Peripheral zone prostate cancer

Accuracy of different interpretative approaches with MR and MR spectroscopic imaging

Antonio C. Westphalen, Fergus Coakley, Aliya Qayyum, Mark Swanson, Jeffry P. Simko, Ying Lu, Shoujun Zhao, Peter R. Carroll, Benjamin M. Yeh, John Kurhanewicz

Research output: Contribution to journalArticle

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Abstract

Purpose: To retrospectively compare relative accuracy of different interpretative approaches to magnetic resonance (MR) and MR spectroscopic imaging of peripheral zone prostate cancer, by using histologic examination results as the reference standard. Materials and Methods: This HIPAA-compliant study had institutional Committee on Human Research approval, with waiver of written consent requirement. Spectroscopic voxels of unequivocally benign (n = 66) or malignant (n = 77) peripheral zone tissue were identified by using step-section histopathologic tumor maps created for 28 men (mean age, 60 years; range, 46-71 years) who underwent endorectal MR and MR spectroscopic imaging before radical prostatectomy. Two readers (9 and 8 years of experience) independendy scored the selected voxels on a scale from 1 (likely benign) to 5 (likely malignant) at randomized review of the corresponding tissue outlined on a transverse T2-weighted MR image (T2 approach), the MR spectrum from the selected voxel only (single-voxel approach), the MR spectra from all voxels at the same axial level (multivoxel approach), and both the corresponding tissue outlined on a transverse T2-weighted image and the MR spectra from all voxels at the same axial level (integrated approach). Readers were aware that spectra were derived in patients with biopsy-proved diagnoses of prostate cancer and represented either benign or malignant tissue but were unaware of which voxels had been labeled benign or malignant and of all other clinical, histopathologic, and MR imaging findings. Receiver operating characteristic (ROC) curve analysis was performed. Generalized estimating equation method was used to estimate sensitivity and specificity for specific cutoff values. Results: Mean areas under the ROC curve (AUCs) for the T2, single-voxel, multivoxel, and integrated approaches were 0.69, 0.72, 0.72, and 0.76, respectively. AUC of the integrated approach was significantly higher than those of the other three approaches (F <.001). κ Values for assessment of interobserver variability for the T2, single-voxel, multivoxel, and integrated approaches were 0.39, 0.39, 0.34, and 0.48, respectively. Conclusion: Addition of MR spectroscopic imaging to MR imaging significantly improves characterization of peripheral zone prostate tissue as benign or malignant; improved performance is obtained when both data sets are interpreted in an integrated fashion.

Original languageEnglish (US)
Pages (from-to)177-184
Number of pages8
JournalRadiology
Volume246
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

Fingerprint

Prostatic Neoplasms
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
ROC Curve
Health Insurance Portability and Accountability Act
Observer Variation
Prostatectomy
Area Under Curve
Prostate
Biopsy
Sensitivity and Specificity
Research
Neoplasms

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Peripheral zone prostate cancer : Accuracy of different interpretative approaches with MR and MR spectroscopic imaging. / Westphalen, Antonio C.; Coakley, Fergus; Qayyum, Aliya; Swanson, Mark; Simko, Jeffry P.; Lu, Ying; Zhao, Shoujun; Carroll, Peter R.; Yeh, Benjamin M.; Kurhanewicz, John.

In: Radiology, Vol. 246, No. 1, 01.2008, p. 177-184.

Research output: Contribution to journalArticle

Westphalen, AC, Coakley, F, Qayyum, A, Swanson, M, Simko, JP, Lu, Y, Zhao, S, Carroll, PR, Yeh, BM & Kurhanewicz, J 2008, 'Peripheral zone prostate cancer: Accuracy of different interpretative approaches with MR and MR spectroscopic imaging', Radiology, vol. 246, no. 1, pp. 177-184. https://doi.org/10.1148/radiol.2453062042
Westphalen, Antonio C. ; Coakley, Fergus ; Qayyum, Aliya ; Swanson, Mark ; Simko, Jeffry P. ; Lu, Ying ; Zhao, Shoujun ; Carroll, Peter R. ; Yeh, Benjamin M. ; Kurhanewicz, John. / Peripheral zone prostate cancer : Accuracy of different interpretative approaches with MR and MR spectroscopic imaging. In: Radiology. 2008 ; Vol. 246, No. 1. pp. 177-184.
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abstract = "Purpose: To retrospectively compare relative accuracy of different interpretative approaches to magnetic resonance (MR) and MR spectroscopic imaging of peripheral zone prostate cancer, by using histologic examination results as the reference standard. Materials and Methods: This HIPAA-compliant study had institutional Committee on Human Research approval, with waiver of written consent requirement. Spectroscopic voxels of unequivocally benign (n = 66) or malignant (n = 77) peripheral zone tissue were identified by using step-section histopathologic tumor maps created for 28 men (mean age, 60 years; range, 46-71 years) who underwent endorectal MR and MR spectroscopic imaging before radical prostatectomy. Two readers (9 and 8 years of experience) independendy scored the selected voxels on a scale from 1 (likely benign) to 5 (likely malignant) at randomized review of the corresponding tissue outlined on a transverse T2-weighted MR image (T2 approach), the MR spectrum from the selected voxel only (single-voxel approach), the MR spectra from all voxels at the same axial level (multivoxel approach), and both the corresponding tissue outlined on a transverse T2-weighted image and the MR spectra from all voxels at the same axial level (integrated approach). Readers were aware that spectra were derived in patients with biopsy-proved diagnoses of prostate cancer and represented either benign or malignant tissue but were unaware of which voxels had been labeled benign or malignant and of all other clinical, histopathologic, and MR imaging findings. Receiver operating characteristic (ROC) curve analysis was performed. Generalized estimating equation method was used to estimate sensitivity and specificity for specific cutoff values. Results: Mean areas under the ROC curve (AUCs) for the T2, single-voxel, multivoxel, and integrated approaches were 0.69, 0.72, 0.72, and 0.76, respectively. AUC of the integrated approach was significantly higher than those of the other three approaches (F <.001). κ Values for assessment of interobserver variability for the T2, single-voxel, multivoxel, and integrated approaches were 0.39, 0.39, 0.34, and 0.48, respectively. Conclusion: Addition of MR spectroscopic imaging to MR imaging significantly improves characterization of peripheral zone prostate tissue as benign or malignant; improved performance is obtained when both data sets are interpreted in an integrated fashion.",
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AU - Coakley, Fergus

AU - Qayyum, Aliya

AU - Swanson, Mark

AU - Simko, Jeffry P.

AU - Lu, Ying

AU - Zhao, Shoujun

AU - Carroll, Peter R.

AU - Yeh, Benjamin M.

AU - Kurhanewicz, John

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N2 - Purpose: To retrospectively compare relative accuracy of different interpretative approaches to magnetic resonance (MR) and MR spectroscopic imaging of peripheral zone prostate cancer, by using histologic examination results as the reference standard. Materials and Methods: This HIPAA-compliant study had institutional Committee on Human Research approval, with waiver of written consent requirement. Spectroscopic voxels of unequivocally benign (n = 66) or malignant (n = 77) peripheral zone tissue were identified by using step-section histopathologic tumor maps created for 28 men (mean age, 60 years; range, 46-71 years) who underwent endorectal MR and MR spectroscopic imaging before radical prostatectomy. Two readers (9 and 8 years of experience) independendy scored the selected voxels on a scale from 1 (likely benign) to 5 (likely malignant) at randomized review of the corresponding tissue outlined on a transverse T2-weighted MR image (T2 approach), the MR spectrum from the selected voxel only (single-voxel approach), the MR spectra from all voxels at the same axial level (multivoxel approach), and both the corresponding tissue outlined on a transverse T2-weighted image and the MR spectra from all voxels at the same axial level (integrated approach). Readers were aware that spectra were derived in patients with biopsy-proved diagnoses of prostate cancer and represented either benign or malignant tissue but were unaware of which voxels had been labeled benign or malignant and of all other clinical, histopathologic, and MR imaging findings. Receiver operating characteristic (ROC) curve analysis was performed. Generalized estimating equation method was used to estimate sensitivity and specificity for specific cutoff values. Results: Mean areas under the ROC curve (AUCs) for the T2, single-voxel, multivoxel, and integrated approaches were 0.69, 0.72, 0.72, and 0.76, respectively. AUC of the integrated approach was significantly higher than those of the other three approaches (F <.001). κ Values for assessment of interobserver variability for the T2, single-voxel, multivoxel, and integrated approaches were 0.39, 0.39, 0.34, and 0.48, respectively. Conclusion: Addition of MR spectroscopic imaging to MR imaging significantly improves characterization of peripheral zone prostate tissue as benign or malignant; improved performance is obtained when both data sets are interpreted in an integrated fashion.

AB - Purpose: To retrospectively compare relative accuracy of different interpretative approaches to magnetic resonance (MR) and MR spectroscopic imaging of peripheral zone prostate cancer, by using histologic examination results as the reference standard. Materials and Methods: This HIPAA-compliant study had institutional Committee on Human Research approval, with waiver of written consent requirement. Spectroscopic voxels of unequivocally benign (n = 66) or malignant (n = 77) peripheral zone tissue were identified by using step-section histopathologic tumor maps created for 28 men (mean age, 60 years; range, 46-71 years) who underwent endorectal MR and MR spectroscopic imaging before radical prostatectomy. Two readers (9 and 8 years of experience) independendy scored the selected voxels on a scale from 1 (likely benign) to 5 (likely malignant) at randomized review of the corresponding tissue outlined on a transverse T2-weighted MR image (T2 approach), the MR spectrum from the selected voxel only (single-voxel approach), the MR spectra from all voxels at the same axial level (multivoxel approach), and both the corresponding tissue outlined on a transverse T2-weighted image and the MR spectra from all voxels at the same axial level (integrated approach). Readers were aware that spectra were derived in patients with biopsy-proved diagnoses of prostate cancer and represented either benign or malignant tissue but were unaware of which voxels had been labeled benign or malignant and of all other clinical, histopathologic, and MR imaging findings. Receiver operating characteristic (ROC) curve analysis was performed. Generalized estimating equation method was used to estimate sensitivity and specificity for specific cutoff values. Results: Mean areas under the ROC curve (AUCs) for the T2, single-voxel, multivoxel, and integrated approaches were 0.69, 0.72, 0.72, and 0.76, respectively. AUC of the integrated approach was significantly higher than those of the other three approaches (F <.001). κ Values for assessment of interobserver variability for the T2, single-voxel, multivoxel, and integrated approaches were 0.39, 0.39, 0.34, and 0.48, respectively. Conclusion: Addition of MR spectroscopic imaging to MR imaging significantly improves characterization of peripheral zone prostate tissue as benign or malignant; improved performance is obtained when both data sets are interpreted in an integrated fashion.

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