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Hellstern M, Martinez C, Wallenhorst C, Beyersdorff D, Lüdemann L, Grimm MO, Teichgräber U, Franiel T. Optimal length and temporal resolution of dynamic contrast-enhanced MR imaging for the differentiation between prostate cancer and normal peripheral zone tissue. PLoS One 2023; 18:e0287651. [PMID: 37352312 PMCID: PMC10289347 DOI: 10.1371/journal.pone.0287651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/12/2023] [Indexed: 06/25/2023] Open
Abstract
The value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the detection of prostate cancer is controversial. There are currently insufficient peer reviewed published data or expert consensus to support routine adoption of DCE-MRI for clinical use. Thus, the objective of this study was to explore the optimal temporal resolution and measurement length for DCE-MRI to differentiate cancerous from normal prostate tissue of the peripheral zone of the prostate by non-parametric MRI analysis and to compare with a quantitative MRI analysis. Predictors of interest were onset time, relative signal intensity (RSI), wash-in slope, peak enhancement, wash-out and wash-out slope determined from non-parametric characterisation of DCE-MRI intensity-time profiles. The discriminatory power was estimated from C-statistics based on cross validation. We analyzed 54 patients with 97 prostate tissue specimens (47 prostate cancer, 50 normal prostate tissue) of the peripheral zone, mean age 63.8 years, mean prostate-specific antigen 18.9 ng/mL and mean of 10.5 days between MRI and total prostatectomy. When comparing prostate cancer tissue with normal prostate tissue, median RSI was 422% vs 330%, and wash-in slope 0.870 vs 0.539. The peak enhancement of 67 vs 42 was higher with prostate cancer tissue, while wash-out (-30% vs -23%) and wash-out slope (-0.037 vs -0.029) were lower, and the onset time (32 seconds) was comparable. The optimal C-statistics was 0.743 for temporal resolution of 8.0 seconds and measurement length of 2.5 minutes compared with 0.656 derived from a quantitative MRI analysis. This study provides evidence that the use of a non-parametric approach instead of a more established parametric approach resulted in greater precision to differentiate cancerous from normal prostate tissue of the peripheral zone of the prostate.
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Affiliation(s)
- Marius Hellstern
- Bürgerhospital und Clementin Kinderhospital gGmbH, Frankfurt am Main, Germany
| | - Carlos Martinez
- Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt am Main, Germany
| | | | - Dirk Beyersdorff
- Department of Diagnostic and Interventional Radiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Lutz Lüdemann
- Department of Medical Physics, Essen University Hospital, Essen, Germany
| | - Marc-Oliver Grimm
- Klinik und Poliklinik für Urologie Universitätsklinikum Jena, Jena, Germany
| | - Ulf Teichgräber
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany
| | - Tobias Franiel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany
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2
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Kooreman ES, van Pelt V, Nowee ME, Pos F, van der Heide UA, van Houdt PJ. Longitudinal Correlations Between Intravoxel Incoherent Motion (IVIM) and Dynamic Contrast-Enhanced (DCE) MRI During Radiotherapy in Prostate Cancer Patients. Front Oncol 2022; 12:897130. [PMID: 35747819 PMCID: PMC9210504 DOI: 10.3389/fonc.2022.897130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Intravoxel incoherent motion (IVIM) is a promising technique that can acquire perfusion information without the use of contrast agent, contrary to the more established dynamic contrast-enhanced (DCE) technique. This is of interest for treatment response monitoring, where patients can be imaged on each treatment fraction. In this study, longitudinal correlations between IVIM- and DCE parameters were assessed in prostate cancer patients receiving radiation treatment. Materials and Methods 20 prostate cancer patients were treated on a 1.5 T MR-linac with 20 x 3 or 3.1 Gy. Weekly IVIM and DCE scans were acquired. Tumors, the peripheral zone (PZ), and the transition zone (TZ) were delineated on a T2-weighted scan acquired on the first fraction. IVIM and DCE scans were registered to this scan and the delineations were propagated. Median values from these delineations were used for further analysis. The IVIM parameters D, f, D* and the product fD* were calculated. The Tofts model was used to calculate the DCE parameters Ktrans, kep and ve. Pearson correlations were calculated for the IVIM and DCE parameters on values from the first fraction for each region of interest (ROI). For longitudinal analysis, the repeated measures correlation coefficient was used to determine correlations between IVIM and DCE parameters in each ROI. Results When averaging over patients, an increase during treatment in all IVIM and DCE parameters was observed in all ROIs, except for D in the PZ and TZ. No significant Pearson correlations were found between any pair of IVIM and DCE parameters measured on the first fraction. Significant but low longitudinal correlations were found for some combinations of IVIM and DCE parameters in the PZ and TZ, while no significant longitudinal correlations were found in the tumor. Notably in the TZ, for both f and fD*, significant longitudinal correlations with all DCE parameters were found. Conclusions The increase in IVIM- and DCE parameters when averaging over patients indicates a measurable response to radiation treatment with both techniques. Although low, significant longitudinal correlations were found which suggests that IVIM could potentially be used as an alternative to DCE for treatment response monitoring.
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Wang YF, Tadimalla S, Hayden AJ, Holloway L, Haworth A. Artificial intelligence and imaging biomarkers for prostate radiation therapy during and after treatment. J Med Imaging Radiat Oncol 2021; 65:612-626. [PMID: 34060219 DOI: 10.1111/1754-9485.13242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/18/2021] [Accepted: 05/02/2021] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly used in the management of prostate cancer (PCa). Quantitative MRI (qMRI) parameters, derived from multi-parametric MRI, provide indirect measures of tumour characteristics such as cellularity, angiogenesis and hypoxia. Using Artificial Intelligence (AI), relevant information and patterns can be efficiently identified in these complex data to develop quantitative imaging biomarkers (QIBs) of tumour function and biology. Such QIBs have already demonstrated potential in the diagnosis and staging of PCa. In this review, we explore the role of these QIBs in monitoring treatment response during and after PCa radiotherapy (RT). Recurrence of PCa after RT is not uncommon, and early detection prior to development of metastases provides an opportunity for salvage treatments with curative intent. However, the current method of monitoring treatment response using prostate-specific antigen levels lacks specificity. QIBs, derived from qMRI and developed using AI techniques, can be used to monitor biological changes post-RT providing the potential for accurate and early diagnosis of recurrent disease.
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Affiliation(s)
- Yu-Feng Wang
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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4
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He N, Li Z, Li X, Dai W, Peng C, Wu Y, Huang H, Liang J. Intravoxel Incoherent Motion Diffusion-Weighted Imaging Used to Detect Prostate Cancer and Stratify Tumor Grade: A Meta-Analysis. Front Oncol 2020; 10:1623. [PMID: 33042805 PMCID: PMC7518084 DOI: 10.3389/fonc.2020.01623] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives: Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) is a promising non-invasive imaging technique to detect and grade prostate cancer (PCa). However, the results regarding the diagnostic performance of IVIM-DWI in the characterization and classification of PCa have been inconsistent among published studies. This meta-analysis was performed to summarize the diagnostic performance of IVIM-DWI in the differential diagnosis of PCa from non-cancerous tissues and to stratify the tumor Gleason grades in PCa. Materials and Methods: Studies concerning the differential diagnosis of prostate lesions using IVIM-DWI were systemically searched in PubMed, Embase, and Web of Science without time limitation. Review Manager 5.3 was used to calculate the standardized mean difference (SMD) and 95% confidence intervals of the apparent diffusion coefficient (ADC), tissue diffusivity (D), pseudodiffusivity (D*), and perfusion fraction (f). Stata 12.0 was used to pool the sensitivity, specificity, and area under the curve (AUC), as well as publication bias and heterogeneity. Fagan's nomogram was used to predict the post-test probabilities. Results: Twenty studies with 854 patients confirmed with PCa were included. Most of the included studies showed a low to unclear risk of bias and low concerns regarding applicability. PCa showed a significantly lower ADC (SMD = −2.34; P < 0.001) and D values (SMD = −1.86; P < 0.001) and a higher D* value (SMD = 0.29; P = 0.01) than non-cancerous tissues, but no difference was noted with the f value (SMD = −0.16; P = 0.50). Low-grade PCa showed higher ADC (SMD = 0.63; P < 0.001) and D values (SMD = 0.80; P < 0.001) than the high-grade lesions. ADC showed comparable diagnostic performance (sensitivity = 86%; specificity = 86%; AUC = 0.87) but higher post-test probabilities (60, 53, 36, and 36% for ADC, D, D*, and f values, respectively) compared with the D (sensitivity = 82%; specificity = 82%; AUC = 0.85), D* (sensitivity = 70%; specificity = 70%; AUC = 0.75), and f values (sensitivity = 73%; specificity = 68%; AUC = 0.76). Conclusion: IVIM parameters are adequate to differentiate PCa from non-cancerous tissues with good diagnostic performance but are not superior to the ADC value. Diffusion coefficients can further stratify the tumor Gleason grades in PCa.
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Affiliation(s)
- Ni He
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhipeng Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xie Li
- Department of Radiology, Maoming People's Hospital, Maoming, China
| | - Wei Dai
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chuan Peng
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yaopan Wu
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Haitao Huang
- Department of Radiology, Maoming People's Hospital, Maoming, China
| | - Jianye Liang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
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5
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Alexander ES, Xiong L, Baird GL, Fernando H, Dupuy DE. CT Densitometry and Morphology of Radiofrequency-Ablated Stage IA Non-Small Cell Lung Cancer: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) Trial. J Vasc Interv Radiol 2020; 31:286-293. [PMID: 31902554 DOI: 10.1016/j.jvir.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate tumor and ablation zone morphology and densitometry related to tumor recurrence in participants with Stage IA non-small cell lung cancer undergoing radiofrequency ablation in a prospective, multicenter trial. MATERIALS AND METHODS Forty-five participants (median 76 years old; 25 women; 20 men) from 16 sites were followed for 2 years (December 2006 to November 2010) with computed tomography (CT) densitometry. Imaging findings before and after ablation were recorded, including maximum CT attenuation (in Hounsfield units) at precontrast and 45-, 90-, 180-, and 300-s postcontrast. RESULTS Every 1-cm increase in the largest axial diameter of the ablation zone at 3-months' follow-up compared to the index tumor reduced the odds of 2-year recurrence by 52% (P = .02). A 1-cm difference performed the best (sensitivity, 0.56; specificity, 0.93; positive likelihood ratio of 8). CT densitometry precontrast and at 45 seconds showed significantly different enhancement patterns in a comparison among pretreated lung cancer (delta = +61.2 HU), tumor recurrence (delta = +57 HU), and treated tumor/ablation zone (delta [change in attenuation] = +16.9 HU), (P < .0001). Densitometry from 45 to 300 s was also different among pretreated tumor (delta = -6.8 HU), recurrence (delta = -11.2 HU), and treated tumor (delta = +12.1 HU; P = .01). Untreated and residual tumor demonstrated washout, whereas treated tumor demonstrated increased attenuation. CONCLUSIONS An ablation zone ≥1 cm larger than the initial tumor, based on 3-month follow-up imaging, is recommended to decrease odds of recurrence. CT densitometry can delineate tumor versus treatment zones.
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Affiliation(s)
- Erica S Alexander
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Lillian Xiong
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Grayson L Baird
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hiran Fernando
- Department of Surgery, Inova Schar Cancer Institute, Fairfax, Virginia
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Cristel G, Esposito A, Damascelli A, Briganti A, Ambrosi A, Brembilla G, Brunetti L, Antunes S, Freschi M, Montorsi F, Del Maschio A, De Cobelli F. Can DCE-MRI reduce the number of PI-RADS v.2 false positive findings? Role of quantitative pharmacokinetic parameters in prostate lesions characterization. Eur J Radiol 2019; 118:51-57. [PMID: 31439258 DOI: 10.1016/j.ejrad.2019.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/16/2019] [Accepted: 07/01/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To test the potential impact of pharmacokinetic parameters, derived from DCE-MRI analysis, on the diagnostic performance of PI-RADSv.2 classification in prostate lesions characterization. METHOD Among patients who underwent multiparametric prostate MRI (mpMRI) (January 2016-March 2018) followed by histological evaluation (targeted biopsies/prostatectomy), 103 men were retrospectively selected. For each patient the index lesion was identified and pharmacokinetic parameters (Ktrans, Kep, Ve, Vp) were assessed. MRI diagnostic performance in the detection of significant tumors [Gleason Score (GS)≥7] was assessed, considering PI-RADS≥3 as positive. RESULTS GS ≥ 7 (n = 59) showed higher Ktrans (p < 0.01) and Kep (p = 0.01) compared to GS < 7. At ROC curve analysis, a Ktrans cut-off of 191 × 10-3/min was identified to predict the presence of GS ≥ 7 (AUC:0.75; sensitivity:95%; specificity:61%). Sensitivity and PPV of mpMRI using PI-RADSv.2 were 98% and 61%. Reclassifying PI-RADS≥3 lesions according to Ktrans cut-off, 22 false positives were shifted to true negatives with 3 false negative findings; PPV raised to 79%. Appling Ktrans cut-off to PI-RADS 3 lesions of peripheral zone (n = 18), 12 true negatives, 4 true positives, 2 false positives were identified. CONCLUSIONS Despite its high sensitivity prostate mpMRI generates many false positive cases: Ktrans in addition to PIRADS v.2 seems to improve MRI-PPV and may help in avoiding redundant biopsies.
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Affiliation(s)
- Giulia Cristel
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
| | - Antonio Esposito
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Anna Damascelli
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Alberto Briganti
- Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy; Department of Urology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Alessandro Ambrosi
- Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Giorgio Brembilla
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Lisa Brunetti
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Sofia Antunes
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Massimo Freschi
- Department of Pathology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Francesco Montorsi
- Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy; Department of Urology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
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7
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Chen YL, Jiang Y, Chen TW, Li R, Zhang XM, Chen F, Wu L, Ou J, Yang JQ. Assessing Microcirculation in Resectable Oesophageal Squamous Cell Carcinoma with Dynamic Contrast-enhanced MRI for Identifying Primary tumour and Lymphatic Metastasis. Sci Rep 2019; 9:124. [PMID: 30644415 PMCID: PMC6333778 DOI: 10.1038/s41598-018-36929-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 11/27/2018] [Indexed: 12/26/2022] Open
Abstract
This study aimed to determine whether dynamic contrast-enhanced MRI (DCE-MRI) derived parameters can identify oesophageal squamous cell carcinoma (SCC) and lymphatic metastasis. Thirty-nine oesophageal SCC patients underwent DCE-MRI. Quantitative parameters including endothelial transfer constant (Ktrans), reflux rate (Kep), fractional extravascular extracellular space volume and fractional plasma volume, and semi-quantitative parameters including time to peak (TTP), max concentration, Max Slope and area under concentration-time curve of both oesophageal SCC and normal oesophagus were measured. Mann-Whitney U test revealed that Ktrans and Kep of oesophageal SCC were higher while TTP was shorter when compared to normal oesophagus (all P-values < 0.05); and areas under receiver operating characteristic [ROC] curves displayed that Kep was superior to TTP or Ktrans for identifying oesophageal SCC (0.903 vs. 0.832 or 0.713). Mann-Whitney U test also demonstrated that Kep was higher and TTP was shorter in patients with lymphatic metastasis when compared to non-metastatic cancer patients (both P-values < 0.05), and area under ROC curve also showed that TTP was superior to Kep for predicting lymphatic metastasis (0.696 vs. 0.659). In conclusion, the combination of quantitative and semi-quantitative parameters derived from DCE-MRI can aid in the identification of oesophageal SCC and lymphatic metastasis.
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Affiliation(s)
- Yan-Li Chen
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yu Jiang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China
| | - Tian-Wu Chen
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China.
| | - Rui Li
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China
| | - Fan Chen
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lan Wu
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China
| | - Jing Ou
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China
| | - Jian-Qiong Yang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Nanchong, Sichuan, China
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8
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Parra NA, Lu H, Li Q, Stoyanova R, Pollack A, Punnen S, Choi J, Abdalah M, Lopez C, Gage K, Park JY, Kosj Y, Pow-Sang JM, Gillies RJ, Balagurunathan Y. Predicting clinically significant prostate cancer using DCE-MRI habitat descriptors. Oncotarget 2018; 9:37125-37136. [PMID: 30647849 PMCID: PMC6324677 DOI: 10.18632/oncotarget.26437] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/16/2018] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer diagnosis and treatment continues to be a major public health challenge. The heterogeneity of the disease is one of the major factors leading to imprecise diagnosis and suboptimal disease management. The improved resolution of functional multi-parametric magnetic resonance imaging (mpMRI) has shown promise to improve detection and characterization of the disease. Regions that subdivide the tumor based on Dynamic Contrast Enhancement (DCE) of mpMRI are referred to as DCE-Habitats in this study. The DCE defined perfusion curve patterns on the identified tumor habitat region are used to assess clinical significance. These perfusion curves were systematically quantified using seven features in association with the patient biopsy outcome and classifier models were built to find the best discriminating characteristics between clinically significant and insignificant prostate lesions defined by Gleason score (GS). Multivariable analysis was performed independently on one institution and validated on the other, using a multi-parametric feature model, based on DCE characteristics and ADC features. The models had an intra institution Area under the Receiver Operating Characteristic (AUC) of 0.82. Trained on Institution I and validated on the cohort from Institution II, the AUC was also 0.82 (sensitivity 0.68, specificity 0.95).
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Affiliation(s)
- N Andres Parra
- Department of Cancer Physiology, H.L. Moffitt Cancer Center, Tampa, FL, USA
| | - Hong Lu
- Department of Cancer Physiology, H.L. Moffitt Cancer Center, Tampa, FL, USA.,Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jung Choi
- Department of Radiology, H.L. Moffitt Cancer Center, Tampa, FL, USA
| | - Mahmoud Abdalah
- Department of Cancer Physiology, H.L. Moffitt Cancer Center, Tampa, FL, USA
| | - Christopher Lopez
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kenneth Gage
- Department of Radiology, H.L. Moffitt Cancer Center, Tampa, FL, USA
| | - Jong Y Park
- Department of Cancer Epidemiology, H.L. Moffitt Cancer Center, Tampa, FL, USA
| | - Yamoah Kosj
- Department of Cancer Epidemiology, H.L. Moffitt Cancer Center, Tampa, FL, USA.,Department of Radiation Oncology, H.L. Moffitt Cancer Center, Tampa, FL, USA
| | - Julio M Pow-Sang
- Department of Urology, H.L. Moffitt Cancer Center, Tampa, FL, USA
| | - Robert J Gillies
- Department of Cancer Physiology, H.L. Moffitt Cancer Center, Tampa, FL, USA.,Department of Radiology, H.L. Moffitt Cancer Center, Tampa, FL, USA
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9
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Tau N, Berlin A, Yeung I, Halankar J, Murphy G, Jhaveri KS, Ghai S, Metser U. Quantitative assessment of dynamic 18F-flumethycholine PET and dynamic contrast enhanced MRI in high risk prostate cancer. Br J Radiol 2018; 92:20180568. [PMID: 30383459 DOI: 10.1259/bjr.20180568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To describe dynamic 18F-flumethycholine PET (dPET) and dynamic contrast enhancement MR (DCE MR) parameters in localized high-risk prostate cancer (PCa), and determine whether these differ from normal prostate. Furthermore, to determine whether a correlation exists between dPET and DCE MR parameters. METHODS: 41 consenting patients who underwent prostate DCE MR and dPET were included in this institutionally approved study. Intraprostatic lesions on MR were assigned a PI-RADS v2 score, and focal lesions on PET were documented. All lesions were correlated with pathology. Quantitative and semi-quantitative DCE MR and two-tissue compartmental model dPET parameters were determined and tumor-to-normal gland ratios (T/N) for these parameters were calculated. Finally, dPET and DCE MR correlation was estimated using Spearman correlation coefficients. RESULTS: There were 46 malignant lesions per standard of reference. On dPET, peripheral zone (PZ) tumors had higher K1 (p < 0.001), and a T/N ratio ≥2 was significant (p < 0.001). On DCE MR, the parameters in, kep, Ktrans and quantitative iAUC were higher for PZ and non-PZ tumors than corresponding normal tissue (p < 0.001); for PZ tumors, a T/N ratio ≥ 1.5 for Ktrans and pei was significant (p = 0.0019 and 0.0026, respectively). Moderate Spearman correlation (0.40 < ρ < 0.59) was found between dPET K1 and DCE MR Ktrans and pei. CONCLUSION: In patients with high-risk PCa, quantitative dPET and DCE-MR parameters in primary tumors differ from normal tissue. Only moderate correlation exists between K1 (dPET) and Ktrans and pei (DCE MR). The incremental value of any of these parameters to PI-RADS v2 warrants further investigation. ADVANCES IN KNOWLEDGE: Unique quantitative and semi-quantitative FCH PET/MR parameters in PCa differ from normal gland, and should be further investigated to determine their potential contribution to PI-RADS v2 in the detection of clinically significant PCa.
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Affiliation(s)
- Noam Tau
- 1 Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto , Toronto, ON , Canada
| | - Alejandro Berlin
- 2 Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
| | - Ivan Yeung
- 2 Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
| | - Jaydeep Halankar
- 1 Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto , Toronto, ON , Canada
| | - Grainne Murphy
- 1 Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto , Toronto, ON , Canada
| | - Kartik S Jhaveri
- 1 Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto , Toronto, ON , Canada
| | - Sangeet Ghai
- 1 Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto , Toronto, ON , Canada
| | - Ur Metser
- 1 Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto , Toronto, ON , Canada
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10
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Klawer EM, van Houdt PJ, Pos FJ, Heijmink SW, van Osch MJ, van der Heide UA. Impact of contrast agent injection duration on dynamic contrast-enhanced MRI quantification in prostate cancer. NMR IN BIOMEDICINE 2018; 31:e3946. [PMID: 29974981 PMCID: PMC6175355 DOI: 10.1002/nbm.3946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 06/08/2023]
Abstract
The volume transfer constant Ktrans , which describes the leakage of contrast agent (CA) from vasculature into tissue, is the most commonly reported quantitative parameter for dynamic contrast-enhanced (DCE-) MRI. However, the variation in reported Ktrans values between studies from different institutes is large. One of the primary sources of uncertainty is quantification of the arterial input function (AIF). The aim of this study is to determine the influence of the CA injection duration on the AIF and tracer kinetic analysis (TKA) parameters (i.e. Ktrans , kep and ve ). Thirty-one patients with prostate cancer received two DCE-MRI examinations with an injection duration of 5 s in the first examination and a prolonged injection duration in the second examination, varying between 7.5 s and 30 s. The DCE examination was carried out on a 3.0 T MRI scanner using a transversal T1 -weighted 3D spoiled gradient echo sequence (300 s duration, dynamic scan time of 2.5 s). Data of 29 of the 31 were further analysed. AIFs were determined from the phase signal in the left and right femoral arteries. Ktrans , kep and ve were estimated with the standard Tofts model for regions of healthy peripheral zone and tumour tissue. We observed a significantly smaller peak height and increased width in the AIF for injection durations of 15 s and longer. However, we did not find significant differences in Ktrans , kep or ve for the studied injection durations. The study demonstrates that the TKA parameters Ktrans , kep and ve , measured in the prostate, do not show a significant change as a function of injection duration.
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Affiliation(s)
- Edzo M.E. Klawer
- Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Petra J. van Houdt
- Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Floris J. Pos
- Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | | | | | - Uulke A. van der Heide
- Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
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11
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Li HH, Zhu H, Yue L, Fu Y, Grimm R, Stemmer A, Fu CX, Peng WJ. Feasibility of free-breathing dynamic contrast-enhanced MRI of gastric cancer using a golden-angle radial stack-of-stars VIBE sequence: comparison with the conventional contrast-enhanced breath-hold 3D VIBE sequence. Eur Radiol 2017; 28:1891-1899. [PMID: 29260366 DOI: 10.1007/s00330-017-5193-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate the feasibility and diagnostic value of free-breathing, radial, stack-of-stars three-dimensional (3D) gradient echo (GRE) sequence ("golden angle") on dynamic contrast-enhanced (DCE) MRI of gastric cancer. METHODS Forty-three gastric cancer patients were divided into cooperative and uncooperative groups. Respiratory fluctuation was observed using an abdominal respiratory gating sensor. Those who breath-held for more than 15 s were placed in the cooperative group and the remainder in the uncooperative group. The 3-T MRI scanning protocol included 3D GRE and conventional breath-hold VIBE (volume-interpolated breath-hold examination) sequences, comparing images quantitatively and qualitatively. DCE-MRI parameters from VIBE images of normal gastric wall and malignant lesions were compared. RESULTS For uncooperative patients, 3D GRE scored higher qualitatively, and had higher SNRs (signal-to-noise ratios) and CNRs (contrast-to-noise ratios) than conventional VIBE quantitatively. Though 3D GRE images scored lower in qualitative parameters compared with conventional VIBE for cooperative patients, it provided images with fewer artefacts. DCE parameters differed significantly between normal gastric wall and lesions, with higher Ve (extracellular volume) and lower Kep (reflux constant) in gastric cancer. CONCLUSIONS The free-breathing, golden-angle, radial stack-of-stars 3D GRE technique is feasible for DCE-MRI of gastric cancer. Dynamic enhanced images can be used for quantitative analysis of this malignancy. KEY POINTS • Golden-angle radial stack-of-stars VIBE aids gastric cancer MRI diagnosis. • The 3D GRE technique is suitable for patients unable to suspend respiration. • Method scored higher in the qualitative evaluation for uncooperative patients. • The technique produced images with fewer artefacts than conventional VIBE sequence. • Dynamic enhanced images can be used for quantitative analysis of gastric cancer.
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Affiliation(s)
- Huan-Huan Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Hui Zhu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lei Yue
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yi Fu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Robert Grimm
- MR Applications Development, Siemens Healthcare, Erlangen, Germany
| | - Alto Stemmer
- MR Applications Development, Siemens Healthcare, Erlangen, Germany
| | - Cai-Xia Fu
- MR Applications Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Wei-Jun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
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