Purpose: We describe the practical technical aspects of magnetic resonance spectroscopic imaging (MRSI), and summarize the current and potential future status of magnetic resonance imaging (MRI) and MRSI in the diagnosis, localization, staging, treatment planning and post-treatment followup of prostate cancer.
Materials and methods: Contemporary series of patients with prostate cancer evaluated by MRI and MRSI were reviewed, with particular respect to imaging accuracy as evaluated by histopathological correlation, and the relationship between MRI and MRSI and outcome.
Results: MRI and MRSI have a limited role in prostate cancer diagnosis but may be helpful for patients with a high index of suspicion and negative initial biopsy. High specificity can be achieved for sextant localization of cancer when sextant biopsy, MRI and MRSI are all positive. Volumetric localization is of limited accuracy for tumors less than 0.5 cc. Staging by MRI, which is improved by the addition of MRSI, is of incremental prognostic significance for patients with moderate and high risk tumors. MRI and MRSI may assist in surgical and radiation treatment planning, and posttreatment followup. In particular, the use of MRI to assist radiation treatment planning has been shown to improve outcome. Interventional MRI guided biopsy and therapy remain under investigation.
Conclusions: Only MRI and MRSI allow combined structural and metabolic evaluation of prostate cancer location, aggressiveness and stage. MRI provides clinically and therapeutically relevant anatomical information. The technology remains in evolution, and continued advances in accuracy and use are likely.