1
|
Stamatelatou A, Rizzo R, Simsek K, van Asten JJA, Heerschap A, Scheenen T, Kreis R. Diffusion-weighted MR spectroscopy of the prostate. Magn Reson Med 2024; 92:1323-1337. [PMID: 38775024 DOI: 10.1002/mrm.30141] [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: 03/11/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Prostate tissue has a complex microstructure, mainly composed of epithelial and stromal cells, and of extracellular (acinar-luminal) spaces. Diffusion-weighted MR spectroscopy (DW-MRS) is ideally suited to explore complex microstructure in vivo with metabolites selectively distributed in different subspaces. To date, this technique has been applied to brain and muscle. This study presents the development and pioneering utilization of 1H-DW-MRS in the prostate, accompanied by in vitro studies to support interpretations of in vivo findings. METHODS Nine healthy volunteers underwent a prostate MR examination (mean age, 56 years; range, 31-66). Metabolic complexation was studied in vitro using solutions with major compounds found in prostatic fluid of the lumen. DW-MRS was performed at 3 T with a non-water-suppressed single-voxel sequence with metabolite-cycling to concurrently measure metabolite and water signals. The water signal was used in postprocessing as a reference in a motion-compensation scheme. The spectra were fitted simultaneously in the spectral and diffusion-weighting dimensions. Apparent diffusion coefficients (ADCs) were derived by fitting signal decays that were assumed to be mono-exponential for metabolites and biexponential for water. RESULTS DW-MRS of the prostate revealed relatively low ADCs for Cho and Cr compounds, aligning with their intracellular location and higher ADCs for citrate and spermine supporting their luminal origin. In vitro assessments of the ADCs of citrate and spermine demonstrated their complex formation and protein binding. Tissue concentrations of MRS-detectable metabolites were as expected for the voxel location. CONCLUSIONS This work successfully demonstrates the feasibility of 1H-DW-MRS of the prostate and its potential for providing valuable microstructural information.
Collapse
Affiliation(s)
- Angeliki Stamatelatou
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rudy Rizzo
- Magnetic Resonance Methodology, Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
- Translational Imaging Center, sitem-insel, Bern, Switzerland
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kadir Simsek
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- School of Computer Science and Informatics, Cardiff University, Cardiff, United Kingdom
| | - Jack J A van Asten
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roland Kreis
- Magnetic Resonance Methodology, Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
- Translational Imaging Center, sitem-insel, Bern, Switzerland
- Institute of Psychology, University of Bern, Bern, Switzerland
| |
Collapse
|
2
|
Park SY, Woo S, Park KJ, Westphalen AC. A pictorial essay of PI-RADS pearls and pitfalls: toward less ambiguity and better practice. Abdom Radiol (NY) 2024; 49:3190-3205. [PMID: 38704782 DOI: 10.1007/s00261-024-04273-0] [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: 11/09/2023] [Revised: 03/02/2024] [Accepted: 03/03/2024] [Indexed: 05/07/2024]
Abstract
Prostate Imaging Reporting and Data System (PI-RADS) was designed to standardize the interpretation of multiparametric magnetic resonance imaging (MRI) of the prostate, aiding in assessing the probability of clinically significant prostate cancer. By providing a structured scoring system, it enables better risk stratification, guiding decisions regarding the need for biopsy and subsequent treatment options. In this article, we explore both the strengths and weaknesses of PI-RADS, offering insights into its updated diagnostic performance and clinical applications, while also addressing potential pitfalls using diverse, representative MRI cases.
Collapse
Affiliation(s)
- Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Radiology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA.
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, 10016, USA
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Antonio C Westphalen
- Department of Radiology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
- Department of Urology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
| |
Collapse
|
3
|
Şahin B, Çetin S, Sözen S, Aslan G, Çelik S, Türkeri L. A novel nomogram to predict clinically significant prostate cancer in MR assisted lesion biopsies: Turkish urooncology association nomogram. Urol Oncol 2024; 42:288.e17-288.e25. [PMID: 38782675 DOI: 10.1016/j.urolonc.2024.04.015] [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: 02/07/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This study aimed to develop a novel nomogram to predict clinically significant prostate cancer in patients undergoing multi-parametric prostate MRI-assisted lesion biopsies, addressing the challenges in deciding on biopsy for patients with PI-RADS 3 lesions and follow-up strategies for patients with negative PI-RADS 4 or 5 lesions. MATERIALS AND METHODS A retrospective case-control study was conducted using the Turkish Urooncology Association Databases (UROCaD). The final dataset included 2428 lesion biopsy data. Univariate analysis, logistic regression, and validation were performed, with 1942 and 486 lesion biopsy data in the training and validation datasets, respectively. RESULTS Age, initial total PSA value, PSA density, prostate volume, lesion length, DRE findings, and PI-RADS score were significantly different between benign or non-significant cancer and clinically significant prostate cancer groups. The developed nomogram incorporated PSA density, age, PI-RADS score, lesion length, and DRE findings. The mean area under the curve for the 6-fold cross-validation was 0.836, while the area under the curve values for the training and validation datasets were 0.827 and 0.861, respectively. The nomogram demonstrated a sensitivity of 75.6% and a specificity of 74.8% at a cut-off score of 24.9, with positive and negative predictive values of 42.2% and 92.6%, respectively. CONCLUSION The TUA nomogram, based on PSA density, age, PI-RADS score, lesion length, and DRE findings, provides a reliable and accurate prediction tool for detecting clinically significant prostate cancer in patients undergoing multi-parametric prostate MRI-assisted lesion (fusion) biopsies, potentially improving patient management and reducing unnecessary biopsies.
Collapse
Affiliation(s)
- Bahadır Şahin
- Urology Department, Marmara University School of Medicine, İstanbul, Turkey.
| | - Serhat Çetin
- Urology Department, Gazi University School of Medicine, Ankara, Turkey
| | - Sinan Sözen
- Urology Department, Gazi University School of Medicine, Ankara, Turkey
| | - Güven Aslan
- Urology Department, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Serdar Çelik
- Urology Department, University of Health Sciences Turkey, Izmir Faculty of Medicine, Izmir City Hospital, İzmir, Turkey
| | - Levent Türkeri
- Urology Department, Acıbadem University School of Medicine, İstanbul, Turkey
| |
Collapse
|
4
|
Ren L, Chen Y, Liu Z, Huang G, Wang W, Yang X, Bai B, Guo Y, Ling J, Mao X. Integration of PSAd and multiparametric MRI to forecast biopsy outcomes in biopsy-naïve patients with PSA 4~20 ng/ml. Front Oncol 2024; 14:1413953. [PMID: 39026982 PMCID: PMC11254766 DOI: 10.3389/fonc.2024.1413953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction This study aims to investigate whether the transrectal ultrasound-guided combined biopsy (CB) improves the detection rates of prostate cancer (PCa) and clinically significant PCa (csPCa) in biopsy-naïve patients. We also aimed to compare the Prostate Imaging Reporting and Data System (PI-RADS v2.1) score, ADC values, and PSA density (PSAd) in predicting csPCa by the combined prostate biopsy. Methods This retrospective and single-center study included 389 biopsy-naïve patients with PSA level 4~20 ng/ml, of whom 197 underwent prebiopsy mpMRI of the prostate. The mpMRI-based scores (PI-RADS v2.1 scores and ADC values) and clinical parameters were collected and evaluated by logistic regression analyses. Multivariable models based on the mpMRI-based scores and clinical parameters were developed by the logistic regression analyses to forecast biopsy outcomes of CB in biopsy-naïve patients. The ROC curves measured by the AUC values, calibration plots, and DCA were performed to assess multivariable models. Results The CB can detect more csPCa compared with TRUSB (32.0% vs. 53%). The Spearman correlation revealed that Gleason scores of the prostate biopsy significantly correlated with PI-RADS scores and ADC values. The multivariate logistic regression confirmed that PI-RADS scores 4, 5, and prostate volume were important predictors of csPCa. The PI-RADS+ADC+PSAd (PAP) model had the highest AUCs of 0.913 for predicting csPCa in biopsy-naïve patients with PSA level 4~20 ng/ml. When the biopsy risk threshold of the PAP model was greater than or equal to 0.10, 51% of patients could avoid an unnecessary biopsy, and only 5% of patients with csPCa were missed. Conclusion The prebiopsy mpMRI and the combined prostate biopsy have a high CDR of csPCa in biopsy-naïve patients. A multivariable model based on the mpMRI-based scores and PSAd could provide a reference for clinicians in forecasting biopsy outcomes in biopsy-naïve patients with PSA 4~20 ng/ml and make a more comprehensive assessment during the decision-making of the prostate biopsy.
Collapse
Affiliation(s)
- Lei Ren
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Zixiong Liu
- Department of Urology, The Seventh Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, China
| | - Guankai Huang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Weifeng Wang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
- Department of Urology, Hui Ya Hospital of The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Huizhou, China
| | - Xu Yang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Baohua Bai
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Jian Ling
- Department of Radiology, The Eastern Hospital of the First Affiliated Hospital of Sun Yat-sen University, Sun Yat-Sen University, Guangzhou, China
| | - Xiaopeng Mao
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
5
|
Yamamoto T, Okada H, Matsunaga N, Endo M, Tsuzuki T, Kajikawa K, Suzuki K. Clinical characteristics and pathological features of undetectable clinically significant prostate cancer on multiparametric magnetic resonance imaging: A single-center and retrospective study. J Clin Imaging Sci 2024; 14:20. [PMID: 38975058 PMCID: PMC11225522 DOI: 10.25259/jcis_37_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/05/2024] [Indexed: 07/09/2024] Open
Abstract
Objectives The objectives of this study were to clarify the pathological features of clinically significant prostate cancer (csPC) that is undetectable on multiparametric magnetic resonance imaging (mpMRI). Material and Methods This single-center and retrospective study enrolled 33 men with prostate cancer (PC), encompassing 109 PC lesions, who underwent mpMRI before radical prostatectomy. Two radiologists independently assessed the mpMR images of all lesions and compared them with the pathological findings of PC. All PC lesions were marked on resected specimens using prostate imaging reporting and data system version 2.1 and classified into magnetic resonance imaging (MRI)-detectable and MRI-undetectable PC lesions. Each lesion was classified into csPC and clinically insignificant PC. Pathological characteristics were compared between MRI-detectable and MRI-undetectable csPC. Statistical analysis was performed to identify factors associated with MRI detectability. A logistic regression model was used to determine the factors associated with MRI-detectable and MRI-undetectable csPC. Results Among 109 PC lesions, MRI-detectable and MRI-undetectable PCs accounted for 31% (34/109) and 69% (75/109) of lesions, respectively. All MRI-detectable PCs were csPC. MRI-undetectable PCs included 30 cases of csPC (40%). The detectability of csPC on mpMRI was 53% (34/64). The MRI-undetectable csPC group had a shorter major diameter (10.6 ± 6.6 mm vs. 19.0 ± 6.9 mm, P < 0.001), shorter minor diameter (5.7 ± 2.9 mm vs. 10.7 ± 3.4 mm, P < 0.001), and lower percentage of lesions with Gleason pattern 5 (17% vs. 71%, P < 0.001). Shorter minor diameter (odds ratio [OR], 2.62; P = 0.04) and lower percentage of Gleason pattern 5 (OR, 24; P = 0.01) were independent predictors of MRI-undetectable csPC. Conclusion The pathological features of MRI-undetectable csPC included shorter minor diameter and lower percentage of Gleason pattern 5. csPC with shorter minor diameter may not be detected on mpMRI. Some MRI-undetectable csPC lesions exhibited sufficient size and Gleason pattern 5, emphasizing the need for further understanding of pathological factors contributing to MRI detectability.
Collapse
Affiliation(s)
- Takahiro Yamamoto
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroaki Okada
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Nozomu Matsunaga
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Makoto Endo
- Department of Radiological Technology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Keishi Kajikawa
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
6
|
Woernle A, Englman C, Dickinson L, Kirkham A, Punwani S, Haider A, Freeman A, Kasivisivanathan V, Emberton M, Hines J, Moore CM, Allen C, Giganti F. Picture Perfect: The Status of Image Quality in Prostate MRI. J Magn Reson Imaging 2024; 59:1930-1952. [PMID: 37804007 DOI: 10.1002/jmri.29025] [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: 07/01/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
Magnetic resonance imaging is the gold standard imaging modality for the diagnosis of prostate cancer (PCa). Image quality is a fundamental prerequisite for the ability to detect clinically significant disease. In this critical review, we separate the issue of image quality into quality improvement and quality assessment. Beginning with the evolution of technical recommendations for scan acquisition, we investigate the role of patient preparation, scanner factors, and more advanced sequences, including those featuring Artificial Intelligence (AI), in determining image quality. As means of quality appraisal, the published literature on scoring systems (including the Prostate Imaging Quality score), is evaluated. Finally, the application of AI and teaching courses as ways to facilitate quality assessment are discussed, encouraging the implementation of future image quality initiatives along the PCa diagnostic and monitoring pathway. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.
Collapse
Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisivanathan
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- North East London Cancer Alliance & North Central London Cancer Alliance Urology, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| |
Collapse
|
7
|
Ponsiglione A, Brembilla G, Cuocolo R, Gutierrez P, Moreira AS, Pecoraro M, Zawaideh J, Barentsz J, Giganti F, Padhani AR, Panebianco V, Puech P, Villeirs G. ESR Essentials: using the right scoring system in prostate MRI-practice recommendations by ESUR. Eur Radiol 2024:10.1007/s00330-024-10792-7. [PMID: 38780764 DOI: 10.1007/s00330-024-10792-7] [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: 01/29/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
MRI has gained prominence in the diagnostic workup of prostate cancer (PCa) patients, with the Prostate Imaging Reporting and Data System (PI-RADS) being widely used for cancer detection. Beyond PI-RADS, other MRI-based scoring tools have emerged to address broader aspects within the PCa domain. However, the multitude of available MRI-based grading systems has led to inconsistencies in their application within clinical workflows. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) assesses the likelihood of clinically significant radiological changes of PCa during active surveillance, and the Prostate Imaging for Local Recurrence Reporting (PI-RR) scoring system evaluates the risk of local recurrence after whole-gland therapies with curative intent. Underlying any system is the requirement to assess image quality using the Prostate Imaging Quality Scoring System (PI-QUAL). This article offers practicing radiologists a comprehensive overview of currently available scoring systems with clinical evidence supporting their use for managing PCa patients to enhance consistency in interpretation and facilitate effective communication with referring clinicians. KEY POINTS: Assessing image quality is essential for all prostate MRI interpretations and the PI-QUAL score represents the standardized tool for this purpose. Current urological clinical guidelines for prostate cancer diagnosis and localization recommend adhering to the PI-RADS recommendations. The PRECISE and PI-RR scoring systems can be used for assessing radiological changes of prostate cancer during active surveillance and the likelihood of local recurrence after radical treatments respectively.
Collapse
Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | | | - Ana Sofia Moreira
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Unidade de Faro, Faro, Portugal
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Jeries Zawaideh
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Jelle Barentsz
- Imaging Department Andros Clinics, Arnhem, The Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Philippe Puech
- Department of radiology, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille Inserm, CHU Lille, Lille, France
| | - Geert Villeirs
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
8
|
Jin L, Yu Z, Gao F, Li M. T2-weighted imaging-based deep-learning method for noninvasive prostate cancer detection and Gleason grade prediction: a multicenter study. Insights Imaging 2024; 15:111. [PMID: 38713377 PMCID: PMC11076444 DOI: 10.1186/s13244-024-01682-z] [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: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To noninvasively detect prostate cancer and predict the Gleason grade using single-modality T2-weighted imaging with a deep-learning approach. METHODS Patients with prostate cancer, confirmed by histopathology, who underwent magnetic resonance imaging examinations at our hospital during September 2015-June 2022 were retrospectively included in an internal dataset. An external dataset from another medical center and a public challenge dataset were used for external validation. A deep-learning approach was designed for prostate cancer detection and Gleason grade prediction. The area under the curve (AUC) was calculated to compare the model performance. RESULTS For prostate cancer detection, the internal datasets comprised data from 195 healthy individuals (age: 57.27 ± 14.45 years) and 302 patients (age: 72.20 ± 8.34 years) diagnosed with prostate cancer. The AUC of our model for prostate cancer detection in the validation set (n = 96, 19.7%) was 0.918. For Gleason grade prediction, datasets comprising data from 283 of 302 patients with prostate cancer were used, with 227 (age: 72.06 ± 7.98 years) and 56 (age: 72.78 ± 9.49 years) patients being used for training and testing, respectively. The external and public challenge datasets comprised data from 48 (age: 72.19 ± 7.81 years) and 91 patients (unavailable information on age), respectively. The AUC of our model for Gleason grade prediction in the training set (n = 227) was 0.902, whereas those of the validation (n = 56), external validation (n = 48), and public challenge validation sets (n = 91) were 0.854, 0.776, and 0.838, respectively. CONCLUSION Through multicenter dataset validation, our proposed deep-learning method could detect prostate cancer and predict the Gleason grade better than human experts. CRITICAL RELEVANCE STATEMENT Precise prostate cancer detection and Gleason grade prediction have great significance for clinical treatment and decision making. KEY POINTS Prostate segmentation is easier to annotate than prostate cancer lesions for radiologists. Our deep-learning method detected prostate cancer and predicted the Gleason grade, outperforming human experts. Non-invasive Gleason grade prediction can reduce the number of unnecessary biopsies.
Collapse
Affiliation(s)
- Liang Jin
- Radiology Department, Huashan Hospital, Affiliated with Fudan University, Shanghai, 200040, China
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040, China
| | - Zhuo Yu
- School of Information and Safety Engineering, Zhongnan University of Economics and Law, Wuhan, China
| | - Feng Gao
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040, China
| | - Ming Li
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040, China.
- Institute of Functional and Molecular Medical Imaging, Shanghai, 200040, China.
| |
Collapse
|
9
|
Chen Y, Meng T, Cao W, Zhang W, Ling J, Wen Z, Qian L, Guo Y, Lin J, Wang H. Histogram analysis of MR quantitative parameters: are they correlated with prognostic factors in prostate cancer? Abdom Radiol (NY) 2024; 49:1534-1544. [PMID: 38546826 DOI: 10.1007/s00261-024-04227-6] [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: 11/15/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE To investigate the correlation between quantitative MR parameters and prognostic factors in prostate cancer (PCa). METHOD A total of 186 patients with pathologically confirmed PCa who underwent preoperative multiparametric MRI (mpMRI), including synthetic MRI (SyMRI), were enrolled from two medical centers. The histogram metrics of SyMRI [T1, T2, proton density (PD)] and apparent diffusion coefficient (ADC) values were extracted. The Mann‒Whitney U test or Student's t test was employed to determine the association between these histogram features and the prognostically relevant factors. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the differentiation performance. Spearman's rank correlation coefficients were calculated to determine the correlations between histogram parameters and the International Society of Urological Pathology (ISUP) grade group as well as pathological T stage. RESULTS Significant correlations were found between the histogram parameters and the ISUP grade as well as pathological T stage of PCa. Among these histogram parameters, ADC_minimum had the strongest correlation with the ISUP grade (r = - 0.481, p < 0.001), and ADC_Median showed the strongest association with pathological T stage (r = - 0.285, p = 0.008). The ADC_10th percentile exhibited the highest performance in identifying clinically significant prostate cancer (csPCa) (AUC 0.833; 95% CI 0.771-0.883). When discriminating between the status of different prognostically relevant factors, a significant difference was observed between extraprostatic extension-positive and -negative cancers with regard to histogram parameters of the ADC map (10th percentile, 90th percentile, mean, median, minimum) and T1 map (minimum) (p = 0.002-0.032). Moreover, histogram parameters of the ADC map (90th percentile, maximum, mean, median), T2 map (10th percentile, median), and PD map (10th percentile, median) were significantly lower in PCa with perineural invasion (p = 0.009-0.049). The T2 values were significantly lower in patients with seminal vesicle invasion (minimum, p = 0.036) and positive surgical margin (10th percentile, 90th percentile, mean, median, and minimum, p = 0.015-0.025). CONCLUSION Quantitative histogram parameters derived from synthetic MRI and ADC maps may have great potential for predicting the prognostic features of PCa.
Collapse
Affiliation(s)
- Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Tiebao Meng
- Department of Radiology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, Guangdong, People's Republic of China
| | - Wenxin Cao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Weijing Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, Guangdong, People's Republic of China
| | - Jian Ling
- Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, No.183 Huangpu Eastern Road, Guangzhou, Guangdong, People's Republic of China
| | - Zhihua Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Long Qian
- MR Research, GE Healthcare, Beijing, People's Republic of China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
| | - Jinhua Lin
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China.
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
| |
Collapse
|
10
|
de Oliveira Correia ET, Purysko AS, Paranhos BM, Shoag JE, Padhani AR, Bittencourt LK. PI-RADS Upgrading Rules: Impact on Prostate Cancer Detection and Biopsy Avoidance of MRI-Directed Diagnostic Pathways. AJR Am J Roentgenol 2024; 222:e2330611. [PMID: 38353450 DOI: 10.2214/ajr.23.30611] [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] [Indexed: 02/22/2024]
Abstract
BACKGROUND. PI-RADS incorporates rules by which ancillary sequence findings upgrade a dominant score to a higher final category. Evidence on the upgrading rules' impact on diagnostic pathways remains scarce. OBJECTIVE. The purpose of this article was to evaluate the clinical net benefit of the PI-RADS upgrading rules in MRI-directed diagnostic pathways. METHODS. This study was a retrospective analysis of a prospectively maintained clinical registry. The study included patients without known prostate cancer who underwent prostate MRI followed by prostate biopsy from January 2016 to May 2020. Clinically significant prostate cancer (csPCa) was defined as International Society of Urological Pathology (ISUP) grade group 2 and higher. csPCa detection was compared between dominant (i.e., no upgrade rule applied) and upgraded lesions. Decision-curve analysis was used to compare the net benefit, considering the trade-off of csPCa detection and biopsy avoidance, of MRI-directed pathways in scenarios considering and disregarding PI-RADS upgrading rules. These included a biopsy-all pathway, MRI-focused pathway (no biopsy for PI-RADS ≤ 2), and risk-based pathway (use of PSA density ≥ 0.15 ng/mL2 to select patients with PI-RADS ≤ 3 for biopsy). RESULTS. The sample comprised 716 patients (mean age, 64.9 years; 93 with a PI-RADS ≤ 2 examination, 623 with total of 780 PI-RADS ≥ 3 lesions). Frequencies of csPCa were not significantly different between dominant and upgraded PI-RADS 3 transition zone lesions (20% vs 19%, respectively), dominant and upgraded PI-RADS 4 transition zone lesions (33% vs 26%), and dominant and upgraded PI-RADS 4 peripheral zone lesions (58% vs 45%) (p > .05). In the biopsy-all, per-guideline MRI-focused, MRI-focused disregarding upgrading rules, per-guideline risk-based, and risk-based disregarding upgrading rules pathways, csPCa frequency was 53%, 52%, 51%, 52%, and 48% and biopsy avoidance was 0%, 13%, 16%, 19%, and 25%, respectively. Disregarding upgrading rules yielded 5.5 and 1.9 biopsies avoided per missed csPCa for MRI-focused and risk-based pathways, respectively. At probability thresholds for biopsy selection of 7.5-30.0%, net benefit was highest for the per-guideline risk-based pathway. CONCLUSION. Disregarding PI-RADS upgrading rules reduced net clinical bene fit of the risk-based MRI-directed diagnostic pathway when considering trade-offs between csPCa detection and biopsy avoidance. CLINICAL IMPACT. This study supports the application of PI-RADS upgrading rules to optimize biopsy selection, particularly in risk-based pathways.
Collapse
Affiliation(s)
| | - Andrei S Purysko
- Department of Radiology, Abdominal Imaging Section, Cleveland Clinic, Cleveland, OH
| | - Bruno Merz Paranhos
- Department of Radiology, Diagnosticos da America S.A, Rio de Janeiro, Brazil
| | - Jonathan E Shoag
- Case Western Reserve University, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
- Department of Urology, Weill Cornell Medicine, New York, NY
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, United Kingdom
| | - Leonardo K Bittencourt
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, Ohio 44106
- Case Western Reserve University, Cleveland, OH
| |
Collapse
|
11
|
Pylväläinen J, Hoffström J, Kenttämies A, Auvinen A, Mirtti T, Rannikko A. Risk of Clinically Significant Prostate Cancer after a Nonsuspicious Prostate MRI-A Comparison with the General Population. Cancer Epidemiol Biomarkers Prev 2024; 33:749-756. [PMID: 38270536 PMCID: PMC11061604 DOI: 10.1158/1055-9965.epi-23-1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND We compare the risk of clinically significant (csPCa; ISUP Grade Group ≥ 2) and insignificant prostate cancer (isPCa; ISUP Grade Group 1) in men with a nonsuspicious prostate MRI (nMRI; PI-RADS ≤ 2) with the general population, and assess the value of PSA density (PSAD) in stratification. METHODS In this retrospective population-based cohort study we identified 1,682 50-79-year-old men, who underwent nMRI at HUS (2016-2019). We compared their age-standardized incidence rates (IR) of csPCa and the odds of isPCa to a local age- and sex-matched general population (n = 230,458) during a six-year follow-up. Comparisons were performed by calculating incidence rate ratios (IRR) and ORs with 95% confidence intervals (CI). We repeated the comparison for the 920 men with nMRI and PSAD < 0.15 ng/mL/cm3. RESULTS Compared with the general population, the IR of csPCa was significantly higher after nMRI [1,852 vs. 552 per 100,000 person-years; IRR 3.4 (95% CI, 2.8-4.1)]. However, the IR was substantially lower if PSAD was low [778 per 100,000 person-years; IRR 1.4 (95% CI, 0.9-2.0)]. ORs for isPCa were 2.4 (95% CI, 1.7-3.5) for all men with nMRI and 5.0 (95% CI, 2.8-9.1) if PSAD was low. CONCLUSIONS Compared with the general population, the risk of csPCa is not negligible after nMRI. However, men with nMRI and PSAD <0.15 ng/mL/cm3 have worse harm-benefit balance than men in the general population. IMPACT Prostate biopsies for men with nMRI should be reserved for cases indicated by additional risk stratification. See related In the Spotlight, p. 641.
Collapse
Affiliation(s)
- Juho Pylväläinen
- Department of Radiology, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaakko Hoffström
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anu Kenttämies
- Department of Radiology, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| | - Anssi Auvinen
- Tampere University, Faculty of Social Sciences, Tampere, Finland
| | - Tuomas Mirtti
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN-Digital Precision Cancer Medicine Flagship, Helsinki, Finland
- Department of Pathology, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Biomedical Engineering, School of Medicine, Emory University Atlanta, Georgia
| | - Antti Rannikko
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Tampere University, Faculty of Social Sciences, Tampere, Finland
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
12
|
Mombiela RM. Editorial Comment: Can Decision-Analytic Techniques Help Clinicians Make Better Decisions Regarding Different Diagnostic Pathways? AJR Am J Roentgenol 2024; 222:e2431015. [PMID: 38380857 DOI: 10.2214/ajr.24.31015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
|
13
|
Okano K, Miyai K, Mikoshi A, Edo H, Ito K, Tsuda H, Shinmoto H. Histological parameters and stromal desmoplastic status affecting accurate diagnosis of extraprostatic extension of prostate cancer using multi-parametric magnetic resonance imaging. Int J Urol 2024; 31:475-482. [PMID: 38193247 DOI: 10.1111/iju.15385] [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: 09/27/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To investigate the clinicopathological factors affecting discrepancies between multi-parametric magnetic resonance imaging (mpMRI) and histopathological evaluation for diagnosis of extraprostatic extension (EPE) of prostate cancer. METHODS One hundred-and-three lesions from 96 cases with suspected EPE on preoperative mpMRI, of which 60 and 43 showed bulging and frank capsular breach, respectively, were grouped according to pathological (p)EPE in radical prostatectomy specimens. Additionally, clinicopathological/immunohistochemical findings for periostin reflecting a desmoplastic stromal reaction were compared between these groups. RESULTS pEPE was detected in 49 (48%) of the 103 lesions. Of these, 25 (42%) showed bulging and 24 (56%) showed frank capsular breach on MRI. In the total cohort, the absence of pEPE was significantly associated with a lower Gleason Grade Group (GG) (p < 0.0001), anterior location (p = 0.003), absence of intraductal carcinoma of the prostate (IDC-P) (p = 0.026), and high stromal periostin expression (p < 0.0001). These trends were preserved in subgroups defined by MRI findings, except for anterior location/IDC-P in the bulging subgroup. CONCLUSIONS GG, anterior location, and periostin expression may cause mpMRI-pathological discrepancies regarding EPE. Periostin expression was a significant pEPE-negative factor in all subgroup analyses. Our results indicate that patients with suspected EPE on MRI, regardless of their pEPE results, should be followed as carefully as those with definite pEPE.
Collapse
Affiliation(s)
- Kousuke Okano
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kosuke Miyai
- Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ayako Mikoshi
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiromi Edo
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| |
Collapse
|
14
|
Hamm CA, Baumgärtner GL, Padhani AR, Froböse KP, Dräger F, Beetz NL, Savic LJ, Posch H, Lenk J, Schallenberg S, Maxeiner A, Cash H, Günzel K, Hamm B, Asbach P, Penzkofer T. Reduction of false positives using zone-specific prostate-specific antigen density for prostate MRI-based biopsy decision strategies. Eur Radiol 2024:10.1007/s00330-024-10700-z. [PMID: 38538841 DOI: 10.1007/s00330-024-10700-z] [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: 11/03/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES To develop and test zone-specific prostate-specific antigen density (sPSAD) combined with PI-RADS to guide prostate biopsy decision strategies (BDS). METHODS This retrospective study included consecutive patients, who underwent prostate MRI and biopsy (01/2012-10/2018). The whole gland and transition zone (TZ) were segmented at MRI using a retrained deep learning system (DLS; nnU-Net) to calculate PSAD and sPSAD, respectively. Additionally, sPSAD and PI-RADS were combined in a BDS, and diagnostic performances to detect Grade Group ≥ 2 (GG ≥ 2) prostate cancer were compared. Patient-based cancer detection using sPSAD was assessed by bootstrapping with 1000 repetitions and reported as area under the curve (AUC). Clinical utility of the BDS was tested in the hold-out test set using decision curve analysis. Statistics included nonparametric DeLong test for AUCs and Fisher-Yates test for remaining performance metrics. RESULTS A total of 1604 patients aged 67 (interquartile range, 61-73) with 48% GG ≥ 2 prevalence (774/1604) were evaluated. By employing DLS-based prostate and TZ volumes (DICE coefficients of 0.89 (95% confidence interval, 0.80-0.97) and 0.84 (0.70-0.99)), GG ≥ 2 detection using PSAD was inferior to sPSAD (AUC, 0.71 (0.68-0.74)/0.73 (0.70-0.76); p < 0.001). Combining PI-RADS with sPSAD, GG ≥ 2 detection specificity doubled from 18% (10-20%) to 43% (30-44%; p < 0.001) with similar sensitivity (93% (89-96%)/97% (94-99%); p = 0.052), when biopsies were taken in PI-RADS 4-5 and 3 only if sPSAD was ≥ 0.42 ng/mL/cc as compared to all PI-RADS 3-5 cases. Additionally, using the sPSAD-based BDS, false positives were reduced by 25% (123 (104-142)/165 (146-185); p < 0.001). CONCLUSION Using sPSAD to guide biopsy decisions in PI-RADS 3 lesions can reduce false positives at MRI while maintaining high sensitivity for GG ≥ 2 cancers. CLINICAL RELEVANCE STATEMENT Transition zone-specific prostate-specific antigen density can improve the accuracy of prostate cancer detection compared to MRI assessments alone, by lowering false-positive cases without significantly missing men with ISUP GG ≥ 2 cancers. KEY POINTS • Prostate biopsy decision strategies using PI-RADS at MRI are limited by a substantial proportion of false positives, not yielding grade group ≥ 2 prostate cancer. • PI-RADS combined with transition zone (TZ)-specific prostate-specific antigen density (PSAD) decreased the number of unproductive biopsies by 25% compared to PI-RADS only. • TZ-specific PSAD also improved the specificity of MRI-directed biopsies by 9% compared to the whole gland PSAD, while showing identical sensitivity.
Collapse
Affiliation(s)
- Charlie A Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
| | - Georg L Baumgärtner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Konrad P Froböse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Franziska Dräger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nick L Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Lynn J Savic
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Helena Posch
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon Schallenberg
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Germany and PROURO, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| |
Collapse
|
15
|
Yakut E. The impact of the relationship between lesion diameter and total core length on the detection rate of clinically significant prostate cancer for PI-RADS 3 lesions. World J Urol 2024; 42:162. [PMID: 38488892 PMCID: PMC10942878 DOI: 10.1007/s00345-024-04845-1] [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: 05/10/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The aim of our study was to determine the effect of total core length (TCL) for prostate imaging reporting and data system (PI-RADS) 3 lesions to facilitate clinically significant prostate cancer (csPCa) detection based on the lesion diameter. MATERIALS AND METHODS A total of 149 patients with at least 1 lesion with a PI-RADS 3 were evaluated retrospectively. The lesions with diameters of < 1 cm were categorized as small lesions and lesions of ≥ 1 cm were categorized as large lesions. The lengths of biopsy cores from PI-RADS 3 lesions were summed for each lesion separately, and TCL was calculated. The relationship between TCL and csPCa was analyzed separately for the small and large groups with multiple logistic regression analyses. RESULTS A total of 208 lesions were detected by multiparametric magnetic resonance imaging (MpMRI) in 149 males included in the study. The mean TCL was 44.68 mm (26-92) and the mean lesion diameter was 10.73 mm (4-27) in PIRADS 3 lesions. For small diameter lesions (< 1 cm), the odds of finding clinically insignificant prostate cancer (ciPCa) increase by 1.67 times if TCL increases by one unit. Hence, increasing TCL for small lesions only increases the odds of ciPCa detection. For large diameter lesions (≥ 1 cm), if TCL increases by one unit, the odds of finding ciPCa increase 1.13 times and the odds of finding csPCa increases1.16 times. Accordingly, large lesions are more likely to have both csPCa and ciPCa as TCL increases. CONCLUSIONS Our study showed that for PI-RADS 3 lesions, both more csPCa and more ciPCa were detected as TCL increased. However, in lesions with a size of < 1 cm, only ciPCa was detected more frequently as TCL increased. In conclusion, taking more and longer biopsy cores in PI-RADS 3 lesions below 1 cm does not contribute to the detection of csPCa.
Collapse
Affiliation(s)
- Emrah Yakut
- Department of Urology, Yuksek Ihtisas University, İşçi Blokları, 1588. Cd. No: 18/A, 06520, Çankaya, Ankara, Turkey.
| |
Collapse
|
16
|
Ozbozduman K, Loc I, Durmaz S, Atasoy D, Kilic M, Yildirim H, Esen T, Vural M, Unlu MB. Machine learning prediction of Gleason grade group upgrade between in-bore biopsy and radical prostatectomy pathology. Sci Rep 2024; 14:5849. [PMID: 38462645 PMCID: PMC10925603 DOI: 10.1038/s41598-024-56415-5] [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: 12/30/2023] [Accepted: 03/06/2024] [Indexed: 03/12/2024] Open
Abstract
This study aimed to enhance the accuracy of Gleason grade group (GG) upgrade prediction in prostate cancer (PCa) patients who underwent MRI-guided in-bore biopsy (MRGB) and radical prostatectomy (RP) through a combined analysis of prebiopsy and MRGB clinical data. A retrospective analysis of 95 patients with prostate cancer diagnosed by MRGB was conducted where all patients had undergone RP. Among the patients, 64.2% had consistent GG results between in-bore biopsies and RP, whereas 28.4% had upgraded and 7.4% had downgraded results. GG1 biopsy results, lower biopsy core count, and fewer positive cores were correlated with upgrades in the entire patient group. In patients with GG > 1 , larger tumor sizes and fewer biopsy cores were associated with upgrades. By integrating MRGB data with prebiopsy clinical data, machine learning (ML) models achieved 85.6% accuracy in predicting upgrades, surpassing the 64.2% baseline from MRGB alone. ML analysis also highlighted the value of the minimum apparent diffusion coefficient ( ADC min ) for GG > 1 patients. Incorporation of MRGB results with tumor size, ADC min value, number of biopsy cores, positive core count, and Gleason grade can be useful to predict GG upgrade at final pathology and guide patient selection for active surveillance.
Collapse
Affiliation(s)
| | - Irem Loc
- Bogazici University Physics Department, Istanbul, Turkey
| | - Selahattin Durmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Duygu Atasoy
- Department of Radiology, University of Koc School of Medicine, Istanbul, Turkey
| | - Mert Kilic
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Hakan Yildirim
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Tarik Esen
- Department of Urology, VKF American Hospital, Istanbul, Turkey
- Department of Urology, University of Koc School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - M Burcin Unlu
- Faculty of Engineering, Ozyegin University, Istanbul, Turkey
- Faculty of Aviation and Aeronautical Sciences Ozyegin University, Istanbul, Turkey
| |
Collapse
|
17
|
Boschheidgen M, Albers P, Schlemmer HP, Hellms S, Bonekamp D, Sauter A, Hadaschik B, Krilaviciute A, Radtke JP, Seibold P, Lakes J, Arsov C, Gschwend JE, Herkommer K, Makowski M, Kuczyk MA, Wacker F, Harke N, Debus J, Körber SA, Benner A, Kristiansen G, Giesel FL, Antoch G, Kaaks R, Becker N, Schimmöller L. Multiparametric Magnetic Resonance Imaging in Prostate Cancer Screening at the Age of 45 Years: Results from the First Screening Round of the PROBASE Trial. Eur Urol 2024; 85:105-111. [PMID: 37863727 DOI: 10.1016/j.eururo.2023.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/05/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been suggested as a tool for guiding biopsy recommendations in prostate cancer (PC) screening. OBJECTIVE To determine the performance of multiparametric MRI (mpMRI) in young men at age 45 yr who participated in a PC screening trial (PROBASE) on the basis of baseline prostate-specific antigen (PSA). DESIGN, SETTING, AND PARTICIPANTS Participants with confirmed PSA ≥3 ng/ml were offered mpMRI followed by MRI/transrectal ultrasound fusion biopsy (FBx) with targeted and systematic cores. mpMRI scans from the first screening round for men randomised to an immediate PSA test in PROBASE were evaluated by local readers and then by two reference radiologists (experience >10 000 prostate MRI examinations) blinded to the histopathology. The PROBASE trial is registered as ISRCTN37591328 OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The local and reference Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and the sensitivity, negative predictive value (NPV), and accuracy were calculated for both readings for different cutoffs (PI-RADS 3 vs 4). RESULTS AND LIMITATIONS Of 186 participants, 114 underwent mpMRI and FBx. PC was detected in 47 (41%), of whom 33 (29%) had clinically significant PC (csPC; International Society of Urological Pathology grade group ≥2). Interobserver reliability between local and reference PI-RADS scores was moderate (k = 0.41). At a cutoff of PI-RADS 4, reference reading showed better performance for csPC detection (sensitivity 79%, NPV 91%, accuracy of 85%) than local reading (sensitivity 55%, NPV 80%, accuracy 68%). Reference reading did not miss any PC cases for a cutoff of PI-RADS <3. If PI-RADS ≥4 were to be used as a biopsy cutoff, mpMRI would reduce negative biopsies by 68% and avoid detection of nonsignificant PC in 71% of cases. CONCLUSIONS Prostate MRI in a young screening population is difficult to read. The MRI accuracy of for csPC detection is highly dependent on reader experience, and double reading might be advisable. More data are needed before MRI is included in PC screening for men at age 45 yr. PATIENT SUMMARY Measurement of prostate specific antigen (PSA) is an effective screening test for early detection of prostate cancer (PC) and can reduce PC-specific deaths, but it can also lead to unnecessary biopsies and treatment. Magnetic resonance imaging (MRI) after a positive PSA test has been proposed as a way to reduce the number of biopsies, with biopsy only recommended for men with suspicious MRI findings. Our results indicate that MRI accuracy is moderate for men aged 45 years but can be increased by a second reading of the images by expert radiologists. For broad application of MRI in routine screening, double reading may be advisable.
Collapse
Affiliation(s)
- Matthias Boschheidgen
- Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - Peter Albers
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Susanne Hellms
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (dktk), University Hospital Essen, Essen, Germany
| | - Agne Krilaviciute
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Philipp Radtke
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany
| | - Petra Seibold
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jale Lakes
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany
| | - Christian Arsov
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Department of Urology and Paediatric Urology, Elisabeth-Krankenhaus Rheydt, Städtische Kliniken Mönchengladbach GmbH, Mönchengladbach, Germany
| | - Jürgen E Gschwend
- Department of Urology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Marcus Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus A Kuczyk
- Department of Urology, Medical University Hannover, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Nina Harke
- Department of Urology, Medical University Hannover, Hannover, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany
| | - Stefan A Körber
- Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Frederik L Giesel
- University Dusseldorf, Medical Faculty, Department of Nuclear Medicine, D-40225 Dusseldorf, Germany
| | - Gerald Antoch
- Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Düsseldorf (CIO ABCD), Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolaus Becker
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lars Schimmöller
- Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
| |
Collapse
|
18
|
Rezaee ME, Macura KJ, Trock BJ, Herati A, Pavlovich CP, Han M, Stoianovici D. Likelihood of sampling prostate cancer at systematic biopsy as a function of gland volume and number of cores. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00780-1. [PMID: 38184758 DOI: 10.1038/s41391-023-00780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Pre-biopsy multiparametric magnetic resonance imaging (mpMRI) of the prostate is used to conduct targeted prostate biopsy (TB), guided by ultrasound and registered (fused) to the MRI. Systematic biopsy (SB) continues to be used together with TB or in mpMRI-negative patients. There is insufficient evidence on how to use SB to inform clinical decision-making in the mpMRI era. The purpose of this study was to estimate the effect of prostate volume and number of SB cores on sampling clinically significant prostate cancer (csPCa) using a simulation method based on clinical data. METHODS SBs were simulated using data from 42 patients enrolled in a transrectal ultrasound robot-assisted biopsy trial. Linear mixed models were used to examine the relationship between the number of SB cores and prostate volume on 1) clinically significant cancer detection probability (csCDP) and 2) percent of mpMRI depicted regions of interest (ROIs) sampled with the SB. RESULTS Median values and interquartile range (IQR) were 47.16 cm3 (35.61-65.57) for prostate volume, 0.57 cm3 (0.39-0.83) for ROI volume, and 4.0 (2-4) for PI-RADS v2.1 scores on MRI. csCDP increased with the increasing number of simulated SB cores and decreased substantially with larger prostate volume. Similarly, the percent of ROIs sampled increased with the increasing number of simulated SB cores and was lower for prostate volumes ≥60 cm3 compared to glands <60 cm3. CONCLUSIONS The effect of the number of SBs performed on detecting csPCa varies largely with gland volume. The common 12-core SB can achieve adequate cancer detection and sampling of ROIs in smaller glands, but not in larger glands. In addition to TB or in mpMRI-negative patients, the number of SB cores can be adjusted to prostate volume. Performing 12-core SB alone in ≥60 cm3 glands results in inadequate sampling and potential PCa underdiagnosis.
Collapse
Affiliation(s)
- Michael E Rezaee
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katarzyna J Macura
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce J Trock
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amin Herati
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Misop Han
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dan Stoianovici
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
19
|
Adamo DA, Greenwood BM, Ghanouni P, Arora S. MR Imaging-Guided Prostate Cancer Therapies. Radiol Clin North Am 2024; 62:121-133. [PMID: 37973238 DOI: 10.1016/j.rcl.2023.06.012] [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] [Indexed: 11/19/2023]
Abstract
Prostate cancer is the most common malignancy diagnosed in men. MR imaging-guided therapies for prostate cancer have become an increasingly common treatment alternative to traditional whole-gland therapies, such as radical prostatectomy or radiation therapy. This is especially true in men with localized, low- to intermediate-risk prostate cancer. Although long-term oncologic data remain limited, the authors describe several MR imaging-guided therapeutic options for the treatment of prostate cancer, including cryoablation, laser ablation, transrectal high-intensity focused ultrasound, and transurethral ultrasound ablation.
Collapse
Affiliation(s)
- Daniel A Adamo
- Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | | | - Pejman Ghanouni
- Department of Radiology, Stanford University, Lucas Center for Imaging, 1201 Welch Road, Room P267, Stanford, CA 94305, USA
| | - Sandeep Arora
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, 330 Cedar Street, TE-2, PO Box 208042, New Haven, CT 06520-8042, USA.
| |
Collapse
|
20
|
Pausch AM, Ghafoor S, Kluckert J, Rupp NJ, Eberli D, Hötker AM. Risk factors for prostate cancer in men with false-negative mpMRI: A retrospective single center cohort study of image quality scores and clinical parameters. Eur J Radiol 2024; 170:111227. [PMID: 38039782 DOI: 10.1016/j.ejrad.2023.111227] [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: 11/02/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To identify predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in men with prior false-negative multiparametric MRI (mpMRI), focusing on image quality scoring systems and clinical parameters. METHODS In this IRB-approved retrospective single-center study, patients with a negative mpMRI (PI-RADS score ≤2) and subsequent prostate biopsies were included. Histopathological results served as reference standard. Welch's t-Test was conducted to identify significant differences in image quality scores (PI-QUAL and PSHS) between patients with and without PCa/csPCA. In addition, clinical parameters (age, BMI, PSA density) and image quality scores (PI-QUAL and PSHS) were examined as potential predictors of PCa/csPCa detection after a false-negative mpMRI in uni- and multivariate analyses. RESULTS Among 96 patients with negative mpMRI results, 44.8 % had PCa and 16.7 % had csPCa upon biopsy with histopathological confirmation. PI-QUAL scores were significantly lower in patients with PCa (p = 0.03) and csPCa (p = 0.005). PSHS scores were lower in patients with csPCa, but the difference was not statistically significant (p = 0.1). Higher age (p = 0.035) and a lower PI-QUAL score (p < 0.004) were predictors of subsequent csPCa detection upon biopsy, however, a lower PI-QUAL score was the only independent predictor of missed csPCa in false-negative mpMRIs. CONCLUSIONS Lower image quality scores were associated with missed PCa/csPCa in patients with false-negative mpMRIs, with PI-QUAL being an independent predictor of failed csPCa detection. This highlights the importance of image quality for prostate MRI and advocats the inclusion of its measurement into the standardized report.
Collapse
Affiliation(s)
- Antonia M Pausch
- Diagnostic and Interventional Radiology, University Hospital, Zurich, Switzerland
| | - Soleen Ghafoor
- Diagnostic and Interventional Radiology, University Hospital, Zurich, Switzerland
| | - Jonas Kluckert
- Diagnostic and Interventional Radiology, University Hospital, Zurich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital, Zurich, Switzerland
| | - Andreas M Hötker
- Diagnostic and Interventional Radiology, University Hospital, Zurich, Switzerland.
| |
Collapse
|
21
|
Abreu-Gomez J, Lim C, Haider MA. Contemporary Approach to Prostate Imaging and Data Reporting System Score 3 Lesions. Radiol Clin North Am 2024; 62:37-51. [PMID: 37973244 DOI: 10.1016/j.rcl.2023.06.008] [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] [Indexed: 11/19/2023]
Abstract
The aim of this article is to review the technical and clinical considerations encountered with PI-RADS 3 lesions, which are equivocal for clinically significant Prostate Cancer (csPCa) with detection rates ranging between 10% and 35%. The number of PI-RADS 3 lesions reported vary according to several factors including MRI quality and radiologist training/expertise among the most influential. PI-RADS v.2.1 updated definitions for scores 2 and 3 in the PZ and scores 1 and 2 in the TZ is reviewed. The role of DWI role is highlighted in the assessment of the TZ with the possibility of upgrading score 2 lesions to score 3 based on DWI score. Given the increased utilization for prostate MRI, biparametric MRI can be considered as an alternative for low-risk patients where there is a need to rule out csPCa acknowledging this technique may increase the number of indeterminate cases going for biopsies. Management of patients with equivocal lesions at mpMRI and factors influencing biopsy decision process remain as an unmet need and additional studies using molecular/imaging markers as well as artificial intelligence tools are needed to further address their role in proper patient selection for biopsy.
Collapse
Affiliation(s)
- Jorge Abreu-Gomez
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Avenue, Suite 3-920, Toronto, ON M5G 2M9, Canada.
| | - Christopher Lim
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AB 279, Toronto, ON M4N 3M5, Canada
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System and the Joint Department of Medical Imaging, Sinai Health System, Princess Margaret Hospital, University of Toronto, 600 University Avenue, Toronto, ON, Canada M5G 1X5
| |
Collapse
|
22
|
Barrett T, Lee KL, de Rooij M, Giganti F. Update on Optimization of Prostate MR Imaging Technique and Image Quality. Radiol Clin North Am 2024; 62:1-15. [PMID: 37973236 DOI: 10.1016/j.rcl.2023.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Prostate MR imaging quality has improved dramatically over recent times, driven by advances in hardware, software, and improved functional imaging techniques. MRI now plays a key role in prostate cancer diagnostic work-up, but outcomes of the MRI-directed pathway are heavily dependent on image quality and optimization. MR sequences can be affected by patient-related degradations relating to motion and susceptibility artifacts which may enable only partial mitigation. In this Review, we explore issues relating to prostate MRI acquisition and interpretation, mitigation strategies at a patient and scanner level, PI-QUAL reporting, and future directions in image quality, including artificial intelligence solutions.
Collapse
Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| |
Collapse
|
23
|
Asbach P. Contrast-medium administration for prostate MRI: yes! Contrast-medium administration can be abandoned. Eur Radiol 2023; 33:8413-8414. [PMID: 37420101 PMCID: PMC10667371 DOI: 10.1007/s00330-023-09766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
24
|
Wang LJ, Jinzaki M, Tan CH, Oh YT, Shinmoto H, Lee CH, Patel NU, Chang SD, Westphalen AC, Kim CK. Use of Imaging and Biopsy in Prostate Cancer Diagnosis: A Survey From the Asian Prostate Imaging Working Group. Korean J Radiol 2023; 24:1102-1113. [PMID: 37899520 PMCID: PMC10613851 DOI: 10.3348/kjr.2023.0644] [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: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To elucidate the use of radiological studies, including nuclear medicine, and biopsy for the diagnosis and staging of prostate cancer (PCA) in clinical practice and understand the current status of PCA in Asian countries via an international survey. MATERIALS AND METHODS The Asian Prostate Imaging Working Group designed a survey questionnaire with four domains focused on prostate magnetic resonance imaging (MRI), other prostate imaging, prostate biopsy, and PCA backgrounds. The questionnaire was sent to 111 members of professional affiliations in Korea, Japan, Singapore, and Taiwan who were representatives of their working hospitals, and their responses were analyzed. RESULTS This survey had a response rate of 97.3% (108/111). The rates of using 3T scanners, antispasmodic agents, laxative drugs, and prostate imaging-reporting and data system reporting for prostate MRI were 21.6%-78.9%, 22.2%-84.2%, 2.3%-26.3%, and 59.5%-100%, respectively. Respondents reported using the highest b-values of 800-2000 sec/mm² and fields of view of 9-30 cm. The prostate MRI examinations per month ranged from 1 to 600, and they were most commonly indicated for biopsy-naïve patients suspected of PCA in Japan and Singapore and staging of proven PCA in Korea and Taiwan. The most commonly used radiotracers for prostate positron emission tomography are prostate-specific membrane antigen in Singapore and fluorodeoxyglucose in three other countries. The most common timing for prostate MRI was before biopsy (29.9%). Prostate-targeted biopsies were performed in 63.8% of hospitals, usually by MRI-ultrasound fusion approach. The most common presentation was localized PCA in all four countries, and it was usually treated with radical prostatectomy. CONCLUSION This survey showed the diverse technical details and the availability of imaging and biopsy in the evaluation of PCA. This suggests the need for an educational program for Asian radiologists to promote standardized evidence-based imaging approaches for the diagnosis and staging of PCA.
Collapse
Affiliation(s)
- Li-Jen Wang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, Chang Gung Medical Foundation, New Taipei, Taiwan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Medical Hospital, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University, School of Medicine, Tokyo, Japan
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, National Health Care Group, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Young Taik Oh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, National Health Care Group, Singapore
| | - Nayana U Patel
- Department of Radiology, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Silvia D Chang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
25
|
Bonaffini PA, De Bernardi E, Corsi A, Franco PN, Nicoletta D, Muglia R, Perugini G, Roscigno M, Occhipinti M, Da Pozzo LF, Sironi S. Towards the Definition of Radiomic Features and Clinical Indices to Enhance the Diagnosis of Clinically Significant Cancers in PI-RADS 4 and 5 Lesions. Cancers (Basel) 2023; 15:4963. [PMID: 37894330 PMCID: PMC10605400 DOI: 10.3390/cancers15204963] [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: 09/07/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Prostate cancer (PC) is the most frequently diagnosed cancer among adult men, and its incidence is increasing worldwide [...].
Collapse
Affiliation(s)
- Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Elisabetta De Bernardi
- Medicine and Surgery Department, Via Cadore, 48, 20900 Monza, MB, Italy
- Interdepartmental Research Centre Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, University of Milano-Bicocca, Via Follereau 3, 20854 Vedano al Lambro, MB, Italy
| | - Andrea Corsi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Paolo Niccolò Franco
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Dario Nicoletta
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Giovanna Perugini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Marco Roscigno
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | | | - Luigi Filippo Da Pozzo
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| |
Collapse
|
26
|
Almansour H, Chernyak V. Revamping Prostate MRI Protocols: From Simple Modifications to Quality Improvement. Radiology 2023; 309:e232398. [PMID: 37815444 DOI: 10.1148/radiol.232398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Haidara Almansour
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tuebingen, Germany (H.A.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C.)
| | - Victoria Chernyak
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tuebingen, Germany (H.A.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C.)
| |
Collapse
|
27
|
Turkbey B. Editorial for "Deep-Learning Models for Detection and Localization of Visible Clinically Significant Prostate Cancer on Multi-Parametric MRI". J Magn Reson Imaging 2023; 58:1082-1083. [PMID: 36661354 DOI: 10.1002/jmri.28609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
- Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
28
|
Giganti F, Ng A, Asif A, Chan VWS, Rossiter M, Nathan A, Khetrapal P, Dickinson L, Punwani S, Brew-Graves C, Freeman A, Emberton M, Moore CM, Allen C, Kasivisvanathan V. Global Variation in Magnetic Resonance Imaging Quality of the Prostate. Radiology 2023; 309:e231130. [PMID: 37815448 DOI: 10.1148/radiol.231130] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background High variability in prostate MRI quality might reduce accuracy in prostate cancer detection. Purpose To prospectively evaluate the quality of MRI scanners taking part in the quality control phase of the global PRIME (Prostate Imaging Using MRI ± Contrast Enhancement) trial using the Prostate Imaging Quality (PI-QUAL) standardized scoring system, give recommendations on how to improve the MRI protocols, and establish whether MRI quality could be improved by these recommendations. Materials and Methods In the prospective clinical trial (PRIME), for each scanner, centers performing prostate MRI submitted five consecutive studies and the MRI protocols (phase I). Submitted data were evaluated in consensus by two expert genitourinary radiologists using the PI-QUAL scoring system that evaluates MRI diagnostic quality using five points (1 and 2 = nondiagnostic; 3 = sufficient; 4 = adequate, 5 = optimal) between September 2021 and August 2022. Feedback was provided for scanners not achieving a PI-QUAL 5 score, and centers were invited to resubmit new imaging data using the modified protocol (phase II). Descriptive comparison of outcomes was made between the MRI scanners, feedback provided, and overall PI-QUAL scores. Results In phase I, 41 centers from 18 countries submitted a total of 355 multiparametric MRI studies from 71 scanners, with nine (13%) scanners achieving a PI-QUAL score of 3, 39 (55%) achieving a score of 4, and 23 (32%) achieving a score of 5. Of the 48 (n = 71 [68%]) scanners that received feedback to improve, the dynamic contrast-enhanced sequences were those that least adhered to the Prostate Imaging Reporting and Data System, version 2.1, criteria (44 of 48 [92%]), followed by diffusion-weighted imaging (20 of 48 [42%]) and T2-weighted imaging (19 of 48 [40%]). In phase II, 36 centers from 17 countries resubmitted revised studies, resulting in a total of 62 (n = 64 [97%]) scanners with a final PI-QUAL score of 5. Conclusion Substantial variation in global prostate MRI acquisition parameters as a measure of quality was observed, particularly with DCE sequences. Basic evaluation and modifications to MRI protocols using PI-QUAL can lead to substantial improvements in quality. Clinical trial registration no. NCT04571840 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Almansour and Chernyak in this issue.
Collapse
Affiliation(s)
- Francesco Giganti
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Alexander Ng
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Aqua Asif
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Vinson Wai-Shun Chan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Marimo Rossiter
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Arjun Nathan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Pramit Khetrapal
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Louise Dickinson
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Shonit Punwani
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Chris Brew-Graves
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Alex Freeman
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Mark Emberton
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Caroline M Moore
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Clare Allen
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Veeru Kasivisvanathan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| |
Collapse
|
29
|
Lee G, Chatterjee A, Harmath C, Karademir I, Engelmann R, Yousuf A, Islam S, Karczmar G, Oto A, Giurcanu M, Antic T, Eggener S. Improving reader accuracy and specificity with the addition of hybrid multidimensional-MRI to multiparametric-MRI in diagnosing clinically significant prostate cancers. Abdom Radiol (NY) 2023; 48:3216-3228. [PMID: 37358605 DOI: 10.1007/s00261-023-03969-z] [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: 02/08/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Compare reader performance when adding the Hybrid Multidimensional-MRI (HM-MRI) map to multiparametric MRI (mpMRI+HM-MRI) versus mpMRI alone and inter-reader agreement in diagnosing clinically significant prostate cancers (CSPCa). METHODS All 61 patients who underwent mpMRI (T2-, diffusion-weighted (DWI), and contrast-enhanced scans) and HM-MRI (with multiple TE/b-value combinations) before prostatectomy or MRI-fused-transrectal ultrasound-guided biopsy between August, 2012 and February, 2020, were retrospectively analyzed. Two experienced readers (R1, R2) and two less-experienced readers (less than 6-year MRI prostate experience) (R3, R4) interpreted mpMRI without/with HM-MRI in the same sitting. Readers recorded the PI-RADS 3-5 score, lesion location, and change in score after adding HM-MRI. Each radiologist's mpMRI+HM-MRI and mpMRI performance measures (AUC, sensitivity, specificity, PPV, NPV, and accuracy) based on pathology, and Fleiss' kappa inter-reader agreement was calculated and compared. RESULTS Per-sextant R3 and R4 mpMRI+HM-MRI accuracy (82% 81% vs. 77%, 71%; p=.006, <.001) and specificity (89%, 88% vs. 84%, 75%; p=.009, <.001) were higher than with mpMRI. Per-patient R4 mpMRI+HM-MRI specificity improved (48% from 7%; p<.001). R1 and R2 mpMRI+HM-MRI specificity per-sextant (80%, 93% vs. 81%, 93%; p=.51,>.99) and per-patient (37%, 41% vs. 48%, 37%; p=.16, .57) remained similar to mpMRI. R1 and R2 per-patient AUC with mpMRI+HM-MRI (0.63, 0.64 vs. 0.67, 0.61; p=.33, .36) remained similar to mpMRI, but R3 and R4 mpMRI+HM-MRI AUC (0.73, 0.62) approached R1 and R2 AUC. Per-patient inter-reader agreement, mpMRI+HM-MRI Fleiss Kappa, was higher than mpMRI (0.36 [95% CI 0.26, 0.46] vs. 0.17 [95% CI 0.07, 0.27]); p=.009). CONCLUSION Adding HM-MRI to mpMRI (mpMRI+HM-MRI) improved specificity and accuracy for less-experienced readers, improving overall inter-reader agreement.
Collapse
Affiliation(s)
- Grace Lee
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA.
| | - Aritrick Chatterjee
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Carla Harmath
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Ibrahim Karademir
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Roger Engelmann
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Ambereen Yousuf
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Salman Islam
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Gregory Karczmar
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Aytekin Oto
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Mihai Giurcanu
- Department of Public Health, University of Chicago, Chicago, Illinois, 60637, USA
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Scott Eggener
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois, 60637, USA
| |
Collapse
|
30
|
Zhang KS, Mayer P, Glemser PA, Tavakoli AA, Keymling M, Rotkopf LT, Meinzer C, Görtz M, Kauczor HU, Hielscher T, Stenzinger A, Bonekamp D, Hohenfellner M, Schlemmer HP. Are T2WI PI-RADS sub-scores of transition zone prostate lesions biased by DWI information? A multi-reader, single-center study. Eur J Radiol 2023; 167:111026. [PMID: 37639843 DOI: 10.1016/j.ejrad.2023.111026] [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: 05/23/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE According to PI-RADS v2.1, T2-weighted imaging (T2WI) is the dominant sequence for transition zone (TZ) lesions. This study aimed to assess, whether diffusion-weighted imaging (DWI) information influences the assignment of T2WI scores. METHOD Out of 283 prostate MRI examinations with correlated biopsy results, fourty-four patients were selected retrospectively: first, 22 patients with a TZ lesion with T2WI and DWI scores ≥ 4, to represent lesions with unequivocal suspicion on T2WI and DWI. Second, 22 additional patients with TZ lesions of similar T2WI appearance but with corresponding DWI score ≤ 3 were added as control. Four residents and one board-certified radiologist each performed two assessments of the included patients: First, only T2WI was available (T2-only read); second, both T2WI and DWI sequences were available (biparametric read). Lesion scores were assessed using Wilcoxon signed-rank test, inter-reader agreement using weighted kappa and Kendall's W statistics, and sensitivity/specificity using McNemar test. RESULTS The T2WI scores were significantly different between the T2-only and biparametric read for 3 out of 4 residents (p ≤ 0.049) but not for the radiologist. The overall PI-RADS scores derived from the two reading sessions differed considerably for 35/220 cases (all readers pooled). Inter-reader agreement was fair for the T2WI and overall PI-RADS scores (mean kappa 0.27-0.30) and moderate for the DWI scores (mean kappa 0.43). CONCLUSIONS For inexperienced readers, assessment of T2WI is variable and potentially biased by availability of DWI information, which can lead to changes of overall PI-RADS score and consequently clinical management. Assessment of T2WI should be performed before reviewing DWI to ensure non-biased interpretation of TZ lesions in the dominant sequence.
Collapse
Affiliation(s)
- Kevin Sun Zhang
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Mayer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Anoshirwan Andrej Tavakoli
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Myriam Keymling
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lukas Thomas Rotkopf
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Clara Meinzer
- Division of Radiology, 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
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany; Heidelberg University Medical School, 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; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| |
Collapse
|
31
|
Lee KL, Kessler DA, Dezonie S, Chishaya W, Shepherd C, Carmo B, Graves MJ, Barrett T. Assessment of deep learning-based reconstruction on T2-weighted and diffusion-weighted prostate MRI image quality. Eur J Radiol 2023; 166:111017. [PMID: 37541181 DOI: 10.1016/j.ejrad.2023.111017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE To evaluate the impact of a commercially available deep learning-based reconstruction (DLR) algorithm with varying combinations of DLR noise reduction settings and imaging parameters on quantitative and qualitative image quality, PI-RADS classification and examination time in prostate T2-weighted (T2WI) and diffusion-weighted (DWI) imaging. METHOD Forty patients were included. Standard-of-care (SoC) prostate MRI sequences including T2WI and DWI were reconstructed without and with different DLR de-noising levels (low, medium, high). In addition, faster T2WI(Fast) and DWI(Fast) sequences, and a higher resolution T2WI(HR) sequence were evaluated. Quantitative analysis included signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) values. Two radiologists performed qualitative analysis, independently evaluating imaging datasets using 5-point scoring scales for image quality and artifacts. PI-RADS category assignment was also performed by the more experienced radiologist. RESULTS All DLR levels resulted in significantly higher SNR and CNR compared to the DLR(off) acquisitions. DLR allowed the acquisition time to be reduced by 33% for T2WI(Fast) and 49% for DWI(Fast) compared to SoC, without affecting image quality, whilst T2WI(HR) with DLR allowed for a 73% increase in spatial resolution in the phase encode direction compared to SoC. The inter-reader agreement for image quality and artifact scores was substantial for all subjective measurements on T2WI and DWI. The T2WI(Fast) protocol with DLR(medium) and DWI(Fast) with DLR(low) received the highest qualitative quality score. CONCLUSION DLR can reduce T2WI and DWI acquisition time and increase SNR and CNR without compromising image quality or altering PI-RADS classification.
Collapse
Affiliation(s)
- Kang-Lung Lee
- Department of Radiology, University of Cambridge, United Kingdom; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | | | - Wellington Chishaya
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Christopher Shepherd
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Bruno Carmo
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Martin J Graves
- Department of Radiology, University of Cambridge, United Kingdom; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, United Kingdom.
| |
Collapse
|
32
|
Feyisetan O, Ezenwa V, Ramadhan M, Al-Hadeyah M, Johnson O, Hayat JN, Ekwueme K. The Predictive Value of Prostate-Specific Antigen Density: A Retrospective Analysis of Likert 3 Multiparametric MRI of the Prostate. Cureus 2023; 15:e45782. [PMID: 37872922 PMCID: PMC10590620 DOI: 10.7759/cureus.45782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Background Many international studies have covered the predictors of prostate cancer, but there is limited information pertaining to Likert 3 MRI scores and the diagnosis of clinically significant prostate cancer (cs-PCa). Therefore, this study aimed to assess the detection rate of significant prostate cancer in men with a Likert 3 score multiparametric MRI (mp-MRI) and the predictive value of prostate-specific antigen (PSA) density in detecting significant prostate cancer. Methods This is a retrospective analysis of patients referred for suspected confined prostate cancer. Inclusion criteria were patients with prostate mp-MRI score of Likert 3 and a prostate biopsy performed. Exclusion criteria included grossly abnormal feeling prostate, no biopsy performed, and an mp-MRI score (Prostate Imaging-Reporting and Data System/Likert) of 1, 2, 4, and 5. cs-PCa was defined as ≥ Gleason 3+4 prostate cancer. PSA density (PSAD) was calculated from MRI estimation of prostate volume. PSAD and histology results were subjected to receiver operating characteristic (ROC) curve analysis with the intention to assess the detection rate of significant prostate cancer in men with Likert 3 mp-MRI and the predictive value of PSAD in detecting significant prostate cancer. Results A total of 819 eligible men had a pre-biopsy mp-MRI scan taken between October 2019 and March 2022. A total of 177 men (21.6%, n = 819) were Likert 3 positive, and 31 did not proceed to take prostate biopsies. A total of 146 patients were included in the study. The median PSAD was 0.19 in men with cs-PCa. Prostate cancer was detected in 42 men (28.8% of the total included set), of which 27 (18.5%) had a Gleason 3+3 prostate cancer and 15 (10.3%) had Gleason ≥ 3+4 prostate cancer. Therefore, 35.7% (n = 42) of biopsy-positive men with Likert 3 mp-MRI had cs-PCa. The ROC curve analysis confirms that PSAD is a predictor of cs-PCa. The optimal PSAD threshold was 0.16 (95% CI: 0.14-0.19), which gives an accuracy of 0.7371, a sensitivity of 0.7333, and a specificity of 0.7375. Conclusion The specificity of PSAD is arguably insufficient for it to stand alone as a decision-making tool when counseling men with equivocal mp-MRI on whether or not to undergo prostate biopsy. A predictive model will need to incorporate other independent risk factors. These may include lesion size, multiplicity, location of lesion(s), and age.
Collapse
Affiliation(s)
| | | | - Mohammed Ramadhan
- Medicine, Ministry of Health, Kuwait, Hawally, KWT
- School of Medical Sciences, The University of Manchester, Manchester, GBR
| | - Merwi Al-Hadeyah
- Medicine, Ministry of Health, Kuwait, Kuwait City, KWT
- School of Medical Sciences, The University of Manchester, Manchester, GBR
| | | | - Jafar N Hayat
- Surgery, Ministry of Health, Kuwait, Kuwait City, KWT
- School of Medical Sciences, The University of Manchester, Manchester, GBR
| | | |
Collapse
|
33
|
Tang S, Li R, Luo T, Huang T, Lu X, Wu X, Dong Y, Wu C, Xu K, Wang Y. Preparation of Gd-doped AuNBP@mSiO 2 nanocomposites for the MR imaging, drug delivery and chemo-photothermal synergistic killing of breast cancer cells. RSC Adv 2023; 13:23976-23983. [PMID: 37577100 PMCID: PMC10413050 DOI: 10.1039/d3ra03753c] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023] Open
Abstract
Under near-infrared (NIR) light, gold nanobipyramids (AuNBPs) exhibit a high photothermal conversion rate and photothermal stability, making them ideal mediators for photothermal therapy (PTT). In this study, highly purified AuNBPs are prepared, followed by coating their surfaces with mesoporous silica (mSiO2). The obtained AuNBP@mSiO2 nanocomplex exhibits an ellipsoidal shape with a relatively large specific surface, pore diameter and pore volume. To achieve MRI guided chemo-photothermal therapy of breast cancer cells, the nanocomplex is further coupled with the MRI contrast agent Gd-DTTA and the chemotherapeutic drug doxorubicin (DOX). The results indicated that under NIR light irradiation, AuNBPs exhibited promising PTT effects, while the cumulative release rate of DOX was significantly enhanced to 81.40%. Moreover, the chemo-photothermal therapy approach effectively eradicated 4T1 breast cancer cells. This work successfully confirms that chemo-photothermal synergistic therapy is an effective tumor treatment strategy and demonstrates the potential application of AuNBP@mSiO2 as a nano-drug delivery platform. Additionally, it introduces new ideas for the integrated study of breast cancer diagnosis and treatment.
Collapse
Affiliation(s)
- Shiyi Tang
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
| | - Ruohan Li
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu 221002 China
| | - Tao Luo
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
| | - Tianhao Huang
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
| | - Xiaotong Lu
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
| | - Xinyao Wu
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
| | - Yulin Dong
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
| | - Changyu Wu
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
| | - Kai Xu
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu 221002 China
| | - Yong Wang
- School of Medical Imaging, Xuzhou Medical University Xuzhou Jiangsu 221004 China
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu 221002 China
| |
Collapse
|
34
|
Yilmaz EC, Belue MJ, Turkbey B, Reinhold C, Choyke PL. A Brief Review of Artificial Intelligence in Genitourinary Oncological Imaging. Can Assoc Radiol J 2023; 74:534-547. [PMID: 36515576 DOI: 10.1177/08465371221135782] [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] [Indexed: 12/15/2022] Open
Abstract
Genitourinary (GU) system is among the most commonly involved malignancy sites in the human body. Imaging plays a crucial role not only in diagnosis of cancer but also in disease management and its prognosis. However, interpretation of conventional imaging methods such as CT or MR imaging (MRI) usually demonstrates variability across different readers and institutions. Artificial intelligence (AI) has emerged as a promising technology that could improve the patient care by providing helpful input to human readers through lesion detection algorithms and lesion classification systems. Moreover, the robustness of these models may be valuable in automating time-consuming tasks such as organ and lesion segmentations. Herein, we review the current state of imaging and existing challenges in GU malignancies, particularly for cancers of prostate, kidney and bladder; and briefly summarize the recent AI-based solutions to these challenges.
Collapse
Affiliation(s)
- Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Caroline Reinhold
- McGill University Health Center, McGill University, Montreal, Canada
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| |
Collapse
|
35
|
Fütterer JJ, Tempany C. Prostate MRI and image quality: The radiologist's perspective. Eur J Radiol 2023; 165:110930. [PMID: 37364484 PMCID: PMC10466385 DOI: 10.1016/j.ejrad.2023.110930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Multiparametric MRI (mpMRI) of the prostate plays an important role in the healthcare pathway of prostate cancer. The implementation of the guidelines resulted in an almost vertical increase in the number of prostate MRI examinations. High image quality is important in the diagnostic pathway of prostate cancer. Standardization of prostate MRI quality using objective and pre-defined criteria is of utmost importance.
Collapse
Affiliation(s)
| | - Clare Tempany
- Department of Radiology, Harvard Medical School, United States
| |
Collapse
|
36
|
Purysko AS, Tempany C, Macura KJ, Turkbey B, Rosenkrantz AB, Gupta RT, Attridge L, Hernandez D, Garcia-Tomkins K, Bhargavan-Chatfield M, Weinreb J, Larson DB. American College of Radiology initiatives on prostate magnetic resonance imaging quality. Eur J Radiol 2023; 165:110937. [PMID: 37352683 PMCID: PMC10461171 DOI: 10.1016/j.ejrad.2023.110937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
Magnetic resonance imaging (MRI) has become integral to diagnosing and managing patients with suspected or confirmed prostate cancer. However, the benefits of utilizing MRI can be hindered by quality issues during imaging acquisition, interpretation, and reporting. As the utilization of prostate MRI continues to increase in clinical practice, the variability in MRI quality and how it can negatively impact patient care have become apparent. The American College of Radiology (ACR) has recognized this challenge and developed several initiatives to address the issue of inconsistent MRI quality and ensure that imaging centers deliver high-quality patient care. These initiatives include the Prostate Imaging Reporting and Data System (PI-RADS), developed in collaboration with an international panel of experts and members of the European Society of Urogenital Radiology (ESUR), the Prostate MR Image Quality Improvement Collaborative, which is part of the ACR Learning Network, the ACR Prostate Cancer MRI Center Designation, and the ACR Appropriateness Criteria. In this article, we will discuss the importance of these initiatives in establishing quality assurance and quality control programs for prostate MRI and how they can improve patient outcomes.
Collapse
Affiliation(s)
- Andrei S Purysko
- Section of Abdominal Imaging and Nuclear Radiology Department, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katarzyna J Macura
- The Russel H. Morgan Department of Radiology and Radiological Science, The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, NCI, NIH, Bethesda, MD, USA
| | | | - Rajan T Gupta
- Departments of Radiology and Surgery and Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | - Jeffrey Weinreb
- Department of Radiology, Yale School of Medicine, New Haven, CT, USA
| | - David B Larson
- Department of Radiology, Stanford University, Stanford, CA, USA
| |
Collapse
|
37
|
Abstract
ABSTRACT The mechanical traits of cancer include abnormally high solid stress as well as drastic and spatially heterogeneous changes in intrinsic mechanical tissue properties. Whereas solid stress elicits mechanosensory signals promoting tumor progression, mechanical heterogeneity is conducive to cell unjamming and metastatic spread. This reductionist view of tumorigenesis and malignant transformation provides a generalized framework for understanding the physical principles of tumor aggressiveness and harnessing them as novel in vivo imaging markers. Magnetic resonance elastography is an emerging imaging technology for depicting the viscoelastic properties of biological soft tissues and clinically characterizing tumors in terms of their biomechanical properties. This review article presents recent technical developments, basic results, and clinical applications of magnetic resonance elastography in patients with malignant tumors.
Collapse
Affiliation(s)
- Jing Guo
- From the Department of Radiology
| | | | | | | |
Collapse
|
38
|
Burk KS, Naik S, Lacson R, Tuncali K, Lee LK, Tempany C, Cole AP, Trinh QD, Kibel AS, Khorasani R. MRI-Targeted, Systematic, or Combined Biopsy for Detecting Clinically Significant Prostate Cancer. J Am Coll Radiol 2023; 20:687-695. [PMID: 37315913 PMCID: PMC10528090 DOI: 10.1016/j.jacr.2023.02.034] [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: 11/22/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of this study was to assess MRI-targeted, systematic, or combined prostate biopsy for diagnosing prostate cancer to identify opportunities for diagnostic accuracy improvement. METHODS This institutional review board-approved, retrospective study, performed at a large, quaternary hospital, included all men undergoing prostate multiparametric MRI (mpMRI) from January 1, 2015, to December 31, 2019, with prostate-specific antigen ≥ 4 ng/mL, biopsy target on mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] 3-5 lesion), and combined targeted and systematic biopsy ≤6 months after MRI. Analysis included the highest grade lesion per patient. The primary outcome was prostate cancer diagnosis by grade group (GG; 1, 2, and ≥3). Secondary outcomes were rates of cancer upgrading by biopsy type and cancer proximity to the targeted biopsy site in patients upgraded by systematic biopsy. RESULTS Two hundred sixty-seven biopsies (267 patients) were included; 94.4% (252 of 267) were biopsy naive. The most suspicious mpMRI lesion was PI-RADS 3 in 18.7% (50 of 267), PI-RADS 4 in 52.4% (140 of 267), and PI-RADS 5 in 28.8% (77 of 267). Prostate cancer was diagnosed in 68.5% (183 of 267): 22.1% (59 of 267) GG 1, 16.1% (43 of 267) GG 2, and 30.3% (81 of 267) GG ≥ 3. Combined biopsy (124 of 267) yielded more GG ≥ 2 prostate cancer diagnoses than systematic (87 of 267) or targeted (110 of 267) biopsy alone. More GG ≥ 2 cancers were upgraded by targeted biopsy than by systematic biopsy (P = .0062). Systematic biopsy upgrades were in close proximity to the targeted biopsy site in 42.1% (24 of 57); GG ≥ 3 cancers 62.5% (15 of 24) constituted most proximal misses. CONCLUSIONS In men with prostate-specific antigen ≥ 4 ng/mL and PI-RADS 3, 4, or 5 lesion on mpMRI, combined biopsy led to more prostate cancer diagnoses than targeted or systematic biopsy alone. Cancers upgraded by systematic biopsy proximal and distant from the targeted biopsy site may indicate opportunities for biopsy and mpMRI improvement, respectively.
Collapse
Affiliation(s)
- Kristine S Burk
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Quality and Safety Officer, Mass General Brigham, Boston, Massachusetts.
| | - Sachin Naik
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Associate Director, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Leslie K Lee
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Director, MRI, Brigham and Women's Hospital, Boston, Massachusetts
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Vice Chair, Radiology Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alexander P Cole
- Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Urological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Urological Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Director, Ambulatory Clinical Operations, and Co-Director, Prostate Cancer Program, Department of Urology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts
| | - Adam S Kibel
- Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Urological Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Chief, Urology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Vice Chair, Quality and Safety, Mass General Brigham; and Director, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
39
|
da Silva ACB, de Toledo LGM, de Carvalho Fernandes R, Ziroldo AR, Sawczyn GV, Alarcon ST, Lewin F. Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System. Ann Surg Oncol 2023; 30:4541-4549. [PMID: 36995451 PMCID: PMC10062252 DOI: 10.1245/s10434-023-13365-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Prostate cancer (PCa) is the most common malignant tumor in males and conventional imaging does not provide accurate primary staging. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) presents superior performance and strongly affects therapeutic choice. OBJECTIVE The aim of this study was to evaluate the impact of PSMA PET, compared with conventional imaging methods, on the therapeutic approach in primary staging scenarios in patients with PCa treated at the Brazilian National Public Health System. METHODS Overall, 35 patients diagnosed with PCa were evaluated using PSMA after conventional staging imaging with multiparametric magnetic resonance (MMR) and/or total abdominal computed tomography (CT) scan and bone scintigraphy (BS). The PCa extension identified by PET was compared with conventional imaging; staging changes and the management impact were then determined. PET comparison with conventional imaging, staging, and decision-making changes was analyzed using descriptive statistics. RESULTS PET revealed local disease (LD) in 15 (42.9%) patients, seminal vesicle invasion (SVI) in 5 (14.3%) patients, pelvic nodal impairment (PNI) in 7 (20%) patients, pelvic and distant nodes in 3 (8.6%) patients, pelvic nodes and bone metastasis in 4 (11.4%) patients, and pelvic and distant nodes and bone metastasis in 1 (2.8%) patient. Staging changes were observed in 60% of patients, with downstaging predominance (76.2%). Volume increase was identified in 11 (31.4%) patients (only 4 related to upstaging, 36.4%). The board changed management decisions for 60% of the patients. The main limitations of this study were the sample size and its retrospective nature. CONCLUSIONS PSMA findings changed the management decisions in more than half of the patients, which made the majority eligible for locoregional treatment and avoided unnecessary procedures in the systemic disease scenario.
Collapse
|
40
|
Park YW, Kang KA, Kim CK, Park SY. Prostate imaging-reporting and data system version 2 has improved biopsy tumor grade accuracy: a single, tertiary institutional experience. Abdom Radiol (NY) 2023; 48:2370-2378. [PMID: 37099184 DOI: 10.1007/s00261-023-03917-x] [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: 10/26/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE To investigate change in prostate biopsy accuracy regarding tumor grade before and after the release of Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) in a single tertiary institution. METHODS We retrospectively evaluated 1191 patients with biopsy-proven prostate cancer (PCa) who had undergone prostate magnetic resonance imaging (MRI) and surgery before (2013 cohort, n = 394) and 5 years after PI-RADSv2 release (2020 cohort, n = 797). The highest tumor grade of each biopsy and surgical specimen was recorded, respectively. We compared concordant, underestimated, and overestimated biopsy rates regarding tumor grade to surgery between two cohorts, respectively. For patients who underwent both prostate MRI and biopsy at our institution, we investigated proportion of pre-biopsy MRI, age, and prostate-specific antigen of patients, and performed logistic regression to analyze which parameters are associated with concordant biopsy. RESULTS Concordant and underestimated biopsy rates were significantly different between two cohorts: Concordance and underestimation rates were 47.2% and 46.3% in 2013 and 54.5% and 36.4% in 2020 (p = .019; p = .003), respectively. Overestimated biopsy rates were similar (p = .993). Proportion of pre-biopsy MRI was significantly higher in 2020 than in 2013 (80.9% versus 4.9%; p < .001), and was independently associated with concordant biopsy results in multivariate analysis (odds ratio = 1.486; 95% confidence interval, 1.057-2.089; p = .022). CONCLUSIONS There was a significant change in proportion of pre-biopsy MRI before and after the release of PI-RADSv2 in patients who underwent surgery for PCa. This change appears to have improved biopsy accuracy regarding tumor grade by reducing underestimation.
Collapse
Affiliation(s)
- Yong Woo Park
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung A Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| |
Collapse
|
41
|
Goh V. Genitourinary Imaging in 2040. Radiology 2023; 307:e230223. [PMID: 37249430 PMCID: PMC10315527 DOI: 10.1148/radiol.230223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Vicky Goh
- From the Department of Cancer Imaging, School of Biomedical
Engineering and Imaging Sciences, King’s College London, SE1 7EH,
United Kingdom; and Department of Radiology, Guy’s & St
Thomas’ NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’
Hospital, Westminster Bridge Rd, London, United Kingdom
| |
Collapse
|
42
|
Weinstein IC, Wu X, Hill A, Brennan D, Omil-Lima D, Basourakos S, Brant A, Lewicki P, Al Hussein Al Awamlh B, Spratt D, Bittencourt LK, Scherr D, Zaorsky NG, Nagar H, Hu J, Barbieri C, Ponsky L, Vickers AJ, Shoag JE. Impact of Magnetic Resonance Imaging Targeting on Pathologic Upgrading and Downgrading at Prostatectomy: A Systematic Review and Meta-analysis. Eur Urol Oncol 2023:S2588-9311(23)00080-9. [PMID: 37236832 DOI: 10.1016/j.euo.2023.04.004] [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: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/28/2023]
Abstract
CONTEXT The evidence supporting multiparametric magnetic resonance imaging (MRI) targeting for biopsy is nearly exclusively based on biopsy pathologic outcomes. This is problematic, as targeting likely allows preferential identification of small high-grade areas of questionable oncologic significance, raising the likelihood of overdiagnosis and overtreatment. OBJECTIVE To estimate the impact of MRI-targeted, systematic, and combined biopsies on radical prostatectomy (RP) grade group concordance. EVIDENCE ACQUISITION PubMed MEDLINE and Cochrane Library were searched from July 2018 to January 2022. Studies that conducted systematic and MRI-targeted prostate biopsies and compared biopsy results with pathology after RP were included. We performed a meta-analysis to assess whether pathologic upgrading and downgrading were influenced by biopsy type and a net-benefit analysis using pooled risk difference estimates. EVIDENCE SYNTHESIS Both targeted only and combined biopsies were less likely to result in upgrading (odds ratio [OR] vs systematic of 0.70, 95% confidence interval [CI] 0.63-0.77, p < 0.001, and 0.50, 95% CI 0.45-0.55, p < 0.001), respectively). Targeted only and combined biopsies increased the odds of downgrading (1.24 (95% CI 1.05-1.46), p = 0.012, and 1.96 (95% CI 1.68-2.27, p < 0.001) compared with systematic biopsies, respectively. The net benefit of targeted and combined biopsies is 8 and 7 per 100 if harms of up- and downgrading are considered equal, but 7 and -1 per 100 if the harm of downgrading is considered twice that of upgrading. CONCLUSIONS The addition of MRI-targeting results in lower rates of upgrading as compared to systematic biopsy at RP (27% vs 42%). However, combined MRI-targeted and systematic biopsies are associated with more downgrading at RP (19% v 11% for combined vs systematic). Strong heterogeneity suggests further research into factors that influence the rates of up- and downgrading and that distinguishes clinically relevant from irrelevant grade changes is needed. Until then, the benefits and harms of combined MRI-targeted and systematic biopsies cannot be fully assessed. PATIENT SUMMARY We reviewed the ability of magnetic resonance imaging (MRI)-targeted biopsies to predict cancer grade at prostatectomy. We found that combined MRI-targeted and systematic biopsies result in more cancers being downgraded than systematic biopsies.
Collapse
Affiliation(s)
- Ilon C Weinstein
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Xian Wu
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Alexander Hill
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Donald Brennan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Danly Omil-Lima
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Spyridon Basourakos
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Aaron Brant
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Patrick Lewicki
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | | | - Daniel Spratt
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Leonardo Kayat Bittencourt
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Doug Scherr
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Himanshu Nagar
- Department of Radiation Oncology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Jim Hu
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Christopher Barbieri
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Lee Ponsky
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
| |
Collapse
|
43
|
Liang H, Wang X, Li F, Xie Y, Shen J, Wang X, Huang Y, Lin S, Chen J, Zhang L, Jiang B, Xing J, Zhu J. Label-free plasmonic metasensing of PSA and exosomes in serum for rapid high-sensitivity diagnosis of early prostate cancer. Biosens Bioelectron 2023; 235:115380. [PMID: 37207584 DOI: 10.1016/j.bios.2023.115380] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
Prostate-specific antigen (PSA) test is widely used to diagnose early prostate cancer (PCa). Its low sensitivity, especially in the gray zone, usually incurs overtreatment or missed diagnosis. As an emerging tumor marker, exosomes have attracted great interest in non-invasive diagnosis of PCa. However, the quick direct detection of exosomes in serum is still a big challenge for convenient screening of early PCa due to their high-degree heterogeneity and complexity. Here we develop the label-free biosensors based on wafer-scale plasmonic metasurfaces, and establish a flexible spectral methodology of exosomes profiling, which facilitates their identification and quantification in serum. We combine the metasurfaces functionalized by anti-PSA and anti-CD63, respectively, and build a portable immunoassay system to detect serum PSA and exosomes simultaneously within 20 min. Our scheme can discriminate early PCa from benign prostatic hyperplasia with a diagnostic sensitivity of 92.3%, which is much higher that of 58.3% for conventional PSA tests. The receiver operating characteristic analysis in clinical trials demonstrates significant PCa distinguishing capability with an area under the curve up to 99.4%. Our work provides a rapid and powerful approach for precise diagnosis of early PCa, and will inspire more exosomes metasensing studies for other early cancer screening.
Collapse
Affiliation(s)
- Haotian Liang
- Institute of Electromagnetics and Acoustics and Key Laboratory of Electromagnetic Wave Science and Detection Technology, Xiamen University, Xiamen, 361005, China
| | - Xuegang Wang
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Fajun Li
- Institute of Electromagnetics and Acoustics and Key Laboratory of Electromagnetic Wave Science and Detection Technology, Xiamen University, Xiamen, 361005, China
| | - Yinong Xie
- Institute of Electromagnetics and Acoustics and Key Laboratory of Electromagnetic Wave Science and Detection Technology, Xiamen University, Xiamen, 361005, China
| | - Jiaqing Shen
- Institute of Electromagnetics and Acoustics and Key Laboratory of Electromagnetic Wave Science and Detection Technology, Xiamen University, Xiamen, 361005, China
| | - Xueqin Wang
- Institute of Electromagnetics and Acoustics and Key Laboratory of Electromagnetic Wave Science and Detection Technology, Xiamen University, Xiamen, 361005, China
| | - Yuqian Huang
- Institute of Electromagnetics and Acoustics and Key Laboratory of Electromagnetic Wave Science and Detection Technology, Xiamen University, Xiamen, 361005, China
| | - Shaowei Lin
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Junjie Chen
- Analysis and Measurement Center, School of Pharmaceutical Science, Xiamen University, Xiamen, 361003, China
| | - Lijian Zhang
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Bingliang Jiang
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Jinchun Xing
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Jinfeng Zhu
- Institute of Electromagnetics and Acoustics and Key Laboratory of Electromagnetic Wave Science and Detection Technology, Xiamen University, Xiamen, 361005, China.
| |
Collapse
|
44
|
Guo Y, Su K, Lu M, Liu X. Incorporation of trans-rectal color doppler flow imaging and risk-stratification nomogram reduce unnecessary prostate biopsies in suspected prostate cancer patients: a bi-centered retrospective validation study. BMC Urol 2023; 23:81. [PMID: 37138271 PMCID: PMC10157911 DOI: 10.1186/s12894-023-01245-2] [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: 09/22/2022] [Accepted: 04/13/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND To explore the role of Trans-rectal Color Doppler Flow Imaging (TR-CDFI) and risk-stratification nomogram in a MRI-directed biopsy pathway and examine its clinical performance, via comparisons between existing four biopsy pathways. METHODS A Bi-centered retrospective cohort study on biopsy-naïve male population who received ultrasound-guided prostate biopsy from Jan. 2015 to Feb. 2022 was proposed. All enrolled patients should have undergone serum-PSA test, TR-CDFI and multiparametric MRI before biopsy, and subsequently opted for surgical intervention, enabling more accurate pathological grading. We then utilized univariate and multivariate logistic regression analysis to construct a predictive nomogram for risk-stratification. Outcome measurements were overall prostate cancer (PCA) detection rate, clinically significant PCA (csPCA) detection rate, clinically insignificant PCA (cisPCA) detection rate, biopsy avoidance rate and missed csPCA detection rate. Decision curve analysis was used to compare the performances between diagnostic pathways. RESULTS Under the criteria mentioned above, 752 patients from two centers were included. Reference pathway (biopsy for all) showed that overall PCA detection rate was 46.1%, csPCA and cisPCA detection rates were 32.3% and 13.8% respectively. Risk-based MRI-directed TR-CDFI pathway, which incorporated both TR-CDFI and risk stratification nomogram, exhibited PCA detection rate of 38.7%, csPCA detection rate of 28.7%, cisPCA detection rate of 7.0%, Biopsy avoidance rate of 42.4%, and missed csPCA detection rate of 3.6%. Decision curve analysis revealed that the risk-based pathway held the most net benefit, under the threshold probability level between 0.1 and 0.5. CONCLUSIONS The risk-based MRI-directed TR-CDFI pathway out-performed other strategies, balancing csPCA detection and biopsy avoidance. This suggested that incorporation of TR-CDFI and risk-stratification nomogram in the early PCA diagnostic procedures could reduce unnecessary biopsies.
Collapse
Affiliation(s)
- YiWei Guo
- Department of Urology, Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China.
| | - KaiBin Su
- Department of Urology, Third Affiliated Hospital, Yuedong Hospital, Sun Yat-Sen University, New County Park North Road, Meizhou, Guangdong Province, China
| | - MinHua Lu
- Department of Urology, Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China.
| | - XiaoPeng Liu
- Department of Urology, Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| |
Collapse
|
45
|
Chapiro J. Explainable AI for Prostate MRI: Don't Trust, Verify. Radiology 2023; 307:e230574. [PMID: 37039689 PMCID: PMC10323286 DOI: 10.1148/radiol.230574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Julius Chapiro
- From the Department of Radiology and Biomedical Imaging, Yale
University School of Medicine, 789 Howard Ave, CB363H, New Haven, CT
06519
| |
Collapse
|
46
|
Yilmaz EC, Shih JH, Belue MJ, Harmon SA, Phelps TE, Garcia C, Hazen LA, Toubaji A, Merino MJ, Gurram S, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Prospective Evaluation of PI-RADS Version 2.1 for Prostate Cancer Detection and Investigation of Multiparametric MRI-derived Markers. Radiology 2023; 307:e221309. [PMID: 37129493 PMCID: PMC10323290 DOI: 10.1148/radiol.221309] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/21/2023] [Accepted: 02/10/2023] [Indexed: 05/03/2023]
Abstract
Background Data regarding the prospective performance of Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 alone and in combination with quantitative MRI features for prostate cancer detection is limited. Purpose To assess lesion-based clinically significant prostate cancer (csPCa) rates in different PI-RADS version 2.1 categories and to identify MRI features that could improve csPCa detection. Materials and Methods This single-center prospective study included men with suspected or known prostate cancer who underwent multiparametric MRI and MRI/US-guided biopsy from April 2019 to December 2021. MRI scans were prospectively evaluated using PI-RADS version 2.1. Atypical transition zone (TZ) nodules were upgraded to category 3 if marked diffusion restriction was present. Lesions with an International Society of Urological Pathology (ISUP) grade of 2 or higher (range, 1-5) were considered csPCa. MRI features, including three-dimensional diameter, relative lesion volume (lesion volume divided by prostate volume), sphericity, and surface to volume ratio (SVR), were obtained from lesion contours delineated by the radiologist. Univariable and multivariable analyses were conducted at the lesion and participant levels to determine features associated with csPCa. Results In total, 454 men (median age, 67 years [IQR, 62-73 years]) with 838 lesions were included. The csPCa rates for lesions categorized as PI-RADS 1 (n = 3), 2 (n = 170), 3 (n = 197), 4 (n = 319), and 5 (n = 149) were 0%, 9%, 14%, 37%, and 77%, respectively. csPCa rates of PI-RADS 4 lesions were lower than PI-RADS 5 lesions (P < .001) but higher than PI-RADS 3 lesions (P < .001). Upgraded PI-RADS 3 TZ lesions were less likely to harbor csPCa compared with their nonupgraded counterparts (4% [one of 26] vs 20% [20 of 99], P = .02). Predictors of csPCa included relative lesion volume (odds ratio [OR], 1.6; P < .001), SVR (OR, 6.2; P = .02), and extraprostatic extension (EPE) scores of 2 (OR, 9.3; P < .001) and 3 (OR, 4.1; P = .02). Conclusion The rates of csPCa differed between consecutive PI-RADS categories of 3 and higher. MRI features, including lesion volume, shape, and EPE scores of 2 and 3, predicted csPCa. Upgrading of PI-RADS category 3 TZ lesions may result in unnecessary biopsies. ClinicalTrials.gov registration no. NCT03354416 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Goh in this issue.
Collapse
Affiliation(s)
- Enis C. Yilmaz
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Joanna H. Shih
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Mason J. Belue
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Stephanie A. Harmon
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Tim E. Phelps
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Charisse Garcia
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Lindsey A. Hazen
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Antoun Toubaji
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Maria J. Merino
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Sandeep Gurram
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Peter L. Choyke
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Bradford J. Wood
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Peter A. Pinto
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Baris Turkbey
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| |
Collapse
|
47
|
Handke AE, Albers P, Schimmöller L, Bonekamp D, Asbach P, Schlemmer HP, Hadaschik BA, Radtke JP. [Systematic or targeted fusion-guided biopsy]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:464-472. [PMID: 36941382 DOI: 10.1007/s00120-023-02062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Early detection of prostate cancer (PCa) is associated with a high risk for detecting low-risk disease. In the primary biopsy indication, systematic biopsy leads to an increased detection of clinically insignificant PCa, and significant prostate cancers are not detected with sufficient sensitivity, especially without prior magnetic resonance imaging (MRI). Similar data have recently become available for PCa screening. OBJECTIVES In light of the current literature, this article aims to discuss the data on systematic and combined targeted and systematic multiparametric MRI (mpMRI)-guided fusion biopsy to improve PCa diagnosis in clinically suspected cancer even in screening using multivariable risk stratification. MATERIALS AND METHODS Literature review on mpMRI and MRI/TRUS fusion biopsy (TRUS: transrectal ultrasonography) for tumor detection in suspected prostate cancer and PCa screening was performed. RESULTS Multiparametric MRI as a reflex test after prostate-specific antigen (PSA) determination (PSA cut-off 4 ng/ml) in combination with targeted biopsy alone reduces the detection of clinically nonsignificant tumors in early detection by half. On the other hand, in the form of a target saturation or in combination with a systematic biopsy, the sensitivity for the detection of cancers of International Society of Urogenital Pathology (ISUP) grade groups 2 or higher can be improved. Similar results are also shown in PCa screening with a PSA cut-off of 3 ng/ml. CONCLUSIONS The evidence for performing a targeted fusion biopsy alone is currently insufficient. Therefore, the combination of mpMRI-guided targeted and systematic biopsy continues to be the recommended standard for prostate cancer diagnosis.
Collapse
Affiliation(s)
- Analena Elisa Handke
- Urologische Klinik, Universitätsklinikum Essen, Essen, Deutschland
- Deutsches Konsortium für Translationale Krebsforschung, Essen, Deutschland
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Abteilung für Personalisierte Früherkennung des Prostatakarzinoms, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Lars Schimmöller
- Medizinische Fakultät, Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - David Bonekamp
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Patrick Asbach
- Klinik für Radiologie, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Heinz-Peter Schlemmer
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Boris A Hadaschik
- Urologische Klinik, Universitätsklinikum Essen, Essen, Deutschland
- Deutsches Konsortium für Translationale Krebsforschung, Essen, Deutschland
| | - Jan Philipp Radtke
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland.
| |
Collapse
|
48
|
Ueda T, Ohno Y, Shinohara M, Yamamoto K, Ikedo M, Yui M, Yoshikawa T, Takenaka D, Ishida S, Furuta M, Matsuyama T, Nagata H, Ikeda H, Ozawa Y, Toyama H. Reverse encoding distortion correction for diffusion-weighted MRI: Efficacy for improving image quality and ADC evaluation for differentiating malignant from benign areas in suspected prostatic cancer patients. Eur J Radiol 2023; 162:110764. [PMID: 36905716 DOI: 10.1016/j.ejrad.2023.110764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The purpose of this study was to determine the influenceof reverse encoding distortion correction (RDC) on ADC measurement and its efficacy for improving image quality and diagnostic performance for differentiating malignant from benign prostatic areas on prostatic DWI. METHODS Forty suspected prostatic cancer patients underwent DWI with or without RDC (i.e. RDC DWI or DWI) using a 3 T MR system as well as pathological examinations. The pathological examination results indicated 86 areas were malignant while 86 out of 394 areas were computationally selected as benign. SNR for benign areas and muscle and ADCs for malignant and benign areas were determined by ROI measurements on each DWI. Moreover, overall image quality was assessed with a 5-point visual scoring system on each DWI. Paired t-test or Wilcoxon's signed rank test was performed to compare SNR and overall image quality for DWIs. ROC analysis was then used to compare the diagnostic performance, and sensitivity (SE), specificity (SP) and accuracy (AC) of ADC were compared between two DWI by means of McNemar's test. RESULTS SNR and overall image quality of RDC DWI showed significant improvements when compared with those of DWI (p < 0.05). Areas under the curve (AUC), SP and AC of DWI RDC DWI (AUC: 0.85, SP: 72.1%, AC: 79.1%) were significantly better than those of DWI (AUC: 0.79, p = 0.008; SP: 64%, p = 0.02; AC: 74.4%, p = 0.008). CONCLUSION RDC technique has the potential to improve image quality and ability to differentiate malignant from benign prostatic areas on DWIs of suspected prostatic cancer patients.
Collapse
Affiliation(s)
- Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshiharu Ohno
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | | | - Kaori Yamamoto
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masato Ikedo
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masao Yui
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Takeshi Yoshikawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Daisuke Takenaka
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Sayuri Ishida
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Minami Furuta
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
49
|
Patsanis A, Sunoqrot MRS, Bathen TF, Elschot M. CROPro: a tool for automated cropping of prostate magnetic resonance images. J Med Imaging (Bellingham) 2023; 10:024004. [PMID: 36895761 PMCID: PMC9990132 DOI: 10.1117/1.jmi.10.2.024004] [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: 02/10/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose To bypass manual data preprocessing and optimize deep learning performance, we developed and evaluated CROPro, a tool to standardize automated cropping of prostate magnetic resonance (MR) images. Approach CROPro enables automatic cropping of MR images regardless of patient health status, image size, prostate volume, or pixel spacing. CROPro can crop foreground pixels from a region of interest (e.g., prostate) with different image sizes, pixel spacing, and sampling strategies. Performance was evaluated in the context of clinically significant prostate cancer (csPCa) classification. Transfer learning was used to train five convolutional neural network (CNN) and five vision transformer (ViT) models using different combinations of cropped image sizes ( 64 × 64 , 128 × 128 , and 256 × 256 pixels2), pixel spacing ( 0.2 × 0.2 , 0.3 × 0.3 , 0.4 × 0.4 , and 0.5 × 0.5 mm 2 ), and sampling strategies (center, random, and stride cropping) over the prostate. T2-weighted MR images ( N = 1475 ) from the online available PI-CAI challenge were used to train ( N = 1033 ), validate ( N = 221 ), and test ( N = 221 ) all models. Results Among CNNs, SqueezeNet with stride cropping (image size: 128 × 128 , pixel spacing: 0.2 × 0.2 mm 2 ) achieved the best classification performance ( 0.678 ± 0.006 ). Among ViTs, ViT-H/14 with random cropping (image size: 64 × 64 and pixel spacing: 0.5 × 0.5 mm 2 ) achieved the best performance ( 0.756 ± 0.009 ). Model performance depended on the cropped area, with optimal size generally larger with center cropping ( ∼ 40 cm 2 ) than random/stride cropping ( ∼ 10 cm 2 ). Conclusion We found that csPCa classification performance of CNNs and ViTs depends on the cropping settings. We demonstrated that CROPro is well suited to optimize these settings in a standardized manner, which could improve the overall performance of deep learning models.
Collapse
Affiliation(s)
- Alexandros Patsanis
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Trondheim, Norway
| | - Mohammed R. S. Sunoqrot
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, Department of Radiology and Nuclear Medicine, Trondheim, Norway
| | - Tone F. Bathen
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, Department of Radiology and Nuclear Medicine, Trondheim, Norway
| | - Mattijs Elschot
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, Department of Radiology and Nuclear Medicine, Trondheim, Norway
| |
Collapse
|
50
|
Surveillance Value of Apparent Diffusion Coefficient Maps: Multiparametric MRI in Active Surveillance of Prostate Cancer. Cancers (Basel) 2023; 15:cancers15041128. [PMID: 36831471 PMCID: PMC9953850 DOI: 10.3390/cancers15041128] [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: 12/13/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND This study aims to establish the value of apparent diffusion coefficient maps and other magnetic resonance sequences for active surveillance of prostate cancer. The study included 530 men with an average age of 66, who were under surveillance for prostate cancer. We have used multiparametric magnetic resonance imaging with subsequent transperineal biopsy (TPB) to verify the imaging findings. RESULTS We have observed a level of agreement of 67.30% between the apparent diffusion coefficient (ADC) maps, other magnetic resonance sequences, and the biopsy results. The sensitivity of the apparent diffusion coefficient is 97.14%, and the specificity is 37.50%. According to our data, apparent diffusion coefficient is the most accurate sequence, followed by diffusion imaging in prostate cancer detection. CONCLUSIONS Based on our findings we advocate that the apparent diffusion coefficient should be included as an essential part of magnetic resonance scanning protocols for prostate cancer in at least bi-parametric settings. The best option will be apparent diffusion coefficient combined with diffusion imaging and T2 sequences. Further large-scale prospective controlled studies are required to define the precise role of multiparametric and bi-parametric magnetic resonance in the active surveillance of prostate cancer.
Collapse
|