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Korhonen J, Kapanen M, Keyriläinen J, Seppälä T, Tenhunen M. A dual model HU conversion from MRI intensity values within and outside of bone segment for MRI-based radiotherapy treatment planning of prostate cancer. Med Phys 2014; 41:011704. [PMID: 24387496 DOI: 10.1118/1.4842575] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The lack of electron density information in magnetic resonance images (MRI) poses a major challenge for MRI-based radiotherapy treatment planning (RTP). In this study the authors convert MRI intensity values into Hounsfield units (HUs) in the male pelvis and thus enable accurate MRI-based RTP for prostate cancer patients with varying tissue anatomy and body fat contents. METHODS T1/T2*-weighted MRI intensity values and standard computed tomography (CT) image HUs in the male pelvis were analyzed using image data of 10 prostate cancer patients. The collected data were utilized to generate a dual model HU conversion technique from MRI intensity values of the single image set separately within and outside of contoured pelvic bones. Within the bone segment local MRI intensity values were converted to HUs by applying a second-order polynomial model. This model was tuned for each patient by two patient-specific adjustments: MR signal normalization to correct shifts in absolute intensity level and application of a cutoff value to accurately represent low density bony tissue HUs. For soft tissues, such as fat and muscle, located outside of the bone contours, a threshold-based segmentation method without requirements for any patient-specific adjustments was introduced to convert MRI intensity values into HUs. The dual model HU conversion technique was implemented by constructing pseudo-CT images for 10 other prostate cancer patients. The feasibility of these images for RTP was evaluated by comparing HUs in the generated pseudo-CT images with those in standard CT images, and by determining deviations in MRI-based dose distributions compared to those in CT images with 7-field intensity modulated radiation therapy (IMRT) with the anisotropic analytical algorithm and 360° volumetric-modulated arc therapy (VMAT) with the Voxel Monte Carlo algorithm. RESULTS The average HU differences between the constructed pseudo-CT images and standard CT images of each test patient ranged from -2 to 5 HUs and from 22 to 78 HUs in soft and bony tissues, respectively. The average local absolute value differences were 11 HUs in soft tissues and 99 HUs in bones. The planning target volume doses (volumes 95%, 50%, 5%) in the pseudo-CT images were within 0.8% compared to those in CT images in all of the 20 treatment plans. The average deviation was 0.3%. With all the test patients over 94% (IMRT) and 92% (VMAT) of dose points within body (lower than 10% of maximum dose suppressed) passed the 1 mm and 1% 2D gamma index criterion. The statistical tests (t- and F-tests) showed significantly improved (p ≤ 0.05) HU and dose calculation accuracies with the soft tissue conversion method instead of homogeneous representation of these tissues in MRI-based RTP images. CONCLUSIONS This study indicates that it is possible to construct high quality pseudo-CT images by converting the intensity values of a single MRI series into HUs in the male pelvis, and to use these images for accurate MRI-based prostate RTP dose calculations.
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Affiliation(s)
- Juha Korhonen
- Clinical Research Institute Helsinki University Central Hospital Ltd., POB-700, 00029 HUS, Finland and Department of Oncology, Helsinki University Central Hospital, POB-180, 00029 HUS, Finland
| | - Mika Kapanen
- Clinical Research Institute Helsinki University Central Hospital Ltd., POB-700, 00029 HUS, Finland; Department of Oncology, Helsinki University Central Hospital, POB-180, 00029 HUS, Finland; and Department of Medical Physics, Tampere University Hospital, POB-2000, 33521 Tampere, Finland
| | - Jani Keyriläinen
- Department of Oncology, Helsinki University Central Hospital, POB-180, 00029 HUS, Finland
| | - Tiina Seppälä
- Department of Oncology, Helsinki University Central Hospital, POB-180, 00029 HUS, Finland
| | - Mikko Tenhunen
- Department of Oncology, Helsinki University Central Hospital, POB-180, 00029 HUS, Finland
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Korhonen J, Kapanen M, Keyriläinen J, Seppälä T, Tuomikoski L, Tenhunen M. Influence of MRI-based bone outline definition errors on external radiotherapy dose calculation accuracy in heterogeneous pseudo-CT images of prostate cancer patients. Acta Oncol 2014; 53:1100-6. [PMID: 24998163 DOI: 10.3109/0284186x.2014.929737] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This work evaluates influences of susceptibility-induced bone outline shift and perturbations, and bone segmentation errors on external radiotherapy dose calculation accuracy in magnetic resonance imaging (MRI)-based pseudo-computed tomography (CT) images of the male pelvis. MATERIAL AND METHODS T₁/T₂*-weighted fast gradient echo, T₁-weighted spin echo and T₂-weighted fast spin echo images were used in bone detection investigation. Bone edge location and bone diameter in MRI were evaluated by comparing those in the images with actual physical measurements of fresh deer bones positioned in a gelatine phantom. Dose calculation accuracy in pseudo-CT images was investigated for 15 prostate cancer patients. Bone outlines in T₁/T₂*-weighted images were contoured and additional segmentation errors were simulated by expanding and contracting the bone contours with 1 mm spacing. Heterogeneous pseudo-CT images were constructed by adopting a technique transforming the MRI intensity values into Hounsfield units with separate conversion models within and outside of bone segment. RESULTS Bone edges and diameter in the phantom were illustrated correctly within a 1 mm-pixel size in MRI. Each 1 mm-sized systematic error in bone segment resulted in roughly 0.4% change to the prostate dose level in the pseudo-CT images. The prostate average (range) dose levels in pseudo-CT images with additional systematic bone segmentation errors of -2 mm, 0 mm and 2 mm were 0.5% (-0.5-1.4%), -0.2% (-1.0-0.7%), and -0.9% (-1.8-0.0%) compared to those in CT images, respectively, in volumetric modulated arc therapy treatment plans calculated by Monte Carlo algorithm. CONCLUSIONS Susceptibility-induced bone outline shift and perturbations do not result in substantial uncertainty for MRI-based dose calculation. Dose consistency of 2% can be achieved reliably for the prostate if heterogeneous pseudo-CT images are constructed with ≤± 2 mm systematic error in bone segment.
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Affiliation(s)
- Juha Korhonen
- Clinical Research Institute Helsinki University Central Hospital Ltd , Helsinki , Finland
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Costa DN, Pedrosa I, Roehrborn C, Rofsky NM. Multiparametric magnetic resonance imaging of the prostate: technical aspects and role in clinical management. Top Magn Reson Imaging 2014; 23:243-257. [PMID: 25099562 DOI: 10.1097/rmr.0000000000000027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The heterogeneity and largely indolent nature of prostate cancer require better tools to avoid overdetection of low-risk disease and improve diagnostic accuracy in high-risk patients. During the last 3 decades, magnetic resonance imaging (MRI) has evolved to become the most accurate imaging technique for prostate cancer detection and staging, with a promising role in risk stratification. Because each MRI technique has advantages and limitations, state of the art of the so-called multiparametric MRI of the prostate is achieved combining anatomical T2-weighted imaging integrated with other techniques in which image contrast is related to the pathophysiology of the disease, such as diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy. After reviewing this article, readers will understand the clinical challenges in the management of patients with confirmed or suspected prostate cancer, when and how multiparametric MRI of the prostate can provide meaningful information, and how to perform and interpret it.
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Affiliation(s)
- Daniel N Costa
- From the Departments of *Radiology and Advanced Imaging Research Center and †Urology, University of Texas Southwestern Medical Center, Dallas, TX
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Multiparametric Magnetic Resonance Imaging Guided Diagnostic Biopsy Detects Significant Prostate Cancer and could Reduce Unnecessary Biopsies and Over Detection: A Prospective Study. J Urol 2014; 192:67-74. [DOI: 10.1016/j.juro.2014.01.014] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/18/2022]
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Porpiglia F, Russo F, Manfredi M, Mele F, Fiori C, Bollito E, Papotti M, Molineris I, Passera R, Regge D. The Roles of Multiparametric Magnetic Resonance Imaging, PCA3 and Prostate Health Index—Which is the Best Predictor of Prostate Cancer after a Negative Biopsy? J Urol 2014; 192:60-6. [DOI: 10.1016/j.juro.2014.01.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Filippo Russo
- Radiology Unit, Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Fabrizio Mele
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Enrico Bollito
- Division of Pathology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Mauro Papotti
- Division of Pathology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Ivan Molineris
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Daniele Regge
- Radiology Unit, Institute for Cancer Research and Treatment, Candiolo, Italy
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Vaché T, Bratan F, Mège-Lechevallier F, Roche S, Rabilloud M, Rouvière O. Characterization of prostate lesions as benign or malignant at multiparametric MR imaging: comparison of three scoring systems in patients treated with radical prostatectomy. Radiology 2014; 272:446-55. [PMID: 24937690 DOI: 10.1148/radiol.14131584] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the subjective Likert score to the Prostate Imaging Reporting and Data System (PIRADS) and morphology-location-signal intensity (MLS) scores for categorization of prostate lesions as benign or malignant at multiparametric magnetic resonance (MR) imaging. MATERIALS AND METHODS Two hundred fifteen patients who underwent T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced multiparametric MR imaging of the prostate before radical prostatectomy were included in a prospective database after they signed the institutional review board-approved forms. Senior readers 1 and 2 prospectively noted the location, shape, and signal intensity of lesions on MR images from individual pulse sequences and scored each for likelihood of malignancy by using a Likert scale (range, 1-5). A junior reader (reader 3) retrospectively reviewed the database and did the same analysis. The MLS score (range, 1-13) was computed by using the readers' descriptions of the lesions. Then, the three readers again scored the lesions they described by using the PIRADS score (range, 3-15). MLS and PIRADS scores were compared with the Likert score by using their areas under the receiver operating characteristic curves. RESULTS Areas under the receiver operating characteristic curves of the Likert, MLS, and PIRADS scores were 0.81, 0.77 (P = .03), and 0.75 (P = .01) for reader 1; 0.88, 0.74 (P < .0001), and 0.76 (P < .0001) for reader 2; and 0.81, 0.78 (P = .23), and 0.75 (P = .01) for reader 3. For diagnosing cancers with Gleason scores greater than or equal to 7, the Likert score was significantly more accurate than the others, except for the MLS score for reader 3. Weighted κ values were 0.470-0.524, 0.405-0.430, and 0.378-0.441 for the Likert, MLS, and PIRADS scores, respectively. CONCLUSION The Likert score allowed significantly more accurate categorization of prostate lesions on MR images than did the MLS and PIRADS scores.
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Affiliation(s)
- Tiphaine Vaché
- From the Departments of Urinary and Vascular Radiology (T.V., F.B., O.R.) and Pathology (F.M.L.), Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 place d'Arsonval, 69437 Lyon Cedex 03-France; Université de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., O.R.); Inserm, U1032, LabTau, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1, France (F.B., O.R.); Department of Biostatistics, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, Villeurbanne, France (S.R., M.R.)
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Boesen L, Noergaard N, Chabanova E, Logager V, Balslev I, Mikines K, Thomsen HS. Early experience with multiparametric magnetic resonance imaging-targeted biopsies under visual transrectal ultrasound guidance in patients suspicious for prostate cancer undergoing repeated biopsy. Scand J Urol 2014; 49:25-34. [DOI: 10.3109/21681805.2014.925497] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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108
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Impact of intraoperative MRI/TRUS fusion on dosimetric parameters in cT3a prostate cancer patients treated with high-dose-rate real-time brachytherapy. J Contemp Brachytherapy 2014; 6:154-60. [PMID: 25097555 PMCID: PMC4105645 DOI: 10.5114/jcb.2014.43299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/06/2014] [Accepted: 06/26/2014] [Indexed: 12/19/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of intraoperative MRI/TRUS fusion procedure in cT3a prostate cancer patients treated with high-dose-rate (HDR) real-time brachytherapy. Material and methods Prostate gland, dominant intraprostatic lesions (DILs), and extracapsular extension (ECE) were delineated in the pre-brachytherapy magnetic resonance images (MRI) of 9 consecutive patients. The pre-implant P-CTVUS (prostate clinical target volume) was defined as the prostate seen in the transrectal ultrasound (TRUS) images. The CTVMR includedthe prostate with the ECE image (ECE-CTV) as defined on the MRI. Two virtual treatment plans were performed based on the MRI/TRUS fusion images, the first one prescribing 100% of the dose to the P-PTVUS, and the second prescribing to the PTVMR. The implant parameters and dose-volume histogram (DVH) related parameters of the prostate, OARs, and ECE were compared between both plans. Results Mean radial distance of ECE was 3.6 mm (SD: 1.1). No significant differences were found between prostate V100, V150, V200, and OARs DVH-related parameters between the plans. Mean values of ECE V100, V150, and V200 were 85.9% (SD: 15.1), 18.2% (SD: 17.3), and 5.85% (SD: 7) when the doses were prescribed to the PTVUS, whereas ECE V100, V150, and V200 were 99.3% (SD: 1.2), 45.8% (SD: 22.4), and 19.6% (SD: 12.6) when doses were prescribed to PTVMR (p = 0.028, p = 0.002 and p = 0.004, respectively). Conclusions TRUS/MRI fusion provides important information for prostate brachytherapy, allowing for better coverage and higher doses to extracapsular disease in patients with clinical stage T3a.
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109
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Standardization of multiparametric prostate MR imaging using PI-RADS. BIOMED RESEARCH INTERNATIONAL 2014; 2014:431680. [PMID: 25003112 PMCID: PMC4070484 DOI: 10.1155/2014/431680] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/29/2014] [Indexed: 12/15/2022]
Abstract
The purpose of this paper is to introduce and describe the Prostate Imaging and Reporting Archiving Data System (PI-RADS). For every single parameter the PI-RADS scoring system will be explained and magnetic resonance imaging (MRI) examples will be given. In the end two patient cases are presented to explain the overall interpretation score in multiparametric imaging.
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110
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Couñago F, Recio M, Del Cerro E, Cerezo L, Díaz Gavela A, Marcos FJ, Murillo R, Rodriguez Luna JM, Thuissard IJ, Martin JLR. Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology. Clin Transl Oncol 2014; 16:993-9. [PMID: 24865628 DOI: 10.1007/s12094-014-1186-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/23/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the accuracy of preoperative 3T multiparametric magnetic resonance imaging (3TmMRI) for local staging of prostate cancer and its influence on the decision to change the clinical target volume (CTV), total dose and hormonal therapy when treating prostate cancer patients with radiotherapy. METHODS From 2009 to 2013, 150 patients, who had confirmed prostate cancer and underwent a 3TmMRI before treatment with radical prostatectomy or radical radiation therapy, were included. Radiation therapy treatment (CTV, total dose and hormonal therapy) was initially determined on the basis of the clinical information, and radiation therapy plan was reevaluated after 3TmMRI review. The value of preoperative 3TmMRI in local staging and in the decision of radiotherapy treatment according to NCCN risk classification was analyzed. RESULTS 3TmMRI performed correct, over- and under staging in 78.7 % (37/47), 6.3 % (3/47), 14.8 % patients (7/47), respectively. 3TmMRI identified 6 cT2a, 7 cT2b, 28 cT2c, 3 cT3a, 3 cT3b tumors. At final pathology, 5 tumors were classified as pT2a, 5 as pT2b, 30 as pT2c, 4 as pT3a, 3 as pT3b. After reviewing the MRI reports, the initial radiotherapy and hormonal therapy plan was changed in 33.9 % patients (35/103). CONCLUSIONS In our group of patients, 3TmMRI has been a reliable technique providing an optimal staging for prostate cancer. Its routine use could induce important changes in radiation therapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue.
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Affiliation(s)
- F Couñago
- Department of Radiation Oncology, Hospital Universitario Quirón Madrid, Calle Diego de Velázquez, 2, Pozuelo de Alarcón, 28223, Madrid, Spain,
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Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy. Urol Oncol 2014; 32:1292-9. [PMID: 24863013 DOI: 10.1016/j.urolonc.2014.04.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/20/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of our study was to test our hypothesis that multiparametric magnetic resonance imaging (mpMRI) may have a higher prognostic accuracy than the Partin tables in predicting organ-confined (OC) prostate cancer and extracapsular extension (ECE) after radical prostatectomy (RP). METHODS AND MATERIALS After institutional review board approval, we retrospectively reviewed 60 patients who underwent 3-T mpMRI before RP. mpMRI was used to assess clinical stage and the updated version of the Partin tables was used to calculate the probability of each patient to harbor OC disease. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in detecting OC and ECE were calculated. Logistic regression models predicting OC pathology were created using either clinical stage at mpMRI or Partin tables probability. The area under the curve was used to calculate the predictive accuracy of each model. RESULTS Median prostate-specific antigen level at diagnosis was 5 ng/ml (range: 4.1-6.7 ng/ml). Overall, 52 (86.7%) men had cT1 disease, 7 (11.7%) had cT2a/b, and 1 (1.6%) had cT3b at digital rectal examination. Biopsy Gleason score was 6, 3+4 = 7, 4+3 = 7, 8, and 9 to 10 in 28 (46.7%), 15 (25%), 3 (5%), 10 (16.7%), and 4 (6.6%) patients, respectively. At mpMRI, clinical stage was defined as cT2a/b, cT2c, cT3a, and cT3b in 11 (18.3%), 23 (38.3%), 21 (35%), and 5 (8.4%) patients, respectively. At final pathology, 38 men (63.3%) had OC disease, whereas 18 (30%) had ECE and 4 (6.7%) had seminal vesicle invasion. The sensitivity, specificity, PPV, and NPV of mpMRI in detecting OC disease were 81.6%, 86.4%, 91.2%, and 73.1%, respectively, whereas in detecting ECE were 77.8%, 83.4%, 66.7%, and 89.7%, respectively. At logistic regression, both the Partin tables-derived probability and the mpMRI clinical staging were significantly associated with OC disease (all P<0.01). The area under the curves of the model built using the Partin tables and that of the mpMRI model were 0.62 and 0.82, respectively (P = 0.04). CONCLUSIONS The predictive accuracy of mpMRI in predicting OC disease on pathological analysis is significantly greater than that of the Partin tables. mpMRI had a high PPV (91.2%) when predicting OC disease and a high NPV (89.7%) with regard to ECE. mpMRI should be considered when planning prostate cancer treatment in addition to readily available clinical parameters.
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Rauscher I, Eiber M, Souvatzoglou M, Schwaiger M, Beer AJ. PET/MR in Oncology: Non-18F-FDG Tracers for Routine Applications. J Nucl Med 2014; 55:25S-31S. [PMID: 24819421 DOI: 10.2967/jnumed.113.129536] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PET/MR is a new multimodal imaging technique that is expected to improve diagnostic performance, especially in oncologic patients in certain indications. Apart from the clinical relevance of PET with 18F-FDG, various other tracers exist and are increasingly used, which allow insights into multiple physiologic and biologic processes. In this review, we discuss the current and potential future applications of hybrid PET/MR, focusing on non-18F-FDG tracers. The combination of PET and MR in hybrid whole-body PET/MR systems has the potential to combine excellent morphologic, functional, and biologic information in 1 imaging session with precise image coregistration, thus paving the way for the concept of multimodal multiparametric imaging for future more widespread clinical use.
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Affiliation(s)
- Isabel Rauscher
- German Cancer Consortium (DKTK), Heidelberg, Germany Department of Nuclear Medicine, Technische Universität München, Munich, Germany German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Matthias Eiber
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | | | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Scialpi M, Piscioli I, Malaspina S, D'Andrea A. Multiparametric magnetic resonance imaging-ultrasound fusion-guided prostate biopsy: role in diagnosis and management of prostatic cancer. Urol Oncol 2014; 32:509-10. [PMID: 24767685 DOI: 10.1016/j.urolonc.2014.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/01/2014] [Accepted: 02/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Michele Scialpi
- Division of Radiology, Department of Surgical, Radiologic, and Odontostomatologic Sciences, Division of Radiology 2, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06156 Perugia, Italy
| | - Irene Piscioli
- Division of Radiology, Budrio Hospital, ASL Budrio, Bologna, Italy
| | - Simona Malaspina
- Division of Radiology, Department of Surgical, Radiologic, and Odontostomatologic Sciences, Division of Radiology 2, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06156 Perugia, Italy
| | - Alfredo D'Andrea
- Division of Radiology, San Giuseppe Moscati Hospital, Aversa, Caserta, Italy
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Accuracy of multiparametric MRI for prostate cancer detection: a meta-analysis. AJR Am J Roentgenol 2014; 202:343-51. [PMID: 24450675 DOI: 10.2214/ajr.13.11046] [Citation(s) in RCA: 322] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this diagnostic meta-analysis was to determine the diagnostic accuracy of multiparametric MRI for prostate cancer detection using anatomic T2-weighted imaging combined with two functional techniques: diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI). MATERIALS AND METHODS We searched electronic databases, including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to February 3, 2012. We included diagnostic accuracy studies using a combination of T2-weighted imaging, DWI, and DCE-MRI to detect prostate cancer with histopathologic data from prostatectomy or biopsy as the reference standard. The methodologic quality was assessed with version 2 of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool by two independent reviewers. Sensitivity and specificity of all studies were calculated from 2 × 2 tables, and the results were plotted in a hierarchic summary receiver operating characteristic plot. RESULTS Seven studies that met the inclusion criteria (526 patients) could be analyzed. The pooled data showed a specificity of 0.88 (95% CI, 0.82-0.92) and sensitivity of 0.74 (95% CI, 0.66-0.81) for prostate cancer detection, with negative predictive values (NPVs) ranging from 0.65 to 0.94. Subgroup analyses showed no significant difference between the subgroups. CONCLUSION The high specificity with variable but high NPVs and sensitivities implies a potential role for multiparametric MRI in detecting prostate cancer.
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Qiu W, Yuan J, Ukwatta E, Sun Y, Rajchl M, Fenster A. Prostate segmentation: an efficient convex optimization approach with axial symmetry using 3-D TRUS and MR images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:947-960. [PMID: 24710163 DOI: 10.1109/tmi.2014.2300694] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We propose a novel global optimization-based approach to segmentation of 3-D prostate transrectal ultrasound (TRUS) and T2 weighted magnetic resonance (MR) images, enforcing inherent axial symmetry of prostate shapes to simultaneously adjust a series of 2-D slice-wise segmentations in a "global" 3-D sense. We show that the introduced challenging combinatorial optimization problem can be solved globally and exactly by means of convex relaxation. In this regard, we propose a novel coherent continuous max-flow model (CCMFM), which derives a new and efficient duality-based algorithm, leading to a GPU-based implementation to achieve high computational speeds. Experiments with 25 3-D TRUS images and 30 3-D T2w MR images from our dataset, and 50 3-D T2w MR images from a public dataset, demonstrate that the proposed approach can segment a 3-D prostate TRUS/MR image within 5-6 s including 4-5 s for initialization, yielding a mean Dice similarity coefficient of 93.2%±2.0% for 3-D TRUS images and 88.5%±3.5% for 3-D MR images. The proposed method also yields relatively low intra- and inter-observer variability introduced by user manual initialization, suggesting a high reproducibility, independent of observers.
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Gibson E, Gaed M, Gómez JA, Moussa M, Romagnoli C, Pautler S, Chin JL, Crukley C, Bauman GS, Fenster A, Ward AD. 3D prostate histology reconstruction: an evaluation of image-based and fiducial-based algorithms. Med Phys 2014; 40:093501. [PMID: 24007184 DOI: 10.1118/1.4816946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Evaluation of in vivo prostate imaging modalities for determining the spatial distribution and aggressiveness of prostate cancer ideally requires accurate registration of images to an accepted reference standard, such as histopathological examination of radical prostatectomy specimens. Three-dimensional (3D) reconstruction of prostate histology facilitates these registration-based evaluations by reintroducing 3D spatial information lost during histology processing. Because the reconstruction accuracy may constrain the clinical questions that can be answered with these data, it is important to assess the tradeoffs between minimally disruptive methods based on intrinsic image information and potentially more robust methods based on extrinsic fiducial markers. METHODS Ex vivo magnetic resonance (MR) images and digitized whole-mount histology images from 12 radical prostatectomy specimens were used to evaluate four 3D histology reconstruction algorithms. 3D reconstructions were computed by registering each histology image to the corresponding ex vivo MR image using one of two similarity metrics (mutual information or fiducial registration error) and one of two search domains (affine transformations or a constrained subset thereof). The algorithms were evaluated for accuracy using the mean target registration error (TRE) computed from homologous intrinsic point landmarks (3-16 per histology section; 232 total) identified on histology and MR images, and for the sensitivity of TRE to rotational, translational, and scaling initialization errors. RESULTS The algorithms using fiducial registration error and mutual information had mean ± standard deviation TREs of 0.7 ± 0.4 and 1.2 ± 0.7 mm, respectively, and one algorithm using fiducial registration error and affine transforms had negligible sensitivities to initialization errors. The postoptimization values of the mutual information-based metric showed evidence of errors due to both the optimizer and the similarity metric, and variation of parameters of the mutual information-based metric did not improve its performance. CONCLUSIONS The extrinsic fiducial-based algorithm had lower mean TRE and lower sensitivity to initialization than the intrinsic intensity-based algorithm using mutual information. A model relating statistical power to registration error for certain imaging validation study designs estimated that a reconstruction algorithm with a mean TRE of 0.7 mm would require 27% fewer subjects than the method used to initialize the algorithms (mean TRE 1.3 ± 0.7 mm), suggesting the choice of reconstruction technique can have a substantial impact on the design of imaging validation studies, and on their overall cost.
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Affiliation(s)
- E Gibson
- Biomedical Engineering Graduate Program, The University of Western Ontario, London, Ontario N6A 5B9, Canada.
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Largeron J, Galonnier F, Védrine N, Alfidja A, Boyer L, Pereira B, Boiteux J, Kemeny J, Guy L. L’IRM 3Tesla multi-paramétrique dans le staging du cancer prostatique en pratique courante. Prog Urol 2014; 24:145-53. [DOI: 10.1016/j.purol.2013.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/07/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
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Habchi H, Bratan F, Paye A, Pagnoux G, Sanzalone T, Mège-Lechevallier F, Crouzet S, Colombel M, Rabilloud M, Rouvière O. Value of prostate multiparametric magnetic resonance imaging for predicting biopsy results in first or repeat biopsy. Clin Radiol 2014; 69:e120-8. [DOI: 10.1016/j.crad.2013.10.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/13/2013] [Accepted: 10/30/2013] [Indexed: 12/31/2022]
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Rosenkrantz AB, Triolo MJ, Melamed J, Rusinek H, Taneja SS, Deng FM. Whole-lesion apparent diffusion coefficient metrics as a marker of percentage Gleason 4 component within Gleason 7 prostate cancer at radical prostatectomy. J Magn Reson Imaging 2014; 41:708-14. [PMID: 24616064 DOI: 10.1002/jmri.24598] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/25/2014] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To retrospectively assess the utility of whole-lesion apparent diffusion coefficient (ADC) metrics in characterizing the Gleason 4 component of Gleason 7 prostate cancer (PCa) at radical prostatectomy. MATERIALS AND METHODS Seventy patients underwent phased-array coil 3T-magnetic resonance imaging (MRI) before prostatectomy. A uropathologist mapped locations and Gleason 4 percentage (G4%) of Gleason 7 tumors. Two radiologists independently reviewed ADC maps, aware of tumor locations but not G4%, and placed a volume-of-interest (VOI) on all slices including each lesion on the ADC map to obtain whole-lesion mean ADC and ADC entropy. Entropy reflects textural variation and increases with greater macroscopic heterogeneity. Performance for characterizing Gleason 7 tumors was assessed with mixed-model analysis of variance (ANOVA) and logistic regression. RESULTS Among 84 Gleason 7 tumors (G4% 5%-85%, median 30%; 59 Gleason 3+4, 25 Gleason 4+3), ADC entropy was significantly higher in Gleason 4+3 than Gleason 3+4 tumors (R1: 5.27 ± 0.61 vs. 4.62 ± 0.78, P = 0.001; R2: 5.91 ± 0.32 vs. 5.57 ± 0.56, P = 0.004); mean ADC was not significantly different between these groups (R1: 0.90 ± 0.15*10(-3) cm(2) /s vs. 0.98 ± 0.21*10(-3) cm(2) /s, P = 0.075; R2: 1.06 ± 0.19*10(-3) cm(2) /s vs. 1.14 ± 0.16*10(-3) cm(2) /s, P = 0.083). The area under the receiver operating characteristic (ROC) curve (AUC) for differentiating groups was significantly higher with ADC entropy than mean ADC for one observer (R1: 0.74 vs. 0.57, P = 0.027; R2: 0.69 vs. 0.61, P = 0.329). For R1, correlation with G4% was moderate for ADC entropy (r = 0.45) and weak for mean ADC (r = -0.25). For R2, correlation with G4% was moderate for ADC entropy (r = 0.41) and mean ADC (r = -0.32). For both readers, ADC entropy (P = 0.028-0.003), but not mean ADC (P = 0.384-0.854), was a significant independent predictor of G4%. CONCLUSION Whole-lesion ADC entropy outperformed mean ADC in characterizing Gleason 7 tumors and may help refine prognosis for this heterogeneous PCa subset.
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Scialpi M, Piscioli I, D'Andrea A. Underestimated role of MRI in EAU guidelines on prostate cancer. Magn Reson Imaging 2014; 32:402-3. [PMID: 24559864 DOI: 10.1016/j.mri.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Michele Scialpi
- Department of Surgical, Radiological and Odontostomatological Sciences, Division of Radiology 2, Perugia University, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia, Italy.
| | - Irene Piscioli
- Division of Radiology, Budrio Hospital, ASL Bologna, Budrio, Italy
| | - Alfredo D'Andrea
- Division of Radiology, San Giuseppe Moscati Hospital, Aversa, Caserta, Italy
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Radiologist, Be Aware: Ten Pitfalls That Confound the Interpretation of Multiparametric Prostate MRI. AJR Am J Roentgenol 2014; 202:109-20. [DOI: 10.2214/ajr.13.10699] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Imaging and Markers as Novel Diagnostic Tools in Detecting Insignificant Prostate Cancer: A Critical Overview. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:243080. [PMID: 27351008 PMCID: PMC4897503 DOI: 10.1155/2014/243080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/19/2014] [Indexed: 11/22/2022]
Abstract
Recent therapeutic advances for managing low-risk prostate cancer include the active surveillance and focal treatment. However, locating a tumor and detecting its volume by adequate sampling is still problematic. Development of predictive biomarkers guiding individual therapeutic choices remains an ongoing challenge. At the same time, prostate cancer magnetic resonance imaging is gaining increasing importance for prostate diagnostics. The high morphological resolution of T2-weighted imaging and functional MRI methods may increase the specificity and sensitivity of diagnostics. Also, recent studies founded an ability of novel biomarkers to identify clinically insignificant prostate cancer, risk of progression, and association with poor differentiation and, therefore, with clinical significance. Probably, the above mentioned methods would improve tumor characterization in terms of its volume, aggressiveness, and focality. In this review, we attempted to evaluate the applications of novel imaging techniques and biomarkers in assessing the significance of the prostate cancer.
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Thompson J, Lawrentschuk N, Frydenberg M, Thompson L, Stricker P. The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int 2013; 112 Suppl 2:6-20. [PMID: 24127671 DOI: 10.1111/bju.12381] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The diagnosis of prostate cancer has long been plagued by the absence of an imaging tool that reliably detects and localises significant tumours. Recent evidence suggests that multi-parametric MRI could improve the accuracy of diagnostic assessment in prostate cancer. This review serves as a background to a recent USANZ position statement. It aims to provide an overview of MRI techniques and to critically review the published literature on the clinical application of MRI in prostate cancer. TECHNICAL ASPECTS The combination of anatomical (T2-weighted) MRI with at least two of the three functional MRI parameters - which include diffusion-weighted imaging, dynamic contrast-enhanced imaging and spectroscopy - will detect greater than 90% of significant (moderate to high risk) tumours; however MRI is less reliable at detecting tumours that are small (<0.5 cc), low grade (Gleason score 6) or in the transitional zone. The higher anatomical resolution provided by 3-Tesla magnets and endorectal coils may improve the accuracy, particularly in primary tumour staging. SCREENING The use of mpMRI to determine which men with an elevated PSA should undergo biopsy is currently the subject of two large clinical trials in Australia. MRI should be used with caution in this setting and then only in centres with established uro-radiological expertise and quality control mechanisms in place. There is sufficient evidence to justify using MRI to determine the need for repeat biopsy and to guide areas in which to focus repeat biopsy. IMAGE-DIRECTED BIOPSY MRI-directed biopsy is an exciting concept supported by promising early results, but none of the three proposed techniques have so far been proven superior to standard biopsy protocols. Further evidence of superior accuracy and core-efficiency over standard biopsy is required, before their costs and complexities in use can be justified. TREATMENT SELECTION AND PLANNING When used for primary-tumour staging (T-staging), MRI has limited sensitivity for T3 disease, but its specificity of greater than 95% may be useful in men with intermediate-high risk disease to identify those with advanced T3 disease not suitable for nerve sparing or for surgery at all. MRI appears to be of value in planning dosimetry in men undergoing radiotherapy, and in guiding selection for and monitoring on active surveillance.
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Affiliation(s)
- James Thompson
- St Vincents Prostate Cancer Centre, Garvan Institute of Medical Research, Department of Surgery Research, University of New South Wales, Sydney, New South Wales
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Busetto GM, De Berardinis E, Sciarra A, Panebianco V, Giovannone R, Rosato S, D'Errigo P, Di Silverio F, Gentile V, Salciccia S. Prostate Cancer Gene 3 and Multiparametric Magnetic Resonance Can Reduce Unnecessary Biopsies: Decision Curve Analysis to Evaluate Predictive Models. Urology 2013; 82:1355-60. [DOI: 10.1016/j.urology.2013.06.078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/18/2013] [Accepted: 06/29/2013] [Indexed: 11/28/2022]
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Cerantola Y, Valerio M, Kawkabani Marchini A, Meuwly JY, Jichlinski P. Can 3T multiparametric magnetic resonance imaging accurately detect prostate cancer extracapsular extension? Can Urol Assoc J 2013; 7:E699-703. [PMID: 24282460 DOI: 10.5489/cuaj.245] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate staging is essential to determine the correct management of patients diagnosed with prostate cancer. We assess the accuracy of 3T multiparametric magnetic resonance imaging (MRI) with endorectal coil (3TemMRI) in detecting prostate cancer local extension. METHODS We retrospectively reviewed charts from January 2008 to July 2012 from all patients undergoing radical prostatectomy. Patients were only included if 3TemMRI and radical prostatectomy were performed at our institution. Based on the presence of extracapsular extension (ECE) at 3TemMRI, prostate cancer was dichotomized into locally advanced or organ-confined disease. The accuracy of 3TemMRI local staging was then evaluated using definitive pathology as a reference. RESULTS Overall, 177 radical prostatectomies were performed within the timeframe. After applying exclusion criteria, 60 patients were included in the final analysis. The mean patient age was 67 ± 7 (standard deviation) years. Mean prostate-specific antigen value was 12.7 ± 12.7 ng/L. Based on preoperative characteristics, we considered 38 of the 60 patients (63%) patients high risk. 3TemMRI identified an organ-confined tumour in 46 patients and locally advanced disease in 14 patients. When correlated to final pathology, 3TemMRI specificity, sensitivity, negative and positive predictive values, and accuracy in detecting locally advanced prostate cancer were 90%, 35%, 57%, 79% and 62%, respectively. INTERPRETATION This study shows that the use of preoperative 3TemMRI can be used to identify organ-confined prostate cancer when locally advanced disease is suspected.
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Affiliation(s)
- Yannick Cerantola
- Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
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Target detection: magnetic resonance imaging-ultrasound fusion-guided prostate biopsy. Urol Oncol 2013; 32:903-11. [PMID: 24239473 DOI: 10.1016/j.urolonc.2013.08.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/04/2013] [Accepted: 08/12/2013] [Indexed: 01/05/2023]
Abstract
Recent advances in multiparametric magnetic resonance imaging (MRI) have enabled image-guided detection of prostate cancer. Fusion of MRI with real-time ultrasound (US) allows the information from MRI to be used to direct biopsy needles under US guidance in an office-based procedure. Fusion can be performed either cognitively or electronically, using a fusion device. Fusion devices allow superimposition (coregistration) of stored MRI images on real-time US images; areas of suspicion found on MRI can then serve as targets during US-guided biopsy. Currently available fusion devices use a variety of technologies to perform coregistration: robotic tracking via a mechanical arm with built-in encoders (Artemis/Eigen, BioJet/Geoscan); electromagnetic tracking (UroNav/Philips-Invivo, Hi-RVS/Hitachi); or tracking with a 3D US probe (Urostation/Koelis). Targeted fusion biopsy has been shown to identify more clinically significant cancers and fewer insignificant cancers than conventional biopsy. Fusion biopsy appears to be a major advancement over conventional biopsy because it allows (1) direct targeting of suspicious areas not seen on US and (2) follow-up biopsy of specific cancerous sites in men undergoing active surveillance.
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127
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Puech P, Sufana-Iancu A, Renard B, Lemaitre L. Prostate MRI: can we do without DCE sequences in 2013? Diagn Interv Imaging 2013; 94:1299-311. [PMID: 24211261 DOI: 10.1016/j.diii.2013.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric MRI (mp-MRI) of the prostate currently provides stable and reproducible performances. The usefulness of dynamic contrast-enhanced (DCE) sequences is currently challenged, as they sometimes only confirm what has already been observed on diffusion-weighted imaging (DWI) and require the additional purchase of a contrast agent. Eliminating these sequences may help accelerate the use of MRI in addition to, or in lieu of, prostate biopsies in selected patients. However, many studies show that these sequences can detect lesions invisible on T2-weighted and diffusion-weighted images, better assess cancer extension and aggressiveness, and finally help detecting recurrence after treatment. We present the various applications of dynamic MRI and discuss the possible consequences of its omission from the current protocol.
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Affiliation(s)
- P Puech
- Department of Uroradiology, Lille Hospital, 1, rue Michel-Polonovski, 59037 Lille cedex, France; University of Lille Nord de France, Lille 59800, France; Inserm U703, 59120 Loos, France.
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Gibson E, Gaed M, Gómez JA, Moussa M, Pautler S, Chin JL, Crukley C, Bauman GS, Fenster A, Ward AD. 3D prostate histology image reconstruction: Quantifying the impact of tissue deformation and histology section location. J Pathol Inform 2013; 4:31. [PMID: 24392245 PMCID: PMC3869958 DOI: 10.4103/2153-3539.120874] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/03/2013] [Indexed: 01/22/2023] Open
Abstract
Background: Guidelines for localizing prostate cancer on imaging are ideally informed by registered post-prostatectomy histology. 3D histology reconstruction methods can support this by reintroducing 3D spatial information lost during histology processing. The need to register small, high-grade foci drives a need for high accuracy. Accurate 3D reconstruction method design is impacted by the answers to the following central questions of this work. (1) How does prostate tissue deform during histology processing? (2) What spatial misalignment of the tissue sections is induced by microtome cutting? (3) How does the choice of reconstruction model affect histology reconstruction accuracy? Materials and Methods: Histology, paraffin block face and magnetic resonance images were acquired for 18 whole mid-gland tissue slices from six prostates. 7-15 homologous landmarks were identified on each image. Tissue deformation due to histology processing was characterized using the target registration error (TRE) after landmark-based registration under four deformation models (rigid, similarity, affine and thin-plate-spline [TPS]). The misalignment of histology sections from the front faces of tissue slices was quantified using manually identified landmarks. The impact of reconstruction models on the TRE after landmark-based reconstruction was measured under eight reconstruction models comprising one of four deformation models with and without constraining histology images to the tissue slice front faces. Results: Isotropic scaling improved the mean TRE by 0.8-1.0 mm (all results reported as 95% confidence intervals), while skew or TPS deformation improved the mean TRE by <0.1 mm. The mean misalignment was 1.1-1.9° (angle) and 0.9-1.3 mm (depth). Using isotropic scaling, the front face constraint raised the mean TRE by 0.6-0.8 mm. Conclusions: For sub-millimeter accuracy, 3D reconstruction models should not constrain histology images to the tissue slice front faces and should be flexible enough to model isotropic scaling.
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Affiliation(s)
- Eli Gibson
- Robarts Research Institute, London, Canada ; Graduate Program in Biomedical Engineering, London, Canada
| | - Mena Gaed
- Robarts Research Institute, London, Canada ; Lawson Health Research Institute, London, Canada ; Department of Pathology, The University of Western Ontario, London, Canada
| | - José A Gómez
- Department of Pathology, The University of Western Ontario, London, Canada
| | - Madeleine Moussa
- Department of Pathology, The University of Western Ontario, London, Canada
| | - Stephen Pautler
- Lawson Health Research Institute, London, Canada ; Department of Urology, The University of Western Ontario, London, Canada
| | - Joseph L Chin
- Department of Urology, The University of Western Ontario, London, Canada
| | - Cathie Crukley
- Robarts Research Institute, London, Canada ; Lawson Health Research Institute, London, Canada
| | - Glenn S Bauman
- Department of Oncology, The University of Western Ontario, London, Canada
| | - Aaron Fenster
- Robarts Research Institute, London, Canada ; Graduate Program in Biomedical Engineering, London, Canada ; Lawson Health Research Institute, London, Canada ; Department of Oncology, The University of Western Ontario, London, Canada ; Department of Medical Biophysics, The University of Western Ontario, London, Canada
| | - Aaron D Ward
- Graduate Program in Biomedical Engineering, London, Canada ; Lawson Health Research Institute, London, Canada ; Department of Oncology, The University of Western Ontario, London, Canada ; Department of Medical Biophysics, The University of Western Ontario, London, Canada
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Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, Heijmink SW, Hoskin P, Kirkham AP, Padhani AR, Raj Persad CM, van der Meulen J, Villers A, Emberton M. Clinical applications of multiparametric MRI within the prostate cancer diagnostic pathway. Urol Oncol 2013; 31:281-4. [PMID: 23627000 PMCID: PMC4274606 DOI: 10.1016/j.urolonc.2012.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Louise Dickinson
- Division of Surgery and Interventional Sciences, University College London, Gower Street London, UK
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Zaorsky NG, Harrison AS, Trabulsi EJ, Gomella LG, Showalter TN, Hurwitz MD, Dicker AP, Den RB. Evolution of advanced technologies in prostate cancer radiotherapy. Nat Rev Urol 2013; 10:565-79. [DOI: 10.1038/nrurol.2013.185] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Arumainayagam N, Ahmed HU, Moore CM, Freeman A, Allen C, Sohaib SA, Kirkham A, van der Meulen J, Emberton M. Multiparametric MR imaging for detection of clinically significant prostate cancer: a validation cohort study with transperineal template prostate mapping as the reference standard. Radiology 2013; 268:761-9. [PMID: 23564713 DOI: 10.1148/radiol.13120641] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of multiparametric (MP) magnetic resonance (MR) imaging for prostate cancer detection by using transperineal template prostate mapping (TTPM) biopsies as the reference standard and to determine the potential ability of MP MR imaging to identify clinically significant prostate cancer. MATERIALS AND METHODS Institutional review board exemption was granted by the local research ethics committee for this retrospective study. Included were 64 men (mean age, 62 years [range, 40-76]; mean prostate-specific antigen, 8.2 ng/mL [8.2 μg/L] [range, 2.1-43 ng/mL]), 51 with biopsy-proved cancer and 13 suspected of having clinically significant cancer that was biopsy negative or without prior biopsy. MP MR imaging included T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging (1.5 T, pelvic phased-array coil). Three radiologists independently reviewed images and were blinded to results of biopsy. Two-by-two tables were derived by using sectors of analysis of four quadrants, two lobes, and one whole prostate. Primary target definition for clinically significant disease necessary to be present within a sector of analysis on TTPM for that sector to be deemed positive was set at Gleason score of 3+4 or more and/or cancer core length involvement of 4 mm or more. Sensitivity, negative predictive value, and negative likelihood ratio were calculated to determine ability of MP MR imaging to rule out cancer. Specificity, positive predictive value, positive likelihood ratio, accuracy (overall fraction correct), and area under receiver operating characteristic curves were also calculated. RESULTS Twenty-eight percent (71 of 256) of sectors had clinically significant cancer by primary endpoint definition. For primary endpoint definition (≥ 4 mm and/or Gleason score ≥ 3+4), sensitivity, negative predictive value, and negative likelihood ratios were 58%-73%, 84%-89%, and 0.3-0.5, respectively. Specificity, positive predictive value, and positive likelihood ratios were 71%-84%, 49%-63%, and 2.-3.44, respectively. Area under the curve values were 0.73-0.84. CONCLUSION Results of this study indicate that MP MR imaging has a high negative predictive value to rule out clinically significant prostate cancer and may potentially have clinical use in diagnostic pathways of men at risk.
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Affiliation(s)
- Nimalan Arumainayagam
- Division of Surgery and Interventional Sciences, University College, Charles Bell House, 67-73 Riding House St, London W1W 7EJ, England
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Abstract
Prostate cancer is a heterogeneous disease, and its management is now evolving to become more personalized and to incorporate new targeted therapies. With these new changes comes a demand for molecular imaging techniques that can not only detect disease but also assess biology and treatment response. This review article summarizes current molecular imaging approaches in prostate cancer (e.g. 99mTc bone scintigraphy and 18F-fluorodeoxyglucose positron emission tomography) and highlights emerging clinical and preclinical imaging agents, with an emphasis on mechanism and clinical application. Emerging agents at various stages of clinical translation include radiolabeled analogs of lipid, amino acid, and nucleoside metabolism, as well as agents more specifically targeting prostate cancer biomarkers including androgen receptor, prostate-specific membrane antigen and others. We also highlight new techniques and targeted contrast agents for magnetic resonance imaging and spectroscopy. For all these imaging techniques, a growing and important unmet need is for well-designed prospective clinical trials to establish clear indications with clinical benefit in prostate cancer.
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Affiliation(s)
- Ana P. Kiess
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Steve Y. Cho
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin G. Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
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Chang JH, Lim Joon D, Nguyen BT, Hiew CY, Esler S, Angus D, Chao M, Wada M, Quong G, Khoo V. MRI scans significantly change target coverage decisions in radical radiotherapy for prostate cancer. J Med Imaging Radiat Oncol 2013; 58:237-43. [PMID: 24690247 DOI: 10.1111/1754-9485.12107] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 07/25/2013] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Conventional clinical staging for prostate cancer has many limitations. This study evaluates the impact of adding MRI scans to conventional clinical staging for guiding decisions about radiotherapy target coverage. METHODS This was a retrospective review of 115 patients who were treated between February 2002 and September 2005 with radical radiotherapy for prostate cancer. All patients had MRI scans approximately 2 weeks before the initiation of radiotherapy. The T stage was assessed by both conventional clinical methods (cT-staging) as well as by MRI (mT-staging). The radiotherapy target volumes were determined first based on cT-staging and then taking the additional mT staging into account. The number of times extracapsular extension or seminal vesicle invasion was incorporated into target volumes was quantified based on both cT-staging and the additional mT-staging. RESULTS Extracapsular extension was incorporated into target volumes significantly more often with the addition of mT-staging (46 patients (40%) ) compared with cT-staging alone (37 patients (32%) ) (P = 0.002). Seminal vesicle invasion was incorporated into target volumes significantly more often with the addition of mT-staging (21 patients (18%) ) compared with cT-staging alone (three patients (3%) ) (P < 0.001). A total of 23 patients (20%) had changes to their target coverage based on the mT-staging. CONCLUSIONS MRI scans can significantly change decisions about target coverage in radical radiotherapy for prostate cancer.
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Affiliation(s)
- Joe H Chang
- Radiation Oncology Centre, Austin Health, Melbourne, Victoria, Australia; Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
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Kuru TH, Roethke MC, Rieker P, Roth W, Fenchel M, Hohenfellner M, Schlemmer HP, Hadaschik BA. Histology core-specific evaluation of the European Society of Urogenital Radiology (ESUR) standardised scoring system of multiparametric magnetic resonance imaging (mpMRI) of the prostate. BJU Int 2013; 112:1080-7. [PMID: 23937255 DOI: 10.1111/bju.12259] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the Prostate Imaging Reporting and Data System (PIRADS) in multiparametric magnetic resonance imaging (mpMRI) based on single cores and single-core histology. To calculate positive (PPV) and negative predictive values (NPV) of different modalities of mpMRI. PATIENTS AND METHODS We performed MRI-targeted transrectal ultrasound-guided perineal prostate biopsies on 50 patients (mean age 66 years, mean PSA level of 9.9 ng/mL) with suspicion of prostate cancer. The biopsy trajectories of every core taken were documented in three dimensions (3D) in a 3D-prostate model. Every core was evaluated separately for prostate cancer and the performed biopsy trajectories were projected on mpMRI images. PIRADS scores of 1177 cores were then assessed by a histology 'blinded' uro-radiologist in T2-weighted (T2W), dynamic contrast-enhanced (DCE), diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS). RESULTS The PIRADS score was significantly higher in cores positive for cancer than in negative cores. There was a significant correlation between the PIRADS score and histopathology for every modality. Receiver operating characteristic (ROC) analysis showed excellent specificity for T2W (90% peripheral zone/97% transition zone) and DWI (98%/97%) images regardless of the prostate region observed. These numbers decreased for DCE (80%/93%) and MRS (76%/83%). All modalities had NPVs of 99%, if a PIRADS score threshold of 2 (for T2W, DCE, and MRS) or 3 (for DWI) was used. However, PPVs were low. CONCLUSIONS Our results show that PIRADS scoring is feasible for clinical routine and allows standardised reporting. PIRADS can be used as a decision-support system for targeting of suspicious lesions. mpMRI has a high NPV for prostate cancer and, thus, might be a valuable tool in the initial diagnostic evaluation.
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Affiliation(s)
- Timur H Kuru
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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135
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Van den Bergh L, Isebaert S, Koole M, Oyen R, Joniau S, Lerut E, Deroose C, De Keyzer F, Van Poppel H, Haustermans K. Does 11C-choline PET-CT contribute to multiparametric MRI for prostate cancer localisation? Strahlenther Onkol 2013; 189:789-95. [DOI: 10.1007/s00066-013-0359-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
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Maas MC, Vos EK, Lagemaat MW, Bitz AK, Orzada S, Kobus T, Kraff O, Maderwald S, Ladd ME, Scheenen TWJ. Feasibility of T2 -weighted turbo spin echo imaging of the human prostate at 7 tesla. Magn Reson Med 2013; 71:1711-9. [PMID: 23798333 DOI: 10.1002/mrm.24818] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/03/2013] [Accepted: 05/02/2013] [Indexed: 11/09/2022]
Abstract
PURPOSE To demonstrate that high quality T2 -weighted (T2w) turbo spin-echo (TSE) imaging of the complete prostate can be achieved routinely and within safety limits at 7 T, using an external transceive body array coil only. METHODS Nine healthy volunteers and 12 prostate cancer patients were scanned on a 7 T whole-body system. Preparation consisted of B0 and radiofrequency shimming and localized flip angle calibration. T1 and T2 relaxation times were measured and used to define the T2w-TSE protocol. T2w imaging was performed using a TSE sequence (pulse repetition time/echo time 3000-3640/71 ms) with prolonged excitation and refocusing pulses to reduce specific absorption rate. RESULTS High quality T2w TSE imaging was performed in less than 2 min in all subjects. Tumors of patients with gold-standard tumor localization (MR-guided biopsy or prostatectomy) were well visualized on 7 T imaging (n = 3). The number of consecutive slices achievable within a 10-g averaged specific absorption rate limit of 10 W/kg was ≥28 in all subjects, sufficient for full prostate coverage with 3-mm slices in at least one direction. CONCLUSION High quality T2w TSE prostate imaging can be performed routinely and within specific absorption rate limits at 7 T with an external transceive body array.
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Affiliation(s)
- Marnix C Maas
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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137
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Incremental value of magnetic resonance imaging for clinically high risk prostate cancer in 922 radical prostatectomies. J Urol 2013; 190:2054-60. [PMID: 23791890 DOI: 10.1016/j.juro.2013.06.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2013] [Indexed: 01/19/2023]
Abstract
PURPOSE We investigated the incremental value of magnetic resonance imaging in addition to clinical variables for predicting pathological outcomes and disease recurrence in patients with clinically high risk prostate cancer. MATERIALS AND METHODS A total of 922 consecutive patients with clinically high risk prostate cancer underwent magnetic resonance imaging before radical prostatectomy. We created multivariate logistic regression and Cox proportional hazards models with clinical variables only or combined with magnetic resonance imaging data to predict pathological outcomes and biochemical recurrence. The models were compared using ROC curves and the Harrell concordance index. RESULTS The proportion of patients with pathological extracapsular extension, seminal vesicle invasion and lymph node metastasis was 57.5%, 12.7% and 6.3%, respectively. The sensitivity and specificity of extracapsular extension, seminal vesicle invasion and lymph node metastasis detection were 43% and 84.2%, 34.9% and 93.8%, and 14.0% and 96.9%, respectively. The area under the ROC curve of the model with clinical variable and magnetic resonance imaging data was greater than that of the model with clinical variables alone to predict extracapsular extension and seminal vesicle invasion (0.734 vs 0.697, p=0.001 and 0.750 vs 0.698, p<0.001, respectively). The 5-year biochemical recurrence-free survival rate was 56.1%. To predict biochemical recurrence the concordance index of the multivariate model with clinical variables only and with clinical variables plus magnetic resonance imaging data was 0.563 and 0.599, respectively (p=0.003). CONCLUSIONS Magnetic resonance imaging findings have incremental value in addition to clinical variables for predicting pathological outcomes and disease recurrence.
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138
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In vivo 3D neuroanatomical evaluation of periprostatic nerve plexus with 3T-MR Diffusion Tensor Imaging. Eur J Radiol 2013; 82:1677-82. [PMID: 23773553 DOI: 10.1016/j.ejrad.2013.05.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate if Diffusion Tensor Imaging technique (DTI) can improve the visualization of periprostatic nerve fibers describing the location and distribution of entire neurovascular plexus around the prostate in patients who are candidates for prostatectomy. MATERIALS AND METHODS Magnetic Resonance Imaging (MRI), including a 2D T2-weighted FSE sequence in 3 planes, 3D T2-weighted and DTI using 16 gradient directions and b=0 and 1000, was performed on 36 patients. Three out of 36 patients were excluded from the analysis due to poor image quality (blurring N=2, artifact N=1). The study was approved by local ethics committee and all patients gave an informed consent. Images were evaluated by two radiologists with different experience in MRI. DTI images were analyzed qualitatively using dedicated software. Also 2D and 3D T2 images were independently considered. RESULTS 3D-DTI allowed description of the entire plexus of the periprostatic nerve fibers in all directions, while 2D and 3D T2 morphological sequences depicted part of the fibers, in a plane by plane analysis of fiber courses. DTI demonstrated in all patients the dispersion of nerve fibers around the prostate on both sides including the significant percentage present in the anterior and anterolateral sectors. CONCLUSIONS DTI offers optimal representation of the widely distributed periprostatic plexus. If validated, it may help guide nerve-sparing radical prostatectomy.
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Partanen A, Yerram NK, Trivedi H, Dreher MR, Oila J, Hoang AN, Volkin D, Nix J, Turkbey B, Bernardo M, Haines DC, Benjamin CJ, Linehan WM, Choyke P, Wood BJ, Ehnholm GJ, Venkatesan AM, Pinto PA. Magnetic resonance imaging (MRI)-guided transurethral ultrasound therapy of the prostate: a preclinical study with radiological and pathological correlation using customised MRI-based moulds. BJU Int 2013; 112:508-16. [PMID: 23746198 DOI: 10.1111/bju.12126] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To characterise the feasibility and safety of a novel transurethral ultrasound (US)-therapy device combined with real-time multi-plane magnetic resonance imaging (MRI)-based temperature monitoring and temperature feedback control, to enable spatiotemporally precise regional ablation of simulated prostate gland lesions in a preclinical canine model. To correlate ablation volumes measured with intra-procedural cumulative thermal damage estimates, post-procedural MRI, and histopathology. MATERIALS AND METHODS Three dogs were treated with three targeted ablations each, using a prototype MRI-guided transurethral US-therapy system (Philips Healthcare, Vantaa, Finland). MRI provided images for treatment planning, guidance, real-time multi-planar thermometry, as well as post-treatment evaluation of efficacy. After treatment, specimens underwent histopathological analysis to determine the extent of necrosis and cell viability. Statistical analyses (Pearson's correlation, Student's t-test) were used to evaluate the correlation between ablation volumes measured with intra-procedural cumulative thermal damage estimates, post-procedural MRI, and histopathology. RESULTS MRI combined with a transurethral US-therapy device enabled multi-planar temperature monitoring at the target as well as in surrounding tissues, allowing for safe, targeted, and controlled ablations of prescribed lesions. Ablated volumes measured by cumulative thermal dose positively correlated with volumes determined by histopathological analysis (r(2) 0.83, P < 0.001). Post-procedural contrast-enhanced and diffusion-weighted MRI showed a positive correlation with non-viable areas on histopathological analysis (r(2) 0.89, P < 0.001, and r(2) 0.91, P = 0.003, respectively). Additionally, there was a positive correlation between ablated volumes according to cumulative thermal dose and volumes identified on post-procedural contrast-enhanced MRI (r(2) 0.77, P < 0.01). There was no difference in mean ablation volumes assessed with the various analysis methods (P > 0.05, Student's t-test). CONCLUSIONS MRI-guided transurethral US therapy enabled safe and targeted ablations of prescribed lesions in a preclinical canine prostate model. Ablation volumes were reliably predicted by intra- and post-procedural imaging. Clinical studies are needed to confirm the feasibility, safety, oncological control, and functional outcomes of this therapy in patients in whom focal therapy is indicated.
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Affiliation(s)
- Ari Partanen
- Philips Healthcare, Cleveland, OH; Department of Physics, University of Helsinki, Helsinki, Finland
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Chesnais A, Niaf E, Bratan F, Mège-Lechevallier F, Roche S, Rabilloud M, Colombel M, Rouvière O. Differentiation of transitional zone prostate cancer from benign hyperplasia nodules: Evaluation of discriminant criteria at multiparametric MRI. Clin Radiol 2013; 68:e323-30. [DOI: 10.1016/j.crad.2013.01.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/12/2013] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
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141
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Mazzoni LN, Lucarini S, Chiti S, Busoni S, Gori C, Menchi I. Diffusion-weighted signal models in healthy and cancerous peripheral prostate tissues: Comparison of outcomes obtained at different b-values. J Magn Reson Imaging 2013; 39:512-8. [DOI: 10.1002/jmri.24184] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/01/2013] [Indexed: 01/31/2023] Open
Affiliation(s)
- Lorenzo N. Mazzoni
- Health Physics Unit; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Silvia Lucarini
- Medical Imaging Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Stefano Chiti
- Medical Imaging Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Simone Busoni
- Health Physics Unit; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Cesare Gori
- Health Physics Unit; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Ilario Menchi
- Medical Imaging Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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Horwich A, Hugosson J, de Reijke T, Wiegel T, Fizazi K, Kataja V, Parker C, Bellmunt J, Berthold D, Bill-Axelson A, Carlsson S, Daugaard G, De Meerleer G, de Reijke T, Dearnaley D, Fizazi K, Fonteyne V, Gillessen S, Heinrich D, Horwich A, Hugosson J, Kataja V, Kwiatkowski M, Nilsson S, Padhani A, Papandreou C, Parker C, Roobol M, Sella A, Valdagni R, Van der Kwast T, Verhagen P, Wiegel T. Prostate cancer: ESMO Consensus Conference Guidelines 2012. Ann Oncol 2013; 24:1141-62. [DOI: 10.1093/annonc/mds624] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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143
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Brachytherapy in Men with Prostate Cancer: Update on Indications and Outcomes. Urologia 2013; 80:87-98. [DOI: 10.5301/ru.2013.11285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Brachytherapy (BT), using either a low-dose-rate (LDR) or mostly high-dose-rate (HDR) technique, is the device able to deliver the highest dose-rate in the most conformal way It is used as monotherapy or in combination with external beam radiotherapy (EBRT). LDR-BT is mostly used as monotherapy; HDR-BT is combined with EBRT +/– adjuvant hormone therapy In patients with low-risk disease and in selected intermediate-risk patients, LDR-BT ensures long-term good disease control rates and HDR-BT shows similar results, even if with shorter follow-up. In patients with intermediate/high risk disease the combination therapy (EBRT + HDR-BT) provides better oncological outcomes compared to EBRT monotherapy, even if the role of adjuvant hormone therapy is still unclear. Literature shows variable efficacy of BT in case of local recurrence after EBRT and radical prostatectomy even if few cases have been reported with short follow-up. Side effects are acceptable (urogenital toxicity, urinary incontinence, sexual function) and comparable with the other treatment modalities. So far, randomized controlled trials comparing the different treatment modalities are necessary to clarify indications and real efficacy.
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Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. Eur Radiol 2013; 23:2019-29. [PMID: 23494494 DOI: 10.1007/s00330-013-2795-0] [Citation(s) in RCA: 212] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/06/2013] [Accepted: 01/11/2013] [Indexed: 01/18/2023]
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145
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Simpkin CJ, Morgan VA, Giles SL, Riches SF, Parker C, deSouza NM. Relationship between T2 relaxation and apparent diffusion coefficient in malignant and non-malignant prostate regions and the effect of peripheral zone fractional volume. Br J Radiol 2013; 86:20120469. [PMID: 23426849 DOI: 10.1259/bjr.20120469] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To establish whether T2 relaxation and apparent diffusion coefficient (ADC) in normal prostate and tumour are related and to investigate the effects of glandular compression from an enlarged transition zone (TZ) on peripheral zone (PZ) T2 and ADC by correlating them with the peripheral zone fractional volume (PZFV). METHODS 48 consecutive patients prospectively underwent multiecho T2 weighted (T2W) (echo times 20, 40, 60, 80, 100 ms) and diffusion-weighted (b=0, 100, 300, 500, 800 s mm(-2)) endorectal MRI. In 43 evaluable patients, single slice whole PZ, TZ and tumour (focal hypointense signal on T2W images in a biopsy-positive octant) regions of interest were transferred to T2 and ADC maps by slice matching. T2 and ADC values were correlated, and PZ values were correlated with PZFV. RESULTS T2 and ADC values were significantly different among groups [T2 mean±standard deviation (SD) PZ, 149±49 ms; TZ, 125±26 ms; tumour, 97±23 ms; PZ vs TZ, p=0.002; PZ vs tumour, p<0.0001; TZ vs tumour, p<0.0001; ADC×10(-6) mm(2) s(-1) mean±SD PZ, 1680±215; TZ, 1478±139; tumour, 1030±205; p<0.0001]. Significant positive correlations existed between T2 and ADC for PZ, TZ, PZ and TZ together, but not for tumour (r=0.515, p<0.0001; r=0.300, p=0.03; r=0.526, p<0.0001; and r=0.239, p=0.32, respectively). No significant correlation existed between PZFV and PZ T2 (r=0.10, p=0.5) or ADC (r=0.03, p=0.8). CONCLUSION The correlation between T2 and ADC that exists in normal prostate is absent in tumour. PZ compression by an enlarged TZ does not alter PZ T2 or ADC to affect tumour-PZ contrast. ADVANCES IN KNOWLEDGE Microstructural features of tumours alter diffusivity independently of their effects on T2 relaxation.
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Affiliation(s)
- C J Simpkin
- Cancer Research UK/EPSRC Imaging Centre, Institute of Cancer Research, Sutton, UK
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Le score PCA3 et l’IRM prostatique permettent-ils de sélectionner les patients candidats a une première série de biopsies prostatiques ? Prog Urol 2013; 23:121-7. [DOI: 10.1016/j.purol.2012.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 08/07/2012] [Accepted: 09/09/2012] [Indexed: 11/23/2022]
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147
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Hegele A, Skrobek L, Hofmann R, Olbert P. [Multiparametric MRI, elastography, contrastenhanced TRUS. Are there indications with reliable diagnostic advantages before prostate biopsy?]. Urologe A 2013; 51:1270-7. [PMID: 22648559 DOI: 10.1007/s00120-012-2874-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Prostate cancer (PCA) is the most common malignancy in men with an increasing incidence and is responsible for about 11,000 deaths per year in Germany. Fortunately, the mortality of PCA has decreased in recent years despite the rising incidence reflecting improvements in diagnostic methods. Many new innovations in imaging techniques for PCA are available and may be helpful in early detection of PCA. Contrast-enhanced sonography, computer-assisted sonography, elastography and multiparametric magnetic resonance imaging (MRI) seem to be the most promising methods to increase the detection rate of PCA during diagnostic work-up. The value of these new innovative techniques concerning improvement in PCA detection is reviewed.
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Affiliation(s)
- A Hegele
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Gießen und Marburg, Philipps-Universität, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
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Kuru TH, Simpfendörfer T, Roethke M, Hohenfellner M, Hadaschik BA. Improving Accuracy in Image-Guided Prostate Biopsy by Using Trocar-Sharpened Needles. Urol Int 2013; 91:404-9. [DOI: 10.1159/000350653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 03/07/2013] [Indexed: 11/19/2022]
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Korhonen J, Kapanen M, Keyriläinen J, Seppälä T, Tuomikoski L, Tenhunen M. Absorbed doses behind bones with MR image-based dose calculations for radiotherapy treatment planning. Med Phys 2012; 40:011701. [DOI: 10.1118/1.4769407] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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150
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Soloperto G, Conversano F, Greco A, Casciaro E, Franchini R, Casciaro S. Advanced spectral analyses for real-time automatic echographic tissue-typing of simulated tumor masses at different compression stages. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2012; 59:2692-2701. [PMID: 23221218 DOI: 10.1109/tuffc.2012.2510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Prototypal software algorithms for advanced spectral analysis of echographic images were developed to perform automatic detection of simulated tumor masses at two different pathological stages. Previously published works documented the possibility of characterizing macroscopic variation of mechanical properties of tissues through elastographic techniques, using different imaging modalities, including ultrasound (US); however, the accuracy of US-based elastography remains affected by the variable manual modality of the applied compression and several attempts are under investigation to overcome this limitation. Quantitative US (QUS), such as Fourier- and wavelet-based analyses of the RF signal associated with the US images, has been developed to perform a microscopic-scale tissue-type imaging offering new solutions for operator-independent examinations. Because materials able to reproduce the harmonic behavior of human liver can be realized, in this study, tissue-mimicking structures were US imaged and the related RF signals were analyzed using wavelet transform through an in-house-developed algorithm for tissue characterization. The classification performance and reliability of the procedure were evaluated on two different tumor stiffnesses (40 and 130 kPa) and with two different applied compression levels (0 and 3.5 N). Our results demonstrated that spectral components associated with different levels of tissue stiffness within the medium exist and can be mapped onto the original US images independently of the applied compressive forces. This wavelet-based analysis was able to identify different tissue stiffness with satisfactory average sensitivity and specificity: respectively, 72.01% ± 1.70% and 81.28% ± 2.02%.
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Affiliation(s)
- Giulia Soloperto
- Bioengineering Division of the National Research Council, Institute of Clinical Physiology, Lecce, Italy
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