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Cheng Y, Fan B, Fu Y, Yin H, Lu J, Li D, Li X, Qiu X, Guo H. Prediction of false-positive PI-RADS 5 lesions on prostate multiparametric MRI: development and internal validation of a clinical-radiological characteristics based nomogram. BMC Urol 2024; 24:76. [PMID: 38566091 PMCID: PMC10986137 DOI: 10.1186/s12894-024-01465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND To develop a risk model including clinical and radiological characteristics to predict false-positive The Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions. METHODS Data of 612 biopsy-naïve patients who had undergone multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy were collected. Clinical variables and radiological variables on mpMRI were adopted. Lesions were divided into the training and validation cohort randomly. Stepwise multivariate logistic regression analysis with backward elimination was performed to screen out variables with significant difference. A diagnostic nomogram was developed in the training cohort and further validated in the validation cohort. Calibration curve and receiver operating characteristic (ROC) analysis were also performed. RESULTS 296 PI-RADS 5 lesions in 294 patients were randomly divided into the training and validation cohort (208 : 88). 132 and 56 lesions were confirmed to be clinically significant prostate cancer in the training and validation cohort respectively. The diagnostic nomogram was developed based on prostate specific antigen density, the maximum diameter of lesion, zonality of lesion, apparent diffusion coefficient minimum value and apparent diffusion coefficient minimum value ratio. The C-index of the model was 0.821 in the training cohort and 0.871 in the validation cohort. The calibration curve showed good agreement between the estimation and observation in the two cohorts. When the optimal cutoff values of ROC were 0.288 in the validation cohort, the sensitivity, specificity, PPV, and NPV were 90.6%, 67.9%, 61.7%, and 92.7% in the validation cohort, potentially avoiding 9.7% unnecessary prostate biopsies. CONCLUSIONS We developed and validated a diagnostic nomogram by including 5 factors. False positive PI-RADS 5 lesions could be distinguished from clinically significant ones, thus avoiding unnecessary prostate biopsy.
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Affiliation(s)
- Yongbing Cheng
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Bo Fan
- Department of Urology, The First People's Hospital of Changshu, The Changshu Hospital Affiliated to Soochow University, Changshu, China
| | - Yao Fu
- Department of Pathology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Haoli Yin
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Jiaming Lu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Danyan Li
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaogong Li
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Xuefeng Qiu
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
- Institute of Urology, Nanjing University, Nanjing, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
- Institute of Urology, Nanjing University, Nanjing, China.
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Spadarotto N, Sauck A, Hainc N, Keller I, John H, Hohmann J. Quantitative Evaluation of Apparent Diffusion Coefficient Values, ISUP Grades and Prostate-Specific Antigen Density Values of Potentially Malignant PI-RADS Lesions. Cancers (Basel) 2023; 15:5183. [PMID: 37958357 PMCID: PMC10648562 DOI: 10.3390/cancers15215183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study was to demonstrate the correlation between ADC values and the ADC/PSAD ratio for potentially malignant prostate lesions classified into ISUP grades and to determine threshold values to differentiate benign lesions (noPCa), clinically insignificant (nsPCa) and clinically significant prostate cancer (csPCa). We enrolled a total of 403 patients with 468 prostate lesions, of which 46 patients with 50 lesions were excluded for different reasons. Therefore, 357 patients with a total of 418 prostate lesions remained for the final evaluation. For all lesions, ADC values were measured; they demonstrated a negative correlation with ISUP grades (p < 0.001), with a significant difference between csPCa and a combined group of nsPCa and noPCa (ns-noPCa, p < 0.001). The same was true for the ADC/PSAD ratio, but only the ADC/PSAD ratio proved to be a significant discriminator between nsPCa and noPCa (p = 0.0051). Using the calculated threshold values, up to 31.6% of biopsies could have been avoided. Furthermore, the ADC/PSAD ratio, with the ability to distinguish between nsPCa and noPCa, offers possible active surveillance without prior biopsy.
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Affiliation(s)
- Nadine Spadarotto
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland;
| | - Anja Sauck
- Clinic of Urology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland; (A.S.); (I.K.); (H.J.)
| | - Nicolin Hainc
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Isabelle Keller
- Clinic of Urology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland; (A.S.); (I.K.); (H.J.)
| | - Hubert John
- Clinic of Urology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland; (A.S.); (I.K.); (H.J.)
- Medical Faculty, University of Zurich, 8032 Zurich, Switzerland
| | - Joachim Hohmann
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland;
- Medical Faculty, University of Basel, 4056 Basel, Switzerland
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Zhang KS, Neelsen CJO, Wennmann M, Glemser PA, Hielscher T, Weru V, Görtz M, Schütz V, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D. Same-day repeatability and Between-Sequence reproducibility of Mean ADC in PI-RADS lesions. Eur J Radiol 2023; 165:110898. [PMID: 37331287 DOI: 10.1016/j.ejrad.2023.110898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE This study aimed to assess repeatability after repositioning (inter-scan), intra-rater, inter-rater and inter-sequence variability of mean apparent diffusion coefficient (ADC) measurements in MRI-detected prostate lesions. METHOD Forty-three patients with suspicion for prostate cancer were included and received a clinical prostate bi-/multiparametric MRI examination with repeat scans of the T2-weighted and two DWI-weighted sequences (ssEPI and rsEPI). Two raters (R1 and R2) performed single-slice, 2D regions of interest (2D-ROIs) and 3D-segmentation-ROIs (3D-ROIs). Mean bias, corresponding limits of agreement (LoA), mean absolute difference, within-subject coefficient of variation (CoV) and repeatability/reproducibility coefficient (RC/RDC) were calculated. Bradley & Blackwood test was used for variance comparison. Linear mixed models (LMM) were used to account for multiple lesions per patient. RESULTS Inter-scan repeatability, intra-rater and inter-sequence reproducibility analysis of ADC showed no significant bias. 3D-ROIs demonstrated significantly less variability than 2D-ROIs (p < 0.01). Inter-rater comparison demonstrated small significant systematic bias of 57 × 10-6 mm2/s for 3D-ROIs (p < 0.001). Intra-rater RC, with the lowest variation, was 145 and 189 × 10-6 mm2/s for 3D- and 2D-ROIs, respectively. For 3D-ROIs of ssEPI, RCs and RDCs were 190-198 × 10-6 mm2/s for inter-scan, inter-rater and inter-sequence variation. No significant differences were found for inter-scan, inter-rater and inter-sequence variability. CONCLUSIONS In a single-scanner setting, single-slice ADC measurements showed considerable variation, which may be lowered using 3D-ROIs. For 3D-ROIs, we propose a cut-off of ∼ 200 × 10-6 mm2/s for differences introduced by repositioning, rater or sequence effects. The results suggest that follow-up measurements should be possible by different raters or sequences.
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Affiliation(s)
- Kevin Sun Zhang
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Vivienn Weru
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany; Junior clinical cooperation unit 'Multiparametric Methods for Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK), Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK), Germany; Heidelberg University Medical School, Heidelberg, Germany.
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Grubmüller B, Huebner NA, Rasul S, Clauser P, Pötsch N, Grubmüller KH, Hacker M, Hartenbach S, Shariat SF, Hartenbach M, Baltzer P. Dual-Tracer PET-MRI-Derived Imaging Biomarkers for Prediction of Clinically Significant Prostate Cancer. Curr Oncol 2023; 30:1683-1691. [PMID: 36826090 PMCID: PMC9954891 DOI: 10.3390/curroncol30020129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate if imaging biomarkers derived from 3-Tesla dual-tracer [(18)F]fluoromethylcholine (FMC) and [68Ga]Ga-PSMAHBED-CC conjugate 11 (PSMA)-positron emission tomography can adequately predict clinically significant prostate cancer (csPC). METHODS We assessed 77 biopsy-proven PC patients who underwent 3T dual-tracer PET/mpMRI followed by radical prostatectomy (RP) between 2014 and 2017. We performed a retrospective lesion-based analysis of all cancer foci and compared it to whole-mount histopathology of the RP specimen. The primary aim was to investigate the pretherapeutic role of the imaging biomarkers FMC- and PSMA-maximum standardized uptake values (SUVmax) for the prediction of csPC and to compare it to the mpMRI-methods and PI-RADS score. RESULTS Overall, we identified 104 cancer foci, 69 were clinically significant (66.3%) and 35 were clinically insignificant (33.7%). We found that the combined FMC+PSMA SUVmax were the only significant parameters (p < 0.001 and p = 0.049) for the prediction of csPC. ROC analysis showed an AUC for the prediction of csPC of 0.695 for PI-RADS scoring (95% CI 0.591 to 0.786), 0.792 for FMC SUVmax (95% CI 0.696 to 0.869), 0.852 for FMC+PSMA SUVmax (95% CI 0.764 to 0.917), and 0.852 for the multivariable CHAID model (95% CI 0.763 to 0.916). Comparing the AUCs, we found that FMC+PSMA SUVmax and the multivariable model were significantly more accurate for the prediction of csPC compared to PI-RADS scoring (p = 0.0123, p = 0.0253, respectively). CONCLUSIONS Combined FMC+PSMA SUVmax seems to be a reliable parameter for the prediction of csPC and might overcome the limitations of PI-RADS scoring. Further prospective studies are necessary to confirm these promising preliminary results.
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Affiliation(s)
- Bernhard Grubmüller
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology and Andrology, University Hospital Krems, 3500 Krems, Austria
- Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Working Group of Diagnostic Imaging in Urology, Austrian Society of Urology, 1090 Vienna, Austria
| | - Nicolai A. Huebner
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Working Group of Diagnostic Imaging in Urology, Austrian Society of Urology, 1090 Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Nina Pötsch
- Department of Biomedical Imaging and Image Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Karl Hermann Grubmüller
- Department of Urology and Andrology, University Hospital Krems, 3500 Krems, Austria
- Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, Weill Medical College of Cornell University, New York, NY 10021, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 116 36 Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
- Karl Landsteiner Institute of Urology and Andrology, 1010 Vienna, Austria
| | - Markus Hartenbach
- Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Pascal Baltzer
- Department of Biomedical Imaging and Image Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
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Nissan N, Bauer E, Moss Massasa EE, Sklair-Levy M. Breast MRI during pregnancy and lactation: clinical challenges and technical advances. Insights Imaging 2022; 13:71. [PMID: 35397082 PMCID: PMC8994812 DOI: 10.1186/s13244-022-01214-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022] Open
Abstract
The breast experiences substantial changes in morphology and function during pregnancy and lactation which affects its imaging properties and may reduce the visibility of a concurrent pathological process. The high incidence of benign gestational-related entities may further add complexity to the clinical and radiological evaluation of the breast during the period. Consequently, pregnancy-associated breast cancer (PABC) is often a delayed diagnosis and carries a poor prognosis. This state-of-the-art pictorial review illustrates how despite currently being underutilized, technical advances and new clinical evidence support the use of unenhanced breast MRI during pregnancy and both unenhanced and dynamic-contrast enhanced (DCE) during lactation, to serve as effective supplementary modalities in the diagnostic work-up of PABC.
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Affiliation(s)
- Noam Nissan
- Radiology Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel.
| | - Ethan Bauer
- Sackler Medicine School, New-York Program, Tel Aviv University, Tel Aviv, Israel
| | - Efi Efraim Moss Massasa
- Joint Medicine School Program of Sheba Medical Center, St. George's, University of London and the University of Nicosia, Sheba Medical Center, Tel Hashomer, Israel
| | - Miri Sklair-Levy
- Radiology Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel
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Reiter R, Majumdar S, Kearney S, Kajdacsy-Balla A, Macias V, Crivellaro S, Abern M, Royston TJ, Klatt D. Investigating the heterogeneity of viscoelastic properties in prostate cancer using MR elastography at 9.4T in fresh prostatectomy specimens. Magn Reson Imaging 2022; 87:113-118. [PMID: 35007693 DOI: 10.1016/j.mri.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To quantify the heterogeneity of viscoelastic tissue properties in prostatectomy specimens from men with prostate cancer (PC) using MR elastography (MRE) with histopathology as reference. METHODS Twelve fresh prostatectomy specimens were examined in a preclinical 9.4T MRI scanner. Maps of the complex shear modulus (|G*| in kPa) with its real and imaginary part (G' and G" in kPa) were calculated at 500 Hz. Prostates were divided into 12 segments for segment-wise measurement of viscoelastic properties and histopathology. Coefficients of variation (CVs in %) were calculated for quantification of heterogeneity. RESULTS Group-averaged values of cancerous vs. benign segments were significantly increased: |G*| of 12.13 kPa vs. 6.14 kPa, G' of 10.84 kPa vs. 5.44 kPa and G" of 5.45 kPa vs. 2.92 kPa, all p < 0.001. In contrast, CVs were significantly increased for benign segments: 23.59% vs. 26.32% (p = 0.014) for |G*|, 27.05% vs. 37.84% (p < 0.003) for G', and 36.51% vs. 50.37% (p = 0.008) for G". DISCUSSION PC is characterized by a stiff yet homogeneous biomechanical signature, which may be due to the unique nondestructive growth pattern of PC with intervening stroma, providing a rigid scaffold in the affected area. In turn, increased heterogeneity in benign prostate segments may be attributable to the presence of different prostate zones with involvement by specific nonmalignant pathology.
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Affiliation(s)
- Rolf Reiter
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany; Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States.
| | - Shreyan Majumdar
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States.
| | - Steven Kearney
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States
| | - André Kajdacsy-Balla
- Department of Pathology, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States.
| | - Virgilia Macias
- Department of Pathology, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States.
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States.
| | - Michael Abern
- Department of Urology, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States.
| | - Thomas J Royston
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States.
| | - Dieter Klatt
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 830 South Wood Street, Chicago, IL 60612, United States.
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Falaschi Z, Tricca S, Attanasio S, Billia M, Airoldi C, Percivale I, Bor S, Perri D, Volpe A, Carriero A. Non-timely clinically applicable ADC ratio in prostate mpMRI: a comparison with fusion biopsy results. Abdom Radiol (NY) 2022; 47:3855-3867. [PMID: 35943517 PMCID: PMC9560938 DOI: 10.1007/s00261-022-03627-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of the study was to assess the diagnostic accuracy of ADC ratio and to evaluate its efficacy in reducing the number of false positives in prostatic mpMRI. MATERIALS AND METHODS All patients who underwent an mpMRI and a targeted fusion biopsy in our institution from 2016 to 2021 were retrospectively selected. Two experienced readers (R1 and R2) independently evaluated the images, blindly to biopsy results. The radiologists assessed the ADC ratios by tracing a circular 10 mm2 ROI on the biopsied lesion and on the apparently benign contralateral parenchyma. Prostate cancers were divided into non-clinically significant (nsPC, Gleason score = 6) and clinically significant (sPC, Gleason score ≥ 7). ROC analyses were performed. RESULTS 167 patients and188 lesions were included. Concordance was 0.62 according to Cohen's K. ADC ratio showed an AUC for PCAs of 0.78 in R1 and 0.8 in R2. The AUC for sPC was 0.85 in R1 and 0.84 in R2. The 100% sensitivity cut-off for sPCs was 0.65 (specificity 25.6%) in R1 and 0.66 (specificity 27.4%) in R2. Forty-three benign or not clinically significant lesions were above the 0.65 threshold in R1; 46 were above the 0.66 cut-off in R2. This would have allowed to avoid an equal number of unnecessary biopsies at the cost of 2 nsPCs in R1 and one nsPC in R2. CONCLUSION In our sample, the ADC ratio was a useful and accurate tool that could potentially reduce the number of false positives in mpMRI.
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Affiliation(s)
- Zeno Falaschi
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Stefano Tricca
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy.
| | - Silvia Attanasio
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Michele Billia
- Department of Urology, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Chiara Airoldi
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Ilaria Percivale
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Simone Bor
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Davide Perri
- Department of Urology, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandro Volpe
- Department of Urology, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandro Carriero
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
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Zhang KS, Schelb P, Kohl S, Radtke JP, Wiesenfarth M, Schimmöller L, Kuder TA, Stenzinger A, Hohenfellner M, Schlemmer HP, Maier-Hein K, Bonekamp D. Improvement of PI-RADS-dependent prostate cancer classification by quantitative image assessment using radiomics or mean ADC. Magn Reson Imaging 2021; 82:9-17. [PMID: 34147597 DOI: 10.1016/j.mri.2021.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/08/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
Background Currently, interpretation of prostate MRI is performed qualitatively. Quantitative assessment of the mean apparent diffusion coefficient (mADC) is promising to improve diagnostic accuracy while radiomic machine learning (RML) allows to probe complex parameter spaces to identify the most promising multi-parametric models. We have previously developed quantitative RML and ADC classifiers for prediction of clinically significant prostate cancer (sPC) from prostate MRI, however these have not been combined with radiologist PI-RADS assessment. Purpose To propose and evaluate diagnostic algorithms combining quantitative ADC or RML and qualitative PI-RADS assessment for prediction of sPC. Methods and population The previously published quantitative models (RML and mADC) were utilized to construct four algorithms: 1) Down(ADC) and 2) Down(RML): clinically detected PI-RADS positive prostate lesions (defined as either PI-RADS≥3 or ≥4) were downgraded to MRI negative upon negative quantitative assessment; and 3) Up(ADC) and 4) Up(RML): MRI-negative lesions were upgraded to MRI-positive upon positive assessment of quantitative parameters. Analyses were performed at the individual lesion level and the patient level in 133 consecutive patients with suspicion for clinically significant prostate cancer (sPC, International Society of Urological Pathology (ISUP) grade group≥2), the test set subcohort of a previously published patient population. McNemar test was used to compare differences in sensitivity, specificity and accuracy. Differences between lesions of different prostate zones were assessed using ANOVA. Reduction in false positive assessments was assessed as ratios. Results Compared to clinical assessment at the PI-RADS≥4 cut-off alone, algorithms Down(ADC/RML) improved specificity from 43% to 65% (p = 0.001)/62% (p = 0.003), while sensitivity did not change significantly at 89% compared to 87% (p = 1.0)/89% (unchanged) on the patient level. Reduction of false positive lesions was 50% [26/52] in the PZ and 53% [15/28] in the TZ. Algorithms Up(ADC/RML) led, on a patient basis, to an unfavorable loss of specificity from 43% to 30% (p = 0.039)/32% (p = 0.106), with insignificant increase of sensitivity from 89% to 96%/96% (both p = 1.0). Compared to clinical assessment at the PI-RADS≥3 cut-off alone, similar results were observed for Down(ADC) with significantly increased specificity from 2% to 23% (p < 0.001) and unchanged sensitivity on the lesion level; patient level specificity increased only non-significantly. Conclusion Downgrading PI-RADS≥3 and ≥ 4 lesions based on quantitative mADC measurements or RML classifiers can increase diagnostic accuracy by enhancing specificity and preserving sensitivity for detection of sPC and reduce false positives.
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Affiliation(s)
- Kevin Sun Zhang
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Schelb
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg University Medical School, Heidelberg, Germany
| | - Simon Kohl
- Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Philipp Radtke
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lars Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - Tristan Anselm Kuder
- Division of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany
| | - Klaus Maier-Hein
- Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany.
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Radiomics in diffusion data: a test-retest, inter- and intra-reader DWI phantom study. Clin Radiol 2020; 75:798.e13-798.e22. [PMID: 32723501 DOI: 10.1016/j.crad.2020.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to evaluate the robustness of radiomics features of a MRI (magnetic resonance imaging) phantom in quantitative diffusion-weighted imaging (DWI) and depending on the image resolution. MATERIALS AND METHODS Scanning of an in-house developed DWI phantom was performed at a 1.5 T MRI scanner (Magnetom AERA, Siemens, Erlangen, Germany) using an echo planar imaging (EPI) DWI sequence (b=0,500,1,000 s/mm2) with low (3×3 mm2) and high (2×2 mm2) image resolutions. Scans were repeated after phantom repositioning to evaluate retest reliability. Radiomics features were extracted after semi-automatic segmentation and standardised pre-processing. Intra-/interobserver reproducibility and test-retest robustness were assessed using intraclass correlation coefficients (ICC). Differences were tested with non-parametric Wilcoxon's signed-rank and Friedman's test (p < 0.05) with Dunn's post-hoc analysis. RESULTS Test-retest ICC was overall high with >0.90 for 39/46 radiomics features in all sequences/resolutions. Decreased test-retest ICCs were pronounced for conventional Min-value (overall ICC=0.817), and grey-level zone length matrix (GLZLM) features Short-Zone Emphasis (SZE) and Short-Zone Low Grey-level Emphasis (SZLGE) (for both overall ICC=0.927). Test-retest reproducibility was significantly different between b=500, 1,000 and apparent diffusion coefficient (ADC) (mean 0.975±0.050, 0.974±0.051 and 0.966±0.063), which remained significant after post-hoc analysis between b=1,000 and ADC (p = 0.022). ICCs were not significantly different between resolutions of 2×2 and 3×3 mm2 regarding b=500 (mean: 0.977±0.052 and 0.974±0.049, p = 0.612), b=1,000 (mean: 0.973±0.059 and 0.974±0.054, p = 0.516), and ADC (mean: 0.972±0.049 and 0.955±0.101, p = 0.851). Inter- and intra-observer reliability was consistently high for all sequences (overall mean 0.992±0.021 and 0.990±0.028). CONCLUSION Under ex-vivo conditions, DWI provided robust radiomics features with those from ADC being slightly less robust than from raw DWI (b=500, 1,000 s/mm2). No significant difference was detected for different resolutions. Although, ex-vivo reliability of DWI radiomics features was high, no implications can be made regarding in-vivo analyses.
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In Vivo Quantification of Water Diffusion, Stiffness, and Tissue Fluidity in Benign Prostatic Hyperplasia and Prostate Cancer. Invest Radiol 2020; 55:524-530. [DOI: 10.1097/rli.0000000000000685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Falaschi Z, Valenti M, Lanzo G, Attanasio S, Valentini E, García Navarro LI, Aquilini F, Stecco A, Carriero A. Accuracy of ADC ratio in discriminating true and false positives in multiparametric prostatic MRI. Eur J Radiol 2020; 128:109024. [PMID: 32387923 DOI: 10.1016/j.ejrad.2020.109024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Our goal was to evaluate the usefulness of apparent diffusion coefficient (ADC) ratios in discriminating true from false positives in multiparametric (mp) prostate MRI in clinical practice. METHODS We retrospectively evaluated 98 prostate lesions in a series of 73 patients who had undergone prostate mpMRI and standard 12-core prostatic biopsy in our institution from 2016 to 2018. Two experienced radiologists performed double blind ADC value quantifications of both MRI-identified lesions and apparently benign contralateral prostatic parenchyma in a circular region of interest (ROI) of ∼10 mm2. The ratios between the mean values of both measurements (i.e., ADC ratio mean) and between the minimum value of the lesion and the maximum value of the benign parenchyma (i.e., ADC ratio min-max) were automatically calculated. The malignancy of all lesions was determined through biopsy according to Gleason score (GS ≥ 6) and localization. RESULTS For Reader 1, the area under the ROC curve (AUC) of ADC ratio mean and ADC ratio min-max were 0.72 and 0.67, respectively, whereas for Reader 2 these values were 0.74 and 0.71, respectively. The best cut-off values for ADC ratio means were ≥ 0.5 (Reader 1) and ≥ 0.6 (Reader 2), with a sensitivity of 76.3 % and 84.2 % and a specificity of 51.7 % and 50 %, respectively. Moreover, based on a threshold of 0.6, no clinically significant prostate cancer (csPCa) was missed by Reader 1, while only one went unnoticed by Reader 2. CONCLUSION The ADC ratio is a useful and moderately accurate complementary tool to diagnose prostate cancer in the mp-MRI.
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Affiliation(s)
- Zeno Falaschi
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy.
| | - Martina Valenti
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
| | - Giuseppe Lanzo
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
| | - Silvia Attanasio
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
| | - Eleonora Valentini
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
| | | | | | - Alessandro Stecco
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
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12
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Gündoğdu E, Emekli E, Kebapçı M. Evaluation of relationships between the final Gleason score, PI-RADS v2 score, ADC value, PSA level, and tumor diameter in patients that underwent radical prostatectomy due to prostate cancer. Radiol Med 2020; 125:827-837. [PMID: 32266690 DOI: 10.1007/s11547-020-01183-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study aimed to investigate the relationship between the serum PSA level, Gleason score (GS), PI-RADS v2 score, tumor ADCmin value, and the largest tumor diameter in patients that underwent radical prostatectomy (RP) due to prostate cancer (PCa) and to comparatively evaluate the variables of these parameters in clinically significant and insignificant PCa groups. MATERIALS AND METHODS The mpMRI examinations of the patients who underwent RP due to PCa were retrospectively evaluated. According to the final GS, the lesions were divided into two groups as clinically significant (GS ≥ 7) and insignificant (GS ≤ 6). The PSA value, tumor ADCmin value, tumor diameter, and PI-RADS score were compared between the clinically significant and nonsignificant PCa groups using Student's t-test. The correlations between the serum PSA level, GS, PI-RADS v2 score, tumor ADCmin value, and tumor diameter were evaluated separately (Pearson's correlation analysis was used for peripheral gland tumors, and Spearman's correlation analysis for central gland tumors). A ROC analysis was undertaken to evaluate the efficacy of the tumor ADCmin, diameter and PSA values in differentiating clinically significant and nonsignificant tumors. RESULTS In both central and peripheral gland tumors, there was a correlation between the PSA level, tumor diameter, PI-RADS score, ADCmin value, and GS at various levels (poor, moderate, and high). In central gland tumors, there was no significant difference between the two groups in terms of the PSA value and PI-RADS scores (p > 0.05), but the ADCmin value and diameter of the tumor significantly differed (p < 0.05). For peripheral gland tumors, significant differences were observed in all parameters (p < 0.05). The cut-off values for the peripheral and central gland tumors are as follows: lesion diameter, 13.5 mm and 19 mm; tumor ADCmin, 0.709 × 10-3 mm2/s and 0.874 × 10-3 mm2/s; and PSA level, 8.47 ng/ml and 11.10 ng/ml, respectively. CONCLUSION The current PI-RADS v2 scoring system can be inadequate in distinguishing clinically significant and insignificant groups in central gland tumors. A separate cut-off value of the tumor diameter should be determined for central and peripheral gland tumors. Tumor ADCmin values can be used as a predictive parameter. The PSA cut-off value should be kept lower in peripheral gland tumors.
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Affiliation(s)
- Elif Gündoğdu
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey.
| | - Emre Emekli
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey
| | - Mahmut Kebapçı
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey
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A Single-Arm, Multicenter Validation Study of Prostate Cancer Localization and Aggressiveness With a Quantitative Multiparametric Magnetic Resonance Imaging Approach. Invest Radiol 2020; 54:437-447. [PMID: 30946180 DOI: 10.1097/rli.0000000000000558] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aims of this study were to assess the discriminative performance of quantitative multiparametric magnetic resonance imaging (mpMRI) between prostate cancer and noncancer tissues and between tumor grade groups (GGs) in a multicenter, single-vendor study, and to investigate to what extent site-specific differences affect variations in mpMRI parameters. MATERIALS AND METHODS Fifty patients with biopsy-proven prostate cancer from 5 institutions underwent a standardized preoperative mpMRI protocol. Based on the evaluation of whole-mount histopathology sections, regions of interest were placed on axial T2-weighed MRI scans in cancer and noncancer peripheral zone (PZ) and transition zone (TZ) tissue. Regions of interest were transferred to functional parameter maps, and quantitative parameters were extracted. Across-center variations in noncancer tissues, differences between tissues, and the relation to cancer grade groups were assessed using linear mixed-effects models and receiver operating characteristic analyses. RESULTS Variations in quantitative parameters were low across institutes (mean [maximum] proportion of total variance in PZ and TZ, 4% [14%] and 8% [46%], respectively). Cancer and noncancer tissues were best separated using the diffusion-weighted imaging-derived apparent diffusion coefficient, both in PZ and TZ (mean [95% confidence interval] areas under the receiver operating characteristic curve [AUCs]; 0.93 [0.89-0.96] and 0.86 [0.75-0.94]), followed by MR spectroscopic imaging and dynamic contrast-enhanced-derived parameters. Parameters from all imaging methods correlated significantly with tumor grade group in PZ tumors. In discriminating GG1 PZ tumors from higher GGs, the highest AUC was obtained with apparent diffusion coefficient (0.74 [0.57-0.90], P < 0.001). The best separation of GG1-2 from GG3-5 PZ tumors was with a logistic regression model of a combination of functional parameters (mean AUC, 0.89 [0.78-0.98]). CONCLUSIONS Standardized data acquisition and postprocessing protocols in prostate mpMRI at 3 T produce equivalent quantitative results across patients from multiple institutions and achieve similar discrimination between cancer and noncancer tissues and cancer grade groups as in previously reported single-center studies.
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14
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Brausi M, Hoskin P, Andritsch E, Banks I, Beishon M, Boyle H, Colecchia M, Delgado-Bolton R, Höckel M, Leonard K, Lövey J, Maroto P, Mastris K, Medeiros R, Naredi P, Oyen R, de Reijke T, Selby P, Saarto T, Valdagni R, Costa A, Poortmans P. ECCO Essential Requirements for Quality Cancer Care: Prostate cancer. Crit Rev Oncol Hematol 2020; 148:102861. [PMID: 32151466 DOI: 10.1016/j.critrevonc.2019.102861] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND ECCO Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give oncology teams, patients, policymakers and managers an overview of essential care throughout the patient journey. PROSTATE CANCER Prostate cancer is the second most common male cancer and has a wide variation in outcomes in Europe. It has complex diagnosis and treatment challenges, and is a major healthcare burden. Care must only be a carried out in prostate/urology cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Maurizio Brausi
- European Association of Urology; Department of Urology, B. Ramazzini Hospital, Carpi-Modena, Italy
| | - Peter Hoskin
- European Society for Radiotherapy and Oncology (ESTRO); Mount Vernon Cancer Centre; University of Manchester, Manchester, United Kingdom
| | - Elisabeth Andritsch
- International Psycho-Oncology Society (IPOS); Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ian Banks
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); European Men's Health Forum, Belgium
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Helen Boyle
- International Society of Geriatric Oncology (SIOG); Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | - Maurizio Colecchia
- European Society of Pathology (ESP); Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Delgado-Bolton
- European Association for Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Michael Höckel
- European Society of Oncology Pharmacy (ESOP); Kliniken Kassel, Gesundheit Nordhessen Holding, Kassel, Germany
| | - Kay Leonard
- European Oncology Nursing Society (EONS); Saint Luke's Radiation Oncology Centre, St James's Hospital, Dublin, Ireland
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Pablo Maroto
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ken Mastris
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); Europa Uomo
| | - Rui Medeiros
- Association of European Cancer Leagues (ECL); Portuguese Cancer League, Instituto Portugues de Oncologia, Porto, Portugal
| | - Peter Naredi
- European Cancer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Raymond Oyen
- European Society of Radiology (ESR); Department of Radiology, KU Leuven, Leuven, Belgium
| | - Theo de Reijke
- European Society of Surgical Oncology (ESSO); Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Selby
- European Cancer Concord (ECC); Leeds Institute of Cancer and Pathology, University of Leeds; St James' University Hospital, Leeds, United Kingdom
| | - Tiina Saarto
- European Association for Palliative Care (EAPC); Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Riccardo Valdagni
- European School of Oncology (ESO); Prostate Cancer Programme and Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Accelerated Segmented Diffusion-Weighted Prostate Imaging for Higher Resolution, Higher Geometric Fidelity, and Multi-b Perfusion Estimation. Invest Radiol 2019; 54:238-246. [PMID: 30601292 DOI: 10.1097/rli.0000000000000536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of this study was to improve the geometric fidelity and spatial resolution of multi-b diffusion-weighted magnetic resonance imaging of the prostate. MATERIALS AND METHODS An accelerated segmented diffusion imaging sequence was developed and evaluated in 25 patients undergoing multiparametric magnetic resonance imaging examinations of the prostate. A reduced field of view was acquired using an endorectal coil. The number of sampled diffusion weightings, or b-factors, was increased to allow estimation of tissue perfusion based on the intravoxel incoherent motion (IVIM) model. Apparent diffusion coefficients measured with the proposed segmented method were compared with those obtained with conventional single-shot echo-planar imaging (EPI). RESULTS Compared with single-shot EPI, the segmented method resulted in faster acquisition with 2-fold improvement in spatial resolution and a greater than 3-fold improvement in geometric fidelity. Apparent diffusion coefficient values measured with the novel sequence demonstrated excellent agreement with those obtained from the conventional scan (R = 0.91 for bmax = 500 s/mm and R = 0.89 for bmax = 1400 s/mm). The IVIM perfusion fraction was 4.0% ± 2.7% for normal peripheral zone, 6.6% ± 3.6% for normal transition zone, and 4.4% ± 2.9% for suspected tumor lesions. CONCLUSIONS The proposed accelerated segmented prostate diffusion imaging sequence achieved improvements in both spatial resolution and geometric fidelity, along with concurrent quantification of IVIM perfusion.
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Abstract
BACKGROUND Multiparametric MRI (mpMRI) is currently the most accurate imaging modality for detection and local staging of prostate cancer (PCa). Disadvantages of this modality are high costs, time consumption and the need for a contrast medium. AIMS The aim of the work was to provide an overview of the current state of fast and contrast-free MRI imaging of the prostate. RESULTS Biparametric examination protocols and the use of three-dimensional T2-weighted sequences are readily available methods that can be used to shorten the examination time without sacrificing diagnostic accuracy.
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Gupta RT, Mehta KA, Turkbey B, Verma S. PI‐RADS: Past, present, and future. J Magn Reson Imaging 2019; 52:33-53. [DOI: 10.1002/jmri.26896] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Rajan T. Gupta
- Department of RadiologyDuke University Medical Center Durham North Carolina USA
- Department of Surgery, Division of Urologic SurgeryDuke University Medical Center Durham North Carolina USA
- Duke Cancer Institute Center for Prostate and Urologic Cancers Durham North Carolina USA
| | - Kurren A. Mehta
- Department of RadiologyDuke University Medical Center Durham North Carolina USA
| | - Baris Turkbey
- National Cancer Institute, Center for Cancer Research Bethesda Maryland USA
| | - Sadhna Verma
- Cincinnati Veterans Hospital, University of Cincinnati Cancer InstituteUniversity of Cincinnati Medical Center Cincinnati Ohio USA
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Prostate Imaging Reporting and Data System Version 2 for MRI of Prostate Cancer: Can We Do Better? AJR Am J Roentgenol 2019; 212:1244-1252. [PMID: 30888865 DOI: 10.2214/ajr.19.21178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE. Although the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) has been widely adopted and is generally considered a success, it has clear limitations. The purpose of this article is to highlight the strengths and weaknesses of PI-RADSv2 and discuss ways that it can be improved. CONCLUSION. PI-RADSv2 has improved standardization of acquisition and interpretation of prostate MR images. Although it improves the detection of clinically significant cancers, its subjectivity and intrareader variability limit its accuracy and reproducibility, causing concerns regarding its reliability.
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19
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Scialpi M, Bianconi F, Cantisani V, Palumbo B. Radiomic Machine Learning: Is It Really a Useful Method for the Characterization of Prostate Cancer? Radiology 2019; 291:269-270. [PMID: 30835185 DOI: 10.1148/radiol.2019182940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michele Scialpi
- Section of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, Italy
| | | | - Vito Cantisani
- Department of Radiology, Oncology, and Anatomy Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy ‡
| | - Barbara Palumbo
- Surgical and Biomedical Sciences, § University of Perugia, Perugia, Italy
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