Prostate Cancer (Clinical Studies)
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Monday May 9th
Room 518-A-C  11:00 - 13:00 Moderators: Jurgen J. Fütterer and Anwar Padhani

11:00 44.   Introduction
Anwar Padhani


11:12 45.   Diffusion Kurtosis Imaging in Prostate Cancer  
Andreas Lemke1, Anja Weidner2, Jörg Döpfert1, Dietmar Dinter2, and Lothar Rudi Schad1
1Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany, 2Department of Clinical Radiology and Nuclear Medicine, Heidelberg University, Mannheim, Germany

Diffusion kurtosis parameter maps of six patients with biopsy confirmed prostate cancer (PCa) were obtained using a 3 Tesla Scanner with an endorectal coil and 6 b-values (b=0,100,500,1000,1500,2000 s/mm²). All patients showed an increased value of the kurtosis in the tumor compared to healthy tissue and five of the patients a decreased ADC- and D-value. The mean parameter values in the tumor and the contralateral healthy tissue were: K=1.02±0.25 vs. 0.65±0.06, D=1.33±0.29 µm²/ms vs. 1.78±0.17 µm²/ms, ADC=0.82±0.2 µm²/ms vs. 1.15±0.08 µm²/ms.

11:24 46.   Preoperative Nomograms Incorporating Magnetic Resonance Imaging and Spectroscopy for Prediction of Insignificant Prostate Cancer 
Amita Shukla-Dave1, Hedvig Hricak1, Oguz Akin1, Changhong Yu2, Kristen L. Zakian1, Victor Reuter1, Peter T. Scardino1, James Eastham1, and Michael W. Kattan2
1Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 2Cleveland Clinic, Cleveland, OH, United States

Many more prostate cancers (PCa) are detected each year. Better methods are needed to predict which patients have insignificant PCa. The aims of the present study were to 1) validate the previously published MR-based nomograms; and 2) design new nomograms incorporating MR Imaging (MRI), MR Spectroscopic Imaging (MRSI) and clinical data without detailed biopsy data for predicting the probability of insignificant PCa. MRI/ MRSI data was examined prospectively in 181 patients studied prior to surgery. We have successfully validated the previously published MR models. The new BaseMRI and BaseMRI/MRSI models after validation may obviate the need for repeat biopsy.

11:36 47.   Multiparametric 3T MR Imaging of Prostate Cancer: Histopathologic Correlation Using Customized MRI-Based Specimen Molds 
Baris Turkbey1, Haresh Mani2, Vijay Shah3,4, Marcelino Bernardo3,4, Ardeshir Rastinehad5, Thomas Pohida6, Yuxi Pang7, Dagane Daar3, Compton Benjamin5, Yolanda McKinney1, Joanna Shih8, Maria J Merino2, Peter A. Pinto5, and Peter L. Choyke1
1Molecular Imaging Program, NCI, NIH, Bethesda, MD, United States, 2Laboratory of Pathology, NCI, NIH, United States, 3Molecular Imaging Program, NCI, NIH, United States, 4Imaging Physics, SAIC Frederick, Inc., NCI-Frederick, 5Urologic Oncology Branch, NCI, NIH, United States, 6Division of Computational Bioscience, Center for Information Technology, NIH, United States, 7Philips Healthcare, United States, 8Biometric Research Branch, NCI, NIH, United States

Multiparametric MRI has better sensitivity for detecting larger (> 5 mm in diameter) and more aggressive (Gleason score of > 7) tumors. The use of the mold enables more exact correlation between each MR parameter and the histopathologic specimen. The customized mold provided tissues blocks that had a one to one correspondence with the in vivo MR.

11:48 48.   Diffusion weighted magnetic resonance imaging (DW-MRI) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) 
Veronica A Morgan1, Sharon L Giles1, Sophie F Riches1, David Dearnaley2, and Nandita M deSouza1
1CRUK & EPSRC Cancer Imaging Centre, Institute of Cancer Research &Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom, 2Academic Urology, Institute of Cancer Research & Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom

This study evaluates the accuracy of T2W plus DW-MRI for detecting recurrent tumor within the prostate following External Beam Radiotherapy (EBRT). Mean ADC measurements of tumor and irradiated non-tumor tissue, confirmed by TRUS biopsy, were documented in 26 patients with evidence of biochemical failure. ADCs of MRI-defined tumor, histology-defined tumor and non-tumor irradiated tissue were compared. Mean ADC for both MRI and histology defined tumor were significantly lower than for non-tumor irradiated tissue. A cut-off ADC of 1337 (x10-6mm2/s) predicted tumor with a 92.9% sensitivity and 100% specificity. DWI MRI can be used for identifying tumor recurrence following EBRT.

12:00 49.   Diagnostic value of ADC in patients with prostate cancer: influence of the choice of b-values  -permission withheld
Gregor Thörmer1, Josephin Otto1, Martin Reiss-Zimmermann1, Matthias Seiwerts1, Nikita Garnov1, Michael Moche1, Thomas Kahn1, and Harald Busse1
1Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Saxony, Germany

The differentiation between high (Gleason Score > 6) and low (ӆ6) grade prostate cancer (PCa) is considered important for therapeutic decision. For that purpose, we investigated the diagnostic potential of the apparent diffusion coefficient (ADC). The influence of the choice of b-values (four methods) was retrospectively studied on 40 patients with known PCa. Although absolute ADC values in PCa and surrounding healthy tissue (SHT) significantly (p<0.001) depended on the b-values, the ADC ratios (PCa/SHT) were nearly independent of the method. Image appearance of ADC maps using b=50 and 800 [mm/s2] was rated most suitable for PCa detection by three readers.

12:12 50.   A Novel Luminal Water Model for DCE MRI of Prostatic Tissues 
Susan M Noworolski1,2, Galen D Reed1,2, and John Kurhanewicz1,2
1Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States, 2Graduate Group in Bioengineering, University of California, San Francisco and Berkeley, San Francisco and Berkeley, CA, United States

It has been suggested that Gd-DTPA does not reach intact prostatic ducts. A novel pharmacokinetic model of the prostate incorporating Gd-inaccessible luminal water is presented. A feature of this Luminal Water model is that it allows for a slower washout, quite common in healthy and benign, glandular prostate tissues. Simulations and an example in vivo case demonstrate that the standard extended Tofts-Kermode model would greatly underestimate Ktrans and Vees in glandular tissues (14% - 44% in cases shown). Incorporation of the Gd-inaccessible luminal water may yield parameters more accurately reflecting underlying tissue and has promise for aiding prostate tissue characterization.

12:24 51.   Validation with DCE-CT proves that the DCE-MRI phase signal can be used for robust measurement of the arterial input function (AIF) in the iliac arteries 
Johannes Georg Korporaal1, Cornelis AT van den Berg1, Matthias JP van Osch2, Greetje Groenendaal1, Marco van Vulpen1, and Uulke A van der Heide1
1Dept. of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands, 2Dept. of Radiology, Leiden University Medical Center, Leiden, Netherlands

Arterial input function (AIF) measurements in the iliac arteries from the DCE-MRI phase signal (AIFPHASE) were validated with DCE-CT (AIFCT) in twelve prostate cancer patients. AIFPHASE and AIFCT were normalized to the injected dose of contrast agent and compared. For all patients, the shape of AIFPHASE is very similar to the shape of AIFCT. No significant differences were found between AIFPHASE and AIFCT for the area under the curve of the first pass peak and the signal 180 seconds after the peak. In conclusion, AIFPHASE shows good agreement in both shape and amplitude with AIFCT.

12:36 52.   Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Improves Biopsy Yield 
Daniel Jason Aaron Margolis1, Shyam Natarajan2, Dinesh Kumar3, Ram Narayanan3, and Leonard Marks4
1Dept. of Radiology, UCLA David Geffen School of Medicine, Los Angeles, CA, United States, 2Center for Advanced Surgical and Interventional Technology, UCLA David Geffen School of Medicine, 3Eigen, 4Dept. of Urology, UCLA David Geffen School of Medicine, Los Angeles, CA, United States

MRI with diffusion and perfusion imaging was performed in 54 consecutive men referred for prostate biopsy. Target lesions based on diffusion and perfusion parameters were ranked based on level of suspicion and contoured on T2-weighted imaging. Subsequent biopsies were performed with real-time image coregistration with transrectal ultrasound. The number of positive cores was significantly higher for targeted biopsies than for systematic 14-point sextant biopsies, and in some cases, cancer was only found with targeted biopsies.

12:48 53.   3T MRI-guided Transperineal Targeted Prostate Biopsy: Clinical Feasibility, Safety, and Early Results 
Kemal Tuncali1, Junichi Tokuda1, Andriy Fedorov1, Iulian Iordachita2, Sam Song1, Sota Oguro1, Andras Lasso3, Fiona M Fennessy1, Yi Tang1, Nobuhiko Hata1, and Clare M Tempany1
1Radiology, Brigham and Women's Hospital, Boston, MA, United States, 2The Johns Hopkins University, Baltimore, MD, United States, 3School of Computing, Queen’s University, ON, Canada

Nine patients with clinically suspected prostate cancer underwent 3T MRI-guided transperineal targeted prostate biopsy successfully in the lithotomy position without significant compications using local anesthesia and intravenous procedural sedation. Multiparametric diagnostic MRI data were registered to intraprocedural T2 weighted turbo spin echo images to facilitate targeting of index lesions. Needle location was confirmed using real-time 2D FISP. Of eight biopsy results available, two were proved cancer and six showed no malignancy. We have shown this approach to be feasible and safe. It can yield clinically useful results in patients with index lesion on diagnostic MRI.