Diffusion and Perfusion MR Imaging of the Prostate

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Conventional anatomic MR imaging has evolved to a superior modality in the evaluation of prostate carcinoma and is now a widely established technique in the detection and staging of this disease, aiding in clinical decision making on treatment and therapy evaluation. Recent improvements in functional MR techniques, such as diffusion-weighted MR imaging and dynamic contrast-enhanced MR imaging, have greatly increased the impact of MR imaging in prostate cancer. The combination of T2-weighted imaging, diffusion-weighted MR imaging, and dynamic contrast-enhanced MR imaging may overcome the limitations of conventional T2-weighted MR imaging of the prostate and may be able accurately to detect, localize, stage, and grade prostate carcinoma and guide biopsies.

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Diffusion and Prostate Cancer

Water molecules exhibit random motion in tissue, related to temperature (Brownian effect).1 DWI can quantify this water motion in an indirect manner.2, 3 The DWI pulse sequence labels hydrogen nuclei in space, of which most is water molecules at any moment, and determines the length of the path that water molecules travel over a short period of time. DWI estimates the mean distance traveled by all hydrogen nuclei in every voxel of imaged tissue. The greater this mean distance the more

Angiogenesis and Prostate Cancer

For a tumor, one critical factor that affects development, growth, invasiveness, and progression into the metastatic form is the ability of the tumor to generate new blood vessels. Angiogenesis, the sprouting of new capillaries from existing blood vessels, and vasculogenesis, the de novo generation of new blood vessels, are the two primary methods of vascular expansion by which nutrient supply to tumor tissue is adjusted to match physiologic needs.49 Tumor growth beyond 1 to 2 mm in solid

Current research and focuses for the future in diffusion-weighted MR imaging and dynamic contrast-enhanced MR imaging of the prostate

The technical feasibility of DWI and DCE MR imaging techniques for prostate imaging is now well established. Current and future research should focus on the additive values of DWI and DCE MR imaging to conventional and other MR imaging techniques of the prostate.

The performance of prostate DWI and DCE MR imaging is likely to gain from computer-assisted diagnosis.66 The combination of the quantitative functional data makes these techniques very suitable for computer analysis and prospective

Summary

DWI is an advanced MR imaging technique that still needs to be clinically validated in addition to the more commonly used anatomic MR imaging sequences, such as high-resolution T2-weighted imaging. With the increasing availability of 3-T systems, and with the concomitant use of an endorectal coil, the quality of prostate DWI will further improve and this will likely increase its clinical usefulness.

DCE MR imaging of the prostate is increasingly recognized as a potential tool for imaging of

Acknowledgments

The authors thank Christina Hulsbergen–van der Kaa, MD, PhD, for sharing her experience on histopathologic assessment of the prostate.

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