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Caglic I, Sushentsev N, Syer T, Lee KL, Barrett T. Biparametric MRI in prostate cancer during active surveillance: is it safe? Eur Radiol 2024; 34:6217-6226. [PMID: 38656709 PMCID: PMC11399179 DOI: 10.1007/s00330-024-10770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Active surveillance (AS) is the preferred option for patients presenting with low-intermediate-risk prostate cancer. MRI now plays a crucial role for baseline assessment and ongoing monitoring of AS. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations aid radiological assessment of progression; however, current guidelines do not advise on MRI protocols nor on frequency. Biparametric (bp) imaging without contrast administration offers advantages such as reduced costs and increased throughput, with similar outcomes to multiparametric (mp) MRI shown in the biopsy naïve setting. In AS follow-up, the paradigm shifts from MRI lesion detection to assessment of progression, and patients have the further safety net of continuing clinical surveillance. As such, bpMRI may be appropriate in clinically stable patients on routine AS follow-up pathways; however, there is currently limited published evidence for this approach. It should be noted that mpMRI may be mandated in certain patients and potentially offers additional advantages, including improving image quality, new lesion detection, and staging accuracy. Recently developed AI solutions have enabled higher quality and faster scanning protocols, which may help mitigate against disadvantages of bpMRI. In this article, we explore the current role of MRI in AS and address the need for contrast-enhanced sequences. CLINICAL RELEVANCE STATEMENT: Active surveillance is the preferred plan for patients with lower-risk prostate cancer, and MRI plays a crucial role in patient selection and monitoring; however, current guidelines do not currently recommend how or when to perform MRI in follow-up. KEY POINTS: Noncontrast biparametric MRI has reduced costs and increased throughput and may be appropriate for monitoring stable patients. Multiparametric MRI may be mandated in certain patients, and contrast potentially offers additional advantages. AI solutions enable higher quality, faster scanning protocols, and could mitigate the disadvantages of biparametric imaging.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Nikita Sushentsev
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tom Syer
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Kang-Lung Lee
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tristan Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom.
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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2
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Tomioka M, Nakane K, Kawase M, Iinuma K, Kato D, Kawase K, Taniguchi T, Tobisawa Y, Sugino F, Kaga T, Kato H, Matsuo M, Kito Y, Saigo C, Suzui N, Ito T, Miyazaki T, Takeuchi T, Koie T. Discrepancy in the Location of Prostate Cancer Indicated on Biparametric Magnetic Resonance Imaging and Pathologically Diagnosed Using Surgical Specimens. Curr Oncol 2024; 31:2846-2855. [PMID: 38785497 PMCID: PMC11119495 DOI: 10.3390/curroncol31050216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Accurate diagnosis of the localization of prostate cancer (PCa) on magnetic resonance imaging (MRI) remains a challenge. We aimed to assess discrepancy between the location of PCa pathologically diagnosed using surgical specimens and lesions indicated as possible PCa by the Prostate Imaging Reporting and Data System on MRI. The primary endpoint was the concordance rate between the site of probable clinically significant PCa (csPCa) identified using biparametric MRI (bpMRI) and location of PCa in the surgical specimen obtained using robot-assisted total prostatectomy. Among 85 lesions identified in 30 patients; 42 (49.4%) were identified as possible PCa on MRI. The 85 PCa lesions were divided into positive and negative groups based on the bpMRI results. None of the patients had missed csPCa. Although the diagnostic accuracy of bpMRI was relatively high for PCas located in the middle of the prostate (p = 0.029), it was relatively low for PCa located at the base of the prostate, all of which were csPCas. Although current modalities can accurately diagnose PCa, the possibility that PCa is present with multiple lesions in the prostate should be considered, even if MRI does not detect PCa.
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Affiliation(s)
- Masayuki Tomioka
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Tomoki Taniguchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Yuki Tobisawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Fumiya Sugino
- Department of Urology, Gifu Municipal Hospital, Gifu 5008513, Japan;
| | - Tetsuro Kaga
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Hiroki Kato
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Yusuke Kito
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Chiemi Saigo
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu 5011194, Japan; (N.S.); (T.M.)
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Gifu University Graduate School of Medicine, Gifu 5011194, Japan;
| | - Tatsuhiko Miyazaki
- Department of Pathology, Gifu University Hospital, Gifu 5011194, Japan; (N.S.); (T.M.)
| | - Tamotsu Takeuchi
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
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3
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Ringe KI, Wang J, Deng Y, Pi S, Geahchan A, Taouli B, Bashir MR. Abbreviated MRI Protocols in the Abdomen and Pelvis. J Magn Reson Imaging 2024; 59:58-69. [PMID: 37144673 DOI: 10.1002/jmri.28764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
Abbreviated MRI (AMRI) protocols rely on the acquisition of a limited number of sequences tailored to a specific question. The main objective of AMRI protocols is to reduce exam duration and costs, while maintaining an acceptable diagnostic performance. AMRI is of increasing interest in the radiology community; however, challenges limiting clinical adoption remain. In this review, we will address main abdominal and pelvic applications of AMRI in the liver, pancreas, kidney, and prostate, including diagnostic performance, pitfalls, limitations, and cost effectiveness will also be discussed. Level of Evidence: 3 Technical Efficacy Stage: 3.
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Affiliation(s)
- Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ying Deng
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shan Pi
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Amine Geahchan
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mustafa R Bashir
- Department of Radiology, Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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4
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Rehman I, Pang E, Harris AC, Chang SD. Bi-parametric prostate MRI with a recall system for contrast enhanced imaging: Improving accessibility while maintaining quality. Eur J Radiol 2023; 169:111186. [PMID: 37989069 DOI: 10.1016/j.ejrad.2023.111186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To review the efficacy of a recall system for bi-parametric non-contrast prostate MRI (bp-MRI). METHODS A bi-parametric protocol was instituted in July 2020 for all patients who had a prostate MRI requested, excluding those after treatment of prostate cancer, patients with hip prosthesis or pacemaker, and those who lived out-of-town. The protocol consisted of tri-planar T2-weighted and diffusion weighted images (DWI) (b = 50, 800 s/mm2 for ADC map; b = 1,500 s/mm2 acquired separately) in accordance with the Prostate Imaging Reporting & Data system (PI-RADS) v2.1 guidelines. After interpretation of bp-MRI exams, patients with equivocal (PI-RADS 3) lesions in peripheral zone (PZ) or any technical limitations were recalled for contrast administration. RESULTS Out of 909 bp-MRI scans performed from July 2020 to April 2021, only 52 (5.7 %) were recalled, of which 46 (88.5 %) attended. Amongst these, 41/52 (78.8 %) were recalled for PZ PI-RADS 3 lesions, while the rest of 11 (21.2 %) cases were recalled for technical reasons. Mean time to subsequent recall scan was 11.6 days. On assessment of post-contrast imaging, 29/46 (63 %) cases were upgraded to PI-RADS 4 while 17/46 (37 %) remained PI-RADS 3. This system avoided contrast-agent use in 857 patients, with contrast cost savings of €64,620 (US$68,560) and 214 hours 15 minutes of scanner time was saved. This allowed 255 additional bp-MRI scans to be performed, reducing the waitlist from 1 year to 2-3 weeks. CONCLUSION A bi-parametric prostate MRI protocol with a robust recall system for contrast administration not only saved time eliminating the marked backlog but was also more cost efficient without compromising the quality of patient care.
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Affiliation(s)
- Iffat Rehman
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada.
| | - Emily Pang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
| | - Alison C Harris
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
| | - Silvia D Chang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
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Guljaš S, Dupan Krivdić Z, Drežnjak Madunić M, Šambić Penc M, Pavlović O, Krajina V, Pavoković D, Šmit Takač P, Štefančić M, Salha T. Dynamic Contrast-Enhanced Study in the mpMRI of the Prostate-Unnecessary or Underutilised? A Narrative Review. Diagnostics (Basel) 2023; 13:3488. [PMID: 37998624 PMCID: PMC10670922 DOI: 10.3390/diagnostics13223488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this review is to summarise recent scientific literature regarding the clinical use of DCE-MRI as a component of multiparametric resonance imaging of the prostate. This review presents the principles of DCE-MRI acquisition and analysis, the current role of DCE-MRI in clinical practice with special regard to its role in presently available categorisation systems, and an overview of the advantages and disadvantages of DCE-MRI described in the current literature. DCE-MRI is an important functional sequence that requires intravenous administration of a gadolinium-based contrast agent and gives information regarding the vascularity and capillary permeability of the lesion. Although numerous studies have confirmed that DCE-MRI has great potential in the diagnosis and monitoring of prostate cancer, its role is still inadequate in the PI-RADS categorisation. Moreover, there have been numerous scientific discussions about abandoning the intravenous application of gadolinium-based contrast as a routine part of MRI examination of the prostate. In this review, we summarised the recent literature on the advantages and disadvantages of DCE-MRI, focusing on an overview of currently available data on bpMRI and mpMRI, as well as on studies providing information on the potential better usability of DCE-MRI in improving the sensitivity and specificity of mpMRI examinations of the prostate.
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Affiliation(s)
- Silva Guljaš
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (S.G.); (Z.D.K.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
| | - Zdravka Dupan Krivdić
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (S.G.); (Z.D.K.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
| | - Maja Drežnjak Madunić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Oncology, University Hospital Centre, 31000 Osijek, Croatia
| | - Mirela Šambić Penc
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Oncology, University Hospital Centre, 31000 Osijek, Croatia
| | - Oliver Pavlović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Vinko Krajina
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Deni Pavoković
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Petra Šmit Takač
- Clinical Department of Surgery, Osijek University Hospital Centre, 31000 Osijek, Croatia;
| | - Marin Štefančić
- Department of Radiology, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia;
| | - Tamer Salha
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Teleradiology and Artificial Intelligence, Health Centre Osijek-Baranja County, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Zhou X, Fan X, Chatterjee A, Yousuf A, Antic T, Oto A, Karczmar GS. Parametric maps of spatial two-tissue compartment model for prostate dynamic contrast enhanced MRI - comparison with the standard tofts model in the diagnosis of prostate cancer. Phys Eng Sci Med 2023; 46:1215-1226. [PMID: 37432557 DOI: 10.1007/s13246-023-01289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/14/2023] [Indexed: 07/12/2023]
Abstract
The spatial two-tissue compartment model (2TCM) was used to analyze prostate dynamic contrast enhanced (DCE) MRI data and compared with the standard Tofts model. A total of 29 patients with biopsy-confirmed prostate cancer were included in this IRB-approved study. MRI data were acquired on a Philips Achieva 3T-TX scanner. After T2-weighted and diffusion-weighted imaging, DCE data using 3D T1-FFE mDIXON sequence were acquired pre- and post-contrast media injection (0.1 mmol/kg Multihance) for 60 dynamic scans with temporal resolution of 8.3 s/image. The 2TCM has one fast ([Formula: see text] and [Formula: see text]) and one slow ([Formula: see text] and [Formula: see text]) exchanging compartment, compared with the standard Tofts model parameters (Ktrans and kep). On average, prostate cancer had significantly higher values (p < 0.01) than normal prostate tissue for all calculated parameters. There was a strong correlation (r = 0.94, p < 0.001) between Ktrans and [Formula: see text] for cancer, but weak correlation (r = 0.28, p < 0.05) between kep and [Formula: see text]. Average root-mean-square error (RMSE) in fits from the 2TCM was significantly smaller (p < 0.001) than the RMSE in fits from the Tofts model. Receiver operating characteristic (ROC) analysis showed that fast [Formula: see text] had the highest area under the curve (AUC) than any other individual parameter. The combined four parameters from the 2TCM had a considerably higher AUC value than the combined two parameters from the Tofts model. The 2TCM is useful for quantitative analysis of prostate DCE-MRI data and provides new information in the diagnosis of prostate cancer.
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Affiliation(s)
- Xueyan Zhou
- School of Technology, Harbin University, Harbin, China.
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA.
| | - Xiaobing Fan
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | | | - Ambereen Yousuf
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, IL, 60637, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
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Zhang J, Xu L, Zhang G, Zhang X, Bai X, Sun H, Jin Z. Effects of dynamic contrast enhancement on transition zone prostate cancer in Prostate Imaging Reporting and Data System Version 2.1. Radiol Oncol 2023; 57:42-50. [PMID: 36655324 PMCID: PMC10039479 DOI: 10.2478/raon-2023-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/18/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The aim of the study was to analyse the effects of dynamic contrast enhanced (DCE)-MRI on transitional-zone prostate cancer (tzPCa) and clinically significant transitional-zone prostate cancer (cs-tzPCa) in Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1. PATIENTS AND METHODS The diagnostic efficiencies of T2-weighted imaging (T2WI) + diffusion-weighted imaging (DWI), T2WI + dynamic contrast-enhancement (DCE), and T2WI + DWI + DCE in tzPCa and cs-tzPCa were compared using the score of ≥ 4 as the positive threshold and prostate biopsy as the reference standard. RESULTS A total of 425 prostate cases were included in the study: 203 cases in the tzPCa group, and 146 in the cs-tzPCa group. The three sequence combinations had the similar areas under the curves in diagnosing tzPCa and cs-tzPCa (all P < 0.05). The sensitivity of T2WI + DCE and T2WI + DWI + DCE (84.7% and 85.7% for tzPCa; 88.4% and 89.7% for cs-tzPCa, respectively) in diagnosing tzPCa and cs-tzPCa was significantly greater than that of T2WI + DWI (79.3% for tzPCa; 82.9% for cs-tzPCa). The specificity of T2WI + DWI (86.5% for tzPCa; 74.9% for cs-tzPCa) were significantly greater than those of T2WI + DCE and T2WI + DWI + DCE (68.0% and 68.5% for tzPCa; 59.1% and 59.5% for cs-tzPCa, respectively) (all P > 0.05). The diagnostic efficacies of T2WI + DCE and T2WI + DWI + DCE had no significant differences (all P < 0.05). CONCLUSIONS DCE can improve the sensitivity of diagnosis for tzPCa and cs-tzPCa, and it is useful for small PCa lesion diagnosis.
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Affiliation(s)
- Jiahui Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lili Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Gumuyang Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Bai
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Sun
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Quality Control of Radiology, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Quality Control of Radiology, Beijing, China
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8
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Iacob R, Stoicescu ER, Cerbu S, Manolescu DL, Bardan R, Cumpănaş A. Could Biparametric MRI Replace Multiparametric MRI in the Management of Prostate Cancer? Life (Basel) 2023; 13:465. [PMID: 36836822 PMCID: PMC9961917 DOI: 10.3390/life13020465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
Prostate cancer (PCa) is a worldwide epidemiological problem, since it is one of the most prevalent types of neoplasia among men, and the third-leading cause of cancer-related deaths, after lung and colorectal tumors. Unfortunately, the early stages of PCa have a wide range of unspecific symptoms. For these reasons, early diagnosis and accurate evaluation of suspicious lesions are crucial. Multiparametric MRI (mpMRI) is currently the imaging modality of choice for diagnostic screening and local staging of PCa, but also has a leading role in guiding biopsies and in treatment biparametric MRI (bpMRI) could partially replace mpMRI due to its lack of adverse reactions caused by contrast agents, relatively lower costs, and shorter acquisition time. Further, 31 relevant articles regarding the advantages and disadvantages of the aforementioned imaging techniques were scanned. As a result, while bpMRI has comparable accuracy in detecting PCa, its roles in the other steps of PCa management are limited.
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Affiliation(s)
- Roxana Iacob
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Emil-Robert Stoicescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Simona Cerbu
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Diana-Luminiţa Manolescu
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Răzvan Bardan
- Discipline of Urology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Alin Cumpănaş
- Discipline of Urology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
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Connor MJ, Gorin MA, Eldred-Evans D, Bass EJ, Desai A, Dudderidge T, Winkler M, Ahmed HU. Landmarks in the evolution of prostate biopsy. Nat Rev Urol 2023; 20:241-258. [PMID: 36653670 DOI: 10.1038/s41585-022-00684-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 01/19/2023]
Abstract
Approaches and techniques used for diagnostic prostate biopsy have undergone considerable evolution over the past few decades: from the original finger-guided techniques to the latest MRI-directed strategies, from aspiration cytology to tissue core sampling, and from transrectal to transperineal approaches. In particular, increased adoption of transperineal biopsy approaches have led to reduced infectious complications and improved antibiotic stewardship. Furthermore, as image fusion has become integral, these novel techniques could be incorporated into prostate biopsy methods in the future, enabling 3D-ultrasonography fusion reconstruction, molecular targeting based on PET imaging and autonomous robotic-assisted biopsy.
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Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK. .,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Edward J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Ankit Desai
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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10
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Comparison between biparametric and multiparametric MRI diagnosis strategy for prostate cancer in the peripheral zone using PI-RADS version 2.1. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2905-2916. [PMID: 35622121 DOI: 10.1007/s00261-022-03553-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare and analyse the diagnostic value of PI-RADS v2.1 when used with biparametric MRI (bpMRI) versus multiparametric MRI (mpMRI), DWI versus T2WI to detect peripheral-zone prostate cancer (pzPCa) and clinically significant peripheral-zone prostate cancer (cs-pzPCa). METHODS The diagnostic efficiencies of mpMRI and bpMRI as well as DWI and T2WI in pzPCa and cs-pzPCa were compared using a PI-RADS score of ≥ 4 as the positive threshold and prostate biopsy and radical prostatectomy as the reference standards. RESULTS A total of 307 prostate cases were included in the study, including 142 in the non-pzPCa group, 165 in the pzPCa group, and 130 in the cs-pzPCa group. The AUCs of mpMRI and bpMRI were 0.717 and 0.733 (P = 0.317), respectively, for the diagnosis of pzPCa (sensitivities: 89.1% and 81.8%; specificities: 54.2% and 64.8%, both P < 0.001) and 0.594 and 0.602 (P = 0.756), respectively, for the diagnosis of cs-pzPCa (sensitivities: 93.1% and 86.2%, P = 0.004; specificities: 25.7% and 34.3%, P = 0.250). The AUCs of DWI and T2WI were 0.733 and 0.749 (P = 0.308), respectively, for the diagnosis of pzPCa (sensitivities: 81.8% and 84.2%; specificities: 64.8% and 66.2%, both P > 0.05) and 0.602 and 0.581 (P = 0.371), respectively, for the diagnosis of cs-pzPCa (sensitivities: 86.2% and 87.7%; specificities: 34.3% and 28.6%, both P > 0.05). CONCLUSION mpMRI and bpMRI as well as DWI and T2WI using PI-RADS v2.1 exhibited similar diagnostic efficiency in pzPCa and cs-pzPCa.
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11
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Yang L, Li Z, Liang X, Xu J, Cai Y, Huang C, Zhang M, Yao J, Song B. Radiomic Machine Learning and External Validation Based on 3.0 T mpMRI for Prediction of Intraductal Carcinoma of Prostate With Different Proportion. Front Oncol 2022; 12:934291. [PMID: 35837116 PMCID: PMC9274129 DOI: 10.3389/fonc.2022.934291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess the association of radiomics features based on multiparametric MRI (mpMRI) with the proportion of intraductal carcinoma of prostate (IDC-P) and validate the predictive models. Materials and Methods We retrospectively included pre-treatment MR images of prostate cancer (PCa) with IDC components of high proportion (≥10%, hpIDC-P), low proportion (<10%, lpIDC-P), and pure acinar adenocarcinoma (PAC) from our institution for training and internal validation and cooperated cohort for external validation. Normalized images of T2WI, diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) map, and dynamic contrast enhanced (DCE) sequences were used for radiomics modeling. The clinical model was built based on serum total prostate specific antigen (tPSA) and Gleason score (GS), and the integrated model was the combination of Rad-score and clinicopathological data. The discrimination ability was assessed by area under the receiver operating characteristic curve (ROC-AUC) in the internal and external validation sets and compared by DeLong test. Results Overall, 97 patients with hpIDC-P, 87 lpIDC-P, and 78 PAC were included for training and internal validation, and 11, 16, and 19 patients for external validation. The integrated model for predicting hpIDC-P got the best ROC-AUC of 0.88 (95%CI = 0.83-0.93) in internal and 0.86 (95%CI = 0.72-1.0) in external validation, which both outperformed clinical models (AUC=0.78, 95% CI = 0.72-0.85, AUC=0.69, 95% CI = 0.5-0.85, respectively) based solely on GS, and the radiomics model (AUC=0.85, 95% CI = 0.79-0.91) was slightly inferior to the integrated model and better than the clinical model in internal dataset. The integrated model for predicting lpIDC-P outperformed both radiomics and clinical models in the internal dataset, while slightly inferior to the integrated model for predicting hpIDC-P. Conclusions Radiomics signature improved differentiation of both hpIDC-P and lpIDC-P versus PAC when compared with the clinical model based on Gleason score, and was validated in an external cohort.
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Affiliation(s)
- Ling Yang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhengyan Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xu Liang
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingxu Xu
- Department of Research Collaboration, R&D center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Yusen Cai
- Department of Research Collaboration, R&D center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Chencui Huang
- Department of Research Collaboration, R&D center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Mengni Zhang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Yao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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12
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Belue MJ, Yilmaz EC, Daryanani A, Turkbey B. Current Status of Biparametric MRI in Prostate Cancer Diagnosis: Literature Analysis. Life (Basel) 2022; 12:804. [PMID: 35743835 PMCID: PMC9224842 DOI: 10.3390/life12060804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/19/2022] Open
Abstract
The role of multiparametric MRI (mpMRI) in the detection of prostate cancer is well-established. Based on the limited role of dynamic contrast enhancement (DCE) in PI-RADS v2.1, the risk of potential side effects, and the increased cost and time, there has been an increase in studies advocating for the omission of DCE from MRI assessments. Per PI-RADS v2.1, DCE is indicated in the assessment of PI-RADS 3 lesions in the peripheral zone, with its most pronounced effect when T2WI and DWI are of insufficient quality. The aim of this study was to evaluate the methodology and reporting in the literature from the past 5 years regarding the use of DCE in prostate MRI, especially with respect to the indications for DCE as stated in PI-RADS v2.1, and to describe the different approaches used across the studies. We searched for studies investigating the use of bpMRI and/or mpMRI in the detection of clinically significant prostate cancer between January 2017 and April 2022 in the PubMed, Web of Science, and Google Scholar databases. Through the search process, a total of 269 studies were gathered and 41 remained after abstract and full-text screening. The following information was extracted from the eligible studies: general clinical and technical characteristics of the studies, the number of PI-RADS 3 lesions, different definitions of clinically significant prostate cancer (csPCa), biopsy thresholds, reference standard methods, and number and experience of readers. Forty-one studies were included in the study. Only 51% (21/41) of studies reported the prevalence of csPCa in their equivocal lesion (PI-RADS category 3 lesions) subgroups. Of the included studies, none (0/41) performed a stratified sub-analysis of the DCE benefit versus MRI quality and 46% (19/41) made explicit statements about removing MRI scans based on a range of factors including motion, noise, and image artifacts. Furthermore, the number of studies investigating the role of DCE using readers with varying experience was relatively low. This review demonstrates that a high proportion of the studies investigating whether bpMRI can replace mpMRI did not transparently report information inherent to their study design concerning the key indications of DCE, such as the number of clinically insignificant/significant PI-RADS 3 lesions, nor did they provide any sub-analyses to test image quality, with some removing bad quality MRI scans altogether, or reader-experience-dependency indications for DCE. For the studies that reported on most of the DCE indications, their conclusions about the utility of DCE were heavily definition-dependent (with varying definitions of csPCa and of the PI-RADS category biopsy significance threshold). Reporting the information inherent to the study design and related to the specific indications for DCE as stated in PI-RADS v2.1 is needed to determine whether DCE is helpful or not. With most of the recent literature being retrospective and not including the data related to DCE indications in particular, the ongoing dispute between bpMRI and mpMRI is likely to linger.
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Affiliation(s)
| | | | | | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD 20892-9760, USA; (M.J.B.); (E.C.Y.); (A.D.)
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13
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Hötker AM, Vargas HA, Donati OF. Abbreviated MR Protocols in Prostate MRI. Life (Basel) 2022; 12:life12040552. [PMID: 35455043 PMCID: PMC9029675 DOI: 10.3390/life12040552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Prostate MRI is an integral part of the clinical work-up in biopsy-naïve patients with suspected prostate cancer, and its use has been increasing steadily over the last years. To further its general availability and the number of men benefitting from it and to reduce the costs associated with MR, several approaches have been developed to shorten examination times, e.g., by focusing on sequences that provide the most useful information, employing new technological achievements, or improving the workflow in the MR suite. This review highlights these approaches; discusses their implications, advantages, and disadvantages; and serves as a starting point whenever an abbreviated prostate MRI protocol is being considered for implementation in clinical routine.
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Affiliation(s)
- Andreas M. Hötker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
- Correspondence:
| | - Hebert Alberto Vargas
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY 10065, USA;
| | - Olivio F. Donati
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
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14
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Häggman M, Dahlman P, Ahlberg M, Liss P, Cantera Ahlman R, Dragomir A, Ladjevardi S. Bi-parametric MRI/TRUS fusion targeted repeat biopsy after systematic 10-12 core TRUS-guided biopsy reveals more significant prostate cancer especially in anteriorly located tumors. Acta Radiol Open 2022; 11:20584601221085520. [PMID: 35392628 PMCID: PMC8980410 DOI: 10.1177/20584601221085520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background MRI and fusion guided biopsy have an increased role in the diagnosis of prostate cancer. Purpose To demonstrate the possible advantages with Bi-parametric MRI fusion-guided repeat biopsy over systematic 10-12-core biopsy for the diagnosis of prostate cancer. Material and Methods Four hundred and twenty-three consecutive men, with previous systematic 10-12-core TRUS-guided biopsy, and with suspicion of, or diagnosis of, low-risk prostate cancer underwent fusion-guided prostate biopsy between February 2015 and February 2017. The material was retrospectively assessed. In 220 cases no previous cancer was diagnosed, and in 203 cases confirmatory fusion guided biopsy was performed prior to active monitoring. MRI was classified according to PI-RADS. Systematic biopsy was compared to fusion guided biopsy for the detection of cancer, and PI-RADS was compared to the Gleason score. Results Fusion guided biopsy detected significantly more cancers than systematic (p < .001). Gleason scores were higher in the fusion biopsy group (p < .001). Anterior tumors were present in 54% of patients. Fusion biopsy from these lesions showed cancer in 53% with previously negative biopsy in systematic biopsies and 66% of them were upgraded from low risk to intermediate or high-risk cancers. Conclusion These results show superior detection rate and grading of bi-parametric MRI/TRUS fusion targeted repeat biopsy over systematic 10-12 core biopsies. Fusion guided biopsy detects more significant cancers despite using fewer cores. The risk group was changed for many patients initially selected for active surveillance due to upgrading of tumors. Bi-parametric MRI shows promising results in detecting anterior tumors in patients with suspected prostate cancer.
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Affiliation(s)
- Michael Häggman
- Department of Urology, Uppsala University Hospital, Uppsala, Sweden
| | - Pär Dahlman
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Ahlberg
- Department of Urology, Uppsala University Hospital, Uppsala, Sweden
| | - Per Liss
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Anca Dragomir
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
- Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Sam Ladjevardi
- Department of Urology, Uppsala University Hospital, Uppsala, Sweden
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15
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Diagnostic value of integrated 18F-PSMA-1007 PET/MRI Compared with that of Biparametric MRI for the detection of Prostate Cancer. Prostate Int 2022; 10:108-116. [PMID: 35510079 PMCID: PMC9052074 DOI: 10.1016/j.prnil.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Materials and methods Results Conclusion
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16
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Pellicer-Valero OJ, Marenco Jiménez JL, Gonzalez-Perez V, Casanova Ramón-Borja JL, Martín García I, Barrios Benito M, Pelechano Gómez P, Rubio-Briones J, Rupérez MJ, Martín-Guerrero JD. Deep learning for fully automatic detection, segmentation, and Gleason grade estimation of prostate cancer in multiparametric magnetic resonance images. Sci Rep 2022; 12:2975. [PMID: 35194056 PMCID: PMC8864013 DOI: 10.1038/s41598-022-06730-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/03/2022] [Indexed: 02/07/2023] Open
Abstract
Although the emergence of multi-parametric magnetic resonance imaging (mpMRI) has had a profound impact on the diagnosis of prostate cancers (PCa), analyzing these images remains still complex even for experts. This paper proposes a fully automatic system based on Deep Learning that performs localization, segmentation and Gleason grade group (GGG) estimation of PCa lesions from prostate mpMRIs. It uses 490 mpMRIs for training/validation and 75 for testing from two different datasets: ProstateX and Valencian Oncology Institute Foundation. In the test set, it achieves an excellent lesion-level AUC/sensitivity/specificity for the GGG[Formula: see text]2 significance criterion of 0.96/1.00/0.79 for the ProstateX dataset, and 0.95/1.00/0.80 for the IVO dataset. At a patient level, the results are 0.87/1.00/0.375 in ProstateX, and 0.91/1.00/0.762 in IVO. Furthermore, on the online ProstateX grand challenge, the model obtained an AUC of 0.85 (0.87 when trained only on the ProstateX data, tying up with the original winner of the challenge). For expert comparison, IVO radiologist's PI-RADS 4 sensitivity/specificity were 0.88/0.56 at a lesion level, and 0.85/0.58 at a patient level. The full code for the ProstateX-trained model is openly available at https://github.com/OscarPellicer/prostate_lesion_detection . We hope that this will represent a landmark for future research to use, compare and improve upon.
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Affiliation(s)
- Oscar J Pellicer-Valero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Av. Universitat, sn, 46100, Bujassot, Valencia, Spain.
| | - José L Marenco Jiménez
- Department of Urology, Fundación Instituto Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Victor Gonzalez-Perez
- Department of Medical Physics, Fundación Instituto, Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | | | - Isabel Martín García
- Department of Radiodiagnosis, Fundación Instituto, Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - María Barrios Benito
- Department of Radiodiagnosis, Fundación Instituto, Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Paula Pelechano Gómez
- Department of Radiodiagnosis, Fundación Instituto, Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - José Rubio-Briones
- Department of Urology, Fundación Instituto Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - María José Rupérez
- Instituto de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València (UPV), Camino de Vera, sn, 46022, Valencia, Spain
| | - José D Martín-Guerrero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Av. Universitat, sn, 46100, Bujassot, Valencia, Spain
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17
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Sharma P, Mahajan M, Gupta V, Gupta P, Abrol D. Evaluation of clinically significant prostate cancer using biparametric magnetic resonance imaging: An evolving concept. J Cancer Res Ther 2022; 18:1640-1645. [DOI: 10.4103/jcrt.jcrt_1313_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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The Role of PSA Density among PI-RADS v2.1 Categories to Avoid an Unnecessary Transition Zone Biopsy in Patients with PSA 4-20 ng/mL. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3995789. [PMID: 34671673 PMCID: PMC8523253 DOI: 10.1155/2021/3995789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/28/2021] [Indexed: 12/28/2022]
Abstract
Objective To evaluate the role of prostate-specific antigen density (PSAD) in different Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) categories to avoid an unnecessary biopsy in transition zone (TZ) patients with PSA ranging from 4 to 20 ng/mL. Materials and Methods In this retrospective and single-center study, 333 biopsy-naïve patients with TZ lesions who underwent biparametric magnetic resonance imaging (bp-MRI) were analyzed from January 2016 to March 2020. Multivariate logistic regression analyses were performed to determine independent predictors of clinically significant prostate cancer (cs-PCa). The receiver operating characteristic (ROC) curve was used to compare diagnostic performance. Results PI-RADS v2.1 and PSAD were the independent predictors for TZ cs-PCa in patients with PSA 4-20 ng/mL. 0.9% (2/213), 10.0% (7/70), and 48.0% (24/50) of PI-RADS v2.1 score 1-2, 3, and 4-5 had TZ cs-PCa. However, for patients with PI-RADS v2.1 score 1-2, there were no obvious changes in the detection of TZ cs-PCa (0.8% (1/129), 1.3% (1/75), and 0.0% (0/9)) combining with different PSAD stratification (PSAD < 0.15, 0.15-0.29, and ≥0.30 ng/mL/mL). For patients with PI-RADS v2.1 score ≥ 3, the TZ cs-PCa detection rate significantly varied according to different PSAD stratification. A PI-RADS v2.1 score 3 and PSAD < 0.15 and 0.15-0.29 ng/mL/mL had 8.6% (3/35) and 3.7% (1/27) of TZ cs-PCa, while a PI-RADS v2.1 score 3 and PSAD ≥ 0.30 ng/mL/mL had a higher TZ cs-PCa detection rate (37.5% (3/8)). A PI-RADS v2.1 score 4-5 and PSAD <0.15 ng/mL/mL had no cs-PCa (0.0% (0/9)). In contrast, a PI-RADS v2.1 score 4-5 and PSAD 0.15-0.29 and ≥0.30 ng/mL/mL had the highest cs-PCa detection rate (50.0% (10/20), 66.7% (14/21)). It showed the highest AUC in the combination of PI-RADS v2.1 and PSAD (0.910), which was significantly higher than PI-RADS v2.1 (0.889, P = 0.039) or PSAD (0.803, P < 0.001). Conclusions For TZ patients with PSA 4-20 ng/mL, PI-RADS v2.1 score ≤ 2 can avoid an unnecessary biopsy regardless of PSAD. PI-RADS v2.1 score ≥ 3 may avoid an unnecessary biopsy after combining with PSAD. PI-RADS v2.1 combined with PSAD could significantly improve diagnostic performance.
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19
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Bass EJ, Pantovic A, Connor M, Gabe R, Padhani AR, Rockall A, Sokhi H, Tam H, Winkler M, Ahmed HU. A systematic review and meta-analysis of the diagnostic accuracy of biparametric prostate MRI for prostate cancer in men at risk. Prostate Cancer Prostatic Dis 2021; 24:596-611. [PMID: 33219368 DOI: 10.1038/s41391-020-00298-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI), the use of three multiple imaging sequences, typically T2-weighted, diffusion weighted (DWI) and dynamic contrast enhanced (DCE) images, has a high sensitivity and specificity for detecting significant cancer. Current guidance now recommends its use prior to biopsy. However, the impact of DCE is currently under debate regarding test accuracy. Biparametric MRI (bpMRI), using only T2 and DWI has been proposed as a viable alternative. We conducted a contemporary systematic review and meta-analysis to further examine the diagnostic performance of bpMRI in the diagnosis of any and clinically significant prostate cancer. METHODS A systematic review of the literature from 01/01/2017 to 06/07/2019 was performed by two independent reviewers using predefined search criteria. The index test was biparametric MRI and the reference standard whole-mount prostatectomy or prostate biopsy. Quality of included studies was assessed by the QUADAS-2 tool. Statistical analysis included pooled diagnostic performance (sensitivity; specificity; AUC), meta-regression of possible covariates and head-to-head comparisons of bpMRI and mpMRI where both were performed in the same study. RESULTS Forty-four articles were included in the analysis. The pooled sensitivity for any cancer detection was 0.84 (95% CI, 0.80-0.88), specificity 0.75 (95% CI, 0.68-0.81) for bpMRI. The summary ROC curve yielded a high AUC value (AUC = 0.86). The pooled sensitivity for clinically significant prostate cancer was 0.87 (95% CI, 0.78-0.93), specificity 0.72 (95% CI, 0.56-0.84) and the AUC value was 0.87. Meta-regression analysis revealed no difference in the pooled diagnostic estimates between bpMRI and mpMRI. CONCLUSIONS This meta-analysis on contemporary studies shows that bpMRI offers comparable test accuracies to mpMRI in detecting prostate cancer. These data are broadly supportive of the bpMRI approach but heterogeneity does not allow definitive recommendations to be made. There is a need for prospective multicentre studies of bpMRI in biopsy naïve men.
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Affiliation(s)
- E J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK.
| | - A Pantovic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, Belgrade, Serbia
| | - M Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - R Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - A R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, UK
| | - A Rockall
- Division of Cancer, Department of Surgery and Cancer,Faculty of Medicine, Imperial College London, London, UK
| | - H Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, UK.,Department of Radiology, Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - H Tam
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
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Youn SY, Choi MH, Kim DH, Lee YJ, Huisman H, Johnson E, Penzkofer T, Shabunin I, Winkel DJ, Xing P, Szolar D, Grimm R, von Busch H, Son Y, Lou B, Kamen A. Detection and PI-RADS classification of focal lesions in prostate MRI: Performance comparison between a deep learning-based algorithm (DLA) and radiologists with various levels of experience. Eur J Radiol 2021; 142:109894. [PMID: 34388625 DOI: 10.1016/j.ejrad.2021.109894] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/30/2021] [Accepted: 08/01/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the performance of lesion detection and Prostate Imaging-Reporting and Data System (PI-RADS) classification between a deep learning-based algorithm (DLA), clinical reports and radiologists with different levels of experience in prostate MRI. METHODS This retrospective study included 121 patients who underwent prebiopsy MRI and prostate biopsy. More than five radiologists (Reader groups 1, 2: residents; Readers 3, 4: less-experienced radiologists; Reader 5: expert) independently reviewed biparametric MRI (bpMRI). The DLA results were obtained using bpMRI. The reference standard was based on pathologic reports. The diagnostic performance of the PI-RADS classification of DLA, clinical reports, and radiologists was analyzed using AUROC. Dichotomous analysis (PI-RADS cutoff value ≥ 3 or 4) was performed, and the sensitivities and specificities were compared using McNemar's test. RESULTS Clinically significant cancer [CSC, Gleason score ≥ 7] was confirmed in 43 patients (35.5%). The AUROC of the DLA (0.828) for diagnosing CSC was significantly higher than that of Reader 1 (AUROC, 0.706; p = 0.011), significantly lower than that of Reader 5 (AUROC, 0.914; p = 0.013), and similar to clinical reports and other readers (p = 0.060-0.661). The sensitivity of DLA (76.7%) was comparable to those of all readers and the clinical reports at a PI-RADS cutoff value ≥ 4. The specificity of the DLA (85.9%) was significantly higher than those of clinical reports and Readers 2-3 and comparable to all others at a PI-RADS cutoff value ≥ 4. CONCLUSIONS The DLA showed moderate diagnostic performance at a level between those of residents and an expert in detecting and classifying according to PI-RADS. The performance of DLA was similar to that of clinical reports from various radiologists in clinical practice.
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Affiliation(s)
- Seo Yeon Youn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Seoul, Republic of Korea.
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Seoul, Republic of Korea.
| | - Henkjan Huisman
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Evan Johnson
- Department of Radiology, New York University, NY, USA
| | - Tobias Penzkofer
- Department of Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
| | | | - David Jean Winkel
- Department of Radiology, University Hospital of Basel, Basel, Switzerland.
| | - Pengyi Xing
- Department of Radiology, Changhai Hospital, Shanghai, China.
| | | | - Robert Grimm
- Diagnostic Imaging, Siemens Healthcare, Erlangen, Germany.
| | | | - Yohan Son
- Siemens Healthineers Ltd., Seoul, Republic of Korea.
| | - Bin Lou
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA.
| | - Ali Kamen
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA.
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Comparison of Sensitivity and Specificity of Biparametric versus Multiparametric Prostate MRI in the Detection of Prostate Cancer in 431 Men with Elevated Prostate-Specific Antigen Levels. Diagnostics (Basel) 2021; 11:diagnostics11071223. [PMID: 34359307 PMCID: PMC8306749 DOI: 10.3390/diagnostics11071223] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 12/31/2022] Open
Abstract
(1) Background: the study of dynamic contrast enhancement (DCE) has a limited role in the detection of prostate cancer (PCa), and there is a growing interest in performing unenhanced biparametric prostate-MRI (bpMRI) instead of the conventional multiparametric-MRI (mpMRI). In this study, we aimed to retrospectively compare the performance of the mpMRI, which includes DCE study, and the unenhanced bpMRI, composed of only T2-weighted imaging and diffusion-weighted imaging (DWI), in PCa detection in men with elevated prostate-specific-antigen (PSA) levels. (2) Methods: a 1.5 T MRI, with an endorectal-coil, was performed on 431 men (aged 61.5 ± 8.3 years) with a PSA ≥4.0 ng/mL. The bpMRI and mpMRI tests were independently assessed in separate sessions by two readers with 5 (R1) and 3 (R2) years of experience. The histopathology or ≥2 years follow-up served as a reference standard. The sensitivity and specificity were calculated with their 95% CI, and McNemar’s and Cohen’s κ statistics were used. (3) Results: in 195/431 (45%) of histopathologically proven PCa cases, 62/195 (32%) were high-grade PCa (GS ≥ 7b) and 133/195 (68%) were low-grade PCa (GS ≤ 7a). The PCa could be excluded by histopathology in 58/431 (14%) and by follow-up in 178/431 (41%) of patients. For bpMRI, the sensitivity was 164/195 (84%, 95% CI: 79–89%) for R1 and 156/195 (80%, 95% CI: 74–86%) for R2; while specificity was 182/236 (77%, 95% CI: 72–82%) for R1 and 175/236 (74%, 95% CI: 68–80%) for R2. For mpMRI, sensitivity was 168/195 (86%, 95% CI: 81–91%) for R1 and 160/195 (82%, 95% CI: 77–87%) for R2; while specificity was 184/236 (78%, 95% CI: 73–83%) for R1 and 177/236 (75%, 95% CI: 69–81%) for R2. Interobserver agreement was substantial for both bpMRI (κ = 0.802) and mpMRI (κ = 0.787). (4) Conclusions: the diagnostic performance of bpMRI and mpMRI were similar, and no high-grade PCa was missed with bpMRI.
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Susceptibility artifacts and PIRADS 3 lesions in prostatic MRI: how often is the dynamic contrast-enhance sequence necessary? Abdom Radiol (NY) 2021; 46:3401-3409. [PMID: 33683430 DOI: 10.1007/s00261-021-03011-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the need of the dynamic contrast-enhanced (DCE) sequence in addition to T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) for the detection of clinically significant prostate cancer in the presence of artifacts associated with rectal gas (which compromise the diffusion assessment) and/or PIRADS 3 lesions. METHODS This retrospective study was approved by the institutional review board; informed consent was not required. Patients referred consecutively over a period of 5 months for elevated PSA underwent multiparametric magnetic resonance imaging (mpMRI). mpMRI was performed using a 3T MRI system without an endorectal coil. The MRI findings were reviewed by two radiologists and were scored according to the Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2). Any discrepancies were resolved by consensus. For statistical purposes, lesions were classified as PIRADS 1-2, PIRADS 3, or PIRADS 4-5. First, all studies were reviewed using a biparametric assessment (T2-WI + DWI), and the presence or absence of susceptibility artifacts was assessed for each prostate. Subsequently, all images were analyzed using the standard multiparametric approach (T2-WI + DWI + DCE). RESULTS The biparametric evaluation (T2-WI + DWI) showed artifacts (due to the presence of rectal gas or other) in 87 patients (43.5%) and no artifacts in 113 patients (56.5%). In the latter group, 15 patients had peripheral zone (PZ) PIRADS 3 lesions. Thus, a total of 102 patients (51%) had artifacts or PZ PIRADS 3 lesions and therefore required DCE. When evaluating the group of prostates without artifacts, 13.3% of prostates required DCE. A total of 17 (23.9%) PIRADS 4-5 prostate lesions would have not been detected without the use of DCE. CONCLUSION Biparametric evaluation of the prostate revealed some limitation due to the presence of artifacts or PIRADS 3 PZ lesions. Artifacts were present in almost 44% of our patients, but when the DWI was correctly evaluated, only 13.3% of prostates required DCE.
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Wei C, Pan P, Chen T, Zhang Y, Dai G, Tu J, Jiang Z, Zhao W, Shen J. A nomogram based on PI-RADS v2.1 and clinical indicators for predicting clinically significant prostate cancer in the transition zone. Transl Androl Urol 2021; 10:2435-2446. [PMID: 34295730 PMCID: PMC8261422 DOI: 10.21037/tau-21-49] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022] Open
Abstract
Background This study attempted to develop a nomogram for predicting clinically significant prostate cancer (cs-PCa) in the transition zone (TZ) with the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) score based on biparametric magnetic resonance imaging (bp-MRI) and clinical indicators. Methods We retrospectively reviewed 383 patients with suspicious prostate lesions in the TZ as a training cohort and 128 patients as the validation cohort from January 2015 to March 2020. Multivariable logistic regression analysis was performed to determine independent predictors for building a nomogram, and the performance of the nomogram was assessed by the area under the receiver operating characteristic curve (AUC), the calibration curve and decision curve. Results The PI-RADS v2.1 score and prostate-specific antigen density (PSAD) were independent predictors of TZ cs-PCa. The prediction model had a significantly higher AUC (0.936) than the individual predictors (0.914 for PI-RADS v2.1 score, P=0.045, 0.842 for PSAD, P<0.001). The nomogram showed good discrimination (AUC of 0.936 in the training cohort and 0.963 in the validation cohort) and favorable calibration. When the PI-RADS v2.1 score was combined with PSAD, the diagnostic sensitivity and specificity were 80.7% and 93.8%, respectively, which were better than those of the PI-RADS v2.1 score (sensitivity, 74.2%; specificity, 92.5%) and PSAD (sensitivity, 66.1%; specificity, 88.2%). Conclusions The newly constructed nomogram exhibits satisfactory predictive accuracy and consistency for TZ cs-PCa. PI-RADS v2.1 based on bp-MRI is a strong predictor in the detection of TZ cs-PCa. Adding PSAD to PI-RADS v2.1 could improve its diagnostic performance, thereby avoiding unnecessary biopsies.
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Affiliation(s)
- Chaogang Wei
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
| | - Peng Pan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Tong Chen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Radiation Oncology Therapeutics of Soochow University, Suzhou, China
| | - Yueyue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guangcheng Dai
- Department of Urology Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Tu
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhen Jiang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenlu Zhao
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Junkang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Radiation Oncology Therapeutics of Soochow University, Suzhou, China
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Caglic I, Sushentsev N, Shah N, Warren AY, Lamb BW, Barrett T. Comparison of biparametric versus multiparametric prostate MRI for the detection of extracapsular extension and seminal vesicle invasion in biopsy naïve patients. Eur J Radiol 2021; 141:109804. [PMID: 34062473 DOI: 10.1016/j.ejrad.2021.109804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare biparametric MRI (bpMRI) with multiparametric MRI (mpMRI) staging accuracy in assessing extracapsular extension (ECE) and seminal vesicle invasion (SVI). METHOD Biopsy-naïve patients undergoing 3 T-MRI before radical prostatectomy for clinically significant prostate cancer were included in this single-centre retrospective study. Two uroradiologists separately evaluated bpMRI and mpMRI for presence of ECE and SVI using a 5-point Likert scale (1: ECE/SVI highly unlikely, 5: ECE/SVI highly likely). RESULTS 110 men of median age 63 years and PSA 8.5 ng/mL were included. ECE and SVI was confirmed histologically in 71/110 (64.5 %) and 18/110 (16.4 %) patients, respectively. Sensitivity and specificity of bpMRI versus mpMRI for predicting ECE was 59.1 % and 87.2 % versus 66.2 % and 84.6 %, respectively. For SVI detection, the sensitivity and specificity for bpMRI versus mpMRI was 66.7 % and 92.4 % versus 83.3 % and 97.8 %, respectively. At an optimal cut-off Likert score ≥3 for ECE prediction, mpMRI area under the receiver operating curve (AUC) was 0.80 (95 % confidence interval (CI) 0.72-0.87) versus 0.78 (95 % CI 0.69-0.86) for bpMRI (p = 0.52) and for SVI, mpMRI AUC was 0.91 (95 % CI 0.84-0.96) versus 0.86 (95 % CI 0.78-0.92) for bpMRI (p = 0.02), respectively. Inter-reader agreement for both ECE and SVI prediction was substantial, with a marginally higher k-value for mpMRI (k range, 0.67-0.75) than bpMRI (k range, 0.65-0.69). CONCLUSIONS Diagnostic performance of bpMRI and mpMRI was comparable for detection of ECE, however, mpMRI with contrast was superior for SVI detection and improved the inter-reader agreement.
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Affiliation(s)
- Iztok Caglic
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Nimish Shah
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Pathology, Addenbrooke's Hospital, Cambridge, UK.
| | - Benjamin W Lamb
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Tristan Barrett
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
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Kato D, Ozawa K, Takeuchi S, Kawase M, Kawase K, Nakai C, Takai M, Iinuma K, Nakane K, Kato H, Matsuo M, Suzui N, Miyazaki T, Koie T. The Utility of Combined Target and Systematic Prostate Biopsies in the Diagnosis of Clinically Significant Prostate Cancer Using Prostate Imaging Reporting and Data System Version 2 Based on Biparametric Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2021; 28:1294-1301. [PMID: 33809967 PMCID: PMC8025823 DOI: 10.3390/curroncol28020123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022]
Abstract
This study aimed to determine the predictive value of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) based on biparametric magnetic resonance imaging (bpMRI) with combined target biopsy (TBx) and systematic biopsy (SBx) in patients with suspicion of having clinically significant prostate cancer (csPCa). In this retrospective study, we reviewed the clinical and pathological records of 184 consecutive patients who underwent bpMRI before prostate biopsy. We focused on patients with PI-RADS v2 scores ≥ 3. MRI was performed using a 3-Tesla clinical scanner with a 32-channel phased-array receiver coil. PI-RADS v2 was used to describe bpMRI findings based on T2-weighted imaging and diffusion-weighted imaging scores. The primary endpoint was the diagnostic accuracy rate of PI-RADS v2 based on bpMRI for patients with prostate cancer (PCa) who underwent combined TBx and SBx. A total of 104 patients were enrolled in this study. Combined TBx and SBx was significantly superior to either method alone for PCa detection in patients with suspicious lesions according to PI-RADS v2. TBx and SBx detected concordant csPCa in only 24.1% of the patients. In addition, the rate of increase in the Gleason score was similar between SBx (41.5%) and TBx (34.1%). The diagnostic accuracy of bpMRI is comparable to that of standard multiparametric MRI for the detection of csPCa. Moreover, combined TBx and SBx may be optimal for the accurate determination of csPCa diagnosis, the International Society of Urological Pathology grade, and risk classification.
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Affiliation(s)
- Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Kaori Ozawa
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan; (K.O.); (S.T.)
| | - Shinichi Takeuchi
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan; (K.O.); (S.T.)
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Chie Nakai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Hiroki Kato
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.K.); (M.M.); (N.S.); (T.M.)
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.K.); (M.M.); (N.S.); (T.M.)
| | - Natsuko Suzui
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.K.); (M.M.); (N.S.); (T.M.)
| | - Tatsuhiko Miyazaki
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.K.); (M.M.); (N.S.); (T.M.)
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
- Correspondence:
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EL-Adalany MA, EL-Razek AAELKA, EL-Diasty T, EL-Hendy A, EL-Metwally D. Comparison between biparametric and multiparametric MR imaging of Prostate Imaging Reporting and Data System Version 2.1 in detection of prostate cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00443-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Prostate cancer (PCa) is considered to be the commonest cancer among males. Early and precise diagnosis of PCa is essential for adequate treatment. Multiparametric MR imaging (mpMRI) is actually the most precise imaging technique used for early diagnosis of PCa. The aim of this work was to assess the diagnostic capability of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) of PI-RADS V2.1 in detection of prostate cancer (PCa). This prospective study was carried on 60 male patients with high PSA. bpMRI and mpMRI were performed for all patients using a 3-T MRI scanner. The diagnostic performance of bpMRI of PI-RADS V2.1 was compared to that of mpMRI of PI-RADS V 2.1. The diagnosis of Pca was confirmed by transrectal ultrasound-guided biopsy and the results of open prostatectomy specimens.
Results
When considering PI-RADS categories 1, 2, and 3 as benign and categories 4 and 5 as malignant, mpMRI had higher sensitivity and diagnostic accuracy when compared with bpMRI (sensitivity was 88.6% for mpMRI versus 60% for bpMRI and diagnostic accuracy was 91.7% for mpMRI versus 75% for bpMRI). When considering PI-RADS categories 1 and 2 as benign and PI-RADS categories 3.4 and 5 as malignant, the sensitivity and diagnostic accuracy of bpMRI and mpMRI were comparable (sensitivity was 94.3% for both bpMRI and mpMRI and diagnostic accuracy was 86.7% for both bpMRI and mpMRI).
Conclusion
Considering PI-RADS scores 4 and 5 as malignant, mpMRI had higher sensitivity and diagnostic accuracy when compared with bpMRI; however, when considering PI-RADS scores 3, 4, and 5 as malignant, both bpMRI and mpMRI had similar diagnostic accuracy.
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Abstract
Currently there is a lot of interest in the use of a "biparametric" or "abbreviated" prostate MR protocol, which usually refers to removal of the dynamic contrast-enhanced (DCE) MRI, in the detection of clinically significant prostate cancer. In this article we describe the benefits of DCE as part of the PI-RADS lexicon, with particular reference to its role in PI-RADS V2 category 3 peripheral zone lesions. We also discuss the benefits of triplanar T2-weighted images, and finally discuss how a mpMRI protocol is of benefit in prostate cancer staging, in evaluating for local disease recurrence, and as a biomarker for neoadjuvant therapy response.
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Palumbo P, Manetta R, Izzo A, Bruno F, Arrigoni F, De Filippo M, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement. Gland Surg 2020; 9:2235-2247. [PMID: 33447576 DOI: 10.21037/gs-20-547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostate cancer is the most common malignancy in male population. Over the last few years, magnetic resonance imaging (MRI) has proved to be a robust clinical tool for identification and staging of clinically significant prostate cancer. Though suggestions by the European Society of Urogenital Radiology to use complete multiparametric (mp) T2-weighted/diffusion weighted imaging (DWI)/dynamic contrast enhancement (DCE) acquisition for all prostate MRI examinations, the real advantage of functional DCE remains a matter of debate. Recent studies demonstrate that biparametric (bp) and mp approaches have similar accuracy, but controversial evidences remain, and the specific potential benefits of contrast medium administration are still poorly discussed in literature. The bp approach is in fact sufficient in most cases to adequately identify a negative test, or to accurately define the degree of aggressiveness of a lesion, especially if larger or with major characteristics of malignancy. This feature would give the DCE a secondary role, probably limited to a second evaluation of the lesion location, for detecting small cancer or in case of controversy. However, DCE has proved to increase the sensitivity of prostate MRI, though a less specificity. Therefore, an appropriate decision algorithm is needed to standardize the MRI approach. Aim of this review study was to provide a schematic description of bpMRI and mpMRI approaches in the study of prostatic anatomy, focusing on comparative validity and current DCE application. Additional theoretical considerations on prostate MRI are provided.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Izzo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Round table: arguments in supporting abbreviated or biparametric MRI of the prostate protocol. Abdom Radiol (NY) 2020; 45:3974-3981. [PMID: 32303773 DOI: 10.1007/s00261-020-02510-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 update, in the attempt to improve clinical guidelines for multiparametric magnetic resonance imaging (mpMRI) of the prostate, has clear limitations. The role of dynamic contrast-enhanced sequences is not defined, precise guidance on the clinical management (biopsy or clinical surveillance) for score 3 lesions [equivocal for clinical significant prostate cancer (sPCa)] is not offered and criteria for lesions interpretation remain difficult and subjective. We report criteria and arguments in supporting the use of abbreviated or biparametric prostate MRI protocol in clinical practice for detection and management of PCa.
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Ward R, Purysko AS. Round table: arguments against using multiparametric prostate MRI protocols. Abdom Radiol (NY) 2020; 45:3997-4002. [PMID: 32140766 DOI: 10.1007/s00261-020-02456-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Biparametric MRI (bpMRI), which uses only T2-weighted imaging and diffusion-weighted imaging, continues to gain support for the detection of prostate cancer, as this imaging technique offers many benefits over traditional mpMRI. However, the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 document released in 2019 emphasized that mpMRI is still preferred over bpMRI in most clinical scenarios. As one article in a series of four providing arguments for and against using mpMRI and bpMRI protocols, this paper provides arguments against using mpMRI. Within this article, we discuss recent data suggesting equivalent performance between bpMRI and mpMRI in the detection of prostate cancer. The limited utility of dynamic contrast enhancement in the evaluation of prostate cancer according to the PI-RADS v2.1 document is also reviewed. Finally, we detail the large financial and time costs, legal and logistical issues, and potential for patient harm that must be considered with the administration of contrast.
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PI-RADS Committee Position on MRI Without Contrast Medium in Biopsy-Naive Men With Suspected Prostate Cancer: Narrative Review. AJR Am J Roentgenol 2020; 216:3-19. [PMID: 32812795 DOI: 10.2214/ajr.20.24268] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The steadily increasing demand for diagnostic prostate MRI has led to concerns regarding the lack of access to and the availability of qualified MRI scanners and sufficiently experienced radiologists, radiographers, and technologists to meet the demand. Solutions must enhance operational benefits without compromising diagnostic performance, quality, and delivery of service. Solutions should also mitigate risks such as decreased reader confidence and referrer engagement. One approach may be the implementation of MRI without the use gadolinium-based contrast medium (bipara-metric MRI), but only if certain prerequisites such as high-quality imaging, expert interpretation quality, and availability of patient recall or on-table monitoring are mandated. Alternatively, or in combination, a clinical risk-based approach could be used for protocol selection, specifically, which biopsy-naive men need MRI with contrast medium (multiparametric MRI). There is a need for prospective studies in which biopsy decisions are made according to MRI without contrast enhancement. Such studies must define clinical and operational benefits and identify which patient groups can be scanned successfully without contrast enhancement. These higher-quality data are needed before the Prostate Imaging Reporting and Data System (PI-RADS) Committee can make evidence-based recommendations about MRI without contrast enhancement as an initial diagnostic approach for prostate cancer workup.
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Udayakumar N, Porter KK. How Fast Can We Go: Abbreviated Prostate MR Protocols. Curr Urol Rep 2020; 21:59. [PMID: 33135121 DOI: 10.1007/s11934-020-01008-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Multiparametric MRI (mpMRI), composed of T2WI, DWI, and DCE sequences, is effective in identifying prostate cancer (PCa), but length and cost preclude its application as a PCa screening tool. Here we review abbreviated MRI protocols that shorten or omit conventional mpMRI components to reduce scan time and expense without forgoing diagnostic accuracy. RECENT FINDINGS The DCE sequence, which plays a limited diagnostic role in PI-RADS, is eliminated in variations of the biparametric MRI (bpMRI). T2WI, the lengthiest sequence, is truncated by only acquiring the axial plane or utilizing 3D acquisition with subsequent 2D reconstruction. DW-EPISMS further accelerates DWI acquisition. The fastest protocol described to date consists of just DW-EPISMS and axial-only 2D T2WI and runs less than 5 min. Abbreviated protocols can mitigate scan expense and increase scan access, allowing prostate MRI to become an efficient PCa screening tool.
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Affiliation(s)
- Neha Udayakumar
- University of Alabama at Birmingham School of Medicine, 1720 2nd Ave S, Birmingham, AL, 35249, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street S, JT N374, Birmingham, AL, 35249, USA.
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Leung DKW, Chiu PKF, Ng CF, Teoh JYC. Role of pre-biopsy multiparametric MRI in prostate cancer diagnosis: Evidence from the literature. Turk J Urol 2020; 47:S65-S70. [PMID: 33016871 DOI: 10.5152/tud.2020.20360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 11/22/2022]
Abstract
As the conventional workup for diagnosing prostate cancer, transrectal systematic biopsy carries the risk of sepsis and overdiagnosis of insignificant prostate cancer. In recent years, multiparametric MRI (mpMRI) has revolutionized the diagnostic approach to prostate cancer. With widespread use of the prostate imaging and data system (PIRADS), MRI reporting has been more standardized. Several landmark papers have indicated that mpMRI in combination with targeted or combined biopsy can confidently diagnose more clinically significant prostate cancer while reducing diagnoses of insignificant disease. In this review, we aim to discuss the advantages of pre-biopsy MRI based on the current literature and to address its reliability in ruling out prostate cancer, reproducibility, and cost-effectiveness.
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Affiliation(s)
- David Ka-Wai Leung
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Bosaily AES, Frangou E, Ahmed HU, Emberton M, Punwani S, Kaplan R, Brown LC, Freeman A, Jameson C, Hindley R, Peppercorn D, Thrower A, Winkler M, Barwick T, Stewart V, Burns-Cox N, Burn P, Ghei M, Kumaradevan J, Prasad R, Ash-Miles J, Shergill I, Agarwal S, Rosario D, Salim F, Bott S, Evans H, Henderson A, Ghosh S, Dudderidge T, Smart J, Tung K, Kirkham A. Additional Value of Dynamic Contrast-enhanced Sequences in Multiparametric Prostate Magnetic Resonance Imaging: Data from the PROMIS Study. Eur Urol 2020; 78:503-511. [PMID: 32312543 DOI: 10.1016/j.eururo.2020.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MP-MRI) is established in the diagnosis of prostate cancer, but the need for enhanced sequences has recently been questioned. OBJECTIVE To assess whether dynamic contrast-enhanced imaging (DCE) improves accuracy over T2 and diffusion sequences. DESIGN, SETTING, AND PARTICIPANTS PROMIS was a multicentre, multireader trial, with, in this part, 497 biopsy-naïve men undergoing standardised 1.5T MP-MRI using T2, diffusion, and DCE, followed by a detailed transperineal prostate mapping (TPM) biopsy at 5 mm intervals. Likert scores of 1-5 for the presence of a significant tumour were assigned in strict sequence, for (1) T2 + diffusion and then (2) T2 + diffusion + dynamic contrast-enhanced images. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS For the primary analysis, the primary PROMIS outcome measure (Gleason score ≥4 + 3 or ≥6 mm maximum cancer length) on TPM was used, and an MRI score of ≥3 was considered positive. RESULTS AND LIMITATIONS Sensitivity without and with DCE was 94% and 95%, specificity 37% and 38%, positive predictive value 51% and 51%, and negative predictive value 90% and 91%, respectively (p > 0.05 in each case). The number of patients avoiding biopsy (scoring 1-2) was similar (123/497 vs 121/497, p = 0.8). The number of equivocal scores (3/5) was slightly higher without DCE (32% vs 28% p = 0.031). The proportion of MRI equivocal (3/5) and positive (4-5) cases showing significant tumours were similar (23% and 71% vs 20% and 69%). No cases of dominant Gleason 4 or higher were missed with DCE, compared with a single case with T2 + diffusion-weighted imaging. No attempt was made to correlate lesion location on MRI and histology, which may be considered a limitation. Radiologists were aware of the patient's prostate-specific antigen. CONCLUSIONS Contrast adds little when MP-MRI is used to exclude significant prostate cancer. PATIENT SUMMARY An intravenous injection of contrast may not be necessary when magnetic resonance imaging is used as a test to rule out significant tumours in the prostate.
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Affiliation(s)
- Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, Royal Free NHS foundation Trust, London, UK.
| | | | - Hashim U Ahmed
- Division of Surgery and Interventional Sciences, University College London, London, UK; Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK
| | | | | | - Alex Freeman
- University College Hospital NHS Foundation Trust, London, UK
| | - Charles Jameson
- University College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Mathias Winkler
- Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK
| | - Tara Barwick
- Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK
| | - Victoria Stewart
- Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK
| | - Nick Burns-Cox
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Paul Burn
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | | | | | | | | | | | | | | | - Simon Bott
- Frimley Health NHS Foundation Trust, Camberley, UK
| | - Hywel Evans
- Frimley Health NHS Foundation Trust, Camberley, UK
| | | | - Sukanya Ghosh
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Tim Dudderidge
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Smart
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ken Tung
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Cem Birbiri U, Hamidinekoo A, Grall A, Malcolm P, Zwiggelaar R. Investigating the Performance of Generative Adversarial Networks for Prostate Tissue Detection and Segmentation. J Imaging 2020; 6:jimaging6090083. [PMID: 34460740 PMCID: PMC8321056 DOI: 10.3390/jimaging6090083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022] Open
Abstract
The manual delineation of region of interest (RoI) in 3D magnetic resonance imaging (MRI) of the prostate is time-consuming and subjective. Correct identification of prostate tissue is helpful to define a precise RoI to be used in CAD systems in clinical practice during diagnostic imaging, radiotherapy and monitoring the progress of disease. Conditional GAN (cGAN), cycleGAN and U-Net models and their performances were studied for the detection and segmentation of prostate tissue in 3D multi-parametric MRI scans. These models were trained and evaluated on MRI data from 40 patients with biopsy-proven prostate cancer. Due to the limited amount of available training data, three augmentation schemes were proposed to artificially increase the training samples. These models were tested on a clinical dataset annotated for this study and on a public dataset (PROMISE12). The cGAN model outperformed the U-Net and cycleGAN predictions owing to the inclusion of paired image supervision. Based on our quantitative results, cGAN gained a Dice score of 0.78 and 0.75 on the private and the PROMISE12 public datasets, respectively.
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Affiliation(s)
- Ufuk Cem Birbiri
- Department of Computer Engineering, Middle East Technical University, Ankara 06800, Turkey;
| | - Azam Hamidinekoo
- Division of Molecular Pathology, Institute of Cancer Research (ICR), London SM2 5NG, UK;
| | | | - Paul Malcolm
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK;
| | - Reyer Zwiggelaar
- Department of Computer Science, Aberystwyth University, Aberystwyth SY23 3DB, UK
- Correspondence:
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Tamada T, Kido A, Yamamoto A, Takeuchi M, Miyaji Y, Moriya T, Sone T. Comparison of Biparametric and Multiparametric MRI for Clinically Significant Prostate Cancer Detection With PI-RADS Version 2.1. J Magn Reson Imaging 2020; 53:283-291. [PMID: 32614123 DOI: 10.1002/jmri.27283] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Biparametric MRI (bpMRI) without dynamic contrast-enhanced MRI (DCE-MRI) results in an elimination of adverse events, shortened examination time, and reduced costs, compared to multiparametric MRI (mpMRI). The ability of bpMRI to detect clinically significant prostate cancer (csPC) with the Prostate Imaging and Reporting Data System version 2.1 (PI-RADS v2.1) compared to standard mpMRI has not been studied extensively. PURPOSE To compare the interobserver reliability and diagnostic performance for detecting csPC of bpMRI and mpMRI using PI-RADS v2.1. STUDY TYPE Retrospective. POPULATION In all, 103 patients with elevated prostate-specific antigen (PSA) levels who underwent mpMRI and subsequent MRI-ultrasonography fusion-guided prostate-targeted biopsy (MRGB) with or without prostatectomy. FIELD STRENGTH/SEQUENCES T2 -weighted imaging (T2 WI), diffusion-weighted imaging (DWI), and DCE-MRI at 3T. ASSESSMENT Three readers independently assessed each suspected PC lesion, assigning a score of 1-5 for T2 WI, a score of 1-5 for DWI, and positive and negative for DCE-MRI according to PI-RADS v2.1 and determined the overall PI-RADS assessment category of bpMRI (T2 WI and DWI) and mpMRI (T2 WI, DWI, and DCE-MRI). The reference standard was MRGB or prostatectomy-derived histopathology. STATISTICAL TESTING Statistical analysis was performed using the kappa statistic and McNemar and Delong tests. RESULTS Of the 165 suspected PC lesions in 103 patients, 81 were diagnosed with csPC and 84 with benign conditions. Interobserver variability of PI-RADS assessment category showed good agreement for bpMRI (kappa value = 0.642) and mpMRI (kappa value = 0.644). For three readers, the diagnostic sensitivity was significantly higher for mpMRI than for bpMRI (P < 0.001 to P = 0.016, respectively), whereas diagnostic specificity was significantly higher for bpMRI than for mpMRI (P < 0.001 each). For three readers, the area under the receiver operating characteristic curve (AUC) was higher for bpMRI than for mpMRI; however, the difference was significant only for Reader 1 and Reader 3 (Reader 1: 0.823 vs. 0.785, P = 0.035; Reader 2: 0.852 vs. 0.829, P = 0.099; and Reader 3: 0.828 vs. 0.773, P = 0.002). DATA CONCLUSION For detecting csPC using PI-RADS v2.1, the interobserver reliability and diagnostic performance of bpMRI was comparable with those of mpMRI. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Ayumu Kido
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Takuya Moriya
- Department of pathology, Kawasaki Medical School, Kurashiki, Japan
| | - Teruki Sone
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
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Mortezavi A, Palsdottir T, Eklund M, Chellappa V, Murugan SK, Saba K, Ankerst DP, Haug ES, Nordström T. Head-to-head Comparison of Conventional, and Image- and Biomarker-based Prostate Cancer Risk Calculators. Eur Urol Focus 2020; 7:546-553. [PMID: 32451315 DOI: 10.1016/j.euf.2020.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/09/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A new generation of risk calculators (RCs) for prostate cancer (PCa) incorporating magnetic resonance imaging (MRI) data have been introduced. However, these have not been validated externally, and their clinical benefit compared with alternative approaches remains unclear. OBJECTIVE To assess previously published PCa RCs incorporating MRI data, and compare their performance with traditional RCs (European Randomized Study of Screening for Prostate Cancer [ERSPC] 3/4 and Prostate Biopsy Collaborative Group [PBCG]) and the blood-based Stockholm3 test. DESIGN, SETTING, AND PARTICIPANTS RCs were tested in a prospective multicenter cohort including 532 men aged 45-74 yr participating in the Stockholm3-MRI study between 2016 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The probabilities of detection of clinically significant PCa (csPCa) defined as Gleason score ≥3 + 4 were calculated for each patient. For each RC and the Stockholm3 test, discrimination was assessed by area under the curve (AUC), calibration by numerical and graphical summaries, and clinical usefulness by decision curve analysis (DCA). RESULTS AND LIMITATIONS The discriminative ability of MRI RCs 1-4 for the detection of csPCa was superior (AUC 0.81-0.87) to the traditional RCs (AUC 0.76-0.80). The observed prevalence of csPCa in the cohort was 37%, but calibration-in-the-large predictions varied from 14% to 63% across models. DCA identified only one model including MRI data as clinically useful at a threshold probability of 10%. The Stockholm3 test achieved equivalent performance for discrimination (AUC 0.86) and DCA, but was underpredicting the actual risk. CONCLUSIONS Although MRI RCs discriminated csPCa better than traditional RCs, their predicted probabilities were variable in accuracy, and DCA identified only one model as clinically useful. PATIENT SUMMARY Novel risk calculators (RCs) incorporating imaging improved the ability to discriminate clinically significant prostate cancer compared with traditional tools. However, all but one predicted divergent compared with actual risks, suggesting that regional modifications be implemented before usage. The Stockholm3 test achieved performance comparable with the best MRI RC without utilization of imaging.
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Affiliation(s)
- Ashkan Mortezavi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; University Hospital Zurich, Department of Urology, Zurich, Switzerland.
| | - Thorgerdur Palsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Venkatesh Chellappa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sarath Kumar Murugan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karim Saba
- Department of Urology, Cantonal Hospital Grisons, Chur, Switzerland
| | - Donna P Ankerst
- Department of Mathematics and Life Sciences, Technical University of Munich, Garching, Munich, Germany
| | - Erik S Haug
- Section of Urology, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Cancer Genomics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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Padhani AR, Schoots I, Villeirs G. Contrast Medium or No Contrast Medium for Prostate Cancer Diagnosis. That Is the Question. J Magn Reson Imaging 2020; 53:13-22. [PMID: 32363651 DOI: 10.1002/jmri.27180] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/20/2022] Open
Abstract
The benefits and drawbacks of the dynamic contrast-enhanced MRI sequence for prostate cancer diagnosis are increasingly being recognized, with many centers adopting the biparametric (bp) MRI approach as the default initial approach. The abandonment of the routine use of contrast medium requires an assessment of the loss of diagnostic power against the gains in operational logistics, costs, time, capacity, and side effects. It is the balance of these factors weighted against the clinical priorities of patients that determines which patient groups can safely avoid dynamic contrast enhancement. Although systematic reviews and individual studies are broadly supportive of the bpMRI approach, the pathway impacts for men with suspected cancer using the bpMRI approach are still not well documented for clinical practice. Robust prospectively acquired data for bpMRI regarding biopsy avoidance, detection of clinically significant and insignificant cancers, and for increasing the precision of tumor grade and volume are needed. There is a requirement for prospective, randomized, or blinded head-to-head, multicenter studies, addressing the noninferiority of biopsy yields prompted by bpMRI and multiparametric MRI approaches. These studies should more precisely define patient groups where the benefits and harms of contrast enhancement are aligned to their clinical priorities. Only then can we be confident in recommending bpMRI as an initial diagnostic approach for prostate cancer diagnosis. Level of Evidence 1 Technical Efficacy Stage 5.
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Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Ivo Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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Biparametric prostate MRI and clinical indicators predict clinically significant prostate cancer in men with "gray zone" PSA levels. Eur J Radiol 2020; 127:108977. [PMID: 32330776 DOI: 10.1016/j.ejrad.2020.108977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To predict clinically significant prostate cancer (cs-PCa) by combining the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score based on biparametric magnetic resonance imaging (bp-MRI) and clinical indicators in men with prostate-specific antigen (PSA) levels in the gray zone of 4-10 ng/mL. METHOD We retrospectively analyzed 364 patients with elevated PSA levels in the gray zone who had pathologically confirmed disease and had undergone MRI examinations from January 2015 to October 2019; a training group (n = 255) and validation group (n = 109) were randomly established. Multivariate logistic regression analysis of the training group was performed to identify the independent predictors for cs-PCa, thereby establishing a predictive model that was evaluated in the training and validation groups by analyzing the receiver operating characteristic (ROC) curve. RESULTS In the training group, the PI-RADS v2 score and prostate volume (PV) were independent predictors of cs-PCa (P < 0.05). The prediction model comprising the PI-RADS v2 score and PV had a larger AUC than the other predictors alone in the training group. The diagnostic sensitivity and specificity of the prediction model were 84.1 % and 83.4 %, respectively. The prediction model was indicated to have better predictive performance in the validation group. CONCLUSIONS The prediction model exhibits a satisfactory predictive value for cs-PCa in men with PSA levels in the gray zone. PI-RADS v2 is the strongest univariate predictor for the detection of cs-PCa in men with PSA in the gray zone, but combining this with the PV can provide superior predictive ability.
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Keller EX, De Coninck V, Doizi S, Daudon M, Traxer O. What is the exact definition of stone dust? An in vitro evaluation. World J Urol 2020; 39:187-194. [PMID: 32270283 DOI: 10.1007/s00345-020-03178-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To propose a size-related definition of stone dust produced by lithotripsy of urinary stones. METHODS Stone dust was defined as particles small enough to adhere to the following criteria: (1) spontaneous floating under 40 cm H2O irrigation pressure; (2) mean sedimentation time of > 2 s through 10 cm saline solution; (3) fully suitable for aspiration through a 3.6 F working channel. Irrigation, sedimentation, and aspiration tests were set up to evaluate each criterion. Primary outcome was particle size limit agreeing with all three criteria. Stone particles with a given size limit (≤ 2 mm, ≤ 1 mm, ≤ 500 µm, ≤ 250 µm, ≤ 125 µm and ≤ 63 µm) were obtained from laser lithotripsy, including samples from prevailing stone types: calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite, and cystine. RESULTS All particles ≤ 250 µm from all stone types were in agreement with all three criteria defining stone dust, except for struvite where size limit for a positive irrigation and sedimentation test was ≤ 125 µm. CONCLUSION A size limit of ≤ 250 µm seems to generally adhere to our definition of stone dust, which is based on floating and sedimentation proprieties of stone particles, as well as on the ability to be fully aspirated through the working channel of a flexible ureteroscope.
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Affiliation(s)
- Etienne Xavier Keller
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent De Coninck
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Steeve Doizi
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Michel Daudon
- Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France. .,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
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41
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Sushentsev N, Caglic I, Sala E, Shaida N, Slough RA, Carmo B, Kozlov V, Gnanapragasam VJ, Barrett T. The effect of capped biparametric magnetic resonance imaging slots on weekly prostate cancer imaging workload. Br J Radiol 2020; 93:20190929. [PMID: 31971823 PMCID: PMC7362922 DOI: 10.1259/bjr.20190929] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To introduce capped biparametric (bp) MRI slots for follow-up imaging of prostate cancer patients enrolled in active surveillance (AS) and evaluate the effect on weekly variation in the number of AS cases and total MRI workload. METHODS Three 20 min bpMRI AS slots on two separate days were introduced at Addenbrooke's Hospital, Cambridge. The weekly numbers of total prostate MRIs and AS cases recorded 15 months before and after the change (Groups 1 and 2, respectively). An intergroup variation in the weekly scan numbers was assessed using the coefficient of variance (CV) and mean absolute deviation; the Mann-Whitney U test was used for an intergroup comparison of the latter. RESULTS In AS patients, a shift from considerable to moderate variation in weekly scan numbers was observed between the two groups (CV, 51.7 and 26.8%, respectively); mean absolute deviation of AS scans also demonstrated a significant decrease in Group 2 (1.28 vs 2.58 in Group 1; p < 0.001). No significant changes in the variation in total prostate MRIs were observed, despite a 10% increased workload in Group 2. CONCLUSION A significant reduction in weekly variation of AS cases was demonstrated following the introduction of capped bpMRI slots, which can be used for more accurate long-term planning of MRI workload. ADVANCES IN KNOWLEDGE The paper illustrates the potential of introducing capped AS MRI slots using a bp protocol to reduce weekly variation in demand and allow for optimising workflow, which will be increasingly important as the demands on radiology departments increase worldwide.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
| | | | | | | | - Rhys A Slough
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
| | - Bruno Carmo
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
| | - Vasily Kozlov
- Department of Public Health and Healthcare Organisation, Sechenov First Moscow State Medical University, Moscow, Russia
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Stabile A, Giganti F, Kasivisvanathan V, Giannarini G, Moore CM, Padhani AR, Panebianco V, Rosenkrantz AB, Salomon G, Turkbey B, Villeirs G, Barentsz JO. Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review. Eur Urol Oncol 2020; 3:145-167. [DOI: 10.1016/j.euo.2020.02.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 01/19/2023]
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Liang Z, Hu R, Yang Y, An N, Duo X, Liu Z, Shi S, Liu X. Is dynamic contrast enhancement still necessary in multiparametric magnetic resonance for diagnosis of prostate cancer: a systematic review and meta-analysis. Transl Androl Urol 2020; 9:553-573. [PMID: 32420161 PMCID: PMC7215029 DOI: 10.21037/tau.2020.02.03] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study is to systematically review the literatures assessing the value of dynamic contrast enhancement (DCE) in the multiparametric magnetic resonance imaging (mpMRI) for the diagnosis of prostate cancer (PCa). Methods We searched Embase, PubMed and Web of science until January 2019 to extract articles exploring the possibilities whether the pre-biopsy biparametric magnetic resonance imaging (bpMRI) can replace the position of mpMRI in the diagnosis of PCa. The sensitivity and specificity of bpMRI were all included. The study quality was assessed by QUADAS-2. Bivariate random effects meta-analyses and a hierarchical summary receiver operating characteristic plot were performed for further study through Revman 5 and Stata12. Results After searching, we acquired 752 articles among which 45 studies with 5,217 participants were eligible for inclusion. The positive likelihood ratio for the detection of PCa was 2.40 (95% CI: 1.50–3.80) and the negative likelihood ratio was 0.31 (95% CI: 0.18–0.53). The sensitivity and specificity were 0.77 (95% CI: 0.73–0.81) and 0.81 (95% CI: 0.76–0.85) respectively. Based on our result, pooled specificity demonstrated little difference between bpMRI and mpMRI [bpMRI, 0.81 (95% CI, 0.76–0.85); mpMRI, 0.82 (95% CI, 0.72–0.88); P=0.169]. The sensitivity, however, indicated a significant difference between these two groups [bpMRI, 0.77 (95% CI, 0.73–0.81); mpMRI, 0.84 (95% CI, 0.78–0.89); P=0.001]. Conclusions bpMRI with high b-value is a sensitive tool for diagnosing PCa. Consistent results were found in multiple subgroup analysis.
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Affiliation(s)
- Zhen Liang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Rui Hu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Yongjiao Yang
- Department of Urology, Tianjin Medical University Second Hospital, Tianjin 300000, China
| | - Neng An
- Department of Urology, Tianjin Medical University Second Hospital, Tianjin 300000, China
| | - Xiaoxin Duo
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Zheng Liu
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Shangheng Shi
- Department of Transplantation, Affiliated Hospital of Medical College Qingdao University, Qingdao 266000, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
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Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility. Diagnostics (Basel) 2020; 10:diagnostics10030164. [PMID: 32192081 PMCID: PMC7151226 DOI: 10.3390/diagnostics10030164] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
The role of dynamic contrast-enhanced-MRI (DCE-MRI) for Prostate Imaging-Reporting and Data System (PI-RADS) scoring is a controversial topic. In this retrospective study, we aimed to measure the added value of DCE-MRI in combination with T2-weighted (T2W) and diffusion-weighted imaging (DWI) using PI-RADS v2.1, in terms of reproducibility and diagnostic accuracy, for detection of prostate cancer (PCa) and clinically significant PCa (CS-PCa, for Gleason Score ≥ 7). 117 lesions in 111 patients were identified as suspicion by multiparametric MRI (mpMRI) and addressed for biopsy. Three experienced readers independently assessed PI-RADS score, first using biparametric MRI (bpMRI, including DWI and T2W), and then multiparametric MRI (also including DCE). The inter-rater and inter-method agreement (bpMRI- vs. mpMRI-based scores) were assessed by Cohen's kappa (κ). Receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic accuracy for PCa and CS-PCa detection among the two scores. Inter-rater agreement was excellent for the three pairs of readers (κ ≥ 0.83), while the inter-method agreement was good (κ ≥ 0.73). Areas under the ROC curve (AUC) showed similar high-values (0.8 ≤ AUC ≤ 0.85). The reproducibility of PI-RADS v2.1 scoring was comparable and high among readers, without relevant differences, depending on the MRI protocol used. The inclusion of DCE did not influence the diagnostic accuracy.
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Zawaideh JP, Sala E, Shaida N, Koo B, Warren AY, Carmisciano L, Saeb-Parsy K, Gnanapragasam VJ, Kastner C, Barrett T. Diagnostic accuracy of biparametric versus multiparametric prostate MRI: assessment of contrast benefit in clinical practice. Eur Radiol 2020; 30:4039-4049. [PMID: 32166495 DOI: 10.1007/s00330-020-06782-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/16/2020] [Accepted: 02/27/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess the added value of dynamic contrast-enhanced (DCE) in prostate MR in clinical practice. METHODS Two hundred sixty-four patients underwent prostate MRI, with T2 and DWI sequences initially interpreted, prior to full multiparametric magnetic resonance imaging (mpMRI) interpretation using a Likert 1-5 scale. A prospective opinion was given on likely benefit of contrast prior to review of the DCE sequence, and retrospectively following full mpMRI review. The final histology result following targeted and/or systematic biopsy of the prostate was used for outcome purposes. RESULTS Biparametric magnetic resonance imaging (bpMRI) and mpMRI were assigned the same score in 86% of cases; when dichotomising to a negative or positive MRI (Likert score ≥ 3), concordance increased to 92.8%. At Likert score ≥ 3 bpMRI detected 89.9% of all cancers and 93.5% clinically significant prostate cancers (csPCa) and mpMRI 90.7% and 94.6%, respectively. mpMRI had fewer false positives than bpMRI (11.4% vs 18.9%) and a lower Likert 3 rate (8.3% vs 17%), conferring higher specificity (74% vs 67%), but similar sensitivity (95% versus 94%) and ROC-AUC (90% vs 89%). At a positive MRI threshold of Likert ≥ 4, mpMRI had a higher sensitivity than bpMRI (89% versus 80%) and detected more csPCa (89.2% versus 79.6%). DCE was prospectively considered of potential benefit in 27.3%, but readers would only recall 11% of patients for DCE sequences, mainly to assess score 3 peripheral zone lesions. Following full mpMRI review, DCE was considered helpful in 28.4% of cases; in 23/75 (30.6%) of these cases this only became apparent after reviewing the sequence, reasons included increased confidence, presence of "safety-net" lesions or inflammatory lesions. CONCLUSION BpMRI has equivalent cancer detection rates to mpMRI; however, mpMRI had fewer Likert 3 call rates and increased specificity and was subjectively considered of benefit by readers in 28.4% of cases. KEY POINTS • bpMRI has similar cancer detection rates to the full mpMRI protocol at a positive MRI threshold of Likert 3. • mpMRI had fewer intermediate category 3 calls (8.3%) than bpMRI (17%) and fewer false positives than bpMRI (11.4% vs 18.9%), conferring higher specificity (74% vs 67%). • Readers considered DCE beneficial in 28.4% of cases, but in a relatively high number (30.6%) this only became apparent after reviewing the sequence.
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Affiliation(s)
- Jeries P Zawaideh
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK. .,Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa, Italy.
| | - Evis Sala
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nadeem Shaida
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Brendan Koo
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,Department of Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - Luca Carmisciano
- Department of Health Sciences (DISSAL), Biostatistics Section, University of Genoa, Genoa, Italy
| | - Kasra Saeb-Parsy
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Vincent J Gnanapragasam
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Christof Kastner
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Eldred-Evans D, Neves JB, Simmons LAM, Kanthabalan A, McCartan N, Shah TT, Arya M, Charman SC, Freeman A, Moore CM, Punwani S, Emberton M, Ahmed HU. Added value of diffusion-weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial. BJU Int 2020; 125:391-398. [PMID: 31733173 DOI: 10.1111/bju.14953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the additional diagnostic value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) in men requiring a repeat biopsy within the PICTURE study. PATIENTS AND METHODS PICTURE was a paired-cohort confirmatory study in which 249 men who required further risk stratification after a previous non-magnetic resonance imaging (MRI)-guided transrectal ultrasonography-guided biopsy underwent a 3-Tesla (3T) multiparametic (mp)MRI consisting of T2-weighted imaging (T2W), DWI and DCE, followed by transperineal template prostate mapping biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver-operating characteristic curve (AUROC) analysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set at a LIKERT score ≥3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed definition 1 (primary definition), UCL/Ahmed definition 2, any Gleason ≥3 + 4 and any Gleason ≥4 + 3. RESULTS Of 249 men, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W, with an AUROC of 0.74 (95% confidence interval [CI] 0.68-0.80), T2W+DWI at 0.76 (95% CI 0.71-0.82), and T2W+DWI+DCE, with an AUROC of 0.77 (95% CI 0.71-0.82; P = 0.55). The AUROC values remained comparable using other definitions of clinically significant disease including UCL/Ahmed definition 2 (P = 0.79), Gleason ≥3 + 4 (P = 0.53) and Gleason ≥4 + 3 (P = 0.53). CONCLUSIONS Using 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy; however, such a strategy can lead to a higher rate of equivocal lesions.
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Affiliation(s)
- David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Joana B Neves
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Lucy A M Simmons
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Abi Kanthabalan
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Neil McCartan
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
| | - Manit Arya
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
| | - Susan C Charman
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Alex Freeman
- Department of Pathology, UCLH NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, UCLH NHS Foundation Trust, London, UK
- Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
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Cho J, Ahn H, Hwang SI, Lee HJ, Choe G, Byun SS, Hong SK. Biparametric versus multiparametric magnetic resonance imaging of the prostate: detection of clinically significant cancer in a perfect match group. Prostate Int 2020; 8:146-151. [PMID: 33425791 PMCID: PMC7767942 DOI: 10.1016/j.prnil.2019.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/12/2019] [Accepted: 12/28/2019] [Indexed: 11/16/2022] Open
Abstract
Background Biparametric (bp) magnetic resonance imaging (MRI) could be an alternative MRI for the detection of the clinically significant prostate cancer (csPCa). Purpose To compare the accuracies of prostate cancer detection and localization between prebiopsy bpMRI and postbiopsy multiparametric MRI (mpMRI) taken on different days, using radical prostatectomy specimens as the reference standards. Material and methods Data of 41 total consecutive patients who underwent the following examinations and procedures between September 2015 and March 2017 were collected: (1) magnetic resonance- and/or ultrasonography-guided biopsy after bpMRI; (2) postbiopsy mpMRI; and (3) radical prostatectomy with csPCa. Two radiologists scored suspected lesions on bpMRI and mpMRI independently using Prostate Imaging Reporting and Data System version 2. The diagnostic accuracy of detecting csPCa and the Dice similarity coefficient were obtained. Apparent diffusion coefficient (ADC) ratios were also obtained for quantitative comparison between bpMRI and mpMRI. Results Diagnostic accuracies on bpMRI and mpMRI were 0.83 and 0.82 for reader 1; 0.80 and 0.82 for reader 2. There are no significantly different values of diagnostic sensitivities or specificities between the readers or between MRI protocols. Intra-observer Dice similarity coefficient was significantly lower in reader 2, compared to that in reader 1 between the two MRI protocols. The range of mean ADC ratio was 0.281-0.635. There was no statistically significant difference in the ADC ratio between bpMRI and mpMRI. Conclusions Diagnostic performance of bpMRI without dynamic contrast enhancement MRI is not significantly different from mpMRI with dynamic contrast enhancement MRI in the detection of csPCa.
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Affiliation(s)
- Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hyungwoo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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48
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A Hybrid End-to-End Approach Integrating Conditional Random Fields into CNNs for Prostate Cancer Detection on MRI. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10010338] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Prostate Cancer (PCa) is the most common oncological disease in Western men. Even though a growing effort has been carried out by the scientific community in recent years, accurate and reliable automated PCa detection methods on multiparametric Magnetic Resonance Imaging (mpMRI) are still a compelling issue. In this work, a Deep Neural Network architecture is developed for the task of classifying clinically significant PCa on non-contrast-enhanced MR images. In particular, we propose the use of Conditional Random Fields as a Recurrent Neural Network (CRF-RNN) to enhance the classification performance of XmasNet, a Convolutional Neural Network (CNN) architecture specifically tailored to the PROSTATEx17 Challenge. The devised approach builds a hybrid end-to-end trainable network, CRF-XmasNet, composed of an initial CNN component performing feature extraction and a CRF-based probabilistic graphical model component for structured prediction, without the need for two separate training procedures. Experimental results show the suitability of this method in terms of classification accuracy and training time, even though the high-variability of the observed results must be reduced before transferring the resulting architecture to a clinical environment. Interestingly, the use of CRFs as a separate postprocessing method achieves significantly lower performance with respect to the proposed hybrid end-to-end approach. The proposed hybrid end-to-end CRF-RNN approach yields excellent peak performance for all the CNN architectures taken into account, but it shows a high-variability, thus requiring future investigation on the integration of CRFs into a CNN.
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49
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Cosma I, Tennstedt-Schenk C, Winzler S, Psychogios MN, Pfeil A, Teichgraeber U, Malich A, Papageorgiou I. The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study. PLoS One 2019; 14:e0227031. [PMID: 31869380 PMCID: PMC6927639 DOI: 10.1371/journal.pone.0227031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/10/2019] [Indexed: 01/01/2023] Open
Abstract
Objective Prostate lesions detected with multiparametric magnetic resonance imaging (mpMRI) are classified for their malignant potential according to the Prostate Imaging-Reporting And Data System (PI-RADS™2). In this study, we evaluate the diagnostic accuracy of the mpMRI with and without gadolinium, with emphasis on the added diagnostic value of the dynamic contrast enhancement (DCE). Materials and methods The study was retrospective for 286 prostate lesions / 213 eligible patients, n = 116/170, and 49/59% malignant for the peripheral (Pz) and transitional zone (Tz), respectively. A stereotactic MRI-guided prostate biopsy served as the histological ground truth. All patients received a mpMRI with DCE. The influence of DCE in the prediction of malignancy was analyzed by blinded assessment of the imaging protocol without DCE and the DCE separately. Results Significant (CSPca) and insignificant (IPca) prostate cancers were evaluated separately to enhance the potential effects of the DCE in the detection of CSPca. The Receiver Operating Characteristics Area Under Curve (ROC-AUC), sensitivity (Se) and specificity (Spe) of PIRADS-without-DCE in the Pz was 0.70/0.47/0.86 for all cancers (IPca and CSPca merged) and 0.73/0.54/0.82 for CSPca. PIRADS-with-DCE for the same patients showed ROC-AUC/Se/Spe of 0.70/0.49/0.86 for all Pz cancers and 0.69/0.54/0.81 for CSPca in the Pz, respectively, p>0.05 chi-squared test. Similar results for the Tz, AUC/Se/Spe for PIRADS-without-DCE was 0.75/0.61/0.79 all cancers and 0.67/0.54/0.71 for CSPca, not influenced by DCE (0.66/0.47/0.81 for all Tz cancers and 0.61/0.39/0.75 for CSPca in Tz). The added Se and Spe of DCE for the detection of CSPca was 88/34% and 78/33% in the Pz and Tz, respectively. Conclusion DCE showed no significant added diagnostic value and lower specificity for the prediction of CSPca compared to the non-enhanced sequences. Our results support that gadolinium might be omitted without mitigating the diagnostic accuracy of the mpMRI for prostate cancer.
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Affiliation(s)
- Ilinca Cosma
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
- Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
| | | | - Sven Winzler
- Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
| | - Marios Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Alexander Pfeil
- Department of Internal Medicine, University Hospital Jena, Jena, Germany
| | - Ulf Teichgraeber
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Ansgar Malich
- Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
| | - Ismini Papageorgiou
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
- Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
- * E-mail:
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50
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Xu L, Zhang G, Shi B, Liu Y, Zou T, Yan W, Xiao Y, Xue H, Feng F, Lei J, Jin Z, Sun H. Comparison of biparametric and multiparametric MRI in the diagnosis of prostate cancer. Cancer Imaging 2019; 19:90. [PMID: 31864408 PMCID: PMC6925429 DOI: 10.1186/s40644-019-0274-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/06/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To compare the diagnostic accuracy of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) and to explore the application value of dynamic contrast-enhanced (DCE) MRI in prostate imaging. METHODS AND MATERIALS This study retrospectively enrolled 235 patients with suspected PCa in our hospital from January 2016 to December 2017, and all lesions were histopathologically confirmed. The lesions were scored according to the Prostate Imaging Reporting and Data System version 2 (PI-RADS V2). The bpMRI (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC]) and mpMRI (T2WI, DWI/ADC and DCE) scores were recorded to plot the receiver operating characteristic (ROC) curves. The area under the curve (AUC), accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for each method were calculated and compared. The patients were further stratified according to bpMRI scores (bpMRI ≥3, and bpMRI = 3, 4, 5) to analyse the difference in DCE MRI between PCa and non-PCa lesions (as well as between csPCa and non-csPCa). RESULTS The AUC values for the bpMRI and mpMRI protocols for PCa were comparable (0.790 [0.732-0.840] and 0.791 [0.733-0.841], respectively). The accuracy, sensitivity, specificity, PPV and NPV of bpMRI for PCa were 76.2, 79.5, 72.6, 75.8, and 76.6%, respectively, and the values for mpMRI were 77.4, 84.4, 69.9, 75.2, and 80.6%, respectively. The AUC values for the bpMRI and mpMRI protocols for the diagnosis of csPCa were similar (0.781 [0.722-0.832] and 0.779 [0.721-0.831], respectively). The accuracy, sensitivity, specificity, PPV and NPV of bpMRI for csPCa were 74.0, 83.8, 66.9, 64.8, and 85.0%, respectively; and 73.6, 87.9, 63.2, 63.2, and 87.8%, respectively, for mpMRI. For patients with bpMRI scores ≥3, positive DCE results were more common in PCa and csPCa lesions (both P = 0.001). Further stratification analysis showed that for patients with a bpMRI score = 4, PCa and csPCa lesions were more likely to have positive DCE results (P = 0.003 and P < 0.001, respectively). CONCLUSION The diagnostic accuracy of bpMRI is comparable with that of mpMRI in the detection of PCa and the identification of csPCa. DCE MRI is helpful in further identifying PCa and csPCa lesions in patients with bpMRI ≥3, especially bpMRI = 4, which may be conducive to achieving a more accurate PCa risk stratification. Rather than omitting DCE, we think further comprehensive studies are required for prostate MRI.
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Affiliation(s)
- Lili Xu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Gumuyang Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Bing Shi
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Yanhan Liu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Tingting Zou
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Jing Lei
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730 China
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