The Choline+Creatine/Citrate Ratio In The Differential Diagnosis Of The Cancer Of Prostate

Objective: To establish MRS importance in the differential BPH and Prostate Cancer and evaluate the combined utility of MRI and MRS in the detection of Prostate Cancer in a man with raised PSA levelMaterial and method: Between January 2006 and June 2009, 122 patients were examinated. Twenty seven were diagnosed with prostate cancer (n=27) and eighty five with benign prostate hyperplasia (BPH) (n=85) and normal patients (n=10). Their ages ranged from 44 to 91 with the median of 68. The PSA values of patients more than 4 ng/ml. All subjects underwent combined general MRI imaging and MRS before and after radical prostatectomy. MR imaging/MR spectroscopic imaging studies were performed with a 1.5 T superconductive magnet scanner (Siemens Sonata, Erlangen, Germany). The sequences included axial T₁WI (normal and bigger FOV), axial T₂WI (fat saturation and no fs), coronal fs T₂WI spectroscopy. The ratios (Cho+Cre/Cit, Cho/ Cre) in control group (BPH) of PZ and CG were randomly measured Conventional MR imaging protocol consisted of a TSE axial T2WI, sagittal T2WI.Results: The patients carrying BPH (n=85), we observe a proliferation of prostatic tissue more on the central level of the zone to the image as in the majority of the cases of BPH. On the level of the Choline rates, Creatine and of Citrate, we observe that the citrate rates are always raised, ratio Cit is 0.2±1.78 and the ratio of (Cho+Cre)/ Cit is 0.40±0.78. The patients with the cancer of prostate (n=27), the results show us an increase in volume of the prostate with a very typical image of tissue proliferation mainly situated in the peripheral zone of gland. On the level of the rates, we can see that the Cho has high peaks (0.148) and (Cho+Cre)/Cit ratio = 4.21; we observe in average in this study a significant growth of Choline what show us that the ratio of (Cho+Cre/Cit) is 1.89±1,97.Conclusion: MR spectroscopy allows cancer to be distinguished from normal glandular tissue on the basis of an increased choline (Cho) + creatine (Cr) to citrate (Cit) ratio ([Cho + Cr]/Cit). MR spectroscopy has been effective in improving the accuracy of MR imaging in prostate cancer localization and staging for patients with PSA > 4ng/ml.