Advances in Molecular Imaging, 2013, 3, 23-36 http://dx.doi.org/10.4236/ami.2013.33005 Published Online July 2013 (http://www.scirp.org/journal/ami) Identification and Localization of Prostate Cancer with Combined Use of T2-Weighted, Diffusion Weighted MRI and Proton MR Spectroscopy, Correlation with Histopathology Baki Hekimoğlu 1 , Hasan Aydin 1 , Volkan Kızılgöz 1 , İdil Güneş Tatar 1 , Ali Rıza Ugan 2 , İrem Paker 3 1 Radiology Department, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey 2 Urology Department, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey 3 Pathology Department, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey Email: dr.hasanaydin@hotmail.com Received May 1, 2013; revised June 3, 2013; accepted June 10, 2013 Copyright © 2013 Baki Hekimoğlu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Purpose: To predict the diagnostic performance of combined use of T2-weighted imaging (T2W)-diffusion weighted MRI (DWI) and apparent diffusion coefficient (ADC)-proton MR spectroscopy (H-MRS) for the detection of prostate cancer, correlated to histopathology as the reference standard. Method: After institutional review board approval, 40 patients with prostate cancer were included in this retrospective research. Two readers evaluated the results of T2W, DWI-ADC mapping and H-MRS independently for the depiction of prostate cancer. Reference standard was the TRUS- guided biopsy and the surgical histopathological results. Statistical analysis was assessed by Fisher’s exact t-test, Wil- coxon signed rank test, variance analysis test with Kappa (k) values and receiver operating characteristics (ROC) curve for ADC values, Cho/Cit and Cho + Cre/Cit ratios for each observer. Results: Both readers declined 46% sensitivity and 68% specificity for T2W sequence, 29% sensitivity and 82% specificity for DWI-ADC mapping and 49% specificity for Cho/Cit and Cho + Cre/Cit ratios, 69% sensitivity for Cho/Cit 70% sensitivity for Cho + Cre/Cit ratios of H-MRS. T2W + DWI-ADC mapping + H-MRS (Cho/Cit and Cho + Cre/Cit ratios) regarded 81% sensitivity and 66% specificity, with significant statistical differences to the reference histopathology (p < 0.05). Conclusion: Combination of T2W, DWI and H-MRS were more sensitive and more accurate than either sequences alone, for prostate cancer localization and detection. Keywords: MRI; Prostate Cancer; DWI; H-MRS; T2W 1. Introduction For the elder men with high blood level of prostate-spe- cific antigen (PSA), the definite diagnosis of prostate cancer is based on biopsy, obtained invasively by en- dorectal sonographic guidance (TRUS) [1-3]. However, it has several limitations like, lower sensitivity and speci- ficity for the detection and local staging of prostate can- cer, limited potential to delineate the malignant foci, lower diagnostic rate for extra-capsular extension of dis- ease, have high false-negative rates up to 40% and at the same time high false-positive rates due to benign pro- static disease like prostatitis, hemorrhage, prostate hy- perplasia and post-treatment sequela [1,3-5]. MR imag- ing, a non-invasive diagnostic tool, has shown a great confidence for the evaluation and management of pros- tate cancer [1,2,4-9]. MRI of prostate with combined pelvic and endorectal coil, has become an accepted method for staging of this cancer [1,4,6,9-12], T2W-MR imaging facilitate appropriate data for the treatment planning of prostate cancer via aiding for the detection, localization and staging of prostate cancer which also include the extra-capsular extension and seminal vesicle invasion [1,4,7,13,14]. However, T2W imaging has quite good sensitivity but lower specificity for tumor detection and discrimination of cancer from non-malignant tissues, to further improve the sensitivity and mainly the speci- ficity of it; Functional MR imaging techniques like 3D H-MRS, dynamic contrast enhanced MRI and DWI- ADC mapping have been proposed to be added to the routine prostate MR protocole for the entire diagnosis of Copyright © 2013 SciRes. AMI