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Prostate MR for elevated PSA

Case Study
Jung, Adam, M.D. San Antonio, UTHSCSA USA
Friel, Harry Philips Healthcare USA

Patient history

A 58-year-old patient with an increased PSA presented for an MRI examination at the University of Texas Health Science Center (UTHSCSA), San Antonio, Texas, USA.

 

Minimal disease was detected on a prior ultrasound guided biopsy of the prostate and the decision was made to take a "watchful waiting" approach with active surveillance of repeated annual PSA testing. The patient's PSA had recently increased to 8.6 ng/ml and the patient was referred for an MRI examination before performing a repeated TRUS biopsy.

MR examination

The examination was performed on Achieva 3.0T combining the Endo coil with the SENSE Cardiac coil in a dual-coil setup.

 

Multiparametric imaging sequences were acquired including high resolution multiplanar T2-weighted images as well as T1-weighted anatomical images.

 

Diffusion weighted images with a b-value of 700 were aquired together with ADC maps.

 

The dynamic contrast-enhanced (DCE) images were acquired with a temporal resolution of approximatley 3.7 seconds.

Images

T2-weighted axial Click on an image to enlargeDCE image DWI/ADC map
T2-weighted axial
DCE image
DWI/ADC map
Click on an image to enlarge

 

The T2-weighted axial image shows a discrete focal region of decreased signal intensity in the right pericapsular posterolateral peripheral zone at the level of the midgland extending towards the base (red circle), a suspicious lesion. A similar lesion is seen in the bilateral medial peripheral zones at the level of the midgland extending towards the apex (these lesions are not imaged on the given slice). The blue circle indicates a relatively uncommonly localized prostatic hyperplastic nodule.

 

The DCE image demonstrates focal regions of early contrast uptake and overall contrast uptake in the right pericapsular posterolateral peripheral zone and bilateral medial peripheral zones corresponding to the T2 abnormalities above (the medial lesions are not imaged in the given image).

 

The DWI/ADC image shows diffusion restriction in the right pericapsular T2 low signal region described above. Note that the BPH nodule in the medial midgland does not demonstrate significant diffusion restriction with high ADC values.

Diagnosis

Multi-focal prostate lesions are visualized in the region of the right pericapsular posterolateral peripheral zone and medial peripheral zones (not imaged on the given slice) extending from the level of the midgland towards the base and apex respectively.

 

An incidental note is made of a relatively uncommonly localized benign prostatic hyperplastic nodule in the peripheral zone just caudal and lateral to the left medial peripheral zone cancers.

 

All regions with suspicious T2 signal demonstrated very rapid and intense gadolinium uptake suggestive of higher Gleason Grade cancers (7 and above).

Clinical impact of the Endo coil 3.0T

Achieva 3.0T with endo coil 3.0T demonstrated multiple regions of relatively large foci abutting the prostatic capsule. This changed treatment options from simple monitoring to active treatment including prostatectomy and radiation therapy (i.e. brachytherapy, IMRT, etc.). Final treatment decisions are pending.

 

The 3.0T dual-coil prostate examination provided images with higher resolution and better detail than obtained at 1.5T. 

 

Dual-coil acquisition also allowed the use of SENSE and diminished overall scan time, as well as improving DWI image quality and DCE temporal resolution.

 

The increased SNR also showed apparent improvements in MR spectroscopy with smaller voxel resolution and metabolite dispersion.



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Feb 20, 2009

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Case Study
Achieva 3.0T X-series
Release 2, Release 2.5, Release 2.6
Quasar, Quasar Dual
3T, Body, endocoil, Prostate
 

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