1
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Collins K, Cheng L. Reprint of: morphologic spectrum of treatment-related changes in prostate tissue and prostate cancer: an updated review. Hum Pathol 2023; 133:92-101. [PMID: 36898948 DOI: 10.1016/j.humpath.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/05/2022] [Indexed: 03/11/2023]
Abstract
A wide range of treatment options are available to patients with prostate cancer. Some treatments are standard (currently used) while some are emerging therapies. Androgen deprivation therapy is typically reserved for localized or metastatic prostate cancer not amenable to surgery. Radiation therapy may be offered to individuals for local therapy with curative intent in low- or intermediate-risk disease that may have a high probability of progression on active surveillance or where surgery is not suitable. Focal therapy/ablation treatment is an alternative approach for those who prefer to avoid radical prostatectomy for localized disease of low- or intermediate-risk or as salvage therapy after failed radiation therapy. Chemotherapy and immunotherapy remain under investigation and are currently used for androgen-independent disease or hormone-refractory prostate cancer; however, a better understanding of therapeutic efficacy is needed. Histopathologic changes observed in benign and malignant prostate tissue induced by hormonal therapies and radiation therapy are well described, whereas treatment-related effects secondary to novel therapies continue to be documented although their clinical significance is not absolutely clear. An informed and accurate evaluation of post-treatment prostate specimens requires pathologists with diagnostic acumen and knowledge relating to the histopathologic spectrum associated with each treatment option. In situations when clinical history is lacking, but morphologic features are suggestive of prior treatment, pathologists are encouraged to consult clinical colleagues regarding prior treatment history including details of when treatment was initiated and duration of therapy. This review aims to provide a concise update of current and emerging therapies for prostate cancer, histologic alterations and recommendations on Gleason grading.
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Affiliation(s)
- Katrina Collins
- Department of Pathology, Indiana University, Indianapolis, IN 46202, USA.
| | - Liang Cheng
- Department of Pathology, Indiana University, Indianapolis, IN 46202, USA
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2
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Wang X, Pennello G, deSouza NM, Huang EP, Buckler AJ, Barnhart HX, Delfino JG, Raunig DL, Wang L, Guimaraes AR, Hall TJ, Obuchowski NA. Multiparametric Data-driven Imaging Markers: Guidelines for Development, Application and Reporting of Model Outputs in Radiomics. Acad Radiol 2023; 30:215-229. [PMID: 36411153 PMCID: PMC9825652 DOI: 10.1016/j.acra.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/21/2022] [Accepted: 10/01/2022] [Indexed: 11/19/2022]
Abstract
This paper is the fifth in a five-part series on statistical methodology for performance assessment of multi-parametric quantitative imaging biomarkers (mpQIBs) for radiomic analysis. Radiomics is the process of extracting visually imperceptible features from radiographic medical images using data-driven algorithms. We refer to the radiomic features as data-driven imaging markers (DIMs), which are quantitative measures discovered under a data-driven framework from images beyond visual recognition but evident as patterns of disease processes irrespective of whether or not ground truth exists for the true value of the DIM. This paper aims to set guidelines on how to build machine learning models using DIMs in radiomics and to apply and report them appropriately. We provide a list of recommendations, named RANDAM (an abbreviation of "Radiomic ANalysis and DAta Modeling"), for analysis, modeling, and reporting in a radiomic study to make machine learning analyses in radiomics more reproducible. RANDAM contains five main components to use in reporting radiomics studies: design, data preparation, data analysis and modeling, reporting, and material availability. Real case studies in lung cancer research are presented along with simulation studies to compare different feature selection methods and several validation strategies.
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Affiliation(s)
- Xiaofeng Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave/JJN3, Cleveland, OH 44195.
| | - Gene Pennello
- Center for Devices and Radiological Health, US Food and Drug Administration Division of Imaging, Diagnostic and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Nandita M deSouza
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, United Kingdom; European Imaging Biomarkers Alliance, European Society of Radiology, London, UK
| | - Erich P Huang
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Huiman X Barnhart
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Jana G Delfino
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - David L Raunig
- Data Science Institute, Statistical and Quantitative Sciences, Takeda Pharmaceuticals America Inc, Lexington, Massachusetts
| | - Lu Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave/JJN3, Cleveland, OH 44195
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave/JJN3, Cleveland, OH 44195
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Khan R, Arshad F, Hassan IU, Naikoo GA, Pedram MZ, Zedegan MS, Pourfarzad H, Aljabali AAA, Serrano-Aroca Á, Haggag Y, Mishra V, Mishra Y, Birkett M, Tambuwala MM. Advances in nanomaterial-based immunosensors for prostate cancer screening. Biomed Pharmacother 2022; 155:113649. [PMID: 36108389 DOI: 10.1016/j.biopha.2022.113649] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/22/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
Prostate cancer is one of the most common health hazards for men worldwide, specifically in Western countries. Rapid prostate cancer screening by analyzing the prostate-specific antigen present in male serum has brought about a sharp decline in the mortality index of this disease. Immunoassay technology quantifies the target analyte in the sample using the antigen-antibody reaction. Immunoassays are now pivotal in disease diagnostics, drug monitoring, and pharmacokinetics. Recently, immunosensors have gained momentum in delivering better results with high specificity and lower limit of detection (LOD). Nanomaterials like gold, silver, and copper exhibit numerous exceptional features and their use in developing immunosensors have garnered excellent results in the diagnostic field. This review highlights the recent and different immunoassay techniques used to detect prostate-specific antigens and discusses the advances in nanomaterial-based immunosensors to detect prostate cancer efficiently. The review also explores the importance of specific biomarkers and nanomaterials-based biosensors with good selectivity and sensitivity to prostate cancer.
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Affiliation(s)
- Rabia Khan
- Neurology Laboratory, National University of Science and Technology, Islamabad PC 051, Pakistan
| | - Fareeha Arshad
- Department of Mathematics and Sciences, College of Arts and Applied Sciences, Dhofar University, Salalah PC 211, Oman
| | - Israr U Hassan
- College of Engineering, Dhofar University, Salalah PC 211, Oman
| | - Gowhar A Naikoo
- Department of Mathematics and Sciences, College of Arts and Applied Sciences, Dhofar University, Salalah PC 211, Oman.
| | - Mona Z Pedram
- Faculty of Mechanical Engineering-Energy Division, K.N. Toosi University of Technology, Tehran, Iran; Department of Analytical Chemistry, University of Kashan, Kashan, Iran.
| | - Mohammed Saeedi Zedegan
- Faculty of Mechanical Engineering-Energy Division, K.N. Toosi University of Technology, Tehran, Iran; Department of Analytical Chemistry, University of Kashan, Kashan, Iran
| | - Hamed Pourfarzad
- Center of excellence in electrochemistry, faculty of chemistry, University of Tehran, Tehran, Iran
| | - Alaa A A Aljabali
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, P. O. BOX 566, Irbid 21163, Jordan
| | - Ángel Serrano-Aroca
- Biomaterials and Bioengineering Lab., Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
| | - Yusuf Haggag
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Tanta University, Tanta 31512, Egypt
| | - Vijay Mishra
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
| | - Yachana Mishra
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
| | - Martin Birkett
- Department of Mechanical and Construction Engineering, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Murtaza M Tambuwala
- School of Pharmacy and Pharmaceutical Science, Ulster University, Coleraine County Londonderry BT52 1SA, Northern Ireland, UK.
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Lazzeri M, Fasulo V, Lughezzani G, Benetti A, Soldà G, Asselta R, De Simone I, Paciotti M, Avolio PP, Contieri R, Saitta C, Saita A, Hurle R, Guazzoni G, Buffi NM, Casale P. Prospective evaluation of the role of imaging techniques and TMPRSS2:ERG mutation for the diagnosis of clinically significant prostate cancer. Front Oncol 2022; 12:968384. [PMID: 36147926 PMCID: PMC9487838 DOI: 10.3389/fonc.2022.968384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To test the hypothesis of a relationship between a specific genetic lesion (T2:ERG) and imaging scores, such as PI-RADS and PRI-MUS, and to test the effectiveness of these parameters for the diagnosis of prostate cancer (PCa) and clinically significant PCa (csPCa). Materials and methods This is a prospective study of men with suspected PCa enrolled between 2016 and 2019 at a high-volume tertiary hospital. Patients underwent systematic US-guided biopsy, plus targeted biopsy if they were presenting with >=1 suspicious lesion (PI-RADS>2) at mpMRI or PR-IMUS >2 at micro-ultrasound assessment. For each patient, one core from the highest PI-RADS or PRI-MUS lesion was collected for T2:ERG analysis. Multivariable logistic regression models (LRMs) were fitted for csPCa with a clinical model (age, total PSA, previous biopsy, family history for PCa), a clinical plus PI-RADS, clinical plus T2:ERG, clinical plus PI-RADS plus T2:ERG, and T2:ERG plus PI-RADS alone. Results The cohort consists of 158 patients: 83.5% and 66.2% had respectively a diagnosis of PCa and csPCa after biopsy. A T2:ERG fusion was found in 37 men and 97.3% of these patients harbored PCa, while 81.1% were diagnosed with csPCa. SE of T2:ERG assay for csPCa was 28.8%, SP 87.0%, NPV 38.8%, and PPV 81.1%. Of 105 patients who performed mpMRI 93.% had PIRADS ≥3. SE of mpMRI for csPCa was 98.5%, SP was 12.8%, NPV was 83.3%, and PPV was 65.7%. Among 67 patients who were subjected to micro-US, 90% had a PRI-MUS ≥3. SE of micro-US for csPCa was 89.1%, SP was 9.52%, NPV was 28.6%, and PPV was 68.3%. At univariable LRM T2:ERG was confirmed as independent of mpMRI and micro-US result (OR 1.49, p=0.133 and OR 1.82, p=0.592, respectively). At multivariable LRM the clinical model alone had an AUC for csPCa of 0.74 while the clinical model including PI-RADS and T2:ERG achieved an AUC of 0.83. Conclusions T2:ERG translocation and imaging results are independent of each other, but both are related csPCa. To evaluate the best diagnostic work-up for PCa and csPCa detection, all available tools (T2:ERG detection and imaging techniques) should be employed together as they appear to have a complementary role.
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Affiliation(s)
- Massimo Lazzeri
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Vittorio Fasulo
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- *Correspondence: Giovanni Lughezzani,
| | - Alessio Benetti
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giulia Soldà
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Rosanna Asselta
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ilaria De Simone
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Paciotti
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pier Paolo Avolio
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberto Contieri
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Cesare Saitta
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Saita
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Paolo Casale
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
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Collins K, Cheng L. Morphologic spectrum of treatment-related changes in prostate tissue and prostate cancer: An Updated Review. Hum Pathol 2022; 127:56-66. [PMID: 35716730 DOI: 10.1016/j.humpath.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/05/2022] [Indexed: 12/21/2022]
Abstract
A wide range of treatment options is available to patients with prostate cancer. Some treatments are standard (currently used) while some are emerging therapies. Androgen deprivation therapy is typically reserved for localized or metastatic prostate cancer not amenable to surgery. Radiation therapy may be offered to individuals for local therapy with curative intent in low- or intermediate-risk disease that may have a high probability of progression on active surveillance or where surgery is not suitable. Focal therapy/ablation treatment is an alternative approach for those who prefer to avoid radical prostatectomy for localized disease of low- or intermediate-risk or as salvage therapy following failed radiation therapy. Chemotherapy and immunotherapy remain under investigation and are currently used for androgen-independent disease or hormone-refractory prostate cancer; however a better understand therapeutic efficacy is needed. Histopathologic changes observed in benign and malignant prostate tissue induced by hormonal therapies and radiation therapy is well described, while treatment-related effects secondary to novel therapies continue to be documented although their clinical significance is not absolutely clear. An informed and accurate evaluation of post-treatment prostate specimens requires pathologists with diagnostic acumen and knowledge relating to the histopathologic spectrum associated with each treatment option. In situations when clinical history is lacking, but morphologic features are suggestive of prior treatment, pathologists are encouraged to consult clinical colleagues regarding prior treatment history including details of when treatment was initiated and duration of therapy. This review aims to provide a concise update of current and emerging therapies for prostate cancer, histologic alterations and recommendations on Gleason grading.
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Affiliation(s)
- Katrina Collins
- Department of Pathology, Indiana University, Indianapolis, IN 46202, USA
| | - Liang Cheng
- Department of Pathology, Indiana University, Indianapolis, IN 46202, USA
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6
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Panzone J, Byler T, Bratslavsky G, Goldberg H. Transrectal Ultrasound in Prostate Cancer: Current Utilization, Integration with mpMRI, HIFU and Other Emerging Applications. Cancer Manag Res 2022; 14:1209-1228. [PMID: 35345605 PMCID: PMC8957299 DOI: 10.2147/cmar.s265058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/14/2022] [Indexed: 01/11/2023] Open
Abstract
Transrectal ultrasound (TRUS) has been an invaluable tool in the assessment of prostate size, anatomy and aiding in prostate cancer (PCa) diagnosis for decades. Emerging techniques warrant an investigation into the efficacy of TRUS, how it compares to new techniques, and options to increase the accuracy of prostate cancer diagnosis. Currently, TRUS is used to guide both transrectal and transperineal biopsy approaches with similar cancer detection rates, but lower rates of infection have been reported with the transperineal approach, while lower rates of urinary retention are often reported with the transrectal approach. Multiparametric MRI has substantial benefits for prostate cancer diagnosis and triage such as lesion location, grading, and can be combined with TRUS to perform fusion biopsies targeting specific lesions. Micro-ultrasound generates higher resolution images that traditional ultrasound and has been shown effective at diagnosing PCa, giving it the potential to become a future standard of care. Finally, high-intensity focused ultrasound focal therapy administered via TRUS has been shown to offer safe and effective short-term oncological control for localized disease with low morbidity, and the precise nature makes it a viable option for salvage and repeat therapy.
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Affiliation(s)
- John Panzone
- Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Timothy Byler
- Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Hanan Goldberg
- Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA
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7
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The volume and thickness of preprostatic fat on MRIs are not associated with prostate cancer aggressiveness in men undergoing radical prostatectomy. Prog Urol 2022; 32:341-353. [DOI: 10.1016/j.purol.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
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Lee CC, Chang KH, Chiu FM, Ou YC, Hwang JI, Hsueh KC, Fan HC. Using IVIM Parameters to Differentiate Prostate Cancer and Contralateral Normal Tissue through Fusion of MRI Images with Whole-Mount Pathology Specimen Images by Control Point Registration Method. Diagnostics (Basel) 2021; 11:diagnostics11122340. [PMID: 34943577 PMCID: PMC8700385 DOI: 10.3390/diagnostics11122340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
The intravoxel incoherent motion (IVIM) model may enhance the clinical value of multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa). However, while past IVIM modeling studies have shown promise, they have also reported inconsistent results and limitations, underscoring the need to further enhance the accuracy of IVIM modeling for PCa detection. Therefore, this study utilized the control point registration toolbox function in MATLAB to fuse T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) MRI images with whole-mount pathology specimen images in order to eliminate potential bias in IVIM calculations. Sixteen PCa patients underwent prostate MRI scans before undergoing radical prostatectomies. The image fusion method was then applied in calculating the patients’ IVIM parameters. Furthermore, MRI scans were also performed on 22 healthy young volunteers in order to evaluate the changes in IVIM parameters with aging. Among the full study cohort, the f parameter was significantly increased with age, while the D* parameter was significantly decreased. Among the PCa patients, the D and ADC parameters could differentiate PCa tissue from contralateral normal tissue, while the f and D* parameters could not. The presented image fusion method also provided improved precision when comparing regions of interest side by side. However, further studies with more standardized methods are needed to further clarify the benefits of the presented approach and the different IVIM parameters in PCa characterization.
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Affiliation(s)
- Cheng-Chun Lee
- Division of Diagnostic Radiology, Department of Medical Imaging, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan; (C.-C.L.); (J.-I.H.)
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan;
- Center for General Education, China Medical University, Taichung 404, Taiwan
- General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
| | - Feng-Mao Chiu
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan;
| | - Jen-I. Hwang
- Division of Diagnostic Radiology, Department of Medical Imaging, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan; (C.-C.L.); (J.-I.H.)
- Department of Radiology, National Defense Medical Center, Taipei 11490, Taiwan
| | - Kuan-Chun Hsueh
- Division of General Surgery, Department of Surgery, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan;
| | - Hueng-Chuen Fan
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan;
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan
- Department of Life Sciences, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Correspondence: ; Tel.: +886-426-581-919 (ext. 4301)
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9
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Hubbard S, Wells SA, Olson K, Jarrard DF, Huang W. Combined mpMRI/US fusion targeted and concurrent standard biopsies in the detection of prostate cancer: a retrospective study. Am J Transl Res 2021; 13:12107-12113. [PMID: 34786148 PMCID: PMC8581879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED In this retrospective study we compared the PCa detection rates between combined (combined MRI/US fusion targeted biopsy with concurrent standard biopsy) and standard systemic, combined and targeted (component), and targeted (component) and concurrent standard (component) biopsies. DESIGN Two cohorts, totaling 735 cases, were selected from the University of Wisconsin Pathology archive. 390 cases (cohort 1) were combined biopsies from 2017-2020 and 345 cases (cohort 2) were part of the standard US-guided systematic biopsies from the same period. PCa was stratified into three categories: low, intermediate, and high risks. RESULTS We found that combined biopsy was significantly better than the standard biopsy in detection of PCa (65.4% vs. 51.6%, P<0.01) and intermediate-risk PCa (18.7% vs. 10.4%, P=0.05) but only slightly better at detecting high-risk PCa (26.7% vs. 23.5%, P=0.32). Further examining the biopsy results in cohort 1, we found that combined biopsy was superior to targeted biopsy (65.4% vs. 56.9%, P=0.02) or concurrent standard biopsy (65.4% vs. 52.1%, P=0.0002) in PCa detection. Combined biopsy detected significantly more high-risk PCa than concurrent standard biopsy (26.7% vs. 17.4, P=0.002), but the difference in detecting high-risk PCa between combined and targeted biopsies was not significant (26.7% vs. 22.1%, P=0.133). Similarly, the differences in detecting PCa and high-risk PCa between targeted and concurrent standard biopsies were not significant (56.9% vs. 52.1%, P=0.172 and 22.1% vs. 17.4, P=0.133, respectively). Both targeted and concurrent standard biopsies missed PCa of each risk level. CONCLUSION Combined MRI/US fusion targeted plus standard prostate biopsy is a superior technique for the detection of PCa and clinically significant PCa.
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Affiliation(s)
- Samuel Hubbard
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Kelly Olson
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - David F Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Wei Huang
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
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Saniour I, Verret JM, Rabrait-Lerman C, Pilleul F, Beuf O. Feasibility and characterization of a safe susceptibility-matched endorectal coil for MR spectroscopy. NMR IN BIOMEDICINE 2020; 33:e4384. [PMID: 32794236 DOI: 10.1002/nbm.4384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
When using endorectal coils, local radiofrequency (RF) heating may occur in the surrounding tissue. Furthermore, most endorectal coils create a susceptibility artifact detrimental to both anatomical magnetic resonance imaging (MRI) and spectroscopy (MRS) acquisitions. We aimed at assessing the safety and MRS performance of a susceptibility-matched endorectal coil for further rectal wall analysis. Experiments were performed on a General Electric MR750 3 T scanner. A variable number of miniaturized passive RF traps were incorporated in the reception cable. The assessment of RF heating and coil sensitivity was conducted on a 1.5% agar-agar phantom doped with NaCl. Several susceptibility-matched materials such as Ultem, perfluorocarbon and barium sulfate were then compared with an external coil. Finally, Ultem was used as a solid support for an endorectal coil and compared with a reference coil. Phantom experiments exhibited a complete suppression of both the RF heating phenomenon and the coil sensitivity artifact. Ultem was the material that produced the smallest image distortion. The full width at half maximum of MR spectra acquired using the susceptibility-matched endorectal coil showed at least 30% narrowing compared with a reference endorectal coil. A susceptibility-matched endorectal coil with RF traps incorporated was validated on phantoms. This coil appears to be a promising device for future in vivo experiments.
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Affiliation(s)
- Isabelle Saniour
- Université Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - Jean-Marie Verret
- Université Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
- General Electric Healthcare, Clinical Science Development Group, Buc, France
| | | | - Frank Pilleul
- Centre Léon Bérard, Department of Radiology, Lyon, France
| | - Olivier Beuf
- Université Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
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Kiełbik A, Szlasa W, Saczko J, Kulbacka J. Electroporation-Based Treatments in Urology. Cancers (Basel) 2020; 12:E2208. [PMID: 32784598 PMCID: PMC7465806 DOI: 10.3390/cancers12082208] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
The observation that an application of a pulsed electric field (PEF) resulted in an increased permeability of the cell membrane has led to the discovery of the phenomenon called electroporation (EP). Depending on the parameters of the electric current and cell features, electroporation can be either reversible or irreversible. The irreversible electroporation (IRE) found its use in urology as a non-thermal ablative method of prostate and renal cancer. As its mechanism is based on the permeabilization of cell membrane phospholipids, IRE (as well as other treatments based on EP) provides selectivity sparing extracellular proteins and matrix. Reversible EP enables the transfer of genes, drugs, and small exogenous proteins. In clinical practice, reversible EP can locally increase the uptake of cytotoxic drugs such as cisplatin and bleomycin. This approach is known as electrochemotherapy (ECT). Few in vivo and in vitro trials of ECT have been performed on urological cancers. EP provides the possibility of transmission of genes across the cell membrane. As the protocols of gene electrotransfer (GET) over the last few years have improved, EP has become a well-known technique for non-viral cell transfection. GET involves DNA transfection directly to the cancer or the host skin and muscle tissue. Among urological cancers, the GET of several plasmids encoding prostate cancer antigens has been investigated in clinical trials. This review brings into discussion the underlying mechanism of EP and an overview of the latest progress and development perspectives of EP-based treatments in urology.
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Affiliation(s)
- Aleksander Kiełbik
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.K.); (W.S.)
| | - Wojciech Szlasa
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.K.); (W.S.)
| | - Jolanta Saczko
- Department of Molecular and Cellular Biology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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Enhancing the magnetic relaxivity of MRI contrast agents via the localized superacid microenvironment of graphene quantum dots. Biomaterials 2020; 250:120056. [PMID: 32339859 DOI: 10.1016/j.biomaterials.2020.120056] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/21/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
The design of contrast agents (CAs) with high magnetic relaxivities is a key issue in the field of magnetic resonance imaging (MRI). The traditional strategy employed is aimed at optimizing the structural design of the magnetic atoms in the CA. However, it is difficult to obtain an agent with magnetic relaxivity over 100 mM-1 s-1 using this approach. In this work, we demonstrate that modulation of the localized superacid microenvironment of certain CAs (Gd3+ loaded polyethylene glycol modified graphene oxide quantum dots or 'GPG' for short) can effectively enhance the longitudinal magnetic relaxivities (r1) by accelerating proton exchange. r1 values of a series of GPGs are significantly increased by 20-30 folds compared to commercially available CAs over a wide range of static magnetic field strengths (e.g. 210.9 mM-1 s-1vs. 12.3 mM-1 s-1 at 114 μT, 127.0 mM-1 s-1vs. 4.9 mM-1 s-1 at 7.0 T). GPG aided MRI images is then acquired both in vitro and in vivo with low biotoxicities. Furthermore, folic-acid-modified GPG is demonstrated suitable for MRI-fluorescence dual-modal tumor targeting imaging in animals with more than 98.3% specific cellular uptake rate.
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Abstract
PURPOSE OF REVIEW Radical treatments for prostate cancer are associated with significant morbidity, including incontinence and erectile dysfunction. Advances in the field of prostate MRI and desire to reduce treatment morbidities have led to a rapid growth in focal treatments for prostate cancer. Here, we review novel focal prostate cancer treatments and their associated recent clinical data, with a particular focus on data reported within the last 24 months. RECENT FINDINGS High-intensity focal ultrasound, focal laser ablation, irreversible electroporation, focal cryotherapy, and photodynamic therapy have been used as treatment modalities for localized prostate cancer treatment. Despite the great variety of treatment techniques, each of these modalities is characterized by a significant rate of prostate cancer persistence within treatment zones (6-50%) and the presence of residual cancer within the prostate on rebiopsy (24-49%). These treatments, however, are associated with very low rates of high-grade complications, rare incontinence, and only mild or transient reductions in erectile function. The most common adverse events are urinary tract infections, hematuria, and urinary retention. SUMMARY Prostate cancer focal therapy is an attractive option for well-selected patients because of its low complication profile; however, long-term oncologic outcome is still lacking and early recurrence rates are high, limiting the ability of most urologic associations from endorsing its routine use.
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Gholizadeh N, Pundavela J, Nagarajan R, Dona A, Quadrelli S, Biswas T, Greer PB, Ramadan S. Nuclear magnetic resonance spectroscopy of human body fluids and in vivo magnetic resonance spectroscopy: Potential role in the diagnosis and management of prostate cancer. Urol Oncol 2020; 38:150-173. [PMID: 31937423 DOI: 10.1016/j.urolonc.2019.10.019] [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] [Received: 04/17/2019] [Revised: 09/22/2019] [Accepted: 10/31/2019] [Indexed: 01/17/2023]
Abstract
Prostate cancer is the most common solid organ cancer in men, and the second most common cause of male cancer-related mortality. It has few effective therapies, and is difficult to diagnose accurately. Prostate-specific antigen (PSA), which is currently the most effective diagnostic tool available, cannot reliably discriminate between different pathologies, and in fact only around 30% of patients found to have elevated levels of PSA are subsequently confirmed to actually have prostate cancer. As such, there is a desperate need for more reliable diagnostic tools that will allow the early detection of prostate cancer so that the appropriate interventions can be applied. Nuclear magnetic resonance (NMR) spectroscopy and magnetic resonance spectroscopy (MRS) are 2 high throughput, noninvasive analytical procedures that have the potential to enable differentiation of prostate cancer from other pathologies using metabolomics, by focusing specifically on certain metabolites which are associated with the development of prostate cancer cells and its progression. The value that this type of approach has for the early detection, diagnosis, prognosis, and personalized treatment of prostate cancer is becoming increasingly apparent. Recent years have seen many promising developments in the fields of NMR spectroscopy and MRS, with improvements having been made to hardware as well as to techniques associated with the acquisition, processing, and analysis of related data. This review focuses firstly on proton NMR spectroscopy of blood serum, urine, and expressed prostatic secretions in vitro, and then on 1- and 2-dimensional proton MRS of the prostate in vivo. Major advances in these fields and methodological principles of data collection, acquisition, processing, and analysis are described along with some discussion of related challenges, before prospects that proton MRS has for future improvements to the clinical management of prostate cancer are considered.
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Affiliation(s)
- Neda Gholizadeh
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Jay Pundavela
- Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rajakumar Nagarajan
- Human Magnetic Resonance Center, Institute for Applied Life Sciences, University of Massachusetts Amherst, MA, USA
| | - Anthony Dona
- Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
| | - Scott Quadrelli
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia; Radiology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tapan Biswas
- Department of Instrumentation and Electronics Engineering, Jadavpur University, Kolkata, India
| | - Peter B Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia; Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia; Imaging Centre, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
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15
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Yuan Y, Wei Z, Chu C, Zhang J, Song X, Walczak P, Bulte JWM. Development of Zinc‐Specific iCEST MRI as an Imaging Biomarker for Prostate Cancer. Angew Chem Int Ed Engl 2019. [DOI: 10.1002/ange.201909429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Yue Yuan
- The Russell H. Morgan Department of Radiology and Radiological Science Division of MR Research The Johns Hopkins University School of Medicine Baltimore MD USA
- Cellular Imaging Section and Vascular Biology Program Institute for Cell Engineering The Johns Hopkins University School of Medicine Baltimore MD USA
| | - Zhiliang Wei
- The Russell H. Morgan Department of Radiology and Radiological Science Division of MR Research The Johns Hopkins University School of Medicine Baltimore MD USA
| | - Chengyan Chu
- The Russell H. Morgan Department of Radiology and Radiological Science Division of MR Research The Johns Hopkins University School of Medicine Baltimore MD USA
- Cellular Imaging Section and Vascular Biology Program Institute for Cell Engineering The Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jia Zhang
- The Russell H. Morgan Department of Radiology and Radiological Science Division of MR Research The Johns Hopkins University School of Medicine Baltimore MD USA
| | - Xiaolei Song
- The Russell H. Morgan Department of Radiology and Radiological Science Division of MR Research The Johns Hopkins University School of Medicine Baltimore MD USA
- Cellular Imaging Section and Vascular Biology Program Institute for Cell Engineering The Johns Hopkins University School of Medicine Baltimore MD USA
| | - Piotr Walczak
- The Russell H. Morgan Department of Radiology and Radiological Science Division of MR Research The Johns Hopkins University School of Medicine Baltimore MD USA
- Cellular Imaging Section and Vascular Biology Program Institute for Cell Engineering The Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jeff W. M. Bulte
- The Russell H. Morgan Department of Radiology and Radiological Science Division of MR Research The Johns Hopkins University School of Medicine Baltimore MD USA
- Cellular Imaging Section and Vascular Biology Program Institute for Cell Engineering The Johns Hopkins University School of Medicine Baltimore MD USA
- Department of Oncology Department of Biomedical Engineering Department of Chemical Biomolecular Engineering The Johns Hopkins University School of Medicine Baltimore MD USA
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Yuan Y, Wei Z, Chu C, Zhang J, Song X, Walczak P, Bulte JWM. Development of Zinc-Specific iCEST MRI as an Imaging Biomarker for Prostate Cancer. Angew Chem Int Ed Engl 2019; 58:15512-15517. [PMID: 31430007 PMCID: PMC7261412 DOI: 10.1002/anie.201909429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 01/16/2023]
Abstract
The healthy prostate contains the highest concentration of mobile zinc in the body. As this level decreases dramatically during the initial development of prostate cancer, in vivo detection of prostate zinc content may be applied for diagnosis of prostate cancer. Using 19 F ion chemical exchange saturation transfer magnetic resonance imaging (iCEST MRI) and TF-BAPTA as a fluorinated Zn-binding probe with micromolar sensitivity, we show that iCEST MRI is able to differentiate between normal and malignant prostate cells with a 10-fold difference in contrast following glucose-stimulated zinc secretion in vitro. The iCEST signal decreased in normal prostate cells upon downregulation of the ZIP1 zinc transporter. In vivo, using an orthotopic prostate cancer mouse model and a transgenic adenocarcinoma of the mouse prostate (TRAMP) model, a gradual decrease of >300 % in iCEST contrast following the transition of normal prostate epithelial cells to cancer cells was detected.
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Affiliation(s)
- Yue Yuan
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhiliang Wei
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chengyan Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jia Zhang
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaolei Song
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Piotr Walczak
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff W M Bulte
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Department of Biomedical Engineering, Department of Chemical Biomolecular Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Savir-Baruch B, Tade F, Henry E, Goldberg A, Petra L, Gabriel M, Wagner RH. Emerging Role of Fluciclovine and Other Next Generation PET Imaging Agents in Prostate Cancer Management. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brown LC, Ahmed HU, Faria R, El-Shater Bosaily A, Gabe R, Kaplan RS, Parmar M, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham A, Oldroyd R, Parker C, Bott S, Burns-Cox N, Dudderidge T, Ghei M, Henderson A, Persad R, Rosario DJ, Shergill I, Winkler M, Soares M, Spackman E, Sculpher M, Emberton M. Multiparametric MRI to improve detection of prostate cancer compared with transrectal ultrasound-guided prostate biopsy alone: the PROMIS study. Health Technol Assess 2019; 22:1-176. [PMID: 30040065 DOI: 10.3310/hta22390] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Men with suspected prostate cancer usually undergo transrectal ultrasound (TRUS)-guided prostate biopsy. TRUS-guided biopsy can cause side effects and has relatively poor diagnostic accuracy. Multiparametric magnetic resonance imaging (mpMRI) used as a triage test might allow men to avoid unnecessary TRUS-guided biopsy and improve diagnostic accuracy. OBJECTIVES To (1) assess the ability of mpMRI to identify men who can safely avoid unnecessary biopsy, (2) assess the ability of the mpMRI-based pathway to improve the rate of detection of clinically significant (CS) cancer compared with TRUS-guided biopsy and (3) estimate the cost-effectiveness of a mpMRI-based diagnostic pathway. DESIGN A validating paired-cohort study and an economic evaluation using a decision-analytic model. SETTING Eleven NHS hospitals in England. PARTICIPANTS Men at risk of prostate cancer undergoing a first prostate biopsy. INTERVENTIONS Participants underwent three tests: (1) mpMRI (the index test), (2) TRUS-guided biopsy (the current standard) and (3) template prostate mapping (TPM) biopsy (the reference test). MAIN OUTCOME MEASURES Diagnostic accuracy of mpMRI, TRUS-guided biopsy and TPM-biopsy measured by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using primary and secondary definitions of CS cancer. The percentage of negative magnetic resonance imaging (MRI) scans was used to identify men who might be able to avoid biopsy. RESULTS Diagnostic study - a total of 740 men were registered and 576 underwent all three tests. According to TPM-biopsy, the prevalence of any cancer was 71% [95% confidence interval (CI) 67% to 75%]. The prevalence of CS cancer according to the primary definition (a Gleason score of ≥ 4 + 3 and/or cancer core length of ≥ 6 mm) was 40% (95% CI 36% to 44%). For CS cancer, TRUS-guided biopsy showed a sensitivity of 48% (95% CI 42% to 55%), specificity of 96% (95% CI 94% to 98%), PPV of 90% (95% CI 83% to 94%) and NPV of 74% (95% CI 69% to 78%). The sensitivity of mpMRI was 93% (95% CI 88% to 96%), specificity was 41% (95% CI 36% to 46%), PPV was 51% (95% CI 46% to 56%) and NPV was 89% (95% CI 83% to 94%). A negative mpMRI scan was recorded for 158 men (27%). Of these, 17 were found to have CS cancer on TPM-biopsy. Economic evaluation - the most cost-effective strategy involved testing all men with mpMRI, followed by MRI-guided TRUS-guided biopsy in those patients with suspected CS cancer, followed by rebiopsy if CS cancer was not detected. This strategy is cost-effective at the TRUS-guided biopsy definition 2 (any Gleason pattern of ≥ 4 and/or cancer core length of ≥ 4 mm), mpMRI definition 2 (lesion volume of ≥ 0.2 ml and/or Gleason score of ≥ 3 + 4) and cut-off point 2 (likely to be benign) and detects 95% (95% CI 92% to 98%) of CS cancers. The main drivers of cost-effectiveness were the unit costs of tests, the improvement in sensitivity of MRI-guided TRUS-guided biopsy compared with blind TRUS-guided biopsy and the longer-term costs and outcomes of men with cancer. LIMITATIONS The PROstate Magnetic resonance Imaging Study (PROMIS) was carried out in a selected group and excluded men with a prostate volume of > 100 ml, who are less likely to have cancer. The limitations in the economic modelling arise from the limited evidence on the long-term outcomes of men with prostate cancer and on the sensitivity of MRI-targeted repeat biopsy. CONCLUSIONS Incorporating mpMRI into the diagnostic pathway as an initial test prior to prostate biopsy may (1) reduce the proportion of men having unnecessary biopsies, (2) improve the detection of CS prostate cancer and (3) increase the cost-effectiveness of the prostate cancer diagnostic and therapeutic pathway. The PROMIS data set will be used for future research; this is likely to include modelling prognostic factors for CS cancer, optimising MRI scan sequencing and biomarker or translational research analyses using the blood and urine samples collected. Better-quality evidence on long-term outcomes in prostate cancer under the various management strategies is required to better assess cost-effectiveness. The value-of-information analysis should be developed further to assess new research to commission. TRIAL REGISTRATION Current Controlled Trials ISRCTN16082556 and NCT01292291. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 39. See the NIHR Journals Library website for further project information. This project was also supported and partially funded by the NIHR Biomedical Research Centre at University College London (UCL) Hospitals NHS Foundation Trust and UCL and by The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research Biomedical Research Centre and was co-ordinated by the Medical Research Council's Clinical Trials Unit at UCL (grant code MC_UU_12023/28). It was sponsored by UCL. Funding for the additional collection of blood and urine samples for translational research was provided by Prostate Cancer UK.
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Affiliation(s)
- Louise Clare Brown
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rhian Gabe
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Katie Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alexander Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Chris Parker
- Department of Academic Urology, Royal Marsden Hospital, Sutton, UK
| | | | | | | | - Maneesh Ghei
- Department of Urology, Whittington Hospital, London, UK
| | | | - Rajendra Persad
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | | | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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O’Donohoe RL, Dunne RM, Kimbrell V, Tempany CM. Prostate MRI using an external phased array wearable pelvic coil at 3T: comparison with an endorectal coil. Abdom Radiol (NY) 2019; 44:1062-1069. [PMID: 30324501 DOI: 10.1007/s00261-018-1804-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate T2w and DWI image quality using a wearable pelvic coil (WPC) compared with an endorectal coil (ERC). METHODS Twenty men consecutively presenting to our prostate cancer MRI clinic were prospectively consented to be scanned using a wearable pelvic coil then an endorectal coil and pelvic phased array coil at 3T. Eighteen patients were suitable for inclusion. Axial T2w images were obtained using the WPC and ERC, and DWI images were obtained using the WPC, ERC, and PPA. Analysis was performed in consensus by two readers with experience in prostate MRI. The readers scored the T2w images using six qualitative criteria and the DWI images using five criteria. Signal-to-noise ratio (SNR) was also measured. RESULTS T2w artifact severity was greater for an ERC than a WPC (p = 0.003). There was no significant difference in T2w qualititatve image quality by other measures. The distinction of zonal anatomy on DWI was superior for an ERC compared with both a WPC and a PPA (p = 0.018 and p < 0.001 respectively), and there was no significant difference in DWI image quality by other measures. SNR was significantly higher for ERC imaging for both T2w and DWI. CONCLUSION WPC imaging provides comparable image quality to that of an ERC, potentially reducing the need for an ERC. WPC imaging shows reduced T2w artifact severity and inferior DWI zonal anatomy distinction compared with an ERC. Imaging with a WPC produces a lower SNR than an ERC.
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Bok R, Lee J, Sriram R, Keshari K, Sukumar S, Daneshmandi S, Korenchan DE, Flavell RR, Vigneron DB, Kurhanewicz J, Seth P. The Role of Lactate Metabolism in Prostate Cancer Progression and Metastases Revealed by Dual-Agent Hyperpolarized 13C MRSI. Cancers (Basel) 2019; 11:cancers11020257. [PMID: 30813322 PMCID: PMC6406929 DOI: 10.3390/cancers11020257] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 01/11/2023] Open
Abstract
This study applied a dual-agent, 13C-pyruvate and 13C-urea, hyperpolarized 13C magnetic resonance spectroscopic imaging (MRSI) and multi-parametric (mp) 1H magnetic resonance imaging (MRI) approach in the transgenic adenocarcinoma of mouse prostate (TRAMP) model to investigate changes in tumor perfusion and lactate metabolism during prostate cancer development, progression and metastases, and after lactate dehydrogenase-A (LDHA) knock-out. An increased Warburg effect, as measured by an elevated hyperpolarized (HP) Lactate/Pyruvate (Lac/Pyr) ratio, and associated Ldha expression and LDH activity were significantly higher in high- versus low-grade TRAMP tumors and normal prostates. The hypoxic tumor microenvironment in high-grade tumors, as measured by significantly decreased HP 13C-urea perfusion and increased PIM staining, played a key role in increasing lactate production through increased Hif1α and then Ldha expression. Increased lactate induced Mct4 expression and an acidic tumor microenvironment that provided a potential mechanism for the observed high rate of lymph node (86%) and liver (33%) metastases. The Ldha knockdown in the triple-transgenic mouse model of prostate cancer resulted in a significant reduction in HP Lac/Pyr, which preceded a reduction in tumor volume or apparent water diffusion coefficient (ADC). The Ldha gene knockdown significantly reduced primary tumor growth and reduced lymph node and visceral metastases. These data suggested a metabolic transformation from low- to high-grade prostate cancer including an increased Warburg effect, decreased perfusion, and increased metastatic potential. Moreover, these data suggested that LDH activity and lactate are required for tumor progression. The lactate metabolism changes during prostate cancer provided the motivation for applying hyperpolarized 13C MRSI to detect aggressive disease at diagnosis and predict early therapeutic response.
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Affiliation(s)
- Robert Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
| | - Jessie Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
| | - Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
| | - Kayvan Keshari
- Department of Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York, NY 10065, USA.
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
- Department of Radiology, Weill Cornell Medical College, New York, NY 10065, USA.
| | - Subramaniam Sukumar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
| | - Saeed Daneshmandi
- Department of Medicine, Division of Interdisciplinary Medicine, Beth Israel Deaconess Medical Center, Beth Israel Cancer Center, Harvard Medical School, Boston, MA 02215, USA.
| | - David E Korenchan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
| | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
| | - Pankaj Seth
- Department of Medicine, Division of Interdisciplinary Medicine, Beth Israel Deaconess Medical Center, Beth Israel Cancer Center, Harvard Medical School, Boston, MA 02215, USA.
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Comparison of Cancer Detection Rates Between TRUS-Guided Biopsy and MRI-Targeted Biopsy According to PSA Level in Biopsy-Naive Patients: A Propensity Score Matching Analysis. Clin Genitourin Cancer 2019; 17:e19-e25. [DOI: 10.1016/j.clgc.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/26/2018] [Accepted: 09/07/2018] [Indexed: 12/14/2022]
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22
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Maidens J, Gordon JW, Chen HY, Park I, Van Criekinge M, Milshteyn E, Bok R, Aggarwal R, Ferrone M, Slater JB, Kurhanewicz J, Vigneron DB, Arcak M, Larson PEZ. Spatio-Temporally Constrained Reconstruction for Hyperpolarized Carbon-13 MRI Using Kinetic Models. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:2603-2612. [PMID: 29994332 PMCID: PMC6279499 DOI: 10.1109/tmi.2018.2844246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We present a method of generating spatial maps of kinetic parameters from dynamic sequences of images collected in hyperpolarized carbon-13 magnetic resonance imaging (MRI) experiments. The technique exploits spatial correlations in the dynamic traces via regularization in the space of parameter maps. Similar techniques have proven successful in other dynamic imaging problems, such as dynamic contrast enhanced MRI. In this paper, we apply these techniques for the first time to hyperpolarized MRI problems, which are particularly challenging due to limited signal-to-noise ratio (SNR). We formulate the reconstruction as an optimization problem and present an efficient iterative algorithm for solving it based on the alternation direction method of multipliers. We demonstrate that this technique improves the qualitative appearance of parameter maps estimated from low SNR dynamic image sequences, first in simulation then on a number of data sets collected in vivo. The improvement this method provides is particularly pronounced at low SNR levels.
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Study of diagnostic accuracy of Fagan's two-step nomogram in increasing the value of predictive tools for prostate cancer: application of specific spatial distribution of positive/negative bioptic cores to predict extracapsular extension. Aging Clin Exp Res 2018; 30:1497-1504. [PMID: 29721783 DOI: 10.1007/s40520-018-0949-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prostate cancer (PC) represents the second most frequent cancer in the male population worldwide. It is mandatory to have a very accurate staging to choice the best possible treatment. AIMS To test the possibility of improving the performance of Partin's tables in predicting the pathological staging of PC by introducing bioptic parameters through an innovative statistic tool (Fagan's two-step nomogram). METHODS We prospectivelly collected data of all 1048 consecutive patients undergoing saturation 24-core transrectal prostate biopsy. Then, in eligible 94 patients, we compared the prediction of presence/absence of extracapsular extension of neoplasm (EPE+/-), with pathological assessment of invasion through (pseudo)capsule in the prostatectomy specimens. Starting from the probability of EPE- (pre-test probability, calculated with formula "100%-risk of EPE+"), we used Fagan's nomogram to examine the diagnostic sensitivity (DSe) and specificity (DSp) of negative "lateral" bioptic cores. RESULTS We specifically analyzed the status of "lateral" cores in each side (94 patients × 2 sides = 188 sides). "Lateral" cores were negative in 42.5% of sides (80/188) with a DSe and DSp of 91.7 and 45.4%, respectively. In these sides, the mean probability of EPE+ according to Partin's tables was 21.6%. With Fagan's nomogram, the post-test probability of EPE+ when all "lateral" cores were negative was 14.1%, with a substantial gain of 7.5%. DISCUSSION The spatial distribution of bioptic positive cores allowed us to demonstrate the role Fagan's nomogram in increasing the accuracy of already existing, predictive tools for PC. CONCLUSIONS This pioneering study may justify the use of the above nomogram in testing "local" predictive parameters in combination with pre-existing nomograms.
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24
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Larson PEZ, Chen HY, Gordon JW, Korn N, Maidens J, Arcak M, Tang S, Criekinge M, Carvajal L, Mammoli D, Bok R, Aggarwal R, Ferrone M, Slater JB, Nelson SJ, Kurhanewicz J, Vigneron DB. Investigation of analysis methods for hyperpolarized 13C-pyruvate metabolic MRI in prostate cancer patients. NMR IN BIOMEDICINE 2018. [PMID: 30230646 DOI: 10.1002/nbm.3997e3997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
MRI using hyperpolarized (HP) carbon-13 pyruvate is being investigated in clinical trials to provide non-invasive measurements of metabolism for cancer and cardiac imaging. In this project, we applied HP [1-13 C]pyruvate dynamic MRI in prostate cancer to measure the conversion from pyruvate to lactate, which is expected to increase in aggressive cancers. The goal of this work was to develop and test analysis methods for improved quantification of this metabolic conversion. In this work, we compared specialized kinetic modeling methods to estimate the pyruvate-to-lactate conversion rate, kPL , as well as the lactate-to-pyruvate area-under-curve (AUC) ratio. The kinetic modeling included an "inputless" method requiring no assumptions regarding the input function, as well as a method incorporating bolus characteristics in the fitting. These were first evaluated with simulated data designed to match human prostate data, where we examined the expected sensitivity of metabolism quantification to variations in kPL , signal-to-noise ratio (SNR), bolus characteristics, relaxation rates, and B1 variability. They were then applied to 17 prostate cancer patient datasets. The simulations indicated that the inputless method with fixed relaxation rates provided high expected accuracy with no sensitivity to bolus characteristics. The AUC ratio showed an undesired strong sensitivity to bolus variations. Fitting the input function as well did not improve accuracy over the inputless method. In vivo results showed qualitatively accurate kPL maps with inputless fitting. The AUC ratio was sensitive to bolus delivery variations. Fitting with the input function showed high variability in parameter maps. Overall, we found the inputless kPL fitting method to be a simple, robust approach for quantification of metabolic conversion following HP [1-13 C]pyruvate injection in human prostate cancer studies. This study also provided initial ranges of HP [1-13 C]pyruvate parameters (SNR, kPL , bolus characteristics) in the human prostate.
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Affiliation(s)
- Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
| | - Natalie Korn
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - John Maidens
- Department of Electrical Engineering and Computer Sciences, University of California - Berkeley, Berkeley, California
| | - Murat Arcak
- Department of Electrical Engineering and Computer Sciences, University of California - Berkeley, Berkeley, California
| | - Shuyu Tang
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - Mark Criekinge
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
| | - Lucas Carvajal
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
| | - Daniele Mammoli
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
| | - Rahul Aggarwal
- Department of Medicine, University of California - San Francisco, San Francisco, California
| | - Marcus Ferrone
- Department of Clinical Pharmacy, University of California - San Francisco, San Francisco, California
| | - James B Slater
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
| | - Sarah J Nelson
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
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25
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Larson PEZ, Chen HY, Gordon JW, Korn N, Maidens J, Arcak M, Tang S, Criekinge M, Carvajal L, Mammoli D, Bok R, Aggarwal R, Ferrone M, Slater JB, Nelson SJ, Kurhanewicz J, Vigneron DB. Investigation of analysis methods for hyperpolarized 13C-pyruvate metabolic MRI in prostate cancer patients. NMR IN BIOMEDICINE 2018; 31:e3997. [PMID: 30230646 PMCID: PMC6392436 DOI: 10.1002/nbm.3997] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/14/2018] [Accepted: 06/28/2018] [Indexed: 05/08/2023]
Abstract
MRI using hyperpolarized (HP) carbon-13 pyruvate is being investigated in clinical trials to provide non-invasive measurements of metabolism for cancer and cardiac imaging. In this project, we applied HP [1-13 C]pyruvate dynamic MRI in prostate cancer to measure the conversion from pyruvate to lactate, which is expected to increase in aggressive cancers. The goal of this work was to develop and test analysis methods for improved quantification of this metabolic conversion. In this work, we compared specialized kinetic modeling methods to estimate the pyruvate-to-lactate conversion rate, kPL , as well as the lactate-to-pyruvate area-under-curve (AUC) ratio. The kinetic modeling included an "inputless" method requiring no assumptions regarding the input function, as well as a method incorporating bolus characteristics in the fitting. These were first evaluated with simulated data designed to match human prostate data, where we examined the expected sensitivity of metabolism quantification to variations in kPL , signal-to-noise ratio (SNR), bolus characteristics, relaxation rates, and B1 variability. They were then applied to 17 prostate cancer patient datasets. The simulations indicated that the inputless method with fixed relaxation rates provided high expected accuracy with no sensitivity to bolus characteristics. The AUC ratio showed an undesired strong sensitivity to bolus variations. Fitting the input function as well did not improve accuracy over the inputless method. In vivo results showed qualitatively accurate kPL maps with inputless fitting. The AUC ratio was sensitive to bolus delivery variations. Fitting with the input function showed high variability in parameter maps. Overall, we found the inputless kPL fitting method to be a simple, robust approach for quantification of metabolic conversion following HP [1-13 C]pyruvate injection in human prostate cancer studies. This study also provided initial ranges of HP [1-13 C]pyruvate parameters (SNR, kPL , bolus characteristics) in the human prostate.
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Affiliation(s)
- Peder E. Z. Larson
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
- UC Berkeley–UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
- UC Berkeley–UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - Jeremy W. Gordon
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
| | - Natalie Korn
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
- UC Berkeley–UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - John Maidens
- Department of Electrical Engineering and Computer Sciences, University of California – Berkeley, Berkeley, California
| | - Murat Arcak
- Department of Electrical Engineering and Computer Sciences, University of California – Berkeley, Berkeley, California
| | - Shuyu Tang
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
- UC Berkeley–UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - Mark Criekinge
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
| | - Lucas Carvajal
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
| | - Daniele Mammoli
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
| | - Rahul Aggarwal
- Department of Medicine, University of California – San Francisco, San Francisco, California
| | - Marcus Ferrone
- Department of Clinical Pharmacy, University of California – San Francisco, San Francisco, California
| | - James B. Slater
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
| | - Sarah J. Nelson
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
- UC Berkeley–UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
- UC Berkeley–UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
| | - Daniel B. Vigneron
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, California
- UC Berkeley–UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California
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26
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Zadra G, Loda M. Metabolic Vulnerabilities of Prostate Cancer: Diagnostic and Therapeutic Opportunities. Cold Spring Harb Perspect Med 2018; 8:cshperspect.a030569. [PMID: 29229664 DOI: 10.1101/cshperspect.a030569] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cancer cells hijack metabolic pathways to support bioenergetics and biosynthetic requirements for their uncontrolled growth. Thus, cancer can be considered as a metabolic disease. In this review, we discuss the main metabolic features of prostate cancer with a particular focus on the link between oncogene-directed cancer metabolic regulation, metabolism rewiring, and epigenetic regulation. The potential of using metabolic profiling as a means to predict disease behavior and to identify novel therapeutic targets and new diagnostic markers will be addressed as well as the current challenges in metabolomics analyses. Finally, diagnostic and prognostic metabolic imaging approaches, including positron emission tomography, mass spectrometry, nuclear magnetic resonance, and their translational applications, will be discussed. Here, we emphasize how targeting metabolic vulnerabilities in prostate cancer may pave the way for novel personalized diagnostic and therapeutic interventions.
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Affiliation(s)
- Giorgia Zadra
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02215.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215
| | - Massimo Loda
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02215.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215.,The Broad Institute, Cambridge, Massachusetts 02142
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27
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Shahedi M, Cool DW, Bauman GS, Bastian-Jordan M, Fenster A, Ward AD. Accuracy Validation of an Automated Method for Prostate Segmentation in Magnetic Resonance Imaging. J Digit Imaging 2018; 30:782-795. [PMID: 28342043 DOI: 10.1007/s10278-017-9964-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Three dimensional (3D) manual segmentation of the prostate on magnetic resonance imaging (MRI) is a laborious and time-consuming task that is subject to inter-observer variability. In this study, we developed a fully automatic segmentation algorithm for T2-weighted endorectal prostate MRI and evaluated its accuracy within different regions of interest using a set of complementary error metrics. Our dataset contained 42 T2-weighted endorectal MRI from prostate cancer patients. The prostate was manually segmented by one observer on all of the images and by two other observers on a subset of 10 images. The algorithm first coarsely localizes the prostate in the image using a template matching technique. Then, it defines the prostate surface using learned shape and appearance information from a set of training images. To evaluate the algorithm, we assessed the error metric values in the context of measured inter-observer variability and compared performance to that of our previously published semi-automatic approach. The automatic algorithm needed an average execution time of ∼60 s to segment the prostate in 3D. When compared to a single-observer reference standard, the automatic algorithm has an average mean absolute distance of 2.8 mm, Dice similarity coefficient of 82%, recall of 82%, precision of 84%, and volume difference of 0.5 cm3 in the mid-gland. Concordant with other studies, accuracy was highest in the mid-gland and lower in the apex and base. Loss of accuracy with respect to the semi-automatic algorithm was less than the measured inter-observer variability in manual segmentation for the same task.
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Affiliation(s)
- Maysam Shahedi
- Baines Imaging Research Laboratory, London Regional Cancer Program, A3-123A, 790 Commissioners Rd E, London, ON, N6A 4L6, Canada. .,Robarts Research Institute, The University of Western Ontario, London, ON, Canada. .,Graduate Program in Biomedical Engineering, The University of Western Ontario, London, ON, Canada.
| | - Derek W Cool
- Robarts Research Institute, The University of Western Ontario, London, ON, Canada.,The Department of Medical Imaging, The University of Western Ontario, London, ON, Canada
| | - Glenn S Bauman
- Baines Imaging Research Laboratory, London Regional Cancer Program, A3-123A, 790 Commissioners Rd E, London, ON, N6A 4L6, Canada.,The Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada.,The Department of Oncology, The University of Western Ontario, London, ON, Canada
| | - Matthew Bastian-Jordan
- The Department of Medical Imaging, The University of Western Ontario, London, ON, Canada
| | - Aaron Fenster
- Robarts Research Institute, The University of Western Ontario, London, ON, Canada.,Graduate Program in Biomedical Engineering, The University of Western Ontario, London, ON, Canada.,The Department of Medical Imaging, The University of Western Ontario, London, ON, Canada.,The Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada
| | - Aaron D Ward
- Baines Imaging Research Laboratory, London Regional Cancer Program, A3-123A, 790 Commissioners Rd E, London, ON, N6A 4L6, Canada.,Graduate Program in Biomedical Engineering, The University of Western Ontario, London, ON, Canada.,The Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada.,The Department of Oncology, The University of Western Ontario, London, ON, Canada
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28
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Jin J, Zhang L, Leng E, Metzger GJ, Koopmeiners JS. Detection of prostate cancer with multiparametric MRI utilizing the anatomic structure of the prostate. Stat Med 2018; 37:3214-3229. [PMID: 29923345 DOI: 10.1002/sim.7810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/05/2018] [Accepted: 04/05/2018] [Indexed: 01/02/2023]
Abstract
Multiparametric magnetic resonance imaging (mpMRI), which combines traditional anatomic and newer quantitative MRI methods, has been shown to result in improved voxel-wise classification of prostate cancer as compared with any single MRI parameter. While these results are promising, substantial heterogeneity in the mpMRI parameter values and voxel-wise prostate cancer risk has been observed both between and within regions of the prostate. This suggests that classification of prostate cancer can potentially be improved by incorporating structural information into the classifier. In this paper, we propose a novel voxel-wise classifier of prostate cancer that accounts for the anatomic structure of the prostate by Bayesian hierarchical modeling, which can be combined with post hoc spatial Gaussian kernel smoothing to account for residual spatial correlation. Our proposed classifier results in significantly improved area under the ROC curve (0.822 vs 0.729, P < .001) and sensitivity corresponding to 90% specificity (0.599 vs 0.429, P < .001), compared with a baseline model that does not account for the anatomic structure of the prostate. Furthermore, the classifier can also be applied on voxels with missing mpMRI parameters, resulting in similar performance, which is an important practical consideration that cannot be easily accommodated using regression-based classifiers. In addition, our classifier achieved high computational efficiency with a closed-form solution for the posterior predictive cancer probability.
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Affiliation(s)
- Jin Jin
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ethan Leng
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Gregory J Metzger
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
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29
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Chang Y, Yang J, Hong H, Ma H, Cui X, Chen L. The Value of Contrast-Enhanced Ultrasonography Combined with Real-Time Strain Elastography in the Early Diagnosis of Prostate Cancer. Aging Dis 2018; 9:480-488. [PMID: 29896435 PMCID: PMC5988602 DOI: 10.14336/ad.2017.0704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/04/2017] [Indexed: 12/29/2022] Open
Abstract
To evaluate the performance of a combination of real-time strain elastography (RTSE) and contrast-enhanced transrectal ultrasound (CETRUS) for prostate cancer detection. Patients with serum prostate-specific antigen (PSA) levels of ≥4.0 ng/ml were prospectively enrolled between June 2014 and December 2016. 153 prostate nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CETRUS and RTSE before a biopsy. Multivariate logistic regression models were established for CETRUS, and CETRUS combined with RTSE to diagnose prostate malignancy. The diagnostic performances of CETRUS, RTSE, and their combined use were evaluated with the receiver operating characteristic (ROC) curve. The multivariate logistic regression for CETRUS combined with RTSE showed that enhanced strength, enhanced uniformity, and elasticity scores were the independent predictors of prostate malignancy. The area under the ROC curve of CETRUS combined with RTSE (0.921±0.023) was higher than that of CETRUS and RTSE (0.88±0.029 and 0.80±0.038, respectively; both p<0.05). Moreover, the sensitivity, accuracy and negative predictive value of CETRUS combined with RTSE were 92.1%, 86.2%, and 84.6%, respectively. The omission diagnostic rate of CETRUS combined with RTSE (7.9%) was reduced. And the diagnostic accuracy of CETRUS combined with RTSE was significantly higher than that of CETRUS and RTSE (p<0.05). While the diagnostic accuracy of CETRUS was close to the RTSE, the difference was not statistically significant (p>0.05). The combined RTSE with CETRUS approach significantly improved the sensitivity and overall accuracy for correctly identifying prostate cancer.
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Affiliation(s)
- Ying Chang
- 1Departments of Ultrasonography, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Jingchun Yang
- 1Departments of Ultrasonography, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Hua Hong
- 2Departments of Ultrasonography, Inner Mongolia Autonomous Region People's Hospital, Hohhot 010017, China
| | - Huijuan Ma
- 1Departments of Ultrasonography, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Xin Cui
- 3Departments of Urology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Li Chen
- 4Departments of Pathology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
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30
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31
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Zhang W, Liu L, Chen H, Hu K, Delahunty I, Gao S, Xie J. Surface impact on nanoparticle-based magnetic resonance imaging contrast agents. Theranostics 2018; 8:2521-2548. [PMID: 29721097 PMCID: PMC5928907 DOI: 10.7150/thno.23789] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/09/2018] [Indexed: 12/23/2022] Open
Abstract
Magnetic resonance imaging (MRI) is one of the most widely used diagnostic tools in the clinic. To improve imaging quality, MRI contrast agents, which can modulate local T1 and T2 relaxation times, are often injected prior to or during MRI scans. However, clinically used contrast agents, including Gd3+-based chelates and iron oxide nanoparticles (IONPs), afford mediocre contrast abilities. To address this issue, there has been extensive research on developing alternative MRI contrast agents with superior r1 and r2 relaxivities. These efforts are facilitated by the fast progress in nanotechnology, which allows for preparation of magnetic nanoparticles (NPs) with varied size, shape, crystallinity, and composition. Studies suggest that surface coatings can also largely affect T1 and T2 relaxations and can be tailored in favor of a high r1 or r2. However, the surface impact of NPs has been less emphasized. Herein, we review recent progress on developing NP-based T1 and T2 contrast agents, with a focus on the surface impact.
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Affiliation(s)
- Weizhong Zhang
- Department of Chemistry, University of Georgia, Athens, Georgia 30602, USA
| | - Lin Liu
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, ErDao District, Changchun 13033, China
| | - Hongmin Chen
- Department of Chemistry, University of Georgia, Athens, Georgia 30602, USA
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Kai Hu
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, Hubei 430072, China
| | - Ian Delahunty
- Department of Chemistry, University of Georgia, Athens, Georgia 30602, USA
| | - Shi Gao
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, ErDao District, Changchun 13033, China
| | - Jin Xie
- Department of Chemistry, University of Georgia, Athens, Georgia 30602, USA
- Bio-Imaging Research Center, University of Georgia, Athens, Georgia 30602, USA
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32
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Pesapane F, Patella F, Fumarola EM, Zanchetta E, Floridi C, Carrafiello G, Standaert C. The prostate cancer focal therapy. Gland Surg 2018; 7:89-102. [PMID: 29770305 PMCID: PMC5938267 DOI: 10.21037/gs.2017.11.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
Abstract
Despite prostate cancer (PCa) is the leading form of non-cutaneous cancer in men, most patients with PCa die with disease rather than of the disease. Therefore, the risk of overtreatment should be considered by clinicians who have to distinguish between patients with high risk PCa (who would benefit from radical treatment) and patients who may be managed more conservatively, such as through active surveillance or emerging focal therapy (FT). The aim of FT is to eradicate clinically significant disease while protecting key genito-urinary structures and function from injury. While effectiveness studies comparing FT with conventional care options are still lacking, the rationale supporting FT relies on evidence-based advances such as the understanding of the index lesion's central role in the natural history of the PCa and the improvement of multiparametric magnetic resonance imaging (mpMRI) in the detection and risk stratification of PCa. In this literature review, we want to highlight the rationale for FT in PCa management and the current evidence on patient eligibility. Furthermore, we summarize the best imaging modalities to localize the target lesion, describe the current FT techniques in PCa, provide an update on their oncological outcomes and highlight trends for future research.
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Affiliation(s)
- Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Edoardo Zanchetta
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Chiara Floridi
- Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Chloë Standaert
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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33
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The impact of computed high b-value images on the diagnostic accuracy of DWI for prostate cancer: A receiver operating characteristics analysis. Sci Rep 2018; 8:3409. [PMID: 29467370 PMCID: PMC5821845 DOI: 10.1038/s41598-018-21523-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/06/2018] [Indexed: 01/13/2023] Open
Abstract
To evaluate the performance of computed high b value diffusion-weighted images (DWI) in prostate cancer detection. 97 consecutive patients who had undergone multiparametric MRI of the prostate followed by biopsy were reviewed. Five radiologists independently scored 138 lesions on native high b-value images (b = 1200 s/mm2), apparent diffusion coefficient (ADC) maps, and computed high b-value images (contrast equivalent to b = 2000 s/mm2) to compare their diagnostic accuracy. Receiver operating characteristic (ROC) analysis and McNemar’s test were performed to assess the relative performance of computed high b value DWI, native high b-value DWI and ADC maps. No significant difference existed in the area under the curve (AUC) for ROCs comparing B1200 (b = 1200 s/mm2) to computed B2000 (c-B2000) in 5 readers. In 4 of 5 readers c-B2000 had significantly increased sensitivity and/or decreased specificity compared to B1200 (McNemar’s p < 0.05), at selected thresholds of interpretation. ADC maps were less accurate than B1200 or c-B2000 for 2 of 5 readers (P < 0.05). This study detected no consistent improvement in overall diagnostic accuracy using c-B2000, compared with B1200 images. Readers detected more cancer with c-B2000 images (increased sensitivity) but also more false positive findings (decreased specificity).
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De Bari B, Fiorentino A, Greto D, Ciammella P, Arcangeli S, Avuzzi B, D'Angelillo RM, Desideri I, Kirienko M, Marchiori D, Massari F, Fundoni C, Franco P, Filippi AR, Alongi F. Prostate cancer as a paradigm of multidisciplinary approach? Highlights from the Italian young radiation oncologist meeting. TUMORI JOURNAL 2018; 99:637-49. [DOI: 10.1177/030089161309900601] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims and background The diagnostic and therapeutic approach to prostate cancer has evolved rapidly in last decades. Young professionals need an update about these recent developments in order to improve the care of patients treated in their daily clinical practice. Methods On May 18, 2013, AIRO Giovani (the young section of the Italian Association of Radiation Oncology) organized a multidisciplinary meeting involving, as speakers, several young physicians from many parts of Italy actively involved in the diagnostic and therapeutic approach to prostate cancer. The meeting was specifically addressed to young physicians (radio-oncologists, urologists, medical oncologists) and presented the state-of-the-art of the diagnostic/therapeutic approach based on the latest evidence on the issue. Highlights of the congress are summarized and presented in this report. Results The large participation in the meeting (more than 120 participants were present) confirmed the interest of young radiation oncologists in improving their skills in prostate cancer management. The contributions of the speakers confirmed the need for regular updates, considering the promising results of recently published studies and the many new ongoing trials, on the diagnostic and therapeutic approaches to prostate cancer. Conclusions Multidisciplinary meetings are helpful to improve the skills of young professionals.
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Affiliation(s)
- Berardino De Bari
- Radiation Oncology Department, AO Spedali Civili and University of Brescia, Brescia
| | - Alba Fiorentino
- Radiation Oncology Department, IRCCS/CROB, Rionero in Vulture (PZ)
- Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Patrizia Ciammella
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia
| | | | - Barbara Avuzzi
- Radiation Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | | | | | | | - Francesco Massari
- Medical Oncology, ‘GB Rossi’ Academic Hospital, University of Verona, Verona
| | | | - Pierfrancesco Franco
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale U Parini, AUSL Valle d'Aosta, Aosta
| | - Andrea R Filippi
- Department of Oncology, Radiation Oncology, University of Torino, Turin
| | - Filippo Alongi
- Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
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Dwivedi DK, Kumar R, Dwivedi AK, Bora GS, Thulkar S, Sharma S, Gupta SD, Jagannathan NR. Prebiopsy multiparametric MRI-based risk score for predicting prostate cancer in biopsy-naive men with prostate-specific antigen between 4-10 ng/mL. J Magn Reson Imaging 2017; 47:1227-1236. [PMID: 28872226 DOI: 10.1002/jmri.25850] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/24/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Risk calculators have traditionally utilized serum prostate-specific antigen (PSA) values in addition to clinical variables to predict the likelihood of prostate cancer (PCa). PURPOSE To develop a prebiopsy multiparametric MRI (mpMRI)-based risk score (RS) and a statistical equation for predicting the risk of PCa in biopsy-naive men with serum PSA between 4-10 ng/mL that may help reduce unnecessary biopsies. STUDY TYPE Prospective cross-sectional study. SUBJECTS In all, 137 consecutive men with PSA between 4-10 ng/mL underwent prebiopsy mpMRI (diffusion-weighted [DW]-MRI and MR spectroscopic imaging [MRSI]) during 2009-2015 were recruited for this study. FIELD STRENGTH/SEQUENCE 1.5T (Avanto, Siemens Health Care, Erlangen, Germany); T1 -weighted, T2 -weighted, DW-MRI, and MRSI sequences were used. ASSESSMENT All eligible patients underwent mpMRI-directed, cognitive-fusion transrectal ultrasound (TRUS)-guided biopsies. STATISTICAL TESTS An equation model and an RS were developed using receiver operating characteristic (ROC) curve analysis and a multivariable logistic regression approach. A 10-fold crossvalidation and simulation analyses were performed to assess diagnostic performance of various combinations of mpMRI parameters. RESULTS Of 137 patients, 32 were diagnosed with PCa on biopsy. Multivariable analysis, adjusted with positive pathology, showed apparent diffusion coefficient (ADC), metabolite ratio, and PSA as significant predictors of PCa (P < 0.05). A statistical equation was derived using these predictors. A simple 6-point mpMRI-based RS was derived for calculating the risk of PCa and it showed that it is highly predictive for PCa (odds ratio = 3.74, 95% confidence interval [CI]: 2.24-6.27, area under the curve [AUC] = 0.87). Both models (equation and RS) yielded high predictive performance (AUC ≥0.85) on validation analysis. DATA CONCLUSION A statistical equation and a simple 6-point mpMRI-based RS can be used as a point-of-care tool to potentially help limit the number of negative biopsies in men with PSA between 4 and 10 ng/mL. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1227-1236.
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Affiliation(s)
- Durgesh Kumar Dwivedi
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Girdhar S Bora
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
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Loggitsi D, Gyftopoulos A, Economopoulos N, Apostolaki A, Kalogeropoulos T, Thanos A, Alexopoulou E, Kelekis NL. Multiparametric Magnetic Resonance Imaging of the Prostate for Tumour Detection and Local Staging: Imaging in 1.5T and Histopathologic Correlation. Can Assoc Radiol J 2017; 68:379-386. [PMID: 28720413 DOI: 10.1016/j.carj.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 12/10/2016] [Accepted: 02/05/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The study sought to prospectively evaluate which technique among T2-weighted images, dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), diffusion-weighted (DW) MRI, or a combination of the 2, is best suited for prostate cancer detection and local staging. METHODS Twenty-seven consecutive patients with biopsy-proven adenocarcinoma of the prostate underwent MRI on a 1.5T scanner with a surface phased-array coil prior radical prostatectomy. Combined anatomical and functional imaging was performed with the use of T2-weighted sequences, DCE MRI, and DW MRI. We compared the imaging results with whole mount histopathology. RESULTS For the multiparametric approach, significantly higher sensitivity values, that is, 53% (95% confidence interval [CI]: 41.0-64.1) were obtained as compared with each modality alone or any combination of the 3 modalities (P < .05). The specificity for this multiparametric approach, being 90.3% (95% CI: 86.3-93.3) was not significantly higher (P < .05) as compared with the values of the combination of T2+DCE MRI, DW+DCE MRI, or DCE MRI alone. Among the 3 techniques, DCE had the best performance for tumour detection in both the peripheral and the transition zone. High negative predictive value rates (>86%) were obtained for both tumour detection and local staging. CONCLUSIONS The combination of T2-weighted sequences, DCE MRI, and DW MRI yields higher diagnostic performance for tumour detection and local staging than can any of these techniques alone or even any combination of them.
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Affiliation(s)
- Dimitra Loggitsi
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece
| | - Anastasios Gyftopoulos
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece.
| | - Nikolaos Economopoulos
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece
| | | | | | - Anastasios Thanos
- Urology Department, St Savvas Anticancer and Oncology Hospital, Athens, Greece
| | - Efthimia Alexopoulou
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece
| | - Nikolaos L Kelekis
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece
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Auer T, De Zordo T, Dejaco C, Gruber L, Pichler R, Jaschke W, Dogra VS, Aigner F. Value of Multiparametric US in the Assessment of Intratesticular Lesions. Radiology 2017. [PMID: 28628420 DOI: 10.1148/radiol.2017161373] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To evaluate the diagnostic accuracy of multiparametric ultrasonography (US) consisting of gray-scale US, color Doppler US, strain elastography, and contrast agent-enhanced US in the assessment of intratesticular lesions. Materials and Methods Institutional review board approval was obtained for this retrospective study. From January 2012 to December 2015, 55 focal testicular lesions that were indeterminate on gray-scale US scans were further characterized with color Doppler US, strain elastography, and contrast-enhanced US. Strain elastography was performed to assess tissue elasticity, and hard lesions were defined as malignant. Color Doppler US and contrast-enhanced US were performed to determine the absence or presence of vascularization. Avascular lesions were defined as benign. Histopathologic results or follow-up examinations served as reference standards. Correct classification rate, sensitivity, specificity, and likelihood ratio were calculated. Results Of 55 testicular lesions, 43 (78.2%) were benign and 12 (21.8%) were malignant. Single-modality sensitivities and specificities were 66.7% and 88.4% for color Doppler US, 100% and 76.7% for contrast-enhanced US, and 100% and 72.1% for strain elastography, respectively. Among 12 malignant lesions, color Doppler US failed to demonstrate vascularization in four (33.3%) lesions, which were positive for cancer at contrast-enhanced US. By combining strain elastography and contrast-enhanced US, a sensitivity of 100% and specificity of 93.0% were achieved in differentiating benign and malignant focal testicular lesions. Positive likelihood ratio was 5.7 for color Doppler US, 4.3 for contrast-enhanced US, 3.6 for strain elastography, 14.3 for strain elastography combined with color Doppler US, and 14.3 for strain elastography combined with contrast-enhanced US. Conclusion Multiparametric US allows for a reliable differentiation of benign and malignant intratesticular lesions and can potentially be useful in deciding whether orchiectomy can be replaced with follow-up or less invasive organ-sparing strategies. © RSNA, 2017.
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Affiliation(s)
- Thomas Auer
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Tobias De Zordo
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Christian Dejaco
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Leonhard Gruber
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Renate Pichler
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Werner Jaschke
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Vikram S Dogra
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Friedrich Aigner
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
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Lee T, Hoogenes J, Wright I, Matsumoto ED, Shayegan B. Utility of preoperative 3 Tesla pelvic phased-array multiparametric magnetic resonance imaging in prediction of extracapsular extension and seminal vesicle invasion of prostate cancer and its impact on surgical margin status: Experience at a Canadian academic tertiary care centre. Can Urol Assoc J 2017; 11:E174-E178. [PMID: 28503230 DOI: 10.5489/cuaj.4211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To evaluate the utility of 3 Tesla (3T) pelvic phased-array (PPA) multiparametric magnetic resonance imaging (mpMRI) to predict extracapsular extension (ECE) and seminal vesicle invasion (SVI) and its subsequent effect on radical prostatectomy (RP) surgical margin status. METHODS A retrospective evaluation was conducted of RP patients who underwent preoperative 3T PPA mpMRI (without endorectal coil) based on clinical probability of adverse pathological features. Frequencies, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting the status of ECE and SVI were calculated. RESULTS Forty-eight consecutive patients were included. Sensitivity, specificity, PPV, and NPV for 3T PPA mpMRI using T2-weighted sequences with diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) imaging to predict ECE was 39%, 56%, 45%, and 50%, respectively, while SVI prediction was 33%, 95%, 50%, and 91%, respectively. Twelve of the 28 cases predicted as being negative for ECE had positive margins, while two of the 20 cases predicted to be positive for ECE had positive margins. Imaging predicted four cases would have SVI, yet two had positive margins, while of the 44 cases predicted as being negative for SVI, four had positive margins. CONCLUSIONS These findings at our centre suggest that the use of 3T PPA mpMRI using T2-weighted sequences with DWI and DCE in predicting pathological ECE and SVI is of questionable benefit. These mpMRI reports may result in closer dissection of neurovascular bundles and subsequent positive surgical margins. Caution should be exercised when basing intraoperative decisions on mpMRI findings.
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Affiliation(s)
- Taehyoung Lee
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Ian Wright
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Edward D Matsumoto
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
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Automated Prostate Gland Segmentation Based on an Unsupervised Fuzzy C-Means Clustering Technique Using Multispectral T1w and T2w MR Imaging. INFORMATION 2017. [DOI: 10.3390/info8020049] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Prostate magnetic resonance imaging for brachytherapists: Anatomy and technique. Brachytherapy 2017; 16:679-687. [PMID: 28237429 DOI: 10.1016/j.brachy.2016.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/23/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To present an overview of mp MRI techniques necessary for high-resolution imaging of prostate. METHODS We summarize examples from our clinical experience and concepts from the current literature that illustrate normal prostate anatomy on multiparametric MRI (mp MRI). RESULTS Our experience regarding optimal mp MRI image acquisition is provided, as well as a summary of prostate and periprostatic anatomy and anatomical variants that pose challenges for BT. CONCLUSIONS mp MRI provides unparalleled assessment of the prostate and periprostatic anatomy, making it the most appropriate imaging modality to facilitate prostate BT treatment planning, implantation, and followup. This work provides an introduction to prostate mp MR imaging, anatomy, and anatomical variants essential for successful integration mp MRI into prostate brachytherapy practice.
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Pesapane F, Patella F, Fumarola EM, Panella S, Ierardi AM, Pompili GG, Franceschelli G, Angileri SA, Magenta Biasina A, Carrafiello G. Intravoxel Incoherent Motion (IVIM) Diffusion Weighted Imaging (DWI) in the Periferic Prostate Cancer Detection and Stratification. Med Oncol 2017; 34:35. [PMID: 28144814 DOI: 10.1007/s12032-017-0892-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/16/2017] [Indexed: 12/18/2022]
Abstract
The aim of this study was to compare the Intravoxel Incoherent Motion (IVIM) parameters between healthy Peripheral Zone (PZ), Benign Prostatic Hyperplasia (BPH) and Prostate Cancer (PCa) and compare them to assess whether there was correlation with Gleason Score (GS) grading system. Thirty-one patients with suspect of PCa underwent 1.5T Multi-Parametric Magnetic Resonance Imaging (MP-MRI) with endorectal coil with a protocol including T2WI, DWI using 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, 1000 s/mm2) and DCE. Monoexponential and IVIM model fits were used to calculate both apparent diffusion coefficient (ADC) and the following IVIM parameters: molecular diffusion coefficient (D), perfusion-related diffusion coefficient (D*) and perfusion fraction (f). The ADC and D values were significantly lower in the PCa (0.70 ± 0.16 × 10-3 mm2/s and 0.88 ± 0.31 × 10-3 mm2/s) compared to those found in the PZ (1.22 ± 0.20 × 10-3 mm2/s and 1.78 ± 0.34 × 10-3 mm2/s) and in the BPH (1.53 ± 0.23 × 10-3 mm2/s and 1.11 ± 0.28 × 10-3 mm2/s). The D* parameter was significantly increased in the PCa (5.35 ± 5.12 × 10-3 mm2/s) compare to the healthy PZ (3.02 ± 2.86 × 10-3 mm2/s), instead there was not significantly difference in the PCa compare to the BPH (5.61 ± 6.77 × 10-3 mm2/s). The f was statistically lower in the PCa (9.01 ± 5.20%) compared to PZ (10.57 ± 9.30%), but not significantly different between PCa and BPH (9.29 ± 7.29%). The specificity, sensitivity and accuracy of T2WI associated with DWI and IVIM were higher (100, 98 and 99%, respectively) than for T2WI/DWI and IVIM alone (89, 92 and 90%, respectively). Only for ADC was found a statistical difference between low- and intermediate-/high-grade tumors. Adding IVIM to the MP-MRI could increase the diagnostic performance to detect clinically relevant PCa. ADC values have been found to have a rule to discriminate PCa reliably from normal areas and differed significantly in low- and intermediate-/high-grade PCa. In contrast, IVIM parameters were unable to distinguish between the different GS.
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Affiliation(s)
- Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Silvia Panella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Anna Maria Ierardi
- Department of Radiology, Interventional Radiology, Insubria University, Varese, Italy
| | - Giovanni Guido Pompili
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, Università degli Studi di Milano, Via A di Rudinì 8, 20142, Milan, Italy
| | - Giuseppe Franceschelli
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, Università degli Studi di Milano, Via A di Rudinì 8, 20142, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, Università degli Studi di Milano, Via A di Rudinì 8, 20142, Milan, Italy
| | - Alberto Magenta Biasina
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, Università degli Studi di Milano, Via A di Rudinì 8, 20142, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, Università degli Studi di Milano, Via A di Rudinì 8, 20142, Milan, Italy
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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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Shahedi M, Cool DW, Romagnoli C, Bauman GS, Bastian-Jordan M, Rodrigues G, Ahmad B, Lock M, Fenster A, Ward AD. Postediting prostate magnetic resonance imaging segmentation consistency and operator time using manual and computer-assisted segmentation: multiobserver study. J Med Imaging (Bellingham) 2016; 3:046002. [PMID: 27872873 DOI: 10.1117/1.jmi.3.4.046002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Prostate segmentation on T2w MRI is important for several diagnostic and therapeutic procedures for prostate cancer. Manual segmentation is time-consuming, labor-intensive, and subject to high interobserver variability. This study investigated the suitability of computer-assisted segmentation algorithms for clinical translation, based on measurements of interoperator variability and measurements of the editing time required to yield clinically acceptable segmentations. A multioperator pilot study was performed under three pre- and postediting conditions: manual, semiautomatic, and automatic segmentation. We recorded the required editing time for each segmentation and measured the editing magnitude based on five different spatial metrics. We recorded average editing times of 213, 328, and 393 s for manual, semiautomatic, and automatic segmentation respectively, while an average fully manual segmentation time of 564 s was recorded. The reduced measured postediting interoperator variability of semiautomatic and automatic segmentations compared to the manual approach indicates the potential of computer-assisted segmentation for generating a clinically acceptable segmentation faster with higher consistency. The lack of strong correlation between editing time and the values of typically used error metrics ([Formula: see text]) implies that the necessary postsegmentation editing time needs to be measured directly in order to evaluate an algorithm's suitability for clinical translation.
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Affiliation(s)
- Maysam Shahedi
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Derek W Cool
- University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Cesare Romagnoli
- University of Western Ontario , Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Glenn S Bauman
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Matthew Bastian-Jordan
- University of Western Ontario , Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - George Rodrigues
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Belal Ahmad
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Michael Lock
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Aaron Fenster
- University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Aaron D Ward
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
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Abstract
Multiparametric MR imaging (mpMRI) combine different sequences that, properly tailored, can provide qualitative and quantitative information about the tumor microenvironment beyond traditional tumor size measures and/or morphologic assessments. This article focuses on mpMRI in the evaluation of urogenital tract malignancies by first reviewing technical aspects and then discussing its potential clinical role. This includes insight into histologic subtyping and grading of renal cell carcinoma and assessment of tumor response to targeted therapies. The clinical utility of mpMRI in the staging and grading of ureteral and bladder tumors is presented. Finally, the evolving role of mpMRI in prostate cancer is discussed.
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Choi JY, Yang J, Noworolski SM, Behr S, Chang AJ, Simko JP, Nguyen HG, Carroll PR, Kurhanewicz J, Seo Y. 18F Fluorocholine Dynamic Time-of-Flight PET/MR Imaging in Patients with Newly Diagnosed Intermediate- to High-Risk Prostate Cancer: Initial Clinical-Pathologic Comparisons. Radiology 2016; 282:429-436. [PMID: 27513849 DOI: 10.1148/radiol.2016160220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the initial clinical value of fluorine 18 (18F) fluorocholine (FCH) dynamic positron emission tomography (PET)/magnetic resonance (MR) imaging by comparing its parameters with clinical-pathologic findings in patients with newly diagnosed intermediate- to high-risk prostate cancer (PCa) who plan to undergo radical prostatectomy. Materials and Methods The institutional review board approved the study protocol, and informed written consent was obtained from all subjects for this HIPAA-compliant study. Twelve men (mean age ± standard deviation, 61.7 years ± 8.4; range, 46-74 years) with untreated intermediate- to high-risk PCa characterized according to Cancer of the Prostate Risk Assessment (CAPRA) underwent preoperative FCH dynamic PET/MR imaging followed by radical prostatectomy between April and November 2015. PET/MR imaging parameters including average and maximum K1 (delivery rate constant) and standardized uptake values (SUVs) and Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores were measured and compared with clinical-pathologic characteristics. For statistical analysis, the Spearman rank correlation and Mann-Whitney U tests were performed. Results Of the PET parameters, maximum SUV of primary tumors showed significant correlations with several clinical-pathologic parameters including serum prostate-specific antigen level (ρ = 0.71, P = .01), pathologic stage (ρ = 0.59, P = .043), and postsurgical CAPRA score (ρ = 0.72, P = .008). The overall PI-RADS score showed significant correlations with pathologic tumor volume (ρ = 0.81, P < .001), percentage of tumor cells with Gleason scores greater than 3 (ρ = 0.59, P = .02), and postsurgical CAPRA score (ρ = 0.58, P = .046). The high-risk postsurgical CAPRA score patient group had a significantly higher maximum SUV than did the intermediate-risk group. Combined PET and MR imaging showed improved sensitivity (88%) for prediction of pathologic extraprostatic extension compared with that with MR imaging (50%) and PET (75%) performed separately. Conclusion Maximum SUVs and PI-RADS scores from FCH PET/MR imaging show good correlation with clinical-pathologic characteristics, such as postsurgical CAPRA score, which are related to prognosis in patients with newly diagnosed intermediate- to high-risk PCa. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Joon Young Choi
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - Jaewon Yang
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - Susan M Noworolski
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - Spencer Behr
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - Albert J Chang
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - Jeffry P Simko
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - Hao G Nguyen
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - Peter R Carroll
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - John Kurhanewicz
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
| | - Youngho Seo
- From the Departments of Radiology and Biomedical Imaging (J.Y.C., J.Y., S.M.N., S.B., J.K., Y.S.), Radiation Oncology (A.J.C., Y.S.), Anatomic Pathology (J.P.S.), and Urology (H.G.N., P.R.C.), University of California, San Francisco, San Francisco, Calif and Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.Y.C. )
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Sahu M, Wijesekera N, Donohue JF. Anterior prostate cancer: Current perspectives and diagnostic dilemmas. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816655724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Anterior zone (transition zone and anterior horn of peripheral zone) tumours represent 20–30% of all prostate cancers. Traditional transrectal prostate biopsies fail to sample this area of the prostate gland adequately, thereby underestimating the true extent of anterior zone cancers. This article outlines the behaviour and significance of this entity and discusses investigations that are currently available which may aid in their detection. The implementation of transperineal template-guided prostate biopsies will allow optimal sampling of the anterior zone whilst advances in the field of magnetic resonance imaging allow the use of multiple sequences (T2-weighted, spectroscopy, diffusion weighted and dynamic contrast enhancement) to identify these tumours accurately. Such investigations will result in more accurate risk stratification compared with the current diagnostic pathway, and could lead to improved management in this subset of men.
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Affiliation(s)
- Mahua Sahu
- Department of Urology, Maidstone and Tunbridge Wells Hospital, UK
| | - Nevin Wijesekera
- Department of Radiology, Kingston Hospital NHS Foundation Trust, UK
| | - John F Donohue
- Department of Urology, Maidstone and Tunbridge Wells Hospital, UK
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47
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Agarwal HK, Mertan FV, Sankineni S, Bernardo M, Senegas J, Keupp J, Daar D, Merino M, Wood BJ, Pinto PA, Choyke PL, Turkbey B. Optimal high b-value for diffusion weighted MRI in diagnosing high risk prostate cancers in the peripheral zone. J Magn Reson Imaging 2016; 45:125-131. [PMID: 27383502 DOI: 10.1002/jmri.25353] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/07/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To retrospectively determine the optimal b-value(s) of diffusion-weighted imaging (DWI) associated with intermediate-high risk cancer in the peripheral zone (PZ) of the prostate. MATERIALS AND METHODS Forty-two consecutive patients underwent multi b-value (16 evenly spaced b-values between 0 and 2000 s/mm2 ) DWI along with multi-parametric MRI (MP-MRI) of the prostate at 3 Tesla followed by trans-rectal ultrasound/MRI fusion guided targeted biopsy of suspicious lesions detected at MP-MRI. Computed DWI images up to a simulated b-value of 4000 s/mm2 were also obtained using a pair of b-values (b = 133 and 400 or 667 or 933 s/mm2 ) from the multi b-value DWI. The contrast ratio of average intensity of the targeted lesions and the background PZ was determined. Receiver operator characteristic curves and the area under the curve (AUCs) were obtained for separating patients eligible for active surveillance with low risk prostate cancers from intermediate-high risk prostate cancers as per the cancer of the prostate risk assessment (CAPRA) scoring system. RESULTS The AUC first increased then decreased with the increase in b-values reaching maximum at b = 1600 s/mm2 (0.74) with no statistically significant different AUC of DWI with b-values 1067-2000 s/mm2 . The AUC of computed DWI increased then decreased with the increase in b-values reaching a maximum of 0.75 around b = 2000 s/mm2 . There was no statistically significant difference between the AUC of optimal acquired DWI and either of optimal computed DWI. CONCLUSION The optimal b-value for acquired DWI in differentiating intermediate-high from low risk prostate cancers in the PZ is b = 1600 s/mm2 . The computed DWI has similar performance as that of acquired DWI with the optimal performance around b = 2000 s/mm2 . LEVEL OF EVIDENCE 4 J. Magn. Reson. Imaging 2017;45:125-131.
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Affiliation(s)
- Harsh K Agarwal
- Molecular Imaging Program, NCI, NIH, Bethesda, Maryland, USA.,Philips Research North America, Cambridge, Massachusetts, USA
| | | | | | - Marcelino Bernardo
- Molecular Imaging Program, NCI, NIH, Bethesda, Maryland, USA.,Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Maryland, USA
| | | | | | - Dagane Daar
- Molecular Imaging Program, NCI, NIH, Bethesda, Maryland, USA.,Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Maryland, USA
| | - Maria Merino
- Laboratory of Pathology, NCI, NIH, Bethesda, Maryland, USA
| | - Bradford J Wood
- Center for Interventional Oncology, NCI and Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Peter A Pinto
- Urologic Oncology Branch, NCI, NIH, Bethesda, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Program, NCI, NIH, Bethesda, Maryland, USA
| | - Baris Turkbey
- Molecular Imaging Program, NCI, NIH, Bethesda, Maryland, USA
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48
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Chen H, Sutedjo J, Wang L, Yin X. Prostate Cancer Magnetic Resonance Spectroscopy Imaging at 1.5 and 3.0 T. Technol Cancer Res Treat 2016; 15:625-31. [PMID: 27147454 DOI: 10.1177/1533034616650779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/22/2016] [Indexed: 11/15/2022] Open
Abstract
Objective: We sought to assess the value of 1.5-T and 3-T magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer by meta-analysis. Methods: Prospective studies were selected from MEDLINE, PubMed, Science Direct, OVID, and Springer between January 2004 and June 2014. Studies were reviewed based on Quality Assessment of Diagnostic Accuracy Studies criteria. Any publication bias was assessed using Deek funnel plot asymmetry test. Pooled sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and 95% confidence intervals were calculated. Summary receiver–operating characteristic curves were used to assess the results. Results: A total of 17 articles were included in this study. The area under the curve values of 1.5-T magnetic resonance spectroscopy imaging with the use of an endorectal coil, 1.5-T magnetic resonance spectroscopy imaging without the use of an endorectal coil, and 3.0-T magnetic resonance spectroscopy imaging without the use of an endorectal coil were 0.90 ± 0.03, 0.75 ± 0.03, and 0.93 ± 0.02, respectively. Conclusion: Three-tesla magnetic resonance spectroscopy imaging without the use of an endorectal coil and 1.5-T magnetic resonance spectroscopy imaging with the use of an endorectal coil both had similar applied values compared to the lower applied value of 1.5-T magnetic resonance spectroscopy imaging without the use of an endorectal coil.
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Affiliation(s)
- Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Janesya Sutedjo
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Liwei Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
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49
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Multiparametric MR can identify high grade prostatic intraepithelial neoplasia (HGPIN) lesions and predict future detection of prostate cancer in men with a negative initial prostate biopsy. Magn Reson Imaging 2016; 34:1081-6. [PMID: 27211254 DOI: 10.1016/j.mri.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/11/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aims to determine the pre-biopsy diffusion-weighted imaging (DWI) and magnetic resonance spectroscopic imaging (MRSI) characteristics of patients with high-grade prostatic intraepithelial neoplasia (HGPIN) and perform follow-up studies in these patients to assess the clinical implications. MATERIALS AND METHODS One hundred sixteen men with prostate specific antigen between 4 and 10ng/ml underwent pre-biopsy MR examinations. Nine of them had HGPIN lesions without concomitant prostate cancer (PCa) on biopsy. Apparent diffusion coefficient (ADC) and metabolite ratio [Citrate/(Choline+Creatine)] were calculated and these 9 patients were followed to determine the clinical outcomes. RESULTS Mean ADC for HGPIN foci was 1.01±0.16×10(-3)mm(2)/s while for the normal peripheral zone it was 1.69±0.25×10(-3)mm(2)/s (p<0.005). Mean metabolite ratio for voxels in the HGPIN region of initial biopsy was 0.24±0.16 while for the normal peripheral zone the value was 2.66±1.57 (p<0.005). Four of 5 patients who were available for follow-up were detected to have prostate cancer on repeat biopsy. No significant change in metabolite ratio and PSA was observed while ADC showed further reduction on follow-up. CONCLUSION HGPIN foci have ADC and metabolite ratio values similar to adenocarcinoma prostate, indicating that such patients have a high likelihood of developing cancer. DWI may help identify such men who may be candidates for close follow-up.
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50
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Starobinets O, Korn N, Iqbal S, Noworolski SM, Zagoria R, Kurhanewicz J, Westphalen AC. Practical aspects of prostate MRI: hardware and software considerations, protocols, and patient preparation. Abdom Radiol (NY) 2016; 41:817-30. [PMID: 27193785 DOI: 10.1007/s00261-015-0590-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of multiparametric MRI scans for the evaluation of men with prostate cancer has increased dramatically and is likely to continue expanding as new developments come to practice. However, it has not yet gained the same level of acceptance of other imaging tests. Partly, this is because of the use of suboptimal protocols, lack of standardization, and inadequate patient preparation. In this manuscript, we describe several practical aspects of prostate MRI that may facilitate the implementation of new prostate imaging programs or the expansion of existing ones.
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Affiliation(s)
- Olga Starobinets
- Graduate Group of Bioengineering, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Box 0946, San Francisco, CA, 94143, USA
| | - Natalie Korn
- Graduate Group of Bioengineering, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Box 0946, San Francisco, CA, 94143, USA
| | - Sonam Iqbal
- Graduate Group of Bioengineering, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Box 0946, San Francisco, CA, 94143, USA
| | - Susan M Noworolski
- Graduate Group of Bioengineering, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Box 0946, San Francisco, CA, 94143, USA
| | - Ronald Zagoria
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, M372, Box 0628, San Francisco, CA, 94143, USA
| | - John Kurhanewicz
- Graduate Group of Bioengineering, Department of Radiology and Biomedical Imaging, University of California San Francisco, 1700 4th Street, Ste. 203, San Francisco, CA, 94158, USA
| | - Antonio C Westphalen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, M372, Box 0628, San Francisco, CA, 94143, USA.
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