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Huang X, Schurr RN, Wang S, Miao Q, Li T, Jia G. Development of Radiofrequency Saturation Amplitude-independent Quantitative Markers for Magnetization Transfer MRI of Prostate Cancer. Curr Med Imaging 2020; 16:695-702. [PMID: 32723241 DOI: 10.2174/1573405615666190318153328] [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: 08/01/2018] [Revised: 02/06/2019] [Accepted: 03/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the United States, prostate cancer has a relatively large impact on men's health. Magnetic resonance imaging (MRI) is useful for the diagnosis and treatment of prostate cancer. INTRODUCTION The purpose of this study was to develop a quantitative marker for use in prostate cancer magnetization transfer (MT) magnetic resonance imaging (MRI) studies that is independent of radiofrequency (RF) saturation amplitude. METHODS Eighteen patients with biopsy-proven prostate cancer were enrolled in this study. MTMRI images were acquired using four RF saturation amplitudes at 33 frequency offsets. ROIs were delineated for the peripheral zone (PZ), central gland (CG), and tumor. Z-spectral data were collected in each region and fit to a three-parameter equation. The three parameters are: the magnitude of the bulk water pool (Aw), the full width at half maximum of the water pool (Gw), and the magnitude of the bound pool (Ab), while, the slopes from the linear regressions of Gw and Ab on RF saturation amplitude (called kAb and kGw) were used as quantitative markers. RESULTS A pairwise statistically significant difference was found between the PZ and tumor regions for the two saturation amplitude-independent quantitative markers. No pairwise statistically significant differences were found between the CG and tumor regions for any quantitative markers. CONCLUSION The significant differences between the values of the two RF saturation amplitudeindependent quantitative markers in the PZ and tumor regions reveal that these markers may be capable of distinguishing healthy PZ tissue from prostate cancer.
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Affiliation(s)
- Xunan Huang
- Xi'an Key Laboratory of Big Data and Intelligent Vision, School of Computer Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China
| | - Ryan N Schurr
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, 70803, United States
| | - Shuzhen Wang
- Xi'an Key Laboratory of Big Data and Intelligent Vision, School of Computer Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China
| | - Qiguang Miao
- Xi'an Key Laboratory of Big Data and Intelligent Vision, School of Computer Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China
| | - Tanping Li
- School of Physics and Optoelectronic Engineering, Xidian University, Xi'an, Shaanxi 710071, China
| | - Guang Jia
- Xi'an Key Laboratory of Big Data and Intelligent Vision, School of Computer Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China
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MRI-guided, transrectal, intraprostatic steam application as potential focal therapeutic modality for prostatic diseases in a large animal translational model: A feasibility follow-up study. PLoS One 2019; 14:e0226764. [PMID: 31869376 PMCID: PMC6927626 DOI: 10.1371/journal.pone.0226764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/03/2019] [Indexed: 12/02/2022] Open
Abstract
Parallel to establishment of diagnostic surveillance protocols for detection of prostatic diseases, novel treatment strategies should be developed. The aim of the present study is to evaluate the feasibility and possible side effects of transrectal, MRI-targeted intraprostatic steam application in dogs as an established large animal translational model for prostatic diseases in humans. Twelve healthy experimental, intact, male beagle dogs without evidence of prostatic pathology were recruited. An initial MRI examination was performed, and MRI-targeted steam was applied intraprostatically immediately thereafter. Serum levels of C-reactive protein (CRP), clinical and ultrasonographic examinations were performed periodically following the procedure to assess treatment effect. Four weeks after treatment, all dogs underwent follow-up MRI examinations and three needle-core biopsies were obtained from each prostatic lobe. Descriptive statistics were performed. MRI-guided intraprostatic steam application was successfully performed in the study population. The first day after steam application, 7/12 dogs had minimal signs of discomfort (grade 1/24 evaluated with the short-form Glasgow Composite Measure Pain Scale) and no dogs showed any sign of discomfort by day 6. CRP elevations were detected in 9/12 dogs during the first week post steam application. Mild to moderate T2 hyperintense intraparenchymal lesions were identified during follow-up MRI in 11/12 dogs four weeks post procedure. Ten of these lesions enhanced mild to moderately after contrast administration. Coagulative necrosis or associated chronic inflammatory response was detected in 80.6% (58/72) of the samples obtained. MRI-targeted intraprostatic steam application is a feasible technique and displays minimal side effects in healthy dogs as translational model for human prostatic diseases. This opens the possibility of minimally invasive novel treatment strategies for intraprostatic lesions.
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Jadvar H. Multimodal Imaging in Focal Therapy Planning and Assessment in Primary Prostate Cancer. Clin Transl Imaging 2017; 5:199-208. [PMID: 28713796 DOI: 10.1007/s40336-017-0228-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE There is increasing interest in focal therapy (male lumpectomy) of localized low-intermediate risk prostate cancer. Focal therapy is typically associated with low morbidity and provides the possibility of retreatment. Imaging is pivotal in stratification of men with localized prostate cancer for active surveillance, focal therapy or radical intervention. This article provides a concise review of focal therapy and the evolving role of imaging in this clinical setting. METHODS We performed a narrative and critical literature review by searching PubMed/Medline database from January 1997 to January 2017 for articles in the English language and the use of search keywords "focal therapy", "prostate cancer", and "imaging". RESULTS Most imaging studies are based on multiparametric magnetic resonance imaging. Transrectal ultrasound is inadequate independently but multiparametric ultrasound may provide new prospects. Positron emission tomography with radiotracers targeted to various underlying tumor biological features may provide unprecedented new opportunities. Multimodal Imaging appears most useful in localization of intraprostatic dominant index lesions amenable to focal therapy, in early assessment of therapeutic efficacy and potential need for additional focal treatments or transition to whole-gland therapy, and in predicting short-term and long-term outcomes. CONCLUSION Multimodal imaging is anticipated to play an increasing role in the focal therapy planning and assessment of low-intermediate risk prostate cancer and thereby moving this form of treatment option forward in the clinic.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, University of Southern California, Los Angeles, California, USA
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Sundaram KM, Chang SS, Penson DF, Arora S. Therapeutic Ultrasound and Prostate Cancer. Semin Intervent Radiol 2017; 34:187-200. [PMID: 28579687 PMCID: PMC5453783 DOI: 10.1055/s-0037-1602710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Therapeutic ultrasound approaches including high-intensity focused ultrasound (HIFU) are emerging as popular minimally invasive alternative treatments for localized, low-to-intermediate risk prostate cancer. FDA approval was recently granted for two ultrasound-guided HIFU devices. Clinical trials for devices using MRI guidance are ongoing. The current level of evidence for whole-gland ultrasound ablation suggests that its clinical efficacy and adverse event rates including erectile dysfunction and urinary incontinence are similar to current definitive therapies such as radical prostatectomy and external-beam radiotherapy. Short-term data suggest that more focal therapy could reduce the rates of adverse events.
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Affiliation(s)
- Karthik M. Sundaram
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandeep Arora
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Natarajan S, Jones TA, Priester AM, Geoghegan R, Lieu P, Delfin M, Felker E, Margolis DJA, Sisk A, Pantuck A, Grundfest W, Marks LS. Focal Laser Ablation of Prostate Cancer: Feasibility of Magnetic Resonance Imaging-Ultrasound Fusion for Guidance. J Urol 2017; 198:839-847. [PMID: 28396184 DOI: 10.1016/j.juro.2017.04.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Focal laser ablation is a potential treatment in some men with prostate cancer. Currently focal laser ablation is performed by radiologists in a magnetic resonance imaging unit (in bore). We evaluated the safety and feasibility of performing focal laser ablation in a urology clinic (out of bore) using magnetic resonance imaging-ultrasound fusion for guidance. MATERIALS AND METHODS A total of 11 men with intermediate risk prostate cancer were enrolled in this prospective, institutional review board approved pilot study. Magnetic resonance imaging-ultrasound fusion was used to guide laser fibers transrectally into regions of interest harboring intermediate risk prostate cancer. Thermal probes were inserted for real-time monitoring of intraprostatic temperatures during laser activation. Multiparametric magnetic resonance imaging (3 Tesla) was done immediately after treatment and at 6 months along with comprehensive fusion biopsy. RESULTS Ten of 11 patients were successfully treated while under local anesthesia. Mean procedure time was 95 minutes (range 71 to 105). Posttreatment magnetic resonance imaging revealed a confined zone of nonperfusion in all 10 men. Mean zone volume was 4.3 cc (range 2.1 to 6.0). No CTCAE grade 3 or greater adverse events developed and no changes were observed in urinary or sexual function. At 6 months magnetic resonance imaging-ultrasound fusion biopsy of the treatment site showed no cancer in 3 patients, microfocal Gleason 3 + 3 in another 3 and persistent intermediate risk prostate cancer in 4. CONCLUSIONS Focal laser ablation of prostate cancer appears safe and feasible with the patient under local anesthesia in a urology clinic using magnetic resonance imaging-ultrasound fusion for guidance and thermal probes for monitoring. Further development is necessary to refine out of bore focal laser ablation and additional studies are needed to determine appropriate treatment margins and oncologic efficacy.
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Affiliation(s)
- Shyam Natarajan
- Department of Urology, University of California-Los Angeles, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Tonye A Jones
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Rory Geoghegan
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Merdie Delfin
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Ely Felker
- Department of Radiology, University of California-Los Angeles, Los Angeles, California
| | | | - Anthony Sisk
- Department of Pathology, University of California-Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Warren Grundfest
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California.
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