Top Figure: Color-coded DCE 3D-Gradient-Echo (6.9/2.1) 2.6-mm-thick image. Note the large anterior tumor easily seen in bright red, adjacent to the pseudo-capsule.
Bottom Figure: Whole mount histopathology proved cancer (black dotted line) in the anterior gland, with a final pathologic stage pT3a with minimal ECE right anteriorly (white arrow) - as reported by MRI.
This 64-year-old patient had 3 negative biopsy sessions (total 63 negative cores) and a rising PSA (27 ng/ml) prior to the MR exam. A targeted ultra-sound guided biopsy based on the MRI findings (A) confirmed cancer in the anterior gland. The whole mount preparation (B) showed a large anterior gland tumor, Gleason 4 + 3.
An important thrust of my research is the development and evaluations of new Magnetic Resonance (MR) techniques that improve body MR imaging. This work is enabled by active collaborations with MR scientists and MR pulse sequence programmers. Prior successes have enabled the emergence of MR angiography and 3D Body acquisitions. A rewarding aspect of this research avenue is the rapid translation from concept to the standard of care, which can occur in as few as 3 years.
As Chief of MRI at BIDMC, I facilitated translational research efforts by intermixing the offices of MDs and PhDs shifting the group's efforts towards a greater physiologic emphasis. This will be a strong initiative for me at UT Southwestern. As an example of a practical application of technology development to physiology, I had implemented arterial spin labeling to quantify perfusion as means to assess tumor response to anti-angiogenesis agents. Another example is the use of sophisticated techniques to quantify liver fat and iron within the timeframe of a breath hold. This technique was developed on one vendor's platform and will need to be translated to the systems at UT Southwestern.One focused area of personal research interest is in prostate cancer. I have been involved with optimizing existing MR techniques and developing new MR techniques to answer key clinical questions that challenge effective patient management for those with known or suspected prostate cancer. The key areas of research focus on using MR techniques to improve staging accuracy, target biopsies for higher yield results, determine tumor aggressiveness and offer assistance in managing those electing an active surveillance strategy. On a structural basis we are developing and evaluating high spatial resolution anatomic techniques to better assess for extra capsular extension of disease. We are also working on techniques to assess tumor physiology such as perfusion, diffusion, MR spectroscopy and oxygenation in order improving specificity to diagnose cancer and to characterize tumors on the basis of their aggressiveness. The latter is aimed at providing individualized, objective measures for assisting those considering or engaged in the option of active surveillance of their disease. The use of sophisticated perfusion techniques has already provided meaningful opportunities to identify those tumors that are occult to repeat biopsies in patients with a rising PSA. The program developed at BIDMC incorporates high quality whole mount pathology preparations. That capacity offers a platform to discover and evaluate the proteinomic and genomic substrates that are spatially linked to the in vivo physiologic ‘biomarkers' generated via MR techniques. I am in the process of reestablishing a similar program at UT Southwestern. New opportunities will certainly involve the use of ultra-high field clinical whole body MR systems such as the one at UT Southwestern operating at 7T.