Investig Magn Reson Imaging.  2017 Sep;21(3):139-147. 10.13104/imri.2017.21.3.139.

Multiparametric MRI of Prostate Cancer after Biopsy: Little Impact of Hemorrhage on Tumor Staging

• Choi MH
• Jung SE
• Park YH
• Lee JY
• Choi YJ

• KMID: 2392684
• DOI: http://doi.org/10.13104/imri.2017.21.3.139

Abstract

PURPOSE
To evaluate differences in staging accuracy of prostate cancer according to the extent of hemorrhage on multiparametric MRI performed after biopsy.
MATERIALS AND METHODS
We enrolled 71 consecutive patients with biopsy-proven prostate cancer. Patients underwent MRI followed by a prostatectomy at our institution in 2014. Two radiologists reviewed the MRI to determine the tumor stage. Correlation between biopsy-MRI interval and extent of hemorrhage was evaluated. Regression analyses were used to determine factors associated with accuracy of tumor staging.
RESULTS
The mean interval between biopsy and MRI was 17.4 ± 10.2 days (range, 0-73 days). The interval between prostate biopsy and MRI and the extent of hemorrhage were not significantly correlated (P = 0.880). There was no significant difference in the accuracy rate of staging between the small and large hemorrhage groups.
CONCLUSION
Biopsy-induced hemorrhage in the prostate gland is not sufficiently absorbed over time. The extent of hemorrhage and the short interval between biopsy and MRI may not impair tumor detection or staging on multiparametric MRI.

Keyword

Prostatic neoplasms; Magnetic resonance imaging; Biopsy; Neoplasm staging; Hemorrhage

MeSH Terms

Biopsy*
Hemorrhage*
Humans
Magnetic Resonance Imaging*
Neoplasm Staging*
Prostate*
Prostatectomy
Prostatic Neoplasms*

Figure

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  Fig. 1 Schematic illustration of MRI shows 6 areas to evaluate hemorrhage in the right peripheral zone of the prostate.

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  Fig. 2 Extent of hemorrhage and time interval between biopsy and MRI. No statistically significant correlation was identified for time interval between transrectal ultrasound-guided biopsy and MRI (r = −0.018, P = 0.880).

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  Fig. 3 A prostate cancer with accurate preoperative stage in a 58-year-old man. There is a small conspicuous lesion (arrow) with T2-low signal intensity (SI) (a) and T1-low SI surrounding T1-high SI (b) in the right peripheral zone. The corresponding area (arrows) shows high SI on diffusion-weighted image (c) and low apparent diffusion-coefficient value (d). MRI was performed nine days after transrectal ultrasound-guided biopsy, and there was a large amount of hemorrhage in the prostate gland (10 of 12 areas). The tumor was classified as an organ-confined cancer (dashed circle) on MRI and no extracapsular extension was confirmed after prostatectomy (e).

• 

  Fig. 4 Large amount of hemorrhage (arrows) in the prostate gland of a 64-year-old man. There are ill-defined T2-low signal intensity (SI) (a) and T1-high SI areas (b) in both peripheral zones. The corresponding area shows heterogeneous SI on diffusion-weighted image (c); apparent diffusion-coefficient value was not decreased (d). MRI was performed 18 days after transrectal ultrasound-guided biopsy, and there was a large amount of hemorrhage in the prostate gland (all 12 areas of the prostate gland). After prostatectomy, there was no tumor in either peripheral zone at this section (e).

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