Value of Endorectal Magnetic Resonance Imaging at 3T for the Local Staging of Prostate Cancer

Abstract

Purpose: To assess the accuracy of endorectal 3 T magnetic resonance imaging (MRI) in detecting extracapsular extension (ECE) and seminal vesicle invasion (SVI) of prostate cancer (PCa).

Materials and Methods: 38 consecutive patients with biopsy-proven PCa underwent multiparametric endorectal MRI at 3 T prior to prostatectomy. Two readers (A with nine years of experience and B with four) used established criteria for ECE and SVI to diagnose the extent of local disease in six regions (apical, dorsolateral, basal; left and right each) with the highest chance of ECE. The standard of reference was provided by intraoperative frozen section analysis and prostatectomy specimens.

Results: Histopathology revealed ECE in 15 of the 222 regions (10 of 37 patients) and SVI in 8 of 74 potential regions (5 of 37 patients). The sensitivity, specificity, and accuracy in detecting ECE for reader A/B were 93 %/67 %, 92 %/95 % and 92 %/93 % per region and 90 %/80 %, 74 %/82 % and 78 %/81 % per patient, respectively. The corresponding values for the detection of SVI were 80 %/100 %, 96 %/99 % and 95 %/97 %, respectively.

Conclusion: Endorectal 3 T MRI is a highly reliable noninvasive technique for the local staging of PCa.

Key points:

• Endorectal 3 T MRI provided high accuracy for the local staging of prostate cancer.

• The sensitivity in detecting extracapsular tumor growth per patient was 80 % or higher.

• The specificity in detecting extracapsular extension (pT3 stage) was good.

Citation Format:

• Otto J, Thörmer G, Seiwerts M et al. Value of Endorectal Magnetic Resonance Imaging at 3T for the Local Staging of Prostate Cancer. Fortschr Röntgenstr 2014; 186: 795 – 802

Zusammenfassung

Ziel: Bestimmung der Wertigkeit der Magnetresonanztomografie (MRT) bei 3 T zur Differenzierung zwischen organbegrenztem und kapselüberschreitendem Tumorwachstum beim Prostatakarzinom (PCa).

Material und Methoden: Bei 38 konsekutiven Patienten mit histologisch gesichertem PCa erfolgte eine multiparametrische 3-T-MRT-Untersuchung mit endorektaler Spule. Zwei Radiologen mit 9 (A) bzw. 4 (B) Jahren Erfahrung in abdomineller und urogenitaler MRT-Bildgebung bewerteten die bildmorphologische Erkennbarkeit einer Kapselüberschreitung (ECE) bzw. Samenblaseninfiltration (SVI). Als Referenz diente die intraoperative Schnellschnittdiagnostik in den sechs Regionen apikal, dorsolateral und harnblasennah, jeweils beidseits sowie die postoperative Aufarbeitung des Prostatektomie-Präparats und der Samenblasen.

Ergebnisse: Die histopathologische Auswertung ergab eine ECE in 15 von 222 Regionen (10 von 37 Patienten) und eine SVI in 8 von 74 Regionen (5 von 37 Patienten). Sensitivitäten, Spezifitäten und Genauigkeiten der Detektion einer ECE betrugen für Radiologe A/B 93 %/67 %, 92 %/95 % und 92 %/93 % pro Region bzw. 90 %/80 %, 74 %/82 % und 78 %/81 % pro Patient. Die entsprechenden Werte für die SVI lagen bei 80 %/100 %, 96 %/99 % und 95 %/97 %.

Schlussfolgerung: Die MRT der Prostata stellt eine zuverlässige, nicht-invasive Methode zum lokalen Staging beim PCa dar.

Kernaussagen:

• Die endorektale 3-T-MRT erreicht hohe Genauigkeiten beim lokalen Staging des Prostatakarzinoms.

• Die patientenbasierte Sensitivität zur Detektion eines extrakapsulären Tumorwachstums betrug 80 % und höher.

• Die entsprechende Spezifität zur Detektion eines organüberschreitenden Tumorwachstums (pT3) war hoch.

Key words

MR imaging - staging - prostate - neoplasms

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