Role of MRI and MRSI in treatment follow-up:
After radiation or hormonal therapy, the prostate shrinks in size, resulting in diffuse low T2 signal intensity and indistinct zonal anatomy. These changes greatly limit the role of MRI in the detection of local recurrence. There is great interest in whether MRSI would be helpful in this setting, an area currently under investigation.
Technical improvements:
Areas of active research interest include volumetric localization of prostate cancer, in vivo MRSI findings at high field strength (3 Tesla), in vitro MRSI findings at very high field strength (7-11 Tesla), novel spectroscopic markers of malignancy such as polyamines and spermine, and MR guidance of interventional procedures such as biopsy and therapeutic maneuvers. MRSI remains a relatively novel technique. Successful implementation will require full anatomic coverage of the region of interest, adequate fat and water suppression which is critical to this technique, and accurate post-processing of the data.
Conclusion:
In the realm of imaging techniques for evaluation of the prostate gland, only MRI and MRSI allow combined anatomic and metabolic evaluation for prostate cancer detection, localization, staging, and characterization of tumor aggressiveness. These new technologies are under development, in constant evolution, and are still largely underused. Increasing awareness of these procedures in the general public and the medical community will fuel the demand for MRI and MRSI, contributing to the realistic assessment of their utility in prostate cancer, and ultimately propelling the maturation and deployment of these methods into widespread clinical use.
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