A vision of 14 T MR for fundamental and clinical science.

OBJECTIVE: We outline our vision for a 14 Tesla MR system. This comprises a novel whole-body magnet design utilizing high temperature superconductor; a console and associated electronic equipment; an optimized radiofrequency coil setup for proton measurement in the brain, which also has a local shim capability; and a high-performance gradient set. RESEARCH FIELDS: The 14 Tesla system can be considered a 'mesocope': a device capable of measuring on biologically relevant scales. In neuroscience the increased spatial resolution will anatomically resolve all layers of the cortex, cerebellum, subcortical structures, and inner nuclei. Spectroscopic imaging will simultaneously measure excitatory and inhibitory activity, characterizing the excitation/inhibition balance of neural circuits. In medical research (including brain disorders) we will visualize fine-grained patterns of structural abnormalities and relate these changes to functional and molecular changes. The significantly increased spectral resolution will make it possible to detect (dynamic changes in) individual metabolites associated with pathological pathways including molecular interactions and dynamic disease processes. CONCLUSIONS: The 14 Tesla system will offer new perspectives in neuroscience and fundamental research. We anticipate that this initiative will usher in a new era of ultra-high-field MR.

Reproducibility of 3D 1H MR spectroscopic imaging of the prostate at 1.5T.

PURPOSE: To determine the reproducibility of 3D proton magnetic resonance spectroscopic imaging ((1)H-MRSI) of the human prostate in a multicenter setting at 1.5T. MATERIALS AND METHODS: Fourteen subjects were measured twice with 3D point-resolved spectroscopy (PRESS) (1)H-MRSI using an endorectal coil. MRSI voxels were selected in the peripheral zone and combined central gland at the same location in the prostate in both measurements. Voxels with approved spectral quality were included to calculate Bland-Altman parameters for reproducibility from the choline plus creatine to citrate ratio (CC/C). The repeated spectroscopic data were also evaluated with a standardized clinical scoring system. RESULTS: A total of 74 voxels were included for reproducibility analysis. The complete range of biologically interesting CC/C ratios was covered. The overall within-voxel standard deviation (SD) of the CC/C ratio of the repeated measurements was 0.13. This value is equal to the between-subject SD of noncancer prostate tissue. In >90% of the voxels the standardized clinical score did not differ relevantly between the measurements. CONCLUSION: Repeated measurements of in vivo 3D (1)H-MRSI of the complete prostate at 1.5T produce equal and quantitative results. The reproducibility of the technique is high enough to provide it as a reliable tool in assessing tumor presence in the prostate.

Discriminating cancer from noncancer tissue in the prostate by 3-dimensional proton magnetic resonance spectroscopic imaging: a prospective multicenter validation study.

OBJECTIVES: A prospective multicenter validation of the ability of 1H magnetic resonance spectroscopic imaging (MRSI) to distinguish cancer from noncancer tissues throughout the prostate with histopathology of the resected organ as the standard of reference. MATERIALS AND METHODS: Institutional review board approval was obtained for all centers and all participating patients and volunteers provided written informed consent. Ninety-nine patients and 10 age-matched volunteers from 8 participating centers underwent magnetic resonance imaging and 3-dimensional MRSI with an endorectal coil at 1.5 T. Selected MRSI voxels were assigned to the peripheral zone (PZ), the central gland (CG), the periurethral area, and cancer tissue. Signal ratios of choline + creatine to citrate (CC/C) in spectra of these voxels were automatically calculated. Receiver operating characteristic curves were constructed to assess the accuracy by which this ratio can discriminate cancer from noncancer tissue. RESULTS: A total of 70% of voxels in noncancer tissue and 90% of voxels in cancer tissue passed the quality check of the automatically fitted spectra. The median CC/C was significantly different between any noncancer and cancer tissue (P < 0.0001), but not between the different contributing centers. CC/C increased with cancer focus size (P =0.0008) and certainty of voxel mapping to histopathologic cancer site (P 0.0001). The area under the receiver operating characteristic curve for discriminating voxels of cancer tissue from noncancer tissue was 0.88 (confidence interval: 0.84-0.92) in the PZ and 0.76 (confidence interval: 0.71- 0.81) in the CG.

Three-dimensional proton MR spectroscopy of human prostate at 3 T without endorectal coil: feasibility.

PURPOSE: To evaluate sensitivity and specificity of proton magnetic resonance (MR) spectroscopy of the prostate with external surface coil elements at 3 T for differentiation of cancer from healthy tissue within an acceptable measurement time, by using histopathologic findings as the reference standard. MATERIALS AND METHODS: The study was approved by the institutional review board; informed consent was obtained. Forty-five men (age range, 51-70 years) underwent 3-T MR imaging with external radiofrequency surface coils for signal reception. MR spectroscopy was performed with acquisition-weighted three-dimensional water- and lipid-suppressed point-resolved spectroscopy pulse sequence. Voxels were classified into healthy peripheral zone, central gland, and periurethral zone and cancer tissue. Cancer voxels were classified according to cancer size and certainty in matching histopathologic findings with MR images. After visual inspection of automated fitting of classified voxels, the choline plus creatine-to-citrate (Cho + Cr/Cit) ratio was calculated for all tissues. Area under the receiver operating characteristic curves (A(z)) values were used to assess accuracy of discrimination of cancer from healthy tissues. P < .05 indicated a significant difference. RESULTS: After exclusion of four patients with no voxels that passed visual inspection of the automated fit, a median of 82% of the classified voxels per patient was used in the analysis. Mean Cho + Cr/Cit ratios for healthy tissues were 0.22 +/- 0.12 (standard deviation) for peripheral zone, 0.34 +/- 0.14 for central gland, and 0.36 +/- 0.20 for periurethral area; all were significantly different from that of cancer (P < .001). A(z) for discrimination of probable and definite cancer tissue from healthy tissue for the peripheral zone (0.84) was significantly higher than that for the central gland (0.69) (P < .05). CONCLUSION: Three-dimensional proton MR spectroscopy of the prostate, with a combination of only external radiofrequency surface coils at 3 T, can be used to discriminate cancer from healthy tissue.

Correlation between metabolite ratios and ADC values of prostate in men with increased PSA level.

Proton magnetic resonance spectroscopic imaging (MRSI) and diffusion-weighted imaging (DWI) were carried out in men with increased prostate-specific antigen (PSA) level. Forty subjects [controls (Group I) and patients (Groups II and III with PSA >20 and 4-20 ng/ml, respectively)] were investigated using endorectal coil at 1.5 T prior to transrectal ultrasound (TRUS)-guided biopsy. Metabolite ratio [citrate/(choline+creatine)] and apparent diffusion coefficient (ADC) were calculated for identical voxels. In patients, voxels that showed lower metabolite ratio showed reduced ADC in the peripheral zone (PZ) of the prostate, and voxels with increased metabolite ratio showed higher ADC. Metabolite ratios were used to predict areas of malignancy if the ratio was <1.4 and if ADC value was <1.17 x 10(-3) mm(2)/s. Patients in Group II had lower metabolite ratio and ADC in the PZ compared to controls and Group III. All 13 were positive for malignancy in MR, while 12 of 13 were positive on TRUS-guided sextant biopsy. In Group III, certain voxels of PZ that showed reduced metabolite ratio also showed lower ADC. A positive correlation was observed between metabolite ratio and ADC. MR predicted areas of malignancy in PZ in 15 of 20 patients; however, only six were positive on TRUS-guided biopsy perhaps due to high false-negative rate of TRUS-guided biopsy. Results show positive correlation between MRSI and DWI and their potential in detection of malignancy, thereby improving the diagnosis especially in patients with PSA level of 4-20 ng/ml.

Three-dimensional 1H-magnetic resonance spectroscopy of the prostate in clinical practice: technique and results in patients with elevated prostate-specific antigen and negative or no previous prostate biopsies.

To assess the benefit of routinely used three-dimensional 1H-spectroscopy of the prostate combined with magnetic resonance imaging in patients with elevated prostate-specific antigen (PSA) levels and negative or no previous prostate biopsies. Fifty-four patients were examined with our combined imaging protocol, which consisted of transversal, coronal and sagittal T2-weighted fast spin echo sequences. For spectroscopy, we used a three-dimensional chemical shift imaging spin echo (3D-CSI-SE) sequence. The study population consisted of patients with elevated PSA levels and histologically proven prostate carcinoma and patients with elevated PSA levels and negative or no previous prostate biopsies. Examination time was 31 min, a time feasible for routine use. Eighty-eight tumour voxels and 67 control voxels of 27 patients with histologically proven prostate carcinoma were analysed. Ratios of (choline + creatine)/citrate [(Cho + Crea)/Cit] below 0.6 were classified as normal and above 0.6 as pathological. Applying this classification to 20 patients with tumour-suspicious lesions of the prostate and negative or no previous prostate biopsies, we could obtain a sensitivity and specificity for tumour detection of 100% and 69%, respectively. Our combined imaging protocol is feasible for routine use and can add valuable information for the diagnostic management of patients with negative or no previous prostate biopsies.

3D proton MR spectroscopic imaging of prostate cancer using a standard spine coil at 1.5 T in clinical routine: a feasibility study.

The objective of this study was to demonstrate the feasibility of 3D proton MR spectroscopic imaging (MRSI) of the prostate using a standard spine instead of a dedicated endorectal coil at 1.5 T. Twenty-eight patients (25 with biopsy proven prostate cancers and three patients with a benign prostate hyperplasia) were examined. MRI and MRSI were conducted with commercial array surface coils at 1.5 T. Ratios of choline (Cho), creatine (Cr) and citrate (Ci) were calculated for tumour, central and peripheral zone retrospectively, based on axial T2 weighed MR images and histology reports. Prostate cancer was characterized by significantly elevated (Cho+Cr)/Ci ratio compared with non-tumourous prostate tissue. The quality of all proton MR spectra was considered to be good or acceptable in 17/28 patients (61%) and poor in 11/28 (39%) examinations. In 20/25 patients with proven malignancy (80%), MRSI was considered to be helpful for the detection of prostate cancer. In 4/25 patients with proven malignancy (16%) who underwent seed implantation, radiotherapy or hormone deprivation before MR examination spectroscopy was of poor and non-diagnostic quality. MRSI of the prostate is feasible within clinical routine using the spine array surface coil at 1.5 T. It can consequently be applied to patients even with contraindications for endorectal coils. However, spectral quality and signal-to-noise ratio is clearly inferior to 3D MRSI examinations with endorectal coils.