HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fütterer, J. J. Articles by Barentsz, J. O. Search for Related Content PubMed PubMed Citation Articles by Fütterer, J. J. Articles by Barentsz, J. O.

Staging Prostate Cancer with Dynamic Contrast-enhanced Endorectal MR Imaging prior to Radical Prostatectomy: Experienced versus Less Experienced Readers¹

¹ From the Departments of Radiology (J.J.F., M.R.E., H.J.H., G.J.J., J.O.B.), Pathology (C.A.H.), and Urology (J.A.W.), University Medical Center Nijmegen, Geert Grooteplein zuid 10, NL 6500 HB, Nijmegen, the Netherlands. Received October 7, 2004; revision requested December 13; revision received January 3, 2005; accepted February 2. Supported by a grant from the Dutch Cancer Society. Address correspondence to J.J.F. (e-mail: J.Futterer{at}rad.umcn.nl).

View larger version (113K): [in a new window]   Figure 1a. Fusion of a T2-weighted fast SE transverse image in gray value with partly opaque rendered color overlay of four contrast enhancement parameters (see text for detailed explanation of parameters). (a) Transverse T2-weighted fast SE image obtained through the prostate demonstrates a low-signal-intensity lesion (T) in the left peripheral zone with bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle. (b) The start-of-enhancement parameter demonstrates an earlier enhancement in part of the low-signal-intensity lesion (arrows) compared with the right peripheral zone (red vs green). (c) Fast time to peak (red) is present in the left peripheral zone (arrows) and right central gland (arrowheads). (d) Peak enhancement is increased markedly in the center of the lesion in the left peripheral zone (arrows) and right central gland (arrowheads). (e) A negative washout area (red) is seen in the left peripheral zone (arrows) and right central gland (arrowheads). (f) Photomicrograph shows stage T3a disease with prostate capsule penetration in the left peripheral zone (arrows) and a prostate tumor lesion (red) in the right central gland (arrowheads).

View larger version (110K): [in a new window]   Figure 1b. Fusion of a T2-weighted fast SE transverse image in gray value with partly opaque rendered color overlay of four contrast enhancement parameters (see text for detailed explanation of parameters). (a) Transverse T2-weighted fast SE image obtained through the prostate demonstrates a low-signal-intensity lesion (T) in the left peripheral zone with bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle. (b) The start-of-enhancement parameter demonstrates an earlier enhancement in part of the low-signal-intensity lesion (arrows) compared with the right peripheral zone (red vs green). (c) Fast time to peak (red) is present in the left peripheral zone (arrows) and right central gland (arrowheads). (d) Peak enhancement is increased markedly in the center of the lesion in the left peripheral zone (arrows) and right central gland (arrowheads). (e) A negative washout area (red) is seen in the left peripheral zone (arrows) and right central gland (arrowheads). (f) Photomicrograph shows stage T3a disease with prostate capsule penetration in the left peripheral zone (arrows) and a prostate tumor lesion (red) in the right central gland (arrowheads).

View larger version (104K): [in a new window]   Figure 1c. Fusion of a T2-weighted fast SE transverse image in gray value with partly opaque rendered color overlay of four contrast enhancement parameters (see text for detailed explanation of parameters). (a) Transverse T2-weighted fast SE image obtained through the prostate demonstrates a low-signal-intensity lesion (T) in the left peripheral zone with bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle. (b) The start-of-enhancement parameter demonstrates an earlier enhancement in part of the low-signal-intensity lesion (arrows) compared with the right peripheral zone (red vs green). (c) Fast time to peak (red) is present in the left peripheral zone (arrows) and right central gland (arrowheads). (d) Peak enhancement is increased markedly in the center of the lesion in the left peripheral zone (arrows) and right central gland (arrowheads). (e) A negative washout area (red) is seen in the left peripheral zone (arrows) and right central gland (arrowheads). (f) Photomicrograph shows stage T3a disease with prostate capsule penetration in the left peripheral zone (arrows) and a prostate tumor lesion (red) in the right central gland (arrowheads).

View larger version (106K): [in a new window]   Figure 1d. Fusion of a T2-weighted fast SE transverse image in gray value with partly opaque rendered color overlay of four contrast enhancement parameters (see text for detailed explanation of parameters). (a) Transverse T2-weighted fast SE image obtained through the prostate demonstrates a low-signal-intensity lesion (T) in the left peripheral zone with bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle. (b) The start-of-enhancement parameter demonstrates an earlier enhancement in part of the low-signal-intensity lesion (arrows) compared with the right peripheral zone (red vs green). (c) Fast time to peak (red) is present in the left peripheral zone (arrows) and right central gland (arrowheads). (d) Peak enhancement is increased markedly in the center of the lesion in the left peripheral zone (arrows) and right central gland (arrowheads). (e) A negative washout area (red) is seen in the left peripheral zone (arrows) and right central gland (arrowheads). (f) Photomicrograph shows stage T3a disease with prostate capsule penetration in the left peripheral zone (arrows) and a prostate tumor lesion (red) in the right central gland (arrowheads).

View larger version (108K): [in a new window]   Figure 1e. Fusion of a T2-weighted fast SE transverse image in gray value with partly opaque rendered color overlay of four contrast enhancement parameters (see text for detailed explanation of parameters). (a) Transverse T2-weighted fast SE image obtained through the prostate demonstrates a low-signal-intensity lesion (T) in the left peripheral zone with bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle. (b) The start-of-enhancement parameter demonstrates an earlier enhancement in part of the low-signal-intensity lesion (arrows) compared with the right peripheral zone (red vs green). (c) Fast time to peak (red) is present in the left peripheral zone (arrows) and right central gland (arrowheads). (d) Peak enhancement is increased markedly in the center of the lesion in the left peripheral zone (arrows) and right central gland (arrowheads). (e) A negative washout area (red) is seen in the left peripheral zone (arrows) and right central gland (arrowheads). (f) Photomicrograph shows stage T3a disease with prostate capsule penetration in the left peripheral zone (arrows) and a prostate tumor lesion (red) in the right central gland (arrowheads).

View larger version (105K): [in a new window]   Figure 1f. Fusion of a T2-weighted fast SE transverse image in gray value with partly opaque rendered color overlay of four contrast enhancement parameters (see text for detailed explanation of parameters). (a) Transverse T2-weighted fast SE image obtained through the prostate demonstrates a low-signal-intensity lesion (T) in the left peripheral zone with bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle. (b) The start-of-enhancement parameter demonstrates an earlier enhancement in part of the low-signal-intensity lesion (arrows) compared with the right peripheral zone (red vs green). (c) Fast time to peak (red) is present in the left peripheral zone (arrows) and right central gland (arrowheads). (d) Peak enhancement is increased markedly in the center of the lesion in the left peripheral zone (arrows) and right central gland (arrowheads). (e) A negative washout area (red) is seen in the left peripheral zone (arrows) and right central gland (arrowheads). (f) Photomicrograph shows stage T3a disease with prostate capsule penetration in the left peripheral zone (arrows) and a prostate tumor lesion (red) in the right central gland (arrowheads).

View larger version (112K): [in a new window]   Figure 2a. Histologically confirmed stage T2 prostate carcinoma in a 66-year-old patient with a PSA level of 11.4 ng/mL and a Gleason score of 6. (a) Transverse T2-weighted fast SE MR image shows a suspicious low-signal-intensity lesion (T) in the left peripheral zone. The experienced radiologist classified this as bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle and scored this as stage T3a disease. (b) After injection of contrast material, the time-to-peak parameter showed fast enhancement (arrows) in the left peripheral zone within the location of the low-signal-intensity lesion within the border of the capsule. (c) Peak enhancement parameter showed a high level of contrast enhancement in the left peripheral zone (arrows) within the contours of the prostate. The combination of T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly downstaged to stage T2a disease, which was confirmed with (d) whole-mount section histopathologic analysis. The red outline in this photograph of the specimen represents a tumor in the left peripheral zone.

View larger version (104K): [in a new window]   Figure 2b. Histologically confirmed stage T2 prostate carcinoma in a 66-year-old patient with a PSA level of 11.4 ng/mL and a Gleason score of 6. (a) Transverse T2-weighted fast SE MR image shows a suspicious low-signal-intensity lesion (T) in the left peripheral zone. The experienced radiologist classified this as bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle and scored this as stage T3a disease. (b) After injection of contrast material, the time-to-peak parameter showed fast enhancement (arrows) in the left peripheral zone within the location of the low-signal-intensity lesion within the border of the capsule. (c) Peak enhancement parameter showed a high level of contrast enhancement in the left peripheral zone (arrows) within the contours of the prostate. The combination of T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly downstaged to stage T2a disease, which was confirmed with (d) whole-mount section histopathologic analysis. The red outline in this photograph of the specimen represents a tumor in the left peripheral zone.

View larger version (96K): [in a new window]   Figure 2c. Histologically confirmed stage T2 prostate carcinoma in a 66-year-old patient with a PSA level of 11.4 ng/mL and a Gleason score of 6. (a) Transverse T2-weighted fast SE MR image shows a suspicious low-signal-intensity lesion (T) in the left peripheral zone. The experienced radiologist classified this as bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle and scored this as stage T3a disease. (b) After injection of contrast material, the time-to-peak parameter showed fast enhancement (arrows) in the left peripheral zone within the location of the low-signal-intensity lesion within the border of the capsule. (c) Peak enhancement parameter showed a high level of contrast enhancement in the left peripheral zone (arrows) within the contours of the prostate. The combination of T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly downstaged to stage T2a disease, which was confirmed with (d) whole-mount section histopathologic analysis. The red outline in this photograph of the specimen represents a tumor in the left peripheral zone.

View larger version (95K): [in a new window]   Figure 2d. Histologically confirmed stage T2 prostate carcinoma in a 66-year-old patient with a PSA level of 11.4 ng/mL and a Gleason score of 6. (a) Transverse T2-weighted fast SE MR image shows a suspicious low-signal-intensity lesion (T) in the left peripheral zone. The experienced radiologist classified this as bulging (arrows) and obliteration (arrowheads) of the rectoprostatic angle and scored this as stage T3a disease. (b) After injection of contrast material, the time-to-peak parameter showed fast enhancement (arrows) in the left peripheral zone within the location of the low-signal-intensity lesion within the border of the capsule. (c) Peak enhancement parameter showed a high level of contrast enhancement in the left peripheral zone (arrows) within the contours of the prostate. The combination of T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly downstaged to stage T2a disease, which was confirmed with (d) whole-mount section histopathologic analysis. The red outline in this photograph of the specimen represents a tumor in the left peripheral zone.

View larger version (111K): [in a new window]   Figure 3a. Stage T3a disease in a 72-year-old patient with a PSA level of 10.2 ng/mL and a Gleason score of 5. (a) Transverse T2-weighted fast SE MR image shows a low-signal-intensity lesion (arrows) in the left peripheral zone, which was scored as stage T2a disease. (b) After contrast material injection, early start of enhancement was present in the right peripheral zone (oval). (c) In the right peripheral zone, faster time-to-peak enhancement was demonstrated with contrast enhancement (arrows) outside the capsule compared with the left peripheral zone. (d) Peak enhancement is displayed, which also showed an asymmetric lesion (arrows). Symmetric enhancement in the central gland was present, which turned out to be benign prostate hyperplasia. (e) No substantial washout was present. (f) The combination of the T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly upstaged to stage T3a disease, which was confirmed with whole-mount section histopathologic analysis. The red outline represents prostate cancer with capsular extension (arrow) in the right peripheral zone.

View larger version (89K): [in a new window]   Figure 3b. Stage T3a disease in a 72-year-old patient with a PSA level of 10.2 ng/mL and a Gleason score of 5. (a) Transverse T2-weighted fast SE MR image shows a low-signal-intensity lesion (arrows) in the left peripheral zone, which was scored as stage T2a disease. (b) After contrast material injection, early start of enhancement was present in the right peripheral zone (oval). (c) In the right peripheral zone, faster time-to-peak enhancement was demonstrated with contrast enhancement (arrows) outside the capsule compared with the left peripheral zone. (d) Peak enhancement is displayed, which also showed an asymmetric lesion (arrows). Symmetric enhancement in the central gland was present, which turned out to be benign prostate hyperplasia. (e) No substantial washout was present. (f) The combination of the T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly upstaged to stage T3a disease, which was confirmed with whole-mount section histopathologic analysis. The red outline represents prostate cancer with capsular extension (arrow) in the right peripheral zone.

View larger version (87K): [in a new window]   Figure 3c. Stage T3a disease in a 72-year-old patient with a PSA level of 10.2 ng/mL and a Gleason score of 5. (a) Transverse T2-weighted fast SE MR image shows a low-signal-intensity lesion (arrows) in the left peripheral zone, which was scored as stage T2a disease. (b) After contrast material injection, early start of enhancement was present in the right peripheral zone (oval). (c) In the right peripheral zone, faster time-to-peak enhancement was demonstrated with contrast enhancement (arrows) outside the capsule compared with the left peripheral zone. (d) Peak enhancement is displayed, which also showed an asymmetric lesion (arrows). Symmetric enhancement in the central gland was present, which turned out to be benign prostate hyperplasia. (e) No substantial washout was present. (f) The combination of the T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly upstaged to stage T3a disease, which was confirmed with whole-mount section histopathologic analysis. The red outline represents prostate cancer with capsular extension (arrow) in the right peripheral zone.

View larger version (95K): [in a new window]   Figure 3d. Stage T3a disease in a 72-year-old patient with a PSA level of 10.2 ng/mL and a Gleason score of 5. (a) Transverse T2-weighted fast SE MR image shows a low-signal-intensity lesion (arrows) in the left peripheral zone, which was scored as stage T2a disease. (b) After contrast material injection, early start of enhancement was present in the right peripheral zone (oval). (c) In the right peripheral zone, faster time-to-peak enhancement was demonstrated with contrast enhancement (arrows) outside the capsule compared with the left peripheral zone. (d) Peak enhancement is displayed, which also showed an asymmetric lesion (arrows). Symmetric enhancement in the central gland was present, which turned out to be benign prostate hyperplasia. (e) No substantial washout was present. (f) The combination of the T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly upstaged to stage T3a disease, which was confirmed with whole-mount section histopathologic analysis. The red outline represents prostate cancer with capsular extension (arrow) in the right peripheral zone.

View larger version (106K): [in a new window]   Figure 3e. Stage T3a disease in a 72-year-old patient with a PSA level of 10.2 ng/mL and a Gleason score of 5. (a) Transverse T2-weighted fast SE MR image shows a low-signal-intensity lesion (arrows) in the left peripheral zone, which was scored as stage T2a disease. (b) After contrast material injection, early start of enhancement was present in the right peripheral zone (oval). (c) In the right peripheral zone, faster time-to-peak enhancement was demonstrated with contrast enhancement (arrows) outside the capsule compared with the left peripheral zone. (d) Peak enhancement is displayed, which also showed an asymmetric lesion (arrows). Symmetric enhancement in the central gland was present, which turned out to be benign prostate hyperplasia. (e) No substantial washout was present. (f) The combination of the T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly upstaged to stage T3a disease, which was confirmed with whole-mount section histopathologic analysis. The red outline represents prostate cancer with capsular extension (arrow) in the right peripheral zone.

View larger version (109K): [in a new window]   Figure 3f. Stage T3a disease in a 72-year-old patient with a PSA level of 10.2 ng/mL and a Gleason score of 5. (a) Transverse T2-weighted fast SE MR image shows a low-signal-intensity lesion (arrows) in the left peripheral zone, which was scored as stage T2a disease. (b) After contrast material injection, early start of enhancement was present in the right peripheral zone (oval). (c) In the right peripheral zone, faster time-to-peak enhancement was demonstrated with contrast enhancement (arrows) outside the capsule compared with the left peripheral zone. (d) Peak enhancement is displayed, which also showed an asymmetric lesion (arrows). Symmetric enhancement in the central gland was present, which turned out to be benign prostate hyperplasia. (e) No substantial washout was present. (f) The combination of the T2-weighted fast SE and fused parametric MR images resulted in this tumor being correctly upstaged to stage T3a disease, which was confirmed with whole-mount section histopathologic analysis. The red outline represents prostate cancer with capsular extension (arrow) in the right peripheral zone.

View larger version (42K): [in a new window]   Figure 4. Receiver operating characteristic curves show the results of the interpretation of T1- and T2-weighted dynamic contrast-enhanced MR imaging by an experienced radiologist and two less experienced radiologists. A significantly greater Az was present with contrast-enhanced MR imaging (Az = 0.82, P = .01) compared with unenhanced T2-weighted MR imaging for the less experienced readers.