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Lin Y, Johnson LA, Fennessy FM, Turkbey B. Prostate Cancer Local Staging with Magnetic Resonance Imaging. Radiol Clin North Am 2024; 62:93-108. [PMID: 37973247 PMCID: PMC10656475 DOI: 10.1016/j.rcl.2023.06.010] [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] [Indexed: 11/19/2023]
Abstract
Accurate determination of the local stage of prostate cancer is crucial for treatment planning and prognosis. The primary objective of local staging is to distinguish between organ-confined and locally advanced disease, with the latter carrying a worse clinical prognosis. The presence of locally advanced disease features of prostate cancer, such as extra-prostatic extension, seminal vesicle invasion, and positive surgical margin, can impact the choice of treatment. Over the past decade, multiparametric MRI (mpMRI) has become the preferred imaging modality for the local staging of prostate cancer and has been shown to provide accurate information on the location and extent of disease. It has demonstrated superior performance compared to staging based on traditional clinical nomograms. Despite being a relatively new technique, mpMRI has garnered considerable attention and ongoing investigations. Therefore, in this review, we will discuss the current use of mpMRI on prostate cancer local staging.
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Affiliation(s)
- Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA
| | - Latrice A Johnson
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA.
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Yu VY, Otazo R, Wu C, Subashi E, Baumann M, Koken P, Doneva M, Mazurkewitz P, Shasha D, Zelefsky M, Cervino L, Cohen O. Quantitative longitudinal mapping of radiation-treated prostate cancer using MR fingerprinting with radial acquisition and subspace reconstruction. Magn Reson Imaging 2023; 101:25-34. [PMID: 37015305 PMCID: PMC10623548 DOI: 10.1016/j.mri.2023.03.019] [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: 02/01/2023] [Accepted: 03/29/2023] [Indexed: 04/06/2023]
Abstract
MR fingerprinting (MRF) enables fast multiparametric quantitative imaging with a single acquisition and has been shown to improve diagnosis of prostate cancer. However, most prostate MRF studies were performed with spiral acquisitions that are sensitive to B0 inhomogeneities and consequent blurring. In this work, a radial MRF acquisition with a novel subspace reconstruction technique was developed to enable fast T1/T2 mapping in the prostate in under 4 min. The subspace reconstruction exploits the extensive temporal correlations in the MRF dictionary to pre-compute a low dimensional space for the solution and thus reduce the number of radial spokes to accelerate the acquisition. Iterative reconstruction with the subspace model and additional regularization of the signal representation in the subspace is performed to minimize the number of spokes and maintain matching quality and SNR. Reconstruction accuracy was assessed using the ISMRM NIST phantom. In-vivo validation was performed on two healthy subjects and two prostate cancer patients undergoing radiation therapy. The longitudinal repeatability was quantified using the concordance correlation coefficient (CCC) in one of the healthy subjects by repeated scans over 1 year. One prostate cancer patient was scanned at three time points, before initiating therapy and following brachytherapy and external beam radiation. Changes in the T1/T2 maps obtained with the proposed method were quantified. The prostate, peripheral and transitional zones, and visible dominant lesion were delineated for each study, and the statistics and distribution of the quantitative mapping values were analyzed. Significant image quality improvements compared with standard reconstruction methods were obtained with the proposed subspace reconstruction method. A notable decrease in the spread of the T1/T2 values without biasing the estimated mean values was observed with the subspace reconstruction and agreed with reported literature values. The subspace reconstruction enabled visualization of small differences in T1/T2 values in the tumor region within the peripheral zone. Longitudinal imaging of a volunteer subject yielded CCC of 0.89 for MRF T1, and 0.81 for MRF T2 in the prostate gland. Longitudinal imaging of the prostate patient confirmed the feasibility of capturing radiation treatment related changes. This work is a proof-of-concept for a high resolution and fast quantitative mapping using golden-angle radial MRF combined with a subspace reconstruction technique for longitudinal treatment response assessment in subjects undergoing radiation treatment.
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Affiliation(s)
- Victoria Y Yu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricardo Otazo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Can Wu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ergys Subashi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Peter Koken
- Philips Research, MR Research, Hamburg, Germany
| | | | | | - Daniel Shasha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Cervino
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ouri Cohen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Ayyildiz H, Salmaslioglu A, Tunaci A, Erturk SM. State-of-the-art Prostate Imaging. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:153-162. [PMID: 37899806 PMCID: PMC10600631 DOI: 10.14744/semb.2023.77910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/02/2023] [Accepted: 01/19/2023] [Indexed: 02/18/2023]
Abstract
Prostate cancer is one of the most common cancers in men. In addition to methods such as prostate-specific antigen test, digital rectal examination, and transrectal ultrasonography, magnetic resonance imaging has an important role for accurate and reproducible diagnosis. However, guidance in targeted biopsies and recent use in determining localization for treatment increase its importance. Due to technical difficulties, patient tolerance, and differences in interpretation, the prostate imaging reporting and data system recommends preparations for the patient and magnetic resonance imaging techniques. However, techniques continue to be developed to improve the diagnosis rate and image quality. In our article, patient preparation before imaging and techniques were tried to be discussed in detail. In addition, current approaches in biparametric magnetic resonance imaging and radiomics and new techniques such as T1 and T2 mapping will be mentioned.
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Affiliation(s)
- Hakan Ayyildiz
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Artur Salmaslioglu
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Atadan Tunaci
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Sukru Mehmet Erturk
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
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Blasi F, Malouhi A, Cho CH, Nißler D, Berger FP, Grimm MO, Abubrig M, Teichgräber U, Franiel T. Staging accuracy of MRI of the prostate with special reference to the influence of the time of last ejaculation on the detection of seminal vesicle invasion. Clin Radiol 2023; 78:e425-e432. [PMID: 36849278 DOI: 10.1016/j.crad.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023]
Abstract
AIM To evaluate the Prostate Imaging Reporting and Data System, version 2.1 (PIRADS V2.1) criteria for seminal vesicle invasion (SVI) and examine whether the timing of last ejaculation influences the detection of SVI. MATERIALS AND METHODS The study population consisted of 68 patients (34 with SVI, 34 without SVI, matching groups by age and prostate volume) who underwent PIRADS V2.1-compliant multiparametric magnetic resonance imaging (MRI; 34 at 1.5 T, 34 at 3 T). Before the examination, the time of last ejaculation (38/68 ≤ 5 days, 30/68 > 5 days) was collected via a questionnaire. The five PIRADS V2.1 criteria for SVI with subsequent overall assessment were evaluated retrospectively by two independent examiners (examiner 1 with >10 years of experience, examiner 2 with 6 months of experience) in a single-blinded fashion for all patients using a questionnaire and a six-point scale (0 = no, 1 = very likely not, 2 = probably not, 3 = possible, 4 = probable, 5 = certain). RESULTS E1 achieved high specificity (100%) and positive predictive value (PPV; 100%) in the overall assessment, independent of the time of last ejaculation (sensitivity = 76.5%, negative predictive value [NPV] = 81%). The area under the curve (AUC) value was 0.882; for E2, it was 0.765. At ≤5 days, the AUC values of E1 and E2 differed significantly (0.867 versus 0.681, p=0.016), as did the diffusion restriction criterion (0.833 versus 0.681, p=0.028). E1 showed high AUC values independent of time. E2 had better values for all criteria at >5 days than at ≤5 days. There were no significant differences between the examiners in all observations at >5 days. CONCLUSION The PIRADS V2.1 criteria are well suited for an experienced examiner to detect SVI independent of time point. An inexperienced examiner will benefit from patients being abstinent >5 days prior to MRI.
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Affiliation(s)
- F Blasi
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany.
| | - A Malouhi
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - C-H Cho
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - D Nißler
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - F P Berger
- Clinic and Polyclinic for Urology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - M-O Grimm
- Clinic and Polyclinic for Urology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - M Abubrig
- Institute of Forensic Medicine, Pathology Section, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - U Teichgräber
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - T Franiel
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
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Suguino RK, Mussi TC, Coelho FMA, Baroni RH. Prostate imaging features on magnetic resonance imaging of young patients. EINSTEIN-SAO PAULO 2022; 20:eAO0024. [PMID: 36477522 DOI: 10.31744/einstein_journal/2022ao0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify magnetic resonance imaging findings of the prostate in young adults, including symptomatic and asymptomatic patients. The aim of this study is to evaluate the main aspects of prostate imaging in young patients. METHODS A total of 102 patients under 40 years of age, who underwent prostate magnetic resonance imaging between January 2016 and January 2019, were included in this study. The patients were divided into two groups: symptomatic for prostatitis (Group 1) and asymptomatic (Group 2). Magnetic resonance imaging scans were anonymized and interpreted by a radiologist blinded for clinical information. The study evaluated peripheral zone signal in T2-weighted sequences, diffusion and apparent diffusion coefficient map; peripheral zone enhancement pattern; seminal vesicles and periprostatic fat. RESULTS All evaluated criteria did not present statistically significant differences between the two groups. The most common pattern was heterogeneous hyposignal on T2 (57.9% in Group 1 and 57.8% in Group 2; p=0.506), mild diffuse / wedge-shaped areas of hypointensity on apparent diffusion coefficient map (61.4% in Group 1 and 64.4% in Group 2; p=0.931) and early post-contrast enhancement (73.7% in Group 1 and 68.9% in Group 2, p=0719). CONCLUSION The magnetic resonance imaging aspect of young patients showed no differences between symptomatic and asymptomatic patients.
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Boss MA, Snyder BS, Kim E, Flamini D, Englander S, Sundaram KM, Gumpeni N, Palmer SL, Choi H, Froemming AT, Persigehl T, Davenport MS, Malyarenko D, Chenevert TL, Rosen MA. Repeatability and Reproducibility Assessment of the Apparent Diffusion Coefficient in the Prostate: A Trial of the ECOG-ACRIN Research Group (ACRIN 6701). J Magn Reson Imaging 2022; 56:668-679. [PMID: 35143059 PMCID: PMC9363527 DOI: 10.1002/jmri.28093] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Uncertainty regarding the reproducibility of the apparent diffusion coefficient (ADC) hampers the use of quantitative diffusion-weighted imaging (DWI) in evaluation of the prostate with magnetic resonance imaging MRI. The quantitative imaging biomarkers alliance (QIBA) profile for quantitative DWI claims a within-subject coefficient of variation (wCV) for prostate lesion ADC of 0.17. Improved understanding of ADC reproducibility would aid the use of quantitative diffusion in prostate MRI evaluation. PURPOSE Evaluation of the repeatability (same-day) and reproducibility (multi-day) of whole-prostate and focal-lesion ADC assessment in a multi-site setting. STUDY TYPE Prospective multi-institutional. SUBJECTS Twenty-nine males, ages 53 to 80 (median 63) years, following diagnosis of prostate cancer, 10 with focal lesions. FIELD STRENGTH/SEQUENCE 3T, single-shot spin-echo diffusion-weighted echo-planar sequence with four b-values. ASSESSMENT Sites qualified for the study using an ice-water phantom with known ADC. Readers performed DWI analyses at visit 1 ("V1") and visit 2 ("V2," 2-14 days after V1), where V2 comprised scans before ("V2pre") and after ("V2post") a "coffee-break" interval with subject removal and repositioning. A single reader segmented the whole prostate. Two readers separately placed region-of-interests for focal lesions. STATISTICAL TESTS Reproducibility and repeatability coefficients for whole prostate and focal lesions derived from median pixel ADC. We estimated the wCV and 95% confidence interval using a variance stabilizing transformation and assessed interreader reliability of focal lesion ADC using the intraclass correlation coefficient (ICC). RESULTS The ADC biases from b0 -b600 and b0 -b800 phantom scans averaged 1.32% and 1.44%, respectively; mean b-value dependence was 0.188%. Repeatability and reproducibility of whole prostate median pixel ADC both yielded wCVs of 0.033 (N = 29). In 10 subjects with an evaluable focal lesion, the individual reader wCVs were 0.148 and 0.074 (repeatability) and 0.137 and 0.078 (reproducibility). All time points demonstrated good to excellent interreader reliability for focal lesion ADC (ICCV1 = 0.89; ICCV2pre = 0.76; ICCV2post = 0.94). DATA CONCLUSION This study met the QIBA claim for prostate ADC. Test-retest repeatability and multi-day reproducibility were largely equivalent. Interreader reliability for focal lesion ADC was high across time points. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2 TOC CATEGORY: Pelvis.
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Affiliation(s)
- Michael A. Boss
- Center for Research and Innovation, American College of Radiology Philadelphia, Pennsylvania, USA
| | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Eunhee Kim
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Dena Flamini
- Center for Research and Innovation, American College of Radiology Philadelphia, Pennsylvania, USA
| | - Sarah Englander
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karthik M. Sundaram
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naveen Gumpeni
- Department of Radiology, Weill Cornell Medical Center, New York, New York, USA
| | - Suzanne L. Palmer
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Haesun Choi
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | - Dariya Malyarenko
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Mark A. Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Hoang-Dinh A, Nguyen-Quang T, Bui-Van L, Gonindard-Melodelima C, Souchon R, Rouvière O. Reproducibility of apparent diffusion coefficient measurement in normal prostate peripheral zone at 1.5T MRI. Diagn Interv Imaging 2022; 103:545-554. [PMID: 35773099 DOI: 10.1016/j.diii.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to quantify the influence of factors of variability on apparent diffusion coefficient (ADC) estimation in the normal prostate peripheral zone (PZ). MATERIALS AND METHODS Fifty healthy volunteers underwent in 2017 (n = 17) or 2020 (n = 33) two-point (0, 800 s/mm²) prostate diffusion-weighted imaging in the morning on 1.5 T scanners A and B from different manufacturers. Additional five-point (50, 150, 300, 500, 800 s/mm²) acquisitions were performed on scanner B in the morning and evening. ADC was measured in PZ at midgland using ADC maps reconstructed with various b-value combinations. ADC distributions from 2017 and 2020 were compared using Wilcoxon rank sum test. ADC obtained in the same volunteers were compared using Bland Altman methodology. The 95% confidence interval upper limit of the repeatability/reproducibility coefficient defined the lowest detectable ADC difference. RESULTS Forty-nine participants with a mean age of 24.6 ± 3.8 [SD] years (range: 21-37 years) were finally included. ADC distributions from 2017 and 2020 were not significantly different and were combined. Despite high individual variability, there was no significant bias (10 × 10-6 mm²/s, P = 0.58) between ADC measurements made on both scanners. On scanner B, differences in lowest b-values chosen within the 0-500 s/mm² range for two-point ADC computation induced significant biases (56-109 × 10-6 mm²/s, P < 0.0001). ADC was significantly lower in the morning (bias: 33 × 10-6 mm²/s, P = 0.006). The number of b-values had little influence on ADC values. The lowest detectable ADC difference varied from 85 × 10-6 to 311 × 10-6 mm²/s across scanners, b-value combinations and periods of the day. CONCLUSIONS The MRI scanner, the lowest b-value used and the period of the day induce substantial variability in ADC computation.
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Affiliation(s)
- Au Hoang-Dinh
- Hanoï Medical University Hospital, Dong Da, Hanoi, Viet Nam
| | | | - Lenh Bui-Van
- Hanoï Medical University Hospital, Dong Da, Hanoi, Viet Nam
| | | | | | - Olivier Rouvière
- LabTAU, INSERM, U1032, 69000, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Vascular and Urinary Imaging, 69000, Lyon, France; Université de Lyon, Lyon 69003, France; Université Lyon 1, Lyon France; Faculté de Médecine, Lyon Est, 69003, Lyon, France.
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Ruetten H, Vezina CM. Relevance of dog as an animal model for urologic diseases. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2022; 189:35-65. [PMID: 35595352 DOI: 10.1016/bs.pmbts.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We utilize animal models in urologic research to improve understanding of urinary physiology, determine the etiology of many urologic diseases, and discover and test novel therapeutic interventions. Dogs have a similar urinary tract anatomy and physiology to human and they develop many urologic diseases spontaneously. This chapter offers detailed comparisons of urinary tract anatomy, physiology, and the most common urologic diseases between humans and dogs. Dogs offer a unique opportunity for urologic research because they can be studied in research colonies and in client owned cohorts. Dogs also are among a limited number of non-human species that require continence and socially appropriate urinary behaviors (ex. going to the bathroom outside, training to not have submissive urination, etc.). These features make dogs unique in the animal kingdom and make them an ideal animal model for urologic research.
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Affiliation(s)
- Hannah Ruetten
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Chad M Vezina
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States.
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Male Lower Urinary Tract Dysfunction: An Underrepresented Endpoint in Toxicology Research. TOXICS 2022; 10:toxics10020089. [PMID: 35202275 PMCID: PMC8880407 DOI: 10.3390/toxics10020089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
Lower urinary tract dysfunction (LUTD) is nearly ubiquitous in men of advancing age and exerts substantial physical, mental, social, and financial costs to society. While a large body of research is focused on the molecular, genetic, and epigenetic underpinnings of the disease, little research has been dedicated to the influence of environmental chemicals on disease initiation, progression, or severity. Despite a few recent studies indicating a potential developmental origin of male LUTD linked to chemical exposures in the womb, it remains a grossly understudied endpoint in toxicology research. Therefore, we direct this review to toxicologists who are considering male LUTD as a new aspect of chemical toxicity studies. We focus on the LUTD disease process in men, as well as in the male mouse as a leading research model. To introduce the disease process, we describe the physiology of the male lower urinary tract and the cellular composition of lower urinary tract tissues. We discuss known and suspected mechanisms of male LUTD and examples of environmental chemicals acting through these mechanisms to contribute to LUTD. We also describe mouse models of LUTD and endpoints to diagnose, characterize, and quantify LUTD in men and mice.
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Franiel T, Asbach P, Beyersdorff D, Blondin D, Kaufmann S, Mueller-Lisse UG, Quentin M, Rödel S, Röthke M, Schlemmer HP, Schimmöller L. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Scanning Protocol. ROFO-FORTSCHR RONTG 2021; 193:763-777. [PMID: 33735931 DOI: 10.1055/a-1406-8477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The Working Group Uroradiology and Urogenital Diagnosis of the German Roentgen Society (DRG) revised and updated the recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate in a consensus process and harmonized it with the managing board of German Roentgen Society and Professional Association of the German Radiologist (BDR e. V.). These detailed recommendation define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer and describe in detail the topic 1. anamnestic datas, 2. termination of examinations and preparation of examinations, 3. examination protocol and 4. MRI-(in-bore)-biopsy. KEY POINTS:: · The recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate were revised and updated in a consensus process and harmonized with the managing board of German Roentgen Society (DRG) and Professional Asssociation of the German Radiologist (BDR).. · Detailed recommendations are given for topic 1. anamnestic datas, 2. termination and preparation of examinations, 3. examination protocoll and 4. MRI-(in-bore)-biopsy.. · These recommendations define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer.. CITATION FORMAT: · Franiel T, Asbach P, Beyersdorff D et al. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Examination Protocol. Fortschr Röntgenstr 2021; 193: 763 - 776.
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Affiliation(s)
- Tobias Franiel
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Jena, Deutschland
| | - Patrick Asbach
- Klinik für Radiologie, Charité Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Deutschland
| | - Dirk Beyersdorff
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Blondin
- Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Städtische Kliniken Mönchengladbach GmbH Elisabeth-Krankenhaus Rheydt, Mönchengladbach, Germany.,Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Städtische Kliniken Mönchengladbach, Germany
| | - Sascha Kaufmann
- Institut für Diagnostische und Interventionelle Radiologie, Siloah St. Trudpert Klinikum, Pforzheim, Deutschland
| | | | - Michael Quentin
- Centrum für Diagnostik und Therapie GmbH, Medizinisches Versorgungszentrum CDT Strahleninstitut GmbH, Köln, Germany
| | - Stefan Rödel
- Radiologische Klinik, Städtisches Klinikum Dresden, Germany
| | - Matthias Röthke
- Conradia Radiologie und Nuklearmedizin, Conradia Hamburg MVZ GmbH, Hamburg, Germany
| | | | - Lars Schimmöller
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Sackett J, Shih JH, Reese SE, Brender JR, Harmon SA, Barrett T, Coskun M, Madariaga M, Marko J, Law YM, Turkbey EB, Mehralivand S, Sanford T, Lay N, Pinto PA, Wood BJ, Choyke PL, Turkbey B. Quality of Prostate MRI: Is the PI-RADS Standard Sufficient? Acad Radiol 2021; 28:199-207. [PMID: 32143993 PMCID: PMC8459209 DOI: 10.1016/j.acra.2020.01.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVE The Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) published a set of minimum technical standards (MTS) to improve image quality and reduce variability in multiparametric prostate MRI. The effect of PIRADSv2 MTS on image quality has not been validated. We aimed to determine whether adherence to PI-RADSv2 MTS improves study adequacy and perceived quality. MATERIALS AND METHODS Sixty-two prostate MRI examinations including T2 weighted (T2W) and diffusion weighted image (DWI) consecutively referred to our center from 62 different institutions within a 12-month period (September 2017 to September 2018) were included. Six readers assessed images as adequate or inadequate for use in PCa detection and a numerical image quality ranking was given using a 1-5 scale. The PI-RADSv2 MTS were synthesized into sets of seven and 10 rules for T2W and DWI, respectively. Image adherence was assessed using Digital Imaging and Communications in Medicine (DICOM) metadata. Statistical analysis of survey results and image adherence was performed based on reader quality scoring (Kendall Rank tau-b) and reader adequate scoring (Wilcoxon test for association) for T2 and DWI quality assessment. RESULTS Out of 62 images, 52 (83%) T2W and 38 (61%) DWIs were rated to be adequate by a majority of readers. Reader adequacy scores showed no significant association with adherence to PI-RADSv2. There was a weak (tau-b = 0.22) but significant (p value = 0.01) correlation between adherence to PIRADSv2 MTS and image quality for T2W. Studies following all PI-RADSv2 T2W rules achieved a higher median average quality score (3.58 for 7/7 vs. 3.0 for <7/7, p = 0.012). No statistical relationship with PI-RADSv2 MTS adherence and DWI quality was found. CONCLUSION Among 62 sites performing prostate MRI, few were considered of high quality, but the majority were considered adequate. DWI showed considerably lower rates of adequate studies in the sample. Adherence to PI-RADSv2 MTS did not increase the likelihood of having a qualitatively adequate T2W or DWI.
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Affiliation(s)
- Jonathan Sackett
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA; Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Joanna H Shih
- Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sarah E Reese
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Jeffrey R Brender
- Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stephanie A Harmon
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA; Leidos Biomedical Research, Inc., NCI Campus at Frederick, Clinical Research Directorate/Clinical Monitoring Research Program, Bethesda, MD, USA
| | - Tristan Barrett
- University of Cambridge School of Clinical Medicine, Cambridge UK
| | - Mehmet Coskun
- Department of Radiology, Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, University of Health Sciences, izmir, Turkey
| | | | - Jamie Marko
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Evrim B Turkbey
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Thomas Sanford
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Nathan Lay
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Bradford J Wood
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA; Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA.
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12
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Spontaneous Ejaculation: A Focused Review for the Clinicians. Sex Med Rev 2020; 9:406-422. [PMID: 33262094 DOI: 10.1016/j.sxmr.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/25/2020] [Accepted: 11/01/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The process of ejaculation has important meanings not only for its association with orgasm but also for the timing to ejaculate in the context of sexual activity. Spontaneous (involuntary) ejaculation (SE) without any sexual stimulation is a distressing symptom. Our understanding of SE is limited. Unfortunately, many physicians are not aware of these cases. OBJECTIVES The objective of this study is to describe the etiopathogenesis, clinical features, diagnosis, and treatment options for SE. METHODS We searched the literature for publications on "SE," "spontaneous emission" or "involuntary ejaculation," and factors influencing SE in the PUBMED/MEDLINE, Scopus, Cochrane Library, EMBASE, PsycINFO, ProQuest, Academic Search Complete database, Google Scholar, and CINAHL databases from inception to August 2020. RESULTS The literature search yielded 36 relevant publications reporting on 43 patients with SE. Attempts to explain the cause of pathologic SE have included 4 etiological groups (spinal cord lesions, psychological causes, rabies, and drug-induced). The underlying mechanisms responsible for induction of SE may include increased adrenergic activity, overactivity in dopaminergic system, decreased serotonergic activity, damage of descending inhibitory pathway, or penile hyperexcitability. SE may occur in the absence of an identifiable trigger or may be triggered by non-sexual circumstances (micturition, defecation, glans touch, anxiety, panic attack, or school examinations). Treatment options include psychoanalytic treatment, paroxetine, citalopram, sertraline, silodosin, and anxiolytics. In drug-induced SE, dose reduction and drug withdrawal with or without switching to another drug may relief SE. CONCLUSIONS SE is one of the least reported ejaculatory dysfunction. The key feature shared in common by these men is SE without any sexual thoughts or fantasies, may be triggered by non-sexual contexts, rarely associated with orgasm or erection. Treatment by psychoanalytic treatment and pharmacotherapy may be helpful. Further research might explore the definite underlying mechanisms. Abdel-Hamid IA, Ali OI. Spontaneous Ejaculation: A Focused Review for the Clinicians. Sex Med Rev 2021;9:406-422.
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13
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Caglic I, Barrett T. Optimising prostate mpMRI: prepare for success. Clin Radiol 2019; 74:831-840. [PMID: 30611559 DOI: 10.1016/j.crad.2018.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/06/2018] [Indexed: 01/06/2023]
Abstract
Multiparametric magnetic resonance imaging (MRI) now plays an essential role in prostate cancer diagnosis and management. The increasing use of MRI before biopsy makes obtaining images of the highest quality vital. The European Society of Urogenital Radiology (ESUR) 2012 guidelines and subsequent Prostate Imaging -Reporting Data System (PI-RADS) version 2 recommendations in 2015 address the technical considerations for optimising MRI acquisition; however, the quality of the multiparametric sequences employed depends not only on the hardware and software utilised and scanning parameters selected, but also on patient-related factors, for which current guidance is lacking. Patient preparation factors include bowel peristalsis, rectal distension, the presence of total hip replacement (THR), post-biopsy haemorrhage, and abstinence from ejaculation. New evidence has been accrued since the release of PI-RADS v2, and this review aims to explore the key issues of patient preparation and their potential to further optimise the image quality of mpMRI.
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Affiliation(s)
- I Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - T Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Assessing the Clinical Value of Positive Multiparametric Magnetic Resonance Imaging in Young Men with a Suspicion of Prostate Cancer. Eur Urol Oncol 2019; 4:594-600. [PMID: 31204312 DOI: 10.1016/j.euo.2019.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/29/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a lack of evidence on the ability of magnetic resonance imaging (MRI) of the prostate to detect clinically significant prostate cancer (csPCa) in young patients. OBJECTIVE We hypothesised that the diagnostic performance of MRI for csPCa varies according to patient's age. To address this, we assessed the variation in the csPCa detection rate of MRI targeted biopsy (MRI-TBx) versus systematic random biopsy (SBx) across different patient ages. DESIGN, SETTING, AND PARTICIPANTS We retrospectively identified 930 patients who underwent prostate MRI and subsequent biopsy at two referral centres between 2013 and 2018. The Prostate Imaging Reporting and Data System (PI-RADS) was used for MRI reporting. INTERVENTION A lesion with a PI-RADS score of ≥3 detected at MRI received an MRI-TBx in addition to an SBx during the same session. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The outcome of our study was the relationship between age and csPCa detection rate at MRI-TBx and SBx, respectively. Clinically significant prostate cancer (PCa) was defined as the presence of PCa with Gleason score ≥3+4. Multivariable logistic regression analyses (MVAs) predicting csPCa detection were assessed for both MRI-TBx and SBx. Covariates were age, prostate-specific antigen density, PI-RADS score, previous biopsy status, digital rectal examination, and the number of targeted and systematic cores. The hypothesis that MRI accuracy in detecting csPCa differed by age was finally tested with a nonparametric loess analysis. RESULTS AND LIMITATIONS The overall rate of csPCa was 54% (n=506). Overall, 325 (35%) and 461 (50%) patients had csPCa at SBx and MRI-TBx, respectively. The median numbers of SBx and MRI-TBx cores were 12 (interquartile range [IQR]: 10-13) and 5 (IQR: 4-7), respectively. At MVA, age at biopsy was an independent predictor of csPCa at MRI-TBx only (odds ratio: 1.05), after accounting for confounders. In men aged less than roughly 50yr, SBx had a higher probability of detecting csPCa relative to MRI-TBx (25% vs 16% at 40yr). Conversely, in patients aged >50yr, the probability of csPCa was higher in MRI-TBx than in SBx, reaching the highest difference for very elderly patients (48% vs 68% at 80yr). The main limitations were the retrospective design and the small number of young patients. CONCLUSIONS In this study, we reported the performance of MRI and MRI-TBx in detecting csPCa changes according to patients' age. PATIENT SUMMARY In young patients, the performance of a systematic random biopsy in detecting clinically significant prostate cancer (csPCa) is higher relative to magnetic resonance imaging targeted biopsy (MRI-TBx), reflecting the lower accuracy of MRI in younger men. Conversely, in older patients, MRI-TBx showed a clinical benefit with a higher csPCa detection rate compared with SBx, suggesting an increase of MRI accuracy with the increase of age.
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15
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Multiparametric MRI - local staging of prostate cancer and beyond. Radiol Oncol 2019; 53:159-170. [PMID: 31103999 PMCID: PMC6572496 DOI: 10.2478/raon-2019-0021] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Accurate local staging is critical for treatment planning and prognosis in patients with prostate cancer (PCa). The primary aim is to differentiate between organ-confined and locally advanced disease with the latter carrying a worse clinical prognosis. Multiparametric MRI (mpMRI) is the imaging modality of choice for the local staging of PCa and has an incremental value in assessing pelvic nodal disease and bone involvement. It has shown superior performance compared to traditional staging based on clinical nomograms, and provides additional information on the site and extent of disease. MRI has a high specificity for diagnosing extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node (LN) metastases, however, sensitivity remains poor. As a result, extended pelvic LN dissection remains the gold standard for assessing pelvic nodal involvement, and there has been recent progress in developing advanced imaging techniques for more distal staging. Conclusions T2W-weighted imaging is the cornerstone for local staging of PCa. Imaging at 3T and incorporating both diffusion weighted and dynamic contrast enhanced imaging can further increase accuracy. "Next generation" imaging including whole body MRI and PET-MRI imaging using prostate specific membrane antigen (68Ga-PSMA), has shown promising for assessment of LN and bone involvement as compared to the traditional work-up using bone scintigraphy and body CT.
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16
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Purysko AS, Rosenkrantz AB. Technique of Multiparametric MR Imaging of the Prostate. Urol Clin North Am 2018; 45:427-438. [DOI: 10.1016/j.ucl.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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17
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Zhang Y, Wells SA, Hernando D. Stimulated echo based mapping (STEM) of T 1 , T 2 , and apparent diffusion coefficient: validation and protocol optimization. Magn Reson Med 2018; 81:167-181. [PMID: 30024051 DOI: 10.1002/mrm.27358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE To present a stimulated-echo based mapping (STEM) approach for simultaneous T1 , T2 , and ADC mapping. METHODS Diffusion-weighted stimulated-echo images with various combinations of mixing time (TM), TE, and b-value were acquired to enable simultaneous mapping of T1 , T2 , and ADC. The proposed STEM method was performed by densely sampling the TM-TE-b space in a phantom and in brain and prostate of healthy volunteers. T1 , T2 , and ADC from STEM were compared to reference mapping methods. Additionally, protocol optimization was performed to enable rapid STEM acquisition within 2 min by sparsely sampling the TM-TE-b space. The T1 , T2 , and ADC measurements from rapid acquisitions were compared to the densely sampled STEM for evaluation. Finally, a patient with biopsy-proven high-risk prostate cancer was imaged to demonstrate the ability of STEM to differentiate cancer and healthy tissues. RESULTS Relative to the reference measurements, densely sampled STEM provided accurate quantitative T1 , T2 , and ADC mapping in phantoms (R2 = 0.999, slope between 0.97-1.03), as well as in brain and prostate. Further, the T1 , T2 , and ADC measurements from the optimized rapid STEM acquisitions agreed closely with densely sampled STEM. Finally, STEM showed decreased T2 and ADC in prostate cancer compared to healthy prostate tissue. CONCLUSION STEM provides accurate simultaneous mapping of T1 , T2 , and ADC. This method may enable rapid and accurate multi-parametric tissue characterization for clinical and research applications.
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Affiliation(s)
- Yuxin Zhang
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shane A Wells
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Diego Hernando
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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18
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Zhang Y, Holmes J, Rabanillo I, Guidon A, Wells S, Hernando D. Quantitative diffusion MRI using reduced field-of-view and multi-shot acquisition techniques: Validation in phantoms and prostate imaging. Magn Reson Imaging 2018; 51:173-181. [PMID: 29678540 DOI: 10.1016/j.mri.2018.04.006] [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: 09/15/2017] [Accepted: 04/14/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the reproducibility of quantitative diffusion measurements obtained with reduced Field of View (rFOV) and Multi-shot EPI (msEPI) acquisitions, using single-shot EPI (ssEPI) as a reference. METHODS Diffusion phantom experiments, and prostate diffusion-weighted imaging in healthy volunteers and patients with known or suspected prostate cancer were performed across the three different sequences. Quantitative diffusion measurements of apparent diffusion coefficient, and diffusion kurtosis parameters (healthy volunteers), were obtained and compared across diffusion sequences (rFOV, msEPI, and ssEPI). Other possible confounding factors like b-value combinations and acquisition parameters were also investigated. RESULTS Both msEPI and rFOV have shown reproducible quantitative diffusion measurements relative to ssEPI; no significant difference in ADC was observed across pulse sequences in the standard diffusion phantom (p = 0.156), healthy volunteers (p ≥ 0.12) or patients (p ≥ 0.26). The ADC values within the non-cancerous central gland and peripheral zone of patients were 1.29 ± 0.17 × 10-3 mm2/s and 1.74 ± 0.23 × 10-3 mm2/s respectively. However, differences in quantitative diffusion parameters were observed across different number of averages for rFOV, and across b-value groups and diffusion models for all the three sequences. CONCLUSION Both rFOV and msEPI have the potential to provide high image quality with reproducible quantitative diffusion measurements in prostate diffusion MRI.
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Affiliation(s)
- Yuxin Zhang
- Department of Medical Physics, University of Wisconsin Madison, Madison, WI, United States; Department of Radiology, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - James Holmes
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - Iñaki Rabanillo
- Laboratorio MR de Procesado de Imagen, Universidad de Valladolid, Valladolid, Spain
| | - Arnaud Guidon
- Applications and Workflow, GE Healthcare, Boston, MA, United States
| | - Shane Wells
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - Diego Hernando
- Department of Medical Physics, University of Wisconsin Madison, Madison, WI, United States; Department of Radiology, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States.
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20
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Purysko AS, Rosenkrantz AB. Technique of Multiparametric MR Imaging of the Prostate. Radiol Clin North Am 2017; 56:211-222. [PMID: 29420977 DOI: 10.1016/j.rcl.2017.10.004] [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] [Indexed: 01/23/2023]
Abstract
Multiparametric MR imaging provides detailed anatomic assessment of the prostate as well as information that allows the detection and characterization of prostate cancer. To obtain high-quality MR imaging of the prostate, radiologists must understand sequence optimization to overcome commonly encountered technical challenges. This review discusses the techniques that are used in state-of-the-art MR imaging of the prostate, including imaging protocols, hardware considerations, and important aspects of patient preparation, with an emphasis on the recommendations provided in the prostate imaging-reporting and data system version 2 guidelines.
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Affiliation(s)
- Andrei S Purysko
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code JB-3, Cleveland, OH 44195, USA.
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016, USA
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Barrett T, Tanner J, Gill AB, Slough RA, Wason J, Gallagher FA. The longitudinal effect of ejaculation on seminal vesicle fluid volume and whole-prostate ADC as measured on prostate MRI. Eur Radiol 2017; 27:5236-5243. [PMID: 28677052 PMCID: PMC5674119 DOI: 10.1007/s00330-017-4905-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To prospectively investigate the longitudinal effect of ejaculatory abstinence on MRI-measured seminal vesicle (SV) volume and whole-prostate ADC over consecutive days. METHODS 15 healthy male volunteers (mean 35.9 years, range 27-53) underwent 3-T MRI at baseline and 1, 2 and 3 days post-ejaculation. Prostate and SV volumes were derived by volume segmentation and whole-gland apparent diffusion coefficient (ADC) values calculated. A mixed-effects linear regression compared ADC values and prostate/seminal vesicle volumes in each volunteer between studies in a pairwise manner. RESULTS All subjects completed the four MRIs. Mean prostate volume was 22.45 cm3 (range 13.04-31.21 cm3), with no change between the four studies (p = 0.89-0.99). 13/15 subjects showed SV volume reduction from baseline to day 1, with group-mean decreasing from 6.45 to 4.80 cm3 (-25.6%, p < 0.001), and a significant reduction from baseline to day 2 (-18.1%, p = 0.002). There was a significant volume increase from both day 1 (+21.3%, p = 0.006) and day 2 (+10.2%, p = 0.022) to day 3 post-ejaculation. There was a significant reduction in ADC from 1.105 at baseline to 1.056 × 10-3 mm2/s at day 1 (mean -4.3%, p = 0.009). CONCLUSION The longitudinal effect of ejaculation on SV volume was demonstrated. Significant reductions in SV volume and whole-gland ADC were observed post-ejaculation, supporting a 3-day period of abstinence before prostate MRI. KEY POINTS • Seminal vesicle volume significantly reduced 24 h post-ejaculation remaining reduced at day 2 • Seminal vesicle fluid volume significantly increased from day 1 to day 3 post-ejaculation • There was a significant reduction in whole-gland prostate ADC values day 1 post-ejaculation • 3-day abstinence from ejaculation is required to ensure maximal seminal vesicle distension.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK.
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK.
| | - James Tanner
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Andrew B Gill
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Rhys A Slough
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK
| | - James Wason
- MRC Biostatistics Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ferdia A Gallagher
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK
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22
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Shin T, Kaji Y, Shukuya T, Nozaki M, Soh S, Okada H. Significant changes of T2 value in the peripheral zone and seminal vesicles after ejaculation. Eur Radiol 2017; 28:1009-1015. [DOI: 10.1007/s00330-017-5077-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/25/2017] [Accepted: 09/12/2017] [Indexed: 11/28/2022]
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van Houdt PJ, Agarwal HK, van Buuren LD, Heijmink SWTPJ, Haack S, van der Poel HG, Ghobadi G, Pos FJ, Peeters JM, Choyke PL, van der Heide UA. Performance of a fast and high-resolution multi-echo spin-echo sequence for prostate T 2 mapping across multiple systems. Magn Reson Med 2017; 79:1586-1594. [PMID: 28671331 DOI: 10.1002/mrm.26816] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/18/2017] [Accepted: 06/09/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the performance of a multi-echo spin-echo sequence with k-t undersampling scheme (k-t T2 ) in prostate cancer. METHODS Phantom experiments were performed at five systems to estimate the bias, short-term repeatability, and reproducibility across all systems expressed with the within-subject coefficient of variation (wCV). Monthly measurements were performed on two systems for long-term repeatability estimation. To evaluate clinical repeatability, two T2 maps (voxel size 0.8 × 0.8 × 3 mm3 ; 5 min) were acquired at separate visits on one system for 13 prostate cancer patients. Repeatability was assessed per patient in relation to spatial resolution. T2 values were compared for tumor, peripheral zone, and transition zone. RESULTS Phantom measurements showed a small bias (median = -0.9 ms) and good short-term repeatability (median wCV = 0.5%). Long-term repeatability was 0.9 and 1.1% and reproducibility between systems was 1.7%. The median bias observed in patients was -1.1 ms. At voxel level, the median wCV was 15%, dropping to 4% for structures of 0.5 cm3 . The median tumor T2 values (79 ms) were significantly lower (P < 0.001) than in the peripheral zone (149 ms), but overlapped with the transition zone (91 ms). CONCLUSIONS Reproducible T2 mapping of the prostate is feasible with good spatial resolution in a clinically reasonable scan time, allowing reliable measurement of T2 in structures as small as 0.5 cm3 . Magn Reson Med 79:1586-1594, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Petra J van Houdt
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harsh K Agarwal
- Philips Research NA, Cambridge, Massachusetts, USA.,National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laurens D van Buuren
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Søren Haack
- Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Henk G van der Poel
- Department of Urology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ghazaleh Ghobadi
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Peter L Choyke
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Uulke A van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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Abstract
MR/US fusion biopsy has emerged as a significant refinement of traditional prostate cancer diagnostic techniques. Utilizing not only quantitative imaging suspicion information from mpMRI but also the spatial accuracy and three-dimensional localization allows such strategies to specifically sample areas of concern with the gland. As such, diagnostic certainty is markedly improved. In this manuscript, we aim to highlight the multidisciplinary approach (amongst urologists, radiologists, pathologists, imaging technologists, nursing staff, and patients) which is required to launch and maintain a successful prostate imaging program.
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Multiparametric MR Imaging for Detection and Locoregional Staging of Prostate Cancer. Top Magn Reson Imaging 2017; 25:109-17. [PMID: 27187165 DOI: 10.1097/rmr.0000000000000089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Detection and staging of prostate cancer (PCa) based on digital rectal examination, prostate-specific antigen levels, and systematic transrectal ultrasound-guided biopsies show notorious limitations in light of the current needs of PCa management. Multiparametric magnetic resonance imaging (mpMRI) has emerged as a useful noninvasive imaging technique for detection, staging, assessment of aggressiveness, and treatment monitoring of PCa, combining anatomic high-resolution T2-weighted images with functional techniques, such as diffusion-weighted imaging and dynamic contrast enhancement evaluation. In this article, the authors review the technical aspects and the current clinical role of mpMRI for detection and locoregional staging of PCa.
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Greer MD, Choyke PL, Turkbey B. PI-RADSv2: How we do it. J Magn Reson Imaging 2017; 46:11-23. [DOI: 10.1002/jmri.25645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/21/2016] [Indexed: 12/27/2022] Open
Affiliation(s)
- Matthew D. Greer
- Molecular Imaging Program, NCI; NIH; Bethesda Maryland USA
- Cleveland Clinic Lerner College of Medicine; Cleveland Ohio USA
| | | | - Baris Turkbey
- Molecular Imaging Program, NCI; NIH; Bethesda Maryland USA
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Yuruk E, Pastuszak AW, Suggs JM, Colakerol A, Serefoglu EC. The association between seminal vesicle size and duration of abstinence from ejaculation. Andrologia 2016; 49. [PMID: 27660049 DOI: 10.1111/and.12707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 01/14/2023] Open
Abstract
There are few data describing the relationship between seminal vesicle (SV) size and duration of abstinence between ejaculations. This study evaluates the association between SV size and duration of abstinence from ejaculation using pelvic magnetic resonance imaging (MRI). Sexually active men 18-68 years old who underwent pelvic MRI for various medical indications were included. The date of last ejaculation was recorded, and the cross-sectional areas of the right and left seminal vesicles were calculated separately using mediolateral and anteroposterior measurements on T2-weighted MRI images. The association between SV area and duration of abstinence between ejaculations was determined via linear regression analysis. The study cohort consisted of 104 men with a mean age of 46.45 ± 11.4 (range 18-68) years old. Mean right and left SV cross-sectional areas were 744.1 ± 351.1 (range: 149.9-1794.7) mm2 and 727.6 ± 359.2 (range 171.4-2248.4) mm2 respectively. The mean duration of abstinence between ejaculations in the cohort was 3.6 ± 2.6 (range 1-15) days. Although no correlation between age and SV area was observed (r = .007, p = .947), linear regression analysis demonstrated a positive correlation between SV area and the duration of abstinence from ejaculation (r = .372, p = .0001). SV cross-sectional area increases with duration of abstinence from ejaculation and can be assessed using MRI. The use of SV size estimation may be applicable in diagnosis, risk stratification and treatment of urological diseases.
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Affiliation(s)
- E Yuruk
- Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - A W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.,Division of Male Reproductive Medicine, Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - J M Suggs
- Baylor College of Medicine, Houston, TX, USA
| | - A Colakerol
- Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - E C Serefoglu
- Bagcilar Research and Training Hospital, Istanbul, Turkey
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Does Abstinence From Ejaculation Before Prostate MRI Improve Evaluation of the Seminal Vesicles? AJR Am J Roentgenol 2016; 207:1205-1209. [PMID: 27657193 DOI: 10.2214/ajr.16.16278] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of the present study is to determine whether abstinence from ejaculation before undergoing multiparametric prostate MRI increases seminal vesicle (SV) volume and therefore improves diagnostic interpretation of the SVs. MATERIALS AND METHODS This retrospective study included 238 patients who underwent 3-T MRI of the prostate over a 4-month period. Patients were requested to complete a questionnaire that asked how long it had been since their last ejaculation (i.e., < 3 days vs ≥ 3 days). Forty-two patients (mean patient age, 62.0 years) indicated that it had been less than 3 days since their last ejaculation and were designated as group 1, whereas the remainder indicated an interval of 3 days or more since their last ejaculation. A group of 42 age-matched subjects (mean patient age, 62.1 years) were randomly selected from the remaining 196 patients and were designated as group 2. SV volumes were measured manually. Two radiologists who were blinded to group assignment and patient characteristics scored the right and left SVs separately to determine diagnostic interpretability, which was scored on a 3-point scale as follows: a score of 1 denoted that the SVs were not dilated and the score was nondiagnostic, a score of 2 indicated that the SVs were not dilated but the score was diagnostic, and a score of 3 denoted that the SVs were dilated and the score was diagnostic. Volume differences and interpretability scores were analyzed using a t test. Interobserver agreement was analyzed using the Cohen kappa statistic. A separate analysis was performed to evaluate differences in diagnostic interpretability for patients 60 years and younger versus patients older than 60 years, by use of the chi-square test and relative risk ratio analysis. RESULTS The right, left, and total SV volumes for group 1 were 3.1 mL, 2.9 mL, and 6.0 mL, respectively, whereas those for group 2 were 4.7 mL, 4.1 mL, and 8.8 mL, respectively (p = 0.011). The mean interpretability scores for group 1 and group 2 were 2.0 and 2.5, respectively. For group 1, reader 1 and reader 2 assigned a nondiagnostic score for 10 and 13 patients, respectively, whereas for group 2, they assigned a nondiagnostic score for two and five patients, respectively (p = 0.01, for reader 1; and p = 0.03, for reader 2). For men in group 1 who were older than 60 years, reader 1 and reader 2 gave a nondiagnostic score for nine and 11 patients, respectively; whereas for men in group 2 who were older than 60 years, the readers gave a nondiagnostic score for two and five patients, respectively (p = 0.01, for reader 1; and p = 0.05, for reader 2). CONCLUSION For men older than 60 years, abstinence from ejaculation for 3 or more days before undergoing MRI examination resulted in larger SV volumes and lower rates of nondiagnostic evaluation and therefore might improve evaluation of SV invasion on multi-parametric MRI. The difference is less striking in men 60 years and younger.
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Abstract
CLINICAL ISSUE Prostate cancer is the most common form of cancer in men in Germany; however, there is a distinct difference between incidence and mortality. STANDARD TREATMENT The detection of prostate cancer is based on clinical and laboratory testing using serum prostate-specific antigen (PSA) levels and transrectal ultrasound with randomized biopsy. DIAGNOSTIC WORK-UP Multiparametric MR imaging of the prostate can provide valuable diagnostic information for detection of prostate cancer, especially after negative results of a biopsy prior to repeat biopsy. PERFORMANCE In addition the use of MR ultrasound fusion-guided biopsy has gained in diagnostic importance and has increased the prostate cancer detection rate. ACHIEVEMENTS AND PRACTICAL RECOMMENDATIONS The prostate imaging reporting and data system (PI-RADS) classification has standardized the reporting of prostate MRI which has positively influenced the acceptance by urologists.
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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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Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, Thoeny HC, Verma S. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol 2015; 69:16-40. [PMID: 26427566 DOI: 10.1016/j.eururo.2015.08.052] [Citation(s) in RCA: 2084] [Impact Index Per Article: 231.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 08/29/2015] [Indexed: 12/13/2022]
Abstract
The Prostate Imaging - Reporting and Data System Version 2 (PI-RADS™ v2) is the product of an international collaboration of the American College of Radiology (ACR), European Society of Uroradiology (ESUR), and AdMetech Foundation. It is designed to promote global standardization and diminish variation in the acquisition, interpretation, and reporting of prostate multiparametric magnetic resonance imaging (mpMRI) examination, and it is based on the best available evidence and expert consensus opinion. It establishes minimum acceptable technical parameters for prostate mpMRI, simplifies and standardizes terminology and content of reports, and provides assessment categories that summarize levels of suspicion or risk of clinically significant prostate cancer that can be used to assist selection of patients for biopsies and management. It is intended to be used in routine clinical practice and also to facilitate data collection and outcome monitoring for research.
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Affiliation(s)
| | | | | | | | - Masoom A Haider
- University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | | | | | | | - Sadna Verma
- University of Cincinnati, Cincinnati, OH, USA
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