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Zawaideh JP, Caglic I, Sushentsev N, Priest AN, Warren AY, Carmisciano L, Barrett T. MRI assessment of seminal vesicle involvement by prostate cancer using T2 signal intensity and volume. Abdom Radiol (NY) 2024; 49:2534-2539. [PMID: 38734785 DOI: 10.1007/s00261-024-04349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Seminal vesicle involvement (SVI) in patients with newly diagnosed prostate cancer is associated with high rates of treatment failure and tumor recurrence; correct identification of SVI allows for effective management decisions and surgical planning. METHODS This single-center retrospective study analyzed MR images of the seminal vesicles from patients undergoing radical prostatectomy with confirmed T3b disease, comparing them to a control group without SVI matched for age and Gleason grade with a final stage of T2 or T3a. Seminal vesicles were segmented by an experienced uroradiologist, "raw" and bladder-normalized T2 signal intensity, as well as SV volume, were obtained. RESULTS Among the 82 patients with SVI, 34 (41.6%) had unilateral invasion, and 48 (58.4%) had bilateral disease. There was no statistically significant difference in the degree of distension between normal and involved seminal vesicles (P = 0.08). Similarly, no statistically significant difference was identified in the raw SV T2 signal intensity (P = 0.09) between the groups. In the 159 patients analyzed, SVI was prospectively suspected in 10 of 82 patients (specificity, 100%; sensitivity, 12.2%). In all these cases, lesions macroscopically invaded the seminal vesicle, and the raw T2 signal intensity was significantly lower than that in the SVI and control groups (P = 0.02 and 0.01). CONCLUSION While signal intensity measurements in T2-weighted images may provide insight into T3b disease, our findings suggest that this data alone is insufficient to reliably predict SVI, indicating the need for further investigation and complementary diagnostic approaches.
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Affiliation(s)
- Jeries P Zawaideh
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - Luca Carmisciano
- Department of Health Sciences (DISSAL), Biostatistics Section, University of Genoa, Genoa, Italy
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Morabbi A, Karimian M. Trace and essential elements as vital components to improve the performance of the male reproductive system: Implications in cell signaling pathways. J Trace Elem Med Biol 2024; 83:127403. [PMID: 38340548 DOI: 10.1016/j.jtemb.2024.127403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
Successful male fertilization requires the main processes such as normal spermatogenesis, sperm capacitation, hyperactivation, and acrosome reaction. The progress of these processes depends on some endogenous and exogenous factors. So, the optimal level of ions and essential and rare elements such as selenium, zinc, copper, iron, manganese, calcium, and so on in various types of cells of the reproductive system could affect conception and male fertility rates. The function of trace elements in the male reproductive system could be exerted through some cellular and molecular processes, such as the management of active oxygen species, involvement in the action of membrane channels, regulation of enzyme activity, regulation of gene expression and hormone levels, and modulation of signaling cascades. In this review, we aim to summarize the available evidence on the role of trace elements in improving male reproductive performance. Also, special attention is paid to the cellular aspects and the involved molecular signaling cascades.
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Affiliation(s)
- Ali Morabbi
- Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran, Babolsar, Iran
| | - Mohammad Karimian
- Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran, Babolsar, Iran.
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3
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Huang TB, Ding XF. Re: Matthias Boschheidgen, Peter Albers, Heinz-Peter Schlemmer, et al. Multiparametric Magnetic Resonance Imaging in Prostate Cancer Screening at the Age of 45 Years: Results from the First Screening Round of the PROBASE Trial, Eur Urol 2024:85:105-111. Eur Urol 2024; 85:e112. [PMID: 38105141 DOI: 10.1016/j.eururo.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Tian-Bao Huang
- Department of Urology, Northern Jiangsu People's Hospital, Affiliated Hospital of Nanjing University Medical School, Yangzhou, China
| | - Xue-Fei Ding
- Department of Urology, Northern Jiangsu People's Hospital, Affiliated Hospital of Nanjing University Medical School, Yangzhou, China.
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Fennessy FM, Maier SE. Quantitative diffusion MRI in prostate cancer: Image quality, what we can measure and how it improves clinical assessment. Eur J Radiol 2023; 167:111066. [PMID: 37651828 PMCID: PMC10623580 DOI: 10.1016/j.ejrad.2023.111066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
Diffusion-weighted imaging is a dependable method for detection of clinically significant prostate cancer. In prostate tissue, there are several compartments that can be distinguished from each other, based on different water diffusion decay signals observed. Alterations in cell architecture, such as a relative increase in tumor infiltration and decrease in stroma, will influence the observed diffusion signal in a voxel due to impeded random motion of water molecules. The amount of restricted diffusion can be assessed quantitatively by measuring the apparent diffusion coefficient (ADC) value. This is traditionally calculated using a monoexponential decay formula represented by the slope of a line produced between the logarithm of signal intensity decay plotted against selected b-values. However, the choice and number of b-values and their distribution, has a significant effect on the measured ADC values. There have been many models that attempt to use higher-order functions to better describe the observed diffusion signal decay, requiring an increased number and range of b-values. While ADC can probe heterogeneity on a macroscopic level, there is a need to optimize advanced diffusion techniques to better interrogate prostate tissue microstructure. This could be of benefit in clinical challenges such as identifying sparse tumors in normal prostate tissue or better defining tumor margins. This paper reviews the principles of diffusion MRI and novel higher order diffusion signal analysis techniques to improve the detection of prostate cancer.
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Affiliation(s)
- Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Stephan E Maier
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Blasi F, Malouhi A, Cho CH, Nißler D, Berger FP, Grimm MO, Abubrig M, Teichgräber U, Franiel T. Staging accuracy of MRI of the prostate with special reference to the influence of the time of last ejaculation on the detection of seminal vesicle invasion. Clin Radiol 2023; 78:e425-e432. [PMID: 36849278 DOI: 10.1016/j.crad.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023]
Abstract
AIM To evaluate the Prostate Imaging Reporting and Data System, version 2.1 (PIRADS V2.1) criteria for seminal vesicle invasion (SVI) and examine whether the timing of last ejaculation influences the detection of SVI. MATERIALS AND METHODS The study population consisted of 68 patients (34 with SVI, 34 without SVI, matching groups by age and prostate volume) who underwent PIRADS V2.1-compliant multiparametric magnetic resonance imaging (MRI; 34 at 1.5 T, 34 at 3 T). Before the examination, the time of last ejaculation (38/68 ≤ 5 days, 30/68 > 5 days) was collected via a questionnaire. The five PIRADS V2.1 criteria for SVI with subsequent overall assessment were evaluated retrospectively by two independent examiners (examiner 1 with >10 years of experience, examiner 2 with 6 months of experience) in a single-blinded fashion for all patients using a questionnaire and a six-point scale (0 = no, 1 = very likely not, 2 = probably not, 3 = possible, 4 = probable, 5 = certain). RESULTS E1 achieved high specificity (100%) and positive predictive value (PPV; 100%) in the overall assessment, independent of the time of last ejaculation (sensitivity = 76.5%, negative predictive value [NPV] = 81%). The area under the curve (AUC) value was 0.882; for E2, it was 0.765. At ≤5 days, the AUC values of E1 and E2 differed significantly (0.867 versus 0.681, p=0.016), as did the diffusion restriction criterion (0.833 versus 0.681, p=0.028). E1 showed high AUC values independent of time. E2 had better values for all criteria at >5 days than at ≤5 days. There were no significant differences between the examiners in all observations at >5 days. CONCLUSION The PIRADS V2.1 criteria are well suited for an experienced examiner to detect SVI independent of time point. An inexperienced examiner will benefit from patients being abstinent >5 days prior to MRI.
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Affiliation(s)
- F Blasi
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany.
| | - A Malouhi
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - C-H Cho
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - D Nißler
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - F P Berger
- Clinic and Polyclinic for Urology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - M-O Grimm
- Clinic and Polyclinic for Urology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - M Abubrig
- Institute of Forensic Medicine, Pathology Section, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - U Teichgräber
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - T Franiel
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
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Hoang-Dinh A, Nguyen-Quang T, Bui-Van L, Gonindard-Melodelima C, Souchon R, Rouvière O. Reproducibility of apparent diffusion coefficient measurement in normal prostate peripheral zone at 1.5T MRI. Diagn Interv Imaging 2022; 103:545-554. [PMID: 35773099 DOI: 10.1016/j.diii.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to quantify the influence of factors of variability on apparent diffusion coefficient (ADC) estimation in the normal prostate peripheral zone (PZ). MATERIALS AND METHODS Fifty healthy volunteers underwent in 2017 (n = 17) or 2020 (n = 33) two-point (0, 800 s/mm²) prostate diffusion-weighted imaging in the morning on 1.5 T scanners A and B from different manufacturers. Additional five-point (50, 150, 300, 500, 800 s/mm²) acquisitions were performed on scanner B in the morning and evening. ADC was measured in PZ at midgland using ADC maps reconstructed with various b-value combinations. ADC distributions from 2017 and 2020 were compared using Wilcoxon rank sum test. ADC obtained in the same volunteers were compared using Bland Altman methodology. The 95% confidence interval upper limit of the repeatability/reproducibility coefficient defined the lowest detectable ADC difference. RESULTS Forty-nine participants with a mean age of 24.6 ± 3.8 [SD] years (range: 21-37 years) were finally included. ADC distributions from 2017 and 2020 were not significantly different and were combined. Despite high individual variability, there was no significant bias (10 × 10-6 mm²/s, P = 0.58) between ADC measurements made on both scanners. On scanner B, differences in lowest b-values chosen within the 0-500 s/mm² range for two-point ADC computation induced significant biases (56-109 × 10-6 mm²/s, P < 0.0001). ADC was significantly lower in the morning (bias: 33 × 10-6 mm²/s, P = 0.006). The number of b-values had little influence on ADC values. The lowest detectable ADC difference varied from 85 × 10-6 to 311 × 10-6 mm²/s across scanners, b-value combinations and periods of the day. CONCLUSIONS The MRI scanner, the lowest b-value used and the period of the day induce substantial variability in ADC computation.
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Affiliation(s)
- Au Hoang-Dinh
- Hanoï Medical University Hospital, Dong Da, Hanoi, Viet Nam
| | | | - Lenh Bui-Van
- Hanoï Medical University Hospital, Dong Da, Hanoi, Viet Nam
| | | | | | - Olivier Rouvière
- LabTAU, INSERM, U1032, 69000, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Vascular and Urinary Imaging, 69000, Lyon, France; Université de Lyon, Lyon 69003, France; Université Lyon 1, Lyon France; Faculté de Médecine, Lyon Est, 69003, Lyon, France.
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Caglic I, Sushentsev N, Shah N, Warren AY, Lamb BW, Barrett T. Integration of Prostate Biopsy Results with Pre-Biopsy Multiparametric Magnetic Resonance Imaging Findings Improves Local Staging of Prostate Cancer. Can Assoc Radiol J 2022; 73:515-523. [PMID: 35199583 DOI: 10.1177/08465371211073158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess the added value of histological information for local staging of prostate cancer (PCa) by comparing the accuracy of multiparametric MRI alone (mpMRI) and mpMRI with biopsy Gleason grade (mpMRI+Bx). METHODS 133 consecutive patients who underwent preoperative 3T-MRI and subsequent radical prostatectomy for PCa were included in this single-centre retrospective study. mpMRI imaging was reviewed independently by two uroradiologists for the presence of extracapsular extension (ECE) and seminal vesicle invasion (SVI) on a 5-point Likert scale. For second reads, the radiologists received results of targeted fused MR/US biopsy (mpMRI+Bx) prior to re-staging. RESULTS The median patient age was 63 years (interquartile range (IQR) 58-67 years) and median PSA was 6.5 ng/mL (IQR 5.0-10.0 ng/mL). Extracapsular extension was present in 85/133 (63.9%) patients and SVI was present in 22/133 (16.5%) patients. For ECE prediction, mpMRI showed sensitivity and specificity of 63.5% and 81.3%, respectively, compared to 77.7% and 81.3% achieved by mpMRI+Bx. At an optimal cut-off value of Likert score ≥ 3, areas under the curves (AUCs) was .85 for mpMRI+Bx and .78 for mpMRI, P < .01. For SVI prediction, AUC was .95 for mpMRI+Bx compared to .92 for mpMRI; P = .20. Inter-reader agreement for ECE and SVI prediction was substantial for mpMRI (k range, .78-.79) and mpMRI+Bx (k range, .74-.79). CONCLUSIONS MpMRI+Bx showed superior diagnostic performance with an increased sensitivity for ECE prediction but no significant difference for SVI prediction. Inter-reader agreement was substantial for both protocols. Integration of biopsy information adds value when staging prostate mpMRI.
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Affiliation(s)
- Iztok Caglic
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Nikita Sushentsev
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nimish Shah
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Urology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Pathology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Benjamin W Lamb
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Urology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Tristan Barrett
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Caglic I, Sushentsev N, Shah N, Warren AY, Lamb BW, Barrett T. Comparison of biparametric versus multiparametric prostate MRI for the detection of extracapsular extension and seminal vesicle invasion in biopsy naïve patients. Eur J Radiol 2021; 141:109804. [PMID: 34062473 DOI: 10.1016/j.ejrad.2021.109804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare biparametric MRI (bpMRI) with multiparametric MRI (mpMRI) staging accuracy in assessing extracapsular extension (ECE) and seminal vesicle invasion (SVI). METHOD Biopsy-naïve patients undergoing 3 T-MRI before radical prostatectomy for clinically significant prostate cancer were included in this single-centre retrospective study. Two uroradiologists separately evaluated bpMRI and mpMRI for presence of ECE and SVI using a 5-point Likert scale (1: ECE/SVI highly unlikely, 5: ECE/SVI highly likely). RESULTS 110 men of median age 63 years and PSA 8.5 ng/mL were included. ECE and SVI was confirmed histologically in 71/110 (64.5 %) and 18/110 (16.4 %) patients, respectively. Sensitivity and specificity of bpMRI versus mpMRI for predicting ECE was 59.1 % and 87.2 % versus 66.2 % and 84.6 %, respectively. For SVI detection, the sensitivity and specificity for bpMRI versus mpMRI was 66.7 % and 92.4 % versus 83.3 % and 97.8 %, respectively. At an optimal cut-off Likert score ≥3 for ECE prediction, mpMRI area under the receiver operating curve (AUC) was 0.80 (95 % confidence interval (CI) 0.72-0.87) versus 0.78 (95 % CI 0.69-0.86) for bpMRI (p = 0.52) and for SVI, mpMRI AUC was 0.91 (95 % CI 0.84-0.96) versus 0.86 (95 % CI 0.78-0.92) for bpMRI (p = 0.02), respectively. Inter-reader agreement for both ECE and SVI prediction was substantial, with a marginally higher k-value for mpMRI (k range, 0.67-0.75) than bpMRI (k range, 0.65-0.69). CONCLUSIONS Diagnostic performance of bpMRI and mpMRI was comparable for detection of ECE, however, mpMRI with contrast was superior for SVI detection and improved the inter-reader agreement.
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Affiliation(s)
- Iztok Caglic
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Nimish Shah
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Pathology, Addenbrooke's Hospital, Cambridge, UK.
| | - Benjamin W Lamb
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Tristan Barrett
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
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Franiel T, Asbach P, Beyersdorff D, Blondin D, Kaufmann S, Mueller-Lisse UG, Quentin M, Rödel S, Röthke M, Schlemmer HP, Schimmöller L. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Scanning Protocol. ROFO-FORTSCHR RONTG 2021; 193:763-777. [PMID: 33735931 DOI: 10.1055/a-1406-8477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The Working Group Uroradiology and Urogenital Diagnosis of the German Roentgen Society (DRG) revised and updated the recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate in a consensus process and harmonized it with the managing board of German Roentgen Society and Professional Association of the German Radiologist (BDR e. V.). These detailed recommendation define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer and describe in detail the topic 1. anamnestic datas, 2. termination of examinations and preparation of examinations, 3. examination protocol and 4. MRI-(in-bore)-biopsy. KEY POINTS:: · The recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate were revised and updated in a consensus process and harmonized with the managing board of German Roentgen Society (DRG) and Professional Asssociation of the German Radiologist (BDR).. · Detailed recommendations are given for topic 1. anamnestic datas, 2. termination and preparation of examinations, 3. examination protocoll and 4. MRI-(in-bore)-biopsy.. · These recommendations define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer.. CITATION FORMAT: · Franiel T, Asbach P, Beyersdorff D et al. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Examination Protocol. Fortschr Röntgenstr 2021; 193: 763 - 776.
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Affiliation(s)
- Tobias Franiel
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Jena, Deutschland
| | - Patrick Asbach
- Klinik für Radiologie, Charité Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Deutschland
| | - Dirk Beyersdorff
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Blondin
- Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Städtische Kliniken Mönchengladbach GmbH Elisabeth-Krankenhaus Rheydt, Mönchengladbach, Germany.,Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Städtische Kliniken Mönchengladbach, Germany
| | - Sascha Kaufmann
- Institut für Diagnostische und Interventionelle Radiologie, Siloah St. Trudpert Klinikum, Pforzheim, Deutschland
| | | | - Michael Quentin
- Centrum für Diagnostik und Therapie GmbH, Medizinisches Versorgungszentrum CDT Strahleninstitut GmbH, Köln, Germany
| | - Stefan Rödel
- Radiologische Klinik, Städtisches Klinikum Dresden, Germany
| | - Matthias Röthke
- Conradia Radiologie und Nuklearmedizin, Conradia Hamburg MVZ GmbH, Hamburg, Germany
| | | | - Lars Schimmöller
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Engels RR, Israël B, Padhani AR, Barentsz JO. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 1: Acquisition. Eur Urol 2020; 77:457-468. [DOI: 10.1016/j.eururo.2019.09.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
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Caglic I, Barrett T. Optimising prostate mpMRI: prepare for success. Clin Radiol 2019; 74:831-840. [PMID: 30611559 DOI: 10.1016/j.crad.2018.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/06/2018] [Indexed: 01/06/2023]
Abstract
Multiparametric magnetic resonance imaging (MRI) now plays an essential role in prostate cancer diagnosis and management. The increasing use of MRI before biopsy makes obtaining images of the highest quality vital. The European Society of Urogenital Radiology (ESUR) 2012 guidelines and subsequent Prostate Imaging -Reporting Data System (PI-RADS) version 2 recommendations in 2015 address the technical considerations for optimising MRI acquisition; however, the quality of the multiparametric sequences employed depends not only on the hardware and software utilised and scanning parameters selected, but also on patient-related factors, for which current guidance is lacking. Patient preparation factors include bowel peristalsis, rectal distension, the presence of total hip replacement (THR), post-biopsy haemorrhage, and abstinence from ejaculation. New evidence has been accrued since the release of PI-RADS v2, and this review aims to explore the key issues of patient preparation and their potential to further optimise the image quality of mpMRI.
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Affiliation(s)
- I Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - T Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Nissan N, Anaby D, Tavor I, Kleinbaum Y, Dotan Z, Konen E, Portnoy O. The Diffusion Tensor Imaging Properties of the Normal Testicles at 3 Tesla Magnetic Resonance Imaging. Acad Radiol 2019; 26:1010-1016. [PMID: 30322748 DOI: 10.1016/j.acra.2018.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES The testicles are structured in a well-defined microtubular network formation, which is expected to be reflected in high anisotropic diffusivity. However, preliminary studies reported on low values of fractional-anisotropy (FA) in the normal testicles. Our aim was to design and apply a diffusion-tensor imaging (DTI) protocol in order to elucidate the diffusivity properties of the testicles and their determining factors. MATERIALS AND METHODS 16 healthy volunteers were prospectively scanned at 3T. The protocol included T2-weighted and DTI sequences, the latter using 24 directional diffusion gradients and 3 b-values (0, 100, and 700 s/mm2) that were separated for analysis based on the reference b-value of 0 or 100 s/mm2. Image processing of the two DTI datasets yielded the diffusion vector maps and parametric maps of their corresponding principal diffusion coefficients λ1, λ2, λ3, mean diffusivity and FA. RESULTS The results demonstrated the feasibility of DTI to provide parametric maps of the testicles. The diffusion tensor parameters obtained using the pair of 0 and 700 s/mm2 b-values, exhibited relatively low diffusivity, with mean λ1 values of 1.36 ± 0.21 × 10-3 mm2/s and low anisotropy, with mean FA values of 0.13 ± 0.05. Analysis of DTI using the 100 and 700 s/mm2 b-values yielded a slight decrease in the diffusivity of 4%-5%, whereas FA remained similar. CONCLUSION The diffusivity of the normal testicles is relatively slow, closed-to isotropic and hardly affected by the low b-values regime exclusion. Thus, DTI parameters of the normal testicles are neither dictated by the underlying architectural anisotropy nor microperfusion effects.
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Affiliation(s)
- Noam Nissan
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel HaShomer 5265601, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Debbie Anaby
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel HaShomer 5265601, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Tavor
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel HaShomer 5265601, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yeruham Kleinbaum
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel HaShomer 5265601, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Dotan
- Department of Urology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer 5265601, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel HaShomer 5265601, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orith Portnoy
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel HaShomer 5265601, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barrett T, Rajesh A, Rosenkrantz AB, Choyke PL, Turkbey B. PI-RADS version 2.1: one small step for prostate MRI. Clin Radiol 2019; 74:841-852. [PMID: 31239107 DOI: 10.1016/j.crad.2019.05.019] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022]
Abstract
Multiparametric (mp) prostate magnetic resonance imaging (MRI) is playing an increasingly prominent role in the diagnostic work-up of patients with suspected prostate cancer. Performing mpMRI before biopsy offers several advantages including biopsy avoidance under certain clinical circumstances and targeting biopsy of suspicious lesions to enable the correct diagnosis. The success of the technique is heavily dependent on high-quality image acquisition, interpretation, and report communication, all areas addressed by previous versions of the Prostate Imaging-Reporting and Data System (PI-RADS) recommendations. Numerous studies have validated the approach, but the widespread adoption of PI-RADS version 2 has also highlighted inconsistencies and limitations, particularly relating to interobserver variability for evaluation of the transition zone. These limitations are addressed in the recently released version 2.1. In this article, we highlight the key changes proposed in PI-RADS v2.1 and explore the background reasoning and evidence for the recommendations.
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Affiliation(s)
- T Barrett
- Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Cambridge CB2 0QQ, UK.
| | - A Rajesh
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Radiology Department, Gwendolen Road, Leicester LE5 4PW, UK
| | - A B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016, USA
| | - P L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - B Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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Evaluation of seminal vesicle volume variability in patients receiving radiotherapy to the prostate. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractIntroduction:Prostate positional variability has been widely explored with seminal vesicle (SV) variability, coming into the forefront only in recent years. While planning target volume (PTV) margins and preparation protocols ameliorate the effects of bladder and rectum volume changes on prostate, studies on SV variation have looked at only position, not volume variability.Aim:The aim of this study was to investigate whether the inter-fraction volume variability of the VSs can exist in patients receiving radiotherapy to the prostate.Method:SV variability was investigated by comparing four on-treatment cone beam computer tomography scans to a planning computer tomography (CT) image for two patients receiving prostate radiotherapy. For each case, variation in volumes (cm3) was compared with intra-observer variation.Results:SV volume variability was seen in both patients, with the largest change in volume being 78·38%. This variance was considerably (between 2 and 10 times) larger than the measured intra-observer variance.Conclusion:This study identified the potential for daily SV volume variability in patients receiving prostate radiotherapy. Future large-scale studies are warranted to identify the extent of this motion and potential clinical impact. Evidence-informed PTV margins and possible SV volume control protocols may need to be adopted.
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Assessing the Clinical Value of Positive Multiparametric Magnetic Resonance Imaging in Young Men with a Suspicion of Prostate Cancer. Eur Urol Oncol 2019; 4:594-600. [PMID: 31204312 DOI: 10.1016/j.euo.2019.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/29/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a lack of evidence on the ability of magnetic resonance imaging (MRI) of the prostate to detect clinically significant prostate cancer (csPCa) in young patients. OBJECTIVE We hypothesised that the diagnostic performance of MRI for csPCa varies according to patient's age. To address this, we assessed the variation in the csPCa detection rate of MRI targeted biopsy (MRI-TBx) versus systematic random biopsy (SBx) across different patient ages. DESIGN, SETTING, AND PARTICIPANTS We retrospectively identified 930 patients who underwent prostate MRI and subsequent biopsy at two referral centres between 2013 and 2018. The Prostate Imaging Reporting and Data System (PI-RADS) was used for MRI reporting. INTERVENTION A lesion with a PI-RADS score of ≥3 detected at MRI received an MRI-TBx in addition to an SBx during the same session. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The outcome of our study was the relationship between age and csPCa detection rate at MRI-TBx and SBx, respectively. Clinically significant prostate cancer (PCa) was defined as the presence of PCa with Gleason score ≥3+4. Multivariable logistic regression analyses (MVAs) predicting csPCa detection were assessed for both MRI-TBx and SBx. Covariates were age, prostate-specific antigen density, PI-RADS score, previous biopsy status, digital rectal examination, and the number of targeted and systematic cores. The hypothesis that MRI accuracy in detecting csPCa differed by age was finally tested with a nonparametric loess analysis. RESULTS AND LIMITATIONS The overall rate of csPCa was 54% (n=506). Overall, 325 (35%) and 461 (50%) patients had csPCa at SBx and MRI-TBx, respectively. The median numbers of SBx and MRI-TBx cores were 12 (interquartile range [IQR]: 10-13) and 5 (IQR: 4-7), respectively. At MVA, age at biopsy was an independent predictor of csPCa at MRI-TBx only (odds ratio: 1.05), after accounting for confounders. In men aged less than roughly 50yr, SBx had a higher probability of detecting csPCa relative to MRI-TBx (25% vs 16% at 40yr). Conversely, in patients aged >50yr, the probability of csPCa was higher in MRI-TBx than in SBx, reaching the highest difference for very elderly patients (48% vs 68% at 80yr). The main limitations were the retrospective design and the small number of young patients. CONCLUSIONS In this study, we reported the performance of MRI and MRI-TBx in detecting csPCa changes according to patients' age. PATIENT SUMMARY In young patients, the performance of a systematic random biopsy in detecting clinically significant prostate cancer (csPCa) is higher relative to magnetic resonance imaging targeted biopsy (MRI-TBx), reflecting the lower accuracy of MRI in younger men. Conversely, in older patients, MRI-TBx showed a clinical benefit with a higher csPCa detection rate compared with SBx, suggesting an increase of MRI accuracy with the increase of age.
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16
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Multiparametric MRI - local staging of prostate cancer and beyond. Radiol Oncol 2019; 53:159-170. [PMID: 31103999 PMCID: PMC6572496 DOI: 10.2478/raon-2019-0021] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Accurate local staging is critical for treatment planning and prognosis in patients with prostate cancer (PCa). The primary aim is to differentiate between organ-confined and locally advanced disease with the latter carrying a worse clinical prognosis. Multiparametric MRI (mpMRI) is the imaging modality of choice for the local staging of PCa and has an incremental value in assessing pelvic nodal disease and bone involvement. It has shown superior performance compared to traditional staging based on clinical nomograms, and provides additional information on the site and extent of disease. MRI has a high specificity for diagnosing extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node (LN) metastases, however, sensitivity remains poor. As a result, extended pelvic LN dissection remains the gold standard for assessing pelvic nodal involvement, and there has been recent progress in developing advanced imaging techniques for more distal staging. Conclusions T2W-weighted imaging is the cornerstone for local staging of PCa. Imaging at 3T and incorporating both diffusion weighted and dynamic contrast enhanced imaging can further increase accuracy. "Next generation" imaging including whole body MRI and PET-MRI imaging using prostate specific membrane antigen (68Ga-PSMA), has shown promising for assessment of LN and bone involvement as compared to the traditional work-up using bone scintigraphy and body CT.
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Zhang W, Stephens CJ, Blumenfeld JD, Behzadi AH, Donahue S, Bobb WO, Newhouse JH, Rennert H, Zhao Y, Prince MR. Relationship of Seminal Megavesicles, Prostate Median Cysts, and Genotype in Autosomal Dominant Polycystic Kidney Disease. J Magn Reson Imaging 2018; 49:894-903. [PMID: 30230107 DOI: 10.1002/jmri.26289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) can involve prostate and seminal vesicles but the potential interrelationship of these findings and associations with PKD gene mutation locus and type is unknown. PURPOSE To determine the interrelationship of seminal megavesicles (seminal vesicles with lumen diameter > 10mm) and prostatic cysts in ADPKD and to determine whether there are associations with PKD gene mutations. STUDY TYPE Retrospective, case control. POPULATION Male ADPKD subjects (n = 92) with mutations in PKD1 (n = 71; 77%) or PKD2 (n = 21; 23%), and age/gender-matched controls without ADPKD (n = 92). FIELD STRENGTH/SEQUENCE 1.5T, axial/coronal T2 -weighted MR images. ASSESSMENT Reviewers blinded to genotype independently measured seminal vesicle lumen diameter and prevalence of cysts in prostate, kidney, and liver. STATISTICAL TESTS Nonparametric tests for group comparisons and univariate and multivariable logistic regression analyses to identify associations of megavesicles and prostate median cysts with mutations and renal/hepatic cyst burden. RESULTS Seminal megavesicles were found in 23 of 92 ADPKD (25%) subjects with PKD1 (22/71, 31%) or PKD2 (n = 1/21, 5%) mutations, but in only two control subjects (P < 0.0001). Prostate median cysts were found in 17/92 (18%) ADPKD subjects, compared with only 6/92 (7%) controls (P = 0.01), and were correlated with seminal vesicle diameters (ρ = 0.24, P = 0.02). Nonmedian prostate cyst prevalence was identical between ADPKD and controls (7/92, 8%). After adjusting for age, estimated glomerular filtration rate, and height-adjusted total kidney volume, ADPKD subjects with megavesicles were 10 times more likely to have a PKD1 than a PKD2 mutation. Among PKD1 subjects, seminal megavesicles occurred more frequently with nontruncating mutations with less severe kidney involvement. DATA CONCLUSION ADPKD is associated with prostate median cysts near ejaculatory ducts. These cysts correlate with seminal megavesicles (dilated to >10 mm) which predict a 10-fold greater likelihood of PKD1 vs. PKD2 mutation. Cysts elsewhere in the prostate are not related to ADPKD. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:894-903.
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Affiliation(s)
- Weiguo Zhang
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Chelsea J Stephens
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Jon D Blumenfeld
- Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | | | | | | | - Hanna Rennert
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Yize Zhao
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Columbia College of Physicians and Surgeons, New York, New York, USA
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