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Visualization of prostate cancer using dynamic contrast-enhanced MRI: comparison with transrectal power Doppler ultrasound

¹ Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-dori Hirokoji Kamigyo-ku Kyoto, 602-8566, ² Department of Urology, Kyoto Prefectural University of Medicine and ³ Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine, Kyoto, Japan

View larger version (17K): [in a new window]   Figure 1. Schematic illustration of time–intensity curve classifications for dynamic contrast-enhanced MRI. Type A is characterized by early peak enhancement (within 60 s), Type B by intermediate-early enhancement (60–100 s) and Type C by delayed enhancement with no signal peak obtained after a continuous increase in intensity for 3 min.

View larger version (82K): [in a new window]   Figure 2. A 72-year-old man suspected to have prostate cancer based on a high serum prostate-specific antigen (36.9 ng ml-1) level and a positive digital rectal examination. The systematic octant biopsy results were positive in the left peripheral zone and left inner gland. Gleason score=4+4. (a) Transrectal ultrasound (left) and power Doppler ultrasound (right) of the prostate gland. Hypoechoic foci are demonstrated in the left peripheral zone (arrows) and the left inner gland (arrowhead). An intensely abnormal Doppler signal is observed in hypoechoic foci. The Doppler signal in the far right lateral peripheral zone is a neurovascular bundle (asterisk). (b) T2 weighted turbo spin echo image (4700/120) shows a low intensity lesion in the left peripheral zone (arrows) and left inner gland (arrowhead). (c) Early dynamic contrast-enhanced MRI shows strong enhancement in the low signal intensity lesion. (d) Regions of interest are superimposed on the source image of the left peripheral zone and left inner gland hypervascular lesions. (e) Time–intensity curves from the right and left peripheral zones. The left peripheral zone shows early, intense enhancement and was classified as Type A. The right peripheral zone shows delayed enhancement with no signal peak and was classified as Type C. The periodic fluctuations in the signal intensity curves are derived from respiratory motion artefacts produced by the abdominal wall.

View larger version (81K): [in a new window]   Figure 3. A 71-year-old man suspected to have prostate cancer based on a border-line elevation of prostate-specific antigen (9.6 ng ml-1) Only one biopsy core was positive in the right peripheral zone. Gleason score=4+4. (a) Transrectal ultrasound (left) and power Doppler ultrasound (right) of the prostate gland. No abnormal echoic lesions are visible. An intensely, focal abnormal Doppler signal is observed in the apex of the right peripheral zone (arrow). The Doppler signal in the ventral part of the prostate gland is an anterior prostatic venous plexus (asterisk). (b) T2 weighted turbo spin echo image (4700/120) shows an equivocal low intensity lesion in the apex of the right peripheral zone (arrow). (c) The source image of dynamic contrast-enhanced MRI shows focal early enhancement in the right-sided apex (arrow). (d) Region of interest is superimposed on the source image for the right apex hypervascular lesion. (e) The time intensity curve from the lesion shows early, intense enhancement and was classified as Type A. The time intensity curve of the left peripheral zone shows delayed enhancement with no signal peak and was classified as Type C.