spectroscopy of the prostate in clinical practice: technique and results in patients with elevated prostate-specific antigen and negative or no previous prostate biopsies

To assess the benefit of routinely used three-dimensional 1 H-spectroscopy of the prostate combined with magnetic resonance imaging in patients with elevated prostate-specific antigen (PSA) levels and negative or no previous prostate biopsies. Fifty-four patients were ex- amined with our combined imaging protocol, which consisted of trans- versal, coronal and sagittal T2- weighted fast spin echo sequences. For spectroscopy, we used a three- dimensional chemical shift imaging spin echo (3D-CSI-SE) sequence. The study population consisted of patients with elevated PSA levels and histo- logically proven prostate carcinoma and patients with elevated PSA levels and negative or no previous prostate biopsies. Examination time was 31 min, a time feasible for routine use. Eighty-eight tumour voxels and 67 control voxels of 27 patients with histologically proven prostate carci- noma were analysed. Ratios of (cho- line + creatine)/citrate ((Cho + Crea)/ Cit) below 0.6 were classified as normal and above 0.6 as pathological. Applying this classification to 20 patients with tumour-suspicious le- sions of the prostate and negative or no previous prostate biopsies, we could obtain a sensitivity and speci- ficity for tumour detection of 100% and 69%, respectively. Our combined imaging protocol is feasible for rou- tine use and can add valuable infor- mation for the diagnostic management of patients with negative or no pre- vious prostate biopsies.