Multiparametric MRI in Prostate Cancer

7/24/2019 Multiparametric MRI in Prostate Cancer

1/6

Editorial

Multiparametric MRI in Prostate Cancer

Tark Esen,1Bars Turkbey,2Anup Patel,and !ur"en #utterer$

1%epartment o& 'rolo"y, (c)ool o& Medicine, *oc 'ni+ersity, $$- Istanbul, Turkey

2Molecular Ima"in" Pro"ram, .CI, .I/, Bet)esda, M% 2-02, '(A

Royal ondon /ospital, Barts /ealt) ./( Trust, ondon E1 1BB, '*

$%epartment o& Radiolo"y, Radboud 'ni+ersity .i3me"en Medical Centre, 4-- /B .i3me"en,

T)e .et)erlands

Recei+ed 11 .o+ember 2-1$5 Accepted 11 .o+ember 2-1$5 Publis)ed 1 %ecember 2-1$

Copyri")t 6 2-1$ Tark Esen et al7 T)is is an open access article distributed under t)e Creati+e

Commons Attribution icense, 8)ic) permits unrestricted use, distribution, and reproduction in

any medium, pro+ided t)e ori"inal 8ork is properly cited7

Prostate cancer 9PCa: is t)e second most common cancer in men and an estimated 171 million

men 8orld8ide 8ere dia"nosed 8it) prostate cancer in 2-12 8it) almost ;-< o& t)e cases

occurrin" in more de+eloped re"ions =1>7 ?it) an estimated -;7-- deat)s in 2-12, prostate

cancer is t)e &i&t) leadin" cause o& deat) &rom cancer in men = 1>7 In patients 8it) ele+ated or

risin" prostate@speci&ic anti"en 9P(A: andor abnormal di"ital rectal eamination 9%RE:, random

systematic transrectal ultrasound 9TR'(: "uided prostate biopsy is t)e most commonly used

tec)niue to establis) PCa dia"nosis7 /o8e+er, P(A alone )as a lo8 speci&icity &or PCa

detection =2> and se+eral modi&ications t)at may impro+e t)e speci&icity o& P(A in PCa dia"nosis

)a+e been described suc) as a"e@speci&ic re&erence ran"es, &ree@to@total P(A ratio, P(A +elocity,

P(A density, P(A transition Done density, P(A molecular &orms 9P/I 9prostate )ealt) inde:

score 9total P(A, &ree P(A, and p2P(A: and t)e $*score, 8)ic) measures blood plasma le+els o&

&our di&&erent prostate@deri+ed kallikrein proteins total P(A, &ree P(A, intact P(A, and )uman

kallikrein 2 9)*2::, and numerous ot)er no+el biomarkers 9PCA, TMPR((2@ERF Fene &usion,

etc7:7
http://www.hindawi.com/42658268/http://www.hindawi.com/97624068/http://www.hindawi.com/97624068/http://www.hindawi.com/43941059/http://www.hindawi.com/81967267/http://creativecommons.org/licenses/by/3.0/http://creativecommons.org/licenses/by/3.0/http://creativecommons.org/licenses/by/3.0/http://www.hindawi.com/journals/bmri/2014/296810/#B1http://www.hindawi.com/journals/bmri/2014/296810/#B1http://www.hindawi.com/journals/bmri/2014/296810/#B2http://www.hindawi.com/97624068/http://www.hindawi.com/43941059/http://www.hindawi.com/81967267/http://creativecommons.org/licenses/by/3.0/http://creativecommons.org/licenses/by/3.0/http://www.hindawi.com/journals/bmri/2014/296810/#B1http://www.hindawi.com/journals/bmri/2014/296810/#B1http://www.hindawi.com/journals/bmri/2014/296810/#B2http://www.hindawi.com/42658268/


2/6

Random systematic prostate samplin" 8it) TR'( "uided biopsy also )as its in)erent limitations7

#irst o& all, clinically insi"ni&icant cancers are o&ten identi&ied by c)ance and a&&ect sur+i+al data

due to lead and len"t) time bias &rom o+erdetection and o+ertreatment o& indolent disease = >7

(econdly, systematic biopsies t)rou") random samplin" error may lead to incorrect risk

strati&ication and may per&orm poorly at documentin" t)e eact etent and )etero"eneity o& t)e

disease =$>7 astly, undersamplin", particularly, 8)en prostate +olume is taken into account,

occurs in up to -< o& cases 8it) clinically si"ni&icant tumors bein" missed 9&alse@ne"ati+ity: on

initial random systematic biopsy =>7 E&&orts to o+ercome t)ese samplin" errors include

per&ormin" multiple repeat random biopsies or increasin" t)e core number durin" random or

systematic template@"uided transperineal saturation biopsies7 /o8e+er, t)is approac) results in a

mar"inal increase in t)e o+erall detection rate 8it)out increasin" t)e rate o& si"ni&icant cancer

detection =4>, 8)ile increasin" cost and morbidity si"ni&icantly7

Ima"in" )as al8ays been problematic in respect to PCa dia"nosis and )as been essentially

limited to biplanar transrectal ultrasound and its modi&ications7 Tec)nolo"ical ultrasound

de+elopments 8it) contrast en)ancement and % recon&i"uration )a+e been underutiliDed by t)e

urolo"ical community as a 8)ole7 Isotopic e&&orts 8it) #%F and 11@c)oline PET scans )a+e also

disappointed in terms o& dia"nostic yield o& prostatic disease7 Recently, 8it) t)e ad+ent o& better

tec)nolo"y and di&&erent seuences, ma"netic resonance ima"in" 9MRI: )as s)o8n to be able to

play a si"ni&icant role in t)is respect7 .umerous studies )a+e no8 indicated t)at multiparametric

9Mp: prostate MRI at Tesla, includin" anatomical and &unctional seuences, enables accurate

PCa detection and local sta"in" 8it) reasonable sensiti+ity and speci&icity =;>7 Fi+en t)at, Mp@

MRI mi")t be use&ul in ima"e@"uided t)erapy suc) as &ocal t)erapy, as 8ell as in 8)ole "land

t)erapy suc) as radical prostatectomy or modern tec)niues o& eternal beam and interstitial

radiot)erapy7

(ensiti+ity &or detectin" lar"er 9G mm: and more a""ressi+e 9Fleason score G ;: tumors is better

&or Mp@MRI, indicatin" t)at it may pre&erentially detect clinically rele+ant tumors =0>7 /o8e+er,

in most studies )istolo"ical correlations 8ere done usin" tar"eted or systematic ultrasound

"uided biopsy samples and t)is does not represent a per&ect core"istration7 Blinded multicenter

studies t)at +alidate Mp@MRI &indin"s 8it) biopsy and t)en 8)ole@mount prostatectomy)istopat)olo"y are lackin"7 Hnly until t)ese are done can 8e determine Mp@MRIs per&ormance

&or detectin" clinically si"ni&icant cancers in di&&erent prostate "land locations 9central Done,

apical re"ion, anterior perip)eral Done, etc7:7

In an e&&ort to standardiDe t)e reportin" o& Mp@MRI &indin"s and to reduce sub3ecti+ity o& ima"e

interpretation, t)e PI@RA%( 9prostate ima"in" and reportin" arc)i+in" data system: classi&ication
http://www.hindawi.com/journals/bmri/2014/296810/#B3http://www.hindawi.com/journals/bmri/2014/296810/#B4http://www.hindawi.com/journals/bmri/2014/296810/#B5http://www.hindawi.com/journals/bmri/2014/296810/#B6http://www.hindawi.com/journals/bmri/2014/296810/#B7http://www.hindawi.com/journals/bmri/2014/296810/#B8http://www.hindawi.com/journals/bmri/2014/296810/#B3http://www.hindawi.com/journals/bmri/2014/296810/#B4http://www.hindawi.com/journals/bmri/2014/296810/#B5http://www.hindawi.com/journals/bmri/2014/296810/#B6http://www.hindawi.com/journals/bmri/2014/296810/#B7http://www.hindawi.com/journals/bmri/2014/296810/#B8


3/6

)as been de+eloped7 In t)is scorin" system e+ery parameter 9T2?I, %?I, %CE@MRI, and MR(I:

is scored on a &i+e@point scale7 Additionally, eac) lesion is "i+en an o+erall score, to predict its

c)ance o& bein" a clinically si"ni&icant cancer =>7 .e+ert)eless, "i+en t)e &act t)at t)e minimum

and optimum reuirements re"ardin" "eneral MRI components and MRI seuence parameters

and tec)niues are not uni+ersally a"reed upon, t)ere remains t)e JAc)illes /eelK o&

considerable interobser+er +ariation7 As a result, more prospecti+e studies )a+e to be eecuted in

order to +alidate t)e accuracy and interobser+er +ariability o& multiparametric prostate ima"in"7

Mp@MRI represents a potential tool to address t)e limitations o& contemporary random

systematic biopsy related to undersamplin" and &alse@ne"ati+ity7 Amon" biopsy@nai+e men, it

increases t)e &reuency o& si"ni&icant cancer detection to -< in lo8@risk 9P(A L 1- n"m,

normal %RE: and ;1< in )i")@risk 9P(A G 1- n"m, abnormal %RE: patients =1->7 In lo8@risk

men, t)e ne"ati+e predicti+e +alue o& a combination o& lo8 le+el o& suspicion based on MRI 8it)

prostate +olume parameters 8as nearly 0< and t)is mi")t be use&ul to a+oid biopsy &or t)ose

8)o 8ill not need immediate acti+e treatment i& dia"nosed 8it) prostate cancer = 1-> but must

compete on cost terms 8it) no+el blood@urine tests7 Amon" men 8it) a pre+ious ne"ati+e TR'(

"uided random biopsy but persistent clinical suspicion, ;2< to 0;< o& cancers detected by MRI

"uidance 8ere clinically si"ni&icant =11>7

Amon" acti+e sur+eillance candidates, repeat biopsy usin" MRI tar"etin" demonstrates )i")

sensiti+ity in con&irmin" lo8@risk disease in lo8 suspicion score lesions and risk up"radin" in

)i")ly suspicious lesions =12>7

Tec)niues o& MRI tar"eted biopsy include +isual co"niti+e transrectal ultrasound "uided biopsy,

so&t8are core"istered ma"netic resonance ima"in"@ultrasound, transrectal ultrasound "uided

biopsy, and in@bore ma"netic resonance ima"in" "uided biopsy7 ?)ile many studies )a+e

compared tar"eted biopsy to systematic biopsy, &e8 )a+e e+aluated t)e cancer detection rates

across di&&erent tar"eted tec)niues7 #usion tar"etin" seems to impro+e accuracy &or smaller

MRI detected lesions as 8ell as )i")@"rade cancer 9Fleason score G ;: =1>7 /o8e+er, t)e

optimal met)od &or MR tar"eted biopsy remains in e+olutionary &lu and )as yet to be

establis)ed7

Mp@MRI is also a &easible and +ery use&ul tool in detectin" local recurrence in patients 8)o )a+eunder"one radical prostatectomy 9RP: or radiot)erapy7 Concernin" post@RP local recurrences,

%CE@MRI seems to be t)e most reliable tec)niue &or detection, t)ou") %?I can be proposed as

a reliable alternati+e =1$>7 #or predictin" locally recurrent PCa a&ter radiation t)erapy, t)e use o&

combined T2?I and %?I s)o8ed a better dia"nostic per&ormance compared to T2?I alone

=1>7
http://www.hindawi.com/journals/bmri/2014/296810/#B9http://www.hindawi.com/journals/bmri/2014/296810/#B10http://www.hindawi.com/journals/bmri/2014/296810/#B10http://www.hindawi.com/journals/bmri/2014/296810/#B11http://www.hindawi.com/journals/bmri/2014/296810/#B12http://www.hindawi.com/journals/bmri/2014/296810/#B13http://www.hindawi.com/journals/bmri/2014/296810/#B14http://www.hindawi.com/journals/bmri/2014/296810/#B15http://www.hindawi.com/journals/bmri/2014/296810/#B9http://www.hindawi.com/journals/bmri/2014/296810/#B10http://www.hindawi.com/journals/bmri/2014/296810/#B10http://www.hindawi.com/journals/bmri/2014/296810/#B11http://www.hindawi.com/journals/bmri/2014/296810/#B12http://www.hindawi.com/journals/bmri/2014/296810/#B13http://www.hindawi.com/journals/bmri/2014/296810/#B14http://www.hindawi.com/journals/bmri/2014/296810/#B15


4/6

Is Mp@MRI ready &or prime time ?ell, t)is uestion remains open7 Currently, t)e use o& Mp@

MRI as a Jscreenin"K tool &or men re&erred 8it) abnormal P(A &or biopsy decision@makin"

cannot be a "eneral recommendation7 /o8e+er, it 8ill undoubtedly )a+e a place alon"side no+el

biomarkers in dia"nostic and sur+eillance strate"ies, in repeat biopsy settin"s, and per)aps in

sur"ical plannin" &or nonmetastatic bulky local disease as part o& a planned multimodality

treatment re"imen7

?e )ope t)at t)e readers o& t)is special issue 8it) 11 manuscripts 8)ic) eplores di&&erent

aspects o& Mp@MRI &or dia"nosin" and treatin" PCa in its di&&erent &orms 8ill &ind some ans8ers

&or di&&erent clinical settin"s7 ?e are con&ident t)at t)is +ery timely compilation 8ill be a ma3or

re&erence &or many o& us interested in prostate cancer7

Ackno8led"ment

?e 8is) to take t)is opportunity to t)ank all contributors and peer re+ie8ers7

Tark Esen

Bars Turkbey

Anup Patel

!ur"en #utterer

Re&erences

17 !7 #erlay, I7 (oer3omataram, R7 %iks)it et al7, JCancer incidence and mortality 8orld8ide

sources, met)ods and ma3or patterns in FHBHCA. 2-12,K International !ournal o& Cancer,

2-1$7 Nie8 at Publis)erO Nie8 at Foo"le (c)olar

27 #7 /7 (c)rder, /7 B7 Carter, T7 ?olters, et al7, JEarly detection o& prostate cancer in

2--;7 Part 1 P(A and P(A kinetics,K European 'rolo"y, +ol7 , no7 , pp7 $40Q$;;, 2--07 Nie8

at Publis)erO Nie8 at Foo"le (c)olarO Nie8 at (copus

7 ?7 (iu, R7 7 %unn, R7 B7 ()a), and !7 T7 ?ei, J'se o& etended pattern tec)niue &orinitial prostate biopsy,K T)e !ournal o& 'rolo"y, +ol7 1;$, no7 2, pp7 -Q-, 2--7 Nie8 at

Publis)erONie8 at Foo"le (c)olarO Nie8 at (copus

$7 P7 Mu&arri3, A7 (ankin, F7 Fodoy, and /7 epor, JPat)olo"ic outcomes o& candidates &or

acti+e sur+eillance under"oin" radical prostatectomy,K 'rolo"y, +ol7 ;4, no7 , pp7 40Q42,

2-1-7 Nie8 at Publis)erO Nie8 at Foo"le (c)olarO Nie8 at (copus
http://dx.doi.org/10.1002/ijc.29210http://dx.doi.org/10.1002/ijc.29210http://scholar.google.com/scholar?q=http://dx.doi.org/10.1002/ijc.29210http://dx.doi.org/10.1016/j.eururo.2007.10.047http://dx.doi.org/10.1016/j.eururo.2007.10.047http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2007.10.047http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-38749107817&partnerID=K84CvKBR&rel=3.0.0&md5=dd36d9c9c880dc425636c70c9761d6fchttp://dx.doi.org/10.1097/01.ju.0000165385.53652.7ahttp://dx.doi.org/10.1097/01.ju.0000165385.53652.7ahttp://scholar.google.com/scholar?q=http://dx.doi.org/10.1097/01.ju.0000165385.53652.7ahttp://scholar.google.com/scholar?q=http://dx.doi.org/10.1097/01.ju.0000165385.53652.7ahttp://scholar.google.com/scholar?q=http://dx.doi.org/10.1097/01.ju.0000165385.53652.7ahttp://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-22144492229&partnerID=K84CvKBR&rel=3.0.0&md5=8ed61665844dc004a81c7ca9b87d5e7chttp://dx.doi.org/10.1016/j.urology.2009.12.075http://dx.doi.org/10.1016/j.urology.2009.12.075http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.urology.2009.12.075http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.urology.2009.12.075http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-78650281668&partnerID=K84CvKBR&rel=3.0.0&md5=b46289a87fe6a96abad438687e20eb66http://dx.doi.org/10.1002/ijc.29210http://scholar.google.com/scholar?q=http://dx.doi.org/10.1002/ijc.29210http://dx.doi.org/10.1016/j.eururo.2007.10.047http://dx.doi.org/10.1016/j.eururo.2007.10.047http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2007.10.047http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-38749107817&partnerID=K84CvKBR&rel=3.0.0&md5=dd36d9c9c880dc425636c70c9761d6fchttp://dx.doi.org/10.1097/01.ju.0000165385.53652.7ahttp://dx.doi.org/10.1097/01.ju.0000165385.53652.7ahttp://scholar.google.com/scholar?q=http://dx.doi.org/10.1097/01.ju.0000165385.53652.7ahttp://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-22144492229&partnerID=K84CvKBR&rel=3.0.0&md5=8ed61665844dc004a81c7ca9b87d5e7chttp://dx.doi.org/10.1016/j.urology.2009.12.075http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.urology.2009.12.075http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-78650281668&partnerID=K84CvKBR&rel=3.0.0&md5=b46289a87fe6a96abad438687e20eb66


5/6

7 E7 C7 (ere&o"lu, (7 Altino+a, .7 (7 '"ras, E7 Akincio"lu, E7 Asil, and M7 %7 Balbay,

J/o8 reliable is 12@core prostate biopsy procedure in t)e detection o& prostate

cancerK Canadian 'rolo"ical Association !ournal, pp7 1Q4, 2-127

47 M7 A7 B3urlin, /7 B7 Carter, P7 (c)ell)ammer, et al7, JHptimiDation o& initial prostate

biopsy in clinical practice samplin", labelin" and specimen processin",K T)e !ournal o&

'rolo"y, +ol7 10, no7 4, pp7 2-Q2-$4, 2-17 Nie8 at Publis)erO Nie8 at Foo"le

(c)olarO Nie8 at (copus

;7 B7 Turkbey, P7 A7 Pinto, /7 Mani, et al7, JProstate cancer +alue o& multiparametric MR

ima"in" at T &or detection)istopat)olo"ic correlation,K Radiolo"y, +ol7 2, no7 1, pp7 0Q,

2-1-7 Nie8 at Publis)erO Nie8 at Foo"le (c)olarO Nie8 at (copus

07 B7 Turkbey, P7 (7 Albert, *7 *urdDiel, and P7 7 C)oyke, JIma"in" localiDed prostate

cancer current approac)es and ne8 de+elopments,K American !ournal o& Roent"enolo"y, +ol7

12, no7 4, pp7 1$;1Q1$0-, 2--7 Nie8 at Publis)erO Nie8 at Foo"le (c)olarO Nie8 at (copus

7 !7 H7 BarentsD, !7 Ric)enber", R7 Clements, et al7, JE('R prostate MR "uidelines

2-12,K European Radiolo"y, +ol7 22, no7 $, pp7 ;$4Q;;, 2-127 Nie8 at Publis)erO Nie8 at

Foo"le (c)olarO Nie8 at (copus

1-7 .7 .umao, (7 Sos)ida, S7 *omai et al7, J'se&ulness o& pre@biopsy multiparametric

ma"netic resonance ima"in" and clinical +ariables to reduce initial prostate biopsy in men 8it)

suspected clinically localiDed prostate cancer,K T)e !ournal o& 'rolo"y, +ol7 1-, no7 2, pp7 -2Q

-0, 2-17 Nie8 at Publis)erO Nie8 at Foo"le (c)olarO Nie8 at (copus

117 C7 M7 A7 /oeks, M7 F7 (c)outen, !7 F7 R7 Bomers et al7, JT)ree@tesla ma"netic

resonance@"uided prostate biopsy in men 8it) increased prostate@speci&ic anti"en and repeated,

ne"ati+e, random, systematic, transrectal ultrasound biopsies detection o& clinically si"ni&icant

prostate cancers,KEuropean 'rolo"y, +ol7 42, no7 , pp7 -2Q-, 2-127 Nie8 at Publis)erO Nie8

at Foo"le (c)olarO Nie8 at (copus

127 /7 A7 Nar"as, H7 Akin, A7 A&a et al7, JMa"netic resonance ima"in" &or predictin"

prostate biopsy &indin"s in patients considered &or acti+e sur+eillance o& clinically lo8 risk

prostate cancer,K T)e !ournal o& 'rolo"y, +ol7 100, no7 , pp7 1;2Q1;0, 2-127 Nie8 at

Publis)erONie8 at Foo"le (c)olarONie8 at (copus17 !7 (7 ?ysock, A7 B7 RosenkrantD, ?7 C7 /uan", et al7, JA prospecti+e, blinded comparison

o& ma"netic resonance 9MR: ima"in"@ultrasound &usion and +isual estimation in t)e per&ormance

o& MR@tar"eted prostate biopsy t)e PRH#'( trial,K European 'rolo"y, +ol7 44, no7 2, pp7 $Q

1, 2-1$7 Nie8 at Publis)erO Nie8 at Foo"le (c)olarO Nie8 at (copus
http://dx.doi.org/10.1016/j.juro.2013.02.072http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2013.02.072http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2013.02.072http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84877633841&partnerID=K84CvKBR&rel=3.0.0&md5=76306fa0b3c82924625716c84542b603http://dx.doi.org/10.1148/radiol.09090475http://dx.doi.org/10.1148/radiol.09090475http://scholar.google.com/scholar?q=http://dx.doi.org/10.1148/radiol.09090475http://scholar.google.com/scholar?q=http://dx.doi.org/10.1148/radiol.09090475http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-77950436636&partnerID=K84CvKBR&rel=3.0.0&md5=2f88a38165743693a689d68ced09b8abhttp://dx.doi.org/10.2214/AJR.09.2527http://dx.doi.org/10.2214/AJR.09.2527http://scholar.google.com/scholar?q=http://dx.doi.org/10.2214/AJR.09.2527http://scholar.google.com/scholar?q=http://dx.doi.org/10.2214/AJR.09.2527http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-67049119014&partnerID=K84CvKBR&rel=3.0.0&md5=2314b4383bbd35ea9311affdb1f7e4cchttp://dx.doi.org/10.1007/s00330-011-2377-yhttp://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-011-2377-yhttp://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-011-2377-yhttp://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84861455749&partnerID=K84CvKBR&rel=3.0.0&md5=01c89a77cee41e1c357f9cecbe0da0e0http://dx.doi.org/10.1016/j.juro.2013.02.3197http://dx.doi.org/10.1016/j.juro.2013.02.3197http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2013.02.3197http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2013.02.3197http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84880047070&partnerID=K84CvKBR&rel=3.0.0&md5=9db4cb0af6dfc4a64f0aad2aae2c47achttp://dx.doi.org/10.1016/j.eururo.2012.01.047http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2012.01.047http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2012.01.047http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84862533390&partnerID=K84CvKBR&rel=3.0.0&md5=d393d7e1cac92fe44698e5f6bd9eb909http://dx.doi.org/10.1016/j.juro.2012.07.024http://dx.doi.org/10.1016/j.juro.2012.07.024http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2012.07.024http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2012.07.024http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2012.07.024http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84867395351&partnerID=K84CvKBR&rel=3.0.0&md5=dd9a4956aa316404c39527d85c382b24http://dx.doi.org/10.1016/j.eururo.2013.10.048http://dx.doi.org/10.1016/j.eururo.2013.10.048http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2013.10.048http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2013.10.048http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84887547737&partnerID=K84CvKBR&rel=3.0.0&md5=eb18b61ec9c1eebf99c3db8951a90fc0http://dx.doi.org/10.1016/j.juro.2013.02.072http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2013.02.072http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2013.02.072http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84877633841&partnerID=K84CvKBR&rel=3.0.0&md5=76306fa0b3c82924625716c84542b603http://dx.doi.org/10.1148/radiol.09090475http://scholar.google.com/scholar?q=http://dx.doi.org/10.1148/radiol.09090475http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-77950436636&partnerID=K84CvKBR&rel=3.0.0&md5=2f88a38165743693a689d68ced09b8abhttp://dx.doi.org/10.2214/AJR.09.2527http://scholar.google.com/scholar?q=http://dx.doi.org/10.2214/AJR.09.2527http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-67049119014&partnerID=K84CvKBR&rel=3.0.0&md5=2314b4383bbd35ea9311affdb1f7e4cchttp://dx.doi.org/10.1007/s00330-011-2377-yhttp://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-011-2377-yhttp://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-011-2377-yhttp://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84861455749&partnerID=K84CvKBR&rel=3.0.0&md5=01c89a77cee41e1c357f9cecbe0da0e0http://dx.doi.org/10.1016/j.juro.2013.02.3197http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2013.02.3197http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84880047070&partnerID=K84CvKBR&rel=3.0.0&md5=9db4cb0af6dfc4a64f0aad2aae2c47achttp://dx.doi.org/10.1016/j.eururo.2012.01.047http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2012.01.047http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2012.01.047http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84862533390&partnerID=K84CvKBR&rel=3.0.0&md5=d393d7e1cac92fe44698e5f6bd9eb909http://dx.doi.org/10.1016/j.juro.2012.07.024http://dx.doi.org/10.1016/j.juro.2012.07.024http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.juro.2012.07.024http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84867395351&partnerID=K84CvKBR&rel=3.0.0&md5=dd9a4956aa316404c39527d85c382b24http://dx.doi.org/10.1016/j.eururo.2013.10.048http://scholar.google.com/scholar?q=http://dx.doi.org/10.1016/j.eururo.2013.10.048http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84887547737&partnerID=K84CvKBR&rel=3.0.0&md5=eb18b61ec9c1eebf99c3db8951a90fc0


6/6

1$7 N7 Panebianco, #7 Barc)etti, A7 (ciarra et al7, JProstate cancer recurrence a&ter radical

prostatectomy t)e role o& @T di&&usion ima"in" in multi@parametric ma"netic resonance

ima"in",K European Radiolo"y, +ol7 2, no7 4, pp7 1;$Q1;2, 2-17 Nie8 at Publis)erONie8 at

Foo"le (c)olarO Nie8 at (copus

17 C7 *7 *im, B7 *7 Park, and /7 M7 ee, JPrediction o& locally recurrent prostate cancer

a&ter radiation t)erapy incremental +alue o& T di&&usion@8ei")ted MRI,K !ournal o& Ma"netic

Resonance Ima"in", +ol7 2, no7 2, pp7 1Q;, 2--7 Nie8 at Publis)erONie8 at Foo"le

(c)olarO Nie8 at (copus
http://dx.doi.org/10.1007/s00330-013-2768-3http://dx.doi.org/10.1007/s00330-013-2768-3http://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-013-2768-3http://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-013-2768-3http://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-013-2768-3http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84878725789&partnerID=K84CvKBR&rel=3.0.0&md5=a8a8b9d30a8c25b2888bc943bc5e1bd3http://dx.doi.org/10.1002/jmri.21645http://scholar.google.com/scholar?q=http://dx.doi.org/10.1002/jmri.21645http://scholar.google.com/scholar?q=http://dx.doi.org/10.1002/jmri.21645http://scholar.google.com/scholar?q=http://dx.doi.org/10.1002/jmri.21645http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-60549109095&partnerID=K84CvKBR&rel=3.0.0&md5=866631def0e4a59a669dd662c74f9548http://dx.doi.org/10.1007/s00330-013-2768-3http://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-013-2768-3http://scholar.google.com/scholar?q=http://dx.doi.org/10.1007/s00330-013-2768-3http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-84878725789&partnerID=K84CvKBR&rel=3.0.0&md5=a8a8b9d30a8c25b2888bc943bc5e1bd3http://dx.doi.org/10.1002/jmri.21645http://scholar.google.com/scholar?q=http://dx.doi.org/10.1002/jmri.21645http://scholar.google.com/scholar?q=http://dx.doi.org/10.1002/jmri.21645http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-60549109095&partnerID=K84CvKBR&rel=3.0.0&md5=866631def0e4a59a669dd662c74f9548

Documents

Multiparametric MRI in Prostate Cancer