Joint Annual Meeting ISMRM-ESMRMB 2014 10-16 May 2014 Milan, Italy

Clinical Prostate Cancer

Friday 16 May 2014
Brown 1 & 2  08:00 - 10:00 Moderators: Valeria Panebianco, M.D., Tom W. J. Scheenen, Ph.D.

Rajakumar Nagarajan1, Zohaib Iqbal1, Brian Burns1, Neil Wilson1, Manoj K Sarma1, Daniel A Margolis1, Robert E Reiter2, Steven S Raman1, and M.Albert Thomas1
1Radiological Sciences, University of California Los Angeles, LOS ANGELES, CA, United States, 2Urology, University of California Los Angeles, LOS ANGELES, CA, United States

Prostate cancer is a difficult disease to correctly diagnose and patients often undergo a painful and uncomfortable biopsy. The non-uniformly undersampled (NUS) four-dimensional (4D) echo-planar J-resolved spectroscopic imaging (EP-JRESI) study aims to establish data fidelity after non-linear reconstruction and to detect more metabolites than the currently used one-dimensional (1D) spectral based MR spectroscopic imaging method. The maximum entropy (MaxEnt) and total variation (TV) methods were used for the reconstruction of the NUS 4D EP-JRESI data. There was an excellent correlation between the two methods (TV and MaxEnt). These methods may help clinicians with an improved diagnosis and on deciding on the best course of treatment for the patient.

08:12 0963.   Altered fatty acid profile of periprostatic adipose tissue in prostate cancer patients: an MR spectroscopic study
Palamadai N Venkatasubramanian1, George Iordanescu1, Kristian Novakovic2, Jennifer Doll3, Charles Brendler2, and Alice M Wyrwicz1
1Radiology, NorthShore University HealthSystem, Evanston, IL, United States, 2Surgery, NorthShore University HealthSystem, Evanston, IL, United States, 3Biomedical Sciences, University of Wisconsin at Milwaukee, Milwaukee, WI, United States

Using ex vivo MR spectroscopy we detected alterations in the fatty acid composition of periprostatic adipose tissue from obese prostate cancer patients, relative to their subcutaneous adipose tissue. The altered periprostatic adipose composition was found to have predictive potential for a pathological criterion for aggressive prostate cancer, namely, extracapsular extension. Our results suggest that in vivo MR spectroscopy may have potential for developing a noninvasive biomarker for aggressive prostate cancer.

08:24 0964.   First steps towards multiparametric prostate MRI at 7T
Marnix C. Maas1, Eline K. Vos1, Mark J. van Uden1, Stephan Orzada2,3, Andreas K. Bitz2,4, Miriam W. Lagemaat1, and Tom W.J. Scheenen1,2
1Radiology, Radboud University Medical Center, Nijmegen, Netherlands, 2Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany, 3Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany,4Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

Increasing the magnetic field strength to 7T can lead to improved quality of prostate imaging and 1H-MRSI, and offers potential for use of new biomarkers in 31P-MRSI. 7T abdominal imaging faces challenges including strong RF inhomogeneity, high SAR and increased sensitivity to off-resonance effects. Here we present the first steps towards a fully multiparametric MRI protocol for prostate at 7T, including high-resolution T2w, DWI and 1H-MRSI. We show that excellent image quality in T2w and DWI with b-values up to 800 s/mm2 and high quality spectra can be achieved in less than 60 minutes in 2 prostate cancer patients.

Raquel Perez-Lopez1,2, Matthew D. Blacklegde1, David Lorente1,2, Ulrike Naumann1, Joaquin Mateo1,2, Thian Yiliang2, Zaki Ahmad2, David J. Collins1, Martin O. Leach1, Gerhardt Attard1,2, Johann S. de Bono1,2, Dow-Mu Koh1,2, and Nina Tunariu1,2
1The Institute of Cancer Research, Sutton, Surrey, United Kingdom, 2The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom

We conducted a study in patients with metastatic castration-resistant prostate cancer (mCRPC) and bone metastases, to evaluate if parameters derived from DWI (volume of bone disease and ADC values distribution in the bone metastases) confer prognostic information for overall survival. Whole body DW-MRI from 33 patients with mCRPC and bone involvement were analyzed and data were correlated with clinical variables. Our results show that the volume of bone disease assessed by DWI, and more so the volume of disease with ADC values between 750-1450 μm2/s, are a strong prognostic biomarker for overall survival in mCRPC and correlate with clinically relevant variables.

08:48 0966.   Detection and Grading of Prostate Cancer using Diffusion Weighted Imaging: Kurtosis versus ADC  - permission withheld
Matthias C. Roethke1, Tristan Kuder2, Timur H. Kuru3, Boris Hadaschik3, Michael Fenchel1, Frederik Laun2, and Bram Stieltjes1
1Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany, 2Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany, 3Urology, University Hospital Heidelberg, Germany

Diffusion weighted imaging is established in state-of-the-art MRI of prostate cancer (PCa). In addition to the classic monoexponential diffusion fit, diffusional kurtosis and may contain additional information about tissue structure. Thus, aim of the study was to investigate the additional value of kurtosis imaging in patients with PCa. 3 Tesla MRI was performed in 55 patients with biopsy-proven PCa. Using a ROI- and pixel-based quantitative evaluation, we found significant difference between PCa and benign tissue using both kurtosis derived parameters and standard ADC. However, considering lesion detection and grading, there was no benefit of kurtosis imaging compared to standard ADC.

09:00 0967.   
3D High Resolution Diffusion-Weighted MRI at 3T: Preliminary Application in Patients undergoing Active Surveillance Protocol for Low-Risk Prostate Cancer
Christopher Nguyen1,2, Zhaoyang Fan1, Ali Afshar3, Yibin Xie1,2, Rola Saouaf4, Hyung Kim3, and Debiao Li1,2
1Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States, 2Bioengineering, University of California Los Angeles, Los Angeles, CA, United States, 3Surgery, Urology Division, Cedars-Sinai Medical Center, Los Angeles, CA, United States, 4Radiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States

We developed a novel 3D diffusion-prepared multi-shot balanced steady-state free precession technique capable of improved spatial resolution, image quality, and lesion contrast-to-noise ratio compared with single-shot diffusion-weighted echo planar imaging (SS DW EPI), while maintaining quantitative estimation of trace apparent diffusion coefficient. Because of these technical advances, the proposed technique yielded significantly better sensitivity, PPV, NPV, and AUC in detecting biopsy-confirmed lesions compared with SS DW EPI in a small group of prostate cancer patients undergoing active surveillance (AS-PC). By improving lesion detection, the proposed technique may allow DW MRI to potentially monitor low-risk prostate cancer lesions in AS-PC.

09:12 0968.   
Multiparametric MR imaging for the assessment of prostate cancer aggressiveness at 3 Tesla
Eline K. Vos1, Thiele Kobus1, Geert Litjens1, Thomas Hambrock1, Christina Hulsbergen-van de Kaa2, Marnix Maas1, and Tom Scheenen1
1Radiology, Radboud university medical center, Nijmegen, Gelderland, Netherlands, 2Pathology, Radboud university medical center, Nijmegen, Gelderland, Netherlands

Multiparametric MRI (mpMRI) was evaluated for the assessment of prostate cancer aggressiveness. For the peripheral zone only the ADC calculated from DWI should be used in combination with anatomical T2-weighted imaging. In the transition zone, both pharmacokinetic parameters (Ktrans and Kep) derived from DCE-MRI and metabolite ratios (CC/C and C/C) from MRSI may be useful additions to T2-weighted imaging and DWI for the discrimination of indolent versus significant PCa

09:24 0969.   Transrectal ultrasound guided biopsy: effect on natural history of multi-parametric MRI signal and derived quantitative parameters
Arash Latifoltojar1, Nikos Dikaios2, Ashley Ridout3, Caroline Moore4, Rowland Illing5, Alex Kirkham6, Clare Allen5, Stuart Taylor2, Steve Halligan2, David Atkinson2, Mark Emberton3, and Shonit Punwani2
1Centre for Medical Imaging, University College London, London, London, United Kingdom, 2Centre for Medical Imaging, University College London, London, United Kingdom, 3Urology, University College London Hospital, London, United Kingdom, 4Urology, University College London, London, United Kingdom, 5Radiology, University College London Hospital, London, United Kingdom, 6Radiology, university College London Hospital, London, United Kingdom

Patients with raised PSA traditionally have transrectal ultrasound guided biopsy (TRUS) performed prior to a pelvic MRI for the assessment of confirmed prostate cancer. However this approach may complicate the interpretation of MRI and cause unnecessary delay in patient management. In this work, the temporal changes in MRI quantitative derived parameters following biopsy is assessed.

09:36 0970.   PI-RADS and Gleason Scores: Are they Correlated? Experience in 298 Patients
Sarah Alessi1, Paul Summers1, Ara Alconchel Pilar1, Sara Raimondi1, Gennaro Musi1, Salvatore L Renne1, Deliu V Matei1, Giuseppe Renne1, Ottavio De Cobelli1,2, Barbara A Jereczek-Fossa1,2, Massimo Bellomi1,2, and Giuseppe Petralia1
1European Institute of Oncology, Milan, MI, Italy, 2University of Milan, Milan, MI, Italy

To investigate whether Prostate Imaging Reporting And Data System (PI-RADS) score and Gleason score (GS) are associated, 298 consecutive biopsy-proven prostate cancer patients underwent multiparametric magnetic resonance imaging of the prostate. Each lesion was given a PI-RADS score and assessed for location, size and probability of extra-prostatic disease. The highest PI-RADS score reported for each patient was compared with the GS of final histology. Patients with a PI-RADS scores of 4 and 5 had respectively more than three and 13-times higher probabilities of having a GS≥7 than patients with PI-RADS≤3. The highest PI-RADS score and Gleason score were strongly associated in our cohort.

09:48 0971.   Rotating frame relaxation imaging of prostate cancer: a feasibility study
Ivan Jambor1, Timo Liimatainen2, Harri Merisaari3, Pekka Taimen4, Peter Boström5, Heikki Minn3, Hannu Aronen1, and Marko Pesola1
1Departement of Diagnostic Radiology, University of Turku, Turku, Finland, 2Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, Kuopio, Finland, 3Turku PET centre, University of Turku, Turku, Finland, 4Department of Pathology, University of Turku, Turku, Finland, 5Department of Surgery, Turku University Hospital, Turku, Finland

Twenty-seven patients with histologically confirmed prostate cancer underwent two repeated 3T MRI examinations consisting of TRAFF, T1lower case Greek rho and T2mapping. Rotating frame imaging (RAFF, and continuous wave T1lower case Greek rho) of PCa was feasible using clinical 3T MRI scanner and demonstrated robust repeatability. Both TRAFF and T1lower case Greek rho of PCa differed significantly from similar value of normal peripheral zone.