Comparative Study of 3.0T MRI and Whole-Mount Prostatectomy Sections for Prostate Cancer Detection.
Larissa V Furtado, Marta Heilbrun, Christopher Dechet, Matthias Schabel, Bryan Foster, Lester J Layfield, Ting Liu. University of Utah Health Sciences Center, Salt Lake City
Background: Radical prostatectomy, as the standard of care for surgical treatment of clinically resectable and significant prostatic adenocarcinoma, is associated with significant morbidity. Less invasive, yet curative procedures are highly desirable. Such procedures would require accurate preoperative assessment of extent and localization of prostatic adenocarcinoma. 3.0T magnetic resonance imaging (MRI) has high signal and spatial resolution and may increase accuracy of assessment for presence of, size, and location of prostatic adenocarcinoma. In this study we correlated histopathologic findings on whole-mount prostatectomy specimens with 3.0T MRI to evaluate the performance of high resolution (3.0T) MRI for prostatic carcinoma.
Design: The study group consisted of twelve cases of prostate adenocarcinomas from patients (mean age: 61 years) for whom 3.0T MRI data were available. All of the prostatectomy specimens were entirely submitted in a whole-mount (approximately 4.5 mm section thickness) fashion, from apex to base. Slides were reviewed to determine location, size and Gleason scores of carcinoma of each plane, independent of radiology evaluation. Prostate MRI was performed with a pelvic surface coil at 3.0T strength. The high resolution T2-weighted images (TR3300/TE125, 3.0mm section thickness) were interpreted, independent of pathologic results. The prostate was divided into sextants, and scored for the presence or absence of disease. For each sextant, imaging and histopathologic findings were compared. Chi-square test was used for analysis.
Results: Compared to histopathologic findings from whole-mount prostatectomy sections, 3.0T MRI showed sensitivity of 66.7% (52.9% -78.6%), specificity of 86.7% (59.5% – 98.3%), positive predictive value of 95% (83.1% – 99.4%), and negative predictive value of 40.6% (23.7% – 59.4%).
Conclusions: 3.0T MRI performance without endorectal coil is comparable to that of standard 1.5T imaging for the detection of prostatic adenocarcinoma. Unfortunately, single parameter T2 signal abnormality still fails to detect some significant disease. Integrating information from additional MRI pulse sequence appears to be required to improve accuracy for prostate cancer detection. Currently, accuracy of MRI evaluation in the detection of prostatic disease is insufficient to allow its use for guidance of focused, limited prostatic resections.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 116, Monday Afternoon