Comparative sensitivities of functional MRI sequences in detection of local recurrence of prostate carcinoma after radical prostatectomy or external-beam radiotherapy

• Published in: American journal of roentgenology (1976) Vol. 200; no. 4; pp. W361 - W368
• Main Authors: Roy, Catherine, Foudi, Fatah, Charton, Jeanne, Jung, Michel, Lang, Hervé, Saussine, Christian, Jacqmin, Didier
• Format: Journal Article
• Language: English
• Published: United States 01.04.2013
• Subjects: Aged; Aged, 80 and over; Contrast Media; Diffusion Magnetic Resonance Imaging; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging - methods; Magnetic Resonance Spectroscopy; Male; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Prostatectomy; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Retrospective Studies; Sensitivity and Specificity; Treatment Outcome
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.12.9106

The aim of this retrospective study was to determine the respective accuracies of three types of functional MRI sequences-diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI, and 3D (1)H-MR spectroscopy (MRS)-in the depiction of local prostate cancer recurrence after two different initial therapy options. From a cohort of 83 patients with suspicion of local recurrence based on prostate-specific antigen (PSA) kinetics who were imaged on a 3-T MRI unit using an identical protocol including the three functional sequences with an endorectal coil, we selected 60 patients (group A, 28 patients who underwent radical prostatectomy; group B, 32 patients who underwent external-beam radiation) who had local recurrence ascertained on the basis of a transrectal ultrasound-guided biopsy results and a reduction in PSA level after salvage therapy. All patients presented with a local relapse. Sensitivity with T2-weighted MRI and 3D (1)H-MRS sequences was 57% and 53%, respectively, for group A and 71% and 78%, respectively, for group B. DCE-MRI alone showed a sensitivity of 100% and 96%, respectively, for groups A and B. DWI alone had a higher sensitivity for group B (96%) than for group A (71%). The combination of T2-weighted imaging plus DWI plus DCE-MRI provided a sensitivity as high as 100% in group B. The performance of functional imaging sequences for detecting recurrence is different after radical prostatectomy and external-beam radiotherapy. DCE-MRI is a valid and efficient tool to detect prostate cancer recurrence in radical prostatectomy as well as in external-beam radiotherapy. The combination of DCE-MRI and DWI is highly efficient after radiation therapy. Three-dimensional (1)H-MRS needs to be improved. Even though it is not accurate enough, T2-weighted imaging remains essential for the morphologic analysis of the area.