Yonsei Med J.  2008 Oct;49(5):765-774. 10.3349/ymj.2008.49.5.765.

Prostate Cancer: Added Value of Subtraction Dynamic Imaging in 3T Magnetic Resonance Imaging with a Phased-array Body Coil

• Yu JS
• Chung JJ
• Hong SW
• Chung BH
• Kim JH
• Kim KW

• KMID: 2158195
• DOI: http://doi.org/10.3349/ymj.2008.49.5.765

Abstract

PURPOSE
To determine the added value of dynamic subtraction magnetic resonance (MR) imaging for the localization of prostate cancer. MATERIALS AND METHODS: We examined 21 consecutive patients who underwent MR imaging in 3T unit with a phased-array body coil and then had radical prostatectomy. After T2-weighted fast spin-echo imaging, we performed a contrast-enhanced dynamic 3D gradient-echo imaging consisting of pre-contrast, 2 successive early-phased (first imaging was started just after the appearance of contrast material in the aortic bifurcation followed by second imaging 35 seconds after the initiation of first imaging) and one 5-minute delayed post-contrast series. Subtraction of pre-contrast images from corresponding post-contrast images of each phase was performed on the console. RESULTS: On ROC analysis, the overall accuracy (Az value) of dynamic imaging combined with subtraction imaging was higher than T2-weighted imaging (p = 0.001) or conventional dynamic imaging alone (p = 0.074) for localization of cancer foci regardless of their zonal locations. Among pathologically verified 81 lesions, the mean volume of detected lesions with the subtraction images (n = 49, 0.69cm3) was smaller than with T2-weighted images (n = 14, 1.05cm3) or conventional dynamic images (n = 43, 0.71cm(3)). CONCLUSION: For localization of small prostate cancer, additional subtraction for the dynamic imaging could be superior to both T2-weighted imaging and un-subtracted dynamic imaging.

Keyword

Prostate; prostate cancer; magnetic resonance imaging; subtraction imaging; dynamic imaging

MeSH Terms

Aged
Humans
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Prostate/pathology
Prostatic Neoplasms/*diagnosis/pathology
Retrospective Studies
Sensitivity and Specificity

Figure

• 

  Fig. 1 71-year-old man with prostate cancer of the left mid-gland. (A) An axial T2-weighted image shows a hypointense lesion (arrows), distinguished from background hyperintensity of peripheral zone. (B) Early phase contrast-enhanced image obtained immediately after appearance of contrast material at the aortic bifurcation level shows an strong contrast enhancement (arrows) at the corresponding area at the same level as in (A). (C) Subtraction images of precontrast image from (B) shows the same hypervascular portion (arrows). (D) Five-minute delayed subtraction image shows relatively hypointense area (arrows), suggesting washout of contrast material from the tumor at the same site, distinguished from surrounding parenchyma.

• 

  Fig. 2 51-year-old man with prostate cancer of the left mid-gland. (A) An axial T2-weighted image shows no definite focal lesion. Precontrast T1-weighted images also shows no abnormal signal intensity (not shown). (B) Early phase contrast-enhanced image obtained immediately after the appearance of contrast material at the aortic bifurcation level shows a dumbell-shaped increased signal intensity area involving central gland and posterior portion of peripheral zone (arrows) at the same level as with (A). (C) Subtraction images of precontrast image from (B) shows the same hypervascular portion (arrows). (D) Five-minute delayed subtraction image shows relatively hypointense area (arrowheads), suggesting washout of contrast material from the tumor at the same site, distinguished from surrounding parenchyma.

• 

  Fig. 3 Diagram of the mid-transverse section of prostate shows crossing imaginary lines and natural outer borderline of the central gland (CG) which divides the prostate into 6 arbitrary areas including anterior and posterior portions of peripheral zone (PZ-A, PZ-P) and a CG on each side.

• 

  Fig. 4 70-year-old man with prostate cancer in the apical gland of right peripheral zone who underwent ultrasonography-guided transrectal sextant biopsy 4 days before the MR imaging. (A) An axial precontrast T1-weighted image shows diffuse and heterogeneous hyperintensity, suggesting subacute parenchymal hemorrhage on apical portion of both sides (arrows). (B) Early phase contrast-enhanced image obtained immediately after the appearance of contrast material at the aortic bifucation level shows increased signal intensity area (arrow), partly masked by the surrounding hyperintensity. (C) Subtraction images of (A) from (B) shows a hypervascular portion (arrowheads), distinguished from background parenchyma. T2-weighted images could not define the lesion (not shown), and prostate cancer at the same area was proven by radical prostatectomy.

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