Abstract Background Sodium (23Na) MRI of prostate cancer (PCa) is a novel but under-documented technique conventionally acquired using an endorectal coil. These endorectal coils are associated with challenges (e.g., a non-uniform sensitivity profile, limited prostate coverage, patient discomfort) that could be mitigated with an external 23Na MRI coil. Purpose To quantify tissue sodium concentration (TSC) differences within the prostate of participants with PCa and healthy volunteers using an external 23Na MRI radiofrequency coil at 3 Tesla. Materials and Methods A prospective study was conducted from January 2022 to June 2024 in healthy volunteers and participants with biopsy-proven PCa. Prostate 23Na MRI was acquired on a 3 Tesla PET/MRI scanner using a custom-built two-loop (diameter, 18 cm) butterfly surface coil tuned for the 23Na frequency (32.6 MHz). The percent difference in TSC (ΔTSC) between prostate cancer lesions and surrounding noncancerous prostate tissue of the peripheral zone (PZ) and transition zone (TZ) was evaluated using a one-sample t-test. TSC was compared to apparent diffusion coefficient (ADC) measurements as a clinical reference. Results 6 healthy volunteers (mean age, 54.5 years ± 12.7) and 20 participants with PCa (mean age, 70.7 years ± 8.3) were evaluated. A total of 31 lesions were detected (21 PZ, 10 TZ) across PCa participants. Compared to noncancerous prostate tissue, prostate cancer lesions had significantly lower TSC (ΔTSC, -14.1% ± 18.2, p = 0.0002) and ADC (ΔADC, -26.6% ± 18.7, p < 0.0001). Conclusion We used an external 23Na MRI coil for whole-gland comparison of TSC in PCa and noncancerous prostate tissue at 3 Tesla. PCa lesions presented with lower TSC compared to surrounding noncancerous PZ and TZ tissue. These findings demonstrate the feasibility of an external 23Na MRI coil to quantify TSC in the prostate and offer a promising, non-invasive approach to prostate cancer diagnosis and management.
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