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Prostate MR after a negative US biopsy and PSA of 45 ng/ml

Case Study
Choyke, Peter, M.D. Bethesda, National Cancer Institute USA
Turkbey, Baris, M.D. Bethesda, National Cancer Institute USA

Patient history

A 73-year-old male with a PSA value of 45 ng/ml and a negative sextant transrectal ultrasound guided prostate biopsy presented for an MR examination at the National Cancer Institute, Bethesda, Maryland, USA.

MR examination

The examination was performed on Achieva 3.0T using the SENSE Cardiac coil and the Endo coil in the dual-coil mode. 

 

The acquired sequences were T1-weighted, multiplanar T2-weighted TSE, diffusion weighted imaging (DWI), spectroscopy (CSI) and dynamic contrast-enhanced imaging (DCE).

Images

T2-weighted TSE axial T2-weighted TSE coronal T2-weighted TSE sagittal
T2-weighted TSE axial
T2-weighted TSE coronal
T2-weighted TSE sagittal

 

The T2-weighted images show a suspicious round shaped, low signal intensity lesion in the right mid peripheral zone (arrows)

ADC map
ADC map

 

The apparent diffusion coefficient (ADC) map, reconstructed from the diffusion weighted images, confirms the right mid-peripheral zone lesion (lower arrow). Moreover, it demonstrates an additional lesion in the right transitional zone (upper arrow).

DCE normal Click image to enlargeDCE lesion Click image to enlarge
DCE normal
DCE lesion
Click image to enlarge
Click image to enlarge

 

The green DCE curve corresponding to the green ROI on the lesion (image DCE abnormal) shows faster wash-in and wash-out when compared to the curve corresponding to the green ROI placed in normal tissue (image DCE normal).

 

The blue curve corresponds to the arterial signal in the left femoral artery.

 

Spectroscopy normal Click image to enlargeSpectroscopy lesion Click image to enlarge
Spectroscopy normal
Spectroscopy lesion
Click image to enlarge
Click image to enlarge

 

The images on the top of the spectra show (left to right) the low signal lesion on the sagittal T2-weighted image, the spectral grid with voxels of displayed spectra highlighted and the Choline to Citrate ratio map superimposed on the axial T2-weighted image. 

The spectra demonstrate elevated choline (Cho) compared to citrate (Cit) in the lesion, while the opposite side of the prostate shows normal spectra.

 

Diagnosis

The T2-weighted images demonstrated a peripheral zone lesion, which was also seen on the DWI, DCE and spectroscopy series, as well as a second lesion in the transitional zone which was not clearly seen on the T2-weighted images. The patient was diagnosed as having prostate adenocarcinoma.

Clinical impact of Endo coil with Achieva 3.0T

Using the Endo coil with the Achieva 3.0T makes it possible to achieve higher matrix size and better resolution so improving image quality. This helps in surgical planning and planning of radiation treatment to the site of the tumor.



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Feb 25, 2009

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Case Study
Achieva 3.0T
Release 2.5
Quasar, Quasar Dual
3T, Body, endocoil, Prostate
 

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