Biomedical subjects

Hedvig Hricak

Publications and source records attributed to Hedvig Hricak.

At least 37 records · Page 2Linked to original sources

PubMed2005

Molecular MR imaging in oncology.

The implementation and integration of systems biology approaches with the emerging nanosciences and microchip technology will revolutionize profoundly molecular imaging and fuel the drive toward a more predictive and individualized health care. In combination with informatics platforms, key gene and protein targets will be identified, and serve as more effective targets for diagnostic and therapeutic interventions. Drug development also will be expedited by the judicious selection of more appropriate molecular biomarkers that will serve as objective end points of treatment efficacy, in addition to facilitating the development of new target-specific therapeutics. Finally, with the more widespread proliferation of high-field magnets and advancements in imaging hardware; acquisition methods; and novel,"smart" MR agents, the ability to achieve higher resolution analyses of tumor biology, cell track-ing, and gene expression will be realized more fully. Although radiologists will continue to serve as diagnostic consultants and assist in management decisions, the contributions from new developments in the biologic and molecular sciences will significantly alter the scope of our profession. Radiologists will be required to participate more actively in the individualized care of the patient and cultivate a deeper understanding of the underlying molecular basis of disease and molecular pharmacology for facilitating selection of the most appropriate combination of imaging studies that address biologically relevant questions. These radical changes in our profession will necessitate the re-education and emergence of a small cadre of professionals that is educated broadly in multiple scientific disciplines, and demonstrate expertise in clinical care and the basic sciences. The optimistic view is that this already is happening.

Biomarkers↗

PubMed2005

Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer.

OBJECTIVE: To determine the relative accuracy of CT or MR imaging in the detection of inoperable tumor sites prior to cytoreductive surgery in a large series of patients with newly diagnosed primary epithelial ovarian cancer. METHODS: One hundred thirty-seven women with newly diagnosed primary epithelial ovarian cancer underwent CT (n = 91) or MR imaging (n = 46) prior to cytoreductive surgery. The following imaging criteria were used to identify inoperable tumor sites: (1) peritoneal implants greater than 2 cm in maximum diameter in the porta hepatis, intersegmental fissure, gall bladder fossa, subphrenic space, gastrohepatic ligament, gastrosplenic ligament, lesser sac, or root of the small bowel mesentery; (2) retroperitoneal adenopathy greater than 2 cm in maximum diameter above the renal hila; (3) hepatic metastases or abdominal wall invasion. Imaging results were compared with operability at surgery. RESULTS: Cytoreductive surgery was suboptimal in 21 of the 137 (15%) patients. Sixteen of these patients had inoperable tumor on preoperative imaging, while one additional patient had apparently inoperable tumor on imaging but was optimally debulked at surgery. The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative imaging for the prediction of suboptimal debulking were 76% (16/21), 99% (115/116), 94% (16/17), and 96% (115/120), respectively. CT and MR imaging were equally effective (P = 1.0) in the detection of inoperable tumor. CONCLUSION: Preoperative CT and MR imaging are equally accurate in the detection of inoperable tumor and the prediction of suboptimal debulking in newly diagnosed epithelial ovarian cancer. This suggests imaging may help select patients who might be more appropriately managed by neoadjuvant chemotherapy.

Adolescent↗

PubMed2005

Magnetic resonance imaging and magnetic resonance spectroscopic imaging of prostate cancer.

Magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) are evolving techniques that offer noninvasive evaluation of anatomic and metabolic features of prostate cancer. The ability of MRI to determine the location and extent of the tumor and to identify metastatic spread is useful in the pretreatment setting, enabling treatment decision-making that is evidence-based. MRSI of the prostate gland expands the diagnostic assessment of prostate cancer through the detection of cellular metabolites, and can lead to noninvasive differentiation of cancer from healthy tissue. MRI/MRSI can also be used to evaluate both local and systemic recurrence, with endorectal MRI being capable of detecting local recurrence, even in patients with rising serum PSA level but no palpable tumor on digital rectal examination. Considering the benefits that MRI and MRSI have been shown to offer patients, the skills and technology required to perform these tests should be widely disseminated to make their routine use possible. Teamwork between members of radiology, pathology, urology and radiation oncology departments is essential in order to exploit these technologies fully.

Humans↗

PubMed2005

Comparison of endorectal magnetic resonance imaging, guided prostate biopsy and digital rectal examination in the preoperative anatomical localization of prostate cancer.

PURPOSE: We compared the accuracy of endorectal magnetic resonance imaging (erMRI), transrectal ultrasound (TRUS) guided biopsy and digital rectal examination (DRE) for detecting the location of cancer in the prostate gland and seminal vesicles. MATERIALS AND METHODS: This is a retrospective study of 106 consecutive patients with prostate cancer who were referred for erMRI before radical prostatectomy. Step-section pathological data and erMRI were available in 90 patients, DRE data were available on 86 and individually labeled sextant core biopsies were available in 45. T1 and T2-weighted erMRI was interpreted by a single reader, who scored the likelihood of tumor on a 5-point scale in each seminal vesicle and in 12 locations in the prostate gland. MR spectroscopy data were not used for erMRI interpretation. One pathologist reviewed whole mount serial sections of radical prostatectomy specimens. The area under ROC curves was used to evaluate accuracy. RESULTS: The area under ROC curves for tumor localization was higher for erMRI than for DRE at the prostatic apex (0.72 vs 0.66), mid gland (0.80 vs 0.69) and base (0.83 vs 0.69). It was likewise higher for erMRI than for TRUS biopsy in the mid gland (0.75 vs 0.68) and base (0.81 vs 0.61) but not in the apex (0.67 vs 0.70). On mixed model analysis erMRI significantly increased the accuracy of prostate cancer localization by DRE or TRUS biopsy (each p <0.0001). CONCLUSIONS: For prostate cancer localization erMRI contributes significant incremental value to DRE or TRUS biopsy findings (each p <0.0001).

Biopsy↗

PubMed2005

Correlation of proton MR spectroscopic imaging with gleason score based on step-section pathologic analysis after radical prostatectomy.

PURPOSE: To determine whether hydrogen 1 magnetic resonance (MR) spectroscopic imaging can be used to predict aggressiveness of prostate cancer. MATERIALS AND METHODS: All patients gave informed consent according to an institutionally approved research protocol. A total of 123 patients (median age, 58 years; age range, 40-74 years) who underwent endorectal MR imaging and MR spectroscopic imaging between January 2000 and December 2002 were included. MR imaging and spectroscopy were performed by using combined pelvic phased-array and endorectal probe. Water and lipids were suppressed, and phase-encoded data were acquired with 6.2-mm resolution. Voxels in the peripheral zone were considered suspicious for cancer if (Cho + Cr)/Cit was at least two standard deviations above the normal level, where Cho represents choline-containing compounds, Cr represents creatine and phosphocreatine, and Cit represents citrate. Correlation between metabolite ratio and four Gleason score groups identified at step-section pathologic evaluation (3 + 3, 3 + 4, 4 + 3, and > or =4 + 4) was assessed with generalized estimating equations. RESULTS: Data from 94 patients were included. Pathologic evaluation was used to identify 239 lesions. Overall sensitivity of MR spectroscopic imaging was 56% for tumor detection, increasing from 44% in lesions with Gleason score of 3 + 3 to 89% in lesions with Gleason score greater than or equal to 4 + 4. There was a trend toward increasing (Cho + Cr)/Cit with increasing Gleason score in lesions identified correctly with MR spectroscopic imaging. Tumor volume assessed with MR spectroscopic imaging increased with increasing Gleason score. CONCLUSION: MR spectroscopic imaging measurement of prostate tumor (Cho + Cr)/Cit and tumor volume correlate with pathologic Gleason score. There is overlap between MR spectroscopic imaging parameters at various Gleason score levels, which may reflect methodologic and physiologic variations. MR spectroscopic imaging has potential in noninvasive assessment of prostate cancer aggressiveness.

Adult↗

PubMed2005

Imaging of transposed ovaries in patients with cervical carcinoma.

OBJECTIVE: Lateral ovarian transposition is a surgical procedure performed in premenopausal women with pelvic malignancies in which the ovaries are surgically displaced from the pelvis, before radiation therapy. In this article, we present the imaging features of normal transposed ovaries as well as the spectrum of abnormalities associated with lateral ovarian transposition. CONCLUSION: After lateral ovarian transposition, it is important to recognize the ovaries to avoid confusing them with peritoneal implants. In addition, benign ovarian lesions must be distinguished from primary and secondary malignancies.

Female↗

PubMed2004

The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy.

BACKGROUND: Because the recovery of erectile function and the avoidance of positive surgical margins are important but competing outcomes, the decision to preserve or resect a neurovascular bundle (NVB) during radical prostatectomy (RP) should be based on the most accurate information concerning the location and extent of the tumor. In the current study, the authors determined the incremental value of endorectal magnetic resonance imaging (eMRI) in making this decision. METHODS: eMRI was performed in 135 patients preoperatively. For each NVB, tumor extension to the NVB and the need for NVB resection was judged by a surgeon on a scale from 1 (definite preservation) to 5 (definite resection) before and after reviewing eMRI with a radiologist. Histopathologic findings were used as the standard of reference. The value of eMRI was assessed using binormal receiver operating characteristic (ROC) analysis adjusted for multiple observations per patient, and a mixed effects ordinal regression model was used for risk stratification. RESULTS: Histopathologic examination determined that NVB resection was warranted in 44 of 270 NVBs (16%) because of posterolateral extracapsular extension (n = 29), positive surgical margins (n = 7), or both (n = 8). The areas under the ROC curves (AUC) were 0.741 for pre-MRI and 0.832 for post-MRI surgical planning (P < 0.01). MRI findings suggested altering the surgical plan in 39% of NVBs (106 of 270 NVBs). When the surgeon judged that the NVB resection was definitely not necessary (165 NVBs), MRI confirmed that decision in 138 NVBs (84%); the concordant decision was correct in 96% of the cases (133 of 138 NVBs). In 36 high-risk patients (> or = 75% probability of extracapsular extension), MRI findings changed the surgical plan for 28 NVBs (78%); the change was found to be appropriate in 26 cases (93%). CONCLUSIONS: MRI was found to significantly improve the surgeon's decision to preserve or resect the NVB during radical prostatectomy.

Adult↗

PubMed2004

Prostate cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension.

PURPOSE: To assess the incremental value of endorectal magnetic resonance (MR) imaging findings in addition to clinical variables for prediction of extracapsular extension (ECE) in patients with prostate cancer. MATERIALS AND METHODS: In this cohort study, 344 consecutive patients with biopsy-proved prostate cancer underwent endorectal MR imaging prior to surgery; 216 of these patients also underwent MR spectroscopic imaging. MR images were interpreted by 10 attending radiologists. The likelihood of ECE was scored retrospectively on the basis of MR imaging reports. Clinical variables included serum prostate-specific antigen (PSA) level, Gleason score, clinical stage of tumor, greatest percentage of cancer in all core biopsy specimens, percentage of cancer-positive core specimens in all core biopsy specimens, and presence of perineural invasion. For data analysis, receiver operating characteristic (ROC) curves and univariate and multivariate logistic regression analyses were used. Jackknife analysis was used for prediction of probability from a model that included clinical variables as tested comparatively with a model that included the clinical variables plus endorectal MR imaging findings. A difference with P <.05 was considered significant. RESULTS: At univariate analysis, all variables were associated with ECE. At ROC univariate analysis, endorectal MR imaging findings had the largest area under the ROC curve. At multivariate analysis, serum PSA level, percentage of cancer in all core biopsy specimens, and endorectal MR imaging findings (P =.001, P =.001, and P <.001, respectively) were predictors of ECE. Areas under ROC curve for two models, with and without endorectal MR imaging findings, were 0.838 and 0.772, respectively (P =.022). CONCLUSION: A model containing endorectal MR imaging findings has a significantly larger area under the ROC curve than a model containing only clinical variables; thus, endorectal MR imaging findings add incremental value in the prediction of ECE.

Adult↗

PubMed2004

Prostate cancer: detection of extracapsular extension by genitourinary and general body radiologists at MR imaging.

PURPOSE: To determine whether predictive value of endorectal magnetic resonance (MR) imaging findings in detection of prostate cancer extracapsular extension (ECE) is significantly affected by the reader's subspecialty experience. MATERIALS AND METHODS: In this cohort study, 344 consecutive patients with biopsy-proved prostate cancer underwent endorectal MR imaging followed by surgery. Likelihood of ECE described in MR imaging reports was compared with clinical predictor variables. ECE was determined from the final pathologic report on specimens resected at surgery. Readers of MR images were classified into genitourinary MR imaging radiologists (n = 4) and general body MR imaging radiologists (n = 6). For data analysis, Wilcoxon rank sum and chi(2) tests, as well as receiver operating characteristic (ROC) curves and univariate and multivariate logistic regression analyses, were used. A difference with P <.05 was considered significant. RESULTS: Univariate analysis results demonstrated that all predictors except clinical stage were significantly associated with detection of ECE in both groups of readers (P <.05). In the genitourinary MR imaging radiologist group of patients, area under the ROC curve for endorectal MR imaging findings (0.833) was larger than areas under the curves for all other predictors (0.566-0.701). In the general body MR imaging radiologist group of patients, area under the ROC curve for endorectal MR imaging findings (0.646) was not larger than areas under the curves for all other predictors (0.582-0.793). Results of multivariate analysis of two models, one with all predictors and another with all predictors except endorectal MR imaging findings, demonstrated a significant increase in area under the ROC curve with endorectal MR images interpreted by genitourinary MR imaging radiologists (P =.019 and.31, respectively). CONCLUSION: Endorectal MR imaging findings are significant predictors for detection of ECE when MR images are interpreted by genitourinary radiologists experienced with MR imaging of the prostate.

Adult↗

PubMed2004

Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging.

PURPOSE: To evaluate endorectal coil magnetic resonance (MR) imaging in the depiction of local recurrence after radical prostatectomy. MATERIALS AND METHODS: Endorectal MR images were reviewed retrospectively in 82 patients who underwent prostatectomy. The interval between prostatectomy and MR imaging ranged between 0.5 and 13.0 years (mean, 3.25 years). Local recurrence was considered present if there was no evidence of distant metastases and there was a positive biopsy result, subsequent reduction in prostate-specific antigen (PSA) level after radiation therapy of the pelvis, or serial MR imaging findings of increased tumor size. Local recurrence on MR images was assessed for location, size, signal intensity, and invasion of adjacent structures. All images were reviewed independently by two readers who were blinded to clinical information. RESULTS: Thirty-four of 82 patients did not meet inclusion criteria. Forty-one of 48 remaining patients had clinically documented local recurrence, which MR imaging depicted in 39 of 41 (95%) patients. Seven of 48 patients had no evidence of local or distant metastases, and none had positive MR imaging findings. Sensitivity of MR imaging was 95%, and specificity was 100%. Local recurrences were perianastomotic in 12 (29%) patients and retrovesical in 17 (40%), within retained seminal vesicles in nine (22%), and at anterior or lateral surgical margins in four (9%). All local recurrences were hyperintense to adjacent pelvic muscles on T2-weighted MR images. The mean diameter of tumors was 1.4 cm (range, 0.8-4.5 cm). PSA levels at MR imaging in patients with clinically proved recurrences ranged from undetectable to 10 ng/mL (mean, 2.18 ng/mL). CONCLUSION: MR imaging depicts a high proportion of local recurrence after prostatectomy. The authors propose incorporation of endorectal coil MR imaging in the diagnostic paradigm of patients who have undergone prostatectomy and are suspected of having local recurrence.

Adult↗

PubMed2004

Pretreatment evaluation of prostate cancer: role of MR imaging and 1H MR spectroscopy.

Magnetic resonance (MR) imaging and hydrogen 1 MR spectroscopy of the prostate gland are performed during the same examination with a conventional clinical MR unit. Prostate zonal anatomy and prostate cancer are best depicted on multiplanar T2-weighted MR images. MR imaging and 1H MR spectroscopy are not used as an initial diagnostic tool. Their use in tumor detection is reserved for patients with elevated prostate-specific antigen levels in whom previous biopsy results were negative. The use of MR imaging and 1H MR spectroscopy for the evaluation of tumor location, local extent (extracapsular extension and/or seminal vesicle invasion), volume, and aggressiveness is generating strong clinical interest. In staging and treatment planning, MR imaging has been shown to have an incremental value additive to the value of clinical nomograms. Furthermore, anatomic and metabolic mapping of the prostate gland with 1H MR spectroscopy offers the possibility of optimizing treatment planning (watchful waiting, surgery, or radiation therapy [intensity-modulated radiation therapy or brachytherapy]), thus further expanding the role of MR imaging in the achievement of patient-specific, individualized treatment.

Adenocarcinoma↗

PubMed2004

Prostate cancer localization with endorectal MR imaging and MR spectroscopic imaging: effect of clinical data on reader accuracy.

PURPOSE: To determine the effect of digital rectal examination findings, sextant biopsy results, and prostate-specific antigen (PSA) levels on reader accuracy in the localization of prostate cancer with endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging. MATERIALS AND METHODS: This was a retrospective study of 37 patients (mean age, 57 years) with biopsy-proved prostate cancer. Transverse T1-weighted, transverse high-spatial-resolution, and coronal T2-weighted MR images and MR spectroscopic images were obtained. Two independent readers, unaware of clinical data, recorded the size and location of suspicious peripheral zone tumor nodules on a standardized diagram of the prostate. Readers also recorded their degree of diagnostic confidence for each nodule on a five-point scale. Both readers repeated this interpretation with knowledge of rectal examination findings, sextant biopsy results, and PSA level. Step-section histopathologic findings were the reference standard. Logistic regression analysis with generalized estimating equations was used to correlate tumor detection with clinical data, and alternative free-response receiver operating characteristic (AFROC) curve analysis was used to examine the overall effect of clinical data on all positive results. RESULTS: Fifty-one peripheral zone tumor nodules were identified at histopathologic evaluation. Logistic regression analysis showed awareness of clinical data significantly improved tumor detection rate (P <.02) from 15 to 19 nodules for reader 1 and from 13 to 19 nodules for reader 2 (27%-37% overall) by using both size and location criteria. AFROC analysis showed no significant change in overall reader performance because there was an associated increase in the number of false-positive findings with awareness of clinical data, from 11 to 21 for reader 1 and from 16 to 25 for reader 2. CONCLUSION: Awareness of clinical data significantly improves reader detection of prostate cancer nodules with endorectal MR imaging and MR spectroscopic imaging, but there is no overall change in reader accuracy, because of an associated increase in false-positive findings. A stricter definition of a true-positive result is associated with reduced sensitivity for prostate cancer nodule detection.

Adult↗

PubMed2004

Chronic prostatitis: MR imaging and 1H MR spectroscopic imaging findings--initial observations.

PURPOSE: To determine whether chronic prostatitis affects three-dimensional proton magnetic resonance (MR) spectroscopic imaging in evaluation of disease in the peripheral zone. MATERIALS AND METHODS: Combined MR imaging and three-dimensional MR spectroscopic imaging data were examined retrospectively in 12 patients with radical prostatectomy specimens that contained regions of chronic prostatitis larger than 6 mm in the peripheral zone. The 6-mm restriction was based on MR spectroscopic imaging spatial resolution of 6.25 mm. Transverse T2-weighted MR images were reviewed for changes in signal intensity (SI): normal, suspicious for cancer (nodular focal low SI), or indeterminate (focal low SI that was not nodular or contour deforming or diffuse low SI). At MR spectroscopic imaging, proton spectra were considered suspicious for cancer if the ratio of choline plus creatine to citrate was more than 2 SDs above normal mean peripheral zone values. RESULTS: In the 12 patients, mean pretreatment prostate-specific antigen level was 5.77 +/- 2.07 (SD), and median biopsy Gleason score for the gland was 6. At MR imaging in the area of histopathologically confirmed chronic prostatitis, seven of 12 patients had focal low SI that was not nodular (contour deforming) over a region in and around the pathologically defined focus of chronic prostatitis. MR imaging in one patient showed diffuse low SI that correlated with a diffuse area of chronic prostatitis at pathologic examination. MR imaging in another patient showed nodular focal low SI that was suspicious for cancer and corresponded to a focus of chronic prostatitis at pathologic examination. The remaining three patients had no MR imaging abnormality in the region of chronic prostatitis. In the pathologically identified regions of chronic prostatitis, MR spectroscopic imaging data in nine of 12 patients demonstrated elevated choline peak and reduced or no citrate, findings that mimic those of cancer. In two patients, the spectra were normal, and in the remaining patient, the spectra were nondiagnostic. CONCLUSION: At MR spectroscopic imaging, pathologically confirmed chronic prostatitis may demonstrate metabolic abnormality that leads to false-positive diagnosis of cancer. The most common MR imaging finding in chronic prostatitis was focal low SI that was not specific for cancer. In one patient, the MR imaging diagnosis of cancer could not be excluded.

Aged↗

PubMed2004

Role of CT in the management of recurrent ovarian cancer.

OBJECTIVE: The purpose of this study was to evaluate the potential role of preoperative CT in patients with recurrent ovarian cancer who undergo secondary cytoreductive surgery. MATERIALS AND METHODS: Preoperative CT examinations of 36 consecutive patients (age range, 30-75 years; mean age, 55 years) were reviewed retrospectively. Patients had recurrent ovarian cancer and secondary cytoreduction within a mean CT-surgery interval of 22 days (range, 2-69 days). The CT findings recorded were upper abdominal metastases (e.g., peritoneal carcinomatosis; perihepatic, perisplenic, gastrohepatic or gastrosplenic ligaments; gallbladder fossa; falciform ligament; lesser sac), lymphadenopathy (above or below the renal hilum), liver metastasis, large- and small-bowel obstruction, hydronephrosis, ascites, and the presence of a pelvic mass. CT findings and cancer antigen-125 (CA-125) levels were correlated with surgical resectability. RESULTS: At surgery, tumors in 27 patients were optimally debulked (residual disease of <or= 1 cm) and in nine patients were nonresectable. Using multivariate analysis, hydronephrosis (odds ratio = 19.4, p = 0.03) and invasion of pelvic sidewall (odds ratio = 35.6, p = 0.006) were found to be most indicative of tumor nonresectability. The presence of small-bowel obstruction; nodal or perihepatic liver metastasis; ascites; peritoneal carcinomatosis; bladder, rectum, sigmoid colon, or vaginal involvement; or infrarenal paraaortic adenopathy; and the level of CA-125 were not strong indicators of tumor nonresectability. CONCLUSION: In patients with recurrent ovarian carcinoma considered for secondary cytoreductive surgery, preoperative CT can be helpful in identifying the extent of the disease and can be used as an adjunct to treatment planning and management decisions.

Adult↗

PubMed2004

Preliminary assessment of magnetic resonance spectroscopic imaging in predicting treatment outcome in patients with prostate cancer at high risk for relapse.

The purpose of the study was to determine whether 3D proton magnetic resonance spectroscopic imaging (MRSI) can predict treatment outcome in high risk patients with prostate cancer. Endorectal magnetic resonance imaging (MRI) and 1H-MRSI were performed in 16 patients with prostate cancer who were considered high risk because of clinical stage T3-4, Gleason score>/=8, and/or prostate-specific antigen (PSA) level>20 ng/mL. Patients were treated with chemotherapy/hormone therapy, underwent radical prostatectomy (RP) or radiation therapy, and were followed for PSA relapse (follow-up, 19-43 months). The ratio of choline plus creatine to citrate was used to localize peripheral zone cancer. An MRSI risk score on a scale of 0-3 was derived from the volume and degree of metabolic abnormality. Magnetic resonance spectroscopic imaging risk score, MRI tumor/node (TN) stage, clinical stage, Gleason score, and PSA were used as predictors of pathologic stage in patients treated with RP (n=10) and PSA relapse in all patients. Magnetic resonance imaging TN stage (P<0.01) and MRSI risk score (P<0.05) correlated with pathologic stage, but clinical stage did not (P=0.35). Magnetic resonance imaging TN stage was the only significant predictor of PSA relapse in the univariate analysis (P<0.05). Although the MRSI risk score did not reach significance (P=0.13), 6 patients with a score<0.9 were relapse-free, whereas 7 of 10 patients with a score>0.9 relapsed. Magnetic resonance imaging and MRSI risk assessments agreed in 15 of 16 patients. These preliminary results suggest that tumor metabolic assessment may indicate treatment outcome in high-risk patients with prostate cancer. Although MRSI did not provide added prognostic value to MRI in this small number of patients, MRSI might increase the confidence of the clinician in assessing risk on MRI by contributing supporting metabolic data.

Disease-Free Survival↗

PubMed2003

Transition zone prostate cancer: metabolic characteristics at 1H MR spectroscopic imaging--initial results.

PURPOSE: To determine whether cancers of the prostate transition zone (TZ) possess a unique metabolic pattern by which they may be identified at proton magnetic resonance (MR) spectroscopic imaging. MATERIALS AND METHODS: Findings in 40 patients who underwent combined endorectal MR imaging and hydrogen 1 MR spectroscopic imaging before radical prostatectomy and who had TZ tumor identified subsequently at step-section pathologic analysis were retrospectively reviewed. Within this population, a subset of 16 patients whose TZ tumor had a largest diameter of 1 cm or greater and was included in the MR spectroscopic imaging excitation volume was identified. In these 16 patients, the ratios of choline-containing compounds (Cho) and creatine/phosphocreatine (Cr) to citrate (Cit) (ie, [Cho + Cr]/Cit), Cho/Cr, and Cho/Cit were compared in tumor and control tissues. The presence of only Cho and the absence of all metabolites were also assessed. RESULTS: The mean values of (Cho + Cr)/Cit, Cho/Cr, and Cho/Cit were different between TZ cancer and control tissues (P =.001, P =.003, and P =.001, respectively; Wilcoxon signed rank test). Nine (56%) of 16 patients had at least one tumor voxel in which Cho comprised the only detectable peak, while no control voxels showed only Cho (P =.008, McNemar test). The percentage of voxels in which no metabolites were detected did not differ between tumor and control tissues (P =.134, McNemar test). CONCLUSION: TZ cancer has a metabolic profile that is different from that of benign TZ tissue; however, the broad range of metabolite ratios observed in TZ cancer precludes the use of a single ratio to differentiate TZ cancer from benign TZ tissue.

Choline↗

PubMed2003

The use of MRI in the diagnosis and management of a bulky cervical carcinoma.

BACKGROUND: In the treatment of gynecologic cancer, surgical planning depends on the site and extent of disease. The evaluation of the origin of a large pelvic mass with combined pelvic examination and ultrasound is often adequate. However, the following case report illustrates the utility of magnetic resonance imaging (MRI) when sonographic findings are indeterminate and the origin of a pelvic mass is unclear. CASE: A 73-year-old woman presented for her first gynecologic exam in over 40 years. On speculum examination the cervix was not visible. A large, mobile pelvic mass was palpated during physical examination. Pelvic ultrasound revealed a large, cystic pelvic mass thought to be ovarian in origin. Surgery for presumed ovarian carcinoma was planned. Because a vaginal Pap smear revealed squamous-cell carcinoma, MRI was performed for further evaluation. MRI demonstrated a blood distended uterus with a large cervical tumor obstructing the endocervical os. After cervical dilatation under sonographic guidance, evacuation of the hematometrium was performed. Multiple biopsies of the cervix confirmed the diagnosis of a bulky Stage IIA squamous-cell carcinoma of the cervix. The patient was subsequently treated with concomitant chemotherapy and radiation therapy. Follow-up MRI demonstrated an excellent treatment response. Modified radical hysterectomy was performed demonstrating very small residual tumor. CONCLUSIONS: Magnetic resonance imaging, through multiplanar capabilities and high-contrast resolution, is a valuable tool that can assist the clinician in the evaluation, diagnosis, and management of challenging gynecologic malignancies.

Aged↗

PubMed2003

Advances in imaging in the postoperative patient with a rising prostate-specific antigen level.

Imaging prostate cancer continues to represent a clinical challenge for both primary and recurrent disease. In the evaluation of the persistent/recurrent/metastatic prostate cancer, knowledge of cancer location (local v distant), size, and extent are essential in order to design a treatment, tailored to each patient's needs. There are evidence-based guidelines for the use of imaging in assessing the presence of distant spread of prostate cancer. Radionuclide bone scans and computed tomography (CT), magnetic resonance imaging (MRI), and/or positron emission tomography (PET) supplement clinical and biochemical evaluations (prostate-specific antigen [PSA]) for suspected metastatic disease to bones and lymph nodes. There is no consensus about the use of imaging in the evaluation of local tumor recurrence. The use of ultrasound has been limited to biopsy guidance of the prostatic bed, or percutaneous biopsy of enlarged lymph nodes detected on CT or MRI. The use of MRI is evolving. Recent studies indicate that the use of MRI provides valuable information in the evaluation of local tumor recurrence, and nodal and bony metastases. In a patient post-radiation therapy, the method of combining MRI anatomic information with MR spectroscopic metabolic information is evolving. Another modality offering information about anatomy and metabolism of the local disease is PET/CT. The value of PET/CT at present is controversial, but new studies exploring the role of PET/CT in aggressive prostate cancer are promising.

Bone Neoplasms↗