Korean J Radiol.  2009 Dec;10(6):535-551. 10.3348/kjr.2009.10.6.535.

Multidisciplinary Functional MR Imaging for Prostate Cancer

• Kim JK
• Jang YJ
• Cho G

• KMID: 1102556
• DOI: http://doi.org/10.3348/kjr.2009.10.6.535

Abstract

Various functional magnetic resonance (MR) imaging techniques are used for evaluating prostate cancer including diffusion-weighted imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy. These techniques provide unique information that is helpful to differentiate prostate cancer from non-cancerous tissue and have been proven to improve the diagnostic performance of MRI not only for cancer detection, but also for staging, post-treatment monitoring, and guiding prostate biopsies. However, each functional MR imaging technique also has inherent challenges. Therefore, in order to make accurate diagnoses, it is important to comprehensively understand their advantages and limitations, histologic background related with image findings, and their clinical relevance for evaluating prostate cancer. This article will review the basic principles and clinical significance of functional MR imaging for evaluating prostate cancer.

Keyword

Prostate cancer; Magnetic resonance (MR); Diffusion-weighted imaging; Dynamic contrast-enhanced MR; Magnetic resonance (MR) spectroscopy

MeSH Terms

Contrast Media
Humans
Image Enhancement/methods
Image Interpretation, Computer-Assisted/methods
Magnetic Resonance Imaging/*methods
Male
Prostatic Neoplasms/*diagnosis/pathology

Figure

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  Fig. 1 Diffusion-weighted imaging. A, B. Diffusion-weighted imagings in regions of interest (arrows) with b-values of 0 s/mm2 (A) and 1,000 s/mm2 (B). C. Apparent diffusion coefficient map. D. Logarithmic-scale signal intensity of diffusion-weighted imagings plotted against b-values. Signal intensities in region of interest (arrows in A-C) are 1,412 a.u. with b-value of 0 s/mm2 and 186 a.u. as well as with b-value of 1,000 s/mm2. Therefore, apparent diffusion coefficient is 2.027 × 10-3 mm/s2.

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  Fig. 2 Effect of b-values on apparent diffusion coefficient. A. Region of interest (arrow) drawn on diffusion-weighted imaging. B. Logarithmic-scale signal intensity of diffusion-weighted imaging plotted against b-values (0, 125, 250, 500, 750, 1,000 mm2/s) used to acquire diffusion-weighted imaging. Logarithmic-scale signal intensity at y-axis is plotted against b-value at x-axis. Each datum point in plot is denoted by two numbers: logarithmic-scale signal intensity, original signal intensity. Different apparent diffusion coefficient values were computed by different pairs of b-values: 4.78 × 10-3 mm/s2 with b-values of 0 and 125 mm2/s, as well as 1.41 × 10-3 mm/s2 with b-values of 125, 250, 500, 750 and 1,000 mm2/s. Apparent diffusion coefficient value was higher with pair of lower b-values because of increased contributions from perfusion effects.

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  Fig. 3 Apparent diffusion coefficient values in various regions of prostate. A. Gross pathological image of radical prostatectomy specimen. Prostate cancer is marked with outline. B-D. Apparent diffusion coefficient map (B), diffusion-weighted imaging (C) and T2-weighted imaging (D) corresponding to A. Prostate cancer (arrows) shows low signal intensity on apparent diffusion coefficient map and high signal intensity on diffusion-weighted imaging. Prostate cancer is clearly identified on apparent diffusion coefficient map and diffusion-weighted imaging, whereas T2-weighted imaging shows lower lesion conspicuity. Prostate cancer is outlined in A. Apparent diffusion coefficients are 0.95 × 10-3 mm/s2 in prostate cancer, 1.02 × 10-3 mm/s2 in non-cancerous transitional zone tissue (black circle in B), and 1.14 × 10-3 mm/s2 in non-cancerous peripheral zone tissue (white circle in B).

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  Fig. 4 Distribution of apparent diffusion coefficient in non-cancerous tissue on color-coded apparent diffusion coefficient map. Scale of color display ranges from 0.5 × 10-3 mm/s2 (black) to 2.2 × 10-3 mm/s2 (red). Apparent diffusion coefficient of non-cancerous tissue ranges from 0.84 × 10-3 mm/s2 to 2.2 × 10-3 mm/s2.

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  Fig. 5 Distribution of apparent diffusion coefficient on color-coded apparent diffusion coefficient map in 62-year-old patient with prostate cancer. A. Gross pathological image of radical prostatectomy specimen. Prostate cancer is marked with black line. B. Corresponding apparent diffusion coefficient map. Scale of color display ranges from 0.5 × 10-3 mm/s2 (black) to 1.8 × 10-3 mm/s2 (red). Apparent diffusion coefficient of prostate cancer ranges from 0.59 × 10-3 mm/s2 to 1.8 × 10-3 mm/s2.

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  Fig. 6 Road map for prostate biopsy. A. T2-weighted imaging of prostate from 59-year-old man with elevated prostate-specific antigen levels (13.5 ng/ml) and prior negative biopsy result. B. Corresponding apparent diffusion coefficient map. Two lesions (arrows) in transitional zone show low signal intensity on apparent diffusion coefficient map, whereas they are not clearly identified on T2-weighted imaging. Targeted biopsy of these lesions was performed under transrectal ultrasonography-guide in which, two lesions were confirmed to be prostate cancer.

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  Fig. 7 T2-weighted imaging (A) and apparent diffusion coefficient map (B) of prostate from 61-year-old man with elevated prostate-specific antigen levels (10.6 ng/ml). Lesion (arrows) in transitional zone shows low signal intensity on both T2-weighted imaging and apparent diffusion coefficient map. Targeted biopsy of this lesion was performed under transrectal ultrasonography-guide, but no cancer was identified.

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  Fig. 8 Time-intensity curves of prostate cancer (A) and non-cancerous tissue (B). Compared to non-cancerous tissue, prostate cancer tissue shows early and strong enhancement as well as rapid de-enhancement.

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  Fig. 9 Schematic drawing of two compartment model. IV contrast material, when administrated, exists in two compartments such as intravascular space and extravascular (interstitial) spaces. In addition, IV contrast material transfer between these two compartments is dependent on difference of concentration between two compartments.

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  Fig. 10 Dynamic contrast-enhanced MR image of 68-year-old male patient with prostate cancer. Ktrans, Ve, initial upslope, Kep, peak enhancement, and wash-out are 0.091/s, 0.137, 30/s, 0.77/s, 350 a.u., and -1.34/s in prostate cancer (double arrows), and 0.018/s, 0.100, 19/s, 0.12/s, 150 a.u., and 0.78/s in non-cancerous tissue (arrow), respectively.

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  Fig. 11 T2-weighted imaging (A) and Kep map (B) of 59-year-old male patient with prostate cancer (arrows). On T2-weighted imaging, extracapsular extension of prostate cancer is not clearly identified. Kep map shows cancer focus in peripheral zone of right lobe. According to T2-weighted imaging and Kep map, extracapsular extension was suggested. Pathologic finding confirmed extracapsular extension in same site.

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  Fig. 12 Transitional zone versus prostate cancer. A. Gross pathological image of radical prostatectomy specimen located where area of prostate cancer is outlined. B. Ktrans map shows increased perfusion in transitional and peripheral zones of right lobe. Multiple foci of high permeability areas in transitional zone are related with benign prostatic hyperplasia rather than prostate cancer.

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  Fig. 13 Spectroscopy in prostate cancer. A. Typical spectrum of prostate cancer, where choline peak (double arrows) is increased and citrate peak (arrow) is decreased. B. Typical spectrum of non-cancerous tissue, which shows high citrate peak (arrow), as well as triplet on 3T MR spectroscopy.

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  Fig. 14 Images of 62-year-old man with prostate cancer. Although prostate cancer is not clearly identified on T2-weighted imaging, MR spectroscopy shows increased choline and creatine (double arrows) over citrate (arrow) ratio in voxels 2, 3, 6 and 7, which were confirmed to be prostate cancer.

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  Fig. 15 MR spectra (A, B) in single voxel. Ratio of choline and creatine over citrate changes after post-processing.

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