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MR imaging and MR spectroscopic imaging in the pre-treatment evaluation of prostate cancer

Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue C278, New York, NY 10021 USA

View larger version (55K): [in a new window]   Figure 1. Clinical stage T2b prostate cancer. (a) Axial T2 weighted MR image demonstrates a large low signal intensity area in the left peripheral zone with obliteration of the rectoprostatic angle (arrow), indicating left side extracapsular invasion. (b) MR spectra show large-volume disease (all eight voxels are abnormal) with absence of citrate and marked elevation of choline, indicating high-grade disease. (c) Step-section pathology confirms large-volume tumour with left side extracapsular extension. Pathology stage pT3a, Gleason grade 4+3.

View larger version (84K): [in a new window]   Figure 2. Clinical stage T1c prostate cancer (non-palpable, biopsy-detected cancer). (a) Axial T2 weighted MR image show a large tumour on the left side of the peripheral zone with a focal bulge and asymmetry of the neurovascular bundle (arrowhead). (b) Sagittal T2 weighted MR image shows a large volume mid-to-base tumour with direct extension into the left seminal vesicle (arrow). On MRI, tumour stage is T3b. Corresponding step-section pathology shows sites of focal extracapsular extension (c) and left seminal vesicle invasion (d, arrowhead) (pathology stage pT3b), confirming the MRI tumour stage.

View larger version (50K): [in a new window]   Figure 3. Clinical stage T1c prostate cancer. (a) Axial T2 weighted MR image shows a large tumour (T) in the transition zone. There is interruption of the low signal fibromuscular stroma (arrows) suggestive of anterior extracapsular extension and thus indicating T3a disease. Corresponding step-section pathology (b) shows the tumour in the transition zone and site of established extracapsular extension. Pathology stage pT3A.

View larger version (58K): [in a new window]   Figure 4. Clinical stage T1c prostate cancer, Gleason grade 3+3. (a) Axial T2 weighted MR image shows foci of low-signal-intensity areas in the right and left sides of the peripheral zone. The tumour is organ-confined. In the region of cancer, MR spectra (b) show that citrate, although decreased, is still present, while choline is moderately elevated, indicating low-grade tumour. (c) Step-section pathology shows scattered organ-confined disease and confirms Gleason grade 3+3, pT2b.

View larger version (111K): [in a new window]   Figure 5. Clinical stage T2b prostate cancer. MRI (section not shown) demonstrated large volume cancer. Axial T2 weighted image shows gross left seminal vesicle invasion (arrow) indicating MR stage T3b disease, which was confirmed at surgical pathology.

View larger version (116K): [in a new window]   Figure 6. Clinical stage T1c prostate cancer. Coronal T2 weighted image shows tumour (T) in the transition zone; tumour abuts the right wall of the urethra (U). The left wall of the prostatic urethra (arrows) is normal. As a result of imaging, the treatment plan was changed from brachytherapy to IMRT.