Functional MR Imaging of Prostate Cancer

doi:10.1148/rg.271065078

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Functional MR Imaging of Prostate Cancer¹

Young Jun Choi, MD, Jeong Kon Kim, MD, Namkug Kim, MS, Kyoung Won Kim, MD, Eugene K. Choi, BA and Kyoung-Sik Cho, MD

¹ From the Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388–1 Poong-nap-dong, Songpa-gu, Seoul 138–736, South Korea (Y.J.C., J.K.K., N.K., K.W.K., K.S.C.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (E.K.C.). Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received April 24, 2006; revision requested May 30 and received July 25; accepted July 26. Supported by Korean Research Foundation Grant KRF-2005–041-E00300. All authors have no financial relationships to disclose.

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Figure 1a. Schematics show the anatomy of the prostate in transverse (a) and sagittal (b) planes. AFT = anterior fibromuscular tissue, CZ = central zone, ED = ejaculatory duct, NVB = neurovascular bundle, PUT = periurethral tissue, PZ = peripheral zone, U = urethra, TZ = transitional zone.

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Figure 1b. Schematics show the anatomy of the prostate in transverse (a) and sagittal (b) planes. AFT = anterior fibromuscular tissue, CZ = central zone, ED = ejaculatory duct, NVB = neurovascular bundle, PUT = periurethral tissue, PZ = peripheral zone, U = urethra, TZ = transitional zone.

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Figure 2a. Axial (a) and coronal (b) T2-weighted MR images show normal zonal anatomy of the prostate. B = urinary bladder, NVB = neurovascular bundle, PZ = peripheral zone, R = rectum, SV = seminal vesicle, U = urethra, TZ = transitional zone.

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Figure 2b. Axial (a) and coronal (b) T2-weighted MR images show normal zonal anatomy of the prostate. B = urinary bladder, NVB = neurovascular bundle, PZ = peripheral zone, R = rectum, SV = seminal vesicle, U = urethra, TZ = transitional zone.

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Figure 3a. Biopsy-proved adenocarcinoma in a 64-year-old man. Axial (a) and coronal (b) T2-weighted MR images show an area of low signal intensity in the base of the left peripheral zone (arrow), a finding indicative of a tumor.

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Figure 3b. Biopsy-proved adenocarcinoma in a 64-year-old man. Axial (a) and coronal (b) T2-weighted MR images show an area of low signal intensity in the base of the left peripheral zone (arrow), a finding indicative of a tumor.

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Figure 4a. Biopsy-proved adenocarcinoma in a 61-year-old man. (a) Wash-in MR image obtained with a fast field echo sequence (17/2.9; flip angle, 20°) shows a higher wash-in rate in the right peripheral zone (arrow) than in other areas. (b) Washout MR image obtained with the same sequence as a shows a higher washout rate in the right peripheral zone (arrow) than in other areas.

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Figure 4b. Biopsy-proved adenocarcinoma in a 61-year-old man. (a) Wash-in MR image obtained with a fast field echo sequence (17/2.9; flip angle, 20°) shows a higher wash-in rate in the right peripheral zone (arrow) than in other areas. (b) Washout MR image obtained with the same sequence as a shows a higher washout rate in the right peripheral zone (arrow) than in other areas.

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Figure 5. Time–signal intensity curves from dynamic contrast-enhanced MR imaging show faster and stronger enhancement and faster washout in prostate cancer (1) than in normal tissue (red curve, 2). The x-axis shows the number of series in MR imaging, and the y-axis shows the signal intensity in arbitrary units. The onset time (a) is the time at which signal intensity began to increase. The time to peak (b) is the period between the onset time and peak enhancement. The wash-in rate (c) represents the velocity of enhancement and is defined by d–c/b–a, where d represents the maximum (peak) enhancement, which is defined as the absolute maximum value of enhancement. Maximum (peak) relative enhancement is defined as the difference between the absolute maximum value of enhancement and the baseline signal intensity. The washout rate is defined as the velocity of enhancement loss. The shaded area represents the area under the time–signal intensity curve for prostate cancer.

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Figure 6a. Parametric imaging of the wash-in rate allows detection and localization of prostate cancer in a 65-year-old man. (a) Histologic step section (original magnification, x1; hematoxylineosin stain) at the middle level of the prostate gland shows cancerous tissue (black lines and dots) in the lateral and medial peripheral zone in the left lobe and in the transitional zone in the right lobe. (b) Unenhanced T1-weighted MR image shows the placement of four regions of interest, according to the histologic findings, in cancerous tissue (1), normal tissue in the peripheral zone (2), normal tissue in the inner two-thirds of the transitional zone (3), and normal tissue in the outer one-third of the transitional zone (4). (c) Time–signal intensity curves for the four regions of interest in b (x-axis, time in seconds; y-axis, signal intensity in arbitrary units [au]) show wash-in rates of 9.7 au/sec for cancerous tissue (1), 2.1 au/sec for normal tissue in the peripheral zone (2), 4.3 au/sec for normal tissue in the inner two-thirds of the transitional zone (3), and 1.3 au/sec for normal tissue in the outer one-third of the transitional zone (4). (d) Parametric MR image at a level corresponding to that in a shows a wash-in rate of more than 5.7 au/sec, which was used as the threshold for differentiating cancerous tissue from normal tissue on the basis of an analysis of receiver operating characteristic curves. The parametric map of wash-in rates concords with the histologic findings. (Reprinted, with permission, from reference 17.)

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Figure 6b. Parametric imaging of the wash-in rate allows detection and localization of prostate cancer in a 65-year-old man. (a) Histologic step section (original magnification, x1; hematoxylineosin stain) at the middle level of the prostate gland shows cancerous tissue (black lines and dots) in the lateral and medial peripheral zone in the left lobe and in the transitional zone in the right lobe. (b) Unenhanced T1-weighted MR image shows the placement of four regions of interest, according to the histologic findings, in cancerous tissue (1), normal tissue in the peripheral zone (2), normal tissue in the inner two-thirds of the transitional zone (3), and normal tissue in the outer one-third of the transitional zone (4). (c) Time–signal intensity curves for the four regions of interest in b (x-axis, time in seconds; y-axis, signal intensity in arbitrary units [au]) show wash-in rates of 9.7 au/sec for cancerous tissue (1), 2.1 au/sec for normal tissue in the peripheral zone (2), 4.3 au/sec for normal tissue in the inner two-thirds of the transitional zone (3), and 1.3 au/sec for normal tissue in the outer one-third of the transitional zone (4). (d) Parametric MR image at a level corresponding to that in a shows a wash-in rate of more than 5.7 au/sec, which was used as the threshold for differentiating cancerous tissue from normal tissue on the basis of an analysis of receiver operating characteristic curves. The parametric map of wash-in rates concords with the histologic findings. (Reprinted, with permission, from reference 17.)

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Figure 6c. Parametric imaging of the wash-in rate allows detection and localization of prostate cancer in a 65-year-old man. (a) Histologic step section (original magnification, x1; hematoxylineosin stain) at the middle level of the prostate gland shows cancerous tissue (black lines and dots) in the lateral and medial peripheral zone in the left lobe and in the transitional zone in the right lobe. (b) Unenhanced T1-weighted MR image shows the placement of four regions of interest, according to the histologic findings, in cancerous tissue (1), normal tissue in the peripheral zone (2), normal tissue in the inner two-thirds of the transitional zone (3), and normal tissue in the outer one-third of the transitional zone (4). (c) Time–signal intensity curves for the four regions of interest in b (x-axis, time in seconds; y-axis, signal intensity in arbitrary units [au]) show wash-in rates of 9.7 au/sec for cancerous tissue (1), 2.1 au/sec for normal tissue in the peripheral zone (2), 4.3 au/sec for normal tissue in the inner two-thirds of the transitional zone (3), and 1.3 au/sec for normal tissue in the outer one-third of the transitional zone (4). (d) Parametric MR image at a level corresponding to that in a shows a wash-in rate of more than 5.7 au/sec, which was used as the threshold for differentiating cancerous tissue from normal tissue on the basis of an analysis of receiver operating characteristic curves. The parametric map of wash-in rates concords with the histologic findings. (Reprinted, with permission, from reference 17.)

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Figure 6d. Parametric imaging of the wash-in rate allows detection and localization of prostate cancer in a 65-year-old man. (a) Histologic step section (original magnification, x1; hematoxylineosin stain) at the middle level of the prostate gland shows cancerous tissue (black lines and dots) in the lateral and medial peripheral zone in the left lobe and in the transitional zone in the right lobe. (b) Unenhanced T1-weighted MR image shows the placement of four regions of interest, according to the histologic findings, in cancerous tissue (1), normal tissue in the peripheral zone (2), normal tissue in the inner two-thirds of the transitional zone (3), and normal tissue in the outer one-third of the transitional zone (4). (c) Time–signal intensity curves for the four regions of interest in b (x-axis, time in seconds; y-axis, signal intensity in arbitrary units [au]) show wash-in rates of 9.7 au/sec for cancerous tissue (1), 2.1 au/sec for normal tissue in the peripheral zone (2), 4.3 au/sec for normal tissue in the inner two-thirds of the transitional zone (3), and 1.3 au/sec for normal tissue in the outer one-third of the transitional zone (4). (d) Parametric MR image at a level corresponding to that in a shows a wash-in rate of more than 5.7 au/sec, which was used as the threshold for differentiating cancerous tissue from normal tissue on the basis of an analysis of receiver operating characteristic curves. The parametric map of wash-in rates concords with the histologic findings. (Reprinted, with permission, from reference 17.)

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Figure 7a. Biopsy-proved adenocarcinoma in a 72-year-old man. (a) Axial T2-weighted MR image shows a low-signal-intensity lesion in the right lobe of the prostate (arrow). (b) ADC map shows a low ADC value in the lesion (arrow), a finding indicative of decreased diffusion. A targeted biopsy was performed.

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Figure 7b. Biopsy-proved adenocarcinoma in a 72-year-old man. (a) Axial T2-weighted MR image shows a low-signal-intensity lesion in the right lobe of the prostate (arrow). (b) ADC map shows a low ADC value in the lesion (arrow), a finding indicative of decreased diffusion. A targeted biopsy was performed.

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Figure 8. Biopsy-proved adenocarcinoma in a 71-year-old man. Left: MR spectrum obtained from an area of the prostate with low signal intensity at T2-weighted imaging, in which cancer was pathologically proved, demonstrates an elevated ratio (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci). Right: MR spectrum obtained from an area with normal signal intensity shows a spectral pattern with citrate dominance and no abnormal elevation of choline and creatine.

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Figure 9a. Biopsy-proved adenocarcinoma in a 65-year-old man with a previous negative biopsy result and a continuously elevated prostate-specific antigen level. (a) Axial T2-weighted MR image shows no focal lesion in the prostate. (b, c) MR spectroscopic image (b) and corresponding spectrum (c) demonstrate an elevated ratio (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci) in the central gland (arrow in b), a finding indicative of prostate cancer, which was confirmed at targeted biopsy.

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Figure 9b. Biopsy-proved adenocarcinoma in a 65-year-old man with a previous negative biopsy result and a continuously elevated prostate-specific antigen level. (a) Axial T2-weighted MR image shows no focal lesion in the prostate. (b, c) MR spectroscopic image (b) and corresponding spectrum (c) demonstrate an elevated ratio (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci) in the central gland (arrow in b), a finding indicative of prostate cancer, which was confirmed at targeted biopsy.

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Figure 9c. Biopsy-proved adenocarcinoma in a 65-year-old man with a previous negative biopsy result and a continuously elevated prostate-specific antigen level. (a) Axial T2-weighted MR image shows no focal lesion in the prostate. (b, c) MR spectroscopic image (b) and corresponding spectrum (c) demonstrate an elevated ratio (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci) in the central gland (arrow in b), a finding indicative of prostate cancer, which was confirmed at targeted biopsy.

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Figure 10a. Biopsy-proved adenocarcinoma in the central zone in both lobes of the prostate in a 67-year-old man. (a) Axial T2-weighted MR image shows areas of abnormally low signal intensity (arrow), a finding that is not definitively indicative of cancer. (b, c) MR spectrum (b) and spectroscopic image (c) show high ratios (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci) in three areas (arrows in c). The findings were indicative of cancer, which was diagnosed at targeted biopsy.

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Figure 10b. Biopsy-proved adenocarcinoma in the central zone in both lobes of the prostate in a 67-year-old man. (a) Axial T2-weighted MR image shows areas of abnormally low signal intensity (arrow), a finding that is not definitively indicative of cancer. (b, c) MR spectrum (b) and spectroscopic image (c) show high ratios (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci) in three areas (arrows in c). The findings were indicative of cancer, which was diagnosed at targeted biopsy.

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Figure 10c. Biopsy-proved adenocarcinoma in the central zone in both lobes of the prostate in a 67-year-old man. (a) Axial T2-weighted MR image shows areas of abnormally low signal intensity (arrow), a finding that is not definitively indicative of cancer. (b, c) MR spectrum (b) and spectroscopic image (c) show high ratios (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci) in three areas (arrows in c). The findings were indicative of cancer, which was diagnosed at targeted biopsy.

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Figure 11a. Biopsy-proved adenocarcinoma in a 65-year-old man. (a) Axial T2-weighted MR image shows an area of low signal intensity (arrow) in the left peripheral zone of the prostate. (b) ADC map shows a low ADC value in the same area (arrow). (c) MR spectrum obtained in the abnormal area shows an elevated ratio (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci).

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Figure 11b. Biopsy-proved adenocarcinoma in a 65-year-old man. (a) Axial T2-weighted MR image shows an area of low signal intensity (arrow) in the left peripheral zone of the prostate. (b) ADC map shows a low ADC value in the same area (arrow). (c) MR spectrum obtained in the abnormal area shows an elevated ratio (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci).

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Figure 11c. Biopsy-proved adenocarcinoma in a 65-year-old man. (a) Axial T2-weighted MR image shows an area of low signal intensity (arrow) in the left peripheral zone of the prostate. (b) ADC map shows a low ADC value in the same area (arrow). (c) MR spectrum obtained in the abnormal area shows an elevated ratio (in arbitrary units) of choline (Ch) and creatine (Cr) to citrate (Ci).

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Figure 12a. Biopsy-proved adenocarcinoma of the whole prostate in a 75-year-old man. (a) Axial T2-weighted MR image shows a huge contoured mass that involves the entire prostate and that has invaded the urinary bladder and rectum. (b) Coronal T2-weighted MR image of the abdomen and pelvis shows multiple metastases in the liver, lungs, and thoracolumbar spine (arrows). (c) Coronal diffusion-weighted image of the abdomen and pelvis shows multifocal restriction of diffusion in the liver and thoracolumbar spine (arrow).

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Figure 12b. Biopsy-proved adenocarcinoma of the whole prostate in a 75-year-old man. (a) Axial T2-weighted MR image shows a huge contoured mass that involves the entire prostate and that has invaded the urinary bladder and rectum. (b) Coronal T2-weighted MR image of the abdomen and pelvis shows multiple metastases in the liver, lungs, and thoracolumbar spine (arrows). (c) Coronal diffusion-weighted image of the abdomen and pelvis shows multifocal restriction of diffusion in the liver and thoracolumbar spine (arrow).

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Figure 12c. Biopsy-proved adenocarcinoma of the whole prostate in a 75-year-old man. (a) Axial T2-weighted MR image shows a huge contoured mass that involves the entire prostate and that has invaded the urinary bladder and rectum. (b) Coronal T2-weighted MR image of the abdomen and pelvis shows multiple metastases in the liver, lungs, and thoracolumbar spine (arrows). (c) Coronal diffusion-weighted image of the abdomen and pelvis shows multifocal restriction of diffusion in the liver and thoracolumbar spine (arrow).

Functional MR Imaging of Prostate Cancer1

Functional MR Imaging of Prostate Cancer¹