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Barth BK, De Visschere PJL, Cornelius A, Nicolau C, Vargas HA, Eberli D, Donati OF. Detection of Clinically Significant Prostate Cancer: Short Dual-Pulse Sequence versus Standard Multiparametric MR Imaging-A Multireader Study. Radiology 2017; 284:725-736. [PMID: 28346073 DOI: 10.1148/radiol.2017162020] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose To compare the diagnostic performance of a short dual-pulse sequence magnetic resonance (MR) imaging protocol versus a standard six-pulse sequence multiparametric MR imaging protocol for detection of clinically significant prostate cancer. Materials and Methods This HIPAA-compliant study was approved by the regional ethics committee. Between July 2013 and March 2015, 63 patients from a prospectively accrued study population who underwent MR imaging of the prostate including transverse T1-weighted; transverse, coronal, and sagittal T2-weighted; diffusion-weighted; and dynamic contrast material-enhanced MR imaging with a 3-T imager at a single institution were included in this retrospective study. The short MR imaging protocol image set consisted of transverse T2-weighted and diffusion-weighted images only. The standard MR imaging protocol image set contained images from all six pulse sequences. Three expert readers from different institutions assessed the likelihood of prostate cancer on a five-point scale. Diagnostic performance on a quadrant basis was assessed by using areas under the receiver operating characteristic curves, and differences were evaluated by using 83.8% confidence intervals. Intra- and interreader agreement was assessed by using the intraclass correlation coefficient. Transperineal template saturation biopsy served as the standard of reference. Results At histopathologic evaluation, 84 of 252 (33%) quadrants were positive for cancer in 38 of 63 (60%) men. There was no significant difference in detection of tumors larger than or equal to 0.5 mL for any of the readers of the short MR imaging protocol, with areas under the curve in the range of 0.74-0.81 (83.8% confidence interval [CI]: 0.64, 0.89), and for readers of the standard MR imaging protocol, areas under the curve were 0.71-0.77 (83.8% CI: 0.62, 0.86). Ranges for sensitivity were 0.76-0.95 (95% CI: 0.53, 0.99) and 0.76-0.86 (95% CI: 0.53, 0.97) and those for specificity were 0.84-0.90 (95% CI: 0.79, 0.94) and 0.82-0.90 (95% CI: 0.77, 0.94) for the short and standard MR protocols, respectively. Ranges for interreader agreement were 0.48-0.60 (83.8% CI: 0.41, 0.66) and 0.49-0.63 (83.8% CI: 0.42, 0.68) for the short and standard MR imaging protocols. Conclusion For the detection of clinically significant prostate cancer, no difference was found in the diagnostic performance of the short MR imaging protocol consisting of only transverse T2-weighted and diffusion-weighted imaging pulse sequences compared with that of a standard multiparametric MR imaging protocol. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Borna K Barth
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Pieter J L De Visschere
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Alexander Cornelius
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Carlos Nicolau
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Hebert Alberto Vargas
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Daniel Eberli
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
| | - Olivio F Donati
- From the Institute of Diagnostic and Interventional Radiology (B.K.B., O.F.D.) and Department of Urology (D.E.), University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland; Department of Radiology, Ghent University Hospital, Ghent, Belgium (P.J.L.D.V.); Department for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland (A.C.); Department of Radiology, CDIC, Hospital Clínic de Barcelona, Barcelona, Spain (C.N.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.)
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Gao P, Shi C, Zhao L, Zhou Q, Luo L. Differential diagnosis of prostate cancer and noncancerous tissue in the peripheral zone and central gland using the quantitative parameters of DCE-MRI: A meta-analysis. Medicine (Baltimore) 2016; 95:e5715. [PMID: 28033274 PMCID: PMC5207570 DOI: 10.1097/md.0000000000005715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The objective of this meta-analysis was to evaluate the clinical usefulness of K, Kep, and Ve values in the differential diagnosis of prostate cancer (PCa) and noncancerous tissue in the peripheral zone (PZ) and central gland (CG). METHODS A search was conducted of the PubMed, MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases from January 2000 to October 2015 using the search terms "prostate cancer," " dynamic contrast-enhanced (DCE)," "magnetic resonance imaging," "K," "Kep," and "Ve." Studies were selected and included according to strict eligibility criteria. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used to compare K, Kep, and Ve values between PCa and noncancerous tissue. RESULTS Fourteen studies representing 484 patients highly suspicious for prostate adenocarcinoma were selected for the meta-analysis. We found that K values measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were significantly higher in PCa tissue than in noncancerous tissue in the PZ (SMD 1.57, 95% CI 0.98-2.16; z = 5.21, P <0.00001) and CG (SMD 1.19, 95% CI 0.46-1.91; z = 3.21, P = 0.001). Kep values measured by DCE-MRI were significantly higher in PCa than in noncancerous tissue in the PZ (SMD 1.41, 95% CI 0.92-1.91; z = 5.59, P < 0.00001) and CG (SMD 1.57, 95% CI 0.69-2.46; z = 3.49, P = 0.0005). Ve values generated by DCE-MRI were slightly higher in PCa than in noncancerous tissue in the PZ (SMD 0.72, 95% CI 0.17-1.27; z = 2.58, P = 0.010), but sensitivity analysis found that the Ve value was unstable for differentiation between PCa and noncancerous PZ tissue. However, there was no significant difference in the Ve value between PCa and noncancerous CG tissue (SMD -0.29, 95% CI -1.18, 0.59; z = 0.65, P = 0.51). CONCLUSION Our meta-analysis shows that K and Kep were the most reliable parameters for differentiating PCa from noncancerous tissue and were critical for evaluation of the internal structure of cancer. The Ve value was not helpful for distinguishing PCa from noncancerous CG tissue; its ability to distinguish between PCa and noncancerous PZ tissue remains uncertain.
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Affiliation(s)
- Peng Gao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou
| | - Changzheng Shi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou
| | - Lianping Zhao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou
- Department of Radiology, Gansu Provincial Hospital, Gansu, China
| | - Quan Zhou
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou
| | - Liangping Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou
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Puech P, Sufana-Iancu A, Renard B, Lemaitre L. Prostate MRI: can we do without DCE sequences in 2013? Diagn Interv Imaging 2013; 94:1299-311. [PMID: 24211261 DOI: 10.1016/j.diii.2013.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric MRI (mp-MRI) of the prostate currently provides stable and reproducible performances. The usefulness of dynamic contrast-enhanced (DCE) sequences is currently challenged, as they sometimes only confirm what has already been observed on diffusion-weighted imaging (DWI) and require the additional purchase of a contrast agent. Eliminating these sequences may help accelerate the use of MRI in addition to, or in lieu of, prostate biopsies in selected patients. However, many studies show that these sequences can detect lesions invisible on T2-weighted and diffusion-weighted images, better assess cancer extension and aggressiveness, and finally help detecting recurrence after treatment. We present the various applications of dynamic MRI and discuss the possible consequences of its omission from the current protocol.
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Affiliation(s)
- P Puech
- Department of Uroradiology, Lille Hospital, 1, rue Michel-Polonovski, 59037 Lille cedex, France; University of Lille Nord de France, Lille 59800, France; Inserm U703, 59120 Loos, France.
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Dynamic gadolinium-enhanced perfusion MRI of prostate cancer: assessment of response to hypofractionated robotic stereotactic body radiation therapy. AJR Am J Roentgenol 2011; 197:907-15. [PMID: 21940578 DOI: 10.2214/ajr.10.6356] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the utility of dynamic gadolinium-enhanced perfusion MRI for monitoring the response to robotic stereotactic body radiation therapy for prostate cancer. MATERIALS AND METHODS Eighty-seven patients with prostate cancer underwent dynamic gadolinium-enhanced MRI before robotic stereotactic body radiation therapy, and prostate volume was calculated. Pharmacokinetic analysis postprocessing software was used to generate colorized parametric maps showing perfusion of enhancing tumors. The transfer constant K(trans) was calculated for identified tumors. Follow-up MRI was performed 2 months after treatment for 22 patients, 6 months for 71 patients, 12 months for 54 patients, and 24 months for 27 patients with repeated measurements of prostate volume and K(trans). RESULTS Perfusion MRI depicted focal enhancing prostate tumors that correlated with the biopsy results in 82 of 87 patients (94%). The median K(trans) of tumors before robotic stereotactic body radiation therapy was 1.79 minutes(-1). Follow-up MRI showed decreases in the size and degree of enhancement of tumors. The median tumor K(trans) decreased to 1.21 minutes(-1) 2 months, 0.39 minutes(-1) 6 months, 0.30 minutes(-1) 12 months, and 0.22 minutes(-1) 24 months after treatment. Prostate volume had decreased 23% 2 months, 26% 6 months, 33% 12 months, and 37% 24 months after robotic stereotactic body radiation therapy. The corresponding median prostate-specific antigen concentration before treatment was 6.45 ng/mL. After treatment, the concentration was 2.90 ng/mL at 2 months, 1.30 ng/mL at 6 months, 1.10 ng/mL at 12 months, and 0.59 ng/mL at 24 months. CONCLUSION Dynamic gadolinium-enhanced MRI is a useful tool for monitoring the response of prostate cancer to robotic stereotactic body radiation therapy, yielding both qualitative and quantitative data.
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Delongchamps NB, Beuvon F, Eiss D, Flam T, Muradyan N, Zerbib M, Peyromaure M, Cornud F. Multiparametric MRI is helpful to predict tumor focality, stage, and size in patients diagnosed with unilateral low-risk prostate cancer. Prostate Cancer Prostatic Dis 2011; 14:232-7. [PMID: 21423266 DOI: 10.1038/pcan.2011.9] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To study the staging accuracy of multiparametric magnetic resonance imaging (MRI) in patients showing unilateral low-risk cancer on prostate biopsy. A total of 58 consecutive patients with low-risk cancer (D'Amico classification) and unilateral cancer involvement on prostate biopsies were included prospectively. All patients underwent multiparametric endorectal MRI before radical prostatectomy, including T2-weighted (T2W), diffusion-weighted (DW) and dynamic contrast enhanced (DCE) sequences. Each gland was divided in eight octants. Tumor foci >0.2 cm(3) identified on pathological analysis were matched with MRI findings. Pathological examination showed tumor foci >0.2 cm(3) in 50/58 glands (86%), and bilateral tumor (pathological stagepT2c) in 20/58 (34%). For tumor detection in the peripheral zone (PZ), T2W+DWI+DCE performed significantly better than T2W+DWI and T2W alone (P<0.001). In the transition zone (TZ), only T2W+DWI performed better than T2W alone (P=0.02). With optimal MR combinations, tumor size was correctly estimated in 77% of tumor foci involving more than one octant. Bilateral tumors were detected in 80% (16/20) of cases. In patients with unilateral low-risk prostate cancer on biopsy, multiparametric MRI can help to predict bilateral involvement. Multiparametric MRI may therefore have a prognostic value and help to determine optimal treatment in such patients.
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Affiliation(s)
- N B Delongchamps
- Department of Urology, Cochin Hospital, Paris Descartes University, Paris, France.
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Salomon L, Azria D, Bastide C, Beuzeboc P, Cormier L, Cornud F, Eiss D, Eschwège P, Gaschignard N, Hennequin C, Molinié V, Mongiat Artus P, Moreau JL, Péneau M, Peyromaure M, Ravery V, Rebillard X, Richaud P, Rischmann P, Rozet F, Staerman F, Villers A, Soulié M. Recommandations en Onco-Urologie 2010 : Cancer de la prostate. Prog Urol 2010; 20 Suppl 4:S217-51. [PMID: 21129644 DOI: 10.1016/s1166-7087(10)70042-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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High-field magnetic resonance imaging of the pelvis: uterus, ovary, and prostate gland. Top Magn Reson Imaging 2010; 21:177-88. [PMID: 21847037 DOI: 10.1097/rmr.0b013e3181ea2a40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Today, magnetic resonance imaging (MRI) is a standard imaging modality for various pathologic disorders in the human pelvis. It has given proof of its usefulness in the diagnosis of several benign and malignant disorders, and it is routinely used for the local staging of different tumors even when confined to specific parts of a pelvic organ. Signal-to-noise ratio and motion artifacts of the examined organ and adjacent bowel structures are major factors for image quality. Setting at 3 T with surface coils avoids technical limitations and discomfort of additional endovaginal or endorectal coils. Definition of high field seems fuzzy because of the availability of MRI machines with 3, 7 T, or higher; therefore, the general aspects of MRI of pelvic structures with emphasis on uterus, ovary, and prostate gland and attention to promising newer techniques such as 3 T, dynamic contrast imaging, and diffusion-weighted imaging are reviewed in this article.
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