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Zhao W, Qin S, Wang Q, Chen Y, Liu K, Xin P, Lang N. Assessment of Hidden Blood Loss in Spinal Metastasis Surgery: A Comprehensive Approach with MRI-Based Radiomics Models. J Magn Reson Imaging 2024; 59:2023-2032. [PMID: 37578031 DOI: 10.1002/jmri.28954] [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: 06/06/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Patients undergoing surgery for spinal metastasis are predisposed to hidden blood loss (HBL), which is associated with poor surgical outcomes but unpredictable. PURPOSE To evaluate the role of MRI-based radiomics models for assess the risk of HBL in patients undergoing spinal metastasis surgery. STUDY TYPE Retrospective. SUBJECTS 202 patients (42.6% female) operated on for spinal metastasis with a mean age of 58 ± 11 years were divided into a training (n = 162) and a validation cohort (n = 40). FIELD STRENGTH/SEQUENCE 1.5T or 3.0T scanners. Sagittal T1-weighted and fat-suppressed T2-weighted imaging sequences. ASSESSMENT HBL was calculated using the Gross formula. Patients were classified as low and high HBL group, with 1000 mL as the threshold. Radiomics models were constructed with radiomics features. The radiomics score (Radscore) was obtained from the optimal radiomics model. Clinical variables were accessed using univariate and multivariate logistic regression analyses. Independent risk variables were used to build a clinical model. Clinical variables combined with Radscore were used to establish a combined model. STATISTICAL TESTS Predictive performance was evaluated using area under the curve (AUC), accuracy, sensitivity, specificity, and F1 score. Calibration curves and decision curves analyses were produced to evaluate the accuracy and clinical utility. RESULTS Among the radiomics models, the fusion (T1WI + FS-T2WI) model demonstrated the highest predictive efficacy (AUC: 0.744, 95% confidence interval [CI]: 0.576-0.914). The Radscore model (AUC: 0.809, 95% CI: 0.664-0.954) performs slightly better than the clinical model (AUC: 0.721, 95% CI: 0.524-0.918; P = 0.418) and the combined model (AUC: 0.752, 95% CI: 0.593-0.911; P = 0.178). DATA CONCLUSION A radiomics model may serve as a promising assessment tool for the risk of HBL in patients undergoing spinal metastasis surgery, and guide perioperative planning to improve surgical outcomes. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Weili Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Siyuan Qin
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Qizheng Wang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yongye Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ke Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Peijin Xin
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
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Jiang X, Hu Z, Wang S, Zhang Y. Deep Learning for Medical Image-Based Cancer Diagnosis. Cancers (Basel) 2023; 15:3608. [PMID: 37509272 PMCID: PMC10377683 DOI: 10.3390/cancers15143608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: The application of deep learning technology to realize cancer diagnosis based on medical images is one of the research hotspots in the field of artificial intelligence and computer vision. Due to the rapid development of deep learning methods, cancer diagnosis requires very high accuracy and timeliness as well as the inherent particularity and complexity of medical imaging. A comprehensive review of relevant studies is necessary to help readers better understand the current research status and ideas. (2) Methods: Five radiological images, including X-ray, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission computed tomography (PET), and histopathological images, are reviewed in this paper. The basic architecture of deep learning and classical pretrained models are comprehensively reviewed. In particular, advanced neural networks emerging in recent years, including transfer learning, ensemble learning (EL), graph neural network, and vision transformer (ViT), are introduced. Five overfitting prevention methods are summarized: batch normalization, dropout, weight initialization, and data augmentation. The application of deep learning technology in medical image-based cancer analysis is sorted out. (3) Results: Deep learning has achieved great success in medical image-based cancer diagnosis, showing good results in image classification, image reconstruction, image detection, image segmentation, image registration, and image synthesis. However, the lack of high-quality labeled datasets limits the role of deep learning and faces challenges in rare cancer diagnosis, multi-modal image fusion, model explainability, and generalization. (4) Conclusions: There is a need for more public standard databases for cancer. The pre-training model based on deep neural networks has the potential to be improved, and special attention should be paid to the research of multimodal data fusion and supervised paradigm. Technologies such as ViT, ensemble learning, and few-shot learning will bring surprises to cancer diagnosis based on medical images.
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Grants
- RM32G0178B8 BBSRC
- MC_PC_17171 MRC, UK
- RP202G0230 Royal Society, UK
- AA/18/3/34220 BHF, UK
- RM60G0680 Hope Foundation for Cancer Research, UK
- P202PF11 GCRF, UK
- RP202G0289 Sino-UK Industrial Fund, UK
- P202ED10, P202RE969 LIAS, UK
- P202RE237 Data Science Enhancement Fund, UK
- 24NN201 Fight for Sight, UK
- OP202006 Sino-UK Education Fund, UK
- RM32G0178B8 BBSRC, UK
- 2023SJZD125 Major project of philosophy and social science research in colleges and universities in Jiangsu Province, China
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Affiliation(s)
- Xiaoyan Jiang
- School of Mathematics and Information Science, Nanjing Normal University of Special Education, Nanjing 210038, China; (X.J.); (Z.H.)
| | - Zuojin Hu
- School of Mathematics and Information Science, Nanjing Normal University of Special Education, Nanjing 210038, China; (X.J.); (Z.H.)
| | - Shuihua Wang
- School of Computing and Mathematical Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | - Yudong Zhang
- School of Computing and Mathematical Sciences, University of Leicester, Leicester LE1 7RH, UK;
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3
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Zhao LT, Liu ZY, Xie WF, Shao LZ, Lu J, Tian J, Liu JG. What benefit can be obtained from magnetic resonance imaging diagnosis with artificial intelligence in prostate cancer compared with clinical assessments? Mil Med Res 2023; 10:29. [PMID: 37357263 DOI: 10.1186/s40779-023-00464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023] Open
Abstract
The present study aimed to explore the potential of artificial intelligence (AI) methodology based on magnetic resonance (MR) images to aid in the management of prostate cancer (PCa). To this end, we reviewed and summarized the studies comparing the diagnostic and predictive performance for PCa between AI and common clinical assessment methods based on MR images and/or clinical characteristics, thereby investigating whether AI methods are generally superior to common clinical assessment methods for the diagnosis and prediction fields of PCa. First, we found that, in the included studies of the present study, AI methods were generally equal to or better than the clinical assessment methods for the risk assessment of PCa, such as risk stratification of prostate lesions and the prediction of therapeutic outcomes or PCa progression. In particular, for the diagnosis of clinically significant PCa, the AI methods achieved a higher summary receiver operator characteristic curve (SROC-AUC) than that of the clinical assessment methods (0.87 vs. 0.82). For the prediction of adverse pathology, the AI methods also achieved a higher SROC-AUC than that of the clinical assessment methods (0.86 vs. 0.75). Second, as revealed by the radiomics quality score (RQS), the studies included in the present study presented a relatively high total average RQS of 15.2 (11.0-20.0). Further, the scores of the individual RQS elements implied that the AI models in these studies were constructed with relatively perfect and standard radiomics processes, but the exact generalizability and clinical practicality of the AI models should be further validated using higher levels of evidence, such as prospective studies and open-testing datasets.
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Affiliation(s)
- Li-Tao Zhao
- School of Engineering Medicine, Beihang University, Beijing, 100191, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Zhen-Yu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
- University of Chinese Academy of Sciences, Beijing, 100080, China
| | - Wan-Fang Xie
- School of Engineering Medicine, Beihang University, Beijing, 100191, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Li-Zhi Shao
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Peking University, 100191, Beijing, China.
| | - Jie Tian
- School of Engineering Medicine, Beihang University, Beijing, 100191, China.
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China.
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, 100191, Beijing, China.
| | - Jian-Gang Liu
- School of Engineering Medicine, Beihang University, Beijing, 100191, China.
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, 100191, Beijing, China.
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, Beijing, 100029, China.
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El‐Taji O, Evans H, Arora V, Amin S, Kumar M, Rajan TN. Diagnostic and cost‐effectiveness of axial skeleton MRI in staging high‐risk prostate cancer. BJUI COMPASS 2023; 4:346-351. [PMID: 37025475 PMCID: PMC10071081 DOI: 10.1002/bco2.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/24/2022] [Accepted: 12/04/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Current literature suggests that axial skeleton magnetic resonance imaging (AS-MRI) is more sensitive than Tc 99m bone scintigraphy (BS) for detecting bone metastases (BM) in high-risk prostate cancer (PCa). However, BS is still widely performed. Its diagnostic accuracy has been studied; however, its feasibility and cost implications are yet to be examined. Methods We reviewed all patients with high risk PCa undergoing AS-MRI over a 5-year period. AS-MRI was performed on patients with histologically confirmed PCa and either PSA > 20 ng/ml, Gleason ≥8, or TNM Stage ≥T3 or N1 disease. All AS-MRI studies were obtained using a 1.5-T AchievaPhilips™MRI scanner. We compared the AS-MRI positivity and equivocal rate with that of BS. Data were analysed according to Gleason score, T-stage and PSA. Multivariate logistic regression analyses were used to quantify the strength of association between positive scans and clinical variables. Feasibility and burden of expenditure was also evaluated. Results Five hundred three patients with a median age of 72 and a mean PSA of 34.8 ng/ml were analysed. Eighty-eight patients (17.5%) were positive for BM on AS-MRI (mean PSA 99 [95% CI 69.1-129.9]). Comparatively 409 patients (81.3%) were negative for BM on AS-MRI (mean PSA 24.7 (95% CI [21.7-27.7]) (p = 0.007); 1.2% (n = 6) of patients had equivocal results (mean PSA 33.4 [95% CI 10.5-56.3]). There was no significant difference in age (p = 0.122) between this group and patients with a positive scan, but there was a significant difference in PSA (p = 0.028), T stage (p = 0.006) and Gleason score (p = 0.023). In comparison with BS, AS-MRI detection rate was equivalent or higher compared with the literature. Based on NHS tariff calculations, there would be a minimum cost saving of £8406.89. All patients underwent AS-MRI within 14 days. Conclusion The use of AS-MRI to stage BM in high-risk PCa is both feasible and results in a reduced burden of expenditure.
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Affiliation(s)
- Omar El‐Taji
- Department of Urology Wirral University Teaching Hospitals Wirral UK
| | - Hannah Evans
- Department of Urology Wirral University Teaching Hospitals Wirral UK
| | - Vandan Arora
- Department of Radiology Wirral University Teaching Hospitals Wirral UK
- School of Medicine University of Bolton Bolton United Kingdom
| | - Suzanne Amin
- Department of Radiology Wirral University Teaching Hospitals Wirral UK
| | - Manal Kumar
- Department of Urology Wirral University Teaching Hospitals Wirral UK
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5
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Fernandes MC, Yildirim O, Woo S, Vargas HA, Hricak H. The role of MRI in prostate cancer: current and future directions. MAGMA (NEW YORK, N.Y.) 2022; 35:503-521. [PMID: 35294642 PMCID: PMC9378354 DOI: 10.1007/s10334-022-01006-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/16/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
There has been an increasing role of magnetic resonance imaging (MRI) in the management of prostate cancer. MRI already plays an essential role in the detection and staging, with the introduction of functional MRI sequences. Recent advancements in radiomics and artificial intelligence are being tested to potentially improve detection, assessment of aggressiveness, and provide usefulness as a prognostic marker. MRI can improve pretreatment risk stratification and therefore selection of and follow-up of patients for active surveillance. MRI can also assist in guiding targeted biopsy, treatment planning and follow-up after treatment to assess local recurrence. MRI has gained importance in the evaluation of metastatic disease with emerging technology including whole-body MRI and integrated positron emission tomography/MRI, allowing for not only better detection but also quantification. The main goal of this article is to review the most recent advances on MRI in prostate cancer and provide insights into its potential clinical roles from the radiologist's perspective. In each of the sections, specific roles of MRI tailored to each clinical setting are discussed along with its strengths and weakness including already established material related to MRI and the introduction of recent advancements on MRI.
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Affiliation(s)
- Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Onur Yildirim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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Pellinen T, Sandeman K, Blom S, Turkki R, Hemmes A, Välimäki K, Eineluoto J, Kenttämies A, Nordling S, Kallioniemi O, Rannikko A, Mirtti T. Stromal FAP Expression is Associated with MRI Visibility and Patient Survival in Prostate Cancer. CANCER RESEARCH COMMUNICATIONS 2022; 2:172-181. [PMID: 36874403 PMCID: PMC9980917 DOI: 10.1158/2767-9764.crc-21-0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
Some clinically significant prostate cancers are missed by MRI. We asked whether the tumor stroma in surgically treated localized prostate cancer lesions positive or negative with MRI are different in their cellular and molecular properties, and whether the differences are reflected to the clinical course of the disease. We profiled the stromal and immune cell composition of MRI-classified tumor lesions by applying multiplexed fluorescence IHC (mfIHC) and automated image analysis in a clinical cohort of 343 patients (cohort I). We compared stromal variables between MRI-visible lesions, invisible lesions, and benign tissue and assessed the predictive significance for biochemical recurrence (BCR) and disease-specific survival (DSS) using Cox regression and log-rank analysis. Subsequently, we carried out a prognostic validation of the identified biomarkers in a population-based cohort of 319 patients (cohort II). MRI true-positive lesions are different from benign tissue and MRI false-negative lesions in their stromal composition. CD163+ cells (macrophages) and fibroblast activation protein (FAP)+ cells were more abundant in MRI true-positive than in MRI false-negative lesions or benign areas. In MRI true-visible lesions, a high proportion of stromal FAP+ cells was associated with PTEN status and increased immune infiltration (CD8+, CD163+), and predicted elevated risk for BCR. High FAP phenotype was confirmed to be a strong indicator of poor prognosis in two independent patient cohorts using also conventional IHC. The molecular composition of the tumor stroma may determine whether early prostate lesions are detectable by MRI and associates with survival after surgical treatment. Significance These findings may have a significant impact on clinical decision making as more radical treatments may be recommended for men with a combination of MRI-visible primary tumors and FAP+ tumor stroma.
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Affiliation(s)
- Teijo Pellinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Kevin Sandeman
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sami Blom
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Riku Turkki
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Science for Life Laboratory, Department of Oncology & Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Annabrita Hemmes
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Katja Välimäki
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Juho Eineluoto
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Kenttämies
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stig Nordling
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Finland
| | - Olli Kallioniemi
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Science for Life Laboratory, Department of Oncology & Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Antti Rannikko
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,iCAN-Digital Precision Cancer Medicine Flagship, Helsinki, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,iCAN-Digital Precision Cancer Medicine Flagship, Helsinki, Finland
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7
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Ye YX, Guan J, Chen XY, Yu YW, Xu ZM, Zeng SMZ, Wang ZC, Wang BZ, Jiao QC, Zhu HL. A new fluorescently labeled bisphosphonate for theranostics in tumor bone metastasis. Talanta 2021; 235:122796. [PMID: 34517654 DOI: 10.1016/j.talanta.2021.122796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
Bone metastasis of malignant solid tumors has become one of the most serious complications, especially in breast cancer, which was particularly challenging for early detection and treatment in clinical practice. In this work, we reported a new fluorescently labeled bisphosphonate for bone metastasis detection of breast cancer. The designed probes were based on Rhodamine B and bisphosphonate as recognition group, which can specifically target hydroxyapatite (HA) existed in bone tissue. After the osteoclasts were adsorbed on the bone surface, the surrounding microenvironment was acidified, causing the HA to locally dissolve. The probe bound to the HA was then released, and realized the fluorescence turn on under acidic conditions. In vitro experiments showed that G0 was more excellent than G2 owing to shorter connecting arm. Subsequently, we proved that G0 could combine with HA rapidly and exhibit excellent response in solid state. More importantly, we established a model of bone metastasis with MDA-MB-231 cells which was similar to the clinical cases and evaluated the theranostics value of G0 prospectively, which provide the potential application prospect in clinical.
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Affiliation(s)
- Ya-Xi Ye
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China
| | - Jing Guan
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China
| | - Xin-Yue Chen
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China
| | - Ya-Wen Yu
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China
| | - Zhu-Min Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China
| | - Shang-Ming-Zhu Zeng
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China
| | - Zhong-Chang Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China; Institute of Artificial Intelligence Biomedicine, Nanjing University, Nanjing, 210023, PR China
| | - Bao-Zhong Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China.
| | - Qing-Cai Jiao
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China.
| | - Hai-Liang Zhu
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing, 210023, PR China.
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Preliminary Results of an Ongoing Prospective Clinical Trial on the Use of 68Ga-PSMA and 68Ga-DOTA-RM2 PET/MRI in Staging of High-Risk Prostate Cancer Patients. Diagnostics (Basel) 2021; 11:diagnostics11112068. [PMID: 34829417 PMCID: PMC8622332 DOI: 10.3390/diagnostics11112068] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study is to investigate the synergic role of 68Ga-PSMA PET/MRI and 68Ga-DOTA-RM2 PET/MRI in prostate cancer (PCa) staging. We present pilot data on twenty-two patients with biopsy-proven PCa that underwent 68Ga-PSMA PET/MRI for staging purposes, with 19/22 also undergoing 68Gaa-DOTA-RM2 PET/MRI. TNM classification based on image findings was performed and quantitative imaging parameters were collected for each scan. Furthermore, twelve patients underwent radical prostatectomy with the availability of histological data that were used as the gold standard to validate intraprostatic findings. A DICE score between regions of interest manually segmented on the primary tumour on 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and on T2 MRI was computed. All imaging modalities detected the primary PCa in 18/19 patients, with 68Ga-DOTA-RM2 PET not detecting any lesion in 1/19 patients. In the remaining patients, 68Ga-PSMA and MRI were concordant. Seven patients presented seminal vesicles involvement on MRI, with two of these being also detected by 68Ga-PSMA, and 68Ga-DOTA-RM2 PET being negative. Regarding extraprostatic disease, 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and MRI resulted positive in seven, four and five patients at lymph-nodal level, respectively, and at a bone level in three, zero and one patients, respectively. These preliminary results suggest the potential complementary role of 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and MRI in PCa characterization during the staging phase.
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9
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Abstract
More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.
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10
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Van Damme J, Tombal B, Collette L, Van Nieuwenhove S, Pasoglou V, Gérard T, Jamar F, Lhommel R, Lecouvet FE. Comparison of 68Ga-Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography Computed Tomography (PET-CT) and Whole-Body Magnetic Resonance Imaging (WB-MRI) with Diffusion Sequences (DWI) in the Staging of Advanced Prostate Cancer. Cancers (Basel) 2021; 13:cancers13215286. [PMID: 34771449 PMCID: PMC8582508 DOI: 10.3390/cancers13215286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Precise staging is key for the optimal management of advanced prostate cancer. PSMA PET-CT and WB-MRI outperform standard imaging technology for staging high-risk prostate cancer, but direct comparison between both modalities is lacking. The primary endpoint of our study was to compare the diagnostic accuracy of both techniques in the detection of lymph node, bone and visceral metastases against a best valuable comparator (BVC), defined as a consensus adjudication of all lesions on the basis of baseline and follow-up imaging, biological and clinical data and histopathologic confirmation when available. Knowing the diagnostic accuracy of both next generation imaging modalities might influence the diagnostic and therapeutic strategy in prostate cancer by tailoring therapy. However, the impact on treatment and patient outcome of an improved detection of metastases has not been determined yet. Abstract Background: Prostate specific membrane antigen (PSMA) positron emission tomography computed tomography (PET-CT) and whole-body magnetic resonance imaging (WB-MRI) outperform standard imaging technology for the detection of metastasis in prostate cancer (PCa). There are few direct comparisons between both modalities. This paper compares the diagnostic accuracy of PSMA PET-CT and WB-MRI for the detection of metastasis in PCa. One hundred thirty-four patients with newly diagnosed PCa (n = 81) or biochemical recurrence after curative treatment (n = 53) with high-risk features prospectively underwent PSMA PET-CT and WB-MRI. The diagnostic accuracy of both techniques for lymph node, skeletal and visceral metastases was compared against a best valuable comparator (BVC). Overall, no significant difference was detected between PSMA PET-CT and WB-MRI to identify metastatic patients when considering lymph nodes, skeletal and visceral metastases together (AUC = 0.96 (0.92–0.99) vs. 0.90 (0.85–0.95); p = 0.09). PSMA PET-CT, however, outperformed WB-MRI in the subgroup of patients with newly diagnosed PCa for the detection of lymph node metastases (AUC = 0.96 (0.92–0.99) vs. 0.86 (0.79–0.92); p = 0.0096). In conclusion, PSMA PET-CT outperforms WB-MRI for the detection of nodal metastases in primary staging of PCa.
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Affiliation(s)
- Julien Van Damme
- Department of Urology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium; (J.V.D.); (B.T.)
| | - Bertrand Tombal
- Department of Urology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium; (J.V.D.); (B.T.)
| | - Laurence Collette
- International Drug Development Institute (IDDI), B-1341 Louvain-la-Neuve, Belgium;
| | - Sandy Van Nieuwenhove
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC-IMAG), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium; (S.V.N.); (V.P.)
| | - Vassiliki Pasoglou
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC-IMAG), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium; (S.V.N.); (V.P.)
| | - Thomas Gérard
- Department of Nuclear Medicine, Institut de Recherche Expérimentale et Clinique (IREC-MIRO), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium; (T.G.); (F.J.); (R.L.)
| | - François Jamar
- Department of Nuclear Medicine, Institut de Recherche Expérimentale et Clinique (IREC-MIRO), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium; (T.G.); (F.J.); (R.L.)
| | - Renaud Lhommel
- Department of Nuclear Medicine, Institut de Recherche Expérimentale et Clinique (IREC-MIRO), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium; (T.G.); (F.J.); (R.L.)
| | - Frédéric E. Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC-IMAG), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium; (S.V.N.); (V.P.)
- Correspondence:
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11
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Choi MH, Lee SW, Kim HG, Kim JY, Oh SW, Han D, Kim DH. 3D MR fingerprinting (MRF) for simultaneous T1 and T2 quantification of the bone metastasis: Initial validation in prostate cancer patients. Eur J Radiol 2021; 144:109990. [PMID: 34638082 DOI: 10.1016/j.ejrad.2021.109990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the feasibility of using 3-dimensional MRF for bone marrow evaluation in the field of view of prostate MRI for T1 and T2 quantification of prostate cancer bone metastases, as well as comparing it to the ADC value. METHODS In this retrospective study, 30 prostate MRIs were included: 14 cases with prostate cancer bone metastasis and 16 cases without prostate cancer (control). MRF was obtained twice before (nonenhanced [NE] MRF) and after contrast injection (contrast-enhanced [CE] MRF), and T1 and T2 maps were generated from each MRF. Two radiologists independently drew regions of interest (ROIs) on the MRF maps and the ADC maps. Mann-Whitney U tests and the area under the receiver operating characteristic curve (AUROC) evaluated the two-reader means of T1, T2 and ADC values between bone metastasis and normal bone. RESULTS There were 83 ROIs, including 39 bone metastases and 44 normal bone. The two-reader average ADC, NE T2 and CE T2 values were significantly lower and NE T1 and CE T1 values were significantly higher in metastatic bone compared with normal bone (P < 0.001). The AUROC of the ADC was lowest (0.685), which was significantly lower than those of NE T1 (1.0, P = 0.001), NE T2 (0.932, P = 0.004), and CE T2 (0.876, P = 0.031). CONCLUSION MRF to assess the pelvic bone during a prostate gland evaluation provides a reliable parametric map for skeletal work-up. With higher diagnostic performance than the ADC value, NE MRF is a potential alternative for quantifying bone marrow metastases in prostate cancer patients.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Hyun Gi Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee Young Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Se Won Oh
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dongyeob Han
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Dong-Hyun Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
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12
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Belmonte M, Saia G, Zugni F, Alessi S, Colombo A, Summers PE, Luzzago S, Marvaso G, Musi G, De Cobelli O, Jereczek-Fossa BA, Petralia G. The role of MRI in the management of a prostate cancer patient with bone and lymph nodes metastases. A case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021214. [PMID: 34487080 PMCID: PMC8477117 DOI: 10.23750/abm.v92i4.11337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
The use of multiparametric prostate magnetic resonance imaging (mpMRI) is recommended, in the European Association of Urology (EAU) guidelines, for local staging of patients with prostate cancer (PCa). Systemic staging is recommended only for patients with unfavourable intermediate and high-risk disease, with bone and lymph node assessments usually being performed using bone scan (BS) and computed tomography (CT), respectively. Magnetic resonance imaging (MRI) is the imaging technique with the highest sensitivity for the detection of bone metastases and has shown promising results also for lymph node assessments. In this report we illustrate how MRI provided a comprehensive assessment of local disease as well as bone and lymph node metastases in a patient with PCa. (www.actabiomedica.it)
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Affiliation(s)
- Maddalena Belmonte
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Giulia Saia
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Alberto Colombo
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Paul E Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Giulia Marvaso
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy. Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy..
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy. Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy. Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
| | - Barbara A Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy. Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy. Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
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13
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Petralia G, Zugni F, Summers PE, Colombo A, Pricolo P, Grazioli L, Colagrande S, Giovagnoni A, Padhani AR. Whole-body magnetic resonance imaging (WB-MRI) for cancer screening: recommendations for use. Radiol Med 2021; 126:1434-1450. [PMID: 34338948 PMCID: PMC8558201 DOI: 10.1007/s11547-021-01392-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023]
Abstract
Whole-body magnetic resonance imaging (WB-MRI) is currently recommended for cancer screening in adult and paediatric subjects with cancer predisposition syndromes, representing a substantial aid for prolonging health and survival of these subjects with a high oncological risk. Additionally, the number of studies exploring the use of WB-MRI for cancer screening in asymptomatic subjects from the general population is growing. The primary aim of this review was to analyse the acquisition protocols found in the literature, in order to identify common sequences across published studies and to discuss the need of additional ones for specific populations. The secondary aim of this review was to provide a synthesis of current recommendations regarding the use of WB-MRI for cancer screening.
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Affiliation(s)
- Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy.
- Department of Oncology and Hematology, University of Milan, Milan, Italy.
| | - Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paul E Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Alberto Colombo
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi Grazioli
- First Department of Radiology, Civic and University Hospital of Brescia, Brescia, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica Delle Marche, Ancona, Italy
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
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14
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Wu J, Zhu Y, Zhang X, Wang X, Zhang J. An automatic framework for evaluating the vascular permeability of bone metastases from prostate cancer. Phys Med Biol 2021; 66. [PMID: 34010811 DOI: 10.1088/1361-6560/ac02d3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022]
Abstract
Objectives.Vascular permeability can reflect tumorigenesis and metastasis. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can assess microvascular permeability by pharmacokinetic parameter estimation. Most estimation methods require manually selected arterial input function (AIF) or reference regions. However, the result will be unstable due to the annotation, which relies on personal experience. In this study, we propose an automatic framework for evaluating vascular permeability of bone metastases from prostate cancer without selecting AIF.Materials and methods.This retrospective study comprised of 15 prostate cancer patients with bone metastases. Based on clinical consensus for three typical DCE-MRI curve patterns, three characteristic curves as regularization constraints were introduced to the extended Tofts model (ETM) using clustering strategy, and the clustering-based blind identification of multichannel (CBM) framework was then proposed for pharmacokinetic parameter estimation. With automatic segmentation of the whole bone area, we obtained the estimation of the pharmacokinetic parameters in the bone area and quantified for bone metastases. Two experienced radiologists compared the CBM estimations with the diagnostic results and we compared the estimations with those of the ETM in bone metastasis regions to evaluate the feasibility of the CBM framework.Results.The higher signal regions ofKtransandKepindicated the metastasis of prostate cancer, which is consistent with the cancer area marked by the radiologists. In addition, theKtransandKepin bone metastasis regions were significantly higher than in normal bone regions (P < 0.001,P < 0.001). The consistency of estimation by using the CBM framework and conventional ETM method was confirmed by Bland-Altman analysis.Conclusion.The proposed CBM framework can provide a fully automatic and reliable quantitative estimation of vascular permeability for bone metastases in prostate cancer patients.
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Affiliation(s)
- Junjie Wu
- College of Engineering, Peking University, Beijing, People's Republic of China
| | - Yi Zhu
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Xiaoying Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China.,Department of Radiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Jue Zhang
- College of Engineering, Peking University, Beijing, People's Republic of China.,Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China
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15
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Summers P, Saia G, Colombo A, Pricolo P, Zugni F, Alessi S, Marvaso G, Jereczek-Fossa BA, Bellomi M, Petralia G. Whole-body magnetic resonance imaging: technique, guidelines and key applications. Ecancermedicalscience 2021; 15:1164. [PMID: 33680078 PMCID: PMC7929776 DOI: 10.3332/ecancer.2021.1164] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Indexed: 12/15/2022] Open
Abstract
Whole-body magnetic resonance imaging (WB-MRI) is an imaging method without ionising radiation that can provide WB coverage with a core protocol of essential imaging contrasts in less than 40 minutes, and it can be complemented with sequences to evaluate specific body regions as needed. In many cases, WB-MRI surpasses bone scintigraphy and computed tomography in detecting and characterising lesions, evaluating their response to therapy and in screening of high-risk patients. Consequently, international guidelines now recommend the use of WB-MRI in the management of patients with multiple myeloma, prostate cancer, melanoma and individuals with certain cancer predisposition syndromes. The use of WB-MRI is also growing for metastatic breast cancer, ovarian cancer and lymphoma as well as for cancer screening amongst the general population. In light of the increasing interest from clinicians and patients in WB-MRI as a radiation-free technique for guiding the management of cancer and for cancer screening, we review its technical basis, current international guidelines for its use and key applications.
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Affiliation(s)
- Paul Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Saia
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.,Advanced Screening Centers, ASC Italia, 24060 Castelli Calepio, Bergamo, Italy
| | - Alberto Colombo
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Massimo Bellomi
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.,Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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16
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Yoshida A, Higashiyama S, Kawabe J. Assessment of a software for semi-automatically calculating the bone scan index on bone scintigraphy scans. Clin Imaging 2021; 78:14-18. [PMID: 33714920 DOI: 10.1016/j.clinimag.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/20/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
AIMS The incidence of bone metastases exceeds 85% in patients who die from prostate cancer. Bone scintigraphy is the most widely used method for the early detection of bone metastases in prostate cancer. We developed a software program that semi-automatically calculated the bone scan index (BSI) on technetium-99m hydroxymethylene diphosphonate bone scintigraphy scans with a computer-aided diagnosis system (CAD) and examined whether the BSI calculated using this software could replace the extent of disease (EOD) score. METHODS The subjects were 175 patients who were diagnosed with prostate cancer at our hospital and underwent bone scintigraphy. We analyzed receiver operating characteristic curves to determine the BSI cutoff value between EOD groups. The cutoff value was determined based on the maximum value of the sum of the sensitivity and specificity. RESULTS BSI cutoff values of 0.20, 1.56, and 4.56 were used to distinguish between EOD 0 and 1-4 (sensitivity [87.2%] and specificity [100.0%]), between EOD 0- and 2-4 (sensitivity [85.2%] and specificity [92.0%]), and between EOD 0-2 and 3-4 (sensitivity [88.4%] and specificity [99.2%]), respectively. CONCLUSION Our results suggest that this software can calculate BSI, and the software may play a role in predicting prognosis and selecting an appropriate treatment strategy. If a sufficient number of other nuclear medicine tests are performed, creating a similar CAD system is possible.
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Affiliation(s)
- Atsushi Yoshida
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka-City, Osaka-Fu 545-8585, Japan
| | - Shigeaki Higashiyama
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka-City, Osaka-Fu 545-8585, Japan
| | - Joji Kawabe
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka-City, Osaka-Fu 545-8585, Japan.
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17
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Liu F, Dong J, Shen Y, Yun C, Wang R, Wang G, Tan J, Wang T, Yao Q, Wang B, Li L, Mi J, Zhou D, Xiong F. Comparison of PET/CT and MRI in the Diagnosis of Bone Metastasis in Prostate Cancer Patients: A Network Analysis of Diagnostic Studies. Front Oncol 2021; 11:736654. [PMID: 34671558 PMCID: PMC8522477 DOI: 10.3389/fonc.2021.736654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Accurate diagnosis of bone metastasis status of prostate cancer (PCa) is becoming increasingly more important in guiding local and systemic treatment. Positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) have increasingly been utilized globally to assess the bone metastases in PCa. Our meta-analysis was a high-volume series in which the utility of PET/CT with different radioligands was compared to MRI with different parameters in this setting. MATERIALS AND METHODS Three databases, including Medline, Embase, and Cochrane Library, were searched to retrieve original trials from their inception to August 31, 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The methodological quality of the included studies was assessed by two independent investigators utilizing Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A Bayesian network meta-analysis was performed using an arm-based model. Absolute sensitivity and specificity, relative sensitivity and specificity, diagnostic odds ratio (DOR), and superiority index, and their associated 95% confidence intervals (CI) were used to assess the diagnostic value. RESULTS Forty-five studies with 2,843 patients and 4,263 lesions were identified. Network meta-analysis reveals that 68Ga-labeled prostate membrane antigen (68Ga-PSMA) PET/CT has the highest superiority index (7.30) with the sensitivity of 0.91 and specificity of 0.99, followed by 18F-NaF, 11C-choline, 18F-choline, 18F-fludeoxyglucose (FDG), and 18F-fluciclovine PET/CT. The use of high magnetic field strength, multisequence, diffusion-weighted imaging (DWI), and more imaging planes will increase the diagnostic value of MRI for the detection of bone metastasis in prostate cancer patients. Where available, 3.0-T high-quality MRI approaches 68Ga-PSMA PET/CT was performed in the detection of bone metastasis on patient-based level (sensitivity, 0.94 vs. 0.91; specificity, 0.94 vs. 0.96; superiority index, 4.43 vs. 4.56). CONCLUSIONS 68Ga-PSMA PET/CT is recommended for the diagnosis of bone metastasis in prostate cancer patients. Where available, 3.0-T high-quality MRI approaches 68Ga-PSMA PET/CT should be performed in the detection of bone metastasis.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yelong Shen
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Canhua Yun
- Department of Nuclear Medicine, The Second Hospital of Shandong University, Jinan, China
| | - Ruixiao Wang
- Department of Urology Surgery, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Ganggang Wang
- Department of Urology Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jiyang Tan
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Tao Wang
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Qun Yao
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jingyi Mi
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fei Xiong
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, China
- *Correspondence: Fei Xiong,
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18
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Mohd Rohani MF, Zanial AZ, Suppiah S, Phay Phay K, Mohamed Aslum Khan F, Mohamad Najib FH, Mohd Noor N, Arumugam M, Amir Hassan SZ, Vinjamuri S. Bone single-photon emission computed tomography/computed tomography in cancer care in the past decade: a systematic review and meta-analysis as well as recommendations for further work. Nucl Med Commun 2021; 42:9-20. [PMID: 33165258 DOI: 10.1097/mnm.0000000000001306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Skeletal whole-body scintigraphy (WBS), although widely used as a sensitive tool for detecting metastatic bone disease in oncology cases, has relatively low specificity. Indeterminate bone lesions (IBLs) detected by WBS cause a diagnostic dilemma, which hampers further management plans. In the advent of hybrid imaging, single-photon emission computed tomography/computed tomography (SPECT/CT) has been gaining popularity as a tool to improve the characterisation of IBLs detected by WBS. As yet, there has not been a systematic review to objectively evaluate the diagnostic capabilities of SPECT/CT in this area. We conducted a systematic review of relevant electronic databases up to 30 August 2020. The outcomes of interest were the reporting of SPECT/CT to identify benign and malignant IBLs and the calculation of the sensitivity and specificity of the index test, based on histopathological examination or clinical and imaging follow-up as the reference standard. After the risk of bias and eligibility assessment, 12 articles were identified and synthesised in the meta-analysis. The pooled sensitivity and specificity of SPECT/CT for diagnosing IBLs are 93.0% [95% confidence interval (CI) 0.91-0.95] and 96.0% (95% CI 0.94-0.97), respectively. There was heterogeneity of the articles due to variable imaging protocols, duration of follow-up and scoring methods for interpreting the SPECT/CT results. The heterogeneity poses a challenge for accurate interpretation of the true diagnostic capability of SPECT/CT. In conclusion, targeted SPECT/CT improves the specificity of diagnosing bone metastases, but efforts need to be made to standardise the thresholds for SPECT/CT, methodology, as well as harmonising the reporting and interpretation criteria. We also make some recommendations for future works.
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Affiliation(s)
| | | | - Subapriya Suppiah
- Department of Nuclear Medicine, Hospital Kuala Lumpur
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
| | | | | | | | - Noramaliza Mohd Noor
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
| | - Manohar Arumugam
- Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | | | - Sobhan Vinjamuri
- Department of Nuclear Medicine, The Royal Liverpool and Broadgreen University Hospitals, NHS Trust, Liverpool, UK
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19
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Downregulation of miRNA-205 Expression and Biological Mechanism in Prostate Cancer Tumorigenesis and Bone Metastasis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6037434. [PMID: 33178832 PMCID: PMC7646560 DOI: 10.1155/2020/6037434] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/22/2020] [Accepted: 10/15/2020] [Indexed: 12/23/2022]
Abstract
Background The expression and mechanism of microRNA-205 (miRNA-205) in prostate cancer (PCa) and its bone metastasis remain controversial. Materials and Methods The expression and discriminating capability of miRNA-205 were assessed by drawing a forest plot and a summarized receiver operating characteristic (SROC) curve, using data available from 27 miRNA-array and miRNA-sequencing datasets. The miRNA-205 target genes were acquired from online prediction tools, differentially upregulated genes in PCa, and differentially expressed genes (DEGs) after miRNA-205 transfection into PCa cell lines. Functional enrichment analysis was conducted to explore the biological mechanism of miRNA-205 targets. Immunohistochemistry (IHC) was applied to verify the protein level of the hub gene. Results The expression of miRNA-205 in the PCa group (1,461 samples) was significantly lower than that in the noncancer group (510 samples), and the downregulation of miRNA-205 showed excellent sensitivity and specificity in differentiating between the two groups. In bone metastatic PCa, the miRNA-205 level was further reduced than in nonbone metastatic PCa, and it showed a good capability in distinguishing between the two groups. In total, 153 miRNA-205 targets were screened through the three aforementioned methods. Based on the results of functional enrichment analysis, the targets of miRNA-205 were mainly enriched during chromosome segregation and phospholipid-translocating ATPase activity and in the spindle microtubule and the p53 signaling pathway. CDK1 had the highest connectivity in the PPI network analysis and was screened as one of the hub genes. A statistically significant negative correlation between miRNA-205 and CDK1 was observed. The expression of CDK1 in PCa samples was pronouncedly upregulated in terms of both the mRNA level and the protein level when compared with noncancer samples. Conclusion miRNA-205 may play a vital role in PCa tumorigenesis and bone metastasis by targeting CDK1.
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20
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Whole-body magnetic resonance imaging (WB-MRI) reporting with the METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P): inter-observer agreement between readers of different expertise levels. Cancer Imaging 2020; 20:77. [PMID: 33109268 PMCID: PMC7590732 DOI: 10.1186/s40644-020-00350-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P) guidelines are designed to enable reproducible assessment in detecting and quantifying metastatic disease response using whole-body magnetic resonance imaging (WB-MRI) in patients with advanced prostate cancer (APC). The purpose of our study was to evaluate the inter-observer agreement of WB-MRI examination reports produced by readers of different expertise when using the MET-RADS-P guidelines. METHODS Fifty consecutive paired WB-MRI examinations, performed from December 2016 to February 2018 on 31 patients, were retrospectively examined to compare reports by a Senior Radiologist (9 years of experience in WB-MRI) and Resident Radiologist (after a 6-months training) using MET-RADS-P guidelines, for detection and for primary/dominant and secondary response assessment categories (RAC) scores assigned to metastatic disease in 14 body regions. Inter-observer agreement regarding RAC score was evaluated for each region by using weighted-Cohen's Kappa statistics (K). RESULTS The number of metastatic regions reported by the Senior Radiologist (249) and Resident Radiologist (251) was comparable. For the primary/dominant RAC pattern, the agreement between readers was excellent for the metastatic findings in cervical, dorsal, and lumbosacral spine, pelvis, limbs, lungs and other sites (K:0.81-1.0), substantial for thorax, retroperitoneal nodes, other nodes and liver (K:0.61-0.80), moderate for pelvic nodes (K:0.56), fair for primary soft tissue and not assessable for skull due to the absence of findings. For the secondary RAC pattern, agreement between readers was excellent for the metastatic findings in cervical spine (K:0.93) and retroperitoneal nodes (K:0.89), substantial for those in dorsal spine, pelvis, thorax, limbs and pelvic nodes (K:0.61-0.80), and moderate for lumbosacral spine (K:0.44). CONCLUSIONS We found inter-observer agreement between two readers of different expertise levels to be excellent in bone, but mixed in other body regions. Considering the importance of bone metastases in patients with APC, our results favor the use of MET-RADS-P in response to the growing clinical need for monitoring of metastasis in these patients.
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Ishiwata Y, Hieda Y, Kaki S, Aso S, Horie K, Kobayashi Y, Nakamura M, Yamada K, Yamashiro T, Utsunomiya D. Improved Diagnostic Accuracy of Bone Metastasis Detection by Water-HAP Associated to Non-Contrast CT. Diagnostics (Basel) 2020; 10:diagnostics10100853. [PMID: 33092274 PMCID: PMC7589875 DOI: 10.3390/diagnostics10100853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
We examined whether water-hydroxyapatite (HAP) images improve the diagnostic accuracy of bone metastasis compared with non-contrast CT alone. We retrospectively evaluated dual-energy computed tomography (DECT) images of 83 cancer patients (bone metastasis, 31; without bone metastasis, 52) from May 2018 to June 2019. Initially, two evaluators examined for bone metastasis on conventional CT images. In the second session, both CT and CT images plus water-HAP images on DECT. The confidence of bone metastasis was scored from 1 (benign) to 5 (malignant). The sensitivity, specificity, positive predictive values, and negative predictive values for both modalities were calculated based on true positive and negative findings. The intra-observer area under curve (AUC) for detecting bone metastasis was compared by receiver operating characteristic analysis. Kappa coefficient calculated the inter-observer agreement. In conventional CT images, sensitivity, specificity, positive predictive value, and negative predictive value of raters 1 and 2 for the identification of bone metastases were 0.742 and 0.710, 0.981 and 0.981, 0.958 and 0.957, and 0.864 and 0.850, respectively. In water-HAP, they were 1.00 and 1.00, 0.981 and 1.00, 0.969 and 1.00, and 1.00 and 1.00, respectively. In CT, AUCs were 0.861 and 0.845 in each observer. On water-HAP images, AUCs were 0.990 and 1.00. Kappa coefficient was 0.964 for CT and 0.976 for water-HAP images. The combination of CT and water-HAP images significantly increased diagnostic accuracy for detecting bone metastasis. Water-HAP images on DECT may enable accurate initial staging, reduced radiation exposure, and cost.
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Affiliation(s)
- Yoshinobu Ishiwata
- Department of Radiology, Yokohama City University Hospital, 3–9 Fukuura, Kanazawa-ward, Yokohama City 2360004, Japan; (S.A.); (K.H.); (T.Y.); (D.U.)
- Correspondence: ; Tel.: +81-457-872-696; Fax: +81-457-860-369
| | - Yojiro Hieda
- Department of Radiology, Odawara Municipal Hospital, 46 Kuno, Odawara City 2508558, Japan; (Y.H.); (S.K.); (K.Y.)
| | - Soichiro Kaki
- Department of Radiology, Odawara Municipal Hospital, 46 Kuno, Odawara City 2508558, Japan; (Y.H.); (S.K.); (K.Y.)
| | - Shinjiro Aso
- Department of Radiology, Yokohama City University Hospital, 3–9 Fukuura, Kanazawa-ward, Yokohama City 2360004, Japan; (S.A.); (K.H.); (T.Y.); (D.U.)
| | - Keiichi Horie
- Department of Radiology, Yokohama City University Hospital, 3–9 Fukuura, Kanazawa-ward, Yokohama City 2360004, Japan; (S.A.); (K.H.); (T.Y.); (D.U.)
| | - Yusuke Kobayashi
- Department of Radiology, Yokohama City University Medical Center, 4–57 Urafune, Minami-ward, Yokohama City 2320024, Japan; (Y.K.); (M.N.)
| | - Motoki Nakamura
- Department of Radiology, Yokohama City University Medical Center, 4–57 Urafune, Minami-ward, Yokohama City 2320024, Japan; (Y.K.); (M.N.)
| | - Kazuhiko Yamada
- Department of Radiology, Odawara Municipal Hospital, 46 Kuno, Odawara City 2508558, Japan; (Y.H.); (S.K.); (K.Y.)
| | - Tsuneo Yamashiro
- Department of Radiology, Yokohama City University Hospital, 3–9 Fukuura, Kanazawa-ward, Yokohama City 2360004, Japan; (S.A.); (K.H.); (T.Y.); (D.U.)
| | - Daisuke Utsunomiya
- Department of Radiology, Yokohama City University Hospital, 3–9 Fukuura, Kanazawa-ward, Yokohama City 2360004, Japan; (S.A.); (K.H.); (T.Y.); (D.U.)
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22
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Abstract
Prostate cancer (PCa) is common among men worldwide and is a major cause of morbidity and mortality. The detection of PCa has historically followed a stepwise process of prostate-specific antigen screening followed with systematic transrectal ultrasound-guided biopsy. Magnetic resonance imaging (MRI), utilizing a set of sequences to assess morphology and function, has gained clinical acceptance to detect, characterize, and stage PCa. The Prostate Imaging - Reporting and Data System has helped facilitate the standardization of reporting across institutions and increased adoption of this method. In this review, we will (1) discuss the strengths and weaknesses of conventional diagnostic methods; (2) describe the clinical utility of prostate MRI, specifically addressing its uses in the detection and staging of PCa; and (3) list important technical parameters required for state-of-the-art prostate MRI.
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23
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Yang M, Wang A, Li C, Sun J, Yi G, Cheng H, Liu X, Wang Z, Zhou Y, Yao G, Wang S, Liang R, Li B, Li D, Zhao H. Methylation-Induced Silencing of ALDH2 Facilitates Lung Adenocarcinoma Bone Metastasis by Activating the MAPK Pathway. Front Oncol 2020; 10:1141. [PMID: 32850324 PMCID: PMC7406638 DOI: 10.3389/fonc.2020.01141] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/05/2020] [Indexed: 01/11/2023] Open
Abstract
Bone metastasis (BM) dramatically reduces the quality of life and life expectancy in lung adenocarcinoma (LUAD) patients. There is an urgent need to identify potential biomarkers for application in the treatment of this deadly disease. We compared patient BM, LUAD, and para-LUAD tissues using proteomic analysis and identified aldehyde dehydrogenase 2 (ALDH2), which can detoxify acetaldehyde to acetic acid, as one of the key regulators in lung tumor metastasis. Both the mRNA and protein levels of ALDH2 were significantly lower in tumor tissues than in normal tissues and were lowest in BM tissues with increased migratory capacity. Also, ALDH2 was upregulated following treatment with 5-azacitidine, a DNA methyltransferase inhibitor, in H1299, H460, and HCC827 cells. Further, we identified a potential methylated CpG island 3, with the longest methylated CpG island area in ALDH2, and performed bisulfite genomic sequencing of these sites. An average of 78.18% of the sites may be methylated in CpG island 3. Knockdown of DNA (cytosine-5)-methyltransferase 3A (DNMT3A) and methylated CpG binding protein 4 (MBD4) upregulated ALDH2 expression. ALDH2 functions as a mitogen-activated protein kinase (MAPK) upstream to inhibit cell proliferation and migration, promote cell apoptosis, and alter the epithelial–mesenchymal transition (EMT) by elevating E-cadherin and attenuating vimentin. Cell proliferation and migration were inhibited after the addition of the JNK inhibitor SP600125. In the multivariate analysis, M stage (p = 0.003), ALDH2 (p = 0.008), and phospho-c-Jun N-terminal kinase (p-JNK) (p = 0.027) expression were independent prognostic factors for overall survival in patients with BM. In vivo experiments also showed that ALDH2 expression could suppress tumor formation. In summary, we found that ALDH2 expression is a prognostic factor for BM in LUAD and that DNMT3A and MBD4 repression of ALDH2 via a MAPK-dependent pathway alters the EMT process, indicating that these proteins could act as potential biomarkers or therapeutic targets for LUAD metastasis.
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Affiliation(s)
- Mengdi Yang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - AiTing Wang
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changcan Li
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of General Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Sun
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Yi
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Cheng
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueni Liu
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyu Wang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yiyi Zhou
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Guangyu Yao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shuai Wang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui Liang
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Li
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Li
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Zhao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Clinical association between pre-treatment levels of plasma fibrinogen and bone metastatic burden in newly diagnosed prostate cancer patients. Chin Med J (Engl) 2020; 132:2684-2689. [PMID: 31725446 PMCID: PMC6940101 DOI: 10.1097/cm9.0000000000000506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Due to the different treatments for low-volume metastatic prostate cancer (PCa) as well as high-volume ones, evaluation of bone metastatic status is clinically significant. In this study, we evaluated the correlation between pre-treatment plasma fibrinogen and the burden of bone metastasis in newly diagnosed PCa patients. Methods: A single-center retrospective analysis, focusing on prostate biopsies of newly diagnosed PCa patients, was performed. A total of 261 patients were enrolled in this study in a 4-year period. All subjects were submitted to single-photon emission computerized tomography-computed tomography to confirm the status of bone metastasis and, if present, the number of metastatic lesions would then be calculated. Clinical information such as age, prostate-specific antigen (PSA), fibrinogen, clinical T stage, and Gleason score were collected. Patients were divided into three groups: (i) a non-metastatic group, (ii) a high volume disease (HVD) group (>3 metastases with at least one lesion outside the spine), and (iii) a low volume disease (LVD) group (metastatic patients excluding HVD ones). The main statistical methods included non-parametric Mann-Whitney test, Spearman correlation, receiver operating characteristic (ROC) curves, and logistic regression. Results: Fibrinogen positively correlated with Gleason score (r = 0.180, P = 0.003), PSA levels (r = 0.216, P < 0.001), and number of metastatic lesions (r = 0.296, P < 0.001). Compared with the non-metastatic and LVD groups, the HVD group showed the highest PSA (104.98 ng/mL, median) and fibrinogen levels (3.39 g/L, median), as well as the largest proportion of Gleason score >7 (86.8%). Both univariate (odds ratio [OR] = 2.16, 95% confidential interval [CI]: 1.536–3.038, P < 0.001) and multivariate (OR = 1.726, 95% CI: 1.206–2.472, P = 0.003) logistic regressions showed that fibrinogen was independently associated with HVD. The ROC curve suggested that fibrinogen acts as a predictor of HVD patients, yielding a cut-off of 3.08 g/L, with a sensitivity of 0.684 and a specificity of 0.760 (area under the curve = 0.739, 95% CI: 0.644–0.833, P < 0.001). Conclusions: Pre-treatment plasma fibrinogen is positively associated with bone metastatic burden in PCa patients. Our results indicate that fibrinogen might be a potential predictor of HVD.
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25
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Mao Y, Chen B, Wang H, Zhang Y, Yi X, Liao W, Zhao L. Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis. Sci Rep 2020; 10:1969. [PMID: 32029809 PMCID: PMC7005325 DOI: 10.1038/s41598-020-58855-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
The prognosis of colorectal cancer (CRC) is largely dependent on the early detection of hepatic metastases. With the advantages of nonradioactivity and the availability of multiple scanning sequences, the efficacy of magnetic resonance imaging (MRI) in the detection of colorectal liver metastases (CRLM) is not yet clear. We performed this meta-analysis to address this issue. PubMed, Embase, and the Cochrane Library were searched for studies reporting diagnostic performance of MRI for CRLM. Descriptive and quantitative data were extracted. The study quality was evaluated for the identified studies and a random effects model was used to determine the integrated diagnosis estimation. Meta-regression and subgroup analyses were implemented to investigate the potential contributors to heterogeneity. As a result, seventeen studies were included for analysis (from the year 1996 to 2018), comprising 1121 patients with a total of 3279 liver lesions. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.90 (95% confidence intervals (CI): 0.81-0.95), 0.88 (0.80-0.92), and 62.19 (23.71-163.13), respectively. The overall weighted area under the curve was 0.94 (0.92-0.96). Using two or more imaging planes and a quantitative/semiquantitative interpretation method showed higher diagnostic performance, although only the latter demonstrated statistical significance (P < 0.05). Advanced scanning sequences with DWI and liver-specific contrast media tended to increase the sensitivity for CRLM detection. We therefore concluded that contemporary MRI has high sensitivity and specificity for screening CRLM, especially for those with advanced scanning sequences. Using two or more imaging planes and adopting a quantitative/semiquantitative imaging interpretation may further improve diagnosis. However, the MRI results should be interpreted with caution because of substantial heterogeneity among studies.
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Affiliation(s)
- Yitao Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Bin Chen
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Haofan Wang
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510630, China
| | - Youming Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Luqing Zhao
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Department of Pathology, School of Basic Medical Science, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410013, China.
- Department of Pathology and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.
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26
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Fennell JT, Gkika E, Grosu AL. Molecular Imaging in Photon Radiotherapy. Recent Results Cancer Res 2020; 216:845-863. [PMID: 32594409 DOI: 10.1007/978-3-030-42618-7_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nowadays, more than ever before, the treatment of cancer patients requires an interdisciplinary approach more than ever. Radiation therapy (RT) has become an indispensable pillar of cancer treatment early on, offering a local, curative treatment option and symptom control in palliative cases.
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Affiliation(s)
| | - Eleni Gkika
- Department of Radiation Oncology, University of Freiburg, Freiburg, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, University of Freiburg, Freiburg, Germany.
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27
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Yoshida S, Takahara T, Ishii C, Arita Y, Waseda Y, Kijima T, Yokoyama M, Ishioka J, Matsuoka Y, Saito K, Fujii Y. METastasis Reporting and Data System for Prostate Cancer as a Prognostic Imaging Marker in Castration-resistant Prostate Cancer. Clin Genitourin Cancer 2019; 18:e391-e396. [PMID: 31902713 DOI: 10.1016/j.clgc.2019.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/28/2019] [Accepted: 12/09/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P) has been proposed as a standard of data acquisition and interpretation for whole-body diffusion-weighted magnetic resonance imaging (WB-DWI) performed in men with advanced prostate cancer. The aim of this study is to demonstrate the clinical significance of the scores in castration-resistant prostate cancer (CRPC). MATERIALS AND METHODS We retrospectively evaluated WB-DWI obtained from 72 patients with CRPC between 2014 and 2017, when disease progression was suspected at the time of starting a new line of anticancer therapy. Twenty-five (35%) and 30 (42%) patients had a treatment history that included taxane-based chemotherapy and new hormonal drugs, respectively. RESULTS Active bone metastases were identified in 60 patients (83%; number of bone metastasis = 0, 1-2, 3-5, 6-10, and > 10: n = 12 [17%], 20 [28%], 11 [15%], 1 [1%], and 28 [39%], respectively). Progressive lymph node and visceral metastases were identified in 10 (14%) and 4 (6%), respectively. During the median follow-up period of 24 months, 36 (50%) died of prostate cancer. Cancer-specific survival (CSS) was significantly stratified according to the MET-RADS-P scores of osseous metastatic burden and the presence of visceral metastasis (P < .0001). Multivariate analysis revealed that high osseous metastatic burden (> 10) and the presence of visceral metastasis were significant indicators of shorter CSS (P = .0036 and P = .0017, respectively). CONCLUSIONS The extent of bone metastasis and the presence of visceral metastasis on WB-DWI were associated with a shorter CSS in CRPC. MET-RADS-P score can be a prognostic imaging biomarker for CRPC.
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Affiliation(s)
- Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
| | - Taro Takahara
- Department of Biomedical Engineering, Tokai University School of Engineering, Tokyo, Japan; AIC Yaesu Clinic, Tokyo, Japan
| | | | - Yuki Arita
- AIC Yaesu Clinic, Tokyo, Japan; Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Comparison of PSMA-PET/CT, choline-PET/CT, NaF-PET/CT, MRI, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a systematic review and meta-analysis. Skeletal Radiol 2019; 48:1915-1924. [PMID: 31127357 DOI: 10.1007/s00256-019-03230-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A systematic review and meta-analysis to compare the diagnostic performance of prostate-specific membrane antigen (PSMA)-PET/CT, choline-PET/CT, Sodium Fluoride (NaF) PET/CT, MRI, and bone scintigraphy (BS) in detecting bone metastases in patients with prostate cancer. METHODS We searched PubMed and Embase for articles published between January 1990 and September 2018. Two evaluators independently extracted the sensitivity, specificity, the numbers of true and false positives, and true and false negatives. We calculated the pooled sensitivity, specificity, and 95% confidence intervals (CI) for each method. We calculated the tests' diagnostic odds ratios (DOR); drew the summary receiver operating characteristic (SROC) curves; and obtained the areas under the curves (AUC), Q* values, and 95% CIs. RESULTS The per-patient pooled sensitivities of PSMA-PET/CT, choline-PET/CT, NaF-PET/CT, MRI, and BS were 0.97, 0.87, 0.96, 0.91, and 0.86, respectively. The pooled specificities were 1.00, 0.99, 0.97, 0.96, and 0.95, respectively. The pooled DOR values were 504.16, 673.67, 242.63, and 114.44, respectively. The AUC were 1.00, 0.99, 0.99, 0.98, and 0.95, respectively. The per-lesion pooled sensitivities of PSMA-PET/CT, choline-PET/CT, NaF-PET/CT, MRI, and bone imaging were 0.88, 0.80, 0.97, 0.81 and 0.68, respectively. CONCLUSIONS According to the meta-analysis, PSMA-PET/CT had the highest per-patient sensitivity and specificity in detecting bone metastases with prostate cancer. The sensitivities of NaF-PET/CT and MRI were better than those for choline-PET/CT and BS. The specificity of PSMA-PET/CT was significantly better than BS. Others were similar. For per-lesion, NaF-PET/CT had the highest sensitivity, PSMA-PET/CT had higher sensitivity than choline-PET/CT and MRI, and BS had the lowest sensitivity.
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Head-to-head comparison of prostate MRI using an endorectal coil versus a non-endorectal coil: meta-analysis of diagnostic performance in staging T3 prostate cancer. Clin Radiol 2019; 75:157.e9-157.e19. [PMID: 31711637 DOI: 10.1016/j.crad.2019.09.142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/24/2019] [Indexed: 01/01/2023]
Abstract
AIM To compare the diagnostic performance of prostate magnetic resonance imaging (MRI) with an endorectal coil (ERC) to performance without an ERC using either body-array (BAC) or pelvic phased-array coil (PAC) in staging T3 prostate cancer. MATERIALS AND METHODS An electronic search of the PUBMED and EMBASE databases was performed until 10 October 2018 to identify studies performing a head-to-head comparison of prostate MRI using a 1.5 or 3 T magnet with an ERC and with a BAC/PAC for staging T3 prostate cancer. Pooled sensitivity and specificity of all studies were plotted in a hierarchical summary receiver operating characteristic plot. The diagnostic performance of the two techniques in staging T3 disease was evaluated using bivariate random-effects meta-analysis. RESULTS Eight studies comparing head-to-head prostate MRI with an ERC and with a BAC/PAC were identified of which six studies compared the diagnostic performance. The pooled sensitivity and specificity of MRI with an ERC for detecting T3a, T3b and T3a+b was 53% and 95%; 52% and 92%; 72% and 65% respectively. For MRI with a BAC/PAC these were 34%, and 95%; 45% and 94%; 70% and 66%. There was no statistical difference between an ERC and a BAC/PAC in terms of sensitivity (p=0.41) and specificity (p=0.63) for T3a. The area under the receiver operating characteristic (AUROC) curve for T3a, T3b and T3a+b was 0.830, 0.901, 0.741 for an ERC and 0.790, 0.645, 0.711 for BAC, respectively. CONCLUSION There is no significant difference in the diagnostic performance of MRI of prostate with an ERC and with a BAC/PAC in staging T3 prostate cancer.
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30
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Keilani M, Kainberger F, Pataraia A, Hasenöhrl T, Wagner B, Palma S, Cenik F, Crevenna R. Typical aspects in the rehabilitation of cancer patients suffering from metastatic bone disease or multiple myeloma. Wien Klin Wochenschr 2019; 131:567-575. [PMID: 31267163 PMCID: PMC6851044 DOI: 10.1007/s00508-019-1524-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022]
Abstract
Background The aim of this study was to present a practical concept focusing on typical aspects of regular physical activity, exercise and physical modalities for patients suffering from metastatic bone disease or multiple myeloma. Methods A narrative review of the relevant scientific literature and presentation of clinical experiences. Results In cancer patients with metastatic bone disease or multiple myeloma, pain is treated in an interdisciplinary and multimodal setting by using medication, radiotherapy and physical medical modalities (e.g. transcutaneous electrical nerve stimulation); however, modalities increasing local blood flow, such as ultrasound therapy, thermotherapy, massage, various electrotherapy options, are not performed at the site of the tumor. For physical activity and exercise, a suitable indication of the static and dynamic capacity of the affected skeletal structures is essential. This process includes strategies to maintain and improve mobility and independence. Individually tailored and adapted physical activity and exercise concepts (programs) within a multidisciplinary and interdisciplinary setting (tumor board) are used to manage the condition and bone load-bearing capacity of the patient. Typical clinical features and complications, such as pathological fractures in patients suffering from metastatic bone disease and additionally hypercalcemia, monoclonal gammopathy with bone marrow aplasia and risk of renal failure in patients with multiple myeloma have to be considered when planning supportive strategies and rehabilitation. Conclusion In order to ensure the safety and effectiveness of regular physical activity, exercise, and physical modalities in patients with metastatic bone disease or multiple myeloma, typical contraindications and considerations should be noted.
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Affiliation(s)
- Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anna Pataraia
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Timothy Hasenöhrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Wagner
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefano Palma
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Fanti S, Minozzi S, Antoch G, Banks I, Briganti A, Carrio I, Chiti A, Clarke N, Eiber M, De Bono J, Fizazi K, Gillessen S, Gledhill S, Haberkorn U, Herrmann K, Hicks RJ, Lecouvet F, Montironi R, Ost P, O'Sullivan JM, Padhani AR, Schalken JA, Scher HI, Tombal B, van Moorselaar RJA, Van Poppel H, Vargas HA, Walz J, Weber WA, Wester HJ, Oyen WJG. Consensus on molecular imaging and theranostics in prostate cancer. Lancet Oncol 2019; 19:e696-e708. [PMID: 30507436 DOI: 10.1016/s1470-2045(18)30604-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 10/27/2022]
Abstract
Rapid developments in imaging and treatment with radiopharmaceuticals targeting prostate cancer pose issues for the development of guidelines for their appropriate use. To tackle this problem, international experts representing medical oncologists, urologists, radiation oncologists, radiologists, and nuclear medicine specialists convened at the European Association of Nuclear Medicine Focus 1 meeting to deliver a balanced perspective on available data and clinical experience of imaging in prostate cancer, which had been supported by a systematic review of the literature and a modified Delphi process. Relevant conclusions included the following: diphosphonate bone scanning and contrast-enhanced CT are mentioned but rarely recommended for most patients in clinical guidelines; MRI (whole-body or multiparametric) and prostate cancer-targeted PET are frequently suggested, but the specific contexts in which these methods affect practice are not established; sodium fluoride-18 for PET-CT bone scanning is not widely advocated, whereas gallium-68 or fluorine-18 prostate-specific membrane antigen gain acceptance; and, palliative treatment with bone targeting radiopharmaceuticals (rhenium-186, samarium-153, or strontium-89) have largely been replaced by radium-223 on the basis of the survival benefit that was reported in prospective trials, and by other systemic therapies with proven survival benefits. Although the advances in MRI and PET-CT have improved the accuracy of imaging, the effects of these new methods on clinical outcomes remains to be established. Improved communication between imagers and clinicians and more multidisciplinary input in clinical trial design are essential to encourage imaging insights into clinical decision making.
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Affiliation(s)
- Stefano Fanti
- Nuclear Medicine Division, Policlinico S Orsola, University of Bologna, Bologna, Italy.
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, Dusseldorf, Germany
| | - Ian Banks
- European Cancer Organisation and European Men's Health Forum, Ulster, UK
| | - Alberto Briganti
- Division of Oncology and Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Ignasi Carrio
- Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Arturo Chiti
- Humanitas University and Humanitas Research Hospital, Milan, Italy
| | | | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, Paris, France
| | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester and The Christie Hospital, Manchester, UK; Division of Oncology and Division of Haematology, Kantonsspital St Gallen and University of Bern, Bern, Switzerland
| | | | - Uwe Haberkorn
- Department of Nuclear Medicine and German Cancer Research Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - Rodney J Hicks
- Cancer Imaging, Peter MacCallum Cancer Institute, Melbourne, VIC, Australia
| | - Frederic Lecouvet
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Rodolfo Montironi
- Genitourinary Cancer Program, Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Piet Ost
- Genitourinary Program, Ghent University Hospital, Ghent, Belgium
| | - Joe M O'Sullivan
- Department of Radiotherapy and Experimental Cancer Research, Queen's University, Belfast, UK
| | - Anwar R Padhani
- Mount Vernon Cancer Centre, Mount Vernon Hospital, London, UK
| | - Jack A Schalken
- Department of Experimental Urology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Howard I Scher
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Bertrand Tombal
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Heindrik Van Poppel
- Urology, University Hospital Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hebert Alberto Vargas
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Wolfgang A Weber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans-Jürgen Wester
- Lehrstuhl für Pharmazeutische Radiochemie, Technische Universität München, Garching, Germany
| | - Wim J G Oyen
- Department of Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands; Department of Nuclear Medicine, The Institute of Cancer Research and The Royal Marsden National Health Service Foundation Trust, London, UK
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Yilmaz B, Turkay R, Colakoglu Y, Baytekin HF, Ergul N, Sahin S, Tugcu V, Inci E, Tasci AI, Cermik TF. Comparison of preoperative locoregional Ga-68 PSMA-11 PET-CT and mp-MRI results with postoperative histopathology of prostate cancer. Prostate 2019; 79:1007-1017. [PMID: 31012125 DOI: 10.1002/pros.23812] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/12/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. MATERIALS AND METHODS Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities. RESULTS Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/CT had strong results for appropriate tumor localization in the gland. CONCLUSION Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning.
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Affiliation(s)
- Burcak Yilmaz
- Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Rustu Turkay
- Clinic of Radiology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Yunus Colakoglu
- Clinic of Urology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Halil F Baytekin
- Clinic of Pathology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Nurhan Ergul
- Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Selcuk Sahin
- Clinic of Urology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Volkan Tugcu
- Clinic of Urology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ercan Inci
- Clinic of Radiology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ali I Tasci
- Clinic of Urology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Tevfik F Cermik
- Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Health Sciences University, Istanbul, Turkey
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Hynes JP, Hughes N, Cunningham P, Kavanagh EC, Eustace SJ. Whole‐body MRI of bone marrow: A review. J Magn Reson Imaging 2019; 50:1687-1701. [DOI: 10.1002/jmri.26759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- John P. Hynes
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | - Nicola Hughes
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | | | - Eoin C. Kavanagh
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | - Stephen J. Eustace
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
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Abstract
Accurate tumor detection and establishment of disease extent are important for optimal management of prostate cancer. Disease stage, beginning with identification of the index prostate lesion, followed by primary tumor, lymph node, and distant metastasis evaluation, provide crucial clinical information that not only have prognostic and predictive value, but guide patient management. A wide array of radiological imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging have been used for the purpose of prostate cancer staging with variable diagnostic performance. Especially, the last years have seen remarkable technological advances in magnetic resonance imaging technology, enabling referring clinicians and radiologists to obtain even more valuable data regarding staging of prostate cancer. Marked improvements have been seen in detection of the index prostate lesion and evaluation of extraprostatic extension while further improvements are still needed in identifying metastatic lymph nodes. Novel approaches such as whole-body MRI are emerging for more accurate and reproducible assessment of bone metastasis. Post-treatment assessment of prostate cancer using radiological imaging is a topic with rapidly changing clinical context and special consideration is needed for the biochemical setting, that is, the relatively high serum prostate-specific antigen levels in studies assessing the value of radiological imaging for post-treatment assessment and emerging therapeutic approaches such as early salvage radiation therapy. The scope of this review is to provide the reader insight into the various ways radiology contribute to staging of prostate cancer in the context of both primary staging and post-treatment assessment. The strengths and limitations of each imaging modality are highlighted as well as topics that warrant future research.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Juárez-Soto A, Garín-Ferreira JM, Rodríguez-Fernández A, Tirado-Hospital JL, González-Serrano MT, Moreno-Jiménez J, Medina-López R, Baena-González V. Diagnosis of metastasis in castration-resistant prostate cancer patients: decision algorithm in imaging tests. Actas Urol Esp 2019; 43:55-61. [PMID: 30082102 DOI: 10.1016/j.acuro.2018.05.011] [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: 03/05/2018] [Revised: 05/08/2018] [Accepted: 05/12/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In castration-resistant prostate cancer (CRPC), early detection of metastases is essential for the selection of treatment, and prevention of bone complications. However detecting incipient metastases remains a challenge as the conventional radiological tests (bone scintigraphy or computerised tomography) lack sufficient sensitivity. Diagnostic imaging techniques are currently available that have greater sensitivity and specificity, but are little used due to shortfalls in the recommendations. OBJECTIVE To create an algorithm that indicates the most suitable diagnostic imaging techniques for the different M0 CRPC patient profiles based on the scientific evidence. EVIDENCE ACQUISITION Meetings were held with eight experts in Urology, Pathological Anatomy, Radiodiagnostics and Nuclear Medicine organised by the Andalusian Association of Urology, in which the recommendations and scientific evidence on each of the diagnostic imaging techniques were reviewed. SUMMARY OF THE EVIDENCE We present the current recommendations for the detection of metastasis in M0 CRPC patients, the patients that would benefit from early detection, and summarise the evidence to support the use of each of the new techniques. CONCLUSIONS Techniques such as 18F-Choline PET/CT or DWWB MRI and probably open MRI have been demonstrated to have good sensitivity and specificity for patients with low PSA (<10ng/ml). Their inclusion in routine clinical practice will help improve the early detection of metastasis in CRPC patients.
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Affiliation(s)
- A Juárez-Soto
- Servicio de Urología, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España.
| | - J M Garín-Ferreira
- Servicio de Radiodiagnóstico, Hospital Universitario Carlos Haya, Málaga, España
| | - A Rodríguez-Fernández
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J L Tirado-Hospital
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M T González-Serrano
- Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, España
| | - J Moreno-Jiménez
- Servicio de Urología, Complejo Hospitalario de Jaén, Jaén, España
| | - R Medina-López
- Servicio de Urología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - V Baena-González
- Servicio de Urología, Hospital Universitario Carlos Haya, Málaga, España
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Samper Ots P, Luis Cardo A, Vallejo Ocaña C, Cabeza Rodríguez MA, Glaria Enríquez LA, Couselo Paniagua ML, Olivera Vegas J. Diagnostic performance of 18F-choline PET-CT in prostate cancer. Clin Transl Oncol 2018; 21:766-773. [DOI: 10.1007/s12094-018-1985-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
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Head-to-Head Comparison Between Biparametric and Multiparametric MRI for the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:W226-W241. [DOI: 10.2214/ajr.18.19880] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Zamboglou C, Eiber M, Fassbender TR, Eder M, Kirste S, Bock M, Schilling O, Reichel K, van der Heide UA, Grosu AL. Multimodal imaging for radiation therapy planning in patients with primary prostate cancer. Phys Imaging Radiat Oncol 2018; 8:8-16. [PMID: 33458410 PMCID: PMC7807571 DOI: 10.1016/j.phro.2018.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/22/2022] Open
Abstract
Implementation of advanced imaging techniques like multiparametric magnetic resonance imaging (mpMRI) or Positron Emission Tomography (PET) in radiation therapy (RT) planning of patients with primary prostate cancer demands several preconditions: accurate staging of the extraprostatic and intraprostatic tumor mass, robust delineation of the intraprostatic gross tumor volume (GTV) and a reproducible characterization of the prostate cancer's biological properties. In the current review we searched for the currently available imaging techniques and we discussed their ability to fulfill these preconditions. We found that current pretreatment imaging was mainly performed with mpMRI and/or Prostate-specific membrane antigen PET imaging. Both techniques offered an accurate detection of the extraprostatic and intraprostatic tumor burden and had a major impact on RT concepts. However, some studies postulated that mpMRI and PSMA PET had complementary information for intraprostatic GTV detection. Moreover, interobserver differences for intraprostatic tumor delineation based on mpMRI were observed. It is currently unclear whether PET based GTV delineation underlies also interobserver heterogeneity. Further research is warranted to answer whether multimodal imaging is able to visualize biological processes related to prostate cancer pathophysiology and radiation resistance.
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Affiliation(s)
- Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
| | - Thomas R. Fassbender
- Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Matthias Eder
- Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
| | - Michael Bock
- Division of Medical Physics, Department of Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
| | - Oliver Schilling
- Institute of Surgical Pathology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
| | - Kathrin Reichel
- Department of Urology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Uulke A. van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Anca L. Grosu
- Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
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68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study. Eur Radiol 2018; 29:1221-1230. [PMID: 30132104 DOI: 10.1007/s00330-018-5682-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/10/2018] [Accepted: 07/27/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of 68gallium prostate-specific membrane antigen (PSMA)-based positron emission tomography/computed tomography (PET/CT) in comparison with 18F-fluoride-based PET/CT (NaF-PET/CT) and whole-body magnetic resonance imaging (WB-MRI) for the detection of bone metastases in patients with prostate cancer. METHODS Sixty patients with prostate cancer were included in the period May 2016 to June 2017. The participants underwent three scans (index tests) within 30 days: a NaF-PET/CT, a WB-MRI and a PSMA-PET/CT. Experienced specialists assessed the scans. In the absence of a histological reference standard, the final diagnosis was determined as a panel diagnosis. Measures of the diagnostic performances of the index tests were calculated from patient-based dichotomous outcomes (0 or ≥ 1 bone metastasis) and pairwise compared (McNemar test). For each index test, the agreement with the final diagnosis with regard to the number of bone metastases detected (0, 1-5, > 5) and the inter-reader agreement was calculated (kappa coefficients). RESULTS Fifty-five patients constituted the final study population; 20 patients (36%) were classified as having bone metastatic disease as their final diagnosis. The patient-based diagnostic performances were (sensitivity, specificity, overall accuracy) PSMA-PET/CT (100%, 100%, 100%), NaF-PET/CT (95%, 97%, 96%) and WB-MRI (80%, 83%, 82%). The overall accuracy of PSMA-PET/CT was significantly more favourable compared to WB-MRI (p = 0.004), but not to NaF-PET/CT (p = 0.48). PSMA-PET/CT classified the number of bone metastases reliably compared to the final diagnosis (kappa coefficient 0.97) and with an "almost perfect" inter-reader agreement (kappa coefficient 0.93). CONCLUSIONS The overall accuracy of PSMA-PET/CT was significantly more advantageous compared to WB-MRI, but not to NaF-PET/CT. KEY POINTS • PSMA-PET/CT assessed the presence of bone metastases correctly in all 55 patients • PSMA-PET/CT was more advantageous compared to WB-MRI • No difference was found between PSMA-PET/CT and NaF-PET/CT.
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Whole-Body MR Imaging: The Novel, "Intrinsically Hybrid," Approach to Metastases, Myeloma, Lymphoma, in Bones and Beyond. PET Clin 2018; 13:505-522. [PMID: 30219185 DOI: 10.1016/j.cpet.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Whole-body MR imaging (WB-MR imaging) has become a modality of choice for detecting bone metastases in multiple cancers, and bone marrow involvement by multiple myeloma or lymphoma. Combination of anatomic and functional sequences imparts an inherently hybrid dimension to this nonirradiating tool and extends the screening of malignancies outside the skeleton. WB-MR imaging outperforms bone scintigraphy and CT and offers an alternative to PET in many tumors by time of lesion detection and assessment of treatment response. Much work has been done to standardize procedures, optimize sequences, validate indications, confirm preliminary research into new applications, rendering clinical application more user-friendly.
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Han S, Woo S, Kim YJ, Suh CH. Impact of 68Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol 2018; 74:179-190. [PMID: 29678358 DOI: 10.1016/j.eururo.2018.03.030] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT 68Gallium prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET) is an emerging imaging modality for assessment of prostate cancer. Recent studies show promising results regarding its ability to detect recurrent or metastatic prostate cancer superior to that of conventional imaging modalities. However, the impact of 68Ga-PSMA PET on management of patients with prostate cancer has not been well established. OBJECTIVE To perform a systematic review and meta-analysis to evaluate the impact of 68Ga-PSMA PET on management of patients with prostate cancer. EVIDENCE ACQUISITION Pubmed and EMBASE databases were searched up to January 20, 2018. We included studies that reported proportion of management change after 68Ga-PSMA PET in patients with prostate cancer. The quality of the studies was evaluated using the GRADE system. The proportion of management changes were pooled using random-effects model. Subgroup analyses and meta-regression analyses were performed to explore heterogeneity. EVIDENCE SYNTHESIS Fifteen studies (1163 patients) were included. The pooled proportion of management changes was 54% (95% confidence interval 47-60%). At meta-regression analyses, PET positivity (%) was a significant factor of heterogeneity (p=0.0486). For patients with biochemical failure, the proportion of radiotherapy (from 56% to 61%), surgery (from 1% to 7%), focal therapy (from 1% to 2%), and multimodal treatment (from 2% to 6%) increased, whereas that of systemic treatment (from 26% to 12%) and no treatment (from 14% to 11%) decreased with 68Ga-PSMA PET. CONCLUSIONS 68Ga-PSMA PET had a large impact on the management of patients with prostate cancer. Greater PET positivity was associated with higher proportion of management changes. PATIENT SUMMARY We reviewed all previous studies assessing the impact of 68Gallium prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET) in patients with prostate cancer. We found that 68Ga-PSMA PET altered the management in approximately half of the patients.
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Affiliation(s)
- Sangwon Han
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, Republic of Korea
| | - Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| | - Yeon Joo Kim
- Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, Republic of Korea
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Ledezma RA. Aportes actuales de la resonancia magnética para el manejo del cáncer de próstata. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gillessen S, Attard G, Beer TM, Beltran H, Bossi A, Bristow R, Carver B, Castellano D, Chung BH, Clarke N, Daugaard G, Davis ID, de Bono J, Borges Dos Reis R, Drake CG, Eeles R, Efstathiou E, Evans CP, Fanti S, Feng F, Fizazi K, Frydenberg M, Gleave M, Halabi S, Heidenreich A, Higano CS, James N, Kantoff P, Kellokumpu-Lehtinen PL, Khauli RB, Kramer G, Logothetis C, Maluf F, Morgans AK, Morris MJ, Mottet N, Murthy V, Oh W, Ost P, Padhani AR, Parker C, Pritchard CC, Roach M, Rubin MA, Ryan C, Saad F, Sartor O, Scher H, Sella A, Shore N, Smith M, Soule H, Sternberg CN, Suzuki H, Sweeney C, Sydes MR, Tannock I, Tombal B, Valdagni R, Wiegel T, Omlin A. Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017. Eur Urol 2018; 73:178-211. [PMID: 28655541 DOI: 10.1016/j.eururo.2017.06.002] [Citation(s) in RCA: 368] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. OBJECTIVE To present the report of APCCC 2017. DESIGN, SETTING, AND PARTICIPANTS Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process. RESULTS AND LIMITATIONS Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data. CONCLUSIONS The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them. PATIENT SUMMARY The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.
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Affiliation(s)
- Silke Gillessen
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland.
| | - Gerhardt Attard
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Tomasz M Beer
- Oregon Health & Science University Knight Cancer Institute, OR, USA
| | - Himisha Beltran
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Bossi
- Department of Radiation Oncology, Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Rob Bristow
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, USA
| | - Brett Carver
- Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, NY, USA
| | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - Gedske Daugaard
- Department of Medical Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ian D Davis
- Monash University and Eastern Health, Eastern Health Clinical School, Box Hill, Australia
| | - Johann de Bono
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Rodolfo Borges Dos Reis
- Department of Urology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Charles G Drake
- Department of Medical Oncology, Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | - Ros Eeles
- Department of Clinical Oncology and Genetics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Eleni Efstathiou
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, TX, USA
| | - Christopher P Evans
- Department of Urology, University of California, Davis School of Medicine, CA, USA
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Italy
| | - Felix Feng
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Karim Fizazi
- Department of Medical Oncology, Gustave Roussy, University of Paris Sud, Paris, France
| | - Mark Frydenberg
- Department of Surgery, Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Martin Gleave
- Department of Urology, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Susan Halabi
- Department of Clinical trials and Statistics, Duke University, Durham, NC, USA
| | | | - Celestia S Higano
- Department of Medicine, Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, WA, USA
| | - Nicolas James
- Department of Clinical Oncology, Clinical Oncology Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Philip Kantoff
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Department of Clinical Oncology, Tampere University Hospital, Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Raja B Khauli
- Department of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Chris Logothetis
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA
| | - Fernando Maluf
- Department of Medical Oncology Hospital Israelita Albert Einstein and Department of Medical Oncology Beneficência Portuguesa de São Paulo
| | - Alicia K Morgans
- Department of Medical Oncology and Epidemiology, Vanderbilt University Medical Center, Division of Hematology/Oncology, Nashville, TN, USA
| | - Michael J Morris
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicolas Mottet
- Department of Urology, University Hospital Nord St. Etienne, St. Etienne, France
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - William Oh
- Department of Medical Oncology, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Anwar R Padhani
- Department of Radiology, Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Chris Parker
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Mark A Rubin
- Department of Pathology, University of Bern and the Inselspital, Bern (CH)
| | - Charles Ryan
- Department of Medical Oncology, Clinical Medicine and Urology at the Helen Diller Family Comprehensive Cancer Center at the University of, California, San Francisco, CA, USA
| | - Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Oliver Sartor
- Department of Medical Oncology, Tulane Cancer Center, New Orleans, LA, USA
| | - Howard Scher
- Department of Medical Oncology, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Avishay Sella
- Department of Medical Oncology, Department of Oncology, Assaf Harofeh Medical Centre, Tel-Aviv University, Sackler School of Medicine, Zerifin, Israel
| | - Neal Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Matthew Smith
- Department of Medical Oncology, Massachusetts General Hospital Cancer Centre, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Japan
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian Tannock
- Department of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Riccardo Valdagni
- Department of Oncology and Haemato-oncology, Università degli Studi di Milano. Radiation Oncology 1, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Thomas Wiegel
- Department of Radiation Oncology, Klinik für Strahlentherapie und Radioonkologie des Universitätsklinikum Ulm, Albert-Einstein-Allee, Ulm, Germany
| | - Aurelius Omlin
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland
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Evaluation and Treatment for High-Risk Prostate Cancer. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Kim JH, Lee B, Chung BI. Re: Sungmin Woo, Chong Hyun Suh, Sang Youn Kim, Jeong Yeon Cho, Seung Hyup Kim. Diagnostic Performance of Magnetic Resonance Imaging for the Detection of Bone Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. In press. http://dx.doi.org/ 10.1016/j.eururo.2017.03.042. Eur Urol 2017; 72:e164-e165. [PMID: 28689900 DOI: 10.1016/j.eururo.2017.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA; Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea.
| | - Bora Lee
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
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Woo S, Suh CH, Kim SY. Reply to Jae Heon Kim, Bora Lee, and Benjamin I. Chung's Letter to the Editor re: Sungmin Woo, Chong Hyun Suh, Sang Youn Kim, Jeong Yeon Cho, Seung Hyup Kim. Diagnostic Performance of Magnetic Resonance Imaging for the Detection of Bone Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. In press. http://dx.doi.org/ 10.1016/j.eururo.2017.03.042. Eur Urol 2017; 72:e166-e167. [PMID: 28688611 DOI: 10.1016/j.eururo.2017.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Radiology, Namwon Medical Center, Jeollabuk-do, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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Hoyle AP, Clarke NW. Magnetic Resonance Imaging and Detection of Metastases in Prostate Cancer: Learning Lessons from History. Eur Urol 2017; 73:92-93. [PMID: 28602204 DOI: 10.1016/j.eururo.2017.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Alex P Hoyle
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Noel W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK.
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Woo S, Suh CH, Kim SY. Reply to Thorsten Derlin, Christoph-A. von Klot, and Katja Hueper's Letter to the Editor re: Sungmin Woo, Chong Hyun Suh, Sang Youn Kim, Jeong Yeon Cho, Seung Hyup Kim. Diagnostic Performance of Magnetic Resonance Imaging for the Detection of Bone Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. In press. http://dx.doi.org/ 10.1016/j.eururo.2017.03.042. Eur Urol 2017; 72:e100-e101. [PMID: 28576505 DOI: 10.1016/j.eururo.2017.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Radiology, Namwon Medical Center, Jeollabuk-do, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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Derlin T, von Klot CA, Hueper K. Re: Sungmin Woo, Chong Hyun Suh, Sang Youn Kim, Jeong Yeon Cho, Seung Hyup Kim. Diagnostic Performance of Magnetic Resonance Imaging for the Detection of Bone Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. In press. http://dx.doi.org/ 10.1016/j.eururo.2017.03.042. Eur Urol 2017; 72:e98-e99. [PMID: 28571882 DOI: 10.1016/j.eururo.2017.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.
| | - Christoph-A von Klot
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Katja Hueper
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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