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Background Application of an endorectal coil (ERC) for 3.0-T prostate magnetic resonance imaging (MRI) is contentious. We hypothesised that a multicoil phased-array protocol provides T2-weighted images (T2WI) and diffusion-weighted images (DWI) with reduced field-of-view (DWIreduced) and monoexponential apparent diffusion coefficient (ADC) maps that are technically equivalent with ERC or without ERC (noERC). Methods Axial T2WI (repetition time [TR] 7500 ms, echo time [TE] 98–101 ms) and DWIreduced (field-of-view 149–179 × 71–73 mm2, TR/TE 4500–5500/61–74 ms, b values, 50/800 s/mm2) ERC and noERC images were obtained on identical clinical 3.0-T scanners at two centres and compared for signal-to-noise ratio (SNR) in anterior and posterior outer pericarp (OP) and peripheral placenta (PP) in five green Hayward kiwifruit (Actinidia deliciosa, European Union regulation 543/2011 class 2). Corroboration in 21 patients with benign prostate hyperplasia (negative biopsy, prostate imaging reporting and data system version 2 ≤ 2) involved identical MRI protocols: 10 at site 1, noERC, and 11 at site 2, with ERC. Two-tailed Student’s t test was used. Results With few exceptions, signal-to-noise ratio (SNR) was similar in kiwifruits and prostates for ERC and noERC. In T2WI, SNR was higher posteriorly in noERC MRI for peripheral zone (PZ) (p

The Working Group Uroradiology and Urogenital Diagnosis of the German Roentgen Society (DRG) revised and updated the recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate in a consensus process and harmonized it with the managing board of German Roentgen Society and Professional Association of the German Radiologist (BDR e. V.). These detailed recommendation define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer and describe in detail the topic 1. anamnestic datas, 2. termination of examinations and preparation of examinations, 3. examination protocol and 4. MRI-(in-bore)-biopsy. KEY POINTS:: · The recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate were revised and updated in a consensus process and harmonized with the managing board of German Roentgen Society (DRG) and Professional Asssociation of the German Radiologist (BDR).. · Detailed recommendations are given for topic 1. anamnestic datas, 2. termination and preparation of examinations, 3. examination protocoll and 4. MRI-(in-bore)-biopsy.. · These recommendations define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer.. CITATION FORMAT: · Franiel T, Asbach P, Beyersdorff D et al. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Examination Protocol. Fortschr Röntgenstr 2021; 193: 763 - 776.Die AG Uroradiologie und Urogenitaldiagnostik der Deutschen Röntgengesellschaft hat die Empfehlungen zur Vorbereitung und Durchführung der multiparametrischen MRT der Prostata im Konsensusverfahren und in Abstimmung mit den Vorständen der Deutschen Röntgengesellschaft und des Berufsverbandes der Deutschen Radiologen überarbeitet und aktualisiert. Diese aktualisierten Empfehlungen definieren die in der deutschen S3-Leitlinie Prostatakarzinom referenzierten „geltenden Qualitätsstandards“ und gehen detailliert auf die Themen 1. Anamnestische Angaben, 2. Untersuchungsterminierung und -vorbereitung, 3. Untersuchungsprotokoll und 4. MRT- (in-bore) -Biopsie ein. KERNAUSSAGEN:: · Die Empfehlungen zur Vorbereitung und Durchführung der multiparametrischen MRT der Prostata wurden von der AG Uroradiologie und Urogenitaldiagnostik der Deutschen Röntgengesellschaft in Abstimmung mit den Vorständen der Deutschen Röntgengesellschaft und des Berufsverbandes der Deutschen Radiologen überarbeitet und aktualisiert.. · Es werden detailiert Empfehlungen zu 1. Anamnestische Angaben, 2. Untersuchungsterminierung und -vorbereitung, 3. Untersuchungsprotokoll und 4. MRT-(in-bore)-Biopsie gegeben.. · Diese Empfehlungen definieren die in der S3-Leitlinie Prostatakarzinom referenzierten „geltenden Qualitätsstandards“.. ZITIERWEISE: · Franiel T, Asbach P, Beyersdorff D et al. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Examination Protocol. Fortschr Röntgenstr 2021; 193: 763 – 777.

This information provided by the Thoracic Imaging Section of the German Radiological Society is intended to give physicians recommendations on the use of thoracic imaging procedures in the context of the current COVID-19 pandemic. It represents the consensus of the authors based on the previous scientific knowledge and is intended to provide guidance for unified, structured CT reporting if COVID-19 pneumonia is suspected. The recommendations presented correspond to state of knowledge at the time of print and will be updated according to the results of ongoing and future scientific studies. KEY POINTS:: · COVID-19. · chest imaging. · German Radiological Society. CITATION FORMAT: · Vogel-Claussen J, Ley-Zaporozhan J, Agarwal P et al. Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1174-8378.Diese Information der AG Thoraxdiagnostik der Deutschen Röntgengesellschaft soll Ärztinnen und Ärzten Empfehlungen zur Anwendung thoraxradiologischer Verfahren im Rahmen der aktuellen COVID-19-Pandemie geben. Sie repräsentiert den Konsensus der Autoren basierend auf den bisherigen wissenschaftlichen Erkenntnissen und soll zur einheitlichen und strukturierten CT-Befundung bei COVID-19 anleiten. Die vorgestellten Empfehlungen entsprechen dem Wissensstand zum Zeitpunkt der Drucklegung und werden entsprechend den Ergebnissen laufender und zukünftiger wissenschaftlicher Untersuchungen bei Bedarf aktualisiert. KERNAUSSAGEN:: · COVID-19. · Thoraxbildgebung. · Deutsche Röntgengesellschaft. ZITIERWEISE: · Vogel-Claussen J, Ley-Zaporozhan J, Agarwal P et al. Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1174-8378.

Mediastinal, hilar, and peripheral pulmonary lymphadenopathy is a hallmark sign of different benign and malignant diseases of the chest. Contrast-enhanced (CE) chest CT is a test frequently applied to examine thoracic lymph node zones. We attempted to find out whether mediastinal, hilar, and peripheral lymph nodes delineate equally in CE chest CT with reduced dose (CE-LDCT, about 1 mSv) when compared with accepted standard CE chest CT (CE-SDCT). In this ethics committee-approved, mono-institutional, retrospective (20 months) matched case–control study, two independent, blinded observers compared measurable lymph node delineation (yes–no) in six different International Association for the Study of Lung Cancer (IASLC) zones (upper mediastinal, aortopulmonary, subcarinal, lower mediastinal, hilar, peripheral) between 62 CE-LDCT cases and 124 CE-SDCT controls (respective tube charge, 100, 120 KVp, computed tomography dose index, 1.66 ± 0.51, 5.36 ± 2.24 mGy, automatic exposure control-modulated 64-row multi-detector chest CT with iterative image reconstruction). Individual matching for gender (53% female), age (53 ± 19 years), body height, weight, anterior–posterior and transverse diameters of chest and lung ruled out pre-test confounders. Lymph node size (cut-off value, 1 cm) was a potential post-test confounder. Two-tailed T test and Chi-square test were significant for p

To apply an easy-to-assemble phantom substitute for human prostates in T2-weighted magnetic resonance imaging (T2WI), diffusion-weighted imaging (DWI) and 3D magnetic resonance spectroscopy (MRS).Kiwi fruit were fixed with gel hot and cold compress packs on two plastic nursery pots, separated by a plastic plate, and submerged in tap water inside a 1-L open-spout plastic watering can for T2WI (TR/TE 7500/101 ms), DWI (5500/61 ms, ADC b50-800 s/mmMean contrast between central placenta (CP) and outer pericarp (OP, 0.346-0.349) or peripheral placenta (PP, 0.364-0.393) of kiwi fruit was similar to Gleason 7b-9 prostate cancer and PZ (0.308) in T2WI. ADC values of OP and PP (1.27 ± 0.07-1.37 ± 0.08 mmThe kiwi fruit phantom reproducibly showed zones similar to PZ, TZ and cancer in human prostates in T2WI and DWI and two metabolite peaks in MRS and appears suitable to compare different MR protocols, coil systems and scanners.• Kiwi fruit appear suitable as phantoms for human prostate in MR examinations. • Kiwi fruit show zonal anatomy like human prostates in T2-weighted MRI and DWI. • MR spectroscopy reliably shows peaks in kiwi fruit (citrate/inositol) and human prostates (citrate/choline+creatine). • The kiwi fruit phantom works both with and without an endorectal coil. • EU regulation No. 543/2011 specifies physical and biochemical properties of kiwi fruit.

The Working Group Uroradiology and Urogenital Diagnosis of the German Roentgen Society has developed uniform recommendations for the preparation and implementation of prostate MRI. In the first part detailed recommendations are given in tabular form regarding 1. anamnestic data before prostate MRI, 2. termination of examinations and preparation of examinations, 3. examination protocol and 4. MRI-guided in-bore biopsy. In the second part, the recommendations are discussed in detail and relevant background information is provided. Key Points: Citation Format

Purpose: The semi-quantitative Brody score measures the severity of cystic fibrosis (CF)-related lung disease. We investigated the short-term (28 – 60 days) and long-term (2 – 7 years) intra- and inter-observer reproducibility of the Brody score in low-dose multidetector row computed tomography examinations performed in inspiration (LDCTs) of adult CF patients. Materials and Methods: Composite Brody scores and respective underlying bronchiectasis, mucus plugging, peribronchial thickening, parenchymal opacity, and hyperinflation subscores were evaluated twice (time interval, 1 – 84 months) by each of 3 independent radiologists (1 – 20 years of professional diagnostic radiology experience) in LDCTs (4 – 64 rows, 120 KVp, 10 – 15 mAs/slice, CTDIw approx. 1.0 mGy, effective dose approx. 0.5 mSv) of 15 adult patients with CF-related lung disease (8 female, 7 male, age, 18 – 50 years, mean, 33 years). Results: The average reproducibility of the Brody score was within +/–7 % (range, 2 – 30 %) between radiologists, and +/–6 % (3 – 12 %) within radiologists (short-term, 28 – 60 days, 4 %, 0 – 12 %, long-term, 2 – 7 years, 12 %, 1 – 36 %). For the different subscores, the reproducibility was within +/–25 % (15 – 41 %) between radiologists and +/–23 % (12 – 46 %) within radiologists. Conclusion: The Brody score shows high average inter-observer reproducibility in LDCTs of adult CF patients. The Brody score also demonstrates high average intra-observer reproducibility if subsequent assessments are made within 28 – 61 days. With time intervals of 2 – 7 years between subsequent evaluations, however, intra-observer reproducibility decreases. Respective subscores each demonstrate lower intra- and inter-observer reproducibility than does the composite Brody score. Citation Format

To compare contrast-enhanced low-dose multidetector-row computed tomography (CE-LDCT) of the chest with unenhanced (UN-) LDCT and contrast-enhanced standard-dose CT (CE-SDCT) in regard to the delineation of intrathoracic lymph nodes.Based on the international association for the study of lung cancer (IASLC) grouping of thoracic lymph nodes, two independent radiologists retrospectively assessed lymph node delineation in 9 CE-LDCTs (64 rows, 120 KV, p 30 mAs/slice) and in 2 control groups of 36 UN-LDCTs and 36 CE-SDCTs, each matched for gender, age, chest/lung diameters, and clinical history. At a significance level of p 0.025 (Bonferroni-correction for two control groups), two-tailed Chi-square and Fisher's exact tests were applied. For the evaluation of the inter-observer agreement, Cohen's kappa statistics were used.CE-LDCT delineated lymph node groups significantly more often than UN-LDCT, in general (p 0.001) and individually in the subcarinal (p 0.025), the hilar (p 0.001), and the peripheral lung (p 0.001) zones. There were no significant differences in lymph node delineation between CE-LDCT and CE-SDCT. Inter-observer agreement was substantial to perfect for all lymph node zones (κ 0.64-1.0). Measurable lymph nodes did not significantly differ in size between cases and controls.At CE-LDCT of the chest, delineation of mediastinal and hilar lymph node groups was superior to UN-LDCT and similar to CE-SDCT. CE-LDCT may be a promising alternative for patients with non-malignant lung disease, unclear chest X-ray findings, or the need for follow-up.

Maligne Beckentumoren stellen 12–13% aller neu diagnostizierten soliden Neoplasien bei Frauen in den USA und in Deutschland dar. Deutsche Leitlinien befurworten bildgebende Untersuchungen bei Lokalrezidiven und Metastasen; fur Primartumoren gibt es keine einschlagigen Empfehlungen. Da das Ausscheidungsurogramm durch die Ausscheidungsaufnahme der CT-Urographie (CTU) weitgehend abgelost ist, wurde bei weiblichen Beckentumoren oder deren Rezidive der Zusammenhang zwischen CTU-Befunden und nachfolgenden operativen urologischen Masnahmen retrospektiv von 2 unabhangigen Auswertern gepruft. Bei 31 CTUs von 27 Frauen (Alter 29–84, Median 57 Jahre) mit 15 Primartumoren und 13 Rezidiven waren 83–100% der unauffalligen oberen, mittleren und unteren Harnleitersegmente in der Ausscheidungsaufnahme (Delay 16 min, Streubreite 6–29) vollstandig abgrenzbar. Haufige pathologische Veranderungen waren Obstruktionen der unteren Harnleiter (19-mal, 61%), Harnblasenkompressionen (13-mal, 42%) und Harnblaseninvasionen (8-mal, 26%). Acht von 20 pathologisch veranderten, jedoch keiner von 10 unauffalligen Harnwegen wurden nachfolgend urologisch operativ versorgt (zweiseitiger Fisher-Exact-Test, p=0,0215). Daher scheint die CTU eine sinnvolle diagnostische Masnahme vor der Weiterbehandlung weiblicher Beckentumoren oder deren Rezidive darzustellen.

Diffusion-weighted magnetic resonance imaging (DWI) can complement MRI of the prostate in the detection and localization of prostate cancer, particularly after previous negative biopsy. A total of 13 original reports and 2 reviews published in 2010 demonstrate that prostate cancer can be detected by DWI due to its increased cell density and decreased diffusiveness, either qualitatively in DWI images or quantitatively by means of the apparent diffusion coefficient (ADC). In the prostate, the ADC is influenced by the strength of diffusion weighting, localization (peripheral or transitional zone), presence of prostatitis or hemorrhage and density and differentiation of prostate cancer cells. Mean differences between healthy tissue of the peripheral zone and prostate cancer appear to be smaller for ADC than for the (choline + creatine)/citrate ratio in MR spectroscopy. Test quality parameters vary greatly between different studies but appear to be slightly better for combined MRI and DWI than for MRI of the prostate alone. Clinical validation of DWI of the prostate requires both increased technical conformity and increased numbers of patients in clinical studies.

An extensive spectrum of differential diagnoses has to be considered when a patient presents with enophthalmos. The most common causes of this presentation include orbital trauma or contraction and atrophy of the orbital contents secondary to scleroderma or radiotherapy. However radiologists also have to consider less common causes of enophthalmos, such as the imploding antrum syndrome or the ethmoid silent sinus syndrome. The latter involves the ethmoidal cells and results in medial orbital wall implosion. Along with the case presentation the pathogenesis, incidence and differential diagnoses of ethmoid silent sinus syndrome are elucidated. In particular the differentiation from normal anatomical variants, such as dehiscent lamina papyracea is discussed.

Excretory-phase CT urography (CTU) may replace excretory urography in patients without urinary tumors. However, radiation exposure is a concern. We retrospectively compared upper urinary tract (UUT) delineation in low-dose and standard CTU. CTU (1-2 phases, 120 KV, 4 × 2.5 mm, pitch 0.875, i.v. non-ionic contrast media, iodine 36 g) was obtained with standard (14 patients, n = 27 UUTs, average 175.6 mAs/slice, average delay 16.8 min) or low-dose (26 patients, n = 86 UUTs, 29 mAs/slice, average delay 19.6 min) protocols. UUT was segmented into intrarenal collecting system (IRCS), upper, middle, and lower ureter (UU,MU,LU). Two independent readers (R1,R2) graded UUT segments as 1-not delineated, 2-partially delineated, 3-completely delineated (noisy margins), 4-completely delineated (clear margins). Chi-square statistics were calculated for partial versus complete delineation and complete delineation (clear margins), respectively. Complete delineation of UUT was similar in standard and low-dose CTU (R1, p > 0.15; R2, p > 0.2). IRCS, UU, and MU clearly delineated similarly often in standard and low-dose CTU (R1, p > 0.25; R2, p > 0.1). LU clearly delineated more often in standard protocols (R1, 18/6 standard, 38/31 low-dose, p > 0.1; R2 18/6 standard, 21/48 low-dose, p

PURPOSE: For nonsuperimposed and three-dimensional imaging of jaws and teeth, multislice computer tomography (MSCT) can be performed, or alternatively digital volume tomography as a cone beam technique can be applied. The radiation dose of both procedures should be evaluated with different methods of dose assessment. MATERIALS AND METHODS: A 4-row MSCT (Volume Zoom Siemens®) and a cone beam CT (NewTom QR-DVT 9000®) were compared regarding the radiation exposure of the patient during a dental examination. Organ dose and effective dose were estimated by thermoluminescence dosimetry (TLD) using an Alderson-Rando phantom for both devices. In addition the effective dose of MSCT was calculated from the CTDI vol -value at scanner display and by CT-Expo® program. RESULTS: The effective dose of MSCT was 0.33 mSv for women (w) and 0.32 mSv for men (m) measured with TLD in the Alderson-Rando phantom, 0.39 / 0.35 mSv (w/m) by CTDI calculation and 0.39 / 0.33 mSv by CT-Expo® program. The effective dose of NewTom® QR-DVT 9000 from TLD measurement was 0.095 / 0.093 mSv (w/m). CONCLUSION: The radiation exposure of a typical dental examination with a NewTom® cone beam DVT is about one third of the MSCT dose. Both techniques, however, moderate patient doses. Dosimetry methods as routinely used for MSCT cannot be applied to cone beam DVT.

The aim was to develop clinical guidelines for multidetector computed tomography urography (CTU) by a group of experts from the European Society of Urogenital Radiology (ESUR). Peer-reviewed papers and reviews were systematically scrutinized. A summary document was produced and discussed at the ESUR 2006 and ECR 2007 meetings with the goal to reach consensus. True evidence-based guidelines could not be formulated, but expert guidelines on indications and CTU examination technique were produced. CTU is justified as a first-line test for patients with macroscopic haematuria, at high-risk for urothelial cancer. Otherwise, CTU may be used as a problem-solving examination. A differential approach using a one-, two- or three-phase protocol is proposed, whereby the clinical indication and the patient population will determine which CTU protocol is employed. Either a combined nephrographic-excretory phase following a split-bolus intravenous injection of contrast medium, or separate nephrographic and excretory phases following a single-bolus injection can be used. Lower dose (CTDIvol 5-6 mGy) is used for benign conditions and normal dose (CTDIvol 9-12 mGy) for potential malignant disease. A low-dose (CTDIvol 2-3 mGy) unenhanced series can be added on indication. The expert-based CTU guidelines provide recommendations to optimize techniques and to unify the radiologist's approach to CTU.

The sensitivity and specificity of MDCT for depiction and localization of urothelial carcinoma (UC) was determined retrospectively. Axial and coronal four-row MDCT of the urinary tract (unenhanced, contrast-enhanced nephrographic, CT urography) was independently reviewed for UC by a radiologist (R1) and a urologist (R2), without other patient information, in 27 patients (22 male, five female; age, 72 +/- 11 years) with previous UC and/or painless macroscopic haematuria. Urinary tract segments included bladder, right and left upper, middle, and lower caliceal groups, renal pelvis, uretero-pelvic junction, upper, middle, and lower ureter. MDCT findings were corroborated by surgery, other invasive procedures, and 1-year follow-up, including MDCT, intravenous urography, and cystoscopy. Receiver-operating characteristic analysis was undertaken and the the area under the curve (AUC) calculated. Eighteen of 27 patients had evidence of UC (pTa, n = 3; pT1-pT3, n = 15; TNM 2002). Tumor was correctly located by both R1 and R2 in 17 patients (sensitivity, 94%; 95% confidence interval, 84-100%) and ruled out in seven (specificity, 78%; 95% confidence interval, 51-100%), with complete agreement. Each detected ten of 11 upper urinary tracts affected by UC. For 35 urinary tract segments with UC and 308 without, the AUC was 0.910 +/- 0.035 (R1) and 0.74 +/- 0.055 (R2), z = 2.4772, Bonferroni-corrected P = 0.022. MDCT depicts urinary tracts affected by UC with high sensitivity and substantial agreement between readers with different training.

To assess structural, technical, and communicative aspects of dedicated MR examinations of the prostate (MRP) offered by radiologists in Germany.We conducted an eight-item online survey among members of the German Radiology Society (DRG). Radiological institutions were asked about their structure, i.e., either hospital department (HD) or private practice (PP), number of board-certified radiologists, postal regions, number of MRPs in 2011, MR technology and MR sequences applied, ways to communicate results, and feedback from referring physicians on results of subsequent tests and procedures. Submissions were cleared of redundancies and anonymized. Differences in the number of positive replies to each item were statistically significant at p0.05 for two-tailed testing in 2 x 2 tables.The survey represented board-certified radiologists in 128 institutions (63 HDs and 65 PPs) in 67/95 German postal regions (71%). Almost two-thirds of institutions performed 11 to 50 MRPs in 2011, more often at 1.5 T (116/128, 91%) than at 3.0 T (36/128, 28%), and most frequently with surface coils (1.5 T, 88/116, 76%; 3.0 T, 34/36, 94%; chi-square, 1.9736, 0.1p0.25). About two-thirds of 1.5 T users and 90% of 3.0 T users applied at least one functional MR modality (diffusion-weighted imaging, dynamic contrast-enhanced imaging, or MR spectroscopy) for MRP. Reports including graphic representations of the prostate were applied by 21/128 institutions (16%). Clinical feedback after MRP to radiologists other than upon their own request was infrequent (HDs, 32-45%, PPs, 18-32%).MRP was a widely available, small-volume examination among radiologists in Germany in 2011. The technology mainstay was a 1.5 T surface coil examination including at least one functional MR modality. Dedicated reporting and feedback mechanisms for quality control were underdeveloped.MRI of the prostate was available in at least 67 of 95 German postal regions (71%) in 2011. MRI of the prostate was most often performed at 1.5 T without an endorectal coil in Germany in 2011. At least two thirds of MRI-examinations of the prostate included both T2WI and at least one functional MR test (mostly DWI, less frequently MRS or DCE) in Germany in 2011. Structured reporting including graphic elements was offered by less than 20% of participating radiological institutions. Feedback to radiologists from referring physicians on subsequent test results in patients with MRI of the prostate most frequently came only upon special request by the radiologist.

Background: Motion artifacts that degrade image quality of coronary CT angiography (CCTA) in patients with high heart rates may be reduced with specific automatic motion correction algorithms (AMC). Objectives: We compared coronary-artery delineation between AMC and conventional CCTA reconstruction (CR). Patients and Methods: CCTA images (clinical single-source-64-slice-CT system) of 17 consecutive patients with heart rates exceeding 55 bpm were reconstructed with both CR and AMC during the individually best-suited phase of the cardiac cycle. Two independent readers who were blinded to the reconstruction algorithm scored image quality of each coronary artery segment (AHA 15-segment-model; 1: non-diagnostic 4: excellent). In case of disagreement a third blinded reader assigned a final score. Two-tailed statistical tests (Wilcoxonmatched-pairs, Pearson-correlation) were significant at P 70 bpm; P = 0.021). Inter-reader agreement was good. (inter-class-correlation, 0.762). Conclusions: CCTA image quality improves significantly with AMC in patients with high heart rates and reduces the proportion of nondiagnostic examinations.

Objectives: The tumor Gleason score is an important prognostic factor in prostate cancer (PCA). This retrospective study analyzes whether serum prostate-specific antigen (PSA), or magnetic resonance imaging (MRI)-based PSA density of the entire prostate (PSAD) or the prostatic transitional zone (PSAT) distinguishes between PCA of Gleason scores 6 or lower (G6-) and 7 or higher (G7+). Materials and Methods: Total prostate and transitional zone volumes were planimetrically determined in axial, T2-weighted fast spin echo (FSE) MRI images of the prostate in 61 patients with previously untreated PCA. Automated standardized microparticle enzyme immuno-assay (EIAs) measured PSA. Results: Thirty patients had G6- and 31 patients had G7+. PSA values ranged from 1.0 to 57.2 ng/mL. Assignment to G6 - or G7+, respectively, was correct in 49 of 61 (80%) cases (odds ratio [OR], 17.1; 95% confidence interval [CI], 4.8-61.5) for PSA above the optimal cutoff level of 10.35 ng/mL, 48 cases (79%; OR, 13.7; 95% CI, 4.0-46.8) for PSAD above the optimal cutoff level of 0.23 ng/ mL/cm 3 , and 45 cases (74%; OR, 6.9; 95% CI, 2.2-21.3) for PSAT above the optimal cutoff level of 0.38 ng/mL/cm 3 (no significant differences, McNemar test). Conclusions: In patients with biopsy-proven PCA, serum PSA level alone and MRI-based PSAD and PSAT help distinguish between G6- and G7+. PSAD and PSAT do not improve the level of confidence at which this discrimination is made.

A novel ureter phantom was developed for investigations of image quality and dose in CT urography. The ureter phantom consisted of a water box (14 cm x 32 cm x 42 cm) with five parallel plastic tubes (diameter 2.7 mm) filled with different concentrations of contrast media (1.88-30 mg iodine/ml). CT density of the tubes and noise of the surrounding water were determined using two multidetector scanners (Philips MX8000 with four rows, Siemens Sensation 16 with 16 rows) with varying tube current-time product (15-100 mAs per slice), voltage (90 kV, 100 kV, 120 kV), pitch (0.875-1.75), and slice thickness (1 mm, 2 mm, 3.2 mm). Contrast-to-noise ratio as a parameter of image quality was correlated with dose (CTDI) and was compared with image evaluation by two radiologists. The CT densities of different concentrations of contrast media and contrast-to-noise ratio were significantly higher when low voltages (90 kV versus 120 kV, 100 kV versus 120 kV) were applied. Smaller slice thickness (1 mm versus 2 mm) did not change CT density but decreased contrast-to-noise ratio due to increased noise. Contrast phantom studies showed favourable effects of low tube voltage on image quality in the low dose range. This may facilitate substantial dose reduction in CT urography.

PURPOSE Intravascular optical coherence tomography (OCT) is a new technique based on infrared light that visualizes the arteries with a resolution of 10-20 microm. Intravascular ultrasound (IVUS) is the current in vivo reference standard and provides a resolution of 100-150 microm. This study compared OCT to IVUS and histopathology with respect to the ability to differentiate atherosclerotic plaques and quantify vascular dimensions in peripheral crural arteries ex vivo. MATERIALS AND METHODS 50 segments of atherosclerotic arteries derived from five amputated human lower extremities were examined. The different plaque types (fibrous, high-lipid content, calcified) were assigned by two independent examiners, and the sensitivity and specificity of OCT in comparison with histopathology as well as intra- and interobserver consensus were calculated. A comparison of OCT with IVUS addressed the parameters: luminal area (LA), vascular wall area (VA) and plaque area (PA). RESULTS When comparing OCT and histopathology with respect to the differentiation of various plaque types, sensitivities of 81 % and specificities of 89 % for fibrous plaques, of 100 % and 93 % for lipid-rich plaques and of 80 % and 89 % for calcified plaques were achieved (overall correlation 83 %). Intra- and interobserver consensus was very high (kappa = 0.86 and kappa = 0.89, p < 0.001, respectively). There was also a high correlation between quantitative measurements (Bland-Altman plot [LA]: mean bias, 0.1 mm(2) accuracy +/- 1.8 mm(2), r = 0.95 [p < 0.001] Bland-Altman plot [VA]: mean bias, 0.3 mm(2) accuracy +/- 2.3 mm(2), r = 0.94 [p < 0.001] Bland-Altman plot [PA]: mean bias, 0.4 mm(2) accuracy +/- 2.3 mm(2), r = 0.80 [p < 0.01]. CONCLUSION OCT allows the differentiation of atherosclerotic plaque types in crural arteries with high accuracy compared to histopathology. Quantitative measurements show a high correlation with IVUS, the current reference standard.

The aim of this study was to reproduce prostate cancer (PCA) localization by MRI based on prostatic sextants (right and left base, middle, and apex) with minimal systematic error. Combined endorectal/body-phased-array-coil MRI of the prostate at 1.5 T was retrospectively evaluated twice, with an interval of more than 1 month, by each of two independent radiologists (R1 readings R11 and R12, and R2 readings R21 and R22) in 23 patients (age 51-75 years) who had radical prostatectomy within 1 month of MRI. PCA stage was pT2 in 14 patients, and pT3 in nine. Median Gleason score was 7 (range 5-9). Histopathology showed 83 sextants with PCA and 55 without. Reproducibility of sextant positions was within one MRI slice (3 mm) in over 80% of cases. For PCA localization, ROC analysis (AUC=0.584+/-0.048-0.724+/-0.043) yielded no significant intra-reader differences. R11 and R21 differed slightly (P=0.035). Intra-observer agreement (kappa=0.52-0.58) exceeded inter-observer agreement (kappa=0.35-0.45). Intra-observer Spearman correlation (r=0.72-0.74) exceeded inter-observer correlation (r=0.43-0.51) for sextants with PCA, but not for sextants without (r=0.69-0.74). Per-sextant localization and reporting provides a highly reliable framework in MRI of the prostate. MRI of the prostate should be followed up by the same radiologists to minimize systematic error of interpretation.

Purpose To assess image quality of chest CT with an 80 to 90 percent dose reduction in follow-up studies of patients with lung disease, dose and image quality of a low-dose protocol was investigated. Materials and methods A follow-up low-dose CT (ND-CT, 120 kV, 10 mAs/slice, 3 mm slice thickness) was performed on 35 patients with non-malignant lung disease and compared with the initial standard dose CT (= SD-CT, 100 mAs/slice, 3 or 5 mm slice thickness). The dose was measured by thermo-luminescence in an Alderson phantom. Image quality was assessed by four independent radiologists in six perihilar, central and peripheral lung regions using a 4-point-scale ("very good", "good", "moderate", and "poor"). Results Effective dose was 0.5 mSv for ND-CT and 4.0 - 5.0 mSv for SD-CT. The ratings "very good"/"good" were given in the perihilar regions in ND-CT 97.5 % versus SD-CT 99.3 % (n. s.), in the central regions in ND-CT 96.4 % versus SD-CT 94.6 % (n. s.), and in the peripheral regions in ND-CT 70.0 % versus SD-CT 88.2 % (p Conclusion Follow-up CT of pulmonary structures in patients with chronic lung disease can be performed with substantial dose reduction. A decrease of image quality may result in peripheral lung regions.

OBJECTIVE As a screening test for prostate cancer (PCA), prostate-specific antigen (PSA) may induce unnecessary prostate biopsy in patients with PSA 4.1-10.0 ng/ml. PCA detection may be delayed in patients with PSA < or =4.0 ng/ml. MRI-based PSA density of the prostate (PSAD) and of the prostatic transitional zone (PSAT) could improve differentiation of PCA and benign prostatic hyperplasia. MATERIAL AND METHODS Total prostate and transitional zone volumes were planimetrically determined in axial, T2-weighted fast spin echo MR images of the prostate. Serum PSA concentration was measured with an automated standardized microparticle enzyme immune assay. PSAD and PSAT were calculated in 17 patients with clinically significant PCA and 42 patients with benign prostatic hypertrophy (BPH) (66 +/- 6 versus 64 +/- 8 years, p = 0.2410, t test) who had PSA levels < or =10.0 ng/ml. RESULTS For differentiation of BPH and PCA, PSA alone above the optimal cutoff level of 4.2 ng/ml showed an odds ratio for PCA of 6.7 (95% confidence interval [CI], 1.9-23.2). PSAD showed an odds ratio for PCA of 71.3 (95% CI, 11.8-430.9) above the optimal cutoff level of 0.07 ng/ml/cc. PSAT demonstrated an odds ratio for PCA of 320.0 (95% CI, 27.1-3781.4) above the optimal cutoff level of 0.15 ng/ml/cc. CONCLUSIONS In patients with PSA < or =10.0 ng/ml, MRI-based PSAD and PSAT appear to improve differentiation of prostate cancer and BPH and are feasible to reduce the frequency of unnecessary prostate biopsy.

The purpose of our study was to evaluate the use of 2D-selective, parallel-transmit excitation magnetic resonance imaging (MRI) for diffusion-weighted echo-planar imaging (pTX-EPI) of the prostate, and to compare it to conventional, single-shot EPI (c-EPI).The MRI examinations of 35 patients were evaluated in this prospective study. PTX-EPI was performed with a TX-acceleration factor of 1.7 and a field of view (FOV) of 150 × 90 mm(2), whereas c-EPI used a full FOV of 380 × 297 mm(2). Two readers evaluated three different aspects of image quality on 5-point Likert scales. To quantify distortion artefacts, maximum diameters and prostate volume were determined for both techniques and compared to T2-weighted imaging.The zoomed pTX-EPI was superior to c-EPI with respect to overall image quality (3.39 ± 0.62 vs 2.45 ± 0.67) and anatomic differentiability (3.29 ± 0.65 vs 2.41 ± 0.65), each with p 0.0001. Artefacts were significantly less severe in pTX-EPI (0.93 ± 0.73 vs 1.49 ± 1.08), p 0.001. The quantitative analysis yielded a higher agreement of pTX-EPI with T2-weighted imaging than c-EPI with respect to coronal (ICCs: 0.95 vs 0.93) and sagittal (0.86 vs 0.73) diameters as well as prostate volume (0.94 vs 0.92). Apparent diffusion coefficient (ADC) values did not differ significantly between the two techniques (p 0.05).Zoomed pTX-EPI leads to substantial improvements in diffusion-weighted imaging (DWI) of the prostate with respect to different aspects of image quality and severity of artefacts.Recent technical developments in MRI allow the use of accelerated, spatially-selective excitation (parallel-transmit, pTX). pTX can be used for zoomed echo-planar prostate imaging (pTX-EPI). pTX-EPI improves different aspects of image quality in prostate MRI. Distortion artefacts are reduced by the use of pTX-EPI in prostate MRI. Further studies should aim at assessing the diagnostic accuracy of pTX-EPI.

To determine the accuracy of combined magnetic resonance (MR) imaging and three-dimensional (3D) proton MR spectroscopic imaging in localizing prostate cancer to a sextant of the gland in patients receiving hormone deprivation therapy.Combined MR imaging/3D MR spectroscopic imaging examinations were performed in 16 hormone-treated patients and 48 nontreated matched control patients before radical prostatectomy and step-section histopathologic analysis. At MR imaging, cancer presence within the peripheral zone was assessed on a per sextant basis by two readers. At 3D MR spectroscopic imaging, cancer was identified by using (choline plus creatine)-to-citrate ratios at cutoff values of 2 and 3 SDs above mean normal peripheral zone values. Data were compared by using receiver operating characteristic analysis.There was no significant difference in the ability of combined MR imaging/3D MR spectroscopic imaging to localize prostate cancer in treated versus control patients. For MR imaging alone, the sensitivity and specificity were 91% and 48% (reader 1) and 75% and 60% (reader 2) in treated patients versus 79% and 60% (reader 1) and 84% and 43% (reader 2) in control patients. For 3D MR spectroscopic imaging alone (3 SDs cutoff), higher specificity (treated, 80%; controls, 73%) but lower sensitivity (treated, 56%; controls, 53%) was attained. In treated patients, high sensitivity or specificity (up to 92%) was achieved when either or both modalities indicated cancer.When performed within 4 months after initiating hormone deprivation therapy, combined MR imaging/3D MR spectroscopic imaging had the same accuracy in localizing prostate cancer as in nontreated patients.

The purpose of our study was to determine relative values of rapid acquisition relaxation enhancement (RARE) and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences in breathhold magnetic resonance (MR) urography in healthy volunteers under nonobstructive conditions of the urinary tract. A total of 20 healthy volunteers underwent MR urography with breathhold RARE and HASTE sequences at 1.5 T. For evaluation, the urinary tract was divided into nine segments on each side. Visualization of segments and artifacts was scored and the intensity ratios (InR) were determined. The upper five urinary segments were sufficiently visualized with RARE and significantly better with HASTE (renal calices, p = 0.002-0.037). The middle and lower ureter was sufficiently delineated both with RARE and HASTE, but HASTE images were statistically superior (p = 0.009-0.041). Both in RARE and HASTE images, the lower ureter was frequently superimposed by bowel contents and bowel motion. Superimposition of genital organs degraded image quality in eight of ten female volunteers. InRs were superior with HASTE in the kidney and ureter (p = 0.0003-0.0125). RARE InRs were higher in the bladder (p = 0.0008-0.014). We concluded that neither the RARE nor the HASTE sequences allowed the evaluation of the entire urinary tract under nonobstructive conditions. Although it cannot entirely replace intravenous urography, MR urography seems to lend itself to combination with other MR techniques, particularly in the investigation of pelvic or retroperitoneal disease.

The purpose of this study was to predict diameters of lesions induced by laser-induced thermotherapy (LITT) of benign prostatic hyperplasia (BPH) from MRI signal/tissue temperature correlations during on-line monitoring with a temperature-sensitive fast low-angle shot (FLASH) sequence. Twenty LITT procedures with Nd:YAG (1,064 nm) and diode (830 nm) lasers were monitored on line with a T1-weighted FLASH sequence at 1.5 Tesla. Interstitial prostate temperature (T) was measured on line in 10 LITT procedures and laser energy deposition in 12. Slopes of linear regression curves for signal intensity (SI) over T were applied to determine SI at 60 degrees C to estimate diameters of intraprostatic LITT lesions. Diameters of unperfused LITT lesion cores in contrast-enhanced T1-weighted images served as gold standards. Linear regression curves with an average slope of -.54% SI/degrees C were obtained in 17 LITT procedures. Correlation coefficients were r = .92-.95 for SI/T and SI/energy deposition. Baseline variation of SI at body temperature was +/-3.9%, corresponding to +/-7 degrees C. Prediction of size (13 lesions) from on-line FLASH imaging was correct in 10 of 13, whereas 3 lesions were overestimated. Prediction of LITT lesion diameters from on-line MRI monitoring is possible with a temperature-sensitive FLASH sequence in the prostate. Accuracy may suffice to assign target regions of interest to tissue locations to be protected from coagulation.

Purpose To summarize current technical and biochemical aspects and clinical applications of proton magnetic resonance spectroscopy (MRS) of the human prostate in vivo . Material and methods Pertinent radiological and biochemical literature was searched and retrieved via electronic media (medline ® , pubmed ® ). Basic concepts of MRS of the prostate and its clinical applications were extracted. Results Clinical MRS is usually based on point resolved spectroscopy (PRESS) or spin echo (SE) sequences, along with outer volume suppression of signals from outside of the prostate. MRS of the prostate detects indicator lines of citrate, choline, and creatine. While healthy prostate tissue demonstrates high levels of citrate and low levels of choline that marks cell wall turnover, prostate cancer utilizes citrate for energy metabolism and shows high levels of choline. The ratio of (choline+creatine)/citrate distinguishes between healthy tissue and prostate cancer. Particularly when combined with magnetic resonance (MR) imaging, three-dimensional MRS imaging (3D-CSI, or 3D-MRSI) detects and localizes prostate cancer in the entire prostate with high sensitivity and specificity. Combined MR imaging and 3D-MRSI exceed the sensitivity and specificity of sextant biopsy of the prostate. When MRS and MR imaging agree on prostate cancer presence, the positive predictive value is about 80–90%. Distinction between healthy tissue and prostate cancer principally is maintained after various therapeutic treatments, including hormone ablation therapy, radiation therapy, and cryotherapy of the prostate. Conclusions Since it is non-invasive, reliable, radiation-free, and essentially repeatable, combined MR imaging and 3D-MRSI of the prostate lends itself to the planning of biopsy and therapy, and to post-therapeutic follow-up. For broad clinical acceptance, it will be necessary to facilitate MRS examinations and their evaluation and make MRS available to a wider range of institutions.

The objective of our study was to determine the diagnostic accuracy and interobserver agreement of 1.5-T prostatic MRI for per-sextant tumor localization and staging of prostate cancer as compared with whole-mount step section histopathology.Combined endorectal-pelvic phased-array prostatic MRI scans obtained at 1.5 T of 106 patients with biopsy-proven prostate cancer who had undergone radical prostatectomy with whole-mount step section histopathology within 28 days of MRI were retrospectively analyzed by three independent abdominal radiologists (reviewers 1, 2, and 3). Sextants of the prostate (right and left base, middle, and apex) were evaluated for the presence of prostate cancer and extracapsular extension (ECE) using a 5-point confidence scale. Data were statistically analyzed using receiver operating characteristic (ROC) analysis. Interobserver variability was assessed by kappa statistics. For calculation of sensitivity and specificity, data from the 5-point confidence scale were dichotomized into negative (score of 1-3) or positive (score of 4 or 5) findings.Forty-one patients had ECE (tumor stage T3), and 65 patients had organ-confined disease (stage T2). Of 636 prostatic sextants, 417 were positive for prostate cancer and 135 were positive for ECE at histopathology. For prostate cancer localization, ROC analysis yielded area under the ROC curve (AUC) values ranging from 0.776 +/- 0.023 (SD) to 0.832 +/- 0.027. For the detection of ECE, the AUC values ranged from 0.740 +/- 0.054 to 0.812 +/- 0.045. Interobserver agreement (kappa) ranged from 0.49 to 0.60 for prostate cancer localization and from 0.59 to 0.67 for the detection of ECE.Using the sextant framework, independent observers reach similar accuracy with moderate to substantial agreement for the localization of prostate cancer and ECE by means of MRI of the prostate.

Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (kappa) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo.

As in other malignant tumors, prognosis in renal cell carcinoma (RCC) depends on tumor extent and metastasis at the time of primary diagnosis. Staging systems formalize the way in which the extent of RCC is being described and classified. Primary staging of RCC aims at evaluating surgical options. Since surgical excision, which is the mainstay of therapy in non-metastatic RCC, and, recently, minimally invasive ablation methods have evolved significantly over the last decades, staging systems continue to evolve along the way. The 40-year-old Robson classification has been replaced with the TNM classification of RCC, because the latter adapts more easily to changing patterns of diagnosis and therapy. Modern cross-sectional imaging methods, such as multidetector-row computed tomography (MDCT), and magnetic resonance imaging (MRI), perform highly in T-staging of local tumor extent and M-staging of distant metastasis. However, both MDCT and MRI perform poorly in N-staging of lymphadenopathy. At present, 18-F-desoxy-glucose positron emission tomography (FDG-PET) appears to be unreliable in the detection of RCC and its metastasis. This overview of current radiological and surgical literature attempts to describe how modern staging systems for RCC are organized, and which radiological and surgical developments currently influence the way in which primary staging and prognosis of RCC depend on one another.

PURPOSE Intravascular optical coherence tomography (OCT) is a new imaging modality that provides microstructural information on atherosclerotic plaques and has an axial resolution of 10–20 μm. OCT of coronary arteries characterizes different atherosclerotic plaque components by their distinctive signal patterns. Peripheral human arteries were examined ex vivo by means of OCT, and attempts to distinguish among fibrous, lipid-rich, and calcified atherosclerotic plaques were made based on imaging criteria previously established for coronary arteries. MATERIALS AND METHODS One hundred fifty-one atherosclerotic arterial segments were obtained from 15 below-knee amputations. OCT imaging criteria for different plaque types (fibrous, lipid-rich, calcified) were established in a subset of 30 arterial segments. The remaining 121 OCT images were analyzed by two independent readers. Each segment was divided into four quadrants. Agreement between histopathology and OCT was quantified by the κ test of concordance, as were interobserver, intraobserver, and intermethod variability. RESULTS Four hundred sixty-nine of 484 quadrants (97%) were available for comparison. Sensitivity and specificity for OCT criteria (consensus readers 1 and 2) were 86% and 86% for fibrous plaques, 78% and 93% for lipid-rich plaques, and 84% and 95% for calcified plaques, respectively (overall agreement, 84%). The interobserver and intraobserver reliabilities of OCT assessment were high (κ values of 0.84 and 0.87, respectively). The intermethod agreement was 0.74 for consensus OCT versus consensus histology. CONCLUSIONS OCT of peripheral human arteries ex vivo characterized different atherosclerotic plaque types with a high degree of agreement with histopathologic findings. Findings were comparable to those reported for coronary arteries. OCT promises to improve understanding of the progression or regression of peripheral atherosclerosis in vivo.

Primare Tumoren der ableitenden Harnwege sind meistens Urothelkarzinome, deutlich seltener andere Tumorentitaten, wie z.B. Plattenepithelkarzinome oder entzundliche Pseudotumoren. Sekundarer Tumorbefall kommt oft durch Einwachsen von malignen Tumoren des Urogenital- oder Gastrointestinaltraktes in die ableitenden Harnwege zu Stande. Unter den bildgebenden Untersuchungsverfahren hat die Sonographie vorwiegend eine Suchfunktion in der Erstdiagnostik. Die gezielte urologische Untersuchung umfasst endoskopische Verfahren mit Biopsiemoglichkeit und radiologische Verfahren wie z.B. Zysturethrographie (CUG), Ausscheidungsurogramm (AUG) oder retrograde Ureteropyelographie (RUP). Diese Untersuchungsverfahren erfassen Lokalbefunde innerhalb der ableitenden Harnwege, wahrend die radiologische CT und MRT bislang vorwiegend zur Bestimmung der extraluminalen Tumorausdehnung eingesetzt worden sind. Die Einfuhrung der Multidetektor-Computertomographie (MDCT) hat die raumliche Auflosung der CT-Aufnahmen in Richtung der Tischverschiebung und die Geschwindigkeit der Datenaufzeichnung erheblich verbessert. Damit kann das Abdomen von den Nebennieren bis zum Blasenboden in einer Atemanhaltephase untersucht werden. Im Vergleich zur Einzeilen-CT ist eine wesentlich genauere Darstellung des Nierenbeckenkelchsystems und der Harnleiter moglich. Die Kombination nativer und kontrastverstarkter MDCT-Aufnahmen (nephrographische Phase und Ausscheidungsphase) kann sowohl Tumoren innerhalb der ableitenden Harnwege als auch die Kompression durch ausere Tumoren erfassen. Vorteile im Vergleich zu CUG, AUG und RUP ergeben sich vor allem bei der Suche nach den Ursachen einer Obstruktion oder Dilatation der ableitenden Harnwege. MRT-Aufnahmen konnen ebenfalls in Atemanhaltetechnik mit hoher raumlicher Auflosung erfolgen, insbesondere wenn moderne Spulensysteme mit multiplen Elementen eingesetzt werden. Gegenwartig wird die MRT in den oberen Harnwegen vorwiegend zur Problemlosung in Einzelfallen eingesetzt. In der Harnblase und Harnrohre kann der Einsatz der MRT aufgrund des hohen Weichteilkontrastes jedoch vorteilhaft sein. Lernziele: Korrespondierender Autor: Mueller-Lisse UG Klinikum der Universitat Munchen, Institut fur Klinische Radiologie, Ziemssenstrasse 1, 80336 Munchen E-Mail: ullrich.mueller-lisse@med.uni-muenchen.de

This study was undertaken to determine respective associations between prostatic citrate or metabolic atrophy (no detectable citrate, choline, and creatine) at magnetic resonance spectroscopy (MRS) and time on hormone-deprivation therapy, serum PSA, and biopsy Gleason score. Clinical data, histopathology reports and PSA levels of 36 patients on hormone-deprivation therapy (age, 64+/-9 years, pre-therapeutic biopsy Gleason sum, median 6, range 3-8, antiandrogens only, n=3, LHRH-analogues only, n=4, combined hormone-deprivation therapy, n=29, duration, 27+/-19 weeks) for locally confined prostate cancer (PCA) were retrospectively correlated with findings in the peripheral zone of the prostate at 3D-MRS (endorectal coil, PRESS, TR 1,000 ms, TE 130 ms). The results show that citrate was usually detected after 13 weeks or less of hormone-deprivation therapy (10/12 vs. 6/24 patients, chi-square-test, p=0.002). All patients with PSA levels exceeding 0.20 ng/ml had detectable metabolites (citrate, n=12, choline without citrate, n=6), while 9/18 patients with PSA 0.20 ng/ml or less showed metabolic atrophy (Fisher-exact-test, p=0.001). There were no significant associations between citrate, metabolic atrophy, pre-therapeutic PSA, and biopsy Gleason sum, respectively. It has been concluded that hormone-deprivation therapy for locally confined PCA has not reached its full deprivation potential after 13 weeks. MRS detects prostate metabolism in patients with PSA exceeding 0.20 ng/ml after hormone-deprivation therapy.