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Sato Y, Ohkuma K. Verification of image quality improvement by deep learning reconstruction to 1.5 T MRI in T2-weighted images of the prostate gland. Radiol Phys Technol 2024; 17:756-764. [PMID: 38850389 DOI: 10.1007/s12194-024-00819-5] [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: 03/19/2024] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
This study aimed to evaluate whether the image quality of 1.5 T magnetic resonance imaging (MRI) of the prostate is equal to or higher than that of 3 T MRI by applying deep learning reconstruction (DLR). To objectively analyze the images from the 13 healthy volunteers, we measured the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the images obtained by the 1.5 T scanner with and without DLR, as well as for images obtained by the 3 T scanner. In the subjective, T2W images of the prostate were visually evaluated by two board-certified radiologists. The SNRs and CNRs in 1.5 T images with DLR were higher than that in 3 T images. Subjective image scores were better for 1.5 T images with DLR than 3 T images. The use of the DLR technique in 1.5 T MRI substantially improved the SNR and image quality of T2W images of the prostate gland, as compared to 3 T MRI.
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Affiliation(s)
- Yoshiomi Sato
- Department of Radiology, Saitama City Hospital, Mimuro 2460, Saitama, 336-8522, Japan.
| | - Kiyoshi Ohkuma
- Department of Diagnostic Radiology, Saitama City Hospital, Mimuro 2460, Saitama, 336-8522, Japan
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2
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Merriman KM, Harmon SA, Belue MJ, Yilmaz EC, Blake Z, Lay NS, Phelps TE, Merino MJ, Parnes HL, Law YM, Gurram S, Wood BJ, Choyke PL, Pinto PA, Turkbey B. Comparison of MRI-Based Staging and Pathologic Staging for Predicting Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy. AJR Am J Roentgenol 2023; 221:773-787. [PMID: 37404084 DOI: 10.2214/ajr.23.29609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND. Currently most clinical models for predicting biochemical recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP) incorporate staging information from RP specimens, creating a gap in preoperative risk assessment. OBJECTIVE. The purpose of our study was to compare the utility of presurgical staging information from MRI and postsurgical staging information from RP pathology in predicting BCR in patients with PCa. METHODS. This retrospective study included 604 patients (median age, 60 years) with PCa who underwent prostate MRI before RP from June 2007 to December 2018. A single genitourinary radiologist assessed MRI examinations for extraprostatic extension (EPE) and seminal vesicle invasion (SVI) during clinical interpretations. The utility of EPE and SVI on MRI and RP pathology for BCR prediction was assessed through Kaplan-Meier and Cox proportional hazards analyses. Established clinical BCR prediction models, including the University of California San Francisco Cancer of the Prostate Risk Assessment (UCSF-CAPRA) model and the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) model, were evaluated in a subset of 374 patients with available Gleason grade groups from biopsy and RP pathology; two CAPRA-MRI models (CAPRA-S model with modifications to replace RP pathologic staging features with MRI staging features) were also assessed. RESULTS. Univariable predictors of BCR included EPE on MRI (HR = 3.6), SVI on MRI (HR = 4.4), EPE on RP pathology (HR = 5.0), and SVI on RP pathology (HR = 4.6) (all p < .001). Three-year BCR-free survival (RFS) rates for patients without versus with EPE were 84% versus 59% for MRI and 89% versus 58% for RP pathology, and 3-year RFS rates for patients without versus with SVI were 82% versus 50% for MRI and 83% versus 54% for RP histology (all p < .001). For patients with T3 disease on RP pathology, 3-year RFS rates were 67% and 41% for patients without and with T3 disease on MRI. AUCs of CAPRA models, including CAPRA-MRI models, ranged from 0.743 to 0.778. AUCs were not significantly different between CAPRA-S and CAPRA-MRI models (p > .05). RFS rates were significantly different between low- and intermediate-risk groups for only CAPRA-MRI models (80% vs 51% and 74% vs 44%; both p < .001). CONCLUSION. Presurgical MRI-based staging features perform comparably to postsurgical pathologic staging features for predicting BCR. CLINICAL IMPACT. MRI staging can preoperatively identify patients at high BCR risk, helping to inform early clinical decision-making. TRIAL REGISTRATION. ClinicalTrials.gov NCT00026884 and NCT02594202.
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Affiliation(s)
- Katie M Merriman
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Stephanie A Harmon
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Mason J Belue
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Enis C Yilmaz
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Zoë Blake
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD
| | - Nathan S Lay
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Tim E Phelps
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | | | | | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | | | - Bradford J Wood
- Center for Interventional Oncology, NCI, NIH, Bethesda, MD
- Department of Radiology, Clinical Center, NIH, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | | | - Baris Turkbey
- Molecular Imaging Branch, NCI, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
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Lee HW, Kim E, Na I, Kim CK, Seo SI, Park H. Novel Multiparametric Magnetic Resonance Imaging-Based Deep Learning and Clinical Parameter Integration for the Prediction of Long-Term Biochemical Recurrence-Free Survival in Prostate Cancer after Radical Prostatectomy. Cancers (Basel) 2023; 15:3416. [PMID: 37444526 DOI: 10.3390/cancers15133416] [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: 05/12/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Radical prostatectomy (RP) is the main treatment of prostate cancer (PCa). Biochemical recurrence (BCR) following RP remains the first sign of aggressive disease; hence, better assessment of potential long-term post-RP BCR-free survival is crucial. Our study aimed to evaluate a combined clinical-deep learning (DL) model using multiparametric magnetic resonance imaging (mpMRI) for predicting long-term post-RP BCR-free survival in PCa. A total of 437 patients with PCa who underwent mpMRI followed by RP between 2008 and 2009 were enrolled; radiomics features were extracted from T2-weighted imaging, apparent diffusion coefficient maps, and contrast-enhanced sequences by manually delineating the index tumors. Deep features from the same set of imaging were extracted using a deep neural network based on pretrained EfficentNet-B0. Here, we present a clinical model (six clinical variables), radiomics model, DL model (DLM-Deep feature), combined clinical-radiomics model (CRM-Multi), and combined clinical-DL model (CDLM-Deep feature) that were built using Cox models regularized with the least absolute shrinkage and selection operator. We compared their prognostic performances using stratified fivefold cross-validation. In a median follow-up of 61 months, 110/437 patients experienced BCR. CDLM-Deep feature achieved the best performance (hazard ratio [HR] = 7.72), followed by DLM-Deep feature (HR = 4.37) or RM-Multi (HR = 2.67). CRM-Multi performed moderately. Our results confirm the superior performance of our mpMRI-derived DL algorithm over conventional radiomics.
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Affiliation(s)
- Hye Won Lee
- Samsung Medical Center, Department of Urology, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Eunjin Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Inye Na
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Seong Il Seo
- Samsung Medical Center, Department of Urology, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hyunjin Park
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon 16419, Republic of Korea
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4
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He K, Zhang Y, Li S, Yuan G, Liang P, Zhang Q, Xie Q, Xiao P, Li H, Meng X, Li Z. Incremental prognostic value of ADC histogram analysis in patients with high-risk prostate cancer receiving adjuvant hormonal therapy after radical prostatectomy. Front Oncol 2023; 13:1076400. [PMID: 36761966 PMCID: PMC9907778 DOI: 10.3389/fonc.2023.1076400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose To investigate the incremental prognostic value of preoperative apparent diffusion coefficient (ADC) histogram analysis in patients with high-risk prostate cancer (PCa) who received adjuvant hormonal therapy (AHT) after radical prostatectomy (RP). Methods Sixty-two PCa patients in line with the criteria were enrolled in this study. The 10th, 50th, and 90th percentiles of ADC (ADC10, ADC50, ADC90), the mean value of ADC (ADCmean), kurtosis, and skewness were obtained from the whole-lesion ADC histogram. The Kaplan-Meier method and Cox regression analysis were used to analyze the relationship between biochemical recurrence-free survival (BCR-fs) and ADC parameters and other clinicopathological factors. Prognostic models were constructed with and without ADC parameters. Results The median follow-up time was 53.4 months (range, 41.1-79.3 months). BCR was found in 19 (30.6%) patients. Kaplan-Meier curves showed that lower ADCmean, ADC10, ADC50, and ADC90 and higher kurtosis could predict poorer BCR-fs (all p<0.05). After adjusting for clinical parameters, ADC50 and kurtosis remained independent prognostic factors for BCR-fs (HR: 0.172, 95% CI: 0.055-0.541, p=0.003; HR: 7.058, 95% CI: 2.288-21.773, p=0.001, respectively). By adding ADC parameters to the clinical model, the C index and diagnostic accuracy for the 24- and 36-month BCR-fs were improved. Conclusion ADC histogram analysis has incremental prognostic value in patients with high-risk PCa who received AHT after RP. Combining ADC50, kurtosis and clinical parameters can improve the accuracy of BCR-fs prediction.
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Affiliation(s)
- Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Qingguo Xie
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Xiao
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Heng Li, ; Xiaoyan Meng,
| | - Xiaoyan Meng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Heng Li, ; Xiaoyan Meng,
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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5
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Mapelli P, Ghezzo S, Samanes Gajate AM, Preza E, Palmisano A, Cucchiara V, Brembilla G, Bezzi C, Rigamonti R, Magnani P, Toninelli E, Bettinardi V, Suardi N, Gianolli L, Scifo P, Briganti A, De Cobelli F, Esposito A, Picchio M. 68Ga-PSMA and 68Ga-DOTA-RM2 PET/MRI in Recurrent Prostate Cancer: Diagnostic Performance and Association with Clinical and Histopathological Data. Cancers (Basel) 2022; 14:cancers14020334. [PMID: 35053499 PMCID: PMC8773792 DOI: 10.3390/cancers14020334] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Prostate cancer (PCa) relapse occurs in up to 50% of patients after radical treatment. Once PCa recurrence is detected, a precise identification of the number and sites of recurrence is necessary to tailor the treatment on the patient’s needs. Positron emission tomography (PET) plays a pivotal role in this clinical setting and new radiotracers have been developed to improve its performance. While 68Ga-PSMA is a well-established radiotracer for PCa recurrence detection, 68Ga-DOTA-RM2 is a recently proposed tracer that targets the gastrin-releasing peptide receptors that are overexpressed in prostate cancer. In this work, the performance of 68Ga-PSMA and 68Ga-DOTA-RM2 PET/MRI in identifying recurrent disease were compared on the same cohort, using the same study protocol, as this is the only way to assess whether one outperforms the other and therefore should be preferred in clinical practice. Furthermore, the association between PET findings and clinical and histopathological characteristics was investigated to find potential biomarkers. Abstract The aim of the present study is to investigate and compare the performances of 68Ga-PSMA and 68Ga-DOTA-RM2 PET/MRI in identifying recurrent prostate cancer (PCa) after primary treatment and to explore the association of dual-tracer PET findings with clinical and histopathological characteristics. Thirty-five patients with biochemical relapse (BCR) of PCa underwent 68Ga PSMA PET/MRI for restaging purpose, with 31/35 also undergoing 68Ga-DOTA-RM2 PET/MRI scan within 16 days (mean: 3 days, range: 2–16 days). Qualitative and quantitative image analysis has been performed by comparing 68Ga-PSMA and 68Ga-DOTA-RM2 PET/MRI findings both on a patient and lesion basis. Clinical and instrumental follow-up was used to validate PET findings. Fisher’s exact test and Mann-Whitney U test were used to investigate the association between dual-tracer PET findings, clinical and histopathological data. p-value significance was defined below the 0.05 level. Patients’ mean age was 70 years (range: 49–84) and mean PSA at time of PET/MR scans was 1.88 ng/mL (range: 0.21–14.4). A higher detection rate was observed for 68Ga-PSMA PET/MRI, with more lesions being detected compared to 68Ga-DOTA-RM2 PET/MRI (26/35 patients, 95 lesions vs. 15/31 patients, 41 lesions; p = 0.016 and 0.002). 68Ga-PSMA and 68Ga-DOTA-RM2 PET/MRI findings were discordant in 11/31 patients; among these, 10 were 68Ga-PSMA positive (9/10 confirmed as true positive and 1/10 as false positive by follow-up examination). Patients with higher levels of PSA and shorter PSA doubling time (DT) presented more lesions on 68Ga-PSMA PET/MRI (p = 0.006 and 0.044), while no association was found between PET findings and Gleason score. 68Ga-PSMA has a higher detection rate than 68Ga-DOTA-RM2 in detecting PCa recurrence. The number of 68Ga-PSMA PET positive lesions is associated with higher levels of PSA and shorter PSA DT, thus representing potential prognostic factors.
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Affiliation(s)
- Paola Mapelli
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
| | - Samuele Ghezzo
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
| | - Ana Maria Samanes Gajate
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
| | - Erik Preza
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
| | - Anna Palmisano
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Vito Cucchiara
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
- Department of Urology, Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Giorgio Brembilla
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Carolina Bezzi
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
| | - Riccardo Rigamonti
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
| | - Patrizia Magnani
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
| | - Elisa Toninelli
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
| | - Valentino Bettinardi
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
| | - Nazareno Suardi
- IRCCS Ospedale Policlinico San Martino, University of Genoa, Via Benzi 10, 16132 Genoa, Italy;
| | - Luigi Gianolli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
| | - Paola Scifo
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
- Department of Urology, Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Antonio Esposito
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Maria Picchio
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy; (P.M.); (S.G.); (A.P.); (V.C.); (G.B.); (C.B.); (E.T.); (A.B.); (F.D.C.); (A.E.)
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.M.S.G.); (E.P.); (R.R.); (P.M.); (V.B.); (L.G.); (P.S.)
- Correspondence: ; Tel.: +39-02-2643-6117
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6
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Miyamoto S, Goto K, Honda Y, Terada H, Fujii S, Ueno T, Fukuoka K, Sekino Y, Kitano H, Ikeda K, Hieda K, Inoue S, Hayashi T, Teishima J, Takeshima Y, Yasui W, Awai K, Matsubara A. Tumor contact length of prostate cancer determined by a three-dimensional method on multiparametric magnetic resonance imaging predicts extraprostatic extension and biochemical recurrence. Int J Urol 2021; 28:1012-1018. [PMID: 34227174 DOI: 10.1111/iju.14633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/03/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the clinical benefit of tumor contact length as a predictor of pathological extraprostatic extension and biochemical recurrence in patients undergoing prostatectomy. METHODS A total of 91 patients who underwent 3T multiparametric magnetic resonance imaging before prostatectomy from April 2014 to July 2019 were included. A total of 94 prostate cancer foci were analyzed retrospectively. We evaluated maximum tumor contact length, which was determined to be the maximum value in the three-dimensional directions, as a predictor of pathological extraprostatic extension and biochemical recurrence. RESULTS A total of 19 lesions (20.2%) had positive pathological extraprostatic extension. Areas under the curves showed maximum tumor contact length to be a significantly better parameter to predict pathological extraprostatic extension than the Prostate Imaging Reporting and Data System (P = 0.002), tumor maximal diameter (P = 0.001), prostate-specific antigen (P = 0.020), Gleason score (P < 0.001), and clinical T stage (P < 0.001). Multivariate analysis showed maximum tumor contact length (P = 0.003) to be an independent risk factor for predicting biochemical recurrence. We classified the patients using preoperative factors (prostate-specific antigen >10, Gleason score >3 + 4 and maximum tumor contact length >10 mm) into three groups: (i) high-risk group (patients having all factors); (ii) intermediate-risk group (patients having two of three factors); and (iii) low-risk group (patients having only one or none of the factors). Kaplan-Meier curves showed that the high-risk group had significantly worse biochemical recurrence than the intermediate-risk group (P = 0.042) and low-risk group (P < 0.001). CONCLUSIONS Our findings suggest that maximum tumor contact length is an independent predictor of pathological extraprostatic extension and biochemical recurrence. A risk stratification system using prostate-specific antigen, Gleason score and maximum tumor contact length might be useful for preoperative assessment of prostate cancer patients.
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Affiliation(s)
- Shunsuke Miyamoto
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Goto
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukiko Honda
- Department of, Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Terada
- Department of, Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinsuke Fujii
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Ueno
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Urology, Nakatsu Daiichi Hospital, Nakatsu, Japan
| | - Kenichiro Fukuoka
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yohei Sekino
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Kitano
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenichiro Ikeda
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Hieda
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Inoue
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Teishima
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Takeshima
- Department of, Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Yasui
- Department of, Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of, Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Departments of, Department of, Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Hiroshima General Hospital, Hatsukaichi, Japan
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7
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Morka N, Simpson BS, Ball R, Freeman A, Kirkham A, Kelly D, Whitaker HC, Emberton M, Norris JM. Clinical outcomes associated with prostate cancer conspicuity on biparametric and multiparametric MRI: a protocol for a systematic review and meta-analysis of biochemical recurrence following radical prostatectomy. BMJ Open 2021; 11:e047664. [PMID: 33952556 PMCID: PMC8103365 DOI: 10.1136/bmjopen-2020-047664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION There is an increasing body of evidence to suggest that visibility of prostate cancer on magnetic resonance (MRI) may be related to likelihood of adverse pathological outcomes. Biochemical recurrence (BCR) after radical prostatectomy remains a significant clinical challenge and a means of predicting likelihood of this prior to surgery could inform treatment choice. It appears that MRI could be a potential candidate strategy for BCR prediction, and as such, there is a need to review extant literature on the prognostic capability of MRI. Here, we describe a protocol for a systematic review and meta-analysis of the utility of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) in predicting BCR following radical prostatectomy for prostate cancer treatment. METHODS AND ANALYSIS PubMed, MEDLINE, Embase and Cochrane databases will be searched and screening will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. In order to meet the inclusion criteria, papers must be English-language articles involving patients who have had bpMRI or mpMRI for suspected prostate cancer and have undergone radical prostatectomy as definitive therapy. Patients must have had prostate-specific antigen monitoring before and after surgery. All relevant papers published from July 1977 to October 2020 will be eligible for inclusion. The Newcastle-Ottawa score will be used to determine the quality and bias of the studies. This protocol is written in-line with the PRISMA protocol 2015 checklist. ETHICS AND DISSEMINATION There are no relevant ethical concerns. Dissemination of this protocol will be via peer-reviewed journals as well as national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020206074.
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Affiliation(s)
- Naomi Morka
- University College London Medical School, London, UK
| | - Benjamin S Simpson
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Rhys Ball
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Hayley C Whitaker
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
| | - Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
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8
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Norris JM, Simpson BS, Freeman A, Kirkham A, Whitaker HC, Emberton M. Conspicuity of prostate cancer on multiparametric magnetic resonance imaging: A cross-disciplinary translational hypothesis. FASEB J 2020; 34:14150-14159. [PMID: 32920937 PMCID: PMC8436756 DOI: 10.1096/fj.202001466r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/03/2020] [Accepted: 08/24/2020] [Indexed: 11/11/2022]
Abstract
Pre-biopsy multiparametric magnetic resonance imaging (mpMRI) has transformed the risk stratification and diagnostic approach for suspected prostate cancer. The majority of clinically significant prostate cancers are visible on pre-biopsy mpMRI, however, there are a subset of significant tumors that are not detected by mpMRI. The radiobiological mechanisms underpinning mpMRI-visibility and invisibility of these cancers remain uncertain. Emerging evidence suggests that mpMRI-visible tumors are enriched with molecular features associated with increased disease aggressivity and poor clinical prognosis, which is supported by short-term endpoints, such as biochemical recurrence following surgery. Furthermore, at the histopathological level, mpMRI-visible tumors appear to exhibit increased architectural and vascular density compared to mpMRI-invisible disease. It seems probable that the genomic, pathological, radiological, and clinical features of mpMRI-visible and mpMRI-invisible prostate cancers are interrelated. Here, we propose a novel cross-disciplinary theory that links genomic and molecular evidence with cellular and histopathological appearances, elucidating both the mpMRI visibility and clinical status of significant prostate cancer.
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Affiliation(s)
- Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Benjamin S Simpson
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley C Whitaker
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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9
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Xu N, Ke ZB, Chen YH, Wu YP, Chen SH, Wei Y, Zheng QS, Huang JB, Li XD, Xue XY. Risk Factors for Pathologically Confirmed Lymph Nodes Metastasis in Patients With Clinical T2N0M0 Stage Prostate Cancer. Front Oncol 2020; 10:1547. [PMID: 32923401 PMCID: PMC7456999 DOI: 10.3389/fonc.2020.01547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/20/2020] [Indexed: 01/03/2023] Open
Abstract
Objective To explore the risk factors for postoperatively pathological lymph node metastasis in patients with clinical T2N0M0 stage prostate cancer (PCa). Methods We retrospectively analyzed clinicopathological data of 316 patients with clinical T2 stage PCa and preoperative negative lymph nodes [LN(−)] indicated by imaging (cT2N0M0) between January 2014 and May 2019. Multivariate logistic regression analysis was performed to determine risk factors for postoperatively pathological pLN(+) in patients with cT2N0M0 stage PCa. Spearman correlation analysis was used to explore the relationship between tumor burden and Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score. Results A total of 45 patients (14.2%) were confirmed by postoperative pathology to have LN metastasis. Univariate analysis indicated that total prostate-specific antigen (tPSA), PI-RADS v2 score, postoperative Gleason grade group (GGG), intraductal carcinoma of the prostate (IDC-P), clinical T2 substaging, and postoperative pathological tumor burden were risk factors for pLN(+) in all patients. Multivariate analysis showed that tPSA and postoperative GGG were risk factors for pLN(+) in all patients. Univariate analysis revealed that tPSA, PIRADS v2 score, clinical T2 substaging, IDC-P, postoperative pathological tumor burden, and postoperative GGG were risk factors for pLN(+) in patients with GGG ≥ 3. Multivariate analysis suggested that tPSA, PI-RADS v2 score, clinical T2 substaging, postoperative pathological tumor burden, and GGG were risk factors for pLN (+) in patients with GGG ≥ 3. Spearman correlation analysis showed that PI-RADS v2 score was positively correlated with clinical T2 substaging and postoperative pathological tumor burden. Conclusion There was a high risk of LN metastasis in patients with cT2 PCa if they had high preoperative tPSA or high postoperative GGG. Patients with cT2 PCa and GGG ≥ 3 had a high risk of LN metastasis if they had high PI-RADS v2 score, high preoperative clinical stage or high postoperative pathological tumor burden. PI-RADS v2 score predicted tumor burden well in patients with GGG ≥ 3.
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Affiliation(s)
- Ning Xu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Bin Ke
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ye-Hui Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yu-Peng Wu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shao-Hao Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yong Wei
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing-Shui Zheng
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jin-Bei Huang
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Dong Li
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xue-Yi Xue
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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10
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Shin TJ, Jung W, Ha JY, Kim BH, Kim YH. The significance of the visible tumor on preoperative magnetic resonance imaging in localized prostate cancer. Prostate Int 2020; 9:6-11. [PMID: 33912508 PMCID: PMC8053693 DOI: 10.1016/j.prnil.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/02/2020] [Accepted: 06/14/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives We investigated the relationship between tumor characteristics and visible tumors on magnetic resonance imaging (MRI) and examined the prognosis of tumor detection on MRI compared with no tumor detection in localized prostate cancer. Materials and methods We reviewed 214 patients with pT2N0M0 prostate cancer who underwent radical prostatectomy between January 2009 and December 2016. All the patients underwent MRI preoperatively. The patients were divided into 2 groups postoperatively: no visible tumor on the MRI group (n = 96, 44.9%) and visible tumor on the MRI group (n = 118, 55.1%). The visible tumor was defined as Prostate Imaging Reporting and Data System, version 2 Grade ≥ 3 on MRI. Age, prostate-specific antigen, prostate volume, positive surgical margin (PSM), lymphovascular invasion, and biochemical recurrence (BCR) were compared between the 2 groups. We also assessed the relationship between visible tumors on MRI and oncologic characteristics. Results The visible tumor on the MRI group showed a higher Gleason score ≥4 + 3 [45.8% versus (vs.) 17.7%], high frequency of postoperative PSMs (28.8% vs. 16.7%), and higher BCR rate (17.8% vs. 7.3%) than the no visible tumor on the MRI group. The Kaplan–Meier analysis for BCR-free survival also showed a significant difference (P = 0.006). In multivariate Cox regression analysis, the detection of tumors on MRI was associated with a higher BCR risk [hazard ratio: 3.35; 95% confidence interval (CI): 1.36-8.27; P = 0.009]. We found a positive association between visible tumors on MRI and primary Gleason pattern of ≥4 (odds ratio: 4.31; 95% CI: 2.21–8.40; P < 0.001). Conclusions In localized prostate cancer, BCR was significantly more frequent when the tumor was detected on MRI, and a visible tumor on MRI was associated with the Gleason score. Therefore, attention should be paid to the possibility of high-grade prostate cancer when a tumor is detected on MRI before radical prostatectomy, and active follow-up may be needed postoperatively.
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Affiliation(s)
- Teak Jun Shin
- Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
| | - Wonho Jung
- Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
| | - Ji Yong Ha
- Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
| | - Byung Hoon Kim
- Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
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11
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Coppola A, Platania G, Ticca C, De Mattia C, Bortolato B, Palazzi MF, Vanzulli A. Sensitivity of CE-MRI in detecting local recurrence after radical prostatectomy. Radiol Med 2020; 125:683-690. [PMID: 32078119 DOI: 10.1007/s11547-020-01149-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/06/2020] [Indexed: 02/07/2023]
Abstract
AIM The aim of our study was to evaluate the sensitivity of contrast-enhanced magnetic resonance (CE-MR) with phased array coil in the diagnosis of local recurrence in patients with prostate cancer after radical prostatectomy and referred for salvage radiotherapy (SRT). MATERIALS AND METHODS This retrospective study included 73 patients treated with SRT after radical prostatectomy in the period between September 2006 and November 2017. All patients performed a CE-MRI with phased array coil before the start of SRT. A total of 213 patients treated at the ASST Grande Ospedale Metropolitano Niguarda in the period between September 2006 and November 2017 with SRT after radical prostatectomy were reviewed. Seventy-three patients with a CE-MRI with phased array coil of the pelvis before the start of SRT were included in the present study. RESULTS At imaging review, recurrence local recurrent disease was diagnosed in 48 of 73 patients. By considering as reference standard the decrease in prostate-specific antigen (PSA) value after radiotherapy, we defined: 41 true positive (patients with MRI evidence of local recurrence and PSA value decreasing after SRT), 7 false positive (patients with MRI evidence of local recurrence without biochemical response after SRT), 3 true negative (patients without MRI evidence of local recurrence and stable or increased PSA value after SRT) and 22 false negative (patients without MRI evidence of local recurrence and PSA value decreasing after SRT) cases. The sensitivity values were calculated in relation to the PSA value before the start of treatment, obtaining a value of 74% for PSA above 0.2 ng/mL. CONCLUSION The sensitivity of CE-MRI in local recurrence detection after radical prostatectomy increases with increasing PSA values. CE-MRI with phased array coil can detect local recurrences after radical prostatectomy with a good sensitivity in patients with pre-RT PSA value above 0.2 ng/mL.
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Affiliation(s)
| | | | - Cristiana Ticca
- Department of Radiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Barbara Bortolato
- Unit of Radiotherapy, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro F Palazzi
- Unit of Radiotherapy, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Vanzulli
- Department of Oncology and Hemato-Oncology, Grande Ospedale Metropolitano Niguarda, University of Milan, Milan, Italy
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12
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Kim R, Kim CK, Park JJ, Kim JH, Seo SI, Jeon SS, Lee HM. Prognostic Significance for Long-Term Outcomes Following Radical Prostatectomy in Men with Prostate Cancer: Evaluation with Prostate Imaging Reporting and Data System Version 2. Korean J Radiol 2019; 20:256-264. [PMID: 30672165 PMCID: PMC6342765 DOI: 10.3348/kjr.2018.0613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/02/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To retrospectively determine whether the use of the Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) helps predict long-term outcomes for prostate cancer (PCa) patients following radical prostatectomy (RP). Materials and Methods A total of 166 patients with localized PCa evaluated with multiparametric magnetic resonance imaging (mpMRI) at 3T before RP were enrolled. Three groups were created based on PI-RADS v2 score used to predict clinical outcomes: group A, ≥ 3; group B, ≥ 4; group C, 5. We calculated biochemical recurrence-free survival (RFS) and progression-free survival (PFS). Cox proportion hazards models were used to identify variables predictive of biochemical recurrence and disease progression. Results During a median follow-up of 9.1 years, biochemical recurrence occurred in 67 patients (40.4%) and disease progression occurred in 55 patients (33.1%). In all groups, 10-year RFS and 10-year PFS were significantly lower for PI-RADS scores ≥ 3, ≥ 4 and 5 than for score < 3, < 4 and < 5 (p <0.05), respectively. In multivariate analysis, PI-RADS score ≥ 3 and score 5 were significant independent risk marker for biochemical recurrence (hazard ratio [HR] = 5.58, p = 0.018; HR = 1.75, p = 0.033) and disease progression (HR = 3.99, p = 0.047; HR = 2.31, p = 0.040). Moderate inter-observer agreement was seen for PI-RADS scoring. Conclusion PI-RADS v2 may be used to predict long-term outcomes following RP in PCa.
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Affiliation(s)
- Ran Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Jung Jae Park
- Department of Radiology, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Hun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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13
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Prognostic value of preoperative dynamic contrast-enhanced magnetic resonance imaging in epithelial ovarian cancer. Eur J Radiol 2019; 115:66-73. [DOI: 10.1016/j.ejrad.2019.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 01/24/2023]
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14
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Can We Improve the Preoperative Prediction of Prostate Cancer Recurrence With Multiparametric MRI? Clin Genitourin Cancer 2019; 17:e745-e750. [PMID: 31201051 DOI: 10.1016/j.clgc.2019.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/18/2019] [Accepted: 03/21/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The use of multiparametric magnetic resonance imaging (mpMRI) to assess prostate cancer (PCa) has increased over the past decade. We aimed to assess if preoperative mpMRI lesion score, a variable routinely available for men undergoing pre-biopsy MRI, improves the performance of commonly used preoperative predictive models for PCa recurrence. PATIENTS AND METHODS We analyzed data from 372 patients with PCa treated with radical prostatectomy in 2012 to 2017 and assessed with pre-biopsy mpMRI within 6 months prior to surgery. Suspicious areas for cancer were scored on a standardized 5-point scale. Cox regression was used to assess the association between mpMRI score and the risk of postoperative biochemical recurrence. Two different models were tested accounting for factors included in the Kattan nomogram and in the D'Amico risk-classification. RESULTS Overall, 53% and 30% of patients were found with a lesion scored 4 or 5 at pre-biopsy mpMRI, respectively. Risk varied widely by mpMRI (29% 2-year risk of biochemical recurrence for a score of 5 vs. 5% for a score of 1-2), and mpMRI score was associated with large hazard ratios after adjusting for stage, grade, and prostate-specific antigen: 1.66, 1.96, and 2.71 for scores 3, 4, and 5, respectively. However, 95% confidence intervals were very wide (0.19-14.20, 0.26-14.65, and 0.36-20.55, respectively) and included 1. CONCLUSIONS Our data did not show that preoperative models, commonly used to assess PCa risk, were improved after including the pre-biopsy mpMRI score. However, the value of pre-biopsy mpMRI to improve preoperative risk models should be investigated in larger data sets.
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Dell’Oglio P, Stabile A, Dias BH, Gandaglia G, Mazzone E, Fossati N, Cucchiara V, Zaffuto E, Mirone V, Suardi N, Mottrie A, Montorsi F, Briganti A. Impact of multiparametric MRI and MRI-targeted biopsy on pre-therapeutic risk assessment in prostate cancer patients candidate for radical prostatectomy. World J Urol 2018; 37:221-234. [DOI: 10.1007/s00345-018-2360-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/28/2018] [Indexed: 12/29/2022] Open
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16
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Zhang YD, Wang J, Wu CJ, Bao ML, Li H, Wang XN, Tao J, Shi HB. An imaging-based approach predicts clinical outcomes in prostate cancer through a novel support vector machine classification. Oncotarget 2018; 7:78140-78151. [PMID: 27542201 PMCID: PMC5363650 DOI: 10.18632/oncotarget.11293] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022] Open
Abstract
Preoperatively predict the probability of Prostate cancer (PCa) biochemical recurrence (BCR) is of definite clinical relevance. The purpose of this study was to develop an imaging-based approach in the prediction of 3-years BCR through a novel support vector machine (SVM) classification. We collected clinicopathologic and MR imaging datasets in 205 patients pathologically confirmed PCa after radical prostatectomy. Univariable and multivariable analyses were used to assess the association between MR findings and 3-years BCR, and modeled the imaging variables and follow-up data to predict 3-year PCa BCR using SVM analysis. The performance of SVM was compared with conventional Logistic regression (LR) and D'Amico risk stratification scheme by area under the receiver operating characteristic curve (Az) analysis. We found that SVM had significantly higher Az (0.959 vs. 0.886; p = 0.007), sensitivity (93.3% vs. 83.3%; p = 0.025), specificity (91.7% vs. 77.2%; p = 0.009) and accuracy (92.2% vs. 79.0%; p = 0.006) than LR analysis. Performance of popularized D'Amico scheme was effectively improved by adding MRI-derived variables (Az: 0.970 vs. 0.859, p < 0.001; sensitivity: 91.7% vs. 86.7%, p = 0.031; specificity: 94.5% vs. 78.6%, p = 0.001; and accuracy: 93.7% vs. 81.0%, p = 0.007). Additionally, beside pathological Gleason score (hazard ratio [HR] = 1.560, p = 0.008), surgical-T3b (HR = 4.525, p < 0.001) and positive surgical margin (HR = 1.314, p = 0.007), apparent diffusion coefficient (HR = 0.149, p = 0.035) was the only independent imaging predictor of time to PSA failure. Therefore, We concluded that imaging-based approach using SVM was superior to LR analysis in predicting PCa outcome. Adding MR variables improved the performance of D'Amico scheme.
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Affiliation(s)
- Yu-Dong Zhang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jing Wang
- Center for Medical Device Evaluation, CFDA, Beijing, 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
| | - Jun Tao
- Department of Urology, 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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Park SY, Cho NH, Jung DC, Oh YT. Prostate Imaging-Reporting and Data System Version 2: Beyond Prostate Cancer Detection. Korean J Radiol 2018. [PMID: 29520176 PMCID: PMC5840047 DOI: 10.3348/kjr.2018.19.2.193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The main purpose of Prostate Imaging-Reporting and Data System Version 2 (PI-RADSv2) is to effectively detect clinically significant prostate cancers (csPCa) using multiparametric magnetic resonance imaging. Since the first introduction of PI-RADSv2, researchers have validated its diagnostic performance in identifying csPCa, and these promising data have influenced biopsy and treatment schemes. However, in this article, we focused on the potential of PI-RADSv2 in relation to various aspects of PCa such as Gleason score, tumor volume, extraprostatic extension, lymph node metastasis, and postoperative biochemical recurrence, beyond prostate cancer detection.
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Affiliation(s)
- Sung Yoon Park
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dae Chul Jung
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Taik Oh
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
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18
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Evaluation and Treatment for Older Men with Elevated PSA. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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19
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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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Tan N, Shen L, Khoshnoodi P, Alcalá HE, Yu W, Hsu W, Reiter RE, Lu DY, Raman SS. Pathological and 3 Tesla Volumetric Magnetic Resonance Imaging Predictors of Biochemical Recurrence after Robotic Assisted Radical Prostatectomy: Correlation with Whole Mount Histopathology. J Urol 2017; 199:1218-1223. [PMID: 29128577 DOI: 10.1016/j.juro.2017.10.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to identify the clinical and magnetic resonance imaging variables predictive of biochemical recurrence after robotic assisted radical prostatectomy in patients who underwent multiparametric 3 Tesla prostate magnetic resonance imaging. MATERIALS AND METHODS We performed an institutional review board approved, HIPAA (Health Insurance Portability and Accountability Act) compliant, single arm observational study of 3 Tesla multiparametric magnetic resonance imaging prior to robotic assisted radical prostatectomy from December 2009 to March 2016. Clinical, magnetic resonance imaging and pathological information, and clinical outcomes were compiled. Biochemical recurrence was defined as prostate specific antigen 0.2 ng/cc or greater. Univariate and multivariate regression analysis was performed. RESULTS Biochemical recurrence had developed in 62 of the 255 men (24.3%) included in the study at a median followup of 23.5 months. Compared to the subcohort without biochemical recurrence the subcohort with biochemical recurrence had a greater proportion of patients with a high grade biopsy Gleason score, higher preoperative prostate specific antigen (7.4 vs 5.6 ng/ml), intermediate and high D'Amico classifications, larger tumor volume on magnetic resonance imaging (0.66 vs 0.30 ml), higher PI-RADS® (Prostate Imaging-Reporting and Data System) version 2 category lesions, a greater proportion of intermediate and high grade radical prostatectomy Gleason score lesions, higher pathological T3 stage (all p <0.01) and a higher positive surgical margin rate (19.3% vs 7.8%, p = 0.016). On multivariable analysis only tumor volume on magnetic resonance imaging (adjusted OR 1.57, p = 0.016), pathological T stage (adjusted OR 2.26, p = 0.02), positive surgical margin (adjusted OR 5.0, p = 0.004) and radical prostatectomy Gleason score (adjusted OR 2.29, p = 0.004) predicted biochemical recurrence. CONCLUSIONS In this cohort tumor volume on magnetic resonance imaging and pathological variables, including Gleason score, staging and positive surgical margins, significantly predicted biochemical recurrence. This suggests an important new imaging biomarker.
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Affiliation(s)
- Nelly Tan
- School of Medicine University of California-Riverside, Riverside, California; Department of Radiology, Loma Linda University, Loma Linda, California.
| | - Luyao Shen
- Department of Radiological Sciences, University of California-Los Angeles, Los Angeles, California
| | - Pooria Khoshnoodi
- Department of Radiological Sciences, University of California-Los Angeles, Los Angeles, California
| | - Héctor E Alcalá
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Weixia Yu
- Computing Technology Research Laboratory, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - William Hsu
- Department of Radiology, Loma Linda University, Loma Linda, California
| | - Robert E Reiter
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - David Y Lu
- Department of Pathology, University of California-Los Angeles, Los Angeles, California
| | - Steven S Raman
- Department of Radiology, Loma Linda University, Loma Linda, California
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Bjurlin MA, Taneja SS. Prediagnostic Risk Assessment with Prostate MRI and MRI-Targeted Biopsy. Urol Clin North Am 2017; 44:535-546. [DOI: 10.1016/j.ucl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Association between a 17-gene genomic prostate score and multi-parametric prostate MRI in men with low and intermediate risk prostate cancer (PCa). PLoS One 2017; 12:e0185535. [PMID: 29016610 PMCID: PMC5634556 DOI: 10.1371/journal.pone.0185535] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to directly compare results from multi-parametric prostate MRI (mpMRI) and a biopsy-based 17-gene RT-PCR assay providing a Genomic Prostate Score (GPS) among individuals who were candidates for active surveillance with low and intermediate risk prostate cancer (PCa). Patients and methods We evaluated the association between GPS results (scale 0–100) and endorectal mpMRI findings in men with clinically localized PCa. MR studies were reviewed to a five-tier scale of increasing suspicion of malignancy. Mean apparent diffusion coefficient (ADC) was calculated from a single dominant lesion. Mean rank of the GPS (0–100) among MRI strata was compared with the Kruskal-Wallis test and Dunn's multiple comparison test. Spearman's correlation was performed to examine the association between mean ADC and scaled GPS. Results Of 186 patients who received GPS testing, 100 were identified who received mpMRI. Mean GPS results differed between mpMRI categories (p = 0.001); however a broad range was observed in all mpMRI categories. Among men with biopsy Gleason pattern 3+3, mean GPS results were not significantly different among MRI groups (p = 0.179), but GPS differences were seen among MRI categories for patients with pattern 3+4 (p = 0.010). Mean ADC was weakly associated with GPS (σ = -0.151). Stromal response (p = 0.015) and cellular organization (p = 0.045) gene group scores differed significantly by MRI findings, but no differences were seen among androgen signaling or proliferation genes. Conclusions Although a statistically significant association was observed between GPS results and MRI scores, a wide range of GPS values were observed across imaging categories suggesting that mpMRI and genomic profiling may offer non- overlapping clinical insights.
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Reisæter LAR, Fütterer JJ, Losnegård A, Nygård Y, Monssen J, Gravdal K, Halvorsen OJ, Akslen LA, Biermann M, Haukaas S, Rørvik J, Beisland C. Optimising preoperative risk stratification tools for prostate cancer using mpMRI. Eur Radiol 2017; 28:1016-1026. [PMID: 28986636 PMCID: PMC5811593 DOI: 10.1007/s00330-017-5031-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/17/2017] [Accepted: 08/10/2017] [Indexed: 01/15/2023]
Abstract
Purpose To improve preoperative risk stratification for prostate cancer (PCa) by incorporating multiparametric MRI (mpMRI) features into risk stratification tools for PCa, CAPRA and D’Amico. Methods 807 consecutive patients operated on by robot-assisted radical prostatectomy at our institution during the period 2010–2015 were followed to identify biochemical recurrence (BCR). 591 patients were eligible for final analysis. We employed stepwise backward likelihood methodology and penalised Cox cross-validation to identify the most significant predictors of BCR including mpMRI features. mpMRI features were then integrated into image-adjusted (IA) risk prediction models and the two risk prediction tools were then evaluated both with and without image adjustment using receiver operating characteristics, survival and decision curve analyses. Results 37 patients suffered BCR. Apparent diffusion coefficient (ADC) and radiological extraprostatic extension (rEPE) from mpMRI were both significant predictors of BCR. Both IA prediction models reallocated more than 20% of intermediate-risk patients to the low-risk group, reducing their estimated cumulative BCR risk from approximately 5% to 1.1%. Both IA models showed improved prognostic performance with a better separation of the survival curves. Conclusion Integrating ADC and rEPE from mpMRI of the prostate into risk stratification tools improves preoperative risk estimation for BCR. Key points • MRI-derived features, ADC and EPE, improve risk stratification of biochemical recurrence. • Using mpMRI to stratify prostate cancer patients improves the differentiation between risk groups. • Using preoperative mpMRI will help urologists in selecting the most appropriate treatment. Electronic supplementary material The online version of this article (10.1007/s00330-017-5031-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars A R Reisæter
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei, N-5021, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Jurgen J Fütterer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Are Losnegård
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei, N-5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yngve Nygård
- Department of Urology, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Jan Monssen
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei, N-5021, Bergen, Norway
| | - Karsten Gravdal
- Department of Pathology, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Ole J Halvorsen
- Department of Pathology, Haukeland University Hospital, N-5021, Bergen, Norway
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Lars A Akslen
- Department of Pathology, Haukeland University Hospital, N-5021, Bergen, Norway
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Martin Biermann
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei, N-5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Svein Haukaas
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Urology, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Jarle Rørvik
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei, N-5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Urology, Haukeland University Hospital, N-5021, Bergen, Norway
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Development of standardized image interpretation for 68Ga-PSMA PET/CT to detect prostate cancer recurrent lesions. Eur J Nucl Med Mol Imaging 2017; 44:1622-1635. [DOI: 10.1007/s00259-017-3725-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
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25
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Local recurrence of prostate cancer after radical prostatectomy is at risk to be missed in 68Ga-PSMA-11-PET of PET/CT and PET/MRI: comparison with mpMRI integrated in simultaneous PET/MRI. Eur J Nucl Med Mol Imaging 2016; 44:776-787. [PMID: 27988802 DOI: 10.1007/s00259-016-3594-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/06/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE The positron emission tomography (PET) tracer 68Ga-PSMA-11, targeting the prostate-specific membrane antigen (PSMA), is rapidly excreted into the urinary tract. This leads to significant radioactivity in the bladder, which may limit the PET-detection of local recurrence (LR) of prostate cancer (PC) after radical prostatectomy (RP), developing in close proximity to the bladder. Here, we analyze if there is additional value of multi-parametric magnetic resonance imaging (mpMRI) compared to the 68Ga-PSMA-11-PET-component of PET/CT or PET/MRI to detect LR. METHODS One hundred and nineteen patients with biochemical recurrence after prior RP underwent both hybrid 68Ga-PSMA-11-PET/CTlow-dose (1 h p.i.) and -PET/MRI (2-3 h p.i.) including a mpMRI protocol of the prostatic bed. The comparison of both methods was restricted to the abdomen with focus on LR (McNemar). Bladder-LR distance and recurrence size were measured in axial T2w-TSE. A logistic regression was performed to determine the influence of these variables on detectability in 68Ga-PSMA-11-PET. Standardized-uptake-value (SUVmean) quantification of LR was performed. RESULTS There were 93/119 patients that had at least one pathologic finding. In addition, 18/119 Patients (15.1%) were diagnosed with a LR in mpMRI of PET/MRI but only nine were PET-positive in PET/CT and PET/MRI. This mismatch was statistically significant (p = 0.004). Detection of LR using the PET-component was significantly influenced by proximity to the bladder (p = 0.028). The PET-pattern of LR-uptake was classified into three types (1): separated from bladder; (2): fuses with bladder, and (3): obliterated by bladder). The size of LRs did not affect PET-detectability (p = 0.84), mean size was 1.7 ± 0.69 cm long axis, 1.2 ± 0.46 cm short-axis. SUVmean in nine men was 8.7 ± 3.7 (PET/CT) and 7.0 ± 4.2 (PET/MRI) but could not be quantified in the remaining nine cases (obliterated by bladder). CONCLUSION The present study demonstrates additional value of hybrid 68Ga-PSMA-11-PET/MRI by gaining complementary diagnostic information compared to the 68Ga-PSMA-11-PET/CTlow-dose for patients with LR of PC.
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26
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Salerno J, Finelli A, Morash C, Morgan SC, Power N, Schieda N, Haider MA. Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline. Can Urol Assoc J 2016; 10:E332-E339. [PMID: 27800062 DOI: 10.5489/cuaj.3823] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation. METHODS MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation. RESULTS The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11-85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases. CONCLUSIONS Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.
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Affiliation(s)
- Jennifer Salerno
- McMaster University, Department of Oncology and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON, Canada
| | | | | | | | | | - Nichola Schieda
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Masoom A Haider
- Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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27
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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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28
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Taouli B, Beer AJ, Chenevert T, Collins D, Lehman C, Matos C, Padhani AR, Rosenkrantz AB, Shukla-Dave A, Sigmund E, Tanenbaum L, Thoeny H, Thomassin-Naggara I, Barbieri S, Corcuera-Solano I, Orton M, Partridge SC, Koh DM. Diffusion-weighted imaging outside the brain: Consensus statement from an ISMRM-sponsored workshop. J Magn Reson Imaging 2016; 44:521-40. [PMID: 26892827 PMCID: PMC4983499 DOI: 10.1002/jmri.25196] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/28/2016] [Accepted: 01/30/2016] [Indexed: 12/11/2022] Open
Abstract
The significant advances in magnetic resonance imaging (MRI) hardware and software, sequence design, and postprocessing methods have made diffusion-weighted imaging (DWI) an important part of body MRI protocols and have fueled extensive research on quantitative diffusion outside the brain, particularly in the oncologic setting. In this review, we summarize the most up-to-date information on DWI acquisition and clinical applications outside the brain, as discussed in an ISMRM-sponsored symposium held in April 2015. We first introduce recent advances in acquisition, processing, and quality control; then review scientific evidence in major organ systems; and finally describe future directions. J. Magn. Reson. Imaging 2016;44:521-540.
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Affiliation(s)
- Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ambros J. Beer
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Thomas Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David Collins
- CR UK Cancer Imaging Centre, Institute of Cancer Research and Department of Radiology, Royal Marsden Hospital, London, UK
| | - Constance Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Celso Matos
- Department of Radiology, Champalimaud Clinical Centre, Lisbon, Portugal
| | | | | | - Amita Shukla-Dave
- Departments of Medical Physics and Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Eric Sigmund
- Irene and Bernard Schwartz Center for Biomedical Imaging (CBI) and Center for Advanced Imaging and Innovation (CAIR), Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Lawrence Tanenbaum
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Harriet Thoeny
- Department of Diagnostic Radiology, Inselspital Bern, Bern, Switzerland
| | | | | | - Idoia Corcuera-Solano
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew Orton
- CR UK Cancer Imaging Centre, Institute of Cancer Research and Department of Radiology, Royal Marsden Hospital, London, UK
| | | | - Dow-Mu Koh
- Institute of Cancer Research and Department of Radiology, Royal Marsden Hospital, London, UK
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Kongnyuy M, Sidana A, George AK, Muthigi A, Iyer A, Ho R, Chelluri R, Mertan F, Frye TP, Su D, Merino MJ, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Tumor contact with prostate capsule on magnetic resonance imaging: A potential biomarker for staging and prognosis. Urol Oncol 2016; 35:30.e1-30.e8. [PMID: 27567248 DOI: 10.1016/j.urolonc.2016.07.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/11/2016] [Accepted: 07/21/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND The high-spatial resolution of multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer. mpMRI characteristics (extraprostatic extension [EPE], number of lesions, etc.) may predict final pathological findings (positive lymph node [pLN] and pathological ECE [pECE]) and biochemical recurrence (BCR). Tumor contact length (TCL) on MRI, defined as the length of a lesion in contact with the prostatic capsule, is a novel marker with promising early results. We aimed to evaluate TCL as a predictor of +pathological EPE (+pEPE),+pathological LN (+pLN), and BCR in patients undergoing robotic-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS A review was performed of a prospectively maintained single-institution database of men with prostate cancer who underwent prostate mpMRI followed by robotic-assisted laparoscopic radical prostatectomy without prior therapy from 2007 to 2015. TCL was measured using T2-weighted magnetic resonance images. Logistic and Cox regression analysis were used to assess associations of clinical, imaging, and histopathological variables with pEPE, pLN, and BCR. Receiver operating characteristic curves were used to characterize and compare TCL performance with Partin tables. RESULTS There were 87/379 (23.0%)+pEPE, 18/384 (4.7%)+pLN, and 33/371 (8.9%) BCR patients. Patients with adverse pathology/oncologic outcomes had longer TCL compared to those without adverse outcomes (+pEPE: 19.8 vs. 10.1mm, P<0.0001,+pLN: 38.0 vs. 11.7mm, P<0.0001, and BCR: 19.2 vs. 11.2mm, P = 0.001). On multivariate analysis, TCL remained a predictor of+pEPE (odds ratio: 1.04, P = 0.001),+pLN (odds ratio: 1.07, P<0.0001), and BCR (hazard ratio: 1.03, P = 0.02). TCL thresholds for predicting+pEPE and+pLN were 12.5 and 19.7mm, respectively. TCL alone was found to have good predictive ability for+pEPE and+PLN (pEPE:TCLAUC: 0.71 vs. PartinAUC: 0.66, P = 0.21; pLN:TCLAUC: 0.77 vs. PartinAUC: 0.88, P = 0.04). CONCLUSION We demonstrate that TCL is an independent predictor of+pEPE, +pLN, and BCR. If validated, this imaging biomarker may facilitate and inform patient counseling and decision-making.
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Affiliation(s)
- Michael Kongnyuy
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Akhil Muthigi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amogh Iyer
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Richard Ho
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Raju Chelluri
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Francesca Mertan
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Thomas P Frye
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Daniel Su
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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30
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Brunsing RL, Schenker-Ahmed NM, White NS, Parsons JK, Kane C, Kuperman J, Bartsch H, Kader AK, Rakow-Penner R, Seibert TM, Margolis D, Raman SS, McDonald CR, Farid N, Kesari S, Hansel D, Shabaik A, Dale AM, Karow DS. Restriction spectrum imaging: An evolving imaging biomarker in prostate MRI. J Magn Reson Imaging 2016; 45:323-336. [PMID: 27527500 DOI: 10.1002/jmri.25419] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/25/2016] [Indexed: 12/28/2022] Open
Abstract
Restriction spectrum imaging (RSI) is a novel diffusion-weighted MRI technique that uses the mathematically distinct behavior of water diffusion in separable microscopic tissue compartments to highlight key aspects of the tissue microarchitecture with high conspicuity. RSI can be acquired in less than 5 min on modern scanners using a surface coil. Multiple field gradients and high b-values in combination with postprocessing techniques allow the simultaneous resolution of length-scale and geometric information, as well as compartmental and nuclear volume fraction filtering. RSI also uses a distortion correction technique and can thus be fused to high resolution T2-weighted images for detailed localization, which improves delineation of disease extension into critical anatomic structures. In this review, we discuss the acquisition, postprocessing, and interpretation of RSI for prostate MRI. We also summarize existing data demonstrating the applicability of RSI for prostate cancer detection, in vivo characterization, localization, and targeting. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:323-336.
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Affiliation(s)
- Ryan L Brunsing
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | | | - Nathan S White
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - J Kellogg Parsons
- Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Christopher Kane
- Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Joshua Kuperman
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Hauke Bartsch
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Andrew Karim Kader
- Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Tyler M Seibert
- Department of Radiation Medicine, University of California San Diego, San Diego, California, USA
| | - Daniel Margolis
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Steven S Raman
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Nikdokht Farid
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Santosh Kesari
- Department of Translational Neuro-Oncology and Neurotherapeutics, Pacific Neuroscience Institute and John Wayne Cancer Institute at Providence Saint John's Health Center, Los Angeles, California, USA
| | - Donna Hansel
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Ahmed Shabaik
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Anders M Dale
- Department of Radiology, University of California San Diego, San Diego, California, USA.,Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - David S Karow
- Department of Radiology, University of California San Diego, San Diego, California, USA
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31
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Woo S, Cho JY, Ku JH, Kim SY, Kim SH. Prostate cancer-specific mortality after radical prostatectomy: value of preoperative MRI. Acta Radiol 2016; 57:1006-13. [PMID: 26508791 DOI: 10.1177/0284185115610933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/11/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although magnetic resonance imaging (MRI) is currently indispensable in the preoperative setting of biopsy-proven prostate cancer, the value of preoperative MRI for predicting prostate cancer-specific mortality (PCSM) is not well known. PURPOSE To evaluate the value of MRI for predicting PCSM in patients who underwent radical prostatectomy (RP) for localized prostate cancer. MATERIAL AND METHODS A total of 318 patients underwent MRI followed by RP. MRI was assessed for the presence of clinically significant cancer using a five-point Likert scale, where ≥4 was considered positive. Cox proportional hazards regression analyses was used to determine the relationship of preoperative factors with PCSM. PCSM was calculated using the Kaplan-Meier method and compared between factors using the log-rank test. RESULTS After a median follow-up of 104 months, 11 (3.5%) patients died of prostate cancer. One hundred and four (32.7%) patients had clinically significant prostate cancer on MRI. Univariate analysis revealed that Gleason grade, greatest percentage of involved core length (GPCL), and clinically significant cancer on MRI were significantly related to PCSM (P = 0.001-0.003). Multivariate analysis showed that GPCL (hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.000-1.057; P = 0.048) and clinically significant cancer on MRI (HR, 10.903; 95% CI, 1.287-92.374; P = 0.028) were independent predictors of PCSM. The 5 - and 10-year PCSM rates were 0.6% and 1.3% in patients with GPCL <50% and 5.1% and 8.6% in those with GPCL ≥50% (P = 0.012). Patients without clinically significant cancer on MRI showed 5 - and 10-year PCSM rates of 0% and 0.5%, respectively, whereas those with clinically significant cancer on MRI showed rates of 8% and 14.2%, respectively (P < 0.001). CONCLUSION Preoperative MRI and GPCL may be used to predict PCSM after RP.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Watson MJ, George AK, Maruf M, Frye TP, Muthigi A, Kongnyuy M, Valayil SG, Pinto PA. Risk stratification of prostate cancer: integrating multiparametric MRI, nomograms and biomarkers. Future Oncol 2016; 12:2417-2430. [PMID: 27400645 DOI: 10.2217/fon-2016-0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Accurate risk stratification of prostate cancer is achieved with a number of existing tools to ensure the identification of at-risk patients, characterization of disease aggressiveness, prediction of cancer burden and extrapolation of treatment outcomes for appropriate management of the disease. Statistical tables and nomograms using classic clinicopathological variables have long been the standard of care. However, the introduction of multiparametric MRI, along with fusion-guided targeted prostate biopsy and novel biomarkers, are being assimilated into clinical practice. The majority of studies to date present the outcomes of each in isolation. The current review offers a critical and objective assessment regarding the integration of multiparametric MRI and fusion-guided prostate biopsy with novel biomarkers and predictive nomograms in contemporary clinical practice.
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Affiliation(s)
- Matthew J Watson
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Arvin K George
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mahir Maruf
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Thomas P Frye
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Akhil Muthigi
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Michael Kongnyuy
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Subin G Valayil
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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Turkbey B, Brown AM, Sankineni S, Wood BJ, Pinto PA, Choyke PL. Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer. CA Cancer J Clin 2016; 66:326-36. [PMID: 26594835 PMCID: PMC7511979 DOI: 10.3322/caac.21333] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Imaging has traditionally played a minor role in the diagnosis and staging of prostate cancer. However, recent controversies generated by the use of prostate-specific antigen (PSA) screening followed by random biopsy have encouraged the development of new imaging methods for prostate cancer. Multiparametric magnetic resonance imaging (mpMRI) has emerged as the imaging method best able to detect clinically significant prostate cancers and to guide biopsies. Here, the authors explain what mpMRI is and how it is used clinically, especially with regard to high-risk populations, and we discuss the impact of mpMRI on treatment decisions for men with prostate cancer. CA Cancer J Clin 2016;66:326-336. © 2015 American Cancer Society.
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Affiliation(s)
- Baris Turkbey
- Staff Clinician, Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Anna M. Brown
- Fellow, Medical Research Scholars Program, Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sandeep Sankineni
- Fellow, Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J. Wood
- Director, National Institutes of Health Center for Interventional Oncology; and Chief, Interventional Radiology Section, National Institutes of Health Clinical Center, Bethesda, MD
| | - Peter A. Pinto
- Head, Prostate Cancer Section, Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L. Choyke
- Program Director, Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Ho R, Siddiqui MM, George AK, Frye T, Kilchevsky A, Fascelli M, Shakir NA, Chelluri R, Abboud SF, Walton-Diaz A, Sankineni S, Merino MJ, Turkbey B, Choyke PL, Wood BJ, Pinto PA. Preoperative Multiparametric Magnetic Resonance Imaging Predicts Biochemical Recurrence in Prostate Cancer after Radical Prostatectomy. PLoS One 2016; 11:e0157313. [PMID: 27336392 PMCID: PMC4919096 DOI: 10.1371/journal.pone.0157313] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/29/2016] [Indexed: 01/08/2023] Open
Abstract
Objectives To evaluate the utility of preoperative multiparametric magnetic resonance imaging (MP-MRI) in predicting biochemical recurrence (BCR) following radical prostatectomy (RP). Materials/Methods From March 2007 to January 2015, 421 consecutive patients with prostate cancer (PCa) underwent preoperative MP-MRI and RP. BCR-free survival rates were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to identify clinical and imaging variables predictive of BCR. Logistic regression was performed to generate a nomogram to predict three-year BCR probability. Results Of the total cohort, 370 patients met inclusion criteria with 39 (10.5%) patients experiencing BCR. On multivariate analysis, preoperative prostate-specific antigen (PSA) (p = 0.01), biopsy Gleason score (p = 0.0008), MP-MRI suspicion score (p = 0.03), and extracapsular extension on MP-MRI (p = 0.03) were significantly associated with time to BCR. A nomogram integrating these factors to predict BCR at three years after RP demonstrated a c-index of 0.84, outperforming the predictive value of Gleason score and PSA alone (c-index 0.74, p = 0.02). Conclusion The addition of MP-MRI to standard clinical factors significantly improves prediction of BCR in a post-prostatectomy PCa cohort. This could serve as a valuable tool to support clinical decision-making in patients with moderate and high-risk cancers.
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Affiliation(s)
- Richard Ho
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mohummad M. Siddiqui
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Surgery, Division of Urology, University of Maryland, Baltimore, Maryland, United States of America
| | - Arvin K. George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Thomas Frye
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Amichai Kilchevsky
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michele Fascelli
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nabeel A. Shakir
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Raju Chelluri
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Steven F. Abboud
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Annerleim Walton-Diaz
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sandeep Sankineni
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bradford J. Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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Prostate Cancer: Utility of Whole-Lesion Apparent Diffusion Coefficient Metrics for Prediction of Biochemical Recurrence After Radical Prostatectomy. AJR Am J Roentgenol 2016; 205:1208-14. [PMID: 26587927 DOI: 10.2214/ajr.15.14482] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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 was to investigate the additional value of whole-lesion histogram apparent diffusion coefficient (ADC) metrics, when combined with standard pathologic features, in prediction of biochemical recurrence (BCR) after radical prostatectomy for prostate cancer. MATERIALS AND METHODS The study included 193 patients (mean age, 61 ± 7 years) who underwent 3-T MRI with DWI (b values, 50 and 1000 s/mm(2)) before prostatectomy. Histogram metrics were derived from 3D volumes of interest encompassing the entire lesion on ADC maps. Pathologic features from radical prostatectomy and subsequent BCR were recorded for each patient. The Fisher exact test and Mann-Whitney test were used to compare ADC-based metrics and pathologic features between patients with and patients without BCR. Stepwise logistic regression analysis was used to construct multivariable models for prediction of BCR, which were assessed by ROC analysis. RESULTS BCR occurred in 16.6% (32/193) of patients. Variables significantly associated with BCR included primary Gleason grade, Gleason score, extraprostatic extension, seminal vesicle invasion, positive surgical margin, preoperative prostate-specific antigen level, MRI tumor volume, mean whole-lesion ADC, entropy ADC, and mean ADC of the bottom 10th, 10-25th, and 25-50th percentiles (p ≤ 0.019). Significant independent predictors of BCR at multivariable analysis were primary Gleason grade, extraprostatic extension, mean of the bottom 10th percentile ADC, and entropy ADC (p = 0.002-0.037). The AUC of this multivariable model was 0.94 for prediction of BCR; the AUC of pathologic features alone was 0.89 (p = 0.001). CONCLUSION A model integrating whole-lesion ADC metrics had significantly higher performance for prediction of BCR than did standard pathologic features alone and may help guide postoperative prognostic assessments and decisions regarding adjuvant therapy.
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Zakian KL, Hatfield W, Aras O, Cao K, Yakar D, Goldman DA, Moskowitz CS, Shukla-Dave A, Tehrani YM, Fine S, Eastham J, Hricak H. Prostate MRSI predicts outcome in radical prostatectomy patients. Magn Reson Imaging 2016; 34:674-81. [PMID: 26821278 DOI: 10.1016/j.mri.2016.01.003] [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: 07/07/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND New non-invasive methods are needed for sub-stratifying high-risk prostate cancer patients. Magnetic resonance spectroscopic imaging (MRSI) maps metabolites in prostate cancer, providing information on tumor aggressiveness and volume. PURPOSE To investigate the correlation between MRSI and treatment failure (TF) after radical prostatectomy (RP). METHODS Two-hundred sixty-two patients who underwent endorectal MRI/MRSI followed by RP at our institution from 2003 to 2007 were studied. MRI stage, number of voxels in the MRSI index lesion (NILV), number of high-grade voxels (NHGV), and number of voxels containing undetectable polyamines (NUPV) were derived. Clinical outcome was followed until August, 2014. Treatment failure was defined as 1) biochemical recurrence (BCR), 2) persistently detectable PSA after RP, or 3) adjuvant therapy initiated in the absence of BCR. MRI/MRSI features and clinical parameters were compared to TF by univariate Cox Proportional Hazards Regression. After backward selection, each MRSI parameter was included in a separate regression model adjusted for NCCN-based clinical risk score (CRS), number of biopsy cores positive (NPC), and MRI stage. RESULTS In univariate analysis, all clinical variables were associated with TF in addition to MRI stage, NILV, NHGV, and NUPV. In multivariate analysis, NILV, NHGV, and NUPV were also significant risk factors for TF (p=0.016, p=0.002, p=0.006, respectively). The association between the number of tumor voxels with undetectable polyamines and the probability of treatment failure has not been previously reported. The number of MRSI cancer voxels correlated with extracapsular extension (ECE) (p<0.0001). CONCLUSIONS MRSI was associated with post-radical prostatectomy treatment failure in models adjusted for the number of positive biopsy cores and clinical risk score. This is the first report that in radical prostatectomy patients MRSI has an association with treatment failure independent of the number of positive biopsy cores. MRSI may help the clinician determine whether patients with high risk disease who undergo RP are candidates for specialized additional treatment.
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Affiliation(s)
- Kristen L Zakian
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY, 10065, USA.
| | | | - Omer Aras
- MSKCC, 1275 York Avenue, NY, NY, 10065, USA.
| | - Kun Cao
- MSKCC, 1275 York Avenue, NY, NY, 10065, USA.
| | - Derya Yakar
- MSKCC, 1275 York Avenue, NY, NY, 10065, USA.
| | | | | | | | | | - Samson Fine
- MSKCC, 1275 York Avenue, NY, NY, 10065, USA.
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Guzzo TJ. Preoperative Risk Assessment. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Prediction of biochemical recurrence after radical prostatectomy with PI-RADS version 2 in prostate cancers: initial results. Eur Radiol 2015; 26:2502-9. [PMID: 26560721 DOI: 10.1007/s00330-015-4077-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine whether the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) helps predict biochemical recurrence (BCR) after radical prostatectomy for prostate cancer (PCa). METHODS We included 158 patients with PCa who underwent magnetic resonance imaging (MRI) and radical prostatectomy (RP). Clinical (prostate-specific antigen, greatest percentage of core, and percentage of positive core number), PI-RADSv2 score on MRI, and surgical parameters (Gleason score, extracapsular extension, seminal vesicle invasion, and tumour volume) were investigated. Univariate and multivariate analyses using Cox's proportional hazards model were performed to assess parameters predictive of BCR (two consecutive prostate specific antigens ≥0.2 ng/ml). Kaplan-Meier survival curves were analyzed. RESULTS The rate of BCR was 13.3 % (21/158) after surgery (median follow-up, 25 months; range, 12-36). No subject with a PI-RADS score <4 had BCR. In univariate analysis, all parameters were significant for BCR (p < 0.05), except seminal vesicle invasion (p = 0.254). Meanwhile, PI-RADS score was the only independent parameter for BCR in multivariate analysis (p < 0.05). Two-year, BCR-free survival post-RP was significantly lower for PI-RADS ≥4 (84.7-85.5 %) than for PI-RADS <4 (100 %; p < 0.05). CONCLUSION As a preoperative imaging tool, PI-RADSv2 may be useful to predict BCR after radical prostatectomy for PCa. KEY POINTS • No subject with PI-RADS <4 had BCR after RP • PI-RADSv2 was the only predictor of BCR in multivariate analysis • Two-year, BCR-free survival following RP was lower for PI-RADS≥4 than for PI-RADS<4 • Inter-rater agreement was good for PI-RADS ≥4 or not.
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Mathieu C, Ferrer L, Carlier T, Colombié M, Rusu D, Kraeber-Bodéré F, Campion L, Rousseau C. Assessment of Lymph Nodes and Prostate Status Using Early Dynamic Curves with (18)F-Choline PET/CT in Prostate Cancer. Front Med (Lausanne) 2015; 2:67. [PMID: 26442269 PMCID: PMC4563255 DOI: 10.3389/fmed.2015.00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction Dynamic image acquisition with 18F-Choline [fluorocholine (FCH)] PET/CT in prostate cancer is mostly used to overcome the bladder repletion, which could obstruct the loco-regional analysis. The aim of our study was to analyze early dynamic FCH acquisitions to define pelvic lymph node or prostate pathological status. Material and methods Retrospective analysis was performed on 39 patients for initial staging (n = 18), or after initial treatment (n = 21). Patients underwent 10-min dynamic acquisitions centered on the pelvis, after injection of 3–4 MBq/kg of FCH. Whole-body images were acquired about 1 h after injection using a PET/CT GE Discovery LS (GE-LS) or Siemens Biograph mCT (mCT). Maximum and mean SUV according to time were measured on nodal and prostatic lesions. SUVmean was corrected for partial volume effect (PVEC) with suitable recovery coefficients. The status of each lesion was based on histological results or patient follow-up (>6 months). A Mann–Whitney test and ANOVA were used to compare mean and receiver operating characteristic (ROC) curve analysis. Results The median PSA was 8.46 ng/mL and the median Gleason score was 3 + 4. Ninety-two lesions (43 lymph nodes and 49 prostate lesions) were analyzed, including 63 malignant lesions. In early dynamic acquisitions, the maximum and mean SUV were significantly higher, respectively, on mCT and GE-LS, in malignant versus benign lesions (p < 0.001, p < 0.001). Mean SUV without PVEC, allowed better discrimination of benign from malignant lesions, in comparison with maximum and mean SUV (with PVEC), for both early and late acquisitions. For patients acquired on mCT, area under the ROC curve showed a trend to better sensitivity and specificity for early acquisitions, compared with late acquisitions (SUVmax AUC 0.92 versus 0.85, respectively). Conclusion Assessment of lymph nodes and prostate pathological status with early dynamic imaging using PET/CT FCH allowed prostate cancer detection in situations where proof of malignancy is difficult to obtain.
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Affiliation(s)
- Cédric Mathieu
- Department of Nuclear Medicine, ICO Cancer Center , Saint Herblain , France ; Department of Nuclear Medicine, University Hospital , Nantes , France
| | - Ludovic Ferrer
- Centre Régional de Recherche en Cancérologie Nantes/Angers, U892, CNRS UMR 6299, INSERM , Nantes , France ; Department of Medical Physics, ICO Cancer Center , Saint Herblain , France
| | - Thomas Carlier
- Department of Nuclear Medicine, University Hospital , Nantes , France ; Centre Régional de Recherche en Cancérologie Nantes/Angers, U892, CNRS UMR 6299, INSERM , Nantes , France
| | - Mathilde Colombié
- Department of Nuclear Medicine, ICO Cancer Center , Saint Herblain , France
| | - Daniela Rusu
- Department of Nuclear Medicine, ICO Cancer Center , Saint Herblain , France
| | - Françoise Kraeber-Bodéré
- Department of Nuclear Medicine, ICO Cancer Center , Saint Herblain , France ; Department of Nuclear Medicine, University Hospital , Nantes , France ; Centre Régional de Recherche en Cancérologie Nantes/Angers, U892, CNRS UMR 6299, INSERM , Nantes , France
| | - Loic Campion
- Department of Statistics, ICO Cancer Center , Saint Herblain , France
| | - Caroline Rousseau
- Department of Nuclear Medicine, ICO Cancer Center , Saint Herblain , France ; Centre Régional de Recherche en Cancérologie Nantes/Angers, U892, CNRS UMR 6299, INSERM , Nantes , France
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Kim CK, Park JJ, Park BK. Prostate diffusion-weighted imaging at 3T: effect of intravenous gadobutrol administration. Eur Radiol 2015; 26:1450-6. [PMID: 26253258 DOI: 10.1007/s00330-015-3942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/13/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate whether gadolinium-based contrast agent (GBCA) administration significantly affects diffusion-weighted imaging (DWI) at 3 T in the evaluation of prostate cancer and benign tissue. METHOD Thirty-four consecutive patients with surgically proven prostate cancer underwent preoperative DWI at 3 T before and after GBCA administration. Exponential apparent diffusion coefficient (EADC) and ADC maps were developed from DWI data. The ADC and EADC values pre- and post-contrast were measured in the cancer and benign tissue, respectively. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were evaluated on pre- and post-contrast DWI. RESULTS The ADC and EADC values of the cancer and benign transition zone were not significantly different between pre- and post-contrast, respectively (P > 0.05), while those in the benign peripheral zone were significantly different (P = 0.030 and 0.037, respectively). In all tissues, the SNRs and CNRs of the DWI, ADC map and EADC map were not significantly different between pre- and post-contrast (P > 0.05). Between pre- and post-contrast, ADC and EADC values showed excellent agreement (intraclass correlation coefficient ≥ 0.894) and variability of ≤3.2 %. CONCLUSION Prostate 3 T-DWI after GBCA administration may be used without a significant difference in SNR or CNR, with minimal variability of the cancer ADC and EADC values. KEY POINTS • ADCs and EADCs have excellent agreement before and after gadobutrol administration. • SNRs of prostate DWI are similar before and after gadobutrol administration. • CNRs of cancers are similar between pre- and post-contrast DWI.
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Affiliation(s)
- Chan Kyo Kim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, 06351, Korea. .,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
| | - Jung Jae Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Byung Kwan Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
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Rakow-Penner RA, White NS, Margolis DJA, Parsons JK, Schenker-Ahmed N, Kuperman JM, Bartsch H, Choi HW, Bradley WG, Shabaik A, Huang J, Liss MA, Marks L, Kane CJ, Reiter RE, Raman SS, Karow DS, Dale AM. Prostate diffusion imaging with distortion correction. Magn Reson Imaging 2015. [PMID: 26220859 DOI: 10.1016/j.mri.2015.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Diffusion imaging in the prostate is susceptible to distortion from B0 inhomogeneity. Distortion correction in prostate imaging is not routinely performed, resulting in diffusion images without accurate localization of tumors. We performed and evaluated distortion correction for diffusion imaging in the prostate. MATERIALS AND METHODS 28 patients underwent pre-operative MRI (T2, Gadolinium perfusion, diffusion at b=800 s/mm(2)). The restriction spectrum protocol parameters included b-values of 0, 800, 1500, and 4000 s/mm(2) in 30 directions for each nonzero b-value. To correct for distortion, forward and reverse trajectories were collected at b=0 s/mm(2). Distortion maps were generated to reflect the offset of the collected data versus the corrected data. Whole-mount histology was available for correlation. RESULTS Across the 27 patients evaluated (excluding one patient due to data collection error), the average root mean square distortion distance of the prostate was 3.1 mm (standard deviation, 2.2mm; and maximum distortion, 12 mm). CONCLUSION Improved localization of prostate cancer by MRI will allow better surgical planning, targeted biopsies and image-guided treatment therapies. Distortion distances of up to 12 mm due to standard diffusion imaging may grossly misdirect treatment decisions. Distortion correction for diffusion imaging in the prostate improves tumor localization.
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Affiliation(s)
| | - Nathan S White
- Department of Radiology, University of California San Diego School of Medicine
| | - Daniel J A Margolis
- Department of Radiology, University of California Los Angeles Geffen School of Medicine
| | | | | | - Joshua M Kuperman
- Department of Radiology, University of California San Diego School of Medicine
| | - Hauke Bartsch
- Department of Radiology, University of California San Diego School of Medicine
| | - Hyung W Choi
- Department of Radiology, University of California San Diego School of Medicine
| | - William G Bradley
- Department of Radiology, University of California San Diego School of Medicine
| | - Ahmed Shabaik
- Department of Pathology, University of California San Diego School of Medicine
| | - Jiaoti Huang
- Department of Pathology, University of California Los Angeles Geffen School of Medicine
| | - Michael A Liss
- Department of Urology, University of Texas Health Science Center San Antonio
| | - Leonard Marks
- Department of Urology, University of California Los Angeles Geffen School of Medicine
| | - Christopher J Kane
- Department of Urology, University of California San Diego School of Medicine
| | - Robert E Reiter
- Department of Urology, University of California Los Angeles Geffen School of Medicine
| | - Steven S Raman
- Department of Radiology, University of California Los Angeles Geffen School of Medicine
| | - David S Karow
- Department of Radiology, University of California San Diego School of Medicine.
| | - Anders M Dale
- Department of Radiology, University of California San Diego School of Medicine
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Rosenkrantz AB, Meng X, Ream JM, Babb JS, Deng FM, Rusinek H, Huang WC, Lepor H, Taneja SS. Likert score 3 prostate lesions: Association between whole-lesion ADC metrics and pathologic findings at MRI/ultrasound fusion targeted biopsy. J Magn Reson Imaging 2015; 43:325-32. [PMID: 26131965 DOI: 10.1002/jmri.24983] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/04/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To assess associations between whole-lesion apparent diffusion coefficient (ADC) metrics and pathologic findings of Likert score 3 prostate lesions at MRI/ultrasound fusion targeted biopsy. METHODS This retrospective Institutional Review Board-approved study received a waiver of consent. We identified patients receiving a highest lesion score of 3 on 3 Tesla multiparametric MRI reviewed by a single experienced radiologist using a 5-point Likert scale and who underwent fusion biopsy. A total of 188 score 3 lesions in 158 patients were included. Three-dimensional volumes-of-interest encompassing each lesion were traced on ADC maps. Logistic regression was used to predict biopsy results based on whole-lesion ADC metrics and patient biopsy history. Biopsy yield was compared between metrics. RESULTS By lesion, targeted biopsy identified tumor in 22.3% and Gleason score (GS) > 6 tumor in 8.5%, although results varied by biopsy history: biopsy-naïve (n = 80), 20.0%/8.8%; prior negative biopsy (n = 53), 9.4%/1.9%; prior positive biopsy (n = 55): 40.0%/14.5%. Biopsy history, whole-lesion mean ADC, whole-lesion ADC10-25 , and whole-lesion ADC25-50 were each significantly associated with tumor or GS > 6 tumor at fusion biopsy (P ≤ 0.047). In men without prior negative prostate biopsy, whole-lesion ADC25-50 ≤ 1.04*10(-3) mm2 /s achieved 90.0% sensitivity and 50.0% specificity for GS > 6 tumor, which was significantly higher (P < 0.001) than specificity of PSA (17.5%) at identical sensitivity. CONCLUSION For score 3 lesions in patients without prior negative biopsy, whole-lesion ADC metrics help detect GS > 6 cancer while avoiding negative biopsies. However, deferral of fusion biopsy may be considered for score 3 lesions in patients with prior negative biopsy (without applying whole-lesion ADC metrics) given exceedingly low (∼ 2%) frequency of GS > 6 tumor in this group.
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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
| | - Xiaosong Meng
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Justin M Ream
- Department of Radiology, 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
| | - Fang-Ming Deng
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Henry Rusinek
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - William C Huang
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Herbert Lepor
- Department of Urology, Division of Urologic Oncology, 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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Rosenkrantz AB, Khalef V, Xu W, Babb JS, Taneja SS, Doshi AM. Does normalisation improve the diagnostic performance of apparent diffusion coefficient values for prostate cancer assessment? A blinded independent-observer evaluation. Clin Radiol 2015; 70:1032-7. [PMID: 26126712 DOI: 10.1016/j.crad.2015.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/18/2015] [Accepted: 05/28/2015] [Indexed: 01/18/2023]
Abstract
AIM To evaluate the performance of normalised apparent diffusion coefficient (ADC) values for prostate cancer assessment when performed by independent observers blinded to histopathology findings. MATERIALS AND METHODS Fifty-eight patients undergoing 3 T phased-array coil magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI; maximal b-value 1000 s/mm(2)) before prostatectomy were included. Two radiologists independently evaluated the images, unaware of the histopathology findings. Regions of interest (ROIs) were drawn within areas showing visually low ADC within the peripheral zone (PZ) and transition zone (TZ) bilaterally. ROIs were also placed within regions in both lobes not suspicious for tumour, allowing computation of normalised ADC (nADC) ratios between suspicious and non-suspicious regions. The diagnostic performance of ADC and nADC were compared. RESULTS For PZ tumour detection, ADC achieved significantly higher area under the receiver operating characteristic curve (AUC; p=0.026) and specificity (p=0.021) than nADC for reader 1, and significantly higher AUC (p=0.025) than nADC for reader 2. For TZ tumour detection, nADC achieved significantly higher specificity (p=0.003) and accuracy (p=0.004) than ADC for reader 2. For PZ Gleason score >3+3 tumour detection, ADC achieved significantly higher AUC (p=0.003) and specificity (p=0.005) than nADC for reader 1, and significantly higher AUC (p=0.023) than nADC for reader 2. For TZ Gleason score >3+3 tumour detection, ADC achieved significantly higher specificity (p=0.019) than nADC for reader 1. CONCLUSION In contrast to prior studies performing unblinded evaluations, ADC was observed to outperform nADC overall for two independent observers blinded to the histopathology findings. Therefore, although strategies to improve the utility of ADC measurements in prostate cancer assessment merit continued investigation, caution is warranted when applying normalisation to improve diagnostic performance in clinical practice.
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Affiliation(s)
- A B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA.
| | - V Khalef
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - W Xu
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - J S Babb
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - S S Taneja
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - A M Doshi
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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Novel technique for characterizing prostate cancer utilizing MRI restriction spectrum imaging: proof of principle and initial clinical experience with extraprostatic extension. Prostate Cancer Prostatic Dis 2015; 18:81-5. [PMID: 25559097 DOI: 10.1038/pcan.2014.50] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/21/2014] [Accepted: 10/25/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Standard magnetic resonance imaging (MRI) of the prostate lacks sensitivity in the diagnosis and staging of prostate cancer (PCa). To improve the operating characteristics of prostate MRI in the detection and characterization of PCa, we developed a novel, enhanced MRI diffusion technique using restriction spectrum imaging (RSI-MRI). METHODS We compared the efficacy of our novel RSI-MRI technique with standard MRI for detecting extraprostatic extension (EPE) among 28 PCa patients who underwent MRI and RSI-MRI prior to radical prostatectomy, 10 with histologically proven pT3 disease. RSI cellularity maps isolating the restricted isotropic water fraction were reconstructed based on all b-values and then standardized across the sample with z-score maps. Distortion correction of the RSI maps was performed using the alternating phase-encode technique. RESULTS 27 patients were evaluated, excluding one patient where distortion could not be performed. Preoperative standard MRI correctly identified extraprostatic the extension in two of the nine pT3 (22%) patients, whereas RSI-MRI identified EPE in eight of nine (89%) patients. RSI-MRI correctly identified pT2 disease in the remaining 18 patients. CONCLUSIONS In this proof of principle study, we conclude that our novel RSI-MRI technology is feasible and shows promise for substantially improving PCa imaging. Further translational studies of prostate RSI-MRI in the diagnosis and staging of PCa are indicated.
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Sailer V, Kristiansen G. Histopathological screening for prostate carcinoma: is a benign biopsy a negative biopsy? APMIS 2014; 122:690-8. [DOI: 10.1111/apm.12291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/14/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Verena Sailer
- Institute of Pathology; University Hospital of Bonn; Bonn Germany
| | - Glen Kristiansen
- Institute of Pathology; University Hospital of Bonn; Bonn Germany
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