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Xiao VG, Kresnanto J, Moses DA, Pather N. Quantitative MRI in the Local Staging of Prostate Cancer: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2024; 59:255-296. [PMID: 37165923 DOI: 10.1002/jmri.28742] [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: 12/05/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Local staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE). PURPOSE To assess the performance of quantitative MRI markers for detecting ECE. STUDY TYPE Systematic review and meta-analysis. SUBJECTS 4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta-analysis. Patients from 46 studies were included for systematic review. FIELD STRENGTH/SEQUENCE Diffusion-weighted, T2-weighted, and dynamic contrast-enhanced MRI at 1.5 T or 3 T. ASSESSMENT PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC-mean) were pooled for meta-analysis, but not for other quantitative markers including radiomics due to low number of studies available. STATISTICAL TESTS Hierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC-mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta-regression. Results were significant if P ≤ 0.05. RESULTS At the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71-0.81] and 0.68 [95% CI 0.63-0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53-0.83] and 0.74 [95% CI 0.60-0.84] respectively. The area under the HSROC curves for TCL and ADC-mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy. DATA CONCLUSION Both 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC-mean may be superior to TCL at higher sensitivities. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Vieley G Xiao
- Medical Education, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Jordan Kresnanto
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Daniel A Moses
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Kensington, New South Wales, 2052, Australia
- Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
| | - Nalini Pather
- Medical Education, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
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Tamada T, Ueda Y, Kido A, Yoneyama M, Takeuchi M, Sanai H, Ono K, Yamamoto A, Sone T. Clinical application of single-shot echo-planar diffusion-weighted imaging with compressed SENSE in prostate MRI at 3T: preliminary experience. MAGMA (NEW YORK, N.Y.) 2022; 35:549-556. [PMID: 35403993 DOI: 10.1007/s10334-022-01010-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Image quality (IQ) of diffusion-weighted imaging (DWI) with single-shot echo-planar imaging (ssEPI) suffers from low signal-to-noise ratio (SNR) in high b-value acquisitions. Compressed SENSE (C-SENSE), which combines SENSE with compressed sensing, enables SNR to be improved by reducing noise. The aim of this study was to compare IQ and prostate cancer (PC) detectability between DWI with ssEPI using SENSE (EPIS) and using C-SENSE (EPICS). MATERIALS AND METHODS Twenty-five patients with pathologically proven PC underwent multi-parametric magnetic resonance imaging at 3T. DW images acquired with EPIS and EPICS were assessed for the following: lesion conspicuity (LC), SNR, contrast-to-noise ratio (CNR), mean and standard deviation (SD) of apparent diffusion coefficient (ADC) of lesion (lADCm and lADCsd), coefficient of variation of lesion ADC (lADCcv), and mean ADC of benign prostate (bADCm). RESULTS LC were comparable between EPIS and EPICS (p > 0.050), and SNR and CNR were significantly higher in EPICS than EPIS (p = 0.001 and p < 0.001). In both EPIS and EPICS, lADCm was significantly lower than bADCm (p < 0.001). In addition, lADCcv was significantly lower in EPICS than in EPIS (p < 0.001). CONCLUSION Compared with EPIS, EPICS has improved IQ and comparable diagnostic performance in PC.
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Affiliation(s)
- Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192, Japan.
| | - Yu Ueda
- Philips Japan, Konan 2-13-37, Minato-ku, Tokyo, 108-8507, Japan
| | - Ayumu Kido
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192, Japan
| | - Masami Yoneyama
- Philips Japan, Konan 2-13-37, Minato-ku, Tokyo, 108-8507, Japan
| | - Mitsuru Takeuchi
- Department of Radiology, Radiolonet Tokai, Asaoka-cho 3-86-2, Chikusa-ku, Nagoya-city , Aichi, 464-0811, Japan
| | - Hiroyasu Sanai
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192, Japan
| | - Kentaro Ono
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192, Japan
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192, Japan
| | - Teruki Sone
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192, Japan
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3
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Becher E, Sali A, Abreu A, Iwata T, Tong A, Deng FM, Iwata A, Gupta C, Gill I, Aron M, Palmer S, Lepor H. MRI predicts prostatic urethral involvement in men undergoing radical prostatectomy: implications for cryo-ablation of localized prostate cancer. World J Urol 2021; 39:3309-3314. [PMID: 33616707 DOI: 10.1007/s00345-020-03566-5] [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: 07/28/2020] [Accepted: 12/12/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine whether multi-parametric magnetic resonance imaging (mpMRI) can reliably predict proximity of prostate cancer to the prostatic urethra in a contemporary series of men undergoing radical prostatectomy (RP) at two academic centers. METHODS Clinical characteristics of consecutive men undergoing pre-operative mpMRI prior to RP and whole-mount axial serial step-sectioned pathology examination at two academic centers between Jun 2016 and Oct 2018 were analyzed retrospectively. Every tumor was characterized by its pathologic minimum distance to the prostatic urethral lumen (pMDUL). Only the cancer closest to the urethra represented the prostatic urethral index lesion. The radiologic minimum distance of the index lesion to the prostatic urethral lumen was measured and noted as ≤ 5 mm versus > 5 mm. The sensitivity, specificity, positive and negative predicting values (PPV and NPV) and area under the receivers operating characteristics curve (AUC) were calculated for performance of mpMRI for predicting pMDUL ≤ 5 mm. RESULTS Of the 163 surgical specimens examined, 112 (69%) exhibited a pMDUL ≤ 5 mm. These men had significantly higher grade group (GG) and advanced pathological and clinical stage. The rates of high PI-RADS score and presence of gross extracapsular extension were also significantly greater for the group with pMDUL ≤ 5 mm. The AUC, sensitivity, specificity, PPV, and NPV were 0.641, 51.8, 76.5, 82.9, and 42.4%, respectively, for mpMRI to predict pMDUL < 5 mm. CONCLUSIONS Nearly 70% of men undergoing RP present with tumor within 5 mm of the prostatic urethra. These tumors present higher risk characteristics, and mpMRI exhibited moderate performance and high PPV in their pre-operative detection. Physicians performing partial gland ablation should take these results into consideration during treatment selection and planning.
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Affiliation(s)
- Ezequiel Becher
- Department of Urology, NYU Langone Health, 222 E41st St, 12th floor, New York, NY, 10017, USA.
| | - Akash Sali
- Department of Urology, Keck School of Medicine, USC Institute of Urology and Catherine and Joseph Aresty, University of Southern California, Los Angeles, CA, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre Abreu
- Department of Urology, Keck School of Medicine, USC Institute of Urology and Catherine and Joseph Aresty, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tsuyoshi Iwata
- Department of Urology, Keck School of Medicine, USC Institute of Urology and Catherine and Joseph Aresty, University of Southern California, Los Angeles, CA, USA
| | - Angela Tong
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Fang-Ming Deng
- Department of Pathology, NYU Langone Health, New York, NY, USA
| | - Atsuko Iwata
- Department of Urology, Keck School of Medicine, USC Institute of Urology and Catherine and Joseph Aresty, University of Southern California, Los Angeles, CA, USA
| | - Chhavi Gupta
- Department of Urology, Keck School of Medicine, USC Institute of Urology and Catherine and Joseph Aresty, University of Southern California, Los Angeles, CA, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- Department of Urology, Keck School of Medicine, USC Institute of Urology and Catherine and Joseph Aresty, University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Suzanne Palmer
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Health, 222 E41st St, 12th floor, New York, NY, 10017, USA
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4
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Abstract
High-risk prostate cancer is a heterogeneous disease that lacks clear consensus on its ideal management. Historically, non-surgical treatment was the preferred strategy, and several studies demonstrated improved survival among men with high-risk disease managed with the combination of radiotherapy and androgen deprivation therapy (ADT) compared with ADT alone. However, practice trends in the past 10-15 years have shown increased use of radical prostatectomy with pelvic lymph node dissection for primary management of high-risk, localized disease. Radical prostatectomy, as a primary monotherapy, offers the potential benefits of avoiding ADT, reducing rates of symptomatic local recurrence, enabling full pathological tumour staging and potentially reducing late adverse effects such as secondary malignancy compared with radiation therapy. Retrospective studies have reported wide variability in short-term (pathological) and long-term (oncological) outcomes of radical prostatectomy. Surgical monotherapy continues to be appropriate for selected patients, whereas in others the best treatment strategy probably involves a multimodal approach. Appropriate risk stratification utilizing clinical, pathological and potentially also genomic risk data is imperative in the initial management of men with prostate cancer. However, data from ongoing and planned prospective trials are needed to identify the optimal management strategy for men with high-risk, localized prostate cancer.
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5
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Prostate MRI: Practical guidelines for interpreting and reporting according to PI-RADS version 2.1. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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6
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Sánchez-Oro R, Nuez JT, Martínez-Sanz G, Ortega QG, Bleila M. Prostate MRI: practical guidelines for interpreting and reporting according to PI-RADS version 2.1. RADIOLOGIA 2020; 62:437-451. [PMID: 33268134 DOI: 10.1016/j.rx.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
The increasing precision of multiparametric magnetic resonance imaging of the prostate, together with greater experience and standardization in its interpretation, has given this technique an important role in the management of prostate cancer, the most prevalent non-cutaneous cancer in men. This article reviews the concepts in PI-RADS version 2.1 for estimating the probability and zonal location of significant tumors of the prostate, using a practical approach that includes current considerations about the prerequisites for carrying out the test and recommendations for interpreting the findings. It emphasizes benign findings that can lead to confusion and the criteria for evaluating the probability of local spread, which must be included in the structured report.
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Affiliation(s)
- R Sánchez-Oro
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España.
| | - J Torres Nuez
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - G Martínez-Sanz
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - Q Grau Ortega
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - M Bleila
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
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7
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Abstract
Accurate tumor detection and establishment of disease extent are important for optimal management of prostate cancer. Disease stage, beginning with identification of the index prostate lesion, followed by primary tumor, lymph node, and distant metastasis evaluation, provide crucial clinical information that not only have prognostic and predictive value, but guide patient management. A wide array of radiological imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging have been used for the purpose of prostate cancer staging with variable diagnostic performance. Especially, the last years have seen remarkable technological advances in magnetic resonance imaging technology, enabling referring clinicians and radiologists to obtain even more valuable data regarding staging of prostate cancer. Marked improvements have been seen in detection of the index prostate lesion and evaluation of extraprostatic extension while further improvements are still needed in identifying metastatic lymph nodes. Novel approaches such as whole-body MRI are emerging for more accurate and reproducible assessment of bone metastasis. Post-treatment assessment of prostate cancer using radiological imaging is a topic with rapidly changing clinical context and special consideration is needed for the biochemical setting, that is, the relatively high serum prostate-specific antigen levels in studies assessing the value of radiological imaging for post-treatment assessment and emerging therapeutic approaches such as early salvage radiation therapy. The scope of this review is to provide the reader insight into the various ways radiology contribute to staging of prostate cancer in the context of both primary staging and post-treatment assessment. The strengths and limitations of each imaging modality are highlighted as well as topics that warrant future research.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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8
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Checcucci E, Amparore D, De Luca S, Autorino R, Fiori C, Porpiglia F. Precision prostate cancer surgery: an overview of new technologies and techniques. MINERVA UROL NEFROL 2019; 71:487-501. [PMID: 30700084 DOI: 10.23736/s0393-2249.19.03365-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Over the past few years several new technologies have become available for the management of PCa. The implementation of robotic surgery allowed an unprecedented refinement of surgical techniques, and the RARP procedure is constantly evolving. Nowadays research is mainly focused towards a "tailored" case-specific surgical approach that might allow to achieve PCa control while preserving urinary continence and erectile function. Therefore, in contemporary urology era, several new tools have been introduced to optimize surgical planning, to aid surgical navigation, and to refine surgical execution. In this non-systematic review emerges that a better imaging technique in the preoperative setting can facilitate surgical planning. Moreover, in the intraoperative setting, new tools for image-guided surgical navigation are promising and will allow real time understanding of surgical anatomy. In the next future, a more personalized approach for the minimally invasive surgical treatment of PCa will be available, and the achievement of the best oncological and functional outcomes will be obtained.
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Affiliation(s)
- Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy -
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Stefano De Luca
- Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | | | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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9
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Ueno YR, Tamada T, Takahashi S, Tanaka U, Sofue K, Kanda T, Nogami M, Ohno Y, Hinata N, Fujisawa M, Murakami T. Computed Diffusion-Weighted Imaging in Prostate Cancer: Basics, Advantages, Cautions, and Future Prospects. Korean J Radiol 2018; 19:832-837. [PMID: 30174471 PMCID: PMC6082756 DOI: 10.3348/kjr.2018.19.5.832] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
Computed diffusion-weighted MRI is a recently proposed post-processing technique that produces b-value images from diffusion-weighted imaging (DWI), acquired using at least two different b-values. This article presents an argument for computed DWI for prostate cancer by viewing four aspects of DWI: fundamentals, image quality and diagnostic performance, computing procedures, and future uses.
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Affiliation(s)
- Yoshiko R Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki 701-0192, Japan
| | - Satoru Takahashi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Utaru Tanaka
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Tomonori Kanda
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.,Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Nobuyuki Hinata
- Department of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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10
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Imaging the High-risk Prostate Cancer Patient: Current and Future Approaches to Staging. Urology 2018; 116:3-12. [DOI: 10.1016/j.urology.2017.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 11/24/2022]
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Luo Q, Luo L, Tang L. A Network Meta-Analysis on the Diagnostic Value of Different Imaging Methods for Lymph Node Metastases in Patients With Cervical Cancer. Technol Cancer Res Treat 2018; 17:1533034617742311. [PMID: 29343205 PMCID: PMC5784560 DOI: 10.1177/1533034617742311] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 09/14/2017] [Accepted: 10/09/2017] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We performed this network meta-analysis to compare the diagnostic value of 4 imaging methods (magnetic resonance imaging, positron emission tomography, computed tomography, and diffusion-weighted imaging) for diagnosing lymph node metastases in cervical cancer. METHOD Diagnostic tests regarding different imaging methods to diagnose lymph node metastases in cervical cancer were retrieved from the Cochrane Library, PubMed, and Embase electronic databases from inception to December 2016. Direct and indirect evidence was performed to calculate the odds ratio and to draw the surface under the cumulative ranking curves of the 4 imaging methods for diagnosing lymph node metastases in cervical cancer. RESULTS Sixteen eligible diagnostic tests were included in this network meta-analysis. The results of network meta-analysis demonstrate that in comparison with the diffusion-weighted imaging, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of positron emission tomography were relatively higher. Additionally, the results further indicate that compared with other diagnosis method, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of positron emission tomography had a higher trend. The surface under the cumulative ranking curve results indicated that in terms of positive likelihood ratio and diagnostic odds ratio, positron emission tomography had a relatively higher diagnostic value for lymph node metastases in patients with cervical cancer. CONCLUSION Our findings indicate that positron emission tomography might have a relatively higher diagnostic value for lymph node metastases in patients with cervical cancer.
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Affiliation(s)
- Qian Luo
- Department of Radiology, Jining No. 1 People’s Hospital, Jining, 272000, Shandong, China
| | - Lan Luo
- Department of Gynaecology, Jining No. 1 People’s Hospital, Jining, 272000, Shandong, China
| | - Liang Tang
- Department of Oncology, Jining No. 1 People’s Hospital, Jining, 272000, Shandong, China
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12
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[Indications and limits of ablative therapies in prostate cancer]. Prog Urol 2017; 27:865-886. [PMID: 28918871 DOI: 10.1016/j.purol.2017.08.004] [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: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To perform a state of the art about indications and limits of ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 107 articles were analysed. RESULTS The objective to combine reduction of side effects and oncological control has induced recent development of several ablative therapies. Beyond this heterogeneity, some preferential indications appear: unilateral cancer of low risk (but with significant volume, excluding active surveillance) or intermediate risk (excluding majority of grade 4); treatment targeted the index lesion, by quarter or hemi-ablation, based on biopsy and mpMRI. In addition, indications must considered specific limits of each energy, such as gland volume and tumor localization. CONCLUSION Based on new imaging and biopsy, ablative therapies will probably increased its role in the future in management of localize prostate cancer. The multiple ongoing trials will certainly be helpful to better define their indications and limits.
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Granja M, Pedraza C, Flórez D, Romero J, Palau M, Aguirre D. Predicting extracapsular involvement in prostate cancer through the tumor contact length and the apparent diffusion coefficient. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Granja M, Pedraza C, Flórez D, Romero J, Palau M, Aguirre D. Predicción de la extensión extracapsular en el cáncer de próstata mediante la longitud del contacto tumoral y el coeficiente de difusión aparente. RADIOLOGIA 2017; 59:313-320. [DOI: 10.1016/j.rx.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/23/2017] [Accepted: 03/19/2017] [Indexed: 11/28/2022]
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Prostate Imaging Reporting and Data System, Version 2, Assessment Categories and Pathologic Outcomes in Patients With Gleason Score 3 + 4 = 7 Prostate Cancer Diagnosed at Biopsy. AJR Am J Roentgenol 2017; 208:1037-1044. [PMID: 28267359 DOI: 10.2214/ajr.16.16843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to assess associations between Prostate Imaging Reporting and Data System, version 2 (PI-RADSv2), categories and the presence of a tumor with a Gleason score (GS) of 4 + 3 = 7 or greater or the presence of extraprostatic extension (EPE) at radical prostatectomy (RP) in patients with a GS 3 + 4 = 7 tumor at biopsy. MATERIALS AND METHODS A total of 81 men with GS 3 + 4 = 7 prostate cancer diagnosed by transrectal ultrasound-guided biopsy underwent multiparametric MRI and RP between 2012 and 2015. Two blinded radiologists assessed multiparametric MR images and assigned PI-RADSv2 assessment categories (categories 1-5) with the use of sector maps, which were compared with regard to the location of the tumor, the GS, and the presence of EPE at RP. Comparisons were performed between groups with the use of chi-square and multivariate analysis. Diagnostic accuracy was assessed using ROC curve analysis, and localization was compared using the Fisher exact test. RESULTS A total of 53.1% of men (43/81) had EPE, and 21.0% (17/81) had GS 4 + 3 = 7 prostate cancer after RP, whereas 2.5% of men (2/81) had their tumors downgraded to GS 3 + 3 = 6. No statistically significant difference in patient age, prostate specific antigen level, or clinical stage existed between groups (p > 0.05). PI-RADSv2 assessment categories were significantly higher for GS 4 + 3 = 7 tumors (p = 0.03). PI-RADSv2 showed moderate accuracy for the diagnosis of GS 4 + 3 = 7 tumors (AUC, 0.65; 95% CI, 0.54-0.77), with a category of 4 or higher having a sensitivity and specificity for diagnosis of 94.1% and 23.4%, respectively. No patient with a PI-RADSv2 category lower than 3 had a GS 4 + 3 = 7 tumor. Accuracy of tumor localization ranged from 86.4% to 92.6%, with 88.2% of errors (15/17) occurring in GS 3 + 3 = 6 or GS 3 + 4 = 7 tumors (p = 0.30). PI-RADSv2 categories were noted to be higher when EPE was present (p < 0.001). Interobserver agreement was moderate (κ = 0.43). CONCLUSION For GS 3 + 4 = 7 cancers detected at transrectal ultrasound-guided biopsy, higher PI-RADSv2 assessment categories are associated with upgrading to GS 4 + 3 = 7 cancer and with the presence of EPE after RP. A PI-RADSv2 score of 3 or higher was 100% sensitive for diagnosing GS 4 + 3 = 7 tumors.
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Popita C, Popita AR, Sitar-Taut A, Petrut B, Fetica B, Coman I. 1.5-Tesla Multiparametric-Magnetic Resonance Imaging for the detection of clinically significant prostate cancer. ACTA ACUST UNITED AC 2017; 90:40-48. [PMID: 28246496 PMCID: PMC5305086 DOI: 10.15386/cjmed-690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/27/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Multiparametric-magnetic resonance imaging (mp-MRI) is the main imaging modality used for prostate cancer detection. The aim of this study is to evaluate the diagnostic performance of mp-MRI at 1.5-Tesla (1.5-T) for the detection of clinically significant prostate cancer. METHODS In this ethical board approved prospective study, 39 patients with suspected prostate cancer were included. Patients with a history of positive prostate biopsy and patients treated for prostate cancer were excluded. All patients were examined at 1.5-T MRI, before standard transrectal ultrasonography-guided biopsy. RESULTS The overall sensitivity, specificity, positive predictive value and negative predictive value for mp-MRI were 100%, 73.68%, 80% and 100%, respectively. CONCLUSION Our results showed that 1.5 T mp-MRI has a high sensitivity for detection of clinically significant prostate cancer and high negative predictive value in order to rule out significant disease.
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Affiliation(s)
- Cristian Popita
- Radiology and Medical Imaging Department, "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania; Radiology and Medical Imaging Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Raluca Popita
- Radiology and Medical Imaging Department, "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania; Radiology and Medical Imaging Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adela Sitar-Taut
- Internal Medicine Department, New Blue Life Medical Center, Cluj-Napoca, Romania
| | - Bogdan Petrut
- Department of Urology, "Prof. Dr. Ion Chiricuţă" Oncology Institute , Cluj-Napoca, Romania; Department of Urology , Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bogdan Fetica
- Department of Pathology, "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania
| | - Ioan Coman
- Department of Urology, "Prof. Dr. Ion Chiricuţă" Oncology Institute , Cluj-Napoca, Romania; Department of Urology , Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Kido A, Tamada T, Sone T, Kanomata N, Miyaji Y, Yamamoto A, Ito K. Incremental value of high b value diffusion-weighted magnetic resonance imaging at 3-T for prediction of extracapsular extension in patients with prostate cancer: preliminary experience. Radiol Med 2016; 122:228-238. [PMID: 27943099 DOI: 10.1007/s11547-016-0712-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 11/20/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate whether high b value diffusion-weighted imaging (DWI) contributes to the improvement of diagnostic ability of extracapsular extension (ECE) in prostate cancer (PC). MATERIALS AND METHODS Forty-three patients with PC underwent multiparametric MRI including DWI (b values: 0, 2000 s/mm2) at 3-T. Two radiologists assessed the presence of ECE and the diagnostic certainty degree using conventional diagnostic method by consensus. Tumor apparent diffusion coefficient (ADC, ×10-3 mm2/s) was also measured. Independent predictors of ECE were identified among PSA, tumor ADC, Gleason score, and conventional MRI. ECE in patients with low diagnostic certainty by conventional MRI was further reevaluated using ADC cutoff value, and the results were combined with those of patients with high diagnostic certainty by conventional MRI (MRI + ADC method). RESULTS Tumor ADC was an independent predictor of ECE, and the ADC cutoff value was 0.72. The sensitivity, specificity, and accuracy of conventional MRI and MRI + ADC method in the diagnosis of ECE were 44, 92, and 72%, and 78, 96, and 88%, respectively. Among MRI findings leading to the judgement of low diagnostic certainty, broad tumor contact was most common (72% of the patients). CONCLUSIONS The addition of ADC obtained with high b value DWI at 3-T to conventional MRI improved the diagnostic ability of ECE.
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Affiliation(s)
- Ayumu Kido
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan.
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
| | - Teruki Sone
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
| | - Naoki Kanomata
- Department of Pathology, Kawasaki Medical School, Kurashiki City, Okayama, 701-0192, Japan
| | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki City, Okayama, 701-0192, Japan
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
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18
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Gaunay GS, Patel V, Shah P, Moreira D, Rastinehad AR, Ben-Levi E, Villani R, Vira MA. Multi-parametric MRI of the prostate: Factors predicting extracapsular extension at the time of radical prostatectomy. Asian J Urol 2016; 4:31-36. [PMID: 29264204 PMCID: PMC5730895 DOI: 10.1016/j.ajur.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 11/12/2022] Open
Abstract
Objective Extracapsular extension (ECE) of prostate cancer is a poor prognostic factor associated with progression, recurrence after treatment, and increased prostate cancer-related mortality. Accurate staging prior to radical prostatectomy is crucial in avoidance of positive margins and when planning nerve-sparing procedures. Multi-parametric magnetic resonance imaging (mpMRI) of the prostate has shown promise in this regard, but is hampered by poor sensitivity. We sought to identify additional clinical variables associated with pathologic ECE and determine our institutional accuracy in the detection of ECE amongst patients who went on to radical prostatectomy. Methods mpMRI studies performed between the years 2012 and 2014 were cross-referenced with radical prostatectomy specimens. Predictive properties of ECE as well as additional clinical and biochemical variables to identify pathology-proven prostate cancer ECE were analyzed. Results The prevalence of ECE was 32.4%, and the overall accuracy of mpMRI for ECE was 84.1%. Overall mpMRI sensitivity, specificity, positive predictive value, and negative predictive value for detection of ECE were 58.3%, 97.8%, 93.3%, and 81.5%, respectively. Specific mpMRI characteristics predictive of pathologic ECE included primary lesion size ((20.73 ± 9.09) mm, mean ± SD, p < 0.001), T2 PIRADS score (p = 0.009), overall primary lesion score (p < 0.001), overall study suspicion score (p = 0.003), and MRI evidence of seminal vesicle invasion (SVI) (p = 0.001). Conclusion While mpMRI is an accurate preoperative assessment tool for the detection of ECE, its overall sensitivity is poor, likely related to the low detection rate of standard protocol MRI for microscopic extraprostatic disease. The additional mpMRI findings described may also be considered in surgical margin planning prior to radical prostatectomy.
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Affiliation(s)
- Geoffrey S Gaunay
- The Smith Institute for Urology, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Vinay Patel
- The Smith Institute for Urology, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Paras Shah
- The Smith Institute for Urology, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | | | | | - Eran Ben-Levi
- Department of Radiology, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Robert Villani
- Department of Radiology, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Manish A Vira
- The Smith Institute for Urology, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
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19
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Kim W, Kim CK, Park JJ, Kim M, Kim JH. Evaluation of extracapsular extension in prostate cancer using qualitative and quantitative multiparametric MRI. J Magn Reson Imaging 2016; 45:1760-1770. [PMID: 27749009 DOI: 10.1002/jmri.25515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/05/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate the value of multiparametric magnetic resonance imaging (mpMRI) for extracapsular extension (ECE) in prostate cancer (PCa). MATERIALS AND METHODS In all, 292 patients who received radical prostatectomy and underwent preoperative mpMRI at 3T were enrolled retrospectively. For determining the associations with ECE, the likelihood of ECE was assessed qualitatively on T2 -weighted imaging (T2 WI) and combined T2 WI and diffusion-weighted imaging (DWI) or dynamic contrast-enhanced imaging (DCEI). Quantitative MRI parameters were measured in PCa based on histopathological findings. Two models for detecting ECE including imaging and clinical parameters were developed using multivariate analysis: Model 1 excluding combined T2 WI and DWI and DCEI and Model 2 excluding combined T2 WI and DWI, and combined T2 WI and DCEI. Diagnostic performance of imaging parameters and models was evaluated using the area under the receiver operating characteristics curve (Az). RESULTS For detecting ECE, the specificity, accuracy, and Az of combined T2 WI and DWI or DCEI were statistically better than those of T2 WI (P < 0.05), and all quantitative MRI parameters showed a statistical difference between the patients with and without ECE (P < 0.05). On multivariate analysis, significant independent markers in Model 1 were combined T2 WI and DWI, combined T2 WI and DCEI, and Ktrans (P < 0.05). In Model 2, significant markers were combined T2 WI and DWI and DCEI, Ktrans , Kep , and Ve (P < 0.05). The Az values of models 1 and 2 were 0.944 and 0.957, respectively. CONCLUSION mpMRI may be useful to improve diagnostic accuracy of the models for determining the associations with ECE in PCa. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1760-1770.
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Affiliation(s)
- Wooil Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jung Jae Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Minji Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Hospital, Seoul, Korea
| | - Jae-Hun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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20
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Zhang YD, Wu CJ, Bao ML, Li H, Wang XN, Liu XS, Shi HB. MR-based prognostic nomogram for prostate cancer after radical prostatectomy. J Magn Reson Imaging 2016; 45:586-596. [PMID: 27654116 DOI: 10.1002/jmri.25441] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yu-Dong Zhang
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Chen-Jiang Wu
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Mei-Ling Bao
- Department of Pathology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Hai Li
- Department of Pathology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Xiao-Ning Wang
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Xi-Sheng Liu
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Hai-Bin Shi
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
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21
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de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol 2016. [DOI: 10.1016/j.eururo.2015.07.029] [Citation(s) in RCA: 366] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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22
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Giganti F, Coppola A, Ambrosi A, Ravelli S, Esposito A, Freschi M, Briganti A, Scattoni V, Salonia A, Gallina A, Dehò F, Cardone G, Balconi G, Gaboardi F, Montorsi F, Maschio AD, De Cobelli F. Apparent diffusion coefficient in the evaluation of side-specific extracapsular extension in prostate cancer: Development and external validation of a nomogram of clinical use. Urol Oncol 2016; 34:291.e9-291.e17. [DOI: 10.1016/j.urolonc.2016.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
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23
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Ueno Y, Tamada T, Bist V, Reinhold C, Miyake H, Tanaka U, Kitajima K, Sugimura K, Takahashi S. Multiparametric magnetic resonance imaging: Current role in prostate cancer management. Int J Urol 2016; 23:550-7. [PMID: 27184019 DOI: 10.1111/iju.13119] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/07/2016] [Indexed: 12/31/2022]
Abstract
Digital rectal examination, serum prostate-specific antigen screening and transrectal ultrasound-guided biopsy are conventionally used as screening, diagnostic and surveillance tools for prostate cancer. However, they have limited sensitivity and specificity. In recent years, the role of multiparametric magnetic resonance imaging has steadily grown, and is now part of the standard clinical management in many institutions. In multiparametric magnetic resonance imaging, the morphological assessment of T2-weighted imaging is correlated with diffusion-weighted imaging, dynamic contrast-enhanced imaging perfusion and/or magnetic resonance spectroscopic imaging. Multiparametric magnetic resonance imaging is currently regarded as the most sensitive and specific imaging technique for the evaluation of prostate cancer, including detection, staging, localization and aggressiveness evaluation. This article presents an overview of multiparametric magnetic resonance imaging, and discusses the current role of multiparametric magnetic resonance imaging in the different fields of prostate cancer management.
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Affiliation(s)
- Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Vipul Bist
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Utaru Tanaka
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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New RESOLVE-Based Diffusional Kurtosis Imaging in MRI-Visible Prostate Cancer: Effect of Reduced b Value on Image Quality and Diagnostic Effectiveness. AJR Am J Roentgenol 2016; 207:330-8. [PMID: 27187062 DOI: 10.2214/ajr.15.15990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this article was to investigate whether a new readout segmentation of long variable echo-trains (RESOLVE)-based diffusional kurtosis imaging (DKI) with reduced b value technique can affect image quality and diagnostic effectiveness in MRI-visible prostate cancer (PCA). SUBJECTS AND METHODS Prostatic RESOLVE DKI (0-1400 s/mm2) was prospectively performed for 12 volunteers. The optimal protocol was then performed in 108 MRI-visible PCAs to determine whether it can compete against a preferred b-value set (0-2000 s/mm(2)) regarding image quality and diagnostic effectiveness. Images were interpreted by two independent radiologists using the prostate imaging reporting and data system (PI-RADS). Readers' concordance and diagnostic effectiveness were tested with the Fleiss kappa and area under the ROC curve (Az) analyses. RESULTS A b value of 1400 s/mm(2) generated a larger apparent diffusion coefficient of gaussian distribution (Dapp) (1.35 ± 0.31 vs 1.30 ± 0.30 mm(2)/s; p < 0.001) and apparent kurtosis coefficient (Kapp) (1.11 ± 0.26 vs 1.00 ± 0.21; p < 0.001) in PCA than did a b value of 2000 s/mm(2). Interreader agreement using PI-RADS was relatively low when Dapp and Kapp maps were excluded from image interpretations (κ = 0.39-0.41 vs κ = 0.66-0.68 with Dapp and Kapp maps). Interreader agreement in staging PCA was relatively high (κ > 0.80) and was not influenced by reducing the b value. The power of Dapp and Kapp to differentiate PCA from normal tissue (Az = 0.97-0.98), tissue with a Gleason score less than or equal to 3 + 4 from tissue with a Gleason score greater than 3 + 4 (Az = 0.77-0.82), and PCA stage lower than pT3 from stage pT3 and higher PCA (Az = 0.70-0.75) was not significantly degraded by reducing the b value. CONCLUSION We found that b values significantly influenced image quality, PI-RADS score, and DKI outputs but did not degrade the diagnostic effectiveness of DKI parameters to detect and classify PCA.
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25
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Tamada T, Sone T, Kanomata N, Miyaji Y, Kido A, Jo Y, Yamamoto A, Ito K. Value of preoperative 3T multiparametric MRI for surgical margin status in patients with prostate cancer. J Magn Reson Imaging 2016; 44:584-93. [PMID: 26872679 DOI: 10.1002/jmri.25185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/25/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To examine the value of preoperative multiparametric magnetic resonance imaging (MRI) as a predictor of surgical margin (SM) status in patients with prostate cancer (PC). MATERIALS AND METHODS The Institutional Review Board approved this retrospective study; the requirement for informed consent was waived. Fifty-six male patients with histologically proven PC underwent preoperative 3T multiparametric MRI including high b value (0, 2000 s/mm(2) ) diffusion-weighted imaging. In each patient, clinical data, such as biopsy Gleason score and D'Amico clinical risk score, and multiparametric MRI findings, such as tumor location, tumor size, tumor extension in the apical or proximal region, tumor apparent diffusion coefficient (ADC), and the presence or absence of MRI findings of extracapsular extension (ECE) were evaluated. Statistical evaluations included the Fisher's exact test, χ(2) test, Mann-Whitney U-test, and logistic regression analysis. RESULTS On histopathological evaluation, 15 patients (27%) were SM-positive (SMP group), and 41 (73%) were SM-negative (SMN group). The tumor ADC was significantly lower in the SMP group than in the SMN group (P = 0.001). The frequency of tumor extension in the apex or base and suspected ECE on MRI were significantly higher in the SMP group than in the SMN group (P = 0.037 and 0.011, respectively). On multivariate analysis, tumor ADC was the only predictor of SM status in PC (P = 0.003). CONCLUSION PC with positive SM was characterized by tumor extension in the apical and proximal regions, lower tumor ADC, and tumors with positive MRI findings of ECE, compared to tumors with negative SM. J. Magn. Reson. Imaging 2016;44:584-593.
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Affiliation(s)
- Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Teruki Sone
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Naoki Kanomata
- Department of Pathology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Ayumu Kido
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshimasa Jo
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
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26
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Cerantola Y, Dragomir A, Tanguay S, Bladou F, Aprikian A, Kassouf W. Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer. Urol Oncol 2015; 34:119.e1-9. [PMID: 26602178 DOI: 10.1016/j.urolonc.2015.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Transrectal ultrasound-guided biopsy (TRUSGB) is the recommended approach to diagnose prostate cancer (PCa). Overdiagnosis and sampling errors represent major limitations. Magnetic resonance imaging (MRI)-targeted biopsy (MRTB) detects higher proportion of significant PCa and reduces diagnosis of insignificant PCa. Costs prevent MRTB from becoming the new standard in PCa diagnosis. The present study aimed at assessing whether added costs of MRI outweigh benefits of MRTB in a cost-utility model. MATERIALS AND METHODS A Markov model was developed to estimate quality-adjusted life-year gained (QALY) and costs for 2 strategies (the standard 12-core TRUSGB strategy and the MRTB strategy) over 5, 10, 15, and 20 years. MRI was used as triage test in biopsy-naive men with clinical suspicion of PCa. The model takes into account probability of men harboring PCa, diagnostic accuracy of both procedures, and probability of being assigned to various treatment options. Direct medical costs based on health care system perspective were included. RESULTS Following standard TRUSGB pathway, calculated cumulative effects at 5, 10, 15, and 20 years were 4.25, 7.17, 9.03, and 10.09 QALY, respectively. Cumulative effects in MRTB pathway were 4.29, 7.26, 9.17, and 10.26 QALY, correspondingly. Costs related to TRUSGB strategy were $8,027, $11,406, $14,883, and $17,587 at 5, 10, 15, and 20 years, respectively, as compared with $7,231, $10,450, $13,267, and $15,400 for the MRTB strategy. At 5, 10, 15, and 20 years, MRTB was the established dominant strategy. CONCLUSIONS Incorporation of MRI and MRTB in PCa diagnosis and management represents a cost-effective measure at 5, 10, 15, and 20 years after initial diagnosis.
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Affiliation(s)
- Yannick Cerantola
- Division of Urology, McGill University, Montreal, Canada; Division of Urology, University Hospital CHUV, Lausanne, Switzerland
| | - Alice Dragomir
- Division of Urology, McGill University, Montreal, Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, Canada
| | - Franck Bladou
- Division of Urology, McGill University, Montreal, Canada
| | - Armen Aprikian
- Division of Urology, McGill University, Montreal, Canada
| | - Wassim Kassouf
- Division of Urology, McGill University, Montreal, Canada.
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27
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Bjurlin MA, Rosenkrantz AB, Beltran LS, Raad RA, Taneja SS. Imaging and evaluation of patients with high-risk prostate cancer. Nat Rev Urol 2015; 12:617-28. [PMID: 26481576 DOI: 10.1038/nrurol.2015.242] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Approximately 15% of men with newly diagnosed prostate cancer have high-risk disease. Imaging is critically important for the diagnosis and staging of these patients, and also for the selection of management. While established prostate cancer staging guidelines have increased the appropriate use of imaging, underuse for high-risk prostate cancer remains substantial. Several factors affect the utility of initial diagnostic imaging, including the variable definition of high-risk prostate cancer, variable guideline recommendations, poor accuracy of existing imaging tests, and the difficulty in validating imaging findings. Conventional imaging modalities, including CT and radionuclide bone scan, have been employed for local and metastatic staging, but their performance characteristics have generally been poor. Emerging modalities including multiparametricMRI, positron emission tomography (PET)-CT, and PET-MRI have shown increased diagnostic accuracy and could improve accuracy in staging patients with high-risk prostate cancer.
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Affiliation(s)
- Marc A Bjurlin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY 10016, USA
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, NY 10016, USA
| | - Luis S Beltran
- Department of Radiology, New York University Langone Medical Center, New York, NY 10016, USA
| | - Roy A Raad
- Department of Radiology, New York University Langone Medical Center, New York, NY 10016, USA
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY 10016, USA
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28
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Rosenkrantz AB, Shanbhogue AK, Wang A, Kong MX, Babb JS, Taneja SS. Length of capsular contact for diagnosing extraprostatic extension on prostate MRI: Assessment at an optimal threshold. J Magn Reson Imaging 2015; 43:990-7. [PMID: 26395278 DOI: 10.1002/jmri.25040] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/20/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the length of capsular contact of dominant lesions on multiparametric prostate magnetic resonance imaging (MRI) for predicting extraprostatic extension (EPE) and to determine a threshold value to apply in clinical practice. MATERIALS AND METHODS Ninety patients undergoing 3T prostate MRI before prostatectomy were included. Two independent readers (R1, R2) recorded for each lobe the presence or absence of capsular irregularity on T2 -weighted imaging (T2 WI) and of overt measurable EPE. Readers also recorded the length of capsular contact of each lobe's dominant lesion for T2 WI and the apparent diffusion coefficient (ADC) map. Based on prostatectomy specimens, EPE was recorded for each lobe and classified as focal (single focus ≤0.5 mm in depth) vs. established. Receiver operating characteristic analysis, logistic regression, and kappa coefficients were used to assess interpretive approaches on a side-specific basis. RESULTS The optimal thresholds were 6 mm and 7 mm of contact using T2 WI and ADC for any EPE, and 10 mm and 7 mm using T2 WI and ADC for nonfocal EPE (AUCs 81.0-82.5%). Capsular contact had higher sensitivity, yet lower specificity, than subjective interpretations for any EPE and for nonfocal EPE (all P ≤ 0.018, aside from any EPE for R2 using ADC). Length of contact exhibited more substantial gains in sensitivity (9-20% for any EPE; 34-41% for nonfocal EPE) than losses in specificity (6-13% for any EPE; 17-27% for nonfocal EPE) compared with subjective interpretations. Interreader agreement: 0.70 for assessments based on length of contact; 0.49-0.59 for subjective assessments. CONCLUSION Length of capsular contact of dominant lesions can improve interreader agreement and sensitivity for EPE compared with subjective features, with relatively mild specificity loss.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Alampady K Shanbhogue
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Annie Wang
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Max Xiangtian Kong
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - James S Babb
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Samir S Taneja
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
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Lu Y, Moreira AL, Hatzoglou V, Stambuk HE, Gonen M, Mazaheri Y, Deasy JO, Shaha AR, Tuttle RM, Shukla-Dave A. Using diffusion-weighted MRI to predict aggressive histological features in papillary thyroid carcinoma: a novel tool for pre-operative risk stratification in thyroid cancer. Thyroid 2015; 25:672-80. [PMID: 25809949 PMCID: PMC4490628 DOI: 10.1089/thy.2014.0419] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Initial management recommendations of papillary thyroid carcinoma (PTC) are very dependent on preoperative studies designed to evaluate the presence of PTC with aggressive features. The purpose of this study was to evaluate whether diffusion-weighted magnetic resonance imaging (DW-MRI) before surgery can be used as a tool to stratify tumor aggressiveness in patients with PTC. METHODS In this prospective study, 28 patients with PTC underwent DW-MRI studies on a three Tesla MR scanner prior to thyroidectomy. Due to image quality, 21 patients were finally suitable for further analysis. Apparent diffusion coefficients (ADCs) of normal thyroid tissues and PTCs for 21 patients were calculated. Tumor aggressiveness was defined by surgical histopathology. The Mann-Whitney U test was used to compare the difference in ADCs among groups of normal thyroid tissues and PTCs with and without features of tumor aggressiveness. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative specificity, sensitivity, and accuracy of and determine the cutoff value for the ADC in stratifying PTCs with tumor aggressiveness. RESULTS There was no significant difference in ADC values between normal thyroid tissues and PTCs. However, ADC values of PTCs with extrathyroidal extension (ETE; 1.53±0.25×10(-3) mm2/s) were significantly lower than corresponding values from PTCs without ETE (2.37±0.67×10(-3) mm2/s; p<0.005). ADC values identified 3 papillary carcinoma patients with extrathyroidal extension that would have otherwise been candidates for observation based on ultrasound evaluations. The cutoff value of ADC to discriminate PTCs with and without ETE was determined at 1.85×10(-3) mm2/s with a sensitivity of 85%, specificity of 85%, and ROC curve area of 0.85. CONCLUSION ADC value derived from DW-MRI before surgery has the potential to stratify ETE in patients with PTCs.
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Affiliation(s)
- Yonggang Lu
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andre L. Moreira
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hilda E. Stambuk
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ashok R. Shaha
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - R. Michael Tuttle
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
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30
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Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology. Eur Radiol 2014; 25:1776-85. [DOI: 10.1007/s00330-014-3543-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/23/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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