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Kluckert J, Hötker AM, Da Mutten R, Konukoglu E, Donati OF. AI-based automated evaluation of image quality and protocol tailoring in patients undergoing MRI for suspected prostate cancer. Eur J Radiol 2024; 177:111581. [PMID: 38925042 DOI: 10.1016/j.ejrad.2024.111581] [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: 04/12/2024] [Revised: 06/08/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To develop and validate an artificial intelligence (AI) application in a clinical setting to decide whether dynamic contrast-enhanced (DCE) sequences are necessary in multiparametric prostate MRI. METHODS This study was approved by the institutional review board and requirement for study-specific informed consent was waived. A mobile app was developed to integrate AI-based image quality analysis into clinical workflow. An expert radiologist provided reference decisions. Diagnostic performance parameters (sensitivity and specificity) were calculated and inter-reader agreement was evaluated. RESULTS Fully automated evaluation was possible in 87% of cases, with the application reaching a sensitivity of 80% and a specificity of 100% in selecting patients for multiparametric MRI. In 2% of patients, the application falsely decided on omitting DCE. With a technician reaching a sensitivity of 29% and specificity of 98%, and resident radiologists reaching sensitivity of 29% and specificity of 93%, the use of the application allowed a significant increase in sensitivity. CONCLUSION The presented AI application accurately decides on a patient-specific MRI protocol based on image quality analysis, potentially allowing omission of DCE in the diagnostic workup of patients with suspected prostate cancer. This could streamline workflow and optimize time utilization of healthcare professionals.
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Affiliation(s)
- Jonas Kluckert
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
| | - Andreas M Hötker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Raffaele Da Mutten
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Ender Konukoglu
- Computer Vision Laboratory, Department of Information Technology and Electrical Engineering, ETH Zurich, Sternwartstrasse 7, 8092 Zurich, Switzerland
| | - Olivio F Donati
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Radiology Octorad / Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
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2
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Kohjimoto Y, Uemura H, Yoshida M, Hinotsu S, Takahashi S, Takeuchi T, Suzuki K, Shinmoto H, Tamada T, Inoue T, Sugimoto M, Takenaka A, Habuchi T, Ishikawa H, Mizowaki T, Saito S, Miyake H, Matsubara N, Nonomura N, Sakai H, Ito A, Ukimura O, Matsuyama H, Hara I. Japanese clinical practice guidelines for prostate cancer 2023. Int J Urol 2024. [PMID: 39078210 DOI: 10.1111/iju.15545] [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: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.
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Affiliation(s)
- Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
- Department of EBM and Guidelines, Japan Council for Quality Health Care (Minds), Tokyo, Japan
| | - Shiro Hinotsu
- Department of Biostatistics and Data Management, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- NPO Prostate Cancer Patients Association, Takarazuka, Hyogo, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Tochigi, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Saito
- Department of Urology, Prostate Cancer Center Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Nagasaki Rosai Hospital, Sasebo, Nagasaki, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
- Department of Urology, JA Yamaguchi Kouseiren Nagato General Hospital, Yamaguchi, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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Bertelli E, Vizzi M, Marzi C, Pastacaldi S, Cinelli A, Legato M, Ruzga R, Bardazzi F, Valoriani V, Loverre F, Impagliazzo F, Cozzi D, Nardoni S, Facchiano D, Serni S, Masieri L, Minervini A, Agostini S, Miele V. Biparametric vs. Multiparametric MRI in the Detection of Cancer in Transperineal Targeted-Biopsy-Proven Peripheral Prostate Cancer Lesions Classified as PI-RADS Score 3 or 3+1: The Added Value of ADC Quantification. Diagnostics (Basel) 2024; 14:1608. [PMID: 39125483 PMCID: PMC11312064 DOI: 10.3390/diagnostics14151608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Biparametric MRI (bpMRI) has an important role in the diagnosis of prostate cancer (PCa), by reducing the cost and duration of the procedure and adverse reactions. We assess the additional benefit of the ADC map in detecting prostate cancer (PCa). Additionally, we examine whether the ADC value correlates with the presence of clinically significant tumors (csPCa). METHODS 104 peripheral lesions classified as PI-RADS v2.1 score 3 or 3+1 at the mpMRI underwent transperineal MRI/US fusion-guided targeted biopsy. RESULTS The lesions were classified as PI-RADS 3 or 3+1; at histopathology, 30 were adenocarcinomas, 21 of which were classified as csPCa. The ADC threshold that maximized the Youden index in order to predict the presence of a tumor was 1103 (95% CI (990, 1243)), with a sensitivity of 0.8 and a specificity of 0.59; both values were greater than those found using the contrast medium, which were 0.5 and 0.54, respectively. Similar results were also found with csPCa, where the optimal ADC threshold was 1096 (95% CI (988, 1096)), with a sensitivity of 0.86 and specificity of 0.59, compared to 0.49 and 0.59 observed in the mpMRI. CONCLUSIONS Our study confirms the possible use of a quantitative parameter (ADC value) in the risk stratification of csPCa, by reducing the number of biopsies and, therefore, the number of unwarranted diagnoses of PCa and the risk of overtreatment.
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Affiliation(s)
- Elena Bertelli
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Michele Vizzi
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Chiara Marzi
- Department of Statistics, Informatics and Applications “G. Parenti” (DiSIA), University of Florence, 50134 Florence, Italy;
| | - Sandro Pastacaldi
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Alberto Cinelli
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Martina Legato
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Ron Ruzga
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Federico Bardazzi
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Vittoria Valoriani
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Francesco Loverre
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Francesco Impagliazzo
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Diletta Cozzi
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Samuele Nardoni
- Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, 50134 Florence, Italy; (S.N.); (D.F.); (S.S.); (L.M.)
| | - Davide Facchiano
- Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, 50134 Florence, Italy; (S.N.); (D.F.); (S.S.); (L.M.)
| | - Sergio Serni
- Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, 50134 Florence, Italy; (S.N.); (D.F.); (S.S.); (L.M.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Lorenzo Masieri
- Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, 50134 Florence, Italy; (S.N.); (D.F.); (S.S.); (L.M.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, 50134 Florence, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (M.V.); (S.P.); (A.C.); (M.L.); (R.R.); (F.B.); (V.V.); (F.L.); (F.I.); (D.C.); (S.A.); (V.M.)
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4
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Khalid MJ, Parker P, Smith S, Byass OR, Cast JEI. Prevalence of clinically significant prostate carcinoma in Prostate Imaging Reporting and Data System (PIRADS) 3 lesions detected in the peripheral zone on biparametric magnetic resonance imaging (MRI)-a local experience. Clin Radiol 2024:S0009-9260(24)00398-2. [PMID: 39129105 DOI: 10.1016/j.crad.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/14/2024] [Accepted: 07/16/2024] [Indexed: 08/13/2024]
Abstract
AIM The aim of this study was to determine whether biparametric magnetic resonance imaging (MRI) is effective in the diagnosis of clinically significant prostate cancer in prostate peripheral zone Prostate Imaging Reporting and Data System (PIRADS) 3 lesions without the use of dynamic contrast enhancement. MATERIALS AND METHODS Patients who underwent biparametric MRI over a 12-month period from January 2022 to December 2022 and were diagnosed with PIRADS 3 lesion in the peripheral zone were included in the study. No patient received dynamic contrast enhancement. Histological analysis was done after performing local anesthetic transperineal biopsy to determine detection rate of clinically significant prostate cancer. Prostate-specific antigen density (PSAD) and biopsy complication rates were also reviewed. RESULTS Sixty-one out of 688 MRIs (8.8%) performed over the study period had a PIRADS 3 lesion in the peripheral zone where contrast is supposed to add value. Fifty-eight of the 61 went ahead to biopsy, and csPCa (Gleason score: ≥3 + 4, with a max core length of ≥6 mm and above) was diagnosed in 17%. Among those diagnosed with csPCa, 80% had a PSAD of >0.15 ng/ml/cc. No postbiopsy complications were reported. CONCLUSION Biparametric MRI without contrast offers a reliable alternative to multiparametric MRI with minimum or neglible impact on clinically significant prostate cancer (csPCa) diagnosis in peripheral zone PIRADS 3 lesions, especially when used in conjunction with other factors such as PSAD. There is potential to address health economics and patient burden in prostate cancer investigation.
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Affiliation(s)
- M J Khalid
- Department of Radiology, Hull University Teaching Hospitals NHS Trust, Kingston-upon-Hull, UK.
| | - P Parker
- Department of Radiology, Hull University Teaching Hospitals NHS Trust, Kingston-upon-Hull, UK
| | - S Smith
- Department of Radiology, Hull University Teaching Hospitals NHS Trust, Kingston-upon-Hull, UK
| | - O R Byass
- Department of Radiology, Hull University Teaching Hospitals NHS Trust, Kingston-upon-Hull, UK
| | - J E I Cast
- Department of Radiology, Hull University Teaching Hospitals NHS Trust, Kingston-upon-Hull, UK
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5
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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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Gulati R, Jiao B, Al-Faouri R, Sharma V, Kaul S, Fleishman A, Wymer K, Boorjian SA, Olumi AF, Etzioni R, Gershman B. Lifetime Health and Economic Outcomes of Biparametric Magnetic Resonance Imaging as First-Line Screening for Prostate Cancer : A Decision Model Analysis. Ann Intern Med 2024; 177:871-881. [PMID: 38830219 PMCID: PMC11250625 DOI: 10.7326/m23-1504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Contemporary prostate cancer (PCa) screening uses first-line prostate-specific antigen (PSA) testing, possibly followed by multiparametric magnetic resonance imaging (mpMRI) for men with elevated PSA levels. First-line biparametric MRI (bpMRI) screening has been proposed as an alternative. OBJECTIVE To evaluate the comparative effectiveness and cost-effectiveness of first-line bpMRI versus PSA-based screening. DESIGN Decision analysis using a microsimulation model. DATA SOURCES Surveillance, Epidemiology, and End Results database; randomized trials. TARGET POPULATION U.S. men aged 55 years with no prior screening or PCa diagnosis. TIME HORIZON Lifetime. PERSPECTIVE U.S. health care system. INTERVENTION Biennial screening to age 69 years using first-line PSA testing (test-positive threshold, 4 µg/L) with or without second-line mpMRI or first-line bpMRI (test-positive threshold, PI-RADS [Prostate Imaging Reporting and Data System] 3 to 5 or 4 to 5), followed by biopsy guided by MRI or MRI plus transrectal ultrasonography. OUTCOME MEASURES Screening tests, biopsies, diagnoses, overdiagnoses, treatments, PCa deaths, quality-adjusted and unadjusted life-years saved, and costs. RESULTS OF BASE-CASE ANALYSIS For 1000 men, first-line bpMRI versus first-line PSA testing prevented 2 to 3 PCa deaths and added 10 to 30 life-years (4 to 11 days per person) but increased the number of biopsies by 1506 to 4174 and the number of overdiagnoses by 38 to 124 depending on the biopsy imaging scheme. At conventional cost-effectiveness thresholds, first-line PSA testing with mpMRI followed by either biopsy approach for PI-RADS 4 to 5 produced the greatest net monetary benefits. RESULTS OF SENSITIVITY ANALYSIS First-line PSA testing remained more cost-effective even if bpMRI was free, all men with low-risk PCa underwent surveillance, or screening was quadrennial. LIMITATION Performance of first-line bpMRI was based on second-line mpMRI data. CONCLUSION Decision analysis suggests that comparative effectiveness and cost-effectiveness of PCa screening are driven by false-positive results and overdiagnoses, favoring first-line PSA testing with mpMRI over first-line bpMRI. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Roman Gulati
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Boshen Jiao
- Fred Hutchinson Cancer Center, Seattle, Washington
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | - Ra’ad Al-Faouri
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Sumedh Kaul
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Aria F. Olumi
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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7
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Martini F, Pigati M, Mattiauda M, Ponzano M, Piol N, Pigozzi S, Spina B, Cittadini G, Giasotto V, Zawaideh JP. Extra-prostatic extension grading system: correlation with MRI features and integration of capsular enhancement sign for "enhanced" detection of T3a lesions. Br J Radiol 2024; 97:971-979. [PMID: 38544291 DOI: 10.1093/bjr/tqae065] [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: 02/20/2024] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 05/09/2024] Open
Abstract
PURPOSE This study aims to confirm the diagnostic accuracy of extra-prostatic extension (EPE) grading system and to explore the predictive capabilities of the prostate MRI while considering various MRI features such as lesion location, apparent diffusion coefficient (ADC) values and capsular enhancement sign (CES). METHODS Our monocentric study is based on a retrospective analysis of 99 patients who underwent radical prostatectomy from January 2021 to January 2023. The observers reviewed for each lesion, including location (transitional or peripheral zone, anterior or posterior location), capsular contact length, irregular bulging of the capsule, asymmetry of the neurovascular bundle, obliteration of the recto-prostatic angle, macroscopic EPE, ADC value, and CES. RESULTS Among 99 patients, 31 patients had EPE. Lesions with EPE have broadercapsule contact (24 mm vs 12 mm) with contact ≥14 mm being the optimal cut-off for EPE discrimination. Among the morphological MRI criteria used to determine the EPE, the one with major sensitivity was shown to be bulging (sen 81%), while macroscopic extension had highest specificity (100%). Univariate analysis showed as significative risk factors for EPE: capsular contact ≥14 mm (P < .001), International Society of Urological Pathology score ≥3 (P = .005), CES (P < .001), bulging (P = .001), neurovascular bundle asymmetry (P < .001) and EPE score ≥2 (P < .001), and in multivariate analysis CES (P = .001) and EPE score ≥2 (P = .004) were significant. The AUC of the EPE score was 0.76, raised to 0.83 when combining it with CES (P = .11). CONCLUSION CES in the setting of multiparametric MRI can increase diagnostic accuracy for the prediction of extracapsular disease. ADVANCES IN KNOWLEDGE This study highlights the potential of contrast media in prostate cancer local staging.
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Affiliation(s)
- Federica Martini
- Department of Health Sciences (DISSAL), Radiology section, University of Genoa, Genova 16132, Italy
| | - Maria Pigati
- Department of Health Sciences (DISSAL), Radiology section, University of Genoa, Genova 16132, Italy
| | - Matilde Mattiauda
- Department of Health Sciences (DISSAL), Radiology section, University of Genoa, Genova 16132, Italy
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genova 16132, Italy
| | - Nataniele Piol
- Anatomia Patologica Universitaria Unit, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
| | - Simona Pigozzi
- Anatomia Patologica Universitaria Unit, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
- Department of Surgical and Diagnostic Sciences (DISC), Urology Section, University of Genova, Genova 16132, Italy
| | - Bruno Spina
- Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
| | - Giuseppe Cittadini
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
| | - Veronica Giasotto
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
| | - Jeries P Zawaideh
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
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8
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Caglic I, Sushentsev N, Syer T, Lee KL, Barrett T. Biparametric MRI in prostate cancer during active surveillance: is it safe? Eur Radiol 2024:10.1007/s00330-024-10770-z. [PMID: 38656709 DOI: 10.1007/s00330-024-10770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Active surveillance (AS) is the preferred option for patients presenting with low-intermediate-risk prostate cancer. MRI now plays a crucial role for baseline assessment and ongoing monitoring of AS. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations aid radiological assessment of progression; however, current guidelines do not advise on MRI protocols nor on frequency. Biparametric (bp) imaging without contrast administration offers advantages such as reduced costs and increased throughput, with similar outcomes to multiparametric (mp) MRI shown in the biopsy naïve setting. In AS follow-up, the paradigm shifts from MRI lesion detection to assessment of progression, and patients have the further safety net of continuing clinical surveillance. As such, bpMRI may be appropriate in clinically stable patients on routine AS follow-up pathways; however, there is currently limited published evidence for this approach. It should be noted that mpMRI may be mandated in certain patients and potentially offers additional advantages, including improving image quality, new lesion detection, and staging accuracy. Recently developed AI solutions have enabled higher quality and faster scanning protocols, which may help mitigate against disadvantages of bpMRI. In this article, we explore the current role of MRI in AS and address the need for contrast-enhanced sequences. CLINICAL RELEVANCE STATEMENT: Active surveillance is the preferred plan for patients with lower-risk prostate cancer, and MRI plays a crucial role in patient selection and monitoring; however, current guidelines do not currently recommend how or when to perform MRI in follow-up. KEY POINTS: Noncontrast biparametric MRI has reduced costs and increased throughput and may be appropriate for monitoring stable patients. Multiparametric MRI may be mandated in certain patients, and contrast potentially offers additional advantages. AI solutions enable higher quality, faster scanning protocols, and could mitigate the disadvantages of biparametric imaging.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Nikita Sushentsev
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tom Syer
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Kang-Lung Lee
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tristan Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom.
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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Shimizu R, Morizane S, Yamamoto A, Yamane H, Nishikawa R, Kimura Y, Yamaguchi N, Hikita K, Honda M, Takenaka A. Assessment of the accuracy of biparametric MRI/TRUS fusion-guided biopsy for index tumor evaluation using postoperative pathology specimens. BMC Urol 2024; 24:79. [PMID: 38575912 PMCID: PMC10996083 DOI: 10.1186/s12894-024-01473-0] [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: 07/15/2023] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Multiparametric MRI (mpMRI) is widely used for the diagnosis, surveillance, and staging of prostate cancer. However, it has several limitations, including higher costs, longer examination times, and the use of gadolinium-based contrast agents. This study aimed to investigate the accuracy of preoperatively assessed index tumors (ITs) using biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion biopsy compared with radical prostatectomy (RP) specimens. METHODS We included 113 patients diagnosed with prostate cancer through bpMRI/TRUS fusion-guided biopsies of lesions with a Prostate Imaging Reporting and Data System (PI-RADS) category ≥ 3. These patients underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our institution between July 2017 and March 2023. We examined the localization of preoperative and postoperative ITs, the highest Gleason score (GS), and tumor diameter in these patients. RESULTS The preoperative cT stage matched the postoperative pT stage in 53 cases (47%), while 31 cases (27%) were upstaged, and 29 cases (26%) were downstaged (Weighted Kappa = 0.21). The preoperative and postoperative IT localizations were consistent in 97 cases (86%). The concordance rate between Gleason groups in targeted biopsies and RP specimens was 51%, with an upgrade in 25 cases (23%) and a downgrade in 27 cases (25%) (Weighted Kappa = 0.42). The maximum diameter of the IT and the maximum cancer core length on biopsy were correlated with the RP tumor's maximum diameter (p < 0.001 for both). CONCLUSION The diagnostic accuracy of bpMRI/TRUS fusion biopsy is comparable to mpMRI, suggesting that it can be a cost-effective and time-saving alternative.
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Affiliation(s)
- Ryutaro Shimizu
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan.
| | - Atsushi Yamamoto
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Hiroshi Yamane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Ryoma Nishikawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Yusuke Kimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Noriya Yamaguchi
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
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10
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Ziayee F, Schimmöller L, Boschheidgen M, Kasprowski L, Al-Monajjed R, Quentin M, Radtke JP, Albers P, Antoch G, Ullrich T. Benefit of dynamic contrast-enhanced (DCE) imaging for prostate cancer detection depending on readers experience in prostate MRI. Clin Radiol 2024; 79:e468-e474. [PMID: 38185579 DOI: 10.1016/j.crad.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024]
Abstract
AIM To investigate the relevance of dynamic contrast enhanced imaging (DCE) within multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer (csPC) depending on reader experience. MATERIALS AND METHODS Consecutive patients with 3 T mpMRI and subsequent combined MRI/ultrasound fusion-guided targeted and systematic biopsy from January to September 2019 were included. All mpMRI examinations were read separately by two less experienced (R1; <500 prostate MRI) and two expert radiologists (R2; >5,000 prostate MRI) in consensus and blinded re-read as biparametric MRI (bpMRI). The primary endpoint was the performance comparison of mpMRI versus bpMRI of R1 and R2. RESULTS Fifty-three of 124 patients had csPC (43%). The PI-RADS agreement of bpMRI and mpMRI was fair for R1 (κ = 0.373) and moderate for R2 (κ = 0.508). R1 assessed 11 csPC with PI-RADS ≤3 (20.8%) on mpMRI and 12 (22.6%) on bpMRI (R2: 1 [1.9%] and 6 [11.3%], respectively). Sensitivity for csPC of mpMRI was 79.3% (NPV 79.3%) for R1 and 98.1% (NPV 97.5%) for R2 (bpMRI: 77.4% [NVP 75.5%] and 86.8% [NPV 84.4%], respectively). Specificity of mpMRI for csPC was 59.2% for R1 and 54.9% for R2 (bpMRI: 52.1% and 53.5%, respectively). Overall accuracy of mpMRI was 79.8% for R1 compared to bpMRI 66.9% (p=0.017; R2: 87.1% and 81.5%; p=0.230). CONCLUSION Prostate MRI benefits from reader experience. Less experienced readers missed a relevant proportion of csPC with mpMRI and even more with bpMRI. The overall performance of expert readers was comparable for mpMRI and bpMRI but DCE enabled detection of some further ISUP 2 PC.
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Affiliation(s)
- F Ziayee
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - L Schimmöller
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
| | - M Boschheidgen
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - L Kasprowski
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - R Al-Monajjed
- Department of Urology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - M Quentin
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - J P Radtke
- Department of Urology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - P Albers
- Department of Urology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - G Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - T Ullrich
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
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Rajendran I, Lee KL, Thavaraja L, Barrett T. Risk stratification of prostate cancer with MRI and prostate-specific antigen density-based tool for personalized decision making. Br J Radiol 2024; 97:113-119. [PMID: 38263825 PMCID: PMC11027333 DOI: 10.1093/bjr/tqad027] [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: 07/04/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES MRI is now established for initial prostate cancer diagnosis; however, there is no standardized pathway to avoid unnecessary biopsy in low-risk patients. Our study aimed to test previously proposed MRI-focussed and risk-adapted biopsy decision models on a real-world dataset. METHODS Single-centre retrospective study performed on 2055 biopsy naïve patients undergoing MRI. Diagnostic pathways included "biopsy all", "MRI-focussed" and two risk-based MRI-directed pathways. Risk thresholds were based on prostate-specific antigen (PSA) density as low (<0.10 ng mL-2), intermediate (0.10-0.15 ng mL-2), high (0.15-0.20 ng mL-2), or very high-risk (>0.20 ng mL-2). The outcome measures included rates of biopsy avoidance, detection of clinically significant prostate cancer (csPCa), missed csPCa, and overdiagnosis of insignificant prostate cancer (iPCa). RESULTS Overall cancer rate was 39.9% (819/2055), with csPCa (Grade-Group ≥2) detection of 30.3% (623/2055). In men with a negative MRI (Prostate Imaging-Reporting and Data System, PI-RADS 1-2), the risk of cancer was 1.2%, 2.6%, 9.0%, and 12.9% in the low, intermediate, high, and very high groups, respectively; for PI-RADS score 3 lesions, the rates were 10.5%, 14.3%, 25.0%, and 33.3%, respectively. MRI-guided pathway and risk-based pathway with a low threshold missed only 1.6% csPCa with a biopsy-avoidance rate of 54.4%, and the risk-based pathway with a higher threshold avoided 62.9% (1292/2055) of biopsies with 2.9% (61/2055) missed csPCa detection. Decision curve analysis found that the "risk-based low threshold" pathway has the highest net benefit for probability thresholds between 3.6% and 13.9%. CONCLUSION Combined MRI and PSA-density risk-based pathways can be a helpful decision-making tool enabling high csPCa detection rates with the benefit of biopsy avoidance and reduced iPCa detection. ADVANCES IN KNOWLEDGE This real-world dataset from a large UK-based cohort confirms that combining MRI scoring with PSA density for risk stratification enables safe biopsy avoidance and limits the over-diagnosis of insignificant cancers.
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Affiliation(s)
- Ishwariya Rajendran
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Liness Thavaraja
- School of Medicine, Addenbrooke’s Hospital, Cambridge CB2 0SP, United Kingdom
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, United Kingdom
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12
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Ringe KI, Wang J, Deng Y, Pi S, Geahchan A, Taouli B, Bashir MR. Abbreviated MRI Protocols in the Abdomen and Pelvis. J Magn Reson Imaging 2024; 59:58-69. [PMID: 37144673 DOI: 10.1002/jmri.28764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
Abbreviated MRI (AMRI) protocols rely on the acquisition of a limited number of sequences tailored to a specific question. The main objective of AMRI protocols is to reduce exam duration and costs, while maintaining an acceptable diagnostic performance. AMRI is of increasing interest in the radiology community; however, challenges limiting clinical adoption remain. In this review, we will address main abdominal and pelvic applications of AMRI in the liver, pancreas, kidney, and prostate, including diagnostic performance, pitfalls, limitations, and cost effectiveness will also be discussed. Level of Evidence: 3 Technical Efficacy Stage: 3.
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Affiliation(s)
- Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ying Deng
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shan Pi
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Amine Geahchan
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mustafa R Bashir
- Department of Radiology, Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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13
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Abreu-Gomez J, Lim C, Haider MA. Contemporary Approach to Prostate Imaging and Data Reporting System Score 3 Lesions. Radiol Clin North Am 2024; 62:37-51. [PMID: 37973244 DOI: 10.1016/j.rcl.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The aim of this article is to review the technical and clinical considerations encountered with PI-RADS 3 lesions, which are equivocal for clinically significant Prostate Cancer (csPCa) with detection rates ranging between 10% and 35%. The number of PI-RADS 3 lesions reported vary according to several factors including MRI quality and radiologist training/expertise among the most influential. PI-RADS v.2.1 updated definitions for scores 2 and 3 in the PZ and scores 1 and 2 in the TZ is reviewed. The role of DWI role is highlighted in the assessment of the TZ with the possibility of upgrading score 2 lesions to score 3 based on DWI score. Given the increased utilization for prostate MRI, biparametric MRI can be considered as an alternative for low-risk patients where there is a need to rule out csPCa acknowledging this technique may increase the number of indeterminate cases going for biopsies. Management of patients with equivocal lesions at mpMRI and factors influencing biopsy decision process remain as an unmet need and additional studies using molecular/imaging markers as well as artificial intelligence tools are needed to further address their role in proper patient selection for biopsy.
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Affiliation(s)
- Jorge Abreu-Gomez
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Avenue, Suite 3-920, Toronto, ON M5G 2M9, Canada.
| | - Christopher Lim
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AB 279, Toronto, ON M4N 3M5, Canada
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System and the Joint Department of Medical Imaging, Sinai Health System, Princess Margaret Hospital, University of Toronto, 600 University Avenue, Toronto, ON, Canada M5G 1X5
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14
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Barrett T, Lee KL, de Rooij M, Giganti F. Update on Optimization of Prostate MR Imaging Technique and Image Quality. Radiol Clin North Am 2024; 62:1-15. [PMID: 37973236 DOI: 10.1016/j.rcl.2023.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Prostate MR imaging quality has improved dramatically over recent times, driven by advances in hardware, software, and improved functional imaging techniques. MRI now plays a key role in prostate cancer diagnostic work-up, but outcomes of the MRI-directed pathway are heavily dependent on image quality and optimization. MR sequences can be affected by patient-related degradations relating to motion and susceptibility artifacts which may enable only partial mitigation. In this Review, we explore issues relating to prostate MRI acquisition and interpretation, mitigation strategies at a patient and scanner level, PI-QUAL reporting, and future directions in image quality, including artificial intelligence solutions.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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15
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Matsuoka Y, Ueno Y, Uehara S, Tanaka H, Kobayashi M, Tanaka H, Yoshida S, Yokoyama M, Kumazawa I, Fujii Y. Deep-learning prostate cancer detection and segmentation on biparametric versus multiparametric magnetic resonance imaging: Added value of dynamic contrast-enhanced imaging. Int J Urol 2023; 30:1103-1111. [PMID: 37605627 DOI: 10.1111/iju.15280] [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: 05/06/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES To develop diagnostic algorithms of multisequence prostate magnetic resonance imaging for cancer detection and segmentation using deep learning and explore values of dynamic contrast-enhanced imaging in multiparametric imaging, compared with biparametric imaging. METHODS We collected 3227 multiparametric imaging sets from 332 patients, including 218 cancer patients (291 biopsy-proven foci) and 114 noncancer patients. Diagnostic algorithms of T2-weighted, T2-weighted plus dynamic contrast-enhanced, biparametric, and multiparametric imaging were built using 2578 sets, and their performance for clinically significant cancer was evaluated using 649 sets. RESULTS Biparametric and multiparametric imaging had following region-based performance: sensitivity of 71.9% and 74.8% (p = 0.394) and positive predictive value of 61.3% and 74.8% (p = 0.013), respectively. In side-specific analyses of cancer images, the specificity was 72.6% and 89.5% (p < 0.001) and the negative predictive value was 78.9% and 83.5% (p = 0.364), respectively. False-negative cancer on multiparametric imaging was smaller (p = 0.002) and more dominant with grade group ≤2 (p = 0.028) than true positive foci. In the peripheral zone, false-positive regions on biparametric imaging turned out to be true negative on multiparametric imaging more frequently compared with the transition zone (78.3% vs. 47.2%, p = 0.018). In contrast, T2-weighted plus dynamic contrast-enhanced imaging had lower specificity than T2-weighted imaging (41.1% vs. 51.6%, p = 0.042). CONCLUSIONS When using deep learning, multiparametric imaging provides superior performance to biparametric imaging in the specificity and positive predictive value, especially in the peripheral zone. Dynamic contrast-enhanced imaging helps reduce overdiagnosis in multiparametric imaging.
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Affiliation(s)
- Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Urology, Saitama Cancer Center, Saitama, Japan
| | - Yoshihiko Ueno
- Department of Information and Communications Engineering, Tokyo Institute of Technology, Yokohama, Kanagawa, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Radiology, Ochanomizu Surugadai Clinic, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Itsuo Kumazawa
- Laboratory for Future Interdisciplinary Research of Science and Technology, Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, Kanagawa, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Guljaš S, Dupan Krivdić Z, Drežnjak Madunić M, Šambić Penc M, Pavlović O, Krajina V, Pavoković D, Šmit Takač P, Štefančić M, Salha T. Dynamic Contrast-Enhanced Study in the mpMRI of the Prostate-Unnecessary or Underutilised? A Narrative Review. Diagnostics (Basel) 2023; 13:3488. [PMID: 37998624 PMCID: PMC10670922 DOI: 10.3390/diagnostics13223488] [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: 08/26/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this review is to summarise recent scientific literature regarding the clinical use of DCE-MRI as a component of multiparametric resonance imaging of the prostate. This review presents the principles of DCE-MRI acquisition and analysis, the current role of DCE-MRI in clinical practice with special regard to its role in presently available categorisation systems, and an overview of the advantages and disadvantages of DCE-MRI described in the current literature. DCE-MRI is an important functional sequence that requires intravenous administration of a gadolinium-based contrast agent and gives information regarding the vascularity and capillary permeability of the lesion. Although numerous studies have confirmed that DCE-MRI has great potential in the diagnosis and monitoring of prostate cancer, its role is still inadequate in the PI-RADS categorisation. Moreover, there have been numerous scientific discussions about abandoning the intravenous application of gadolinium-based contrast as a routine part of MRI examination of the prostate. In this review, we summarised the recent literature on the advantages and disadvantages of DCE-MRI, focusing on an overview of currently available data on bpMRI and mpMRI, as well as on studies providing information on the potential better usability of DCE-MRI in improving the sensitivity and specificity of mpMRI examinations of the prostate.
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Affiliation(s)
- Silva Guljaš
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (S.G.); (Z.D.K.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
| | - Zdravka Dupan Krivdić
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (S.G.); (Z.D.K.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
| | - Maja Drežnjak Madunić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Oncology, University Hospital Centre, 31000 Osijek, Croatia
| | - Mirela Šambić Penc
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Oncology, University Hospital Centre, 31000 Osijek, Croatia
| | - Oliver Pavlović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Vinko Krajina
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Deni Pavoković
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Petra Šmit Takač
- Clinical Department of Surgery, Osijek University Hospital Centre, 31000 Osijek, Croatia;
| | - Marin Štefančić
- Department of Radiology, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia;
| | - Tamer Salha
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Teleradiology and Artificial Intelligence, Health Centre Osijek-Baranja County, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Nong W, Huang Q, Gao Y. Development and validation of a nomogram for predicting prostate cancer based on combining contrast-enhanced transrectal ultrasound and biparametric MRI imaging. Front Oncol 2023; 13:1275773. [PMID: 38044995 PMCID: PMC10691548 DOI: 10.3389/fonc.2023.1275773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives This study was to explore the feasibility of combining contrast-enhanced transrectal ultrasound (CE-TRUS) with biparametric MRI (CEUS-BpMRI) score for diagnosing prostate cancer (PCa). Methods A total of 183 patients with suspected PCa who underwent multiparametric MRI (Mp-MRI) and CE-TRUS were included. CEUS-BpMRI score was developed based on the results of Mp-MRI and CE-TRUS. The diagnostic performance was evaluated by the area under the curve (AUC). The diagnostic efficacy of the CEUS-BpMRI score, BpMRI score, and PI-RADS v2.1 score were compared. Total patients were randomly assigned to a training cohort (70%) or validation cohort (30%). A nomogram was constructed based on univariate and multivariate logistic regression. The model was evaluated by AUC and calibration curve. Results The diagnostic performance of CEUS-BpMRI score (AUC 0.857) was comparable to that of PI-RADS v2.1 (AUC 0.862) (P = 0.499), and both were superior to Bp-MRI score (AUC 0.831, P < 0.05). In peripheral zone lesions with Bp-MRI score of 3, there was no statistically significant difference between PI-RADS v2.1 score (AUC 0.728) and CEUS-BpMRI score (AUC 0.668) (P = 0.479). Multivariate analysis showed that age, total prostate specific antigen/free prostate specific antigen (F/T), time to peak (TTP), and CEUS-BpMRI score were independent factors. The AUC of the nomogram was 0.909 in the training cohort and 0.914 in the validation cohort. Conclusions CEUS-BpMRI score has high diagnostic efficacy for diagnosing PCa. A nomogram model established by combining age, F/T, TTP, and CEUS-BpMRI score can achieve the best predictive accuracy for PCa.
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Affiliation(s)
- Wanxian Nong
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qun Huang
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yong Gao
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Sanmugalingam N, Sushentsev N, Lee KL, Caglic I, Englman C, Moore CM, Giganti F, Barrett T. The PRECISE Recommendations for Prostate MRI in Patients on Active Surveillance for Prostate Cancer: A Critical Review. AJR Am J Roentgenol 2023; 221:649-660. [PMID: 37341180 DOI: 10.2214/ajr.23.29518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations were published in 2016 to standardize the reporting of MRI examinations performed to assess for disease progression in patients on active surveillance for prostate cancer. Although a limited number of studies have reported outcomes from use of PRECISE in clinical practice, the available studies have demonstrated PRECISE to have high pooled NPV but low pooled PPV for predicting progression. Our experience in using PRECISE in clinical practice at two teaching hospitals has highlighted issues with its application and areas requiring clarification. This Clinical Perspective critically appraises PRECISE on the basis of this experience, focusing on the system's key advantages and disadvantages and exploring potential changes to improve the system's utility. These changes include consideration of image quality when applying PRECISE scoring, incorporation of quantitative thresholds for disease progression, adoption of a PRECISE 3F sub-category for progression not qualifying as substantial, and comparisons with both the baseline and most recent prior examinations. Items requiring clarification include derivation of a patient-level score in patients with multiple lesions, intended application of PRECISE score 5 (i.e., if requiring development of disease that is no longer organ-confined), and categorization of new lesions in patients with prior MRI-invisible disease.
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Affiliation(s)
- Nimalan Sanmugalingam
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Cameron Englman
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
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19
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Mayer R, Turkbey B, Choyke PL, Simone CB. Relationship between Eccentricity and Volume Determined by Spectral Algorithms Applied to Spatially Registered Bi-Parametric MRI and Prostate Tumor Aggressiveness: A Pilot Study. Diagnostics (Basel) 2023; 13:3238. [PMID: 37892059 PMCID: PMC10605733 DOI: 10.3390/diagnostics13203238] [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: 09/22/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Non-invasive prostate cancer assessments using multi-parametric MRI are essential to the reliable detection of lesions and proper management of patients. While current guidelines call for the administration of Gadolinium-containing intravenous contrast injections, eliminating such injections would simplify scanning and reduce patient risk and costs. However, augmented image analysis is necessary to extract important diagnostic information from MRIs. Purpose: This study aims to extend previous work on the signal to clutter ratio and test whether prostate tumor eccentricity and volume are indicators of tumor aggressiveness using bi-parametric (BP)-MRI. (2) Methods: This study retrospectively processed 42 consecutive prostate cancer patients from the PI-CAI data collection. BP-MRIs (apparent diffusion coefficient, high b-value, and T2 images) were resized, translated, cropped, and stitched to form spatially registered BP-MRIs. The International Society of Urological Pathology (ISUP) grade was used to judge cases of prostate cancer as either clinically significant prostate cancer (CsPCa) (ISUP ≥ 2) or clinically insignificant prostate cancer (CiPCa) (ISUP < 2). The Adaptive Cosine Estimator (ACE) algorithm was applied to the BP-MRIs, followed by thresholding, and then eccentricity and volume computations, from the labeled and blobbed detection maps. Then, univariate and multivariate linear regression fittings of eccentricity and volume were applied to the ISUP grade. The fits were quantitatively evaluated by computing correlation coefficients (R) and p-values. Area under the curve (AUC) and receiver operator characteristic (ROC) curve scores were used to assess the logistic fitting to CsPCa/CiPCa. (3) Results: Modest correlation coefficients (R) (>0.35) and AUC scores (0.70) for the linear and/or logistic fits from the processed prostate tumor eccentricity and volume computations for the spatially registered BP-MRIs exceeded fits using the parameters of prostate serum antigen, prostate volume, and patient age (R~0.17). (4) Conclusions: This is the first study that applied spectral approaches to BP-MRIs to generate tumor eccentricity and volume metrics to assess tumor aggressiveness. This study found significant values of R and AUC (albeit below those from multi-parametric MRI) to fit and relate the metrics to the ISUP grade and CsPCA/CiPCA, respectively.
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Affiliation(s)
- Rulon Mayer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Oncoscore, Garrett Park, MD 20896, USA
| | - Baris Turkbey
- National Institutes of Health, Bethesda, MD 20892, USA; (B.T.); (P.L.C.)
| | - Peter L. Choyke
- National Institutes of Health, Bethesda, MD 20892, USA; (B.T.); (P.L.C.)
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20
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Nicola R, Bittencourt LK. PI-RADS 3 lesions: a critical review and discussion of how to improve management. Abdom Radiol (NY) 2023; 48:2401-2405. [PMID: 37160472 DOI: 10.1007/s00261-023-03929-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
Since the publication of PI-RADS v1 in 2012, the debate regarding the question of how to manage PI-RADS 3 lesions has been mostly unsolved. However, based on our review of the current literature we discuss possible solutions and improvements to the original classification, factors such as PSAD (Prostate Specific Antigen Density), age, and tumor volume, in the decision of whether to proceed with a biopsy or not.
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Affiliation(s)
- Refky Nicola
- Division of Abdominal Radiology, SUNY-Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA.
| | - Leonardo Kayat Bittencourt
- School of Medicine, Abdominal Imaging, Case Western University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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21
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Wu M, Zheng X, Wang W, Chang J, Xue M, Zhang Y, Song J, Zhao J. Primary seminal vesicle Burkitt lymphoma in a patient living with HIV undergoing radical prostate and seminal vesicle resection: a rare missed case report. Infect Agent Cancer 2023; 18:32. [PMID: 37226239 DOI: 10.1186/s13027-023-00509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023] Open
Abstract
Primary seminal vesicle Burkitt lymphoma (PSBL) is rare that is not frequently reported. Burkitt lymphoma is often associated with extranodal organs. The diagnosis of carcinoma in seminal vesical can be difficult. In this report, we present a missed case of PSBL in a male patient who underwent radical prostate and seminal vesicle resection. We retrospectively analyzed the clinical data to explore the diagnosis, pathological features, treatment, and prognosis of this rare disease. The patient visited our hospital for dysuria, and the serum prostate-specific antigen (PSA) was moderately elevated. Pelvic magnetic resonance imaging (MRI) and computed tomography (CT) scans suggested a notable enlargement of the seminal vesicle. The patient then underwent radical surgery and the pathology diagnosis revealed Burkitt lymphoma. The diagnosis of PSBL is difficult, and the prognosis is generally poorer than that of other types of lymphoma. However, earlier diagnosis and treatment may help to improve the survival rate among patients with Burkitt lymphoma.
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Affiliation(s)
- Menghua Wu
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xin Zheng
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jing Chang
- Department of Clinical Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Meng Xue
- Department of Medical Record, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yu Zhang
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
| | - Jian Song
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jimao Zhao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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22
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Nematollahi H, Moslehi M, Aminolroayaei F, Maleki M, Shahbazi-Gahrouei D. Diagnostic Performance Evaluation of Multiparametric Magnetic Resonance Imaging in the Detection of Prostate Cancer with Supervised Machine Learning Methods. Diagnostics (Basel) 2023; 13:diagnostics13040806. [PMID: 36832294 PMCID: PMC9956028 DOI: 10.3390/diagnostics13040806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Prostate cancer is the second leading cause of cancer-related death in men. Its early and correct diagnosis is of particular importance to controlling and preventing the disease from spreading to other tissues. Artificial intelligence and machine learning have effectively detected and graded several cancers, in particular prostate cancer. The purpose of this review is to show the diagnostic performance (accuracy and area under the curve) of supervised machine learning algorithms in detecting prostate cancer using multiparametric MRI. A comparison was made between the performances of different supervised machine-learning methods. This review study was performed on the recent literature sourced from scientific citation websites such as Google Scholar, PubMed, Scopus, and Web of Science up to the end of January 2023. The findings of this review reveal that supervised machine learning techniques have good performance with high accuracy and area under the curve for prostate cancer diagnosis and prediction using multiparametric MR imaging. Among supervised machine learning methods, deep learning, random forest, and logistic regression algorithms appear to have the best performance.
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23
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Barrett T, de Rooij M, Giganti F, Allen C, Barentsz JO, Padhani AR. Quality checkpoints in the MRI-directed prostate cancer diagnostic pathway. Nat Rev Urol 2023; 20:9-22. [PMID: 36168056 DOI: 10.1038/s41585-022-00648-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
Multiparametric MRI of the prostate is now recommended as the initial diagnostic test for men presenting with suspected prostate cancer, with a negative MRI enabling safe avoidance of biopsy and a positive result enabling MRI-directed sampling of lesions. The diagnostic pathway consists of several steps, from initial patient presentation and preparation to performing and interpreting MRI, communicating the imaging findings, outlining the prostate and intra-prostatic target lesions, performing the biopsy and assessing the cores. Each component of this pathway requires experienced clinicians, optimized equipment, good inter-disciplinary communication between specialists, and standardized workflows in order to achieve the expected outcomes. Assessment of quality and mitigation measures are essential for the success of the MRI-directed prostate cancer diagnostic pathway. Quality assurance processes including Prostate Imaging-Reporting and Data System, template biopsy, and pathology guidelines help to minimize variation and ensure optimization of the diagnostic pathway. Quality control systems including the Prostate Imaging Quality scoring system, patient-level outcomes (such as Prostate Imaging-Reporting and Data System MRI score assignment and cancer detection rates), multidisciplinary meeting review and audits might also be used to provide consistency of outcomes and ensure that all the benefits of the MRI-directed pathway are achieved.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK
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24
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Wei X, Zhu L, Zeng Y, Xue K, Dai Y, Xu J, Liu G, Liu F, Xue W, Wu D, Wu G. Detection of prostate cancer using diffusion-relaxation correlation spectrum imaging with support vector machine model - a feasibility study. Cancer Imaging 2022; 22:77. [PMID: 36575555 PMCID: PMC9795630 DOI: 10.1186/s40644-022-00516-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To evaluate the performance of diffusion-relaxation correlation spectrum imaging (DR-CSI) with support vector machine (SVM) in detecting prostate cancer (PCa). METHODS In total, 114 patients (mean age, 66 years, range, 48-87 years) who received a prostate MRI and underwent biopsy were enrolled in three stages. Thirty-nine were assigned for the exploration stage to establish the model, 18 for the validation stage to choose the appropriate scale for mapping and 57 for the test stage to compare the diagnostic performance of the DR-CSI and PI-RADS. RESULTS In the exploration stage, the DR-CSI model was established and performed better than the ADC and T2 values (both P < 0.001). The validation result shows that at least 2 pixels were required for both the long-axis and short-axis in the mapping procedure. In the test stage, DR-CSI had higher accuracy than PI-RADS ≥ 3 as a positive finding based on patient (84.2% vs. 63.2%, P = 0.004) and lesion (78.8% vs. 57.6%, P = 0.001) as well as PI-RADS ≥ 4 on lesion (76.5% vs. 64.7%, P = 0.029), while there was no significant difference between DR-CSI and PI-RADS ≥ 4 based on patient (P = 0.508). For clinically significant PCa, DR-CSI had higher accuracy than PI-RADS ≥ 3 based on patients (84.2% vs. 63.2%, P = 0.004) and lesions (62.4% vs. 48.2%, P = 0.036). There was no significant difference between DR-CSI and PI-RADS ≥ 4 (P = 1.000 and 0.845 for the patient and lesion levels, respectively). CONCLUSIONS DR-CSI combined with the SVM model may improve the diagnostic accuracy of PCa. TRIAL REGISTRATION This study was approved by the Ethics Committee of our institute (Approval No. KY2018-213). Written informed consent was obtained from all participants.
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Affiliation(s)
- Xiaobin Wei
- grid.16821.3c0000 0004 0368 8293Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Zhu
- grid.16821.3c0000 0004 0368 8293Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanyan Zeng
- Quanzhou Maternity and Children’s Hospital, Fujian, China
| | - Ke Xue
- grid.497849.fCentral Research Institute, MR Collaboration, United Imaging Healthcare, Shanghai, China
| | - Yongming Dai
- grid.497849.fCentral Research Institute, MR Collaboration, United Imaging Healthcare, Shanghai, China
| | - Jianrong Xu
- grid.16821.3c0000 0004 0368 8293Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guiqin Liu
- grid.16821.3c0000 0004 0368 8293Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Liu
- grid.16821.3c0000 0004 0368 8293Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xue
- grid.16821.3c0000 0004 0368 8293Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dongmei Wu
- grid.22069.3f0000 0004 0369 6365Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronics Science, East China Normal University, Shanghai, China
| | - Guangyu Wu
- grid.16821.3c0000 0004 0368 8293Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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25
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Prebiopsy bpMRI and hematological parameter-based risk scoring model for predicting outcomes in biopsy-naive men with PSA 4-20 ng/mL. Sci Rep 2022; 12:21895. [PMID: 36536031 PMCID: PMC9763436 DOI: 10.1038/s41598-022-26242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Excessive prostate biopsy is a common problem for clinicians. Although some hematological and bi-parametric magnetic resonance imaging (bpMRI) parameters might help increase the rate of positive prostate biopsies, there is a lack of studies on whether their combination can further improve clinical detection efficiency. We retrospectively enrolled 394 patients with PSA levels of 4-20 ng/mL who underwent prebiopsy bpMRI during 2010-2021. Based on bpMRI and hematological indicators, six models and a nomogram were constructed to predict the outcomes of biopsy. Furthermore, we constructed and evaluated a risk scoring model based on the nomogram. Age, prostate-specific antigen (PSA) density (PSAD), systemic immune-inflammation index, cystatin C level, and the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 score were significant predictors of prostate cancer (PCa) on multivariable logistic regression analyses (P < 0.05) and the five parameters were used to construct the XYFY nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram was 0.916. Based on the nomogram, a risk scoring model (XYFY risk model) was constructed and then we divided the patients into low-(XYFY score: < 95), medium-(XYFY score: 95-150), and, high-risk (XYFY score: > 150) groups. The predictive values for diagnosis of PCa and clinically-significant PCa among the three risk groups were 3.0%(6/201), 41.8%(51/122), 91.5%(65/71); 0.5%(1/201), 19.7%(24/122), 60.6%(43/71), respectively. In conclusion, in this study, we used hematological and bpMRI parameters to establish and internally validate a XYFY risk scoring model for predicting the biopsy outcomes for patients with PSA levels of 4-20 ng/mL and this risk model would support clinical decision-making and reduce excessive biopsies.
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26
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Adams LC, Makowski MR, Engel G, Rattunde M, Busch F, Asbach P, Niehues SM, Vinayahalingam S, van Ginneken B, Litjens G, Bressem KK. Prostate158 - An expert-annotated 3T MRI dataset and algorithm for prostate cancer detection. Comput Biol Med 2022; 148:105817. [PMID: 35841780 DOI: 10.1016/j.compbiomed.2022.105817] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/12/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The development of deep learning (DL) models for prostate segmentation on magnetic resonance imaging (MRI) depends on expert-annotated data and reliable baselines, which are often not publicly available. This limits both reproducibility and comparability. METHODS Prostate158 consists of 158 expert annotated biparametric 3T prostate MRIs comprising T2w sequences and diffusion-weighted sequences with apparent diffusion coefficient maps. Two U-ResNets trained for segmentation of anatomy (central gland, peripheral zone) and suspicious lesions for prostate cancer (PCa) with a PI-RADS score of ≥4 served as baseline algorithms. Segmentation performance was evaluated using the Dice similarity coefficient (DSC), the Hausdorff distance (HD), and the average surface distance (ASD). The Wilcoxon test with Bonferroni correction was used to evaluate differences in performance. The generalizability of the baseline model was assessed using the open datasets Medical Segmentation Decathlon and PROSTATEx. RESULTS Compared to Reader 1, the models achieved a DSC/HD/ASD of 0.88/18.3/2.2 for the central gland, 0.75/22.8/1.9 for the peripheral zone, and 0.45/36.7/17.4 for PCa. Compared with Reader 2, the DSC/HD/ASD were 0.88/17.5/2.6 for the central gland, 0.73/33.2/1.9 for the peripheral zone, and 0.4/39.5/19.1 for PCa. Interrater agreement measured in DSC/HD/ASD was 0.87/11.1/1.0 for the central gland, 0.75/15.8/0.74 for the peripheral zone, and 0.6/18.8/5.5 for PCa. Segmentation performances on the Medical Segmentation Decathlon and PROSTATEx were 0.82/22.5/3.4; 0.86/18.6/2.5 for the central gland, and 0.64/29.2/4.7; 0.71/26.3/2.2 for the peripheral zone. CONCLUSIONS We provide an openly accessible, expert-annotated 3T dataset of prostate MRI and a reproducible benchmark to foster the development of prostate segmentation algorithms.
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Affiliation(s)
- Lisa C Adams
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Radiology, Luisenstraße 7, 10117, Hindenburgdamm 30, 12203, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Marcus R Makowski
- Technical University of Munich, Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Günther Engel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Radiology, Luisenstraße 7, 10117, Hindenburgdamm 30, 12203, Berlin, Germany; Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Maximilian Rattunde
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Radiology, Luisenstraße 7, 10117, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Felix Busch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Radiology, Luisenstraße 7, 10117, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Patrick Asbach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Radiology, Luisenstraße 7, 10117, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan M Niehues
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Radiology, Luisenstraße 7, 10117, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, GA, the Netherlands
| | | | - Geert Litjens
- Radboud University Medical Center, Nijmegen, GA, the Netherlands
| | - Keno K Bressem
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Radiology, Luisenstraße 7, 10117, Hindenburgdamm 30, 12203, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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27
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Current Status of Biparametric MRI in Prostate Cancer Diagnosis: Literature Analysis. Life (Basel) 2022; 12:life12060804. [PMID: 35743835 PMCID: PMC9224842 DOI: 10.3390/life12060804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/19/2022] Open
Abstract
The role of multiparametric MRI (mpMRI) in the detection of prostate cancer is well-established. Based on the limited role of dynamic contrast enhancement (DCE) in PI-RADS v2.1, the risk of potential side effects, and the increased cost and time, there has been an increase in studies advocating for the omission of DCE from MRI assessments. Per PI-RADS v2.1, DCE is indicated in the assessment of PI-RADS 3 lesions in the peripheral zone, with its most pronounced effect when T2WI and DWI are of insufficient quality. The aim of this study was to evaluate the methodology and reporting in the literature from the past 5 years regarding the use of DCE in prostate MRI, especially with respect to the indications for DCE as stated in PI-RADS v2.1, and to describe the different approaches used across the studies. We searched for studies investigating the use of bpMRI and/or mpMRI in the detection of clinically significant prostate cancer between January 2017 and April 2022 in the PubMed, Web of Science, and Google Scholar databases. Through the search process, a total of 269 studies were gathered and 41 remained after abstract and full-text screening. The following information was extracted from the eligible studies: general clinical and technical characteristics of the studies, the number of PI-RADS 3 lesions, different definitions of clinically significant prostate cancer (csPCa), biopsy thresholds, reference standard methods, and number and experience of readers. Forty-one studies were included in the study. Only 51% (21/41) of studies reported the prevalence of csPCa in their equivocal lesion (PI-RADS category 3 lesions) subgroups. Of the included studies, none (0/41) performed a stratified sub-analysis of the DCE benefit versus MRI quality and 46% (19/41) made explicit statements about removing MRI scans based on a range of factors including motion, noise, and image artifacts. Furthermore, the number of studies investigating the role of DCE using readers with varying experience was relatively low. This review demonstrates that a high proportion of the studies investigating whether bpMRI can replace mpMRI did not transparently report information inherent to their study design concerning the key indications of DCE, such as the number of clinically insignificant/significant PI-RADS 3 lesions, nor did they provide any sub-analyses to test image quality, with some removing bad quality MRI scans altogether, or reader-experience-dependency indications for DCE. For the studies that reported on most of the DCE indications, their conclusions about the utility of DCE were heavily definition-dependent (with varying definitions of csPCa and of the PI-RADS category biopsy significance threshold). Reporting the information inherent to the study design and related to the specific indications for DCE as stated in PI-RADS v2.1 is needed to determine whether DCE is helpful or not. With most of the recent literature being retrospective and not including the data related to DCE indications in particular, the ongoing dispute between bpMRI and mpMRI is likely to linger.
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Kortenbach KC, Løgager V, Thomsen HS, Boesen L. Early experience in avoiding biopsies for biopsy-naïve men with clinical suspicion of prostate cancer but non-suspicious biparametric magnetic resonance imaging results and prostate-specific antigen density < 0.15 ng/mL 2: A 2-year follow-up study. Acta Radiol Open 2022; 11:20584601221094825. [PMID: 35464293 PMCID: PMC9024082 DOI: 10.1177/20584601221094825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Only limited data have been published on the diagnostic accuracy of combining biparametric (bp) magnetic resonance imaging (MRI) and prostate-specific antigen density (PSAd) to rule out biopsies. Purpose The purpose is to assess the 2-year risk of being diagnosed with sPCa following the strategy of avoiding immediate biopsies in men with non-suspicious bp MRIs and a PSAd <0.15 ng/mL2. Material and Methods Two hundred biopsy-naïve men with clinical suspicion of PCa underwent a pre-biopsy bp MRI from March to July 2019. Of these, 109 men had a Prostate Imaging Reporting and Data System (PI-RADS) score of 1–3 including 77 men with calculated PSAd <0.15 ng/mL2. As a result, no biopsies were performed in these 77 men, who were clinically followed up for at least 2 years and re-examined in case of rising suspicion of sPCa. The remaining 32 men with a calculated PSAd ≥0.15 ng/mL2 underwent systematic biopsies and targeted biopsies of any PI-RADS 3 lesion. Results One of the 77 men (1.3%) had an sPCa diagnosed within 2 years of follow-up. All men were referred back to their general practitioner within 1 year and 9% (7/77) were re-referred to the urology department during follow-up. Among these men, 43% (3/7) continued to have PSA levels that were above their individual thresholds at confirmatory testing and underwent secondary MRI scans. Conclusions No biopsies for men with bpMRI results exhibiting maximum PI-RADS 3 and with a PSAd <0.15 ng/mL2 resulted in a 2-year risk of being diagnosed with sPCa of 1.3%.
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Affiliation(s)
| | - Vibeke Løgager
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Henrik S Thomsen
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Lars Boesen
- Department of Urological Research, Herlev Gentofte University Hospital, Herlev, Denmark
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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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Pellicer-Valero OJ, Marenco Jiménez JL, Gonzalez-Perez V, Casanova Ramón-Borja JL, Martín García I, Barrios Benito M, Pelechano Gómez P, Rubio-Briones J, Rupérez MJ, Martín-Guerrero JD. Deep learning for fully automatic detection, segmentation, and Gleason grade estimation of prostate cancer in multiparametric magnetic resonance images. Sci Rep 2022; 12:2975. [PMID: 35194056 PMCID: PMC8864013 DOI: 10.1038/s41598-022-06730-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/03/2022] [Indexed: 02/07/2023] Open
Abstract
Although the emergence of multi-parametric magnetic resonance imaging (mpMRI) has had a profound impact on the diagnosis of prostate cancers (PCa), analyzing these images remains still complex even for experts. This paper proposes a fully automatic system based on Deep Learning that performs localization, segmentation and Gleason grade group (GGG) estimation of PCa lesions from prostate mpMRIs. It uses 490 mpMRIs for training/validation and 75 for testing from two different datasets: ProstateX and Valencian Oncology Institute Foundation. In the test set, it achieves an excellent lesion-level AUC/sensitivity/specificity for the GGG[Formula: see text]2 significance criterion of 0.96/1.00/0.79 for the ProstateX dataset, and 0.95/1.00/0.80 for the IVO dataset. At a patient level, the results are 0.87/1.00/0.375 in ProstateX, and 0.91/1.00/0.762 in IVO. Furthermore, on the online ProstateX grand challenge, the model obtained an AUC of 0.85 (0.87 when trained only on the ProstateX data, tying up with the original winner of the challenge). For expert comparison, IVO radiologist's PI-RADS 4 sensitivity/specificity were 0.88/0.56 at a lesion level, and 0.85/0.58 at a patient level. The full code for the ProstateX-trained model is openly available at https://github.com/OscarPellicer/prostate_lesion_detection . We hope that this will represent a landmark for future research to use, compare and improve upon.
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Affiliation(s)
- Oscar J Pellicer-Valero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Av. Universitat, sn, 46100, Bujassot, Valencia, Spain.
| | - José L Marenco Jiménez
- Department of Urology, Fundación Instituto Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Victor Gonzalez-Perez
- Department of Medical Physics, Fundación Instituto, Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | | | - Isabel Martín García
- Department of Radiodiagnosis, Fundación Instituto, Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - María Barrios Benito
- Department of Radiodiagnosis, Fundación Instituto, Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Paula Pelechano Gómez
- Department of Radiodiagnosis, Fundación Instituto, Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - José Rubio-Briones
- Department of Urology, Fundación Instituto Valenciano de Oncología (FIVO), Beltrán Báguena, 8, 46009, Valencia, Spain
| | - María José Rupérez
- Instituto de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València (UPV), Camino de Vera, sn, 46022, Valencia, Spain
| | - José D Martín-Guerrero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Av. Universitat, sn, 46100, Bujassot, Valencia, Spain
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Li D, Han X, Gao J, Zhang Q, Yang H, Liao S, Guo H, Zhang B. Deep Learning in Prostate Cancer Diagnosis Using Multiparametric Magnetic Resonance Imaging With Whole-Mount Histopathology Referenced Delineations. Front Med (Lausanne) 2022; 8:810995. [PMID: 35096899 PMCID: PMC8793798 DOI: 10.3389/fmed.2021.810995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Multiparametric magnetic resonance imaging (mpMRI) plays an important role in the diagnosis of prostate cancer (PCa) in the current clinical setting. However, the performance of mpMRI usually varies based on the experience of the radiologists at different levels; thus, the demand for MRI interpretation warrants further analysis. In this study, we developed a deep learning (DL) model to improve PCa diagnostic ability using mpMRI and whole-mount histopathology data. Methods: A total of 739 patients, including 466 with PCa and 273 without PCa, were enrolled from January 2017 to December 2019. The mpMRI (T2 weighted imaging, diffusion weighted imaging, and apparent diffusion coefficient sequences) data were randomly divided into training (n = 659) and validation datasets (n = 80). According to the whole-mount histopathology, a DL model, including independent segmentation and classification networks, was developed to extract the gland and PCa area for PCa diagnosis. The area under the curve (AUC) were used to evaluate the performance of the prostate classification networks. The proposed DL model was subsequently used in clinical practice (independent test dataset; n = 200), and the PCa detective/diagnostic performance between the DL model and different level radiologists was evaluated based on the sensitivity, specificity, precision, and accuracy. Results: The AUC of the prostate classification network was 0.871 in the validation dataset, and it reached 0.797 using the DL model in the test dataset. Furthermore, the sensitivity, specificity, precision, and accuracy of the DL model for diagnosing PCa in the test dataset were 0.710, 0.690, 0.696, and 0.700, respectively. For the junior radiologist without and with DL model assistance, these values were 0.590, 0.700, 0.663, and 0.645 versus 0.790, 0.720, 0.738, and 0.755, respectively. For the senior radiologist, the values were 0.690, 0.770, 0.750, and 0.730 vs. 0.810, 0.840, 0.835, and 0.825, respectively. The diagnosis made with DL model assistance for radiologists were significantly higher than those without assistance (P < 0.05). Conclusion: The diagnostic performance of DL model is higher than that of junior radiologists and can improve PCa diagnostic accuracy in both junior and senior radiologists.
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Affiliation(s)
- Danyan Li
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaowei Han
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Gao
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qing Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Haibo Yang
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Shu Liao
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Diagnostic Accuracy of Abbreviated Bi-Parametric MRI (a-bpMRI) for Prostate Cancer Detection and Screening: A Multi-Reader Study. Diagnostics (Basel) 2022; 12:diagnostics12020231. [PMID: 35204322 PMCID: PMC8871361 DOI: 10.3390/diagnostics12020231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Background: There is currently limited evidence on the diagnostic accuracy of abbreviated biparametric MRI (a-bpMRI) protocols for prostate cancer (PCa) detection and screening. In the present study, we aim to investigate the performance of a-bpMRI among multiple readers and its potential application to an imaging-based screening setting. (2) Methods: A total of 151 men who underwent 3T multiparametric MRI (mpMRI) of the prostate and transperineal template prostate mapping biopsies were retrospectively selected. Corresponding bpMRI (multiplanar T2WI, DWI, ADC maps) and a-bpMRI (axial T2WI and b 2000 s/mm2 DWI only) dataset were derived from mpMRI. Three experienced radiologists scored a-bpMRI, standard biparametric MRI (bpMRI) and mpMRI in separate sessions. Diagnostic accuracy and interreader agreement of a-bpMRI was tested for different positivity thresholds and compared to bpMRI and mpMRI. Predictive values of a-bpMRI were computed for lower levels of PCa prevalence to simulate a screening setting. The primary definition of clinically significant PCa (csPCa) was Gleason ≥ 4 + 3, or cancer core length ≥ 6 mm. (3) Results: The median age was 62 years, the median PSA was 6.8 ng/mL, and the csPCa prevalence was 40%. Using a cut off of MRI score ≥ 3, the sensitivity and specificity of a-bpMRI were 92% and 48%, respectively. There was no significant difference in sensitivity compared to bpMRI and mpMRI. Interreader agreement of a-bpMRI was moderate (AC1 0.58). For a low prevalence of csPCa (e.g., <10%), higher cut offs (MRI score ≥ 4) yield a more favourable balance between the predictive values and positivity rate of MRI. (4) Conclusion: Abbreviated bpMRI protocols could match the diagnostic accuracy of bpMRI and mpMRI for the detection of csPCa. If a-bpMRI is used in low-prevalence settings, higher cut-offs for MRI positivity should be prioritised.
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Kortenbach KC, Boesen L, Løgager V, Thomsen HS. Outcome of 5-year follow-up in men with negative findings on initial biparametric MRI. Heliyon 2021; 7:e08325. [PMID: 34820539 PMCID: PMC8601994 DOI: 10.1016/j.heliyon.2021.e08325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/23/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background We assessed the 5-year risk of being diagnosed with significant prostate cancer following a low-suspicion biparametric magnetic resonance imaging result. Methods The study population was derived from a prospective database used to assess the diagnostic accuracy of biparametric magnetic resonance imaging for significant prostate cancer detection in 1020 biopsy-naïve men. Significant prostate cancer was defined as any core with Gleason grade group ≥3 or a maximum cancerous core length greater than 50% of Gleason grade group 2. A secondary definition of significant prostate cancer was also included: any core with prostate cancer Gleason grade group ≥2. Of the 1020 men, 305 had a low-suspicion biparametric magnetic resonance imaging result (Prostate Imaging Reporting and Data System score of 1 or 2) but four men were excluded from follow-up. Thus, the final study population consisted of 301 men, who were clinically followed-up from inclusion (November 2015 to June 2017) until 1 June 2021. Findings Overall, 1·7% (5/301) of the study population had significant prostate cancer diagnosed within 5 years (median 1480 days, Interquartile Range (1587-1382)) of their low-suspicion result and corresponding set of biopsies. When the secondary definition of significant prostate cancer was applied, this increased to 5% (15/301) of the study population. Interpretation The 5-year risk of being diagnosed with significant prostate cancer after a prebiopsy low-suspicion prebiopsy biparametric magnetic resonance imaging result was 1·7%.
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Affiliation(s)
- Karen-Cecilie Kortenbach
- Herlev Gentofte University Hospital, Department of Radiology, Borgmester Ib Juuls vej 17, DK-2730 Herlev, Denmark
| | - Lars Boesen
- Herlev Gentofte University Hospital, Department of Radiology, Borgmester Ib Juuls vej 17, DK-2730 Herlev, Denmark
| | - Vibeke Løgager
- Herlev Gentofte University Hospital, Department of Radiology, Borgmester Ib Juuls vej 17, DK-2730 Herlev, Denmark
| | - Henrik S Thomsen
- Herlev Gentofte University Hospital, Department of Radiology, Borgmester Ib Juuls vej 17, DK-2730 Herlev, Denmark
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Schick F, Pieper CC, Kupczyk P, Almansour H, Keller G, Springer F, Mürtz P, Endler C, Sprinkart AM, Kaufmann S, Herrmann J, Attenberger UI. 1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 1. Invest Radiol 2021; 56:680-691. [PMID: 34324464 DOI: 10.1097/rli.0000000000000812] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Whole-body magnetic resonance imaging (MRI) systems with a field strength of 3 T have been offered by all leading manufacturers for approximately 2 decades and are increasingly used in clinical diagnostics despite higher costs. Technologically, MRI systems operating at 3 T have reached a high standard in recent years, as well as the 1.5-T devices that have been in use for a longer time. For modern MRI systems with 3 T, more complexity is required, especially for the magnet and the radiofrequency (RF) system (with multichannel transmission). Many clinical applications benefit greatly from the higher field strength due to the higher signal yield (eg, imaging of the brain or extremities), but there are also applications where the disadvantages of 3 T might outweigh the advantages (eg, lung imaging or examinations in the presence of implants). This review describes some technical features of modern 1.5-T and 3-T whole-body MRI systems, and reports on the experience of using both types of devices in different clinical settings, with all sections written by specialist radiologists in the respective fields.This first part of the review includes an overview of the general physicotechnical aspects of both field strengths and elaborates the special conditions of diffusion imaging. Many relevant aspects in the application areas of musculoskeletal imaging, abdominal imaging, and prostate diagnostics are discussed.
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Affiliation(s)
- Fritz Schick
- From the Section of Experimental Radiology, Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen
| | | | - Patrick Kupczyk
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Haidara Almansour
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Gabriel Keller
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Fabian Springer
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Petra Mürtz
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Christoph Endler
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Alois M Sprinkart
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Sascha Kaufmann
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Judith Herrmann
- Department of Radiology, Diagnostic, and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Ulrike I Attenberger
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
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Bass EJ, Pantovic A, Connor M, Gabe R, Padhani AR, Rockall A, Sokhi H, Tam H, Winkler M, Ahmed HU. A systematic review and meta-analysis of the diagnostic accuracy of biparametric prostate MRI for prostate cancer in men at risk. Prostate Cancer Prostatic Dis 2021; 24:596-611. [PMID: 33219368 DOI: 10.1038/s41391-020-00298-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI), the use of three multiple imaging sequences, typically T2-weighted, diffusion weighted (DWI) and dynamic contrast enhanced (DCE) images, has a high sensitivity and specificity for detecting significant cancer. Current guidance now recommends its use prior to biopsy. However, the impact of DCE is currently under debate regarding test accuracy. Biparametric MRI (bpMRI), using only T2 and DWI has been proposed as a viable alternative. We conducted a contemporary systematic review and meta-analysis to further examine the diagnostic performance of bpMRI in the diagnosis of any and clinically significant prostate cancer. METHODS A systematic review of the literature from 01/01/2017 to 06/07/2019 was performed by two independent reviewers using predefined search criteria. The index test was biparametric MRI and the reference standard whole-mount prostatectomy or prostate biopsy. Quality of included studies was assessed by the QUADAS-2 tool. Statistical analysis included pooled diagnostic performance (sensitivity; specificity; AUC), meta-regression of possible covariates and head-to-head comparisons of bpMRI and mpMRI where both were performed in the same study. RESULTS Forty-four articles were included in the analysis. The pooled sensitivity for any cancer detection was 0.84 (95% CI, 0.80-0.88), specificity 0.75 (95% CI, 0.68-0.81) for bpMRI. The summary ROC curve yielded a high AUC value (AUC = 0.86). The pooled sensitivity for clinically significant prostate cancer was 0.87 (95% CI, 0.78-0.93), specificity 0.72 (95% CI, 0.56-0.84) and the AUC value was 0.87. Meta-regression analysis revealed no difference in the pooled diagnostic estimates between bpMRI and mpMRI. CONCLUSIONS This meta-analysis on contemporary studies shows that bpMRI offers comparable test accuracies to mpMRI in detecting prostate cancer. These data are broadly supportive of the bpMRI approach but heterogeneity does not allow definitive recommendations to be made. There is a need for prospective multicentre studies of bpMRI in biopsy naïve men.
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Affiliation(s)
- E J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK.
| | - A Pantovic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, Belgrade, Serbia
| | - M Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - R Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - A R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, UK
| | - A Rockall
- Division of Cancer, Department of Surgery and Cancer,Faculty of Medicine, Imperial College London, London, UK
| | - H Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, UK.,Department of Radiology, Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - H Tam
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
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Czyzewska D, Sushentsev N, Latoch E, Slough RA, Barrett T. T2-PROPELLER Compared to T2-FRFSE for Image Quality and Lesion Detection at Prostate MRI. Can Assoc Radiol J 2021; 73:355-361. [PMID: 34423672 DOI: 10.1177/08465371211030206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The primary objective was to compare T2-FRFSE and T2-PROPELLER sequences for image quality. The secondary objective was to compare the ability to detect prostate lesions at MRI in the presence and absence of motion artefact using the 2 sequences. METHODS 99 patients underwent 3 T MRI examination of the prostate, including T2-FRFSE and T2-PROPELLER sequences. All patients underwent prostate biopsy. Two independent readers rated overall image quality, presence of motion artefact, and blurring for both sequences using a 5-point Likert scale. Scores were compared for the whole group and for subgroups with and without significant motion artefact. Outcome for lesion detection at an MRI threshold of PI-RADS score ≥3 was compared between T2-FRFSE and T2-PROPELLER. RESULTS The overall image quality was not significantly different between T2-FRFSE and T2-PROPELLER sequences (3.74 vs. 3.93, p = 0.275). T2-PROPELLER recorded a lesser degree of motion artefact (score 4.53 vs. 3.78, p <0.0001), but demonstrated greater image blurring (score 3.29 vs. 3.73, p <0.001). However, in a subgroup of patients with significant motion artefact on T2-FRFSE, the T2-PROPELLER sequence demonstrated significantly higher image quality (3.46 vs. 2.49, p <0.001). T2-FRFSE and T2-PROPELLER showed comparable positive predictive values for lesion detection at 93.2% and 97.7%, respectively. CONCLUSIONS T2-PROPELLER provides higher quality imaging in the presence of motion artefact, but T2-FRFSE is preferred in the absence of motion. T2-PROPELLER is therefore recommended as a secondary T2 sequence when imaging requires repeat acquisition due to motion artefact.
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Affiliation(s)
- Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Eryk Latoch
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Poland
| | - Rhys A Slough
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
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Hötker AM, Da Mutten R, Tiessen A, Konukoglu E, Donati OF. Improving workflow in prostate MRI: AI-based decision-making on biparametric or multiparametric MRI. Insights Imaging 2021; 12:112. [PMID: 34370164 PMCID: PMC8353049 DOI: 10.1186/s13244-021-01058-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To develop and validate an artificial intelligence algorithm to decide on the necessity of dynamic contrast-enhanced sequences (DCE) in prostate MRI. METHODS This study was approved by the institutional review board and requirement for study-specific informed consent was waived. A convolutional neural network (CNN) was developed on 300 prostate MRI examinations. Consensus of two expert readers on the necessity of DCE acted as reference standard. The CNN was validated in a separate cohort of 100 prostate MRI examinations from the same vendor and 31 examinations from a different vendor. Sensitivity/specificity were calculated using ROC curve analysis and results were compared to decisions made by a radiology technician. RESULTS The CNN reached a sensitivity of 94.4% and specificity of 68.8% (AUC: 0.88) for the necessity of DCE, correctly assigning 44%/34% of patients to a biparametric/multiparametric protocol. In 2% of all patients, the CNN incorrectly decided on omitting DCE. With a technician reaching a sensitivity of 63.9% and specificity of 89.1%, the use of the CNN would allow for an increase in sensitivity of 30.5%. The CNN achieved an AUC of 0.73 in a set of examinations from a different vendor. CONCLUSIONS The CNN would have correctly assigned 78% of patients to a biparametric or multiparametric protocol, with only 2% of all patients requiring re-examination to add DCE sequences. Integrating this CNN in clinical routine could render the requirement for on-table monitoring obsolete by performing contrast-enhanced MRI only when needed.
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Affiliation(s)
- Andreas M Hötker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Raffaele Da Mutten
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Anja Tiessen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ender Konukoglu
- Computer Vision Laboratory, Department of Information Technology and Electrical Engineering, ETH Zurich, Sternwartstrasse 7, 8092, Zurich, Switzerland
| | - Olivio F Donati
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Ippoliti S, Fletcher P, Orecchia L, Miano R, Kastner C, Barrett T. Optimal biopsy approach for detection of clinically significant prostate cancer. THE BRITISH JOURNAL OF RADIOLOGY 2021; 95:20210413. [PMID: 34357796 PMCID: PMC8978235 DOI: 10.1259/bjr.20210413] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prostate cancer (PCa) diagnostic and therapeutic work-up has evolved significantly in the last decade, with pre-biopsy multiparametric MRI now widely endorsed within international guidelines. There is potential to move away from the widespread use of systematic biopsy cores and towards an individualised risk-stratified approach. However, the evidence on the optimal biopsy approach remains heterogeneous, and the aim of this review is to highlight the most relevant features following a critical assessment of the literature. The commonest biopsy approaches are via the transperineal (TP) or transrectal (TR) routes. The former is considered more advantageous due to its negligible risk of post-procedural sepsis and reduced need for antimicrobial prophylaxis; the more recent development of local anaesthetic (LA) methods now makes this approach feasible in the clinic. Beyond this, several techniques are available, including cognitive registration, MRI-Ultrasound fusion imaging and direct MRI in-bore guided biopsy. Evidence shows that performing targeted biopsies reduces the number of cores required and can achieve acceptable rates of detection whilst helping to minimise complications and reducing pathologist workloads and costs to health-care facilities. Pre-biopsy MRI has revolutionised the diagnostic pathway for PCa, and optimising the biopsy process is now a focus. Combining MR imaging, TP biopsy and a more widespread use of LA in an outpatient setting seems a reasonable solution to balance health-care costs and benefits, however, local choices are likely to depend on the expertise and experience of clinicians and on the technology available.
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Affiliation(s)
- Simona Ippoliti
- Urology Department, The Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, Norfolk, UK
| | - Peter Fletcher
- Urology Department, Cambridge University Hospitals, Cambridge, UK
| | - Luca Orecchia
- Urology Department, Cambridge University Hospitals, Cambridge, UK.,Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy
| | - Roberto Miano
- Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy.,Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Christof Kastner
- Urology Department, Cambridge University Hospitals, Cambridge, UK
| | - Tristan Barrett
- Radiology Department, Cambridge University Hospitals, Cambridge, UK
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MRI-derived radiomics model for baseline prediction of prostate cancer progression on active surveillance. Sci Rep 2021; 11:12917. [PMID: 34155265 PMCID: PMC8217549 DOI: 10.1038/s41598-021-92341-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
Nearly half of patients with prostate cancer (PCa) harbour low- or intermediate-risk disease considered suitable for active surveillance (AS). However, up to 44% of patients discontinue AS within the first five years, highlighting the unmet clinical need for robust baseline risk-stratification tools that enable timely and accurate prediction of tumour progression. In this proof-of-concept study, we sought to investigate the added value of MRI-derived radiomic features to standard-of-care clinical parameters for improving baseline prediction of PCa progression in AS patients. Tumour T2-weighted imaging (T2WI) and apparent diffusion coefficient radiomic features were extracted, with rigorous calibration and pre-processing methods applied to select the most robust features for predictive modelling. Following leave-one-out cross-validation, the addition of T2WI-derived radiomic features to clinical variables alone improved the area under the ROC curve for predicting progression from 0.61 (95% confidence interval [CI] 0.481-0.743) to 0.75 (95% CI 0.64-0.86). These exploratory findings demonstrate the potential benefit of MRI-derived radiomics to add incremental benefit to clinical data only models in the baseline prediction of PCa progression on AS, paving the way for future multicentre studies validating the proposed model and evaluating its impact on clinical outcomes.
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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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Wallström J, Geterud K, Kohestani K, Maier SE, Månsson M, Pihl CG, Socratous A, Arnsrud Godtman R, Hellström M, Hugosson J. Bi- or multiparametric MRI in a sequential screening program for prostate cancer with PSA followed by MRI? Results from the Göteborg prostate cancer screening 2 trial. Eur Radiol 2021; 31:8692-8702. [PMID: 33890152 PMCID: PMC8523442 DOI: 10.1007/s00330-021-07907-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 12/24/2022]
Abstract
Objectives The PIRADS Steering Committee has called for “higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up,” however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa). Methods Within the ongoing Göteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3–5 with bpMRI and/or mpMRI. Results Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4–18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3–18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84–0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01–1.10. Conclusions In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives. Key Points • In screening for prostate cancer with PSA followed by MRI, biparametric MRI allows radiologists to detect an almost similar number of prostate cancers and score fewer false positive lesions compared to multiparametric MRI. • In a screening program, high sensitivity should be weighed against cost and risks for healthy men; a large number of men can be saved the exposure of gadolinium contrast medium by adopting biparametric MRI and at the same time allowing for a higher turnover in the MRI room. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07907-9.
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Affiliation(s)
- Jonas Wallström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 11B, 413 45, Gothenburg, Sweden. .,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Kjell Geterud
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kimia Kohestani
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stephan E Maier
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 11B, 413 45, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl-Gustaf Pihl
- Department of Pathology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Socratous
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 11B, 413 45, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Zeng J, Cheng Q, Zhang D, Fan M, Shi C, Luo L. Diagnostic Ability of Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Prostate Cancer and Clinically Significant Prostate Cancer in Equivocal Lesions: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:620628. [PMID: 33680965 PMCID: PMC7933498 DOI: 10.3389/fonc.2021.620628] [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: 10/23/2020] [Accepted: 01/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) now has been used to diagnose prostate cancer (PCa). Equivocal lesions are defined as PIRADS category 3 or a Likert scale of 1 to 5 category 3 lesions. Currently, there are no clear recommendations for the management of these lesions. This study aimed to estimate the diagnostic capacity of DCE-MRI for PCa and clinically significant prostate cancer (csPCa) in equivocal lesions. Materials and methods Two researchers searched PubMed, Embase and Web of Science to identify studies that met our subject. We searched for articles that mention the accuracy of the diagnosis of DCE-MRI for PCa or csPCa in equivocal lesions and used histopathological results as the reference standard. We used a tool (the Quality Assessment of Diagnostic Accuracy Studies-2 tool) to evaluate the quality of the studies that we screened out. Meta-regression was used to explore the reasons for heterogeneity in results. Results Ten articles were eventually included in our study. The sensitivity, specificity and 95% confidence intervals (CI) for DCE-MRI in diagnosing csPCa were 0.67 (95% CI, 0.56–0.76), 0.58 (95% CI, 0.46–0.68). The sensitivity and specificity and 95% CI for DCE-MRI in diagnosing PCa were 0.57 (95% CI, 0.46–0.68), 0.58 (95% CI, 0.45–0.70). The areas under the curve (AUC) of DCE-MRI were 0.67 (95% CI, 0.63–0.71) and 0.60 (95% CI, 0.55–0.64) while diagnosing csPCa and PCa. Through meta-regression, we found that study design, magnetic field strength, the definition of csPCa, and the scoring system were the sources of heterogeneity. Conclusion The results of our study indicate that the role of DCE-MRI in equivocal lesions may be limited.
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Affiliation(s)
- Jing Zeng
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qingqing Cheng
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dong Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Meng Fan
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, Guangzhou, China
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, Guangzhou, China
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Jochumsen MR, Sörensen J, Pedersen BG, Nyengaard JR, Krag SRP, Frøkiær J, Borre M, Bouchelouche K, Tolbod LP. Tumour blood flow for prediction of human prostate cancer aggressiveness: a study with Rubidium-82 PET, MRI and Na +/K +-ATPase-density. Eur J Nucl Med Mol Imaging 2021; 48:532-542. [PMID: 32808078 PMCID: PMC7835182 DOI: 10.1007/s00259-020-04998-2] [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: 05/20/2020] [Accepted: 08/11/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Tumour blood flow (TBF) is a crucial determinant of cancer growth. Recently, we validated Rubidium-82 (82Rb) positron emission tomography (PET) for TBF measurement in prostate cancer (PCa) and found TBF and cancer aggressiveness positively correlated. The aims of the present study were to determine the ability of TBF for separating significant from insignificant PCa and to examine the relation to underlying Na+/K+-ATPase density, which is relevant as 82Rb is transported intracellularly via the Na+/K+-ATPase. METHODS One hundred and two patients were included for pelvic 82Rb PET scan prior to magnetic resonance imaging (MRI)-guided prostate biopsy. Findings constituted 100 PCa lesions (86 patients) and 25 benign lesions (16 patients). Tumours were defined on MRI and transferred to 82Rb PET for TBF measurement. Immunohistochemical Na+/K+-ATPase staining was subsequently performed on biopsies. RESULTS TBF was the superior predictor (rho = 0.68, p < 0.0001, inflammatory lesions excluded) of MRI-guided biopsy grade group (GG) over lowest apparent diffusion coefficient (ADC) value (rho = -0.23, p = 0.01), independent of ADC value and tumour volume (p < 0.0001). PET could separate GG-2-5 from GG-1 and benign lesions with an area under the curve (AUC), sensitivity, and specificity of 0.79, 96%, and 59%, respectively. For separating GG-3-5 from GG-1-2 and benign lesions the AUC, sensitivity, and specificity were 0.82, 95%, and 63%, respectively. Na+/K+-ATPase density per PCa cell profile was 38% lower compared with that of the benign prostate cell profiles. Neither cell density nor Na+/K+-ATPase density determined tumour 82Rb uptake. CONCLUSION TBF is an independent predictor of PCa aggressiveness and deserves more attention, as it may be valuable in separating clinically significant from insignificant PCa.
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Affiliation(s)
- Mads Ryø Jochumsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Jens Sörensen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bodil Ginnerup Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University, Aarhus, Denmark
| | | | - Jørgen Frøkiær
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Sushentsev N, Kaggie JD, Slough RA, Carmo B, Barrett T. Reproducibility of magnetic resonance fingerprinting-based T1 mapping of the healthy prostate at 1.5 and 3.0 T: A proof-of-concept study. PLoS One 2021; 16:e0245970. [PMID: 33513165 PMCID: PMC7846281 DOI: 10.1371/journal.pone.0245970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022] Open
Abstract
Facilitating clinical translation of quantitative imaging techniques has been suggested as means of improving interobserver agreement and diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) of the prostate. One such technique, magnetic resonance fingerprinting (MRF), has significant competitive advantages over conventional mapping techniques in terms of its multi-site reproducibility, short scanning time and inherent robustness to motion. It has also been shown to improve the detection of clinically significant prostate cancer when added to standard mpMRI sequences, however, the existing studies have all been conducted on 3.0 T MRI systems, limiting the technique's use on 1.5 T MRI scanners that are still more widely used for prostate imaging across the globe. The aim of this proof-of-concept study was, therefore, to evaluate the cross-system reproducibility of prostate MRF T1 in healthy volunteers (HVs) using 1.5 and 3.0 T MRI systems. The initial validation of MRF T1 against gold standard inversion recovery fast spin echo (IR-FSE) T1 in the ISMRM/NIST MRI system revealed a strong linear correlation between phantom-derived MRF and IR-FSE T1 values was observed at both field strengths (R2 = 0.998 at 1.5T and R2 = 0.993 at 3T; p = < 0.0001 for both). In young HVs, inter-scanner CVs demonstrated marginal differences across all tissues with the highest difference of 3% observed in fat (2% at 1.5T vs 5% at 3T). At both field strengths, MRF T1 could confidently differentiate prostate peripheral zone from transition zone, which highlights the high quantitative potential of the technique given the known difficulty of tissue differentiation in this age group. The high cross-system reproducibility of MRF T1 relaxometry of the healthy prostate observed in this preliminary study, therefore, supports the technique's prospective clinical validation as part of larger trials employing 1.5 T MRI systems, which are still widely used clinically for routine mpMRI of the prostate.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Joshua D. Kaggie
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Rhys A. Slough
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Bruno Carmo
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- CamPARI Prostate Cancer Group, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
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45
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Palumbo P, Manetta R, Izzo A, Bruno F, Arrigoni F, De Filippo M, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement. Gland Surg 2020; 9:2235-2247. [PMID: 33447576 DOI: 10.21037/gs-20-547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostate cancer is the most common malignancy in male population. Over the last few years, magnetic resonance imaging (MRI) has proved to be a robust clinical tool for identification and staging of clinically significant prostate cancer. Though suggestions by the European Society of Urogenital Radiology to use complete multiparametric (mp) T2-weighted/diffusion weighted imaging (DWI)/dynamic contrast enhancement (DCE) acquisition for all prostate MRI examinations, the real advantage of functional DCE remains a matter of debate. Recent studies demonstrate that biparametric (bp) and mp approaches have similar accuracy, but controversial evidences remain, and the specific potential benefits of contrast medium administration are still poorly discussed in literature. The bp approach is in fact sufficient in most cases to adequately identify a negative test, or to accurately define the degree of aggressiveness of a lesion, especially if larger or with major characteristics of malignancy. This feature would give the DCE a secondary role, probably limited to a second evaluation of the lesion location, for detecting small cancer or in case of controversy. However, DCE has proved to increase the sensitivity of prostate MRI, though a less specificity. Therefore, an appropriate decision algorithm is needed to standardize the MRI approach. Aim of this review study was to provide a schematic description of bpMRI and mpMRI approaches in the study of prostatic anatomy, focusing on comparative validity and current DCE application. Additional theoretical considerations on prostate MRI are provided.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Izzo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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46
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Kamsut S, Reid K, Tan N. Roundtable: arguments in support of using multi-parametric prostate MRI protocol. Abdom Radiol (NY) 2020; 45:3990-3996. [PMID: 32385623 DOI: 10.1007/s00261-020-02543-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There is increasing evidence to suggest the value of bi-parametric prostate MRI to replace multi-parametric MRI, which includes the dynamic contrast enhancement (DCE) sequence. In this review, we discuss the value of DCE in select scenarios, specifically in resolving equivocal cases, improving the diagnostic accuracy in the inexperienced reader, rescuing exams in the settings of failed T2W and DWI, detecting biochemical recurrence, while imposing minimal to no risk to the patient with respect to IV gadolinium use, specifically group II agents.
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Affiliation(s)
- Sirisin Kamsut
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kimberly Reid
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Nelly Tan
- Loma Linda University School of Medicine, Loma Linda, CA, USA.
- Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
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47
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A multifaceted approach to quality in the MRI-directed biopsy pathway for prostate cancer diagnosis. Eur Radiol 2020; 31:4386-4389. [PMID: 33241520 DOI: 10.1007/s00330-020-07527-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
KEY POINTS • Identify, assure, and measure major sources of variability affecting the MRI-directed biopsy pathway for prostate cancer diagnosis.• Develop strategies to control and minimize variations that impair pathway effectiveness including the performance of main players and team working.• Assure end-to-end quality of the diagnostic chain with robust multidisciplinary team working.
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48
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Sushentsev N, Kaggie JD, Buonincontri G, Schulte RF, Graves MJ, Gnanapragasam VJ, Barrett T. The effect of gadolinium-based contrast agent administration on magnetic resonance fingerprinting-based T 1 relaxometry in patients with prostate cancer. Sci Rep 2020; 10:20475. [PMID: 33235229 PMCID: PMC7686305 DOI: 10.1038/s41598-020-77331-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
Magnetic resonance fingerprinting (MRF) is a rapidly developing fast quantitative mapping technique able to produce multiple property maps with reduced sensitivity to motion. MRF has shown promise in improving the diagnosis of clinically significant prostate cancer but requires further validation as part of a prostate multiparametric (mp) MRI protocol. mpMRI protocol mandates the inclusion of dynamic contrast enhanced (DCE) imaging, known for its significant T1 shortening effect. MRF could be used to measure both pre- and post-contrast T1 values, but its utility must be assessed. In this proof-of-concept study, we sought to evaluate the variation in MRF T1 measurements post gadolinium-based contrast agent (GBCA) injection and the utility of such T1 measurements to differentiate peripheral and transition zone tumours from normal prostatic tissue. We found that the T1 variation in all tissues increased considerably post-GBCA following the expected significant T1 shortening effect, compromising the ability of MRF T1 to identify transition zone lesions. We, therefore, recommend performing MRF T1 prior to DCE imaging to maintain its benefit for improving detection of both peripheral and transition zone lesions while reducing additional scanning time. Demonstrating the effect of GBCA on MRF T1 relaxometry in patients also paves the way for future clinical studies investigating the added value of post-GBCA MRF in PCa, including its dynamic analysis as in DCE-MRF.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Joshua D Kaggie
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | | | | | - Martin J Graves
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
- Academic Urology Group, Department of Surgery and Oncology, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK.
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
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49
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PI-RADS Committee Position on MRI Without Contrast Medium in Biopsy-Naive Men With Suspected Prostate Cancer: Narrative Review. AJR Am J Roentgenol 2020; 216:3-19. [PMID: 32812795 DOI: 10.2214/ajr.20.24268] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The steadily increasing demand for diagnostic prostate MRI has led to concerns regarding the lack of access to and the availability of qualified MRI scanners and sufficiently experienced radiologists, radiographers, and technologists to meet the demand. Solutions must enhance operational benefits without compromising diagnostic performance, quality, and delivery of service. Solutions should also mitigate risks such as decreased reader confidence and referrer engagement. One approach may be the implementation of MRI without the use gadolinium-based contrast medium (bipara-metric MRI), but only if certain prerequisites such as high-quality imaging, expert interpretation quality, and availability of patient recall or on-table monitoring are mandated. Alternatively, or in combination, a clinical risk-based approach could be used for protocol selection, specifically, which biopsy-naive men need MRI with contrast medium (multiparametric MRI). There is a need for prospective studies in which biopsy decisions are made according to MRI without contrast enhancement. Such studies must define clinical and operational benefits and identify which patient groups can be scanned successfully without contrast enhancement. These higher-quality data are needed before the Prostate Imaging Reporting and Data System (PI-RADS) Committee can make evidence-based recommendations about MRI without contrast enhancement as an initial diagnostic approach for prostate cancer workup.
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50
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Bao J, Zhi R, Hou Y, Zhang J, Wu C, Wang X, Zhang Y. Optimized
MRI
Assessment for Clinically Significant Prostate Cancer: A
STARD
‐Compliant Two‐Center Study. J Magn Reson Imaging 2020; 53:1210-1219. [PMID: 33075177 DOI: 10.1002/jmri.27394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jie Bao
- Department of Radiology The First Affiliated Hospital of Soochow University Suzhou China
| | - Rui Zhi
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Ying Hou
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Jing Zhang
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Chen‐Jiang Wu
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xi‐Ming Wang
- Department of Radiology The First Affiliated Hospital of Soochow University Suzhou China
| | - Yu‐Dong Zhang
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
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