J Korean Soc Magn Reson Med.  2013 Sep;17(3):192-199. 10.13104/jksmrm.2013.17.3.192.

Dynamic Contrast-Enhanced MR Imaging in Detecting Local Tumor Progression after HIFU Ablation of Localized Prostate Cancer

• Park JJ
• Kim CK
• Lee HM
• Park BK
• Park SY

• KMID: 2206917
• DOI: http://doi.org/10.13104/jksmrm.2013.17.3.192

Abstract

PURPOSE
To retrospectively evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging (DCE-MRI) in detecting recurrent prostate cancer after HIFU of clinically localized cancer, as compared with T2-weighted imaging (T2WI).
MATERIALS AND METHODS
Twenty-six patients with increased prostate-specific antigen levels after HIFU were included in this study. All MR examinations were performed using T2WI and DCE-MRI, followed by transrectal ultrasound-guided biopsy. MRI and biopsy results were correlated in six prostate sectors. Residual or recurrent cancer after HIFU was defined as local tumor progression if biopsy results showed any cancer foci. Two independent readers interpreted the MR images.
RESULTS
Of 156 prostate sectors, 51 (33%) were positive for cancer in 17 patients. For detecting local tumor progression, the sensitivity of DCE-MRI and T2WI was 80% and 57% for reader 1 (P < 0.001) versus 84% and 61% for reader 2 (P < 0.001), respectively. The specificity and overall accuracy between DCE-MRI and T2WI showed no statistical difference in both readers (P > 0.05). Interobserver agreement of DCE-MRI and T2WI was moderate and fair, respectively.
CONCLUSION
For detecting local tumor progression of prostate cancer after HIFU, DCE-MRI was more sensitive than T2WI, with less interobserver variability.

Keyword

High intensity focused ultrasound; Localized prostate cancer; Magnetic resonance imaging (MRI); Dynamic contrast-enhanced MRI

MeSH Terms

Biopsy
Humans
Observer Variation
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Retrospective Studies
Sensitivity and Specificity
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Local tumor progression of prostate cancer in anterior portion of both lobes in 72-year-old man (prostate-specific antigen level, 5.88 ng/ml; Gleason sum score, 7). (a) Axial T2-weighted turbo-spin echo image shows a focal low signal lesion in the anterior portion of both lobes (arrows). (b-e) Parametric images of the wash-in rate (b), maximal enhancement (c), wash-out rate (d) and time to peak (e) demonstrate a color-coded area (arrows) in the corresponding site with A, representing the possibility of local tumor progression. In this case, T2-weighted imaging was equivalent to dynamic contrast-enhanced imaging of parametric images.

• 

  Fig. 2 Local tumor progression of prostate cancer in right lobe at the level of midgland in 69-year-old man (prostate-specific antigen level, 3.50 ng/ml; Gleason sum score, 8). (a) Axial T2-weighted turbo-spin echo image shows diffusely low signal lesion in both lobes at the level of midgland (arrows). (b-d) Parametric images of the maximal enhancement (b), wash-out rate (c) and time to peak (d) demonstrate a color-coded area (arrow) in right lobe at the level of midgland, representing the possibility of local tumor progression. Note an asterisk indicates the prostatic urethra. In this case, dynamic contrast-enhanced imaging of parametric images was superior to T2-weighted imaging.

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