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Published online before print March 28, 2006, 10.1148/radiol.2392050949
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Transition Zone Prostate Cancers: Features, Detection, Localization, and Staging at Endorectal MR Imaging1

Oguz Akin, MD, Evis Sala, MD, PhD, FRCR, Chaya S. Moskowitz, PhD, Kentaro Kuroiwa, MD, Nicole M. Ishill, MS, Darko Pucar, MD, PhD, Peter T. Scardino, MD and Hedvig Hricak, MD, PhD

1 From the Departments of Radiology (O.A., E.S., D.P., 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. Received June 6, 2005; revision requested August 1; revision received August 9; accepted September 7; final version accepted October 10. Supported by NIH grant R01 CA76423. Address correspondence to O.A. (e-mail: akino{at}mskcc.org).


Figure 1
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  		Figure 1: Graph shows receiver operating characteristic curve and AUC for each reader as a measure of accuracy of MR imaging findings in prediction of the location of transition zone cancers. Weighted {kappa} statistic was 0.64, which indicates fair agreement between readers.

 

Figure 2
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  		Figure 2: Graph shows receiver operating characteristic curve and AUC for each reader as a measure of the accuracy of MR imaging findings in detection of transition zone cancers according to tumor volume. Tumor volume was dichotomized at a median tumor volume of 0.77 mL.

 

Figure 3
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  		Figure 3a: Images in a 66-year-old man with Gleason grade 3 + 3 pT2b prostate cancer. (a) Transverse T2-weighted MR image shows a typical BPH nodule (arrows) demonstrating mixed T2 signal intensity with well-defined margins and a distinct capsule. (b) Corresponding step-section pathologic findings confirm the presence of a BPH nodule (arrows), without any cancer foci in the transition zone.

 

Figure 3
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  		Figure 3b: Images in a 66-year-old man with Gleason grade 3 + 3 pT2b prostate cancer. (a) Transverse T2-weighted MR image shows a typical BPH nodule (arrows) demonstrating mixed T2 signal intensity with well-defined margins and a distinct capsule. (b) Corresponding step-section pathologic findings confirm the presence of a BPH nodule (arrows), without any cancer foci in the transition zone.

 

Figure 4
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  		Figure 4a: Images in a 60-year-old man with Gleason grade 3 + 3 pT2b prostate cancer. (a) Transverse T2-weighted MR image shows a lenticular lesion (*) demonstrating homogeneous low T2 signal intensity with ill-defined margins and without a distinct capsule (arrows). (b) Corresponding step-section pathologic findings confirm the presence of transition zone (TZ) cancer (*) without extraprostatic extension. PZ = peripheral zone.

 

Figure 4
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  		Figure 4b: Images in a 60-year-old man with Gleason grade 3 + 3 pT2b prostate cancer. (a) Transverse T2-weighted MR image shows a lenticular lesion (*) demonstrating homogeneous low T2 signal intensity with ill-defined margins and without a distinct capsule (arrows). (b) Corresponding step-section pathologic findings confirm the presence of transition zone (TZ) cancer (*) without extraprostatic extension. PZ = peripheral zone.

 

Figure 5
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  		Figure 5a: Images in a 59-year-old man with Gleason grade 4 + 3 pT3a prostate cancer. (a) Transverse T2-weighted MR image shows transition zone cancer (*) invading the anterior fibromuscular stroma (arrows) and extending (arrowhead) beyond the confines of the prostate anteriorly on the left side. (b) Corresponding step-section pathologic findings confirm the presence of transition zone cancer (*) with established (line) and focal (bullet) extraprostatic extension. Two small foci of peripheral zone cancer (arrows) are also seen.

 

Figure 5
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  		Figure 5b: Images in a 59-year-old man with Gleason grade 4 + 3 pT3a prostate cancer. (a) Transverse T2-weighted MR image shows transition zone cancer (*) invading the anterior fibromuscular stroma (arrows) and extending (arrowhead) beyond the confines of the prostate anteriorly on the left side. (b) Corresponding step-section pathologic findings confirm the presence of transition zone cancer (*) with established (line) and focal (bullet) extraprostatic extension. Two small foci of peripheral zone cancer (arrows) are also seen.

 




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