BERKELEY, CA (UroToday.com) - Multiparametric MRI has emerged as the most promising and powerful imaging modality for loco-regional staging of prostate cancer. It also holds excellent potential for anatomic imaging.
Historically, our knowledge of the neuroanatomy of the prostate has been based almost entirely on fresh and cadaveric dissection studies. While this seminal work has laid the foundation for anatomic nerve-sparing radical prostatectomy and dramatically improved recovery rates of potency and continence after surgery, it is limited in its ability to demonstrate the “complete picture” that the human eye cannot see or appreciate. In addition, dissection studies may disrupt fine nerve bundles due to mechanical disruption or specimen processing.
Diffusion tensor imaging tractography (DTI) is an MRI-based imaging method that identifies tracts of highly directionalized water self-diffusion, a process that typically occurs along nerves and blood vessels. It has previously been used to depict nerve tracts in the brain and spinal cord for neurosurgical mapping and planning. In the present study we adapted DTI to the prostatic milieu to attempt to delineate and map periprostatic fiber tracks around the prostatic capsule as a surrogate representation of neurovascular anatomy. Using this technology, we revealed a never before seen, dense and delicate network of periprostatic fibers around the entire border of the prostate. Moreover, we found asymmetric distribution of fiber tracts between sides of the prostate and differences in fiber density among patients. Such heterogeneity may help explain the variable recovery of potency we see among some men after radical prostatectomy.
This pilot study successfully demonstrated the feasibility of this imaging technique to image periprostatic tract anatomy. Fiber tracts were visualized circumferentially around the entire border of the prostate. Subsequent anatomic correlation is needed to validate our findings. If validated, DTI may play a role in radical prostatectomy nerve-sparing planning and post-operative functional evaluation of potency and continence recovery.
Written by:
David S. Finley, MD and Benjamin Ellingson, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA USA
