Characterization of Prostate Cancer With 3T MR
In our laboratory we have combined the use of new 3T clinical magnetic resonance (MR)
technology, dynamic-contrast enhancement (DCE), and a unique endorectal-coil (ERC) probe in
order to non-invasively obtain images of the prostate gland with higher signal-to-noise
resolution and better spectral dispersion than has been previously achieved. This imaging
strategy acquires higher-resolution images with smaller voxel sizes than has been possible
with prior MR technology and more comprehensive tissue sampling compared to other
pre-surgical assessments. This methodology should make it feasible to assess prostate-tissue
morphology and additional features of prostate cancer such as tissue metabolism, tissue
kinetics, and the vascular microenvironment, and thus provide a non-invasive tool to: 1)
detect extra-capsular spread, 2) detect specific areas within the prostate that harbor
cancer, 3) determine the aggressiveness of the cancer and 4) direct biopsy and treatment
specifically to diseased areas.
In order to prospectively validate these goals we will recruit successive patients who have
been scheduled for prostate removal to participate to our protocol. Each patient will be
studied with an ERC MRI at 3T using T2-weighted (T2W) imaging, DCE 3D T1-weighted imaging
and MR spectroscopy (MRS). A pathologist using whole mount preparations will independently
analyze each patient's prostate specimen. The whole mount data will be used as the standard
against which we will compare the observations and data obtained from the 3T MRI findings.
Aim 1: To evaluate the accuracy of T2W MRI, DCE-MRI and their combined data for staging
Supplementing T2W imaging with the high-resolution capability of 3TMR, we will apply
standard morphologic criteria used at 1.5T to determine the presence or absence of
extracapsular extension (ECE) of disease. The possible incremental value of high spatial
resolution, dynamic contrast-enhanced data will be investigated. MRI results will be
compared to ECE determination at whole-mount pathology.
Aim 2: To evaluate the accuracy of MRI in determining tumor volume in the prostate gland.
Using dynamic-contrast enhanced MRI with parametric analyses and T2-weighted images, both at
smaller voxel sizes than have been used previously, will be our approach. Tumor volumes
determined with MRI will be compared to those determined at pathology.
Aim 3: To evaluate the accuracy of MRI in grading prostate cancer.
The enhanced resolution available at 3T offers new opportunities to compare Gleason grades
with independent and combined assessments of tissue kinetics and metabolism. Pixel by pixel
parametric analyses will be obtained. Furthermore, choline to citrate and choline plus
creatine to citrate ratios determined using MRS techniques will be obtained. Single voxel
techniques will first be employed, followed by 3D chemical shift imaging, when the latter
becomes available at 3T. DCE and MRS data will be compared both separately and in
combination to the histologic Gleason scores of the comparable tumor identified at whole
Observational Model: Case-Only, Time Perspective: Prospective
Barbara Klemm-Ellis, N.P.
Beth Israel Deaconess Medical Center
United States: Institutional Review Board
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