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Old 08-16-2012, 02:40 PM   #1
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Diffusion weighted prostate mri or mri spectroscopy

I've requested an MRI of my prostate from my urologist before getting my first bioposy. I have a rising PSA and wanted to gather as much info as I can other than PSA and Free PSA. I originally requested an MRI spectroscopy and found out that my doctor had ordered a diffusion weighted MRI with the 3T of the prostate. Is there an advantage at this stage for me with one type of MRI over the other? (diffusion weighted with and without contrast versus MRI spectroscopy)

 
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Old 08-16-2012, 03:21 PM   #2
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Re: Diffusion weighted prostate mri or mri spectroscopy

Usually parametric MRIs are reserved for those with negative biopsies who nevertheless have suspiciously rising PSA.

Which one is best all depends on the skill of the reader. There is tremendous variance between readers in detecting small foci of cancer on the various parametric MRIs. In a recent study, researchers could even detect Gleason score with great accuracy from an MRSI, but the detection rate was lower (but still pretty good) with the DWI-MRI:
http://www.ncbi.nlm.nih.gov/pubmed/22581787

In a recent Dutch study, they found that MRSI was better at detecting cancers in the peripheral zone (where most prostate cancers occur) while DWI-MRI was better at finding cancers in the transition zone:
http://www.ncbi.nlm.nih.gov/pubmed/22843767

Some readers are better at finding cancers with some of the other parametric MRIs (e.g., T2 weighted, dynamic contrast enhanced (DCE)), and some prefer to see several (i.e., multi-parametric). There is a big difference in detection rates between experienced readers and novice readers.

You might want to find out who the reader would be and ask for his/her preference.

- Allen

 
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Old 08-16-2012, 03:29 PM   #3
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Re: Diffusion weighted prostate mri or mri spectroscopy

I forgot to mention that the diffusion weighted MRI was being done with and without contrast.

 
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Old 08-16-2012, 03:41 PM   #4
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Re: Diffusion weighted prostate mri or mri spectroscopy

Quote:
Originally Posted by Tall Allen View Post
Usually parametric MRIs are reserved for those with negative biopsies who nevertheless have suspiciously rising PSA.

Which one is best all depends on the skill of the reader. There is tremendous variance between readers in detecting small foci of cancer on the various parametric MRIs. In a recent study, researchers could even detect Gleason score with great accuracy from an MRSI, but the detection rate was lower (but still pretty good) with the DWI-MRI:
http://www.ncbi.nlm.nih.gov/pubmed/22581787

In a recent Dutch study, they found that MRSI was better at detecting cancers in the peripheral zone (where most prostate cancers occur) while DWI-MRI was better at finding cancers in the transition zone:
http://www.ncbi.nlm.nih.gov/pubmed/22843767

Some readers are better at finding cancers with some of the other parametric MRIs (e.g., T2 weighted, dynamic contrast enhanced (DCE)), and some prefer to see several (i.e., multi-parametric). There is a big difference in detection rates between experienced readers and novice readers.

You might want to find out who the reader would be and ask for his/her preference.

- Allen
Thanks Tall Allen......Taking into consideration, the reader is of utmost importance,If one MRI can be more sensitive or advantageous in one area of the prostate than the other, why not have both MRIs done? Can't they be done at the same time?

 
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Old 08-16-2012, 05:10 PM   #5
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Re: Diffusion weighted prostate mri or mri spectroscopy

Yes, you can. As long as you have that coil up your butt you can do as many scans as you want (i.e., multiparametric) or can afford. It won't do you any good, however, if the reader isn't proficient at reading that particular type. It's not obvious to the casual viewer, and requires a lot of experience. After looking at some such MRIs and color doppler ultrasounds, I'm in awe of those with the trained eyes who can detect something there.

- Allen

 
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Old 08-16-2012, 05:22 PM   #6
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Re: Diffusion weighted prostate mri or mri spectroscopy

This place does not use the endorectal coil. I thought an MRI spectroscopy can be done with or without a coil. I do recall the urologist mentioning the radiologist by name as if he has worked with him on a regular basis. Perhaps the urologist knows the reader's preference. Regardless, I'm going to request to add the spectroscopy to the prescription. I don't want to find out if I ask for the spectroscopy later, the insurance company might deny it as unecessary.

Last edited by Infinity29; 08-16-2012 at 05:25 PM.

 
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Old 08-16-2012, 05:34 PM   #7
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Re: Diffusion weighted prostate mri or mri spectroscopy

The endorectal coil gives a much better image -- makes a big difference. You're looking for really small soft tissue differences. Some places now have as much as a 10T MRI -- might not improve much on that. But for a 3T or 1.5T, it's a good idea.

 
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Old 08-16-2012, 06:06 PM   #8
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Re: Diffusion weighted prostate mri or mri spectroscopy

I didn't even know that there there was a 10T out. Tall Allen......You know your stuff! My thinking is that, the more info I have now, the better decisions and tools I will have to make future decisions. Although I can see how some radiologists would prefer certain MRI types, however the MRIs I obtain now will always be available for others to view and interpret. This was great information. Thanks again for your wealth of info Tall Allen.

Last edited by Infinity29; 08-16-2012 at 06:08 PM.

 
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Old 08-17-2012, 01:58 PM   #9
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Re: Diffusion weighted prostate mri or mri spectroscopy

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Originally Posted by Tall Allen View Post
The endorectal coil gives a much better image -- makes a big difference. You're looking for really small soft tissue differences. Some places now have as much as a 10T MRI -- might not improve much on that. But for a 3T or 1.5T, it's a good idea.
No one is doing 10 Tesla prostate MRI.
A 3 Tesla scan without an endorectal coil is fine for detection. An endorectal coil is needed to assess for capsular invasion, i.e. preoperative planning. At 1.5 Tesla, an endorectal coil is generally needed for detection and preoperative planning.
Prostate MRI is in its early stages in the USA. Worldwide, the technique and interpretation criteria are evolving.

 
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Old 08-17-2012, 04:22 PM   #10
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Re: Diffusion weighted prostate mri or mri spectroscopy

University of Illinois Chicago has a 9.4 T MRI, and there are a number of 7 T MRIs around the globe. We'll see more and more of these in the coming years and they will find uses in clinical practice. A 3T without a coil may be fine if you have a big (cm-sized) nodule. Since you can't know that going in, I'd ask for the coil.

- Allen

Last edited by Tall Allen; 08-17-2012 at 04:23 PM.

 
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Old 08-17-2012, 08:01 PM   #11
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Re: Diffusion weighted prostate mri or mri spectroscopy

Quote:
Originally Posted by Tall Allen View Post
University of Illinois Chicago has a 9.4 T MRI, and there are a number of 7 T MRIs around the globe. We'll see more and more of these in the coming years and they will find uses in clinical practice. A 3T without a coil may be fine if you have a big (cm-sized) nodule. Since you can't know that going in, I'd ask for the coil.

- Allen
The endorectalcoil is not being used at any of the facilities which have the 3T and work with my Urologist. I did a search locally, and it is not easy to even find the 3T. I will be going the route of the diffusion weighted MRI (with and without contrast) and have requested the spectroscopy (without coil) to be added to the prescription by my urologist. I will have to wait for him to update my prescription, and hopefully he will oblige. I'm getting my first PCA3 within the next few weeks as well to add to the equation. Once I get many of the pieces of the puzzle together, I will most likely forward everything to USC for their evaluation with Dr Ukimura. It's hard enough dealing with this disease without the additional distress with red tape from clinics, hospitals, and insurance companies with what is available and what will be paid for. I still have not gone the ultrasound color dopler route but I know it will be used as a major tool at USC with their MRI(if the MRI shows anything). Being our own advocates is very draining and all out consuming. I hope I'm just not spinning my wheels. My urologist seems to feel that these institutions using the targeted biopsies are not all that accurate, but I'm still going foward, giving myself the best possible opportunity for the best diagnosis available to me with today's science. After all, I am not buying a pair of shoes.

Last edited by Infinity29; 08-17-2012 at 08:10 PM.

 
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Old 08-17-2012, 10:24 PM   #12
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Re: Diffusion weighted prostate mri or mri spectroscopy

Infinity: My MRI at USC was Parametric without coil. It was a 3T, one of their articles claimed 94% specificity. I do not know much about this stuff. If your MRI shows a suspicios spot, then Dr. Ukimura is going to insist on a biopsy. Also, It is not just a targeted biopsy, it is a tradional 12-core plus XX depends on your MRI and Color Doppler Elastography US results. If your MRI result is negative and your US result shows no suspicious spot, he may or may not perform the biopsy based on your advanced agreement during your consultation. I will be calling him Monday for my biopsy result done on August 3rd.

 
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Old 08-18-2012, 06:00 AM   #13
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Re: Diffusion weighted prostate mri or mri spectroscopy

Multiparametric 3T MRI without endorectal coil performs well for prostate cancer detection.

More data needed.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297750/

Last edited by hb-mod; 08-18-2012 at 07:04 AM. Reason: Please don't post unapproved website links, or recommend Internet searches, per Posting Policy. Thanks.

 
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Old 08-18-2012, 06:12 AM   #14
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Re: Diffusion weighted prostate mri or mri spectroscopy

I had a PSA of 3.8. Decided to get PCA3 tests. They were around 15, which is low. Thought about MRI, but decided against it. Would have had to travel. Its not the standard of care yet. Went ahead and had a standard TRUS 12 core biopsy. It was negative for cancer. That, with the low PCA3, lowers the risk of harboring a clinically significant prostate cancer greatly. If my PSA continues to rise, I will probably get an MRI.

 
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Old 08-18-2012, 06:58 AM   #15
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Re: Diffusion weighted prostate mri or mri spectroscopy

What are the differences between multiparametric imaging, T2 weighted,diffusion weighted and spectroscopy? Why do some urologists prefer one over the other?

 
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