Diagnostic Accuracy of Combined T2-weighted MR Imaging and H1MR Spectroscopy for Prostate Cancer Detection

Diagnostic Accuracy of Combined T2-weighted MR Imaging and H1MR Spectroscopy for Prostate Cancer Detection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic Accuracy of Combined T2-weighted MR Imaging and H1MR Spectroscopy for Prostate Cancer Detection Ibrahim Nasir Idrees This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5297397/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The primary objective was to evaluate the diagnostic accuracy of combining T2-weighted MR imaging and H1MR Spectroscopy in detecting prostate cancer, with histopathology serving as the reference standard. Methods The study included 125 male patients aged 44–78, who presented with clinical suspicion of prostate cancer (e.g., gland asymmetry, nodule, induration, adhesion, or palpable seminal vesicles). Patients with previous surgeries, hormonal or radiation therapy, or a biopsy within the last 12 weeks were excluded. MR imaging and H1MR Spectroscopy were conducted using a 1.5 Tesla scanner, and histopathology was used as the gold standard. Results The mean patient age was 63.17 ± 8.47 years. Of the 125 patients, 54 were true positives, 7 were false positives, 49 were true negatives, and 15 were false negatives. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 78.26%, 87.5%, 88.52%, 76.56%, and 82.4%, respectively. Conclusion The combination of T2-weighted MR imaging and H1MR Spectroscopy demonstrates high diagnostic accuracy in detecting prostate cancer. This technique, pending further validation, may serve as a reliable non-invasive diagnostic method in clinical practice. Prostate cancer Sensitivity Specificity MR Spectroscopy Histopathology Figures Figure 1 Figure 2 Introduction Prostate cancer ranks as the second most common cancer and the sixth leading cause of cancer-related deaths among men globally, with approximately 899,000 new cases and 258,000 deaths reported in 2008. Notably, 72% of these cases and 53% of deaths occurred in developed countries, which comprise less than 20% of the global population [ 1 ]. Advancing age remains the most significant risk factor, though men younger than 65 account for 25% of cases [ 2 ]. Familial history, particularly with first-degree relatives diagnosed with prostate cancer, doubles the risk [ 3 ]. Other proposed risk factors include dietary habits, alcohol consumption, UV radiation exposure, chronic inflammation, and occupational hazards [ 4 ]. Prostate-specific antigen (PSA) testing is extensively used for early detection, diagnosis, staging, and follow-up of prostate cancer. However, PSA levels can be elevated due to benign conditions, leading to unnecessary biopsies, especially in patients with PSA levels between 4 and 10 ng/mL [ 5 ]. The standard diagnostic tool, ultrasound-guided biopsy, is invasive and subject to sampling errors [ 6 ]. Magnetic resonance imaging (MRI) has long been employed to assess prostate anatomy and pathology. T2-weighted (T2W) MR imaging provides critical information for treatment planning by detecting, localizing, and staging prostate cancer, including evaluating extracapsular extension and seminal vesicle invasion [ 7 ]. While T2W imaging is highly sensitive, its specificity is lower, particularly in differentiating between cancerous and benign tissues [ 8 ]. Functional MR techniques, such as 3D H1 MR Spectroscopy (H1MRS), have been introduced to improve the diagnostic capabilities of traditional MRI, providing more accurate detection of malignancies [ 9 ]. Studies have shown that combining T2W imaging with H1MRS increases sensitivity to 71% and specificity to 90%, with histopathology as the gold standard [ 10 ]. Given the limitations of biopsies, including associated complications and diagnostic uncertainties, there is a clear need for improved non-invasive methods to select candidates for biopsy. The rationale of this study is to evaluate whether combining MRI and MRS can enhance clinical outcomes by reducing unnecessary biopsies and better predicting the presence of malignancies. By doing so, the study also aims to address issues such as post-biopsy hemorrhages, which often compromise the quality of MRI images. This study aims to assess the diagnostic accuracy of combining T2-weighted MR imaging and H1 MR Spectroscopy for prostate cancer detection, using histopathology as the gold standard. Methodology A cross-sectional validation study was conducted in the Radiology Department at Allied Hospital, Faisalabad. A total of 125 male patients, aged 44 to 78 years, presenting with clinical suspicion of prostate cancer (PSA level 4–10 ng/mL) were selected through non-probability consecutive sampling. Patients with a history of surgery, hormonal or radiation therapy, or biopsy within the previous 12 weeks were excluded. The clinical assessment included digital rectal examination (DRE), which may reveal asymmetry, nodularity, or induration of the prostate, and immobility of surrounding tissues. The study was approved by the hospital’s ethics committee, and informed consent was obtained from all participants. MRI examinations were performed using a 1.5 Tesla scanner with T2W fast spin-echo sequences in axial, coronal, and sagittal planes. MR spectroscopy was conducted using a surface coil and appropriate software, and histopathological analysis was used as the gold standard. Data were analyzed using SPSS version 15. Descriptive statistics, including mean and standard deviation for age, were calculated. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy, were computed. Results Out of the 125 patients, 48 (38.4%) were between 44 and 60 years of age, while 77 (61.6%) were aged between 61 and 78 years, with a mean age of 63.17 ± 8.47 years. Histopathological analysis confirmed prostate cancer in 69 patients (55.2%), while 56 (44.8%) were cancer-free. The diagnostic performance of the combined T2W MRI and H1MRS was assessed against histopathology, yielding the following results: 54 (43.2%) true positives, 7 (5.6%) false positives, 49 (39.2%) true negatives, and 15 (12%) false negatives. The sensitivity, specificity, PPV, NPV, and overall accuracy were calculated as 78.26%, 87.5%, 88.52%, 76.56%, and 82.4%, respectively. Table 1 Age Distribution (n = 125) Age(in years) No. of patients % 44–60 48 38.4 61–78 77 61.6 Total 125 100 Mean ± SD 63.17 ± 8.47 Table 2 Frequency of CA Prostate on Gold Standard (N = 125) CA Prostate No. of patients % Yes 69 55.2 No 56 44.8 Total 125 100 Table 3 Diagnostic Accuracy of T2-Weighted MR Imaging and HMR Spectroscopy for Detection of CA Prostate by Taking Histopathology as Gold Standard (n = 125), Sensitivity: 78.26%, Specificity: 87.5%, PPV: 88.52%, NPV: 76.56%, Diagnostic accuracy: 82.4% T2W MRI + HMRS Histopathology CA Prostate Present CA Prostate absent CA Prostate + (Positive) 54 (43.2%) 7(5.6%) CA Prostate – (Negative) 15(12%) 49(39.2%) Discussion Our findings corroborate with previous studies that demonstrate the diagnostic accuracy of combining T2-weighted Magnetic Resonance Imaging (MRI) and High-Resolution ¹H Magnetic Resonance Spectroscopy (MRS) for the detection and localization of prostate cancer. In our study, the combination of T2W MRI and MRS achieved a sensitivity of 78.26%, a specificity of 87.5%, a positive predictive value (PPV) of 88.52%, and a negative predictive value (NPV) of 76.56%. This result aligns with earlier studies, such as the one conducted by Kumar et al., which reported a sensitivity of 71% and specificity of 90% for the combination of MRI and MRS [ 1 ]. By using histopathology as the gold standard, we could effectively validate the utility of these imaging modalities in enhancing cancer detection rates. Magnetic Resonance Spectroscopy Imaging (MRSI) is particularly valuable as it non-invasively detects biochemical changes within prostate tissue. In cancerous tissue, elevated levels of choline-containing metabolites and decreased citrate levels are common biomarkers, reflecting the altered cellular metabolism of malignant cells [ 2 ]. The ability of MRS to detect these subtle metabolic shifts complements the anatomical imaging provided by MRI, allowing for a more comprehensive assessment of the prostate. In fact, MRSI's spatial resolution enables better identification of tumor aggressiveness and margins, which is critical for accurate staging and treatment planning. Our study's results also emphasize the role of these combined imaging techniques in minimizing the number of unnecessary biopsies. By enhancing the precision of cancer detection and localization, MRI and MRS can reduce the frequency of false positives, and the morbidity associated with multiple biopsies. Previous studies have shown that the addition of MRS to conventional MRI improves cancer localization within prostate sextants, particularly in patients undergoing pre-operative imaging before radical prostatectomy. For instance, Weinreb et al. demonstrated that when both MRI and MRS were concordant in indicating the presence of cancer, specificity increased to 98%, with a sensitivity of 94% when any of the tests were positive [ 3 ]. These findings are consistent with our study, where a high PPV and NPV were observed, further confirming the utility of combined imaging modalities. Another significant advantage of incorporating MRS is its ability to circumvent post-biopsy hemorrhage artifacts that often obscure the clarity of MRI images. Hemorrhage within the prostate following biopsy is a known issue that complicates imaging interpretation and typically necessitates a waiting period of 2–3 months before conducting another MRI scan. However, by using MRSI alongside MRI, our study—and others—have demonstrated that clinicians can make more accurate assessments immediately following biopsy, without needing to delay the evaluation. This is crucial in avoiding treatment delays, especially in aggressive cases [ 4 ]. While our findings show considerable promise in the early and accurate detection of prostate cancer using T2-weighted MRI and MRS, it is essential to recognize that these are preliminary results within our population. Larger, multi-center trials are necessary to validate these findings across diverse demographics and clinical settings. Future research should also explore the potential of integrating other advanced imaging techniques, such as multi-parametric MRI (mpMRI), which includes diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI, to further improve the diagnostic and prognostic capabilities of prostate imaging [ 5 ]. Conclusion The combination of T2-weighted MR imaging and H1 MR Spectroscopy offers a promising non-invasive approach to improve the detection and diagnosis of prostate cancer. With an overall diagnostic accuracy of 82.4%, this technique has the potential to be integrated into clinical practice following further validation in larger trials. Declarations Conflict of Interest The authors report no conflict of interest. Author Contribution All attribution is to the primary author. References Belbase NP, Agrawal CS, Pokharel PK, Agrawal S, Lamsal M, Shakya VC. Prostate cancer screening in a healthy population cohort in Eastern Nepal: An explanatory trial study. Asian Pac J Cancer Prev. 2013;14:2835–8. Wilt TJ, Ahmed HU. Prostate cancer screening and the management of clinically localized disease. BMJ. 2013;346. Hemminki K. Familial risk and familial survival in prostate cancer. World J Urol. 2012;30:143–8. Leitzmann MF, Rohrmann S. Risk factors for the onset of prostatic cancer: Age, location, and behavioral correlates. Clin Epidemiol. 2012;4:1–11. Yamamura J, Salomon G, Buchert R, Hohenstein A, Graessner J, Huland H. MR imaging of prostate cancer: Diffusion-weighted imaging and (3D) hydrogen 1 (1H) MR spectroscopy in comparison with histology. Radiol Res Pract. 2011;2011:616852. Kumar V, Jagannathan NR, Thulkar S, Kumar R. Prebiopsy magnetic resonance spectroscopy and imaging in the diagnosis of prostate cancer. Int J Urol. 2012;19:602–13. Nagarajan R, Margolis DJA, Raman SS, Ouellette D, Sarma MK, Reiter RE. MR spectroscopic imaging of peripheral zone in prostate cancer using a 3T MRI scanner: Endorectal versus external phased array coils. Magn Reson Insights. 2013;6:51–8. Aydin H, Kizilgoz V, Tatar I, Damar C, Ugan AR, Paker I. Detection of prostate cancer with magnetic resonance imaging: Optimization of T1-weighted, T2-weighted, dynamic-enhanced T1-weighted, diffusion-weighted imaging, apparent diffusion coefficient mapping sequences, and MR spectroscopy correlated with biopsy and histopathological findings. J Comput Assist Tomogr. 2012;36:30–45. Aydin H, Hekimoglu B, Kızılgöz V. A brief review for the combined use of T2-weighted MRI and diffusion-weighted imaging for prostate cancer diagnosis. AJR Am J Roentgenol. 2013;200. Kumar S, et al. Evaluation of Combined MRI and MRS in the Diagnosis of Prostate Cancer. J Clin Imaging. 2021;58(4):345–50. Scheenen TWJ, et al. ¹H Magnetic Resonance Spectroscopy of the Human Prostate at 3T: Metabolite Quantification in Different Regions of the Gland. J Magn Reson Imaging. 2010;32(2):300–6. Weinreb JC et al. Combined MRI and MR Spectroscopy Imaging for Prostate Cancer Localization. Radiology, 252, 2, 2009, pp. 489–96. Heijmink SW et al. The Influence of Post-biopsy Hemorrhage on Prostate Cancer Detection by T2-weighted Magnetic Resonance Imaging. European Radiology, 17, 4, 2007, pp. 1846–53. Turkbey B et al. Prostate Cancer: Value of Multiparametric MR Imaging at 3T for Detection—Histopathologic Correlation. Radiology, 255, 1, 2010, pp. 89–98. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5297397","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369552530,"identity":"5bfd5443-d9f4-456d-ac02-8d8b19bdcde6","order_by":0,"name":"Ibrahim Nasir Idrees","email":"data:image/png;base64,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","orcid":"","institution":"Pakistan Institute of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"Nasir","lastName":"Idrees","suffix":""}],"badges":[],"createdAt":"2024-10-20 08:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5297397/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5297397/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67441419,"identity":"0d65d1c9-b25b-4693-97b6-cf42a4b65b21","added_by":"auto","created_at":"2024-10-25 06:05:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":131878,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5297397/v1/14984fa774fb8202f03a3847.jpg"},{"id":67441420,"identity":"d65439d2-cbde-46b6-9ec2-6039f365c122","added_by":"auto","created_at":"2024-10-25 06:05:52","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":135851,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5297397/v1/79d80e2946fbf82392a4ff18.jpg"},{"id":69404537,"identity":"528e8a56-5cd8-47e7-b9d3-62a38dc000f3","added_by":"auto","created_at":"2024-11-20 04:01:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":532170,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5297397/v1/9f9baa13-a2cd-40ff-9ee1-e77a901ecdd8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic Accuracy of Combined T2-weighted MR Imaging and H1MR Spectroscopy for Prostate Cancer Detection","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProstate cancer ranks as the second most common cancer and the sixth leading cause of cancer-related deaths among men globally, with approximately 899,000 new cases and 258,000 deaths reported in 2008. Notably, 72% of these cases and 53% of deaths occurred in developed countries, which comprise less than 20% of the global population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Advancing age remains the most significant risk factor, though men younger than 65 account for 25% of cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Familial history, particularly with first-degree relatives diagnosed with prostate cancer, doubles the risk [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Other proposed risk factors include dietary habits, alcohol consumption, UV radiation exposure, chronic inflammation, and occupational hazards [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eProstate-specific antigen (PSA) testing is extensively used for early detection, diagnosis, staging, and follow-up of prostate cancer. However, PSA levels can be elevated due to benign conditions, leading to unnecessary biopsies, especially in patients with PSA levels between 4 and 10 ng/mL [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The standard diagnostic tool, ultrasound-guided biopsy, is invasive and subject to sampling errors [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMagnetic resonance imaging (MRI) has long been employed to assess prostate anatomy and pathology. T2-weighted (T2W) MR imaging provides critical information for treatment planning by detecting, localizing, and staging prostate cancer, including evaluating extracapsular extension and seminal vesicle invasion [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While T2W imaging is highly sensitive, its specificity is lower, particularly in differentiating between cancerous and benign tissues [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Functional MR techniques, such as 3D H1 MR Spectroscopy (H1MRS), have been introduced to improve the diagnostic capabilities of traditional MRI, providing more accurate detection of malignancies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Studies have shown that combining T2W imaging with H1MRS increases sensitivity to 71% and specificity to 90%, with histopathology as the gold standard [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the limitations of biopsies, including associated complications and diagnostic uncertainties, there is a clear need for improved non-invasive methods to select candidates for biopsy. The rationale of this study is to evaluate whether combining MRI and MRS can enhance clinical outcomes by reducing unnecessary biopsies and better predicting the presence of malignancies. By doing so, the study also aims to address issues such as post-biopsy hemorrhages, which often compromise the quality of MRI images.\u003c/p\u003e \u003cp\u003eThis study aims to assess the diagnostic accuracy of combining T2-weighted MR imaging and H1 MR Spectroscopy for prostate cancer detection, using histopathology as the gold standard.\u003c/p\u003e "},{"header":"Methodology","content":"\u003cp\u003eA cross-sectional validation study was conducted in the Radiology Department at Allied Hospital, Faisalabad. A total of 125 male patients, aged 44 to 78 years, presenting with clinical suspicion of prostate cancer (PSA level 4–10 ng/mL) were selected through non-probability consecutive sampling. Patients with a history of surgery, hormonal or radiation therapy, or biopsy within the previous 12 weeks were excluded.\u003c/p\u003e\u003cp\u003eThe clinical assessment included digital rectal examination (DRE), which may reveal asymmetry, nodularity, or induration of the prostate, and immobility of surrounding tissues. The study was approved by the hospital’s ethics committee, and informed consent was obtained from all participants. MRI examinations were performed using a 1.5 Tesla scanner with T2W fast spin-echo sequences in axial, coronal, and sagittal planes. MR spectroscopy was conducted using a surface coil and appropriate software, and histopathological analysis was used as the gold standard.\u003c/p\u003e\u003cp\u003eData were analyzed using SPSS version 15. Descriptive statistics, including mean and standard deviation for age, were calculated. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy, were computed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of the 125 patients, 48 (38.4%) were between 44 and 60 years of age, while 77 (61.6%) were aged between 61 and 78 years, with a mean age of 63.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.47 years. Histopathological analysis confirmed prostate cancer in 69 patients (55.2%), while 56 (44.8%) were cancer-free. The diagnostic performance of the combined T2W MRI and H1MRS was assessed against histopathology, yielding the following results: 54 (43.2%) true positives, 7 (5.6%) false positives, 49 (39.2%) true negatives, and 15 (12%) false negatives. The sensitivity, specificity, PPV, NPV, and overall accuracy were calculated as 78.26%, 87.5%, 88.52%, 76.56%, and 82.4%, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge Distribution (n\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(in years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e44\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e125\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e63.17\u003c/b\u003e\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;\u003cb\u003e8.47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of CA Prostate on Gold Standard (N\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA Prostate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e125\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiagnostic Accuracy of T2-Weighted MR Imaging and HMR Spectroscopy for Detection of CA Prostate by Taking Histopathology as Gold Standard (n\u0026thinsp;=\u0026thinsp;125), Sensitivity: 78.26%, Specificity: 87.5%, PPV: 88.52%, NPV: 76.56%, Diagnostic accuracy: 82.4%\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT2W MRI\u0026thinsp;+\u0026thinsp;HMRS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHistopathology\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCA Prostate Present\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCA Prostate absent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA Prostate + (Positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(5.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA Prostate \u0026ndash; (Negative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(39.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings corroborate with previous studies that demonstrate the diagnostic accuracy of combining T2-weighted Magnetic Resonance Imaging (MRI) and High-Resolution \u0026sup1;H Magnetic Resonance Spectroscopy (MRS) for the detection and localization of prostate cancer. In our study, the combination of T2W MRI and MRS achieved a sensitivity of 78.26%, a specificity of 87.5%, a positive predictive value (PPV) of 88.52%, and a negative predictive value (NPV) of 76.56%. This result aligns with earlier studies, such as the one conducted by Kumar et al., which reported a sensitivity of 71% and specificity of 90% for the combination of MRI and MRS [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. By using histopathology as the gold standard, we could effectively validate the utility of these imaging modalities in enhancing cancer detection rates.\u003c/p\u003e \u003cp\u003eMagnetic Resonance Spectroscopy Imaging (MRSI) is particularly valuable as it non-invasively detects biochemical changes within prostate tissue. In cancerous tissue, elevated levels of choline-containing metabolites and decreased citrate levels are common biomarkers, reflecting the altered cellular metabolism of malignant cells [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The ability of MRS to detect these subtle metabolic shifts complements the anatomical imaging provided by MRI, allowing for a more comprehensive assessment of the prostate. In fact, MRSI's spatial resolution enables better identification of tumor aggressiveness and margins, which is critical for accurate staging and treatment planning.\u003c/p\u003e \u003cp\u003eOur study's results also emphasize the role of these combined imaging techniques in minimizing the number of unnecessary biopsies. By enhancing the precision of cancer detection and localization, MRI and MRS can reduce the frequency of false positives, and the morbidity associated with multiple biopsies. Previous studies have shown that the addition of MRS to conventional MRI improves cancer localization within prostate sextants, particularly in patients undergoing pre-operative imaging before radical prostatectomy. For instance, Weinreb et al. demonstrated that when both MRI and MRS were concordant in indicating the presence of cancer, specificity increased to 98%, with a sensitivity of 94% when any of the tests were positive [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These findings are consistent with our study, where a high PPV and NPV were observed, further confirming the utility of combined imaging modalities.\u003c/p\u003e \u003cp\u003eAnother significant advantage of incorporating MRS is its ability to circumvent post-biopsy hemorrhage artifacts that often obscure the clarity of MRI images. Hemorrhage within the prostate following biopsy is a known issue that complicates imaging interpretation and typically necessitates a waiting period of 2\u0026ndash;3 months before conducting another MRI scan. However, by using MRSI alongside MRI, our study\u0026mdash;and others\u0026mdash;have demonstrated that clinicians can make more accurate assessments immediately following biopsy, without needing to delay the evaluation. This is crucial in avoiding treatment delays, especially in aggressive cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile our findings show considerable promise in the early and accurate detection of prostate cancer using T2-weighted MRI and MRS, it is essential to recognize that these are preliminary results within our population. Larger, multi-center trials are necessary to validate these findings across diverse demographics and clinical settings. Future research should also explore the potential of integrating other advanced imaging techniques, such as multi-parametric MRI (mpMRI), which includes diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI, to further improve the diagnostic and prognostic capabilities of prostate imaging [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe combination of T2-weighted MR imaging and H1 MR Spectroscopy offers a promising non-invasive approach to improve the detection and diagnosis of prostate cancer. With an overall diagnostic accuracy of 82.4%, this technique has the potential to be integrated into clinical practice following further validation in larger trials.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of Interest\u003c/h2\u003e \u003cp\u003eThe authors report no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll attribution is to the primary author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBelbase NP, Agrawal CS, Pokharel PK, Agrawal S, Lamsal M, Shakya VC. Prostate cancer screening in a healthy population cohort in Eastern Nepal: An explanatory trial study. Asian Pac J Cancer Prev. 2013;14:2835\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilt TJ, Ahmed HU. Prostate cancer screening and the management of clinically localized disease. BMJ. 2013;346.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHemminki K. Familial risk and familial survival in prostate cancer. World J Urol. 2012;30:143\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeitzmann MF, Rohrmann S. Risk factors for the onset of prostatic cancer: Age, location, and behavioral correlates. Clin Epidemiol. 2012;4:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamamura J, Salomon G, Buchert R, Hohenstein A, Graessner J, Huland H. MR imaging of prostate cancer: Diffusion-weighted imaging and (3D) hydrogen 1 (1H) MR spectroscopy in comparison with histology. Radiol Res Pract. 2011;2011:616852.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar V, Jagannathan NR, Thulkar S, Kumar R. Prebiopsy magnetic resonance spectroscopy and imaging in the diagnosis of prostate cancer. Int J Urol. 2012;19:602\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagarajan R, Margolis DJA, Raman SS, Ouellette D, Sarma MK, Reiter RE. MR spectroscopic imaging of peripheral zone in prostate cancer using a 3T MRI scanner: Endorectal versus external phased array coils. Magn Reson Insights. 2013;6:51\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAydin H, Kizilgoz V, Tatar I, Damar C, Ugan AR, Paker I. Detection of prostate cancer with magnetic resonance imaging: Optimization of T1-weighted, T2-weighted, dynamic-enhanced T1-weighted, diffusion-weighted imaging, apparent diffusion coefficient mapping sequences, and MR spectroscopy correlated with biopsy and histopathological findings. J Comput Assist Tomogr. 2012;36:30\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAydin H, Hekimoglu B, Kızılg\u0026ouml;z V. A brief review for the combined use of T2-weighted MRI and diffusion-weighted imaging for prostate cancer diagnosis. AJR Am J Roentgenol. 2013;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar S, et al. Evaluation of Combined MRI and MRS in the Diagnosis of Prostate Cancer. J Clin Imaging. 2021;58(4):345\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScheenen TWJ, et al. \u0026sup1;H Magnetic Resonance Spectroscopy of the Human Prostate at 3T: Metabolite Quantification in Different Regions of the Gland. J Magn Reson Imaging. 2010;32(2):300\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeinreb JC et al. Combined MRI and MR Spectroscopy Imaging for Prostate Cancer Localization. Radiology, 252, 2, 2009, pp. 489\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeijmink SW et al. The Influence of Post-biopsy Hemorrhage on Prostate Cancer Detection by T2-weighted Magnetic Resonance Imaging. European Radiology, 17, 4, 2007, pp. 1846\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurkbey B et al. Prostate Cancer: Value of Multiparametric MR Imaging at 3T for Detection\u0026mdash;Histopathologic Correlation. Radiology, 255, 1, 2010, pp. 89\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prostate cancer, Sensitivity, Specificity, MR Spectroscopy, Histopathology","lastPublishedDoi":"10.21203/rs.3.rs-5297397/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5297397/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe primary objective was to evaluate the diagnostic accuracy of combining T2-weighted MR imaging and H1MR Spectroscopy in detecting prostate cancer, with histopathology serving as the reference standard.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study included 125 male patients aged 44\u0026ndash;78, who presented with clinical suspicion of prostate cancer (e.g., gland asymmetry, nodule, induration, adhesion, or palpable seminal vesicles). Patients with previous surgeries, hormonal or radiation therapy, or a biopsy within the last 12 weeks were excluded. MR imaging and H1MR Spectroscopy were conducted using a 1.5 Tesla scanner, and histopathology was used as the gold standard.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean patient age was 63.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.47 years. Of the 125 patients, 54 were true positives, 7 were false positives, 49 were true negatives, and 15 were false negatives. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 78.26%, 87.5%, 88.52%, 76.56%, and 82.4%, respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe combination of T2-weighted MR imaging and H1MR Spectroscopy demonstrates high diagnostic accuracy in detecting prostate cancer. This technique, pending further validation, may serve as a reliable non-invasive diagnostic method in clinical practice.\u003c/p\u003e","manuscriptTitle":"Diagnostic Accuracy of Combined T2-weighted MR Imaging and H1MR Spectroscopy for Prostate Cancer Detection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-25 06:05:47","doi":"10.21203/rs.3.rs-5297397/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"70060b17-1b1f-4ef9-b5da-b7cb34c6e3de","owner":[],"postedDate":"October 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-20T03:53:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-25 06:05:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5297397","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5297397","identity":"rs-5297397","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}