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MRI of Prostate Cancer

Because prostate cancers demonstrate a wide range of biologic activity with the majority of cases not leading to a prostate cancer related death, management decisions for patients with prostate cancer present a dilemma for both patients and their clinicians. Current treatment options have significant side effects, such as incontinence, rectal injury and impotence. Key elements for guiding appropriate treatment include: distinction of organ-confined disease from extra-capsular extension (ECE) and determination of tumor volume and tumor aggressiveness, none of which have been satisfactorily accomplished in today’s pre-treatment paradigm. We have found that Dynamic Contrast Enhanced MRI (DCE-MRI) can be employed at 3T (Figure 1) as a tool for the routine clinical work-up of men with either biopsy proven prostate cancer of a high suspicion of this disease.

 

LL_MRI_PC_Fig1

Figure 1. Prostate imaging at 3T. a: Image obtained using a body coil with a field of view (FOV) of 23 cm and a section thickness of 4 mm in 7 minutes. b: Image obtained at 3T using a phased array coil with an FOV of 14 cm and a section thickness of 4 mm in 3 minutes and 18 seconds. c: Image obtained using an endorectal coil with an FOV of 12 cm and a section thickness of 1.5 mm in 6 minutes and 9 seconds. Note the high detail including definition of the neurovascular bundle structures (long arrow) as well as the motion artifacts (short arrows) that propagate through the image.

 

This work has involved the validation of DCEMRI against whole mount histopathology, gene expression profiles, and immuno-histochemistry (1-6) (see Figure 2). A key part of this effort was the development of a non-rigid registration algorithm that automatically generates overlays of MRI images onto histopathological images (7).

 

 

LL_MRI_PC_FIG2

 

An unanticipated clinical benefit of these developments has been the ability to use DCEMRI to image men with elevated PSA and repeat negative biopsy. In an ongoing prospective study using histopathology of the subsequent biopsy as the reference standard, MR based biopsy detected prostate cancer in >50% of patients, with the tumor being located in the anterior gland, as predicted by MRI, in the majority of the cases. These results suggest a marked improvement over previously reported results of randomly performed repeat biopsies or targeted sextant biopsies with emphasis on anterior and lateral tissue sampling suggesting that MRI can assist in the reduction of repeat negative biopsies in men with rising PSA.

We are improving the analysis of DCE-MRI will be improved to more accurately reflect the different kinds of anti-angiogenic activity in prostate cancer. New techniques for assessment of perfusion (e.g. arterial spin labeling, a contrast-media free method to quantify perfusion) have bben implemented and evaluated and additional other techniques (e.g. diffusion and magnetization transfer) will be developed and assessed as part of a multi-parametric in-vivo imaging approach to prostate cancer. For all MR assessments, detailed comparisons are being made between immuno-fluorescense staining performed on surgical specimen slices sectioned in an identical fashion as the in vivo MRI sections are obtained.  This effort combines the existing expertise in DCE-MRI and other MR imaging of the prostate (Dr. Neil Rofsky, Radiology), in clinical correlative skills and surgical management of disease (Dr. Claus Roehrborn, Urology) and in the technical and analytical skills in mapping and assessment.

 

References.

  1. Bloch BN, Furman-Haran E, Helbich TH, Lenkinski RE, Degani H, Kratzik C, Susani M, Haitel A, Jaromi S, Ngo L, Rofsky NM. Prostate cancer: Accurate determination of extracapsular extension with high-spatial-resolution dynamic contrast-enhanced and T2-weighted MR imaging – Initial results. Radiology. 2007;245(1):176-85.
  2. Bloch BN, Kaplan ID, Lenkinski RE, Rofsky NM. Prostate postbrachytherapy seed distribution: Comparison of high-resolution, contrast-enhanced, T-1- and T-2-weighted endorectal magnetic resonance imaging versus computed tomography: Initial experience: In regard to Bloch etal. (Int J Radiat Oncol Biol Phys 2007;69 : 70-78) – In reply to Drs. Beaulieu and verhagen. International Journal of Radiation Oncology Biology Physics. 2008;71(4):1289-90.
  3. Bloch BN, Lenkinski RE, Rofsky NM. The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: The Beth Israel Deaconess Medical Center (BIDMC) approach. Cancer Biomarkers. 2008;4(4-5):251-62.
  4. Lenkinski RE, Bloch BN, Liu F, Frangioni JV, Perner S, Rubin MA, Genega EM, Rofsky NM, Gaston SM. An illustration of the potential for mapping MRI/MRS parameters with genetic over-expression profiles in human prostate cancer. Magnetic Resonance Materials in Physics Biology and Medicine. 2008;21(6):411-21.
  5. McMahon CJ, Bloch BN, Lenkinski RE, Rofsky NM. Dynamic Contrast-Enhanced MR Imaging in the Evaluation of Patients with Prostate Cancer. Magnetic Resonance Imaging Clinics of North America. 2009;17(2):363-+.
  6. Rosen Y, Bloch BN, Lenkinski RE, Greenman RL, Marquis RP, Rofsky NM. 3T MR of the prostate: Reducing susceptibility gradients by inflating the endorectal coil with a barium sulfate suspension. Magnetic Resonance in Medicine. 2007;57(5):898-904.
  7. Viswanath S, Bloch BN, Genega E, Rofsky N, Lenkinski R, Chappelow J, Toth R, Madabhushi A. A comprehensive segmentation, registration, and cancer detection scheme on 3 Tesla in vivo prostate DCE-MRI. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv. 2008;11(Pt 1):662-9.

Prostate Publications 2010-2104.

  1. Chappelow J, Bloch BN, Rofsky N, Genega E, Lenkinski R, Dewolf W, Madabhushi A. Elastic registration of multimodal prostate MRI and histology via multiattribute combined mutual information. Medical Physics. 2011;38(4):2005-1
  2. Toth R, Bloch BN, Genega EM, Rofsky NM, Lenkinski RE, Rosen MA, Kalyanpur A, Pungavkar S, Madabhushi A. Accurate Prostate Volume Estimation Using Multifeature Active Shape Models on T2-weighted MRI. Academic Radiology. 2011;18(6):745-54.
  3. Toth R, Bulman J, Patel AD, Bloch BN, Genega EM, Rofsky NM, Lenkinski RE, Madabhushi A, editors. Integrating an adaptive region-based appearance model with a landmark-free statistical shape model: Application to prostate MRI segmentation. Progress in Biomedical Optics and Imaging – Proceedings of SPIE; 2011.
  4. Viswanath S, Bloch BN, Chappelow J, Patel P, Rofsky N, Lenkinski R, Genega E, Madabhushi A, editors. Enhanced multi-protocol analysis via intelligent supervised embedding (EMPrAvISE): Detecting prostate cancer on multi-parametric MRI. Progress in Biomedical Optics and Imaging – Proceedings of SPIE; 2011.
  5. Viswanath S, Palumbo D, Chappelow J, Patel P, Bloch BN, Rofsky N, Lenkinski R, Genega E, Madabhushi A, editors. Empirical evaluation of bias field correction algorithms for computer-aided detection of prostate cancer on T2w MRI. Progress in Biomedical Optics and Imaging – Proceedings of SPIE; 2011.
  6. Xiao G, Bloch BN, Chappelow J, Genega EM, Rofsky NM, Lenkinski RE, Tomaszewski J, Feldman MD, Rosen M, Madabhushi A. Determining histology-MRI slice correspondences for defining MRI-based disease signatures of prostate cancer. Computerized Medical Imaging and Graphics. 2011;35(7-8):568-78.
  7. Viswanath SE, Bloch NB, Chappelow JC, Toth R, Rofsky NM, Genega EM, Lenkinski RE, Madabhushi A. Central gland and peripheral zone prostate tumors have significantly different quantitative imaging signatures on 3 tesla endorectal, in vivo T2-weighted MR imagery. Journal of Magnetic Resonance Imaging. 2012;36(1):213-24.
  8. Brook OR, Faintuch S, Brook A, Goldberg SN, Rofsky NM, Lenkinski RE. Embolization therapy for benign prostatic hyperplasia: Influence of embolization particle size on gland perfusion. Journal of Magnetic Resonance Imaging. 2013;38(2):380-7.
  9. Ginsburg SB, Bloch BN, Rofsky NM, Genega EM, Lenkinski RE, Madabhushi A, editors. Iterative multiple reference tissue method for estimating pharmacokinetic parameters on prostate DCE MRI. Proceedings of SPIE – The International Society for Optical Engineering; 2013.
  10. Rusu M, Bloch BN, Jaffe CC, Rofsky NM, Genega EM, Feleppa E, Lenkinski RE, Madabhushi A, editors. Statistical 3D prostate imaging atlas construction via anatomically constrained registration. Progress in Biomedical Optics and Imaging – Proceedings of SPIE; 2013.
  11. Donato F, Costa DN, Yuan Q, Rofsky NM, Lenkinski RE, Pedrosa I. Geometric Distortion in Diffusion-weighted MR Imaging of the Prostate-Contributing Factors and Strategies for Improvement. Academic Radiology. 2014;21(6):817-23.
  12. Ginsburg SB, Viswanath SE, Bloch BN, Rofsky NM, Genega EM, Lenkinski RE, Madabhushi A. Novel PCA-VIP scheme for ranking MRI protocols and identifying computer-extracted MRI measurements associated with central gland and peripheral zone prostate tumors. Journal of Magnetic Resonance Imaging. 2014.
  13. Rusu M, Bloch BN, Jaffe CC, Genega EM, Lenkinski RE, Rofsky NM, Feleppa E, Madabhushi A. Prostatome: A combined anatomical and disease based MRI atlas of the prostate. Medical Physics. 2014;41(7).