Transrectal ultrasound‐guided biopsy of prostate voxels identified as suspicious of malignancy on three‐dimensional <sup>1</sup>H MR spectroscopic imaging in patients with abnormal digital rectal examination or raised prostate specific antigen level of 4–10 ng/ml

NMR in Biomedicine - Tập 20 Số 1 - Trang 11-20 - 2007
Virendra Kumar1, N. R. Jagannathan1, Rajeev Kumar2, Sanjay Thulkar3, S. Dutta Gupta4, Ashok K. Hemal2, N.P. Gupta2
1Department of NMR, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
2Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India
3Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India.
4Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India

Tóm tắt

AbstractResults of the evaluation of transrectal ultrasound (TRUS) guided needle biopsy of voxels identified as suspicious of malignancy on magnetic resonance spectroscopic imaging (MRSI) in a large cohort of men (n = 83) with abnormal digital rectal examination (DRE) [prostate specific antigen (PSA) 0–4 ng/ml] or PSA less than 10 ng/ml, are reported. Three‐dimensional 1H MRSI was carried out at 1.5 T using a pelvic‐phased array coil in combination with an endorectal surface coil. Voxels were classified as suspicious of malignancy based on Cit/(Cho + Cr) metabolite ratio. TRUS‐guided biopsy of suspicious voxels was performed using the z‐ and x‐coordinates obtained from MR images and two to three cores were taken from the suspected site. A systematic sextant biopsy was also carried out. MRSI showed voxels suspicious of malignancy in 44 patients while biopsy revealed cancer in 11 patients (25%). Patients who were negative for malignancy on MRSI were also negative on biopsy. An overall sensitivity of 100%, specificity of 54%, negative predictive value of 100% and accuracy of 60% were obtained. The site of biopsy was confirmed (n = 20) as a hypo‐intense area on repeat MRI while repeat MRSI revealed high choline and low citrate. The overall success rate of MRI‐directed TRUS‐guided biopsy of 25% was higher compared with a 9% success rate achieved without MR guidance in another group of 120 patients. Our results indicate that TRUS‐guided biopsy of suspicious area identified as malignant from MRSI can be performed using the coordinates of the voxel derived from MR images. This increases the detection rate of prostate cancer in men with PSA level <10 ng/ml or abnormal DRE and also demonstrates the potential of MR in routine clinical practice. Copyright © 2006 John Wiley & Sons, Ltd.

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NMR in Biomedicine

Tập 20 Số 1

11-20

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