Skip to main content Accessibility help
  • Print publication year: 2009
  • Online publication date: August 2010

12 - MRS in prostate cancer


Key points

Prostate cancer has a high incidence, and is one of the leading causes of death in men.

The sensitivity and specificity of diagnosing prostate cancer with conventional imaging methods (ultra sound, MRI) is relatively low.

The normal prostate contains high levels of citrate (Cit) which can be detected in the proton spectrum at 2.6 ppm. Other compounds detectable in vivo include creatine, choline, spermine, and lipids.

Citrate is a strongly coupled mutiple at 1.5 and 3.0 T. For optimum detection, careful attention to pulse sequence parameters (TR, TE) is required. TE 120 ms is commonly used at 1.5 T, and TE 75–100 ms at 3 T.

Multiple studies have reported that prostate cancer is associated with decreased levels of citrate and increased levels of Cho, compared to both normal prostate and also benign prostatic hyperplasia (BPH).

MRS and MRSI of the prostate is technically challenging: water- and lipid-suppressed 3D-MRSI is the method of choice for most prostate spectroscopy studies.

Some studies report that adding MRSI to conventional MRI increases sensitivity and specificity of prostate cancer diagnosis.

MRSI is traditionally performed with an endorectal surface coil, but acceptable quality data may be obtained at 3 T with external phased-array coils which are more comfortable for patients.

Stewart, BW, Kleihus, P, Eds. World Cancer Report. Lyon: IARC Press, 2003.
,American Cancer Society website:; Cancer Facts and Figures 2006.
,American Cancer Society. Cancer Facts & Figures 2009. Atlanta: American Cancer Society; 2009.
Hricak, H, White, S, Vigneron, D, Kurhanewicz, J, Kosco, A, Levin, D, et al. Carcinoma of the prostate gland: MR imaging with pelvic phased-array coils versus integrated endorectal-pelvic phased-array coils. Radiology 1991; 193: 703–09.
Kurhanewicz, J, Vigneron, DB, Males, RG, Swanson, MG, Yu, K, Hricak, H. The prostate: MR imaging and spectroscopy. Present and future. Radiol Clin North Am 2000; 38: 115–38, viii–ix.
McNeal, JE. Normal anatomy of the prostate and changes in benign hypertrophy and carcinoma. Semin US CT MR 1988; 9: 329–34.
Perrotti, M, Han, KR, Epstein, RE, Kennedy, EC, Rabbani, F, Badani, K, et al. Prospective evaluation of endorectal magnetic resonance imaging to detect tumor foci in men with prior negative prostatic biopsy: A pilot study. J Urol 1999; 162: 1314–7.
Schiebler, M, Miyamoto, KK, White, M, Maygarden, SJ, Mohler, JL. In vitro high resolution 1H-spectroscopy of the human prostate: Benign prostatic hyperplasia, normal peripheral zone and adenocarcinoma. Magn Reson Med 1993; 29: 285–91.
Torricelli, P, Iadanza, M, Santis, M, Pollastri, CA, Cesinaro, AM, Trentini, G, et al. Magnetic resonance with endorectal coil in the local staging of prostatic carcinoma. Comparison with histologic macrosections in 40 cases. Radiol Med (Torino) 1999; 97: 491–8.
White, S, Hricak, H, Forstner, R, Kurhanewicz, J, Vigneron, DB, Zaloudek, CJ, et al. Prostate cancer: Effect of postbiopsy hemorrhage on interpretation of MR images. Radiology 1995; 195: 385–90.
Chen, M, Hricak, H, Kalbhen, CL, Kurhanewicz, J, Vigneron, DB, Weiss, JM, et al. Hormonal ablation of prostatic cancer: Effects on prostate morphology, tumor detection, and staging by endorectal coil MR imaging. Am J Roentgenol 1995; 166: 1157–63.
Engelbrecht, MR, Jager, GJ, Laheij, RJ, Verbeek, ALM, Lier, HJ, Barentsz, JO. Local staging of prostate cancer using magnetic resonance imaging: A meta-analysis. Eur Radiol 2002; 12: 2294–302.
Costello, LC, Franklin, RB, Narayan, P. Citrate in the diagnosis of prostate cancer. The Prostate 1999; 38: 237–45.
Costello, LC, Franklin, RB. The intermediary metabolism of the prostate: A key to understanding the pathogenesis and progression of prostate malignancy. Oncology 2000; 59: 269–82.
Cooper, JF, Imfeld, H. The role of citric acid in the physiology of the prostate: A preliminary report. J Urol 1959; 81: 157–63.
Cooper, JF, Farid, I. The role of citric acid in the physiology of the prostate: Lactic/citrate rations in benign and malignant prostatic homogenates as an index of prostatic malignancy. J Urol 1984; 92: 533–6.
Costello, LC, Liu, Y, Franklin, RB, Kennedy, MC. Zinc inhibition of mitochondrial aconitase and its importance in citrate metabolism of prostate epithelial cells. J Biol Chem 1997; 46: 28875–81.
Costello, LC, Franklin, RB. Novel role of zinc in the regulation of prostate citrate metabolism and its implications in prostate cancer. The Prostate 1998; 35: 285–96.
Zaichick, VY, Sviridova, TV, Zaichick, SV. Zinc concentration in human prostatic fluid: Normal, chronic prostatitis, adenoma and cancer. Int Urol Nephrol 1996; 28: 687–94.
Franklin, RB, Ma, J, Zou, J, Kukoyi, BI, Feng, P, Costello, LC. hZIP1 is a major zinc uptake transporter for the accumulation of zinc in prostate cells. J Inorg Biochem 2003; 96: 435–42.
Zaichick, VY, Sviridova, TV, Zaichick, SV. Zinc in the human prostate gland: Normal hyperplasia, cancerous. Int Urol Nephrol 1997; 29: 565–74.
Costello, LC, Franklin, RB, Liu, Y, Kennedy, MC. Zinc causes a shift toward citrate at equilibrium of the m-aconitase reaction of prostate mitochondria. Inorg Biochem 2000; 78: 161–5.
Negendank, W. Studies of human tumors by MRS: A review. NMR Biomed 1992; 5: 303–24.
Gillies, RJ, Morse, DL. In vivo magnetic resonance spectroscopy in cancer. Annu Rev Biomed Eng 2005; 7: 287–326.
Costello, LC, Franklin, RB. Bioenergetic theory of prostate malignancy. Prostate 1994; 25: 162–6.
Graaf, M, Schipper, RG, Oosterhof, GO, Schalken, JA, Verhofstad, AA, Heerschap, A. Proton MR spectroscopy of prostatic tissue focused on the detection of spermine, a possible biomarker of malignant behavior in prostate cancer. Magma 2000; 10: 153–9.
Childs, AC, Mehta, DJ, Gerner, EW. Polyamine-dependent gene expression. Cell Mol Life Sci 2003; 60: 1394–406.
Babban, N, Gerner, EW. Polyamines as modifiers of genetic risk factors in human intestinal cancers. Biochem. Soc Trans 2003; 31: 388–92.
Kurhanewicz, J, Dahiya, R, Macdonald, JM, Chang, LH, James, TL, Narayan, P. Citrate alterations in primary and metastasis human prostatic Aden carcinomas: 1H magnetic resonance spectroscopy and biochemical study. Magn Reson Med 1993; 29: 149–57.
Fowler, AH, Pappas, AA, Holder, JC, Finkbeiner, AE, Dalrymple, GV, Mullins, MS, et al. Differentiation of human prostate cancer from benign hypertrophy by in vitro 1H NMR. Magn Reson Med 1992; 25: 140–7.
Cornel, EB, Smits, GAHJ, Oosterhof, GON, Karthaus, HFM, Debruyne, FMJ, Schalken, JA, et al. Characterization of human prostate cancer, benign prostatic hyperplasia and normal prostate by in vitro 1H and 31P magnetic resonance spectroscopy. J Urol 1993; 150: 2019–24.
Narayan, D, Vigneron, DB, Jajodia, CM, Anderson, CM, Hedgcock, MW, Tanagho, EA, et al. Transrectal probe for 1H MRI and 31P MR spectroscopy of the prostate gland. J Magn Reson 1989; 11: 209–20.
Narayan, P, Kurhanewicz, J. Magnetic resonance spectroscopy in prostate disease: Diagnostic possibilities and future developments. Prostate 1992; 4: 43–50.
Thomas, MA, Narayan, P, Kurhanewicz, J, Jajodia, P, Weiner, MW. 1H MR spectroscopy of normal and malignant human prostate in vivo. J Magn Reson 1990; 87; 610–9.
Kurhanewicz, J, Vigneron, DB, Nelson, SJ, Hricak, H, MacDonald, JM, Konety, B, et al. Citrate as an in vivo marker to discriminate prostate cancer from benign prostatic hyperplasia and normal prostate peripheral zone: Detection via localized proton spectroscopy. Urology 1995; 45; 459–66.
Liney, GP, Lowry, M, Turnbull, LW, Manton, DJ, Knowles, AJ, Blackband, SJ, et al. Proton MR T2 maps correlate with the citrate concentration in the prostate. NMR Biomed 1996; 9: 59–64.
Liney, GP, Turnbull, LW, Lowry, M, Turnbull, LS, Knowles, AJ, Horsman, A. In vivo quantification of citrate concentration and water T2 relaxation time of the pathologic prostate gland using 1H MRS and MRI. Magn Reson Imag 1997; 15: 1177–86.
Frahm, J, Bruhn, H, Gyngell, ML, Merbolt, KD, Hanicke, W, Sauter, R. Localized high-resolution proton NMR spectroscopy using echoes: Initial applications to human brain in vivo. Magn Reson Med 1989; 9: 79–93.
Bottomley, PA. Spatial localization in NMR spectroscopy in vivo. Ann NY Acad Sci 1987; 508: 333–48.
Heerschap, A, Jager, G, Koster, A, Barentsz, J, Rosette, J, Debruyne, F, et al. 1H MRS of prostate pathology. In Proceedings of Soc of Magn Reson Med, 12th annual meeting, New York, 1993, p. 213.
Brown, TR. Practical applications of chemical shift imaging. NMR Biomed 1992; 5: 238–43.
Brown, TR, Kincaid, BM, Ugurbil, K. NMR chemical shift in three dimensions. Proc Natl Acad Sci USA 1982; 79: 3523–6.
Maudsley, AA, Hilal, SK, Simon, HE, Wittekoek, S. In vivo MR spectroscopic imaging with P-31. Work in progress. Radiology 1984; 153: 745–50.
Luyten, PR, Marien, AJ, den HJ. Acquisition and quantitation in proton spectroscopy. NMR Biomed 1991; 4: 64–9.
Star-Lack, J, Nelson, SJ, Kurhanewicz, J, Huang, LR, Vigneron, DB. Improved water and lipid suppression for 3D PRESS CSI using RF Band selective inversion with gradient dephasing (BASING). Magn Reson Med 1997; 38: 311–21.
Tran, T-KC, Vigneron, DB, Sailasuta, N, Tropp, J, Roux, P, Kurhanewicz, J, et al. Very selective suppression pulses for clinical MRSI studies of brain and prostate cancer. Magn Reson Med 2000; 43: 23–33.
Star-Lack, J, Vigneron, DB, Pauly, J, Kurhanewicz, J, Nelson, SJ. Improved solvent suppression and increased spatial excitation bandwidths for three-dimensional PRESS CSI using phase-compensating spectral/spatial spin-echo pulses. J Magn Reson Imaging 1997; 7: 745–57.
Males, RG, Vigneron, DB, Star-Lack, J, Falbo, SC, Nelson, SJ, Hricak, H, et al. Clinical application of BASING and spectral/spatial water and lipid suppression pulses for prostate cancer staging and localization by in vivo 3D 1H magnetic resonance spectroscopic imaging. Magn Reson Med 2000; 43: 17–22.
Kurhanewicz, J, Vigneron, DB, Hricak, H, Narayan, P, Carroll, P, Nelson, SJ. Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24–0.7 cm3) spatial resolution. Radiology 1996; 198: 795–805.
Graaf, M, Boogert, HJ, Jager, GJ, Barentsz, JO, Heerschap, A. Human prostate: Multisection proton MR spectroscopic imaging with a single spin-echo sequence – preliminary experience. Radiology 1999; 213: 919–25.
Wefer, AE, Hricak, J, Vigneron, DB. Sextant localization of prostate cancer; comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology. J Urol 2000; 164: 400–04.
Zakian, KL, Eberhardt, S, Hricak, H, Shukla-Dave, A, Kleinman, S, Muruganandham, M, et al. Transition zone prostate cancer: Metabolic characteristics at 1H spectroscopic imaging – initial results. Radiology 2003; 229: 241–7.
Beyersdorff, D, Taupitz, M, Winkelmann, B, Fischer, T, Lenk, S, Loening, SA, et al. Patients with a history of elevated prostate-specific antigen levels and negative transrectal US-guided quadrant or sextant biopsy results: Value of MR imaging. Radiology 2002; 224: 701–06.
Terris, MK. Prostate biopsy strategies: Past, present, future. Urol Clin North Am 2002; 29: 205–12.
Zelefsky, MJ, Cohen, G, Zakian, KL, Dyke, J, Koutcher, JA, Hricak, H, et al. Intraoperative conformal optimization for transperineal prostate implantation using magnetic resonance spectroscopic imaging. Cancer J 2000; 6: 249–55.
Zaider, M, Zelefsky, MJ, Lee, EK, Zakian, KL, Amols, HI, Dyke, J, et al. Treatment planning for prostate implants using magnetic resonance spectroscopy imaging. Int J Radiation Oncology Biol Phys 2000; 47: 1085–96.
Pickett, B, Vigneault, E, Kurhanewicz, J, Verhey, L, Roach, M. Static field intensity modulation to treat a dominant intra-prostatic lesion to 90 Gy compared to seven field 3-dimensional radiotherapy. Int J Radiat Oncol Biol Phys 1999; 44: 921–9.
Xia, P, Pickett, B, Vigneault, E, Verhey, LJ, Roach, M 3rd. Forward or inversely planned segmental multileaf collimator IMRT and sequential tomotherapy to treat multiple dominant intraprostatic lesions of prostate cancer to 90 Gy. Int J Radiat Oncol Biol Phys 2001; 51: 244–54.
DiBiase, SJ, Hosseinzadeh, K, Gullapalli, RP, Jacobs, SC, Naslund, MJ, Sklar, GN, et al. Magnetic resonance spectroscopic imaging-guided brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2002; 52: 429–38.
Coakley, FV, Kurhanewicz, J, Lu, Y, Jones, KD, Swanson, MG, Chang, SD, et al. Prostate cancer tumor volume: Measurement with endorectal MR and MR spectroscopic imaging. Radiology 2002; 223: 91–7.
Hom, JJ, Coakley, FV, Simko, JP, Qayyum, A, Lu, Y, Schmitt, L, et al. Prostate cancer: Endorectal MR imaging and MR spectroscopic imaging – distinction of true-positive results from chance-detected lesions. Radiology 2006; 238: 192–9.
Mizowaki, T, Cohen, GN, Fung, AY, Zaider, M. Towards integrating functional imaging in the treatment of prostate cancer with radiation: The registration of the MR spectroscopy to ultrasound/CT images and its implementation in treatment planning. Int J Radiat Oncol Biol Phys 2002; 54: 1558–64.
Wu, X, Dibiase, SJ, Gullapalli, RP, Yu, CX. Deformable image registration for the use of magnetic resonance spectroscopy in prostate treatment planning. Int J Radiat Oncol Biol Phys 2004; 58: 1577–83.
Coakley, FV, The, HS, Qayyum, A, Swanson, MG, Lu, Y, Roach, M 3rd, et al. Endorectal MR imaging and MR spectroscopic imaging for locally recurrent prostate cancer after external beam radiation therapy: preliminary experience. Radiology 2004; 233: 441–8.
Pucar, D, Shukla-Dave, A, Hricak, H, Moskowitz, CS, Kuroiwa, K, Olgac, S, et al. Prostate cancer: Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy-initial experience. Radiology 2005; 236: 545–53.
Pickett, B, Ten Haken, RK, Kurhanewicz, J, Qayyum, A, Shinohara, K, Fein, B, et al. Time to metabolic atrophy after permanent prostate seed implantation based on magnetic resonance spectroscopic imaging. Int J Radiat Oncol Biol Phys 2004; 59: 665–73.
Pickett, B, Kurhanewicz, J, Coakley, F, Shinohara, K, Fein, B, Roach, M 3rd. Use of MRI and spectroscopy in evaluation of external beam radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2004; 60: 1047–55.
Yu, KK, Scheidler, J, Hricak, H, Vigneron, DB, Zaloudek, CJ, Males, RG, et al. Prostate cancer: Prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. Radiology 1999; 213: 481–8.
Coakley, FV, Kurhanewicz, J, Liu, Y, Jones, KD, Swanson, MG, Chang, SD, et al. Prostate cancer tumor volume: Measurement by endorectal MR imaging and MR spectroscopic imaging. Radiology 2002; 223: 91–7.
Kurhanewicz, J, Vigneron, DB, Nelson, SJ. Three-dimensional magnetic resonance spectroscopic imaging of brain and prostate cancer. Neoplasia 2000; 2: 166–89.
Scheme, TWJ, Klomp, DWJ, Roll, SA, Futterer, JJ, Barentsz, JO, Heerschap, A. Fast acquisition-weighted three-dimensional proton MR spectroscopic imaging of the human prostate. Magn Reson Med 2004; 52: 80–8.
Scheme, TWJ, Gambarota, G, Weiland, E, Klomp, DWJ, Futterer, JJ, Barentsz, Heerschap, A. Optimal timing for in vivo 1H-MR spectroscopic imaging of the human prostate at 3 T. Magn Reson Med 2005; 53: 1268–74.
Swanson, MG, Vigneron, DB, Tran, T-KC, Kurhanewicz, J. Magnetic resonance imaging and spectroscopic imaging of prostate cancer. Cancer Invest 2001; 19: 510–23.
Jung, JA, Coakley, FV, Vigneron, DB, Swanson, MG, Qayyum, A, Weinberg, V, et al. Prostate depiction at endorectal MR spectroscopic imaging: Investigation of a standardized evaluation system. Radiology 2004; 233: 701–08.
Zakian, KL, Sircar, K, Hricak, H, Chen, H-N, Shukla-Dave, A, Eberhardt, S, et al. Correlation of proton MR spectroscopic imaging with Gleason score based on step-section pathological analysis after radical prostatectomy. Radiology 2005; 234: 804–14.
Graaf, M, Jager, GJ, Heerschap, A. Removal of the outer lines of the citrate multiplet in proton magnetic resonance spectra of the prostatic gland by accurate timing of a point-resolved spectroscopy pulse sequence. MAGMA 1994; 5: 65–9.
Cunningham, CH, Vigneron, DB, Marjanska, M, Chen, AP, Xu, D, Hurd, RE, et al. Sequence design for magnetic resonance spectroscopic imaging of prostate cancer at 3 T. Magn Reson Med 2005; 53: 1033–9.
Yue, K, Marmot, A, Bines, N, Thomas, MA. 2D JPRESS of human prostates using an endorectal receiver coil. Magn Reson Med 2002; 47: 1059–64.
Kim, D-H, Henry, R, Spielman, DM. Fast multi-voxel two-dimensional spectroscopic imaging at 3 T. Magn Reson Imaging 2007; 25: 1144–61.
Kim, D-H, Margolis, D, Xing, L, Daniel, B, Spielman, D. In vivo prostate magnetic resonance spectroscopic imaging using two-dimensional J-resolved PRESS at 3 T. Magn Reson Med 2005; 49: 1177–82.
Baseline, CMJ, Duane, GD, Risky, NM, Alsip, DC. MR imaging relaxation times of abdominal and pelvic tissues measured in vivo at 3.0 T: Preliminary results. Radiology 2004; 230: 652–9.
Beyersdorff, D, Taymoorian, K, Knosel, T, Schnorr, D, Felix, R, Hamm, B, et al. MRI of prostate cancer at 1.5 and 3.0 T: Comparison of image quality in tumor detection and staging. Am J Roentgenol 2005; 185: 1214–20.
Sosna, J, Rofsky, NM, Gaston, SM, DeWolf, WC, Lenkinski, RE. Determinations of prostate volume at 3-Tesla using an external phased array coil: Comparison to pathologic specimens. Acad Radiol 2003; 10: 846–53.
Sosna, J, Pedrosa, I, Dewolf, WC, Mahallati, H, Lenkinski, RE, Rofsky, NM. MR imaging of the prostate at 3 Tesla: Comparison of an external phased-array coil to imaging with an endorectal coil at 1.5 Tesla. Acad Radiol 2004; 11: 857–62.
Bloch, BN, Rofsky, NM, Baroni, RH, Marquis, RP, Lenkiski, RE. 3-Tesla magnetic resonance imaging of the prostate with combined pelvic phased-array and endorectal coils initial experience. Acad Radiol 2004; 11: 863–7.
Scheenan, TWJ, Heijmink, SWTPJ, Roell, SA, Kaa, Hulsbergen-Van, Knipscheer, BC, Witjes, JA, et al. Three-dimensional proton MR spectroscopy of human prostate at 3 T without endorectal coil: Feasibility. Radiology 2007; 245: 507–16.
Futterer, JJ, Scheenen, TWJ, Huisman, HJ, Klomp, DWJ, Dorsten, FA, Hulsbergen-van de Kaa, CA, et al. Initial experience of 3 Tesla endorectal coil magnetic resonance imaging and 1H-spectroscopic imaging of the prostate. Invest Radiol 2004; 39: 671–80.
Kim, H-W, Buckley, DL, Peterson, DM, Duensing, GR, Caserta, J, Fitzsimmons, J, et al. In vivo prostate magnetic resonance imaging and magnetic resonance spectroscopy at 3 Tesla using a transceiver pelvic phased array coil. Invest Radiol 2003; 38: 443–51.
Kaji, Y, Kuroda, K, Maeda, T, Kitamura, Y, Fujiwara, T, Matsuoka, Y, et al. Anatomical and metabolic assessment of prostate using a 3-Tesla MR scanner with a custom-made external transceiver coil: Healthy volunteer study. J Magn Reson Imaging 2007; 25: 517–26.
D'Amico, AV, Whittington, R, Malkowicz, B, Schnall, M, Schultz, D, Cote, K, et al. Endorectal magnetic resonance imaging as a predictor of biochemical outcome after radical prostatectomy in men with clinically localized prostate cancer. J Urol 2000; 164: 759–63.
Wetter, A, Engl, TA, Nadjmabadi, D, Fliessback, K, Lehnert, T, Gurung, J, et al. Combined MRI and MR spectroscopy of the prostate before radical prostatectomy. Am J Roentgenol 2006; 187: 724–30.
Weinreb, JC, Coakley, F, Blume, J, Wheeler, T, Cormack, J, Kurhanewicz, J. ACRIN 6659: MRI and MRSI of prostate cancer prior to radical prostatectomy: A prospective multi-institutional clinicopathological study. Chicago: RSNA, 2006
Gibbs, P, Pickles, MD, Turnbull, LW. Diffusion imaging of the prostate at 3.0 Tesla. Invest Radiol 2006; 41: 185–8.
Pickles, MD, Gibbs, P, Sreenivas, M, Turnbull, LW. Diffusion-weighted imaging of normal and malignant prostate tissue at 3.0 T. J Magn Reson Imaging 2006; 23: 130–4.
Shimofusa, R, Fujimoto, H, Akamata, H, Motoori, K, Yamamoto, S, Ueda, T, et al. Diffusion-weighted imaging of prostate cancer. J Comput Assist Tomogr 2005; 29: 149–53.
Padhani, AR, Gapinski, CJ, Macvicar, DA, Parker, GJ, Suckling, J, Revell, PB, et al. Dynamic contrast enhanced MRI of prostate cancer: Correlation with morphology and tumor stage, histological grade and PSA. Clin Radiol 2000; 55: 99–109.
Hara, N, Okuizumi, M, Koiki, H, Kawaguchi, M, Bali, V. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a useful modality for the precise detection and staging of early prostate cancer. The Prostate 2004; 62: 140–7.
Huisman, HJ, Engelbrecht, MR, Barentsz, JO. Accurate estimation of pharmacokinetic contrast enhanced dynamic MRI parameters of the prostate. J Magn Reson Imaging 2001; 13: 607–14.
Engebrecht, MR, Huisman, HJ, Laheij, RJF, Jager, GJ, Leenders, GJLH, Hulsbergenvan de Kaa, CA, et al. Discrimination of prostate cancer from normal peripheral zone and central gland tissue by using contrast-enhanced MR imaging. Radiology 2003; 229: 248–54.
Buckley, D, Roberts, C, Parker, GJM, Hutchinson, CE. Prostate cancer: Evaluation of vascular characteristics with dynamic contrast-enhanced T1-weighted MR imaging – initial experience. Radiology 2004; 233: 709–15.
Dorsten, FA, Graaf, M, Engelbrecht, MR, Leenders, GJLH, Verhofstad, A, Rjpkema, M, et al. Combined quantitative dynamic contrast enhanced MR imaging and 1H MR spectroscopic imaging of human prostate cancer. J Magn Reson Imaging 2004; 20: 279–87.
Prando, A, Kurhanewicz, J, Borges, AP, Oliveira, EM Jr, Figueiredo, E. Prostatic biopsy directed with endorectal MR spectroscopic imaging findings in patients with elevated prostate specific antigen levels and prior negative biopsy findings: Early experience. Radiology 2005; 236: 903–10.
Umbehr, M, Bachmann, LM, Held, U, Kessler, TM, Sulser, T, Weishaupt, D, et al. Combined magnetic resonance imaging and magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer: A systematic review and meta-analysis. Eur Urol 2009; 55: 575–91.