. 2011;259:453–61.
    1. Turkbey B, Shah VP, Pang Y, Bernardo M, Xu S, Kruecker J, et al. Is apparent diffusion coefficient associated with clinical risk scores for prostate cancers that are visible on 3-T MR images? Radiology. 2011;258:488–95.
    1. Kumar V, Jagannathan NR, Kumar R, Thulkar S, Gupta SD, Dwivedi SN, et al. Apparent diffusion coefficient of the prostate in men prior to biopsy: Determination of a cut-off value to predict malignancy of the peripheral zone. NMR Biomed. 2007;20:505–11.
    1. Haider MA, van der Kwast TH, Tanguay J, Evans AJ, Hashmi AT, Lockwood G, et al. Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. AJR Am J Roentgenol. 2007;189:323–8.
    1. Tan CH, Wei W, Johnson V, Kundra V. Diffusion-weighted MRI in the detection of prostate cancer: Meta-analysis. AJR Am J Roentgenol. 2012;199:822–9.
    1. Wu LM, Xu JR, Gu HY, Hua J, Chen J, Zhang W, et al. Usefulness of diffusion-weighted magnetic resonance imaging in the diagnosis of prostate cancer. Acad Radiol. 2012;19:1215–24.
    1. Wu LM, Xu JR, Ye YQ, Lu Q, Hu JN. The clinical value of diffusion-weighted imaging in combination with T2-weighted imaging in diagnosing prostate carcinoma: A systematic review and meta-analysis. AJR Am J Roentgenol. 2012;199:103–10.
    1. Katahira K, Takahara T, Kwee TC, Oda S, Suzuki Y, Morishita S, et al. Ultra-high-b-value diffusion-weighted MR imaging for the detection of prostate cancer: Evaluation in 201 cases with histopathological correlation. Eur Radiol. 2011;21:188–96.
    1. Osugi K, Tanimoto A, Nakashima J, Shinoda K, Hashiguchi A, Oya M, et al. What is the most effective tool for detecting prostate cancer using a standard MR scanner? Magn Reson Med Sci. 2013;12:271–80.
    1. Bonekamp D, Jacobs MA, El-Khouli R, Stoianovici D, Macura KJ. Advancements in MR imaging of the prostate: From diagnosis to interventions. Radiographics. 2011;31:677–703.
    1. Kitajima K, Murphy RC, Nathan MA, Froemming AT, Hagen CE, Takahashi N, et al. Detection of recurrent prostate cancer after radical prostatectomy: Comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil. J Nucl Med. 2014;55:223–32.
    1. Umbehr M, Bachmann LM, Held U, Kessler TM, Sulser T, Weishaupt D, et al. Combined magnetic resonance imaging and magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer: A systematic review and meta-analysis. Eur Urol. 2009;55:575–90.
    1. Villeirs GM, De Meerleer GO, De Visschere PJ, Fonteyne VH, Verbaeys AC, Oosterlinck W. Combined magnetic resonance imaging and spectroscopy in the assessment of high grade prostate carcinoma in patients with elevated PSA: A single-institution experience of 356 patients. Eur J Radiol. 2011;77:340–5.
    1. Javali TD, Dwivedi DK, Kumar R, Jagannathan NR, Thulkar S, Dinda AK. Magnetic resonance spectroscopy imaging-directed transrectal ultrasound biopsy increases prostate cancer detection in men with prostate-specific antigen between 4-10 ng/mL and normal digital rectal examination. Int J Urol. 2014;21:257–62.
    1. Kobus T, Hambrock T, Hulsbergen-van de Kaa CA, Wright AJ, Barentsz JO, Heerschap A, et al. In vivo assessment of prostate cancer aggressiveness using magnetic resonance spectroscopic imaging at 3 T with an endorectal coil. Eur Urol. 2011;60:1074–80.
    1. Kobus T, Wright AJ, Van Asten JJ, Heerschap A, Scheenen TW. In vivo (1) H MR spectroscopic imaging of aggressive prostate cancer: Can we detect lactate? Magn Reson Med. 2014;71:26–34.
    1. Selnaes KM, Gribbestad IS, Bertilsson H, Wright A, Angelsen A, Heerschap A, et al. Spatially matched in vivo and ex vivo MR metabolic profiles of prostate cancer -- investigation of a correlation with Gleason score. NMR Biomed. 2013;26:600–6.
    1. Sciarra A, Panebianco V, Salciccia S, Osimani M, Lisi D, Ciccariello M, et al. Role of dynamic contrast-enhanced magnetic resonance (MR) imaging and proton MR spectroscopic imaging in the detection of local recurrence after radical prostatectomy for prostate cancer. Eur Urol. 2008;54:589–600.
    1. Pucar D, Shukla-Dave A, Hricak H, Moskowitz CS, Kuroiwa K, Olgac S, et al. Prostate cancer: Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy-initial experience. Radiology. 2005;236:545–53.
    1. Fütterer JJ, Heijmink SW, Scheenen TW, Veltman J, Huisman HJ, Vos P, et al. Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology. 2006;241:449–58.
    1. Tanimoto A, Nakashima J, Kohno H, Shinmoto H, Kuribayashi S. Prostate cancer screening: The clinical value of diffusion-weighted imaging and dynamic MR imaging in combination with T2-weighted imaging. J Magn Reson Imaging. 2007;25:146–52.
    1. Turkbey B, Pinto PA, Mani H, Bernardo M, Pang Y, McKinney YL, et al. Prostate cancer: Value of multiparametric MR imaging at 3 T for detection-histopathologic correlation. Radiology. 2010;255:89–99.
    1. de Rooij M, Hamoen EH, Fütterer JJ, Barentsz JO, Rovers MM. Accuracy of multiparametric MRI for prostate cancer detection: A meta-analysis. AJR Am J Roentgenol. 2014;202:343–51.
    1. Abd-Alazeez M, Ahmed HU, Arya M, Charman SC, Anastasiadis E, Freeman A, et al. The accuracy of multiparametric MRI in men with negative biopsy and elevated PSA level-can it rule out clinically significant prostate cancer? Urol Oncol. 2014;32:45.e17–22.
    1. Itatani R, Namimoto T, Atsuji S, Katahira K, Morishita S, Kitani K, et al. Negative predictive value of multiparametric MRI for prostate cancer detection: Outcome of 5-year follow-up in men with negative findings on initial MRI studies. Eur J Radiol. 2014;83:1740–5.
    1. Shakir NA, George AK, Siddiqui MM, Rothwax JT, Rais-Bahrami S, Stamatakis L, et al. Identification of threshold prostate specific antigen levels to optimize the detection of clinically significant prostate cancer by magnetic resonance imaging/ultrasound fusion guided biopsy. J Urol. 2014;192:1642–9.
    1. Delongchamps NB, Rouanne M, Flam T, Beuvon F, Liberatore M, Zerbib M, et al. Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: Combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int. 2011;107:1411–8.
    1. Jung SI, Donati OF, Vargas HA, Goldman D, Hricak H, Akin O. Transition zone prostate cancer: Incremental value of diffusion-weighted endorectal MR imaging in tumor detection and assessment of aggressiveness. Radiology. 2013;269:493–503.
    1. Cornud F, Khoury G, Bouazza N, Beuvon F, Peyromaure M, Flam T, et al. Tumor target volume for focal therapy of prostate cancer-does multiparametric magnetic resonance imaging allow for a reliable estimation? J Urol. 2014;191:1272–9.
    1. Rosenkrantz AB, Mendrinos S, Babb JS, Taneja SS. Prostate cancer foci detected on multiparametric magnetic resonance imaging are histologically distinct from those not detected. J Urol. 2012;187:2032–8.
    1. Langer DL, van der Kwast TH, Evans AJ, Sun L, Yaffe MJ, Trachtenberg J, et al. Intermixed normal tissue within prostate cancer: Effect on MR imaging measurements of apparent diffusion coefficient and T2--sparse versus dense cancers. Radiology. 2008;249:900–8.
    1. Bratan F, Melodelima C, Souchon R, Hoang Dinh A, Mège-Lechevallier F, Crouzet S, et al. How accurate is multiparametric MR imaging in evaluation of prostate cancer volume? Radiology. 2015;275:144–54.
    1. Nakashima J, Tanimoto A, Imai Y, Mukai M, Horiguchi Y, Nakagawa K, et al. Endorectal MRI for prediction of tumor site, tumor size, and local extension of prostate cancer. Urology. 2004;64:101–5.
    1. Coakley FV, Kurhanewicz J, Lu Y, Jones KD, Swanson MG, Chang SD, et al. Prostate cancer tumor volume: Measurement with endorectal MR and MR spectroscopic imaging. Radiology. 2002;223:91–7.
    1. Hamoen EH, de Rooij M, Witjes JA, Barentsz JO, Rovers MM. Use of the prostate imaging reporting and data system (PI-RADS) for prostate cancer detection with multiparametric magnetic resonance imaging: A diagnostic meta-analysis. Eur Urol. 2015;67:1112–21.
    1. American College of Radiology. MR Prostate Imaging Reporting and Data System version 2.0. [Accessed Jan 2015]. from
    1. Mowatt G, Scotland G, Boachie C, Cruickshank M, Ford JA, Fraser C, et al. The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: A systematic review and economic evaluation. (1-281).Health Technol Assess. 2013;17:vii–xix.
    1. de Rooij M, Crienen S, Witjes JA, Barentsz JO, Rovers MM, Grutters JP. Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer: A modelling study from a health care perspective. Eur Urol. 2014;66:430–6.
    1. Haffner J, Lemaitre L, Puech P, Haber GP, Leroy X, Jones JS, et al. Role of magnetic resonance imaging before initial biopsy: Comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int. 2011;108:E171–8.
    1. Mozer P, Rouprêt M, Le Cossec C, Granger B, Comperat E, de Gorski A, et al. First round of targeted biopsies using magnetic resonance imaging/ultrasonography fusion compared with conventional transrectal ultrasonography-guided biopsies for the diagnosis of localised prostate cancer. BJU Int. 2015;115:50–7.
    1. Puech P, Rouvière O, Renard-Penna R, Villers A, Devos P, Colombel M, et al. Prostate cancer diagnosis: Multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy--prospective multicenter study. Radiology. 2013;268:461–9.
    1. Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: A systematic review and meta-analysis. Eur Urol. 2014 Epub ahead of print.
    1. Zhang ZX, Yang J, Zhang CZ, Li KA, Quan QM, Wang XF, et al. The value of magnetic resonance imaging in the detection of prostate cancer in patients with previous negative biopsies and elevated prostate-specific antigen levels: A meta-analysis. Acad Radiol. 2014;21:578–89.
    1. Hoeks CM, Schouten MG, Bomers JG, Hoogendoorn SP, Hulsbergen-van de Kaa CA, Hambrock T, et al. Three-Tesla magnetic resonance-guided prostate biopsy in men with increased prostate-specific antigen and repeated, negative, random, systematic, transrectal ultrasound biopsies:Detection of clinically significant prostate cancers. Eur Urol. 2012;62:902–9.
    1. Sonn GA, Chang E, Natarajan S, Margolis DJ, Macairan M, Lieu P, et al. Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. Eur Urol. 2014;65:809–15.
    1. Bjurlin MA, Meng X, Le Nobin J, Wysock JS, Lepor H, Rosenkrantz AB, et al. Optimization of prostate biopsy: The role of magnetic resonance imaging targeted biopsy in detection, localization and risk assessment. J Urol. 2014;192:648–58.
    1. Margel D, Yap SA, Lawrentschuk N, Klotz L, Haider M, Hersey K, et al. Impact of multiparametric endorectal coil prostate magnetic resonance imaging on disease reclassification among active surveillance candidates: A prospective cohort study. J Urol. 2012;187:1247–52.
    1. Turkbey B, Mani H, Aras O, Ho J, Hoang A, Rastinehad AR, et al. Prostate cancer: Can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology. 2013;268:144–52.
    1. Dianat SS, Carter HB, Pienta KJ, Schaeffer EM, Landis PK, Epstein JI, et al. Magnetic resonance-invisible versus magnetic resonance-visible prostate cancer in active surveillance: A preliminary report on disease outcomes. Urology. 2015;85:147–53.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa