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Woodrum D, Kawashima A, Gorny K, Mynderse L. Prostate cancer: state of the art imaging and focal treatment. Clin Radiol 2017; 72:665-679. [DOI: 10.1016/j.crad.2017.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/26/2017] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
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52
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Jiménez Londoño G, García Vicente A, Amo-Salas M, Fúnez Mayorga F, López Guerrero M, Talavera Rubio M, Gutierrez Martin P, González García B, de la Torre Pérez J, Soriano Castrejón Á. Role of 18 F-Choline PET/CT in guiding biopsy in patients with risen PSA levels and previous negative biopsy for prostate cancer. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Giganti F, Moore CM. A critical comparison of techniques for MRI-targeted biopsy of the prostate. Transl Androl Urol 2017; 6:432-443. [PMID: 28725585 PMCID: PMC5503959 DOI: 10.21037/tau.2017.03.77] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
MRI-targeted biopsy is a promising technique that offers an improved detection of clinically significant prostate cancer over standard non-targeted biopsy. It is established that prostate MRI is of use in both the primary and repeat biopsy setting for the detection of significant prostate cancer. There are three approaches to targeting biopsies to areas of interest seen on prostate MRI. They each rely on the acquisition and reporting of a diagnostic quality multi-parametric MRI scan used to identify areas of interest, and the subsequent use of those diagnostic quality images in combination with real-time images of the prostate during the biopsy procedure. The three techniques are: visual registration of the MRI images with a real-time ultrasound image; software-assisted fusion of the MRI images and the real-time ultrasound images, and in-bore biopsy, which requires registration of a diagnostic quality MRI scan with a real time interventional MRI image. In this paper we compare the three techniques and evaluate those studies where there is a direct comparison of more than one MRI-targeting technique. PubMed was searched from inception to November 2016 using the search terms (cognitive registration OR visual registration OR fusion biopsy OR in-bore biopsy OR targeted biopsy) AND (prostate cancer OR prostate adenocarcinoma OR prostate carcinoma OR prostatic carcinoma OR prostatic adenocarcinoma) AND (MRI OR NMR OR magnetic resonance imaging OR mpMRI OR multiparametric MRI). The initial search included 731 abstracts. Eleven full text papers directly compared two or more techniques of MRI-targeting, and were selected for inclusion. The detection of clinically significant prostate cancer varied from 0% to 93.3% for visual registration, 23.2% to 100% for software-assisted registration and 29% to 80% for in-bore biopsy. Detection rates for clinically significant cancer are dependent on the prevalence of cancer within the population biopsied, which in turn is determined by the selection criteria [biopsy naïve, previous negative biopsy, prostate specific antigen (PSA) selection criteria, presence of a lesion on MRI]. Cancer detection rates varied more between study populations than between biopsy approaches. Currently there is no consensus on which type of MRI-targeted biopsy performs better in a given setting. Although there have been studies supporting each of the three techniques, substantial differences in methodology and reporting the findings make it difficult to reliably compare their outcomes.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Wysock JS, Lepor H. Multi-parametric MRI imaging of the prostate-implications for focal therapy. Transl Androl Urol 2017; 6:453-463. [PMID: 28725587 PMCID: PMC5503978 DOI: 10.21037/tau.2017.04.29] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The primary goal of a focal therapy treatment paradigm is to achieve cancer control through targeted tissue destruction while simultaneously limiting deleterious effects on peri-prostatic structures. Focal therapy approaches are employed in several oncologic treatment protocols, and have been shown to provide equivalent cancer control for malignancies such as breast cancer and renal cell carcinoma. Efforts to develop a focal therapy approach for prostate cancer have been challenged by several concepts including the multifocal nature of the disease and limited capability of prostate ultrasound and systematic biopsy to reliably localize the site(s) and aggressiveness of disease. Multi-parametric MRI (mpMRI) of the prostate has significantly improved disease localization, spatial demarcation and risk stratification of cancer detected within the prostate. The accuracy of this imaging modality has further enabled the urologist to improve biopsy approaches using targeted biopsy via MRI-ultrasound fusion. From this foundation, an improved delineation of the location of disease has become possible, providing a critical foundation to the development of a focal therapy strategy. This chapter reviews the accuracy of mpMRI for detection of “aggressive“ disease, the accuracy of mpMRI in determining the tumor volume, and the ability of mpMRI to accurately identify the index lesion. While mpMRI provides a critical, first step in developing a strategy for focal therapy, considerable questions remain regarding the relationship between MR identified tumor volume and pathologic tumor volume, the accuracy and utility of mpMRI for treatment surveillance and the optimal role and timing of follow-up mpMRI.
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Affiliation(s)
- James S Wysock
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
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Hansen NL, Koo BC, Gallagher FA, Warren AY, Doble A, Gnanapragasam V, Bratt O, Kastner C, Barrett T. Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy. Eur Radiol 2017; 27:2259-2266. [PMID: 27778089 PMCID: PMC5408042 DOI: 10.1007/s00330-016-4635-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/18/2016] [Accepted: 10/03/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy. METHODS Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher's exact test. RESULTS Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00. CONCLUSIONS Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions. KEY POINTS • Multiparametric MRIs were more often called negative in subspecialist reads (41 % vs 20 %). • Second readings of prostate mpMRIs by subspecialist uroradiologists significantly improved NPV and PPV. • Reporter experience may reduce overcalling and avoid overtargeting of lesions. • Greater education and training of radiologists in prostate MRI interpretation is advised.
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Affiliation(s)
- Nienke L Hansen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
| | - Brendan C Koo
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
| | - Ferdia A Gallagher
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
| | - Anne Y Warren
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
- Department of Pathology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK
| | - Andrew Doble
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK
| | - Vincent Gnanapragasam
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK
| | - Ola Bratt
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK
| | - Christof Kastner
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK
| | - Tristan Barrett
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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Follow-up MR imaging of PI-RADS 3 and PI-RADS 4 prostate lesions. Clin Imaging 2017; 43:64-68. [DOI: 10.1016/j.clinimag.2017.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/12/2017] [Accepted: 01/27/2017] [Indexed: 01/09/2023]
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Automated Prostate Gland Segmentation Based on an Unsupervised Fuzzy C-Means Clustering Technique Using Multispectral T1w and T2w MR Imaging. INFORMATION 2017. [DOI: 10.3390/info8020049] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Barth BK, De Visschere PJL, Cornelius A, Nicolau C, Vargas HA, Eberli D, Donati OF. Detection of Clinically Significant Prostate Cancer: Short Dual-Pulse Sequence versus Standard Multiparametric MR Imaging-A Multireader Study. Radiology 2017; 284:725-736. [PMID: 28346073 DOI: 10.1148/radiol.2017162020] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose To compare the diagnostic performance of a short dual-pulse sequence magnetic resonance (MR) imaging protocol versus a standard six-pulse sequence multiparametric MR imaging protocol for detection of clinically significant prostate cancer. Materials and Methods This HIPAA-compliant study was approved by the regional ethics committee. Between July 2013 and March 2015, 63 patients from a prospectively accrued study population who underwent MR imaging of the prostate including transverse T1-weighted; transverse, coronal, and sagittal T2-weighted; diffusion-weighted; and dynamic contrast material-enhanced MR imaging with a 3-T imager at a single institution were included in this retrospective study. The short MR imaging protocol image set consisted of transverse T2-weighted and diffusion-weighted images only. The standard MR imaging protocol image set contained images from all six pulse sequences. Three expert readers from different institutions assessed the likelihood of prostate cancer on a five-point scale. Diagnostic performance on a quadrant basis was assessed by using areas under the receiver operating characteristic curves, and differences were evaluated by using 83.8% confidence intervals. Intra- and interreader agreement was assessed by using the intraclass correlation coefficient. Transperineal template saturation biopsy served as the standard of reference. Results At histopathologic evaluation, 84 of 252 (33%) quadrants were positive for cancer in 38 of 63 (60%) men. There was no significant difference in detection of tumors larger than or equal to 0.5 mL for any of the readers of the short MR imaging protocol, with areas under the curve in the range of 0.74-0.81 (83.8% confidence interval [CI]: 0.64, 0.89), and for readers of the standard MR imaging protocol, areas under the curve were 0.71-0.77 (83.8% CI: 0.62, 0.86). Ranges for sensitivity were 0.76-0.95 (95% CI: 0.53, 0.99) and 0.76-0.86 (95% CI: 0.53, 0.97) and those for specificity were 0.84-0.90 (95% CI: 0.79, 0.94) and 0.82-0.90 (95% CI: 0.77, 0.94) for the short and standard MR protocols, respectively. Ranges for interreader agreement were 0.48-0.60 (83.8% CI: 0.41, 0.66) and 0.49-0.63 (83.8% CI: 0.42, 0.68) for the short and standard MR imaging protocols. Conclusion For the detection of clinically significant prostate cancer, no difference was found in the diagnostic performance of the short MR imaging protocol consisting of only transverse T2-weighted and diffusion-weighted imaging pulse sequences compared with that of a standard multiparametric MR imaging protocol. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Borna K Barth
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Pieter J L De Visschere
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Alexander Cornelius
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Carlos Nicolau
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Hebert Alberto Vargas
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Daniel Eberli
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Olivio F Donati
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
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Jiménez Londoño GA, García Vicente AM, Amo-Salas M, Fúnez Mayorga F, López Guerrero MA, Talavera Rubio MP, Gutierrez Martin P, González García B, de la Torre Pérez JA, Soriano Castrejón ÁM. Role of 18F-Choline PET/CT in guiding biopsy in patients with risen PSA levels and previous negative biopsy for prostate cancer. Rev Esp Med Nucl Imagen Mol 2017; 36:241-246. [PMID: 28330596 DOI: 10.1016/j.remn.2017.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To study 18F-Choline PET/CT in the diagnosis and biopsy guide of prostate cancer (pCa) in patients with persistently high prostate-specific antigen (PSA) and previous negative prostate biopsy. To compare the clinical risk factors and metabolic variables as predictors of malignancy. METHODS Patients with persistently elevated PSA in serum (total PSA >4ng/mL) and at least a previous negative or inconclusive biopsy were consecutively referred for a whole body 18F-Choline PET/CT. Patient age, PSA level, PSA doubling time (PSAdt) and PSA velocity (PSAvel) were obtained. PET images were visually (positive or negative) and semiquantitatively (SUVmax) reviewed. 18F-Choline uptake prostate patterns were defined as focal, multifocal, homogeneous or heterogeneous. Histology on biopsy using transrectal ultrasound-guided approach was the gold standard. Sensitivity (Se), specificity (Sp) and accuracy (Ac) of PET/CT for diagnosis of pCa were evaluated using per-patient and per-prostate lobe analysis. Receiver-operating-characteristic (ROC) curve analysis was used to assess the value of SUVmax to diagnose pCa. Correlation between PET/CT and biopsy results per-prostate lobe was assessed using the Chi-square test. Univariate and multivariate logistic regression analysis were applied to compare clinical risk factors and metabolic variables as predictors of malignancy. RESULTS Thirty-six out of 43 patients with histologic confirmation were included. In 11 (30.5%) patients, pCa was diagnosed (Gleason score from 4 to 9). The mean values of patient age, PSA level, PSAdt and PSAvel were: 65.5 years, 15.6ng/ml, 28.1 months and 8.5ng/mL per year, respectively. Thirty-three patients had a positive PET/CT; 18 had a focal pattern, 7 multifocal, 4 homogeneous and 4 heterogeneous. Se, Sp and Ac of PET/CT were of 100%, 12% and 38% in the patient based analysis, and 87%, 29% and 14% in the prostate lobe based analysis, respectively. The ROC curve analysis of SUVmax showed an AUC of 0.568 (p=0.52). On a lobe analysis, poor agreement was observed between PET/CT findings and biopsy results (p=0.097). In the univariate/multivariate analysis, none of clinical and metabolic variables were statistically significant as predictor of pCa. CONCLUSION Choline PET/CT is a suitable procedure for the detection of pCa in highly selected patients, however, a high rate of false positive should be expected.
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Affiliation(s)
- G A Jiménez Londoño
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain.
| | - A M García Vicente
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - M Amo-Salas
- Mathematic Department, University of Castilla La Mancha, Ciudad Real, Spain
| | - F Fúnez Mayorga
- Urology Department, Hospital Virgen de Altagracia, Manzanares, Ciudad Real, Spain
| | | | - M P Talavera Rubio
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - P Gutierrez Martin
- Urology Department, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - B González García
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - J A de la Torre Pérez
- Urology Department, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - Á M Soriano Castrejón
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
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Iyama Y, Nakaura T, Katahira K, Iyama A, Nagayama Y, Oda S, Utsunomiya D, Yamashita Y. Development and validation of a logistic regression model to distinguish transition zone cancers from benign prostatic hyperplasia on multi-parametric prostate MRI. Eur Radiol 2017; 27:3600-3608. [PMID: 28289941 DOI: 10.1007/s00330-017-4775-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 02/13/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To develop a prediction model to distinguish between transition zone (TZ) cancers and benign prostatic hyperplasia (BPH) on multi-parametric prostate magnetic resonance imaging (mp-MRI). MATERIALS AND METHODS This retrospective study enrolled 60 patients with either BPH or TZ cancer, who had undergone 3 T-MRI. We generated ten parameters for T2-weighted images (T2WI), diffusion-weighted images (DWI) and dynamic MRI. Using a t-test and multivariate logistic regression (LR) analysis to evaluate the parameters' accuracy, we developed LR models. We calculated the area under the receiver operating characteristic curve (ROC) of LR models by a leave-one-out cross-validation procedure, and the LR model's performance was compared with radiologists' performance with their opinion and with the Prostate Imaging Reporting and Data System (Pi-RADS v2) score. RESULTS Multivariate LR analysis showed that only standardized T2WI signal and mean apparent diffusion coefficient (ADC) maintained their independent values (P < 0.001). The validation analysis showed that the AUC of the final LR model was comparable to that of board-certified radiologists, and superior to that of Pi-RADS scores. CONCLUSION A standardized T2WI and mean ADC were independent factors for distinguishing between BPH and TZ cancer. The performance of the LR model was comparable to that of experienced radiologists. KEY POINTS • It is difficult to diagnose transition zone (TZ) cancer. • We performed quantitative image analysis in multi-parametric MRI. • Standardized-T2WI and mean-ADC were independent factors for diagnosing TZ cancer. • We developed logistic-regression analysis to diagnose TZ cancer accurately. • The performance of the logistic-regression analysis was higher than PIRADSv2.
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Affiliation(s)
- Yuji Iyama
- Department of Diagnostic Radiology, Kumamoto Chuo Hospital, Tainoshima 1-5-1, Kumamoto, Kumamoto, 862-0965, Japan. .,Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan.
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan
| | - Kazuhiro Katahira
- Department of Diagnostic Radiology, Kumamoto Chuo Hospital, Tainoshima 1-5-1, Kumamoto, Kumamoto, 862-0965, Japan
| | - Ayumi Iyama
- Department of Diagnostic Radiology, National Hospital Organization Kumamoto Medical Center, Ninomaru 1-5, Kumamoto, Kumamoto, 860-0008, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Kumamoto Chuo Hospital, Tainoshima 1-5-1, Kumamoto, Kumamoto, 862-0965, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto, 860-8556, Japan
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Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham AP, Oldroyd R, Parker C, Emberton M. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017; 389:815-822. [PMID: 28110982 DOI: 10.1016/s0140-6736(16)32401-1] [Citation(s) in RCA: 2055] [Impact Index Per Article: 293.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Men with high serum prostate specific antigen usually undergo transrectal ultrasound-guided prostate biopsy (TRUS-biopsy). TRUS-biopsy can cause side-effects including bleeding, pain, and infection. Multi-parametric magnetic resonance imaging (MP-MRI) used as a triage test might allow men to avoid unnecessary TRUS-biopsy and improve diagnostic accuracy. METHODS We did this multicentre, paired-cohort, confirmatory study to test diagnostic accuracy of MP-MRI and TRUS-biopsy against a reference test (template prostate mapping biopsy [TPM-biopsy]). Men with prostate-specific antigen concentrations up to 15 ng/mL, with no previous biopsy, underwent 1·5 Tesla MP-MRI followed by both TRUS-biopsy and TPM-biopsy. The conduct and reporting of each test was done blind to other test results. Clinically significant cancer was defined as Gleason score ≥4 + 3 or a maximum cancer core length 6 mm or longer. This study is registered on ClinicalTrials.gov, NCT01292291. FINDINGS Between May 17, 2012, and November 9, 2015, we enrolled 740 men, 576 of whom underwent 1·5 Tesla MP-MRI followed by both TRUS-biopsy and TPM-biopsy. On TPM-biopsy, 408 (71%) of 576 men had cancer with 230 (40%) of 576 patients clinically significant. For clinically significant cancer, MP-MRI was more sensitive (93%, 95% CI 88-96%) than TRUS-biopsy (48%, 42-55%; p<0·0001) and less specific (41%, 36-46% for MP-MRI vs 96%, 94-98% for TRUS-biopsy; p<0·0001). 44 (5·9%) of 740 patients reported serious adverse events, including 8 cases of sepsis. INTERPRETATION Using MP-MRI to triage men might allow 27% of patients avoid a primary biopsy and diagnosis of 5% fewer clinically insignificant cancers. If subsequent TRUS-biopsies were directed by MP-MRI findings, up to 18% more cases of clinically significant cancer might be detected compared with the standard pathway of TRUS-biopsy for all. MP-MRI, used as a triage test before first prostate biopsy, could reduce unnecessary biopsies by a quarter. MP-MRI can also reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer. FUNDING PROMIS is funded by the UK Government Department of Health, National Institute of Health Research-Health Technology Assessment Programme, (Project number 09/22/67). This project is also supported and partly funded by UCLH/UCL Biomedical Research Centre and The Royal Marsden and Institute for Cancer Research Biomedical Research Centre and is coordinated by the Medical Research Council Clinical Trials Unit (MRC CTU) at UCL. It is sponsored by University College London (UCL).
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Affiliation(s)
- Hashim U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
| | - Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | | | - Rhian Gabe
- Hull York Medical School and Department of Health Sciences, University of York, UK
| | | | | | | | - Katie Ward
- MRC Clinical Trials Unit at UCL, London, UK
| | | | - Alex Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, UK
| | - Alex P Kirkham
- Department of Radiology, UCLH NHS Foundation Trust, London, UK
| | | | - Chris Parker
- Department of Academic Urology, Royal Marsden Hospital, Sutton, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
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Wang R, Wang J, Gao G, Hu J, Jiang Y, Zhao Z, Zhang X, Zhang YD, Wang X. Prebiopsy mp-MRI Can Help to Improve the Predictive Performance in Prostate Cancer: A Prospective Study in 1,478 Consecutive Patients. Clin Cancer Res 2017; 23:3692-3699. [PMID: 28143868 DOI: 10.1158/1078-0432.ccr-16-2884] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/14/2017] [Accepted: 01/22/2017] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate whether prebiopsy multi-parametric (mp) MRI can help to improve predictive performance in prostate cancer.Experimental Design: Based on a support vector machine (SVM) analysis, we prospectively modeled clinical data (age, PSA, digital rectal examination, transrectal ultrasound, PSA density, and prostate volume) and mp-MRI findings [Prostate Imaging and Reporting and Data System (PI-RADS) score and tumor-node-metastasis stage] in 985 men to predict the risk of prostate cancer. The new nomogram was validated in 493 patients treated at the same institution. Multivariable Cox regression analyses assessed the association between input variables and risk of prostate cancer, and area under the receiver operating characteristic curve (Az) analyzed the predictive ability.Results: At 5-year follow-up period, 34.3% of patients had systemic progression of prostate cancer. Nomogram (SVM-MRI) predicting 5-year prostate cancer rate trained with clinical and mp-MRI data was accurate and discriminating with an externally validated Az of 0.938, positive predictive value (PPV) of 77.4%, and negative predictive value of 91.5%. The improvement was significant (P < 0.001) compared with the nomogram trained with clinical data. When stratified by PSA, SVM-MRI nomogram had high PPV (93.6%) in patients with PSA > 20 ng/mL, with intermediate to low PPV in PSA 10 to 20 ng/mL (64%), PSA 4 to 10 ng/mL (55.8%), and PSA 0 to 4 ng/mL (29%). PI-RADS score (Cox HR, 2.112; P < 0.001), PSA level (HR, 1.435; P < 0.001), and age (HR, 1.012; P = 0.043) were independent predictors of prostate cancer.Conclusions: Featured with low false positive rate, mp-MRI could be the first investigation of a man with a raised PSA before prostate biopsy. Clin Cancer Res; 23(14); 3692-9. ©2017 AACR.
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Affiliation(s)
- Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jing Wang
- Center for Medical Device Evaluation, CFDA, Beijing, China
| | - Ge Gao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Juan Hu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yuanyuan Jiang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zhenlong Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China.
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Shahedi M, Cool DW, Romagnoli C, Bauman GS, Bastian-Jordan M, Rodrigues G, Ahmad B, Lock M, Fenster A, Ward AD. Postediting prostate magnetic resonance imaging segmentation consistency and operator time using manual and computer-assisted segmentation: multiobserver study. J Med Imaging (Bellingham) 2016; 3:046002. [PMID: 27872873 DOI: 10.1117/1.jmi.3.4.046002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Prostate segmentation on T2w MRI is important for several diagnostic and therapeutic procedures for prostate cancer. Manual segmentation is time-consuming, labor-intensive, and subject to high interobserver variability. This study investigated the suitability of computer-assisted segmentation algorithms for clinical translation, based on measurements of interoperator variability and measurements of the editing time required to yield clinically acceptable segmentations. A multioperator pilot study was performed under three pre- and postediting conditions: manual, semiautomatic, and automatic segmentation. We recorded the required editing time for each segmentation and measured the editing magnitude based on five different spatial metrics. We recorded average editing times of 213, 328, and 393 s for manual, semiautomatic, and automatic segmentation respectively, while an average fully manual segmentation time of 564 s was recorded. The reduced measured postediting interoperator variability of semiautomatic and automatic segmentations compared to the manual approach indicates the potential of computer-assisted segmentation for generating a clinically acceptable segmentation faster with higher consistency. The lack of strong correlation between editing time and the values of typically used error metrics ([Formula: see text]) implies that the necessary postsegmentation editing time needs to be measured directly in order to evaluate an algorithm's suitability for clinical translation.
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Affiliation(s)
- Maysam Shahedi
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Derek W Cool
- University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Cesare Romagnoli
- University of Western Ontario , Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Glenn S Bauman
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Matthew Bastian-Jordan
- University of Western Ontario , Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - George Rodrigues
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Belal Ahmad
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Michael Lock
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Aaron Fenster
- University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Aaron D Ward
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
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Wahab SA, Verma S. Review of Prostate Imaging Reporting and Data System version 2. Future Oncol 2016; 12:2479-2494. [DOI: 10.2217/fon-2016-0285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Prostate MRI has been a hot topic in recent years in large part due to the high incidence of prostate cancer worldwide. Advances in technology have allowed multiparametric MRI to improve lesion detection and characterization in prostate imaging. Additionally, prostate MRI has shown great promise in the detection of clinically significant cancer. In 2012, the European Society of Urogenital Radiology established clinical guidelines for multiparametric MRI of the prostate to facilitate a greater level of standardization and consistency, which became known as the Prostate Imaging Reporting and Data System (PI-RADS). Subsequently, the American College of Radiology, European Society of Urogenital Radiology and the AdMeTech Foundation jointly created PI-RADS version 2. This article focuses on summarizing the key points of PI-RADS version 2.
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Affiliation(s)
- Shaun A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
- Department of Urology, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
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65
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Rhee H, Thomas P, Shepherd B, Gustafson S, Vela I, Russell P, Nelson C, Chung E, Wood G, Malone G, Wood S, Heathcote P. Prostate Specific Membrane Antigen Positron Emission Tomography May Improve the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer. J Urol 2016; 196:1261-7. [DOI: 10.1016/j.juro.2016.02.3000] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 12/12/2022]
Affiliation(s)
- H. Rhee
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
| | - P. Thomas
- Department of Nuclear Medicine, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - B. Shepherd
- Pathology Queensland, Princess Alexandra Hospital, Queensland, Australia
| | - S. Gustafson
- Department of Radiology, Princess Alexandra Hospital, Queensland, Australia
| | - I. Vela
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
| | - P.J. Russell
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
| | - C. Nelson
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
| | - E. Chung
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
| | - G. Wood
- Department of Urology, Greenslopes Private Hospital, Queensland, Australia
| | - G. Malone
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Department of Urology, Greenslopes Private Hospital, Queensland, Australia
| | - S. Wood
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Department of Urology, Greenslopes Private Hospital, Queensland, Australia
| | - P. Heathcote
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Department of Urology, Greenslopes Private Hospital, Queensland, Australia
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
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Tewes S, Mokov N, Hartung D, Schick V, Peters I, Schedl P, Pertschy S, Wacker F, Voshage G, Hueper K. Standardized Reporting of Prostate MRI: Comparison of the Prostate Imaging Reporting and Data System (PI-RADS) Version 1 and Version 2. PLoS One 2016; 11:e0162879. [PMID: 27657729 PMCID: PMC5033350 DOI: 10.1371/journal.pone.0162879] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Objective of our study was to determine the agreement between version 1 (v1) and v2 of the Prostate Imaging Reporting and Data System (PI-RADS) for evaluation of multiparametric prostate MRI (mpMRI) and to compare their diagnostic accuracy, their inter-observer agreement and practicability. Material and Methods mpMRI including T2-weighted imaging, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) of 54 consecutive patients, who subsequently underwent MRI-guided in-bore biopsy were re-analyzed according to PI-RADS v1 and v2 by two independent readers. Diagnostic accuracy for detection of prostate cancer (PCa) was assessed using ROC-curve analysis. Agreement between PI-RADS versions and observers was calculated and the time needed for scoring was determined. Results MRI-guided biopsy revealed PCa in 31 patients. Diagnostic accuracy for detection of PCa was equivalent with both PI-RADS versions for reader 1 with sensitivities and specificities of 84%/91% (AUC = 0.91 95%CI[0.8–1]) for PI-RADS v1 and 100%/74% (AUC = 0.92 95% CI[0.8–1]) for PI-RADS v2. Reader 2 achieved similar diagnostic accuracy with sensitivity and specificity of 74%/91% (AUC = 0.88 95%CI[0.8–1]) for PI-RADS v1 and 81%/91% (AUC = 0.91 95%CI[0.8–1]) for PI-RADS v2. Agreement between scores determined with different PI-RADS versions was good (reader 1: κ = 0.62, reader 2: κ = 0.64). Inter-observer agreement was moderate with PI-RADS v2 (κ = 0.56) and fair with v1 (κ = 0.39). The time required for building the PI-RADS score was significantly lower with PI-RADS v2 compared to v1 (24.7±2.3 s vs. 41.9±2.6 s, p<0.001). Conclusion Agreement between PI-RADS versions was high and both versions revealed high diagnostic accuracy for detection of PCa. Due to better inter-observer agreement for malignant lesions and less time demand, the new PI-RADS version could be more practicable for clinical routine.
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Affiliation(s)
- Susanne Tewes
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Nikolaj Mokov
- Institute for Diagnostic and Interventional Radiology, Klinikum der Region Hannover, Hannover, Gehrden, Germany
| | - Dagmar Hartung
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Volker Schick
- Clinic for Urology, Klinikum der Region Hannover, Hannover, Gehrden, Germany
| | - Inga Peters
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Peter Schedl
- Clinic for Urology, Klinikum der Region Hannover, Hannover, Gehrden, Germany
| | - Stefanie Pertschy
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Götz Voshage
- Institute for Diagnostic and Interventional Radiology, Klinikum der Region Hannover, Hannover, Gehrden, Germany
| | - Katja Hueper
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Woodrum DA, Gorny KR, Greenwood B, Mynderse LA. MRI-Guided Prostate Biopsy of Native and Recurrent Prostate Cancer. Semin Intervent Radiol 2016; 33:196-205. [PMID: 27582607 DOI: 10.1055/s-0036-1586151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second-leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive, curative treatment of the whole gland with either radical prostatectomy or radiation therapy. However, many men are reluctant to take the definitive step due to potential morbidity associated with either therapy. A growing interest in active surveillance or focal therapy has emerged as realistic alternatives for many patients. With each of these management strategies, it is critical to accurately quantify and stage the cancer with improved biopsy targeting and more precise imaging with magnetic resonance imaging (MRI). Furthermore, having dependable prostate imaging allows for targeted biopsies to improve the yield of clinically significant prostate cancer and decrease detection of indolent prostate cancer. MRI-guided targeted biopsy techniques include cognitive MRI/transrectal ultrasound fusion biopsy, in-bore transrectal targeted biopsy using a calibrated guidance device, and in-bore direct MR-guided transperineal biopsy with a software-based transperineal grid template. Herein we present a contemporary review of MRI-guided targeted biopsy techniques for new and recurrent cancerous foci of the prostate.
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Porpiglia F, Manfredi M, Mele F, Cossu M, Bollito E, Veltri A, Cirillo S, Regge D, Faletti R, Passera R, Fiori C, De Luca S. Diagnostic Pathway with Multiparametric Magnetic Resonance Imaging Versus Standard Pathway: Results from a Randomized Prospective Study in Biopsy-naïve Patients with Suspected Prostate Cancer. Eur Urol 2016; 72:282-288. [PMID: 27574821 DOI: 10.1016/j.eururo.2016.08.041] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/17/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND An approach based on multiparametric magnetic resonance imaging (mpMRI) might increase the detection rate (DR) of clinically significant prostate cancer (csPCa). OBJECTIVE To compare an mpMRI-based pathway with the standard approach for the detection of prostate cancer (PCa) and csPCa. DESIGN, SETTING, AND PARTICIPANTS Between November 2014 and April 2016, 212 biopsy-naïve patients with suspected PCa (prostate specific antigen level ≤15 ng/ml and negative digital rectal examination results) were included in this randomized clinical trial. Patients were randomized into a prebiopsy mpMRI group (arm A, n=107) or a standard biopsy (SB) group (arm B, n=105). INTERVENTION In arm A, patients with mpMRI evidence of lesions suspected for PCa underwent mpMRI/transrectal ultrasound fusion software-guided targeted biopsy (TB) (n=81). The remaining patients in arm A (n=26) with negative mpMRI results and patients in arm B underwent 12-core SB. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was comparison of the DR of PCa and csPCa between the two arms of the study; the secondary end point was comparison of the DR between TB and SB. RESULTS AND LIMITATIONS The overall DRs were higher in arm A versus arm B for PCa (50.5% vs 29.5%, respectively; p=0.002) and csPCa (43.9% vs 18.1%, respectively; p<0.001). Concerning the biopsy approach, that is, TB in arm A, SB in arm A, and SB in arm B, the overall DRs were significantly different for PCa (60.5% vs 19.2% vs 29.5%, respectively; p<0.001) and for csPCa (56.8% vs 3.8% vs 18.1%, respectively; p<0.001). The reproducibility of the study could have been affected by the single-center nature. CONCLUSIONS A diagnostic pathway based on mpMRI had a higher DR than the standard pathway in both PCa and csPCa. PATIENT SUMMARY In this randomized trial, a pathway for the diagnosis of prostate cancer based on multiparametric magnetic resonance imaging (mpMRI) was compared with the standard pathway based on random biopsy. The mpMRI-based pathway had better performance than the standard pathway.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
| | - Matteo Manfredi
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Fabrizio Mele
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Marco Cossu
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Enrico Bollito
- Division of Pathology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Andrea Veltri
- Division of Radiology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | | | - Daniele Regge
- Department of Radiology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Turin, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, University of Turin, San Giovanni Battista Hospital, Turin, Italy
| | - Cristian Fiori
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Stefano De Luca
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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Differentiating Transition Zone Cancers From Benign Prostatic Hyperplasia by Quantitative Multiparametric Magnetic Resonance Imaging. J Comput Assist Tomogr 2016; 40:218-24. [PMID: 26760185 DOI: 10.1097/rct.0000000000000353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the value of quantitative diffusion and perfusion parameters to aid in discriminating between transition zone carcinomas and benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Twenty-four transition zone cancers and BPH nodules were contoured on T2-weighted magnetic resonance imaging (MRI), apparent diffusion coefficient (ADC) maps, and raw dynamic contrast-enhanced (DCE) MRI. Benign prostatic hyperplasia nodules were then stratified into 2 groups based on the presence or absence of a capsule. Apparent diffusion coefficient values, per-voxel Ktrans, kep, vp, and ve were all compared across all groups. RESULTS Average ADCs (×10 mm/s) were 1019.22, 1338.11, and 1272.46 for cancer, encapsulated BPH, and nonencapsulated BPH, respectively. Both subgroups of BPH were found to be significantly different than that of cancer (P < 0.05). No individual DCE-MRI parameter was significantly different between cancer and either BPH group. The area under the curve for ADC alone was 0.83, and no individual DCE imaging parameter improved the area under the curve of ADC. CONCLUSIONS Apparent diffusion coefficient may play a role in distinguishing TZ cancers from non-encapsulated BPH nodules that closely resemble cancer.
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Renard-Penna R, Rouvière O, Puech P, Borgogno C, Abbas L, Roy C, Claudon M, Correas JM, Cormier L, Ploussard G, Mejean A, Tezenas-du-Montcel S, Rozet F. Current practice and access to prostate MR imaging in France. Diagn Interv Imaging 2016; 97:1125-1129. [PMID: 27451262 DOI: 10.1016/j.diii.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/18/2016] [Accepted: 06/23/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE To obtain an overview of the degree of discrepancy between current clinical practice of prostate magnetic resonance imaging (MRI) in France and recommendations. MATERIALS AND METHODS A brief survey was sent to 1229 members of the French society of urology in order to identify their indications of prostate MRI and its impact on patient management. The urologists were asked to answer several questions regarding age, practice modality, prostate MRI examinations (technique, indication before first biopsy, second biopsy, cancer staging, active surveillance, recurrence, focal therapy) and quality of reports. RESULTS A total of 445 responses were received (participation rate of 36%). The mean delay for obtaining an appointment for prostate MRI ranged between 15-30 days in 54%. Fifty-four percent of MRI reports contained a PIRADS score and 23% a Likert score. The indications of multiparametric-MRI were tumor detection/location prior to repeat biopsy (90%), cancer staging (85%), management of patients under active surveillance (85%), selection of candidates to focal therapy (63%), tumor detection/location in biopsy naïve patients (53%), detection of local recurrence after radical (51%). Only 119 urologists (28.6%) had access to image fusion (MRI and transrectal ultrasound) and 351 (85.4%) used cognitive fusion. Mostly, targeted biopsies are done by urologists alone (nearly 80%), a very few are done by radiologists (8%) or by the two of them in collaboration (12%). CONCLUSION The majority of urologists consider that prostate MRI is essential for the management of patients with prostate cancer. Practices are ahead of recommendations particularly before the first biopsy and in active surveillance.
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Affiliation(s)
- R Renard-Penna
- Department of radiology, hôpital Tenon, Pitié-Salpétrière hospital, AP-HP, GRC n(o) 5, ONCOTYPE-URO, institut universitaire de cancérologie, UPMC université Paris 06, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - O Rouvière
- Hospices civils de Lyon, department of urinary and vascular radiology, hôpital Édouard-Herriot, 69437 Lyon, France; Faculté de médecine Lyon Est, université de Lyon, université Lyon 1, 69003 Lyon, France
| | - P Puech
- Department of radiology, Inserm, university de Lille, U1189 - ONCO-THAI - Image assisted laser therapy for oncology, CHU de Lille, 59000 Lille, France
| | - C Borgogno
- Department of urology, René-Dubos hospital, 95300 Pontoise, France
| | - L Abbas
- AP-HP, Pitié-Salpétrière hospital, department of biostatistics, public health and medical information, 75013 Paris, France; Sorbonne université, UPMC université-Paris 06 UMR_S1136, Inserm UMR_S 1136, institut Pierre-Louis d'épidémiologie et de Santé publique, 75013 Paris, France
| | - C Roy
- Department of radiology B, universitary hospital of Strasbourg, Civil hospital, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - M Claudon
- Department of radiology adults, Brabois hospital, university of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - J-M Correas
- Department of radiology, hospital Necker, 75015 Paris, France
| | - L Cormier
- Bourgogne university, academic department of urology, 21000 Dijon, France
| | - G Ploussard
- Department of urology, Saint-Louis hospital, Assistance publique-Hôpitaux de Paris, université Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - A Mejean
- AP-HP, HEGP academic department of urology, 75007 Paris, France
| | - S Tezenas-du-Montcel
- AP-HP, Pitié-Salpétrière hospital, department of biostatistics, public health and medical information, 75013 Paris, France; Sorbonne université, UPMC université-Paris 06 UMR_S1136, Inserm UMR_S 1136, institut Pierre-Louis d'épidémiologie et de Santé publique, 75013 Paris, France
| | - F Rozet
- Montsouris institute, urology department, 75014 Paris, France
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71
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Straub S, Laun FB, Emmerich J, Jobke B, Hauswald H, Katayama S, Herfarth K, Schlemmer HP, Ladd ME, Ziener CH, Bonekamp D, Röthke MC. Potential of quantitative susceptibility mapping for detection of prostatic calcifications. J Magn Reson Imaging 2016; 45:889-898. [PMID: 27418017 DOI: 10.1002/jmri.25385] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 06/26/2016] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate whether quantitative susceptibility (QSM) may be used as an alternative to computed tomography (CT) to detect calcification in prostate cancer patients. MATERIALS AND METHODS Susceptibility map calculation was performed using 3D gradient echo magnetic resonance imaging (MRI) data from 26 patients measured at 3T who previously received a planning CT of the prostate. Phase images were unwrapped using Laplacian-based phase unwrapping, the background field was removed with the V-SHARP method, and susceptibility maps were calculated with the iLSQR method. Two blinded readers were asked to identify peri- and intraprostatic calcifications. RESULTS Average mean and minimum susceptibility values (referenced to iliopsoas muscle) of calcifications were -0.249 ± 0.179 ppm and -0.551 ± 0.323 ppm, and average mean and maximum intensities in CT images were 319 ± 164 HU and 679 ± 392 HU. Twenty-one and 17 out of 22 prostatic calcifications were identified using susceptibility maps and magnitude images, respectively, as well as more than half of periprostatic phleboliths depicted by CT. Calcifications in the prostate and its periphery were quantitatively differentiable from noncalcified prostate tissue in CT (mean values for calcifications / for noncalcified tissue: 71 to 649 / -1 to 83 HU) and in QSM (mean values for calcifications / for noncalcified tissue: -0.641 to 0.063 / -0.046 to 0.181 ppm). Moreover, there was a significant correlation between susceptibility values and CT image intensities for calcifications (P < 0.004). CONCLUSION Prostatic calcifications could be well identified with QSM. Susceptibility maps can be easily obtained from clinical prostate MR protocols that include a 3D gradient echo sequence, rendering it a promising technique for detection and quantification of intraprostatic calcifications. LEVEL OF EVIDENCE 1 J. Magn. Reson. Imaging 2017;45:889-898.
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Affiliation(s)
- Sina Straub
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiology, Heidelberg, Germany
| | - Frederik B Laun
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiology, Heidelberg, Germany
| | - Julian Emmerich
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiology, Heidelberg, Germany
| | - Björn Jobke
- German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany
| | - Henrik Hauswald
- German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Heidelberg, Germany.,Heidelberg University Hospital, Department of Radiation Oncology, Heidelberg, Germany
| | - Sonja Katayama
- Heidelberg University Hospital, Department of Radiation Oncology, Heidelberg, Germany
| | - Klaus Herfarth
- Heidelberg University Hospital, Department of Radiation Oncology, Heidelberg, Germany
| | | | - Mark E Ladd
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiology, Heidelberg, Germany
| | - Christian H Ziener
- German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany
| | - David Bonekamp
- German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany
| | - Matthias C Röthke
- German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany
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72
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Sahu M, Wijesekera N, Donohue JF. Anterior prostate cancer: Current perspectives and diagnostic dilemmas. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816655724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Anterior zone (transition zone and anterior horn of peripheral zone) tumours represent 20–30% of all prostate cancers. Traditional transrectal prostate biopsies fail to sample this area of the prostate gland adequately, thereby underestimating the true extent of anterior zone cancers. This article outlines the behaviour and significance of this entity and discusses investigations that are currently available which may aid in their detection. The implementation of transperineal template-guided prostate biopsies will allow optimal sampling of the anterior zone whilst advances in the field of magnetic resonance imaging allow the use of multiple sequences (T2-weighted, spectroscopy, diffusion weighted and dynamic contrast enhancement) to identify these tumours accurately. Such investigations will result in more accurate risk stratification compared with the current diagnostic pathway, and could lead to improved management in this subset of men.
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Affiliation(s)
- Mahua Sahu
- Department of Urology, Maidstone and Tunbridge Wells Hospital, UK
| | - Nevin Wijesekera
- Department of Radiology, Kingston Hospital NHS Foundation Trust, UK
| | - John F Donohue
- Department of Urology, Maidstone and Tunbridge Wells Hospital, UK
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73
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Combined T2 and diffusion-weighted MR imaging with template prostate biopsies in men suspected with prostate cancer but negative transrectal ultrasound-guided biopsies. World J Urol 2016; 35:213-220. [PMID: 27236302 PMCID: PMC5272897 DOI: 10.1007/s00345-016-1855-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/14/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose Transperineal template prostate (TPB) biopsy has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. Diagnostic performance of this approach especially MR imaging and using reliable reference standard remains scantly reported. Materials and methods A total of 200 patients, who were previously TRUS biopsy negative, were recruited in this study. All the participants had at least 28-core TPB under general anesthetic within 8 weeks of previous negative TRUS biopsies. In 15 men undergoing laparoscopic radical prostatectomy, prostate specimens were sectioned using custom-made molds and analyzed by experienced pathologist as a feasibility study. Results In total, 120 of 200 patients (60 %) had positive TPB biopsy results. All of these men had at least one negative biopsy from transrectal route. T2 diffusion-weighted MR imaging showed no lesion in almost one-third of these men (61/200; 30.5 %). Out of these, 33 (33/61; 54 %) showed malignancy on TPB including high-grade tumors (>Gleason 7). Out of 15 patients underwent surgery with a total of 52 lesions (mean 3.5) on radical prostatectomy histology analyses, TPB detected 36 (70 %) lesions only. Some of these lesions were Gleason 7 and more mostly located in the posterior basal area of prostate. Conclusions Transperineal template biopsy technique is associated with significantly high prostate cancer detection rate in men with previous negative TRUS biopsies, however compared to radical prostatectomy histology map, a significant number of lesions can still be missed in the posterior and basal area of prostate.
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74
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Durand M, Jain M, Robinson B, Aronowitz E, El Douahy Y, Leung R, Scherr DS, Ng A, Donzeau D, Amiel J, Spincemaille P, Villers A, Ballon DJ. Magnetic resonance microscopy may enable distinction between normal histomorphological features and prostate cancer in the resected prostate gland. BJU Int 2016; 119:414-423. [PMID: 27154761 DOI: 10.1111/bju.13523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine imaging protocol parameters for characterization of prostate tissue at histological length scales. MATERIAL AND METHODS Rapid acquisition with relaxation enhancement, spin echo and gradient echo fast low angle shot data were acquired using ex vivo 3-Tesla or 7-Tesla magnetic field strengths from fresh prostatectomy specimens (n = 15) obtained from either organ donor or patients with prostate cancer (PCa). To achieve the closest correspondence between histopathological components and magnetic resonance imaging (MRI) results, in terms of resolution and sectioning planes, multiple high-resolution imaging protocols (ranging from a few minutes to overnight) were tested. Ductograms were generated as part of image post-processing. Specimens were subsequently submitted for histopathological evaluation. RESULTS A total of seven imaging protocols were tested. Ex vivo 7-Tesla MRI identified normal components of prostate glands, including ducts, blood vessels, concretions and stroma at a spatial resolution of 60 × 60 × 60 μm3 to 107 × 107 × 500 μm3 . Malignant glands and nests of tumour cells identified at 60 × 60 × 90 μm3 were highly similar to low-magnification (×2) histopathology. Ductograms enhanced the differentiation between benign and malignant glands. The results of the present study were encouraging, and further work is warranted with a larger sample size. CONCLUSION We showed that critical histopathological features of the prostate gland can be identified with high-resolution ex vivo MRI examination and this offers promise that MRI microscopy of PCa will ultimately be possible in vivo.
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Affiliation(s)
- Matthieu Durand
- Department of Urology, Institute of Prostate Cancer and Lefrak Center for Robotic Surgery, Weill Medical College of Cornell University, New York, NY, USA.,Department of Urology, Hôpital Pasteur 2, CHU Nice, University of Nice-Sophia-Antipolis, Nice, France.,INSERM, U1189, ONCO-THAI, Lille, France
| | - Manu Jain
- Department of Pathology and, Weill Medical College of Cornell University, New York, NY, USA
| | - Brian Robinson
- Department of Pathology and, Weill Medical College of Cornell University, New York, NY, USA
| | - Eric Aronowitz
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Youssef El Douahy
- Department of Urology, Institute of Prostate Cancer and Lefrak Center for Robotic Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Robert Leung
- Department of Urology, Institute of Prostate Cancer and Lefrak Center for Robotic Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Douglas S Scherr
- Department of Urology, Institute of Prostate Cancer and Lefrak Center for Robotic Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Amelia Ng
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Dominique Donzeau
- Department of Urology, Hôpital Pasteur 2, CHU Nice, University of Nice-Sophia-Antipolis, Nice, France
| | - Jean Amiel
- Department of Urology, Hôpital Pasteur 2, CHU Nice, University of Nice-Sophia-Antipolis, Nice, France
| | - Pascal Spincemaille
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Arnauld Villers
- INSERM, U1189, ONCO-THAI, Lille, France.,Department of Urology, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France
| | - Douglas J Ballon
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA
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Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second-leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive treatment of the whole gland including radical prostatectomy, radiation therapy, and cryosurgery. Active surveillance is a growing alternative option for patients with documented low-volume, low-grade prostate cancer. With recent advances in software and hardware of MRI, multiparametric MRI of the prostate has been shown to improve the accuracy in detecting and characterizing clinically significant prostate cancer. Targeted biopsy is increasingly utilized to improve the yield of MR-detected, clinically significant prostate cancer and to decrease in detection of indolent prostate cancer. MR-guided targeted biopsy techniques include cognitive MR fusion TRUS biopsy, in-bore transrectal targeted biopsy using robotic transrectal device, and in-bore direct MR-guided transperineal biopsy with a software-based transperineal grid template. In addition, advances in MR compatible thermal ablation technology allow accurate focal or regional delivery of optimal thermal energy to the biopsy-proved, MRI-detected tumor, utilizing cryoablation, laser ablation, high-intensity focused ultrasound ablation under MR guidance and real-time or near simultaneous monitoring of the ablation zone. Herein we present a contemporary review of MR-guided targeted biopsy techniques of MR-detected lesions as well as MR-guided focal or regional thermal ablative therapies for localized naïve and recurrent cancerous foci of the prostate.
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Wu LM, Zhao ZZ, Chen XX, Lu Q, Suo ST, Liu Q, Hu J, Haccke EM, Xu JR. Comparison of T2(*) mapping with diffusion-weighted imaging in the characterization of low-grade vs intermediate-grade and high-grade prostate cancer. Br J Radiol 2016; 89:20151076. [PMID: 27089897 DOI: 10.1259/bjr.20151076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic value of T2(*) mapping compared with apparent diffusion coefficient (ADC) mapping in the characterization of low-grade (Gleason score, ≤6) vs intermediate-grade and high-grade (Gleason score ≥7) prostate cancer (PCa). METHODS 62 patients who underwent MRI before prostatectomy were evaluated. Two readers independently scored the probabilities of tumours in 12 regions of the prostate on T2(*) and ADC images. The data were divided into two groups, i.e. low- vs intermediate- and high-grade PCa, and correlated with the histopathological results. The diagnostic performance parameters, areas under the receiver-operating characteristic curves and interreader agreements were calculated. RESULTS For Reader 2, ADC mapping exhibited a greater accuracy for intermediate-grade PCas than for high-grade PCas (0.77 vs 0.83, p < 0.05). For both readers, T2(*) mapping exhibited a greater accuracy for intermediate-grade PCas than for high-grade PCas (Reader 1, 0.86 vs 0.81; Reader 2, 0.83 vs 0.78; p < 0.05). The areas under the curve of T2(*) mappings were greater than those of the ADC mappings for the intermediate- and high-grade PCas (Reader 1, 0.83 vs 0.78; Reader 2, 0.80 vs 0.75; p < 0.05) but not for the low-grade PCas (Reader 1, 0.86 vs 0.84; Reader 2, 0.83 vs 0.82; p > 0.05). The weighted κ value of T2(*) mapping was 0.59. CONCLUSION T2(*) mapping improves the accuracy of the characterization of intermediate- and high-grade PCas but not low-grade PCas compared with ADC mapping. ADVANCES IN KNOWLEDGE T2(*) mapping exhibited greater diagnostic accuracy than ADC mapping in the characterization of intermediate- and high-grade PCas. T2(*) mapping exhibited limited value in the characterization of low-grade PCa.
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Affiliation(s)
- Lian-Ming Wu
- 1 Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zi-Zhou Zhao
- 1 Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Xi Chen
- 1 Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Lu
- 1 Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shi-Teng Suo
- 1 Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Liu
- 2 Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiani Hu
- 3 Department of Radiology, Wayne State University, Detroit, MI, USA
| | - E Mark Haccke
- 3 Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Jian-Rong Xu
- 1 Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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77
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Barrett T, Patterson AJ, Koo BC, Wadhwa K, Warren AY, Doble A, Gnanapragasam VJ, Kastner C, Gallagher FA. Targeted transperineal biopsy of the prostate has limited additional benefit over background cores for larger MRI-identified tumors. World J Urol 2016; 34:501-8. [PMID: 26238348 PMCID: PMC4799791 DOI: 10.1007/s00345-015-1650-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare histological outcomes in patients undergoing MRI-transrectal ultrasound fusion transperineal (MTTP) prostate biopsy and determine the incremental benefit of targeted cores. METHODS Seventy-six consecutive patients with 89 MRI-identified targets underwent MTTP biopsy. Separate targeted biopsies and background cores were obtained according to a standardized protocol. Target biopsies were considered of added diagnostic value if these cores showed a higher Gleason grade than non-targeted cores taken from the same sector (Group 1, n = 41). Conversely, where background cores demonstrated an equal or higher Gleason grade, target cores were considered to be non-beneficial (Group 2, n = 48). RESULTS There was no significant difference in age, PSA, prostate volume, time-to-biopsy, and number of cores obtained between the groups. A greater proportion of target cores were positive for cancer (158/228; 69.3 %) compared to background (344/1881; 18.38 %). The median target volume was 0.54 cm(3) for Group 1 (range 0.09-2.79 cm(3)) and 1.65 cm(3) for Group 2 (0.3-9.07 cm(3)), p < 0.001. The targets in Group 1 had statistically lower diameters for short and long axes, even after correction for gland size. The highest area under the receiver operating characteristic curve was demonstrated when a lesion cutoff value of 1.0 cm in short axis was applied, resulting in a sensitivity of 83.3 % and a specificity of 82.9 %. CONCLUSIONS When a combined systematic and targeted transperineal prostate biopsy is performed, there is limited benefit in acquiring additional cores from larger-volume targets with a short axis diameter >1.0 cm.
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Affiliation(s)
- Tristan Barrett
- />Department of Radiology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
- />University of Cambridge, Cambridge, CB2 0QQ UK
| | | | - Brendan C. Koo
- />Department of Radiology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Karan Wadhwa
- />Department of Urology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Anne Y. Warren
- />Department of Histopathology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Andrew Doble
- />Department of Urology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Vincent J. Gnanapragasam
- />University of Cambridge, Cambridge, CB2 0QQ UK
- />Department of Urology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
- />Translational Prostate Cancer Group, Department of Oncology, Hutchinson-MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Christof Kastner
- />Department of Urology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Ferdia A. Gallagher
- />Department of Radiology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
- />University of Cambridge, Cambridge, CB2 0QQ UK
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Comparison of prostate cancer detection at 3-T MRI with and without an endorectal coil: A prospective, paired-patient study. Urol Oncol 2016; 34:255.e7-255.e13. [PMID: 26971190 DOI: 10.1016/j.urolonc.2016.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/02/2016] [Accepted: 02/06/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare the sensitivity of 2 different non-endorectal coil strategies vs. endorectal coil (ERC) magnetic resonance imaging (MRI) for detection of prostate cancer (PCa). METHODS In this prospective, single-center, paired-patient, paired-reader study, 49 men with a clinical indication for MRI underwent non-ERC (phased-array coil only) T2-weighted imaging and diffusion-weighted imaging followed by the same sequences using both ERC and phased-array coils (ERC Protocol). Patients were randomized into 1 of 2 arms: standard non-ERC protocol and augmented non-ERC protocol. Lesions with Likert score≥3 were defined as suspicious for cancer. Radical prostatectomy specimen or combined systematic plus targeted biopsies served as the standard of reference. Cancers were stratified into risk groups according to the National Comprehensive Cancer Network guidelines. Generalized estimating equations with Bonferroni correction were used for comparisons. The level of reader confidence was inferred by the Likert scores assigned to index lesions. RESULTS The ERC protocol provided sensitivity (78%) superior to MRI without ERC for PCa detection, both with a standard (43%) (P<0.0001) or augmented (60%) (P<0.01) protocol. The ERC MRI missed less-intermediate or high-risk index lesions (4%) than standard non-ERC (42%) (P = 0.02) and augmented non-ERC MRI (25%), although the latter did not reach significance (P = 0.09). The ERC improved radiologist confidence for the detection of PCa (average Likert score = 4.2±1.4) compared to standard (2.3±2.3) and augmented (2.9±2.1) non-ERC (P = 0.001). CONCLUSIONS The use of combined ERC and pelvic phased-array coil for T2-weighted imaging and diffusion-weighted imaging provides superior sensitivity for the detection of PCa compared to an examination performed without the ERC.
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79
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Wysock JS, Mendhiratta N, Zattoni F, Meng X, Bjurlin M, Huang WC, Lepor H, Rosenkrantz AB, Taneja SS. Predictive value of negative 3T multiparametric magnetic resonance imaging of the prostate on 12-core biopsy results. BJU Int 2016; 118:515-20. [PMID: 26800439 DOI: 10.1111/bju.13427] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- James S. Wysock
- Department of Urology; NYU Langone Medical Center; New York NY USA
| | - Neil Mendhiratta
- Department of Urology; NYU Langone Medical Center; New York NY USA
| | - Fabio Zattoni
- Department of Urology; NYU Langone Medical Center; New York NY USA
| | - Xiaosong Meng
- Department of Urology; NYU Langone Medical Center; New York NY USA
| | - Marc Bjurlin
- Department of Urology; NYU Langone Medical Center; New York NY USA
| | - William C. Huang
- Department of Urology; NYU Langone Medical Center; New York NY USA
| | - Herbert Lepor
- Department of Urology; NYU Langone Medical Center; New York NY USA
| | | | - Samir S. Taneja
- Department of Urology; NYU Langone Medical Center; New York NY USA
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80
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The University College London/Medical Research Council/National Institute of Health Research-Health Technology Assessment PROMIS Trial: An Update. Eur Urol Focus 2016; 1:212-214. [PMID: 26839919 PMCID: PMC4694096 DOI: 10.1016/j.euf.2015.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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81
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De Visschere PJL, Briganti A, Fütterer JJ, Ghadjar P, Isbarn H, Massard C, Ost P, Sooriakumaran P, Surcel CI, Valerio M, van den Bergh RCN, Ploussard G, Giannarini G, Villeirs GM. Role of multiparametric magnetic resonance imaging in early detection of prostate cancer. Insights Imaging 2016; 7:205-14. [PMID: 26847758 PMCID: PMC4805618 DOI: 10.1007/s13244-016-0466-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/07/2016] [Accepted: 01/20/2016] [Indexed: 11/30/2022] Open
Abstract
Abstract Most prostate cancers (PC) are currently found on the basis of an elevated PSA, although this biomarker has only moderate accuracy. Histological confirmation is traditionally obtained by random transrectal ultrasound guided biopsy, but this approach may underestimate PC. It is generally accepted that a clinically significant PC requires treatment, but in case of an non-significant PC, deferment of treatment and inclusion in an active surveillance program is a valid option. The implementation of multiparametric magnetic resonance imaging (mpMRI) into a screening program may reduce the risk of overdetection of non-significant PC and improve the early detection of clinically significant PC. A mpMRI consists of T2-weighted images supplemented with diffusion-weighted imaging, dynamic contrast enhanced imaging, and/or magnetic resonance spectroscopic imaging and is preferably performed and reported according to the uniform quality standards of the Prostate Imaging Reporting and Data System (PIRADS). International guidelines currently recommend mpMRI in patients with persistently rising PSA and previous negative biopsies, but mpMRI may also be used before first biopsy to improve the biopsy yield by targeting suspicious lesions or to assist in the selection of low-risk patients in whom consideration could be given for surveillance. Teaching Points • MpMRI may be used to detect or exclude significant prostate cancer. • MpMRI can guide targeted rebiopsy in patients with previous negative biopsies. • In patients with negative mpMRI consideration could be given for surveillance. • MpMRI may add valuable information for the optimal treatment selection.
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Affiliation(s)
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University San Raffaele, Milan, Italy
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hendrik Isbarn
- Department of Urology, Regio Clinic Wedel, Wedel, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christophe Massard
- Department of Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Prasanna Sooriakumaran
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Cristian I Surcel
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Guillaume Ploussard
- Urology Department, Saint Jean Languedoc Hospital, Toulouse, France.,Research Unit INSERM U955, Paris Est University, Team 7, Paris, France
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre Hospital «Santa Maria della Misericordia», Udine, Italy
| | - Geert M Villeirs
- Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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Wang Y, Cheng JZ, Ni D, Lin M, Qin J, Luo X, Xu M, Xie X, Heng PA. Towards Personalized Statistical Deformable Model and Hybrid Point Matching for Robust MR-TRUS Registration. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:589-604. [PMID: 26441446 DOI: 10.1109/tmi.2015.2485299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Registration and fusion of magnetic resonance (MR) and 3D transrectal ultrasound (TRUS) images of the prostate gland can provide high-quality guidance for prostate interventions. However, accurate MR-TRUS registration remains a challenging task, due to the great intensity variation between two modalities, the lack of intrinsic fiducials within the prostate, the large gland deformation caused by the TRUS probe insertion, and distinctive biomechanical properties in patients and prostate zones. To address these challenges, a personalized model-to-surface registration approach is proposed in this study. The main contributions of this paper can be threefold. First, a new personalized statistical deformable model (PSDM) is proposed with the finite element analysis and the patient-specific tissue parameters measured from the ultrasound elastography. Second, a hybrid point matching method is developed by introducing the modality independent neighborhood descriptor (MIND) to weight the Euclidean distance between points to establish reliable surface point correspondence. Third, the hybrid point matching is further guided by the PSDM for more physically plausible deformation estimation. Eighteen sets of patient data are included to test the efficacy of the proposed method. The experimental results demonstrate that our approach provides more accurate and robust MR-TRUS registration than state-of-the-art methods do. The averaged target registration error is 1.44 mm, which meets the clinical requirement of 1.9 mm for the accurate tumor volume detection. It can be concluded that the presented method can effectively fuse the heterogeneous image information in the elastography, MR, and TRUS to attain satisfactory image alignment performance.
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83
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Dregely I, Margolis DAJ, Sung K, Zhou Z, Rangwala N, Raman SS, Wu HH. Rapid quantitative T2mapping of the prostate using three-dimensional dual echo steady state MRI at 3T. Magn Reson Med 2016; 76:1720-1729. [DOI: 10.1002/mrm.26053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Isabel Dregely
- Department of Radiological Sciences; University of California; Los Angeles California USA
| | - Daniel A. J. Margolis
- Department of Radiological Sciences; University of California; Los Angeles California USA
| | - Kyunghyun Sung
- Department of Radiological Sciences; University of California; Los Angeles California USA
| | - Ziwu Zhou
- Department of Radiological Sciences; University of California; Los Angeles California USA
| | - Novena Rangwala
- Department of Radiological Sciences; University of California; Los Angeles California USA
| | - Steven S. Raman
- Department of Radiological Sciences; University of California; Los Angeles California USA
| | - Holden H. Wu
- Department of Radiological Sciences; University of California; Los Angeles California USA
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84
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Zidan S, Tantawy HI. Prostate carcinoma: Accuracy of diagnosis and differentiation with Dynamic Contrast-Enhanced MRI and Diffusion Weighted Imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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85
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Serrao EM, Barrett T, Wadhwa K, Parashar D, Frey J, Koo BC, Warren AY, Doble A, Kastner C, Gallagher FA. Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy. Can Urol Assoc J 2015; 9:E853-8. [PMID: 26788234 PMCID: PMC4707904 DOI: 10.5489/cuaj.2895] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We characterized false negative prostate magnetic resonance imaging (MRI) reporting by using histology derived from MRI-transrectal ultrasound (TRUS)-guided transperineal (MTTP) fusion biopsies. METHODS In total, 148 consecutive patients were retrospectively reviewed. Men underwent multiparametric MRI (mpMRI), reported by a consultant/attending radiologist in line with European Society of Urogenital Radiology (ESUR) standards. MTTP biopsy of the lesions was performed according to the Ginsburg recommendations. Cases with an MRI-histology mismatch were identified and underwent a second read by an experienced radiologist. A third review was performed with direct histology comparison to determine a true miss from an MRI-occult cancer. Statistical analysis was performed with McNemar's test. RESULTS False negative lesions were identified in 29 MRI examinations (19.6%), with a total of 46 lesions. Most false negative lesions (21/46) were located in the anterior sectors of the prostate. The second read led to a significant decrease of false-negative lesions with 7/29 further studies identified as positive on a patient-by-patient basis (24.1% of studies, p = 0.016) and 11/46 lesions (23.9%; p = 0.001). Of these, 30 lesions following the first read and 23 lesions after the second read were considered significant cancer according to the University College London criteria. However, on direct comparison with histology, most lesions were MRI occult. CONCLUSION We demonstrate that MRI can fail to detect clinically relevant lesions. Improved results were achieved with a second read but despite this, a number of lesions remain MRI-occult. Further advances in imaging are required to reduce false negative results.
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Affiliation(s)
- Eva M. Serrao
- Department of Radiology, Champalimaud Foundation, Lisbon, Portugal, and Department of Biochemistry, University of Cambridge and Cancer Research, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
| | - Karan Wadhwa
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
| | - Deepak Parashar
- Cancer Research Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Julia Frey
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
| | - Brendan C. Koo
- Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Andrew Doble
- Department of Urology, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Ferdia A. Gallagher
- Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
- University of Cambridge, Cambridge, UK
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86
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Barrett T, Turkbey B, Choyke PL. PI-RADS version 2: what you need to know. Clin Radiol 2015; 70:1165-76. [PMID: 26231470 PMCID: PMC6369533 DOI: 10.1016/j.crad.2015.06.093] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/17/2015] [Accepted: 06/25/2015] [Indexed: 12/01/2022]
Abstract
Prostate cancer is the second most prevalent cancer in men worldwide and its incidence is expected to double by 2030. Multi-parametric magnetic resonance imaging (MRI) incorporating anatomical and functional imaging has now been validated as a means of detecting and characterising prostate tumours and can aid in risk stratification and treatment selection. The European Society of Urogenital Radiology (ESUR) in 2012 established the Prostate Imaging-Reporting and Data System (PI-RADS) guidelines aimed at standardising the acquisition, interpretation and reporting of prostate MRI. Subsequent experience and technical developments have highlighted some limitations, and a joint steering committee formed by the American College of Radiology, ESUR, and the AdMeTech Foundation have recently announced an updated version of the proposals. We summarise the main proposals of PI-RADS version 2, explore the evidence behind the recommendations, and highlight key differences for the benefit of those already familiar with the original.
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Affiliation(s)
- T Barrett
- Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Cambridge, CB2 0QQ, UK.
| | - B Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - P L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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87
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Relationship between non-suspicious MRI and insignificant prostate cancer: results from a monocentric study. World J Urol 2015; 34:673-8. [DOI: 10.1007/s00345-015-1685-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022] Open
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88
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Utilidad de la biopsia guiada cognitivamente por resonancia magnética multiparamétrica para diagnosticar la lesión dominante del cáncer de próstata. RADIOLOGIA 2015; 57:428-33. [DOI: 10.1016/j.rx.2014.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/14/2014] [Accepted: 06/01/2014] [Indexed: 11/22/2022]
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89
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Garcia Bennett J, Conejero Olesti A, Hurtado Salom C, Rebenaque E, Parada D, Serrano Alcalá E, Abreu De Con J. Usefulness of cognitive targeting in multiparametric MRI-guided biopsy to diagnose the dominant lesion in prostate cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rxeng.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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90
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Anastasiadis E, Charman SC, Arumainayagam N, Sohaib AS, Allen C, Freeman A, Emberton M, Ahmed HU. What Burden of Prostate Cancer Can Radiologists Rule Out on Multiparametric Magnetic Resonance Imaging? A Sensitivity Analysis Based on Varying the Target Condition in Template Prostate Mapping Biopsies. Urology 2015; 86:544-51. [PMID: 26253041 DOI: 10.1016/j.urology.2015.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/12/2015] [Accepted: 05/03/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the minimum disease burden of prostate cancer at which multiparametric magnetic resonance imaging (MRI) optimally performs. METHODS Between 2006 and 2008, 64 men underwent multiparametric MRI imaging (index test) followed by template prostate mapping biopsy (reference test). Three radiologists independently reported each quadrant of every prostate on a scale of 1 to 5: highly likely benign, likely benign, equivocal, likely malignant, highly likely malignant (≥3 or ≥4 was considered positive). There were 256 prostate sectors; bootstrapping adjustment was used to account for nonindependence. The target condition indicating cancer on biopsies was varied by changing the maximum cancer core length (MCCL) and total cancer core length (TCCL) within each sector from 1 mm to 10 mm. The sensitivity, specificity, and positive (PPVs) and negative predictive values (PPVs) were calculated for each MCCL and TCCL. Gleason ≤3+3 and Gleason ≥3+4 cancers were analyzed separately. RESULTS Mean age was 62 years (range, 40-76 years), and mean prostate-specific antigen level was 8.2 μg/L (range, 2.1-43 μg/L). Fifty percent of quadrants (127 of 256) had prostate cancer, of which 65% (83 of 127) were Gleason ≤3+3. For Gleason ≤3+3, multiparametric MRI had an NPV of ≥95% at an MCCL of ≥5 mm and at a TCCL of ≥7 mm (MRI score ≥3). For Gleason ≥3+4, an NPV of ≥95% was seen at an MCCL of ≥5 mm (MRI score ≥3) and TCCL ≥6 mm. CONCLUSION Multiparametric MRI may allow areas of the prostate which test negative to avoid biopsy. Whether multiparametric MRI can be used as a "triage" test before the first biopsy requires results from ongoing prospective validating cohort studies.
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Affiliation(s)
- Eleni Anastasiadis
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom.
| | - Susan C Charman
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nimalan Arumainayagam
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Aslam S Sohaib
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Clare Allen
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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91
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Lee N, Yoo D, Ling D, Cho MH, Hyeon T, Cheon J. Iron Oxide Based Nanoparticles for Multimodal Imaging and Magnetoresponsive Therapy. Chem Rev 2015; 115:10637-89. [PMID: 26250431 DOI: 10.1021/acs.chemrev.5b00112] [Citation(s) in RCA: 588] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Nohyun Lee
- School of Advanced Materials Engineering, Kookmin University , Seoul 136-702, Korea
| | - Dongwon Yoo
- Department of Chemistry, Yonsei University , Seoul 120-749, Korea
| | - Daishun Ling
- Center for Nanoparticle Research, Institute for Basic Science (IBS) , Seoul 151-742, Korea.,School of Chemical and Biological Engineering, Seoul National University , Seoul 151-742, Korea.,Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University , Hangzhou 310058, PR China
| | - Mi Hyeon Cho
- Department of Chemistry, Yonsei University , Seoul 120-749, Korea
| | - Taeghwan Hyeon
- Center for Nanoparticle Research, Institute for Basic Science (IBS) , Seoul 151-742, Korea.,School of Chemical and Biological Engineering, Seoul National University , Seoul 151-742, Korea
| | - Jinwoo Cheon
- Department of Chemistry, Yonsei University , Seoul 120-749, Korea
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92
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You JY, Lee HJ, Hwang SI, Bae YJ, Kim H, Hong H, Choe G. Value of T1/T2-weighted magnetic resonance imaging registration to reduce the postbiopsy hemorrhage effect for prostate cancer localization. Prostate Int 2015; 3:80-6. [PMID: 26473149 PMCID: PMC4588389 DOI: 10.1016/j.prnil.2015.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to evaluate the value of T1/T2-weighted imaging (T1/T2WI) registration to reduce the postbiopsy hemorrhage effect for prostate cancer localization on prostate magnetic resonance imaging (MRI). Methods Twenty-one men with pathology-proven prostate cancer who underwent preoperative MRI in a single institution were selected. The zonal anatomy was divided into 16 sections. T2WI, T1/T2-weighted registered imaging (T1/T2RI), T2WI combined with diffusion-weighted imaging (T2WI + DWI), and T1/T2RI combined with DWI (T1/T2RI + DWI) were scored for the likelihood of cancer by two radiology faculty members and two trainees, and were compared with histology results. Areas under the receiver operating characteristics curve (AUCs) were used to assess diagnostic accuracy. Results For the trainees (Reader 3 and Reader 4), the AUC values were significantly higher (P < 0.05) for T1/T2RI (0.60 and 0.62, respectively) than for T2WI (0.54 and 0.56, respectively) in tumor detection, whereas no significant difference was observed for faculty members. There was no significant difference in AUC values between T1/T2RI and T2WI + DWI for all readers except for Reader 1. There was no additional diagnostic benefit for adding DWI with T1/T2RI for all readers. Conclusions T1/T2WI registration is a feasible technique. For less experienced readers, T1/T2RI is better than T2WI in localization of prostate cancer.
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Affiliation(s)
- Ja Yeon You
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea ; Program in Nano Science and Technology, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Suwon, South Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hannah Kim
- Department of Computer Science and Engineering, Seoul Women's University, Seoul, South Korea
| | - Helen Hong
- Department of Multimedia Engineering, Seoul Women's University, Seoul, South Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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93
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De Visschere PJL, Naesens L, Libbrecht L, Van Praet C, Lumen N, Fonteyne V, Pattyn E, Villeirs G. What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging? Eur Radiol 2015; 26:1098-107. [DOI: 10.1007/s00330-015-3894-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
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94
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Yoo S, Kim JK, Jeong IG. Multiparametric magnetic resonance imaging for prostate cancer: A review and update for urologists. Korean J Urol 2015; 56:487-97. [PMID: 26175867 PMCID: PMC4500805 DOI: 10.4111/kju.2015.56.7.487] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022] Open
Abstract
Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mpMRI). mpMRI consists of T2-weighted sequences combined with several functional sequences including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and/or magnetic resonance spectroscopy imaging. Interest has been growing in mpMRI because no single MRI sequence adequately detects and characterizes prostate cancer. During the last decade, the role of mpMRI has been expanded in prostate cancer detection, staging, and targeting or guiding prostate biopsy. Recently, mpMRI has been used to assess prostate cancer aggressiveness and to identify anteriorly located tumors before and during active surveillance. Moreover, recent studies have reported that mpMRI is a reliable imaging modality for detecting local recurrence after radical prostatectomy or external beam radiation therapy. In this regard, some urologic clinical practice guidelines recommended the use of mpMRI in the diagnosis and management of prostate cancer. Because mpMRI is the evolving reference standard imaging modality for prostate cancer, urologists should acquire cutting-edge knowledge about mpMRI. In this article, we review the literature on the use of mpMRI in urologic practice and provide a brief description of techniques. More specifically, we state the role of mpMRI in prostate biopsy, active surveillance, high-risk prostate cancer, and detection of recurrence after radical prostatectomy.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Kon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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95
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Wang JG, Huang J, Chin AI. RARP in high-risk prostate cancer: use of multi-parametric MRI and nerve sparing techniques. Asian J Androl 2015; 16:715-9. [PMID: 24969055 PMCID: PMC4215674 DOI: 10.4103/1008-682x.129942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To examine the outcomes of patients with high-risk prostate cancer (PCa) treated by robot-assisted radical prostatectomy (RARP) and evaluate the value of multi-parametric magnetic resonance imaging (MRI) in estimating tumor stage, extracapsular extension, and grade, and the application of nerve sparing (NS) techniques. Patient demographics, preoperative imaging, surgical parameters, pathological features, functional and recurrence outcomes were collected retrospectively in patients with high-risk PCa who underwent RARP between December 2009 and October 2013. Pathological whole mount slides to assess NS were compared with potency, recovery of continence, and surgical margins (SM). Forty-four cases of high-risk PCa were identified with a median followup of 24 months and positive surgical margins (PSM) rate of 14%. Continence returned in 86%, with potency rate of 58%. Of the 25 cases with a preoperative multi-parametric MRI, MRI improved clinical staging from 28% to 88%, respectively. Following risk stratification of NS by microscopic analysis of whole mount pathology, patients with Group A (bilateral NS), Group B (unilateral NS), Group C (partial NS), and Group D (non-NS) had 100%, 92%, 91%, and 50% continence rates, and 100%, 80%, 45%, and 0% potency rates, respectively, with an inverse correlation to PSM. RARP in men with high-risk PCa can achieve favorable oncologic and functional outcomes. Preoperative MRI may localize high-grade tumors and improve clinical staging. Extent of NS is influenced by clinical staging and may balance potency and continence with PSMs.
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Affiliation(s)
| | | | - Arnold I Chin
- Department of Urology, Institute of Urologic Oncology, Broad Stem Cell Research Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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96
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Meng X, Rosenkrantz AB, Mendhiratta N, Fenstermaker M, Huang R, Wysock JS, Bjurlin MA, Marshall S, Deng FM, Zhou M, Melamed J, Huang WC, Lepor H, Taneja SS. Relationship Between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion-targeted Prostate Biopsy Outcomes. Eur Urol 2015; 69:512-7. [PMID: 26112001 DOI: 10.1016/j.eururo.2015.06.005] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 06/06/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Increasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion-targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB). OBJECTIVE To compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included. INTERVENTIONS All men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB. OUTCOMES Detection rates for all PCa and high-grade PCa (Gleason score [GS] ≥7) were compared using the McNemar test. RESULTS AND LIMITATIONS MRF-TB detected fewer GS 6 PCas (75 vs 121; p<0.001) and more GS ≥7 PCas (158 vs 117; p<0.001) than SB. Higher mSS was associated with higher detection of GS ≥7 PCa (p<0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS ≥7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS ≥7 PCas in men with no prior biopsy (88 vs 72; p=0.012), in men with a prior negative biopsy (28 vs 16; p=0.010), and in men with a prior cancer diagnosis (42 vs 29; p=0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p<0.001) and men with prior cancer (30 vs 46; p=0.034). Limitations include the retrospective design and the potential for selection bias given a referral population. CONCLUSIONS MRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted. PATIENT SUMMARY We examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.
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Affiliation(s)
- Xiaosong Meng
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | | | - Neil Mendhiratta
- School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | | | - Richard Huang
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - James S Wysock
- Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Urology, New York Hospital Queens, Flushing, NY, USA
| | - Marc A Bjurlin
- Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Urology, St. Barnabas Hospital, Bronx, NY, USA
| | - Susan Marshall
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Fang-Ming Deng
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
| | - Ming Zhou
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
| | - Jonathan Melamed
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
| | - William C Huang
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Samir S Taneja
- Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Radiology, NYU Langone Medical Center, New York, NY, USA.
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97
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Prostate cancer identification: quantitative analysis of T2-weighted MR images based on a back propagation artificial neural network model. SCIENCE CHINA-LIFE SCIENCES 2015; 58:666-73. [PMID: 26025283 DOI: 10.1007/s11427-015-4876-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
Computer-aided diagnosis (CAD) systems have been proposed to assist radiologists in making diagnostic decisions by providing helpful information. As one of the most important sequences in prostate magnetic resonance imaging (MRI), image features from T2-weighted images (T2WI) were extracted and evaluated for the diagnostic performances by using CAD. We extracted 12 quantitative image features from prostate T2-weighted MR images. The importance of each feature in cancer identification was compared in the peripheral zone (PZ) and central gland (CG), respectively. The performance of the computer-aided diagnosis system supported by an artificial neural network was tested. With computer-aided analysis of T2-weighted images, many characteristic features with different diagnostic capabilities can be extracted. We discovered most of the features (10/12) had significant difference (P<0.01) between PCa and non-PCa in the PZ, while only five features (sum average, minimum value, standard deviation, 10th percentile, and entropy) had significant difference in CG. CAD prediction by features from T2w images can reach high accuracy and specificity while maintaining acceptable sensitivity. The outcome is convictive and helpful in medical diagnosis.
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98
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El-Shater Bosaily A, Parker C, Brown LC, Gabe R, Hindley RG, Kaplan R, Emberton M, Ahmed HU. PROMIS--Prostate MR imaging study: A paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer. Contemp Clin Trials 2015; 42:26-40. [PMID: 25749312 PMCID: PMC4460714 DOI: 10.1016/j.cct.2015.02.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/22/2015] [Accepted: 02/24/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transrectal ultrasound-guided prostate biopsies are prone to detection errors. Multi-parametric MRI (MP-MRI) may improve the diagnostic pathway. METHODS PROMIS is a prospective validating paired-cohort study that meets criteria for level 1 evidence in diagnostic test evaluation. PROMIS will investigate whether multi-parametric (MP)-MRI can discriminate between men with and without clinically-significant prostate cancer who are at risk prior to first biopsy. Up to 714 men will have MP-MRI (index), 10-12 core TRUS-biopsy (standard) and 5mm transperineal template mapping (TPM) biopsies (reference). The conduct and reporting of each test will be blinded to the others. RESULTS PROMIS will measure and compare sensitivity, specificity, and positive and negative predictive values of both MP-MRI and TRUS-biopsy against TPM biopsies. The MP-MRI results will be used to determine the proportion of men who could safely avoid biopsy without compromising detection of clinically-significant cancers. For the primary outcome, significant cancer on TPM is defined as Gleason grade >/= 4+3 and/or maximum cancer core length of ≥ 6 mm. PROMIS will also assess inter-observer variability among radiologists among other secondary outcomes. Cost-effectiveness of MP-MRI prior to biopsy will also be evaluated. CONCLUSIONS PROMIS will determine whether MP-MRI of the prostate prior to first biopsy improves the detection accuracy of clinically-significant cancer.
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Affiliation(s)
- A El-Shater Bosaily
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
| | - C Parker
- Department of Academic Urology, Royal Marsden Hospital, Sutton, UK
| | | | - R Gabe
- Department of Health Sciences, University of York, UK
| | - R G Hindley
- Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK
| | - R Kaplan
- MRC Clinical Trials Unit at UCL, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK.
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Costa DN, Pedrosa I, Donato F, Roehrborn CG, Rofsky NM. MR Imaging–Transrectal US Fusion for Targeted Prostate Biopsies: Implications for Diagnosis and Clinical Management. Radiographics 2015; 35:696-708. [DOI: 10.1148/rg.2015140058] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tewes S, Hueper K, Hartung D, Imkamp F, Herrmann TRW, Weidemann J, Renckly S, Kuczyk MA, Wacker F, Peters I. Targeted MRI/TRUS fusion-guided biopsy in men with previous prostate biopsies using a novel registration software and multiparametric MRI PI-RADS scores: first results. World J Urol 2015; 33:1707-14. [DOI: 10.1007/s00345-015-1525-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/02/2015] [Indexed: 11/28/2022] Open
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