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Niu XB, Li YP, Wang J, Mei XL, Zhao XY, Liu TT, Xu SS, Han XM, Cheng JL. Diagnostic value of 18F-PSMA-1007 PET/CT for predicting the pathological grade of prostate cancer. Cancer Biol Ther 2024; 25:2287120. [PMID: 38117551 PMCID: PMC10761109 DOI: 10.1080/15384047.2023.2287120] [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: 08/22/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study was designed to evaluate the diagnostic efficacy of relevant parameters of 18F-prostate-specific membrane antigen (PSMA)-1007 PET/CT in predicting the pathological grade of primary prostate cancer. Briefly, a prospective analysis was performed on 53 patients diagnosed with prostate cancer by systematic puncture biopsy, followed by 18F-PSMA-1007 PET/CT examination prior to treatment within 10 d. The patients were grouped in accordance with the Gleason grading system revised by the International Association of Urology Pathology (ISUP). They were divided into high-grade group (ISUP 4-5 group) and low-grade group (ISUP 1-3 group). The differences in maximum standardized uptake value (SUVmax), tumor-to-background ratio (TBR), intraprostatic PSMA-derived tumor volume (iPSMA-TV), and intraprostatic total lesion PSMA (iTL-PSMA) between the high- and low-grade group were statistically significant (p < .001). No significant difference was found for mean standardized uptake value (SUVmean) between the high- and low-grade groups (Z = -1.131, p = .258). Besides, binary multivariate logistic regression analysis showed that only iPSMA-TV and iTL-PSMA were independent predictors of the pathological grading, for which the odds ratios were 18.821 [95% confidence interval (CI): 2.040-173.614, p = .010] and 0.758 (95% CI: 0.613-0.938, p = .011), respectively. The area under the ROC of this regression model was 0.983 (95% CI: 0.958-1.00, p < .001). Only iTL-PSMA was a significant parameter for distinguishing ISUP-4 and ISUP-5 groups (Z = -2.043, p = .041). In a nutshell, 18F-PSMA-1007 PET/CT has good application value in predicting the histopathological grade of primary prostate cancer. Three-dimensional volume metabolism parameters iPSMA-TV and iTL-PSMA were found to be independent predictors for pathological grade.
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Affiliation(s)
- Xiao-Bo Niu
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yan-Peng Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jun Wang
- Department of Urinary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Xiao-Li Mei
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Xue-Yan Zhao
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Ting-Ting Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Sha-Sha Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Xing-Min Han
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jing-Liang Cheng
- Department of Magnetic resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
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Ahn H, Kim JK, Hwang SI, Hong SK, Byun SS, Song SH, Choe G, Jee HM, Park SW. Exploring the potential of ex-vivo 7-T magnetic resonance imaging on patients with clinically significant prostate cancer: visibility and size perspective. Prostate Int 2024; 12:79-85. [PMID: 39036759 PMCID: PMC11255944 DOI: 10.1016/j.prnil.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 07/23/2024] Open
Abstract
Background Despite progress in multiparametric magnetic resonance imaging (MRI), issues of prostate cancer invisibility and underestimated tumor burden persist. This study investigates the potential of an ultra-high field MRI at 7-T in an ex-vivo setting to address these limitations. Methods This prospective study included 54 tumors from 20 treatment-naïve clinically significant prostate cancer patients, confirmed by biopsy, despite negative findings on preoperative 3-T MRI. Ex-vivo 7-T MRI of resected prostates was performed, with assessment on tumor visibility and size. Factors influencing visibility were analyzed using logistic regression analyses. Results Tumor visibility was confirmed in 80% of patients, and 48% of all tumors on ex-vivo imaging. Gleason pattern 4 percentage (odds ratio 1.09) and tumor size on pathology (odds ratio 1.36) were significantly associated with visibility (P < 0.05). Mean MRI-visible and invisible tumor sizes were 10.5 mm and 5.3 mm, respectively. The size discrepancy between MRI and pathology was 2.7 mm. Conclusion Tumor visibility on ex-vivo 7-T MRI was influenced by tumor grade and size. The notable tumor visibility initially overlooked on 3-T MRI, along with small size discrepancy with pathology, suggests potential improvements in resolution.
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Affiliation(s)
- Hyungwoo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Mi Jee
- Preclinical Research Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Woo Park
- Department of Biomedical Engineering, Seoul National University Hospital, Seoul, Korea
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Duan L, Liu Z, Wan F, Dai B. Advantage of whole-mount histopathology in prostate cancer: current applications and future prospects. BMC Cancer 2024; 24:448. [PMID: 38605339 PMCID: PMC11007899 DOI: 10.1186/s12885-024-12071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/29/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Whole-mount histopathology (WMH) has been a powerful tool to investigate the characteristics of prostate cancer. However, the latest advancement of WMH was yet under summarization. In this review, we offer a comprehensive exposition of current research utilizing WMH in diagnosing and treating prostate cancer (PCa), and summarize the clinical advantages of WMH and outlines potential on future prospects. METHODS An extensive PubMed search was conducted until February 26, 2023, with the search term "prostate", "whole-mount", "large format histology", which was limited to the last 4 years. Publications included were restricted to those in English. Other papers were also cited to contribute a better understanding. RESULTS WMH exhibits an enhanced legibility for pathologists, which improved the efficacy of pathologic examination and provide educational value. It simplifies the histopathological registration with medical images, which serves as a convincing reference standard for imaging indicator investigation and medical image-based artificial intelligence (AI). Additionally, WMH provides comprehensive histopathological information for tumor volume estimation, post-treatment evaluation, and provides direct pathological data for AI readers. It also offers complete spatial context for the location estimation of both intraprostatic and extraprostatic cancerous region. CONCLUSIONS WMH provides unique benefits in several aspects of clinical diagnosis and treatment of PCa. The utilization of WMH technique facilitates the development and refinement of various clinical technologies. We believe that WMH will play an important role in future clinical applications.
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Affiliation(s)
- Lewei Duan
- Department of Urology, Fudan University Shanghai Cancer Center, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
- Shanghai Genitourinary Cancer Institute, 200032, Shanghai, China
| | - Zheng Liu
- Department of Urology, Fudan University Shanghai Cancer Center, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
- Shanghai Genitourinary Cancer Institute, 200032, Shanghai, China
| | - Fangning Wan
- Department of Urology, Fudan University Shanghai Cancer Center, 200032, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China.
- Shanghai Genitourinary Cancer Institute, 200032, Shanghai, China.
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, 200032, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China.
- Shanghai Genitourinary Cancer Institute, 200032, Shanghai, China.
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Jeganathan T, Salgues E, Schick U, Tissot V, Fournier G, Valéri A, Nguyen TA, Bourbonne V. Inter-Rater Variability of Prostate Lesion Segmentation on Multiparametric Prostate MRI. Biomedicines 2023; 11:3309. [PMID: 38137530 PMCID: PMC10741937 DOI: 10.3390/biomedicines11123309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION External radiotherapy is a major treatment for localized prostate cancer (PCa). Dose escalation to the whole prostate gland increases biochemical relapse-free survival but also acute and late toxicities. Dose escalation to the dominant index lesion (DIL) only is of growing interest. It requires a robust delineation of the DIL. In this context, we aimed to evaluate the inter-observer variability of DIL delineation. MATERIAL AND METHODS Two junior radiologists and a senior radiation oncologist delineated DILs on 64 mpMRIs of patients with histologically confirmed PCa. For each mpMRI and each reader, eight individual DIL segmentations were delineated. These delineations were blindly performed from one another and resulted from the individual analysis of the T2, apparent diffusion coefficient (ADC), b2000, and dynamic contrast enhanced (DCE) sequences, as well as the analysis of combined sequences (T2ADC, T2ADCb2000, T2ADCDCE, and T2ADCb2000DCE). Delineation variability was assessed using the DICE coefficient, Jaccard index, Hausdorff distance measure, and mean distance to agreement. RESULTS T2, ADC, T2ADC, b2000, T2 + ADC + b2000, T2 + ADC + DCE, and T2 + ADC + b2000 + DCE sequences obtained DICE coefficients of 0.51, 0.50, 0.54, 0.52, 0.54, 0.55, 0.53, respectively, which are significantly higher than the perfusion sequence alone (0.35, p < 0.001). The analysis of other similarity metrics lead to similar results. The tumor volume and PI-RADS classification were positively correlated with the DICE scores. CONCLUSION Our study showed that the contours of prostatic lesions were more reproducible on certain sequences but confirmed the great variability of prostatic contours with a maximum DICE coefficient calculated at 0.55 (joint analysis of T2, ADC, and perfusion sequences).
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Affiliation(s)
- Thibaut Jeganathan
- Radiology Department, University Hospital, 29200 Brest, France; (T.J.); (E.S.); (V.T.)
| | - Emile Salgues
- Radiology Department, University Hospital, 29200 Brest, France; (T.J.); (E.S.); (V.T.)
| | - Ulrike Schick
- Radiation Oncology Department, University Hospital, 29200 Brest, France;
- INSERM, LaTIM UMR 1101, University of Western Brittany, 29238 Brest, France; (G.F.); (A.V.); (T.-A.N.)
| | - Valentin Tissot
- Radiology Department, University Hospital, 29200 Brest, France; (T.J.); (E.S.); (V.T.)
| | - Georges Fournier
- INSERM, LaTIM UMR 1101, University of Western Brittany, 29238 Brest, France; (G.F.); (A.V.); (T.-A.N.)
- Urology Department, University Hospital, 29200 Brest, France
| | - Antoine Valéri
- INSERM, LaTIM UMR 1101, University of Western Brittany, 29238 Brest, France; (G.F.); (A.V.); (T.-A.N.)
- Urology Department, University Hospital, 29200 Brest, France
| | - Truong-An Nguyen
- INSERM, LaTIM UMR 1101, University of Western Brittany, 29238 Brest, France; (G.F.); (A.V.); (T.-A.N.)
- Urology Department, University Hospital, 29200 Brest, France
| | - Vincent Bourbonne
- Radiation Oncology Department, University Hospital, 29200 Brest, France;
- INSERM, LaTIM UMR 1101, University of Western Brittany, 29238 Brest, France; (G.F.); (A.V.); (T.-A.N.)
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Chatterjee A, Gallan A, Fan X, Medved M, Akurati P, Bourne RM, Antic T, Karczmar GS, Oto A. Prostate Cancers Invisible on Multiparametric MRI: Pathologic Features in Correlation with Whole-Mount Prostatectomy. Cancers (Basel) 2023; 15:5825. [PMID: 38136370 PMCID: PMC10742185 DOI: 10.3390/cancers15245825] [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: 11/07/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
We investigated why some prostate cancers (PCas) are not identified on multiparametric MRI (mpMRI) by using ground truth reference from whole-mount prostatectomy specimens. A total of 61 patients with biopsy-confirmed PCa underwent 3T mpMRI followed by prostatectomy. Lesions visible on MRI prospectively or retrospectively identified after correlating with histology were considered "identified cancers" (ICs). Lesions that could not be identified on mpMRI were considered "unidentified cancers" (UCs). Pathologists marked the Gleason score, stage, size, and density of the cancer glands and performed quantitative histology to calculate the tissue composition. Out of 115 cancers, 19 were unidentified on MRI. The UCs were significantly smaller and had lower Gleason scores and clinical stage lesions compared with the ICs. The UCs had significantly (p < 0.05) higher ADC (1.34 ± 0.38 vs. 1.02 ± 0.30 μm2/ms) and T2 (117.0 ± 31.1 vs. 97.1 ± 25.1 ms) compared with the ICs. The density of the cancer glands was significantly (p = 0.04) lower in the UCs. The percentage of the Gleason 4 component in Gleason 3 + 4 lesions was nominally (p = 0.15) higher in the ICs (20 ± 12%) compared with the UCs (15 ± 8%). The UCs had a significantly lower epithelium (32.9 ± 21.5 vs. 47.6 ± 13.1%, p = 0.034) and higher lumen volume (20.4 ± 10.0 vs. 13.3 ± 4.1%, p = 0.021) compared with the ICs. Independent from size and Gleason score, the tissue composition differences, specifically, the higher lumen and lower epithelium in UCs, can explain why some of the prostate cancers cannot be identified on mpMRI.
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Affiliation(s)
- Aritrick Chatterjee
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA; (X.F.); (M.M.); (G.S.K.); (A.O.)
- Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy, University of Chicago, Chicago, IL 60637, USA
| | - Alexander Gallan
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Xiaobing Fan
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA; (X.F.); (M.M.); (G.S.K.); (A.O.)
- Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy, University of Chicago, Chicago, IL 60637, USA
| | - Milica Medved
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA; (X.F.); (M.M.); (G.S.K.); (A.O.)
- Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy, University of Chicago, Chicago, IL 60637, USA
| | | | - Roger M. Bourne
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA;
| | - Gregory S. Karczmar
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA; (X.F.); (M.M.); (G.S.K.); (A.O.)
- Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy, University of Chicago, Chicago, IL 60637, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA; (X.F.); (M.M.); (G.S.K.); (A.O.)
- Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy, University of Chicago, Chicago, IL 60637, USA
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Zhuang H, Chatterjee A, Fan X, Qi S, Qian W, He D. A radiomics based method for prediction of prostate cancer Gleason score using enlarged region of interest. BMC Med Imaging 2023; 23:205. [PMID: 38066434 PMCID: PMC10709874 DOI: 10.1186/s12880-023-01167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is one of the most common cancers in men worldwide, and its timely diagnosis and treatment are becoming increasingly important. MRI is in increasing use to diagnose cancer and to distinguish between non-clinically significant and clinically significant PCa, leading to more precise diagnosis and treatment. The purpose of this study is to present a radiomics-based method for determining the Gleason score (GS) for PCa using tumour heterogeneity on multiparametric MRI (mp-MRI). METHODS Twenty-six patients with biopsy-proven PCa were included in this study. The quantitative T2 values, apparent diffusion coefficient (ADC) and signal enhancement rates (α) were calculated using multi-echo T2 images, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI), for the annotated region of interests (ROI). After texture feature analysis, ROI range expansion and feature filtering was performed. Then obtained data were put into support vector machine (SVM), K-Nearest Neighbor (KNN) and other classifiers for binary classification. RESULTS The highest classification accuracy was 73.96% for distinguishing between clinically significant (Gleason 3 + 4 and above) and non-significant cancers (Gleason 3 + 3) and 83.72% for distinguishing between Gleason 3 + 4 from Gleason 4 + 3 and above, which was achieved using initial ROIs drawn by the radiologists. The accuracy improved when using expanded ROIs to 80.67% using SVM and 88.42% using Bayesian classification for distinguishing between clinically significant and non-significant cancers and Gleason 3 + 4 from Gleason 4 + 3 and above, respectively. CONCLUSIONS Our results indicate the research significance and value of this study for determining the GS for prostate cancer using the expansion of the ROI region.
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Affiliation(s)
- Haoming Zhuang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Aritrick Chatterjee
- Department of Radiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Xiaobing Fan
- Department of Radiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Wei Qian
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Dianning He
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
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Lee G, Chatterjee A, Harmath C, Karademir I, Engelmann R, Yousuf A, Islam S, Karczmar G, Oto A, Giurcanu M, Antic T, Eggener S. Improving reader accuracy and specificity with the addition of hybrid multidimensional-MRI to multiparametric-MRI in diagnosing clinically significant prostate cancers. Abdom Radiol (NY) 2023; 48:3216-3228. [PMID: 37358605 DOI: 10.1007/s00261-023-03969-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Compare reader performance when adding the Hybrid Multidimensional-MRI (HM-MRI) map to multiparametric MRI (mpMRI+HM-MRI) versus mpMRI alone and inter-reader agreement in diagnosing clinically significant prostate cancers (CSPCa). METHODS All 61 patients who underwent mpMRI (T2-, diffusion-weighted (DWI), and contrast-enhanced scans) and HM-MRI (with multiple TE/b-value combinations) before prostatectomy or MRI-fused-transrectal ultrasound-guided biopsy between August, 2012 and February, 2020, were retrospectively analyzed. Two experienced readers (R1, R2) and two less-experienced readers (less than 6-year MRI prostate experience) (R3, R4) interpreted mpMRI without/with HM-MRI in the same sitting. Readers recorded the PI-RADS 3-5 score, lesion location, and change in score after adding HM-MRI. Each radiologist's mpMRI+HM-MRI and mpMRI performance measures (AUC, sensitivity, specificity, PPV, NPV, and accuracy) based on pathology, and Fleiss' kappa inter-reader agreement was calculated and compared. RESULTS Per-sextant R3 and R4 mpMRI+HM-MRI accuracy (82% 81% vs. 77%, 71%; p=.006, <.001) and specificity (89%, 88% vs. 84%, 75%; p=.009, <.001) were higher than with mpMRI. Per-patient R4 mpMRI+HM-MRI specificity improved (48% from 7%; p<.001). R1 and R2 mpMRI+HM-MRI specificity per-sextant (80%, 93% vs. 81%, 93%; p=.51,>.99) and per-patient (37%, 41% vs. 48%, 37%; p=.16, .57) remained similar to mpMRI. R1 and R2 per-patient AUC with mpMRI+HM-MRI (0.63, 0.64 vs. 0.67, 0.61; p=.33, .36) remained similar to mpMRI, but R3 and R4 mpMRI+HM-MRI AUC (0.73, 0.62) approached R1 and R2 AUC. Per-patient inter-reader agreement, mpMRI+HM-MRI Fleiss Kappa, was higher than mpMRI (0.36 [95% CI 0.26, 0.46] vs. 0.17 [95% CI 0.07, 0.27]); p=.009). CONCLUSION Adding HM-MRI to mpMRI (mpMRI+HM-MRI) improved specificity and accuracy for less-experienced readers, improving overall inter-reader agreement.
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Affiliation(s)
- Grace Lee
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA.
| | - Aritrick Chatterjee
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Carla Harmath
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Ibrahim Karademir
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Roger Engelmann
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Ambereen Yousuf
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Salman Islam
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Gregory Karczmar
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Aytekin Oto
- Department of Diagnostic Radiology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Mihai Giurcanu
- Department of Public Health, University of Chicago, Chicago, Illinois, 60637, USA
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, Illinois, 60637, USA
| | - Scott Eggener
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois, 60637, USA
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8
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Zhou X, Fan X, Chatterjee A, Yousuf A, Antic T, Oto A, Karczmar GS. Parametric maps of spatial two-tissue compartment model for prostate dynamic contrast enhanced MRI - comparison with the standard tofts model in the diagnosis of prostate cancer. Phys Eng Sci Med 2023; 46:1215-1226. [PMID: 37432557 DOI: 10.1007/s13246-023-01289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/14/2023] [Indexed: 07/12/2023]
Abstract
The spatial two-tissue compartment model (2TCM) was used to analyze prostate dynamic contrast enhanced (DCE) MRI data and compared with the standard Tofts model. A total of 29 patients with biopsy-confirmed prostate cancer were included in this IRB-approved study. MRI data were acquired on a Philips Achieva 3T-TX scanner. After T2-weighted and diffusion-weighted imaging, DCE data using 3D T1-FFE mDIXON sequence were acquired pre- and post-contrast media injection (0.1 mmol/kg Multihance) for 60 dynamic scans with temporal resolution of 8.3 s/image. The 2TCM has one fast ([Formula: see text] and [Formula: see text]) and one slow ([Formula: see text] and [Formula: see text]) exchanging compartment, compared with the standard Tofts model parameters (Ktrans and kep). On average, prostate cancer had significantly higher values (p < 0.01) than normal prostate tissue for all calculated parameters. There was a strong correlation (r = 0.94, p < 0.001) between Ktrans and [Formula: see text] for cancer, but weak correlation (r = 0.28, p < 0.05) between kep and [Formula: see text]. Average root-mean-square error (RMSE) in fits from the 2TCM was significantly smaller (p < 0.001) than the RMSE in fits from the Tofts model. Receiver operating characteristic (ROC) analysis showed that fast [Formula: see text] had the highest area under the curve (AUC) than any other individual parameter. The combined four parameters from the 2TCM had a considerably higher AUC value than the combined two parameters from the Tofts model. The 2TCM is useful for quantitative analysis of prostate DCE-MRI data and provides new information in the diagnosis of prostate cancer.
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Affiliation(s)
- Xueyan Zhou
- School of Technology, Harbin University, Harbin, China.
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA.
| | - Xiaobing Fan
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | | | - Ambereen Yousuf
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, IL, 60637, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
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Hellstern M, Martinez C, Wallenhorst C, Beyersdorff D, Lüdemann L, Grimm MO, Teichgräber U, Franiel T. Optimal length and temporal resolution of dynamic contrast-enhanced MR imaging for the differentiation between prostate cancer and normal peripheral zone tissue. PLoS One 2023; 18:e0287651. [PMID: 37352312 PMCID: PMC10289347 DOI: 10.1371/journal.pone.0287651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/12/2023] [Indexed: 06/25/2023] Open
Abstract
The value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the detection of prostate cancer is controversial. There are currently insufficient peer reviewed published data or expert consensus to support routine adoption of DCE-MRI for clinical use. Thus, the objective of this study was to explore the optimal temporal resolution and measurement length for DCE-MRI to differentiate cancerous from normal prostate tissue of the peripheral zone of the prostate by non-parametric MRI analysis and to compare with a quantitative MRI analysis. Predictors of interest were onset time, relative signal intensity (RSI), wash-in slope, peak enhancement, wash-out and wash-out slope determined from non-parametric characterisation of DCE-MRI intensity-time profiles. The discriminatory power was estimated from C-statistics based on cross validation. We analyzed 54 patients with 97 prostate tissue specimens (47 prostate cancer, 50 normal prostate tissue) of the peripheral zone, mean age 63.8 years, mean prostate-specific antigen 18.9 ng/mL and mean of 10.5 days between MRI and total prostatectomy. When comparing prostate cancer tissue with normal prostate tissue, median RSI was 422% vs 330%, and wash-in slope 0.870 vs 0.539. The peak enhancement of 67 vs 42 was higher with prostate cancer tissue, while wash-out (-30% vs -23%) and wash-out slope (-0.037 vs -0.029) were lower, and the onset time (32 seconds) was comparable. The optimal C-statistics was 0.743 for temporal resolution of 8.0 seconds and measurement length of 2.5 minutes compared with 0.656 derived from a quantitative MRI analysis. This study provides evidence that the use of a non-parametric approach instead of a more established parametric approach resulted in greater precision to differentiate cancerous from normal prostate tissue of the peripheral zone of the prostate.
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Affiliation(s)
- Marius Hellstern
- Bürgerhospital und Clementin Kinderhospital gGmbH, Frankfurt am Main, Germany
| | - Carlos Martinez
- Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt am Main, Germany
| | | | - Dirk Beyersdorff
- Department of Diagnostic and Interventional Radiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Lutz Lüdemann
- Department of Medical Physics, Essen University Hospital, Essen, Germany
| | - Marc-Oliver Grimm
- Klinik und Poliklinik für Urologie Universitätsklinikum Jena, Jena, Germany
| | - Ulf Teichgräber
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany
| | - Tobias Franiel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany
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10
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Reijnen JS, Ryg U, Marthinsen JB, Schönhardt I, Seierstad T, Hole KH. Monoparametric high-resolution diffusion weighted MRI as a possible first step in an MRI-directed diagnostic pathway for men with suspicion of prostate cancer. Front Oncol 2023; 13:1102860. [PMID: 36798813 PMCID: PMC9927387 DOI: 10.3389/fonc.2023.1102860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 02/01/2023] Open
Abstract
Purpose To explore if a high-resolution diffusion weighted MRI sequence (DWI-only) could be used as a first step in an MRI-directed diagnostic pathway. Methods Prospective single center study that between December 2017 and August 2018 included 129 consecutive patients with suspicion of prostate cancer into a PI-RADS-based MRI-directed diagnostic pathway. All patients had multiparametric MRI (mpMRI). Based on only the transversal high-resolution DWI images two consultant radiologists prospectively categorized the findings as positive, equivocal, or negative for clinically significant cancer. The radiologists then interpreted the mpMRI and assigned a PI-RADS score. A third independent reader retrospectively categorized the DWI-only exams without access to the mpMRI. The interpretations of DWI-only were compared to the PI-RADS classification from mpMRI and the histopathology from the biopsies. Non-biopsied patients were followed in a safety net monitoring for 56 months. Results Based on DWI-only, 29 (22.5%) of the exams were categorized as negative, 38 (29.5%) as equivocal and 62 (48.1%) as positive. Of the 56 patients with PI-RADS 4-5 at mpMRI, 55 were also categorized as positive at DWI-only. All patients diagnosed with clinically significant cancer were identified using DWI-only. 56 months of safety net monitoring did not reveal any clinically significant cancers among patients with exams categorized as negative or equivocal. There was high inter-reader agreement on positive findings, but less agreement on negative and equivocal findings. Conclusions In this concept study, the monoparametric DWI-only identified all patients with clinically significant cancer in a mpMRI-directed diagnostic pathway.
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Affiliation(s)
- Jeroen Sebastiaan Reijnen
- Department of Radiology, Sørlandet Hospital Trust, Kristiansand, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Una Ryg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Jon B. Marthinsen
- Department of Radiology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Irina Schönhardt
- Department of Pathology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Therese Seierstad
- Division of Radiology and Nuclear Medicine, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Knut H. Hole
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Radiumhospitalet, Oslo University Hospital, Oslo, Norway,*Correspondence: Knut H. Hole,
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11
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Droghetti M, Bianchi L, Beretta C, Balestrazzi E, Costa F, Feruzzi A, Piazza P, Roveroni C, Gaudiano C, Corcioni B, Giunchi F, Fiorentino M, Golfieri R, Schiavina R, Brunocilla E. Site-specific concordance of targeted and systematic biopsy cores at the index lesion on multiparametric magnetic resonance: can we spare the double-tap? World J Urol 2023; 41:27-33. [PMID: 36471133 DOI: 10.1007/s00345-022-04229-3] [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] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To define the impact of systematic biopsy (SB) cores directed in the same area of index lesion in patients undergoing targeted biopsy (TB) and SB for prostate cancer (PCa) suspicion. METHODS We retrospectively analyzed data of biopsy-naïve patients with one single suspicious lesion at mpMRI who underwent TB plus SB at our institution between January 2015 and September 2021. A convenient sample of 336 patients was available for our analyses. The primary outcome was to evaluate the impact of overlapping SB cores directed to the index lesion at mpMRI. The secondary outcome was to evaluate the SB cores concordance in terms of highest Gleason Score Detection with TB cores. RESULTS 56% of patients were found to have site-specific concordance. SB cores determined disease upgrade in 22.1% patients. Thirty-one (16.4%) site-concordant patients experienced upgrade through overlapping SB cores, while 149 (79.3%) had no benefit by SB cores, and 8 (4.3%) patients had the worst ISUP at TB cores. 50% of the patients with negative-TB were upgraded to insignificant PCa, and 17.5% was upgraded from negative to unfavorable-intermediate- or high-risk PCa. Overall, 14 (19.4%) patients were also upgraded from ISUP 1 on TB to csPCa, with 28.5% of these harboring high-risk PCa. In csPCas at TB, 9 (12.5%) patients were upgraded from intermediate- to high-risk disease by SB. CONCLUSIONS TB alone consents to identify worst ISUP PCa in vast majority of patients scheduled for biopsy. A non-negligible number of patients are upgraded via-SB cores, including also index lesion overlapping cores. Omitting these cores might lead to a suboptimal patient management.
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Affiliation(s)
- Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy.
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
| | - Carlo Beretta
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
| | - Francesco Costa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
| | - Alberto Feruzzi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
| | - Carlo Roveroni
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Beniamino Corcioni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesca Giunchi
- Department of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy
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12
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Singh D, Das CJ, Kumar V, Singh A, Mehndiratta A. Quantification of prostate tumour diameter and volume from MR images using 3D ellipsoid model and its impact on PI-RADS v2.1 assessment. Sci Rep 2022; 12:21501. [PMID: 36513800 PMCID: PMC9748032 DOI: 10.1038/s41598-022-26065-6] [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: 05/15/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Maximum diameter and volume of the tumour provide important clinical information and are decision-making parameters for patients suspected with prostate cancer (PCa). The objectives of this study were to develop an automated method for 3D tumour measurement and compare it with the radiologist's manual assessment, as well as to investigate the impact of 3D tumour measurement on Prostate Imaging-Reporting and Data System version-2.1 (PI-RADS v2.1) scoring of prostate cancer. Tumour maximum diameter and volume were calculated using automated ellipsoid-fit method. For all PI-RADS scores, mean ± standard deviation range of tumour maximum diameter and volume measured using ellipsoid-fit method were 1.36 ± 0.28 to 1.97 ± 0.67 cm and 0.49 ± 0.31 to 1.05 ± 0.78 cc and manual assessment were in range of 0.73 ± 0.12 to 1.14 ± 0.25 cm and 0.36 ± 0.21 to 0.93 ± 0.39 cc, respectively. Ellipsoid-fit method showed significantly (p < 0.05) higher values for maximum diameter and volume than manual assessment. 3D measurement of tumour using ellipsoid-fit method was found to have higher maximum diameter and volume values (in 40-61% patients) compared to conventional assessment by radiologist, which may have an impact on PI-RADS v2.1 scoring system.
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Affiliation(s)
- Dharmesh Singh
- grid.417967.a0000 0004 0558 8755Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Chandan J. Das
- grid.413618.90000 0004 1767 6103Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Virendra Kumar
- grid.413618.90000 0004 1767 6103Department of NMR, All India Institute of Medical Sciences, New Delhi, India
| | - Anup Singh
- grid.417967.a0000 0004 0558 8755Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India ,grid.413618.90000 0004 1767 6103Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Mehndiratta
- grid.417967.a0000 0004 0558 8755Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India ,grid.413618.90000 0004 1767 6103Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India ,grid.417967.a0000 0004 0558 8755Centre for Biomedical Engineering, IIT Delhi Hauz-Khas, Room No-298, Block III, New Delhi, 110016 India
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13
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A Comparative Study of Multiparametric MRI Sequences in Measuring Prostate Cancer Index Lesion Volume. J Belg Soc Radiol 2022; 106:105. [DOI: 10.5334/jbsr.2832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
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14
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Chatterjee A, Turchan WT, Fan X, Griffin A, Yousuf A, Karczmar GS, Liauw SL, Oto A. Can Pre-treatment Quantitative Multi-parametric MRI Predict the Outcome of Radiotherapy in Patients with Prostate Cancer? Acad Radiol 2022; 29:977-985. [PMID: 34645572 DOI: 10.1016/j.acra.2021.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate whether pre-treatment quantitative multiparametric MRI can predict biochemical outcome of prostate cancer (PCa) patients treated with primary radiotherapy (RT). MATERIALS AND METHODS Fifty-one patients with biopsy confirmed PCa underwent prostate multiparametric MRI on 3T MR scanner prior to RT. Thirty-seven men (73%) were treated with external beam RT alone, 12 men (24%) were treated with brachytherapy monotherapy, and two men (4%) were treated with external beam RT with brachytherapy boost. The index lesion was outlined by a radiologist and quantitative apparent diffusion coefficient (ADC), T2 and DCE parameters were measured. Biochemical failure was defined using the Phoenix criteria. RESULTS After a median follow-up of 65 months, seven patients had biochemical failure. ADC had an area under the receiver operating characteristic curve of 0.71 for predicting RT outcome with significantly lower ADC (0.78 ± 0.17 vs 0.96 ± 0.26 µm2/ms, p = 0.04) of the index lesion in men with biochemical failure. Ideal ADC cutoff point (Youdens index) was 0.96 µm2/ms which had a sensitivity of 100% and specificity of 48% for predicting biochemical failure. Kaplan-Meier analysis showed that lower ADC values were associated with significantly lower freedom from biochemical failure (FFBF, p = 0.03, no failures out of 20 men if ADC ≥ 0.96 µm2/ms; seven of 31 with failures if ADC < 0.96 µm2/ms). On multivariable analysis, ADC was associated with FFBF (HR 0.96 per increase in ADC of 0.01 um2/ms [95% CI, 0.92-1.00]; p = 0.042) after accounting for National Comprehensive Cancer Network risk category (p = 0.064) and receipt of androgen deprivation therapy (p = 0.141). Quantitative T2 and DCE parameters were not associated with biochemical outcome. CONCLUSION Our results suggest that quantitative ADC values of the index lesion may predict biochemical failure following primary radiotherapy in patients with PCa. Lower ADC values were associated with inferior biochemical control.
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Affiliation(s)
- Aritrick Chatterjee
- Department of Radiology (A.C., X.F., A.G., A.Y., G.S.K., A.O.), University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.Y., G.S.K., A.O.), University of Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology (W.T.T., S.L.L.), University of Chicago, Chicago, Illinois
| | - William Tyler Turchan
- Department of Radiology (A.C., X.F., A.G., A.Y., G.S.K., A.O.), University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.Y., G.S.K., A.O.), University of Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology (W.T.T., S.L.L.), University of Chicago, Chicago, Illinois
| | - Xiaobing Fan
- Department of Radiology (A.C., X.F., A.G., A.Y., G.S.K., A.O.), University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.Y., G.S.K., A.O.), University of Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology (W.T.T., S.L.L.), University of Chicago, Chicago, Illinois
| | - Alexander Griffin
- Department of Radiology (A.C., X.F., A.G., A.Y., G.S.K., A.O.), University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.Y., G.S.K., A.O.), University of Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology (W.T.T., S.L.L.), University of Chicago, Chicago, Illinois
| | - Ambereen Yousuf
- Department of Radiology (A.C., X.F., A.G., A.Y., G.S.K., A.O.), University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.Y., G.S.K., A.O.), University of Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology (W.T.T., S.L.L.), University of Chicago, Chicago, Illinois
| | - Gregory S Karczmar
- Department of Radiology (A.C., X.F., A.G., A.Y., G.S.K., A.O.), University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.Y., G.S.K., A.O.), University of Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology (W.T.T., S.L.L.), University of Chicago, Chicago, Illinois
| | - Stanley L Liauw
- Department of Radiology (A.C., X.F., A.G., A.Y., G.S.K., A.O.), University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.Y., G.S.K., A.O.), University of Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology (W.T.T., S.L.L.), University of Chicago, Chicago, Illinois
| | - Aytekin Oto
- Department of Radiology (A.C., X.F., A.G., A.Y., G.S.K., A.O.), University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.Y., G.S.K., A.O.), University of Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology (W.T.T., S.L.L.), University of Chicago, Chicago, Illinois.
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15
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Analysis of Apparent Diffusion Coefficient Value and Dynamic Contrast-Enhanced Magnetic Resonance Imaging Parameters of Prostate Cancer Patients after Diagnosis and Treatment with Magnetic Resonance Imaging. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3111054. [PMID: 35785146 PMCID: PMC9246578 DOI: 10.1155/2022/3111054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022]
Abstract
This research was aimed at exploring the changes in the apparent diffusion coefficient (ADC) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters of prostate cancer (PCa) patients. Sixty PCa patients from the hospital were recruited as the research object, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) scans were performed to determine the shape, scope, and enhancement characteristics of prostate lesions and their relationship with surrounding tissues. The quantitative parameters of ADC and DCE-MRI were measured. There were 4 patients (6.67%) with a Gleason score of 6 and 15 patients (25%) with a 4 + 3 score. The ADC with Gleason = 6 is 0.81 ± 0.08 × 10−3 s/mm2, the ADC with Gleason = 3 + 4 is 0.74 ± 0.07 × 10−3 s/mm2, the ADC with Gleason = 4 + 3 is 0.73 ± 0.05 × 10−3 s/mm2, the ADC with Gleason = 9 is 0.65 ± 0.06 × 10−3 s/mm2, and the ADC with Gleason = 10 is 0.59 ± 0.07 × 10−3 s/mm2. As the Gleason score increased, the ADC decreased and the permeation parameter transfer constant increased. When the ADC was combined with the permeability parameter transfer constant, the AUC of Gleason = 6 points and Gleason = 7 points was greatly different (P < 0.05). The 95% CI of the ADC combined permeability parameter transport constant when Gleason = 6 points and Gleason = 7 points was 0.898-0.934, the sensitivity was 75.4%, and the specificity was 86.2%. The ADC value was negatively correlated with Gleason score. The ADC value combined with VTC value has good diagnostic performance in evaluating the invasion of PCa, which is very important for making treatment plan and evaluating prognosis.
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16
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Fan X, Chatterjee A, Pittman JM, Yousuf A, Antic T, Karczmar GS, Oto A. Effectiveness of Dynamic Contrast Enhanced MRI with a Split Dose of Gadoterate Meglumine for Detection of Prostate Cancer. Acad Radiol 2022; 29:796-803. [PMID: 34583866 DOI: 10.1016/j.acra.2021.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/19/2021] [Accepted: 07/31/2021] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate whether dynamic contrast enhanced (DCE) MRI with a split injection of 30% followed by 70% of a standard dose (30PSD and 70PSD) of gadoterate meglumine (DOTAREM) can improve diagnosis of prostate cancer (PCa). MATERIALS AND METHODS MRI for twenty patients was performed on a Philips Ingenia 3T scanner without an endorectal coil followed by subsequent radical prostatectomy. DCE 3D T1-FFE data were acquired with injection of 0.03 mmol/kg followed after 2 minutes by 0.07 mmol/kg of DOTAREM. Regions-of-interest on histologically verified PCa and normal tissue in different prostate zones and the iliac artery were drawn. Average signal intensity as function of time was calculated for each ROI and fitted by using the signal intensity form of the Tofts (SI-Tofts) model to extract physiological parameters (Ktrans and ve). In addition, the scaled arterial input function (AIF) obtained from 30PSD data was used to analyze 70PSD data. RESULTS The AIF obtained from 30PSD data showed both first and second passes clearly and had much higher peak magnitude than AIFs from 70PSD data. Ktrans was significantly (p < 0.05) larger in PCa than in normal tissue in peripheral zone (PZ) and central zone (CZ) for both 70PSD and 70PSD data analyzed with a scaled AIF. Ktrans in cancer overlapped with that of normal tissue in the transition zone (TZ). There was no statistical difference in ve between cancer and normal tissue. Receiver operating characteristic analysis showed that use of the AIF from 30PSD data to analyze 70PSD data increased the diagnostic efficacy of Ktrans in the PZ and CZ. CONCLUSION The split dose protocol for injection of Dotarem increased diagnostic accuracy of quantitative analysis with the SI-Tofts model.
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17
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Physically implausible signals as a quantitative quality assessment metric in prostate diffusion-weighted MR imaging. Abdom Radiol (NY) 2022; 47:2500-2508. [PMID: 35583823 DOI: 10.1007/s00261-022-03542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To provide a quantitative assessment of diffusion-weighted MR images of the prostate through identification of PIDS which clearly represents artifacts in the data. We calculated the percentage and distribution of PIDS in prostate DWI and compare the amount of PIDS between mpMRI images obtained with and without an endorectal coil. METHODS This IRB approved retrospective study (from 03/03/2014 to 03/10/2020), included 40 patients scanned with endorectal coil (ERC) and 40 without ER coil (NERC). PIDS contains any voxel where: (1) the diffusion signal increases despite an increase in b-value; and/or (2) apparent diffusion coefficient (ADC) is more than 3.0 μm2/ms (the ADC of pure water at 37 °C and it is physically implausible for any material to have a higher ADC). PIDS for transition zone (TZ) and peripheral zone (PZ) was calculated using an in-house MATLAB program. DWI images were quantitatively inspected for noise, motion, and distortion. T-test was used to compare the difference between PIDS levels in ERC versus NERC and ANOVA to compare the PIDS levels in the anatomic zones. The images were evaluated by a fellowship-trained radiologist in Abdominal Imaging with more than 10 years of experience in reading prostate MRI. This was tested only in prostate in this study. RESULTS 80 patients (58 ± 8 years old, 80 men) were evaluated. The percentage of voxels exhibiting PIDS was 17.1 ± 8.1% for the ERC cohort and 22.2 ± 15.5% for the NERC cohort. PIDS for NERC versus ERC were not significantly different (p = 0.14). The apex and base showed similar percentages of PIDS in ERC (p = 0.30) and NERC (p = 0.86). The mid (13.8 ± 8.6%) in ERC showed lower values (p = 0.02) of PIDS compared to apex (19.9 ± 11.1%) and base (17.5 ± 8.3%). CONCLUSION PIDS maps provide a spatially resolved quantitative quality assessment for prostate DWI. Average PIDS over the entire prostate were similar for the ERC and NERC cohorts, and did not differ significantly across prostate zones. However, for many of the patients, PIDS was focally much higher in specific prostate zones. PIDS assessment can guide Radiologist's evaluation of images and the development of improved DWI sequences.
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18
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Masoom SN, Sundaram KM, Ghanouni P, Fütterer J, Oto A, Ayyagari R, Sprenkle P, Weinreb J, Arora S. Real-Time MRI-Guided Prostate Interventions. Cancers (Basel) 2022; 14:cancers14081860. [PMID: 35454773 PMCID: PMC9030365 DOI: 10.3390/cancers14081860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Magnetic resonance imaging has shown to be a reliable imaging method for detecting clinically significant prostate cancer and directly targeting lesions during biopsy. As newer treatment methods emerge, the role of MRI in minimally-invasive (focal) treatment of prostate cancer is also increasing. Here, we review the real-time MRI-guided prostate interventions for prostate cancer diagnosis and treatment, focusing on the technical aspects of each modality. Abstract Prostate cancer (PCa) is the second most common cause of cancer death in males. Targeting MRI-visible lesions has led to an overall increase in the detection of clinically significant PCa compared to the prior practice of random ultrasound-guided biopsy of the prostate. Additionally, advances in MRI-guided minimally invasive focal treatments are providing new options for patients with PCa. This review summarizes the currently utilized real-time MRI-guided interventions for PCa diagnosis and treatment.
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Affiliation(s)
- Seyedeh Nina Masoom
- Department of Radiology, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA; (S.N.M.); (K.M.S.)
| | - Karthik M. Sundaram
- Department of Radiology, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA; (S.N.M.); (K.M.S.)
| | - Pejman Ghanouni
- Department of Radiology, Stanford University Medical Center, Palo Alto, CA 04304, USA;
| | - Jurgen Fütterer
- Department of Radiology, Radboud University Nijmegen Medical Center, 6525 GA Nijmegan, The Netherlands;
| | - Aytekin Oto
- Department of Radiology, The University of Chicago, Chicago, IL 60637, USA;
| | - Raj Ayyagari
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA; (R.A.); (J.W.)
| | - Preston Sprenkle
- Department of Urology, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Jeffrey Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA; (R.A.); (J.W.)
| | - Sandeep Arora
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA; (R.A.); (J.W.)
- Correspondence:
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19
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Giganti F, Allen C, Stavrinides V, Stabile A, Haider A, Freeman A, Pashayan N, Punwani S, Emberton M, Moore CM, Kirkham A. Tumour growth rates of prostate cancer during active surveillance: is there a difference between MRI-visible low and intermediate-risk disease? Br J Radiol 2022; 95:20210321. [PMID: 34233491 PMCID: PMC8978245 DOI: 10.1259/bjr.20210321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the changes in lesion volume on serial multiparametric magnetic resonance (mpMRI) during active surveillance for prostate cancer. METHODS A total of 160 patients with a targeted biopsy-confirmed visible lesion on mpMRI, stratified by low- and intermediate-risk disease (Gleason Grade Group 1 vs Gleason Grade Group 2), were analysed. The % change per year was calculated using the formula: [(final volume/initial volume) exp (1/interval between scans in years)]-1. RESULTS There was no significant difference in the annual median percentage change between Gleason Grade Group 1 (18%) and Gleason Grade Group 2 (23%) disease (p = 0.16), and between ≤ 10% (23%) and > 10% (22%) of Gleason pattern 4 (p = 0.78).Assuming a spherical lesion, these changes corresponded to annual increases in mean tumour diameter of 6% and 7% for Gleason Grade Group 1 and Gleason Grade Group 2 respectively, which may be less than the interscan variability of serial mpMRI. CONCLUSION In an active surveillance cohort, we did not see a significant difference in the annual growth rate of Gleason Grade Group 1 and 2 tumours. ADVANCES IN KNOWLEDGE In patients on active surveillance, the measured growth rates for visible tumours in Gleason Grade Groups 1 and 2 were similar. The annual growth rate was small in most cases and this may have implications for the MRI follow-up interval in active surveillance.
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Affiliation(s)
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | | | | | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
| | | | - Mark Emberton
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
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20
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Raison N, Servian P, Patel A, Santhirasekaram A, Smith A, Yeung M, Lloyd J, Mannion E, Rockall A, Ahmed H, Winkler M. Is tumour volume an independent predictor of outcome after radical prostatectomy for high-risk prostate cancer? Prostate Cancer Prostatic Dis 2021:10.1038/s41391-021-00468-4. [PMID: 34845306 DOI: 10.1038/s41391-021-00468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/21/2021] [Accepted: 10/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preoperative PSA, ISUP grade group (GG), prostate examination and multiparametric MRI (mpMRI) form the basis of prostate cancer staging. Unlike other solid organ tumours, tumour volume (TV) is not routinely used aside from crude estimates such as maximum cancer core length. The aim of this study is to assess the role of TV as a marker for oncological outcomes in high-risk non-metastatic prostate cancer. METHODS A prospectively maintained database of patients undergoing minimally invasive (laparoscopic or robot-assisted laparoscopic) radical prostatectomy at a UK centre between 2007 and 2019 were analysed. A total of 251 patients with NCCN high or very high-risk prostate cancer were identified. Primary outcome measure was time to biochemical recurrence (BCR) and the secondary outcome was time to treatment failure (TTF). TV was measured on the pathological specimen using the stacking method. Multivariable cox regression analysis was used to identify factors predicting BCR and TFF. TV as a predictor of BCR and TFF was further analysed through time-dependent receiver operating characteristic (ROC) curves. Kaplan-Meier survival estimates were used to evaluate TV cut-off scores. RESULTS Median follow up was 4.50 years. Four factors were associated with BCR and TFF on multivariable analysis (TV, pathological GG, pathological T stage, positive margin >3 mm). Area under the Curve (AUC) for TV as a predictor of BCR and TTF at 5 years was 0.71 and 0.75, respectively. Including all 4 variables in the model increased AUC to 0.84 and 0.85 for BCR and TFF. A 2.50 cm TV cut off demonstrated a significance difference in time to BCR, p < 0.001. CONCLUSIONS Pathological tumour volume is an independent predictor of oncological outcomes in high risk prostate cancer but does not add significant prognostic value when combined with established variables. However, the option of accurate TV measurement on mpMRI raises the possibility of using TV as useful marker for preoperative risk stratification.
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Affiliation(s)
- Nicholas Raison
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,MRC Center for Transplantation, King's College London, London, UK
| | - Pol Servian
- Department of Urology, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain.,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Amit Patel
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Ainkaran Santhirasekaram
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK.,Department of Computing, Imperial College London, London, UK
| | - Andrew Smith
- North West London Pathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Maidie Yeung
- North West London Pathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Josephine Lloyd
- North West London Pathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Ethna Mannion
- North West London Pathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Andrea Rockall
- Division of Cancer, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Hashim Ahmed
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Mathias Winkler
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. .,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
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21
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Chatterjee A, Mercado C, Bourne RM, Yousuf A, Hess B, Antic T, Eggener S, Oto A, Karczmar GS. Validation of Prostate Tissue Composition by Using Hybrid Multidimensional MRI: Correlation with Histologic Findings. Radiology 2021; 302:368-377. [PMID: 34751615 PMCID: PMC8805656 DOI: 10.1148/radiol.2021204459] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Tissue estimates obtained by using microstructure imaging techniques, such as hybrid multidimensional (HM) MRI, may improve prostate cancer diagnosis but require histologic validation. Purpose To validate prostate tissue composition measured by using HM MRI, with quantitative histologic evaluation from whole-mount prostatectomy as the reference standard. Materials and Methods In this HIPAA-compliant study, from December 2016 to July 2018, prospective participants with biopsy-confirmed prostate cancer underwent 3-T MRI before radical prostatectomy. Axial HM MRI was performed with all combinations of echo times (57, 70, 150, and 200 msec) and b values (0, 150, 750, and 1500 sec/mm2). Data were fitted by using a three-compartment signal model to generate volumes for each tissue component (stroma, epithelium, lumen). Quantitative histologic evaluation was performed to calculate volume fractions for each tissue component for regions of interest corresponding to MRI. Tissue composition measured by using HM MRI and quantitative histologic evaluation were compared (paired t test) and correlated (Pearson correlation coefficient), and agreement (concordance correlation) was assessed. Receiver operating characteristic curve analysis for cancer diagnosis was performed. Results Twenty-five participants (mean age, 60 years ± 7 [standard deviation]; 30 cancers and 45 benign regions of interest) were included. Prostate tissue composition measured with HM MRI and quantitative histologic evaluation did not differ (stroma, 45% ± 11 vs 44% ± 11 [P = .23]; epithelium, 31% ± 15 vs 34% ± 15 [P = .08]; and lumen, 24% ± 13 vs 22% ± 11 [P = .80]). Between HM MRI and histologic evaluation, there was excellent correlation (Pearson r: overall, 0.91; stroma, 0.82; epithelium, 0.93; lumen, 0.90 [all P < .05]) and agreement (concordance correlation coefficient: overall, 0.91; stroma, 0.81; epithelium, 0.90; and lumen, 0.87). High areas under the receiver operating characteristic curve obtained with HM MRI (0.96 for epithelium and 0.94 for lumen, P < .001) and histologic evaluation (0.94 for epithelium and 0.88 for lumen, P < .001) were found for differentiation between benign tissue and prostate cancer. Conclusion Tissue composition measured by using hybrid multidimensional MRI had excellent correlation with quantitative histologic evaluation as the reference standard. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Muglia in this issue.
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22
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Boschheidgen M, Schimmöller L, Arsov C, Ziayee F, Morawitz J, Valentin B, Radke KL, Giessing M, Esposito I, Albers P, Antoch G, Ullrich T. MRI grading for the prediction of prostate cancer aggressiveness. Eur Radiol 2021; 32:2351-2359. [PMID: 34748064 PMCID: PMC8921105 DOI: 10.1007/s00330-021-08332-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES T o evaluate the value of multiparametric MRI (mpMRI) for the prediction of prostate cancer (PCA) aggressiveness. METHODS In this single center cohort study, consecutive patients with histologically confirmed PCA were retrospectively enrolled. Four different ISUP grade groups (1, 2, 3, 4-5) were defined and fifty patients per group were included. Several clinical (age, PSA, PSAD, percentage of PCA infiltration) and mpMRI parameters (ADC value, signal increase on high b-value images, diameter, extraprostatic extension [EPE], cross-zonal growth) were evaluated and correlated within the four groups. Based on combined descriptors, MRI grading groups (mG1-mG3) were defined to predict PCA aggressiveness. RESULTS In total, 200 patients (mean age 68 years, median PSA value 8.1 ng/ml) were analyzed. Between the four groups, statistically significant differences could be shown for age, PSA, PSAD, and for MRI parameters cross-zonal growth, high b-value signal increase, EPE, and ADC (p < 0.01). All examined parameters revealed a significant correlation with the histopathologic biopsy ISUP grade groups (p < 0.01), except PCA diameter (p = 0.09). A mixed linear model demonstrated the strongest prediction of the respective ISUP grade group for the MRI grading system (p < 0.01) compared to single parameters. CONCLUSIONS MpMRI yields relevant pre-biopsy information about PCA aggressiveness. A combination of quantitative and qualitative parameters (MRI grading groups) provided the best prediction of the biopsy ISUP grade group and may improve clinical pathway and treatment planning, adding useful information beyond PI-RADS assessment category. Due to the high prevalence of higher grade PCA in patients within mG3, an early re-biopsy seems indicated in cases of negative or post-biopsy low-grade PCA. KEY POINTS • MpMRI yields relevant pre-biopsy information about prostate cancer aggressiveness. • MRI grading in addition to PI-RADS classification seems to be helpful for a size independent early prediction of clinically significant PCA. • MRI grading groups may help urologists in clinical pathway and treatment planning, especially when to consider an early re-biopsy.
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Affiliation(s)
- M Boschheidgen
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - L Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - C Arsov
- Department of Urology, Medical Faculty, University Dusseldorf, 40225, Düsseldorf, Germany
| | - F Ziayee
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - B Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - K L Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - M Giessing
- Department of Urology, Medical Faculty, University Dusseldorf, 40225, Düsseldorf, Germany
| | - I Esposito
- Department of Pathology, Medical Faculty, University Dusseldorf, 40225, Düsseldorf, Germany
| | - P Albers
- Department of Urology, Medical Faculty, University Dusseldorf, 40225, Düsseldorf, Germany
| | - G Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - T Ullrich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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23
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Stabile A, Mazzone E, Cirulli GO, De Cobelli F, Grummet J, Thoeny HC, Emberton M, Pokorny M, Pinto PA, Taneja SS. Association Between Multiparametric Magnetic Resonance Imaging of the Prostate and Oncological Outcomes after Primary Treatment for Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2021; 4:519-528. [PMID: 33384275 DOI: 10.1016/j.euo.2020.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/10/2020] [Accepted: 11/27/2020] [Indexed: 12/25/2022]
Abstract
CONTEXT The diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) for prostate cancer (PCa) diagnosis has been extensively explored. Little is known about the prognostic value of mpMRI suspicion scores and other quantitative mpMRI information. OBJECTIVE To systematically review the current literature assessing the relationship between pretreatment mpMRI and oncological outcomes after primary treatment for PCa to assess the role of mpMRI as a prognostic tool. EVIDENCE ACQUISITION A computerized bibliographic search of MEDLINE/PubMed, EMBASE, Scopus, and the Cochrane Library CENTRAL databases was performed for all studies assessing the relationship between mpMRI and oncological outcomes after primary treatment for PCa. The review protocol is registered in the PROSPERO database (CRD42020209899). EVIDENCE SYNTHESIS A total of six studies were included. Reliable evidence is still limited in this field. The Prostate Imaging-Reporting and Data System (PI-RADS) score was an independent predictor of biochemical recurrence (BCR) after radical prostatectomy (RP) in the majority of the studies included. The tumor volume at mpMRI was not significantly associated with BCR after RP for PCa. Data on disease progression and PCa-specific mortality are limited. Heterogeneity among the studies was substantial. CONCLUSIONS The review shows that PI-RADS scores provide information on the future likelihood of cancer recurrence or progression, at least for men undergoing RP. We are of the view that this information should be taken into account to identify men at higher risk of unfavorable outcomes. PATIENT SUMMARY A higher Prostate Imaging-Reporting and Data System score for magnetic resonance imaging of the prostate seems to be positively associated with oncological failure in prostate cancer and should be incorporated into future risk models.
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Affiliation(s)
- Armando Stabile
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe O Cirulli
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Harriet C Thoeny
- Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland
| | - Mark Emberton
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Morgan Pokorny
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samir S Taneja
- Department of Urologic Oncology, NYU Langone Medical Center, New York, NY, USA
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24
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Giannarini G, Cereser L, Como G, Bonato F, Pizzolitto S, Valotto C, Ficarra V, Dal Moro F, Zuiani C, Girometti R. Accuracy of abbreviated multiparametric MRI-derived protocols in predicting local staging of prostate cancer in men undergoing radical prostatectomy. Acta Radiol 2021; 62:949-958. [PMID: 32718179 DOI: 10.1177/0284185120943047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Abbreviated magnetic resonance imaging (aMRI) protocols have emerged as an alternative to multiparametric MRI (mpMRI) to reduce examination time and costs. PURPOSE To compare multiple aMRI protocols for predicting pathological stage ≥T3 (≥pT3) prostate cancer (PCa). MATERIAL AND METHODS One hundred and eight men undergoing staging mpMRI before radical prostatectomy (RP) were retrospectively evaluated. 3.0-T imaging was performed with a 32-channel surface coil and a protocol including diffusion-weighted imaging (DWI), transverse T2-weighted (tT2W) imaging, coronal T2W (cT2W) imaging, sagittal T2W (sT2) imaging, and dynamic contrast-enhanced (DCE) imaging. Two readers independently assessed whether any MRI observation showed stage ≥T3 on each sequence (reading order: DWI, cT2W, tT2W, sT2W, DCE). Final stage was assessed by matching readers' assignments to pathology, and combining them into eight protocols: DWI + tT2W, DWI + cT2W + tT2W, DWI + tT2W + sT2W, DWI + cT2W + tT2W + sT2W, DWI + tT2W + DCE, DWI + cT2W + tT2W + DCE, DWI + tT2W + sT2W + DCE, and mpMRI. Diagnostic accuracy and inter-reader agreement for aMRI protocols were calculated. RESULTS Prevalence of ≥pT3 PCa was 31.5%. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of aMRI protocols were comparable to mpMRI for R1. Sensitivity was 74.3% (95% confidence interval [CI] 64.8-72.0) to 77.1% (95% CI 67.9-84.4), and NPV 86.8% (95% CI 78.6-92.3) to 88.1% (95% CI 80.1-93.3). All accuracy measures of the various aMRI protocols were similar to mpMRI also for R2, albeit all slightly lower compared to R1. On a per-protocol basis, there was substantial inter-reader agreement in predicting stage ≥pT3 (k 0.63-0.67). CONCLUSION When comparing the diagnostic accuracy of multiple aMRI protocols against mpMRI for predicting stage ≥pT3 PCa, the protocol with the fewest sequences (DWI + tT2W) is apparently equivalent to standard mpMRI.
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Affiliation(s)
- Gianluca Giannarini
- Urology Unit, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Giuseppe Como
- Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Filippo Bonato
- Department of Medicine, University of Udine, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Stefano Pizzolitto
- Pathology Unit, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Claudio Valotto
- Urology Unit, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi,” Urologic Section, University of Messina, Messina, Italy
| | - Fabrizio Dal Moro
- Urologic Clinic, University of Udine, Udine, Italy
- Department of Surgery, Oncology and Gastroenterology, Urology Unit, University of Padua, Padua, Italy
| | - Chiara Zuiani
- Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
- Department of Medicine, University of Udine, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
- Department of Medicine, University of Udine, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
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25
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Rosa C, Pizzi AD, Augurio A, Caravatta L, DI Tommaso M, Mincuzzi E, Cinalli S, Basilico R, Porreca A, DI Nicola M, Genovesi D. Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers. In Vivo 2021; 34:1981-1986. [PMID: 32606170 DOI: 10.21873/invivo.11995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/25/2023]
Abstract
AIM To delineate cervical cancer gross tumor volume (GTV) on T2-magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) maps, assessing volumes and inter-observer agreement between two observers. PATIENTS AND METHODS A radiologist and a radiation oncologist delineated GTV on T2 (T2GTV) and ADC (ADCGTV) sequences. Dice similarity index (DICE) and Bland-Altman analysis were used to estimated concordance. RESULTS Mean T2GTV and ADCGTV volumes were 43.84±71.47 cc and 37.28±68.92 cc according to the radiologist, and 43.4±70.44 cc and 36.65±69.21 cc according to the radiation oncologist. ADC led to statistically significantly smaller volumes compared to T2. The mean DICE index was 0.86 for T2GTV and 0.84 for ADCGTV The Bland-Altman plots globally showed concordance. CONCLUSION GTV delineation was smaller in the ADC maps compared to T2-MRI, reaching an almost perfect agreement between observers. Thanks to this acceptable variability, adding functional imaging might provide more information for tumor delineation, improving reproducibility for image-guided adaptive radiotherapy.
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Affiliation(s)
- Consuelo Rosa
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy .,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy.,Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Antonietta Augurio
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Luciana Caravatta
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Monica DI Tommaso
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Erica Mincuzzi
- Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | | | - Raffaella Basilico
- Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | | | - Marta DI Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | - Domenico Genovesi
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
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26
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Salvage interstitial laser thermal therapy under MRI guidance (MRgFLA) for high-intensity focal ultrasound (HIFU) recurrences: feasibility study. Clin Imaging 2021; 76:217-221. [PMID: 33965848 DOI: 10.1016/j.clinimag.2021.04.014] [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: 02/05/2021] [Revised: 04/04/2021] [Accepted: 04/25/2021] [Indexed: 02/02/2023]
Abstract
While focal therapy (FT) is increasingly endorsed for treating localized prostate cancer in the appropriately selected patient, management of recurrences following FT is not well-established in the literature. This case series describes three patients who received high-intensity focal ultrasound (HIFU) for primary treatment followed by focal laser interstitial thermal therapy (FLTT) for salvage therapy treated in the context of an ongoing clinical trial. Evaluation of these reported patients demonstrates that FLTT is feasible in the salvage setting with promising short-term oncologic outcomes and with the potential to preserve functional outcomes. Repeat focal therapy for previous failures is feasible however, it requires sophisticated imaging modalities for the accurate identification of recurrence and treatment of the tumor.
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27
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Céspedes MS, Radtke JP, Cathelineau X, Sanchez-Salas R. Prostate specific membrane antigen (PSMA) and Prostate Cancer Staging: is our current conventional staging obsolete? Int Braz J Urol 2021; 47:1243-1249. [PMID: 33861056 PMCID: PMC8486444 DOI: 10.1590/s1677-5538.ibju.2020.0997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Xavier Cathelineau
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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28
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Franiel T, Asbach P, Beyersdorff D, Blondin D, Kaufmann S, Mueller-Lisse UG, Quentin M, Rödel S, Röthke M, Schlemmer HP, Schimmöller L. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Scanning Protocol. ROFO-FORTSCHR RONTG 2021; 193:763-777. [PMID: 33735931 DOI: 10.1055/a-1406-8477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The Working Group Uroradiology and Urogenital Diagnosis of the German Roentgen Society (DRG) revised and updated the recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate in a consensus process and harmonized it with the managing board of German Roentgen Society and Professional Association of the German Radiologist (BDR e. V.). These detailed recommendation define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer and describe in detail the topic 1. anamnestic datas, 2. termination of examinations and preparation of examinations, 3. examination protocol and 4. MRI-(in-bore)-biopsy. KEY POINTS:: · The recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate were revised and updated in a consensus process and harmonized with the managing board of German Roentgen Society (DRG) and Professional Asssociation of the German Radiologist (BDR).. · Detailed recommendations are given for topic 1. anamnestic datas, 2. termination and preparation of examinations, 3. examination protocoll and 4. MRI-(in-bore)-biopsy.. · These recommendations define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer.. CITATION FORMAT: · Franiel T, Asbach P, Beyersdorff D et al. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Examination Protocol. Fortschr Röntgenstr 2021; 193: 763 - 776.
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Affiliation(s)
- Tobias Franiel
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Jena, Deutschland
| | - Patrick Asbach
- Klinik für Radiologie, Charité Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Deutschland
| | - Dirk Beyersdorff
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Blondin
- Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Städtische Kliniken Mönchengladbach GmbH Elisabeth-Krankenhaus Rheydt, Mönchengladbach, Germany.,Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Städtische Kliniken Mönchengladbach, Germany
| | - Sascha Kaufmann
- Institut für Diagnostische und Interventionelle Radiologie, Siloah St. Trudpert Klinikum, Pforzheim, Deutschland
| | | | - Michael Quentin
- Centrum für Diagnostik und Therapie GmbH, Medizinisches Versorgungszentrum CDT Strahleninstitut GmbH, Köln, Germany
| | - Stefan Rödel
- Radiologische Klinik, Städtisches Klinikum Dresden, Germany
| | - Matthias Röthke
- Conradia Radiologie und Nuklearmedizin, Conradia Hamburg MVZ GmbH, Hamburg, Germany
| | | | - Lars Schimmöller
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Shieh AC, Guler E, Ojili V, Paspulati RM, Elliott R, Ramaiya NH, Tirumani SH. Extraprostatic extension in prostate cancer: primer for radiologists. Abdom Radiol (NY) 2020; 45:4040-4051. [PMID: 32390076 DOI: 10.1007/s00261-020-02555-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The presence of extraprostatic extension (EPE) on multiparametric MRI (mpMRI) is an important factor in determining the management of prostate cancer. EPE is an established risk factor for biochemical recurrence of prostate cancer after radical prostatectomy (RP) and patients with EPE may be considered for wider resection margins, non-nerve-sparing surgery, adjuvant radiation therapy (RT), or androgen deprivation therapy (ADT). Several statistical nomograms and scoring systems have been developed to predict pathological stage at time of RP but with varying accuracies. Using the current PI-RADS v2 mpMRI staging guidelines results in high specificity but lacks in sensitivity. These findings reveal the need for more standardization and further refinement of existing MRI protocols and prostate cancer prediction tools. Current studies have looked into indirect additional imaging criteria such as index tumor volume, length of capsular contact, and apparent diffusion coefficient. Measuring for these features can improve the robustness of mpMRI in staging prostate cancer, as they have been shown to be independent predictors of EPE. MRI/ultrasound fusion-guided targeted biopsy can detect EPE not found on standard biopsy. Collectively, these measurements and imaging techniques can augment the detection of EPE and subsequent risk stratification.
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Affiliation(s)
- Alice C Shieh
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ezgi Guler
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Robin Elliott
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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Abstract
Prostate MRI has seen increasing interest in recent years and has led to the development of new MRI techniques and sequences to improve prostate cancer (PCa) diagnosis which are reviewed in this article. Numerous studies have focused on improving image quality (segmented DWI) and faster acquisition (compressed sensing, k-t-SENSE, PROPELLER). An increasing number of studies have developed new quantitative and computer-aided diagnosis methods including artificial intelligence (PROSTATEx challenge) that mitigate the subjective nature of mpMRI interpretation. MR fingerprinting allows rapid, simultaneous generation of quantitative maps of multiple physical properties (T1, T2), where PCa are characterized by lower T1 and T2 values. New techniques like luminal water imaging (LWI), restriction spectrum imaging (RSI), VERDICT and hybrid multi-dimensional MRI (HM-MRI) have been developed for microstructure imaging, which provide information similar to histology. The distinct MR properties of tissue components and their change with the presence of cancer is used to diagnose prostate cancer. LWI is a T2-based imaging technique where long T2-component corresponding to luminal water is reduced in PCa. RSI and VERDICT are diffusion-based techniques where PCa is characterized by increased signal from intra-cellular restricted water and increased intracellular volume fraction, respectively, due to increased cellularity. VERDICT also reveal loss of extracellular-extravascular space in PCa due to loss of glandular structure. HM-MRI measures volumes of prostate tissue components, where PCa has reduced lumen and stromal and increased epithelium volume similar to results shown in histology. Similarly, molecular imaging using hyperpolarized 13C imaging has been utilized.
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Abstract
The prostate imaging reporting and data system (PI-RADS) has revolutionized the use of magnetic resonance imaging (MRI) for the management of prostate cancer (PCa). The most recent version 2.1, PI-RADS v2.1, provides specific refinements in the performance, relaxing some recommendations which were not found to be helpful, while reinforcing and clarifying others. The interpretation of T2-weighted imaging (T2WI) in the transition zone (TZ), and the overall assessment of TZ nodules, now allows for a clearer distinction between those which are clearly benign and those which might warrant tissue sampling. Additional changes also resolve discrepancies in T2WI and diffusion-weighted imaging (DWI) of the peripheral zone (PZ). PI-RADS v2.1 is a simpler, more straightforward, and more reproducible method to better communicate between physicians regarding findings on prostate MRI.
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Affiliation(s)
- Silvina P Dutruel
- Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA
| | - Sunil Jeph
- Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA
| | - Daniel J A Margolis
- Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA.
| | - Natasha Wehrli
- Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA
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Bosaily AES, Frangou E, Ahmed HU, Emberton M, Punwani S, Kaplan R, Brown LC, Freeman A, Jameson C, Hindley R, Peppercorn D, Thrower A, Winkler M, Barwick T, Stewart V, Burns-Cox N, Burn P, Ghei M, Kumaradevan J, Prasad R, Ash-Miles J, Shergill I, Agarwal S, Rosario D, Salim F, Bott S, Evans H, Henderson A, Ghosh S, Dudderidge T, Smart J, Tung K, Kirkham A. Additional Value of Dynamic Contrast-enhanced Sequences in Multiparametric Prostate Magnetic Resonance Imaging: Data from the PROMIS Study. Eur Urol 2020; 78:503-511. [PMID: 32312543 DOI: 10.1016/j.eururo.2020.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MP-MRI) is established in the diagnosis of prostate cancer, but the need for enhanced sequences has recently been questioned. OBJECTIVE To assess whether dynamic contrast-enhanced imaging (DCE) improves accuracy over T2 and diffusion sequences. DESIGN, SETTING, AND PARTICIPANTS PROMIS was a multicentre, multireader trial, with, in this part, 497 biopsy-naïve men undergoing standardised 1.5T MP-MRI using T2, diffusion, and DCE, followed by a detailed transperineal prostate mapping (TPM) biopsy at 5 mm intervals. Likert scores of 1-5 for the presence of a significant tumour were assigned in strict sequence, for (1) T2 + diffusion and then (2) T2 + diffusion + dynamic contrast-enhanced images. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS For the primary analysis, the primary PROMIS outcome measure (Gleason score ≥4 + 3 or ≥6 mm maximum cancer length) on TPM was used, and an MRI score of ≥3 was considered positive. RESULTS AND LIMITATIONS Sensitivity without and with DCE was 94% and 95%, specificity 37% and 38%, positive predictive value 51% and 51%, and negative predictive value 90% and 91%, respectively (p > 0.05 in each case). The number of patients avoiding biopsy (scoring 1-2) was similar (123/497 vs 121/497, p = 0.8). The number of equivocal scores (3/5) was slightly higher without DCE (32% vs 28% p = 0.031). The proportion of MRI equivocal (3/5) and positive (4-5) cases showing significant tumours were similar (23% and 71% vs 20% and 69%). No cases of dominant Gleason 4 or higher were missed with DCE, compared with a single case with T2 + diffusion-weighted imaging. No attempt was made to correlate lesion location on MRI and histology, which may be considered a limitation. Radiologists were aware of the patient's prostate-specific antigen. CONCLUSIONS Contrast adds little when MP-MRI is used to exclude significant prostate cancer. PATIENT SUMMARY An intravenous injection of contrast may not be necessary when magnetic resonance imaging is used as a test to rule out significant tumours in the prostate.
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Affiliation(s)
- Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, Royal Free NHS foundation Trust, London, UK.
| | | | - Hashim U Ahmed
- Division of Surgery and Interventional Sciences, University College London, London, UK; Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK
| | | | | | - Alex Freeman
- University College Hospital NHS Foundation Trust, London, UK
| | - Charles Jameson
- University College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Mathias Winkler
- Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK
| | - Tara Barwick
- Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK
| | - Victoria Stewart
- Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK
| | - Nick Burns-Cox
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Paul Burn
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | | | | | | | | | | | | | | | - Simon Bott
- Frimley Health NHS Foundation Trust, Camberley, UK
| | - Hywel Evans
- Frimley Health NHS Foundation Trust, Camberley, UK
| | | | - Sukanya Ghosh
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Tim Dudderidge
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Smart
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ken Tung
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Giganti F, Stavrinides V, Stabile A, Osinibi E, Orczyk C, Radtke JP, Freeman A, Haider A, Punwani S, Allen C, Emberton M, Kirkham A, Moore CM. Prostate cancer measurements on serial MRI during active surveillance: it's time to be PRECISE. Br J Radiol 2020; 93:20200819. [PMID: 32955923 DOI: 10.1259/bjr.20200819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The PRECISE criteria for reporting multiparametric MRI in patients on active surveillance (AS) for prostate cancer (PCa) score the likelihood of clinically significant change over time using a 1-5 scale, where 4 or 5 indicates radiological progression. According to the PRECISE recommendations, the index lesion size can be reported using different definitions of volume (planimetry or ellipsoid formula) or by measuring one or two diameters. We compared different measurements using planimetry as the reference standard and stratified changes according to the PRECISE scores. METHODS We retrospectively analysed 196 patients on AS with PCa confirmed by targeted biopsy who had two MR scans (baseline and follow-up). Lesions were measured on T2 weighted imaging (T2WI) according to all definitions. A PRECISE score was assessed for each patient. RESULTS The ellipsoid formula exhibited the highest correlation with planimetry at baseline (ρ = 0.97) and follow-up (ρ = 0.98) imaging, compared to the biaxial measurement and single maximum diameter. There was a significant difference (p < 0.001) in the yearly percentage volume change between radiological regression/stability (PRECISE 2-3) and progression (PRECISE 4-5) for planimetry (39.64%) and for the ellipsoid formula (46.78%). CONCLUSION The ellipsoid formula could be used to monitor tumour growth during AS. Evidence of a significant yearly percentage volume change between radiological regression/stability (PRECISE 2-3) and progression (PRECISE 4-5) has been also observed. ADVANCES IN KNOWLEDGE The ellipsoid formula is a reasonable surrogate for planimetry in capturing tumour volume changes on T2WI in patients on imaging-led AS. This is also associated with radiological changes using the PRECISE recommendations.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Elizabeth Osinibi
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Cimadamore A, Cheng L, Lopez-Beltran A, Mazzucchelli R, Lucianò R, Scarpelli M, Montorsi F, Montironi R. Added Clinical Value of Whole-mount Histopathology of Radical Prostatectomy Specimens: A Collaborative Review. Eur Urol Oncol 2020; 4:558-569. [PMID: 32883645 DOI: 10.1016/j.euo.2020.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Whole-mount histopathology, that is, large format histology or whole-mount sectioning, refers to the histopathological examination of tissue sections from specimens processed with large tissue cassette. In some institutions, it is applied routinely to specimens with genitourinary cancers. OBJECTIVE To give an overview of the application of the large format histology to the morphological examination of the radical prostatectomy (RP) specimens. EVIDENCE ACQUISITION A comprehensive PubMed search was performed up to May 2020, using the keywords "prostate carcinoma," "radical prostatectomy specimens," "whole-mount histopathology," "whole mount sectioning," "large format histology," "macrosectioning," "diagnostic criteria," and "prognosis." The search, supplemented with a hand search, was restricted to articles published in the English language. No limitations were placed on the publication year. References in relevant articles were also reviewed. EVIDENCE SYNTHESIS Even though the whole-mount sections of RPs appear not to be superior to regular sections in detecting adverse pathological features, their use has the advantage of displaying the architecture of the prostate gland and identifying and locating tumor nodule(s) more clearly, with particular reference to the index tumor. Further, it is easier to compare the pathological features with clinical findings derived, for instance, from digital rectal examination, transrectal ultrasound, multiparametric magnetic resonance imaging, surgical operation, and prostate biopsies. CONCLUSIONS Urologists, radiologists, and oncologists are updated about the step forward made by pathologists when diagnostic and prognostic information is derived from an approach that closely resembles that used by the clinicians when dealing with imaging findings. PATIENT SUMMARY Adoption of the whole-mount histopathology adds clinical value in correlation with clinical/imaging findings of radical prostatectomy specimens.
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Affiliation(s)
- Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Pathology and Surgery, Faculty of Medicine, University of Cordoba, Cordoba, Spain
| | - Roberta Mazzucchelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Roberta Lucianò
- Pathological Anatomy Service, Ospedale San Raffaele, Milan, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
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Cosma I, Tennstedt-Schenk C, Winzler S, Psychogios MN, Pfeil A, Teichgraeber U, Malich A, Papageorgiou I. The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study. PLoS One 2019; 14:e0227031. [PMID: 31869380 PMCID: PMC6927639 DOI: 10.1371/journal.pone.0227031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/10/2019] [Indexed: 01/01/2023] Open
Abstract
Objective Prostate lesions detected with multiparametric magnetic resonance imaging (mpMRI) are classified for their malignant potential according to the Prostate Imaging-Reporting And Data System (PI-RADS™2). In this study, we evaluate the diagnostic accuracy of the mpMRI with and without gadolinium, with emphasis on the added diagnostic value of the dynamic contrast enhancement (DCE). Materials and methods The study was retrospective for 286 prostate lesions / 213 eligible patients, n = 116/170, and 49/59% malignant for the peripheral (Pz) and transitional zone (Tz), respectively. A stereotactic MRI-guided prostate biopsy served as the histological ground truth. All patients received a mpMRI with DCE. The influence of DCE in the prediction of malignancy was analyzed by blinded assessment of the imaging protocol without DCE and the DCE separately. Results Significant (CSPca) and insignificant (IPca) prostate cancers were evaluated separately to enhance the potential effects of the DCE in the detection of CSPca. The Receiver Operating Characteristics Area Under Curve (ROC-AUC), sensitivity (Se) and specificity (Spe) of PIRADS-without-DCE in the Pz was 0.70/0.47/0.86 for all cancers (IPca and CSPca merged) and 0.73/0.54/0.82 for CSPca. PIRADS-with-DCE for the same patients showed ROC-AUC/Se/Spe of 0.70/0.49/0.86 for all Pz cancers and 0.69/0.54/0.81 for CSPca in the Pz, respectively, p>0.05 chi-squared test. Similar results for the Tz, AUC/Se/Spe for PIRADS-without-DCE was 0.75/0.61/0.79 all cancers and 0.67/0.54/0.71 for CSPca, not influenced by DCE (0.66/0.47/0.81 for all Tz cancers and 0.61/0.39/0.75 for CSPca in Tz). The added Se and Spe of DCE for the detection of CSPca was 88/34% and 78/33% in the Pz and Tz, respectively. Conclusion DCE showed no significant added diagnostic value and lower specificity for the prediction of CSPca compared to the non-enhanced sequences. Our results support that gadolinium might be omitted without mitigating the diagnostic accuracy of the mpMRI for prostate cancer.
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Affiliation(s)
- Ilinca Cosma
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
- Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
| | | | - Sven Winzler
- Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
| | - Marios Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Alexander Pfeil
- Department of Internal Medicine, University Hospital Jena, Jena, Germany
| | - Ulf Teichgraeber
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Ansgar Malich
- Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
| | - Ismini Papageorgiou
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
- Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
- * E-mail:
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Prognostic Value of Pretreatment MRI in Patients With Prostate Cancer Treated With Radiation Therapy: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2019; 214:597-604. [PMID: 31799874 DOI: 10.2214/ajr.19.21836] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE. Despite a substantial increase in the use of MRI for pretreatment evaluation of prostate cancer, its prognostic value in patients undergoing radiation therapy (RT) is not well known. Therefore, the purpose of this study was to systematically review the literature and perform a meta-analysis on the prognostic value of pretreatment MRI in patients with prostate cancer who underwent external beam radiation therapy (EBRT) or brachytherapy. MATERIALS AND METHODS. PubMed and Embase databases were searched for studies published on or before March 13, 2019. We included studies that evaluated pretreatment MRI as a prognostic factor in prostate cancer regarding biochemical recurrence (BCR), metastatic failure, and overall or cancer-specific mortality. Effect sizes were measured in terms of the hazard ratio (HR) and were meta-analytically pooled using the random-effects model. The quality of the studies was independently evaluated using the Quality in Prognostic Studies tool. RESULTS. Twelve studies (2205 patients) were included. All studies assessed BCR; metastasis was evaluated in three studies, and mortality was evaluated in one study. Extraprostatic extension (EPE), seminal vesicle invasion (SVI), large tumor size or volume, number of sextants involved, and tumor involvement of prostatic apex were significant prognostic factors of BCR (pooled HRs = 1.50-4.47). EPE, larger tumor size, greater tumor volume, presence of metastatic pelvic lymph nodes (LNs), and presence of SVI were significant risk factors for metastasis (pooled HRs = 1.12-11.96). Pelvic LN metastasis was significantly predictive of cancer-specific mortality (HR = 4.45 [95% CI, 1.30-15.23]). CONCLUSION. Several pretreatment MRI findings were significant prognostic factors in patients with prostate cancer who underwent RT.
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Prostate Cancer Index Lesion Detection and Volume Estimation: Is Dynamic Contrast-Enhanced MRI Really Reliable? AJR Am J Roentgenol 2019; 213:W289. [DOI: 10.2214/ajr.19.21764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Reply to “Prostate Cancer Index Lesion Detection and Volume Estimation: Is Dynamic Contrast-Enhanced MRI Really Reliable?”. AJR Am J Roentgenol 2019; 213:W290. [DOI: 10.2214/ajr.19.21950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Can Extraprostatic Extension Be Predicted by Tumor-Capsule Contact Length in Prostate Cancer? Relationship With International Society of Urological Pathology Grade Groups. AJR Am J Roentgenol 2019; 214:588-596. [PMID: 31670596 DOI: 10.2214/ajr.19.21828] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE. The objective of our study was to evaluate the relationship between the tumor-capsule contact length, defined as tumor contact length (TCL), and extraprostatic extension (EPE) using the MRI-based TCL measurements and the real TCL measurements from pathology and to determine whether the International Society of Urological Pathology (ISUP) grade group of the tumors influenced this relationship. MATERIALS AND METHODS. In this retrospective study, we reviewed prostate multiparametric MRI (mpMRI) studies performed between 2012 and 2018 of 1576 patients and found that 134 patients also underwent radical prostatectomy (RP) after mpMRI. Finally, 86 patients with index lesions in contact with the prostate capsule in RP specimens were enrolled in the study. ROC analysis was used to evaluate the cutoff values of TCLs measured at pathology and TCLs measured on MRI in terms of EPE according to ISUP grade groups. RESULTS. There was no statistically significant cutoff value for pathology-based TCL measurements in individual ISUP grade groups and subgroups. Although not statistically significant, pathology-based TCL cutoff values decreased (from 21.0 to 11.0 mm) as ISUP grade group increased in terms of EPE positivity. When the relationship between MRI-based TCL measurements and EPE was considered, statistically significant cutoff values (range, 14.5-16.6 mm) could be determined in many groups and subgroups with low ISUP grades (sensitivity, 66.7-100%; specificity, 52.8-93.0%; p = 0.006-0.042). However, no statistically significant cutoff value was found for high ISUP grades. CONCLUSION. ISUP grade groups may have an effect on the TCL-EPE relationship. When the MRI-based TCL and EPE relationship is evaluated independent of ISUP grade group, a cutoff value around 15-16 mm may be usable to predict EPE.
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Richenberg J, Løgager V, Panebianco V, Rouviere O, Villeirs G, Schoots IG. The primacy of multiparametric MRI in men with suspected prostate cancer. Eur Radiol 2019; 29:6940-6952. [PMID: 31172275 PMCID: PMC6828624 DOI: 10.1007/s00330-019-06166-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/07/2019] [Accepted: 03/14/2019] [Indexed: 12/14/2022]
Abstract
Background Multiparametric MRI (mpMRI) became recognised in investigating those with suspected prostate cancer between 2010 and 2012; in the USA, the preventative task force moratorium on PSA screening was a strong catalyst. In a few short years, it has been adopted into daily urological and oncological practice. The pace of clinical uptake, born along by countless papers proclaiming high accuracy in detecting clinically significant prostate cancer, has sparked much debate about the timing of mpMRI within the traditional biopsy-driven clinical pathways. There are strongly held opposing views on using mpMRI as a triage test regarding the need for biopsy and/or guiding the biopsy pattern. Objective To review the evidence base and present a position paper on the role of mpMRI in the diagnosis and management of prostate cancer. Methods A subgroup of experts from the ESUR Prostate MRI Working Group conducted literature review and face to face and electronic exchanges to draw up a position statement. Results This paper considers diagnostic strategies for clinically significant prostate cancer; current national and international guidance; the impact of pre-biopsy mpMRI in detection of clinically significant and clinically insignificant neoplasms; the impact of pre-biopsy mpMRI on biopsy strategies and targeting; the notion of mpMRI within a wider risk evaluation on a patient by patient basis; the problems that beset mpMRI including inter-observer variability. Conclusions The paper concludes with a set of suggestions for using mpMRI to influence who to biopsy and who not to biopsy at diagnosis. Key Points • Adopt mpMRI as the first, and primary, investigation in the workup of men with suspected prostate cancer. • PI-RADS assessment categories 1 and 2 have a high negative predictive value in excluding significant disease, and systematic biopsy may be postponed, especially in men with low-risk of disease following additional risk stratification. • PI-RADS assessment category lesions 4 and 5 should be targeted; PI-RADS assessment category lesion 3 may be biopsied as a target, as part of systematic biopsies or may be observed depending on risk stratification. Electronic supplementary material The online version of this article (10.1007/s00330-019-06166-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan Richenberg
- Department of Imaging, Brighton & Sussex University Hospitals NHS Trust and Brighton and Sussex Medical School, Brighton, BN2 5BE, UK.
| | - Vibeke Løgager
- Department of Radiology, Herlev University Hospital Copenhagen University, Herlev, Denmark
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza, University of Rome, Rome, Italy
| | - Olivier Rouviere
- Hospices civils de Lyon, Department of Urinary and Vascular Radiology, hôpital Édouard-Herriot, 69437, Lyon, France.,Faculté de médecine Lyon Est, Université Lyon 1, 69003, Lyon, France
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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