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Feasibility and Preliminary Experience of Quantitative T2* Mapping at 3.0 T for Detection and Assessment of Aggressiveness of Prostate Cancer

Posted Jul 31, 2014 Updated Apr 10, 2023
By Lian-Ming Wu MD PhD , Xiao-Xi Chen MD , Han-Qing Xuan MD , Qiang Liu MD , Si-Teng Suo MS , Jia-Ni Hu PhD , Jian-Rong Xu MD PhD
6 min read

Rationale and Objectives

To assess the feasibility of quantitative T2* mapping at 3.0 T for prostate cancer detection and to investigate the use of T2* values to characterize tumor aggressiveness, with whole-mount step-section pathologic analysis as the reference standard.

Materials and Methods

Prostate multiecho T2* was performed in 55 consecutive patients with prostate cancer using a multishot fast-field echo sequence at 3.0 T magnetic resonance imaging. T2* mapping was obtained by exponentially fitting the multiecho T2* images pixel by pixel with different echo times for each slice. Generalized estimating equations were used to test the T2* value difference between normal and malignant prostate regions and the association between T2* value and tumor Gleason scores.

Results

The T2* values of the cancerous prostatic regions (mean: 42.51 ± 0.65 milliseconds) were significantly lower ( P < .001) than those of the normal prostatic regions (mean: 74.87 ± 0.99 milliseconds). Adopting a threshold value of 59.27 milliseconds, T2* mapping resulted in 94.8% sensitivity and 77.3% specificity in the identification of prostate cancer. A lower mean T2* value was significantly associated with a higher tumor Gleason score (mean T2* values of 53.53, 43.75, 33.66, and 22.95 milliseconds were associated with Gleason score of 3 + 3, 3 + 4, 4 + 3, and ≥8, respectively P < .05).

Conclusions

From these preliminary data, quantitative T2* mapping seems to be a potential method in the characterization of prostate cancer. T2* mapping may provide additional quantitative information that significantly correlated with prostate cancer aggressiveness.

The prostate is the most common noncutaneous site of cancer among men in the United States . Owing to the increasing awareness of its variable biologic aggressiveness, the biggest challenge in managing patients with newly diagnosed prostate cancer is shifting from tumor detection alone to identifying patients with aggressive disease who would benefit from more radical therapy, while sparing those with indolent cancers.

Current clinical prostate magnetic resonance imaging (MRI) uses a multiparametric imaging approach to increase the sensitivity and specificity of diagnosis, including T2W-weighted turbo-spin echo (TSE) sequence, diffusion-weighted (DW) imaging, dynamic contrast enhancement (DCE) using gadolinium, and magnetic resonance spectroscopic (MRS) imaging. High-grade prostate cancer demonstrates decreased signal on T2W-TSE images, diffusion restriction, early/intense contrast enhancement with early contrast washout, and increased choline/decreased citrate on MRS . Multiple functional MRI techniques could make MRI a much more powerful tool for noninvasively characterizing prostate cancer. However, practical methods to analyze, interpret, and integrate the large amount of data generated by such a multiparametric approach are still lacking. Furthermore, for DCE-MRI, it required the administration of contrast material. Although DW-MRI is the one most commonly used in clinical prostate MRI protocols, it is still an evolving technique with several limitations to be overcome; these include intrinsic technical difficulties that result in image distortions and susceptibility artifacts and a lack of anatomic information and standardized acquisition and image analysis methods.

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Materials and Methods

Eligibility Criteria and Patient Characteristics

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Figure 1, Flowchart summarizing patient selection.

Table 1

Patient Characteristics

Characteristic Value Age (years) 56 (43–78) Initial prostate-specific antigen (ng/mL) 6.5 (0.9–107.2) Time between magnetic resonance imaging and prostatectomy (days) 23 (1–181) Patients ( n ) 55 Gleason score Biopsy 3 + 3 19 (35) 3 + 4 23 (42) 4 + 3 8 (15) >4 + 4 5 (9) Prostatectomy 3 + 3 10 (18) 3 + 4 30 (55) 4 + 3 14 (25) >4 + 4 1 (2)

Data are represented as n (%) or median (range).

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MRI Acquisition

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MRI Interpretation

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Figure 2, The relative position of the tumor (T) was translatable and annotated on the T2* mapping, matching the size and distribution of the tumor. ROI, region of interest; ROI (normal) = ROI of the contralateral segment of the normal peripheral zone; ROI (tumor) = ROI of tumor.

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Histopathologic Analysis and Image Correlation

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Statistical Analysis

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Results

Histopathology Results

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MRI Results

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Figure 3, Gleason score 6 (3 + 3) tumor of the left and right prostatic apex in a 53-year-old patient is seen as (a) a homogeneous focus of low signal intensity on a transverse T2*-weighted magnetic resonance image (1200/7; outlined in white ) and (b) corresponding T2* mapping.

Figure 4, Gleason score 7 (4 + 3) tumor of the right prostatic base in a 62-year-old patient is seen as (a) a homogeneous focus of low signal intensity on a transverse T2*-weighted magnetic resonance image (1200/7; outlined in white ) and (b) corresponding T2* mapping.

Figure 5, Gleason score 8 (4 + 4) tumor of the left peripheral zone in a 71-year-old patient is seen as (a) a homogeneous focus of low signal intensity on a transverse T2*-weighted magnetic resonance image (1200/7; outlined in white ) and (b) corresponding T2* mapping.

Figure 6, ROC curve demonstrates the discriminating performance of median T2* value in the differentiation between normal and malignant lesions. ROC, receiver operating characteristic.

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Figure 7, Box and whisker plots show T2* value (millimeter) of lesions detected on T2* maps stratified by Gleason score (3 + 3, 3 + 4, 4 + 3, and ≥8). Center line = median; top of box = 75th percentile; bottom of box = 25th percentile; whiskers = 10th and 90th percentiles; and circles = outlier.

Table 2

Relationship Between Gleason Score (3 + 3, 3 + 4, 4 + 3, and ≥8) and Mean T2* Values

Number of Foci Mean T2* Value of the Foci_P_ Value Normal 286 74.87 ± 0.99P < .05 Malignant 286 42.51 ± 0.65 Gleason score = 3 + 3 52 53.53 ± 1.20P < .05 Gleason score = 3 + 4 156 43.75 ± 0.72 Gleason score = 4 + 3 71 33.66 ± 0.81 Gleason score ≥8 7 22.95 ± 1.31

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Discussion

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Academic Radiology, Volume 21, Issue 8
Journals General Radiology
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