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Published online before print January 19, 2006, 10.1148/radiol.2383050657
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Endorectal MR Imaging in the Evaluation of Seminal Vesicle Invasion: Diagnostic Accuracy and Multivariate Feature Analysis1

Evis Sala, MD, PhD, FRCR, Oguz Akin, MD, Chaya S. Moskowitz, PhD, Halley F. Eisenberg, Kentaro Kuroiwa, MD, Nicole M. Ishill, MS, Balashanmugam Rajashanker, MBBS, MRCP, FRCR, Peter T. Scardino, MD and Hedvig Hricak, MD, PhD

1 From the Departments of Radiology (E.S., O.A., H.F.E., B.R., H.H.), Epidemiology and Biostatistics (C.S.M., N.M.I.), Pathology (K.K.), and Urology (P.T.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021. From the 2005 RSNA Annual Meeting. Received April 20, 2005; revision requested June 16; revision received July 5; final version accepted July 28. Supported by grant R01-CA76423 from the National Institutes of Health. Address correspondence to H.H.


Figure 1
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  		Figure 1a: Clinical stage T2a prostate cancer in 61-year-old man with Gleason score of 9 and PSA level of 8.45 ng/mL. (a, b) Transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show tumor (T) and ECE (arrow in a and c) at right side of prostate base. Seminal vesicles demonstrate low signal intensity, mass effect, and loss of normal architecture (b–d). Angle obliteration (arrow in d) is noted. (e, f) Corresponding whole-mount sections confirm tumor (T) and bilateral SVI. RSV = right seminal vesicle, LSV = left seminal vesicle.

 

Figure 1
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  		Figure 1b: Clinical stage T2a prostate cancer in 61-year-old man with Gleason score of 9 and PSA level of 8.45 ng/mL. (a, b) Transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show tumor (T) and ECE (arrow in a and c) at right side of prostate base. Seminal vesicles demonstrate low signal intensity, mass effect, and loss of normal architecture (b–d). Angle obliteration (arrow in d) is noted. (e, f) Corresponding whole-mount sections confirm tumor (T) and bilateral SVI. RSV = right seminal vesicle, LSV = left seminal vesicle.

 

Figure 1
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  		Figure 1c: Clinical stage T2a prostate cancer in 61-year-old man with Gleason score of 9 and PSA level of 8.45 ng/mL. (a, b) Transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show tumor (T) and ECE (arrow in a and c) at right side of prostate base. Seminal vesicles demonstrate low signal intensity, mass effect, and loss of normal architecture (b–d). Angle obliteration (arrow in d) is noted. (e, f) Corresponding whole-mount sections confirm tumor (T) and bilateral SVI. RSV = right seminal vesicle, LSV = left seminal vesicle.

 

Figure 1
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  		Figure 1d: Clinical stage T2a prostate cancer in 61-year-old man with Gleason score of 9 and PSA level of 8.45 ng/mL. (a, b) Transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show tumor (T) and ECE (arrow in a and c) at right side of prostate base. Seminal vesicles demonstrate low signal intensity, mass effect, and loss of normal architecture (b–d). Angle obliteration (arrow in d) is noted. (e, f) Corresponding whole-mount sections confirm tumor (T) and bilateral SVI. RSV = right seminal vesicle, LSV = left seminal vesicle.

 

Figure 1
View larger version (105K):

[in a new window]
  		Figure 1e: Clinical stage T2a prostate cancer in 61-year-old man with Gleason score of 9 and PSA level of 8.45 ng/mL. (a, b) Transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show tumor (T) and ECE (arrow in a and c) at right side of prostate base. Seminal vesicles demonstrate low signal intensity, mass effect, and loss of normal architecture (b–d). Angle obliteration (arrow in d) is noted. (e, f) Corresponding whole-mount sections confirm tumor (T) and bilateral SVI. RSV = right seminal vesicle, LSV = left seminal vesicle.

 

Figure 1
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  		Figure 1f: Clinical stage T2a prostate cancer in 61-year-old man with Gleason score of 9 and PSA level of 8.45 ng/mL. (a, b) Transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show tumor (T) and ECE (arrow in a and c) at right side of prostate base. Seminal vesicles demonstrate low signal intensity, mass effect, and loss of normal architecture (b–d). Angle obliteration (arrow in d) is noted. (e, f) Corresponding whole-mount sections confirm tumor (T) and bilateral SVI. RSV = right seminal vesicle, LSV = left seminal vesicle.

 

Figure 2
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  		Figure 2a: Clinical stage T2c prostate cancer in 63-year-old man with Gleason score of 8 and PSA level of 56.24 ng/mL. (a) Transverse T1-weighted (500/10) MR image and (b) transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show right SVI (T). Note the presence of extensive hemorrhage in both seminal vesicles (high signal intensity in a). In b–d, a focal area of low signal intensity (T) is seen in the right seminal vesicle. This area causes mass effect and distortion of the normal architecture of the seminal vesicle, which are both indicative of SVI.

 

Figure 2
View larger version (174K):

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  		Figure 2b: Clinical stage T2c prostate cancer in 63-year-old man with Gleason score of 8 and PSA level of 56.24 ng/mL. (a) Transverse T1-weighted (500/10) MR image and (b) transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show right SVI (T). Note the presence of extensive hemorrhage in both seminal vesicles (high signal intensity in a). In b–d, a focal area of low signal intensity (T) is seen in the right seminal vesicle. This area causes mass effect and distortion of the normal architecture of the seminal vesicle, which are both indicative of SVI.

 

Figure 2
View larger version (176K):

[in a new window]
  		Figure 2c: Clinical stage T2c prostate cancer in 63-year-old man with Gleason score of 8 and PSA level of 56.24 ng/mL. (a) Transverse T1-weighted (500/10) MR image and (b) transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show right SVI (T). Note the presence of extensive hemorrhage in both seminal vesicles (high signal intensity in a). In b–d, a focal area of low signal intensity (T) is seen in the right seminal vesicle. This area causes mass effect and distortion of the normal architecture of the seminal vesicle, which are both indicative of SVI.

 

Figure 2
View larger version (158K):

[in a new window]
  		Figure 2d: Clinical stage T2c prostate cancer in 63-year-old man with Gleason score of 8 and PSA level of 56.24 ng/mL. (a) Transverse T1-weighted (500/10) MR image and (b) transverse, (c) coronal, and (d) sagittal T2-weighted fast spin-echo (5800/100) MR images show right SVI (T). Note the presence of extensive hemorrhage in both seminal vesicles (high signal intensity in a). In b–d, a focal area of low signal intensity (T) is seen in the right seminal vesicle. This area causes mass effect and distortion of the normal architecture of the seminal vesicle, which are both indicative of SVI.

 

Figure 3
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  		Figure 3: ROC curves summarize the accuracy of endorectal MR imaging in demonstrating and localizing SVI.

 

Figure 4
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  		Figure 4a: ROC curves summarize the accuracy of endorectal MR imaging in demonstrating and localizing (a) tumor at the base of prostate and (b) ECE in patients with SVI.

 

Figure 4
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  		Figure 4b: ROC curves summarize the accuracy of endorectal MR imaging in demonstrating and localizing (a) tumor at the base of prostate and (b) ECE in patients with SVI.

 

Figure 5
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  		Figure 5: ROC curves summarize the accuracy of three multivariate models in detecting and localizing SVI for reader 1.

 




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