Improved prostate cancer diagnostics and treatment planning with Magnetic ResonanceElastography (MRE), Diffusion Tensor Imaging (DTI) and Chemical Exchange Saturation Transfer (CEST): ex-vivo imaging and translation to an in-vivo application for patients

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Motivation:In Germany, prostate cancer (PCa) is the most common tumor in men. Despite the success of multiparametric magnetic resonance imaging (mpMRI) in evaluating PCa, there are significant limitations such as the low specificity for distinguishing benign prostatic hyperplasia and malignant tumors, low sensitivity for detecting extraprostatic tumor extension and moderate inter-reader reliability of radiologists. This project builds on the previous study and also aims to improve non-invasive PCa diagnostics. The innovation of this project consists of expansion and acceleration of diagnostic methods as well as translation to an in-vivo application for patients.Methods:A total of three new MRI techniques will be investigated which will provide quantitative information on viscoelastic properties (magnetic resonance elastography, MRE), structural organization (diffusion tensor imaging, DTI) and physiology (chemical exchange saturation transfer, CEST) of the prostate. Additionally, for the first time, a simultaneous acquisition of DTI and MRE of the prostate will be performed - the so-called DTI-MRE. Subsequently, the examination times can be accelerated and artifacts, e.g., due to involuntary bowel movements, can be reduced for in-vivo applications. These techniques are first studied ex-vivo on ten resected prostatectomy specimens from patients with PCa on an ultra-high-field 9.4 Tesla MRI scanner. Afterwards, a translation to an in-vivo application with ten healthy volunteers and ten patients with PCa on a clinical 3 Tesla MRI scanner will be performed. To evaluate the diagnostic accuracy, results are compared with pathology as the reference standard. Furthermore, the quantitative data is used to develop a 3D visualization software and predictive multivariable logistic regression model for PCa probability determination. Hypothesis and aims:We hypothesize that the addition of a time-efficient DTI-MRE and CEST sequence to current standard mpMRI protocols improves the detection, grading and treatment planning of PCa without a significant additional effort for clinical routine. In the future, patients may benefit from this non-invasive method because complications of transrectal biopsies, such as infections and rectal bleedings, but also unnecessary surgical prostatectomy and its risks, such as incontinence and impotence, can be avoided. Moreover, we hypothesize that the implementation of quantitative data increases the inter-reader reliability of radiologists. In order to make this information actionable for clinical practice, we will visually integrate quantitative data with current standard mpMRI and pathology.