Original article Value of magnetic resonance spectroscopy (MSR) and dynamic contrast-enhanced magnetic resonance (DCEMR) imaging for the characterization of high-grade prostatic intraepithelial neoplasia (HGPIN) foci Alessandro Sciarra*, Valeria Panebianco, M.D., Stefano Salciccia, M.D., Alessandro Gentilucci, M.D., Andrea Alfarone, M.D., Luisa Dimare, M.D., Dino Lisi, M.D., Susanna Catturino, M.D., Giovanni Di Pierro, M.D., Magnus Von Heland, Mauro Ciccariello, M.D., Roberto Passariello, Vincenzo Gentile Departments of Urology and Radiology, University Sapienza, Rome, Italy Received 27 June 2009; received in revised form 20 July 2009; accepted 21 July 2009 Abstract Background: Despite an increasing interest in high-grade prostatic intraepithelial neoplasia (HGPIN), the clinical suspicious aspect of this premalignant lesion remains poorly characterized. The aim of this study was to analyze the magnetic resonance spectroscopy (MSR) and dynamic contrast-enhanced magnetic resonance (DCEMR) imaging features of isolated HGPIN lesions. Materials and methods: From January 2007 to January 2009, 330 cases were included in a protocol that involve the use of MSR and DCEMR for the diagnosis of prostate diseases. Of these, 27 patients with isolated (no associated prostate cancer diagnosis) HGPIN histologic diagnosis at the first prostate biopsy were included in the present study. All cases were previously submitted to MSR/DCEMR (1.5 T scanner) and, no later than 10 days to a random 12-core biopsy scheme. Biopsy targeting was done in zones corresponding to those analyzed with MSR and DCEMR. Results: In the 27 patients, 30 HGPIN foci with a diameter of 6 mm or greater were analyzed and compared with 27 peripheral zone areas of normal prostate tissue. With MSR, HGPIN foci were characterized by a significantly higher (P  0.05) absolute value of choline and choline + creatine/citrate ratio compared with normal tissue. With DCEMR, HGPIN foci were characterized by lower values of all dynamic parameters but differences did not reach statistical significance (P  0.05). Conclusions: In our experience, HGPIN lesions can be metabolically characterized by MSR through the absolute value of choline and the choline + creatine/citrate ratio. © 2009 Elsevier Inc. All rights reserved. Keywords: Prostate neoplasm; High grade prostatic intraepithelial neoplasia; Magnetic resonance; Spectroscopy 1. Introduction High-grade prostatic intraepithelial neoplasia (HGPIN) is now considered the most likely precursor lesion to ade- nocarcinoma of the prostate [1,2]. The histologic diagnosis of an isolated HGPIN at prostate biopsy is clinically rele- vant and can condition the choice for the future follow-up of the patient. In fact, in a meta-analysis of 2,077 cases from 17 studies, the presence of HGPIN at prostate biopsy was associated with a 28% incidence of prostate cancer at fol- low-up biopsies [2]. Moreover HGPIN lesion can also be associated with prostate cancer in the same patient. Qian et al. on 105 prostate cancer submitted to radical prosta- tectomy, reported HGPIN in 86% of the cases [3]. De- spite an increasing interest in HGPIN, the clinical suspi- cious aspect of this premalignant lesion remain poorly characterized. No specific markers have been found and PSA cannot significantly characterize patients with HG- PIN compared with patients with benign prostatic lesions or prostate cancer. Moreover, HGPIN is currently unde- * Corresponding author. Tel.: +39-3333977820; fax: +39-06- 4461959. E-mail address: a.sciarra@lycos.it (A. Sciarra). Urologic Oncology: Seminars and Original Investigations xx (2009) xxx 1078-1439/09/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.urolonc.2009.07.033 ARTICLE IN PRESS