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Guljaš S, Dupan Krivdić Z, Drežnjak Madunić M, Šambić Penc M, Pavlović O, Krajina V, Pavoković D, Šmit Takač P, Štefančić M, Salha T. Dynamic Contrast-Enhanced Study in the mpMRI of the Prostate-Unnecessary or Underutilised? A Narrative Review. Diagnostics (Basel) 2023; 13:3488. [PMID: 37998624 PMCID: PMC10670922 DOI: 10.3390/diagnostics13223488] [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: 08/26/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this review is to summarise recent scientific literature regarding the clinical use of DCE-MRI as a component of multiparametric resonance imaging of the prostate. This review presents the principles of DCE-MRI acquisition and analysis, the current role of DCE-MRI in clinical practice with special regard to its role in presently available categorisation systems, and an overview of the advantages and disadvantages of DCE-MRI described in the current literature. DCE-MRI is an important functional sequence that requires intravenous administration of a gadolinium-based contrast agent and gives information regarding the vascularity and capillary permeability of the lesion. Although numerous studies have confirmed that DCE-MRI has great potential in the diagnosis and monitoring of prostate cancer, its role is still inadequate in the PI-RADS categorisation. Moreover, there have been numerous scientific discussions about abandoning the intravenous application of gadolinium-based contrast as a routine part of MRI examination of the prostate. In this review, we summarised the recent literature on the advantages and disadvantages of DCE-MRI, focusing on an overview of currently available data on bpMRI and mpMRI, as well as on studies providing information on the potential better usability of DCE-MRI in improving the sensitivity and specificity of mpMRI examinations of the prostate.
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Affiliation(s)
- Silva Guljaš
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (S.G.); (Z.D.K.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
| | - Zdravka Dupan Krivdić
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (S.G.); (Z.D.K.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
| | - Maja Drežnjak Madunić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Oncology, University Hospital Centre, 31000 Osijek, Croatia
| | - Mirela Šambić Penc
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Oncology, University Hospital Centre, 31000 Osijek, Croatia
| | - Oliver Pavlović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Vinko Krajina
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Deni Pavoković
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Petra Šmit Takač
- Clinical Department of Surgery, Osijek University Hospital Centre, 31000 Osijek, Croatia;
| | - Marin Štefančić
- Department of Radiology, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia;
| | - Tamer Salha
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Teleradiology and Artificial Intelligence, Health Centre Osijek-Baranja County, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Nilsson E, Sandgren K, Grefve J, Jonsson J, Axelsson J, Lindberg AK, Söderkvist K, Karlsson CT, Widmark A, Blomqvist L, Strandberg S, Riklund K, Bergh A, Nyholm T. The grade of individual prostate cancer lesions predicted by magnetic resonance imaging and positron emission tomography. COMMUNICATIONS MEDICINE 2023; 3:164. [PMID: 37945817 PMCID: PMC10636013 DOI: 10.1038/s43856-023-00394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET) are widely used for the management of prostate cancer (PCa). However, how these modalities complement each other in PCa risk stratification is still largely unknown. We aim to provide insights into the potential of mpMRI and PET for PCa risk stratification. METHODS We analyzed data from 55 consecutive patients with elevated prostate-specific antigen and biopsy-proven PCa enrolled in a prospective study between December 2016 and December 2019. [68Ga]PSMA-11 PET (PSMA-PET), [11C]Acetate PET (Acetate-PET) and mpMRI were co-registered with whole-mount histopathology. Lower- and higher-grade lesions were defined by International Society of Urological Pathology (ISUP) grade groups (IGG). We used PET and mpMRI data to differentiate between grades in two cases: IGG 3 vs. IGG 2 (case 1) and IGG ≥ 3 vs. IGG ≤ 2 (case 2). The performance was evaluated by receiver operating characteristic (ROC) analysis. RESULTS We find that the maximum standardized uptake value (SUVmax) for PSMA-PET achieves the highest area under the ROC curve (AUC), with AUCs of 0.72 (case 1) and 0.79 (case 2). Combining the volume transfer constant, apparent diffusion coefficient and T2-weighted images (each normalized to non-malignant prostatic tissue) results in AUCs of 0.70 (case 1) and 0.70 (case 2). Adding PSMA-SUVmax increases the AUCs by 0.09 (p < 0.01) and 0.12 (p < 0.01), respectively. CONCLUSIONS By co-registering whole-mount histopathology and in-vivo imaging we show that mpMRI and PET can distinguish between lower- and higher-grade prostate cancer, using partially discriminative cut-off values.
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Affiliation(s)
- Erik Nilsson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden.
| | - Kristina Sandgren
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Josefine Grefve
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Joakim Jonsson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | | | - Karin Söderkvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Anders Widmark
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Sara Strandberg
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Tufve Nyholm
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
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Guljaš S, Benšić M, Krivdić Dupan Z, Pavlović O, Krajina V, Pavoković D, Šmit Takač P, Hranić M, Salha T. Dynamic Contrast Enhanced Study in Multiparametric Examination of the Prostate—Can We Make Better Use of It? Tomography 2022; 8:1509-1521. [PMID: 35736872 PMCID: PMC9231365 DOI: 10.3390/tomography8030124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/18/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022] Open
Abstract
We sought to investigate whether quantitative parameters from a dynamic contrast-enhanced study can be used to differentiate cancer from normal tissue and to determine a cut-off value of specific parameters that can predict malignancy more accurately, compared to the obturator internus muscle as a reference tissue. This retrospective study included 56 patients with biopsy proven prostate cancer (PCa) after multiparametric magnetic resonance imaging (mpMRI), with a total of 70 lesions; 39 were located in the peripheral zone, and 31 in the transition zone. The quantitative parameters for all patients were calculated in the detected lesion, morphologically normal prostate tissue and the obturator internus muscle. Increase in the Ktrans value was determined in lesion-to-muscle ratio by 3.974368, which is a cut-off value to differentiate between prostate cancer and normal prostate tissue, with specificity of 72.86% and sensitivity of 91.43%. We introduced a model to detect prostate cancer that combines Ktrans lesion-to-muscle ratio value and iAUC lesion-to-muscle ratio value, which is of higher accuracy compared to individual variables. Based on this model, we identified the optimal cut-off value with 100% sensitivity and 64.28% specificity. The use of quantitative DCE pharmacokinetic parameters compared to the obturator internus muscle as reference tissue leads to higher diagnostic accuracy for prostate cancer detection.
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Affiliation(s)
- Silva Guljaš
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (Z.K.D.); (M.H.)
- Correspondence:
| | - Mirta Benšić
- Department of Mathematics, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Zdravka Krivdić Dupan
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (Z.K.D.); (M.H.)
- Department of Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Oliver Pavlović
- Department of Urology, University Hospital Centre Osijek, 31000 Osijek, Croatia; (O.P.); (V.K.); (D.P.)
| | - Vinko Krajina
- Department of Urology, University Hospital Centre Osijek, 31000 Osijek, Croatia; (O.P.); (V.K.); (D.P.)
| | - Deni Pavoković
- Department of Urology, University Hospital Centre Osijek, 31000 Osijek, Croatia; (O.P.); (V.K.); (D.P.)
| | - Petra Šmit Takač
- Clinical Department of Surgery, Osijek University Hospital Centre, 31000 Osijek, Croatia;
| | - Matija Hranić
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (Z.K.D.); (M.H.)
| | - Tamer Salha
- Department of Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Department of Teleradiology and Artificial Intelligence, Health Centre Osijek-Baranja County, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Boschheidgen M, Schimmöller L, Arsov C, Ziayee F, Morawitz J, Valentin B, Radke KL, Giessing M, Esposito I, Albers P, Antoch G, Ullrich T. MRI grading for the prediction of prostate cancer aggressiveness. Eur Radiol 2021; 32:2351-2359. [PMID: 34748064 PMCID: PMC8921105 DOI: 10.1007/s00330-021-08332-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES T o evaluate the value of multiparametric MRI (mpMRI) for the prediction of prostate cancer (PCA) aggressiveness. METHODS In this single center cohort study, consecutive patients with histologically confirmed PCA were retrospectively enrolled. Four different ISUP grade groups (1, 2, 3, 4-5) were defined and fifty patients per group were included. Several clinical (age, PSA, PSAD, percentage of PCA infiltration) and mpMRI parameters (ADC value, signal increase on high b-value images, diameter, extraprostatic extension [EPE], cross-zonal growth) were evaluated and correlated within the four groups. Based on combined descriptors, MRI grading groups (mG1-mG3) were defined to predict PCA aggressiveness. RESULTS In total, 200 patients (mean age 68 years, median PSA value 8.1 ng/ml) were analyzed. Between the four groups, statistically significant differences could be shown for age, PSA, PSAD, and for MRI parameters cross-zonal growth, high b-value signal increase, EPE, and ADC (p < 0.01). All examined parameters revealed a significant correlation with the histopathologic biopsy ISUP grade groups (p < 0.01), except PCA diameter (p = 0.09). A mixed linear model demonstrated the strongest prediction of the respective ISUP grade group for the MRI grading system (p < 0.01) compared to single parameters. CONCLUSIONS MpMRI yields relevant pre-biopsy information about PCA aggressiveness. A combination of quantitative and qualitative parameters (MRI grading groups) provided the best prediction of the biopsy ISUP grade group and may improve clinical pathway and treatment planning, adding useful information beyond PI-RADS assessment category. Due to the high prevalence of higher grade PCA in patients within mG3, an early re-biopsy seems indicated in cases of negative or post-biopsy low-grade PCA. KEY POINTS • MpMRI yields relevant pre-biopsy information about prostate cancer aggressiveness. • MRI grading in addition to PI-RADS classification seems to be helpful for a size independent early prediction of clinically significant PCA. • MRI grading groups may help urologists in clinical pathway and treatment planning, especially when to consider an early re-biopsy.
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Affiliation(s)
- M Boschheidgen
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - L Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - C Arsov
- Department of Urology, Medical Faculty, University Dusseldorf, 40225, Düsseldorf, Germany
| | - F Ziayee
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - B Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - K L Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - M Giessing
- Department of Urology, Medical Faculty, University Dusseldorf, 40225, Düsseldorf, Germany
| | - I Esposito
- Department of Pathology, Medical Faculty, University Dusseldorf, 40225, Düsseldorf, Germany
| | - P Albers
- Department of Urology, Medical Faculty, University Dusseldorf, 40225, Düsseldorf, Germany
| | - G Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - T Ullrich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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Abstract
This review article is written as a contribution to the special issue presented in conjunction with the 100th anniversary of Acta Radiologica.An overview is given of what has happened with and in the journal during the 15 years from 2003 to 2017 and a resume is provided concerning the handling and flow of manuscripts, manuscript publication, scientific prizes awarded by the journal, and finally the process leading up to establishing the new open-access journal Acta Radiologica Short Reports/Acta Radiologica Open.
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Affiliation(s)
- Arnulf Skjennald
- Professor Emeritus, University of Oslo, University Hospital, Oslo, Norway
- Chief Editor Emeritus, Acta Radiologica, Oslo, Norway
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Wujciak D, Antoch G. [Financing perspectives for multiparametric magnetic resonance prostatography]. Radiologe 2021; 61:825-828. [PMID: 34213621 DOI: 10.1007/s00117-021-00867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Not only is the evidence for multiparametric magnetic resonance prostatography clearly proven based on current research, the S3 guideline for prostate cancer recommends its use prior to invasive biopsy. Remuneration through the GKV does not occur. OBJECTIVES The negotiations concerning the inclusion in the EBM (German Uniform Evaluation Standard) Catalogue of statutory health insurance funds take place in a highly politicized environment and under economic priorities. The routes that are possible in the complex registration procedure are described. MATERIALS AND METHODS Radiology associations (Berufsverband der Deutschen Radiologen [BDR] und Deutsche Röntgengesellschaft [DRG]) have supported their methods with evidence and quality assurance. Special contracts with health insurance funds, coordinated at the level of the federal states, pave the way and accelerate accreditation. RESULTS The definition of the service according to the EBM, the recommendation concerning remuneration as well as supporting documents and a functional quality assurance system have been made available to the Joint Valuation Committee of physicians & health insurance funds as part of the application for approval. CONCLUSIONS Due to the nature of the system, the presented evidence and quality assurance, as well as the development of special contracts, have inevitably been transferred to radiology and the unified work of their associations. The imaging modality prostatography shows the advancement of radiological methods for dedicated multiparametric organ diagnostics.
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Affiliation(s)
- Detlef Wujciak
- Radiologische Praxis Halle, Niemeyerstraße 23, 06110, Halle/ Saale, Deutschland.
| | - Gerald Antoch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Xie J, Li B, Min X, Zhang P, Fan C, Li Q, Wang L. Prediction of Pathological Upgrading at Radical Prostatectomy in Prostate Cancer Eligible for Active Surveillance: A Texture Features and Machine Learning-Based Analysis of Apparent Diffusion Coefficient Maps. Front Oncol 2021; 10:604266. [PMID: 33614487 PMCID: PMC7890009 DOI: 10.3389/fonc.2020.604266] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/18/2020] [Indexed: 12/09/2022] Open
Abstract
Objective To evaluate a combination of texture features and machine learning-based analysis of apparent diffusion coefficient (ADC) maps for the prediction of Grade Group (GG) upgrading in Gleason score (GS) ≤6 prostate cancer (PCa) (GG1) and GS 3 + 4 PCa (GG2). Materials and methods Fifty-nine patients who were biopsy-proven to have GG1 or GG2 and underwent MRI examination with the same MRI scanner prior to transrectal ultrasound (TRUS)-guided systemic biopsy were included. All these patients received radical prostatectomy to confirm the final GG. Patients were divided into training cohort and test cohort. 94 texture features were extracted from ADC maps for each patient. The independent sample t-test or Mann−Whitney U test was used to identify the texture features with statistically significant differences between GG upgrading group and GG non-upgrading group. Texture features of GG1 and GG2 were compared based on the final pathology of radical prostatectomy. We used the least absolute shrinkage and selection operator (LASSO) algorithm to filter features. Four supervised machine learning methods were employed. The prediction performance of each model was evaluated by area under the receiver operating characteristic curve (AUC). The statistical comparison between AUCs was performed. Results Six texture features were selected for the machine learning models building. These texture features were significantly different between GG upgrading group and GG non-upgrading group (P < 0.05). The six features had no significant difference between GG1 and GG2 based on the final pathology of radical prostatectomy. All machine learning methods had satisfactory predictive efficacy. The diagnostic performance of nearest neighbor algorithm (NNA) and support vector machine (SVM) was better than random forests (RF) in the training cohort. The AUC, sensitivity, and specificity of NNA were 0.872 (95% CI: 0.750−0.994), 0.967, and 0.778, respectively. The AUC, sensitivity, and specificity of SVM were 0.861 (95%CI: 0.732−0.991), 1.000, and 0.722, respectively. There had no significant difference between AUCs in the test cohort. Conclusion A combination of texture features and machine learning-based analysis of ADC maps could predict PCa GG upgrading from biopsy to radical prostatectomy non-invasively with satisfactory predictive efficacy.
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Affiliation(s)
- Jinke Xie
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Basen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangde Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peipei Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chanyuan Fan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiubai Li
- Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, United States
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ragheb SR, Bassiouny RH. Can mean ADC value and ADC ratio of benign prostate tissue to prostate cancer assist in the prediction of clinically significant prostate cancer within the PI-RADSv2 scoring system? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study is to investigate whether quantitative DW metrics can provide additive value to the reliable categorization of lesions within existing PI-RADSv2 guidelines. Fifty-eight patients with clinically suspicious prostate cancer who underwent PR examination, PSA serum levels, sextant TRUS-guided biopsies, and bi-parametric MR imaging were included in the study.
Results
Sixty-six lesions were detected by histopathological analysis of surgical specimens. The mean ADC values were significantly lower in tumor than non-tumor tissue. The mean ADC value inversely correlated with Gleason score of tumors with a significant p value < 0.001.Conversely, a positive relationship was found between the ADC ratio (ADC of benign prostatic tissue to prostate cancer) and the pathologic Gleason score with a significant elevation of the ADC ratio along with an increase of the pathologic Gleason score (p < 0.001). ROC curves constructed for the tumor ADC and ADC ratio helped to distinguish pathologically aggressive (Gleason score ≥ 7) from non-aggressive (Gleason score ≤ 6) tumors and to correlate it with PIRADSv2 scoring to predict the presence of clinically significant PCA (PIRADSv2 DW ≥ 4). The ability of the tumor ADC and ADC ratio to predict highly aggressive tumors (GS> 7) was high (AUC for ADC and ADC ratio, 0.946 and 0.897; p = 0.014 and 0.039, respectively). The ADC cut-off value for GS ≥ 7 was < 0.7725 and for GS ≤ 6 was > 0.8620 with sensitivity and specificity 97 and 94%. The cutoff ADC ratio for predicting (GS > 7) was 1.42 and for GS ≤ 6 was > 1.320 with sensitivity and specificity 97 and 92%. By applying this ADC ratio cut-off value the sensitivity and specificity of reader 1 for correct categorization of PIRADSv2 DW > 4 increased from 90 and 68% to 95 and 90% and that of reader 2 increased from 94 and 88% to 97 and 92%, respectively.
Conclusion
Estimation of DW metrics (ADC and ADC ratio between benign prostatic tissue and prostate cancer) allow the non-invasive assessment of biological aggressiveness of prostate cancer and allow reliable application of the PIRADSv2 scoring to determine clinically significant cancer (DW score > 4) which may contribute in planning initial treatment strategies.
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McNally CJ, Ruddock MW, Moore T, McKenna DJ. Biomarkers That Differentiate Benign Prostatic Hyperplasia from Prostate Cancer: A Literature Review. Cancer Manag Res 2020; 12:5225-5241. [PMID: 32669872 PMCID: PMC7335899 DOI: 10.2147/cmar.s250829] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022] Open
Abstract
Prediction of prostate cancer in primary care is typically based upon serum total prostate-specific antigen (tPSA) and digital rectal examination results. However, these tests lack sensitivity and specificity, leading to over-diagnosis of disease and unnecessary, invasive biopsies. Therefore, there is a clinical need for diagnostic tests that can differentiate between benign conditions and early-stage malignant disease in the prostate. In this review, we evaluate research papers published from 2009 to 2019 reporting biomarkers that identified or differentiated benign prostatic hyperplasia (BPH) from prostate cancer. Our review identifies hundreds of potential biomarkers in urine, serum, tissue, and semen proposed as useful targets for differentiating between prostate cancer and BPH patients. However, it is still not apparent which of these candidate biomarkers are most useful, and many will not progress beyond the discovery stage unless they are properly validated for clinical practice. We conclude that this validation will come through the use of multivariate panels which can assess the value of biomarker candidates in combination with clinical parameters as part of a risk prediction calculator. Implementation of such a model will help clinicians stratify patients with prostate cancer symptoms in primary care, with tangible benefits for both the patient and the health service.
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Affiliation(s)
- Christopher J McNally
- Randox Laboratories Ltd, Crumlin, Co. Antrim BT29 4QY, Northern Ireland.,Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - Mark W Ruddock
- Randox Laboratories Ltd, Crumlin, Co. Antrim BT29 4QY, Northern Ireland
| | - Tara Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - Declan J McKenna
- Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, Northern Ireland
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Schieda N, Lim CS, Zabihollahy F, Abreu-Gomez J, Krishna S, Woo S, Melkus G, Ukwatta E, Turkbey B. Quantitative Prostate MRI. J Magn Reson Imaging 2020; 53:1632-1645. [PMID: 32410356 DOI: 10.1002/jmri.27191] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022] Open
Abstract
Prostate MRI is reported in clinical practice using the Prostate Imaging and Data Reporting System (PI-RADS). PI-RADS aims to standardize, as much as possible, the acquisition, interpretation, reporting, and ultimately the performance of prostate MRI. PI-RADS relies upon mainly subjective analysis of MR imaging findings, with very few incorporated quantitative features. The shortcomings of PI-RADS are mainly: low-to-moderate interobserver agreement and modest accuracy for detection of clinically significant tumors in the transition zone. The use of a more quantitative analysis of prostate MR imaging findings is therefore of interest. Quantitative MR imaging features including: tumor size and volume, tumor length of capsular contact, tumor apparent diffusion coefficient (ADC) metrics, tumor T1 and T2 relaxation times, tumor shape, and texture analyses have all shown value for improving characterization of observations detected on prostate MRI and for differentiating between tumors by their pathological grade and stage. Quantitative analysis may therefore improve diagnostic accuracy for detection of cancer and could be a noninvasive means to predict patient prognosis and guide management. Since quantitative analysis of prostate MRI is less dependent on an individual users' assessment, it could also improve interobserver agreement. Semi- and fully automated analysis of quantitative (radiomic) MRI features using artificial neural networks represent the next step in quantitative prostate MRI and are now being actively studied. Validation, through high-quality multicenter studies assessing diagnostic accuracy for clinically significant prostate cancer detection, in the domain of quantitative prostate MRI is needed. This article reviews advances in quantitative prostate MRI, highlighting the strengths and limitations of existing and emerging techniques, as well as discussing opportunities and challenges for evaluation of prostate MRI in clinical practice when using quantitative assessment. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Christopher S Lim
- Department of Medical Imaging, Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | | | - Jorge Abreu-Gomez
- Department of Medical Imaging, Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gerd Melkus
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eran Ukwatta
- Faculty of Engineering, Guelph University, Guelph, Ontario, Canada
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute NIH, Bethesda, Maryland, USA
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11
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Winkel DJ, Breit HC, Shi B, Boll DT, Seifert HH, Wetterauer C. Predicting clinically significant prostate cancer from quantitative image features including compressed sensing radial MRI of prostate perfusion using machine learning: comparison with PI-RADS v2 assessment scores. Quant Imaging Med Surg 2020; 10:808-823. [PMID: 32355645 DOI: 10.21037/qims.2020.03.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background To investigate if supervised machine learning (ML) classifiers would be able to predict clinically significant cancer (sPC) from a set of quantitative image-features and to compare these results with established PI-RADS v2 assessment scores. Methods We retrospectively included 201, histopathologically-proven, peripheral zone (PZ) prostate cancer lesions. Gleason scores ≤3+3 were considered as clinically insignificant (inPC) and Gleason scores ≥3+4 as sPC and were encoded in a binary fashion, serving as ground-truth. MRI was performed at 3T with high spatiotemporal resolution DCE using Golden-angle RAdial SParse (GRASP) MRI. Perfusion maps (Ktrans, Kep, Ve), apparent diffusion coefficient (ADC), and absolute T2-signal intensities (SI) were determined in all lesions and served as input parameters for four supervised ML models: Gradient Boosting Machines (GBM), Neural Networks (NNet), Random Forest (RF) and Support Vector Machines (SVM). ML results and PI-RADS scores were compared with the ground-truth. Next ROC-curves and AUC values were calculated. Results All ML models outperformed PI-RADS v2 assessment scores in the prediction of sPC (RF, GBM, NNet and SVM vs. PI-RADS: AUC 0.899, 0.864, 0.884 and 0.874 vs. 0.595, all P<0.001). Conclusions Using quantitative imaging parameters as input, supervised ML models outperformed PI-RADS v2 assessment scores in the prediction of sPC. These results indicate that quantitative imagining parameters contain relevant information for the prediction of sPC from image features.
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Affiliation(s)
- David Jean Winkel
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | | | - Bibo Shi
- Siemens Medical Imaging Technologies, Princeton, NJ, USA
| | - Daniel T Boll
- Department of Radiology, University Hospital Basel, Basel, Switzerland
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12
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Antonelli M, Johnston EW, Dikaios N, Cheung KK, Sidhu HS, Appayya MB, Giganti F, Simmons LAM, Freeman A, Allen C, Ahmed HU, Atkinson D, Ourselin S, Punwani S. Machine learning classifiers can predict Gleason pattern 4 prostate cancer with greater accuracy than experienced radiologists. Eur Radiol 2019; 29:4754-4764. [PMID: 31187216 PMCID: PMC6682575 DOI: 10.1007/s00330-019-06244-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/03/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was: To test whether machine learning classifiers for transition zone (TZ) and peripheral zone (PZ) can correctly classify prostate tumors into those with/without a Gleason 4 component, and to compare the performance of the best performing classifiers against the opinion of three board-certified radiologists. METHODS A retrospective analysis of prospectively acquired data was performed at a single center between 2012 and 2015. Inclusion criteria were (i) 3-T mp-MRI compliant with international guidelines, (ii) Likert ≥ 3/5 lesion, (iii) transperineal template ± targeted index lesion biopsy confirming cancer ≥ Gleason 3 + 3. Index lesions from 164 men were analyzed (119 PZ, 45 TZ). Quantitative MRI and clinical features were used and zone-specific machine learning classifiers were constructed. Models were validated using a fivefold cross-validation and a temporally separated patient cohort. Classifier performance was compared against the opinion of three board-certified radiologists. RESULTS The best PZ classifier trained with prostate-specific antigen density, apparent diffusion coefficient (ADC), and maximum enhancement (ME) on DCE-MRI obtained a ROC area under the curve (AUC) of 0.83 following fivefold cross-validation. Diagnostic sensitivity at 50% threshold of specificity was higher for the best PZ model (0.93) when compared with the mean sensitivity of the three radiologists (0.72). The best TZ model used ADC and ME to obtain an AUC of 0.75 following fivefold cross-validation. This achieved higher diagnostic sensitivity at 50% threshold of specificity (0.88) than the mean sensitivity of the three radiologists (0.82). CONCLUSIONS Machine learning classifiers predict Gleason pattern 4 in prostate tumors better than radiologists. KEY POINTS • Predictive models developed from quantitative multiparametric magnetic resonance imaging regarding the characterization of prostate cancer grade should be zone-specific. • Classifiers trained differently for peripheral and transition zone can predict a Gleason 4 component with a higher performance than the subjective opinion of experienced radiologists. • Classifiers would be particularly useful in the context of active surveillance, whereby decisions regarding whether to biopsy are necessitated.
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Affiliation(s)
- Michela Antonelli
- Centre for Medical Image Computing, University College London, London, UK
- School of Biomedical Engineering and Imaging Science, King's College London, London, UK
| | - Edward W Johnston
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Nikolaos Dikaios
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - King K Cheung
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Harbir S Sidhu
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Mrishta B Appayya
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Lucy A M Simmons
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
| | - David Atkinson
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Science, King's College London, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
- Department of Radiology, University College London Hospital, London, UK.
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13
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Alessandrino F, Taghipour M, Hassanzadeh E, Ziaei A, Vangel M, Fedorov A, Tempany CM, Fennessy FM. Predictive role of PI-RADSv2 and ADC parameters in differentiating Gleason pattern 3 + 4 and 4 + 3 prostate cancer. Abdom Radiol (NY) 2019; 44:279-285. [PMID: 30066169 PMCID: PMC6349548 DOI: 10.1007/s00261-018-1718-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare the predictive roles of qualitative (PI-RADSv2) and quantitative assessment (ADC metrics), in differentiating Gleason pattern (GP) 3 + 4 from the more aggressive GP 4 + 3 prostate cancer (PCa) using radical prostatectomy (RP) specimen as the reference standard. METHODS We retrospectively identified treatment-naïve peripheral (PZ) and transitional zone (TZ) Gleason Score 7 PCa patients who underwent multiparametric 3T prostate MRI (DWI with b value of 0,1400 and where unavailable, 0,500) and subsequent RP from 2011 to 2015. For each lesion identified on MRI, a PI-RADSv2 score was assigned by a radiologist blinded to pathology data. A PI-RADSv2 score ≤ 3 was defined as "low risk," a PI-RADSv2 score ≥ 4 as "high risk" for clinically significant PCa. Mean tumor ADC (ADCT), ADC of adjacent normal tissue (ADCN), and ADCratio (ADCT/ADCN) were calculated. Stepwise regression analysis using tumor location, ADCT and ADCratio, b value, low vs. high PI-RADSv2 score was performed to differentiate GP 3 + 4 from 4 + 3. RESULTS 119 out of 645 cases initially identified met eligibility requirements. 76 lesions were GP 3 + 4, 43 were 4 + 3. ADCratio was significantly different between the two GP groups (p = 0.001). PI-RADSv2 score ("low" vs. "high") was not significantly different between the two GP groups (p = 0.17). Regression analysis selected ADCT (p = 0.03) and ADCratio (p = 0.0007) as best predictors to differentiate GP 4 + 3 from 3 + 4. Estimated sensitivity, specificity, and accuracy of the predictive model in differentiating GP 4 + 3 from 3 + 4 were 37, 82, and 66%, respectively. CONCLUSIONS ADC metrics could differentiate GP 3 + 4 from 4 + 3 PCa with high specificity and moderate accuracy while PI-RADSv2, did not differentiate between these patterns.
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Affiliation(s)
- Francesco Alessandrino
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA.
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Mehdi Taghipour
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
| | - Elmira Hassanzadeh
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
- Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Alireza Ziaei
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
| | - Mark Vangel
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
| | - Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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14
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The value of MR textural analysis in prostate cancer. Clin Radiol 2018; 74:876-885. [PMID: 30573283 DOI: 10.1016/j.crad.2018.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/16/2018] [Indexed: 01/18/2023]
Abstract
Current diagnosis and treatment stratification of patients with suspected prostate cancer relies on a combination of histological and magnetic resonance imaging (MRI) findings. The aim of this article is to provide a brief overview of prostate pathological grading as well as the relevant aspects of multiparametric (MRI) mpMRI, before indicating the potential that magnetic resonance textural analysis (MRTA) offers within prostate cancer. A review of the evidence base on MRTA in prostate cancer will enable discussion of the utility of this field while also indicating recommendations to future research. Radiomic textural analysis allows the assessment of spatial inter-relationships between pixels within an image by use of mathematical methods. First-order textural analysis is better understood and may have more clinical validity than higher-order textural features. Textural features extracted from apparent diffusion coefficient maps have shown the most potential for clinical utility in MRTA of prostate cancers. Future studies should aim to integrate machine learning techniques to better represent the role of MRTA in prostate cancer clinical practice. Nomenclature should be used to reduce misidentification between first-order and second-order energy and entropy. Automated methods of segmentation should be encouraged in order to reduce problems associated with inclusion of normal tissue within regions of interest. The retrospective and small-scale nature of most published studies, make it difficult to draw meaningful conclusions. Future larger prospective studies are required to validate the textural features indicated to have potential in characterisation and/or diagnosis of prostate cancer before translation into routine clinical practice.
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15
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Lee CH, Ku JY, Park WY, Lee NK, Ha HK. Comparison of the accuracy of multiparametric magnetic resonance imaging (mpMRI) results with the final pathology findings for radical prostatectomy specimens in the detection of prostate cancer. Asia Pac J Clin Oncol 2018; 15:e20-e27. [PMID: 29920966 DOI: 10.1111/ajco.13027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/19/2018] [Indexed: 01/21/2023]
Abstract
AIMS To assess the accuracy of multiparametric magnetic resonance imaging (mpMRI), used in conjunction with the Prostrate Imaging Reporting and Data System (PI-RADS), version 2, in the detection of prostate cancer (PCa), and to determine the extent of the efficacy of mpMRI as a screening test in biopsy-naïve patients. METHODS Retrospective analysis was conducted in 107 patients who underwent mpMRI prior to radical prostatectomy (RP) at a single institution. The mpMRI findings were reassessed using PI-RADS, version 2. A comparison was made between the histological findings for the RP specimens and the mpMRI results. RESULTS Unique histologically confirmed PCa foci (237) were identified in 107 patients. Overall, mpMRI sensitivity of 46% was found for PCa detection (110/237). The sensitivity, specificity and negative predictive value of mpMRI was 75.5%, 77.0% and 79.8%, respectively, for clinically significant cancer, and 75.7%, 77.7% and 79.5%, for pathological index tumors. A moderate and significant correlation was observed between a high PI-RADS score and a high pathological grade, tumor volume, index tumor status and clinically significant cancer status (all, P < 0.001, respectively). Pathological tumor volume was a significant predictor of PCa detection using mpMRI according to multivariate analysis. Using a cut-off value of 0.89 cc, the sensitivity and specificity of mpMRI for PCa detection were 0.87 and 0.65, respectively. CONCLUSION The mpMRI, used in conjunction with PI-RADS, was useful in detecting PCa and in predicting tumor aggressiveness. However, the detection of 20% of clinically significant cancer was missed using mpMRI. Thus, its inclusion in a triage test should be limited to selected biopsy-naïve patients.
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Affiliation(s)
- Chan Ho Lee
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Won Young Park
- Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Nam Kyung Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea.,Pusan National University School of Medicine, Biomedical Research Institute, Busan, South Korea
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16
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New prostate cancer prognostic grade group (PGG): Can multiparametric MRI (mpMRI) accurately separate patients with low-, intermediate-, and high-grade cancer? Abdom Radiol (NY) 2018; 43:702-712. [PMID: 28721479 DOI: 10.1007/s00261-017-1255-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Our objective is to determine the accuracy of multiparametric MRI (mpMRI) in predicting pathologic grade of prostate cancer (PCa) after radical prostatectomy (RP) using simple apparent diffusion coefficient metrics and, specifically, whether mpMRI can accurately separate disease into one of two risk categories (low vs. higher grade) or one of three risk categories (low, intermediate, or high grade) corresponding to the new prognostic grade group (PGG) criteria. METHODS This retrospective, HIPAA-compliant, IRB-approved study included 140 patients with PCa who underwent 3 T mpMRI with endorectal coil and transrectal ultrasound-guided (TRUS-G) biopsy before RP. MpMRI was used to classify lesions using a two-tier (low-grade/PGG 1 vs. high-grade/PGG 2-5) or a three-tier system (low-grade/PGG 1 vs. intermediate-grade/PGG 2 vs. high-grade/PGG 3-5). Accuracy of mpMRI was compared against RP for each system. RESULTS The predictive accuracy of mpMRI using the two-tier system is higher than when using three-tier system (0.77 and 0.45, respectively). There were similar rates of undergrading between mpMRI and TRUS-G biopsy compared to RP (16% & 21%; respectively); rate of overgrading was higher for mpMRI vs. TRUS-G biopsy compared to RP (42% & 17%, respectively). When mpMRI and TRUS-G biopsy are combined, rate of undergrading is 1.4% and overgrading is 11%. CONCLUSIONS MpMRI predictive accuracy is higher when using a two-tier vs. a three-tier system, suggesting that advanced metrics may be necessary to delineate intermediate- from high-grade disease. Rates of under- and overgrading decreased when mpMRI and TRUS-G biopsy are combined, suggesting that these techniques may be complementary in predicting tumor grade.
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17
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Hung SW, Lin YT, Liu MC. Multiparametric magnetic resonance imaging of prostate cancer. UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_57_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Giganti F, Gambarota G, Moore CM, Robertson NL, McCartan N, Jameson C, Bott SRJ, Winkler M, Whitcher B, Castro-Santamaria R, Emberton M, Allen C, Kirkham A. Prostate cancer detection using quantitative T 2 and T 2 -weighted imaging: The effects of 5-alpha-reductase inhibitors in men on active surveillance. J Magn Reson Imaging 2017; 47:1646-1653. [PMID: 29135073 DOI: 10.1002/jmri.25891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/25/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND T2 -weighted imaging (T2 -WI) information has been used in a qualitative manner in the assessment of prostate cancer. Quantitative derivatives (T2 relaxation time) can be generated from T2 -WI. These outputs may be useful in helping to discriminate clinically significant prostate cancer from background signal. PURPOSE/HYPOTHESIS To investigate changes in quantitative T2 parameters in lesions and noncancerous tissue of men on active surveillance for prostate cancer taking dutasteride 0.5 mg or placebo daily for 6 months. STUDY TYPE Retrospective. POPULATION/SUBJECTS Forty men randomized to 6 months of daily dutasteride (n = 20) or placebo (n = 20). FIELD STRENGTH/SEQUENCE Multiparametric 3T MRI at baseline and 6 months. This included a multiecho MR sequence for quantification of the T2 relaxation times, in three regions of interest (index lesion, noncancerous peripheral [PZ] and transitional [TZ] zones). A synthetic signal contrast (T2 Q contrast) between lesion and noncancerous tissue was assessed using quantitative T2 values. Signal contrast was calculated using the T2 -weighted sequence (T2 W contrast). ASSESSMENT Two radiologists reviewed the scans in consensus according to Prostate Imaging Reporting and Data System (PI-RADS v. 2) guidelines. STATISTICAL TESTS Wilcoxon and Mann-Whitney U-tests, Spearman's correlation. RESULTS When compared to noncancerous tissue, shorter T2 values were observed within lesions at baseline (83.5 and 80.5 msec) and 6 months (81.5 and 81.9 msec) in the placebo and dutasteride arm, respectively. No significant differences for T2 W contrast at baseline and after 6 months were observed, both in the placebo (0.40 [0.29-0.49] vs. 0.43 [0.25-0.49]; P = 0.881) and dutasteride arm (0.35 [0.24-0.47] vs. 0.37 [0.22-0.44]; P = 0.668). There was a significant, positive correlation between the T2 Q contrast and the T2 W contrast values (r = 0.786; P < 0.001). DATA CONCLUSION The exposure to antiandrogen therapy did not significantly influence the T2 contrast or the T2 relaxation values in men on active surveillance for prostate cancer. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1646-1653.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Giulio Gambarota
- INSERM, U1099, Rennes, France.,Université de Rennes 1, LTSI, Rennes, France
| | - 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
| | - Nicola L Robertson
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Neil McCartan
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Charles Jameson
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Simon R J Bott
- Department of Urology, Frimley Park Hospital, Surrey, UK
| | - Mathias Winkler
- Department of Urology, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Brandon Whitcher
- Klarismo, London, UK.,Department of Mathematics, Imperial College 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
| | - Clare Allen
- 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
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Abstract
Prostate cancer is the most common male malignant tumor in Germany, which thus places growing demands on differentiated imaging and risk-adapted therapeutic approaches. Multiparametric MRI (mpMRI) of the prostate enables reliable detection of clinically significant cancers and is currently the leading imaging modality for the detection, characterization, and local staging of prostate cancer. According to the German S3 guideline, mpMRI of the prostate is currently primarily recommended in patients with previous negative TRUS biopsies and persisting tumor suspicion. The serial use of mpMRI in the pretherapeutic setting can support individual therapy planning of patients with locally advanced prostate cancer in the near future.
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20
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Skjennald A. Radiological prizes awarded in 2016. Acta Radiol 2017; 58:643-644. [PMID: 28406047 DOI: 10.1177/0284185117702623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Abstract
A successful paradigm shift toward personalized management strategies for patients with prostate cancer (PCa) is heavily dependent on the availability of noninvasive diagnostic tools capable of accurately establishing the true extent of disease at the time of diagnosis and estimating the risk of subsequent disease progression and related mortality. Although there is still considerable scope for improvement in its diagnostic, predictive, and prognostic capabilities, multiparametric prostate magnetic resonance imaging (MRI) is currently regarded as the imaging modality of choice for local staging of PCa. A negative MRI, that is, the absence of any MRI-visible intraprostatic lesion, has a high negative predictive value for the presence of clinically significant PCa and can substantiate the consideration of active surveillance as a preferred initial management approach. MRI-derived quantitative and semi-quantitative parameters can be utilized to noninvasively characterize MRI-visible prostate lesions and identify those patients who are most likely to benefit from radical treatment, and differentiate them from patients with benign or indolent prostate pathology that may also be visible on MRI. This literature review summarizes current strategies how MRI can be used to determine a tailored management strategy for an individual patient.
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22
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Li C, Chen M, Wang J, Wang X, Zhang W, Zhang C. Apparent diffusion coefficient values are superior to transrectal ultrasound-guided prostate biopsy for the assessment of prostate cancer aggressiveness. Acta Radiol 2017; 58:232-239. [PMID: 27055916 DOI: 10.1177/0284185116639764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Few studies have focused on comparing the utility of diffusion-weighted imaging (DWI) and transrectal ultrasound (TRUS)-guided biopsy in predicting prostate cancer aggressiveness. Whether apparent diffusion coefficient (ADC) values can provide more information than TRUS-guided biopsy should be confirmed. Purpose To retrospectively assess the utility of ADC values in predicting prostate cancer aggressiveness, compared to the TRUS-guided prostate biopsy Gleason score (GS). Material and Methods The DW images of 54 patients with biopsy-proven prostate cancer were obtained using 1.5-T magnetic resonance (MR). The mean ADC values of cancerous areas and biopsy GS were correlated with prostatectomy GS and D'Amico clinical risk scores, respectively. Meanwhile, the utility of ADC values in identifying high-grade prostate cancer (with Gleason 4 and/or 5 components in prostatectomy) in patients with a biopsy GS ≤ 3 + 3 = 6 was also evaluated. Results A significant negative correlation was found between mean ADC values of cancerous areas and the prostatectomy GS ( P < 0.001) and D'Amico clinical risk scores ( P < 0.001). No significant correlation was found between biopsy GS and prostatectomy GS ( P = 0.140) and D'Amico clinical risk scores ( P = 0.342). Patients harboring Gleason 4 and/or 5 components in prostatectomy had significantly lower ADC values than those harboring no Gleason 4 and/or 5 components ( P = 0.004). Conclusion The ADC values of cancerous areas in the prostate are a better indicator than the biopsy GS in predicting prostate cancer aggressiveness. Moreover, the use of ADC values can help identify the presence of high-grade tumor in patients with a Gleason score ≤ 3 + 3 = 6 during biopsy.
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Affiliation(s)
- Chunmei Li
- Department of Radiology, Beijing Hospital, Beijing, PR China
| | - Min Chen
- Department of Radiology, Beijing Hospital, Beijing, PR China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, Beijing, PR China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, Beijing, PR China
| | - Wei Zhang
- Department of Pathology, Beijing Hospital, Beijing, PR China
| | - Chen Zhang
- Department of Radiology, Beijing Hospital, Beijing, PR China
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Abstract
Improvements in prostate MR imaging techniques and the introduction of MR imaging-targeted biopsies have had central roles in prostate cancer (PCa) management. The role of MR imaging has progressed from largely staging patients with biopsy-proven PCa to detecting, characterizing, and guiding the biopsy of suspected PCa. These diagnostic advances, combined with improved therapeutic interventions, have led to a more sophisticated and individually tailored approach to patients' unique PCa profile. This review discusses the MR imaging, a standardized reporting scheme, and the role of fusion-targeted prostate biopsy.
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Affiliation(s)
- Hiram Shaish
- Department of Radiology, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA.
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA
| | - Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA
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Gaunay G, Patel V, Shah P, Moreira D, Hall SJ, Vira MA, Schwartz M, Kreshover J, Ben-Levi E, Villani R, Rastinehad A, Richstone L. Role of multi-parametric MRI of the prostate for screening and staging: Experience with over 1500 cases. Asian J Urol 2016; 4:68-74. [PMID: 29264209 PMCID: PMC5730898 DOI: 10.1016/j.ajur.2016.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/05/2016] [Indexed: 01/17/2023] Open
Abstract
Objective Contemporary prostate cancer (PCa) screening modalities such as prostate specific antigen (PSA) and digital rectal examination (DRE) are limited in their ability to predict the detection of clinically significant disease. Multi-parametric magnetic resonance imaging (mpMRI) of the prostate has been explored as a staging modality for PCa. Less is known regarding its utility as a primary screening modality. We examined our experience with mpMRI as both a screening and staging instrument. Methods mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography (TRUS) biopsy findings. Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant (Gleason score ≥7) disease. Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy. mpMRI studies were also cross-referenced with RP specimens. Statistical analyses determined predictive ability of extracapsular extension (ECE), seminal vesicle involvement (SVI), and pathologic evidence of clinically significant disease (Gleason score ≥7). Results Four hundred biopsy naïve or prior negative biopsy patients had positive mpMRI studies. Overall sensitivity, specificity, positive and negative predictive values were 94%, 37%, 58%, and 87%, respectively and 95%, 31%, 42%, and 93%, respectively for overall cancer detection and Gleason score ≥7 disease. In patients with no prior biopsy history, mpMRI sensitivity, specificity, positive and negative predictive values were 94%, 36%, 65%, and 82%, for all cancers, and 95%, 30%, 50%, and 89% for Gleason score≥7 lesions, respectively. In those with prior negative biopsy sensitivity, specificity, positive and negative predictive values were 94%, 37%, 52%, and 90% for all cancers, and 96%, 32%, 36%, and 96% for Gleason score ≥7 lesions, respectively. Seventy-four patients underwent radical prostatectomy (RP) after mpMRI. Lesion size on mpMRI correlated with the presence of Gleason score ≥7 cancers (p = 0.005). mpMRI sensitivity, specificity, positive and negative predictive values were 84%, 39%, 81%, and 44% respectively, for Gleason ≥7 cancer. For ECE and SVI, sensitivity and specificity were 58% and 98% and 44% and 97%, respectively. Conclusion mpMRI is an accurate predictor of TRUS biopsy and RP outcomes. mpMRI has significant potential to change PCa management, particularly in the screening population, in whom a significant proportion may avoid TRUS biopsy. Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.
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Affiliation(s)
- Geoffrey Gaunay
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Vinay Patel
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Paras Shah
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Daniel Moreira
- Department of Urology, University of Illinois Chicago, Chicago, IL, USA
| | - Simon J Hall
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Manish A Vira
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Michael Schwartz
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Jessica Kreshover
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Eran Ben-Levi
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Robert Villani
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Ardeshir Rastinehad
- Department of Urology & Interventional Radiology, Mount Sinai Health System, New York City, NY, USA
| | - Lee Richstone
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
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Abstract
CLINICAL ISSUE Prostate cancer is the most common form of cancer in men in Germany; however, there is a distinct difference between incidence and mortality. STANDARD TREATMENT The detection of prostate cancer is based on clinical and laboratory testing using serum prostate-specific antigen (PSA) levels and transrectal ultrasound with randomized biopsy. DIAGNOSTIC WORK-UP Multiparametric MR imaging of the prostate can provide valuable diagnostic information for detection of prostate cancer, especially after negative results of a biopsy prior to repeat biopsy. PERFORMANCE In addition the use of MR ultrasound fusion-guided biopsy has gained in diagnostic importance and has increased the prostate cancer detection rate. ACHIEVEMENTS AND PRACTICAL RECOMMENDATIONS The prostate imaging reporting and data system (PI-RADS) classification has standardized the reporting of prostate MRI which has positively influenced the acceptance by urologists.
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26
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Liu L, Tian Z, Zhang Z, Fei B. Computer-aided Detection of Prostate Cancer with MRI: Technology and Applications. Acad Radiol 2016; 23:1024-46. [PMID: 27133005 PMCID: PMC5355004 DOI: 10.1016/j.acra.2016.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 01/10/2023]
Abstract
One in six men will develop prostate cancer in his lifetime. Early detection and accurate diagnosis of the disease can improve cancer survival and reduce treatment costs. Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mp-MRI). Mp-MRI consists of T2-weighted sequences combined with functional sequences including dynamic contrast-enhanced MRI, diffusion-weighted MRI, and magnetic resonance spectroscopy imaging. Because of the big data and variations in imaging sequences, detection can be affected by multiple factors such as observer variability and visibility and complexity of the lesions. To improve quantitative assessment of the disease, various computer-aided detection systems have been designed to help radiologists in their clinical practice. This review paper presents an overview of literatures on computer-aided detection of prostate cancer with mp-MRI, which include the technology and its applications. The aim of the survey is threefold: an introduction for those new to the field, an overview for those working in the field, and a reference for those searching for literature on a specific application.
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Affiliation(s)
- Lizhi Liu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329; Center of Medical Imaging and Image-guided Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Zhiqiang Tian
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329
| | - Zhenfeng Zhang
- Center of Medical Imaging and Image-guided Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Baowei Fei
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329; Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, 1841 Clifton Road NE, Atlanta, Georgia 30329; Winship Cancer Institute of Emory University, 1841 Clifton Road NE, Atlanta, Georgia 30329.
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27
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Downey K, Attygalle AD, Morgan VA, Giles SL, MacDonald A, Davis M, Ind TEJ, Shepherd JH, deSouza NM. Comparison of optimised endovaginal vs external array coil T2-weighted and diffusion-weighted imaging techniques for detecting suspected early stage (IA/IB1) uterine cervical cancer. Eur Radiol 2016; 26:941-50. [PMID: 26162579 PMCID: PMC4778155 DOI: 10.1007/s00330-015-3899-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/09/2015] [Accepted: 06/22/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare sensitivity and specificity of endovaginal versus external-array coil T2-W and T2-W + DWI for detecting and staging small cervical tumours. METHODS Optimised endovaginal and external array coil MRI at 3.0-T was done prospectively in 48 consecutive patients with stage Ia/Ib1 cervical cancer. Sensitivity/specificity for detecting tumour and parametrial extension against histopathology for a reading radiologist were determined on coronal T2-W and T2W + DW images. An independent radiologist also scored T2-W images without and with addition of DWI for the external-array and endovaginal coils on separate occasions >2 weeks apart. Cohen's kappa assessed inter- and intra-observer agreement. RESULTS Median tumour volume in 19/38 cases positive on subsequent histology was 1.75 cm(3). Sensitivity, specificity, PPV, NPV were: reading radiologist 91.3 %, 89.5 %, 91.3 %, 89.5 %, respectively; independent radiologist T2-W 82.6 %, 73.7 %, 79.1 %, 77.8 % for endovaginal, 73.9 %, 89.5 %, 89.5 %, 73.9 % for external-array coil. Adding DWI improved sensitivity and specificity of endovaginal imaging (78.2 %, 89.5 %); adding DWI to external-array imaging improved specificity (94.7 %) but reduced sensitivity (66.7 %). Inter- and intra-observer agreement on T2-W + DWI was good (kappa = 0.67 and 0.62, respectively). CONCLUSION Endovaginal coil T2-W MRI is more sensitive than external-array coil for detecting tumours <2 cm(3); adding DWI improves specificity of endovaginal imaging but reduces sensitivity of external-array imaging. KEY POINTS • Endovaginal more accurate than external-array T2-W MRI for detecting small cervical cancers. • Addition of DWI improves sensitivity and specificity of endovaginal T2-W imaging. • Addition of DWI substantially reduces sensitivity of external-array T2-W imaging.
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Affiliation(s)
- Kate Downey
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Veronica A Morgan
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Sharon L Giles
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - A MacDonald
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - M Davis
- Department of Gynaecology, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames, Surrey, KT2 7QB, UK
| | - Thomas E J Ind
- Gynecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - John H Shepherd
- Gynecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Nandita M deSouza
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK.
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Felker ER, Margolis DJ, Nassiri N, Marks LS. Prostate cancer risk stratification with magnetic resonance imaging. Urol Oncol 2016; 34:311-9. [PMID: 27040381 DOI: 10.1016/j.urolonc.2016.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/22/2016] [Accepted: 03/01/2016] [Indexed: 01/13/2023]
Abstract
In recent years, multiparametric magnetic resonance imaging (mpMRI) has shown promise for prostate cancer (PCa) risk stratification. mpMRI, often followed by targeted biopsy, can be used to confirm low-grade disease before enrollment in active surveillance. In patients with intermediate or high-risk PCa, mpMRI can be used to inform surgical management. mpMRI has sensitivity of 44% to 87% for detection of clinically significant PCa and negative predictive value of 63% to 98% for exclusion of significant disease. In addition to tumor identification, mpMRI has also been shown to contribute significant incremental value to currently used clinical nomograms for predicting extraprostatic extension. In combination with conventional clinical criteria, accuracy of mpMRI for prediction of extraprostatic extension ranges from 92% to 94%, significantly higher than that achieved with clinical criteria alone. Supplemental sequences, such as diffusion-weighted imaging and dynamic contrast-enhanced imaging, allow quantitative evaluation of cancer-suspicious regions. Apparent diffusion coefficient appears to be an independent predictor of PCa aggressiveness. Addition of apparent diffusion coefficient to Epstein criteria may improve sensitivity for detection of significant PCa by as much as 16%. Limitations of mpMRI include variability in reporting, underestimation of PCa volume and failure to detect clinically significant disease in a small but significant number of cases.
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Affiliation(s)
- Ely R Felker
- Department of Radiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Daniel J Margolis
- Department of Radiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Nima Nassiri
- Department of Urology, David Geffen School of Medicine, Los Angeles, CA
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, Los Angeles, CA.
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29
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Hoang Dinh A, Melodelima C, Souchon R, Lehaire J, Bratan F, Mège-Lechevallier F, Ruffion A, Crouzet S, Colombel M, Rouvière O. Quantitative Analysis of Prostate Multiparametric MR Images for Detection of Aggressive Prostate Cancer in the Peripheral Zone: A Multiple Imager Study. Radiology 2016; 280:117-27. [PMID: 26859255 DOI: 10.1148/radiol.2016151406] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Purpose To assess the intermanufacturer variability of quantitative models in discriminating cancers with a Gleason score of at least 7 among peripheral zone (PZ) lesions seen at 3-T multiparametric magnetic resonance (MR) imaging. Materials and Methods An institutional review board-approved prospective database of 257 patients who gave written consent and underwent T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced imaging before prostatectomy was retrospectively reviewed. It contained outlined lesions found to be suspicious for malignancy by two independent radiologists and classified as malignant or benign after correlation with prostatectomy whole-mount specimens. One hundred six patients who underwent imaging with 3-T MR systems from two manufacturers were selected (data set A, n = 72; data set B, n = 34). Eleven parameters were calculated in PZ lesions: normalized T2-weighted signal intensity, skewness and kurtosis of T2-weighted signal intensity, T2 value, wash-in rate, washout rate, time to peak (TTP), mean apparent diffusion coefficient (ADC), 10th percentile of the ADC, and skewness and kurtosis of the histogram of the ADC values. Parameters were selected on the basis of their specificity for a sensitivity of 0.95 in diagnosing cancers with a Gleason score of at least 7, and the area under the receiver operating characteristic curve (AUC) for the models was calculated. Results The model of the 10th percentile of the ADC with TTP yielded the highest AUC in both data sets. In data set A, the AUC was 0.90 (95% confidence interval [CI]: 0.85, 0.95) or 0.89 (95% CI: 0.82, 0.94) when it was trained in data set A or B, respectively. In data set B, the AUC was 0.84 (95% CI: 0.74, 0.94) or 0.86 (95% CI: 0.76, 0.95) when it was trained in data set A or B, respectively. No third variable added significantly independent information in any data set. Conclusion The model of the 10th percentile of the ADC with TTP yielded accurate results in discriminating cancers with a Gleason score of at least 7 among PZ lesions at 3 T in data from two manufacturers. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Au Hoang Dinh
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Christelle Melodelima
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Rémi Souchon
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Jérôme Lehaire
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Flavie Bratan
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Florence Mège-Lechevallier
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Alain Ruffion
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Sébastien Crouzet
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Marc Colombel
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
| | - Olivier Rouvière
- From INSERM, U1032, LabTau, Lyon, France (A.H.D., R.S., J.L., F.B., S.C., O.R.); CNRS, UMR 5553, BP 53, Grenoble, France (C.M.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); Department of Urinary and Vascular Imaging (F.B., O.R.), Department of Pathology (F.M.L.), and Department of Urology (S.C., M.C.), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon P Radio, 5 place d'Arsonval, Lyon 69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); and Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France (A.R.)
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Abstract
Multiparametric-magnetic resonance imaging (mp-MRI) has shown promising results in diagnosis, localization, risk stratification and staging of clinically significant prostate cancer. It has also opened up opportunities for focal treatment of prostate cancer. Combinations of T2-weighted imaging, diffusion imaging, perfusion (dynamic contrast-enhanced imaging) and spectroscopic imaging have been used in mp-MRI assessment of prostate cancer, but T2 morphologic assessment and functional assessment by diffusion imaging remains the mainstay for prostate cancer diagnosis on mp-MRI. Because assessment on mp-MRI can be subjective, use of the newly developed standardized reporting Prostate Imaging and Reporting Archiving Data System scoring system and education of specialist radiologists are essential for accurate interpretation. This review focuses on the present status of mp-MRI in prostate cancer and its evolving role in the management of prostate cancer.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Ontario, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Ontario, Canada
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