A qualitative approach to combined magnetic resonance imaging and spectroscopy in the diagnosis of prostate cancer

Abstract Purpose To investigate the feasibility and diagnostic value of a whole prostate qualitative approach to combined magnetic resonance imaging and spectroscopy (MRI + MRS) in the detection of prostate cancer in patients with elevated PSA. Materials and methods Three hundred and fifty six subjects (mean serum PSA 11.47 ng/ml, range 0.40–133 ng/ml) were examined with fast-T2-weighted images (MRI) and 3D-magnetic resonance spectroscopy (MRS). Both modalities were qualitatively analyzed on a whole prostate basis by a single radiologist using a 4-point diagnostic scale. Prostate cancer was histopathologically proven in 220 patients and non-evidence of cancer was determined after at least 12 months clinical follow-up in 136 subjects. Results Receiver operating curve analysis revealed a significantly better diagnostic performance of MRI + MRS ( Az = 0.857) than MRI alone ( Az = 0.801) and MRS alone ( Az = 0.810). The sensitivity, specificity and accuracy of MRI + MRS for detection of prostate cancer were 72.3%, 92.6%, and 80.1%, respectively. Conclusions Spectral evaluation with a whole prostate qualitative approach is feasible in routine clinical practice. The combination of MRI and MRS yields superior diagnostic results than either modality alone.