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Gayo IJMB, Saeed SU, Bonmati E, Barratt DC, Clarkson MJ, Hu Y. The distinct roles of reinforcement learning between pre-procedure and intra-procedure planning for prostate biopsy. Int J Comput Assist Radiol Surg 2024; 19:1003-1012. [PMID: 38451359 PMCID: PMC11178630 DOI: 10.1007/s11548-024-03084-4] [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: 01/22/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Magnetic resonance (MR) imaging targeted prostate cancer (PCa) biopsy enables precise sampling of MR-detected lesions, establishing its importance in recommended clinical practice. Planning for the ultrasound-guided procedure involves pre-selecting needle sampling positions. However, performing this procedure is subject to a number of factors, including MR-to-ultrasound registration, intra-procedure patient movement and soft tissue motions. When a fixed pre-procedure planning is carried out without intra-procedure adaptation, these factors will lead to sampling errors which could cause false positives and false negatives. Reinforcement learning (RL) has been proposed for procedure plannings on similar applications such as this one, because intelligent agents can be trained for both pre-procedure and intra-procedure planning. However, it is not clear if RL is beneficial when it comes to addressing these intra-procedure errors. METHODS In this work, we develop and compare imitation learning (IL), supervised by demonstrations of predefined sampling strategy, and RL approaches, under varying degrees of intra-procedure motion and registration error, to represent sources of targeting errors likely to occur in an intra-operative procedure. RESULTS Based on results using imaging data from 567 PCa patients, we demonstrate the efficacy and value in adopting RL algorithms to provide intelligent intra-procedure action suggestions, compared to IL-based planning supervised by commonly adopted policies. CONCLUSIONS The improvement in biopsy sampling performance for intra-procedure planning has not been observed in experiments with only pre-procedure planning. These findings suggest a strong role for RL in future prospective studies which adopt intra-procedure planning. Our open source code implementation is available here .
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Affiliation(s)
- Iani J M B Gayo
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | - Shaheer U Saeed
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Ester Bonmati
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Computer Science and Engineering, University of Westminster, London, UK
| | - Dean C Barratt
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Matthew J Clarkson
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Yipeng Hu
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
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Sun Z, Liu Y, Yu W, Wang H, Shen Q, Zhang C. Diagnostic performance of regional systematic biopsy for prostate cancer stratified by PI-RADS and histologic zones. Insights Imaging 2024; 15:118. [PMID: 38755502 PMCID: PMC11098978 DOI: 10.1186/s13244-024-01680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/27/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES To explore the diagnostic performance of targeted biopsy (TB) combined with regional systematic biopsy (RSB) in patients with different Prostate Imaging Reporting and Data System (PI-RADS) and histologic zones for prostate lesions. METHODS This retrospective study included 1301 patients who underwent multiparametric MRI followed by combined MRI/US fusion-guided TB+systematic biopsy (SB) between January 2019 and October 2022. RSB was defined as the four perilesional SB cores adjacent to an MRI-positive lesion. Cancer detection rates were calculated for TB + SB, TB, SB, and TB + RSB, while the McNemar test was utilized for multiple comparisons among them. Subgroup analyses were performed based on different Pl-RADS and histologic zones. RESULTS Of 1301 included participants (median age, 68 years; interquartile range, 63-74 years), 16,104 total biopsy cores were performed. TB + RSB detected clinically significant prostate cancer in 70.9% (922/1301) of patients, which was significantly higher than TB (67.4%, p < 0.001) or SB (67.5%, p < 0.001) but similar to TB + SB (71.0%, p = 0.50). Compared with TB + SB, TB + RSB required fewer median biopsy cores (6.3 vs. 12.4, p < 0.001) and had a higher proportion of positive cores (56.3% vs. 39.0%, p < 0.001). Subgroup analysis showed that TB had outstanding sensitivity for detecting PI-RADS 5 lesions in the PZ. CONCLUSIONS Compared with TB + SB, TB + RSB achieved a similar clinically significant prostate cancer detection rate while requiring fewer biopsy cores and exhibiting higher diagnostic efficiency. CRITICAL RELEVANCE STATEMENT For MRI-positive prostate lesions, targeted biopsy combined with regional systematic biopsy could serve as an alternative diagnostic approach to targeted biopsy combined with systematic biopsy. KEY POINTS The scheme of prostate biopsy needs to be optimized. Regional systematic biopsy decreases the total number of cores taken. Targeted biopsies combined with regional systematic biopsies improve prostate diagnostic efficiency.
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Affiliation(s)
- Zhoujie Sun
- Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, China
- Institute of Urology, Peking University, No.8 Xishiku St. Xicheng District, Beijing, China
- The National Urological Cancer Center of China, No.8 Xishiku St. Xicheng District, Beijing, China
| | - Yi Liu
- Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, China
- Institute of Urology, Peking University, No.8 Xishiku St. Xicheng District, Beijing, China
- The National Urological Cancer Center of China, No.8 Xishiku St. Xicheng District, Beijing, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, China
- Institute of Urology, Peking University, No.8 Xishiku St. Xicheng District, Beijing, China
- The National Urological Cancer Center of China, No.8 Xishiku St. Xicheng District, Beijing, China
| | - He Wang
- Department of Radiology, Peking University First Hospital, Beijing, 100034, China
| | - Qi Shen
- Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, China
- Institute of Urology, Peking University, No.8 Xishiku St. Xicheng District, Beijing, China
- The National Urological Cancer Center of China, No.8 Xishiku St. Xicheng District, Beijing, China
| | - Cuijian Zhang
- Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, China.
- Institute of Urology, Peking University, No.8 Xishiku St. Xicheng District, Beijing, China.
- The National Urological Cancer Center of China, No.8 Xishiku St. Xicheng District, Beijing, China.
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Privé BM, Israël B, Janssen MJR, van der Leest MMG, de Rooij M, van Ipenburg JA, Jonker M, Peters SMB, de Groot M, Zámecnik P, Hoepping A, Bomers JG, Gotthardt M, Sedelaar JPM, Barentsz JO, van Oort IM, Nagarajah J. Multiparametric MRI and 18F-PSMA-1007 PET/CT for the Detection of Clinically Significant Prostate Cancer. Radiology 2024; 311:e231879. [PMID: 38771185 DOI: 10.1148/radiol.231879] [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: 05/22/2024]
Abstract
Background Multiparametric MRI (mpMRI) is effective for detecting prostate cancer (PCa); however, there is a high rate of equivocal Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions and false-positive findings. Purpose To investigate whether fluorine 18 (18F) prostate-specific membrane antigen (PSMA) 1007 PET/CT after mpMRI can help detect localized clinically significant PCa (csPCa), particularly for equivocal PI-RADS 3 lesions. Materials and Methods This prospective study included participants with elevated prostate-specific antigen (PSA) levels referred for prostate mpMRI between September 2020 and February 2022. 18F-PSMA-1007 PET/CT was performed within 30 days of mpMRI and before biopsy. PI-RADS category and level of suspicion (LOS) were assessed. PI-RADS 3 or higher lesions at mpMRI and/or LOS 3 or higher lesions at 18F-PSMA-1007 PET/CT underwent targeted biopsies. PI-RADS 2 or lower and LOS 2 or lower lesions were considered nonsuspicious and were monitored during a 1-year follow-up by means of PSA testing. Diagnostic accuracy was assessed, with histologic examination serving as the reference standard. International Society of Urological Pathology (ISUP) grade 2 or higher was considered csPCa. Results Seventy-five participants (median age, 67 years [range, 52-77 years]) were assessed, with PI-RADS 1 or 2, PI-RADS 3, and PI-RADS 4 or 5 groups each including 25 participants. A total of 102 lesions were identified, of which 80 were PI-RADS 3 or higher and/or LOS 3 or higher and therefore underwent targeted biopsy. The per-participant sensitivity for the detection of csPCa was 95% and 91% for mpMRI and 18F-PSMA-1007 PET/CT, respectively, with respective specificities of 45% and 62%. 18F-PSMA-1007 PET/CT was used to correctly differentiate 17 of 26 PI-RADS 3 lesions (65%), with a negative and positive predictive value of 93% and 27%, respectively, for ruling out or detecting csPCa. One additional significant and one insignificant PCa lesion (PI-RADS 1 or 2) were found at 18F-PSMA-1007 PET/CT that otherwise would have remained undetected. Two participants had ISUP 2 tumors without PSMA uptake that were missed at PET/CT. Conclusion 18F-PSMA-1007 PET/CT showed good sensitivity and moderate specificity for the detection of csPCa and ruled this out in 93% of participants with PI-RADS 3 lesions. Clinical trial registration no. NCT04487847 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Turkbey in this issue.
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Affiliation(s)
- Bastiaan M Privé
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Bas Israël
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Marcel J R Janssen
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Marloes M G van der Leest
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Maarten de Rooij
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Jolique A van Ipenburg
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Marianne Jonker
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Steffie M B Peters
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Michel de Groot
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Patrik Zámecnik
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Alexander Hoepping
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Joyce G Bomers
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Martin Gotthardt
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - J P Michiel Sedelaar
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Jelle O Barentsz
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - Inge M van Oort
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
| | - James Nagarajah
- From the Department of Medical Imaging and Nuclear Medicine (B.M.P., B.I., M.J.R.J., M.M.G.v.d.L., M.d.R., S.M.B.P., M.d.G., P.Z., J.G.B., M.G., J.O.B., J.N.), Department of Urology (B.I., J.P.M.S., I.M.v.O.), and Department of Radiation Oncology (B.I.), Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, the Netherlands (B.M.P.); Department of Pathology (J.A.v.I.) and Department of Health Evidence, Biostatistics Section (M.J.), Radboud University Medical Center, Nijmegen, the Netherlands; and Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds, Radeberg, Germany (A.H.)
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Englman C, Maffei D, Allen C, Kirkham A, Albertsen P, Kasivisvanathan V, Baroni RH, Briganti A, De Visschere P, Dickinson L, Gómez Rivas J, Haider MA, Kesch C, Loeb S, Macura KJ, Margolis D, Mitra AM, Padhani AR, Panebianco V, Pinto PA, Ploussard G, Puech P, Purysko AS, Radtke JP, Rannikko A, Rastinehad A, Renard-Penna R, Sanguedolce F, Schimmöller L, Schoots IG, Shariat SF, Schieda N, Tempany CM, Turkbey B, Valerio M, Villers A, Walz J, Barrett T, Giganti F, Moore CM. PRECISE Version 2: Updated Recommendations for Reporting Prostate Magnetic Resonance Imaging in Patients on Active Surveillance for Prostate Cancer. Eur Urol 2024:S0302-2838(24)02232-2. [PMID: 38556436 DOI: 10.1016/j.eururo.2024.03.014] [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: 01/02/2024] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVE The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty. METHODS A panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology. Panellists scored 193 statements using a 1-9 agreement scale, where 9 means full agreement. A summary of agreement, uncertainty, or disagreement (derived from the group median score) and consensus (determined using the Interpercentile Range Adjusted for Symmetry method) was calculated for each statement and presented for discussion before individual rescoring. KEY FINDINGS AND LIMITATIONS Participants agreed that MRI scans must meet a minimum image quality standard (median 9) or be given a score of 'X' for insufficient quality. The current scan should be compared with both baseline and previous scans (median 9), with the PRECISE score being the maximum from any lesion (median 8). PRECISE 3 (stable MRI) was subdivided into 3-V (visible) and 3-NonV (nonvisible) disease (median 9). Prostate Imaging Reporting and Data System/Likert ≥3 lesions should be measured on T2-weighted imaging, using other sequences to aid in the identification (median 8), and whenever possible, reported pictorially (diagrams, screenshots, or contours; median 9). There was no consensus on how to measure tumour size. More research is needed to determine a significant size increase (median 9). PRECISE 5 was clarified as progression to stage ≥T3a (median 9). CONCLUSIONS AND CLINICAL IMPLICATIONS The updated PRECISE recommendations reflect expert consensus opinion on minimal standards and reporting criteria for prostate MRI in AS. PATIENT SUMMARY The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations are used in clinical practice and research to guide the interpretation and reporting of magnetic resonance imaging for patients on active surveillance for prostate cancer. An international panel has updated these recommendations, clarified the areas of uncertainty, and highlighted the areas for further research.
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Affiliation(s)
- Cameron Englman
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Davide Maffei
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Peter Albertsen
- Department of Surgery (Urology), UConn Health, Farmington, CT, USA
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ronaldo Hueb Baroni
- Department of Radiology, Hospital Israelita Albert Einstein. Sao Paulo, Brazil
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Pieter De Visschere
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Louise Dickinson
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Juan Gómez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Masoom A Haider
- Joint Department of Medical Imaging, Sinai Health System, University of Toronto, Toronto, Canada
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Stacy Loeb
- Department of Urology and Population Health, New York University Langone Health and Manhattan Veterans Affairs, New York, NY, USA
| | - Katarzyna J Macura
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Margolis
- Weill Cornell Medical College, Department of Radiology, New York, NY, USA
| | - Anita M Mitra
- Department of Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Rickmansworth Road, Middlesex, UK
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Philippe Puech
- Department of Radiology, University of Lille, Lille, France
| | - Andrei S Purysko
- Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jan Philipp Radtke
- University Dusseldorf, Medical Faculty, Department of Urology, Dusseldorf, Germany
| | - Antti Rannikko
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Art Rastinehad
- Department of Urology, Lenox Hill Hospital, New York, NY, USA
| | - Raphaele Renard-Penna
- Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francesco Sanguedolce
- Department of Urology, Autonoma University of Barcelona, Barcelona, Spain; Department of Medicine, Surgery and Pharmacy, Universitá degli studi di Sassari - Italy
| | - Lars Schimmöller
- Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Clare M Tempany
- Department of Radiology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Arnauld Villers
- Department of Urology, Hospital Claude Huriez, CHU Lille, Lille, France
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Addenbrook''s Hospital, Cambridge, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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5
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Beatrici E, Frego N, Chiarelli G, Sordelli F, Mancon S, Saitta C, De Carne F, Garofano G, Arena P, Avolio PP, Gobbo A, Uleri A, Contieri R, Paciotti M, Lazzeri M, Hurle R, Casale P, Buffi NM, Lughezzani G. A Comparative Evaluation of Multiparametric Magnetic Resonance Imaging and Micro-Ultrasound for the Detection of Clinically Significant Prostate Cancer in Patients with Prior Negative Biopsies. Diagnostics (Basel) 2024; 14:525. [PMID: 38472997 DOI: 10.3390/diagnostics14050525] [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: 01/30/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The diagnostic process for prostate cancer after a negative biopsy is challenging. This study compares the diagnostic accuracy of micro-ultrasound (mUS) with multiparametric magnetic resonance imaging (mpMRI) for such cases. METHODS A retrospective cohort study was performed, targeting men with previous negative biopsies and using mUS and mpMRI to detect prostate cancer and clinically significant prostate cancer (csPCa). RESULTS In our cohort of 1397 men, 304 had a history of negative biopsies. mUS was more sensitive than mpMRI, with better predictive value for negative results. Importantly, mUS was significantly associated with csPCa detection (adjusted odds ratio [aOR]: 6.58; 95% confidence interval [CI]: 1.15-37.8; p = 0.035). CONCLUSIONS mUS may be preferable for diagnosing prostate cancer in previously biopsy-negative patients. However, the retrospective design of this study at a single institution suggests that further research across multiple centers is warranted.
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Affiliation(s)
- Edoardo Beatrici
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giuseppe Chiarelli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Federica Sordelli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Stefano Mancon
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Fabio De Carne
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giuseppe Garofano
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Paola Arena
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
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6
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Hu L, Guo X, Zhou D, Wang Z, Dai L, Li L, Li Y, Zhang T, Long H, Yu C, Shi ZW, Han C, Lu C, Zhao J, Li Y, Zha Y, Liu Z. Development and Validation of a Deep Learning Model to Reduce the Interference of Rectal Artifacts in MRI-based Prostate Cancer Diagnosis. Radiol Artif Intell 2024; 6:e230362. [PMID: 38446042 PMCID: PMC10985636 DOI: 10.1148/ryai.230362] [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: 08/31/2023] [Revised: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
Purpose To develop an MRI-based model for clinically significant prostate cancer (csPCa) diagnosis that can resist rectal artifact interference. Materials and Methods This retrospective study included 2203 male patients with prostate lesions who underwent biparametric MRI and biopsy between January 2019 and June 2023. Targeted adversarial training with proprietary adversarial samples (TPAS) strategy was proposed to enhance model resistance against rectal artifacts. The automated csPCa diagnostic models trained with and without TPAS were compared using multicenter validation datasets. The impact of rectal artifacts on the diagnostic performance of each model at the patient and lesion levels was compared using the area under the receiver operating characteristic curve (AUC) and the area under the precision-recall curve (AUPRC). The AUC between models was compared using the DeLong test, and the AUPRC was compared using the bootstrap method. Results The TPAS model exhibited diagnostic performance improvements of 6% at the patient level (AUC: 0.87 vs 0.81, P < .001) and 7% at the lesion level (AUPRC: 0.84 vs 0.77, P = .007) compared with the control model. The TPAS model demonstrated less performance decline in the presence of rectal artifact-pattern adversarial noise than the control model (ΔAUC: -17% vs -19%, ΔAUPRC: -18% vs -21%). The TPAS model performed better than the control model in patients with moderate (AUC: 0.79 vs 0.73, AUPRC: 0.68 vs 0.61) and severe (AUC: 0.75 vs 0.57, AUPRC: 0.69 vs 0.59) artifacts. Conclusion This study demonstrates that the TPAS model can reduce rectal artifact interference in MRI-based csPCa diagnosis, thereby improving its performance in clinical applications. Keywords: MR-Diffusion-weighted Imaging, Urinary, Prostate, Comparative Studies, Diagnosis, Transfer Learning Clinical trial registration no. ChiCTR23000069832 Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
| | | | - Dawei Zhou
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Zhen Wang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Lisong Dai
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Liang Li
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Ying Li
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Tian Zhang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Haining Long
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Chengxin Yu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Zhen-wei Shi
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Chu Han
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Cheng Lu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Jungong Zhao
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Yuehua Li
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Yunfei Zha
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Zaiyi Liu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
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7
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Ortner G, Mavridis C, Fritz V, Schachtner J, Mamoulakis C, Nagele U, Tokas T. The Added Value of MRI-Based Targeted Biopsy in Biopsy-Naïve Patients: A Propensity-Score Matched Comparison. J Clin Med 2024; 13:1355. [PMID: 38592166 PMCID: PMC10931596 DOI: 10.3390/jcm13051355] [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: 01/12/2024] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Multiparametric Magnetic Resonance Imaging (mpMRI)-based targeted biopsy has shown to be beneficial in detecting Clinically Significant Prostate Cancer (csPCa) and avoiding diagnosis of Non-csPCa (ncsPCa); however, its role in the treatment of biopsy-naïve patients is still under discussion. METHODS After identifying predictors for the diagnosis of csPCa via Multivariate Logistic Regression Analysis (MLRA), a propensity-score (1:1 nearest neighbor) matched comparison was performed between a Systematic-Only Biopsy (SOB) cohort and a mpMRI-based Combined (systematic + targeted) Biopsy (CB) cohort from two tertiary urologic centers (SOB: Department of Urology, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Crete, Greece; CB: LKH Hall in Tirol, Austria). Only biopsy-naïve patients were included in the study. The study period for the included patients was from February 2018 to July 2023 for the SOB group and from July 2017 to June 2023 for the CB group. The primary outcome was the diagnosis of csPCa (≥ISUP 2); secondary outcomes were overall cancer detection, the added value of targeted biopsy in csPCa detection, and the reduction in ncsPCa diagnosis with CB compared to SOB. To estimate the Average Treatment effect of the Treated groups (ATT), cluster-robust standard errors were used to perform g-computation in the matched sample. p-values < 0.05 with a two-sided 95% confidence interval were considered statistically significant. RESULTS Matching achieved well-balanced groups (each n = 140 for CB and SOB). In the CB group, 65/140 (46.4%) patients were diagnosed with csPCa compared to 44/140 (31.4%) in the SOB group (RR 1.48, 95%-CI: 1.09-2.0, p = 0.01). In the CB group, 4.3% (6/140) and 1.4% (2/140) of csPCa cases were detected with targeted-only and systematic-only biopsy cores, respectively. In the CB group, 22/140 (15.7%) patients were diagnosed with ncsPCa compared to 33/140 (23.6%) in the SOB group (RR = 0.67, 95% CI: 0.41-1.08, p = 0.1). When comparing SOB to CB (ATT), the marginal OR was 0.56 (95% CI: 0.38-0.82, p = 0.003) for the diagnosis of csPCa and 0.75 (95% CI: 0.47-1.05, p = 0.085) for the diagnosis of overall cancer (≥ISUP 1). CONCLUSION The CB approach was superior to the SOB approach in detecting csPCa, while no additional detection of ncsPCa was seen. Our results support the application of mpMRI for biopsy-naïve patients with suspicions of prostate cancer.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria; (G.O.); (V.F.); (J.S.); (U.N.)
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
| | - Charalampos Mavridis
- Department of Urology, University General Hospital of Heraklion, 71110 Heraklion, Greece;
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Veronika Fritz
- Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria; (G.O.); (V.F.); (J.S.); (U.N.)
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
| | - Jörg Schachtner
- Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria; (G.O.); (V.F.); (J.S.); (U.N.)
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, 71110 Heraklion, Greece;
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria; (G.O.); (V.F.); (J.S.); (U.N.)
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
- Department of Urology, University General Hospital of Heraklion, 71110 Heraklion, Greece;
- School of Medicine, University of Crete, 71003 Heraklion, Greece
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8
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Khan A, Moore CM, Minhaj Siddiqui M. Prostate MRI and image quality: The urologist's perspective. Eur J Radiol 2024; 170:111255. [PMID: 38101197 DOI: 10.1016/j.ejrad.2023.111255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
The development of different imaging modalities of the prostate has significantly improved tumor detection, patient risk stratification, and quality of care.Among these, multiparametric magnetic resonance imaging (mp-MRI) has emerged as the most sensitive tool.It is useful in the diagnosis, localization, risk stratification, and staging of clinically significant prostate cancer, PCa. As a result, mp-MRI of the prostate is recommended as the initial diagnostic test for men with suspected PCa. A multidisciplinary approach is crucial in the diagnosis and management of prostate cancer and mp-MRI plays a fundamental role in this scenario.While many aspects of image quality certainly fall within the purview of radiology, it is important to recognize that urologists must also be attentive to imaging quality when utilizing mp-MRI to facilitate PCa management. We present our viewpoint as urologists on how image quality impacts the management of men diagnosed with PCa andattempt to identify the factors that impact mp-MRI image quality, consequences of poor image quality, and finally suggestions for improvements.
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Affiliation(s)
- Amir Khan
- Division of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Caroline M Moore
- Division of Surgical and Interventional Sciences, University College London, London, UK.
| | - M Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.
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9
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Grynkiewicz M, Wiewióra M. A current role status of micro-ultrasound imaging in prostate cancer diagnosis. Clin Hemorheol Microcirc 2024; 87:89-100. [PMID: 38160349 DOI: 10.3233/ch-232024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Recently diagnostic field in medicine was enriched by advances in ultrasonography (US) technology, which led to establishment of novel modalities, one of which is micro-ultrasound. Results demonstrated by early studies have been promising, simultaneously rising a question if those new modalities could become an alternative in diagnosis of prostatic carcinoma (PCa). To answer this question, several studies have been conducted where micro-ultrasound have been compared to standard diagnostic tools, such as conventional TRUS or mpMRI. Nevertheless, new technology presents with some limitations, which include inconsistent results, necessity for specialized equipment, need of training for investigators to understand the findings, and external validation. In this publication, we have identified studies that provided evaluation of the accuracy and efficiency of the micro-ultrasound technology. Additionally, analysis of the results provided a better understanding of the novel imaging tool when compared standard modalities in diagnosis of PCa. Increasing number of studies demonstrated that micro-ultrasound carries high detection rate of PCa and clinically significant prostatic cancer (csPCa), suggesting a similar performance to mpMRI and even showing superiority over conventional TRUS. Recent studies have also showed that micro-ultrasound takes active role in improving the detection of csPCa and guidance for prostate biopsy (PBx) as well as further treatment. Moreover, certain practical aspects such as lower costs, decreased waiting time, real-time imaging and application of the imaging tool for patients that are not suitable for mpMRI (contrast allergy, prosthetics etc.) are significant advantages. Analysis of the results still does not provide clear answer whether micro-ultrasound outperforms mpMRI. Further studies are necessary in order to completely understand the potential of this new technology.
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Affiliation(s)
- Michael Grynkiewicz
- Department of Urology, Pediatric Urology and Robot Assisted Minimally Invasive Urology, Sozialstiftung Bamberg, Hospital Bamberg, Bamberg, Germany
| | - Maciej Wiewióra
- Department of Cardiac Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
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10
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Kovacs B, Netzer N, Baumgartner M, Schrader A, Isensee F, Weißer C, Wolf I, Görtz M, Jaeger PF, Schütz V, Floca R, Gnirs R, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D, Maier-Hein KH. Addressing image misalignments in multi-parametric prostate MRI for enhanced computer-aided diagnosis of prostate cancer. Sci Rep 2023; 13:19805. [PMID: 37957250 PMCID: PMC10643562 DOI: 10.1038/s41598-023-46747-z] [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: 10/18/2022] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
Prostate cancer (PCa) diagnosis on multi-parametric magnetic resonance images (MRI) requires radiologists with a high level of expertise. Misalignments between the MRI sequences can be caused by patient movement, elastic soft-tissue deformations, and imaging artifacts. They further increase the complexity of the task prompting radiologists to interpret the images. Recently, computer-aided diagnosis (CAD) tools have demonstrated potential for PCa diagnosis typically relying on complex co-registration of the input modalities. However, there is no consensus among research groups on whether CAD systems profit from using registration. Furthermore, alternative strategies to handle multi-modal misalignments have not been explored so far. Our study introduces and compares different strategies to cope with image misalignments and evaluates them regarding to their direct effect on diagnostic accuracy of PCa. In addition to established registration algorithms, we propose 'misalignment augmentation' as a concept to increase CAD robustness. As the results demonstrate, misalignment augmentations can not only compensate for a complete lack of registration, but if used in conjunction with registration, also improve the overall performance on an independent test set.
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Affiliation(s)
- Balint Kovacs
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany.
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany.
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
| | - Nils Netzer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Baumgartner
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
| | - Adrian Schrader
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Fabian Isensee
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Cedric Weißer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Ivo Wolf
- Mannheim University of Applied Sciences, Mannheim, Germany
| | - Magdalena Görtz
- Junior Clinical Cooperation Unit 'Multiparametric Methods for Early Detection of Prostate Cancer', German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Paul F Jaeger
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Interactive Machine Learning Group, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Victoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Ralf Floca
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| | - Regula Gnirs
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
| | - Klaus H Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
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11
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Stabile A, Sorce G, Barletta F, Brembilla G, Mazzone E, Pellegrino F, Cannoletta D, Cirulli GO, Gandaglia G, De Cobelli F, Montorsi F, Briganti A. Impact of prostate MRI central review over the diagnostic performance of MRI-targeted biopsy: should we routinely ask for an expert second opinion? World J Urol 2023; 41:3231-3237. [PMID: 36943477 DOI: 10.1007/s00345-023-04365-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE There is substantial variability in multiparametric MRI (mpMRI) protocols and inter-readers' agreement. We tested the effect of a central mpMRI review on the detection of clinically significant PCa (csPCa) in a tertiary referral center. METHODS We retrospectively analyzed a cohort of 364 consecutive men with a positive externally performed mpMRI (PI-RADS ≥ 3) who underwent a targeted biopsy (TBx) plus a systematic biopsy at a single tertiary referral center (2018-2020). Of those mpMRIs, 32% (n = 116) were centrally reviewed. We compared the detection of csPCa between the non-central-reviewed vs reviewed group. Multivariable logistic regression models (MVA) tested the relationship between mpMRI central review and the detection of csPCa at TBx. RESULTS The detection of csPCa at TBx in non-central-reviewed vs central-reviewed group was 41 vs 63%, respectively (p = 0.001). The distribution of PI-RADS 2, 3, 4, and 5 at initial assessment vs after mpMRI central review was 0, 37, 47, and 16% vs 39, 9, 35, and 16%, respectively (p < 0.004). Of 43 patients with initial PI-RADS 3 score, respectively 67, 21, and 12, and 0% had a revised PI-RADS score of ≤ 2, 3, 4, and 5. At MVA, mpMRI central review (OR: 1.65, CI 0.85-0.98) was significantly associated with higher csPCa detection at TBx. CONCLUSIONS We demonstrated that a central review of external mpMRIs may decrease the overcall of equivocal lesions, namely PI-RADS 3, and should be considered to maximize the clinical benefit of TBx in terms of increasing the detection of csPCa and eventually decreasing the rate of unnecessary biopsies.
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Affiliation(s)
- Armando Stabile
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Gabriele Sorce
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Barletta
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Pellegrino
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Donato Cannoletta
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Giorgio Gandaglia
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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12
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Asl ER, Sarabandi S, Shademan B, Dalvandi K, sheikhansari G, Nourazarian A. MicroRNA targeting: A novel therapeutic intervention for ovarian cancer. Biochem Biophys Rep 2023; 35:101519. [PMID: 37521375 PMCID: PMC10382632 DOI: 10.1016/j.bbrep.2023.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023] Open
Abstract
Ovarian cancer, a perilous form of cancer affecting the female reproductive system, exhibits intricate communication networks that contribute to its progression. This study aims to identify crucial molecular abnormalities linked to the disease to enhance diagnostic and therapeutic strategies. In particular, we investigate the role of microRNAs (miRNAs) as diagnostic biomarkers and explore their potential in treating ovarian cancer. By targeting miRNAs, which can influence multiple pathways and genes, substantial therapeutic benefits can be attained. In this review we want to shed light on the promising application of miRNA-based interventions and provide insights into the specific miRNAs implicated in ovarian cancer pathogenesis.
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Affiliation(s)
- Elmira Roshani Asl
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Sajed Sarabandi
- Department of Veterinary, Faculty of Medicine Sciences, Islamic Azad University of Karaj, Karaj, Iran
| | - Behrouz Shademan
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kourosh Dalvandi
- Ministry of Health and Medical Education, Health Department, Tehran, Iran
| | | | - Alireza Nourazarian
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran
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13
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Vilanova JC, Catalá-Sventzetzky V, Hernández-Mancera J. MRI for detection, staging, and follow-up of prostate cancer: Synthesis of the PI-RADS v2.1, MET-RADS, PRECISE, and PI-RR guidelines. RADIOLOGIA 2023; 65:431-446. [PMID: 37758334 DOI: 10.1016/j.rxeng.2022.12.005] [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: 12/01/2022] [Accepted: 12/19/2022] [Indexed: 10/03/2023]
Abstract
Prostate cancer is very common among men. Radiology, mainly through MRI, plays a key role in the different stages of prostate cancer: diagnosis, staging and treatment assessment. The correct management of MRI requires knowledge and proper use of the different guidelines developed for the acquisition, interpretation and reporting of MRI in diagnosis (PI-RADS guide), whole body staging (MET-RADS guide), active surveillance (PRECISE guide) and local recurrence (PI-RR guide) in prostate cancer. The objective of this article is to show an update and synthesis of the most relevant aspects of these MRI guidelines for an optimal use and thus providing a more effective management of prostate cancer.
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Affiliation(s)
- J C Vilanova
- Departamento Radiología, Clínica Girona, Institut de Diagnòstic per la Imatge (IDI), Hospital Dr. J. Trueta/Hospital Sta. Caterina, Departamento de Ciencias Médicas, Facultad de Medicina, Universitat de Girona, Girona, Spain.
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14
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Martinez-Marroquin E, Chau M, Turner M, Haxhimolla H, Paterson C. Use of artificial intelligence in discerning the need for prostate biopsy and readiness for clinical practice: a systematic review protocol. Syst Rev 2023; 12:126. [PMID: 37461083 DOI: 10.1186/s13643-023-02282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Variability and inaccuracies in the diagnosis of prostate cancer, and the risk of complications from invasive tests, have been extensively reported in the research literature. To address this, the use of artificial intelligence (AI) has been attracting increased interest in recent years to improve the diagnostic accuracy and objectivity. Although AI literature has reported promising results, further research is needed on the identification of evidence gaps that limit the potential adoption in prostate cancer screening practice. METHODS A systematic electronic search strategy will be used to identify peer-reviewed articles published from inception to the date of searches and indexed in CINAHL, IEEE Xplore, MEDLINE, Scopus, and Web of Science Core Collection databases. Registries including Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and International Clinical Trials Registry Platform (ICTRP) will be searched for unpublished studies, and experts were invited to provide suitable references. The research and reporting will be based on Cochrane recommendations and PRISMA guidelines, respectively. The screening and quality assessment of the articles will be conducted by two of the authors independently, and conflicts will be resolved by a third author. DISCUSSION This systematic review will summarise the use of AI techniques to predict the need for prostate biopsy based on clinical and demographic indicators, including its diagnostic accuracy and readiness for adoption in clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022336540.
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Affiliation(s)
- Elisa Martinez-Marroquin
- Faculty of Science and Technology, University of Canberra, Canberra, Australian Capital Territory, 2617, Australia.
| | - Minh Chau
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
| | - Murray Turner
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
| | - Hodo Haxhimolla
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
| | - Catherine Paterson
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
- Robert Gordon University, Aberdeen, AB10 7AQ, Scotland, UK
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Shademan B, Karamad V, Nourazarian A, Masjedi S, Isazadeh A, Sogutlu F, Avcı CB. MicroRNAs as Targets for Cancer Diagnosis: Interests and Limitations. Adv Pharm Bull 2023; 13:435-445. [PMID: 37646065 PMCID: PMC10460809 DOI: 10.34172/apb.2023.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/02/2022] [Accepted: 07/01/2022] [Indexed: 09/01/2023] Open
Abstract
MicroRNAs are small RNAs with ability to attach to the large number of RNA that regulate gene expression on post-transcriptional level via inhibition or degradation of specific mRNAs. MiRNAs in cells are the primary regulators of functions such as cell growth, differentiation, and apoptosis and considerably influence cell function. The expression levels of microRNAs change in human diseases, including cancer. These changes highlight their essential role in cancer pathogenesis. Ubiquitous irregular expression profiles of miRNAs have been detected in various human cancers using genome-wide identification techniques, which are emerging as novel diagnostic and prognostic cancer biomarkers of high specificity and sensitivity. The measurable miRNAs with enhanced stability in blood, tissues, and other body fluids provide a comprehensive source of miRNA-dependent biomarkers for human cancers. The leading role of miRNAs as potential biomarkers in human cancers is discussed in this article. In addition, the interests and difficulties of miRNAs as biomarkers have been explored.
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Affiliation(s)
- Behrouz Shademan
- Department of Medical Biology, Faculty of Medicine, EGE University, Izmir, Turkey
| | - Vahidreza Karamad
- Department of Medical Biology, Faculty of Medicine, EGE University, Izmir, Turkey
| | - Alireza Nourazarian
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran
| | - Sepideh Masjedi
- Department of Cellular and Molecular Biology Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Alireza Isazadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatma Sogutlu
- Department of Medical Biology, Faculty of Medicine, EGE University, Izmir, Turkey
| | - Cigir Biray Avcı
- Department of Medical Biology, Faculty of Medicine, EGE University, Izmir, Turkey
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16
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Berger D, Van Dyk S, Beaulieu L, Major T, Kron T. Modern Tools for Modern Brachytherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00182-6. [PMID: 37217434 DOI: 10.1016/j.clon.2023.05.003] [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: 10/14/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
This review aims to showcase the brachytherapy tools and technologies that have emerged during the last 10 years. Soft-tissue contrast using magnetic resonance and ultrasound imaging has seen enormous growth in use to plan all forms of brachytherapy. The era of image-guided brachytherapy has encouraged the development of advanced applicators and given rise to the growth of individualised 3D printing to achieve reproducible and predictable implants. These advances increase the quality of implants to better direct radiation to target volumes while sparing normal tissue. Applicator reconstruction has moved beyond manual digitising, to drag and drop of three-dimensional applicator models with embedded pre-defined source pathways, ready for auto-recognition and automation. The simplified TG-43 dose calculation formalism directly linked to reference air kerma rate of high-energy sources in the medium water remains clinically robust. Model-based dose calculation algorithms accounting for tissue heterogeneity and applicator material will advance the field of brachytherapy dosimetry to become more clinically accurate. Improved dose-optimising toolkits contribute to the real-time and adaptive planning portfolio that harmonises and expedites the entire image-guided brachytherapy process. Traditional planning strategies remain relevant to validate emerging technologies and should continue to be incorporated in practice, particularly for cervical cancer. Overall, technological developments need commissioning and validation to make the best use of the advanced features by understanding their strengths and limitations. Brachytherapy has become high-tech and modern by respecting tradition and remaining accessible to all.
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Affiliation(s)
- D Berger
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria.
| | - S Van Dyk
- Radiation Therapy Services, Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - L Beaulieu
- Service de Physique Médicale et Radioprotection, et Axe Oncologie du Centre de Recherche du CHU de Québec, CHU de Québec, Québec, Canada; Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec, Canada
| | - T Major
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - T Kron
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
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Resonancia magnética en la detección, estadificación y seguimiento del cáncer de próstata: síntesis de las guías PI-RADS v2.1, MET-RADS, PRECISE y PI-RR. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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The impact of local staging of prostate cancer determined on MRI or DRE at time of radical prostatectomy on progression-free survival: A Will Rogers phenomenon. Urol Oncol 2023; 41:106.e9-106.e16. [PMID: 36564258 DOI: 10.1016/j.urolonc.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/01/2022] [Accepted: 10/20/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION We aimed to test whether the current practice of using mpMRI stage might lead to a Will Rogers phenomenon with a stage migration compared to DRE in men undergoing radical prostatectomy. MATERIAL AND METHODS A total of 572 consecutive patients who underwent radical prostatectomy at a single institution (2007-2017) were included. Clinical stage using digital rectal examination was determined on table by the operating surgeon; mpMRI and pathological stage were recorded after tumor board review. Progression-free survival (PFS) was defined as no rising PSA, no adjuvant/salvage treatment, and no metastases or mortality. PFS was compared between groups and a model incorporating mpMRI into the EAU risk groups was created. RESULTS Median age was 63 years (IQR 58.5-67) and median PSA was 8.9 ng/ml (IQR 6.5-13.2). Using DRE stage, 20% were NCCN low risk, 43% were intermediate, and 37% high. Median follow-up was 48 months (IQR 22-73). Estimated PFS at 1, 3, and 5 years was 75%, 59%, and 54%, respectively. When comparing PFS between DRE and mpMRI stages, patients deemed T1 (P < 0.01) or T3 (P = 0.03) by mpMRI showed better outcomes than patients staged T1 or T3 by DRE. On univariable analysis lower risk for failure was seen for MRI T1 disease (HR 0.10 95%, CI 0.01-0.73, P = 0.02) or MRI T3 (HR 0.70, CI 0.51-0.97, P = 0.03). On multivariable analysis, only MRI T1 remained a significant predictor (HR 0.08, 95% CI 0.01-0.59, P = 0.01). The subsequent, modified EAU risk model using both DRE and mpMRI performed significantly better than the DRE model. CONCLUSION PFS based on mpMRI is not the same as DRE staging. Current risk groups which use DRE should be used with caution in whom local stage is based on mpMRI. Our modified EAU-risk categories can provide greater accuracy.
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Sun Z, Wang H, Fu W, Zhu S, Song G. MRI-based analysis of different clinically significant prostate cancer detection rate of prostate imaging reporting and data system score 4 in the peripheral zone. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:390-398. [PMID: 36305943 DOI: 10.1007/s00261-022-03712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare the clinically significant prostate cancer (csPCa) detection rate between diffusion-weighted imaging (DWI) 4 and DWI 3 with positive dynamic contrast-enhanced (DCE) (hereinafter called 'DWI 3/DCE+') lesions in the peripheral zone (PZ) and to explore the diagnostic performance of targeted biopsy (TB) or systematic biopsy (SB) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions. METHODS We retrospectively enrolled 206 patients who underwent multiparametric magnetic resonance imaging and had at least one PI-RADS 4 lesion in the PZ. All patients subsequently underwent combined magnetic resonance imaging/ultrasound fusion-guided TB and ultrasound-guided 12-core SB. The chi-square test was used to compare the csPCa detection rates between DWI 4 and DWI 3/DCE+ lesions. Based on the TB + SB results as a standard reference, we analyzed the sensitivity, negative predictive value, and diagnostic accuracy of TB alone or SB alone. RESULTS Patients with DWI 4 lesions had higher csPCa detection rate than those with DWI 3/DCE+ lesions when using TB + SB, TB, and SB, and the differences were significant for TB + SB (72.22 vs. 54.84%, p = 0.015) or SB (65.97 vs. 46.77%, p = 0.010). For DWI 3/DCE+ patients whose prostate-specific antigen levels ranged from 4 to 10 ng/mL, TB alone showed the highest negative predictive value (95% Cl 78.12-100). CONCLUSIONS DWI 4 tends to have worse results than DWI 3/DCE+. TB has great diagnostic performances in DWI 3/DCE+ patients, especially for those prostate-specific antigen ranging from 4 to 10 ng/mL.
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Affiliation(s)
- Zhoujie Sun
- Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, 100034, China
- Institute of Urology, Peking University, Beijing, 100034, China
- The National Urological Cancer Center of China, Beijing, 100034, China
| | - He Wang
- Department of Radiology, Peking University First Hospital, Beijing, 100034, China
| | - Weixiao Fu
- Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, 100034, China
- Institute of Urology, Peking University, Beijing, 100034, China
- The National Urological Cancer Center of China, Beijing, 100034, China
| | - Sainan Zhu
- Department of Statistics, Peking University First Hospital, Beijing, 100034, China
| | - Gang Song
- Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, 100034, China.
- Institute of Urology, Peking University, Beijing, 100034, China.
- The National Urological Cancer Center of China, Beijing, 100034, China.
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Barrett T, de Rooij M, Giganti F, Allen C, Barentsz JO, Padhani AR. Quality checkpoints in the MRI-directed prostate cancer diagnostic pathway. Nat Rev Urol 2023; 20:9-22. [PMID: 36168056 DOI: 10.1038/s41585-022-00648-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
Multiparametric MRI of the prostate is now recommended as the initial diagnostic test for men presenting with suspected prostate cancer, with a negative MRI enabling safe avoidance of biopsy and a positive result enabling MRI-directed sampling of lesions. The diagnostic pathway consists of several steps, from initial patient presentation and preparation to performing and interpreting MRI, communicating the imaging findings, outlining the prostate and intra-prostatic target lesions, performing the biopsy and assessing the cores. Each component of this pathway requires experienced clinicians, optimized equipment, good inter-disciplinary communication between specialists, and standardized workflows in order to achieve the expected outcomes. Assessment of quality and mitigation measures are essential for the success of the MRI-directed prostate cancer diagnostic pathway. Quality assurance processes including Prostate Imaging-Reporting and Data System, template biopsy, and pathology guidelines help to minimize variation and ensure optimization of the diagnostic pathway. Quality control systems including the Prostate Imaging Quality scoring system, patient-level outcomes (such as Prostate Imaging-Reporting and Data System MRI score assignment and cancer detection rates), multidisciplinary meeting review and audits might also be used to provide consistency of outcomes and ensure that all the benefits of the MRI-directed pathway are achieved.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK
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Are Urologists Ready for Interpretation of Multiparametric MRI Findings? A Prospective Multicentric Evaluation. Diagnostics (Basel) 2022; 12:diagnostics12112656. [PMID: 36359499 PMCID: PMC9689928 DOI: 10.3390/diagnostics12112656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Aim: To assess urologists’ proficiency in the interpretation of multiparametric magnetic resonance imaging (mpMRI). Materials and Methods: Twelve mpMRIs were shown to 73 urologists from seven Italian institutions. Responders were asked to identify the site of the suspicious nodule (SN) but not to assign a PIRADS score. We set an a priori cut-off of 75% correct identification of SN as a threshold for proficiency in mpMRI reading. Data were analyzed according to urologists’ hierarchy (UH; resident vs. consultant) and previous experience in fusion prostate biopsies (E-fPB, defined as <125 vs. ≥125). Additionally, we tested for differences between non-proficient vs. proficient mpMRI readers. Multivariable logistic regression analyses (MVLRA) tested potential predictors of proficiency in mpMRI reading. Results: The median (IQR) number of correct identifications was 8 (6−8). Anterior nodules (number 3, 4 and 6) represented the most likely prone to misinterpretation. Overall, 34 (47%) participants achieved the 75% cut-off. When comparing consultants vs. residents, we found no differences in terms of E-fPB (p = 0.9) or in correct identification rates (p = 0.6). We recorded higher identification rates in urologists with E-fBP vs. their no E-fBP counterparts (75% vs. 67%, p = 0.004). At MVLRA, only E- fPB reached the status of independent predictor of proficiency in mpMRI reading (OR: 3.4, 95% CI 1.2−9.9, p = 0.02) after adjusting for UH and type of institution. Conclusions: Despite urologists becoming more familiar with interpretation of mpMRI, their results are still far from proficient. E-fPB enhances the proficiency in mpMRI interpretation.
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22
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Chang SD, Reinhold C, Kirkpatrick IDC, Clarke SE, Schieda N, Hurrell C, Cool DW, Tunis AS, Alabousi A, Diederichs BJ, Haider MA. Canadian Association of Radiologists Prostate MRI White Paper. Can Assoc Radiol J 2022; 73:626-638. [PMID: 35971326 DOI: 10.1177/08465371221105532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer is the most common malignancy and the third most common cause of death in Canadian men. In light of evolving diagnostic pathways for prostate cancer and the increased use of MRI, which now includes its use in men prior to biopsy, the Canadian Association of Radiologists established a Prostate MRI Working Group to produce a white paper to provide recommendations on establishing and maintaining a Prostate MRI Programme in the context of the Canadian healthcare system. The recommendations, which are based on available scientific evidence and/or expert consensus, are intended to maintain quality in image acquisition, interpretation, reporting and targeted biopsy to ensure optimal patient care. The paper covers technique, reporting, quality assurance and targeted biopsy considerations and includes appendices detailing suggested reporting templates, quality assessment tools and sample image acquisition protocols relevant to the Canadian healthcare context.
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Affiliation(s)
- Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Caroline Reinhold
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Nicola Schieda
- Department of Diagnostic Imaging, The Ottawa Hospital- Civic Campus, Ottawa, ON, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Derek W Cool
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Adam S Tunis
- Department of Medical Imaging, University of Toronto, North York General Hospital, Toronto, ON, Canada
| | - Abdullah Alabousi
- Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Masoom A Haider
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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23
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Prostate MRI using a rigid two-channel phased-array endorectal coil: comparison with phased array coil acquisition at 3 T. Cancer Imaging 2022; 22:15. [PMID: 35296357 PMCID: PMC8925156 DOI: 10.1186/s40644-022-00453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background To compare image quality, lesion detection and patient comfort of 3T prostate MRI using a combined rigid two-channel phased-array endorectal coil and an external phased-array coil (ERC-PAC) compared to external PAC acquisition in the same patients. Methods Thirty three men (mean age 65.3y) with suspected (n = 15) or biopsy-proven prostate cancer (PCa, n = 18) were prospectively enrolled in this exploratory study. 3T prostate MRI including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) was performed using an ERC-PAC versus PAC alone, in random order. Image quality, lesion detection and characterization (biparametric PI-RADSv2.1) were evaluated by 2 independent observers. Estimated signal-to-noise ratio (eSNR) was measured in identified lesions and the peripheral zone (PZ). Patient comfort was assessed using a questionnaire. Data were compared between sequences and acquisitions. Inter/intra-observer agreement for PI-RADS scores was evaluated. Results Twenty four prostate lesions (22 PCa) were identified in 20/33 men. Superior image quality was found for ERC-PAC compared to PAC for T2WI for one observer (Obs.1, p < 0.03) and high b-value DWI for both observers (p < 0.05). The sensitivity of PI-RADS for lesion detection for ERC-PAC and PAC acquisitions was 79.2 and 75% for Obs.1, and 79.1 and 66.7%, for Obs.2, without significant difference for each observer (McNemar p-values ≥0.08). Inter−/intra-observer agreement for PI-RADS scores was moderate-to-substantial (kappa = 0.52–0.84). Higher eSNR was observed for lesions and PZ for T2WI and PZ for DWI using ERC-PAC (p < 0.013). Most patients (21/33) reported discomfort at ERC insertion. Conclusion Despite improved image quality and eSNR using the rigid ERC-PAC combination, no significant improvement in lesion detection was observed, therefore not supporting the routine use of ERC for prostate MRI. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00453-7.
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Immerzeel J, Israël B, Bomers J, Schoots IG, van Basten JP, Kurth KH, de Reijke T, Sedelaar M, Debruyne F, Barentsz J. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 4: Transperineal Magnetic Resonance-Ultrasound Fusion Guided Biopsy Using Local Anesthesia. Eur Urol 2021; 81:110-117. [PMID: 34799197 DOI: 10.1016/j.eururo.2021.10.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/19/2021] [Accepted: 10/22/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Transperineal magnetic resonance imaging-transrectal ultrasound fusion guided biopsy (MFGB) is an increasingly popular technique due to increasing rates of biopsy-related infections. However, its widespread implementation has been hampered by the supposed necessity of epidural or general anesthesia. OBJECTIVE To demonstrate the technique, feasibility, and results of transperineal MFGB under local anesthesia, in an ambulatory setting without the administration of prophylactic antibiotics. DESIGN, SETTING, AND PARTICIPANTS This single-center study enrolled consecutive biopsy-naïve men with a clinical suspicion of prostate cancer into a prospective database between November 2015 and November 2020. Men with Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores 3-5 underwent transperineal MFGB. SURGICAL PROCEDURE Transperineal MFGB was performed in an ambulatory setting under local anesthesia by a single operator. MEASUREMENTS Procedure-associated adverse events were recorded. Patient discomfort during both the local anesthesia and the biopsy procedure was determined using a visual analogic scale (0-10). Detection rates of grade group (GG) ≥2 prostate cancer and the proportion of men with GG 1 cancer were assessed. RESULTS AND LIMITATIONS A total of 1097 eligible men underwent transperineal MFGB. The complication rate was 0.73% (8/1097); complications comprised five (0.46%) urinary tract infections including one hospitalization and three (0.27%) urinary retentions. In 735 men, the median pain scores were 2 (interquartile range [IQR] 2-3) for the local anesthesia procedure and 1 (IQR 0-2) for the biopsy. Prostate cancer was detected in 84% (926/1097) of men; 66% (723/1097) had GG ≥2 and 19% (203/1097) GG 1. CONCLUSIONS Transperineal MFGB can safely be performed as an outpatient procedure under local anesthesia in an ambulatory setting. The detection rate of clinically significant prostate cancer is high, and biopsy is well tolerated. Although no antibiotic prophylaxis was used, the rate of infectious complications is practicably negligible. PATIENT SUMMARY This article shows how tissue samples (biopsies) can accurately be obtained from suspicious regions seen on prostate magnetic resonance imaging via needles inserted in the perineum (skin between the scrotum and the anus) in men with suspected prostate cancer. This technique appears to be very well tolerated under local anesthesia and has a lower risk of infection without antibiotic prophylaxis than the more common biopsy route through the rectum, with antibiotics.
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Affiliation(s)
- Jos Immerzeel
- Department of Urology, Andros Clinics, Arnhem, The Netherlands
| | - Bas Israël
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joyce Bomers
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jean-Paul van Basten
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; Prosper Collaborative Prostate Cancer Clinics, Nijmegen-Eindhoven, The Netherlands
| | | | - Theo de Reijke
- Department of Urology, Andros Clinics, Arnhem, The Netherlands; Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Prosper Collaborative Prostate Cancer Clinics, Nijmegen-Eindhoven, The Netherlands
| | - Frans Debruyne
- Department of Urology, Andros Clinics, Arnhem, The Netherlands
| | - Jelle Barentsz
- Department of Urology, Andros Clinics, Arnhem, The Netherlands; Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
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Hosseinzadeh M, Saha A, Brand P, Slootweg I, de Rooij M, Huisman H. Deep learning-assisted prostate cancer detection on bi-parametric MRI: minimum training data size requirements and effect of prior knowledge. Eur Radiol 2021; 32:2224-2234. [PMID: 34786615 PMCID: PMC8921042 DOI: 10.1007/s00330-021-08320-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 01/14/2023]
Abstract
Objectives To assess Prostate Imaging Reporting and Data System (PI-RADS)–trained deep learning (DL) algorithm performance and to investigate the effect of data size and prior knowledge on the detection of clinically significant prostate cancer (csPCa) in biopsy-naïve men with a suspicion of PCa. Methods Multi-institution data included 2734 consecutive biopsy-naïve men with elevated PSA levels (≥ 3 ng/mL) that underwent multi-parametric MRI (mpMRI). mpMRI exams were prospectively reported using PI-RADS v2 by expert radiologists. A DL framework was designed and trained on center 1 data (n = 1952) to predict PI-RADS ≥ 4 (n = 1092) lesions from bi-parametric MRI (bpMRI). Experiments included varying the number of cases and the use of automatic zonal segmentation as a DL prior. Independent center 2 cases (n = 296) that included pathology outcome (systematic and MRI targeted biopsy) were used to compute performance for radiologists and DL. The performance of detecting PI-RADS 4–5 and Gleason > 6 lesions was assessed on 782 unseen cases (486 center 1, 296 center 2) using free-response ROC (FROC) and ROC analysis. Results The DL sensitivity for detecting PI-RADS ≥ 4 lesions was 87% (193/223, 95% CI: 82–91) at an average of 1 false positive (FP) per patient, and an AUC of 0.88 (95% CI: 0.84–0.91). The DL sensitivity for the detection of Gleason > 6 lesions was 85% (79/93, 95% CI: 77–83) @ 1 FP compared to 91% (85/93, 95% CI: 84–96) @ 0.3 FP for a consensus panel of expert radiologists. Data size and prior zonal knowledge significantly affected performance (4%, \documentclass[12pt]{minimal}
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\begin{document}$$p<0.05$$\end{document}p<0.05). Conclusion PI-RADS-trained DL can accurately detect and localize Gleason > 6 lesions. DL could reach expert performance using substantially more than 2000 training cases, and DL zonal segmentation. Key Points • AI for prostate MRI analysis depends strongly on data size and prior zonal knowledge. • AI needs substantially more than 2000 training cases to achieve expert performance. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08320-y.
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Affiliation(s)
- Matin Hosseinzadeh
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Anindo Saha
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Patrick Brand
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Ilse Slootweg
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Maarten de Rooij
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Henkjan Huisman
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands.
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Sathiadoss P, Schieda N, Haroon M, Osman H, Alrasheed S, Flood TA, Melkus G. Utility of Quantitative T2-Mapping Compared to Conventional and Advanced Diffusion Weighted Imaging Techniques for Multiparametric Prostate MRI in Men with Hip Prosthesis. J Magn Reson Imaging 2021; 55:265-274. [PMID: 34223675 DOI: 10.1002/jmri.27803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diffusion weighted imaging (DWI) is fundamental for prostate cancer (PCa) detection with MRI; however, limited by susceptibility artifact from hip prosthesis. PURPOSE To evaluate image quality and ability to detect PCa with quantitative T2-mapping and DWI in men with hip prosthesis undergoing prostate MRI. STUDY TYPE Prospective, cross-sectional study. POPULATION Thirty consecutive men with hip replacement (18 unilateral, 12 bilateral) undergoing prostate MRI from 2019 to 2021. FIELD STRENGTH/SEQUENCE 3-T; multiparametric MRI (T2W, DCE-MRI, echo-planar [EPI]-DWI), T2-mapping (Carr-Purcell-Meiboom-Gill), FOCUS-EPI-DWI, PROPELLER-DWI. ASSESSMENT Five blinded radiologists independently evaluated MRI image quality using a 5-point Likert scale. PI-RADS v2.1 scores were applied in four interpretation strategies: 1) T2W-FSE+DCE-MRI+EPI-DWI, 2) T2W-FSE+DCE-MRI+EPI-DWI+FOCUS-EPI-DWI, 3) T2W-FSE+DCE-MRI+EPI-DWI+PROPELLER-DWI, 4) T2W-FSE+DCE-MRI+EPI-DWI+T2-maps. Five-point confidence scores were recorded. STATISTICAL ANALYSIS ANOVA, Kruskal-Wallis with pair-wise comparisons by Wilcoxon sign-rank, and paired t-tests, P < 0.05 was considered significant. Cohen's Kappa (k) for PI-RADSv2.1 scoring and proportion of correctly classified lesions tabulated for pathology-confirmed cases with 95% confidence intervals (CIs). RESULTS For all radiologists, T2-map image quality was significantly higher than EPI-DWI, FOCUS-EPI-DWI, and PROPELLER-DWI and similar (P = 0.146-0.706) or significantly better (for two readers) than T2W-FSE and DCE-MRI. PI-RADS v2.1 agreement improved comparing strategy A (k = 0.46) to strategy B (k = 0.58) to strategy C (k = 0.58) and was highest with strategy D which included T2-maps (k = 1.00). Radiologists' confidence was significantly highest with strategy D. Strategies B and C had similar confidence (P = 0.051-0.063) both significantly outperforming strategy A. Twelve men with 17 lesions had pathology confirmed diagnoses (13 PCa, 4 benign). Strategy D had the highest proportion of correctly classified lesions (76.5-82.4%) with overlapping 95% confidence intervals. DATA CONCLUSION T2-mapping may be a valuable adjunct to prostate MRI in men with hip replacement resulting in improved image quality, higher reader confidence, interobserver agreement, and accuracy in PI-RADS scoring. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Paul Sathiadoss
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohammad Haroon
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Heba Osman
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Sumaya Alrasheed
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor A Flood
- Department of Anatomical Pathology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Gerd Melkus
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Checcucci E, Piramide F, Amparore D, De Cillis S, Granato S, Sica M, Verri P, Volpi G, Piana A, Garrou D, Manfredi M, Fiori C, Porpiglia F. Beyond the Learning Curve of Prostate MRI/TRUS Target Fusion Biopsy after More than 1000 Procedures. Urology 2021; 155:39-45. [PMID: 34224778 DOI: 10.1016/j.urology.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the learning curve (LC) of two urology residents in the execution of fusion biopsy (FB) in terms of overall prostate cancer (PCa) and clinically significant (cs) PCa detection rate (DR) and according to different characteristics of the lesions on MRI MATERIAL AND METHODS: We analyzed data from our prospective maintained FB database between January 2015 and December 2019. FB was performed using the BioJet fusion system (D&K Technologies, Barum, Germany) with a transrectal or transperineal approach. An ANOVA test was used to evaluate the homogeneity of our cohort. Multivariable linear and logistic regression analysis were used to evaluate the relationship between operator experience and DR for PCa and csPCa. Then, the postprocedural complication rate trend was evaluated. RESULTS 1005 patients were included. The overall DR of PCa was 61.2% (615/1005) [IC 0.58 - 0.64]; whilst DR for csPCA was 54.6% (549/1005) [IC 0.51 - 0.57]. Operator experience does not seem to influence the DR of overall PCa and csPCa; whilst for lesions <8 mm in diameter, PCa and csPCa DR increased significantly with operator experience (P = 0.048 and P = 0.038, respectively). Postprocedural complications remained stable during the whole study period (P = 0.75). CONCLUSION A standardized FB approach turned out to be feasible, safe, and effective since the beginning of the residents' LC. PCa and csPCa DR remained stable, at 60% and 55% respectively, after more than 1,000 biopsies. However, for lesions smaller than 8 mm, at least 100 FB of experience is needed to correctly sample the area.
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Affiliation(s)
- Enrico Checcucci
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, 10043.
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Stefano Granato
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Gabriele Volpi
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Diletta Garrou
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, 10043
| | - Matteo Manfredi
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
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Saha A, Hosseinzadeh M, Huisman H. End-to-end prostate cancer detection in bpMRI via 3D CNNs: Effects of attention mechanisms, clinical priori and decoupled false positive reduction. Med Image Anal 2021; 73:102155. [PMID: 34245943 DOI: 10.1016/j.media.2021.102155] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 01/22/2023]
Abstract
We present a multi-stage 3D computer-aided detection and diagnosis (CAD) model2 for automated localization of clinically significant prostate cancer (csPCa) in bi-parametric MR imaging (bpMRI). Deep attention mechanisms drive its detection network, targeting salient structures and highly discriminative feature dimensions across multiple resolutions. Its goal is to accurately identify csPCa lesions from indolent cancer and the wide range of benign pathology that can afflict the prostate gland. Simultaneously, a decoupled residual classifier is used to achieve consistent false positive reduction, without sacrificing high sensitivity or computational efficiency. In order to guide model generalization with domain-specific clinical knowledge, a probabilistic anatomical prior is used to encode the spatial prevalence and zonal distinction of csPCa. Using a large dataset of 1950 prostate bpMRI paired with radiologically-estimated annotations, we hypothesize that such CNN-based models can be trained to detect biopsy-confirmed malignancies in an independent cohort. For 486 institutional testing scans, the 3D CAD system achieves 83.69±5.22% and 93.19±2.96% detection sensitivity at 0.50 and 1.46 false positive(s) per patient, respectively, with 0.882±0.030 AUROC in patient-based diagnosis -significantly outperforming four state-of-the-art baseline architectures (U-SEResNet, UNet++, nnU-Net, Attention U-Net) from recent literature. For 296 external biopsy-confirmed testing scans, the ensembled CAD system shares moderate agreement with a consensus of expert radiologists (76.69%; kappa = 0.51±0.04) and independent pathologists (81.08%; kappa = 0.56±0.06); demonstrating strong generalization to histologically-confirmed csPCa diagnosis.
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Affiliation(s)
- Anindo Saha
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen 6525 GA, the Netherlands.
| | - Matin Hosseinzadeh
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen 6525 GA, the Netherlands
| | - Henkjan Huisman
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen 6525 GA, the Netherlands
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29
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MRI-derived radiomics model for baseline prediction of prostate cancer progression on active surveillance. Sci Rep 2021; 11:12917. [PMID: 34155265 PMCID: PMC8217549 DOI: 10.1038/s41598-021-92341-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
Nearly half of patients with prostate cancer (PCa) harbour low- or intermediate-risk disease considered suitable for active surveillance (AS). However, up to 44% of patients discontinue AS within the first five years, highlighting the unmet clinical need for robust baseline risk-stratification tools that enable timely and accurate prediction of tumour progression. In this proof-of-concept study, we sought to investigate the added value of MRI-derived radiomic features to standard-of-care clinical parameters for improving baseline prediction of PCa progression in AS patients. Tumour T2-weighted imaging (T2WI) and apparent diffusion coefficient radiomic features were extracted, with rigorous calibration and pre-processing methods applied to select the most robust features for predictive modelling. Following leave-one-out cross-validation, the addition of T2WI-derived radiomic features to clinical variables alone improved the area under the ROC curve for predicting progression from 0.61 (95% confidence interval [CI] 0.481-0.743) to 0.75 (95% CI 0.64-0.86). These exploratory findings demonstrate the potential benefit of MRI-derived radiomics to add incremental benefit to clinical data only models in the baseline prediction of PCa progression on AS, paving the way for future multicentre studies validating the proposed model and evaluating its impact on clinical outcomes.
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30
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Razek AAKA, El-Diasty T, Elhendy A, Fahmy D, El-Adalany MA. Prostate Imaging Reporting and Data System (PI-RADS): What the radiologists need to know? Clin Imaging 2021; 79:183-200. [PMID: 34098371 DOI: 10.1016/j.clinimag.2021.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023]
Abstract
We aim to review the new modifications in MR imaging technique, image interpretation, lexicon, and scoring system of the last version of Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) in a simple and practical way. This last version of PI-RADS v2.1 describes the new technical modifications in the protocol of Multiparametric MRI (MpMRI) including T2, diffusion-weighted imaging (DWI), and dynamic contrast enhancement (DCE) parameters. It includes also; new guidelines in the image interpretation specifications in new locations (lesions located in the central zone and anterior fibromuscular stroma), clarification of T2 scoring of lesions of the transition zone, the distinction between DWI score 2 and 3 lesions in the transition zone and peripheral zone, as well as between positive and negative enhancement in DCE. Biparametric MRI (BpMRI) along with simplified PI-RADS is gaining more acceptances in the assessment of clinically significant prostatic cancer.
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Affiliation(s)
| | - Tarek El-Diasty
- Department of Diagnostic Radiology, Mansoura Urology and Nephrology Center, Mansoura, Egypt
| | - Ahmed Elhendy
- Department of Diagnostic Radiology, Mansoura Urology and Nephrology Center, Mansoura, Egypt
| | - Dalia Fahmy
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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31
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Ingole SM, Mehta RU, Kazi ZN, Bhuyar RV. Multiparametric Magnetic Resonance Imaging in Evaluation of Clinically Significant Prostate Cancer. Indian J Radiol Imaging 2021; 31:65-77. [PMID: 34316113 PMCID: PMC8299509 DOI: 10.1055/s-0041-1730093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim
In this prospective study, we evaluate the role of multiparametric magnetic resonance imaging (mp-MRI) in the assessment of clinically significant prostate cancer at 1.5 T without endorectal coil (ERC).
Materials and Methods
Forty-five men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] level > 4 ng/mL, hard prostate on digital rectal examination, and suspicious area at transrectal ultrasound [TRUS]) were evaluated using the mp-MRI protocol over a period of 24 months. All cases were interpreted using the Prostate Imaging Reporting and Data System (PI-RADS) version 2 guidelines and correlated with histopathology.
Statistical Analysis Used
A chi-squared test was used for analysis of nominal/categorical variables and receiver operating characteristic (ROC) curve and one-way analysis of variance (ANOVA) test for continuous variables.
Results
The mean age was 67 years and the mean PSA was 38.2 ng/mL. Eighty percent had prostate cancer and 20% were benign (11% benign prostatic hyperplasia [BPH] and 9% chronic prostatitis). Eighty-six percent of all malignancies were in the peripheral zone. The PI-RADS score for T2-weighted (T2W) imaging showed good sensitivity (81%) but low specificity (67%). The PI-RADS score for diffusion weighted imaging (DWI) with sensitivity of 92% and specificity of 78% had a better accuracy overall than T2W imaging alone. The mean apparent diffusion coefficient (ADC) value (×10
–6
mm
2
/s) was 732 ± 160 in prostate cancer, 1,009 ± 161 in chronic prostatitis, 1,142 ± 82 in BPH, and 663 in a single case of granulomatous prostatitis. Low ADC values (<936) have shown good correlation (area under curve [AUC]: 0.87) with the presence of cancer foci. Inverse correlation was observed between Gleason scores and ADC values. Dynamic contrast-enhanced (DCE) imaging has shown 100% sensitivity/negative predictive value (NPV), but moderate specificity (67%) in predicting malignancy. The final PI-RADS score had 100% sensitivity and NPV with good overall positive predictive value (PPV) of 95%.
Conclusions
T2W imaging and DWI remain the mainstays in diagnosis of prostate cancer with mp-MRI. DCE-MRI can be a problem-solving tool in case of equivocal findings. Because assessment with mp-MRI can be subjective, use of the newly developed PI-RADS version 2 scoring system is helpful in accurate interpretation.
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Affiliation(s)
- Sarang M Ingole
- Department of Imaging Sciences and Pathology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Rajeev U Mehta
- Department of Imaging Sciences and Pathology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Zubair N Kazi
- Department of Imaging Sciences and Pathology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Rutuja V Bhuyar
- Department of Imaging Sciences and Pathology, Saifee Hospital, Mumbai, Maharashtra, India
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32
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Pecoraro M, Messina E, Bicchetti M, Carnicelli G, Del Monte M, Iorio B, La Torre G, Catalano C, Panebianco V. The future direction of imaging in prostate cancer: MRI with or without contrast injection. Andrology 2021; 9:1429-1443. [PMID: 33998173 DOI: 10.1111/andr.13041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiparametric MRI (mpMRI) is the "state of the art" management tool for patients with suspicion of prostate cancer (PCa). The role of non-contrast MRI is investigated to move toward a more personalized, less invasive, and highly cost-effective PCa diagnostic workup. OBJECTIVE To perform a non-systematic review of the existing literature to highlight strength and flaws of performing non-contrast MRI, and to provide a critical overview of the international scientific production on the topic. MATERIALS AND METHODS Online databases (Medline, PubMed, and Web of Science) were searched for original articles, systematic review and meta-analysis, and expert opinion papers. RESULTS Several investigations have shown comparable diagnostic accuracy of biparametric (bpMRI) and mpMRI for the detection of PCa. The advantage of abandoning contrast-enhanced sequences improves operational logistics, lowering costs, acquisition time, and side effects. The main limitations of bpMRI are that most studies comparing non-contrast with contrast MRI come from centers with high expertise that might not be reproducible in the general community setting; besides, reduced protocols might be insufficient for estimation of the intra- and extra-prostatic extension and regional disease. The mentioned observations suggest that low-quality mpMRI for the general population might represent the main shortage to overcome. DISCUSSION Non-contrast MRI future trends are likely represented by PCa screening and the application of artificial intelligence (AI) tools. PCa screening is still a controversial topic; bpMRI has become one of the most promising diagnostic applications, as it is a more sensitive test for PCa early detection, compared to serum PSA level test. Also, AI applications and radiomic have been the object of several studies investigating PCa detection using bpMRI, showing encouraging results. CONCLUSION Today, the accessibility to MRI for early detection of PCa is a priority. Results from prospective, multicenter, multireader, and paired validation studies are needed to provide evidence supporting its role in the clinical practice.
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Affiliation(s)
- Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Marco Bicchetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Giorgia Carnicelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Maurizio Del Monte
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Beniamino Iorio
- Department of Surgical Sciences, "Tor Vergata" University of Rome, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Disease, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
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Scialpi M, Scialpi P, Martorana E, Torre R, Improta A, Aisa MC, D’Andrea A, Di Blasi A. Simplified PI-RADS (S-PI-RADS) for biparametric MRI to detect and manage prostate cancer: What urologists need to know. Turk J Urol 2021; 47:175-182. [PMID: 35929870 PMCID: PMC8260088 DOI: 10.5152/tud.2021.21004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/09/2021] [Indexed: 09/14/2023]
Abstract
Biparametric magnetic resonance imaging (bpMRI) of the prostate has emerged as an alternative to multiparametric MRI (mpMRI) for the detection of clinically significant prostate cancer (csPCa). However, while the Prostate Imaging Reporting and Data System (PI-RADS) is widely known for mpMRI, a proper PI-RADS for bpMRI has not yet been adopted. In this review, we report the current status and the future directions of bpMRI, and propose a simplified PI-RADS (S-PI-RADS) that could help radiologists and urologists in the detection and management of PCa.
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Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Pietro Scialpi
- Division of Urology, Portogruaro Hospital, Venice, Italy
| | | | - Riccardo Torre
- Division of Radiology, Ospedale Santa Maria, Terni, Italy
| | - Antonio Improta
- Division of Diagnostic Imaging, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Maria Cristina Aisa
- Division of Obstetrics and Gynaecology, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Aldo Di Blasi
- Division of Radiology, Tivoli Hospital, Tivoli, Italy
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Meyer HJ, Wienke A, Surov A. Can dynamic contrast enhanced MRI predict gleason score in prostate cancer? a systematic review and meta analysis. Urol Oncol 2021; 39:784.e17-784.e25. [PMID: 33934966 DOI: 10.1016/j.urolonc.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Multiparametric MRI has become a corner stone in diagnosis of prostate cancer (PC). DCE-MRI is used to quantify the influx of contrast media into tissues, which was shown to correlate with histopathology features. The present analysis sought to correlate DCE-MRI parameters with Gleason score (GS) based upon a large patient sample. MATERIAL AND METHODS MEDLINE library, Cochrane and SCOPUS databases were screened for the associations between DCE-MRI and GS in PC up to April 2020. The primary endpoint of the systematic review was the correlation between DCE-MRI parameters and GS and mean Ktrans and Kep and Ve values with standard deviation. In total, 13 studies with overall 894 patients were suitable for the analysis and included into the present study. RESULTS The highest correlation was identified for Ktrans with a pooled correlation coefficient of r = 0.36 (95% CI 0.14-0.59). A large overlap was identified between clinical significant and non-significant PC for all DCE-parameters, for Ktrans the pooled mean value of clinically non-significant PC was 0.32 min-1 [95% CI 0.13-0.51] and for clinically significant PC it was 0.45 min-1 (95% CI 0.25-0.64). CONCLUSION DCE-MRI cannot be used to predict GS in PC, and consequently cannot discriminate clinically significant from non-significant cancers.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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Franiel T, Asbach P, Beyersdorff D, Blondin D, Kaufmann S, Mueller-Lisse UG, Quentin M, Rödel S, Röthke M, Schlemmer HP, Schimmöller L. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Scanning Protocol. ROFO-FORTSCHR RONTG 2021; 193:763-777. [PMID: 33735931 DOI: 10.1055/a-1406-8477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The Working Group Uroradiology and Urogenital Diagnosis of the German Roentgen Society (DRG) revised and updated the recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate in a consensus process and harmonized it with the managing board of German Roentgen Society and Professional Association of the German Radiologist (BDR e. V.). These detailed recommendation define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer and describe in detail the topic 1. anamnestic datas, 2. termination of examinations and preparation of examinations, 3. examination protocol and 4. MRI-(in-bore)-biopsy. KEY POINTS:: · The recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate were revised and updated in a consensus process and harmonized with the managing board of German Roentgen Society (DRG) and Professional Asssociation of the German Radiologist (BDR).. · Detailed recommendations are given for topic 1. anamnestic datas, 2. termination and preparation of examinations, 3. examination protocoll and 4. MRI-(in-bore)-biopsy.. · These recommendations define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer.. CITATION FORMAT: · Franiel T, Asbach P, Beyersdorff D et al. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Examination Protocol. Fortschr Röntgenstr 2021; 193: 763 - 776.
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Affiliation(s)
- Tobias Franiel
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Jena, Deutschland
| | - Patrick Asbach
- Klinik für Radiologie, Charité Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Deutschland
| | - Dirk Beyersdorff
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Blondin
- Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Städtische Kliniken Mönchengladbach GmbH Elisabeth-Krankenhaus Rheydt, Mönchengladbach, Germany.,Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Städtische Kliniken Mönchengladbach, Germany
| | - Sascha Kaufmann
- Institut für Diagnostische und Interventionelle Radiologie, Siloah St. Trudpert Klinikum, Pforzheim, Deutschland
| | | | - Michael Quentin
- Centrum für Diagnostik und Therapie GmbH, Medizinisches Versorgungszentrum CDT Strahleninstitut GmbH, Köln, Germany
| | - Stefan Rödel
- Radiologische Klinik, Städtisches Klinikum Dresden, Germany
| | - Matthias Röthke
- Conradia Radiologie und Nuklearmedizin, Conradia Hamburg MVZ GmbH, Hamburg, Germany
| | | | - Lars Schimmöller
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Sushentsev N, Kaggie JD, Slough RA, Carmo B, Barrett T. Reproducibility of magnetic resonance fingerprinting-based T1 mapping of the healthy prostate at 1.5 and 3.0 T: A proof-of-concept study. PLoS One 2021; 16:e0245970. [PMID: 33513165 PMCID: PMC7846281 DOI: 10.1371/journal.pone.0245970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022] Open
Abstract
Facilitating clinical translation of quantitative imaging techniques has been suggested as means of improving interobserver agreement and diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) of the prostate. One such technique, magnetic resonance fingerprinting (MRF), has significant competitive advantages over conventional mapping techniques in terms of its multi-site reproducibility, short scanning time and inherent robustness to motion. It has also been shown to improve the detection of clinically significant prostate cancer when added to standard mpMRI sequences, however, the existing studies have all been conducted on 3.0 T MRI systems, limiting the technique's use on 1.5 T MRI scanners that are still more widely used for prostate imaging across the globe. The aim of this proof-of-concept study was, therefore, to evaluate the cross-system reproducibility of prostate MRF T1 in healthy volunteers (HVs) using 1.5 and 3.0 T MRI systems. The initial validation of MRF T1 against gold standard inversion recovery fast spin echo (IR-FSE) T1 in the ISMRM/NIST MRI system revealed a strong linear correlation between phantom-derived MRF and IR-FSE T1 values was observed at both field strengths (R2 = 0.998 at 1.5T and R2 = 0.993 at 3T; p = < 0.0001 for both). In young HVs, inter-scanner CVs demonstrated marginal differences across all tissues with the highest difference of 3% observed in fat (2% at 1.5T vs 5% at 3T). At both field strengths, MRF T1 could confidently differentiate prostate peripheral zone from transition zone, which highlights the high quantitative potential of the technique given the known difficulty of tissue differentiation in this age group. The high cross-system reproducibility of MRF T1 relaxometry of the healthy prostate observed in this preliminary study, therefore, supports the technique's prospective clinical validation as part of larger trials employing 1.5 T MRI systems, which are still widely used clinically for routine mpMRI of the prostate.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Joshua D. Kaggie
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Rhys A. Slough
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Bruno Carmo
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- CamPARI Prostate Cancer Group, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
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Chen Y, Ruan M, Zhou B, Hu X, Wang H, Liu H, Liu J, Song G. Cutoff Values of Prostate Imaging Reporting and Data System Version 2.1 Score in Men With Prostate-specific Antigen Level 4 to 10 ng/mL: Importance of Lesion Location. Clin Genitourin Cancer 2021; 19:288-295. [PMID: 33632569 DOI: 10.1016/j.clgc.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/18/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI) has been shown to have a good performance in predicting cancer among patients with a prostate-specific antigen (PSA) level of 4 to 10 ng/mL. However, lesion location on mpMRI has never been separately considered. PATIENTS AND METHODS Patients with PSA level of 4 to 10 ng/mL were prospectively enrolled and underwent transrectal ultrasound-guided prostate biopsy. Patient information was collected, and logistic regression analysis was performed to determine the predictive factors of clinically significant prostate cancer (csPCa). Patients were grouped by lesion location to determine the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 cutoff value in predicting csPCa. RESULTS Among 222 patients, 121 were diagnosed with PCa and 92 had csPCa. Age, prostate volume, PSA density, location (peripheral zone, csPCa only), and PI-RADS v2.1 score were correlated with PCa and csPCa, and PI-RADS v2.1 score was the best predictor. A PI-RADS v2.1 score of 4 was the best cutoff value for predicting csPCa in patients with lesions only in the transitional zone with respect to the Youden index (0.5896) and negative predictive value (93.10%) with acceptable sensitivity (81.82%) and specificity (77.14%). An adjustment of the cutoff value to 3 for lesions in the peripheral zone would increase the negative predictive value (92.00%) and decrease the false negative rate (2.90%) with an acceptable sensitivity (97.10%) and specificity (30.67%). CONCLUSION PI-RADS v2.1 score is an effective predictor of csPCa in patients with PSA levels of 4 to 10 ng/mL. Patients with transitional zone or peripheral zone lesions should undergo biopsy if the PI-RADS v2.1 score is ≥ 4 or ≥ 3, respectively.
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Affiliation(s)
- Yuanchong Chen
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center of China, Beijing, China
| | - Mingjian Ruan
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center of China, Beijing, China
| | - Binyi Zhou
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center of China, Beijing, China
| | - Xuege Hu
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center of China, Beijing, China
| | - Hao Wang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center of China, Beijing, China
| | - Hua Liu
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center of China, Beijing, China
| | - Jia Liu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Gang Song
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center of China, Beijing, China.
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MR safety considerations for patients undergoing prostate MRI. Abdom Radiol (NY) 2020; 45:4097-4108. [PMID: 32902658 DOI: 10.1007/s00261-020-02730-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/15/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
Over the past decade, there has been a dramatic increase in the number of patients undergoing prostate MRI scans. Patients presenting for prostate MRI are an ageing population and may present with a variety of passive or active implants and devices. These implants and devices can be MR safe or MR conditional or MR unsafe. Patients with certain MR-conditional active implants and devices can safely obtain prostate MRI in a specified MR environment within specific MR imaging parameters. Prostate MRI and PET-MRI in patients with passive implants such as hip prostheses, fiducial markers for SBRT, brachytherapy seeds and prostatectomy bed clips have unique concerns for image optimization that can cause geometric distortion of the diffusion-weighted imaging (DWI) sequence. We discuss strategies to overcome these susceptibility artifacts. Prostate MRI in patients with MR conditional active implants such as cardiac implantable electronic devices (CIED) also require modification of imaging parameters and magnet strength. In this setting, a diagnostic quality prostate MRI can be performed at a lower magnet strength (1.5 T) along with modification of imaging parameters to ensure patient safety. Imaging strategies to minimize susceptibility artifact and decrease the specific absorption rate (SAR) in both settings are described. Knowledge of MR safety considerations and imaging strategies specific to prostate MRI and PET-MRI in patients with implants and devices is essential to ensure diagnostic-quality MR images and patient safety.
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Cata E, Andras I, Ferro M, Kadula P, Leucuta D, Musi G, Matei DV, De Cobelli O, Tamas-Szora A, Caraiani C, Lebovici A, Epure F, Bungardean M, Coman RT, Crisan N. Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting-prospective single center experience after 300 cases in first biopsy setting. Transl Androl Urol 2020; 9:2510-2518. [PMID: 33457225 PMCID: PMC7807351 DOI: 10.21037/tau-20-1001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy have become an integral part of the diagnosis of prostate cancer (PCa), as recommended by the European Association of Urology Guidelines. The aim of the current study was to evaluate the performance of MRI and MRI-transrectal ultrasound (TRUS) fusion prostate biopsy as first biopsy setting in a tertiary center. Methods A cohort of 300 patients was included in the current analysis. All patients presented with clinical or biochemical suspicion of PCa and harbored at least one suspect lesion on mpMRI. MRI-TRUS fusion prostate biopsy, followed by 12 core systematic prostate biopsy were performed by the same operator using a rigid registration system. Results The mean age of the patients was 64 years (IQR: 58–68.5 years) and the mean PSA was 6.35 ng/mL (IQR: 4.84–9.46 ng/mL). Overall cancer and csPCa diagnosis rates were 47% and 40.66%. Overall PCa/csPCa detection rates were 20.4%/11.1%, 52%/45% and 68.5%/66.7% for PI-RADS lesions 3, 4 and 5 (P<0.001/P<0.0001). Larger lesion diameter and lesion volume were associated with PCa diagnosis (P=0.006 and P=0.001, respectively). MRI-TRUS fusion biopsy missed PCa diagnosis in 37 cases (of whom 48.6% ISUP 1) in comparison with 9 patients missed by systematic biopsy (of whom 11.1% ISUP 1). In terms of csPCa, systematic biopsy missed 77.7% of the tumors located in the anterior and transitional areas. The rate of csPCa was highest when targeted biopsy was associated with systematic biopsy: 86.52% vs. 68.79% for targeted biopsy vs. 80.14% for systematic biopsy, P=0.0004. In 60.6% of cases, systematic biopsy was positive for PCa at the same site as the targeted lesion. Of these patients, eight harbored csPCa and were diagnosed exclusively on systematic biopsy. Conclusions MRI-TRUS fusion prostate biopsy improves the diagnosis of csPCa. The main advantage of an MRI-guided approach is the diagnosis of anterior and transitional area tumors. The best results in terms of csPCa diagnosis are obtained by the combination of MRI-TRUS fusion with systematic biopsy. The systematic biopsy performed during MRI-targeted biopsy could have an important role in overcoming errors of MRI-TRUS fusion systems.
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Affiliation(s)
- Emanuel Cata
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Urology Department, Municipal Hospital, Cluj Napoca, Romania
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Urology Department, Municipal Hospital, Cluj Napoca, Romania
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Pierre Kadula
- Urology Department, Municipal Hospital, Cluj Napoca, Romania
| | - Daniel Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu-Victor Matei
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Milan, Italy
| | | | - Cosmin Caraiani
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Andrei Lebovici
- Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Flavia Epure
- Medical Imaging Department, Medisprof Cancer Center, Cluj Napoca, Romania
| | - Maria Bungardean
- Pathology Department, County Emergency Hospital, Cluj Napoca, Romania
| | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Urology Department, Municipal Hospital, Cluj Napoca, Romania
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Muglia VF, Vargas HA. Doctor, a patient is on the phone asking about the endorectal coil! Abdom Radiol (NY) 2020; 45:4003-4011. [PMID: 32300836 DOI: 10.1007/s00261-020-02528-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The question referred to in the title of this article is a relatively common situation when performing prostate MRI in some healthcare settings. Moreover, the answer is not always straightforward. The decisions on type of receiver coil for prostate MRI and whether or not an endorectal coil (ERC) should be used is based on several factors. These relate to the patient (e.g., body habitus, presence of metallic devices in the pelvis), the focus of the exam (diagnosis, staging, recurrence), and characteristics of the MRI system (e.g., magnetic field strength and hardware components including coil design and number of elements/channels available in the surface coil). Historically, the combined use of an ERC and a surface coil was the optimal combination for maximizing the signal-to-noise ratio (SNR), particularly for low-strength magnetic fields (1.5T). However, there are several disadvantages associated with the use of an ERC, and several studies have advocated equivalent clinical performance of modern MRI systems for diagnosis and staging of prostate cancer (PCa), either with ERC or surface alone. Accordingly, there is a wide variation in the precise imaging technique across institutions. This article focuses on the most relevant aspects of the decision of whether to use an ERC for PCa MR imaging.
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Affiliation(s)
- Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Av. Bandeirantes 3900, Campus Monte Alegre, Ribeirão Prêto, 14049-900, Brazil.
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Wang Z, Zhao W, Shen J, Jiang Z, Yang S, Tan S, Zhang Y. PI-RADS version 2.1 scoring system is superior in detecting transition zone prostate cancer: a diagnostic study. Abdom Radiol (NY) 2020; 45:4142-4149. [PMID: 32902659 DOI: 10.1007/s00261-020-02724-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE The studies comparing the versions 2 vs. 2.1 of the Prostate Imaging Reporting and Data System (PI-RADS) are rare. This study aimed to evaluate whether PI-RADS version 2.1 is superior in detecting transition zone prostate cancer in comparison with PI-RADS version 2. METHODS This was a diagnostic study of patients with prostate diseases who visited the Urology Department of The Second Affiliated Hospital of Soochow University and underwent a magnetic resonance imaging (MRI) examination between 03-01-2016 and 10-31-2018. The images originally analyzed using PI-RADS version 2 were retrospectively re-analyzed and scored in 2019 according to the updated PI-RADS version 2.1. The kappa and receiver operating characteristic (ROC) curves were used. RESULTS For Reader 1, compared with PI-RADS version 2, version 2.1 had higher sensitivity (85% vs. 79%, P = 0.03), lower specificity (65% vs. 83%, P < 0.001), and lower area under the curve (AUC) (0.749 vs. 0.809, P < 0.001). For Reader 2 (first attempt), compared with PI-RADS version 2, version 2.1 had lower specificity (67% vs. 91%, P < 0.001) and lower AUC (0.702 vs. 0.844, P < 0.001). For Reader 2 (second attempt), compared with PI-RADS version 2, version 2.1 had higher sensitivity (88% vs. 78%, P < 0.001) and lower specificity (77% vs. 91%, P < 0.001). The kappa between the two attempts for Reader 2 was 0.321. CONCLUSION These results suggest that PI-RADS version 2.1 might improve the detection of prostate cancers in the transition zone compared with PI-RADS version 2 but that it might results in higher numbers of biopsies because of lower specificity.
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PI-RADS Committee Position on MRI Without Contrast Medium in Biopsy-Naive Men With Suspected Prostate Cancer: Narrative Review. AJR Am J Roentgenol 2020; 216:3-19. [PMID: 32812795 DOI: 10.2214/ajr.20.24268] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The steadily increasing demand for diagnostic prostate MRI has led to concerns regarding the lack of access to and the availability of qualified MRI scanners and sufficiently experienced radiologists, radiographers, and technologists to meet the demand. Solutions must enhance operational benefits without compromising diagnostic performance, quality, and delivery of service. Solutions should also mitigate risks such as decreased reader confidence and referrer engagement. One approach may be the implementation of MRI without the use gadolinium-based contrast medium (bipara-metric MRI), but only if certain prerequisites such as high-quality imaging, expert interpretation quality, and availability of patient recall or on-table monitoring are mandated. Alternatively, or in combination, a clinical risk-based approach could be used for protocol selection, specifically, which biopsy-naive men need MRI with contrast medium (multiparametric MRI). There is a need for prospective studies in which biopsy decisions are made according to MRI without contrast enhancement. Such studies must define clinical and operational benefits and identify which patient groups can be scanned successfully without contrast enhancement. These higher-quality data are needed before the Prostate Imaging Reporting and Data System (PI-RADS) Committee can make evidence-based recommendations about MRI without contrast enhancement as an initial diagnostic approach for prostate cancer workup.
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Carpagnano FA, Eusebi L, Tupputi U, Testini V, Giannubilo W, Bartelli F, Guglielmi G. Multiparametric MRI: Local Staging of Prostate Cancer. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00374-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Prostate MRI: Practical guidelines for interpreting and reporting according to PI-RADS version 2.1. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sánchez-Oro R, Nuez JT, Martínez-Sanz G, Ortega QG, Bleila M. Prostate MRI: practical guidelines for interpreting and reporting according to PI-RADS version 2.1. RADIOLOGIA 2020; 62:437-451. [PMID: 33268134 DOI: 10.1016/j.rx.2020.09.001] [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: 04/18/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
The increasing precision of multiparametric magnetic resonance imaging of the prostate, together with greater experience and standardization in its interpretation, has given this technique an important role in the management of prostate cancer, the most prevalent non-cutaneous cancer in men. This article reviews the concepts in PI-RADS version 2.1 for estimating the probability and zonal location of significant tumors of the prostate, using a practical approach that includes current considerations about the prerequisites for carrying out the test and recommendations for interpreting the findings. It emphasizes benign findings that can lead to confusion and the criteria for evaluating the probability of local spread, which must be included in the structured report.
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Affiliation(s)
- R Sánchez-Oro
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España.
| | - J Torres Nuez
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - G Martínez-Sanz
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - Q Grau Ortega
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - M Bleila
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
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Bao J, Zhi R, Hou Y, Zhang J, Wu C, Wang X, Zhang Y. Optimized
MRI
Assessment for Clinically Significant Prostate Cancer: A
STARD
‐Compliant Two‐Center Study. J Magn Reson Imaging 2020; 53:1210-1219. [PMID: 33075177 DOI: 10.1002/jmri.27394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jie Bao
- Department of Radiology The First Affiliated Hospital of Soochow University Suzhou China
| | - Rui Zhi
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Ying Hou
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Jing Zhang
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Chen‐Jiang Wu
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xi‐Ming Wang
- Department of Radiology The First Affiliated Hospital of Soochow University Suzhou China
| | - Yu‐Dong Zhang
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
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Giganti F, Allen C, Emberton M, Moore CM, Kasivisvanathan V. Prostate Imaging Quality (PI-QUAL): A New Quality Control Scoring System for Multiparametric Magnetic Resonance Imaging of the Prostate from the PRECISION trial. Eur Urol Oncol 2020; 3:615-619. [PMID: 32646850 DOI: 10.1016/j.euo.2020.06.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
The PRECISION trial was a multicentre randomised study that demonstrated that multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy is superior to standard transrectal ultrasound-guided biopsy for the detection of prostate cancer. The outcomes of studies reporting mpMRI-targeted biopsies are dependent on the quality of the mpMRI but there are currently no scoring systems available for evaluating this. We introduced a novel scoring system, the Prostate Imaging Quality (PI-QUAL) score, to assess the quality of scans in the PRECISION trial. PI-QUAL is a score on a Likert scale from 1 to 5, where 1 means that no mpMRI sequences are of diagnostic quality and 5 implies that each sequence is independently of optimal diagnostic quality. Fifty-eight out of 252 (23%) mpMRI scans chosen at random from each of the 22 centres in this trial were evaluated by two experienced radiologists from the coordinating trial centre, in consensus, blinded to pathology results. Overall, the mpMRI quality in the centres participating in PRECISION was good. MpMRI quality was of sufficient diagnostic quality (PI-QUAL ≥3) for 55 scans (95%) and of good or optimal diagnostic quality (PI-QUAL ≥4) for 35 scans (60%). Fifty-five out of 58 (95%) scans were of diagnostic quality for T2WI, followed by DWI (46/58 scans; 79%), and DCE (38/58 scans; 66%). Further validation of this scoring system is warranted. PATIENT SUMMARY: In this study we developed a scoring system (PI-QUAL) to assess the quality of multiparametric magnetic resonance imaging (mpMRI) in prostate cancer detection. We used scans from 22 centres that participated in the PRECISION trial. Although there was room for improvement in images that used intravenous contrast, we found that mpMRI in the PRECISION trial was of sufficient diagnostic quality (PI-QUAL score ≥3) for 95% of the scans.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Wei H, Tan T, Cheng L, Liu J, Song H, Li L, Zhang K. MRI tracing of ultrasmall superparamagnetic iron oxide nanoparticle‑labeled endothelial progenitor cells for repairing atherosclerotic vessels in rabbits. Mol Med Rep 2020; 22:3327-3337. [PMID: 32945451 PMCID: PMC7453557 DOI: 10.3892/mmr.2020.11431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/30/2020] [Indexed: 12/14/2022] Open
Abstract
Endothelial progenitor cells (EPCs) have been discovered to be relevant to the prognosis of cardiovascular diseases. Previous research has demonstrated that EPCs serve vital roles in the occurrence and development of atherosclerosis. Significant improvements have been made in MRI technology and in the experimental use of EPCs for therapeutic angiogenesis and vascular repair. Nevertheless, the migratory, adhesive, proliferative and angiogenic properties of EPCs remain unknown. The aims of the present study were to investigate the potential of using non-invasive monitoring with ultrasmall superparamagnetic iron oxide nanoparticle (USPION)-labeled endothelial progenitor cells (EPCs) after transplantation, and to assess the treatment outcomes in an atherosclerotic rabbit model. EPCs derived from rabbit peripheral blood samples were labeled with USPION-poly-l-lysine (USPION-PLL). The morphology, proliferation, adhesive ability and labeling efficiency of the EPCs were determined by optical and electron microscopy. Moreover, biological activity was assessed by flow cytometry. In addition, T2-weighted image fast spin-echo MRI was used to detect cell labeling. USPION content in the labeled EPCs was determined by Prussian blue staining and scanning electron microscopy. Rabbit atherosclerosis model was established using a high-fat diet. USPION-labeled EPCs were transplanted into rabbits, and in vivo MRI was performed 1 and 7 days after transplantation. It was found that EPCs cultured on Matrigel formed capillary-like structures, and expressed the surface markers CD133, CD31, CD34 and vascular endothelial growth factor receptor 2 (VEGFR2). The optimal USPION concentration was 32 µg/ml, as determined by adhesion and proliferation assays. It was identified that USPION-PLL nanoparticles were 10–20 nm in diameter. Histopathological analysis results indicated that 1 day after transplantation of the labeled EPCs, blue-stained granules were observed in the intima of vascular lesions in rabbit models after Prussian blue staining. Therefore, the present results suggest that USPION-labeled EPCs may play a role in repairing endothelial injury and preventing atherosclerosis in vivo.
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Affiliation(s)
- Hongxia Wei
- Department of Laboratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, P.R. China
| | - Tingting Tan
- Department of Laboratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, P.R. China
| | - Li Cheng
- Department of Laboratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, P.R. China
| | - Jiapeng Liu
- Department of Medical Imaging, Shanghai Jiahui International Hospital, Shanghai 200233, P.R. China
| | - Hongyan Song
- Department of Laboratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, P.R. China
| | - Lei Li
- Department of Laboratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, P.R. China
| | - Kui Zhang
- Department of Laboratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, P.R. China
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Panebianco V, Pecoraro M, Del Giudice F, Takeuchi M, Muglia VF, Messina E, Cipollari S, Giannarini G, Catalano C, Narumi Y. VI-RADS for Bladder Cancer: Current Applications and Future Developments. J Magn Reson Imaging 2020; 55:23-36. [PMID: 32939939 DOI: 10.1002/jmri.27361] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 01/07/2023] Open
Abstract
Bladder cancer (BCa) is among the ten most frequent cancers globally. It is the tumor with the highest lifetime treatment-associated costs, and among the tumors with the heaviest impacts on postoperative quality of life. The purpose of this article is to review the current applications and future perspectives of the Vesical Imaging Reporting and Data System (VI-RADS). VI-RADS is a newly developed scoring system aimed at standardization of MRI acquisition, interpretation, and reporting for BCa. An insight will be given on the BCa natural history, current MRI applications for local BCa staging with assessment of muscle invasiveness, and clinical implications of the score for disease management. Future applications include risk stratification of nonmuscle invasive BCa, surveillance, and prediction and monitoring of therapy response. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza/Policlinico Umberto I, Rome, Italy
| | | | - Valdair F Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Stefano Cipollari
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
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