1. Impact of Endorectal Coil on Prostate Cancer
Detection using Multi-parametric 3T Prostate MRI
Nelly Tan, Daniel Margolis, David Y. Lu, Pooria Khoshnoodi, Wei-Chen Lin,
Leonard Marks, Robert E Reiter, SS Raman
UCLA Prostate Imaging Research Group
David Geffen School of Medicine at UCLA

2. Introduction
• Controversial if endorectal coil (ERC) improved
performance for staging and may curb the
problem of over staging
• Pelvic phased array coil (PAC) yields better
overall image quality than ERC and superior
visibility of anterior gland & NVB
• Superiority of ERC vs PAC not established

3. Objective
• To determine the performance of 3.0 Tesla
multiparametric prostate MRI for prostate
cancer (PCa) detection with and without
endorectal coil.

4. Methods
• A retrospective HIPAA-compliant, IRB
approved study
• Multiparametric 3T MR followed by Robotic
assisted radical prostatectomy (RALP)
• Clinical, MR & pathological information was
obtained.

5. Methods
• Upgrading defined by an increased GS on
Biopsy compared to whole mount pathology
• Stratified by systematic versus US/MR
guided biopsy
• Statistical Analysis
– Mann-Whitney test for continuous variables
– Chi Square were used for categorical variables.

6. Results
• 264 patients with 589 tumors
• 68 (25.8%) with endorectal coil
• 82 (31.1%) were upgraded
Biopsy Prostatectomy
GS 6, n(%) 83 (31.4) 41 (15.5)
GS 3+4, n(%) 102 (38.6) 128 (48.5)
GS 4+3, n(%) 35 (12.9) 59 (22.6)
GS 8-10, n(%) 45 (17.1) 36 (13.6)

7. Results

8. Results

9. Results

10. Results
Systematic TRUS US/MR Bx P-value
Not upgraded
Upgraded
136 (67.0)
67 (33.0)
46 (75.4)
15(24.6)
0.048
MR tumor diameter, cm (IQR) 1.3 (0.9-1.8) 1.1 (1-1.8) 0.37
T2 score, median (IQR) 4 (3-4) 3 (3-4) 0.38
ADC, median (IQR) 944 (780-1085) 946 (827-1150) 0.70
DCE score, median (IQR) 4 (3-4) 3 (3-4) 0.95
MR Prostate volume, median (IQR) 35 (28-44) 41.6 (32-56) 0.004

11. Results
No upgrading Upgrading P-value
MR tumor diameter, cm (SD) 1.2 (0.9-1.7) 1.4 (1-1.9) 0.07
T2 score, median (IQR) 3 (3-4) 4 (4-5) 0.24
ADC, median (IQR) 965 (786-1106) 929 (793-1050) 0.28
DCE score, median (IQR) 4 (3-4) 4 (3-4) 0.76
MR Prostate volume, median (IQR) 35 (28-43) 38 (30-51) 0.07
Targeted Biopsy 46 (75.4) 15 (24.6) 0.048
PSA 5.8 (4.5-8) 5.6 (4.8-7.0) 0.91

12. Conclusions
• Significant upgrading in systematic bx 33%
vs Targeted bx 25%
• MR Prostate volume larger in Targeted
• Only significant predictor of upgrading was
use of Targeted Bx

13. Limitations
• Retrospective study
• Single institution
• Despite these limitations, this is the largest
study to evaluate upgrading of Gleason
score in fusion biopsy compared to
systematic

14. Acknowledgments
• Radiology
• Steven Raman, MD
• Daniel Margolis, MD
• David SK Lu, MD
• Pooria Khoshnoodi, MD
• Martin Lin, MD
• Brenda Brown, MA
• Sandra J Smith, MBA
• Afsoon Moazzez, MBA
• Dave Nelson (Media)
• Steven Do (Media)
• Dieter Enzmann, MD
• Former Trainees and Volunteers
• Kevin King, MD
• Htwe Khin, JD
• Kevin Beroukium, MD
• David Finley, MD
• Medical Imaging Informatics
• Weixia Yu, PhD
• William Hsu, PhD
• Wenchao Tao, PhD
• Center for Computer Vision and Imaging
• Mahesh Nagarajan, PhD
• Bharath Ramakrishna, PhD
• Matt Brown, PhD
• Heidi Coy, BS
• Urology
• Robert Reiter, MD
• Pathology
• Jiaoti Huang, MD
• David Y. Lu, MD
• Susan Kerkoutian, MD