A qualitative approach to combined magnetic resonance imaging and spectroscopy in the diagnosis of prostate cancer.

ABSTRACT

PURPOSE: To investigate the feasibility and diagnostic value of a whole prostate qualitative approach to combined magnetic resonance imaging and spectroscopy (MRI+MRS) in the detection of prostate cancer in patients with elevated PSA. MATERIALS AND METHODS: Three hundred and fifty six subjects (mean serum PSA 11.47ng/ml, range 0.40-133ng/ml) were examined with fast-T2-weighted images (MRI) and 3D-magnetic resonance spectroscopy (MRS). Both modalities were qualitatively analyzed on a whole prostate basis by a single radiologist using a 4-point diagnostic scale. Prostate cancer was histopathologically proven in 220 patients and non-evidence of cancer was determined after at least 12 months clinical follow-up in 136 subjects. RESULTS: Receiver operating curve analysis revealed a significantly better diagnostic performance of MRI+MRS (A(z)=0.857) than MRI alone (A(z)=0.801) and MRS alone (A(z)=0.810). The sensitivity, specificity and accuracy of MRI+MRS for detection of prostate cancer were 72.3%, 92.6%, and 80.1%, respectively. CONCLUSIONS: Spectral evaluation with a whole prostate qualitative approach is feasible in routine clinical practice. The combination of MRI and MRS yields superior diagnostic results than either modality alone.