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Patel KR, van der Heide UA, Kerkmeijer LGW, Schoots IG, Turkbey B, Citrin DE, Hall WA. Target Volume Optimization for Localized Prostate Cancer. Pract Radiat Oncol 2024:S1879-8500(24)00148-6. [PMID: 39019208 DOI: 10.1016/j.prro.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024]
Abstract
Historically, the treatment of prostate cancer has required little anatomic information beyond the location of the prostate gland and adjacent seminal vesicles. Radiation therapy has classically been prescribed to the whole prostate due to the high frequency of multifocal cancer in surgical specimens and the inability to localize the precise boundaries of individual tumor foci on imaging. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase III data have demonstrated that incorporating focal dose escalation improves biochemical control without significantly increasing toxicity. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice. In this review we summarize the currently available literature on image-based focal target delineation with MRI and PET. Our review includes a summary of the available data on anatomic patterns of spread to inform clinical judgement for the definition of clinical target volumes. Key knowledge gaps are identified and suggestions for novel implementation strategies are provided.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo G Schoots
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - William A Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
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Edwards SJ, Yao J, Schechter MC, Fayfman M, Santamarina G, Feiweier T, Blanco G, Alvarez J, Risk BB, Rajani R, Reiter DA. Feasibility of Multiparametric Perfusion Assessment in Diabetic Foot Ulcer Using Intravoxel Incoherent Motion and Blood Oxygenation-Level Dependent MRI. J Magn Reson Imaging 2024; 59:1555-1566. [PMID: 37596872 PMCID: PMC10875144 DOI: 10.1002/jmri.28955] [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: 05/24/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Patients with type-2 diabetes (T2DM) are at increased risk of developing diabetic foot ulcers (DFU) and experiencing impaired wound healing related to underlying microvascular disease. PURPOSE To evaluate the sensitivity of intra-voxel incoherent motion (IVIM) and blood oxygen level dependent (BOLD) MRI to microvascular changes in patients with DFUs. STUDY TYPE Case-control. POPULATION 20 volunteers who were age and body mass index matched, including T2DM patients with DFUs (N = 10, mean age = 57.5 years), T2DM patients with controlled glycemia and without DFUs (DC, N = 5, mean age = 57.4 years) and healthy controls (HC, N = 5, mean age = 52.8 years). FIELD STRENGTH/SEQUENCE 3T/multi-b-value IVIM and dynamic BOLD. ASSESSMENT Resting IVIM parameters were obtained using a multi-b-value diffusion-weighted imaging sequence and two IVIM models were fit to obtain diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and microvascular volume fraction (MVF) parameters. Microvascular reactivity was evaluated by inducing an ischemic state in the foot with a blood pressure cuff during dynamic BOLD imaging. Perfusion indices were assessed in two regions of the foot: the medial plantar (MP) and lateral plantar (LP) regions. STATISTICAL TESTS Effect sizes of group mean differences were assessed using Hedge's g adjusted for small sample sizes. RESULTS DFU participants exhibited elevated D*, f, and MVF values in both regions (g ≥ 1.10) and increased D (g = 1.07) in the MP region compared to DC participants. DC participants showed reduced f and MVF compared to HC participants in the MP region (g ≥ 1.06). Finally, the DFU group showed reduced tolerance for ischemia in the LP region (g = -1.51) and blunted reperfusion response in both regions (g < -2.32) compared to the DC group during the cuff-occlusion challenge. DATA CONCLUSION The combined use of IVIM and BOLD MRI shows promise in differentiating perfusion abnormalities in the feet of diabetic patients and suggests hyperperfusion in DFU patients. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Scott J. Edwards
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jingting Yao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcos C. Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Maya Fayfman
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriel Santamarina
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Division of Vascular Surgery, Department of Surgery, Atlanta, GA, United States of America
| | | | - Gerardo Blanco
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin B. Risk
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ravi Rajani
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Vascular Surgery, Department of Surgery, Atlanta, GA, United States of America
| | - David A. Reiter
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA
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Cao Y, Davarani SN, You D, Feiweier T, Casper K, Balis U, Udager A, Balter J, Mierzwa M. In Vivo Microstructure Imaging in Oropharyngeal Squamous Cell Carcinoma Using the Random Walk With Barriers Model. J Magn Reson Imaging 2024; 59:929-938. [PMID: 37366349 DOI: 10.1002/jmri.28831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Apparent diffusion coefficient is not specifically sensitive to tumor microstructure and therapy-induced cellular changes. PURPOSE To investigate time-dependent diffusion imaging with the short-time-limit random walk with barriers model (STL-RWBM) for quantifying microstructure parameters and early cancer cellular response to therapy. STUDY TYPE Prospective. POPULATION Twenty-seven patients (median age of 58 years and 7.4% of females) with p16+/p16- oropharyngeal/oral cavity squamous cell carcinomas (OPSCC/OCSCC) underwent MRI scans before therapy, of which 16 patients had second scans at 2 weeks of the 7-weeks chemoradiation therapy (CRT). FIELD STRENGTH/SEQUENCE 3-T, diffusion sequence with oscillating gradient spine echo (OGSE) and pulse gradient spin echo (PGSE). ASSESSMENT Diffusion weighted images were acquired using OGSE and PGSE. Effective diffusion times were derived for the STL-RWBM to estimate free diffusion coefficient D0 , volume-to-surface area ratio of cellular membranes V/S, and cell membrane permeability κ. Mean values of these parameters were calculated in tumor volumes. STATISTICAL TESTS Tumor microstructure parameters were compared with clinical stages of p16+ I-II OPSCC, p16+ III OPSCC, and p16- IV OCSCC by Spearman's rank correlation and with digital pathological analysis of a resected tissue sample. Tumor microstructure parameter responses during CRT in the 16 patients were assessed by paired t-tests. A P-value of <0.05 was considered statistically significant. RESULTS The derived effective diffusion times affected estimated values of V/S and κ by 40%. The tumor V/S values were significantly correlated with clinical stages (r = 0.47) as an increase from low to high clinical stages. The in vivo estimated cell size agreed with one from pathological analysis of a tissue sample. Early tumor cellular responses showed a significant increase in D0 (14%, P = 0.03) and non-significant increases in κ (56%, P = 0.6) and V/S (10%, P = 0.1). DATA CONCLUSION Effective diffusion time estimation might impact microstructure parameter estimation. The tumor V/S was correlated with OPSCC/OCSCC clinical stages. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Daekeun You
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ulysses Balis
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron Udager
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - James Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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Grauhan NF, Grünebach N, Brockstedt L, Sanner A, Feiweier T, Schöffling V, Brockmann MA, Othman AE. Reduction of Distortion Artifacts in Brain MRI Using a Field Map-based Correction Technique in Diffusion-weighted Imaging : A Prospective Study. Clin Neuroradiol 2024; 34:85-91. [PMID: 37640838 PMCID: PMC10881677 DOI: 10.1007/s00062-023-01338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The aim of this study was to evaluate the image quality and feasibility of a field map-based technique to correct for susceptibility-induced geometric distortions which are typical for diffusion EPI brain imaging. METHODS We prospectively included 52 patients during clinical routine in this single-center study. All scans were performed on a 3T MRI. Patients' indications for MRI mainly consisted of suspected stroke due to the clinical presentation. For the morphological comparison of the corrected and uncorrected EPI diffusion, three experienced radiologists assessed the image quality of the sequences in a blinded and randomized fashion using a Likert scale (1 being poor; 5 being excellent). To ensure comparability of the two methods, an additional quantitative analysis of the apparent diffusion coefficient (ADC) was performed. RESULTS Corrected EPI diffusion was rated significantly superior in all the selected categories: overall level of artifacts (p < 0.001), degree of distortion at the frontal, temporal, occipital and brainstem levels (p < 0.001), conspicuousness of ischemic lesions (p < 0.001), image quality (p < 0.001), naturality (p < 0.001), contrast (p < 0.001), and diagnostic confidence (p < 0.001). CONCLUSION Corrected EPI diffusion offers a significant reduction of geometric distortion in all evaluated brain regions and an improved conspicuousness of ischemic lesions. Image quality, overall artifacts, naturality, contrast and diagnostic confidence were also rated superior in comparison to uncorrected EPI diffusion.
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Affiliation(s)
- Nils F Grauhan
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Natascha Grünebach
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Lavinia Brockstedt
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Antoine Sanner
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- Technical University of Darmstadt, Darmstadt, Germany
| | | | - Vanessa Schöffling
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Katscher U, Meineke J, Zhang S, Steinhorst B, Keupp J. Estimation of effective b-value for a diffusion-weighted double-echo steady-state sequence with bipolar gradients. Magn Reson Imaging 2024; 105:10-16. [PMID: 37863374 DOI: 10.1016/j.mri.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Abstract
Diffusion-weighted double-echo steady-state (dwDESS) MRI with bipolar diffusion gradients is a promising candidate to obtain diffusion weighted images (DWI) free of geometric distortions and with low motion sensitivity. However, a wider clinical application of dwDESS is currently hindered as no method is reported to explicitly calculate the effective b-value of the obtained DWI from the diffusion-gradients applied in the sequence. To this end, a previously described signal model was adapted for dwDESS with bipolar diffusion gradients, which allows to estimate an effective b-value, dubbed b'. Evaluation in phantom examinations was performed on a clinical 1.5 T MR system. Experimental results were compared with theoretical predictions, including the apparent diffusion coefficient (ADC) based on b-values from a standard EPI-DWI sequence and ADC' based on the effective b' from the dwDESS sequence. The adapted signal model was able to describe the experimental results, and the obtained values of ADC' were in line with conventional ADC measurements.
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Affiliation(s)
- Ulrich Katscher
- Philips Research Europe, Roentgenstrasse 24-26, 22335 Hamburg, Germany.
| | - Jakob Meineke
- Philips Research Europe, Roentgenstrasse 24-26, 22335 Hamburg, Germany
| | - Shuo Zhang
- Philips Healthcare, Roentgenstrasse 24-26, 22335 Hamburg, Germany
| | - Björn Steinhorst
- Philips Research Europe, Roentgenstrasse 24-26, 22335 Hamburg, Germany
| | - Jochen Keupp
- Philips Research Europe, Roentgenstrasse 24-26, 22335 Hamburg, Germany
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Lemberskiy G, Chandarana H, Bruno M, Ginocchio LA, Huang C, Tong A, Keerthivasan MB, Fieremans E, Novikov DS. Feasibility of Accelerated Prostate Diffusion-Weighted Imaging on 0.55 T MRI Enabled With Random Matrix Theory Denoising. Invest Radiol 2023; 58:720-729. [PMID: 37222526 PMCID: PMC10527232 DOI: 10.1097/rli.0000000000000979] [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] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Prostate cancer diffusion weighted imaging (DWI) MRI is typically performed at high-field strength (3.0 T) in order to overcome low signal-to-noise ratio (SNR). In this study, we demonstrate the feasibility of prostate DWI at low field enabled by random matrix theory (RMT)-based denoising, relying on the MP-PCA algorithm applied during image reconstruction from multiple coils. METHODS Twenty-one volunteers and 2 prostate cancer patients were imaged with a 6-channel pelvic surface array coil and an 18-channel spine array on a prototype 0.55 T system created by ramping down a commercial magnetic resonance imaging system (1.5 T MAGNETOM Aera Siemens Healthcare) with 45 mT/m gradients and 200 T/m/s slew rate. Diffusion-weighted images were acquired with 4 non-collinear directions, for which b = 50 s/mm 2 was used with 8 averages and b = 1000 s/mm 2 with 40 averages; 2 extra b = 50 s/mm 2 were used as part of the dynamic field correction. Standard and RMT-based reconstructions were applied on DWI over different ranges of averages. Accuracy/precision was evaluated using the apparent diffusion coefficient (ADC), and image quality was evaluated over 5 separate reconstructions by 3 radiologists with a 5-point Likert scale. For the 2 patients, we compare image quality and lesion visibility of the RMT reconstruction versus the standard one on 0.55 T and on clinical 3.0 T. RESULTS The RMT-based reconstruction in this study reduces the noise floor by a factor of 5.8, thereby alleviating the bias on prostate ADC. Moreover, the precision of the ADC in prostate tissue after RMT increases over a range of 30%-130%, with the increase in both signal-to-noise ratio and precision being more prominent for a low number of averages. Raters found that the images were consistently of moderate to good overall quality (3-4 on the Likert scale). Moreover, they determined that b = 1000 s/mm 2 images from a 1:55-minute scan with the RMT-based reconstruction were on par with the corresponding images from a 14:20-minute scan with standard reconstruction. Prostate cancer was visible on ADC and calculated b = 1500 images even with the abbreviated 1:55-minute scan reconstructed with RMT. CONCLUSIONS Prostate imaging using DWI is feasible at low field and can be performed more rapidly with noninferior image quality compared with standard reconstruction.
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Affiliation(s)
- Gregory Lemberskiy
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Hersh Chandarana
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Mary Bruno
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Luke A. Ginocchio
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Chenchan Huang
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Angela Tong
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | | | - Els Fieremans
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Dmitry S. Novikov
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
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Sjöholm T, Kullberg J, Strand R, Engström M, Ahlström H, Malmberg F. Improved geometric accuracy of whole body diffusion-weighted imaging at 1.5T and 3T using reverse polarity gradients. Sci Rep 2022; 12:11605. [PMID: 35804034 PMCID: PMC9270424 DOI: 10.1038/s41598-022-15872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Whole body diffusion-weighted imaging (WB-DWI) is increasingly used in oncological applications, but suffers from misalignments due to susceptibility-induced geometric distortion. As such, DWI and structural images acquired in the same scan session are not geometrically aligned, leading to difficulties in e.g. lesion detection and segmentation. In this work we assess the performance of the reverse polarity gradient (RPG) method for correction of WB-DWI geometric distortion. Multi-station DWI and structural magnetic resonance imaging (MRI) data of healthy controls were acquired at 1.5T (n = 20) and 3T (n = 20). DWI data was distortion corrected using the RPG method based on b = 0 s/mm2 (b0) and b = 50 s/mm2 (b50) DWI acquisitions. Mutual information (MI) between low b-value DWI and structural data increased with distortion correction (P < 0.05), while improvements in region of interest (ROI) based similarity metrics, comparing the position of incidental findings on DWI and structural data, were location dependent. Small numerical differences between non-corrected and distortion corrected apparent diffusion coefficient (ADC) values were measured. Visually, the distortion correction improved spine alignment at station borders, but introduced registration-based artefacts mainly for the spleen and kidneys. Overall, the RPG distortion correction gave an improved geometric accuracy for WB-DWI data acquired at 1.5T and 3T. The b0- and b50-based distortion corrections had a very similar performance.
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Affiliation(s)
- T Sjöholm
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - J Kullberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Antaros Medical AB, Mölndal, Sweden
| | - R Strand
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - M Engström
- Applied Science Laboratory, GE Healthcare, Uppsala, Sweden
| | - H Ahlström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Antaros Medical AB, Mölndal, Sweden
| | - F Malmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Information Technology, Uppsala University, Uppsala, Sweden
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Li C, Li N, Li Z, Shen L. Diagnostic accuracy of high b-value diffusion weighted imaging for patients with prostate cancer: a diagnostic comprehensive analysis. Aging (Albany NY) 2021; 13:16404-16424. [PMID: 34156972 PMCID: PMC8266335 DOI: 10.18632/aging.203164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/31/2021] [Indexed: 12/04/2022]
Abstract
We performed a meta-analysis to assess the diagnostic accuracy of high b-value diffusion-weighted imaging for patients with prostate cancer. A comprehensive literature search of the PubMed, Excerpta Medica Database, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang databases from January 1, 1995, to April 30, 2021, was conducted. The quality of the retrieved papers was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and their 95% confidence intervals (CIs) were evaluated using bivariate mixed effects models. A total of twenty-four articles matched the selection criteria and were finally included after screening the titles, abstracts, and full texts of 641 initial articles. The pooled sensitivity and specificity (95% CI) were 0.84 (0.80-0.87) and 0.87 (0.81-0.91), respectively. The pooled positive and negative likelihood ratios (95% CI) were 6.4 (4.4-9.3) and 0.19 (0.16-0.23), respectively. The diagnostic odds ratio was 34 (95% CI: 22-51). The area under the summary receiver operator characteristic curve was 0.91 (95% CI: 0.88-0.93). Subgroup analysis presents similar results. The diagnostic accuracy of high b-value diffusion-weighted imaging was similarly high in the qualitative and quantitative evaluation of prostate cancer.
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Affiliation(s)
- Chao Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
| | - Na Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
| | - Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
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