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Clinical Research

Novel technique for characterizing prostate cancer utilizing MRI restriction spectrum imaging: proof of principle and initial clinical experience with extraprostatic extension

Abstract

Background:

Standard magnetic resonance imaging (MRI) of the prostate lacks sensitivity in the diagnosis and staging of prostate cancer (PCa). To improve the operating characteristics of prostate MRI in the detection and characterization of PCa, we developed a novel, enhanced MRI diffusion technique using restriction spectrum imaging (RSI-MRI).

Methods:

We compared the efficacy of our novel RSI-MRI technique with standard MRI for detecting extraprostatic extension (EPE) among 28 PCa patients who underwent MRI and RSI-MRI prior to radical prostatectomy, 10 with histologically proven pT3 disease. RSI cellularity maps isolating the restricted isotropic water fraction were reconstructed based on all b-values and then standardized across the sample with z-score maps. Distortion correction of the RSI maps was performed using the alternating phase-encode technique.

Results:

27 patients were evaluated, excluding one patient where distortion could not be performed. Preoperative standard MRI correctly identified extraprostatic the extension in two of the nine pT3 (22%) patients, whereas RSI-MRI identified EPE in eight of nine (89%) patients. RSI-MRI correctly identified pT2 disease in the remaining 18 patients.

Conclusions:

In this proof of principle study, we conclude that our novel RSI-MRI technology is feasible and shows promise for substantially improving PCa imaging. Further translational studies of prostate RSI-MRI in the diagnosis and staging of PCa are indicated.

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References

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Isebaert S, Van den Bergh L, Haustermans K, Joniau S, Lerut E, De Wever L et al. Multiparametric MRI for prostate cancer localization in correlation to whole-mount histopathology. J Magn Reson Imaging 2013; 37: 1392–1401.

    Article  PubMed  Google Scholar 

  3. Haider MA, van der Kwast TH, Tanguay J, Evans AJ, Hashmi A-T, Lockwood G et al. Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. AJR Am J Roentgenol 2007; 189: 323–328.

    Article  PubMed  Google Scholar 

  4. Rastinehad AR, Baccala AA, Chung PH, Proano JM, Kruecker J, Xu S et al. D'Amico risk stratification correlates with degree of suspicion of prostate cancer on multiparametric magnetic resonance imaging. J Urol 2011; 185: 815–820.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rais-Bahrami S, Türkbey B, Rastinehad AR, Walton-Diaz A, Hoang AN, Siddiqui MM et al. Natural history of small index lesions suspicious for prostate cancer on multiparametric MRI: recommendations for interval imaging follow-up. Diagn Interv Radiol 2014; 20: 293–298.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Hoeks CMA, Somford DM, van Oort IM, Vergunst H, Oddens JR, Smits GA et al. Value of 3-T multiparametric magnetic resonance imaging and magnetic resonance-guided biopsy for early risk restratification in active surveillance of low-risk prostate cancer: a prospective multicenter cohort study. Invest Radiol 2014; 49: 165–172.

    Article  PubMed  Google Scholar 

  8. Stamatakis L, Siddiqui MM, Nix JW, Logan J, Rais-Bahrami S, Walton-Diaz A et al. Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer. Cancer 2013; 119: 3359–3366.

    Article  PubMed  Google Scholar 

  9. Abd-Alazeez M, Kirkham A, Ahmed HU, Arya M, Anastasiadis E, Charman SC et al. Performance of multiparametric MRI in men at risk of prostate cancer before the first biopsy: a paired validating cohort study using template prostate mapping biopsies as the reference standard. Prostate Cancer Prostatic Dis 2014; 17: 40–46.

    Article  CAS  PubMed  Google Scholar 

  10. 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: 144–152.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rais-Bahrami S, Siddiqui MM, Turkbey B, Stamatakis L, Logan J, Hoang AN et al. Utility of multiparametric magnetic resonance imaging suspicion levels for detecting prostate cancer. J Urol 2013; 190: 1721–1727.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Park JJ, Kim CK, Park SY, Park BK, Lee HM, Cho SW . Prostate cancer: role of pretreatment multiparametric 3-T MRI in predicting biochemical recurrence after radical prostatectomy. Am J Radiol 2014; 202: W459–W465.

    Google Scholar 

  13. Somford DM, Hamoen EH, Fütterer JJ, van Basten JP, Hulsbergen-van de Kaa CA, Vreuls W et al. The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. J Urol 2013; 190: 1728–1734.

    Article  CAS  PubMed  Google Scholar 

  14. Lim HK, Kim JK, Kim KA, Cho K-S . Prostate cancer: apparent diffusion coefficient map with T2-weighted images for detection—a multireader study. Radiology 2009; 250: 145–151.

    Article  PubMed  Google Scholar 

  15. 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: 146–152.

    Article  PubMed  Google Scholar 

  16. Donati OF, Jung SI, Vargas HA, Gultekin DH, Zheng J, Moskowitz CS et al. Multiparametric prostate MR imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences: are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy? Radiology 2013; 268: 440–450.

    Article  PubMed  Google Scholar 

  17. Mazaheri Y, Hricak H, Fine SW, Akin O, Shukla-Dave A, Ishill NM et al. Prostate tumor volume measurement with combined T2-weighted imaging and diffusion-weighted MR: correlation with pathologic tumor volume. Radiology 2009; 252: 449–457.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Miao H, Fukatsu H, Ishigaki T . Prostate cancer detection with 3-T MRI: comparison of diffusion-weighted and T2-weighted imaging. Eur J Radiol 2007; 61: 297–302.

    Article  PubMed  Google Scholar 

  19. Giannarini G, Nguyen DP, Thalmann GN, Thoeny HC . Diffusion-weighted magnetic resonance imaging detects local recurrence after radical prostatectomy: initial experience. Eur Urol 2012; 61: 616–620.

    Article  PubMed  Google Scholar 

  20. Donato F, Costa DN, Yuan Q, Rofsky NM, Lenkinski RE, Pedrosa I . Geometric distortion in diffusion-weighted MR imaging of the prostate-contributing factors and strategies for improvement. Acad Radiol 2014; 21: 817–823.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yoshimitsu K, Kiyoshima K, Irie H, Tajima T, Asayama Y, Hirakawa M et al. Usefulness of apparent diffusion coefficient map in diagnosing prostate carcinoma: correlation with stepwise histopathology. J Magn Reson Imaging 2008; 27: 132–139.

    Article  PubMed  Google Scholar 

  22. White NS, Leergaard TB, D'Arceuil H, Bjaalie JG, Dale AM . Probing tissue microstructure with restriction spectrum imaging: histological and theoretical validation. Hum Brain Mapp 2013; 34: 327–346.

    Article  PubMed  Google Scholar 

  23. White NS, McDonald CR, Farid N, Kuperman JM, Kesari S, Dale AM . Improved conspicuity and delineation of high-grade primary and metastatic brain tumors using ‘restriction spectrum imaging’: quantitative comparison with high B-value DWI and ADC. AJNR Am J Neuroradiol 2012; 34: 958–964.

    Article  PubMed  Google Scholar 

  24. Holland D, Kuperman JM, Dale AM . Efficient correction of inhomogeneous static magnetic field-induced distortion in Echo Planar Imaging. Neuroimage 2010; 50: 175–183.

    Article  PubMed  Google Scholar 

  25. White NS, Dale AM . Distinct effects of nuclear volume fraction and cell diameter on high b-value diffusion MRI contrast in tumors. Magn Reson Med 2013; 72: 1435–1443.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank Brenda Brown for her help on this project. This work was supported by the Department of Defense, Prostate Cancer Research Program W81XWH-13-1-0391, the American Cancer Society—Institutional Research Grant Number 70-002 and the UCSD Clinician Scientist Program.

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Correspondence to D S Karow.

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The authors declare no conflict of interest.

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Rakow-Penner, R., White, N., Parsons, J. et al. Novel technique for characterizing prostate cancer utilizing MRI restriction spectrum imaging: proof of principle and initial clinical experience with extraprostatic extension. Prostate Cancer Prostatic Dis 18, 81–85 (2015). https://doi.org/10.1038/pcan.2014.50

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  • DOI: https://doi.org/10.1038/pcan.2014.50

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