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Ultraschall Med 2015; 36(04): 355-361
DOI: 10.1055/s-0034-1366563
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Fusion of Magnetic Resonance Imaging and Real-Time Elastography to Visualize Prostate Cancer: A Prospective Analysis using Whole Mount Sections after Radical Prostatectomy

Fusion von Magnetresonanztomografie und Real-time-Elastografie zur Visualisierung des Prostatakarzinoms: Eine prospektive Analyse anhand von Großflächenschnitten nach radikaler Prostatektomie
M. Brock
1   Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
,
F. Roghmann
1   Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
,
C. Sonntag
2   Radiology, Ruhr-University Bochum, Marienhospital Herne, Germany
,
F. Sommerer
3   Pathology, Ruhr-University Bochum, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Bochum, Germany
,
Z. Tian
4   Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
,
B. Löppenberg
1   Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
,
R. J. Palisaar
1   Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
,
J. Noldus
1   Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
,
J. Hanske
1   Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
,
C. von Bodman
1   Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
› Author Affiliations
Further Information

Publication History

25 November 2013

23 April 2014

Publication Date:
22 May 2014 (online)

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Abstract

Purpose: To determine whether the fusion of multiparametric magnetic resonance imaging (MRI) with transrectal real-time elastography (RTE) improves the visualization of PCa lesions compared to MRI alone.

Materials and Methods: In a prospective setting, 45 patients with biopsy-proven PCa received prostate MRI prior to radical prostatectomy (RP). T2 and diffusion-weighted imaging (T2WI/DW-MRI) and, if applicable, dynamic contrast-enhanced sequences (T2WI/DW/DCE-MRI) were used to perform MRI/RTE fusion. The probability of PCa on MRI was graded according to the PI-RADS score for 12 different prostate sectors per patient. MRI images were fused with RTE to stratify suspicious from non-suspicious sectors. Imaging results were compared to whole mount sections using nonparametrical receiver operating characteristic curves and the area under these curves (AUC).

Results: 41 of 45 patients were eligible for final analyses. Histopathology confirmed PCa in 261 (53 %) of 492 prostate sectors. MRI alone provided an AUC of 0.62 (T2WI/DW-MRI) and 0.65 (T2WI/DW/DCE-MRI) to predict PCa and was meaningfully enhanced to 0.75 (T2WI/DW-MRI) and 0.74 (T2WI/DW/DCE-MRI) using MRI/RTE fusion. Sole MRI showed a sensitivity and specificity of 57.9 % and 61 % with the best results for ventral prostate sectors whereas RTE was superior in dorsal and apical sectors. MRI/RTE fusion improved sensitivity and specificity to 65.9 % and 75.3 %, respectively. Additional use of DCE sequences showed a sensitivity and specificity of 65 % and 55.7 % for MRI and 72.1 % and 66 % for MRI/RTE fusion.

Conclusion: MRI/RTE fusion provides improved PCa visualization by combining the strength of both imaging techniques in regard to prostate zonal anatomy and thereby might improve future biopsy-guided PCa detection.

Zusammenfassung

Ziel: Die Aussagekraft der Fusion von Magnetresonanztomografie (MRT) und transrektaler Real-time Elastografie (RTE) soll hinsichtlich der Visualisierung des Prostatakarzinoms (PCa) bewertet werden.

Material und Methode: 45 konsekutive Patienten mit vorbekanntem PCa erhielten vor radikaler Prostatektomie (RP) ein MRT. Die Bilddaten aus T2- und diffusionsgewichteten MRT (T2WI/DW-MRI) sowie kontrastmittelverstärktem MRT (T2WI/DW/DCE-MRI) wurden für eine MRT/RTE-Fusion verwendet. Die PCa-Vorhersage mittels MRT und MRT/RTE-Fusion erfolgte separat für 12 definierte Sektoren in Anlehnung an die Pi-RADS Klassifikation. Die Aussagen beider Verfahren wurde unter Verwendung von ROC-Analysen mit Großflächenschnitten nach RP verglichen.

Ergebnisse: Die Auswertung von 41 der 45 Patienten zeigte in 261 (53 %) der 492 Sektoren ein PCa. Die AUC der alleinigen MRT betrug 0,62 (T2WI/DW-MRI) bzw. 0,65 (T2WI/DW/DCE-MRI) und konnte unter Anwendung der MRT/RTE-Fusion auf 0,75 (T2WI/DW-MRI) bzw. 0,74 (T2WI/DW/DCE-MRI) erhöht werden. Die Sensitivität und Spezifität der MRT zur PCa-Vorhersage betrug 57,9 % bzw. 61 % verglichen mit 65,9 % bzw. 75,3 % der MRT/RTE-Fusion. Unter zusätzlicher Anwendung Kontrastmittel-verstärkter Bildsequenzen lag die Sensitivität und Spezifität der MRT bei 65 % und 55,7 % verglichen mit 72,1 % und 66 % unter Anwendung der MRT/RTE-Fusion.

Schlussfolgerungen: Die MRT/RTE-Fusion ermöglicht eine verbesserte PCa-Visualisierung und kombiniert die Vorteile beider bildgebenden Verfahren unter Berücksichtigung der zonalen Prostataanatomie. Die Anwendung der MRT/RTE-Fusion im Rahmen zukünftiger Biopsieprotokolle könnte eine gezielte PCa-Detektion ermöglichen.

Key words

prostate - ultrasound - MR imaging - treatment planning - staging
 

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