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Oerther B, Nedelcu A, Engel H, Schmucker C, Schwarzer G, Brugger T, Schoots IG, Eisenblaetter M, Sigle A, Gratzke C, Bamberg F, Benndorf M. Update on PI-RADS Version 2.1 Diagnostic Performance Benchmarks for Prostate MRI: Systematic Review and Meta-Analysis. Radiology 2024; 312:e233337. [PMID: 39136561 DOI: 10.1148/radiol.233337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Background Prostate MRI for the detection of clinically significant prostate cancer (csPCa) is standardized by the Prostate Imaging Reporting and Data System (PI-RADS), currently in version 2.1. A systematic review and meta-analysis infrastructure with a 12-month update cycle was established to evaluate the diagnostic performance of PI-RADS over time. Purpose To provide estimates of diagnostic accuracy and cancer detection rates (CDRs) of PI-RADS version 2.1 categories for prostate MRI, which is required for further evidence-based patient management. Materials and Methods A systematic search of PubMed, Embase, Cochrane Library, and multiple trial registers (English-language studies published from March 1, 2019, to August 30, 2022) was performed. Studies that reported data on diagnostic accuracy or CDRs of PI-RADS version 2.1 with csPCa as the primary outcome were included. For the meta-analysis, pooled estimates for sensitivity, specificity, and CDRs were derived from extracted data at the lesion level and patient level. Sensitivity and specificity for PI-RADS greater than or equal to 3 and PI-RADS greater than or equal to 4 considered as test positive were investigated. In addition to individual PI-RADS categories 1-5, subgroup analyses of subcategories (ie, 2+1, 3+0) were performed. Results A total of 70 studies (11 686 lesions, 13 330 patients) were included. At the patient level, with PI-RADS greater than or equal to 3 considered positive, meta-analysis found a 96% summary sensitivity (95% CI: 95, 98) and 43% specificity (95% CI: 33, 54), with an area under the summary receiver operating characteristic (SROC) curve of 0.86 (95% CI: 0.75, 0.93). For PI-RADS greater than or equal to 4, meta-analysis found an 89% sensitivity (95% CI: 85, 92) and 66% specificity (95% CI: 58, 74), with an area under the SROC curve of 0.89 (95% CI: 0.85, 0.92). CDRs were as follows: PI-RADS 1, 6%; PI-RADS 2, 5%; PI-RADS 3, 19%; PI-RADS 4, 54%; and PI-RADS 5, 84%. The CDR was 12% (95% CI: 7, 19) for transition zone 2+1 lesions and 19% (95% CI: 12, 29) for 3+0 lesions (P = .12). Conclusion Estimates of diagnostic accuracy and CDRs for PI-RADS version 2.1 categories are provided for quality benchmarking and to guide further evidence-based patient management. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Tammisetti and Jacobs in this issue.
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Affiliation(s)
- Benedict Oerther
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Andrea Nedelcu
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Hannes Engel
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Christine Schmucker
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Guido Schwarzer
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Timo Brugger
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Ivo G Schoots
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Michel Eisenblaetter
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - August Sigle
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Christian Gratzke
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Fabian Bamberg
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Matthias Benndorf
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
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Tomioka M, Nakane K, Kawase M, Iinuma K, Kato D, Kawase K, Taniguchi T, Tobisawa Y, Sugino F, Kaga T, Kato H, Matsuo M, Kito Y, Saigo C, Suzui N, Ito T, Miyazaki T, Takeuchi T, Koie T. Discrepancy in the Location of Prostate Cancer Indicated on Biparametric Magnetic Resonance Imaging and Pathologically Diagnosed Using Surgical Specimens. Curr Oncol 2024; 31:2846-2855. [PMID: 38785497 PMCID: PMC11119495 DOI: 10.3390/curroncol31050216] [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: 04/19/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Accurate diagnosis of the localization of prostate cancer (PCa) on magnetic resonance imaging (MRI) remains a challenge. We aimed to assess discrepancy between the location of PCa pathologically diagnosed using surgical specimens and lesions indicated as possible PCa by the Prostate Imaging Reporting and Data System on MRI. The primary endpoint was the concordance rate between the site of probable clinically significant PCa (csPCa) identified using biparametric MRI (bpMRI) and location of PCa in the surgical specimen obtained using robot-assisted total prostatectomy. Among 85 lesions identified in 30 patients; 42 (49.4%) were identified as possible PCa on MRI. The 85 PCa lesions were divided into positive and negative groups based on the bpMRI results. None of the patients had missed csPCa. Although the diagnostic accuracy of bpMRI was relatively high for PCas located in the middle of the prostate (p = 0.029), it was relatively low for PCa located at the base of the prostate, all of which were csPCas. Although current modalities can accurately diagnose PCa, the possibility that PCa is present with multiple lesions in the prostate should be considered, even if MRI does not detect PCa.
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Affiliation(s)
- Masayuki Tomioka
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Tomoki Taniguchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Yuki Tobisawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
| | - Fumiya Sugino
- Department of Urology, Gifu Municipal Hospital, Gifu 5008513, Japan;
| | - Tetsuro Kaga
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Hiroki Kato
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (T.K.); (H.K.); (M.M.)
| | - Yusuke Kito
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Chiemi Saigo
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu 5011194, Japan; (N.S.); (T.M.)
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Gifu University Graduate School of Medicine, Gifu 5011194, Japan;
| | - Tatsuhiko Miyazaki
- Department of Pathology, Gifu University Hospital, Gifu 5011194, Japan; (N.S.); (T.M.)
| | - Tamotsu Takeuchi
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (Y.K.); (C.S.); (T.T.)
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (K.N.); (M.K.); (K.I.); (D.K.); (K.K.); (T.T.); (Y.T.)
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3
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Quentin M, Boschheidgen M, Radtke JP, Spohn F, Ullrich T, Drewes L, Valentin B, Lakes J, Al-Monajjed, Arsov C, Esposito I, Albers P, Antoch G, Schimmöller L. MRI in-bore biopsy following MRI/US fusion-guided biopsy in patients with persistent suspicion of clinically significant prostate cancer. Eur J Radiol 2024; 175:111436. [PMID: 38522396 DOI: 10.1016/j.ejrad.2024.111436] [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: 12/17/2023] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Patients with suspicion of clinically significant prostate cancer (csPC) on multiparametric prostate MRI (mpMRI) but negative or inconclusive MRI/US fusion-guided biopsy (FB) can be challenging in clinical practice. To assess the utility of MRI in-bore biopsy (IB) in patients with discordant imaging and histopathological findings after FB. METHODS Consecutive patients with Prostate Imaging Reporting and Data System (PI-RADS) category 4 or 5 on mpMRI at 3T after FB without histologically confirmed csPC who underwent IB between 01/2014 and 05/2022, were retrospectively included. The primary objective was to assess the detection rate of csPC. Secondary objectives were to analyze clinical parameters, MRI parameters, and lesion localization. RESULTS In the final cohort of 51 patients, the IB resulted in an overall detection rate of 71% for PC and 47% for csPC. Furthermore, in 55% of cases with initial low-grade PC, the Gleason score was upgraded after IB. CsPC was often detected apical and/or anterior. The detection rate for PC was 58% in PI-RADS category 4 and 94% in PI-RADS category 5 (csPC 39% and 61%, respectively). Patients with csPC had statistically significant smaller prostate volumes, a higher PI-RADS category, a higher prostate-specific antigen density (PSAD), and were older. CONCLUSIONS For a relevant proportion of patients with PI-RADS category 4 or 5 and negative or inconclusive findings on previous FB, but with persistent suspicion of csPC, a subsequent IB verified the presence of csPC. Therefore, IB can be a backup in cases of uncertainty.
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Affiliation(s)
- M Quentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - M Boschheidgen
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - J P Radtke
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - F Spohn
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - T Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Drewes
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - B Valentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - J Lakes
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - Al-Monajjed
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - C Arsov
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Elisabeth-Krankenhaus Rheydt, Departement of Urology and Paediatric Urology, Staedtische Kliniken Moenchengladbach GmbH, Moenchengladbach, Germany.
| | - I Esposito
- University Dusseldorf, Medical Faculty, Institute of Pathology, D-40225 Dusseldorf, Germany.
| | - P Albers
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
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4
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Afshari Mirak S, Raman SS. MRI-guided interventional procedures: current use and future potentials. Eur Radiol 2023; 33:5717-5718. [PMID: 37382620 DOI: 10.1007/s00330-023-09853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Sohrab Afshari Mirak
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA.
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Rosenzweig B, Drori T, Raz O, Goldinger G, Shlomai G, Zilberman DE, Shechtman M, Ramon J, Dotan ZA, Portnoy O. The urologist's learning curve of "in-bore" magnetic resonance-guided prostate biopsy. BMC Urol 2021; 21:169. [PMID: 34872545 PMCID: PMC8650564 DOI: 10.1186/s12894-021-00936-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background The combination of multi-parametric MRI to locate and define suspected lesions together with their being targeted by an MRI-guided prostate biopsy has succeeded in increasing the detection rate of clinically significant disease and lowering the detection rate of non-significant prostate cancer. In this work we investigate the urologist’s learning curve of in-bore MRI-guided prostate biopsy which is considered to be a superior biopsy technique. Materials and methods Following Helsinki approval by The Chaim Sheba Medical Center ethics committee in accordance with The Sheba Medical Center institutional guidelines (5366-28-SMC) we retrospectively reviewed 110 IB-MRGpBs performed from 6/2016 to 1/2019 in a single tertiary center. All patients had a prostate multi-parametric MRI finding of at least 1 target lesion (prostate imaging reporting and data system [PI-RADS] score ≥ 3). We analyzed biopsy duration and clinically significant prostate cancer detection of targeted sampling in 2 groups of 55 patients each, once by a urologist highly trained in IB-MRGpBs and again by a urologist untrained in IB-MRGpBs. These two parameters were compared according to operating urologist and chronologic order. Results The patients’ median age was 68 years (interquartile range 62–72). The mean prostate-specific antigen level and prostate size were 8.6 ± 9.1 ng/d and 53 ± 27 cc, respectively. The mean number of target lesions was 1.47 ± 0.6. Baseline parameters did not differ significantly between the 2 urologists’ cohorts. Overall detection rates of clinically significant prostate cancer were 19%, 55%, and 69% for PI-RADS 3, 4 and 5, respectively. Clinically significant cancer detection rates did not differ significantly along the timeline or between the 2 urologists. The average duration of IB-MRGpB targeted sampling was 28 ± 15.8 min, correlating with the number of target lesions (p < 0.0001), and independent of the urologist’s expertise. Eighteen cases defined the cutoff for the procedure duration learning curve (p < 0.05). Conclusions Our data suggest a very short learning curve for IB-MRGpB-targeted sampling duration, and that clinically significant cancer detection rates are not influenced by the learning curve of this technique.
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Affiliation(s)
- Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel. .,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,The Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Tomer Drori
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Raz
- Assuta Ashdod University Hospital, Ashdod, Israel
| | - Gil Goldinger
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gadi Shlomai
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Department of Internal Medicine D and the Hypertension Unit, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shechtman
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Anesthesiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Ramon
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orith Portnoy
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
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Dentry M, McBean R, Garrett A, Brown N. A novel technique for a rare diagnosis: MRI-guided vaginal biopsy of Skene gland adenocarcinoma: Pictorial Essay. J Med Imaging Radiat Oncol 2021; 65:724-727. [PMID: 34240821 DOI: 10.1111/1754-9485.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022]
Abstract
FDG-PET and MRI imaging of the pelvis identified a suspicious lesion in a patient with a history of small cell neuroendocrine tumour of the vagina, and after a negative surgical biopsy, a multidisciplinary team meeting decided to proceed with MRGB (magnetic resonance-guided biopsy). The patient remains well and in remission two years after anterior exenteration, with final histology of the lesion determined to be Skene gland adenocarcinoma. MRGB is a novel and effective way to diagnose vaginal lesions.
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Affiliation(s)
- Matt Dentry
- I-Med Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Rhiannon McBean
- I-Med Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Andrea Garrett
- I-Med Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Nicholas Brown
- I-Med Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
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7
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Diagnostic Yield of Incremental Biopsy Cores and Second Lesion Sampling for In-Gantry MRI-Guided Prostate Biopsy. AJR Am J Roentgenol 2021; 217:908-918. [PMID: 33336582 DOI: 10.2214/ajr.20.24918] [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] [Indexed: 01/22/2023]
Abstract
BACKGROUND. In-gantry MRI-guided biopsy (MRGB) of the prostate has been shown to be more accurate than other targeted prostate biopsy methods. However, the optimal number of cores to obtain during in-gantry MRGB remains undetermined. OBJECTIVE. The purpose of this study was to assess the diagnostic yield of obtaining an incremental number of cores from the primary lesion and of second lesion sampling during in-gantry MRGB of the prostate. METHODS. This retrospective study included 128 men with 163 prostate lesions who underwent in-gantry MRGB between 2016 and 2019. The men had a total of 163 lesions sampled with two or more cores, 121 lesions sampled with three or more cores, and 52 lesions sampled with four or more cores. A total of 40 men underwent sampling of a second lesion. Upgrade on a given core was defined as a greater International Society of Urological Pathology (ISUP) grade group (GG) relative to the previously obtained cores. Clinically significant prostate cancer (csPCa) was defined as ISUP GG 2 or greater. RESULTS. The frequency of any upgrade was 12.9% (21/163) on core 2 versus 10.7% (13/121) on core 3 (p = .29 relative to core 2) and 1.9% (1/52) on core 4 (p = .03 relative to core 3). The frequency of upgrade to csPCa was 7.4% (12/163) on core 2 versus 4.1% (5/121) on core 3 (p = .13 relative to core 2) and 0% (0/52) on core 4 (p = .07 relative to core 3). The frequency of upgrade on core 2 was higher for anterior lesions (p < .001) and lesions with a higher PI-RADS score (p = .007); the frequency of upgrade on core 3 was higher for apical lesions (p = .01) and lesions with a higher PI-RADS score (p = .01). Sampling of a second lesion resulted in an upgrade in a single patient (2.5%; 1/40); both lesions were PI-RADS category 4 and showed csPCa. CONCLUSION. When performing in-gantry MRGB of the prostate, obtaining three cores from the primary lesion is warranted to optimize csPCa diagnosis. Obtaining a fourth core from the primary lesion or sampling a second lesion has very low yield in upgrading cancer diagnoses. CLINICAL IMPACT. To reduce patient discomfort and procedure times, operators may refrain from obtaining more than three cores or second lesion sampling.
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Oerther B, Engel H, Bamberg F, Sigle A, Gratzke C, Benndorf M. Cancer detection rates of the PI-RADSv2.1 assessment categories: systematic review and meta-analysis on lesion level and patient level. Prostate Cancer Prostatic Dis 2021; 25:256-263. [PMID: 34230616 PMCID: PMC9184264 DOI: 10.1038/s41391-021-00417-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/05/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Prostate Imaging Reporting and Data System, version 2.1 (PI-RADSv2.1) standardizes reporting of multiparametric MRI of the prostate. Assigned assessment categories are a risk stratification algorithm, higher categories indicate a higher probability of clinically significant cancer compared to lower categories. PI-RADSv2.1 does not define these probabilities numerically. We conduct a systematic review and meta-analysis to determine the cancer detection rates (CDR) of the PI-RADSv2.1 assessment categories on lesion level and patient level. METHODS Two independent reviewers screen a systematic PubMed and Cochrane CENTRAL search for relevant articles (primary outcome: clinically significant cancer, index test: prostate MRI reading according to PI-RADSv2.1, reference standard: histopathology). We perform meta-analyses of proportions with random-effects models for the CDR of the PI-RADSv2.1 assessment categories for clinically significant cancer. We perform subgroup analysis according to lesion localization to test for differences of CDR between peripheral zone lesions and transition zone lesions. RESULTS A total of 17 articles meet the inclusion criteria and data is independently extracted by two reviewers. Lesion level analysis includes 1946 lesions, patient level analysis includes 1268 patients. On lesion level analysis, CDR are 2% (95% confidence interval: 0-8%) for PI-RADS 1, 4% (1-9%) for PI-RADS 2, 20% (13-27%) for PI-RADS 3, 52% (43-61%) for PI-RADS 4, 89% (76-97%) for PI-RADS 5. On patient level analysis, CDR are 6% (0-20%) for PI-RADS 1, 9% (5-13%) for PI-RADS 2, 16% (7-27%) for PI-RADS 3, 59% (39-78%) for PI-RADS 4, 85% (73-94%) for PI-RADS 5. Higher categories are significantly associated with higher CDR (P < 0.001, univariate meta-regression), no systematic difference of CDR between peripheral zone lesions and transition zone lesions is identified in subgroup analysis. CONCLUSIONS Our estimates of CDR demonstrate that PI-RADSv2.1 stratifies lesions and patients as intended. Our results might serve as an initial evidence base to discuss management strategies linked to assessment categories.
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Affiliation(s)
- Benedict Oerther
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany
| | - Hannes Engel
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany
| | - August Sigle
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany
| | - Matthias Benndorf
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany.
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Vural M, Coskun B, Kilic M, Durmaz S, Gumus T, Cengiz D, Onay A, Saglican Y, Colakoglu B, Akpek S, Yildirim H, Esen T, Rozanes I. In-bore MRI-guided prostate biopsy in a patient group with PI-RADS 4 and 5 targets: A single center experience. Eur J Radiol 2021; 141:109785. [PMID: 34091134 DOI: 10.1016/j.ejrad.2021.109785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the diagnostic yield of magnetic resonance imaging (MRI) guided in-bore biopsy in patients with high likelihood multiparametric MRI (mpMRI) findings, regarding overall and clinically significant prostate cancer (csPCa) detection rates and concordance of biopsy and radical prostatectomy (RP) Gleason scores (GS). METHODS This retrospective study consisted of 277 Prostate Imaging Reporting and Data System (PI-RADS) assessment category 4 and 5 targets in 246 patients (mean age, 65.7 years; median prostate specific antigen value, 7.75 ng/mL) who had undergone in-bore biopsy at our institution between 2012 and 2020. Eighty-one patients who underwent RP were eligible for the concordance analysis of biopsy and RP specimen GS. RESULTS Overall PCa detection rates were 80.5 % per patient (198/246) and 78 % per target (216/277) and 83.5 % and 67.4 % in primary (biopsy naive) and secondary (at least one negative prior biopsy) settings. csPCa was found in 63 % overall, 66 % of patients (132/200) in the primary, and 50 % of patients (23/46) in the secondary biopsy settings (p < 0.001). The prostate cancer detection rate was 68 % and 92 % in PI-RADS 4 and 5, respectively (p < 0.001). In the radical prostatectomy subcohort, 27.2 % of patients were upgraded, 8.6 % of patients were downgraded from needle biopsy. Significant complications occurred in 1.2 % of patients. CONCLUSIONS MRI-guided in-bore prostate biopsy has a high detection rate of csPCa in primary and secondary biopsy cohorts. Biopsy results were satisfactory in terms of the number of positive cores, cancer percentage in positive cores, and concordance of GS in needle biopsy and RP specimen.
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Affiliation(s)
- Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Bilgen Coskun
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Mert Kilic
- Department of Urology, VKF American Hospital, Istanbul, Turkey.
| | - Selahattin Durmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Terman Gumus
- Department of Radiology, University of Koc School of Medicine, Istanbul, Turkey.
| | - Duygu Cengiz
- Department of Radiology, University of Koc School of Medicine, Istanbul, Turkey.
| | - Aslihan Onay
- Department of Radiology, TOBB University of Economics and Technology, Faculty of Medicine, Ankara, Turkey.
| | - Yesim Saglican
- Department of Pathology, Acibadem Maslak Hospital, Istanbul, Turkey.
| | - Bulent Colakoglu
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Sergin Akpek
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Hakan Yildirim
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Tarik Esen
- Department of Urology, VKF American Hospital, Istanbul, Turkey.
| | - Izzet Rozanes
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
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Behzad S, Aghaghazvini L, Radmard AR, Gholamrezanezhad A. Extrapulmonary manifestations of COVID-19: Radiologic and clinical overview. Clin Imaging 2020; 66:35-41. [PMID: 32425338 PMCID: PMC7233216 DOI: 10.1016/j.clinimag.2020.05.013] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 is principally a respiratory illness and pulmonary manifestations constitute main presentations of the disease. According to the reported studies, SARS-CoV-2 infection is not limited to the respiratory system and other organs can be also affected. Renal dysfunction, gastrointestinal complications, liver dysfunction, cardiac manifestations, mediastinal findings, neurological abnormalities, and hematological manifestations are among the reported extrapulmonary features. Considering the broad spectrum of clinical manifestations and the increasing worldwide burden of the disease, there is an urgent need to rapidly scale up the diagnostic capacity to detect COVID-19 and its complications. This paper focuses on the most common extrapulmonary manifestations in patients with COVID-19 pneumonia. Further studies are needed to elaborate and confirm the causative relationship between SARS-CoV-2 and the reported extrapulmonary manifestations of COVID-19.
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Affiliation(s)
- Shima Behzad
- School of Medicine, Azad University, Tehran, Iran
| | - Leila Aghaghazvini
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
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11
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Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol 2020; 5:831-840. [PMID: 32219363 DOI: 10.1001/jamacardio.2020.1286] [Citation(s) in RCA: 1190] [Impact Index Per Article: 297.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system. Observations Coronavirus disease 2019 can cause a viral pneumonia with additional extrapulmonary manifestations and complications. A large proportion of patients have underlying cardiovascular disease and/or cardiac risk factors. Factors associated with mortality include male sex, advanced age, and presence of comorbidities including hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases. Acute cardiac injury determined by elevated high-sensitivity troponin levels is commonly observed in severe cases and is strongly associated with mortality. Acute respiratory distress syndrome is also strongly associated with mortality. Conclusions and Relevance Coronavirus disease 2019 is associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. Extensive efforts are underway to find specific vaccines and antivirals against SARS-CoV-2. Meanwhile, cardiovascular risk factors and conditions should be judiciously controlled per evidence-based guidelines.
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Affiliation(s)
- Mohammad Madjid
- McGovern Medical School, Department of Medicine, University of Texas Health Science Center at Houston, Houston
| | | | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Nagpal P, Narayanasamy S, Vidholia A, Guo J, Shin KM, Lee CH, Hoffman EA. Imaging of COVID-19 pneumonia: Patterns, pathogenesis, and advances. Br J Radiol 2020; 93:20200538. [PMID: 32758014 PMCID: PMC7465853 DOI: 10.1259/bjr.20200538] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022] Open
Abstract
COVID-19 pneumonia is a newly recognized lung infection. Initially, CT imaging was demonstrated to be one of the most sensitive tests for the detection of infection. Currently, with broader availability of polymerase chain reaction for disease diagnosis, CT is mainly used for the identification of complications and other defined clinical indications in hospitalized patients. Nonetheless, radiologists are interpreting lung imaging in unsuspected patients as well as in suspected patients with imaging obtained to rule out other relevant clinical indications. The knowledge of pathological findings is also crucial for imagers to better interpret various imaging findings. Identification of the imaging findings that are commonly seen with the disease is important to diagnose and suggest confirmatory testing in unsuspected cases. Proper precautionary measures will be important in such unsuspected patients to prevent further spread. In addition to understanding the imaging findings for the diagnosis of the disease, it is important to understand the growing set of tools provided by artificial intelligence. The goal of this review is to highlight common imaging findings using illustrative examples, describe the evolution of disease over time, discuss differences in imaging appearance of adult and pediatric patients and review the available literature on quantitative CT for COVID-19. We briefly address the known pathological findings of the COVID-19 lung disease that may help better understand the imaging appearance, and we provide a demonstration of novel display methodologies and artificial intelligence applications serving to support clinical observations.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - Sabarish Narayanasamy
- Department of Radiology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - Aditi Vidholia
- Department of Pathology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
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Khalaj K, Figueira RL, Antounians L, Lauriti G, Zani A. Systematic review of extracellular vesicle-based treatments for lung injury: are EVs a potential therapy for COVID-19? J Extracell Vesicles 2020; 9:1795365. [PMID: 32944185 PMCID: PMC7481829 DOI: 10.1080/20013078.2020.1795365] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Severe COVID-19 infection results in bilateral interstitial pneumonia, often leading to
acute respiratory distress syndrome (ARDS) and pulmonary fibrosis in survivors. Most
patients with severe COVID-19 infections who died had developed ARDS. Currently, ARDS is
treated with supportive measures, but regenerative medicine approaches including
extracellular vesicle (EV)-based therapies have shown promise. Herein, we aimed to analyse
whether EV-based therapies could be effective in treating severe pulmonary conditions that
affect COVID-19 patients and to understand their relevance for an eventual therapeutic
application to human patients. Using a defined search strategy, we conducted a systematic
review of the literature and found 39 articles (2014–2020) that reported effects of EVs,
mainly derived from stem cells, in lung injury models (one large animal study, none in
human). EV treatment resulted in: (1) attenuation of inflammation (reduction of
pro-inflammatory cytokines and neutrophil infiltration, M2 macrophage polarization); (2)
regeneration of alveolar epithelium (decreased apoptosis and stimulation of surfactant
production); (3) repair of microvascular permeability (increased endothelial cell junction
proteins); (4) prevention of fibrosis (reduced fibrin production). These effects were
mediated by the release of EV cargo and identified factors including miRs-126, −30b-3p,
−145, −27a-3p, syndecan-1, hepatocyte growth factor and angiopoietin-1. This review
indicates that EV-based therapies hold great potential for COVID-19 related lung injuries
as they target multiple pathways and enhance tissue regeneration. However, before
translating EV therapies into human clinical trials, efforts should be directed at
developing good manufacturing practice solutions for EVs and testing optimal dosage and
administration route in large animal models.
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Affiliation(s)
- Kasra Khalaj
- Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rebeca Lopes Figueira
- Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lina Antounians
- Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giuseppe Lauriti
- Department of Pediatric Surgery, Spirito Santo Hospital, Pescara, Italy.,Department of Medicine and Aging Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Augusto Zani
- Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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