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European Radiology
Published in: European Radiology 8/2019

Open Access 01-08-2019 | Magnetic Resonance

Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

Authors: Catarina Dinis Fernandes, Ghazaleh Ghobadi, Henk G. van der Poel, Jeroen de Jong, Stijn W. T. P. J. Heijmink, Ivo Schoots, Iris Walraven, Petra J. van Houdt, Milena Smolic, Floris J. Pos, Uulke A. van der Heide

Published in: European Radiology | Issue 8/2019

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Abstract

Objectives

Diagnosis of radio-recurrent prostate cancer using multi-parametric MRI (mp-MRI) can be challenging due to the presence of radiation effects. We aim to characterize imaging of prostate tissue after radiation therapy (RT), using histopathology as ground truth, and to investigate the visibility of tumor lesions on mp-MRI.

Methods

Tumor delineated histopathology slides from salvage radical prostatectomy patients, primarily treated with RT, were registered to MRI. Median T2-weighted, ADC, Ktrans, and kep values in tumor and other regions were calculated. Two radiologists independently performed mp-MRI-based tumor delineations which were compared with the true pathological extent. General linear mixed-effect modeling was used to establish the contribution of each imaging modality and combinations thereof in distinguishing tumor and benign voxels.

Results

Nineteen of the 21 included patients had tumor in the available histopathology slides. Recurrence was predominantly multifocal with large tumor foci seen after external beam radiotherapy, whereas these were small and sparse after low-dose-rate brachytherapy. MRI-based delineations missed small foci and slightly underestimated tumor extent. The combination of T2-weighted, ADC, Ktrans, and kep had the best performance in distinguishing tumor and benign voxels.

Conclusions

Using high-resolution histopathology delineations, the real tumor extent and size were found to be underestimated on MRI. mp-MRI obtained the best performance in identifying tumor voxels. Appropriate margins around the visible tumor-suspected region should be included when designing focal salvage strategies. Recurrent tumor delineation guidelines are warranted.

Key Points

• Compared to the use of individual sequences, multi-parametric MRI obtained the best performance in distinguishing recurrent tumor from benign voxels.
• Delineations based on mp-MRI miss smaller foci and slightly underestimate tumor volume of local recurrent prostate cancer.
• Focal salvage strategies should include appropriate margins around the visible tumor.
Appendix
Available only for authorised users
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Metadata
Title
Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy
Authors
Catarina Dinis Fernandes
Ghazaleh Ghobadi
Henk G. van der Poel
Jeroen de Jong
Stijn W. T. P. J. Heijmink
Ivo Schoots
Iris Walraven
Petra J. van Houdt
Milena Smolic
Floris J. Pos
Uulke A. van der Heide
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5819-y

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