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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; 34:6217-6226. [PMID: 38656709 PMCID: PMC11399179 DOI: 10.1007/s00330-024-10770-z] [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: 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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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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Tomioka M, Nakane K, Kawase M, Iinuma K, Kato D, Kawase K, Taniguchi T, Tobisawa Y, Sugino F, Kaga T, Kato H, Matsuo M, Kito Y, Saigo C, Suzui N, Ito T, Miyazaki T, Takeuchi T, Koie T. Discrepancy in the Location of Prostate Cancer Indicated on Biparametric Magnetic Resonance Imaging and Pathologically Diagnosed Using Surgical Specimens. Curr Oncol 2024; 31:2846-2855. [PMID: 38785497 PMCID: PMC11119495 DOI: 10.3390/curroncol31050216] [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: 04/19/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Accurate diagnosis of the localization of prostate cancer (PCa) on magnetic resonance imaging (MRI) remains a challenge. We aimed to assess discrepancy between the location of PCa pathologically diagnosed using surgical specimens and lesions indicated as possible PCa by the Prostate Imaging Reporting and Data System on MRI. The primary endpoint was the concordance rate between the site of probable clinically significant PCa (csPCa) identified using biparametric MRI (bpMRI) and location of PCa in the surgical specimen obtained using robot-assisted total prostatectomy. Among 85 lesions identified in 30 patients; 42 (49.4%) were identified as possible PCa on MRI. The 85 PCa lesions were divided into positive and negative groups based on the bpMRI results. None of the patients had missed csPCa. Although the diagnostic accuracy of bpMRI was relatively high for PCas located in the middle of the prostate (p = 0.029), it was relatively low for PCa located at the base of the prostate, all of which were csPCas. Although current modalities can accurately diagnose PCa, the possibility that PCa is present with multiple lesions in the prostate should be considered, even if MRI does not detect PCa.
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Affiliation(s)
- Masayuki Tomioka
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Tomoki Taniguchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Yuki Tobisawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Fumiya Sugino
- Department of Urology, Gifu Municipal Hospital, Gifu 5008513, Japan;
| | - Tetsuro Kaga
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Hiroki Kato
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Yusuke Kito
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Chiemi Saigo
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu 5011194, Japan; (N.S.); (T.M.)
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Gifu University Graduate School of Medicine, Gifu 5011194, Japan;
| | - Tatsuhiko Miyazaki
- Department of Pathology, Gifu University Hospital, Gifu 5011194, Japan; (N.S.); (T.M.)
| | - Tamotsu Takeuchi
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
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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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Riedel A, Michael M, Grünberg J, Mehralivand S, Böehm K, Hachtel J, Platzek I, Sommer U, Baunacke M, Thomas C, Borkowetz A. The Role of Multiparametric MRI (mpMRI) in the Prediction of Adverse Prostate Cancer Pathology in Radical Prostatectomy Specimen. Urol Int 2024; 108:146-152. [PMID: 38246150 DOI: 10.1159/000536256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Prostate cancer (PCa) risk stratification is essential in guiding therapeutic decision. Multiparametric magnetic resonance tomography (mpMRI) holds promise in the prediction of adverse pathologies (AP) after prostatectomy (RP). This study aims to identify clinical and imaging markers in the prediction of adverse pathology. METHODS Patients with PCa, diagnosed by targeted biopsy after mpMRI and undergoing RP, were included. The predictive accuracy of mpMRI for extraprostatic extension (ECE), seminal vesicle infiltration (SVI), and lymph node positivity was calculated from the final histopathology. RESULTS 846 patients were involved. Independent risk parameters include imaging findings such as ECE (OR 3.12), SVI (OR 2.55), and PI-RADS scoring (4: OR 2.01 and 5: OR 4.34). mpMRI parameters such as ECE, SVI, and lymph node metastases showed a high prognostic accuracy (73.28% vs. 95.35% vs. 93.38%) with moderate sensitivity compared to the final histopathology. The ROC analysis of our combined scoring system (D'Amico classification, PSA density, and MRI risk factors) improves the prediction of adverse pathology (AUC: 0.73 vs. 0.69). CONCLUSION Our study supports the use of mpMRI for comprehensive pretreatment risk assessment in PCa. Due to the high accuracy of factors like ECE, SVI, and PI-RADS scoring, utilizing mpMRI data enabled accurate prediction of unfavorable pathology after RP.
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Affiliation(s)
- Andreas Riedel
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany,
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tuebingen, Germany,
| | - Marlene Michael
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Jenny Grünberg
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Sherif Mehralivand
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Katharina Böehm
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Jakob Hachtel
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Ivan Platzek
- Department of Radiology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Ulrich Sommer
- Department of Pathology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
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Zhu J, Wu X, Xue Y, Li X, Zheng Q, Xue X, Huang Z, Chen S. Prospective analysis of the diagnostic accuracy of digital rectal examination and magnetic resonance imaging for T staging of prostate cancer. J Cancer Res Ther 2023; 19:1024-1030. [PMID: 37675732 DOI: 10.4103/jcrt.jcrt_176_23] [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: 09/08/2023]
Abstract
Background Accurate staging of prostate cancer (PCa) is the basis for the risk stratification to select targeted treatment. Therefore, this study aimed to compare the diagnostic accuracy rates of magnetic resonance imaging (MRI) and digital rectal examination (DRE) for preoperative T staging of potentially resectable PCa. Methods From March 2021 to March 2022, patients with PCa with T staging by prostate biopsy were included. All examinations used postoperative histopathologic T staging as the reference standard. All patients underwent DRE and MRI before the puncture. Two blinded urologists and radiologists independently evaluated DRE and MRI, respectively. Before the examination, patients were then divided into early- (T1, T2) and late-(T3, T4) stage cancer. Analysis of a paired sample sign test was performed to determine differences between DRE and MRI. Results A total of 136 study participants with PCa were evaluated histopathologically, of whom 71% (97/136) and 29% (39/136) were at the early- and late-stage cancer, respectively. MRI had a significantly higher accuracy (91.9% vs. 76.5%, P < 0.001) compared with DRE. Further, MRI showed a higher sensitivity than DRE to diagnose early PCa (92.8% vs. 74.2%; P < 0.001). However, the specificity was not significantly different between them (89.7% vs. 82.1%; P = 0.375). Area under the curve (receiver operating curve) values were calculated as 0.78 ± 0.038 (95% confidence interval [CI], 0.71-0.86), 0.91 ± 0.028 (95% CI, 0.86-0.97), and 0.872 ± 0.028 (95% CI, 0.80-0.92) for DRE-, MRI-, MRI + DRE-based PCa predictions, respectively. The prediction performance of MRI was better than that of DRE (DeLong test, z = 3.632, P = 0.0003) and MRI + DRE (DeLong test, z = 3.715, P = 0.0002). Conclusion For resectable PCa, the diagnostic potential of MRI in assessing the T stage was higher than that of DRE. However, DRE is still valuable, especially for patients with locally advanced PCa.
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Affiliation(s)
- Junming Zhu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaohui Wu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuting Xue
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaodong Li
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qingshui Zheng
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xueyi Xue
- Department of Urology, Urology Research Institute, The First Affiliated Hospital; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospitalu; Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhiyang Huang
- Department of Urology Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Shaohao Chen
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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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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Iacob R, Stoicescu ER, Cerbu S, Manolescu DL, Bardan R, Cumpănaş A. Could Biparametric MRI Replace Multiparametric MRI in the Management of Prostate Cancer? Life (Basel) 2023; 13:465. [PMID: 36836822 PMCID: PMC9961917 DOI: 10.3390/life13020465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
Prostate cancer (PCa) is a worldwide epidemiological problem, since it is one of the most prevalent types of neoplasia among men, and the third-leading cause of cancer-related deaths, after lung and colorectal tumors. Unfortunately, the early stages of PCa have a wide range of unspecific symptoms. For these reasons, early diagnosis and accurate evaluation of suspicious lesions are crucial. Multiparametric MRI (mpMRI) is currently the imaging modality of choice for diagnostic screening and local staging of PCa, but also has a leading role in guiding biopsies and in treatment biparametric MRI (bpMRI) could partially replace mpMRI due to its lack of adverse reactions caused by contrast agents, relatively lower costs, and shorter acquisition time. Further, 31 relevant articles regarding the advantages and disadvantages of the aforementioned imaging techniques were scanned. As a result, while bpMRI has comparable accuracy in detecting PCa, its roles in the other steps of PCa management are limited.
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Affiliation(s)
- Roxana Iacob
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Emil-Robert Stoicescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Simona Cerbu
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Diana-Luminiţa Manolescu
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Răzvan Bardan
- Discipline of Urology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Alin Cumpănaş
- Discipline of Urology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
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Reijnen JS, Ryg U, Marthinsen JB, Schönhardt I, Seierstad T, Hole KH. Monoparametric high-resolution diffusion weighted MRI as a possible first step in an MRI-directed diagnostic pathway for men with suspicion of prostate cancer. Front Oncol 2023; 13:1102860. [PMID: 36798813 PMCID: PMC9927387 DOI: 10.3389/fonc.2023.1102860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 02/01/2023] Open
Abstract
Purpose To explore if a high-resolution diffusion weighted MRI sequence (DWI-only) could be used as a first step in an MRI-directed diagnostic pathway. Methods Prospective single center study that between December 2017 and August 2018 included 129 consecutive patients with suspicion of prostate cancer into a PI-RADS-based MRI-directed diagnostic pathway. All patients had multiparametric MRI (mpMRI). Based on only the transversal high-resolution DWI images two consultant radiologists prospectively categorized the findings as positive, equivocal, or negative for clinically significant cancer. The radiologists then interpreted the mpMRI and assigned a PI-RADS score. A third independent reader retrospectively categorized the DWI-only exams without access to the mpMRI. The interpretations of DWI-only were compared to the PI-RADS classification from mpMRI and the histopathology from the biopsies. Non-biopsied patients were followed in a safety net monitoring for 56 months. Results Based on DWI-only, 29 (22.5%) of the exams were categorized as negative, 38 (29.5%) as equivocal and 62 (48.1%) as positive. Of the 56 patients with PI-RADS 4-5 at mpMRI, 55 were also categorized as positive at DWI-only. All patients diagnosed with clinically significant cancer were identified using DWI-only. 56 months of safety net monitoring did not reveal any clinically significant cancers among patients with exams categorized as negative or equivocal. There was high inter-reader agreement on positive findings, but less agreement on negative and equivocal findings. Conclusions In this concept study, the monoparametric DWI-only identified all patients with clinically significant cancer in a mpMRI-directed diagnostic pathway.
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Affiliation(s)
- Jeroen Sebastiaan Reijnen
- Department of Radiology, Sørlandet Hospital Trust, Kristiansand, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Una Ryg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Jon B. Marthinsen
- Department of Radiology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Irina Schönhardt
- Department of Pathology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Therese Seierstad
- Division of Radiology and Nuclear Medicine, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Knut H. Hole
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Radiumhospitalet, Oslo University Hospital, Oslo, Norway,*Correspondence: Knut H. Hole,
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Colarieti A, Shaida N, Thiruchelvam N, Barrett T. Transperineal Ultrasound Before and After Prostatectomy: Technical Approach and Description. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3125-3135. [PMID: 35866181 PMCID: PMC9796877 DOI: 10.1002/jum.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
This study assessed the feasibility of dynamic transperineal ultrasound (TPUS) pre/post-radical prostatectomy (RP). Ninety-eight patients were scanned pre-operatively and at four time-points post-operatively. TPUS was performed in 98 patients using an abdominal transducer at rest, during pelvic floor contraction (PFC) and Valsalva (VS) maneuver in supine and standing positions. Urodynamic evaluations included bladder neck angle at rest/PFC/VS, and degree of bladder neck movement. Pre-operative and post-operative measurements were technically feasible in >85% (supine) and >90% (standing) of patients. TPUS offers a reliable non-invasive dynamic assessment of the pelvic floor post-prostatectomy and may prove a useful adjunct for guiding exercises to preserve continence.
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Affiliation(s)
| | - Nadeem Shaida
- Department of Radiology, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
| | - Nikesh Thiruchelvam
- Department of Urology, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
- CamPARI Clinic, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
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11
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Biparametric prostate MRI: impact of a deep learning-based software and of quantitative ADC values on the inter-reader agreement of experienced and inexperienced readers. Radiol Med 2022; 127:1245-1253. [PMID: 36114928 PMCID: PMC9587977 DOI: 10.1007/s11547-022-01555-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
Abstract
Objective To investigate the impact of an artificial intelligence (AI) software and quantitative ADC (qADC) on the inter-reader agreement, diagnostic performance, and reporting times of prostate biparametric MRI (bpMRI) for experienced and inexperienced readers. Materials and methods A total of 170 multiparametric MRI (mpMRI) of patients with suspicion of prostate cancer (PCa) were retrospectively reviewed by one experienced and one inexperienced reader three times, following a wash-out period. First, only the bpMRI sequences, including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) sequences, and apparent diffusion coefficient (ADC) maps, were used. Then, bpMRI and quantitative ADC values were used. Lastly, bpMRI and the AI software were used. Inter-reader agreement between the two readers and between each reader and the mpMRI original reports was calculated. Detection rates and reporting times were calculated for each group. Results Inter-reader agreement with respect to mpMRI was moderate for bpMRI, Quantib, and qADC for both the inexperienced (weighted k of 0.42, 0.45, and 0.41, respectively) and the experienced radiologists (weighted k of 0.44, 0.46, and 0.42, respectively). Detection rate of PCa was similar between the inexperienced (0.24, 0.26, and 0.23) and the experienced reader (0.26, 0.27 and 0.27), for bpMRI, Quantib, and qADC, respectively. Reporting times were lower for Quantib (8.23, 7.11, and 9.87 min for the inexperienced reader and 5.62, 5.07, and 6.21 min for the experienced reader, for bpMRI, Quantib, and qADC, respectively). Conclusions AI and qADC did not have a significant impact on the diagnostic performance of both readers. The use of Quantib was associated with lower reporting times.
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12
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Caglic I, Sushentsev N, Colarieti A, Warren AY, Shah N, Lamb BW, Barrett T. Value of the capsular enhancement sign on dynamic contrast-enhanced prostate multiparametric MRI for the detection of extracapsular extension. Eur J Radiol 2022; 150:110275. [DOI: 10.1016/j.ejrad.2022.110275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 01/10/2023]
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13
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Dinneen E, Allen C, Strange T, Heffernan-Ho D, Banjeglav J, Lindsay J, Mulligan JP, Briggs T, Nathan S, Sridhar A, Grierson J, Haider A, Panayi C, Patel D, Freeman A, Aning J, Persad R, Ahmad I, Dutto L, Oakley N, Ambrosi A, Parry T, Kasivisvanathan V, Giganti F, Shaw G, Punwani S. Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy. Diagnostics (Basel) 2022; 12:1057. [PMID: 35626214 PMCID: PMC9139507 DOI: 10.3390/diagnostics12051057] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1-5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77-0.86). The AUC was 0.76 (95% CI: 0.64-0.88), 0.78 (0.72-0.84), and 0.92 (0.88-0.96) for biparametric scans, PI-QUAL 1-3, and PI-QUAL 4-5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Clare Allen
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Tom Strange
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Daniel Heffernan-Ho
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Jelena Banjeglav
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Jamie Lindsay
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - John-Patrick Mulligan
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Tim Briggs
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Senthil Nathan
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Ashwin Sridhar
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Christos Panayi
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Dominic Patel
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Alex Freeman
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Jonathan Aning
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol BS10 5NB, UK; (J.A.); (R.P.)
| | - Raj Persad
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol BS10 5NB, UK; (J.A.); (R.P.)
| | - Imran Ahmad
- Department of Urology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, 1345 Govan Road, Glasgow G51 4TF, UK; (I.A.); (L.D.)
| | - Lorenzo Dutto
- Department of Urology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, 1345 Govan Road, Glasgow G51 4TF, UK; (I.A.); (L.D.)
| | - Neil Oakley
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK;
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milano, Italy;
| | - Tom Parry
- Centre for Medical Imaging, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London W1W 7TS, UK;
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
- Centre for Medical Imaging, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London W1W 7TS, UK;
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14
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Diffusion-Weighted MRI in the Genitourinary System. J Clin Med 2022; 11:jcm11071921. [PMID: 35407528 PMCID: PMC9000195 DOI: 10.3390/jcm11071921] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Diffusion weighted imaging (DWI) constitutes a major functional parameter performed in Magnetic Resonance Imaging (MRI). The DW sequence is performed by acquiring a set of native images described by their b-values, each b-value representing the strength of the diffusion MR gradients specific to that sequence. By fitting the data with models describing the motion of water in tissue, an apparent diffusion coefficient (ADC) map is built and allows the assessment of water mobility inside the tissue. The high cellularity of tumors restricts the water diffusion and decreases the value of ADC within tumors, which makes them appear hypointense on ADC maps. The role of this sequence now largely exceeds its first clinical apparitions in neuroimaging, whereby the method helped diagnose the early phases of cerebral ischemic stroke. The applications extend to whole-body imaging for both neoplastic and non-neoplastic diseases. This review emphasizes the integration of DWI in the genitourinary system imaging by outlining the sequence's usage in female pelvis, prostate, bladder, penis, testis and kidney MRI. In gynecologic imaging, DWI is an essential sequence for the characterization of cervix tumors and endometrial carcinomas, as well as to differentiate between leiomyosarcoma and benign leiomyoma of the uterus. In ovarian epithelial neoplasms, DWI provides key information for the characterization of solid components in heterogeneous complex ovarian masses. In prostate imaging, DWI became an essential part of multi-parametric Magnetic Resonance Imaging (mpMRI) to detect prostate cancer. The Prostate Imaging-Reporting and Data System (PI-RADS) scoring the probability of significant prostate tumors has significantly contributed to this success. Its contribution has established mpMRI as a mandatory examination for the planning of prostate biopsies and radical prostatectomy. Following a similar approach, DWI was included in multiparametric protocols for the bladder and the testis. In renal imaging, DWI is not able to robustly differentiate between malignant and benign renal tumors but may be helpful to characterize tumor subtypes, including clear-cell and non-clear-cell renal carcinomas or low-fat angiomyolipomas. One of the most promising developments of renal DWI is the estimation of renal fibrosis in chronic kidney disease (CKD) patients. In conclusion, DWI constitutes a major advancement in genitourinary imaging with a central role in decision algorithms in the female pelvis and prostate cancer, now allowing promising applications in renal imaging or in the bladder and testicular mpMRI.
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15
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Cole AP, Langbein BJ, Giganti F, Fennessy FM, Tempany CM, Emberton M. Is perfect the enemy of good? Weighing the evidence for biparametric MRI in prostate cancer. Br J Radiol 2022; 95:20210840. [PMID: 34826223 PMCID: PMC8978228 DOI: 10.1259/bjr.20210840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022] Open
Abstract
The role of multiparametric MRI in diagnosis, staging and treatment planning for prostate cancer is well established. However, there remain several challenges to widespread adoption. One such challenge is the duration and cost of the examination. Abbreviated exams omitting contrast-enhanced sequences may help address this challenge. In this review, we will discuss the rationale for biparametric MRI for detection and characterization of clinically significant prostate cancer prior to biopsy and synthesize the published literature. We will weigh up the advantages and disadvantages to this approach and lay out a conceptual cost/benefit analysis regarding adoption of biparametric MRI.
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Affiliation(s)
| | | | | | | | - Clare M. Tempany
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Michael J, Neuzil K, Altun E, Bjurlin MA. Current Opinion on the Use of Magnetic Resonance Imaging in Staging Prostate Cancer: A Narrative Review. Cancer Manag Res 2022; 14:937-951. [PMID: 35256864 PMCID: PMC8898014 DOI: 10.2147/cmar.s283299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Accurate staging is critical for treatment planning and prognosis in men with prostate Cancer. Prostate magnetic imaging resonance (MRI) may aid in the staging evaluation by verifying organ-confined status, assessing the status of the pelvic lymph nodes, and establishing the local extent of the tumor in patients being considered for therapy. MRI has a high specificity for diagnosing extracapsular extension, and therefore may impact the decision to perform nerve sparing prostatectomy, along with seminal vesicle invasion and lymph node metastases; however, its sensitivity remains limited. Current guidelines vary significantly regarding endorsing the use of MRI for staging locoregional disease. For high-risk prostate cancer, most guidelines recommend cross sectional imaging, including MRI, to evaluate for more extensive disease that may merit change in radiation field, extended androgen deprivation therapy, or guiding surgical planning. Although MRI offers reasonable performance characteristics to evaluate bone metastases, guidelines continue to support the use of bone scintigraphy. Emerging imaging technologies, including coupling positron emission tomography (PET) with MRI, have the potential to improve the accuracy of prostate cancer staging with the use of novel radiotracers.
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Affiliation(s)
- Jamie Michael
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Kevin Neuzil
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Correspondence: Marc A Bjurlin, Associate Professor, Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, 2nd Floor, Chapel Hill, NC, USA, Email
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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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