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Lin Y, Belue MJ, Yilmaz EC, Law YM, Merriman KM, Phelps TE, Gelikman DG, Ozyoruk KB, Lay NS, Merino MJ, Wood BJ, Gurram S, Choyke PL, Harmon SA, Pinto PA, Turkbey B. Deep learning-based image quality assessment: impact on detection accuracy of prostate cancer extraprostatic extension on MRI. Abdom Radiol (NY) 2024; 49:2891-2901. [PMID: 38958754 PMCID: PMC11300622 DOI: 10.1007/s00261-024-04468-5] [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: 04/18/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE To assess impact of image quality on prostate cancer extraprostatic extension (EPE) detection on MRI using a deep learning-based AI algorithm. MATERIALS AND METHODS This retrospective, single institution study included patients who were imaged with mpMRI and subsequently underwent radical prostatectomy from June 2007 to August 2022. One genitourinary radiologist prospectively evaluated each patient using the NCI EPE grading system. Each T2WI was classified as low- or high-quality by a previously developed AI algorithm. Fisher's exact tests were performed to compare EPE detection metrics between low- and high-quality images. Univariable and multivariable analyses were conducted to assess the predictive value of image quality for pathological EPE. RESULTS A total of 773 consecutive patients (median age 61 [IQR 56-67] years) were evaluated. At radical prostatectomy, 23% (180/773) of patients had EPE at pathology, and 41% (131/318) of positive EPE calls on mpMRI were confirmed to have EPE. The AI algorithm classified 36% (280/773) of T2WIs as low-quality and 64% (493/773) as high-quality. For EPE grade ≥ 1, high-quality T2WI significantly improved specificity for EPE detection (72% [95% CI 67-76%] vs. 63% [95% CI 56-69%], P = 0.03), but did not significantly affect sensitivity (72% [95% CI 62-80%] vs. 75% [95% CI 63-85%]), positive predictive value (44% [95% CI 39-49%] vs. 38% [95% CI 32-43%]), or negative predictive value (89% [95% CI 86-92%] vs. 89% [95% CI 85-93%]). Sensitivity, specificity, PPV, and NPV for EPE grades ≥ 2 and ≥ 3 did not show significant differences attributable to imaging quality. For NCI EPE grade 1, high-quality images (OR 3.05, 95% CI 1.54-5.86; P < 0.001) demonstrated a stronger association with pathologic EPE than low-quality images (OR 1.76, 95% CI 0.63-4.24; P = 0.24). CONCLUSION Our study successfully employed a deep learning-based AI algorithm to classify image quality of prostate MRI and demonstrated that better quality T2WI was associated with more accurate prediction of EPE at final pathology.
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Affiliation(s)
- Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore, Singapore
| | - Katie M Merriman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - David G Gelikman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Kutsev B Ozyoruk
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Nathan S Lay
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA.
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Windisch O, Diana M, Tilki D, Marra G, Martini A, Valerio M. Intraoperative technologies to assess margin status during radical prostatectomy - a narrative review. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00868-2. [PMID: 39025926 DOI: 10.1038/s41391-024-00868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
Positive surgical margin (PSM) is a frequent concern for surgeons performing radical prostatectomy for prostate cancer (PCa). PSM are recognized as risk factors for earlier biochemical recurrence and expose patients to adjuvant or salvage treatments such as external radiotherapy and hormonotherapy. Several strategies have been established to reduce PSM rate, while still allowing safe nerve-sparing surgery. Precise preoperative staging by multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy is recommended to identify suspicious areas of extracapsular extension (ECE) that warrant special attention during dissection. However, even with optimal imaging, ECE can be missed, some cancers are not well defined or visible, and capsular incision during surgery remains an issue. Hence, intraoperative frozen section techniques, such as the neurovascular structure-adjacent frozen section examination (NeuroSAFE) have been developed and lately widely disseminated. The NeuroSAFE technique reduces PSM rate while allowing higher rate of nerve-sparing surgery. However, its use is limited to high volume or expert center because of its high barrier-to-entry in terms of logistics, human resources and expertise, as well as cost. Also, NeuroSAFE is a time-consuming process, even in expert hands. To address these issues, several technologies have been developed for an ex vivo and in vivo use. Ex vivo technology such as fluorescent confocal microscopy and intraoperative PET-CT require the extraction of the specimen for preparation, and digital images acquisition. In vivo technology, such as augmented reality based on mpMRI images and PSMA-fluorescent guided surgery have the advantage to provide an intracorporeal analysis of the completeness of the resection. The current manuscript provides a narrative review of established techniques, and details several new and promising techniques for intraoperative PSM assessment.
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Affiliation(s)
- O Windisch
- Service of Urology, Department of Surgery, Geneva University Hospitals, Genève, Switzerland.
- Faculty of Medicine, Geneva University, Genève, Switzerland.
| | - M Diana
- Faculty of Medicine, Geneva University, Genève, Switzerland
| | - D Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - G Marra
- Department of Surgical Sciences, San Giovanni Battista Hospital and University of Turin, Turin, Italy
| | - A Martini
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Valerio
- Service of Urology, Department of Surgery, Geneva University Hospitals, Genève, Switzerland
- Faculty of Medicine, Geneva University, Genève, Switzerland
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Gundogdu B, Medved M, Chatterjee A, Engelmann R, Rosado A, Lee G, Oren NC, Oto A, Karczmar GS. Self-supervised multicontrast super-resolution for diffusion-weighted prostate MRI. Magn Reson Med 2024; 92:319-331. [PMID: 38308149 PMCID: PMC11288973 DOI: 10.1002/mrm.30047] [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: 06/27/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE This study addresses the challenge of low resolution and signal-to-noise ratio (SNR) in diffusion-weighted images (DWI), which are pivotal for cancer detection. Traditional methods increase SNR at high b-values through multiple acquisitions, but this results in diminished image resolution due to motion-induced variations. Our research aims to enhance spatial resolution by exploiting the global structure within multicontrast DWI scans and millimetric motion between acquisitions. METHODS We introduce a novel approach employing a "Perturbation Network" to learn subvoxel-size motions between scans, trained jointly with an implicit neural representation (INR) network. INR encodes the DWI as a continuous volumetric function, treating voxel intensities of low-resolution acquisitions as discrete samples. By evaluating this function with a finer grid, our model predicts higher-resolution signal intensities for intermediate voxel locations. The Perturbation Network's motion-correction efficacy was validated through experiments on biological phantoms and in vivo prostate scans. RESULTS Quantitative analyses revealed significantly higher structural similarity measures of super-resolution images to ground truth high-resolution images compared to high-order interpolation (p< $$ < $$ 0.005). In blind qualitative experiments,96 . 1 % $$ 96.1\% $$ of super-resolution images were assessed to have superior diagnostic quality compared to interpolated images. CONCLUSION High-resolution details in DWI can be obtained without the need for high-resolution training data. One notable advantage of the proposed method is that it does not require a super-resolution training set. This is important in clinical practice because the proposed method can easily be adapted to images with different scanner settings or body parts, whereas the supervised methods do not offer such an option.
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Affiliation(s)
- Batuhan Gundogdu
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Milica Medved
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | | | - Roger Engelmann
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Avery Rosado
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Grace Lee
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Nisa C Oren
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
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4
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Stanzione A, Lee KL, Sanmugalingam N, Rajendran I, Sushentsev N, Caglič I, Barrett T. Expect the unexpected: investigating discordant prostate MRI and biopsy results. Eur Radiol 2024; 34:4810-4820. [PMID: 38503918 PMCID: PMC11213781 DOI: 10.1007/s00330-024-10702-x] [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: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES To evaluate discrepant radio-pathological outcomes in biopsy-naïve patients undergoing prostate MRI and to provide insights into the underlying causes. MATERIALS AND METHODS A retrospective analysis was conducted on 2780 biopsy-naïve patients undergoing prostate MRI at a tertiary referral centre between October 2015 and June 2022. Exclusion criteria were biopsy not performed, indeterminate MRI findings (PI-RADS 3), and clinically insignificant PCa (Gleason score 3 + 3). Patients with discrepant findings between MRI and biopsy results were categorised into two groups: MRI-negative/Biopsy-positive and MRI-positive/Biopsy-negative (biopsy-positive defined as Gleason score ≥ 3 + 4). An expert uroradiologist reviewed discrepant cases, retrospectively re-assigning PI-RADS scores, identifying any missed MRI targets, and evaluating the quality of MRI scans. Potential explanations for discrepancies included MRI overcalls (including known pitfalls), benign pathology findings, and biopsy targeting errors. RESULTS Patients who did not undergo biopsy (n = 1258) or who had indeterminate MRI findings (n = 204), as well as those with clinically insignificant PCa (n = 216), were excluded, with a total of 1102 patients analysed. Of these, 32/1,102 (3%) were classified as MRI-negative/biopsy-positive and 117/1102 (11%) as MRI-positive/biopsy-negative. In the MRI-negative/Biopsy-positive group, 44% of studies were considered non-diagnostic quality. Upon retrospective image review, target lesions were identified in 28% of cases. In the MRI-positive/Biopsy-negative group, 42% of cases were considered to be MRI overcalls, and 32% had an explanatory benign pathological finding, with biopsy targeting errors accounting for 11% of cases. CONCLUSION Prostate MRI demonstrated a high diagnostic accuracy, with low occurrences of discrepant findings as defined. Common reasons for MRI-positive/Biopsy-negative cases included explanatory benign findings and MRI overcalls. CLINICAL RELEVANCE STATEMENT This study highlights the importance of optimal prostate MRI image quality and expertise in reducing diagnostic errors, improving patient outcomes, and guiding appropriate management decisions in the prostate cancer diagnostic pathway. KEY POINTS • Discrepancies between prostate MRI and biopsy results can occur, with higher numbers of MRI-positive/biopsy-negative relative to MRI-negative/biopsy-positive cases. • MRI-positive/biopsy-negative cases were mostly overcalls or explainable by benign biopsy findings. • In about one-third of MRI-negative/biopsy-positive cases, a target lesion was retrospectively identified.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131, Naples, Italy
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nimalan Sanmugalingam
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Ishwariya Rajendran
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Iztok Caglič
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK.
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5
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Coelho FMA, Baroni RH. Strategies for improving image quality in prostate MRI. Abdom Radiol (NY) 2024:10.1007/s00261-024-04396-4. [PMID: 38940911 DOI: 10.1007/s00261-024-04396-4] [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: 03/31/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024]
Abstract
Prostate magnetic resonance imaging (MRI) stands as the cornerstone in diagnosing prostate cancer (PCa), offering superior detection capabilities while minimizing unnecessary biopsies. Despite its critical role, global disparities in MRI diagnostic performance persist, stemming from variations in image quality and radiologist expertise. This manuscript reviews the challenges and strategies for enhancing image quality in prostate MRI, spanning patient preparation, MRI unit optimization, and radiology team engagement. Quality assurance (QA) and quality control (QC) processes are pivotal, emphasizing standardized protocols, meticulous patient evaluation, MRI unit workflow, and radiology team performance. Additionally, artificial intelligence (AI) advancements offer promising avenues for improving image quality and reducing acquisition times. The Prostate-Imaging Quality (PI-QUAL) scoring system emerges as a valuable tool for assessing MRI image quality. A comprehensive approach addressing technical, procedural, and interpretative aspects is essential to ensure consistent and reliable prostate MRI outcomes.
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Affiliation(s)
| | - Ronaldo Hueb Baroni
- Department of Radiology, Hospital Israelita Albert Einstein, 627 Albert Einstein Ave., Sao Paulo, SP, 05652-900, Brazil.
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Correia ETDO, Baydoun A, Li Q, Costa DN, Bittencourt LK. Emerging and anticipated innovations in prostate cancer MRI and their impact on patient care. Abdom Radiol (NY) 2024:10.1007/s00261-024-04423-4. [PMID: 38877356 DOI: 10.1007/s00261-024-04423-4] [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: 03/30/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
Prostate cancer (PCa) remains the leading malignancy affecting men, with over 3 million men living with the disease in the US, and an estimated 288,000 new cases and almost 35,000 deaths in 2023 in the United States alone. Over the last few decades, imaging has been a cornerstone in PCa care, with a crucial role in the detection, staging, and assessment of PCa recurrence or by guiding diagnostic or therapeutic interventions. To improve diagnostic accuracy and outcomes in PCa care, remarkable advancements have been made to different imaging modalities in recent years. This paper focuses on reviewing the main innovations in the field of PCa magnetic resonance imaging, including MRI protocols, MRI-guided procedural interventions, artificial intelligence algorithms and positron emission tomography, which may impact PCa care in the future.
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Affiliation(s)
| | - Atallah Baydoun
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Qiubai Li
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daniel N Costa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Leonardo Kayat Bittencourt
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Radiology, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
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Woernle A, Englman C, Dickinson L, Kirkham A, Punwani S, Haider A, Freeman A, Kasivisivanathan V, Emberton M, Hines J, Moore CM, Allen C, Giganti F. Picture Perfect: The Status of Image Quality in Prostate MRI. J Magn Reson Imaging 2024; 59:1930-1952. [PMID: 37804007 DOI: 10.1002/jmri.29025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
Magnetic resonance imaging is the gold standard imaging modality for the diagnosis of prostate cancer (PCa). Image quality is a fundamental prerequisite for the ability to detect clinically significant disease. In this critical review, we separate the issue of image quality into quality improvement and quality assessment. Beginning with the evolution of technical recommendations for scan acquisition, we investigate the role of patient preparation, scanner factors, and more advanced sequences, including those featuring Artificial Intelligence (AI), in determining image quality. As means of quality appraisal, the published literature on scoring systems (including the Prostate Imaging Quality score), is evaluated. Finally, the application of AI and teaching courses as ways to facilitate quality assessment are discussed, encouraging the implementation of future image quality initiatives along the PCa diagnostic and monitoring pathway. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisivanathan
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- North East London Cancer Alliance & North Central London Cancer Alliance Urology, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
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van Velthoven R, Diamand R, Mozer P, Barry de Longchamp N. Letter to the Editor on "Comparison in Detection Rate of Clinically Significant Prostate Cancer Between Microultrasound-guided Prostate Biopsy (ExactVu) and Multiparametric Resonance Imaging-guided Prostate Biopsy (Koelis System)". Urology 2024:S0090-4295(24)00346-7. [PMID: 38729267 DOI: 10.1016/j.urology.2024.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/17/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Roland van Velthoven
- Urology Department, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Mozer
- Service d'Urologie, Groupe Hospitalier Pitié-Salpétrière, Paris, France
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Trecarten S, Sunnapwar AG, Clarke GD, Liss MA. Prostate MRI for the detection of clinically significant prostate cancer: Update and future directions. Adv Cancer Res 2024; 161:71-118. [PMID: 39032957 DOI: 10.1016/bs.acr.2024.04.002] [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: 07/23/2024]
Abstract
PURPOSE OF REVIEW In recent decades, there has been an increasing role for magnetic resonance imaging (MRI) in the detection of clinically significant prostate cancer (csPC). The purpose of this review is to provide an update and outline future directions for the role of MRI in the detection of csPC. RECENT FINDINGS In diagnosing clinically significant prostate cancer pre-biopsy, advances include our understanding of MRI-targeted biopsy, the role of biparametric MRI (non-contrast) and changing indications, for example the role of MRI in screening for prostate cancer. Furthermore, the role of MRI in identifying csPC is maturing, with emphasis on standardization of MRI reporting in active surveillance (PRECISE), clinical staging (EPE grading, MET-RADS-P) and recurrent disease (PI-RR, PI-FAB). Future directions of prostate MRI in detecting csPC include quality improvement, artificial intelligence and radiomics, positron emission tomography (PET)/MRI and MRI-directed therapy. SUMMARY The utility of MRI in detecting csPC has been demonstrated in many clinical scenarios, initially from simply diagnosing csPC pre-biopsy, now to screening, active surveillance, clinical staging, and detection of recurrent disease. Continued efforts should be undertaken not only to emphasize the reporting of prostate MRI quality, but to standardize reporting according to the appropriate clinical setting.
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Affiliation(s)
- Shaun Trecarten
- Department of Urology, UT Health San Antonio, San Antonio, TX, United States
| | - Abhijit G Sunnapwar
- Department of Radiology, UT Health San Antonio, San Antonio, TX, United States
| | - Geoffrey D Clarke
- Department of Radiology, UT Health San Antonio, San Antonio, TX, United States
| | - Michael A Liss
- Department of Urology, UT Health San Antonio, San Antonio, TX, United States.
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10
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Belue MJ, Law YM, Marko J, Turkbey E, Malayeri A, Yilmaz EC, Lin Y, Johnson L, Merriman KM, Lay NS, Wood BJ, Pinto PA, Choyke PL, Harmon SA, Turkbey B. Deep Learning-Based Interpretable AI for Prostate T2W MRI Quality Evaluation. Acad Radiol 2024; 31:1429-1437. [PMID: 37858505 PMCID: PMC11015987 DOI: 10.1016/j.acra.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023]
Abstract
RATIONALE AND OBJECTIVES Prostate MRI quality is essential in guiding prostate biopsies. However, assessment of MRI quality is subjective with variation. Quality degradation sources exert varying impacts based on the sequence under consideration, such as T2W versus DWI. As a result, employing sequence-specific techniques for quality assessment could yield more advantageous outcomes. This study aims to develop an AI tool that offers a more consistent evaluation of T2W prostate MRI quality, efficiently identifying suboptimal scans while minimizing user bias. MATERIALS AND METHODS This retrospective study included 1046 patients from three cohorts (ProstateX [n = 347], All-comer in-house [n = 602], enriched bad-quality MRI in-house [n = 97]) scanned between January 2011 and May 2022. An expert reader assigned T2W MRIs a quality score. A train-validation-test split of 70:15:15 was applied, ensuring equal distribution of MRI scanners and protocols across all partitions. T2W quality AI classification model was based on 3D DenseNet121 architecture using MONAI framework. In addition to multiclassification, binary classification was utilized (Classes 0/1 vs. 2). A score of 0 was given to scans considered non-diagnostic or unusable, a score of 1 was given to those with acceptable diagnostic quality with some usability but with some quality distortions present, and a score of 2 was given to those considered optimal diagnostic quality and usability. Partial occlusion sensitivity maps were generated for anatomical correlation. Three body radiologists assessed reproducibility within a subgroup of 60 test cases using weighted Cohen Kappa. RESULTS The best validation multiclass accuracy of 77.1% (121/157) was achieved during training. In the test dataset, multiclassification accuracy was 73.9% (116/157), whereas binary accuracy was 84.7% (133/157). Sub-class sensitivity for binary quality distortion classification for class 0 was 100% (18/18), and sub-class specificity for T2W classification of absence/minimal quality distortions for class 2 was 90.5% (95/105). All three readers showed moderate to substantial agreement with ground truth (R1-R3 κ = 0.588, κ = 0.649, κ = 0.487, respectively), moderate to substantial agreement with each other (R1-R2 κ = 0.599, R1-R3 κ = 0.612, R2-R3 κ = 0.685), fair to moderate agreement with AI (R1-R3 κ = 0.445, κ = 0.410, κ = 0.292, respectively). AI showed substantial agreement with ground truth (κ = 0.704). 3D quality heatmap evaluation revealed that the most critical non-diagnostic quality imaging features from an AI perspective related to obscuration of the rectoprostatic space (94.4%, 17/18). CONCLUSION The 3D AI model can assess T2W prostate MRI quality with moderate accuracy and translate whole sequence-level classification labels into 3D voxel-level quality heatmaps for interpretation. Image quality has a significant downstream impact on ruling out clinically significant cancers. AI may be able to help with reproducible identification of MRI sequences requiring re-acquisition with explainability.
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Affiliation(s)
- Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.)
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore (Y.M.L.)
| | - Jamie Marko
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA (J.M.)
| | - Evrim Turkbey
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA (E.T., A.M., B.J.W.)
| | - Ashkan Malayeri
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA (E.T., A.M., B.J.W.)
| | - Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.)
| | - Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.)
| | - Latrice Johnson
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.)
| | - Katie M Merriman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.)
| | - Nathan S Lay
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.)
| | - Bradford J Wood
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA (E.T., A.M., B.J.W.); Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (B.J.W.)
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (P.A.P.)
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.)
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.)
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (M.J.B., E.C.Y., Y.L., L.J., K.M.M, N.S.L., P.L.C., S.A.H., B.T.).
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11
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Rodríguez-Sánchez L, Emberton M, de Reijke T, Stricker P, Miñana B, Bianco F, Escrig JLD, Lantz A, Sanchez-Salas R. Revisiting Delphi to Create a Basis for the Future of Focal Therapy for Prostate Cancer. World J Mens Health 2024; 42:245-255. [PMID: 37853538 PMCID: PMC10949031 DOI: 10.5534/wjmh.230160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Theo de Reijke
- Department of Urology, UMC Amsterdam University Hospital, Amsterdam, the Netherlands
| | - Phillip Stricker
- Department of Urology, St. Vincent's Private Hospital and Clinic, Melbourne, Australia
| | - Bernardino Miñana
- Department of Urology, Clinica Universidad de Navarra, Madrid, Spain
| | - Fernando Bianco
- Urological Research Network, Nova Southeastern University, Hollywood, FL, USA
| | | | - Anna Lantz
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Rafael Sanchez-Salas
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
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12
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Barrett T, Lee KL, de Rooij M, Giganti F. Update on Optimization of Prostate MR Imaging Technique and Image Quality. Radiol Clin North Am 2024; 62:1-15. [PMID: 37973236 DOI: 10.1016/j.rcl.2023.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Prostate MR imaging quality has improved dramatically over recent times, driven by advances in hardware, software, and improved functional imaging techniques. MRI now plays a key role in prostate cancer diagnostic work-up, but outcomes of the MRI-directed pathway are heavily dependent on image quality and optimization. MR sequences can be affected by patient-related degradations relating to motion and susceptibility artifacts which may enable only partial mitigation. In this Review, we explore issues relating to prostate MRI acquisition and interpretation, mitigation strategies at a patient and scanner level, PI-QUAL reporting, and future directions in image quality, including artificial intelligence solutions.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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13
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Khan A, Moore CM, Minhaj Siddiqui M. Prostate MRI and image quality: The urologist's perspective. Eur J Radiol 2024; 170:111255. [PMID: 38101197 DOI: 10.1016/j.ejrad.2023.111255] [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: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
The development of different imaging modalities of the prostate has significantly improved tumor detection, patient risk stratification, and quality of care.Among these, multiparametric magnetic resonance imaging (mp-MRI) has emerged as the most sensitive tool.It is useful in the diagnosis, localization, risk stratification, and staging of clinically significant prostate cancer, PCa. As a result, mp-MRI of the prostate is recommended as the initial diagnostic test for men with suspected PCa. A multidisciplinary approach is crucial in the diagnosis and management of prostate cancer and mp-MRI plays a fundamental role in this scenario.While many aspects of image quality certainly fall within the purview of radiology, it is important to recognize that urologists must also be attentive to imaging quality when utilizing mp-MRI to facilitate PCa management. We present our viewpoint as urologists on how image quality impacts the management of men diagnosed with PCa andattempt to identify the factors that impact mp-MRI image quality, consequences of poor image quality, and finally suggestions for improvements.
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Affiliation(s)
- Amir Khan
- Division of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Caroline M Moore
- Division of Surgical and Interventional Sciences, University College London, London, UK.
| | - M Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.
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14
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Singh S, Giganti F, Dickinson L, Rogers H, Kanber B, Clemente J, Pye H, Heavey S, Stopka-Farooqui U, Johnston EW, Moore CM, Freeman A, Whitaker HC, Alexander DC, Panagiotaki E, Punwani S. Prostate MR image quality of apparent diffusion coefficient maps versus fractional intracellular volume maps from VERDICT MRI using the PI-QUAL score and a dedicated Likert scale for artefacts. Eur J Radiol 2023; 168:111109. [PMID: 37769532 DOI: 10.1016/j.ejrad.2023.111109] [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: 04/07/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE This study aimed to assess the image quality of apparent diffusion coefficient (ADC) maps derived from conventional diffusion-weighted MRI and fractional intracellular volume maps (FIC) from VERDICT MRI (Vascular, Extracellular, Restricted Diffusion for Cytometry in Tumours) in patients from the INNOVATE trial. The inter-reader agreement was also assessed. METHODS Two readers analysed both ADC and FIC maps from 57 patients enrolled in the INNOVATE prospective trial. Image quality was assessed using the Prostate Imaging Quality (PI-QUAL) score and a subjective image quality Likert score (Likert-IQ). The image quality of FIC and ADC were compared using a Wilcoxon Signed Ranks test. The inter-reader agreement was assessed with Cohen's kappa. RESULTS There was no statistically significant difference between the PI-QUAL score for FIC datasets compared to ADC datasets for either reader (p = 0.240 and p = 0.614). Using the Likert-IQ score, FIC image quality was higher compared to ADC (p = 0.021) as assessed by reader-1 but not for reader-2 (p = 0.663). The inter-reader agreement was 'fair' for PI-QUAL scoring of datasets with FIC maps at 0.27 (95% confidence interval; 0.08-0.46) and ADC datasets at 0.39 (95% confidence interval 0.22-0.57). For Likert scoring, the inter-reader agreement was also 'fair' for FIC maps at 0.38 (95% confidence interval; 0.10-0.65) and substantial for ADC maps at 0.62 (95% confidence interval; 0.39-0.86). CONCLUSION Image quality was comparable for FIC and ADC. The inter-reader agreement was similar when using PIQUAL for both FIC and ADC datasets but higher for ADC maps compared to FIC maps using the image quality Likert score.
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Affiliation(s)
- Saurabh Singh
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Harriet Rogers
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Baris Kanber
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Joey Clemente
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Hayley Pye
- Division of Surgery & Interventional Science, University College London, London, UK; Molecular Diagnostics and Therapeutics Group, University College London, UK
| | - Susan Heavey
- Division of Surgery & Interventional Science, University College London, London, UK; Molecular Diagnostics and Therapeutics Group, University College London, UK
| | - Urszula Stopka-Farooqui
- Division of Surgery & Interventional Science, University College London, London, UK; Molecular Diagnostics and Therapeutics Group, University College London, UK
| | - Edward W Johnston
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK; Department of Interventional Radiology, Royal Marsden Hospital, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley C Whitaker
- Molecular Diagnostics and Therapeutics Group, University College London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
| | - Eleftheria Panagiotaki
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
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15
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Nakamoto A, Onishi H, Tsuboyama T, Fukui H, Ota T, Yano K, Kiso K, Honda T, Tarewaki H, Koyama Y, Tatsumi M, Tomiyama N. High-resolution Diffusion-weighted Imaging of the Prostate Using Multiplexed Sensitivity-encoding: Comparison with the Conventional and Reduced Field-of-view Techniques. Magn Reson Med Sci 2023:mp.2023-0039. [PMID: 37899224 DOI: 10.2463/mrms.mp.2023-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
PURPOSE To compare objective and subjective image quality, lesion conspicuity, and apparent diffusion coefficient (ADC) of high-resolution multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE-DWI) with conventional DWI (c-DWI) and reduced FOV DWI (rFOV-DWI) in prostate MRI. METHODS Forty-seven patients who underwent prostate MRI, including c-DWI, rFOV-DWI, and MUSE-DWI, were retrospectively evaluated. SNR and ADC of normal prostate tissue and contrast-to-noise ratio (CNR) and ADC of prostate cancer (PCa) were measured and compared between the three sequences. Image quality and lesion conspicuity were independently graded by two radiologists using a 5-point scale and compared between the three sequences. RESULTS The SNR of normal prostate tissue was significantly higher with rFOV-DWI than with the other two DWI techniques (P ≤ 0.01). The CNR of the PCa was significantly higher with rFOV-DWI than with MUSE-DWI (P < 0.05). The ADC of normal prostate tissue measured by rFOV-DWI was lower than that measured by MUSE-DWI and c-DWI (P < 0.01), while there was no difference in the ADC of cancers. In the qualitative analysis, MUSE-DWI showed significantly higher scores than rFOV-DWI and c-DWI for visibility of anatomy and overall image quality in both readers, and significantly higher scores for distortion in one of the two readers (P < 0.001). There was no difference in lesion conspicuity between the three sequences. CONCLUSION High-resolution MUSE-DWI showed higher image quality and reduced distortion compared to c-DWI, while maintaining a wide FOV and similar ADC quantification, although no difference in lesion conspicuity was observed.
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Affiliation(s)
- Atsushi Nakamoto
- Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine
| | - Hiromitsu Onishi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Takahiro Tsuboyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Hideyuki Fukui
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Takashi Ota
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Keigo Yano
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Kengo Kiso
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Toru Honda
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Hiroyuki Tarewaki
- Division of Radiology, Department of Medical Technology, Osaka University Hospital
| | - Yoshihiro Koyama
- Division of Radiology, Department of Medical Technology, Osaka University Hospital
| | - Mitsuaki Tatsumi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
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16
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Almansour H, Chernyak V. Revamping Prostate MRI Protocols: From Simple Modifications to Quality Improvement. Radiology 2023; 309:e232398. [PMID: 37815444 DOI: 10.1148/radiol.232398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Haidara Almansour
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tuebingen, Germany (H.A.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C.)
| | - Victoria Chernyak
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tuebingen, Germany (H.A.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C.)
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17
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Sabbah M, Gutierrez P, Puech P. MA-QC: Free online software for prostate MR quality control and PI-QUAL assessment. Eur J Radiol 2023; 167:111027. [PMID: 37634441 DOI: 10.1016/j.ejrad.2023.111027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To validate MRI Analyzer Quality Control (MA-QC), a free and open-source online software designed to facilitate MR data acquisition quality control and PI-QUAL score calculation. MATERIAL AND METHODS MA-QC is a web-based software, designed for analysing DICOM data related to MR acquisition parameters. The software allows automatic extraction of 18 technical criteria, and manual input of 12 visual criteria, to calculate the PI-QUAL score. We collected 100 prostate MRI datasets from four MR device manufacturers to test data compatibility, automatic sequence recognition, and robustness of technical criteria extraction from DICOM data. The main issue was to determine the spatial resolution in the phase and frequency directions, due to variable encoding of the DICOM datasets. RESULTS Acquisition data could be extracted from all sample examinations (100%), with a median analysis speed of 15.2 ± 4.4 images per second and mean processing time of 96 [11-326] seconds per examination. MA-CQ automatically detected the optimal T2-w, DWI and DCE sequences in 71 out of 100 (71%) cases, and required manual selection of at least one sequence in 29 out of 100 (29%) cases to get the best parameters. Display of technical criteria for the 3 sequences was instantaneous. PI-QUAL score could be calculated in all cases. CONCLUSION This software brings substantial help in the quality assessment of prostate MRI examinations, by providing fast extraction of series data and the 18 technical parameters of PI-QUAL. PI-QUAL scoring can be performed in less than two minutes, helping to focus on the visual criteria, allowing use of this software in the clinical workflow in the aim of improving overall image quality in prostate MR imaging.
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Affiliation(s)
- M Sabbah
- Univ. Lille, CHU Lille, Department of Genito-urinary Imaging, F-59000 Lille, France
| | - P Gutierrez
- CH Dunkerque, Department of Radiology, F-59240 Dunkerque, France
| | - P Puech
- Univ. Lille, Inserm, CHU Lille, Department of Radiology, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.
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18
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Giganti F, Ng A, Asif A, Chan VWS, Rossiter M, Nathan A, Khetrapal P, Dickinson L, Punwani S, Brew-Graves C, Freeman A, Emberton M, Moore CM, Allen C, Kasivisvanathan V. Global Variation in Magnetic Resonance Imaging Quality of the Prostate. Radiology 2023; 309:e231130. [PMID: 37815448 DOI: 10.1148/radiol.231130] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background High variability in prostate MRI quality might reduce accuracy in prostate cancer detection. Purpose To prospectively evaluate the quality of MRI scanners taking part in the quality control phase of the global PRIME (Prostate Imaging Using MRI ± Contrast Enhancement) trial using the Prostate Imaging Quality (PI-QUAL) standardized scoring system, give recommendations on how to improve the MRI protocols, and establish whether MRI quality could be improved by these recommendations. Materials and Methods In the prospective clinical trial (PRIME), for each scanner, centers performing prostate MRI submitted five consecutive studies and the MRI protocols (phase I). Submitted data were evaluated in consensus by two expert genitourinary radiologists using the PI-QUAL scoring system that evaluates MRI diagnostic quality using five points (1 and 2 = nondiagnostic; 3 = sufficient; 4 = adequate, 5 = optimal) between September 2021 and August 2022. Feedback was provided for scanners not achieving a PI-QUAL 5 score, and centers were invited to resubmit new imaging data using the modified protocol (phase II). Descriptive comparison of outcomes was made between the MRI scanners, feedback provided, and overall PI-QUAL scores. Results In phase I, 41 centers from 18 countries submitted a total of 355 multiparametric MRI studies from 71 scanners, with nine (13%) scanners achieving a PI-QUAL score of 3, 39 (55%) achieving a score of 4, and 23 (32%) achieving a score of 5. Of the 48 (n = 71 [68%]) scanners that received feedback to improve, the dynamic contrast-enhanced sequences were those that least adhered to the Prostate Imaging Reporting and Data System, version 2.1, criteria (44 of 48 [92%]), followed by diffusion-weighted imaging (20 of 48 [42%]) and T2-weighted imaging (19 of 48 [40%]). In phase II, 36 centers from 17 countries resubmitted revised studies, resulting in a total of 62 (n = 64 [97%]) scanners with a final PI-QUAL score of 5. Conclusion Substantial variation in global prostate MRI acquisition parameters as a measure of quality was observed, particularly with DCE sequences. Basic evaluation and modifications to MRI protocols using PI-QUAL can lead to substantial improvements in quality. Clinical trial registration no. NCT04571840 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Almansour and Chernyak in this issue.
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Affiliation(s)
- Francesco Giganti
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Alexander Ng
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Aqua Asif
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Vinson Wai-Shun Chan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Marimo Rossiter
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Arjun Nathan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Pramit Khetrapal
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Louise Dickinson
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Shonit Punwani
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Chris Brew-Graves
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Alex Freeman
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Mark Emberton
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Caroline M Moore
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Clare Allen
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Veeru Kasivisvanathan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
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19
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Robertson SH, Owenby E, Beasley C, Wall L, Gray B, Boru I, Kalisz KR, Kruse DE, Marin D, Thomas SP, Macdonald EB, Purysko AS, Gupta RT. Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach. Eur J Radiol 2023; 166:110998. [PMID: 37506475 DOI: 10.1016/j.ejrad.2023.110998] [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: 04/21/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To evaluate the utility of the PI-QUAL score in assessing protocol changes aimed to improve image quality from a non-endorectal coil prostate MR imaging protocol during a 9-month quality improvement (QI) project and to quantify the inter-reader agreement of PI-QUAL scores between radiologists, technologists, and physicists. METHODS This retrospective study audited 1,012 multiparametric prostate MRI examinations as part of a national QI project according to the PI-QUAL standard. PI-QUAL scores were used to inform MR protocol changes. Following the project, 4 radiologists, 2 technologists, and 1 medical physicist collectively audited an additional set of 150 examinations to identify statistical improvements in image quality using the two-tailed Wilcoxon rank sum test. The improvements due to individual protocol changes were assessed among subsets of the 1,012 examinations which compared examinations occurring before and after the isolated protocol change. Inter-reader variability was assessed using the percent majority agreement and the average standard deviation of PI-QUAL scores between evaluators. RESULTS During this QI project, PI-QUAL scores improved from 3.67 ± 0.75 to 4.16 ± 0.59 (p < 0.01) after implementing a series of protocol changes. Among a subset of 451 cases, we found that adopting R/L rather than A/P phase encoding reduced distortion in diffusion-weighted imaging (DW) from 21.6% (41/190 A/P phase encoded cases) to 11.5% (30/261 R/L phase encoded cases) (p < 0.01). Similarly, in the same 451 cases, adopting R/L phase encoding in T2WI reduced breathing motion artifacts from 34.6% (94/272 A/P phase encoding cases) to 12.8% (23/179 R/L phase encoding cases) (p < 0.01). DWI wraparound artifact was mitigated by employing a full-pelvis shim and enabling the abdomen shim option. The occurrence of low signal-to-noise ratio was reduced from 19.4% (19/98 cases without a weight-based threshold) to 6.3% (10/160) by instituting a weight-based threshold for using an endorectal coil (p < 0.01). The percent majority agreement was similar between radiologists, technologists and physicists, and all evaluators combined (72%, 77%, and 67%, respectively). CONCLUSIONS PI-QUAL can evaluate image quality changes resulting from protocol optimizations at both the exam- and series-levels. With training, radiologists, technologists, and physicists can perform PI-QUAL scoring with similar performance. Broadening the scope of the quality improvement team can result in meaningful and lasting change.
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Affiliation(s)
- Scott H Robertson
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Erica Owenby
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Christopher Beasley
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Lisa Wall
- Department of Radiology, Duke University Medical Center, Durham, NC, United States
| | - Bradley Gray
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Issack Boru
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Kevin R Kalisz
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Danielle E Kruse
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Sarah P Thomas
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Erin B Macdonald
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Andrei S Purysko
- Section of Abdominal Imaging, Imaging Institute, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, United States; Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, United States.
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20
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Ponsiglione A, Stanzione A, Califano G, De Giorgi M, Collà Ruvolo C, D'Iglio I, Morra S, Longo N, Imbriaco M, Cuocolo R. MR image quality in local staging of prostate cancer: Role of PI-QUAL in the detection of extraprostatic extension. Eur J Radiol 2023; 166:110973. [PMID: 37453275 DOI: 10.1016/j.ejrad.2023.110973] [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: 04/29/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To assess the impact of prostate MRI image quality by means of the Prostate Imaging Quality (PI-QUAL) score, on the identification of extraprostatic extension of disease (EPE), predicted using the EPE Grade Score, Likert Scale Score (LSS) and a clinical nomogram (MSKCCn). METHODS We retrospectively included 105 patients with multiparametric prostate MRI prior to prostatectomy. Two radiologists evaluated image quality using PI-QUAL (≥4 was considered high quality) in consensus. All cases were also scored using the EPE Grade, the LSS, and the MSKCCn (dichotomized). Inter-rater reproducibility for each score was also assessed. Accuracy was calculated for the entire population and by image quality, considering two thresholds for EPE Grade (≥2 and = 3) and LSS (≥3 and ≥ 4) and using McNemar's test for comparison. RESULTS Overall, 66 scans achieved high quality. The accuracy of EPE Grade ranged from 0.695 to 0.743, while LSS achieved values between 0.705 and 0.733. Overall sensitivity for the radiological scores (range = 0.235-0.529) was low irrespective of the PI-QUAL score, while specificity was higher (0.775-0.986). The MSKCCn achieved an AUC of 0.76, outperforming EPE Grade (=3 threshold) in studies with suboptimal image quality (0.821 vs 0.564, p = 0.016). EPE Grade (=3 threshold) accuracy was also better in high image quality studies (0.849 vs 0.564, p = 0.001). Reproducibility was good to excellent overall (95 % Confidence Interval range = 0.782-0.924). CONCLUSION Assessing image quality by means of PI-QUAL is helpful in the evaluation of EPE, as a scan of low quality makes its performance drop compared to clinical staging tools.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Imma D'Iglio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Baronissi, Italy
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21
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Coelho FMA, Amaral LTW, Mitsutake LKN, Mussi TC, Baroni RH. Quality assessment of prostate MRI by PI-QUAL score: Inter-reader agreement and impact on prostate cancer local staging at 3 Tesla. Eur J Radiol 2023; 165:110921. [PMID: 37336037 DOI: 10.1016/j.ejrad.2023.110921] [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: 03/08/2023] [Revised: 05/07/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To evaluate whether the Prostate Imaging Quality (PI-QUAL) score impacts prostate cancer (PCa) staging on MRI. The secondary goal was to test inter-reader agreement among radiologists experienced in prostate imaging. METHOD A retrospective, single-center study with patients who underwent 3 Tesla prostate MRI scans and were submitted to radical prostatectomy (RP) between January 2018 and November 2021 and were eligible for our study. Extraprostatic extension (EPE) data were collected from original MR reports (EPEm) and pathological reports of RP specimens (EPEp). Three expert prostate radiologists (ESUR/ESUI criteria R1, R2, R3) independently evaluated all MRI exams according to PI-QUAL score for image quality (1 to 5; 1: poor, 5: excellent), blinded to original imaging reports and clinical data. We studied the diagnostic performance of MRI using pooled data from PI-QUAL scores (≤3 vs. ≥4). We also performed univariate and multivariate analyses to assess the PI-QUAL score impact on local PCa staging. Cohen's K and Tau-b Kendall tests were used to assess the inter-reader agreement for PI-QUAL score, T2WI, DWI, and DCE. RESULTS Our final cohort included 146 patients, of which 27.4% presented EPE on pathology. We observed no impact of imaging quality on accuracy for EPE prediction: AUC of 0.750 (95% CI 0.26-1) for PI-QUAL ≤ 3 and 0.705 (95% CI 0.618-0.793) for PI-QUAL ≥ 4. The multivariate analysis demonstrated a correlation of EPEm (OR 3.25, p 0.001) and ISUP grade group (OR 1.89, p 0.012) to predict EPEp. The inter-reader agreement was moderate to substantial (0.539 for R1-R2, 0.522 for R2-R3, and 0.694 for R1-R3). CONCLUSION Our clinical impact evaluation showed no direct correlation between MRI quality by PI-QUAL score and accuracy in detecting EPE in patients undergoing RP. Additionally, we had moderate to a substantial inter-reader agreement for the PI-QUAL score.
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Affiliation(s)
| | - Lucas Tadashi Wada Amaral
- Department of Radiology, Hospital Israelita Albert Einstein. 627 Albert Einstein Ave. Sao Paulo, SP 05652-900, Brazil.
| | - Leonardo Kenji Nesi Mitsutake
- Department of Radiology, Hospital Israelita Albert Einstein. 627 Albert Einstein Ave. Sao Paulo, SP 05652-900, Brazil.
| | - Thais Caldara Mussi
- Department of Radiology, Hospital Israelita Albert Einstein. 627 Albert Einstein Ave. Sao Paulo, SP 05652-900, Brazil.
| | - Ronaldo Hueb Baroni
- Department of Radiology, Hospital Israelita Albert Einstein. 627 Albert Einstein Ave. Sao Paulo, SP 05652-900, Brazil.
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22
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Wang R, Pinto D, Liu T, Hamade M, Jubane M, Arif A, Boateng J, Maloney S, Amin A, Sandhu J, Nini S, Manov J, Tordjman L, Villavicencio J, Chamoun M, Leslom S, Aristizabal J, Felix M, Gomez-Rodriguez C, Alessandrino F. Effect of a dedicated PI-QUAL curriculum on the assessment of prostate MRI quality. Eur J Radiol 2023; 164:110865. [PMID: 37167684 DOI: 10.1016/j.ejrad.2023.110865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The Prostate Imaging Quality (PI-QUAL) score is a metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study evaluated the impact of a prostate MRI quality training lecture on the participant's ability to assess prostate MRI image quality. METHODS Eighteen in-training-radiologists of varying experience in reviewing diagnostic prostate MRI assessed the image quality of ten examinations. Then, they attended a dedicated lecture on MRI quality assessment using the PI-QUAL score. After the lecture, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic (ROC) analysis. The reference standard was the PI-QUAL score assessed by a fellowship trained abdominal radiologist with experience in reading prostate MRI. RESULTS There was a significant improvement in the average area under the curve (AUC) for assessment of prostate MRI image quality from baseline (0.82; [0.576 - 0.888]) to post teaching (1.0; [0.954-1]), with an improvement of 0.18 (p < 0.03). When ROC curves were computed for different cohorts stratified based on year of training, difference ranged from 0.48 for second year residents to 0.32 for fourth year residents (p < 0.001-0.01). For abdominal imaging fellows, the pre-teaching AUC was 0.9 [0.557-1] and post teaching AUC was 1 [0.957-1], a difference of 0.1 (p = 0.20). CONCLUSIONS A dedicated lecture on PI-QUAL improved the ability of radiologists-in-training to assess prostate MRI image quality, with variable impact depending on year of training.
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Affiliation(s)
- Richard Wang
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Denver Pinto
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - TianHao Liu
- Division of Biostatistics, Department of Public Health Science, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Mohamad Hamade
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Maverick Jubane
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Aazim Arif
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Joseph Boateng
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Sean Maloney
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Ayush Amin
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jagteshwar Sandhu
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Saad Nini
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - John Manov
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Laura Tordjman
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Joseph Villavicencio
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Michelle Chamoun
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Salman Leslom
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Julieta Aristizabal
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Marcelo Felix
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Carolina Gomez-Rodriguez
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Francesco Alessandrino
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA; Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA.
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23
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Brembilla G, Lavalle S, Parry T, Cosenza M, Russo T, Mazzone E, Pellegrino F, Stabile A, Gandaglia G, Briganti A, Montorsi F, Esposito A, De Cobelli F. Impact of prostate imaging quality (PI-QUAL) score on the detection of clinically significant prostate cancer at biopsy. Eur J Radiol 2023; 164:110849. [PMID: 37141845 DOI: 10.1016/j.ejrad.2023.110849] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/20/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To investigate the impact of Prostate Imaging Quality (PI-QUAL) scores on the diagnostic performance of multiparametric MRI (mpMRI) in a targeted biopsy cohort. PATIENTS AND METHODS 300 patients who underwent both mpMRI and biopsy were included. PI-QUAL scores were retrospectively assigned by two radiologists in consensus and were correlated to pre-biopsy PI-RADS scores and biopsy outcomes. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥ 2. RESULTS Image quality was optimal (PI-QUAL ≥ 4) in 249/300 (83%) and suboptimal (PI-QUAL < 4) in 51/300 (17%). The proportion of PI-RADS 3 scores referred for biopsy was higher in scans of suboptimal vs optimal quality (51% vs 33%). For PI-QUAL < 4 scans, the positive predictive value (PPV) was lower compared to PI-QUAL ≥ 4 (35% [95%CI: 22, 48] vs 48% [95%CI: 41, 55]; difference -13% [95%CI: -27, 2]; p 0.090), as was the detection rate of csPCa in both PI-RADS 3 and PI-RADS 4-5 (15% vs 23% and 56 vs 63%, respectively). The overall MRI quality increased over time. CONCLUSIONS Scan quality may affect the diagnostic performance of prostate mpMRI in patients undergoing MRI-guided biopsy. Scans of suboptimal quality (PI-QUAL < 4) were associated with lower PPV for csPCa.
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Affiliation(s)
- Giorgio Brembilla
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Salvatore Lavalle
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Tom Parry
- Centre for Medical Imaging, University College London, UCL Centre for Medical Imaging, 43-45 Foley Street, London, UK
| | - Michele Cosenza
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Tommaso Russo
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Pellegrino
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Armando Stabile
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Giorgio Gandaglia
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Montorsi
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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