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Gottumukkala RV, Lee LK, Tu W, Tempany CM, Fennessy FM. Local Staging of Prostate Cancer at MRI: What the Urologist and Radiation Oncologist Want to Know. Radiographics 2023; 43:e220100. [PMID: 37561642 PMCID: PMC10506065 DOI: 10.1148/rg.220100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 08/12/2023]
Abstract
This slide presentation provides an overview of prostate cancer risk stratification and management, reviews key anatomic and imaging principles pertaining to local staging of prostate cancer, and highlights inflection points where MRI findings regarding local staging may modify clinical management.
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Affiliation(s)
- Ravi V. Gottumukkala
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
| | - Leslie K. Lee
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
| | - Wendy Tu
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
| | - Clare M. Tempany
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
| | - Fiona M. Fennessy
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
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2
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Chandrasekar T, Denisenko A, Mico V, McPartland C, Shah Y, Mark JR, Lallas CD, Fonshell C, Danella J, Jacobs B, Lanchoney T, Raman JD, Tomaszewski J, Reese A, Singer EA, Ginzburg S, Smaldone M, Uzzo R, Guzzo TJ, Trabulsi EJ. Multiparametric MRI is not sufficient for prostate cancer staging: A single institutional experience validated by a multi-institutional regional collaborative. Urol Oncol 2023:S1078-1439(23)00162-X. [PMID: 37357123 DOI: 10.1016/j.urolonc.2023.05.004] [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: 01/19/2023] [Revised: 04/17/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized in prostate cancer (CaP) diagnosis and staging. While Level 1 data supports MRI utility in CaP diagnosis, there is less data on staging utility. We sought to evaluate the real-world accuracy of mpMRI in staging localized CaP. MATERIALS AND METHODS Men who underwent radical prostatectomy (RP) for CaP in 2021 at our institution were identified. Sensitivity, specificity, positive predictive value and negative predictive value of mpMRI in predicting pT2N0 organ confined disease , extracapsular extension , seminal vesicle invasion , lymph node involvement, and bladder neck invasion were evaluated. Associations between MRI accuracy and AUA risk stratification (AUA RS), MRI institution (MRI-I), MRI strength (1.5 vs. 3T) (MRI-S), and MRI timing (MRI-T) were assessed. These analyses were repeated using Pennsylvania Urologic Regional Collaborative (PURC) data. RESULTS Institutional and community mpMRI CaP staging data demonstrated poor sensitivity (2.9%-49.2%% vs. 16.8%-24.4%), positive predictive value (40%-100% vs. 35.8%-68.2%), and negative predictive value (56.3%-94.3% vs. 68.4%-96.2%) in predicting surgical pathologic features - in contrast, specificity (89.1%-100% vs. 93.9%-98.6%) was adequate. mpMRI accuracy for extracapsular extension, seminal vesicle invasion, and lymph node involvement was significantly (p < 0.001) associated with AUA RS. There was no association between mpMRI accuracy and MRI-I, MRI-S, and MRI-T. CONCLUSION Despite enthusiasm for its use, in a real-world setting, mpMRI appears to be a poor staging study for localized CaP and is unreliable as the sole means of staging patients prior to prostatectomy. mpMRI should be used cautiously as a staging tool for CaP, and should be interpreted considering individual patient risk strata.
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Affiliation(s)
| | | | - Vasil Mico
- Department of Internal Medicine, Tufts Medical Center, Boston MA
| | | | - Yash Shah
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - James R Mark
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Bruce Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, PA
| | | | - Jay D Raman
- Penn State Milton S. Hershey Medical Center, Hershey, PA
| | | | - Adam Reese
- Department of Urology, Temple University, Philadelphia, PA
| | - Eric A Singer
- Department of Urology, Ohio State University, Columbus, OH
| | - Serge Ginzburg
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA
| | | | | | - Thomas J Guzzo
- Division of Urology, University of Pennsylvania, Philadelphia, PA
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The Added Value of [18F]Choline PET/CT in Low-Risk Prostate Cancer Staging: A Case Report. Life (Basel) 2022; 12:life12111728. [DOI: 10.3390/life12111728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
In the management of prostate cancer (PCa), correct staging is crucial in order to assess the right therapeutic approach. [18F]Choline PET/CT has been shown to provide more accurate staging information than conventional imaging approaches. The aim of this paper is to provide a real practice demonstration of the impact of [18F]Choline PET/CT on low-risk prostate cancer staging and clinical management. We report a 64-year-old man with biochemical PCa recurrence diagnosis after transurethral resection of the prostate. The patient, after the detection of an increased level of PSA, underwent multi-parametric prostate magnetic resonance imaging (mpMRI) that did not show evidence of disease. The patient was admitted to perform [18F]Choline PET/CT that showed a macroscopic prostate recurrence. Patient underwent photon external beam radiation therapy (EBRT) treatment, and [18F]Choline PET/CT was also used to define treatment volumes. At 3- and 6-month clinical follow-up evaluations, no late toxicity was detected and a significant reduction in PSA value was shown. Therefore, our case highlights the potential usefulness of [18F]Choline PET/CT for the staging of low-risk prostate cancer and its impact on the management and quality of life of such patients. The presented case should urge the scientific community to enhance larger and multicentric studies, assessing more extensively the potential impact of [18F]Choline PET/CT in this clinical scenario.
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Palumbo P, Manetta R, Izzo A, Bruno F, Arrigoni F, De Filippo M, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement. Gland Surg 2020; 9:2235-2247. [PMID: 33447576 DOI: 10.21037/gs-20-547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostate cancer is the most common malignancy in male population. Over the last few years, magnetic resonance imaging (MRI) has proved to be a robust clinical tool for identification and staging of clinically significant prostate cancer. Though suggestions by the European Society of Urogenital Radiology to use complete multiparametric (mp) T2-weighted/diffusion weighted imaging (DWI)/dynamic contrast enhancement (DCE) acquisition for all prostate MRI examinations, the real advantage of functional DCE remains a matter of debate. Recent studies demonstrate that biparametric (bp) and mp approaches have similar accuracy, but controversial evidences remain, and the specific potential benefits of contrast medium administration are still poorly discussed in literature. The bp approach is in fact sufficient in most cases to adequately identify a negative test, or to accurately define the degree of aggressiveness of a lesion, especially if larger or with major characteristics of malignancy. This feature would give the DCE a secondary role, probably limited to a second evaluation of the lesion location, for detecting small cancer or in case of controversy. However, DCE has proved to increase the sensitivity of prostate MRI, though a less specificity. Therefore, an appropriate decision algorithm is needed to standardize the MRI approach. Aim of this review study was to provide a schematic description of bpMRI and mpMRI approaches in the study of prostatic anatomy, focusing on comparative validity and current DCE application. Additional theoretical considerations on prostate MRI are provided.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Izzo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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5
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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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Losnegård A, Reisæter LAR, Halvorsen OJ, Jurek J, Assmus J, Arnes JB, Honoré A, Monssen JA, Andersen E, Haldorsen IS, Lundervold A, Beisland C. Magnetic resonance radiomics for prediction of extraprostatic extension in non-favorable intermediate- and high-risk prostate cancer patients. Acta Radiol 2020; 61:1570-1579. [PMID: 32108505 DOI: 10.1177/0284185120905066] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To investigate whether magnetic resonance (MR) radiomic features combined with machine learning may aid in predicting extraprostatic extension (EPE) in high- and non-favorable intermediate-risk patients with prostate cancer. PURPOSE To investigate the diagnostic performance of radiomics to detect EPE. MATERIAL AND METHODS MR radiomic features were extracted from 228 patients, of whom 86 were diagnosed with EPE, using prostate and lesion segmentations. Prediction models were built using Random Forest. Further, EPE was also predicted using a clinical nomogram and routine radiological interpretation and diagnostic performance was assessed for individual and combined models. RESULTS The MR radiomic model with features extracted from the manually delineated lesions performed best among the radiomic models with an area under the curve (AUC) of 0.74. Radiology interpretation yielded an AUC of 0.75 and the clinical nomogram (MSKCC) an AUC of 0.67. A combination of the three prediction models gave the highest AUC of 0.79. CONCLUSION Radiomic analysis combined with radiology interpretation aid the MSKCC nomogram in predicting EPE in high- and non-favorable intermediate-risk patients.
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Affiliation(s)
- Are Losnegård
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Lars A. R. Reisæter
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Ole J. Halvorsen
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Norway
| | - Jakub Jurek
- Institute of Electronics, Technical University of Lodz, Poland
| | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Norway
| | - Jarle B. Arnes
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Alfred Honoré
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Jan A. Monssen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Erling Andersen
- Department of Clinical Engineering, Haukeland University Hospital, Norway
| | - Ingfrid S. Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Arvid Lundervold
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Norway
| | - Christian Beisland
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Urology, Haukeland University Hospital, Bergen, Norway
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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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8
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Magnetta MJ, Catania R, Girometti R, Westphalen AC, Borhani AA, Furlan A. Prostate MRI: staging and decision-making. Abdom Radiol (NY) 2020; 45:2143-2153. [PMID: 32047994 DOI: 10.1007/s00261-020-02431-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Multi-parametric prostate MRI (mpMRI) plays a critical role in the diagnosis, staging, and evaluation of treatment response in patients with prostate cancer. Radiologists, through an accurate and standardized interpretation of mpMRI, can clinically stage prostate cancer and help to risk stratify patients who may benefit from more invasive treatment or exclude patients who may be harmed by overtreatment. The purpose of this article is to describe key findings to accurately stage prostate cancer with mpMRI and to describe the contexts in which mpMRI is best applied.
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Affiliation(s)
- Michael J Magnetta
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Abdominal Radiology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Roberta Catania
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Institute of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital, S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, UD, Italy
| | - Antonio C Westphalen
- Departments of Radiology and Biomedical Imaging, and Urology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA
| | - Amir A Borhani
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
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Abstract
The role of prostate MRI in clinical practice has continued to broaden over time. Multiple iterations of PI-RADS reporting have aided in improving detection and reporting of prostate cancer. In addition, recent recommendations from the PI-RADS Steering Committee promote an MRI-first approach with an MRI-directed prostate cancer diagnostic pathway. It is imperative for radiologists to be knowledgeable and familiar with prostate MRI and PI-RADS recommendations, as there is an increasing demand for prostate imaging by clinicians and patients alike.
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Affiliation(s)
- Grace C Lo
- Division of Body Imaging, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY, 10065, USA.
| | - Daniel J A Margolis
- Division of Body Imaging, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY, 10065, USA
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Trabzonlu L, Kulac I, Zheng Q, Hicks JL, Haffner MC, Nelson WG, Sfanos KS, Ertunc O, Lotan TL, Heaphy CM, Meeker AK, Yegnasubramanian S, De Marzo AM. Molecular Pathology of High-Grade Prostatic Intraepithelial Neoplasia: Challenges and Opportunities. Cold Spring Harb Perspect Med 2019; 9:a030403. [PMID: 30082453 PMCID: PMC6444695 DOI: 10.1101/cshperspect.a030403] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A better understanding of the early stages of prostate cancer initiation, potentially arising from precursor lesions, may fuel development of powerful approaches for prostate cancer prevention or interception. The best-known candidate for such a precursor lesion has been referred to as high-grade prostatic intraepithelial neoplasia (HGPIN). Although there is significant evidence supporting the notion that such HGPIN lesions can give rise to invasive adenocarcinomas of the prostate, there are also numerous complicating considerations and evidence that cloud the picture in many instances. Notably, recent evidence has suggested that some fraction of such lesions that are morphologically consistent with HGPIN may actually be invasive carcinomas masquerading as HGPIN-a state that we term "postinvasive intraepithelial carcinoma" (PIC). Although the prevalence of such PIC lesions is not fully understood, this and other factors can confound the potential of identifying prostate precursors that can be targeted for disease prevention, interception, or treatment. Here, we review our current understanding of the morphological and molecular pathological features of prostate cancer precursor lesions.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Ibrahim Kulac
- Department of Pathology, Koc University School of Medicine, Istanbul 34010, Turkey
| | - Qizhi Zheng
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Jessica L Hicks
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Michael C Haffner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - William G Nelson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
- The Brady Urological Research Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Karen S Sfanos
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
- The Brady Urological Research Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Onur Ertunc
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Tamara L Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Christopher M Heaphy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
- The Brady Urological Research Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Alan K Meeker
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
- The Brady Urological Research Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Srinivasan Yegnasubramanian
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
- The Brady Urological Research Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
| | - Angelo M De Marzo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
- The Brady Urological Research Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
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Breto AL, Padgett KR, Ford JC, Kwon D, Chang C, Fuss M, Stoyanova R, Mellon EA. Analysis of Magnetic Resonance Image Signal Fluctuations Acquired During MR-Guided Radiotherapy. Cureus 2018; 10:e2385. [PMID: 29850380 PMCID: PMC5973490 DOI: 10.7759/cureus.2385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Magnetic resonance-guided radiotherapy (MRgRT) is a new and evolving treatment modality that allows unprecedented visualization of the tumor and surrounding anatomy. MRgRT includes daily 3D magnetic resonance imaging (MRI) for setup and rapidly repeated near real-time MRI scans during treatment for target tracking. One of the more exciting potential benefits of MRgRT is the ability to analyze serial MRIs to monitor treatment response or predict outcomes. A typical radiation treatment (RT) over the span of 10-15 minutes on the MRIdian system (ViewRay, Cleveland, OH) yields thousands of "cine" images, each acquired in 250 ms. This unique data allows for a glimpse in image intensity changes during RT delivery. In this report, we analyze cine images from a single fraction RT of a glioblastoma patient on the ViewRay platform in order to characterize the dynamic signal changes occurring during RT therapy. The individual frames in the cines were saved into DICOM format and read into an MIM image analysis platform (MIM Software, Cleveland, OH) as a time series. The three possible states of the three Cobalt-60 radiation sources-OFF, READY, and ON-were also recorded. An in-house Java plugin for MIM was created in order to perform principal component analysis (PCA) on each of the datasets. The analysis resulted in first PC, related to monotonous signal increase over the course of the treatment fraction. We found several distortion patterns in the data that we postulate result from the perturbation of the magnetic field due to the moving metal parts in the platform while treatment was being administered. The largest variations were detected when all Cobalt-60 sources were OFF. During this phase of the treatment, the gantry and multi-leaf collimators (MLCs) are moving. Conversely, when all Cobalt-60 sources were in the ON position, the image signal fluctuations were minimal, relating to very little mechanical motion. At this phase, the gantry, the MLCs, and sources are fixed in their positions. These findings were confirmed in a study with the daily quality assurance (QA) phantom. While the identified variations were not related to physiological processes, our findings confirm the sensitivity of the developed approach to identify very small fluctuations. Relating these variations to the physical changes that occur during treatment shows the methodical ability of the technique to uncover their underlying sources.
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Affiliation(s)
- Adrian L Breto
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, USA
| | - Kyle R Padgett
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, USA
| | - John C Ford
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, USA
| | - Deukwoo Kwon
- Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, USA
| | - Channing Chang
- Miller School of Medicine, University of Miami Medical School, Miami, USA
| | - Martin Fuss
- Clinical Cooperative Think Tank, Viewray Inc
| | - Radka Stoyanova
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, USA
| | - Eric A Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, USA
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