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Palmeri ML, Miller ZA, Glass TJ, Garcia-Reyes K, Gupta RT, Rosenzweig SJ, Kauffman C, Polascik TJ, Buck A, Kulbacki E, Madden J, Lipman SL, Rouze NC, Nightingale KR. B-mode and acoustic radiation force impulse (ARFI) imaging of prostate zonal anatomy: comparison with 3T T2-weighted MR imaging. ULTRASONIC IMAGING 2015; 37:22-41. [PMID: 25060914 PMCID: PMC4423560 DOI: 10.1177/0161734614542177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Prostate cancer (PCa) is the most common non-cutaneous malignancy among men in the United States and the second leading cause of cancer-related death. Multi-parametric magnetic resonance imaging (mpMRI) has gained recent popularity to characterize PCa. Acoustic Radiation Force Impulse (ARFI) imaging has the potential to aid PCa diagnosis and management by using tissue stiffness to evaluate prostate zonal anatomy and lesions. MR and B-mode/ARFI in vivo imaging datasets were compared with one another and with gross pathology measurements made immediately after radical prostatectomy. Images were manually segmented in 3D Slicer to delineate the central gland (CG) and prostate capsule, and 3D models were rendered to evaluate zonal anatomy dimensions and volumes. Both imaging modalities showed good correlation between estimated organ volume and gross pathologic weights. Ultrasound and MR total prostate volumes were well correlated (R(2) = 0.77), but B-mode images yielded prostate volumes that were larger (16.82% ± 22.45%) than MR images, due to overestimation of the lateral dimension (18.4% ± 13.9%), with less significant differences in the other dimensions (7.4% ± 17.6%, anterior-to-posterior, and -10.8% ± 13.9%, apex-to-base). ARFI and MR CG volumes were also well correlated (R(2) = 0.85). CG volume differences were attributed to ARFI underestimation of the apex-to-base axis (-28.8% ± 9.4%) and ARFI overestimation of the lateral dimension (21.5% ± 14.3%). B-mode/ARFI imaging yielded prostate volumes and dimensions that were well correlated with MR T2-weighted image (T2WI) estimates, with biases in the lateral dimension due to poor contrast caused by extraprostatic fat. B-mode combined with ARFI imaging is a promising low-cost, portable, real-time modality that can complement mpMRI for PCa diagnosis, treatment planning, and management.
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Affiliation(s)
- Mark L Palmeri
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Zachary A Miller
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Tyler J Glass
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | | | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Stephen J Rosenzweig
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | | | - Thomas J Polascik
- Department of Surgery (Urology), Duke University Medical Center, Durham, NC, USA
| | - Andrew Buck
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Evan Kulbacki
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - John Madden
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Samantha L Lipman
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Ned C Rouze
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Kathryn R Nightingale
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
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152
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Commandeur F, Acosta O, Simon A, Mathieu R, Fautrel A, Gnep K, Haigron P, de Crevoisier R. Prostate whole-mount histology reconstruction and registration to MRI for correlating in-vivo observations with biological findings. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:2399-2402. [PMID: 26736777 DOI: 10.1109/embc.2015.7318877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Multi-parametric magnetic resonance imaging (mMRI) is the standard exam for prostate cancer diagnosis, staging and risk assessment in current clinical routine. Correlating mMRI in-vivo observations with biological findings from radical prostatectomy specimen would improve the optimal therapy selection. Thus, we proposed a method for reconstructing and registering the prostate whole-mount histology (WMH) to the MRI, considering a thin slicing of the prostatectomy specimen. The method was evaluated on 3 patients, included in a prospective study, for which hematein-eosinsafran and immunohistochemistry stainings were performed. The registration error was assessed by measuring the Euclidean distance between landmarks, previously identified by an expert on both mMRI and histological slices. The mean error was 4:90α1:34 mm. Our method demonstrated promising results for registering prostate WMH to in-vivo mMRI, thus allowing for spatial accurate correlation between radiologic observations and biological information.
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153
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Lim C, Quon J, McInnes M, Shabana WM, El-Khodary M, Schieda N. Does a cleansing enema improve image quality of 3T surface coil multiparametric prostate MRI? J Magn Reson Imaging 2014; 42:689-97. [PMID: 25556957 DOI: 10.1002/jmri.24833] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 12/08/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assesses the utility of a preparatory enema in the interpretation of prostate multiparametric (MP) magnetic resonance imaging (MRI). MATERIALS AND METHODS Under a waiver from the Institutional Review Board (IRB), 32 patients without bowel preparation and 28 patients who underwent a self-administered enema were imaged consecutively with 3T MP-MRI over 6 months. Two blinded radiologists independently assessed image quality on T2 -weighted (T2 W), trace b 1000 mm(2) /sec echo-planar (EPI) and apparent-diffusion coefficient (ADC) and assessed for motion/blur on T2 W and distortion/blur on EPI and ADC. Radiologists also quantified rectal stool and gas. A third blinded radiologist generated contrast curves from dynamic contrast-enhanced (DCE) data at six locations and measured the number of corrupted data points, defined as >10% aberrant signal intensity change. Subjective scores were compared using Wilcoxon sign rank test. Rectal contents were correlated to artifact using Spearman correlation. Contrast curves were evaluated with independent t-tests. RESULTS There was no difference in image quality on T2 W (P = 0.66-0.74), EPI (P = 0.13-0.36) or ADC (P = 0.49-0.59). There was less rectal stool in the enema group (P = 0.004) and amount of stool correlated with motion artifact on T2 W (r = 0.23, P = 0.02); however, there was no difference in motion artifact between groups (P = 0.47-0.94). Only a minority of patients in the non-enema group had moderate or large amounts of stool (16%) and none of these patients had severe or extensive artifact on T2 . There was less rectal gas in the enema group (P = 0.002); however, amount of gas did not correlate with distortion artifact on EPI or ADC (P = 0.17-0.41) and there was no difference in blur (P = 0.41-0.91) or distortion (P = 0.31-0.99) on EPI or ADC between groups. There was no difference in corrupted data points on DCE (P = 0.46). CONCLUSION In this study the use of a preparatory enema did not improve image quality or reduce artifact in prostate MP-MRI.
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Affiliation(s)
- Christopher Lim
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
| | - Jeff Quon
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
| | - Matt McInnes
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
| | - Wael M Shabana
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
| | - Mohamed El-Khodary
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
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154
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Mukherjee A, Morton S, Fraser S, Salmond J, Baxter G, Leung HY. Magnetic resonance imaging-directed transperineal limited-mapping prostatic biopsies to diagnose prostate cancer: a Scottish experience. Scott Med J 2014; 59:204-8. [PMID: 25314954 DOI: 10.1177/0036933014556197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transperineal prostatic biopsy is firmly established as an important tool in the diagnosis of prostate cancer. The benefit of additional imaging (magnetic resonance imaging) to target biopsy remains to be fully addressed. METHODS Using a cohort of consecutive patients undergoing transperineal template mapping biopsies, we studied positive biopsies in the context of magnetic resonance imaging findings and examined the accuracy of magnetic resonance imaging in predicting the location of transperineal template mapping biopsies-detected prostate cancer. RESULTS Forty-four patients (mean age: 65 years, range 53-78) underwent transperineal template mapping biopsies. Thirty-four patients had 1-2 and 10 patients had ≥3 previous transrectal ultrasound scan-guided biopsies. The mean prostate-specific antigen was 15 ng/mL (range 2.5-79 ng/mL). High-grade prostatic intraepithelial neoplasia was found in 12 (27%) patients and prostate cancer with Gleason <7, 7 and >7 in 13, 10 and 8 patients, respectively. Suspicious lesions on magnetic resonance imaging scans were scored from 1 to 5. In 28 patients, magnetic resonance imaging detected lesions with score ≥3. Magnetic resonance imaging correctly localised transperineal template mapping biopsies-detected prostate cancer in a hemi-gland approach, particularly in a right to left manner (79% positive prediction rate), but not in a quadrant approach (33% positive prediction rate). CONCLUSION Our findings support the notion of magnetic resonance imaging-based selection of patients for transperineal template mapping biopsies and that lesions revealed by magnetic resonance imaging are likely useful for targeted biopsies.
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Affiliation(s)
- Ankur Mukherjee
- Core Surgical Trainee, Department of Urology, NHS Greater Glasgow and Clyde, UK
| | - Simon Morton
- Clinical Fellow, Department of Urology, NHS Greater Glasgow and Clyde, UK
| | - Sioban Fraser
- Consultant Pathologist, Department of Pathology, NHS Greater Glasgow and Clyde, UK
| | - Jonathan Salmond
- Consultant Pathologist, Department of Pathology, NHS Greater Glasgow and Clyde, UK
| | - Grant Baxter
- Consultant Radiologist, Department of Radiology, NHS Greater Glasgow and Clyde, UK
| | - Hing Y Leung
- Professor of Urology/Consultant Urologist, Department of Urology, NHS Greater Glasgow and Clyde, UK; Beatson Institute for Cancer Research, UK; Institute of Cancer Sciences, University of Glasgow, UK
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155
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Tilak G, Tuncali K, Song SE, Tokuda J, Olubiyi O, Fennessy F, Fedorov A, Penzkofer T, Tempany C, Hata N. 3T MR-guided in-bore transperineal prostate biopsy: A comparison of robotic and manual needle-guidance templates. J Magn Reson Imaging 2014; 42:63-71. [PMID: 25263213 DOI: 10.1002/jmri.24770] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 09/11/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To demonstrate the utility of a robotic needle-guidance template device as compared to a manual template for in-bore 3T transperineal magnetic resonance imaging (MRI)-guided prostate biopsy. MATERIALS AND METHODS This two-arm mixed retrospective-prospective study included 99 cases of targeted transperineal prostate biopsies. The biopsy needles were aimed at suspicious foci noted on multiparametric 3T MRI using manual template (historical control) as compared with a robotic template. The following data were obtained: the accuracy of average and closest needle placement to the focus, histologic yield, percentage of cancer volume in positive core samples, complication rate, and time to complete the procedure. RESULTS In all, 56 cases were performed using the manual template and 43 cases were performed using the robotic template. The mean accuracy of the best needle placement attempt was higher in the robotic group (2.39 mm) than the manual group (3.71 mm, P < 0.027). The mean core procedure time was shorter in the robotic (90.82 min) than the manual group (100.63 min, P < 0.030). Percentage of cancer volume in positive core samples was higher in the robotic group (P < 0.001). Cancer yields and complication rates were not statistically different between the two subgroups (P = 0.557 and P = 0.172, respectively). CONCLUSION The robotic needle-guidance template helps accurate placement of biopsy needles in MRI-guided core biopsy of prostate cancer.
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Affiliation(s)
- Gaurie Tilak
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sang-Eun Song
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Olutayo Olubiyi
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fiona Fennessy
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tobias Penzkofer
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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156
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Rais-Bahrami S, Turkbey B, Grant KB, Pinto PA, Choyke PL. Role of multiparametric magnetic resonance imaging in the diagnosis of prostate cancer. Curr Urol Rep 2014; 15:387. [PMID: 24430169 DOI: 10.1007/s11934-013-0387-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Prostate cancer is the most common solid-organ malignancy among American men. It is currently most commonly diagnosed on random systematic biopsies prompted by elevated serum PSA levels. Multi-parametric MRI (MP-MRI) of the prostate has emerged as an anatomic and functional imaging modality, which offers accurate detection, localization and staging of prostate cancer. Recently, MP-MRI has gained an increasing role in guiding biopsies to sites of abnormality and in monitoring patients on active surveillance. Here, we discuss the historical development, current role, and potential future directions of MP-MRI in the diagnosis of prostate cancer.
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Affiliation(s)
- Soroush Rais-Bahrami
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10 - CRC, Bethesda, MD, 20892, USA
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157
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Penzkofer T, Tuncali K, Fedorov A, Song SE, Tokuda J, Fennessy FM, Vangel MG, Kibel AS, Mulkern RV, Wells WM, Hata N, Tempany CMC. Transperineal in-bore 3-T MR imaging-guided prostate biopsy: a prospective clinical observational study. Radiology 2014; 274:170-80. [PMID: 25222067 DOI: 10.1148/radiol.14140221] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine the detection rate, clinical relevance, Gleason grade, and location of prostate cancer ( PCa prostate cancer ) diagnosed with and the safety of an in-bore transperineal 3-T magnetic resonance (MR) imaging-guided prostate biopsy in a clinically heterogeneous patient population. MATERIALS AND METHODS This prospective retrospectively analyzed study was HIPAA compliant and institutional review board approved, and informed consent was obtained. Eighty-seven men (mean age, 66.2 years ± 6.9) underwent multiparametric endorectal prostate MR imaging at 3 T and transperineal MR imaging-guided biopsy. Three subgroups of patients with at least one lesion suspicious for cancer were included: men with no prior PCa prostate cancer diagnosis, men with PCa prostate cancer who were undergoing active surveillance, and men with treated PCa prostate cancer and suspected recurrence. Exclusion criteria were prior prostatectomy and/or contraindication to 3-T MR imaging. The transperineal MR imaging-guided biopsy was performed in a 70-cm wide-bore 3-T device. Overall patient biopsy outcomes, cancer detection rates, Gleason grade, and location for each subgroup were evaluated and statistically compared by using χ(2) and one-way analysis of variance followed by Tukey honestly significant difference post hoc comparisons. RESULTS Ninety biopsy procedures were performed with no serious adverse events, with a mean of 3.7 targets sampled per gland. Cancer was detected in 51 (56.7%) men: 48.1% (25 of 52) with no prior PCa prostate cancer , 61.5% (eight of 13) under active surveillance, and 72.0% (18 of 25) in whom recurrence was suspected. Gleason pattern 4 or higher was diagnosed in 78.1% (25 of 32) in the no prior PCa prostate cancer and active surveillance groups. Gleason scores were not assigned in the suspected recurrence group. MR targets located in the anterior prostate had the highest cancer yield (40 of 64, 62.5%) compared with those for the other parts of the prostate (P < .001). CONCLUSION In-bore 3-T transperineal MR imaging-guided biopsy, with a mean of 3.7 targets per gland, allowed detection of many clinically relevant cancers, many of which were located anteriorly.
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Affiliation(s)
- Tobias Penzkofer
- From the Division of MRI in the Department of Radiology (T.P., K.T., A.F., S.S., J.T., F.M.F., R.V.M., W.M.W., N.H., C.M.C.T.) and the Division of Urology (A.S.K.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany (T.P.). Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.G.V.); Department of Radiology, Dana-Farber Cancer Institute, Boston, Mass (F.M.F.); and Department of Radiology, Children's Hospital, Boston, Mass (R.V.M.)
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158
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Tempany CMC, Jayender J, Kapur T, Bueno R, Golby A, Agar N, Jolesz FA. Multimodal imaging for improved diagnosis and treatment of cancers. Cancer 2014; 121:817-27. [PMID: 25204551 DOI: 10.1002/cncr.29012] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/03/2014] [Accepted: 07/14/2014] [Indexed: 12/17/2022]
Abstract
The authors review methods for image-guided diagnosis and therapy that increase precision in the detection, characterization, and localization of many forms of cancer to achieve optimal target definition and complete resection or ablation. A new model of translational, clinical, image-guided therapy research is presented, and the Advanced Multimodality Image-Guided Operating (AMIGO) suite is described. AMIGO was conceived and designed to allow for the full integration of imaging in cancer diagnosis and treatment. Examples are drawn from over 500 procedures performed on brain, neck, spine, thorax (breast, lung), and pelvis (prostate and gynecologic) areas and are used to describe how they address some of the many challenges of treating brain, prostate, and lung tumors. Cancer 2015;121:817-827. © 2014 American Cancer Society.
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Affiliation(s)
- Clare M C Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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159
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Cepek J, Lindner U, Ghai S, Louis AS, Davidson SRH, Gertner M, Hlasny E, Sussman MS, Fenster A, Trachtenberg J. Mechatronic system for in-bore MRI-guided insertion of needles to the prostate: An in vivo needle guidance accuracy study. J Magn Reson Imaging 2014; 42:48-55. [PMID: 25195664 DOI: 10.1002/jmri.24742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 08/11/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To present our experiences in initial clinical evaluation of a novel mechatronic system for in-bore guidance of needles to the prostate for MRI-guided prostate interventions in 10 patients. We report accuracy of this device in the context of focal laser ablation therapy for localized prostate cancer. METHODS An MRI-compatible needle guidance device was developed for transperineal prostate interventions. Ten patients underwent MRI-guided focal laser ablation therapy with device-mediated laser fiber delivery. We recorded needle guidance error and needle delivery time. RESULTS A total of 37 needle insertions were evaluated. Median needle guidance error was 3.5 mm (interquartile range, 2.1-5.4 mm), and median needle delivery time was 9 min (interquartile range, 6.5-12 min). CONCLUSION This system provides a reliable method of accurately aligning needle guides for in-bore transperineal needle delivery to the prostate.
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Affiliation(s)
- Jeremy Cepek
- Department of Surgical Oncology, Division of Urology, University Health Network, Toronto, Canada.,Robarts Research Institute, The University of Western Ontario, London, Canada
| | - Uri Lindner
- Department of Surgical Oncology, Division of Urology, University Health Network, Toronto, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Alyssa S Louis
- Department of Surgical Oncology, Division of Urology, University Health Network, Toronto, Canada
| | - Sean R H Davidson
- Ontario Cancer Institute, University Health Network, Toronto, Canada
| | - Mark Gertner
- Division of Biophysics and Bioimaging, Ontario Cancer Institute, University Health Network, Toronto, Canada
| | - Eugen Hlasny
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Marshall S Sussman
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Aaron Fenster
- Robarts Research Institute, The University of Western Ontario, London, Canada.,Biomedical Engineering, The University of Western Ontario, London, Canada
| | - John Trachtenberg
- Department of Surgical Oncology, Division of Urology, University Health Network, Toronto, Canada
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160
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Multiparametric MRI in biopsy guidance for prostate cancer: fusion-guided. BIOMED RESEARCH INTERNATIONAL 2014; 2014:439171. [PMID: 25126559 PMCID: PMC4122009 DOI: 10.1155/2014/439171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/09/2014] [Accepted: 06/11/2014] [Indexed: 12/21/2022]
Abstract
Prostate cancer (PCa) is the most common solid-organ malignancy among American men and the second most deadly. Current guidelines recommend a 12-core systematic biopsy following the finding of an elevated serum prostate-specific antigen (PSA). However, this strategy fails to detect an unacceptably high percentage of clinically significant cancers, leading researchers to develop new, innovative methods to improve the effectiveness of prostate biopsies. Multiparametric-MRI (MP-MRI) has emerged as a promising instrument in identifying suspicious regions within the prostate that require special attention on subsequent biopsy. Fusion platforms, which incorporate the MP-MRI into the biopsy itself and provide active targets within real-time imaging, have shown encouraging results in improving the detection rate of significant cancer. Broader applications of this technology, including MRI-guided focal therapy for prostate cancer, are in early phase trials.
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161
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Coffey N, Schieda N, Cron G, Gulavita P, Mai KT, Flood TA. Multi-parametric (mp) MRI of prostatic ductal adenocarcinoma. J Magn Reson Imaging 2014; 41:1639-45. [PMID: 25044687 DOI: 10.1002/jmri.24694] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 06/18/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Prostatic ductal adenocarcinoma (DCa) is an aggressive variant of conventional adenocarcinoma (CCa) with mixed DCa and CCa tumors comprising up to 5% of all prostate cancers. DCa may be underestimated on T2-weighted (T2W) MRI. This study assessed the mp-MRI appearance of DCa as compared with CCa. METHODS With research ethics board approval, we identified 38 patients who underwent mp-MRI (T2W, DWI, and DCE) and radical prostatectomy (RP) between 2012 and 2014. Eight DCa in 8 patients and 39 CCa tumor foci in 30 consecutive patients were identified. Tumor volume, apparent diffusion coefficient (ADC;10(-3) mm(2) /s), and time-signal intensity (SI) curves were calculated. Parametric data were compared using the Kruskal-Wallis test and univariate regression. Time-SI curves were compared using the chi-square test. RESULTS Tumor volumes were: 1.62(±1.02) for DCa, 1.03(±0.54) for Gleason 9, 0.88(±0.93) for Gleason 7/8, and 0.26(±0.14) mL for Gleason 6. There was no difference in size between DCa and Gleason 9 (P = 0.22); however, DCa were larger than Gleason 7/8 (P = 0.03) and Gleason 6 (P = 0.003) tumors. ADC values were: 0.789(±0.22) for DCa, 1.01(±0.19) for Gleason 9, 0.992(±0.23) for Gleason 7/8 and 1.389(±0.41) 10(-3) mm(2) /s for Gleason 6 tumors. There was no difference in ADC between DCa and Gleason 9 (P = 0.14) or Gleason 7/8 (P = 0.055) tumors. There was a difference in ADC for DCa and Gleason ≥7 CCa compared to Gleason 6 tumors, (P < 0.001 and P = 0.012). All DCa demonstrated type III time-SI curves. Gleason ≥ 7 tumors demonstrated type II/III curves. Gleason 6 tumors demonstrated Type I/II time-SI curves. There was no difference in curve type between groups, (P = 0.18). CONCLUSION Although DCa mimics Gleason score 3 + 3 = 6 tumor at T2W MRI; DCa resembles Gleason ≥7 CCa on mp-MRI.
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Affiliation(s)
- Niamh Coffey
- The Ottawa Hospital, The University of Ottawa, Department of Medical Imaging, Ottawa, Ontario, Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa, Department of Medical Imaging, Ottawa, Ontario, Canada
| | - Greg Cron
- The Ottawa Hospital, The University of Ottawa, Department of Medical Imaging, Ottawa, Ontario, Canada
| | - Previn Gulavita
- The Ottawa Hospital, The University of Ottawa, Department of Anatomical Pathology, Ottawa, Ontario, Canada
| | - Kien T Mai
- The Ottawa Hospital, The University of Ottawa, Department of Anatomical Pathology, Ottawa, Ontario, Canada
| | - Trevor A Flood
- The Ottawa Hospital, The University of Ottawa, Department of Anatomical Pathology, Ottawa, Ontario, Canada
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162
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Haq NF, Kozlowski P, Jones EC, Chang SD, Goldenberg SL, Moradi M. A data-driven approach to prostate cancer detection from dynamic contrast enhanced MRI. Comput Med Imaging Graph 2014; 41:37-45. [PMID: 25060941 DOI: 10.1016/j.compmedimag.2014.06.017] [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] [Received: 01/09/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
Magnetic resonance imaging (MRI), particularly dynamic contrast enhanced (DCE) imaging, has shown great potential in prostate cancer diagnosis and staging. In the current practice of DCE-MRI, diagnosis is based on quantitative parameters extracted from the series of T1-weighted images acquired after the injection of a contrast agent. To calculate these parameters, a pharmacokinetic model is fitted to the T1-weighted intensities. Most models make simplistic assumptions about the perfusion process. Moreover, these models require accurate estimation of the arterial input function, which is challenging. In this work we propose a data-driven approach to characterization of the prostate tissue that uses the time series of DCE T1-weighted images without pharmacokinetic modeling. This approach uses a number of model-free empirical parameters and also the principal component analysis (PCA) of the normalized T1-weighted intensities, as features for cancer detection from DCE MRI. The optimal set of principal components is extracted with sparse regularized regression through least absolute shrinkage and selection operator (LASSO). A support vector machine classifier was used with leave-one-patient-out cross validation to determine the ability of this set of features in cancer detection. Our data is obtained from patients prior to radical prostatectomy and the results are validated based on histological evaluation of the extracted specimens. Our results, obtained on 449 tissue regions from 16 patients, show that the proposed data-driven features outperform the traditional pharmacokinetic parameters with an area under ROC of 0.86 for LASSO-isolated PCA parameters, compared to 0.78 for pharmacokinetic parameters. This shows that our novel approach to the analysis of DCE data has the potential to improve the multiparametric MRI protocol for prostate cancer detection.
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Affiliation(s)
| | | | | | | | | | - Mehdi Moradi
- University of British Columbia, Vancouver, BC, Canada.
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163
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Logan JK, Rais-Bahrami S, Turkbey B, Gomella A, Amalou H, Choyke PL, Wood BJ, Pinto PA. Current status of magnetic resonance imaging (MRI) and ultrasonography fusion software platforms for guidance of prostate biopsies. BJU Int 2014; 114:641-52. [PMID: 24298917 DOI: 10.1111/bju.12593] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Prostate MRI is currently the best diagnostic imaging method for detecting PCa. Magnetic resonance imaging (MRI)/ultrasonography (US) fusion allows the sensitivity and specificity of MRI to be combined with the real-time capabilities of transrectal ultrasonography (TRUS). Multiple approaches and techniques exist for MRI/US fusion and include direct 'in bore' MRI biopsies, cognitive fusion, and MRI/US fusion via software-based image coregistration platforms.
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164
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The role of MRI-targeted and confirmatory biopsies for cancer upstaging at selection in patients considered for active surveillance for clinically low-risk prostate cancer. World J Urol 2014; 32:951-8. [DOI: 10.1007/s00345-014-1314-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 04/28/2014] [Indexed: 10/25/2022] Open
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165
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Prostatic ductal adenocarcinoma: an aggressive tumour variant unrecognized on T2 weighted magnetic resonance imaging (MRI). Eur Radiol 2014; 24:1349-56. [DOI: 10.1007/s00330-014-3150-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/06/2014] [Accepted: 03/09/2014] [Indexed: 01/22/2023]
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166
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Schieda N, Avruch L, Shabana WM, Malone SC. Multi-echo gradient recalled echo imaging of the pelvis for improved depiction of brachytherapy seeds and fiducial markers facilitating radiotherapy planning and treatment of prostatic carcinoma. J Magn Reson Imaging 2014; 41:715-20. [DOI: 10.1002/jmri.24590] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/09/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nicola Schieda
- The Ottawa Hospital, The University of Ottawa; Department of Radiology; Civic Campus C1 Ottawa Ontario Canada
| | - Leonard Avruch
- The Ottawa Hospital, The University of Ottawa; Department of Radiology; Civic Campus C1 Ottawa Ontario Canada
| | - Wael M. Shabana
- The Ottawa Hospital, The University of Ottawa; Department of Radiology; Civic Campus C1 Ottawa Ontario Canada
| | - Shawn Christopher Malone
- The Ottawa Hospital, The University of Ottawa; Department of Radiation Oncology; Ottawa Ontario Canada
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167
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Fennessy FM, McKay RR, Beard CJ, Taplin ME, Tempany CM. Dynamic contrast-enhanced magnetic resonance imaging in prostate cancer clinical trials: potential roles and possible pitfalls. Transl Oncol 2014; 7:120-9. [PMID: 24772215 PMCID: PMC3998683 DOI: 10.1593/tlo.13922] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/04/2014] [Accepted: 03/06/2014] [Indexed: 12/21/2022] Open
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluates the tissue microvasculature and may have a role in assessing and predicting therapeutic response in prostate cancer (PCa). In this review, we review principles of DCE-MRI and present the potential quantitative information that can be obtained. We discuss how it may be used as a biomarker for treatment with antiangiogenic and antivascular agents and potentially identify patients with PCa who may benefit from this form of therapy. Likewise, DCE-MRI may play a role in assessing response to combined androgen deprivation therapy and radiation therapy and theoretically could be a prognostic biomarker in evaluating second-generation hormone therapies. We also address the challenges of using DCE-MRI in PCa clinical trials and discuss the difficulties with standardization of this methodology to allow for biomarker validation, with particular reference to PCa.
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Affiliation(s)
- Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Boston, MA ; Department of Radiology, Dana-Farber Cancer Institute, Boston, MA
| | - Rana R McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Clair J Beard
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
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168
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Fedorov A, Fluckiger J, Ayers GD, Li X, Gupta SN, Tempany C, Mulkern R, Yankeelov TE, Fennessy FM. A comparison of two methods for estimating DCE-MRI parameters via individual and cohort based AIFs in prostate cancer: a step towards practical implementation. Magn Reson Imaging 2014; 32:321-9. [PMID: 24560287 DOI: 10.1016/j.mri.2014.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/20/2013] [Accepted: 01/07/2014] [Indexed: 12/17/2022]
Abstract
Multi-parametric Magnetic Resonance Imaging, and specifically Dynamic Contrast Enhanced (DCE) MRI, play increasingly important roles in detection and staging of prostate cancer (PCa). One of the actively investigated approaches to DCE MRI analysis involves pharmacokinetic (PK) modeling to extract quantitative parameters that may be related to microvascular properties of the tissue. It is well-known that the prescribed arterial blood plasma concentration (or Arterial Input Function, AIF) input can have significant effects on the parameters estimated by PK modeling. The purpose of our study was to investigate such effects in DCE MRI data acquired in a typical clinical PCa setting. First, we investigated how the choice of a semi-automated or fully automated image-based individualized AIF (iAIF) estimation method affects the PK parameter values; and second, we examined the use of method-specific averaged AIF (cohort-based, or cAIF) as a means to attenuate the differences between the two AIF estimation methods. Two methods for automated image-based estimation of individualized (patient-specific) AIFs, one of which was previously validated for brain and the other for breast MRI, were compared. cAIFs were constructed by averaging the iAIF curves over the individual patients for each of the two methods. Pharmacokinetic analysis using the Generalized kinetic model and each of the four AIF choices (iAIF and cAIF for each of the two image-based AIF estimation approaches) was applied to derive the volume transfer rate (K(trans)) and extravascular extracellular volume fraction (ve) in the areas of prostate tumor. Differences between the parameters obtained using iAIF and cAIF for a given method (intra-method comparison) as well as inter-method differences were quantified. The study utilized DCE MRI data collected in 17 patients with histologically confirmed PCa. Comparison at the level of the tumor region of interest (ROI) showed that the two automated methods resulted in significantly different (p<0.05) mean estimates of ve, but not of K(trans). Comparing cAIF, different estimates for both ve, and K(trans) were obtained. Intra-method comparison between the iAIF- and cAIF-driven analyses showed the lack of effect on ve, while K(trans) values were significantly different for one of the methods. Our results indicate that the choice of the algorithm used for automated image-based AIF determination can lead to significant differences in the values of the estimated PK parameters. K(trans) estimates are more sensitive to the choice between cAIF/iAIF as compared to ve, leading to potentially significant differences depending on the AIF method. These observations may have practical consequences in evaluating the PK analysis results obtained in a multi-site setting.
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Affiliation(s)
- Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
| | - Jacob Fluckiger
- Department of Radiology, Northwestern University, Chicago, Illinois 60611
| | - Gregory D Ayers
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee 37212
| | - Xia Li
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37212; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee 37212
| | | | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Robert Mulkern
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Department of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115
| | - Thomas E Yankeelov
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37212; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee 37212; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37212; Department of Physics, Vanderbilt University, Nashville, Tennessee 37212; Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee 37212
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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169
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Penzkofer T, Tempany-Afdhal CM. Prostate cancer detection and diagnosis: the role of MR and its comparison with other diagnostic modalities--a radiologist's perspective. NMR IN BIOMEDICINE 2014; 27:3-15. [PMID: 24000133 PMCID: PMC3851933 DOI: 10.1002/nbm.3002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 06/16/2013] [Accepted: 06/18/2013] [Indexed: 05/07/2023]
Abstract
It is now universally recognized that many prostate cancers are over-diagnosed and over-treated. The European Randomized Study of Screening for Prostate Cancer from 2009 evidenced that, to save one man from death from prostate cancer, over 1400 men need to be screened, and 48 need to undergo treatment. The detection of prostate cancer is traditionally based on digital rectal examination (DRE) and the measurement of serum prostate-specific antigen (PSA), followed by ultrasound-guided biopsy. The primary role of imaging for the detection and diagnosis of prostate cancer has been transrectal ultrasound (TRUS) guidance during biopsy. Traditionally, MRI has been used primarily for the staging of disease in men with biopsy-proven cancer. It has a well-established role in the detection of T3 disease, planning of radiation therapy, especially three-dimensional conformal or intensity-modulated external beam radiation therapy, and planning and guiding of interstitial seed implant or brachytherapy. New advances have now established that prostate MRI can accurately characterize focal lesions within the gland, an ability that has led to new opportunities for improved cancer detection and guidance for biopsy. Two new approaches to prostate biopsy are under investigation. Both use pre-biopsy MRI to define potential targets for sampling, and the biopsy is performed either with direct real-time MR guidance (in-bore) or MR fusion/registration with TRUS images (out-of-bore). In-bore and out-of-bore MRI-guided prostate biopsies have the advantage of using the MR target definition for the accurate localization and sampling of targets or suspicious lesions. The out-of-bore method uses combined MRI/TRUS with fusion software that provides target localization and increases the sampling accuracy of TRUS-guided biopsies by integrating prostate MRI information with TRUS. Newer parameters for each imaging modality, such as sonoelastography or shear wave elastography, contrast-enhanced ultrasound and MRI elastography, show promise to further enrich datasets.
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Affiliation(s)
- Tobias Penzkofer
- Division of MRI and Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen, Germany
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170
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Cepek J, Lindner U, Davidson SRH, Haider MA, Ghai S, Trachtenberg J, Fenster A. Treatment planning for prostate focal laser ablation in the face of needle placement uncertainty. Med Phys 2013; 41:013301. [DOI: 10.1118/1.4842535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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171
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Fraioli F, Punwani S. Clinical and research applications of simultaneous positron emission tomography and MRI. Br J Radiol 2013; 87:20130464. [PMID: 24234585 DOI: 10.1259/bjr.20130464] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Evaluation of the molecular processes responsible for disease pathogenesis and progression represents the new frontier of clinical radiology. Multimodality imaging lies at the cutting edge, combining the power of MRI for tissue characterization, microstructural appraisal and functional assessment together with new positron emission tomography (PET) tracers designed to target specific metabolic processes. The recent commercial availability of an integrated clinical whole-body PET-MRI provides a hybrid platform for exploring and exploiting the synergies of multimodal imaging. First experiences on the clinical and research application of hybrid PET-MRI are emerging. This article reviews the rapidly evolving field and speculates on the potential future direction.
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Affiliation(s)
- F Fraioli
- Institute of Nuclear Medicine, University College London, London, UK
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