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Abstract
Hypoxia is associated with prostate tumor aggressiveness, local recurrence, and biochemical failure. Magnetic resonance imaging (MRI) offers insight into tumor pathophysiology and recent reports have related transverse relaxation rate (R2*) and longitudinal relaxation rate (R1) measurements to tumor hypoxia. We have investigated the inclusion of oxygen-enhanced MRI for multi-parametric evaluation of tumor malignancy. Multi-parametric MRI sequences at 3 Tesla were evaluated in 10 patients to investigate hypoxia in prostate cancer prior to radical prostatectomy. Blood oxygen level dependent (BOLD), tissue oxygen level dependent (TOLD), dynamic contrast enhanced (DCE), and diffusion weighted imaging MRI were intercorrelated and compared with the Gleason score. The apparent diffusion coefficient (ADC) was significantly lower in tumor than normal prostate. Baseline R2* (BOLD-contrast) was significantly higher in tumor than normal prostate. Upon the oxygen breathing challenge, R2* decreased significantly in the tumor tissue, suggesting improved vascular oxygenation, however changes in R1 were minimal. R2* of contralateral normal prostate decreased in most cases upon oxygen challenge, although the differences were not significant. Moderate correlation was found between ADC and Gleason score. ADC and R2* were correlated and trends were found between Gleason score and R2*, as well as maximum-intensity-projection and area-under-the-curve calculated from DCE. Tumor ADC and R2* have been associated with tumor hypoxia, and thus the correlations are of particular interest. A multi-parametric approach including oxygen-enhanced MRI is feasible and promises further insights into the pathophysiological information of tumor microenvironment.
Highlights
Prostate cancer (CaP) is the most frequently diagnosed non-skin malignancy in men
Several Magnetic resonance imaging (MRI) techniques have been used to identify potential cancer areas within the prostate and certain MRI features have been shown to be associated with higher Gleason scores [2,3,4,5]
We are only aware of three previous studies examining MRI response to hyperoxic gas breathing challenge in patients with CaP, each of which examined Blood oxygen level dependent (BOLD) response to carbogen (5 and 2% CO2, respectively in oxygen [14,16,20]): we have examined a pure oxygen breathing challenge, since this is expected to be less stressful
Summary
Prostate cancer (CaP) is the most frequently diagnosed non-skin malignancy in men. If CaP is identified in the biopsies, they are graded with the Gleason scoring system, which correlates with the CaP prognosis [1]. Magnetic resonance imaging (MRI) is an established modality for prostate evaluation, due to its high soft tissue contrast. In addition to providing high resolution imaging of the prostate gland, MRI can provide complementary functional tissue information, such as assessment of vascular permeability and perfusion. Several MRI techniques have been used to identify potential cancer areas within the prostate and certain MRI features have been shown to be associated with higher Gleason scores [2,3,4,5]
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