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Light A, Sarphie DF, Mian R, Li X, Otieno M, Ahmed HU, Shah TT. The 'Leucocyte Coping Capacity' test for identifying radiorecurrent prostate cancer: a pilot study. BJU Int 2023; 132:268-271. [PMID: 37169727 PMCID: PMC11034710 DOI: 10.1111/bju.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Alexander Light
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | | | | | | | - Marjorie Otieno
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Hashim U. Ahmed
- Imperial Prostate, Division of Surgery, 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 and Interventional Sciences, University College London, London, UK
| | - Taimur T. Shah
- Imperial Prostate, Division of Surgery, 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 and Interventional Sciences, University College London, London, UK
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Scialpi M, Martorana E, Trippa F, Di Marzo A, Battista Scalera G, Cristina Aisa M, D’Andrea A, Maria Mancioli F, Nicola R, Scialpi P, Di Blasi A. Prostate Imaging for Local Recurrence Reporting and Data System for Biparametric Magnetic Resonance Imaging: A Proposal. UROLOGY RESEARCH & PRACTICE 2023; 49:233-240. [PMID: 37877824 PMCID: PMC10544277 DOI: 10.5152/tud.2023.22228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 06/05/2023] [Indexed: 10/26/2023]
Abstract
We investigated a novel dedicated Prostate Imaging for Local Recurrence Reporting and Data System (PI-RRADS) in biochemical recurrence after radiotherapy (RT) and rad- ical prostatectomy (RP) evaluating biparametric magnetic resonance imaging (bpMRI) exams, at 3T MRI of 55 patients. Associating bpMRI and biochemical recurrence data, we calculated bpMRI diagnostic accuracy. Four probability categories, from 1 (very low) to 4 (very high), were distinguished. In 20 patients with radiotherapy, 25% and 75% of lesions were reported as PI-RRADS 3, and 4, respectively. In 35 patients with radi- cal prostatectomy, 7.7% of lesions were included in PI-RRADS 1-2, whereas 40.4% and 51.9% in PI-RRADS 3 and 4 categories, respectively. Excellent agreement and significant correlation between bpMRI and biochemical recurrence were found. BpMRI showed sensitivity, specificity, positive predictive value, negative predictive value, false-posi- tive value, false-negative value, and total diagnostic accuracy of 96.15%, 86.7%, 97.4 %, 81.25%, 13.3%, 3.8% and 94.6%, respectively. BpMRI-based PI-RRADS allows the detection and localization local recurrence in biochemical recurrence after RT and RP contributing in clinical management and treatment.
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Affiliation(s)
- Michele Scialpi
- Department of Medicine and Surgery, Division of Diagnostic Imaging, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Fabio Trippa
- Radiation Oncology Centre, Ospedale Santa Maria, Terni, Italy
| | | | | | - Maria Cristina Aisa
- Department of Medicine and Surgery, Division of Obstetric and Gynaecology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | | | - Refky Nicola
- Department of Radiology, Syracuse, SUNY Upstate Medical, State University of New York Upstate Medical University, USA
| | - Pietro Scialpi
- Division of Urology, Portogruaro Hospital, Venice, Italy
| | - Aldo Di Blasi
- Division of Radiology, Tivoli Hospital, Tivoli, Italy
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Zapała P, Ślusarczyk A, Rajwa P, Gandaglia G, Zapała Ł, Zattoni F, Lorenc T, Ploussard G, Radziszewski P. Magnetic resonance imaging (MRI) for local staging before salvage radical prostatectomy: a meta-analysis. World J Urol 2023; 41:1275-1284. [PMID: 37019997 DOI: 10.1007/s00345-023-04383-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
PURPOSE The reliability of magnetic resonance imaging (MRI) as a local and nodal staging tool in radio-recurrent prostate cancer (PCa) is still unclear. The present study aims at evaluating the predictive value of MRI in the detection of extracapsular extension (ECE), seminal vesical invasion (SVI) and nodal involvement (LNI) in patients after primary radio (EBRT) and/or brachytherapy (BT) before salvage radical prostatectomy (SRP). METHODS This systematic review and meta-analysis were performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Pubmed, Scopus, and Web of Science databases were systemically reviewed to extract the data on diagnostic performance of MRI in radio-recurrent PCa. RESULTS Four studies comprising 94 radio-recurrent PCa patients were included. The pooled prevalence of ECE, SVI, and LNI was 61%, 41%, and 20%, respectively. The pooled sensitivity for ECE, SVI and LNI detection was 53% (CI 95% 19.8-83.6%), 53% (CI 95% 37.2-68%) and 33% (CI 95% 4.7-83.1%) respectively, whereas specificity was 75% (CI 95% 40.6-92.6%), 88% (CI 95% 71.7-95.9%) and 92% (CI 95% 79.6-96.8%). The sensitivity analysis revealed that a single outlying study using only T2-weighted imaging instead of multiparametric MRI reported significantly higher sensitivity with significantly lower specificity. CONCLUSIONS This is the first meta-analysis reporting reliability of staging MRI in a radio-recurrent setting. MRI provides poor sensitivity while maintaining high specificity for local and nodal staging before SRP. However, current evidence is limited to the low number of heterogenous studies at meaningful risk of bias.
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Affiliation(s)
- Piotr Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Aleksander Ślusarczyk
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Paweł Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, IRCCS San Raffaele, San Raffaele Hospital, Milan, Italy
| | - Łukasz Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128, Padua, Italy
| | - Tomasz Lorenc
- 1St Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Piotr Radziszewski
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
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Algohary A, Alhusseini M, Breto AL, Kwon D, Xu IR, Gaston SM, Castillo P, Punnen S, Spieler B, Abramowitz MC, Dal Pra A, Kryvenko ON, Pollack A, Stoyanova R. Longitudinal Changes and Predictive Value of Multiparametric MRI Features for Prostate Cancer Patients Treated with MRI-Guided Lattice Extreme Ablative Dose (LEAD) Boost Radiotherapy. Cancers (Basel) 2022; 14:cancers14184475. [PMID: 36139635 PMCID: PMC9496901 DOI: 10.3390/cancers14184475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/01/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
We investigated the longitudinal changes in multiparametric MRI (mpMRI) (T2-weighted, Apparent Diffusion Coefficient (ADC), and Dynamic Contrast Enhanced (DCE-)MRI) of prostate cancer patients receiving Lattice Extreme Ablative Dose (LEAD) radiotherapy (RT) and the capability of their imaging features to predict RT outcome based on endpoint biopsies. Ninety-five mpMRI exams from 25 patients, acquired pre-RT and at 3-, 9-, and 24-months post-RT were analyzed. MRI/Ultrasound-fused biopsies were acquired pre- and at two-years post-RT (endpoint). Five regions of interest (ROIs) were analyzed: Gross tumor volume (GTV), normally-appearing tissue (NAT) and peritumoral volume in both peripheral (PZ) and transition (TZ) zones. Diffusion and perfusion radiomics features were extracted from mpMRI and compared before and after RT using two-tailed Student t-tests. Selected features at the four scan points and their differences (Δ radiomics) were used in multivariate logistic regression models to predict the endpoint biopsy positivity. Baseline ADC values were significantly different between GTV, NAT-PZ, and NAT-TZ (p-values < 0.005). Pharmaco-kinetic features changed significantly in the GTV at 3-month post-RT compared to baseline. Several radiomics features at baseline and three-months post-RT were significantly associated with endpoint biopsy positivity and were used to build models with high predictive power of this endpoint (AUC = 0.98 and 0.89, respectively). Our study characterized the RT-induced changes in perfusion and diffusion. Quantitative imaging features from mpMRI show promise as being predictive of endpoint biopsy positivity.
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Affiliation(s)
- Ahmad Algohary
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Mohammad Alhusseini
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Adrian L. Breto
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Deukwoo Kwon
- Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Isaac R. Xu
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sandra M. Gaston
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Patricia Castillo
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sanoj Punnen
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Benjamin Spieler
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Matthew C. Abramowitz
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Oleksandr N. Kryvenko
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Correspondence: ; Tel.: +1-305-243-5856
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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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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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Evangelista L, Cassarino G, Lauro A, Morlacco A, Sepulcri M, Nguyen AAL, Ietto F, Cecchin D, Lacognata C, Zucchetta P. Comparison of MRI, PET, and 18F-choline PET/MRI in patients with oligometastatic recurrent prostate cancer. Abdom Radiol (NY) 2021; 46:4401-4409. [PMID: 34047801 PMCID: PMC8346454 DOI: 10.1007/s00261-021-03131-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/19/2022]
Abstract
Objectives The aims of the study were (i) to examine the PCa detection rate of 18F-choline (FCH) PET/MRI and (ii) to assess the impact of PET/MRI findings in patients with PCa who develop OMD using PSA response as a biomarker. Methods We retrospectively analyzed a cohort of 103 patients undergoing FCH PET/MRI for biochemical recurrence of PCa. The inclusion criteria were (1) previous radical prostatectomy (RP) with or without adjuvant radiotherapy (RT); (2) PSA levels available at the time of PET; (3) OMD, defined as a maximum of 5 lesions on PET/MRI; and (4) follow-up data available for at least 6 months after PET. All images were reviewed by two nuclear medicine physicians and interpreted with the support of two radiologists. Results Seventy patients were eligible for the study: 52 patients had a positive FCH PET/MRI and 18 had a negative scan. The overall PCa detection rates for MRI, PET, and PET/MRI were 65.7%, 37.1%, and 74.3%, respectively. Thirty-five patients were treated with radiotherapy (RT), 16 received hormonal therapy (HT), 3 had a combined therapy (RT + HT), and 16 (23%) underwent PSA surveillance. At follow-up, PSA levels decreased in 51 patients (73%), most of whom had been treated with RT or RT + HT. Therapeutic management was guided by PET/MRI in 74% of patients, which performed better than MRI alone (68% of patients). Conclusion FCH PET/MRI has a higher detection rate than MRI or PET alone for PCa patients with OMD and PSA levels > 0.5 ng/mL, prompting a better choice of treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00261-021-03131-7.
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Affiliation(s)
- Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Gianluca Cassarino
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Alberto Lauro
- Radiology Unit, University-Hospital of Padova, Padua, Italy
| | - Alessandro Morlacco
- Department of Surgical Oncological and Gastroenterological Sciences, Urology University of Padua, Padua, Italy
| | - Matteo Sepulcri
- Radiotherapy Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Alex Ahn Li Nguyen
- Department of Surgical Oncological and Gastroenterological Sciences, Urology University of Padua, Padua, Italy
| | - Francesco Ietto
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | | | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
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Wang C, Padgett KR, Su MY, Mellon EA, Maziero D, Chang Z. Multi-parametric MRI (mpMRI) for treatment response assessment of radiation therapy. Med Phys 2021; 49:2794-2819. [PMID: 34374098 DOI: 10.1002/mp.15130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022] Open
Abstract
Magnetic resonance imaging (MRI) plays an important role in the modern radiation therapy (RT) workflow. In comparison with computed tomography (CT) imaging, which is the dominant imaging modality in RT, MRI possesses excellent soft-tissue contrast for radiographic evaluation. Based on quantitative models, MRI can be used to assess tissue functional and physiological information. With the developments of scanner design, acquisition strategy, advanced data analysis, and modeling, multiparametric MRI (mpMRI), a combination of morphologic and functional imaging modalities, has been increasingly adopted for disease detection, localization, and characterization. Integration of mpMRI techniques into RT enriches the opportunities to individualize RT. In particular, RT response assessment using mpMRI allows for accurate characterization of both tissue anatomical and biochemical changes to support decision-making in monotherapy of radiation treatment and/or systematic cancer management. In recent years, accumulating evidence have, indeed, demonstrated the potentials of mpMRI in RT response assessment regarding patient stratification, trial benchmarking, early treatment intervention, and outcome modeling. Clinical application of mpMRI for treatment response assessment in routine radiation oncology workflow, however, is more complex than implementing an additional imaging protocol; mpMRI requires additional focus on optimal study design, practice standardization, and unified statistical reporting strategy to realize its full potential in the context of RT. In this article, the mpMRI theories, including image mechanism, protocol design, and data analysis, will be reviewed with a focus on the radiation oncology field. Representative works will be discussed to demonstrate how mpMRI can be used for RT response assessment. Additionally, issues and limits of current works, as well as challenges and potential future research directions, will also be discussed.
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Affiliation(s)
- Chunhao Wang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Kyle R Padgett
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA.,Department of Radiology, University of Miami, Miami, Florida, USA
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, California, USA.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Eric A Mellon
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Danilo Maziero
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Zheng Chang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
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Syversen IF, Elschot M, Sandsmark E, Bertilsson H, Bathen TF, Goa PE. Exploring the diagnostic potential of adding T2 dependence in diffusion-weighted MR imaging of the prostate. PLoS One 2021; 16:e0252387. [PMID: 34043735 PMCID: PMC8158951 DOI: 10.1371/journal.pone.0252387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is essential in the detection and staging of prostate cancer. However, improved tools to distinguish between low-risk and high-risk cancer are needed in order to select the appropriate treatment. Purpose To investigate the diagnostic potential of signal fractions estimated from a two-component model using combined T2- and diffusion-weighted imaging (T2-DWI). Material and methods 62 patients with prostate cancer and 14 patients with benign prostatic hyperplasia (BPH) underwent combined T2-DWI (TE = 55 and 73 ms, b-values = 50 and 700 s/mm2) following clinical suspicion of cancer, providing a set of 4 measurements per voxel. Cancer was confirmed in post-MRI biopsy, and regions of interest (ROIs) were delineated based on radiology reporting. Signal fractions of the slow component (SFslow) of the proposed two-component model were calculated from a model fit with 2 free parameters, and compared to conventional bi- and mono-exponential apparent diffusion coefficient (ADC) models. Results All three models showed a significant difference (p<0.0001) between peripheral zone (PZ) tumor and normal tissue ROIs, but not between non-PZ tumor and BPH ROIs. The area under the receiver operating characteristics curve distinguishing tumor from prostate voxels was 0.956, 0.949 and 0.949 for the two-component, bi-exponential and mono-exponential models, respectively. The corresponding Spearman correlation coefficients between tumor values and Gleason Grade Group were fair (0.370, 0.499 and -0.490), but not significant. Conclusion Signal fraction estimates from a two-component model based on combined T2-DWI can differentiate between tumor and normal prostate tissue and show potential for prostate cancer diagnosis. The model performed similarly to conventional diffusion models.
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Affiliation(s)
- Ingrid Framås Syversen
- Kavli Institute for Systems Neuroscience, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Mattijs Elschot
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elise Sandsmark
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Helena Bertilsson
- Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Frost Bathen
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Erik Goa
- Department of Physics, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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10
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Li M, Li W. Clinical application and progress of quantitative functional magnetic resonance imaging in prostate cancer. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:414-420. [PMID: 33967089 PMCID: PMC10930317 DOI: 10.11817/j.issn.1672-7347.2021.200316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Indexed: 11/03/2022]
Abstract
Magnetic resonance imaging (MRI) is a very important imaging method for diagnosis and treatment of prostate cancer (PCa) in clinical practice. As functional MRI is growing and maturing, its quantitative parameters are expected to enhance the clinical value of MRI furtherly. Intravoxel incoherent motion diffusion imaging, diffusion tensor imaging, and diffusion kurtosis imaging, which were derived from diffusion weighted imaging, have provided richer and more accurate parameters. The newly-developed magnetic resonance elastography can complement the mechanical characteristics of PCa.
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Affiliation(s)
- Mengsi Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China.
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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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Panebianco V, Villeirs G, Weinreb JC, Turkbey BI, Margolis DJ, Richenberg J, Schoots IG, Moore CM, Futterer J, Macura KJ, Oto A, Bittencourt LK, Haider MA, Salomon G, Tempany CM, Padhani AR, Barentsz JO. Prostate Magnetic Resonance Imaging for Local Recurrence Reporting (PI-RR): International Consensus -based Guidelines on Multiparametric Magnetic Resonance Imaging for Prostate Cancer Recurrence after Radiation Therapy and Radical Prostatectomy. Eur Urol Oncol 2021; 4:868-876. [PMID: 33582104 DOI: 10.1016/j.euo.2021.01.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Imaging techniques are used to identify local recurrence of prostate cancer (PCa) for salvage therapy and to exclude metastases that should be addressed with systemic therapy. For magnetic resonance imaging (MRI), a reduction in the variability of acquisition, interpretation, and reporting is required to detect local PCa recurrence in men with biochemical relapse after local treatment with curative intent. OBJECTIVE To propose a standardised method for image acquisition and assessment of PCa local recurrence using MRI after radiation therapy (RP) and radical prostatectomy (RT). EVIDENCE ACQUISITION Prostate Imaging for Recurrence Reporting (PI-RR) was formulated using the existing literature. An international panel of experts conducted a nonsystematic review of the literature. The PI-RR system was created via consensus through a combination of face-to-face and online discussions. EVIDENCE SYNTHESIS Similar to with PI-RADS, based on the best available evidence and expert opinion, the minimum acceptable MRI parameters for detection of recurrence after radiation therapy and radical prostatectomy are set. Also, a simplified and standardised terminology and content of the reports that use five assessment categories to summarise the suspicion of local recurrence (PI-RR) are designed. PI-RR scores of 1 and 2 are assigned to lesions with a very low and low likelihood of recurrence, respectively. PI-RR 3 is assigned if the presence of recurrence is uncertain. PI-RR 4 and 5 are assigned for a high and very high likelihood of recurrence, respectively. PI-RR is intended to be used in routine clinical practice and to facilitate data collection and outcome monitoring for research. CONCLUSIONS This paper provides a structured reporting system (PI-RR) for MRI evaluation of local recurrence of PCa after RT and RP. PATIENT SUMMARY A new method called PI-RR was developed to promote standardisation and reduce variations in the acquisition, interpretation, and reporting of magnetic resonance imaging for evaluating local recurrence of prostate cancer and guiding therapy.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy.
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey C Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Baris I Turkbey
- National Cancer Institute, Center for Cancer Research, Bethesda, MD, USA
| | | | - Jonathan Richenberg
- Department of Imaging, Brighton and Sussex University Hospitals NHS Trust and Brighton and Sussex Medical School, Brighton, UK
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Jurgen Futterer
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Katarzyna J Macura
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | | | - Masoom A Haider
- Department of Medical Imaging, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Clare M Tempany
- Department of Radiology, Brigham &Women's Hospital, Boston, MA, USA
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
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13
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Abstract
Prostate cancer is the fifth leading cause of death worldwide. A variety of treatment options is available for localized prostate cancer and may range from active surveillance to focal therapy or whole gland treatment, that is, surgery or radiotherapy. Serum prostate-specific antigen levels are an important tool to monitor treatment success after whole gland treatment, unfortunately prostate-specific antigen is unreliable after focal therapy. Multiparametric magnetic resonance imaging of the prostate is rapidly gaining field in the management of prostate cancer and may play a crucial role in the evaluation of recurrent prostate cancer. This article will focus on postprocedural magnetic resonance imaging after different forms of local therapy in patients with prostate cancer.
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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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Latifoltojar A, Appayya MB, Barrett T, Punwani S. Similarities and differences between Likert and PIRADS v2.1 scores of prostate multiparametric MRI: a pictorial review of histology-validated cases. Clin Radiol 2019; 74:895.e1-895.e15. [PMID: 31627804 DOI: 10.1016/j.crad.2019.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/27/2019] [Indexed: 12/21/2022]
Abstract
The UK National Institute for Health and Care Excellence (NICE) 2019 "Prostate cancer: diagnosis and management" guidelines have recommended that all patients suspected of prostate cancer undergo multiparametric magnetic resonance imaging (mpMRI) prior to biopsy. The Likert scoring system is advocated for mpMRI reporting based on multicentre studies that have demonstrated its effectiveness within the National Health Service (NHS). In recent years, there has been considerable drive towards standardised prostate reporting, which led to the development of "Prostate Imaging-Reporting And Data System" (PI-RADS). The PI-RADS system has been adopted by the majority of European countries and within the US. This paper reviews these systems indicating the similarities and specific differences that exist between PI-RADS and Likert assessment through a series of histologically proven clinical cases.
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Affiliation(s)
- A Latifoltojar
- Centre for Medical Imaging, University College London, Division of Medicine, Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - M B Appayya
- Centre for Medical Imaging, University College London, Division of Medicine, Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - T Barrett
- Department of Radiology, Addenbrooke's Hospital, 277 Hills Rd, Cambridge CB2 0QQ, UK; Cambridge Biomedical Research Centre, 277 Hills Road Cambridge CB2 0QQ, UK
| | - S Punwani
- Centre for Medical Imaging, University College London, Division of Medicine, Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK.
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16
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Wu X, Reinikainen P, Kapanen M, Vierikko T, Ryymin P, Kellokumpu-Lehtinen PL. Monitoring radiotherapy induced tissue changes in localized prostate cancer by multi-parametric magnetic resonance imaging (MP-MRI). Diagn Interv Imaging 2019; 100:699-708. [DOI: 10.1016/j.diii.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 01/11/2023]
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17
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Ghafoor S, Burger IA, Vargas AH. Multimodality Imaging of Prostate Cancer. J Nucl Med 2019; 60:1350-1358. [PMID: 31481573 DOI: 10.2967/jnumed.119.228320] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/29/2019] [Indexed: 01/02/2023] Open
Abstract
Prostate cancer is a very heterogeneous disease, and contemporary management is focused on identification and treatment of the prognostically adverse high-risk tumors while minimizing overtreatment of indolent, low-risk tumors. In recent years, imaging has gained increasing importance in the detection, staging, posttreatment assessment, and detection of recurrence of prostate cancer. Several imaging modalities including conventional and functional methods are used in different clinical scenarios with their very own advantages and limitations. This continuing medical education article provides an overview of available imaging modalities currently in use for prostate cancer followed by a more specific section on the value of these different imaging modalities in distinct clinical scenarios, ranging from initial diagnosis to advanced, metastatic castration-resistant prostate cancer. In addition to established imaging indications, we will highlight some potential future applications of contemporary imaging modalities in prostate cancer.
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Affiliation(s)
- Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Irene A Burger
- Department of Nuclear Medicine, Baden Cantonal Hospital, Baden, Switzerland
| | - Alberto H Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
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18
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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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19
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Dinis Fernandes C, van Houdt PJ, Heijmink SWTPJ, Walraven I, Keesman R, Smolic M, Ghobadi G, van der Poel HG, Schoots IG, Pos FJ, van der Heide UA. Quantitative 3T multiparametric MRI of benign and malignant prostatic tissue in patients with and without local recurrent prostate cancer after external-beam radiation therapy. J Magn Reson Imaging 2018; 50:269-278. [PMID: 30585368 PMCID: PMC6618021 DOI: 10.1002/jmri.26581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 12/27/2022] Open
Abstract
Background Post‐radiotherapy locally recurrent prostate cancer (PCa) patients are candidates for focal salvage treatment. Multiparametric MRI (mp‐MRI) is attractive for tumor localization. However, radiotherapy‐induced tissue changes complicate image interpretation. To develop focal salvage strategies, accurate tumor localization and distinction from benign tissue is necessary. Purpose To quantitatively characterize radio‐recurrent tumor and benign radiation‐induced changes using mp‐MRI, and investigate which sequences optimize the distinction between tumor and benign surroundings. Study Type Prospective case–control. Subjects Thirty‐three patients with biochemical failure after external‐beam radiotherapy (cases), 35 patients without post‐radiotherapy recurrent disease (controls), and 13 patients with primary PCa (untreated). Field Strength/Sequences 3T; quantitative mp‐MRI: T2‐mapping, ADC, and Ktrans and kep maps. Assessment Quantitative image‐analysis of prostatic regions, within and between cases, controls, and untreated patients. Statistical Tests Within‐groups: nonparametric Friedman analysis of variance with post‐hoc Wilcoxon signed‐rank tests; between‐groups: Mann–Whitney tests. All with Bonferroni corrections. Generalized linear mixed modeling to ascertain the contribution of each map and location to tumor likelihood. Results Benign imaging values were comparable between cases and controls (P = 0.15 for ADC in the central gland up to 0.91 for kep in the peripheral zone), both with similarly high peri‐urethral Ktrans and kep values (min−1) (median [range]: Ktrans = 0.22 [0.14–0.43] and 0.22 [0.14–0.36], P = 0.60, kep = 0.43 [0.24–0.57] and 0.48 [0.32–0.67], P = 0.05). After radiotherapy, benign central gland values were significantly decreased for all maps (P ≤ 0.001) as well as T2, Ktrans, and kep of benign peripheral zone (all with P ≤ 0.002). All imaging maps distinguished recurrent tumor from benign peripheral zone, but only ADC, Ktrans, and kep were able to distinguish it from benign central gland. Recurrent tumor and peri‐urethral Ktrans values were not significantly different (P = 0.81), but kep values were (P < 0.001). Combining all quantitative maps and voxel location resulted in an optimal distinction between tumor and benign voxels. Data Conclusion Mp‐MRI can distinguish recurrent tumor from benign tissue. Level of Evidence: 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:269–278.
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Affiliation(s)
| | - Petra J van Houdt
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Iris Walraven
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rick Keesman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Milena Smolic
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ghazaleh Ghobadi
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ivo G Schoots
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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20
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Fedorov A, Schwier M, Clunie D, Herz C, Pieper S, Kikinis R, Tempany C, Fennessy F. An annotated test-retest collection of prostate multiparametric MRI. Sci Data 2018; 5:180281. [PMID: 30512014 PMCID: PMC6278692 DOI: 10.1038/sdata.2018.281] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/26/2018] [Indexed: 12/13/2022] Open
Abstract
Multiparametric Magnetic Resonance Imaging (mpMRI) is widely used for characterizing prostate cancer. Standard of care use of mpMRI in clinic relies on visual interpretation of the images by an expert. mpMRI is also increasingly used as a quantitative imaging biomarker of the disease. Little is known about repeatability of such quantitative measurements, and no test-retest datasets have been available publicly to support investigation of the technical characteristics of the MRI-based quantification in the prostate. Here we present an mpMRI dataset consisting of baseline and repeat prostate MRI exams for 15 subjects, manually annotated to define regions corresponding to lesions and anatomical structures, and accompanied by region-based measurements. This dataset aims to support further investigation of the repeatability of mpMRI-derived quantitative prostate measurements, study of the robustness and reliability of the automated analysis approaches, and to support development and validation of new image analysis techniques. The manuscript can also serve as an example of the use of DICOM for standardized encoding of the image annotation and quantification results.
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Affiliation(s)
- Andriy Fedorov
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Schwier
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Christian Herz
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Ron Kikinis
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Fraunhofer MEVIS, Bremen, Germany
- Mathematics/Computer Science Faculty, University of Bremen, Bremen, Germany
| | - Clare Tempany
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Fiona Fennessy
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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21
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Dinis Fernandes C, Ghobadi G, van der Poel HG, de Jong J, Heijmink SWTPJ, Schoots I, Walraven I, van Houdt PJ, Smolic M, Pos FJ, van der Heide UA. Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy. Eur Radiol 2018; 29:4160-4168. [PMID: 30421016 PMCID: PMC6610274 DOI: 10.1007/s00330-018-5819-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/30/2018] [Accepted: 10/02/2018] [Indexed: 12/21/2022]
Abstract
Objectives Diagnosis of radio-recurrent prostate cancer using multi-parametric MRI (mp-MRI) can be challenging due to the presence of radiation effects. We aim to characterize imaging of prostate tissue after radiation therapy (RT), using histopathology as ground truth, and to investigate the visibility of tumor lesions on mp-MRI. Methods Tumor delineated histopathology slides from salvage radical prostatectomy patients, primarily treated with RT, were registered to MRI. Median T2-weighted, ADC, Ktrans, and kep values in tumor and other regions were calculated. Two radiologists independently performed mp-MRI-based tumor delineations which were compared with the true pathological extent. General linear mixed-effect modeling was used to establish the contribution of each imaging modality and combinations thereof in distinguishing tumor and benign voxels. Results Nineteen of the 21 included patients had tumor in the available histopathology slides. Recurrence was predominantly multifocal with large tumor foci seen after external beam radiotherapy, whereas these were small and sparse after low-dose-rate brachytherapy. MRI-based delineations missed small foci and slightly underestimated tumor extent. The combination of T2-weighted, ADC, Ktrans, and kep had the best performance in distinguishing tumor and benign voxels. Conclusions Using high-resolution histopathology delineations, the real tumor extent and size were found to be underestimated on MRI. mp-MRI obtained the best performance in identifying tumor voxels. Appropriate margins around the visible tumor-suspected region should be included when designing focal salvage strategies. Recurrent tumor delineation guidelines are warranted. Key Points • Compared to the use of individual sequences, multi-parametric MRI obtained the best performance in distinguishing recurrent tumor from benign voxels. • Delineations based on mp-MRI miss smaller foci and slightly underestimate tumor volume of local recurrent prostate cancer. • Focal salvage strategies should include appropriate margins around the visible tumor. Electronic supplementary material The online version of this article (10.1007/s00330-018-5819-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catarina Dinis Fernandes
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ghazaleh Ghobadi
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen de Jong
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ivo Schoots
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris Walraven
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Milena Smolic
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Hedgire S, Kilcoyne A, Tonyushkin A, Mao Y, Uyeda JW, Gervais DA, Harisinghani MG. Effect of androgen deprivation and radiation therapy on MRI fiber tractography in prostate cancer: can we assess treatment response on imaging? Br J Radiol 2018; 92:20170170. [PMID: 30209952 DOI: 10.1259/bjr.20170170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate quantitative changes in Diffusion Tensor Magnetic Resonance Tractography in prostate cancer following androgen deprivation and radiation therapy. METHODS 22 patients with elevated PSA and biopsy proven prostate carcinoma who underwent MRI of the prostate at 1.5 T with an endorectal coil were included. Group A) was the study group (n = 11), participants who underwent androgen deprivation and/or radiation therapy and group B) were Gleason-matched control group (n = 11) participants who did not undergo such therapy. Diffusion weighted images were used to generate three-dimensional (3D) map of fiber tracts from DTI. 3D regions of interest (ROI) were drawn over the tumor and healthy prostatic parenchyma in both groups to record tract number and tract density. Tumor region and normal parenchymal tract densities within each group were compared. RESULTS Mean tract density in the tumor region and normal parenchyma was 2.3 and 3.3 in study group (tract numbers: 116.6 and 170.2 respectively) and 1.6 and 2.7 in the control group respectively (tract numbers: 252.5 and 346.3 respectively). The difference between these values was statistically significant for the control group (p = 0.0018) but not for the study group (p = 0.11). The difference between the tract numbers of tumor and normal parenchyma appears to narrow following therapy. CONCLUSION The study demonstrated utility in using tractography as a biomarker in prostate cancer patients post treatment. ADVANCES IN KNOWLEDGE Quantitative DTI fiber tractography is a promising imaging biomarker to quantitatively assess treatment response in the setting of post-androgen deprivation and radiation therapy for prostate cancer.
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Affiliation(s)
- Sandeep Hedgire
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Aoife Kilcoyne
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Alexey Tonyushkin
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, USA.,Physics Department, University of Massachusetts Boston, Boston, MA, USA
| | - Yun Mao
- Department of Radiology, The first affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Jennifer W Uyeda
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Debra A Gervais
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Mukesh G Harisinghani
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, USA
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23
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Luzurier A, Jouve De Guibert PH, Allera A, Feldman SF, Conort P, Simon JM, Mozer P, Compérat E, Boudghene F, Servois V, Lucidarme O, Granger B, Renard-Penna R. Dynamic contrast-enhanced imaging in localizing local recurrence of prostate cancer after radiotherapy: Limited added value for readers of varying level of experience. J Magn Reson Imaging 2018. [DOI: 10.1002/jmri.25991] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Anna Luzurier
- Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University Paris; France
| | | | - Alexandre Allera
- Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University Paris; France
| | - Sarah F. Feldman
- Academic Departement of Statistic, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University; France
| | - Pierre Conort
- Academic Department of Urology, Hopital Pitié-Salpétrière; AP-HP Sorbonne University; France
| | - Jean Marc Simon
- Academic Department of Radiotherapy, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University; France
| | - Pierre Mozer
- Academic Department of Urology, Hopital Pitié-Salpétrière; AP-HP Sorbonne University; France
| | - Eva Compérat
- Academic Department of Pathology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University; France
| | - Franck Boudghene
- Academic Department of Radiology, Hopital Tenon, AP-HP; Sorbonne University; France
| | - Vincent Servois
- Academic department of Radiology; Curie Institute, Descartes Univ Paris 05; Paris France
| | - Olivier Lucidarme
- Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University Paris; France
| | - Benjamin Granger
- Academic Departement of Statistic, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University; France
| | - Raphaele Renard-Penna
- Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University Paris; France
- Academic Department of Radiology, Hopital Tenon, AP-HP; Sorbonne University; France
- GRC-UPMC Oncotype-URO; Sorbonne University; Paris France
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24
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Akin-Akintayo O, Tade F, Mittal P, Moreno C, Nieh PT, Rossi P, Patil D, Halkar R, Fei B, Master V, Jani AB, Kitajima H, Osunkoya AO, Ormenisan-Gherasim C, Goodman MM, Schuster DM. Prospective evaluation of fluciclovine ( 18F) PET-CT and MRI in detection of recurrent prostate cancer in non-prostatectomy patients. Eur J Radiol 2018; 102:1-8. [PMID: 29685521 DOI: 10.1016/j.ejrad.2018.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/16/2017] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the disease detection rate, diagnostic performance and interobserver agreement of fluciclovine (18F) PET-CT and multiparametric magnetic resonance imaging (mpMR) in recurrent prostate cancer. METHODS Twenty-four patients with biochemical failure after non-prostatectomy definitive therapy, 16/24 of whom had undergone brachytherapy, underwent fluciclovine PET-CT and mpMR with interpretation by expert readers blinded to patient history, PSA and other imaging results. Reference standard was established via a multidisciplinary truth panel utilizing histology and clinical follow-up (22.9 ± 10.5 months) and emphasizing biochemical control. The truth panel was blinded to investigative imaging results. Diagnostic performance and interobserver agreement (kappa) for the prostate and extraprostatic regions were calculated for each of 2 readers for PET-CT (P1 and P2) and 2 different readers for mpMR (M1 and M2). RESULTS On a whole body basis, the detection rate for fluciclovine PET-CT was 94.7% (both readers), while it ranged from 31.6-36.8% for mpMR. Kappa for fluciclovine PET-CT was 0.90 in the prostate and 1.0 in the extraprostatic regions. For mpMR, kappa was 0.25 and 0.74, respectively. In the prostate, 22/24 patients met the reference standard with 13 malignant and 9 benign results. Sensitivity, specificity and positive predictive value (PPV) were 100.0%, 11.1% and 61.9%, respectively for both PET readers. For mpMR readers, values ranged from 15.4-38.5% for sensitivity, 55.6-77.8% for specificity and 50.0-55.6% for PPV. For extraprostatic disease determination, 18/24 patients met the reference standard. Sensitivity, specificity and PPV were 87.5%, 90.0% and 87.5%, respectively, for fluciclovine PET-CT, while for mpMR, sensitivity ranged from 50 to 75%, specificity 70-80% and PPV 57-75%. CONCLUSION The disease detection rate for fluciclovine PET-CT in non-prostatectomy patients with biochemical failure was 94.7% versus 31.6-36.8% for mpMR. For extraprostatic disease detection, fluciclovine PET-CT had overall better diagnostic performance than mpMR. For the treated prostate, fluciclovine PET-CT had high sensitivity though low specificity for disease detection, while mpMR had higher specificity, though low sensitivity. Interobserver agreement was also higher with fluciclovine PET-CT compared with mpMR.
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Affiliation(s)
| | - Funmilayo Tade
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Pardeep Mittal
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Courtney Moreno
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Peter T Nieh
- Urology, Emory University, Atlanta, GA, United States
| | - Peter Rossi
- Urology, Emory University, Atlanta, GA, United States
| | | | - Raghuveer Halkar
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Baowei Fei
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Viraj Master
- Urology, Emory University, Atlanta, GA, United States
| | - Ashesh B Jani
- Radiation Oncology, Emory University, Atlanta, GA, United States
| | - Hiroumi Kitajima
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Adeboye O Osunkoya
- Urology, Emory University, Atlanta, GA, United States; Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Claudia Ormenisan-Gherasim
- Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States; Pathology, Brigham & Women's Hospital-Harvard Medical School, Boston, MA, United States
| | - Mark M Goodman
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - David M Schuster
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States.
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25
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Kumar KA, Peck KK, Karimi S, Lis E, Holodny AI, Bilsky MH, Yamada Y. A Pilot Study Evaluating the Use of Dynamic Contrast-Enhanced Perfusion MRI to Predict Local Recurrence After Radiosurgery on Spinal Metastases. Technol Cancer Res Treat 2017; 16:857-865. [PMID: 28449626 PMCID: PMC5762041 DOI: 10.1177/1533034617705715] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: Dynamic contrast-enhanced magnetic resonance imaging offers noninvasive characterization of the vascular microenvironment and hemodynamics. Stereotactic radiosurgery, or stereotactic body radiation therapy, engages a vascular component of the tumor response which may be detectable using dynamic contrast-enhanced magnetic resonance imaging. The purpose of this study is to examine whether dynamic contrast-enhanced magnetic resonance imaging can be used to predict local tumor recurrence in patients with spinal bone metastases who undergo high-dose radiotherapy with stereotactic radiosurgery. Materials and Methods: We conducted a study of 30 patients with spinal metastases who underwent dynamic contrast-enhanced magnetic resonance imaging before and after radiotherapy. Twenty patients received single-fraction stereotactic radiosurgery (24 Gy), while 10 received hypofractionated stereotactic radiosurgery (3-5 fractions, 27-30 Gy total). Kaplan-Meier analysis was used to estimate the actuarial local recurrence rates. Two perfusion parameters (Ktrans: permeability and Vp: plasma volume) were measured for each metastasis. Percentage change in parameter values from pre- to posttreatment was calculated and compared. Results: At 20-month median follow-up, 5 of the 30 patients had pathological evidence of local recurrence. One- and 3-year actuarial local recurrence rates were 24% and 44% for the hypofractionated stereotactic radiosurgery cohort versus 5% and 16% for the single-fraction stereotactic radiosurgery cohort (P = .20). The average change in Vp and Ktrans for patients without local recurrence versus those with local recurrence was −76% and −66% versus +28% and −14% (P < .01 for both). With a cutoff point of −20%, Vp had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 98%, 91%, and 100%, respectively, for the detection of local recurrence following high-dose radiotherapy. Using this definition, dynamic contrast-enhanced magnetic resonance imaging identified local recurrence up to 18 months (mean [standard deviation], 6.6 [6.8] months) earlier than standard magnetic resonance imaging. Conclusions: We demonstrated that changes in perfusion parameters, particularly Vp, after high-dose radiotherapy to spinal bone metastases were predictive of local tumor recurrence. These changes predicted local recurrence on average >6 months earlier than standard imaging did.
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Affiliation(s)
- Kiran A Kumar
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Kyung K Peck
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark H Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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26
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Abstract
There is growing consensus that multiparametric magnetic resonance imaging (mpMRI) is an effective modality in the detection of locally recurrent prostate cancer after prostatectomy and radiation therapy. The emergence of magnetic resonance (MR)-guided focal therapies, such as cryoablation, high-intensity focused ultrasound, and laser ablation, have made the use of mpMRI even more important, as the normal anatomy is inevitably altered and the detection of recurrence is made more difficult. The aim of this article is to review the utility of mpMRI in detecting recurrent prostate cancer in patients following radical prostatectomy, radiation therapy, and focal therapy and to discuss expected post-treatment mpMRI findings, the varied appearance of recurrent tumors, and their mimics.
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27
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Zattoni F, Kawashima A, Morlacco A, Davis BJ, Nehra AK, Mynderse LA, Froemming AT, Jeffrey Karnes R. Detection of recurrent prostate cancer after primary radiation therapy: An evaluation of the role of multiparametric 3T magnetic resonance imaging with endorectal coil. Pract Radiat Oncol 2017; 7:42-49. [DOI: 10.1016/j.prro.2016.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/27/2016] [Accepted: 06/07/2016] [Indexed: 02/02/2023]
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28
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Rangwala NA, Dregely I, Wu HH, Sung K. Optimization and evaluation of reference region variable flip angle (RR-VFA)
B1+ and T
1
Mapping in the Prostate at 3T. J Magn Reson Imaging 2016; 45:751-760. [DOI: 10.1002/jmri.25410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Novena A. Rangwala
- Department of Radiological Sciences; University of California Los Angeles; California USA
| | - Isabel Dregely
- Department of Radiological Sciences; University of California Los Angeles; California USA
| | - Holden H. Wu
- Department of Radiological Sciences; University of California Los Angeles; California USA
| | - Kyunghyun Sung
- Department of Radiological Sciences; University of California Los Angeles; California USA
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29
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Pilot Study of the Use of Hybrid Multidimensional T2-Weighted Imaging-DWI for the Diagnosis of Prostate Cancer and Evaluation of Gleason Score. AJR Am J Roentgenol 2016; 207:592-8. [PMID: 27352026 DOI: 10.2214/ajr.15.15626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the role of a hybrid T2-weighted imaging-DWI sequence for prostate cancer diagnosis and differentiation of aggressive prostate cancer from nonaggressive prostate cancer. MATERIALS AND METHODS Twenty-one patients with prostate cancer who underwent preoperative 3-T MRI and prostatectomy were included in this study. Patients underwent a hybrid T2-weighted imaging-DWI examination consisting of DW images acquired with TEs of 47, 75, and 100 ms and b values of 0 and 750 s/mm(2). The apparent diffusion coefficient (ADC) and T2 were calculated for cancer and normal prostate ROIs at each TE and b value. Changes in ADC and T2 as a function of increasing the TE and b value, respectively, were analyzed. A new metric termed "PQ4" was defined as the percentage of voxels within an ROI that has increasing T2 with increasing b value and has decreasing ADC with increasing TE. RESULTS ADC values were significantly higher in normal ROIs than in cancer ROIs at all TEs (p < 0.0001). With increasing TE, the mean ADC increased 3% in cancer ROIs and increased 12% in normal ROIs. T2 was significantly higher in normal ROIs than in cancer ROIs at both b values (p ≤ 0.0002). The mean T2 decreased with increasing b value in cancer ROIs (ΔT2 = -17 ms) and normal ROIs (ΔT2 = -52 ms). PQ4 clearly differentiated normal ROIs from prostate cancer ROIs (p = 0.0004) and showed significant correlation with Gleason score (ρ = 0.508, p < 0.0001). CONCLUSION Hybrid MRI measures the response of ADC and T2 to changing TEs and b values, respectively. This approach shows promise for detecting prostate cancer and determining its aggressiveness noninvasively.
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30
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Oppenheimer DC, Weinberg EP, Hollenberg GM, Meyers SP. Multiparametric Magnetic Resonance Imaging of Recurrent Prostate Cancer. J Clin Imaging Sci 2016; 6:18. [PMID: 27195184 PMCID: PMC4863405 DOI: 10.4103/2156-7514.181494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022] Open
Abstract
Multiparametric magnetic resonance (MR) imaging of the prostate combines both morphological and functional MR techniques by utilizing small field of view T1-weighted, T2-weighted, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy to accurately detect, localize, and stage primary and recurrent prostate cancer. Localizing the site of recurrence in patients with rising prostate-specific antigen following treatment affects decision making regarding treatment and can be accomplished with multiparametric prostate MR. Several different treatment options are available for prostate cancer including radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, or a number of focal therapy techniques. The findings of recurrent prostate cancer can be different depending on the treatment the patient has received, and the radiologist must be able to recognize the variety of imaging findings seen with this common disease. This review article will detail the findings of recurrent prostate cancer on multiparametric MR and describe common posttreatment changes which may create challenges to accurate interpretation.
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Affiliation(s)
| | - Eric P Weinberg
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Gary M Hollenberg
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Steven P Meyers
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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31
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Detection of locally radio-recurrent prostate cancer at multiparametric MRI: Can dynamic contrast-enhanced imaging be omitted? Diagn Interv Imaging 2016; 97:433-41. [PMID: 26928245 DOI: 10.1016/j.diii.2016.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/17/2016] [Accepted: 01/26/2016] [Indexed: 11/21/2022]
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32
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Lopes Dias J, Lucas R, Magalhães Pina J, João R, Costa NV, Leal C, Bilhim T, Campos Pinheiro L, Mateus Marques R. Post-treated prostate cancer: normal findings and signs of local relapse on multiparametric magnetic resonance imaging. ACTA ACUST UNITED AC 2016; 40:2814-38. [PMID: 26105522 DOI: 10.1007/s00261-015-0473-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The use of multiparametric magnetic resonance imaging (mp-MRI) for prostate cancer has increased over recent years, mainly for detection, staging, and active surveillance. However, suspicion of recurrence in the set of biochemical failure is becoming a significant reason for clinicians to request mp-MRI. Radiologists should be able to recognize the normal post-treatment MRI findings. Fibrosis and atrophic remnant seminal vesicles after prostatectomy are often found and must be differentiated from local relapse. Moreover, brachytherapy, external beam radiotherapy, cryosurgery, and hormonal therapy tend to diffusely decrease the signal intensity of the peripheral zone on T2-weighted images (T2WI) due to the loss of water content, consequently mimicking tumor and hemorrhage. The combination of T2WI and functional studies like diffusion-weighted imaging and dynamic contrast-enhanced improves the identification of local relapse. Tumor recurrence tends to restrict on diffusion images and avidly enhances after contrast administration either within or outside the gland. The authors provide a pictorial review of the normal findings and the signs of local tumor relapse after radical prostatectomy, external beam radiotherapy, brachytherapy, cryosurgery, and hormonal therapy.
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Affiliation(s)
- João Lopes Dias
- Department of Radiology, Hospital de S. José, Rua José António Serrano, 1150-199, Lisbon, Portugal. .,, Rua Herculano Rodrigues, n15, 2esq, 2695-044, Lisbon, Portugal. .,Faculdade de Ciências Médicas, Nova Medica School, Lisbon, Portugal.
| | - Rita Lucas
- Department of Radiology, Hospital de Santo António dos Capuchos, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - João Magalhães Pina
- Department of Urology, Hospital de S. José, Rua José António Serrano, 1150-199, Lisbon, Portugal.,Faculdade de Ciências Médicas, Nova Medica School, Lisbon, Portugal
| | - Raquel João
- Department of Urology, Hospital de S. José, Rua José António Serrano, 1150-199, Lisbon, Portugal.,Faculdade de Ciências Médicas, Nova Medica School, Lisbon, Portugal
| | - Nuno Vasco Costa
- Department of Radiology, Hospital de S. José, Rua José António Serrano, 1150-199, Lisbon, Portugal.,Faculdade de Ciências Médicas, Nova Medica School, Lisbon, Portugal
| | - Cecília Leal
- Department of Radiology, Hospital de Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.,Faculdade de Ciências Médicas, Nova Medica School, Lisbon, Portugal
| | - Tiago Bilhim
- Department of Radiology, Hospital de S. José, Rua José António Serrano, 1150-199, Lisbon, Portugal.,Faculdade de Ciências Médicas, Nova Medica School, Lisbon, Portugal
| | - Luís Campos Pinheiro
- Department of Radiology, Hospital de S. José, Rua José António Serrano, 1150-199, Lisbon, Portugal.,Faculdade de Ciências Médicas, Nova Medica School, Lisbon, Portugal
| | - Rui Mateus Marques
- Department of Radiology, Hospital de S. José, Rua José António Serrano, 1150-199, Lisbon, Portugal.,Faculdade de Ciências Médicas, Nova Medica School, Lisbon, Portugal
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33
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Pitfalls in Interpreting mp-MRI of the Prostate: A Pictorial Review with Pathologic Correlation. Insights Imaging 2015; 6:611-30. [PMID: 26385690 PMCID: PMC4656245 DOI: 10.1007/s13244-015-0426-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/23/2015] [Accepted: 07/29/2015] [Indexed: 01/20/2023] Open
Abstract
Objectives The purpose of this pictorial review is to present a wide spectrum of prostate multiparametric MRI (mp-MRI) pitfalls that may occur in clinical practice, with radiological and pathological correlation. Methods All examinations were performed according to ESUR Guidelines protocols. Results and Conclusion mp-MRI imaging of the prostate often leads to interpreting doubts and misdiagnosis due to the many interpretative pitfalls that a tissue, whether healthy or treated, may cause. These “false-positive” findings may occur in each stage of the disease history, from the primary diagnosis and staging, to the post-treatment stage, and whether they are caused by the tissue itself or are iatrogenic, their recognition is critical for proper treatment and management. Knowledge of these known pitfalls and their interpretation in the anatomical-radiological context can help radiologists avoid misdiagnosis and consequently mistreatment. Main Messages • Some physiological changes in the peripheral and central zone may simulate prostate cancer. • Technical errors, such as mispositioned endorectal coils, can affect the mp-MRI interpretation. • Physiological changes post-treatment can simulate recurrence
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34
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Nachsorge urologischer Tumorbehandlungen. Urologe A 2015; 54:1223-33. [DOI: 10.1007/s00120-015-3936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Opposits G, Kis SA, Trón L, Berényi E, Takács E, Dobai JG, Bognár L, Szűcs B, Emri M. Population based ranking of frameless CT-MRI registration methods. Z Med Phys 2015; 25:353-367. [PMID: 26279292 DOI: 10.1016/j.zemedi.2015.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinical practice often requires simultaneous information obtained by two different imaging modalities. Registration algorithms are commonly used for this purpose. Automated procedures are very helpful in cases when the same kind of registration has to be performed on images of a high number of subjects. Radiotherapists would prefer to use the best automated method to assist therapy planning, however there are not accepted procedures for ranking the different registration algorithms. PURPOSE We were interested in developing a method to measure the population level performance of CT-MRI registration algorithms by a parameter of values in the [0,1] interval. MATERIALS AND METHODS Pairs of CT and MRI images were collected from 1051 subjects. Results of an automated registration were corrected manually until a radiologist and a neurosurgeon expert both accepted the result as good. This way 1051 registered MRI images were produced by the same pair of experts to be used as gold standards for the evaluation of the performance of other registration algorithms. Pearson correlation coefficient, mutual information, normalized mutual information, Kullback-Leibler divergence, L1 norm and square L2 norm (dis)similarity measures were tested for sensitivity to indicate the extent of (dis)similarity of a pair of individual mismatched images. RESULTS The square Hellinger distance proved suitable to grade the performance of registration algorithms at population level providing the developers with a valuable tool to rank algorithms. CONCLUSIONS The developed procedure provides an objective method to find the registration algorithm performing the best on the population level out of newly constructed or available preselected ones.
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Affiliation(s)
- Gabor Opposits
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, Hungary.
| | - Sándor A Kis
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Lajos Trón
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Ervin Berényi
- Department of Biomedical Laboratory and Imaging Science, Faculty of Medicine, University of Debrecen, Hungary
| | | | - József G Dobai
- Department of Neurosurgery, Medical Center, University of Debrecen, Hungary
| | - László Bognár
- Department of Neurosurgery, Medical Center, University of Debrecen, Hungary
| | | | - Miklós Emri
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, Hungary
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36
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Hedgire SS, Eberhardt SC, Borczuk R, McDermott S, Harisinghani MG. Interpretation and reporting multiparametric prostate MRI: a primer for residents and novices. ACTA ACUST UNITED AC 2015; 39:1036-51. [PMID: 24566965 DOI: 10.1007/s00261-014-0097-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multiparametric MRI has developed as a tool for prostate cancer lesion detection, characterization, staging, surveillance, and imaging of local recurrence. Given the disease frequency and the growing importance of imaging, as reliance on PSA declines, radiologists involved in prostate MRI imaging must become proficient with the fundamentals of multiparametric prostate MRI (T2WI, DWI, DCE-MRI, and MR spectroscopy). Interpretation and reporting must yield accuracy, consistency, and add value to clinical care. This review provides a primer to novices and trainees learning about multiparametric prostate MRI. MRI technique is presented along with the use of particular MRI sequences. Relevant prostate anatomy is outlined and imaging features of prostate cancer with staging are discussed. Finally structured reporting is introduced, and some limitations of prostate MRI are discussed.
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Affiliation(s)
- Sandeep S Hedgire
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA,
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37
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Post-treatment imaging—a desperate need for solid evidence. Nat Rev Urol 2015; 12:307-8. [DOI: 10.1038/nrurol.2015.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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38
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Abd-Alazeez M, Ramachandran N, Dikaios N, Ahmed HU, Emberton M, Kirkham A, Arya M, Taylor S, Halligan S, Punwani S. Multiparametric MRI for detection of radiorecurrent prostate cancer: added value of apparent diffusion coefficient maps and dynamic contrast-enhanced images. Prostate Cancer Prostatic Dis 2015; 18:128-36. [PMID: 25644248 DOI: 10.1038/pcan.2014.55] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/16/2014] [Accepted: 12/10/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mp-MRI) is increasingly advocated for prostate cancer detection. There are limited reports of its use in the setting of radiorecurrent disease. Our aim was to assess mp-MRI for detection of radiorecurrent prostate cancer and examine the added value of its functional sequences. METHODS Thirty-seven men with mean age of 69.7 (interquartile range, 66-74) with biochemical failure after external beam radiotherapy underwent mp-MRI (T2-weighted, high b-value, multi-b-value apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) imaging); then transperineal systematic template prostate mapping (TPM) biopsy. Using a locked sequential read paradigm (with the sequence order above), two experienced radiologists independently reported mp-MRI studies using score 1-5. Radiologist scores were matched with TPM histopathology at the hemigland level (n=74). Accuracy statistics were derived for each reader. Interobserver agreement was evaluated using kappa statistics. RESULTS Receiver-operator characteristic area under curve (AUC) for readers 1 and 2 increased from 0.67 (95% confidence interval (CI), 0.55-0.80) to 0.80 (95% CI, 0.69-0.91) and from 0.67 (95% CI, 0.55-0.80) to 0.84 (95% CI, 0.76-0.93), respectively, between T2-weighted imaging alone and full mp-MRI reads. Addition of ADC maps and DCE imaging to the examination did not significantly improve AUC for either reader (P=0.08 and 0.47 after adding ADC, P=0.90 and 0.27 after adding DCE imaging) compared with T2+high b-value review. Inter-reader agreement increased from k=0.39 to k=0.65 between T2 and full mp-MRI review. CONCLUSIONS mp-MRI can detect radiorecurrent prostate cancer. The optimal examination included T2-weighted imaging and high b-value DWI; adding ADC maps and DCE imaging did not significantly improve the diagnostic accuracy.
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Affiliation(s)
- M Abd-Alazeez
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - N Ramachandran
- Department of Radiology, University College London Hospital, London, UK
| | - N Dikaios
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - H U Ahmed
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Division of Surgery and Interventional Science, University College London, London, UK
| | - M Emberton
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Division of Surgery and Interventional Science, University College London, London, UK
| | - A Kirkham
- Department of Radiology, University College London Hospital, London, UK
| | - M Arya
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Barts Cancer Institute, Queen Mary University of London, London, UK
| | - S Taylor
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - S Halligan
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - S Punwani
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
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Alberts AR, Schoots IG, Roobol MJ. Prostate-specific antigen-based prostate cancer screening: Past and future. Int J Urol 2015; 22:524-32. [PMID: 25847604 DOI: 10.1111/iju.12750] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 12/21/2022]
Abstract
Prostate-specific antigen-based prostate cancer screening remains a controversial topic. Up to now, there is worldwide consensus on the statement that the harms of population-based screening, mainly as a result of overdiagnosis (the detection of clinically insignificant tumors that would have never caused any symptoms), outweigh the benefits. However, worldwide opportunistic screening takes place on a wide scale. The European Randomized Study of Screening for Prostate Cancer showed a reduction in prostate cancer mortality through prostate-specific antigen based-screening. These population-based data need to be individualized in order to avoid screening in those who cannot benefit and start screening in those who will. For now, lacking a more optimal screening approach, screening should only be started after the process of shared decision-making. The focus of future research is the reduction of unnecessary testing and overdiagnosis by further research to better biomarkers and the value of the multiparametric magnetic resonance imaging, potentially combined in already existing prostate-specific antigen-based multivariate risk prediction models.
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Affiliation(s)
- Arnout R Alberts
- Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ivo G Schoots
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Aydın H, Kızılgöz V, Tekin BO. Overview of current multiparametric magnetic resonance imaging approach in the diagnosis and staging of prostate cancer. Kaohsiung J Med Sci 2015; 31:167-78. [DOI: 10.1016/j.kjms.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 10/07/2014] [Accepted: 02/19/2014] [Indexed: 01/08/2023] Open
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Tsien C, Cao Y, Chenevert T. Clinical applications for diffusion magnetic resonance imaging in radiotherapy. Semin Radiat Oncol 2015; 24:218-26. [PMID: 24931097 DOI: 10.1016/j.semradonc.2014.02.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In this article, we review the clinical applications of diffusion magnetic resonance imaging (MRI) in the radiotherapy treatment of several key clinical sites, including those of the central nervous system, the head and neck, the prostate, and the cervix. Diffusion-weighted MRI (DWI) is an imaging technique that is rapidly gaining widespread acceptance owing to its ease and wide availability. DWI measures the mobility of water within tissue at the cellular level without the need of any exogenous contrast agent. For radiotherapy treatment planning, DWI improves upon conventional imaging techniques, by better characterization of tumor tissue properties required for tumor grading, diagnosis, and target volume delineation. Because DWI is also a sensitive marker for alterations in tumor cellularity, it has potential clinical applications in the early assessment of treatment response following radiation therapy.
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Affiliation(s)
- Christina Tsien
- Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, MI.
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, MI
| | - Thomas Chenevert
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI
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Ménard C, Iupati D, Publicover J, Lee J, Abed J, O’Leary G, Simeonov A, Foltz WD, Milosevic M, Catton C, Morton G, Bristow R, Bayley A, Atenafu EG, Evans AJ, Jaffray DA, Chung P, Brock KK, Haider MA. MR-guided Prostate Biopsy for Planning of Focal Salvage after Radiation Therapy. Radiology 2015; 274:181-91. [DOI: 10.1148/radiol.14122681] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Coffey N, Schieda N, Cron G, Gulavita P, Mai KT, Flood TA. Multi-parametric (mp) MRI of prostatic ductal adenocarcinoma. J Magn Reson Imaging 2014; 41:1639-45. [PMID: 25044687 DOI: 10.1002/jmri.24694] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 06/18/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Prostatic ductal adenocarcinoma (DCa) is an aggressive variant of conventional adenocarcinoma (CCa) with mixed DCa and CCa tumors comprising up to 5% of all prostate cancers. DCa may be underestimated on T2-weighted (T2W) MRI. This study assessed the mp-MRI appearance of DCa as compared with CCa. METHODS With research ethics board approval, we identified 38 patients who underwent mp-MRI (T2W, DWI, and DCE) and radical prostatectomy (RP) between 2012 and 2014. Eight DCa in 8 patients and 39 CCa tumor foci in 30 consecutive patients were identified. Tumor volume, apparent diffusion coefficient (ADC;10(-3) mm(2) /s), and time-signal intensity (SI) curves were calculated. Parametric data were compared using the Kruskal-Wallis test and univariate regression. Time-SI curves were compared using the chi-square test. RESULTS Tumor volumes were: 1.62(±1.02) for DCa, 1.03(±0.54) for Gleason 9, 0.88(±0.93) for Gleason 7/8, and 0.26(±0.14) mL for Gleason 6. There was no difference in size between DCa and Gleason 9 (P = 0.22); however, DCa were larger than Gleason 7/8 (P = 0.03) and Gleason 6 (P = 0.003) tumors. ADC values were: 0.789(±0.22) for DCa, 1.01(±0.19) for Gleason 9, 0.992(±0.23) for Gleason 7/8 and 1.389(±0.41) 10(-3) mm(2) /s for Gleason 6 tumors. There was no difference in ADC between DCa and Gleason 9 (P = 0.14) or Gleason 7/8 (P = 0.055) tumors. There was a difference in ADC for DCa and Gleason ≥7 CCa compared to Gleason 6 tumors, (P < 0.001 and P = 0.012). All DCa demonstrated type III time-SI curves. Gleason ≥ 7 tumors demonstrated type II/III curves. Gleason 6 tumors demonstrated Type I/II time-SI curves. There was no difference in curve type between groups, (P = 0.18). CONCLUSION Although DCa mimics Gleason score 3 + 3 = 6 tumor at T2W MRI; DCa resembles Gleason ≥7 CCa on mp-MRI.
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Affiliation(s)
- Niamh Coffey
- The Ottawa Hospital, The University of Ottawa, Department of Medical Imaging, Ottawa, Ontario, Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa, Department of Medical Imaging, Ottawa, Ontario, Canada
| | - Greg Cron
- The Ottawa Hospital, The University of Ottawa, Department of Medical Imaging, Ottawa, Ontario, Canada
| | - Previn Gulavita
- The Ottawa Hospital, The University of Ottawa, Department of Anatomical Pathology, Ottawa, Ontario, Canada
| | - Kien T Mai
- The Ottawa Hospital, The University of Ottawa, Department of Anatomical Pathology, Ottawa, Ontario, Canada
| | - Trevor A Flood
- The Ottawa Hospital, The University of Ottawa, Department of Anatomical Pathology, Ottawa, Ontario, Canada
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Multiparametric MRI for recurrent prostate cancer post radical prostatectomy and postradiation therapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:316272. [PMID: 24967355 PMCID: PMC4055489 DOI: 10.1155/2014/316272] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/25/2014] [Indexed: 12/30/2022]
Abstract
The clinical suspicion of local recurrence of prostate cancer (PCa) after radical prostatectomy (RP) and after radiation therapy (RT) is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI) in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam). Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments.
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Rosenkrantz AB, Geppert C, Grimm R, Block TK, Glielmi C, Feng L, Otazo R, Ream JM, Romolo MM, Taneja SS, Sodickson DK, Chandarana H. Dynamic contrast-enhanced MRI of the prostate with high spatiotemporal resolution using compressed sensing, parallel imaging, and continuous golden-angle radial sampling: preliminary experience. J Magn Reson Imaging 2014; 41:1365-73. [PMID: 24833417 DOI: 10.1002/jmri.24661] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/24/2014] [Accepted: 04/28/2014] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To demonstrate dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate with both high spatial and temporal resolution via a combination of golden-angle radial k-space sampling, compressed sensing, and parallel-imaging reconstruction (GRASP), and to compare image quality and lesion depiction between GRASP and conventional DCE in prostate cancer patients. MATERIALS AND METHODS Twenty prostate cancer patients underwent two 3T prostate MRI examinations on separate dates, one using standard DCE (spatial resolution 3.0 × 1.9 × 1.9 mm, temporal resolution 5.5 sec) and the other using GRASP (spatial resolution 3.0 × 1.1 × 1.1 mm, temporal resolution 2.3 sec). Two radiologists assessed measures of image quality and dominant lesion size. The experienced reader recorded differences in contrast arrival times between the dominant lesion and benign prostate. RESULTS Compared with standard DCE, GRASP demonstrated significantly better clarity of the capsule, peripheral/transition zone boundary, urethra, and periprostatic vessels; image sharpness; and lesion conspicuity for both readers (P < 0.001-0.020). GRASP showed improved interreader correlation for lesion size (GRASP: r = 0.691-0.824, standard: r = 0.495-0.542). In 8/20 cases, only GRASP showed earlier contrast arrival in tumor than benign; in no case did only standard DCE show earlier contrast arrival in tumor. CONCLUSION High spatiotemporal resolution prostate DCE is possible with GRASP, which has the potential to improve image quality and lesion depiction as compared with standard DCE.
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Abstract
CLINICAL/METHODICAL ISSUE A present goal is to improve detection and staging of prostate cancer using innovative imaging technology such as PET/MRI. STANDARD RADIOLOGICAL METHODS The modality of choice for detection of prostate cancer is multiparametric MRI. Furthermore, PET/CT is used, in particular, for the detection and staging of distant metastases and recurrent disease. For assessment of bone metastases, the method most commonly used is bone scintigraphy. METHODICAL INNOVATIONS The development of a simultaneous hybrid PET/MRI system is the last great "fusion" of the known cross-sectional image modalities. In addition, synthesis of new, innovative tracers such as (18)F-FACBC or (68)Ga-PSMA allows more specific detection of prostate cancer. PERFORMANCE Hybrid PET/MRI imaging has the potential to replace conventional imaging techniques in the future. ACHIEVEMENTS The method is just starting the broad application. Clinical studies must be expanded in order to substantiate the additional value of the method. PRACTICAL RECOMMENDATIONS Currently, there is still a low distribution situation, since it is a new and cost-intensive method. At the same time, there is still no consistent solution for reimbursement. The importance in practice first rises by clarifying the payment situation and further demonstration of the method's benefit by larger studies.
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Affiliation(s)
- M C Röthke
- Abteilung für onkologische Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 Heidelberg, Deutschland.
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Nensa F, Stattaus J, Morgan B, Horsfield MA, Soria JC, Besse B, Gounant V, Khalil A, Seng K, Fischer B, Krissel H, Laurent D, Christoph D, Eberhardt WEE, Gauler TC. Dynamic contrast-enhanced MRI parameters as biomarkers for the effect of vatalanib in patients with non-small-cell lung cancer. Future Oncol 2014; 10:823-33. [PMID: 24799063 DOI: 10.2217/fon.13.248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT: Aims: To assess the utility of dynamic contrast-enhanced MRI parameters in the demonstration of early antiangiogenic effects and as prognostic biomarkers in second-line treatment of advanced-stage non-small-cell lung cancer with vatalanib. Patients & methods: The transfer constant (Ktrans) and the initial area under the contrast concentration–time curve at 60 s (AUC60) were assessed in 46 patients. Changes were compared with response evaluation from computed tomography imaging and Response Evaluation Criteria In Solid Tumors guidelines. Results: Statistically significant mean reductions in Ktrans (38.4%; p < 0.0001) and AUC60 (24.9%; p < 0.0001) were found at day 2. After 12 weeks, 16 patients (35%) demonstrated stable disease and 30 (65%) demonstrated progressive disease. No statistically significant differences in day 2 Ktrans and AUC60 reductions between stable disease and progressive disease patients were found. Conclusion: Dynamic contrast-enhanced MRI can demonstrate a statistically significant reduction in vascular parameters of non-small-cell lung cancer, but does not predict patient outcome.
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Affiliation(s)
- Felix Nensa
- Department of Diagnostic & Interventional Radiology & Neuroradiology, University Hospital of University Duisburg-Essen, Essen, Germany
| | - Jörg Stattaus
- Department of Radiology & Nuclear Medicine, Bergmannsheil und KinderklinikBuer GmbH, Gelsenkirchen, Germany
| | - Bruno Morgan
- Department of Cancer Studies & Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - Mark A Horsfield
- Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | | | - Benjamin Besse
- Département de Médecine, Institut Gustave Roussy, Villejuif, France
| | - Valerie Gounant
- Unité Fonctionnelle de Pneumologie (Orientation Oncologique), Hôpital Tenon, Paris, France
| | - Antoine Khalil
- Unité Fonctionnelle de Pneumologie (Orientation Oncologique), Hôpital Tenon, Paris, France
| | - Katja Seng
- Department of Diagnostic & Interventional Radiology & Neuroradiology, University Hospital of University Duisburg-Essen, Essen, Germany
| | - Berthold Fischer
- Department of Respiratory Diseases III, Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Heiko Krissel
- Global Clinical Development Oncology, Bayer Pharma AG, Berlin, Germany
| | - Dirk Laurent
- Global Clinical Development Oncology, Bayer Pharma AG, Berlin, Germany
| | - Daniel Christoph
- Department of Medicine (Cancer Research), West German Tumor Center, University Hospital of University Duisburg-Essen, Essen, Germany
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, CO, USA
| | - Wilfried EE Eberhardt
- Department of Medicine (Cancer Research), West German Tumor Center, University Hospital of University Duisburg-Essen, Essen, Germany
| | - Thomas C Gauler
- Department of Medicine (Cancer Research), West German Tumor Center, University Hospital of University Duisburg-Essen, Essen, Germany
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Verma V, Chen L, Michalski JM, Hu Y, Zhang W, Robinson K, Verma S, Eschen L, Fergus S, Mullen D, Strope S, Grubb R, Gay HA. Evaluation of 3 T pelvic MRI imaging in prostate cancer patients receiving post-prostatectomy IMRT. World J Urol 2014; 33:69-75. [PMID: 24647879 DOI: 10.1007/s00345-014-1269-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/18/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of the study was to evaluate the utility of a 3 T pelvic magnetic resonance imaging (MRI) in detecting a local recurrence in post-prostatectomy prostate cancer patients prior to receiving adjuvant or salvage intensity-modulated radiation therapy (IMRT). METHODS Ninety prostate cancer patients status post-prostatectomy with rising prostate-specific antigen (PSA) had a 3 T pelvic MRI prior to IMRT. The following variables were analyzed for predicting positive findings on MRI: initial presenting and initial post-op PSA, PSA at the time of imaging, PSA velocity, surgical margins, Gleason score, pathological stage, pre-RT digital rectal examination, and type of surgical prostatectomy. RESULTS The only significant variable predictive of a positive MRI was positive margins. Specifically, 15 of 46 (33 %) patients with positive margins had a positive MRI, while 5 of 44 (11 %) patients with negative margins had a positive MRI. In the MRI positive group, the location of the positive findings on MRI corresponded with the pathology report in 9 of 12 (75 %) cases. CONCLUSION Post-prostatectomy patients with pathologic positive margins are three times more likely to have positive findings on a 3 T MRI.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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Yu J, Fulcher AS, Turner MA, Cockrell CH, Cote EP, Wallace TJ. Prostate cancer and its mimics at multiparametric prostate MRI. Br J Radiol 2014; 87:20130659. [PMID: 24646125 DOI: 10.1259/bjr.20130659] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
One in six males will develop prostate cancer during their lifetime. Prostate cancer is the second leading cause of cancer death in American males, behind only lung cancer. Unfortunately, even though this disease is so common, clinical screening methods such as prostate-specific antigen test and transrectal ultrasound-guided prostate biopsy lack sensitivity and specificity in diagnosing prostate cancer. In recent years, multiparametric prostate MRI has emerged as a very important tool in the diagnosis of prostate carcinoma with a high accuracy. However, diagnostic difficulty is often encountered even with an experienced abdominal radiologist. That is mainly because many normal and abnormal entities can mimic prostate carcinoma at multiparametric MRI. Therefore, the purpose of this pictorial review is to discuss the usefulness of multiparametric prostate MRI in the diagnosis of prostate carcinoma, emphasizing the key MRI features that help to make a distinction of prostate carcinoma from its mimics.
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Affiliation(s)
- J Yu
- Department of Radiology, Virginia Commonwealth University Health System Main Hospital, Richmond, VA, USA
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50
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Abd-Alazeez M, Kirkham A, Ahmed HU, Arya M, Anastasiadis E, Charman SC, Freeman A, Emberton M. Performance of multiparametric MRI in men at risk of prostate cancer before the first biopsy: a paired validating cohort study using template prostate mapping biopsies as the reference standard. Prostate Cancer Prostatic Dis 2014; 17:40-6. [PMID: 24126797 PMCID: PMC3954968 DOI: 10.1038/pcan.2013.43] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 07/23/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) has the potential to serve as a non-invasive triage test for men at risk of prostate cancer. Our objective was to determine the performance characteristics of mpMRI in men at risk before the first biopsy using 5 mm template prostate mapping (TPM) as the reference standard. METHODS One hundred and twenty-nine consecutive men with clinical suspicion of prostate cancer, who had no prior biopsy, underwent mpMRI (T1/T2-weighted, diffusion-weighting, dynamic contrast enhancement) followed by TPM. The primary analysis used were as follows: (a) radiological scores of suspicion of ≥3 attributed from a five-point ordinal scale, (b) a target condition on TPM of any Gleason pattern ≥4 and/or a maximum cancer core length of ≥4 mm and (c) two sectors of analysis per prostate (right and left prostate halves). Secondary analyses evaluated the impact of changing the mpMRI score threshold to ≥4 and varying the target definition for clinical significance. RESULTS One hundred and forty-one out of 258 (55%) sectors of analysis showed 'any cancer' and 77/258 (30%) had the target histological condition for the purpose of deriving the primary outcome. Median (with range) for age, PSA, gland volume and number of biopsies taken were 62 years (41-82), 5.8 ng ml(-1) (1.2-20), 40 ml (16-137) and 41 cores (20-93), respectively. For the primary outcome sensitivity, specificity, positive and negative predictive values and area under the receiver-operating curve (with 95% confidence intervals) were 94% (88-99%), 23% (17-29%), 34% (28-40%), 89% (79-98%) and 0.72 (0.65-0.79), respectively. CONCLUSIONS MpMRI demonstrated encouraging diagnostic performance characteristics in detecting and ruling out clinically significant prostate cancer in men at risk, who were biopsy naive.
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Affiliation(s)
- Mohamed Abd-Alazeez
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College Hospitals NHS Foundation Trust, London, UK
| | - Hashim U. Ahmed
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Barts Cancer Institute
| | - Eleni Anastasiadis
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Susan C. Charman
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine
| | - Alex Freeman
- Department of Histopathology, University College Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
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