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Ringe KI, Wang J, Deng Y, Pi S, Geahchan A, Taouli B, Bashir MR. Abbreviated MRI Protocols in the Abdomen and Pelvis. J Magn Reson Imaging 2024; 59:58-69. [PMID: 37144673 DOI: 10.1002/jmri.28764] [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: 01/26/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
Abbreviated MRI (AMRI) protocols rely on the acquisition of a limited number of sequences tailored to a specific question. The main objective of AMRI protocols is to reduce exam duration and costs, while maintaining an acceptable diagnostic performance. AMRI is of increasing interest in the radiology community; however, challenges limiting clinical adoption remain. In this review, we will address main abdominal and pelvic applications of AMRI in the liver, pancreas, kidney, and prostate, including diagnostic performance, pitfalls, limitations, and cost effectiveness will also be discussed. Level of Evidence: 3 Technical Efficacy Stage: 3.
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Affiliation(s)
- Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ying Deng
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shan Pi
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Amine Geahchan
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mustafa R Bashir
- Department of Radiology, Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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2
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Spilseth B, Margolis DJA, Gupta RT, Chang SD. Interpretation of Prostate Magnetic Resonance Imaging Using Prostate Imaging and Data Reporting System Version 2.1: A Primer. Radiol Clin North Am 2024; 62:17-36. [PMID: 37973241 DOI: 10.1016/j.rcl.2023.06.007] [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] [Indexed: 11/19/2023]
Abstract
Prostate magnetic resonance imaging (MRI) is increasingly being used to diagnose and stage prostate cancer. The Prostate Imaging and Data Reporting System (PI-RADS) version 2.1 is a consensus-based reporting system that provides a standardized and reproducible method for interpreting prostate MRI. This primer provides an overview of the PI-RADS system, focusing on its current role in clinical interpretation. It discusses the appropriate use of PI-RADS and how it should be applied by radiologists in clinical practice to assign and report PI-RADS assessments. We also discuss the changes from prior versions and published validation studies on PI-RADS accuracy and reproducibility.
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Affiliation(s)
- Benjamin Spilseth
- Department of Radiology, University of Minnesota Medical School, MMC 292420, Delaware Street, Minneapolis, MN 55455, USA.
| | - Daniel J A Margolis
- Weill Cornell Medical College, Department of Radiology, 525 East 68th Street, Box 141, New York, NY 10068, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Duke Cancer Institute Center for Prostate & Urologic Cancers, DUMC Box 3808, Durham, NC 27710, USA; Department of Surgery, Duke University Medical Center, Duke Cancer Institute Center for Prostate & Urologic Cancers, DUMC Box 3808, Durham, NC 27710, USA
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 West 12th Avenue, Vancouver B.C., Canada V5M 1M9
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Mingels C, Loebelenz LI, Huber AT, Alberts I, Rominger A, Afshar-Oromieh A, Obmann VC. Literature review: Imaging in prostate cancer. Curr Probl Cancer 2023:100968. [PMID: 37336689 DOI: 10.1016/j.currproblcancer.2023.100968] [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: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
Imaging plays an increasingly important role in the detection and characterization of prostate cancer (PC). This review summarizes the key conventional and advanced imaging modalities including multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging and tries to instruct clinicians in finding the best image modality depending on the patient`s PC-stage. We aim to give an overview of the different image modalities and their benefits and weaknesses in imaging PC. Emphasis is put on primary prostate cancer detection and staging as well as on recurrent and castration resistant prostate cancer. Results from studies using various imaging techniques are discussed and compared. For the different stages of PC, advantages and disadvantages of the different imaging modalities are discussed. Moreover, this review aims to give an outlook about upcoming, new imaging modalities and how they might be implemented in the future into clinical routine. Imaging patients suffering from PC should aim for exact diagnosis, accurate detection of PC lesions and should mirror the true tumor burden. Imaging should lead to the best patient treatment available in the current PC-stage and should avoid unnecessary therapeutic interventions. New image modalities such as long axial field of view PET/CT with photon-counting CT and radiopharmaceuticals like androgen receptor targeting radiopharmaceuticals open up new possibilities. In conclusion, PC imaging is growing and each image modality is aiming for improvement.
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Affiliation(s)
- Clemens Mingels
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Laura I Loebelenz
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
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Vilanova JC, Pérez de Tudela A, Thio-Henestrosa S, Barceló J, Boada M, Planas M, Sala S, Artazkoz J, García-Figueiras R, Baleato-González S, Vilanova C, Puig J. Usefulness of balanced SSFP sequence in robot-assisted MRI-guided prostate biopsy: Beyond scouting. Eur J Radiol 2023; 160:110707. [PMID: 36689791 DOI: 10.1016/j.ejrad.2023.110707] [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: 10/24/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine whether bSSFP images are useful for visualizing prostatic lesionsin MRI-guided in-bore transrectal biopsy. METHODS This retrospective studyincluded 67 men witha single suspected cancer on MRI (PI-RADS 2.1 category ≥ 3) who underwent in-bore transrectal MRI-guided biopsy. Two uroradiologists independently rated lesion conspicuity on a 3-point scale (1:non-visible, 2:slightly visible, 3:clearly visible) on T2WI, DWI, and balanced SSFP.We used measures of frequency to compare lesion conspicuity in 3 sequences. We used Cohen's kappa to assess inter-rater reliability. RESULTS Lesions were rated (1) non-visible in 18 % (12/67) of T2WI, 5 % (3/67) of DWI, and 10 % (7/67) of balanced SSFP images, (2) slightly visible in 56 % (37/67) on T2WI, 13 % (9/67) on DWI, and 48 % (32/67) on bSSFP, and (3) clearly visible in 27 %(18/67) on T2WI, 82 % (55/67) on DWI, and 42 % (28/67) on bSSFP. Lesions classified as prostate cancer at histology were slightly-clearly visible in 85 % (41/48) on T2WI, 100 % (48/48) on DWI, and 94 % (45/48) on bSSFP. Lesions classified as PI-RADS ≥ 4 were visible in 87 % (47/54) of T2WI, 100 % (54/54) of DWI, and 93 % (50/54) of bSSFP. Gleason ≥ 3 + 4 lesions were visible in 85 % (37/43) of T2WI, 100 % (43/43) of DWI, and 95 % (41/43) of bSSFP. Inter-rater agreement was excellent for T2WI (k = 0.97) and bSSFP (k = 0.94), and good for DWI (k = 0.75). CONCLUSION Balanced SSFP is useful for visualizing prostatic lesions. Replacing T2WI with balanced SSFP can reduce the duration of in-bore transrectal MRI-guided biopsy.
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Affiliation(s)
- Joan C Vilanova
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain; Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology (Girona Biomedical Research Institute) IDIBGI, Hospital Universitari Dr. Josep Trueta, 17007 Girona, Spain; Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003 Girona, Spain.
| | | | - Santiago Thio-Henestrosa
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, 17003 Girona, Spain
| | - Joaquim Barceló
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain; Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology (Girona Biomedical Research Institute) IDIBGI, Hospital Universitari Dr. Josep Trueta, 17007 Girona, Spain; Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003 Girona, Spain
| | - Maria Boada
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain; Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003 Girona, Spain
| | - Montse Planas
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain
| | - Sònia Sala
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain
| | - Juanjo Artazkoz
- Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003 Girona, Spain
| | - Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706. Spain
| | - Sandra Baleato-González
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706. Spain
| | - Cristina Vilanova
- Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Josep Puig
- Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology (Girona Biomedical Research Institute) IDIBGI, Hospital Universitari Dr. Josep Trueta, 17007 Girona, Spain
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Iacob R, Stoicescu ER, Cerbu S, Manolescu DL, Bardan R, Cumpănaş A. Could Biparametric MRI Replace Multiparametric MRI in the Management of Prostate Cancer? Life (Basel) 2023; 13:465. [PMID: 36836822 PMCID: PMC9961917 DOI: 10.3390/life13020465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
Prostate cancer (PCa) is a worldwide epidemiological problem, since it is one of the most prevalent types of neoplasia among men, and the third-leading cause of cancer-related deaths, after lung and colorectal tumors. Unfortunately, the early stages of PCa have a wide range of unspecific symptoms. For these reasons, early diagnosis and accurate evaluation of suspicious lesions are crucial. Multiparametric MRI (mpMRI) is currently the imaging modality of choice for diagnostic screening and local staging of PCa, but also has a leading role in guiding biopsies and in treatment biparametric MRI (bpMRI) could partially replace mpMRI due to its lack of adverse reactions caused by contrast agents, relatively lower costs, and shorter acquisition time. Further, 31 relevant articles regarding the advantages and disadvantages of the aforementioned imaging techniques were scanned. As a result, while bpMRI has comparable accuracy in detecting PCa, its roles in the other steps of PCa management are limited.
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Affiliation(s)
- Roxana Iacob
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Emil-Robert Stoicescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Simona Cerbu
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Diana-Luminiţa Manolescu
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Răzvan Bardan
- Discipline of Urology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Alin Cumpănaş
- Discipline of Urology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
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Song J, Zhao C, Zhang F, Yuan Y, Wang LM, Sah V, Zhang J, Weng W, Yang Z, Wang Z, Wang L. The diagnostic performance in clinically significant prostate cancer with PI-RADS version 2.1: simplified bpMRI versus standard mpMRI. Abdom Radiol (NY) 2023; 48:704-712. [PMID: 36464756 DOI: 10.1007/s00261-022-03750-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVES To compare the diagnostic performance for the detection of clinically significant prostate cancer (csPCa) between bpMRI with only axial T2WI (simplified bpMRI) and standard-multiparametric MRI (mpMRI). METHODS A total of 569 patients who underwent mpMRI followed by biopsy or prostatectomy were enrolled in this retrospective study. According to PI-RADS v2.1, three radiologists (A, B, C) from three centers blinded to clinical variables were assigned scores on lesions with simplified bpMRI and then with mpMRI 2 weeks later. Diagnostic performance of simplified bpMRI was compared with mpMRI using histopathology as reference standard. RESULTS For all the three radiologists, the diagnostic sensitivity was significantly higher with mpMRI than with simplified bpMRI (P < 0.001 to P = 0.035); and although specificity was also higher with mpMRI than with simplified bpMRI for radiologist B and radiologist C, it was statistically significant only for radiologist B (P = 0.011, P = 0.359, respectively). On the contrary, for radiologist A, specificity was higher with simplified bpMRI than with mpMRI (P = 0.001). The area under the receiver operating characteristic curve (AUC) was significantly higher for mpMRI than for simplified bpMRI except for radiologist A (radiologist A: 0.903 vs 0.913, P = 0.1542; radiologist B: 0.861 vs 0.834 P = 0.0013; and radiologist C: 0.884 vs 0.848, P = 0.0003). Interobserver reliability of PI-RADS v2.1 showed good agreement for both simplified bpMRI (kappa = 0.665) and mpMRI (kappa = 0.739). CONCLUSION Although the detection of csPCa with simplified bpMRI was comparatively lower than that with mpMRI, the diagnostic performance was still high in simplified bpMRI. Our data justify using mpMRI outperforms simplified bpMRI for prostate cancer screening and imply simplified bpMRI as a potential screening tool.
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Affiliation(s)
- Jihui Song
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Dalian University Affiliated Xinhua Hospital, No.156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Chenglin Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fei Zhang
- Department of Radiology, QUFU City People Hospital, No.111 Chunqiu West Road, Qufu, 273100, Shandong, China
| | - Yingdi Yuan
- Department of Radiology, Ganzhou District People's Hospital, No.705 Beihuan Road, Ganzhou District, Zhangye, 734000, Gansu, China
| | - Lee M Wang
- Carnegie Mellon University, Pittsburgh, USA
| | - Vivek Sah
- ADK Hospital, Sosun Magu, Male, 20070, Maldives
| | - Jun Zhang
- Department of Radiology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Haigang District, Qinhuangdao, 066000, Hebei, China
| | - Wencai Weng
- Department of Radiology, Dalian University Affiliated Xinhua Hospital, No.156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Index lesion detection in multifocal prostate cancer: Simplified PI-RADS biparametric MRI vs PI-RADS v2.1 multiparametric MRI. Clin Imaging 2023; 94:108-115. [PMID: 36527796 DOI: 10.1016/j.clinimag.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
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Kortenbach KC, Løgager V, Thomsen HS, Boesen L. Comparison of PSA density and lesion volume strategies for selecting men with equivocal PI-RADS 3 lesions on bpMRI for biopsies. Abdom Radiol (NY) 2023; 48:688-693. [PMID: 36318331 PMCID: PMC9902318 DOI: 10.1007/s00261-022-03720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare two strategies: Prostate-specific antigen density (PSAd) and lesion volume measurement in ruling out significant prostate cancer (sPCa) in men with equivocal Prostate Imaging Reporting and Data System (PI-RADS) category 3 index lesions on biparametric magnetic resonance imaging. METHODS In total, 130 men from our database had index lesions with PI-RADS scores of 3. Prostate volume was measured using the ellipsoid method, in accordance with PI-RADS version 2.1 criteria. Index lesion volumes were also measured using the ellipsoidal formula on the diffusion-weighted imaging sequence with the highest b-value and sagittal T2 sequences. RESULTS Among 130 men with PI-RADS category 3 index lesions, 23 (18%) had sPCa. In total, 6 of the 89 men with PSAd < 0.15 ng/mL2 (7%) had sPCa, whereas 8 of the 49 men with index lesion volumes < 0.5 mL (16%) had sPCa. The difference was statistically significant (McNemar, p < 0.0001). CONCLUSION The PSAd strategy performed better than the lesion volume strategy in ruling out sPCa in men with equivocal PI-RADS category 3 index lesions.
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Affiliation(s)
- Karen-Cecilie Kortenbach
- Department of Radiology, Herlev Gentofte University Hospital, Borgmester Ib Juuls Vej 17, 2730, Herlev, Denmark.
| | - Vibeke Løgager
- Department of Radiology, Herlev Gentofte University Hospital, Borgmester Ib Juuls Vej 17, 2730 Herlev, Denmark
| | - Henrik S. Thomsen
- Department of Radiology, Herlev Gentofte University Hospital, Borgmester Ib Juuls Vej 17, 2730 Herlev, Denmark
| | - Lars Boesen
- Department of Radiology, Herlev Gentofte University Hospital, Borgmester Ib Juuls Vej 17, 2730 Herlev, Denmark ,Department of Urological Research, Herlev Gentofte University Hospital, Herlev, Denmark
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Kortenbach KC, Løgager V, Thomsen HS, Boesen L. Early experience in avoiding biopsies for biopsy-naïve men with clinical suspicion of prostate cancer but non-suspicious biparametric magnetic resonance imaging results and prostate-specific antigen density < 0.15 ng/mL 2: A 2-year follow-up study. Acta Radiol Open 2022; 11:20584601221094825. [PMID: 35464293 PMCID: PMC9024082 DOI: 10.1177/20584601221094825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Only limited data have been published on the diagnostic accuracy of combining biparametric (bp) magnetic resonance imaging (MRI) and prostate-specific antigen density (PSAd) to rule out biopsies. Purpose The purpose is to assess the 2-year risk of being diagnosed with sPCa following the strategy of avoiding immediate biopsies in men with non-suspicious bp MRIs and a PSAd <0.15 ng/mL2. Material and Methods Two hundred biopsy-naïve men with clinical suspicion of PCa underwent a pre-biopsy bp MRI from March to July 2019. Of these, 109 men had a Prostate Imaging Reporting and Data System (PI-RADS) score of 1–3 including 77 men with calculated PSAd <0.15 ng/mL2. As a result, no biopsies were performed in these 77 men, who were clinically followed up for at least 2 years and re-examined in case of rising suspicion of sPCa. The remaining 32 men with a calculated PSAd ≥0.15 ng/mL2 underwent systematic biopsies and targeted biopsies of any PI-RADS 3 lesion. Results One of the 77 men (1.3%) had an sPCa diagnosed within 2 years of follow-up. All men were referred back to their general practitioner within 1 year and 9% (7/77) were re-referred to the urology department during follow-up. Among these men, 43% (3/7) continued to have PSA levels that were above their individual thresholds at confirmatory testing and underwent secondary MRI scans. Conclusions No biopsies for men with bpMRI results exhibiting maximum PI-RADS 3 and with a PSAd <0.15 ng/mL2 resulted in a 2-year risk of being diagnosed with sPCa of 1.3%.
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Affiliation(s)
| | - Vibeke Løgager
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Henrik S Thomsen
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Lars Boesen
- Department of Urological Research, Herlev Gentofte University Hospital, Herlev, Denmark
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10
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Kortenbach KC, Boesen L, Løgager V, Thomsen HS. Outcome of 5-year follow-up in men with negative findings on initial biparametric MRI. Heliyon 2021; 7:e08325. [PMID: 34820539 PMCID: PMC8601994 DOI: 10.1016/j.heliyon.2021.e08325] [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: 08/03/2021] [Revised: 08/23/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background We assessed the 5-year risk of being diagnosed with significant prostate cancer following a low-suspicion biparametric magnetic resonance imaging result. Methods The study population was derived from a prospective database used to assess the diagnostic accuracy of biparametric magnetic resonance imaging for significant prostate cancer detection in 1020 biopsy-naïve men. Significant prostate cancer was defined as any core with Gleason grade group ≥3 or a maximum cancerous core length greater than 50% of Gleason grade group 2. A secondary definition of significant prostate cancer was also included: any core with prostate cancer Gleason grade group ≥2. Of the 1020 men, 305 had a low-suspicion biparametric magnetic resonance imaging result (Prostate Imaging Reporting and Data System score of 1 or 2) but four men were excluded from follow-up. Thus, the final study population consisted of 301 men, who were clinically followed-up from inclusion (November 2015 to June 2017) until 1 June 2021. Findings Overall, 1·7% (5/301) of the study population had significant prostate cancer diagnosed within 5 years (median 1480 days, Interquartile Range (1587-1382)) of their low-suspicion result and corresponding set of biopsies. When the secondary definition of significant prostate cancer was applied, this increased to 5% (15/301) of the study population. Interpretation The 5-year risk of being diagnosed with significant prostate cancer after a prebiopsy low-suspicion prebiopsy biparametric magnetic resonance imaging result was 1·7%.
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Affiliation(s)
- Karen-Cecilie Kortenbach
- Herlev Gentofte University Hospital, Department of Radiology, Borgmester Ib Juuls vej 17, DK-2730 Herlev, Denmark
| | - Lars Boesen
- Herlev Gentofte University Hospital, Department of Radiology, Borgmester Ib Juuls vej 17, DK-2730 Herlev, Denmark
| | - Vibeke Løgager
- Herlev Gentofte University Hospital, Department of Radiology, Borgmester Ib Juuls vej 17, DK-2730 Herlev, Denmark
| | - Henrik S Thomsen
- Herlev Gentofte University Hospital, Department of Radiology, Borgmester Ib Juuls vej 17, DK-2730 Herlev, Denmark
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11
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Scialpi M. Simplified PI-RADS-based biparametric MRI: A rationale for detecting and managing prostate cancer. Clin Imaging 2021; 80:290-291. [PMID: 34455239 DOI: 10.1016/j.clinimag.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/18/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
Biparametric MRI is a potential and valid alternative to multiparametric MRI. The simplified Prostate Imaging-Reporting and Data System (S-PI-RADS)-based biparametric MRI represents the rationale for the validation and standardization in clinical practice of MRI in detecting, managing and guiding biopsy in naïve men with suspicion prostate cancer.
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Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
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12
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Solyanik O, Heimer M. [Clinical impact of abbreviated unenhanced prostate protocols in magnetic resonance imaging]. Radiologe 2021; 61:810-817. [PMID: 34297140 DOI: 10.1007/s00117-021-00890-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND According to the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 multiparametric magnetic resonance imaging (mpMRI) with gadolinium-(Gd)-based contrast agents is the diagnostic standard of care in the detection of prostate cancer (PCa). Recent data suggest equivalent performance of biparametric MRI (bpMRI) and mpMRI in defined indications. OBJECTIVES Evaluation of the current role of abbreviated or unenhanced protocols in MRI of the prostate in various clinical settings. MATERIALS AND METHODS Evaluation of clinical trials, guidelines and expert opinions. RESULTS The use of dynamic contrast-enhanced (DCE) MRI sequences is associated with contrast agent-associated risks and has significant impact on the imaging procedure and costs. Arguments for and against the use of contrast agent in prostate protocols as well as equivalence from bpMRI and mpMRI are discussed. CONCLUSIONS Currently, bpMRI can only be performed if very good image quality is available and in the hands of a radiologist with extensive experience in reading prostate MRI. There is a need for prospective studies to qualify bpMRI as the diagnostic method for the primary diagnosis of PCa.
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Affiliation(s)
- Olga Solyanik
- Klinik und Poliklinik für Radiologie, LMU-Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
| | - Maurice Heimer
- Klinik und Poliklinik für Radiologie, LMU-Klinikum, Marchioninistraße 15, 81377, München, Deutschland
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Wang G, Yu G, Chen J, Yang G, Xu H, Chen Z, Wang G, Bai Z. Can high b-value 3.0 T biparametric MRI with the Simplified Prostate Image Reporting and Data System (S-PI-RADS) be used in biopsy-naïve men? Clin Imaging 2021; 88:80-86. [PMID: 34243992 DOI: 10.1016/j.clinimag.2021.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyze the clinical value of high b-value 3.0 T biparametric magnetic resonance with the Simplified Prostate Image Reporting and Data System (S-PI-RADS) in biopsy-naïve men. METHODS A retrospective analysis of the data of 224 patients who underwent prostate biopsy (cognitive fusion targeted biopsy combined with systematic biopsy) after a high b-value 3.0 T magnetic resonance examination at Haikou Hospital from July 2018 to July 2020 was performed. Two radiologists performed multi-parameter magnetic resonance imaging (mp-MRI) with the prostate imaging report and data system version 2 (PI-RADS v2) and biparametric magnetic resonance imaging (bp-MRI) with the simplified prostate image reporting and data system (S-PI-RADS). The detection efficacy of the two regimens was evaluated by classifying prostate cancer (PCa) and clinically significant prostate cancer (csPCa) according to pathology, and the statistical significance of the differences between the two regimens was determined by Z-test. RESULTS The area under the receiver operating curve (AUC) values of mp-MRI based on PI-RADS v2 and bp-MRI based on S-PI-RADS to detect PCa were 0.905 and 0.892, respectively, while the AUC values for the detection of csPCa were 0.919 and 0.906, respectively. There was no statistically significant difference between the two tests (Z values were 0.909 and 1.145, p > 0.05). CONCLUSION There was no significant difference in the detection efficacy of high b-value bp-MRI based on the S-PI-RADS score for prostate cancer and clinically significant prostate cancer compared with the standard PI-RADS v2 score with mp-MRI protocols, which can be applied clinically.
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Affiliation(s)
- Gang Wang
- Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No.43 Renmin Street, Meilan District, Haikou 570208, Hainan Province, China.
| | - Gang Yu
- Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No.43 Renmin Street, Meilan District, Haikou 570208, Hainan Province, China
| | - Jing Chen
- Department of Radiology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No.43 Renmin Street, Meilan District, Haikou 570208, Hainan Province, China
| | - Guang Yang
- Department of Radiology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No.43 Renmin Street, Meilan District, Haikou 570208, Hainan Province, China
| | - Haixia Xu
- Department of Pathology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No.43 Renmin Street, Meilan District, Haikou 570208, Hainan Province, China
| | - Zegu Chen
- Department of Radiology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No.43 Renmin Street, Meilan District, Haikou 570208, Hainan Province, China
| | - Guoren Wang
- Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No.43 Renmin Street, Meilan District, Haikou 570208, Hainan Province, China
| | - Zhiming Bai
- Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No.43 Renmin Street, Meilan District, Haikou 570208, Hainan Province, China.
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Razek AAKA, El-Diasty T, Elhendy A, Fahmy D, El-Adalany MA. Prostate Imaging Reporting and Data System (PI-RADS): What the radiologists need to know? Clin Imaging 2021; 79:183-200. [PMID: 34098371 DOI: 10.1016/j.clinimag.2021.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023]
Abstract
We aim to review the new modifications in MR imaging technique, image interpretation, lexicon, and scoring system of the last version of Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) in a simple and practical way. This last version of PI-RADS v2.1 describes the new technical modifications in the protocol of Multiparametric MRI (MpMRI) including T2, diffusion-weighted imaging (DWI), and dynamic contrast enhancement (DCE) parameters. It includes also; new guidelines in the image interpretation specifications in new locations (lesions located in the central zone and anterior fibromuscular stroma), clarification of T2 scoring of lesions of the transition zone, the distinction between DWI score 2 and 3 lesions in the transition zone and peripheral zone, as well as between positive and negative enhancement in DCE. Biparametric MRI (BpMRI) along with simplified PI-RADS is gaining more acceptances in the assessment of clinically significant prostatic cancer.
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Affiliation(s)
| | - Tarek El-Diasty
- Department of Diagnostic Radiology, Mansoura Urology and Nephrology Center, Mansoura, Egypt
| | - Ahmed Elhendy
- Department of Diagnostic Radiology, Mansoura Urology and Nephrology Center, Mansoura, Egypt
| | - Dalia Fahmy
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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Scialpi M, Scialpi P, Martorana E, Torre R, Improta A, Aisa MC, D’Andrea A, Di Blasi A. Simplified PI-RADS (S-PI-RADS) for biparametric MRI to detect and manage prostate cancer: What urologists need to know. Turk J Urol 2021; 47:175-182. [PMID: 35929870 PMCID: PMC8260088 DOI: 10.5152/tud.2021.21004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/09/2021] [Indexed: 09/14/2023]
Abstract
Biparametric magnetic resonance imaging (bpMRI) of the prostate has emerged as an alternative to multiparametric MRI (mpMRI) for the detection of clinically significant prostate cancer (csPCa). However, while the Prostate Imaging Reporting and Data System (PI-RADS) is widely known for mpMRI, a proper PI-RADS for bpMRI has not yet been adopted. In this review, we report the current status and the future directions of bpMRI, and propose a simplified PI-RADS (S-PI-RADS) that could help radiologists and urologists in the detection and management of PCa.
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Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Pietro Scialpi
- Division of Urology, Portogruaro Hospital, Venice, Italy
| | | | - Riccardo Torre
- Division of Radiology, Ospedale Santa Maria, Terni, Italy
| | - Antonio Improta
- Division of Diagnostic Imaging, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Maria Cristina Aisa
- Division of Obstetrics and Gynaecology, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Aldo Di Blasi
- Division of Radiology, Tivoli Hospital, Tivoli, Italy
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Brancato V, Aiello M, Basso L, Monti S, Palumbo L, Di Costanzo G, Salvatore M, Ragozzino A, Cavaliere C. Evaluation of a multiparametric MRI radiomic-based approach for stratification of equivocal PI-RADS 3 and upgraded PI-RADS 4 prostatic lesions. Sci Rep 2021; 11:643. [PMID: 33436929 PMCID: PMC7804929 DOI: 10.1038/s41598-020-80749-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/24/2020] [Indexed: 12/11/2022] Open
Abstract
Despite the key-role of the Prostate Imaging and Reporting and Data System (PI-RADS) in the diagnosis and characterization of prostate cancer (PCa), this system remains to be affected by several limitations, primarily associated with the interpretation of equivocal PI-RADS 3 lesions and with the debated role of Dynamic Contrast Enhanced-Magnetic Resonance Imaging (DCE-MRI), which is only used to upgrade peripheral PI-RADS category 3 lesions to PI-RADS category 4 if enhancement is focal. We aimed at investigating the usefulness of radiomics for detection of PCa lesions (Gleason Score ≥ 6) in PI-RADS 3 lesions and in peripheral PI-RADS 3 upgraded to PI-RADS 4 lesions (upPI-RADS 4). Multiparametric MRI (mpMRI) data of patients who underwent prostatic mpMRI between April 2013 and September 2018 were retrospectively evaluated. Biopsy results were used as gold standard. PI-RADS 3 and PI-RADS 4 lesions were re-scored according to the PI-RADS v2.1 before and after DCE-MRI evaluation. Radiomic features were extracted from T2-weighted MRI (T2), Apparent diffusion Coefficient (ADC) map and DCE-MRI subtracted images using PyRadiomics. Feature selection was performed using Wilcoxon-ranksum test and Minimum Redundancy Maximum Relevance (mRMR). Predictive models were constructed for PCa detection in PI-RADS 3 and upPI-RADS 4 lesions using at each step an imbalance-adjusted bootstrap resampling (IABR) on 1000 samples. 41 PI-RADS 3 and 32 upPI-RADS 4 lesions were analyzed. Among 293 radiomic features, the top selected features derived from T2 and ADC. For PI-RADS 3 stratification, second order model showed higher performances (Area Under the Receiver Operating Characteristic Curve-AUC- = 80%), while for upPI-RADS 4 stratification, first order model showed higher performances respect to superior order models (AUC = 89%). Our results support the significant role of T2 and ADC radiomic features for PCa detection in lesions scored as PI-RADS 3 and upPI-RADS 4. Radiomics models showed high diagnostic efficacy in classify PI-RADS 3 and upPI-RADS 4 lesions, outperforming PI-RADS v2.1 performance.
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Affiliation(s)
| | | | | | - Serena Monti
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Luigi Palumbo
- Department of Radiology, S. Maria Delle Grazie Hospital, Pozzuoli, Italy
| | | | | | - Alfonso Ragozzino
- Department of Radiology, S. Maria Delle Grazie Hospital, Pozzuoli, Italy
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Beyer T, Schlemmer HP, Weber MA, Thierfelder KM. PI-RADS 2.1 - Image Interpretation: The Most Important Updates and Their Clinical Implications. ROFO-FORTSCHR RONTG 2020; 193:787-796. [PMID: 33348384 DOI: 10.1055/a-1324-4010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MRI) of the prostate plays a central role in the diagnosis of patients with suspected prostate cancer. The increasing distribution and application of the guideline for the standardization of image acquisition, evaluation, and reporting (Prostate Imaging - Reporting and Data System, PI-RADS), which was updated in 2019 to version 2.1, contributes to the success of the technique. MATERIALS AND METHODS The most important updates of PI-RADS version 2.1 presented in 2019 compared to the previous version PI-RADS 2.0 are highlighted and interpreted with regard to their clinical implications. RESULTS PI-RADS version 2.1 aims to simplify the application of the scoring scheme without changing the basic concept of dominant sequences (DWI in the peripheral zone, T2 in the transition zone). Of particular importance are the increasing role of diffusion-weighted imaging in the transition zone, the now mandatory high b-value of at least 1400 s/mm2, and new information on the assessment of the central zone and the anterior fibromuscular stroma. CONCLUSION PI-RADS version 2.1 published in 2019 addresses a number of changes to the previous version, including both the examination technique and image interpretation. Prospective clinical studies have yet to prove the extent to which the goals of reducing interreader variability and increasing the detection rate in the transition zone will be achieved. KEY POINTS · The new PI-RADS version 2.1. includes changes regarding image interpretation and examination technique. · The role of diffusion-weighted imaging is strengthened in the transition zone. · An ultra-high b-value of at least 1400 s/mm2 is mandatory according to PI-RADS 2.1. · Biparametric MRI is not recommended for general application. CITATION FORMAT · Beyer T, Schlemmer H, Weber M et al. PI-RADS 2.1 - Image Interpretation: The Most Important Updates and Their Clinical Implications. Fortschr Röntgenstr 2021; 193: 787 - 795.
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Affiliation(s)
- Thomas Beyer
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | | | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Kolja M Thierfelder
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
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Udayakumar N, Porter KK. How Fast Can We Go: Abbreviated Prostate MR Protocols. Curr Urol Rep 2020; 21:59. [PMID: 33135121 DOI: 10.1007/s11934-020-01008-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Multiparametric MRI (mpMRI), composed of T2WI, DWI, and DCE sequences, is effective in identifying prostate cancer (PCa), but length and cost preclude its application as a PCa screening tool. Here we review abbreviated MRI protocols that shorten or omit conventional mpMRI components to reduce scan time and expense without forgoing diagnostic accuracy. RECENT FINDINGS The DCE sequence, which plays a limited diagnostic role in PI-RADS, is eliminated in variations of the biparametric MRI (bpMRI). T2WI, the lengthiest sequence, is truncated by only acquiring the axial plane or utilizing 3D acquisition with subsequent 2D reconstruction. DW-EPISMS further accelerates DWI acquisition. The fastest protocol described to date consists of just DW-EPISMS and axial-only 2D T2WI and runs less than 5 min. Abbreviated protocols can mitigate scan expense and increase scan access, allowing prostate MRI to become an efficient PCa screening tool.
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Affiliation(s)
- Neha Udayakumar
- University of Alabama at Birmingham School of Medicine, 1720 2nd Ave S, Birmingham, AL, 35249, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street S, JT N374, Birmingham, AL, 35249, USA.
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Rico L, Contreras P, Vitagliano G, Rios Pita H, Ameri C, Blas L. Value of prostate-specific antigen density in negative or equivocal lesions on multiparametric magnetic resonance imaging. Turk J Urol 2020; 46:367-372. [PMID: 32744992 DOI: 10.5152/tud.2020.20111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/09/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The prostate-specific antigen density (PSAD) is an accessory tool when suspecting prostate cancer. Multiparametric magnetic resonance imaging (mpMRI) of the prostate has a high rate of false negatives. The aim of this study is to evaluate the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) when adding the PSAD and negative or equivocal mpMRI. MATERIAL AND METHODS A retrospective study that included prostate biopsies performed using a transperineal approach and guided by ultrasound between 2015 and 2019 was conducted. Clinically significant prostate cancer (csPCa) was defined as Gleason score ≥3+4. The population was divided into groups according to the PSAD level-≤0.15 and >0.15. Sensitivity, specificity, NPV, and PPV of mpMRI were calculated. RESULTS A total of 292 patients were included; 12.1% (4/33 patients) of the negative mpMRI group presented csPCa, and only 7 in the equivocal mpMRI group presented csPCa. NPV and sensitivity were 91.15% and 90.5%, respectively. In the positive mpMRI group, 53.7% (96/179) had csPCa, with a PPV of 53.6% and specificity of 55.3%. Of the patients with PSAD ≤0.15, 23 (16.54%) presented csPCa. All of them presented a positive mpMRI. All patients with a negative or equivocal mpMRI and a PSAD ≤0.15 presented a clinically non-significant tumor or benign result. The addition of this tool to mpMRI resulted in 100% sensitivity, 69% specificity, and 34.8% PPV. CONCLUSION In our series, PSAD ≤0.15 increased the NPV in negative or equivocal mpMRI, and through this unnecessary prostate biopsies could be avoided.
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Affiliation(s)
- Luis Rico
- Hospital Aleman de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Pablo Contreras
- Hospital Aleman de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | | | | | - Carlos Ameri
- Hospital Aleman de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Leandro Blas
- Hospital Aleman de Buenos Aires, Ciudad de Buenos Aires, Argentina
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