Korean J Urol.  2011 Oct;52(10):674-680. 10.4111/kju.2011.52.10.674.

Effect of Prostate Biopsy Hemorrhage on MRDW and MRS Imaging

• Lee JY
• Chang IH
• Moon YT
• Kim KD
• Myung SC
• Kim TH
• Lee JB

• KMID: 2061429
• DOI: http://doi.org/10.4111/kju.2011.52.10.674

Abstract

PURPOSE
To retrospectively evaluate the effect of post-prostate-biopsy hemorrhage on the interpretation of magnetic resonance diffusion-weighted (MRDW) and magnetic resonance spectroscopic (MRS) imaging in the detection of prostate cancer. We also investigated the optimal timing for magnetic resonance examination after prostate biopsy.
MATERIALS AND METHODS
We reviewed the records of 135 men. All patients underwent prostate magnetic resonance imaging (MRI). The prostate was divided into eight regions according to the biopsy site. Subsequently, we measured hemorrhage on apparent diffusion coefficient (ADC) values and (choline+creatinine)/citrate ([Cho+Cr]/Cit) ratios in the same regions on the MRI. We investigated the effect of hemorrhage at ADC values and (Cho+Cr)/Cit ratios on MRI and the relationship between prostate biopsy results and MRI findings.
RESULTS
The mean patient age was 68.7 years and the mean time between biopsy and MRI was 23.5 days. The total hemorrhagic score demonstrated no significant associations with intervals from biopsy to MRI. Higher hemorrhagic scores were associated with higher ADC values, prostate cancer, and noncancer groups, respectively (p<0.001). ADC values were lower in tumors than in normal tissue (p<0.001), and ADC values were inversely correlated with tumor Gleason score in biopsy cores (p<0.001). However, (Cho+Cr)/Cit ratios did not exhibit any association with prostate biopsy results and hemorrhage.
CONCLUSIONS
Hemorrhage had no significant associations with the interval from biopsy to MRI. ADC values may help to detect prostate cancer and predict the aggressiveness of cancer; however, it is important to consider the bias effect of hemorrhage on the interpretation of MRDW imaging given that hemorrhage affects ADC values.

Keyword

Hemorrhage; Magnetic resonance imaging; Magnetic resonance spectroscopy; Prostatic neoplasms

MeSH Terms

Bias (Epidemiology)
Biopsy
Diffusion
Hemorrhage
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Male
Neoplasm Grading
Prostate
Prostatic Neoplasms
Retrospective Studies

Figure

• 

  FIG. 1 (A) A schematic illustration demonstrating the peripheral zone of the prostate divided into eight sectors on the magnetic resonance imaging (MRI). (B) Transverse T1-weighted MRI obtained at 3 weeks after prostate biopsy demonstrating a post-biopsy hemorrhage score of three (arrow) as a high signal intensity area in the prostate peripheral zone. (C) Apparent diffusion coefficient value (0.88×10-3 mm2/s) showing low diffusivity in the right peripheral zone (star). (D) Fusion imaging of MRI and magnetic resonance spectroscopic imaging and related (choline+creatinine)/citrate ([Cho+Cr]/Cit) ratio.

• 

  FIG. 2 Total hemorrhage score on magnetic resonance imaging (MRI) according to the interval from biopsy to MRI (p=0.133).

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  FIG. 3 Scatterplot showing the relationship between apparent diffusion coefficient (ADC) values in a diffusion-weighted image and tumor Gleason score. ADC values were inversely correlated with tumor Gleason score in biopsy cores (p<0.001).

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