In vivo MR spectroscopic imaging of the prostate, from application to interpretation

Proton magnetic resonance spectroscopic imaging (¹H MRSI) enables non-invasive assessment of certain metabolites in the prostate gland. Several studies have demonstrated that this metabolic information, in combination with anatomical information from T2-weighted MR imaging significantly improves prostate cancer detection, localization and disease characterization. The technology of ¹H MRSI is continuously evolving with improvements of hardware and acquisition methods. Recently, ³¹P and ¹³C MRSI of the prostate have regained new interest after a dormant period of decades. This review focuses on recent technical progress of in vivo¹H MRSI of the prostate, in particular those that enhance clinical applicability at 3T with respect to commonly used techniques to examine the prostate. These developments consist of higher magnetic field strengths, and better MR coils and acquisition techniques. Besides the improvements for ¹H MRSI, the developments and opportunities for ³¹P and ¹³C MRSI for the prostate are reviewed. Finally, we briefly review ¹³C MRS of the prostate, in particular the new possibilities with hyperpolarized substrates.