imaging in prostate

8/12/2019 Imaging in Prostate

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ANATOMY OFPROSTATEThe normal prostate

weighs 18 g measures 3 cm in length ! cm in wi"than" # cm in "epth

Although o$oi" the prostate is re%erre"to as ha$ing

Anterior Posterior an"

&ateral sur%aces

'as a Narrowe" ape( in%eriorl)an"

*roa" +ase


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PROSTAT-..APS/&E Enclose" +) a capsule compose" o%collagen elastin an" a+un"ant smoothmuscle,

Posteriorl) an" laterall) thiscapsule has an a$erage thic0ness o%,2 mm

Microscopic +an"s o% smoothmuscle e(ten" %rom the posteriorsur%ace o% the capsule to %usewith enon$illiers4 %ascia,


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Towar" the ape( the pu+oprostaticligaments e(ten" anteriorl) to 5(the prostate to the pu+ic +one

&aterall) the prostate is cra"le" +)the pu+ococc)geal portion o% le$ator ani

an" is "irectl) relate" to its o$erl)ingen"opel$ic %ascia

*elow the 6uncture o% the parietal

an" $isceral en"opel$ic %ascia 7arcusten"ineus %ascia pel$is the pel$ic%ascia an" prostate capsuleseparate an" the space +etween

them is 5lle" +) %att) areolar


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MRI SHOWING

PROSTATIC CAPSULE


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CZ, TZ AND PUGA RELATED TO PROXIMAL PROSTATIC URETHRA

CZ SURROUNDS PROXIMAL PROSTATIC URETHRAPOSTERO SUPERIORLY ENCLOSING PUGA AND TZ

PZ SURROUNDS CZ AND DISTAL PROSTATIC URETHRA


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TRANS-T-ON9ONE

2> to 1> o% the glan"ulartissue an" surroun"s the pro(imalurethra

A "iscrete 5+romuscular +an" o%tissue separates the transition :one%rom the remaining glan"ularcompartments

The transition :one commonl)gi$es rise to +enign prostatich)pertroph) which e(pan"s tocompress the 5+romuscular +an" into a surgical capsule seen at


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.ENTRA&9ONE

Arise circum%erentiall) aroun" theopenings o% the e6aculator) "ucts,

#2> o% the glan"ular tissue o% the

prostate an" e(pan"s in a coneshape aroun" the e6aculator) "ucts

to the +ase o% the +la""er,

The glan"s are structurall) an"immuno histochemicall) "istinct %romthe remaining prostatic glan"s

Onl) 1> to 2> o%

a"enocarcinomas arise in the central


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PERIPHERAL ZONE

Ma0es up the +ul0 o% theprostatic glan"ular tissue 7 ?>an" co$ers the posterior an"lateral aspects o% the glan",

-ts "ucts "rain in to the prostaticsinus along the entire length o% the7postsphincteric prostatic urethra,

Se$ent) percent o% prostatic cancersarise in this :one

-t is the :one most commonl)

a;ecte" +) chronic prostatitis,


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TNM definitions for prostate cancer (AJCC Prostate CancerStaging)

Primar) tumor 7TTX: Primary tumor cannot be assessedT0: No evidence of rimary tumor

T1< .linicall) the tumor is neither palpa+le nor$isi+le +) imagingT!a: Tumor incidenta" #isto"o$ic %ndin$ in &' or "ess of tissue resectedT!b: Tumor incidenta" #isto"o$ic %ndin$ in more t#an &' of tissue

resectedT!c: Tumor identi%ed by need"e biosy (e)$)* because of e"evated P+A,

T#< Tumor con5ne" within prostateT-a: Tumor invo"ves one #a"f of ! "obe or "essT-b: Tumor invo"ves more t#an one #a"f of ! "obe but not bot# "obes

T-c: Tumor invo"ves bot# "obes

T3< Tumor e(ten"s through the prostate capsuleT.a: E/tracasu"ar e/tension (uni"atera" or bi"atera",T.b: Tumor invades semina" vesic"e(s,


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Re$iona" "ym# nodes (N,

NX: Re$iona" "ym# nodes 2ere not assessed

N0: No re$iona" "ym# node metastasisN!: 3etastasis in re$iona" "ym# node(s,

4istant metastasis (3,

3X: 4istant metastasis cannot be assessed (noteva"uated by any

moda"ity,

30: No distant metastasis3!: 4istant metastasis3!a: Nonre$iona" "ym# node(s,3!b: 5one(s,


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GRAY SCALE ULTRASOUND

3ost common indication is foreva"uation of susected rostatic

carcinoma)

TR6+ is usua""y erformed in

con7unction 2it# need"e biosy of t#erostate)

T#e indication is eit#er an

abnorma"ity on 4RE or e"evation in t#eserum P+A "eve")

Occasiona"" men under o TR6+


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Prostate cancer is c"assica""ydescribed as a #yoec#oic "esion* but

may a"so aear as ec#o$enic orisoec#oic "esion

Hyoec#oic aearance is be"ieved tobe due to t#e increased microvesse"density* and it is estimated t#at a

#yoec#oic nodu"e #as a !89&8'

c#ance of bein$ identi%ed as rostatecancer

Ho2ever* u to .0' of a"" rostate


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A@ANTA=ES usionrestriction,

BASED ON DIFFUSION CO EFFICIENT

MR Spectroscop) o% the Prostate


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MR Spectroscop) o% the Prostate=lan"

T#e combination of 3RI and !H;3R+I maybecome an imortant too" in t#e detectionand sta$in$ of rostate cancer

4ia$nostic assessment t#rou$# t#e detectionof ce""u"ar metabo"ites and may otentia""y"ead to noninvasive

di>erentiation of cancer from #ea"t#y tissue

Norma" rostate tissue contains #i$# "eve"s ofcitrate and "o2 "eve"s of c#o"ine and creatine)


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e d e e ces e co ce a o s ometabo"itesare be"ieved to be due to en#ancement of

#os#o"iid3embrane turnover associated 2it# tumor

ce"" ro"iferation and increased ce""u"arityand $ro2t#)

T#e individua" c#o"ine creatine 1citrate ratiois used for sectra" ana"ysis in t#e c"inica"settin$ because t#e sectra" eas of creatineand c#o"ine often over"a and maybeinsearab"e )

T#e c#o"ine creatine1citrate ratio for norma"

0)-- S 0)!.

3R+ Princi"e


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3R+;Princi"e In Prostatic ca


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etection o% &)mph No"e Metastasis D Role o%


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MR-

T#e conventiona" criterion fordetection of metastatic "ym# nodeson ima$in$ (eit#er


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$ (6+PIO, are in7ected intravenous"y -F #oursbefore 3R ima$in$) T#ey are s"o2"y

e/travasated into t#e interstitia" sace and aretransorted to "ym# nodes via t#e"ym#atics*2#ere t#ey are interna"ied bymacro#a$es)

4ue to t#eT- suscetibi"ity e>ect* t#e norma"art of t#e node "oses si$na" intensitybecause it contains macro#a$es* 2#i"et#e metastasis remains of #i$# si$na"intensity due to "ac of macro#a$es

+eci%city of B0'

+ensitivity of !' ( .&' for

MR LYMPHOGRAPHY USING USPIO


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MR LYMPHOGRAPHY USING USPIO

etection o% *one Metastasis D Role% MR-


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o% MR-Radionuc"ide bone scinti$ra#y is t#e

initia" ima$in$ moda"ity)

Ho2ever* 3RI is suerior to bone scinti$ra#y

in detectin$ bone metastasis in t#e a/ia"se"eton and is a usefu" rob"em;so"vin$ too" inatients 2it# euivoca" bone scinti$rams

5one metastasis tyica""y #as

Low signal intensity on T1-weighted

images

High signal intensity on T2-weighted images

MR -maging o% Recurrent Prostate


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.ancer6sed to eva"uate bot# "oca" and

systemic recurrence* 2it# endorecta" 3RIbein$ caab"e of detectin$ "oca" recurrenceeven in atients 2it# risin$ P+A butno a"ab"e tumor on 4RE)

+i"verman and rebs reorted e/ce""entsensitivity (!00', and seci%city

(!00', of 3RI

in t#e eva"uation "oca" recurrencefo""o2in$ RRP)

@o""o2in$ RRP* tumor recurrence is


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g p )Remains t#e most 2ide"y accetedmet#od for eva"uatin$ t#e se"eton for

evidence of metastatic rostate cancer)

5one scans #ave a sensitivity of u to&' for detectin$ bone metastases)

Radionuc"ide bone scannin$ iserformed usin$ radio"abe"ed

di#os#onates "abe""ed 2it# tec#netiumsuc# as mTc met#y"ene di#os#onate(mTc;34P,)

After intravenous in7ection* t#e

Radioactivity from isotoe accumu"ation is


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Radioactivity from isotoe accumu"ation isdetected usin$ A33A


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Lo2 P+A ("ess t#an !0 or -0U$1L, a bonescan 2as not indicated in t#e absence of boneain or a #i$#;$rade tumor ("eason score B or

above,)

+ymtomatic atients or t#ose 2it# P+A-0 n$1m"or $reater* "oca""y advanced disease* or"eason score B or $reater are at #i$#er risfor bone metastases and s#ou"d be considered

for bone scan

POSITI0E 1ONE SCAN 2 UPTA3E IN AXIAL S3ELETON


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APPLI


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Assessment of Disease Activity andTreatment Resonse

!onitoring !etastatic "rostate Cancer

"redicting t#e atient rognosis$

A/ia" metastases carry a betterro$nosis t#an aendicu"ar metastasis)

In addition t#e ercenta$e of area ositiveon bone scan is a nove" arameter for

redictin$ t#e ro$nosis of atients 2it#

advanced rostatic cancer


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Positron Emission


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Tomograph)PRIN


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C$mm$(l+ #se) is$"$*es i( PET s.a((i(g

a() "'ei 'al-/li-eadio isotope !a"f#"ife

4l#$i(e / 56 557 mi(

Ca$( / 55 87 mi(1$mi(e / 9 ;6 mi(

Ox+ge( / 5 8 mi(

Ni"$ge( /5< 57 mi(

I()i#m / 555 =9 '

5y ta$$in$ radioisotoes to natura""yi b i # # b d


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occurrin$ substances in t#e #uman body* PETscannin$ is ab"e to su"y uniue information

on t#e metabo"ic activity of a tissue)

T#e most common"y used radionuc"ide in PETscannin$ combines t#e radioisotoe =uorine;!B

2it# t#e 4;$"ucose ana"o$ue:

Tumor ima$in$ 2it# !B@;@4 is based on t#eremise t#at tumors are more metabo"ica""yactive t#an t#eir surroundin$ tissues and

t#us 2i"" metabo"ie more $"ucose)

Tumor ce""s active"y tae u and s#utt"e !B@;

- =uoro;-;deo/y;4;$"ucose(!B@;@4,)

T#is metabo"ite becomes traed and cannotroceed a"on$ t#e norma" at#2ay of $"ucose


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roceed a"on$ t#e norma" at#2ay of $"ucosemetabo"ism)

Over time* increased amounts of !B@;@4accumu"ate 2it#in ma"i$nant ce""s) T#isabnorma" concentration of !B@;@4 in t#e tumor

ce""s roduces a detectab"e si$na" t#at is $reatert#an t#e bac$round* t#us a""o2in$ iso"ation oftumor deosits

T#e re"ative"y recent introduction of combinedPET;


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@4 PET


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&imitations in Prostatic caI t t ti f t i ft i i d


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Interretation of utae is often imairedby t#e norma" urinary e/cretion of

radioisotoe)

It is redominant"y oo"in$ of radioisotoein t#e b"adder combined 2it# norma" b"adder

activity t#at #amers t#e assessment ofrostate activity)

4iuretics suc# as frusemide as an aidmay #ave a ro"e* but t#is #as not been2ide"y used 2it# most centers re"yin$ on#ydration)

Other Ra"iotracers %or Prostate .ancerA i i f " t b "i # t


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As ima$in$ of $"ucose metabo"ism #as not roven adramatica""y usefu" too" to date* radiotracers ab"e toidentify ce"" membrane turnover* rotein synt#esis* 4NAsynt#esis* and testosterone metabo"ism 2it#in t#erostate are current"y bein$ investi$ated)

C#o%ine & F%'oroc#o%ine (FC)* andCar+oc#o%ine (,,C-C#o%ine* !et#ionine

( ,,C- !et#ionine *Acetate (, ,C- Acetate *F%'orot#ymidine (FLT*F%'orodi#ydrotestosterone (FD)T*

PET a"ications in cancer medicine #ave beenfocused on t#ree c"inica" $oa"s:

(!, 4etection and 4ia$nosis?

(-, +ta$in$

Monoclonal Anti+o"ies

imaging in prostate

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