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Crop F, Robert C, Viard R, Dumont J, Kawalko M, Makala P, Liem X, El Aoud I, Ben Miled A, Chaton V, Patin L, Pasquier D, Guillaud O, Vandendorpe B, Mirabel X, Ceugnart L, Decoene C, Lacornerie T. Efficiency and Accuracy Evaluation of Multiple Diffusion-Weighted MRI Techniques Across Different Scanners. J Magn Reson Imaging 2024; 59:311-322. [PMID: 37335079 DOI: 10.1002/jmri.28869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The choice between different diffusion-weighted imaging (DWI) techniques is difficult as each comes with tradeoffs for efficient clinical routine imaging and apparent diffusion coefficient (ADC) accuracy. PURPOSE To quantify signal-to-noise-ratio (SNR) efficiency, ADC accuracy, artifacts, and distortions for different DWI acquisition techniques, coils, and scanners. STUDY TYPE Phantom, in vivo intraindividual biomarker accuracy between DWI techniques and independent ratings. POPULATION/PHANTOMS NIST diffusion phantom. 51 Patients: 40 with prostate cancer and 11 with head-and-neck cancer at 1.5 T FIELD STRENGTH/SEQUENCE: Echo planar imaging (EPI): 1.5 T and 3 T Siemens; 3 T Philips. Distortion-reducing: RESOLVE (1.5 and 3 T Siemens); Turbo Spin Echo (TSE)-SPLICE (3 T Philips). Small field-of-view (FOV): ZoomitPro (1.5 T Siemens); IRIS (3 T Philips). Head-and-neck and flexible coils. ASSESSMENT SNR Efficiency, geometrical distortions, and susceptibility artifacts were quantified for different b-values in a phantom. ADC accuracy/agreement was quantified in phantom and for 51 patients. In vivo image quality was independently rated by four experts. STATISTICAL TESTS QIBA methodology for accuracy: trueness, repeatability, reproducibility, Bland-Altman 95% Limits-of-Agreement (LOA) for ADC. Wilcoxon Signed-Rank and student tests on P < 0.05 level. RESULTS The ZoomitPro small FOV sequence improved b-image efficiency by 8%-14%, reduced artifacts and observer scoring for most raters at the cost of smaller FOV compared to EPI. The TSE-SPLICE technique reduced artifacts almost completely at a 24% efficiency cost compared to EPI for b-values ≤500 sec/mm2 . Phantom ADC 95% LOA trueness were within ±0.03 × 10-3 mm2 /sec except for small FOV IRIS. The in vivo ADC agreement between techniques, however, resulted in 95% LOAs in the order of ±0.3 × 10-3 mm2 /sec with up to 0.2 × 10-3 mm2 /sec of bias. DATA CONCLUSION ZoomitPro for Siemens and TSE SPLICE for Philips resulted in a trade-off between efficiency and artifacts. Phantom ADC quality control largely underestimated in vivo accuracy: significant ADC bias and variability was found between techniques in vivo. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Frederik Crop
- Department of Medical Physics, Centre Oscar Lambret, Lille, France
- University of Lille, IEMN, Lille, France
| | - Clémence Robert
- Department of Medical Physics, Centre Oscar Lambret, Lille, France
| | - Romain Viard
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, PLBS UAR 2014-US 41, Lille, France
- University of Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, Lille, France
| | - Julien Dumont
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, PLBS UAR 2014-US 41, Lille, France
| | - Marine Kawalko
- Department of Radiology, Centre Oscar Lambret, Lille, France
| | - Pauline Makala
- Academic Department of Radiotherapy, Centre Oscar Lambret, Lille, France
| | - Xavier Liem
- Academic Department of Radiotherapy, Centre Oscar Lambret, Lille, France
| | - Imen El Aoud
- Department of Radiology, Centre Oscar Lambret, Lille, France
| | - Aicha Ben Miled
- Department of Radiology, Centre Oscar Lambret, Lille, France
| | - Victor Chaton
- Department of Radiology, Centre Oscar Lambret, Lille, France
| | - Lucas Patin
- Department of Radiology, Centre Oscar Lambret, Lille, France
| | - David Pasquier
- Academic Department of Radiotherapy, Centre Oscar Lambret, Lille, France
- University of Lille, Centre de recherche en informatique, Signal et automatique de Lille, Lille, France
| | | | | | - Xavier Mirabel
- Academic Department of Radiotherapy, Centre Oscar Lambret, Lille, France
| | - Luc Ceugnart
- Department of Radiology, Centre Oscar Lambret, Lille, France
| | - Camille Decoene
- Department of Medical Physics, Centre Oscar Lambret, Lille, France
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Light A, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Emara A, Haroon A, Latifoltojar A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra AV, Bomanji J, Winkler M, Horan G, Moore CM, Emberton M, Punwani S, Ahmed HU, Shah TT. The Role of Multiparametric MRI and MRI-targeted Biopsy in the Diagnosis of Radiorecurrent Prostate Cancer: An Analysis from the FORECAST Trial. Eur Urol 2024; 85:35-46. [PMID: 37778954 DOI: 10.1016/j.eururo.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The role of multiparametric magnetic resonance imaging (MRI) for detecting recurrent prostate cancer after radiotherapy is unclear. OBJECTIVE To evaluate MRI and MRI-targeted biopsies for detecting intraprostatic cancer recurrence and planning for salvage focal ablation. DESIGN, SETTING, AND PARTICIPANTS FOcal RECurrent Assessment and Salvage Treatment (FORECAST; NCT01883128) was a prospective cohort diagnostic study that recruited 181 patients with suspected radiorecurrence at six UK centres (2014 to 2018); 144 were included here. INTERVENTION All patients underwent MRI with 5 mm transperineal template mapping biopsies; 84 had additional MRI-targeted biopsies. MRI scans with Likert scores of 3 to 5 were deemed suspicious. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS First, the diagnostic accuracy of MRI was calculated. Second, the pathological characteristics of MRI-detected and MRI-undetected tumours were compared using the Wilcoxon rank sum test and chi-square test for trend. Third, four biopsy strategies involving an MRI-targeted biopsy alone and with systematic biopsies of one to two other quadrants were studied. Fisher's exact test was used to compare MRI-targeted biopsy alone with the best other strategy for the number of patients with missed cancer and the number of patients with cancer harbouring additional tumours in unsampled quadrants. Analyses focused primarily on detecting cancer of any grade or length. Last, eligibility for focal therapy was evaluated for men with localised (≤T3bN0M0) radiorecurrent disease. RESULTS AND LIMITATIONS Of 144 patients, 111 (77%) had cancer detected on biopsy. MRI sensitivity and specificity at the patient level were 0.95 (95% confidence interval [CI] 0.92 to 0.99) and 0.21 (95% CI 0.07 to 0.35), respectively. At the prostate quadrant level, 258/576 (45%) quadrants had cancer detected on biopsy. Sensitivity and specificity were 0.66 (95% CI 0.59 to 0.73) and 0.54 (95% CI 0.46 to 0.62), respectively. At the quadrant level, compared with MRI-undetected tumours, MRI-detected tumours had longer maximum cancer core length (median difference 3 mm [7 vs 4 mm]; 95% CI 1 to 4 mm, p < 0.001) and a higher grade group (p = 0.002). Of the 84 men who also underwent an MRI-targeted biopsy, 73 (87%) had recurrent cancer diagnosed. Performing an MRI-targeted biopsy alone missed cancer in 5/73 patients (7%; 95% CI 3 to 15%); with additional systematic sampling of the other ipsilateral and contralateral posterior quadrants (strategy 4), 2/73 patients (3%; 95% CI 0 to 10%) would have had cancer missed (difference 4%; 95% CI -3 to 11%, p = 0.4). If an MRI-targeted biopsy alone was performed, 43/73 (59%; 95% CI 47 to 69%) patients with cancer would have harboured undetected additional tumours in unsampled quadrants. This reduced but only to 7/73 patients (10%; 95% CI 4 to 19%) with strategy 4 (difference 49%; 95% CI 36 to 62%, p < 0.0001). Of 73 patients, 43 (59%; 95% CI 47 to 69%) had localised radiorecurrent cancer suitable for a form of focal ablation. CONCLUSIONS For patients with recurrent prostate cancer after radiotherapy, MRI and MRI-targeted biopsy, with or without perilesional sampling, will diagnose cancer in the majority where present. MRI-undetected cancers, defined as Likert scores of 1 to 2, were found to be smaller and of lower grade. However, if salvage focal ablation is planned, an MRI-targeted biopsy alone is insufficient for prostate mapping; approximately three of five patients with recurrent cancer found on an MRI-targeted biopsy alone harboured further tumours in unsampled quadrants. Systematic sampling of the whole gland should be considered in addition to an MRI-targeted biopsy to capture both MRI-detected and MRI-undetected disease. PATIENT SUMMARY After radiotherapy, magnetic resonance imaging (MRI) is accurate for detecting recurrent prostate cancer, with missed cancer being smaller and of lower grade. Targeting a biopsy to suspicious areas on MRI results in a diagnosis of cancer in most patients. However, for every five men who have recurrent cancer, this targeted approach would miss cancers elsewhere in the prostate in three of these men. If further focal treatment of the prostate is planned, random biopsies covering the whole prostate in addition to targeted biopsies should be considered so that tumours are not missed.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Abi Kanthabalan
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Norman R Williams
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Athar Haroon
- Department of Nuclear Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Harbir Sidhu
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Heather Payne
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Anita V Mitra
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
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Awiwi MO, Gjoni M, Vikram R, Altinmakas E, Dogan H, Bathala TK, Naik S, Ravizzini G, Kandemirli SG, Elsayes KM, Salem UI. MRI and PSMA PET/CT of Biochemical Recurrence of Prostate Cancer. Radiographics 2023; 43:e230112. [PMID: 37999983 DOI: 10.1148/rg.230112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Prostate cancer may recur several years after definitive treatment, such as prostatectomy or radiation therapy. A rise in serum prostate-specific antigen (PSA) level is the first sign of disease recurrence, and this is termed biochemical recurrence. Patients with biochemical recurrence have worse survival outcomes. Radiologic localization of recurrent disease helps in directing patient management, which may vary from active surveillance to salvage radiation therapy, androgen-deprivation therapy, or other forms of systemic and local therapy. The likelihood of detecting the site of recurrence increases with higher serum PSA level. MRI provides optimal diagnostic performance for evaluation of the prostatectomy bed. Prostate-specific membrane antigen (PSMA) PET radiotracers currently approved by the U.S. Food and Drug Administration demonstrate physiologic urinary excretion, which can obscure recurrence at the vesicourethral junction. However, MRI and PSMA PET/CT have comparable diagnostic performance for evaluation of local recurrence after external-beam radiation therapy or brachytherapy. PSMA PET/CT outperforms MRI in identifying recurrence involving the lymph nodes and bones. Caveats for use of both PSMA PET/CT and MRI do exist and may cause false-positive or false-negative results. Hence, these techniques have complementary roles and should be interpreted in conjunction with each other, taking the patient history and results of any additional prior imaging studies into account. Novel PSMA agents at various stages of investigation are being developed, and preliminary data show promising results; these agents may revolutionize the landscape of prostate cancer recurrence imaging in the future. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Turkbey in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Muhammad O Awiwi
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Migena Gjoni
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Raghunandan Vikram
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Emre Altinmakas
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Hakan Dogan
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Tharakeswara K Bathala
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Sagar Naik
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Gregory Ravizzini
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Sedat Giray Kandemirli
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Khaled M Elsayes
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Usama I Salem
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
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Pecoraro M, Turkbey BI, Purysko AS, Girometti R, Giannarini G, Villeirs G, Roberto M, Catalano C, Padhani AR, Barentsz JO, Panebianco V. Diagnostic Accuracy and Observer Agreement of the MRI Prostate Imaging for Recurrence Reporting Assessment Score. Radiology 2022; 304:342-350. [PMID: 35536130 DOI: 10.1148/radiol.212252] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Prostate cancer local recurrence location and extent must be determined in an accurate and timely manner. Because of the lack of a standardized MRI approach after whole-gland treatment, a panel of international experts recently proposed the Prostate Imaging for Recurrence Reporting (PI-RR) assessment score. Purpose To determine the diagnostic accuracy of PI-RR for detecting local recurrence in patients with biochemical recurrence (BCR) after radiation therapy (RT) or radical prostatectomy (RP) and to evaluate the interreader variability of PI-RR scoring. Materials and Methods This retrospective observational study included patients who underwent multiparametric MRI between September 2016 and May 2021 for BCR after RT or RP. MRI scans were analyzed, and a PI-RR score was assigned independently by four radiologists. The reference standard was defined using histopathologic findings, follow-up imaging, or clinical response to treatment. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated to assess PI-RR performance for each reader. The intraclass correlation coefficient was used to determine interreader agreement. Results A total of 100 men were included: 48 patients after RT (median age, 76 years [IQR, 70-82 years]) and 52 patients after RP (median age, 70 years [IQR, 66-74 years]). After RT, with PI-RR of 3 or greater as a cutoff (assigned when recurrence is uncertain), diagnostic performance ranges were 71%-81% sensitivity, 74%-93% specificity, 71%-89% PPV, 79%-86% NPV, and 77%-88% accuracy across the four readers. After RP, with PI-RR of 3 or greater as a cutoff, performance ranges were 59%-83% sensitivity, 87%-100% specificity, 88%-100% PPV, 66%-80% NPV, and 75%-85% accuracy. The intraclass correlation coefficient was 0.87 across the four readers for both the RT and RP groups. Conclusion MRI scoring with the Prostate Imaging for Recurrence Reporting assessment provides structured, reproducible, and accurate evaluation of local recurrence after definitive therapy for prostate cancer. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Haider in this issue.
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Affiliation(s)
- Martina Pecoraro
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Baris I Turkbey
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Andrei S Purysko
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Rossano Girometti
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Gianluca Giannarini
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Geert Villeirs
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Michela Roberto
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Carlo Catalano
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Anwar R Padhani
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Jelle O Barentsz
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Valeria Panebianco
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
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5
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Hötker AM, Vargas HA, Donati OF. Abbreviated MR Protocols in Prostate MRI. Life (Basel) 2022; 12:life12040552. [PMID: 35455043 PMCID: PMC9029675 DOI: 10.3390/life12040552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Prostate MRI is an integral part of the clinical work-up in biopsy-naïve patients with suspected prostate cancer, and its use has been increasing steadily over the last years. To further its general availability and the number of men benefitting from it and to reduce the costs associated with MR, several approaches have been developed to shorten examination times, e.g., by focusing on sequences that provide the most useful information, employing new technological achievements, or improving the workflow in the MR suite. This review highlights these approaches; discusses their implications, advantages, and disadvantages; and serves as a starting point whenever an abbreviated prostate MRI protocol is being considered for implementation in clinical routine.
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Affiliation(s)
- Andreas M. Hötker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
- Correspondence:
| | - Hebert Alberto Vargas
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY 10065, USA;
| | - Olivio F. Donati
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
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6
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Peters I, Derlin K, Peperhove MJ, Hensen B, Pertschy S, Wolters M, von Klot CAJ, Wacker F, Hellms S. First experiences and results after cryoablation of prostate cancer with histopathological evaluation and imaging-based follow-up. Future Oncol 2022; 18:1705-1716. [PMID: 35255716 DOI: 10.2217/fon-2021-1146] [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: 11/21/2022] Open
Abstract
Aim: To share our experience after 28 cryoablation treatments for prostate cancer (PCa) with histopathology, clinical data and MRI as the follow-up methods. Methods: Clinical follow-up comprised prostate specific antigen (PSA)-measurements, PSA-density and quality-of-life-parameters. multi-parametric (mp)MRI pre- and post-cryoablation were retrospectively re-analyzed in 23 cases using Likert scores. Follow-up-histopathology was performed via MRI/ultrasound fusion-guided and/or systematic biopsy. Receiver operating characteristic curve analysis was performed. Results: 17 PCa (61%) were diagnosed within 12-month post-cryotherapy (infield and out-of-field disease). PSA levels and PSA density were not significantly different between patients with or without PCa recurrence. mpMRI can characterize the decrease in prostate volume and necrosis. Area under the curve for the detection of PCa was 81% (global Likert scores), 74-87% (T2), 78% (diffusion weighted imaging) and 57-78% (dynamic contrast enhanced imaging; Youden-selected cutoff ≥3). Conclusion: Besides histopathological evaluation and control biopsy, MRI might have the potential to accurately detect PCa after cryotherapy. Clinical data and interdisciplinary communication are required for efficient monitoring after cryoablation treatments for PCa.
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Affiliation(s)
- Inga Peters
- Department of Urology & Urologic Oncology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany
| | - Katja Derlin
- Institute for Diagnostic & Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany
| | - Matti Joonas Peperhove
- Institute for Diagnostic & Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany
| | - Bennet Hensen
- Institute for Diagnostic & Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany
| | - Stefanie Pertschy
- Institute for Diagnostic & Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany
| | - Mathias Wolters
- Department of Urology & Urologic Oncology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany
| | | | - Frank Wacker
- Institute for Diagnostic & Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany
| | - Susanne Hellms
- Institute for Diagnostic & Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany
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7
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Zhang-Yin J, Montravers F, Montagne S, Hennequin C, Renard-Penna R. Diagnosis of early biochemical recurrence after radical prostatectomy or radiation therapy in patients with prostate cancer: State of the art. Diagn Interv Imaging 2022; 103:191-199. [DOI: 10.1016/j.diii.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 12/30/2022]
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8
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Sargos P, Supiot S, Créhange G, Fromont-Hankard G, Barret E, Beauval JB, Brureau L, Dariane C, Fiard G, Gauthé M, Mathieu R, Roubaud G, Ruffion A, Renard-Penna R, Neuzillet Y, Rouprêt M, Ploussard G. Oncologic Impact and Safety of Pre-Operative Radiotherapy in Localized Prostate and Bladder Cancer: A Comprehensive Review from the Cancerology Committee of the Association Française d'Urologie. Cancers (Basel) 2021; 13:cancers13236070. [PMID: 34885179 PMCID: PMC8656987 DOI: 10.3390/cancers13236070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Radiotherapy may have an interesting role of reinforcing the loco-regional control of cancer, in addition to surgery, when used as a preoperative treatment. This sequence has demonstrated its efficacy and safety in various malignancies, but no strong data exist in the era of uro-oncology. In this review article, we aim to highlight the potential usefulness of preoperative radiotherapy in prostate and muscle-invasive bladder cancer, aiming to enhance pathological response and local control and to prevent intraoperative tumor seeding. We also emphasize the need for further clinical studies assessing the functional safety of subsequent surgical procedures in a competitive context of new systemic agents that have proven to demonstrate a survival benefit in locally advanced urologic cancers. Abstract Preoperative radiotherapy (RT) is commonly used for the treatment of various malignancies, including sarcomas, rectal, and gynaecological cancers, but it is preferentially used as a competitive treatment to radical surgery in uro-oncology or as a salvage procedure in cases of local recurrence. Nevertheless, preoperative RT represents an attractive strategy to prevent from intraoperative tumor seeding in the operative field, to sterilize microscopic extension outside the organ, and to enhance the pathological and/or imaging tumor response rate. Several clinical works support this research field in uro-oncology. In this review article, we summarized the oncologic impact and safety of preoperative RT in localized prostate and muscle-invasive bladder cancer. Preliminary studies suggest that both modalities can be complementary as initial primary tumor treatments and that a pre-operative radiotherapy strategy could be beneficial in a well-defined population of patients who are at a very high-risk of local relapse. Future prospective trials are warranted to evaluate the oncologic benefit of such a combination of local treatments in addition to new life-prolonging systemic therapies, such as immunotherapy, and new generation hormone therapies. Moreover, the safety and the feasibility of salvage surgical procedures due to non-response or local recurrence after pelvic RT remain poorly evaluated in that context.
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Affiliation(s)
- Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France;
| | - Stéphane Supiot
- Department of Radiotherapy, Insitut de Cancérologie de l’Ouest, 44800 St-Herblain, France;
| | - Gilles Créhange
- Department of Radiotherapy, Institut Curie, 75005 Paris, France;
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, 75014 Paris, France;
| | | | - Laurent Brureau
- Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, 97110 Pointe-à-Pitre, France;
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris—Paris University—U1151 Inserm-INEM, Necker, 75015 Paris, France;
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000 Grenoble, France;
| | - Mathieu Gauthé
- Unité de Recherche Clinique en Économie de la Santé, CRESS METHODS INSERM UMR 1153, 75000 Paris, France;
| | - Romain Mathieu
- Department of Urology, CHU Rennes, 35033 Rennes, France;
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France;
| | - Alain Ruffion
- Service d’Urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69002 Lyon, France;
- Equipe 2, Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, 69002 Lyon, France
| | - Raphaële Renard-Penna
- Department of Radiology, Sorbonne University, AP-HP, Pitie-Salpetriere Hospital, 75013 Paris, France;
| | - Yann Neuzillet
- Department of Urology, Hôpital Foch, 92151 Suresnes, France;
| | - Morgan Rouprêt
- Department of Urology, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, 75013 Paris, France;
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hôpital, 31130 Quint Fonsegrives, France;
- Correspondence: ; Tel.: +33-5-32027202; Fax: +33-5-32027203
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9
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Purysko AS, Childes BJ, Ward RD, Bittencourt LK, Klein EA. Pitfalls in Prostate MRI Interpretation: A Pictorial Review. Semin Roentgenol 2021; 56:391-405. [PMID: 34688342 DOI: 10.1053/j.ro.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/08/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrei S Purysko
- Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH.; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH..
| | - Benjamin J Childes
- Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan D Ward
- Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | | | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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10
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Wang YF, Tadimalla S, Hayden AJ, Holloway L, Haworth A. Artificial intelligence and imaging biomarkers for prostate radiation therapy during and after treatment. J Med Imaging Radiat Oncol 2021; 65:612-626. [PMID: 34060219 DOI: 10.1111/1754-9485.13242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/18/2021] [Accepted: 05/02/2021] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly used in the management of prostate cancer (PCa). Quantitative MRI (qMRI) parameters, derived from multi-parametric MRI, provide indirect measures of tumour characteristics such as cellularity, angiogenesis and hypoxia. Using Artificial Intelligence (AI), relevant information and patterns can be efficiently identified in these complex data to develop quantitative imaging biomarkers (QIBs) of tumour function and biology. Such QIBs have already demonstrated potential in the diagnosis and staging of PCa. In this review, we explore the role of these QIBs in monitoring treatment response during and after PCa radiotherapy (RT). Recurrence of PCa after RT is not uncommon, and early detection prior to development of metastases provides an opportunity for salvage treatments with curative intent. However, the current method of monitoring treatment response using prostate-specific antigen levels lacks specificity. QIBs, derived from qMRI and developed using AI techniques, can be used to monitor biological changes post-RT providing the potential for accurate and early diagnosis of recurrent disease.
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Affiliation(s)
- Yu-Feng Wang
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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11
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Kowa JY, Soneji N, Sohaib SA, Mayer E, Hazell S, Butterfield N, Shur J, Ap Dafydd D. Detection and staging of radio-recurrent prostate cancer using multiparametric MRI. Br J Radiol 2021; 94:20201423. [PMID: 33586998 DOI: 10.1259/bjr.20201423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We determined the sensitivity and specificity of multiparametric magnetic resonance imaging (MP-MRI) in detection of locally recurrent prostate cancer and extra prostatic extension in the post-radical radiotherapy setting. Histopathological reference standard was whole-mount prostatectomy specimens. We also assessed for any added value of the dynamic contrast enhancement (DCE) sequence in detection and staging of local recurrence. METHODS This was a single centre retrospective study. Participants were selected from a database of males treated with salvage prostatectomy for locally recurrent prostate cancer following radiotherapy. All underwent pre-operative prostate-specific antigen assay, positron emission tomography CT, MP-MRI and transperineal template prostate mapping biopsy prior to salvage prostatectomy. MP-MRI performance was assessed using both Prostate Imaging-Reporting and Data System v. 2 and a modified scoring system for the post-treatment setting. RESULTS 24 patients were enrolled. Using Prostate Imaging-Reporting and Data System v. 2, sensitivity, specificity, positive predictive value and negative predictive value was 64%, 94%, 98% and 36%. MP-MRI under staged recurrent cancer in 63%. A modified scoring system in which DCE was used as a co-dominant sequence resulted in improved diagnostic sensitivity (61%-76%) following subgroup analysis. CONCLUSION Our results show MP-MRI has moderate sensitivity (64%) and high specificity (94%) in detecting radio-recurrent intraprostatic disease, though disease tends to be under quantified and under staged. Greater emphasis on dynamic contrast images in overall scoring can improve diagnostic sensitivity. ADVANCES IN KNOWLEDGE MP-MRI tends to under quantify and under stage radio-recurrent prostate cancer. DCE has a potentially augmented role in detecting recurrent tumour compared with the de novo setting. This has relevance in the event of any future modified MP-MRI scoring system for the irradiated gland.
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Affiliation(s)
- Jie-Ying Kowa
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Neil Soneji
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - S Aslam Sohaib
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Erik Mayer
- Department of Surgery, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK.,Department of Surgery & Cancer, St Mary's Hospital Campus, Imperial College London, Praed Street, London, UK
| | - Stephen Hazell
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Nicholas Butterfield
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Joshua Shur
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Derfel Ap Dafydd
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
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12
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Magnetic resonance imaging of the prostate after focal therapy with high-intensity focused ultrasound. Abdom Radiol (NY) 2020; 45:3882-3895. [PMID: 32447414 DOI: 10.1007/s00261-020-02577-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For clinically significant, locally confined prostate cancer, whole-gland radical prostatectomy and radiotherapy are established effective treatment strategies that, however, come at a cost of significant morbidity related to urinary and sexual side effects. The concept of risk stratification paired with a better understanding of prognostic factors has led to the development of alternative management options including active surveillance and focal therapy for appropriately selected patients with localized disease. High-intensity focused ultrasound (HIFU) is one such minimally invasive, image-guided treatment option for prostate cancer. Due to the relative novelty of HIFU and the increased use of magnetic resonance imaging in prostate cancer, many radiologists are not yet familiar with imaging findings related to HIFU, their temporal evolution as well as imaging appearance of recurrent disease after this type of focal therapy. HIFU induces sharply demarcated, localized coagulative necrosis of a tumor through thermal energy delivered via an endorectal or transurethral ultrasound transducer. In this pictorial review, we aim at providing relevant background information that will guide the reader through the general principles of HIFU in the prostate, as well as demonstrate the imaging appearance of expected post-HIFU changes versus recurrent tumor.
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13
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Bosaily AES, Frangou E, Ahmed HU, Emberton M, Punwani S, Kaplan R, Brown LC, Freeman A, Jameson C, Hindley R, Peppercorn D, Thrower A, Winkler M, Barwick T, Stewart V, Burns-Cox N, Burn P, Ghei M, Kumaradevan J, Prasad R, Ash-Miles J, Shergill I, Agarwal S, Rosario D, Salim F, Bott S, Evans H, Henderson A, Ghosh S, Dudderidge T, Smart J, Tung K, Kirkham A. Additional Value of Dynamic Contrast-enhanced Sequences in Multiparametric Prostate Magnetic Resonance Imaging: Data from the PROMIS Study. Eur Urol 2020; 78:503-511. [PMID: 32312543 DOI: 10.1016/j.eururo.2020.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MP-MRI) is established in the diagnosis of prostate cancer, but the need for enhanced sequences has recently been questioned. OBJECTIVE To assess whether dynamic contrast-enhanced imaging (DCE) improves accuracy over T2 and diffusion sequences. DESIGN, SETTING, AND PARTICIPANTS PROMIS was a multicentre, multireader trial, with, in this part, 497 biopsy-naïve men undergoing standardised 1.5T MP-MRI using T2, diffusion, and DCE, followed by a detailed transperineal prostate mapping (TPM) biopsy at 5 mm intervals. Likert scores of 1-5 for the presence of a significant tumour were assigned in strict sequence, for (1) T2 + diffusion and then (2) T2 + diffusion + dynamic contrast-enhanced images. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS For the primary analysis, the primary PROMIS outcome measure (Gleason score ≥4 + 3 or ≥6 mm maximum cancer length) on TPM was used, and an MRI score of ≥3 was considered positive. RESULTS AND LIMITATIONS Sensitivity without and with DCE was 94% and 95%, specificity 37% and 38%, positive predictive value 51% and 51%, and negative predictive value 90% and 91%, respectively (p > 0.05 in each case). The number of patients avoiding biopsy (scoring 1-2) was similar (123/497 vs 121/497, p = 0.8). The number of equivocal scores (3/5) was slightly higher without DCE (32% vs 28% p = 0.031). The proportion of MRI equivocal (3/5) and positive (4-5) cases showing significant tumours were similar (23% and 71% vs 20% and 69%). No cases of dominant Gleason 4 or higher were missed with DCE, compared with a single case with T2 + diffusion-weighted imaging. No attempt was made to correlate lesion location on MRI and histology, which may be considered a limitation. Radiologists were aware of the patient's prostate-specific antigen. CONCLUSIONS Contrast adds little when MP-MRI is used to exclude significant prostate cancer. PATIENT SUMMARY An intravenous injection of contrast may not be necessary when magnetic resonance imaging is used as a test to rule out significant tumours in the prostate.
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Affiliation(s)
- Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, Royal Free NHS foundation Trust, London, UK.
| | | | - Hashim U Ahmed
- Division of Surgery and Interventional Sciences, University College London, London, UK; Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK
| | | | | | - Alex Freeman
- University College Hospital NHS Foundation Trust, London, UK
| | - Charles Jameson
- University College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Mathias Winkler
- Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK
| | - Tara Barwick
- Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK
| | - Victoria Stewart
- Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK
| | - Nick Burns-Cox
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Paul Burn
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | | | | | | | | | | | | | | | - Simon Bott
- Frimley Health NHS Foundation Trust, Camberley, UK
| | - Hywel Evans
- Frimley Health NHS Foundation Trust, Camberley, UK
| | | | - Sukanya Ghosh
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Tim Dudderidge
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Smart
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ken Tung
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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14
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van Son MJ, Peters M, Moerland MA, Lagendijk JJW, Eppinga WSC, Shah TT, Ahmed HU, van der Voort van Zyp JRN. MRI-Guided Ultrafocal Salvage High-Dose-Rate Brachytherapy for Localized Radiorecurrent Prostate Cancer: Updated Results of 50 Patients. Int J Radiat Oncol Biol Phys 2020; 107:126-135. [PMID: 32006609 DOI: 10.1016/j.ijrobp.2020.01.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Most patients with local prostate cancer recurrence after radiation therapy undergo palliative androgen deprivation therapy because whole-gland salvage treatments have a high risk of severe toxicity. Focal treatment reduces this risk while offering a second opportunity for cure. We report updated outcomes of ultrafocal salvage high-dose-rate brachytherapy (HDR-BT). METHODS AND MATERIALS Prospectively collected data from the first 50 treated patients were analyzed. Disease status was assessed by 3T multiparametric magnetic resonance imaging (MRI), 18F-Choline or 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography, and systematic or tumor-targeted biopsies. Ultrafocal salvage HDR-BT (1 × 19 Gy) was performed by implanting the clinical target volume (CTV: gross tumor volume + 5 mm margin) under fused transrectal ultrasound/MRI guidance. Follow-up included toxicity grading (using Common Terminology Criteria for Adverse Events 4.0), quality of life assessment, and prostate-specific antigen (PSA) testing. RESULTS Median follow-up was 31 months. Median CTV D95% was 18.8 Gy. We observed 2% grade 3 genitourinary toxicity, no grade 3 gastrointestinal toxicity, and 22% newly developed grade 3 erectile dysfunction. Five of 13 patients (38%) with self-reported pretreatment potency (International Index of Erectile Function >17) remained potent. Clinically relevant quality of life deterioration was reported for only 6 of 31 items and was not statistically significant. Biochemical failure (nadir + 2) occurred in 26 patients. Among intraprostatic recurrences, 73% were in field. After 2.5 years, biochemical disease-free survival was 51% (95% confidence interval, 37%-69%), metastases-free survival was 75% (64%-89%), androgen deprivation therapy-free survival was 90% (82%-99%), and overall survival was 98% (94%-100%). Presalvage PSA, CTV size, and stage ≥T3 were significantly associated with biochemical failure. Higher-risk patients (stage ≥T3, PSA ≥10, or PSA double time ≤9 months) had 25% biochemical disease-free survival at 2.5 years versus 71% for lower-risk patients. CONCLUSIONS At this early stage, MRI-guided ultrafocal HDR-BT seems to be a safe salvage treatment option, with acceptable biochemical control in a well-selected group of patients and potential for effectively postponing androgen deprivation therapy.
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Affiliation(s)
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, the Netherlands
| | - Marinus A Moerland
- Department of Radiotherapy, University Medical Center Utrecht, the Netherlands
| | - Jan J W Lagendijk
- Department of Radiotherapy, University Medical Center Utrecht, the Netherlands
| | - Wietse S C Eppinga
- Department of Radiotherapy, University Medical Center Utrecht, the Netherlands
| | - Taimur T Shah
- Department of Surgery and Cancer, Division of Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Hashim U Ahmed
- Department of Surgery and Cancer, Division of Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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15
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Dinis Fernandes C, Simões R, Ghobadi G, Heijmink SW, Schoots IG, de Jong J, Walraven I, van der Poel HG, van Houdt PJ, Smolic M, Pos FJ, van der Heide UA. Multiparametric MRI Tumor Probability Model for the Detection of Locally Recurrent Prostate Cancer After Radiation Therapy: Pathologic Validation and Comparison With Manual Tumor Delineations. Int J Radiat Oncol Biol Phys 2019; 105:140-148. [DOI: 10.1016/j.ijrobp.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022]
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16
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Commentary on: mpMRI of the prostate: is there a role for semi-quantitative analysis of DCE-MRI and late gadolinium enhancement in the characterisation of prostate cancer? Clin Radiol 2019; 74:257-258. [DOI: 10.1016/j.crad.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/21/2022]
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17
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van der Poel H, Grivas N, van Leeuwen P, Heijmink S, Schoots I. The role of MRI for detection and staging of radio- and focal therapy-recurrent prostate cancer. World J Urol 2019; 37:1485-1490. [DOI: 10.1007/s00345-019-02677-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022] Open
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18
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Liao XL, Wei JB, Li YQ, Zhong JH, Liao CC, Wei CY. Functional Magnetic Resonance Imaging in the Diagnosis of Locally Recurrent Prostate Cancer: Are All Pulse Sequences Helpful? Korean J Radiol 2018; 19:1110-1118. [PMID: 30386142 PMCID: PMC6201967 DOI: 10.3348/kjr.2018.19.6.1110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/24/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To perform a meta-analysis to quantitatively assess functional magnetic resonance imaging (MRI) in the diagnosis of locally recurrent prostate cancer. Materials and Methods A comprehensive search of the PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews was conducted from January 1, 1995 to December 31, 2016. Diagnostic accuracy was quantitatively pooled for all studies by using hierarchical logistic regression modeling, including bivariate modeling and hierarchical summary receiver operating characteristic (HSROC) curves (AUCs). The Z test was used to determine whether adding functional MRI to T2-weighted imaging (T2WI) results in significantly increased diagnostic sensitivity and specificity. Results Meta-analysis of 13 studies involving 826 patients who underwent radical prostatectomy showed a pooled sensitivity and specificity of 91%, and the AUC was 0.96. Meta-analysis of 7 studies involving 329 patients who underwent radiotherapy showed a pooled sensitivity of 80% and specificity of 81%, and the AUC was 0.88. Meta-analysis of 11 studies reporting 1669 sextant biopsies from patients who underwent radiotherapy showed a pooled sensitivity of 54% and specificity of 91%, and the AUC was 0.85. Sensitivity after radiotherapy was significantly higher when diffusion-weighted MRI data were combined with T2WI than when only T2WI results were used. This was true when meta-analysis was performed on a per-patient basis (p = 0.027) or per sextant biopsy (p = 0.046). A similar result was found when 1H-magnetic resonance spectroscopy (1H-MRS) data were combined with T2WI and sextant biopsy was the unit of analysis (p = 0.036). Conclusion Functional MRI data may not strengthen the ability of T2WI to detect locally recurrent prostate cancer in patients who have undergone radical prostatectomy. By contrast, diffusion-weight MRI and 1H-MRS data may improve the sensitivity of T2WI for patients who have undergone radiotherapy.
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Affiliation(s)
- Xiao-Li Liao
- Department of First Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Jun-Bao Wei
- Department of Therapeutic Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yong-Qiang Li
- Department of First Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Cheng-Cheng Liao
- Department of Third Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Chang-Yuan Wei
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
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19
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Adams LC, Ralla B, Bender YNY, Bressem K, Hamm B, Busch J, Fuller F, Makowski MR. Renal cell carcinoma with venous extension: prediction of inferior vena cava wall invasion by MRI. Cancer Imaging 2018; 18:17. [PMID: 29724245 PMCID: PMC5934829 DOI: 10.1186/s40644-018-0150-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/25/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) are accompanied by inferior vena cava (IVC) thrombus in up to 10% of the cases, with surgical resection remaining the only curative option. In case of IVC wall invasion, the operative procedure is more challenging and may even require IVC resection. This study aims to determine the diagnostic performance of contrast-enhanced magnetic resonance imaging (MRI) for the assessment of wall invasion by IVC thrombus in patients with RCC, validated with intraoperative findings. METHODS Data were collected on 81 patients with RCC and IVC thrombus, who received a radical nephrectomy and vena cava thrombectomy between February 2008 and November 2017. Forty eight patients met the inclusion criteria. Sensitivity and specificity as well as the positive and negative predictive values were calculated for preoperative MRI, based on the assessments of the two readers for visual wall invasion. Furthermore, a logistic regression model was used to determine if there was an association between intraoperative wall adherence and IVC diameter. RESULTS Complete occlusion of the IVC lumen or vessel breach could reliably assess IVC wall invasion with a sensitivity of 92.3% (95%-CI: 0.75-0.99) and a specificity of 86.4% (95%-CI: 0.65-0.97) (Fisher-test: p-value< 0.001). The positive predictive value (PPV) was 88.9% (95%-CI: 0.71-0.98) and the negative predictive value reached 90.5% (95%-CI: 0.70-0.99). There was an excellent interobserver agreement for determining IVC wall invasion with a kappa coefficient of 0.90 (95%CI: 0.79-1.00). CONCLUSIONS The present study indicates that standard preoperative MR imaging can be used to reliably assess IVC wall invasion, evaluating morphologic features such as the complete occlusion of the IVC lumen or vessel breach. Increases in IVC diameter are associated with a higher probability of IVC wall invasion.
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Affiliation(s)
- Lisa C Adams
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany.
| | - Bernhard Ralla
- Department of Urology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Yi-Na Y Bender
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Keno Bressem
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Jonas Busch
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Florian Fuller
- Department of Urology, Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
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