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Gassenmaier S, Afat S, Nickel MD, Mostapha M, Herrmann J, Almansour H, Nikolaou K, Othman AE. Accelerated T2-Weighted TSE Imaging of the Prostate Using Deep Learning Image Reconstruction: A Prospective Comparison with Standard T2-Weighted TSE Imaging. Cancers (Basel) 2021; 13:cancers13143593. [PMID: 34298806 PMCID: PMC8303682 DOI: 10.3390/cancers13143593] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 12/22/2022] Open
Abstract
Multiparametric MRI (mpMRI) of the prostate has become the standard of care in prostate cancer evaluation. Recently, deep learning image reconstruction (DLR) methods have been introduced with promising results regarding scan acceleration. Therefore, the aim of this study was to investigate the impact of deep learning image reconstruction (DLR) in a shortened acquisition process of T2-weighted TSE imaging, regarding the image quality and diagnostic confidence, as well as PI-RADS and T2 scoring, as compared to standard T2 TSE imaging. Sixty patients undergoing 3T mpMRI for the evaluation of prostate cancer were prospectively enrolled in this institutional review board-approved study between October 2020 and March 2021. After the acquisition of standard T2 TSE imaging (T2S), the novel T2 TSE sequence with DLR (T2DLR) was applied in three planes. Overall, the acquisition time for T2S resulted in 10:21 min versus 3:50 min for T2DLR. The image evaluation was performed by two radiologists independently using a Likert scale ranging from 1-4 (4 best) applying the following criteria: noise levels, artifacts, overall image quality, diagnostic confidence, and lesion conspicuity. Additionally, T2 and PI-RADS scoring were performed. The mean patient age was 69 ± 9 years (range, 49-85 years). The noise levels and the extent of the artifacts were evaluated to be significantly improved in T2DLR versus T2S by both readers (p < 0.05). Overall image quality was also evaluated to be superior in T2DLR versus T2S in all three acquisition planes (p = 0.005-<0.001). Both readers evaluated the item lesion conspicuity to be superior in T2DLR with a median of 4 versus a median of 3 in T2S (p = 0.001 and <0.001, respectively). T2-weighted TSE imaging of the prostate in three planes with an acquisition time reduction of more than 60% including DLR is feasible with a significant improvement of image quality.
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Affiliation(s)
- Sebastian Gassenmaier
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (S.G.); (S.A.); (J.H.); (H.A.); (K.N.)
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (S.G.); (S.A.); (J.H.); (H.A.); (K.N.)
| | | | - Mahmoud Mostapha
- Digital Technology & Innovation, Siemens Medical Solutions USA, Inc., Princeton, NJ 08540, USA;
| | - Judith Herrmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (S.G.); (S.A.); (J.H.); (H.A.); (K.N.)
| | - Haidara Almansour
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (S.G.); (S.A.); (J.H.); (H.A.); (K.N.)
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (S.G.); (S.A.); (J.H.); (H.A.); (K.N.)
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, 72076 Tuebingen, Germany
| | - Ahmed E. Othman
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (S.G.); (S.A.); (J.H.); (H.A.); (K.N.)
- Department of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- Correspondence: ; Tel.: +49-7071-29-68624; Fax: +49-7071-29-5845
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Barry Delongchamps N, Schull A, Anract J, Abecassis JP, Zerbib M, Sibony M, Jilet L, Abdoul H, Goffin V, Peyromaure M. Feasibility and safety of targeted focal microwave ablation of the index tumor in patients with low to intermediate risk prostate cancer: Results of the FOSTINE trial. PLoS One 2021; 16:e0252040. [PMID: 34260598 PMCID: PMC8279354 DOI: 10.1371/journal.pone.0252040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the feasibility, safety and precision of organ-based tracking (OBT)-fusion targeted focal microwave ablation (FMA), in patients with low to intermediate risk prostate cancer. PATIENTS AND METHOD Ten patients with a visible index tumor of Gleason score ≤3+4, largest diameter <20mm were included. Transrectal OBT-fusion targeted FMA was performed using an 18G needle. Primary endpoint was the evidence of complete overlap of the index tumor by ablation zone necrosis on MRI 7 days after ablation. Urinary and sexual function were assessed with IPSS, IIEF5 and MSHQ-EjD-SF. Oncological outcomes were assessed with PSA at 2 and 6 months, and re-biopsy at 6 months. RESULTS Median [IQR] age was 64.5 [61-72] years and baseline PSA was 5 [4.3-8.1] ng/mL. Seven (70%) and 3 (30%) patients had a low and intermediate risk cancer, respectively. Median largest tumor axis was of 11 [9.0-15.0] mm. Median duration of procedure was of 82 [44-170] min. No patient reported any pain or rectal bleeding, and all 10 patients were discharged the next day. Seven days after ablation, total necrosis of the index tumor on MRI was obtained in eight (80% [95%CI 55%-100%]) patients. One patient was treated with radical prostatectomy. Re-biopsy at 6 months in the other 9 did not show evidence of cancer in 4 patients. IPSS, IIEF-5 and MSHQ-EjD-SF were not statistically different between baseline and 6 months follow up. CONCLUSIONS OBT-fusion targeted FMA was feasible, precise, and safe in patients with low to intermediate risk localized prostate cancer.
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Affiliation(s)
- Nicolas Barry Delongchamps
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | - Alexandre Schull
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Julien Anract
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | | | - Marc Zerbib
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Mathilde Sibony
- Department of Pathology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Léa Jilet
- Clinical Research Unit, Cochin hospital, APHP, Paris Descartes University, Paris, France
| | - Hendy Abdoul
- Clinical Research Unit, Cochin hospital, APHP, Paris Descartes University, Paris, France
| | - Vincent Goffin
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | - Michaël Peyromaure
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
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Gassenmaier S, Afat S, Nickel D, Mostapha M, Herrmann J, Othman AE. Deep learning-accelerated T2-weighted imaging of the prostate: Reduction of acquisition time and improvement of image quality. Eur J Radiol 2021; 137:109600. [PMID: 33610853 DOI: 10.1016/j.ejrad.2021.109600] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To introduce a novel deep learning (DL) T2-weighted TSE imaging (T2DL) sequence in prostate MRI and investigate its impact on examination time, image quality, diagnostic confidence, and PI-RADS classification compared to standard T2-weighted TSE imaging (T2S). METHOD Thirty patients who underwent multiparametric MRI (mpMRI) of the prostate due to suspicion of prostatic cancer were included in this retrospective study. Standard sequences were acquired consisting of T1- and T2-weighted imaging and diffusion-weighted imaging as well as the novel T2DL. Axial acquisition time of T2S was 4:37 min compared to 1:38 min of T2DL. Two radiologists independently evaluated all imaging datasets in a blinded reading regarding image quality, lesion detectability, and diagnostic confidence using a Likert-scale ranging from 1 to 4 with 4 being the best. T2 score as well as PI-RADS score were obtained for the most malignant lesion. RESULTS Mean patient age was 65 ± 11 years. Noise levels and overall image quality were rated significantly superior by both readers with a median of 4 in T2DL compared to a median of 3 in T2S (all p < 0.001). Lesion detectability was also rated higher in T2DL by both readers with a median of 4 versus a median of 3 in T2S (p = 0.005 and <0.001, respectively). There was no difference regarding PI-RADS scoring between T2DL and T2S affecting patient management. CONCLUSIONS Deep learning axial T2w TSE imaging of the prostate is feasible with reduction of examination time of 65 % compared to standard imaging and improvement of image quality and lesion detectability.
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Affiliation(s)
- Sebastian Gassenmaier
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Dominik Nickel
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Mahmoud Mostapha
- Digital Technology & Innovation, Siemens Medical Solutions USA, Inc., Princeton, NJ, USA
| | - Judith Herrmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Ahmed E Othman
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany; Department of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
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Ragheb SR, Bassiouny RH. Can mean ADC value and ADC ratio of benign prostate tissue to prostate cancer assist in the prediction of clinically significant prostate cancer within the PI-RADSv2 scoring system? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study is to investigate whether quantitative DW metrics can provide additive value to the reliable categorization of lesions within existing PI-RADSv2 guidelines. Fifty-eight patients with clinically suspicious prostate cancer who underwent PR examination, PSA serum levels, sextant TRUS-guided biopsies, and bi-parametric MR imaging were included in the study.
Results
Sixty-six lesions were detected by histopathological analysis of surgical specimens. The mean ADC values were significantly lower in tumor than non-tumor tissue. The mean ADC value inversely correlated with Gleason score of tumors with a significant p value < 0.001.Conversely, a positive relationship was found between the ADC ratio (ADC of benign prostatic tissue to prostate cancer) and the pathologic Gleason score with a significant elevation of the ADC ratio along with an increase of the pathologic Gleason score (p < 0.001). ROC curves constructed for the tumor ADC and ADC ratio helped to distinguish pathologically aggressive (Gleason score ≥ 7) from non-aggressive (Gleason score ≤ 6) tumors and to correlate it with PIRADSv2 scoring to predict the presence of clinically significant PCA (PIRADSv2 DW ≥ 4). The ability of the tumor ADC and ADC ratio to predict highly aggressive tumors (GS> 7) was high (AUC for ADC and ADC ratio, 0.946 and 0.897; p = 0.014 and 0.039, respectively). The ADC cut-off value for GS ≥ 7 was < 0.7725 and for GS ≤ 6 was > 0.8620 with sensitivity and specificity 97 and 94%. The cutoff ADC ratio for predicting (GS > 7) was 1.42 and for GS ≤ 6 was > 1.320 with sensitivity and specificity 97 and 92%. By applying this ADC ratio cut-off value the sensitivity and specificity of reader 1 for correct categorization of PIRADSv2 DW > 4 increased from 90 and 68% to 95 and 90% and that of reader 2 increased from 94 and 88% to 97 and 92%, respectively.
Conclusion
Estimation of DW metrics (ADC and ADC ratio between benign prostatic tissue and prostate cancer) allow the non-invasive assessment of biological aggressiveness of prostate cancer and allow reliable application of the PIRADSv2 scoring to determine clinically significant cancer (DW score > 4) which may contribute in planning initial treatment strategies.
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Labra A, González F, Silva C, Franz G, Pinochet R, Gupta RT. MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2. Abdom Radiol (NY) 2020; 45:2235-2243. [PMID: 32249349 DOI: 10.1007/s00261-020-02481-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the efficacy of multiparametric magnetic resonance/transrectal ultrasound fusion (MRI/TRUS fusion) biopsy versus systematic biopsy and its association with PI-RADS v2 categories in patients with suspected prostate cancer. MATERIALS AND METHODS 122 patients undergoing both MRI/TRUS fusion and systematic biopsy, with suspicion of prostate cancer, with suspicious findings on MRI based on PI-RADS v2, were included between April 2016 and March 2017. Comparison of tumor detection rates using each technique and combined techniques was performed for all lesions as well as those that are traditionally difficult to access (i.e., anterior lesions). RESULTS Prostate cancer was detected in 83/122 patients (68%) with 74.6% clinically significant lesions (Gleason 3 + 4 or greater). There was a statistically significant difference in presence of clinically significant prostate cancer in PI-RADS v2 categories of 3, 4, and 5 (20%, 52% and 77%, respectively, p < 0.001). Fusion biopsy was positive in a significantly higher percentage of patients versus systematic biopsy (56% versus 48%, respectively, p < 0.05). The fusion biopsy alone was positive in 20%. Of 34 patients with anterior lesions on MRI, 44% were detected only by fusion biopsy, with a joint yield of 71%. In patients with previous negative systematic biopsies, 48.7% lesions were found by fusion biopsy with 20.5% being exclusively positive by this method. The percentage of positive cores for fusion biopsies was significantly higher than for systematic biopsies (26% vs. 12.3%, p < 0.001). CONCLUSION The incorporation of MRI/TRUS fusion biopsy significantly improves the detection rate of prostate cancer versus systematic biopsy, particularly for anterior lesions.
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Affiliation(s)
- Andrés Labra
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Fernando González
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA
| | - Claudio Silva
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Gerhard Franz
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Rodrigo Pinochet
- Department of Surgery, Division of Urology, Clínica Alemana de Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA.
- Duke Cancer Institute Center for Prostate and Urologic Cancers, 20 Duke Medicine Circle, DUMC Box 103861, Durham, NC, 27710, USA.
- Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, DUMC Box 2804, Durham, NC, 27710, USA.
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Giganti F, Rosenkrantz AB, Villeirs G, Panebianco V, Stabile A, Emberton M, Moore CM. The Evolution of MRI of the Prostate: The Past, the Present, and the Future. AJR Am J Roentgenol 2019; 213:384-396. [PMID: 31039022 DOI: 10.2214/ajr.18.20796] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE. The purpose of this article is to discuss the evolution of MRI in prostate cancer from the early 1980s to the current day, providing analysis of the key studies on this topic. CONCLUSION. The rapid diffusion of MRI technology has meant that residual variability remains between centers regarding the quality of acquisition and the quality and standardization of reporting.
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Affiliation(s)
- Francesco Giganti
- 1 Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
| | | | - Geert Villeirs
- 4 Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Valeria Panebianco
- 5 Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Armando Stabile
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 6 Department of Urology, Division of Experiemental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mark Emberton
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 7 Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline M Moore
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 7 Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
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Delongchamps NB, Portalez D, Bruguière E, Rouvière O, Malavaud B, Mozer P, Fiard G, Cornud F. Are Magnetic Resonance Imaging-Transrectal Ultrasound Guided Targeted Biopsies Noninferior to Transrectal Ultrasound Guided Systematic Biopsies for the Detection of Prostate Cancer? J Urol 2016; 196:1069-75. [DOI: 10.1016/j.juro.2016.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Nicolas Barry Delongchamps
- Department of Urology, Cochin University Hospital, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | | | | | - Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Edouard Herriot Hospital and University Lyon 1, Lyon, France
| | | | - Pierre Mozer
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Edouard Herriot Hospital and University Lyon 1, Lyon, France
| | | | - François Cornud
- Department of Urology, Cochin University Hospital, Paris Descartes University, Paris, France
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Abstract
Multiparametric MR imaging (mpMRI) combine different sequences that, properly tailored, can provide qualitative and quantitative information about the tumor microenvironment beyond traditional tumor size measures and/or morphologic assessments. This article focuses on mpMRI in the evaluation of urogenital tract malignancies by first reviewing technical aspects and then discussing its potential clinical role. This includes insight into histologic subtyping and grading of renal cell carcinoma and assessment of tumor response to targeted therapies. The clinical utility of mpMRI in the staging and grading of ureteral and bladder tumors is presented. Finally, the evolving role of mpMRI in prostate cancer is discussed.
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Niendorf T, Paul K, Oezerdem C, Graessl A, Klix S, Huelnhagen T, Hezel F, Rieger J, Waiczies H, Frahm J, Nagel AM, Oberacker E, Winter L. W(h)ither human cardiac and body magnetic resonance at ultrahigh fields? technical advances, practical considerations, applications, and clinical opportunities. NMR IN BIOMEDICINE 2016; 29:1173-97. [PMID: 25706103 DOI: 10.1002/nbm.3268] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/26/2014] [Accepted: 01/13/2015] [Indexed: 05/12/2023]
Abstract
The objective of this study was to document and review advances and groundbreaking progress in cardiac and body MR at ultrahigh fields (UHF, B0 ≥ 7.0 T) with the goal to attract talent, clinical adopters, collaborations and resources to the biomedical and diagnostic imaging communities. This review surveys traits, advantages and challenges of cardiac and body MR at 7.0 T. The considerations run the gamut from technical advances to clinical opportunities. Key concepts, emerging technologies, practical considerations, frontier applications and future directions of UHF body and cardiac MR are provided. Examples of UHF cardiac and body imaging strategies are demonstrated. Their added value over the kindred counterparts at lower fields is explored along with an outline of research promises. The achievements of cardiac and body UHF-MR are powerful motivators and enablers, since extra speed, signal and imaging capabilities may be invested to overcome the fundamental constraints that continue to hamper traditional cardiac and body MR applications. If practical obstacles, concomitant physics effects and technical impediments can be overcome in equal measure, sophisticated cardiac and body UHF-MR will help to open the door to new MRI and MRS approaches for basic research and clinical science, with the lessons learned at 7.0 T being transferred into broad clinical use including diagnostics and therapy guiding at lower fields. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Thoralf Niendorf
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Katharina Paul
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Celal Oezerdem
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Andreas Graessl
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Sabrina Klix
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Till Huelnhagen
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Fabian Hezel
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | | | - Jens Frahm
- Biomedizinische NMR Forschungs GmbH, am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Göttingen, Germany
| | - Armin M Nagel
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Oberacker
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Lukas Winter
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
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Palmeri ML, Glass TJ, Miller ZA, Rosenzweig SJ, Buck A, Polascik TJ, Gupta RT, Brown AF, Madden J, Nightingale KR. Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic Radiation Force Impulse Imaging with Whole-Mount Histology Validation. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1251-62. [PMID: 26947445 PMCID: PMC4860099 DOI: 10.1016/j.ultrasmedbio.2016.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/10/2015] [Accepted: 01/11/2016] [Indexed: 05/04/2023]
Abstract
Overly aggressive prostate cancer (PCa) treatment adversely affects patients and places an unnecessary burden on our health care system. The inability to identify and grade clinically significant PCa lesions is a factor contributing to excessively aggressive PCa treatment, such as radical prostatectomy, instead of more focal, prostate-sparing procedures such as cryotherapy and high-dose radiation therapy. We have performed 3-D in vivo B-mode and acoustic radiation force impulse (ARFI) imaging using a mechanically rotated, side-fire endorectal imaging array to identify regions suspicious for PCa in 29 patients being treated with radical prostatectomies for biopsy-confirmed PCa. Whole-mount histopathology analyses were performed to identify regions of clinically significant/insignificant PCa lesions, atrophy and benign prostatic hyperplasia. Regions of suspicion for PCa were reader-identified in ARFI images based on boundary delineation, contrast, texture and location. These regions of suspicion were compared with histopathology identified lesions using a nearest-neighbor regional localization approach. Of all clinically significant lesions identified on histopathology, 71.4% were also identified using ARFI imaging, including 79.3% of posterior and 33.3% of anterior lesions. Among the ARFI-identified lesions, 79.3% corresponded to clinically significant PCa lesions, with these lesions having higher indices of suspicion than clinically insignificant PCa. ARFI imaging had greater sensitivity for posterior versus anterior lesions because of greater displacement signal-to-noise ratio and finer spatial sampling. Atrophy and benign prostatic hyperplasia can cause appreciable prostate anatomy distortion and heterogeneity that confounds ARFI PCa lesion identification; however, in general, ARFI regions of suspicion did not coincide with these benign pathologies.
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Affiliation(s)
- Mark L Palmeri
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
| | - Tyler J Glass
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Zachary A Miller
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Stephen J Rosenzweig
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Andrew Buck
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas J Polascik
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Alison F Brown
- School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - John Madden
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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Yang DM, Kim HC, Kim SW, Jahng GH, Won KY, Lim SJ, Oh JH. Prostate cancer: correlation of intravoxel incoherent motion MR parameters with Gleason score. Clin Imaging 2016; 40:445-50. [PMID: 27133684 DOI: 10.1016/j.clinimag.2016.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/04/2015] [Accepted: 01/06/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the potential of intravoxel incoherent motion (IVIM) imaging to predict histological prognostic parameters by investigating whether IVIM parameters correlate with Gleason score. MATERIALS AND METHODS The institutional review board approved this retrospective study, and informed consent was waived. A total of 41 patients with histologically proven prostate cancer who underwent prostate MRI using a 3T MRI machine were included. For eight diffusion-weighted imaging b-values (0, 10, 20, 50, 100, 200, 500, and 800s/mm(2)), a spin-echo echo-planar imaging sequence was performed. D, f, D(⁎), and ADCfit values were compared among three groups of patients with prostate cancer: Gleason score 6 (n=9), 7 (n=16), or 8 or higher (n=16). Receiver operating characteristic (ROC) curves were generated for D, f, D(⁎), and ADCfit to assess the ability of each parameter to distinguish cancers with low Gleason scores from cancers with intermediate or high Gleason scores. RESULTS Pearson's coefficient analysis revealed significant negative correlations between Gleason score and ADCfit (r=-0.490, P=.001) and Gleason score and D values (r=-0.514, P=.001). Gleason score was poorly correlated with f (r=0.168, P=.292) and D(⁎) values (r=-0.108, P=.500). The ADCfit and D values of prostate cancers with Gleason scores 7 or ≥8 were significantly lower than values for prostate cancers with Gleason score 6 (P<.05). ROC curves were constructed to assess the ability of IVIM parameters to discriminate prostate cancers with Gleason score 6 from cancers with Gleason scores 7 or ≥8. Areas under the curve were 0.671 to 0.974. ADCfit and D yielded the highest Az value (0.960-0.956), whereas f yielded the lowest Az value (0.633). CONCLUSIONS The pure molecular diffusion parameter, D, was the IVIM parameter that best discriminated prostate cancers with low Gleason scores from prostate cancers with intermediate or high Gleason scores.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
| | - Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang Won Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kyu Yeoun Won
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sung Jig Lim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jang-Hoon Oh
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, Yongin, Republic of Korea
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12
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Ginsburg SB, Viswanath SE, Bloch BN, Rofsky NM, Genega EM, Lenkinski RE, Madabhushi A. Novel PCA-VIP scheme for ranking MRI protocols and identifying computer-extracted MRI measurements associated with central gland and peripheral zone prostate tumors. J Magn Reson Imaging 2015; 41:1383-93. [PMID: 24943647 PMCID: PMC8176951 DOI: 10.1002/jmri.24676] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/02/2014] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To identify computer-extracted features for central gland and peripheral zone prostate cancer localization on multiparametric magnetic resonance imaging (MRI). MATERIALS AND METHODS Preoperative T2-weighted (T2w), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) MRI were acquired from 23 men with confirmed prostate cancer. Following radical prostatectomy, the cancer extent was delineated by a pathologist on ex vivo histology and mapped to MRI by nonlinear registration of histology and corresponding MRI slices. In all, 244 computer-extracted features were extracted from MRI, and principal component analysis (PCA) was employed to reduce the data dimensionality so that a generalizable classifier could be constructed. A novel variable importance on projection (VIP) measure for PCA (PCA-VIP) was leveraged to identify computer-extracted MRI features that discriminate between cancer and normal prostate, and these features were used to construct classifiers for cancer localization. RESULTS Classifiers using features selected by PCA-VIP yielded an area under the curve (AUC) of 0.79 and 0.85 for peripheral zone and central gland tumors, respectively. For tumor localization in the central gland, T2w, DCE, and DWI MRI features contributed 71.6%, 18.1%, and 10.2%, respectively; for peripheral zone tumors T2w, DCE, and DWI MRI contributed 29.6%, 21.7%, and 48.7%, respectively. CONCLUSION PCA-VIP identified relatively stable subsets of MRI features that performed well in localizing prostate cancer on MRI.
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Affiliation(s)
- Shoshana B. Ginsburg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Satish E. Viswanath
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - B. Nicolas Bloch
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Neil M. Rofsky
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth M. Genega
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert E. Lenkinski
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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13
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Costa DN, Pedrosa I, Donato F, Roehrborn CG, Rofsky NM. MR Imaging–Transrectal US Fusion for Targeted Prostate Biopsies: Implications for Diagnosis and Clinical Management. Radiographics 2015; 35:696-708. [DOI: 10.1148/rg.2015140058] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Baco E, Rud E, Eri LM, Moen G, Vlatkovic L, Svindland A, Eggesbø HB, Ukimura O. A Randomized Controlled Trial To Assess and Compare the Outcomes of Two-core Prostate Biopsy Guided by Fused Magnetic Resonance and Transrectal Ultrasound Images and Traditional 12-core Systematic Biopsy. Eur Urol 2015; 69:149-56. [PMID: 25862143 DOI: 10.1016/j.eururo.2015.03.041] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/27/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prostate biopsy guided by computer-assisted fusion of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) images (MRI group) has not yet been compared with 12-core random biopsy (RB; control group) in a randomized controlled trial (RCT). OBJECTIVE To compare the rate of detection of clinically significant prostate cancer (csPCa) between the two groups. DESIGN, SETTING, AND PARTICIPANTS This RCT included 175 biopsy-naïve patients with suspicion for prostate cancer, randomized to an MRI group (n=86) and a control group (n=89) between September 2011 and June 2013. INTERVENTION In the MRI group, two-core targeted biopsy (TB) guided by computer-assisted fusion of MRI/TRUS images of MRI-suspicious lesions was followed by 12-core RB. In the control group, both two-core TB for abnormal digital rectal examination (DRE) and/or TRUS-suspicious lesions and 12-core RB were performed. In patients with normal MRI or DRE/TRUS, only 12-core RB was performed. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS The detection rates for any cancer and csPCa were compared between the two groups and between TB and RB. RESULTS AND LIMITATIONS Detection rates for any cancer (MRI group 51/86, 59%; control group 48/89, 54%; p=0.4) and csPCa (38/86, 44% vs 44/89, 49%; p=0.5) did not significantly differ between the groups. Detection of csPCa was comparable between two-core MRI/TRUS-TB (33/86, 38%) and 12-core RB in the control group (44/89, 49%; p=0.2). In a subset analysis of patients with normal DRE, csPCa detection was similar between two-core MRI/TRUS-TB (14/66, 21%) and 12-core RB in the control group (15/60, 25%; p=0.7). Among biopsy-proven csPCas in MRI group, 87% (33/38) were detected by MRI/TRUS-TB. The definition of csPCa was only based on biopsy outcomes. CONCLUSION Overall csPCa detection was similar between the MRI and control groups. Two-core MRI/TRUS-TB was comparable to 12-core RB for csPCa detection. PATIENT SUMMARY Our randomized controlled trial revealed a similar rate of prostate cancer detection between targeted biopsy guided by magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) and 12-core random biopsy. The traditional 12-core random biopsy may be replaced by two-core MRI/TRUS targeted biopsy for detection of clinically significant prostate cancer.
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Affiliation(s)
- Eduard Baco
- Department of Urology, Division for Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway.
| | - Erik Rud
- University of Oslo, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Lars Magne Eri
- Department of Urology, Division for Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Gunnar Moen
- Department of Urology, Division for Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Oslo, Norway
| | | | - Aud Svindland
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Heidi B Eggesbø
- University of Oslo, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Osamu Ukimura
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Palmeri ML, Miller ZA, Glass TJ, Garcia-Reyes K, Gupta RT, Rosenzweig SJ, Kauffman C, Polascik TJ, Buck A, Kulbacki E, Madden J, Lipman SL, Rouze NC, Nightingale KR. B-mode and acoustic radiation force impulse (ARFI) imaging of prostate zonal anatomy: comparison with 3T T2-weighted MR imaging. ULTRASONIC IMAGING 2015; 37:22-41. [PMID: 25060914 PMCID: PMC4423560 DOI: 10.1177/0161734614542177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Prostate cancer (PCa) is the most common non-cutaneous malignancy among men in the United States and the second leading cause of cancer-related death. Multi-parametric magnetic resonance imaging (mpMRI) has gained recent popularity to characterize PCa. Acoustic Radiation Force Impulse (ARFI) imaging has the potential to aid PCa diagnosis and management by using tissue stiffness to evaluate prostate zonal anatomy and lesions. MR and B-mode/ARFI in vivo imaging datasets were compared with one another and with gross pathology measurements made immediately after radical prostatectomy. Images were manually segmented in 3D Slicer to delineate the central gland (CG) and prostate capsule, and 3D models were rendered to evaluate zonal anatomy dimensions and volumes. Both imaging modalities showed good correlation between estimated organ volume and gross pathologic weights. Ultrasound and MR total prostate volumes were well correlated (R(2) = 0.77), but B-mode images yielded prostate volumes that were larger (16.82% ± 22.45%) than MR images, due to overestimation of the lateral dimension (18.4% ± 13.9%), with less significant differences in the other dimensions (7.4% ± 17.6%, anterior-to-posterior, and -10.8% ± 13.9%, apex-to-base). ARFI and MR CG volumes were also well correlated (R(2) = 0.85). CG volume differences were attributed to ARFI underestimation of the apex-to-base axis (-28.8% ± 9.4%) and ARFI overestimation of the lateral dimension (21.5% ± 14.3%). B-mode/ARFI imaging yielded prostate volumes and dimensions that were well correlated with MR T2-weighted image (T2WI) estimates, with biases in the lateral dimension due to poor contrast caused by extraprostatic fat. B-mode combined with ARFI imaging is a promising low-cost, portable, real-time modality that can complement mpMRI for PCa diagnosis, treatment planning, and management.
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Affiliation(s)
- Mark L Palmeri
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Zachary A Miller
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Tyler J Glass
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | | | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Stephen J Rosenzweig
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | | | - Thomas J Polascik
- Department of Surgery (Urology), Duke University Medical Center, Durham, NC, USA
| | - Andrew Buck
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Evan Kulbacki
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - John Madden
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Samantha L Lipman
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Ned C Rouze
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Kathryn R Nightingale
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
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16
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MRI for managing intermediate & low risk prostate cancer. Cancer Imaging 2014. [PMCID: PMC4242002 DOI: 10.1186/1470-7330-14-s1-o9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Boesen L, Noergaard N, Chabanova E, Logager V, Balslev I, Mikines K, Thomsen HS. Early experience with multiparametric magnetic resonance imaging-targeted biopsies under visual transrectal ultrasound guidance in patients suspicious for prostate cancer undergoing repeated biopsy. Scand J Urol 2014; 49:25-34. [DOI: 10.3109/21681805.2014.925497] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Hirst AM, Frame FM, Maitland NJ, O'Connell D. Low temperature plasma: a novel focal therapy for localized prostate cancer? BIOMED RESEARCH INTERNATIONAL 2014; 2014:878319. [PMID: 24738076 PMCID: PMC3971493 DOI: 10.1155/2014/878319] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/06/2014] [Indexed: 12/16/2022]
Abstract
Despite considerable advances in recent years for the focal treatment of localized prostate cancer, high recurrence rates and detrimental side effects are still a cause for concern. In this review, we compare current focal therapies to a potentially novel approach for the treatment of early onset prostate cancer: low temperature plasma. The rapidly evolving plasma technology has the potential to deliver a wide range of promising medical applications via the delivery of plasma-induced reactive oxygen and nitrogen species. Studies assessing the effect of low temperature plasma on cell lines and xenografts have demonstrated DNA damage leading to apoptosis and reduction in cell viability. However, there have been no studies on prostate cancer, which is an obvious candidate for this novel therapy. We present here the potential of low temperature plasma as a focal therapy for prostate cancer.
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Affiliation(s)
- Adam M Hirst
- Department of Physics, York Plasma Institute, University of York, Heslington, York YO10 5DD, UK
| | - Fiona M Frame
- YCR Cancer Research Unit, Department of Biology, University of York, Heslington, York YO10 5DD, UK
| | - Norman J Maitland
- YCR Cancer Research Unit, Department of Biology, University of York, Heslington, York YO10 5DD, UK
| | - Deborah O'Connell
- Department of Physics, York Plasma Institute, University of York, Heslington, York YO10 5DD, UK
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19
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Caivano R, Rabasco P, Lotumolo A, Cirillo P, D'Antuono F, Zandolino A, Villonio A, Macarini L, Salvatore M, Cammarota A. Comparison Between Gleason Score and Apparent Diffusion Coefficient Obtained from Diffusion-Weighted Imaging of Prostate Cancer Patients. Cancer Invest 2013; 31:625-9. [DOI: 10.3109/07357907.2013.845673] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Arumainayagam N, Ahmed HU, Moore CM, Freeman A, Allen C, Sohaib SA, Kirkham A, van der Meulen J, Emberton M. Multiparametric MR imaging for detection of clinically significant prostate cancer: a validation cohort study with transperineal template prostate mapping as the reference standard. Radiology 2013; 268:761-9. [PMID: 23564713 DOI: 10.1148/radiol.13120641] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of multiparametric (MP) magnetic resonance (MR) imaging for prostate cancer detection by using transperineal template prostate mapping (TTPM) biopsies as the reference standard and to determine the potential ability of MP MR imaging to identify clinically significant prostate cancer. MATERIALS AND METHODS Institutional review board exemption was granted by the local research ethics committee for this retrospective study. Included were 64 men (mean age, 62 years [range, 40-76]; mean prostate-specific antigen, 8.2 ng/mL [8.2 μg/L] [range, 2.1-43 ng/mL]), 51 with biopsy-proved cancer and 13 suspected of having clinically significant cancer that was biopsy negative or without prior biopsy. MP MR imaging included T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging (1.5 T, pelvic phased-array coil). Three radiologists independently reviewed images and were blinded to results of biopsy. Two-by-two tables were derived by using sectors of analysis of four quadrants, two lobes, and one whole prostate. Primary target definition for clinically significant disease necessary to be present within a sector of analysis on TTPM for that sector to be deemed positive was set at Gleason score of 3+4 or more and/or cancer core length involvement of 4 mm or more. Sensitivity, negative predictive value, and negative likelihood ratio were calculated to determine ability of MP MR imaging to rule out cancer. Specificity, positive predictive value, positive likelihood ratio, accuracy (overall fraction correct), and area under receiver operating characteristic curves were also calculated. RESULTS Twenty-eight percent (71 of 256) of sectors had clinically significant cancer by primary endpoint definition. For primary endpoint definition (≥ 4 mm and/or Gleason score ≥ 3+4), sensitivity, negative predictive value, and negative likelihood ratios were 58%-73%, 84%-89%, and 0.3-0.5, respectively. Specificity, positive predictive value, and positive likelihood ratios were 71%-84%, 49%-63%, and 2.-3.44, respectively. Area under the curve values were 0.73-0.84. CONCLUSION Results of this study indicate that MP MR imaging has a high negative predictive value to rule out clinically significant prostate cancer and may potentially have clinical use in diagnostic pathways of men at risk.
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Affiliation(s)
- Nimalan Arumainayagam
- Division of Surgery and Interventional Sciences, University College, Charles Bell House, 67-73 Riding House St, London W1W 7EJ, England
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