1
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Coelho FMA, Baroni RH. Strategies for improving image quality in prostate MRI. Abdom Radiol (NY) 2024:10.1007/s00261-024-04396-4. [PMID: 38940911 DOI: 10.1007/s00261-024-04396-4] [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: 03/31/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024]
Abstract
Prostate magnetic resonance imaging (MRI) stands as the cornerstone in diagnosing prostate cancer (PCa), offering superior detection capabilities while minimizing unnecessary biopsies. Despite its critical role, global disparities in MRI diagnostic performance persist, stemming from variations in image quality and radiologist expertise. This manuscript reviews the challenges and strategies for enhancing image quality in prostate MRI, spanning patient preparation, MRI unit optimization, and radiology team engagement. Quality assurance (QA) and quality control (QC) processes are pivotal, emphasizing standardized protocols, meticulous patient evaluation, MRI unit workflow, and radiology team performance. Additionally, artificial intelligence (AI) advancements offer promising avenues for improving image quality and reducing acquisition times. The Prostate-Imaging Quality (PI-QUAL) scoring system emerges as a valuable tool for assessing MRI image quality. A comprehensive approach addressing technical, procedural, and interpretative aspects is essential to ensure consistent and reliable prostate MRI outcomes.
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Affiliation(s)
| | - Ronaldo Hueb Baroni
- Department of Radiology, Hospital Israelita Albert Einstein, 627 Albert Einstein Ave., Sao Paulo, SP, 05652-900, Brazil.
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2
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Abramson M, DeMasi M, Zhu D, Hines L, Lin W, Kanmaniraja D, Chernyak V, Agalliu I, Watts KL. Biparametric versus multiparametric MRI for the detection of clinically significant prostate cancer in a diverse, multiethnic population. Abdom Radiol (NY) 2024:10.1007/s00261-024-04332-6. [PMID: 38839651 DOI: 10.1007/s00261-024-04332-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE There is not yet satisfactory performance data comparing multiparametric MRI (mpMRI) versus biparametric MRI (bpMRI) for detecting prostate cancer (PCa), particularly in high-risk populations. We compared both protocols for detecting overall PCa and clinically significant PCa (CS-PCa; defined as Grade Group ≥ 2) in a multiethnic urban population. METHODS We retrospectively reviewed electronic medical record data from men who underwent image-guided fusion prostate biopsy (FB) between 2016 and 2021 at our institution. Patient characteristics, Prostate Imaging Reporting and Data System (PI-RADS) scores, and FB outcomes were analyzed based on MRI protocol. Multivariate mixed-effects logistic regression models were used to examine associations of bpMRI versus mpMRI for detecting overall PCa and CS-PCa in targeted lesions, among all patients and stratified by race/ethnicity. RESULTS Overall, 566 men (44.0% Non-Hispanic Black [NHB]; 27.0% Hispanic) with 975 PI-RADS 3-5 lesions on MRI underwent FB. Of these, 312 (55%) men with 497 lesions underwent mpMRI and 254 (45%) men with 478 lesions underwent bpMRI. On multivariate analyses among all men, the odds of detecting overall PCa (OR = 1.18, 95% CI: 1.05-3.11, p = 0.031) and CS-PCa (OR = 2.15, 95% CI: 1.16-4.00, p = 0.014) on FB were higher for lesions identified on bpMRI than mpMRI. When stratified by race/ethnicity, the odds of detecting overall PCa (OR = 1.86; p = 0.15) and CS-PCa (OR = 2.20; p = 0.06) were not statistically different between lesions detected on bpMRI or mpMRI. CONCLUSION BpMRI has similar diagnostic performance to mpMRI in detecting overall and CS-PCa within a racially/ethnically diverse population. BpMRI can be utilized for evaluating suspected CS-PCa among NHB and Hispanic men.
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Affiliation(s)
- Max Abramson
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew DeMasi
- Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Laena Hines
- Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Wilson Lin
- Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Urology, New York University Langone Health, New York, NY, USA
| | | | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Ilir Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA.
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Tower 1; Penthouse, Bronx, NY, 10461, USA.
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Woernle A, Englman C, Dickinson L, Kirkham A, Punwani S, Haider A, Freeman A, Kasivisivanathan V, Emberton M, Hines J, Moore CM, Allen C, Giganti F. Picture Perfect: The Status of Image Quality in Prostate MRI. J Magn Reson Imaging 2024; 59:1930-1952. [PMID: 37804007 DOI: 10.1002/jmri.29025] [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: 07/01/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
Magnetic resonance imaging is the gold standard imaging modality for the diagnosis of prostate cancer (PCa). Image quality is a fundamental prerequisite for the ability to detect clinically significant disease. In this critical review, we separate the issue of image quality into quality improvement and quality assessment. Beginning with the evolution of technical recommendations for scan acquisition, we investigate the role of patient preparation, scanner factors, and more advanced sequences, including those featuring Artificial Intelligence (AI), in determining image quality. As means of quality appraisal, the published literature on scoring systems (including the Prostate Imaging Quality score), is evaluated. Finally, the application of AI and teaching courses as ways to facilitate quality assessment are discussed, encouraging the implementation of future image quality initiatives along the PCa diagnostic and monitoring pathway. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Centre for Medical Imaging, University College London, 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
| | - Veeru Kasivisivanathan
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, 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
| | - John Hines
- Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- North East London Cancer Alliance & North Central London Cancer Alliance Urology, 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
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
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4
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De Vrieze M, Hübner A, Al-Monajjed R, Albers P, Radtke JP, Schimmöller L, Boschheidgen M. [Prostate cancer screening-current overview]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:479-487. [PMID: 38743100 DOI: 10.1007/s00117-024-01312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The harm-to-benefit ratio of prostate cancer (PCa) screening remains controversial mainly due to the unfavorable test characteristics of prostate-specific antigen (PSA) as a screening test. METHODS In this nonsystematic review, we present a current overview of the body of evidence on prostate cancer screening with a focus on the role of magnetic resonance imaging (MRI) of the prostate. RESULTS Evidence generated in large randomized controlled trials showed that PSA-based screening significantly decreases cancer-specific mortality. The main obstacle in developing and implementing PCa screening strategies is the resulting overdiagnosis and as a consequence overtreatment of indolent cancers. Opportunistic screening is characterized by an adverse benefit-to-harm ratio and should, therefore, not be recommended. The German Statutory Early Detection Program for prostate cancer, which consists of a digital rectal examination (DRE) as a stand-alone screening test, is not evidence-based, neither specific nor sensitive enough and results in unnecessary diagnostics. The European Commission recently urged member states to develop population-based and organized risk-adapted PSA-based screening programs, which are currently tested in the ongoing German PROBASE trial. Finetuning of the diagnostic pathway following PSA-testing seems key to improve its positive and negative predictive value and thereby making PCa screening more accurate. Incorporation of prostatic MRI into screening strategies leads to more accurate diagnosis of clinically significant prostate cancer, while diagnosis of indolent cancers is reduced. In the future, molecular liquid-based biomarkers have the potential to complement or even replace PSA in PCa screening and further personalize screening strategies. Active surveillance as an alternative to immediate radical therapy of demographically increasing PCa diagnoses can potentially further improve the benefit-to-harm ratio of organized screening. CONCLUSION Early detection of PCa should be organized on a population level into personalized and evidence-based screening strategies. Multiparametric MRI of the prostate may play a key role in this setting.
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Affiliation(s)
- Maxime De Vrieze
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Deutschland
| | - Anne Hübner
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Rouvier Al-Monajjed
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Deutschland.
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Peter Albers
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Deutschland
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Deutschland
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland
| | - Lars Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, 40225, Düsseldorf, Deutschland
- Department of Urology, University Hospital Düsseldorf, Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Deutschland
| | - Matthias Boschheidgen
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, 40225, Düsseldorf, Deutschland
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Schieda N, Nisha Y, Hadziomerovic AR, Prabhakar S, Flood TA, Breau RH, McGrath TA, Ramsay T, Morash C. Comparison of Positive Predictive Values of Biparametric MRI and Multiparametric MRI-directed Transrectal US-guided Targeted Prostate Biopsy. Radiology 2024; 311:e231383. [PMID: 38860899 DOI: 10.1148/radiol.231383] [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: 06/12/2024]
Abstract
Background Biparametric MRI (bpMRI) of the prostate is an alternative to multiparametric MRI (mpMRI), with lower cost and increased accessibility. Studies investigating the positive predictive value (PPV) of bpMRI-directed compared with mpMRI-directed targeted biopsy are lacking in the literature. Purpose To compare the PPVs of bpMRI-directed and mpMRI-directed targeted prostate biopsies. Materials and Methods This retrospective cross-sectional study evaluated men who underwent bpMRI-directed or mpMRI-directed transrectal US (TRUS)-guided targeted prostate biopsy at a single institution from January 2015 to December 2022. The PPVs for any prostate cancer (PCa) and clinically significant PCa (International Society of Urological Pathology grade ≥2) were calculated for bpMRI and mpMRI using mixed-effects logistic regression modeling. Results A total of 1538 patients (mean age, 67 years ± 8 [SD]) with 1860 lesions underwent bpMRI-directed (55%, 849 of 1538) or mpMRI-directed (45%, 689 of 1538) prostate biopsy. When adjusted for the number of lesions and Prostate Imaging Reporting and Data System (PI-RADS) score, there was no difference in PPVs for any PCa or clinically significant PCa (P = .61 and .97, respectively) with bpMRI-directed (55% [95% CI: 51, 59] and 34% [95% CI: 30, 38], respectively) or mpMRI-directed (56% [95% CI: 52, 61] and 34% [95% CI: 30, 39], respectively) TRUS-guided targeted biopsy. PPVs for any PCa and clinically significant PCa stratified according to clinical indication were as follows: biopsy-naive men, 64% (95% CI: 59, 69) and 43% (95% CI: 39, 48) for bpMRI, 67% (95% CI: 59, 75) and 51% (95% CI: 43, 59) for mpMRI (P = .65 and .26, respectively); and active surveillance, 59% (95% CI: 49, 69) and 30% (95% CI: 22, 39) for bpMRI, 73% (95% CI: 65, 89) and 38% (95% CI: 31, 47) for mpMRI (P = .04 and .23, respectively). Conclusion There was no evidence of a difference in PPV for clinically significant PCa between bpMRI- and mpMRI-directed TRUS-guided targeted biopsy. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Nicola Schieda
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Yashmin Nisha
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Alexa R Hadziomerovic
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Suman Prabhakar
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Trevor A Flood
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Rodney H Breau
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Trevor A McGrath
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Tim Ramsay
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Christopher Morash
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
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Ponsiglione A, Brembilla G, Cuocolo R, Gutierrez P, Moreira AS, Pecoraro M, Zawaideh J, Barentsz J, Giganti F, Padhani AR, Panebianco V, Puech P, Villeirs G. ESR Essentials: using the right scoring system in prostate MRI-practice recommendations by ESUR. Eur Radiol 2024:10.1007/s00330-024-10792-7. [PMID: 38780764 DOI: 10.1007/s00330-024-10792-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
MRI has gained prominence in the diagnostic workup of prostate cancer (PCa) patients, with the Prostate Imaging Reporting and Data System (PI-RADS) being widely used for cancer detection. Beyond PI-RADS, other MRI-based scoring tools have emerged to address broader aspects within the PCa domain. However, the multitude of available MRI-based grading systems has led to inconsistencies in their application within clinical workflows. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) assesses the likelihood of clinically significant radiological changes of PCa during active surveillance, and the Prostate Imaging for Local Recurrence Reporting (PI-RR) scoring system evaluates the risk of local recurrence after whole-gland therapies with curative intent. Underlying any system is the requirement to assess image quality using the Prostate Imaging Quality Scoring System (PI-QUAL). This article offers practicing radiologists a comprehensive overview of currently available scoring systems with clinical evidence supporting their use for managing PCa patients to enhance consistency in interpretation and facilitate effective communication with referring clinicians. KEY POINTS: Assessing image quality is essential for all prostate MRI interpretations and the PI-QUAL score represents the standardized tool for this purpose. Current urological clinical guidelines for prostate cancer diagnosis and localization recommend adhering to the PI-RADS recommendations. The PRECISE and PI-RR scoring systems can be used for assessing radiological changes of prostate cancer during active surveillance and the likelihood of local recurrence after radical treatments respectively.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | | | - Ana Sofia Moreira
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Unidade de Faro, Faro, Portugal
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Jeries Zawaideh
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Jelle Barentsz
- Imaging Department Andros Clinics, Arnhem, The Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Philippe Puech
- Department of radiology, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille Inserm, CHU Lille, Lille, France
| | - Geert Villeirs
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
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7
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Zawaideh JP, Caglic I, Sushentsev N, Priest AN, Warren AY, Carmisciano L, Barrett T. MRI assessment of seminal vesicle involvement by prostate cancer using T2 signal intensity and volume. Abdom Radiol (NY) 2024:10.1007/s00261-024-04349-x. [PMID: 38734785 DOI: 10.1007/s00261-024-04349-x] [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: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Seminal vesicle involvement (SVI) in patients with newly diagnosed prostate cancer is associated with high rates of treatment failure and tumor recurrence; correct identification of SVI allows for effective management decisions and surgical planning. METHODS This single-center retrospective study analyzed MR images of the seminal vesicles from patients undergoing radical prostatectomy with confirmed T3b disease, comparing them to a control group without SVI matched for age and Gleason grade with a final stage of T2 or T3a. Seminal vesicles were segmented by an experienced uroradiologist, "raw" and bladder-normalized T2 signal intensity, as well as SV volume, were obtained. RESULTS Among the 82 patients with SVI, 34 (41.6%) had unilateral invasion, and 48 (58.4%) had bilateral disease. There was no statistically significant difference in the degree of distension between normal and involved seminal vesicles (P = 0.08). Similarly, no statistically significant difference was identified in the raw SV T2 signal intensity (P = 0.09) between the groups. In the 159 patients analyzed, SVI was prospectively suspected in 10 of 82 patients (specificity, 100%; sensitivity, 12.2%). In all these cases, lesions macroscopically invaded the seminal vesicle, and the raw T2 signal intensity was significantly lower than that in the SVI and control groups (P = 0.02 and 0.01). CONCLUSION While signal intensity measurements in T2-weighted images may provide insight into T3b disease, our findings suggest that this data alone is insufficient to reliably predict SVI, indicating the need for further investigation and complementary diagnostic approaches.
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Affiliation(s)
- Jeries P Zawaideh
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - Luca Carmisciano
- Department of Health Sciences (DISSAL), Biostatistics Section, University of Genoa, Genoa, Italy
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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8
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de Oliveira Correia ET, Purysko AS, Paranhos BM, Shoag JE, Padhani AR, Bittencourt LK. Reply to "Is PI-RADS Ready for Biparametric Prostate MRI?". AJR Am J Roentgenol 2024; 222:e2431169. [PMID: 38506542 DOI: 10.2214/ajr.24.31169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
| | | | | | - Jonathan E Shoag
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
- Weill Cornell Medicine, New York, NY
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK
| | - Leonardo K Bittencourt
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
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9
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Loeb S. Engaging in Clinical Research and Practice Approaches that Reduce Environmental Impact. Eur Urol Oncol 2024:S2588-9311(24)00099-3. [PMID: 38688768 DOI: 10.1016/j.euo.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Telemedicine, virtual conferences, and reducing waste in the operating room are ways in which urologists can reduce their environmental impact in daily practice. Patient counseling should also consider advice that simultaneously promotes overall, urological, and planetary health, such as plant-based diets and active transport.
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Affiliation(s)
- Stacy Loeb
- Department of Urology and Population Health, New York University Langone Health and Manhattan Veterans Affairs, New York, NY, USA.
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10
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Caglic I, Sushentsev N, Syer T, Lee KL, Barrett T. Biparametric MRI in prostate cancer during active surveillance: is it safe? Eur Radiol 2024:10.1007/s00330-024-10770-z. [PMID: 38656709 DOI: 10.1007/s00330-024-10770-z] [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: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Active surveillance (AS) is the preferred option for patients presenting with low-intermediate-risk prostate cancer. MRI now plays a crucial role for baseline assessment and ongoing monitoring of AS. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations aid radiological assessment of progression; however, current guidelines do not advise on MRI protocols nor on frequency. Biparametric (bp) imaging without contrast administration offers advantages such as reduced costs and increased throughput, with similar outcomes to multiparametric (mp) MRI shown in the biopsy naïve setting. In AS follow-up, the paradigm shifts from MRI lesion detection to assessment of progression, and patients have the further safety net of continuing clinical surveillance. As such, bpMRI may be appropriate in clinically stable patients on routine AS follow-up pathways; however, there is currently limited published evidence for this approach. It should be noted that mpMRI may be mandated in certain patients and potentially offers additional advantages, including improving image quality, new lesion detection, and staging accuracy. Recently developed AI solutions have enabled higher quality and faster scanning protocols, which may help mitigate against disadvantages of bpMRI. In this article, we explore the current role of MRI in AS and address the need for contrast-enhanced sequences. CLINICAL RELEVANCE STATEMENT: Active surveillance is the preferred plan for patients with lower-risk prostate cancer, and MRI plays a crucial role in patient selection and monitoring; however, current guidelines do not currently recommend how or when to perform MRI in follow-up. KEY POINTS: Noncontrast biparametric MRI has reduced costs and increased throughput and may be appropriate for monitoring stable patients. Multiparametric MRI may be mandated in certain patients, and contrast potentially offers additional advantages. AI solutions enable higher quality, faster scanning protocols, and could mitigate the disadvantages of biparametric imaging.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Nikita Sushentsev
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tom Syer
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Kang-Lung Lee
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tristan Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom.
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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11
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Shimizu R, Morizane S, Yamamoto A, Yamane H, Nishikawa R, Kimura Y, Yamaguchi N, Hikita K, Honda M, Takenaka A. Assessment of the accuracy of biparametric MRI/TRUS fusion-guided biopsy for index tumor evaluation using postoperative pathology specimens. BMC Urol 2024; 24:79. [PMID: 38575912 PMCID: PMC10996083 DOI: 10.1186/s12894-024-01473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Multiparametric MRI (mpMRI) is widely used for the diagnosis, surveillance, and staging of prostate cancer. However, it has several limitations, including higher costs, longer examination times, and the use of gadolinium-based contrast agents. This study aimed to investigate the accuracy of preoperatively assessed index tumors (ITs) using biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion biopsy compared with radical prostatectomy (RP) specimens. METHODS We included 113 patients diagnosed with prostate cancer through bpMRI/TRUS fusion-guided biopsies of lesions with a Prostate Imaging Reporting and Data System (PI-RADS) category ≥ 3. These patients underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our institution between July 2017 and March 2023. We examined the localization of preoperative and postoperative ITs, the highest Gleason score (GS), and tumor diameter in these patients. RESULTS The preoperative cT stage matched the postoperative pT stage in 53 cases (47%), while 31 cases (27%) were upstaged, and 29 cases (26%) were downstaged (Weighted Kappa = 0.21). The preoperative and postoperative IT localizations were consistent in 97 cases (86%). The concordance rate between Gleason groups in targeted biopsies and RP specimens was 51%, with an upgrade in 25 cases (23%) and a downgrade in 27 cases (25%) (Weighted Kappa = 0.42). The maximum diameter of the IT and the maximum cancer core length on biopsy were correlated with the RP tumor's maximum diameter (p < 0.001 for both). CONCLUSION The diagnostic accuracy of bpMRI/TRUS fusion biopsy is comparable to mpMRI, suggesting that it can be a cost-effective and time-saving alternative.
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Affiliation(s)
- Ryutaro Shimizu
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan.
| | - Atsushi Yamamoto
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Hiroshi Yamane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Ryoma Nishikawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Yusuke Kimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Noriya Yamaguchi
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
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12
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Couchoux T, Jaouen T, Melodelima-Gonindard C, Baseilhac P, Branchu A, Arfi N, Aziza R, Barry Delongchamps N, Bladou F, Bratan F, Brunelle S, Colin P, Correas JM, Cornud F, Descotes JL, Eschwege P, Fiard G, Guillaume B, Grange R, Grenier N, Lang H, Lefèvre F, Malavaud B, Marcelin C, Moldovan PC, Mottet N, Mozer P, Potiron E, Portalez D, Puech P, Renard-Penna R, Roumiguié M, Roy C, Timsit MO, Tricard T, Villers A, Walz J, Debeer S, Mansuy A, Mège-Lechevallier F, Decaussin-Petrucci M, Badet L, Colombel M, Ruffion A, Crouzet S, Rabilloud M, Souchon R, Rouvière O. Performance of a Region of Interest-based Algorithm in Diagnosing International Society of Urological Pathology Grade Group ≥2 Prostate Cancer on the MRI-FIRST Database-CAD-FIRST Study. Eur Urol Oncol 2024:S2588-9311(24)00056-7. [PMID: 38493072 DOI: 10.1016/j.euo.2024.03.003] [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: 02/01/2024] [Accepted: 03/01/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Prostate multiparametric magnetic resonance imaging (MRI) shows high sensitivity for International Society of Urological Pathology grade group (GG) ≥2 cancers. Many artificial intelligence algorithms have shown promising results in diagnosing clinically significant prostate cancer on MRI. To assess a region-of-interest-based machine-learning algorithm aimed at characterising GG ≥2 prostate cancer on multiparametric MRI. METHODS The lesions targeted at biopsy in the MRI-FIRST dataset were retrospectively delineated and assessed using a previously developed algorithm. The Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) score assigned prospectively before biopsy and the algorithm score calculated retrospectively in the regions of interest were compared for diagnosing GG ≥2 cancer, using the areas under the curve (AUCs), and sensitivities and specificities calculated with predefined thresholds (PIRADSv2 scores ≥3 and ≥4; algorithm scores yielding 90% sensitivity in the training database). Ten predefined biopsy strategies were assessed retrospectively. KEY FINDINGS AND LIMITATIONS After excluding 19 patients, we analysed 232 patients imaged on 16 different scanners; 85 had GG ≥2 cancer at biopsy. At patient level, AUCs of the algorithm and PI-RADSv2 were 77% (95% confidence interval [CI]: 70-82) and 80% (CI: 74-85; p = 0.36), respectively. The algorithm's sensitivity and specificity were 86% (CI: 76-93) and 65% (CI: 54-73), respectively. PI-RADSv2 sensitivities and specificities were 95% (CI: 89-100) and 38% (CI: 26-47), and 89% (CI: 79-96) and 47% (CI: 35-57) for thresholds of ≥3 and ≥4, respectively. Using the PI-RADSv2 score to trigger a biopsy would have avoided 26-34% of biopsies while missing 5-11% of GG ≥2 cancers. Combining prostate-specific antigen density, the PI-RADSv2 and algorithm's scores would have avoided 44-47% of biopsies while missing 6-9% of GG ≥2 cancers. Limitations include the retrospective nature of the study and a lack of PI-RADS version 2.1 assessment. CONCLUSIONS AND CLINICAL IMPLICATIONS The algorithm provided robust results in the multicentre multiscanner MRI-FIRST database and could help select patients for biopsy. PATIENT SUMMARY An artificial intelligence-based algorithm aimed at diagnosing aggressive cancers on prostate magnetic resonance imaging showed results similar to expert human assessment in a prospectively acquired multicentre test database.
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Affiliation(s)
- Thibaut Couchoux
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | | | - Pierre Baseilhac
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Arthur Branchu
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Arfi
- Department of Urology, Hôpital Saint Joseph Saint Luc, Lyon, France
| | - Richard Aziza
- Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | | | - Franck Bladou
- Department of Urology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Flavie Bratan
- Department of Diagnostic and Interventional Imaging, Hôpital Saint Joseph Saint Luc, Lyon, France
| | - Serge Brunelle
- Department of Radiology and Medical Imaging, Institut Paoli-Calmettes Cancer Center, Marseille, France
| | - Pierre Colin
- Department of Urology, Hôpital privé La Louvrière, Lille, France
| | - Jean-Michel Correas
- Department of Radiology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Cornud
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Luc Descotes
- Université Grenoble Alpes, Grenoble, France; Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Pascal Eschwege
- Department of Urology, Centre Hospitalier Régional et Universitaire de Nancy, Vandoeuvre, France
| | - Gaelle Fiard
- Université Grenoble Alpes, Grenoble, France; Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Bénédicte Guillaume
- Department of Radiology, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Apes, Grenoble, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Nicolas Grenier
- Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Hervé Lang
- Department of Urology, Centre Hospitalier Universitaire de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Frédéric Lefèvre
- Department of Radiology, Centre Hospitalier Régional et Universitaire de Nancy, Vandoeuvre, France
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Clément Marcelin
- Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Paul C Moldovan
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Mottet
- Department of Urology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Pierre Mozer
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Potiron
- Clinique Urologique de Nantes, Saint-Herblain, France
| | - Daniel Portalez
- Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Philippe Puech
- Department of Radiology, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Raphaele Renard-Penna
- Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; GRC no 5, ONCOTYPE-URO, Sorbonne Universités, Paris, France
| | - Matthieu Roumiguié
- Department of Urology, Toulouse-Rangueil University Hospital, Toulouse France
| | - Catherine Roy
- Department of Radiology B, Centre Hospitalier Universitaire de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibault Tricard
- Department of Urology, Centre Hospitalier Universitaire de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Arnauld Villers
- Department of Urology, Univ. Lille, CHU Lille, Lille, France
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France
| | - Sabine Debeer
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Adeline Mansuy
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | | | - Lionel Badet
- Department of Urology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France; Department of Urology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Université de Lyon, Lyon, France
| | - Marc Colombel
- Department of Urology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Université de Lyon, Lyon, France
| | - Alain Ruffion
- Université Lyon 1, Université de Lyon, Lyon, France; Department of Urology, Centre Hospitalier Lyon Sud, Hospices Cibvils de Lyon, Pierre-Bénite, France
| | - Sébastien Crouzet
- LabTau, INSERM Unit 1032, Lyon, France; Department of Urology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Université de Lyon, Lyon, France
| | - Muriel Rabilloud
- Université Lyon 1, Université de Lyon, Lyon, France; Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | | | - Olivier Rouvière
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; LabTau, INSERM Unit 1032, Lyon, France; Université Lyon 1, Université de Lyon, Lyon, France.
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Birosh A, Salinas-Miranda E, Breau RH, McInnes MDF, Morash C, Schieda N. Multiparametric Versus Biparametric Prostate MRI: Comparison of NPV for Clinically Significant Prostate Cancer. AJR Am J Roentgenol 2024; 222:e2330496. [PMID: 38090807 DOI: 10.2214/ajr.23.30496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Adam Birosh
- The University of Ottawa, Ottawa, ON, Canada
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14
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Feng X, Chen X, Peng P, Zhou H, Hong Y, Zhu C, Lu L, Xie S, Zhang S, Long L. Values of multiparametric and biparametric MRI in diagnosing clinically significant prostate cancer: a multivariate analysis. BMC Urol 2024; 24:40. [PMID: 38365673 PMCID: PMC10870467 DOI: 10.1186/s12894-024-01411-0] [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: 03/22/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND To investigate the value of semi-quantitative and quantitative parameters (PI-RADS score, T2WI score, ADC, Ktrans, and Kep) based on multiparametric MRI (mpMRI) or biparametric MRI (bpMRI) combined with prostate specific antigen density (PSAD) in detecting clinically significant prostate cancer (csPCa). METHODS A total of 561 patients (276 with csPCa; 285 with non-csPCa) with biopsy-confirmed prostate diseases who underwent preoperative mpMRI were included. Prostate volume was measured for calculation of PSAD. Prostate index lesions were scored on a five-point scale on T2WI images (T2WI score) and mpMRI images (PI-RADS score) according to the PI-RADS v2.1 scoring standard. DWI and DCE-MRI images were processed to measure the quantitative parameters of the index lesion, including ADC, Kep, and Ktrans values. The predictors of csPCa were screened by logistics regression analysis. Predictive models of bpMRI and mpMRI were established. ROC curves were used to evaluate the efficacy of parameters and the model in diagnosing csPCa. RESULTS The independent diagnostic accuracy of PSA density, PI-RADS score, T2WI score, ADCrec, Ktrans, and Kep for csPCa were 80.2%, 89.5%, 88.3%, 84.6%, 58.5% and 61.6%, respectively. The diagnostic accuracy of bpMRI T2WI score and ADC value combined with PSAD was higher than that of PI-RADS score. The combination of mpMRI PI‑RADS score, ADC value with PSAD had the highest diagnostic accuracy. CONCLUSIONS PI-RADS score according to the PI-RADS v2.1 scoring standard was the most accurate independent diagnostic index. The predictive value of bpMRI model for csPCa was slightly lower than that of mpMRI model, but higher than that of PI-RADS score.
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Affiliation(s)
- Xiao Feng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Xin Chen
- Department of Radiology, Jiangjin Hospital, Chongqing University, No.725, Jiangzhou Avenue, Dingshan Street, Chongqing, 402260, China
| | - Peng Peng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - He Zhou
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Yi Hong
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Chunxia Zhu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Libing Lu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Siyu Xie
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Sijun Zhang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China.
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15
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Parillo M, Mallio CA, Van der Molen AJ, Rovira À, Dekkers IA, Karst U, Stroomberg G, Clement O, Gianolio E, Nederveen AJ, Radbruch A, Quattrocchi CC. The role of gadolinium-based contrast agents in magnetic resonance imaging structured reporting and data systems (RADS). MAGMA (NEW YORK, N.Y.) 2024; 37:15-25. [PMID: 37702845 PMCID: PMC10876744 DOI: 10.1007/s10334-023-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023]
Abstract
Among the 28 reporting and data systems (RADS) available in the literature, we identified 15 RADS that can be used in Magnetic Resonance Imaging (MRI). Performing examinations without using gadolinium-based contrast agents (GBCA) has benefits, but GBCA administration is often required to achieve an early and accurate diagnosis. The aim of the present review is to summarize the current role of GBCA in MRI RADS. This overview suggests that GBCA are today required in most of the current RADS and are expected to be used in most MRIs performed in patients with cancer. Dynamic contrast enhancement is required for correct scores calculation in PI-RADS and VI-RADS, although scientific evidence may lead in the future to avoid the GBCA administration in these two RADS. In Bone-RADS, contrast enhancement can be required to classify an aggressive lesion. In RADS scoring on whole body-MRI datasets (MET-RADS-P, MY-RADS and ONCO-RADS), in NS-RADS and in Node-RADS, GBCA administration is optional thanks to the intrinsic high contrast resolution of MRI. Future studies are needed to evaluate the impact of the high T1 relaxivity GBCA on the assignment of RADS scores.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Aart J Van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilona A Dekkers
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 48, 48149, Münster, Germany
| | - Gerard Stroomberg
- RIWA-Rijn-Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Olivier Clement
- Service de Radiologie, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, 20 Rue LeBlanc, 75015, Paris, France
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Science, University of Turin, Via Nizza 52, 10125, Turin, Italy
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
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Kim SJ, Park M, Choi A, Yoo S. Microbiome and Prostate Cancer: Emerging Diagnostic and Therapeutic Opportunities. Pharmaceuticals (Basel) 2024; 17:112. [PMID: 38256945 PMCID: PMC10819128 DOI: 10.3390/ph17010112] [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: 12/11/2023] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
This review systematically addresses the correlation between the microbiome and prostate cancer and explores its diagnostic and therapeutic implications. Recent research has indicated an association between the urinary and gut microbiome composition and prostate cancer incidence and progression. Specifically, the urinary microbiome is a potential non-invasive biomarker for early detection and risk evaluation, with altered microbial profiles in prostate cancer patients. This represents an advancement in non-invasive diagnostic approaches to prostate cancer. The role of the gut microbiome in the efficacy of various cancer therapies has recently gained attention. Gut microbiota variations can affect the metabolism and effectiveness of standard treatment modalities, including chemotherapy, immunotherapy, and hormone therapy. This review explores the potential of gut microbiome modification through dietary interventions, prebiotics, probiotics, and fecal microbiota transplantation for improving the treatment response and mitigating adverse effects. Moreover, this review discusses the potential of microbiome profiling for patient stratification and personalized treatment strategies. While the current research identifies the pivotal role of the microbiome in prostate cancer, it also highlights the necessity for further investigations to fully understand these complex interactions and their practical applications in improving patient outcomes in prostate cancer management.
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Affiliation(s)
- Sung Jin Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Republic of Korea;
| | - Myungchan Park
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea;
| | - Ahnryul Choi
- Department of Biomedical Engineering, College of Medical Convergence, Catholic Kwandong University, Gangneung 25601, Republic of Korea
| | - Sangjun Yoo
- Department of Urology, SNU-SMG Boramae Medical Center, Seoul 07061, Republic of Korea
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Englman C, Barrett T, Moore CM, Giganti F. Active Surveillance for Prostate Cancer: Expanding the Role of MR Imaging and the Use of PRECISE Criteria. Radiol Clin North Am 2024; 62:69-92. [PMID: 37973246 DOI: 10.1016/j.rcl.2023.06.009] [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] [Indexed: 11/19/2023]
Abstract
Multiparametric magnetic resonance (MR) imaging has had an expanding role in active surveillance (AS) for prostate cancer. It can improve the accuracy of prostate biopsies, assist in patient selection, and help monitor cancer progression. The PRECISE recommendations standardize reporting of serial MR imaging scans during AS. We summarize the evidence on MR imaging-led AS and provide a clinical primer to help report using the PRECISE criteria. Some limitations to both serial imaging and the PRECISE recommendations must be considered as we move toward a more individualized risk-stratified approach to AS.
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Affiliation(s)
- Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Department of Urology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK.
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Abreu-Gomez J, Lim C, Haider MA. Contemporary Approach to Prostate Imaging and Data Reporting System Score 3 Lesions. Radiol Clin North Am 2024; 62:37-51. [PMID: 37973244 DOI: 10.1016/j.rcl.2023.06.008] [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] [Indexed: 11/19/2023]
Abstract
The aim of this article is to review the technical and clinical considerations encountered with PI-RADS 3 lesions, which are equivocal for clinically significant Prostate Cancer (csPCa) with detection rates ranging between 10% and 35%. The number of PI-RADS 3 lesions reported vary according to several factors including MRI quality and radiologist training/expertise among the most influential. PI-RADS v.2.1 updated definitions for scores 2 and 3 in the PZ and scores 1 and 2 in the TZ is reviewed. The role of DWI role is highlighted in the assessment of the TZ with the possibility of upgrading score 2 lesions to score 3 based on DWI score. Given the increased utilization for prostate MRI, biparametric MRI can be considered as an alternative for low-risk patients where there is a need to rule out csPCa acknowledging this technique may increase the number of indeterminate cases going for biopsies. Management of patients with equivocal lesions at mpMRI and factors influencing biopsy decision process remain as an unmet need and additional studies using molecular/imaging markers as well as artificial intelligence tools are needed to further address their role in proper patient selection for biopsy.
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Affiliation(s)
- Jorge Abreu-Gomez
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Avenue, Suite 3-920, Toronto, ON M5G 2M9, Canada.
| | - Christopher Lim
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AB 279, Toronto, ON M4N 3M5, Canada
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System and the Joint Department of Medical Imaging, Sinai Health System, Princess Margaret Hospital, University of Toronto, 600 University Avenue, Toronto, ON, Canada M5G 1X5
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Barrett T, Lee KL, de Rooij M, Giganti F. Update on Optimization of Prostate MR Imaging Technique and Image Quality. Radiol Clin North Am 2024; 62:1-15. [PMID: 37973236 DOI: 10.1016/j.rcl.2023.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Prostate MR imaging quality has improved dramatically over recent times, driven by advances in hardware, software, and improved functional imaging techniques. MRI now plays a key role in prostate cancer diagnostic work-up, but outcomes of the MRI-directed pathway are heavily dependent on image quality and optimization. MR sequences can be affected by patient-related degradations relating to motion and susceptibility artifacts which may enable only partial mitigation. In this Review, we explore issues relating to prostate MRI acquisition and interpretation, mitigation strategies at a patient and scanner level, PI-QUAL reporting, and future directions in image quality, including artificial intelligence solutions.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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20
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Messina E, La Torre G, Pecoraro M, Pisciotti ML, Sciarra A, Poscia R, Catalano C, Panebianco V. Design of a magnetic resonance imaging-based screening program for early diagnosis of prostate cancer: preliminary results of a randomized controlled trial-Prostate Cancer Secondary Screening in Sapienza (PROSA). Eur Radiol 2024; 34:204-213. [PMID: 37561183 DOI: 10.1007/s00330-023-10019-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES The main objective is to propose an MRI-based screening protocol, investigating the role of MRI without the injection of contrast media (bi-parametric MRI, bpMRI) as a secondary prevention test for prostate cancer (PCa) early diagnosis, comparing MRI with the prostate specific antigen (PSA) test. For this reason, preliminary results of Prostate Cancer Secondary Screening in Sapienza (PROSA) are presented, to investigate the efficiency of an MRI-based screening protocol. PROSA is a prospective, randomized, single-center study. To date, 351 men have been enrolled and blindly randomized into two different arms: (A) Men underwent a bpMRI regardless of their PSA values (175); (B) Men followed as per clinical practice: those with increased PSA (61) were referred to bpMRI, while those with normal PSA (112) were not. Men who screened positive on MRI were directed to MR-directed targeted biopsy. On arm A, 4 clinically significant PCa have been detected, while none was found on arm B (p = 0.046). To evaluate the efficiency of the screening protocol, we calculated the experimental event rate (EER, 3.6%), control event rate (CER, 1.2%.), absolute risk reduction (ARR, 2.5%), and number needed to treat (NNT, 40.3). PROSA represents an interesting experience in the field of imaging-based PCa screening. The preliminary data from this trial highlight the promising role of non-contrast MRI as a screening tool for early detection of PCa. Further data will finally validate the most appropriate screening program. CLINICAL RELEVANCE STATEMENT PROSA depicts an interesting experience in the field of research focused on imaging-based prostate cancer screening. Its preliminary data highlight the promising role of non-contrast MRI as a screening tool for early detection of PCa. KEY POINTS • Promotion of an MRI-based screening protocol, investigating the role of non-contrast MRI as a secondary prevention test for prostate cancer early diagnosis, comparing MRI with PSA test. • Prostate Cancer Secondary Screening in Sapienza (PROSA) represents an interesting experience in the field of research focused on imaging-based prostate cancer screening; its preliminary results indicate that it is possible to use non-contrast MRI as a screening tool for early detection of PCa. • This new approach to PCa screening could facilitate the early diagnosis of clinically significant prostate cancer while reducing the number of unnecessary prostate biopsies and the detection of clinically insignificant prostate cancer.
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Affiliation(s)
- Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Martina Lucia Pisciotti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Roberto Poscia
- Department of Clinical Research and Clinical Competence, DG AOU Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy.
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Asbach P. Contrast-medium administration for prostate MRI: yes! Contrast-medium administration can be abandoned. Eur Radiol 2023; 33:8413-8414. [PMID: 37420101 PMCID: PMC10667371 DOI: 10.1007/s00330-023-09766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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22
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Rouvière O. Contrast-medium administration for prostate MRI can be abandoned: no(t so simple)! Eur Radiol 2023; 33:8415-8416. [PMID: 37436510 DOI: 10.1007/s00330-023-09767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/01/2023] [Accepted: 05/22/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France.
- Université de Lyon, Lyon, France.
- Université Lyon 1, faculté de médecine Lyon Est, Lyon, France.
- INSERM U 1032, Lyon, France.
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23
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Rehman I, Pang E, Harris AC, Chang SD. Bi-parametric prostate MRI with a recall system for contrast enhanced imaging: Improving accessibility while maintaining quality. Eur J Radiol 2023; 169:111186. [PMID: 37989069 DOI: 10.1016/j.ejrad.2023.111186] [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: 04/26/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To review the efficacy of a recall system for bi-parametric non-contrast prostate MRI (bp-MRI). METHODS A bi-parametric protocol was instituted in July 2020 for all patients who had a prostate MRI requested, excluding those after treatment of prostate cancer, patients with hip prosthesis or pacemaker, and those who lived out-of-town. The protocol consisted of tri-planar T2-weighted and diffusion weighted images (DWI) (b = 50, 800 s/mm2 for ADC map; b = 1,500 s/mm2 acquired separately) in accordance with the Prostate Imaging Reporting & Data system (PI-RADS) v2.1 guidelines. After interpretation of bp-MRI exams, patients with equivocal (PI-RADS 3) lesions in peripheral zone (PZ) or any technical limitations were recalled for contrast administration. RESULTS Out of 909 bp-MRI scans performed from July 2020 to April 2021, only 52 (5.7 %) were recalled, of which 46 (88.5 %) attended. Amongst these, 41/52 (78.8 %) were recalled for PZ PI-RADS 3 lesions, while the rest of 11 (21.2 %) cases were recalled for technical reasons. Mean time to subsequent recall scan was 11.6 days. On assessment of post-contrast imaging, 29/46 (63 %) cases were upgraded to PI-RADS 4 while 17/46 (37 %) remained PI-RADS 3. This system avoided contrast-agent use in 857 patients, with contrast cost savings of €64,620 (US$68,560) and 214 hours 15 minutes of scanner time was saved. This allowed 255 additional bp-MRI scans to be performed, reducing the waitlist from 1 year to 2-3 weeks. CONCLUSION A bi-parametric prostate MRI protocol with a robust recall system for contrast administration not only saved time eliminating the marked backlog but was also more cost efficient without compromising the quality of patient care.
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Affiliation(s)
- Iffat Rehman
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada.
| | - Emily Pang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
| | - Alison C Harris
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
| | - Silvia D Chang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
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Guljaš S, Dupan Krivdić Z, Drežnjak Madunić M, Šambić Penc M, Pavlović O, Krajina V, Pavoković D, Šmit Takač P, Štefančić M, Salha T. Dynamic Contrast-Enhanced Study in the mpMRI of the Prostate-Unnecessary or Underutilised? A Narrative Review. Diagnostics (Basel) 2023; 13:3488. [PMID: 37998624 PMCID: PMC10670922 DOI: 10.3390/diagnostics13223488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this review is to summarise recent scientific literature regarding the clinical use of DCE-MRI as a component of multiparametric resonance imaging of the prostate. This review presents the principles of DCE-MRI acquisition and analysis, the current role of DCE-MRI in clinical practice with special regard to its role in presently available categorisation systems, and an overview of the advantages and disadvantages of DCE-MRI described in the current literature. DCE-MRI is an important functional sequence that requires intravenous administration of a gadolinium-based contrast agent and gives information regarding the vascularity and capillary permeability of the lesion. Although numerous studies have confirmed that DCE-MRI has great potential in the diagnosis and monitoring of prostate cancer, its role is still inadequate in the PI-RADS categorisation. Moreover, there have been numerous scientific discussions about abandoning the intravenous application of gadolinium-based contrast as a routine part of MRI examination of the prostate. In this review, we summarised the recent literature on the advantages and disadvantages of DCE-MRI, focusing on an overview of currently available data on bpMRI and mpMRI, as well as on studies providing information on the potential better usability of DCE-MRI in improving the sensitivity and specificity of mpMRI examinations of the prostate.
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Affiliation(s)
- Silva Guljaš
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (S.G.); (Z.D.K.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
| | - Zdravka Dupan Krivdić
- Clinical Department of Radiology, University Hospital Centre, 31000 Osijek, Croatia; (S.G.); (Z.D.K.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
| | - Maja Drežnjak Madunić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Oncology, University Hospital Centre, 31000 Osijek, Croatia
| | - Mirela Šambić Penc
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Oncology, University Hospital Centre, 31000 Osijek, Croatia
| | - Oliver Pavlović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Vinko Krajina
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Deni Pavoković
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Urology, University Hospital Centre, 31000 Osijek, Croatia
| | - Petra Šmit Takač
- Clinical Department of Surgery, Osijek University Hospital Centre, 31000 Osijek, Croatia;
| | - Marin Štefančić
- Department of Radiology, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia;
| | - Tamer Salha
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.D.M.); (M.Š.P.); (O.P.); (V.K.); (D.P.)
- Department of Teleradiology and Artificial Intelligence, Health Centre Osijek-Baranja County, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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25
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Sanmugalingam N, Sushentsev N, Lee KL, Caglic I, Englman C, Moore CM, Giganti F, Barrett T. The PRECISE Recommendations for Prostate MRI in Patients on Active Surveillance for Prostate Cancer: A Critical Review. AJR Am J Roentgenol 2023; 221:649-660. [PMID: 37341180 DOI: 10.2214/ajr.23.29518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations were published in 2016 to standardize the reporting of MRI examinations performed to assess for disease progression in patients on active surveillance for prostate cancer. Although a limited number of studies have reported outcomes from use of PRECISE in clinical practice, the available studies have demonstrated PRECISE to have high pooled NPV but low pooled PPV for predicting progression. Our experience in using PRECISE in clinical practice at two teaching hospitals has highlighted issues with its application and areas requiring clarification. This Clinical Perspective critically appraises PRECISE on the basis of this experience, focusing on the system's key advantages and disadvantages and exploring potential changes to improve the system's utility. These changes include consideration of image quality when applying PRECISE scoring, incorporation of quantitative thresholds for disease progression, adoption of a PRECISE 3F sub-category for progression not qualifying as substantial, and comparisons with both the baseline and most recent prior examinations. Items requiring clarification include derivation of a patient-level score in patients with multiple lesions, intended application of PRECISE score 5 (i.e., if requiring development of disease that is no longer organ-confined), and categorization of new lesions in patients with prior MRI-invisible disease.
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Affiliation(s)
- Nimalan Sanmugalingam
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Cameron Englman
- Division of Surgery & Interventional Science, University College London, London, UK
- 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
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
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Paulino Pereira LJ, Reesink DJ, de Bruin P, Gandaglia G, van der Hoeven EJRJ, Marra G, Prinsen A, Rajwa P, Soeterik T, Kasivisvanathan V, Wever L, Zattoni F, van Melick HHE, van den Bergh RCN. Outcomes of a Diagnostic Pathway for Prostate Cancer Based on Biparametric MRI and MRI-Targeted Biopsy Only in a Large Teaching Hospital. Cancers (Basel) 2023; 15:4800. [PMID: 37835494 PMCID: PMC10571962 DOI: 10.3390/cancers15194800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Diagnostic pathways for prostate cancer (PCa) balance detection rates and burden. MRI impacts biopsy indication and strategy. METHODS A prospectively collected cohort database (N = 496) of men referred for elevated PSA and/or abnormal DRE was analyzed. All underwent biparametric MRI (3 Tesla scanner) and ERSPC prostate risk-calculator. Indication for biopsy was PIRADS ≥ 3 or risk-calculator ≥ 20%. Both targeted (cognitive-fusion) and systematic cores were combined. A hypothetical full-MRI-based pathway was retrospectively studied, omitting systematic biopsies in: (1) PIRADS 1-2 but risk-calculator ≥ 20%, (2) PIRADS ≥ 3, receiving targeted biopsy-cores only. RESULTS Significant PCa (GG ≥ 2) was detected in 120 (24%) men. Omission of systematic cores in cases with PIRADS 1-2 but risk-calculator ≥ 20%, would result in 34% less biopsy indication, not-detecting 7% significant tumors. Omission of systematic cores in PIRADS ≥ 3, only performing targeted biopsies, would result in a decrease of 75% cores per procedure, not detecting 9% significant tumors. Diagnosis of insignificant PCa dropped by 52%. PCa undetected by targeted cores only, were ipsilateral to MRI-index lesions in 67%. CONCLUSIONS A biparametric MRI-guided PCa diagnostic pathway would have missed one out of six cases with significant PCa, but would have considerably reduced the number of biopsy procedures, cores, and insignificant PCa. Further refinement or follow-up may identify initially undetected cases. Center-specific data on the performance of the diagnostic pathway is required.
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Affiliation(s)
- Leonor J. Paulino Pereira
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Daan J. Reesink
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Peter de Bruin
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Erik J. R. J. van der Hoeven
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Giancarlo Marra
- Department of Urology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy
| | - Anne Prinsen
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Timo Soeterik
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, UK
| | - Lieke Wever
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Fabio Zattoni
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padua, Italy
| | - Harm H. E. van Melick
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Roderick C. N. van den Bergh
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
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27
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Vilanova JC, Catalá-Sventzetzky V, Hernández-Mancera J. MRI for detection, staging, and follow-up of prostate cancer: Synthesis of the PI-RADS v2.1, MET-RADS, PRECISE, and PI-RR guidelines. RADIOLOGIA 2023; 65:431-446. [PMID: 37758334 DOI: 10.1016/j.rxeng.2022.12.005] [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: 12/01/2022] [Accepted: 12/19/2022] [Indexed: 10/03/2023]
Abstract
Prostate cancer is very common among men. Radiology, mainly through MRI, plays a key role in the different stages of prostate cancer: diagnosis, staging and treatment assessment. The correct management of MRI requires knowledge and proper use of the different guidelines developed for the acquisition, interpretation and reporting of MRI in diagnosis (PI-RADS guide), whole body staging (MET-RADS guide), active surveillance (PRECISE guide) and local recurrence (PI-RR guide) in prostate cancer. The objective of this article is to show an update and synthesis of the most relevant aspects of these MRI guidelines for an optimal use and thus providing a more effective management of prostate cancer.
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Affiliation(s)
- J C Vilanova
- Departamento Radiología, Clínica Girona, Institut de Diagnòstic per la Imatge (IDI), Hospital Dr. J. Trueta/Hospital Sta. Caterina, Departamento de Ciencias Médicas, Facultad de Medicina, Universitat de Girona, Girona, Spain.
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Asbach P, Padhani AR. Are upgraded DCE-positive PI-RADS 3 lesions truly suspicious for clinically significant prostate cancer? Eur Radiol 2023; 33:5825-5827. [PMID: 37154954 DOI: 10.1007/s00330-023-09711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/05/2023] [Accepted: 04/22/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK.
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Kalchev E. Evaluating the Utility of Prostate-Specific Antigen Density in Risk Stratification of PI-RADS 3 Peripheral Zone Lesions on Non-Contrast-Enhanced Prostate MRI: An Exploratory Single-Institution Study. Cureus 2023; 15:e41369. [PMID: 37546087 PMCID: PMC10399968 DOI: 10.7759/cureus.41369] [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] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Objective This study aimed to explore the potential of prostate-specific antigen density (PSAD) as a supplementary tool for defining high-risk Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions in the peripheral zone on non-contrast-enhanced MRI. This additional stratification tool could supplement the decision-making process for biopsy, potentially helping in identifying higher-risk patients more accurately, minimizing unnecessary procedures in lower-risk patients, and limiting the need for dynamic contrast-enhanced (DCE) scans. Materials and methods Between January 2019 and April 2023, 30 patients with PI-RADS 3 lesions underwent MRI-ultrasound fusion biopsies at our institution. Age and PSAD values were investigated using logistic regression and chi-square automatic interaction detection (CHAID) analysis to discern their predictive value for malignancy. Results The mean patient age was 64.7 years, and the mean PSAD was 0.13 ng/mL2. Logistic regression demonstrated PSAD to be a significant predictor of cancer (p=0.012), but not age (p=0.855). CHAID analysis further identified a PSAD cut-off value of 0.12, below which the cancer detection rate was 23.1% and above which the rate increased to 76.5%. Conclusions This exploratory study suggests that PSAD might be utilized to enhance the stratification of high-risk PI-RADS 3 lesions in the peripheral zone on non-contrast-enhanced MRI, aiding in decision-making for biopsy. While biopsy remains the gold standard for definitive diagnosis, a high PSAD value may suggest a greater need for biopsy in this specific group. Although further validation in larger cohorts is required, our findings contribute to the ongoing discourse on optimizing PI-RADS 3 lesion management. Limitations include a small sample size, the retrospective nature of the study, and the single-center setting, which may impact the generalizability of our results.
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Affiliation(s)
- Emilian Kalchev
- Diagnostic Imaging, St Marina University Hospital, Varna, BGR
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Mingels C, Loebelenz LI, Huber AT, Alberts I, Rominger A, Afshar-Oromieh A, Obmann VC. Literature review: Imaging in prostate cancer. Curr Probl Cancer 2023:100968. [PMID: 37336689 DOI: 10.1016/j.currproblcancer.2023.100968] [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: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
Imaging plays an increasingly important role in the detection and characterization of prostate cancer (PC). This review summarizes the key conventional and advanced imaging modalities including multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging and tries to instruct clinicians in finding the best image modality depending on the patient`s PC-stage. We aim to give an overview of the different image modalities and their benefits and weaknesses in imaging PC. Emphasis is put on primary prostate cancer detection and staging as well as on recurrent and castration resistant prostate cancer. Results from studies using various imaging techniques are discussed and compared. For the different stages of PC, advantages and disadvantages of the different imaging modalities are discussed. Moreover, this review aims to give an outlook about upcoming, new imaging modalities and how they might be implemented in the future into clinical routine. Imaging patients suffering from PC should aim for exact diagnosis, accurate detection of PC lesions and should mirror the true tumor burden. Imaging should lead to the best patient treatment available in the current PC-stage and should avoid unnecessary therapeutic interventions. New image modalities such as long axial field of view PET/CT with photon-counting CT and radiopharmaceuticals like androgen receptor targeting radiopharmaceuticals open up new possibilities. In conclusion, PC imaging is growing and each image modality is aiming for improvement.
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Affiliation(s)
- Clemens Mingels
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Laura I Loebelenz
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
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Turkbey B, Purysko AS. PI-RADS: Where Next? Radiology 2023; 307:e223128. [PMID: 37097134 PMCID: PMC10315529 DOI: 10.1148/radiol.223128] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 04/26/2023]
Abstract
Prostate MRI plays an important role in the clinical management of localized prostate cancer, mainly assisting in biopsy decisions and guiding biopsy procedures. The Prostate Imaging Reporting and Data System (PI-RADS) has been available to radiologists since 2012, with the most up-to-date and actively used version being PI-RADS version 2.1. This review article discusses the current use of PI-RADS, including its limitations and controversies, and summarizes research that aims to improve future iterations of this system.
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Affiliation(s)
- Baris Turkbey
- From the Molecular Imaging Branch, National Cancer Institute,
National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85,
Bethesda, MD 20892 (B.T.); and Section of Abdominal Imaging, Department of
Nuclear Radiology, Cleveland Clinic Imaging Institute, Cleveland, Ohio
(A.S.P.)
| | - Andrei S. Purysko
- From the Molecular Imaging Branch, National Cancer Institute,
National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85,
Bethesda, MD 20892 (B.T.); and Section of Abdominal Imaging, Department of
Nuclear Radiology, Cleveland Clinic Imaging Institute, Cleveland, Ohio
(A.S.P.)
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Girometti R, Giannarini G, De Martino M, Caregnato E, Cereser L, Soligo M, Rozze D, Pizzolitto S, Isola M, Zuiani C. Multivariable stratification of PI-RADS version 2.1 categories for the risk of false-positive target biopsy: Impact on prostate biopsy decisions. Eur J Radiol 2023; 165:110897. [PMID: 37300933 DOI: 10.1016/j.ejrad.2023.110897] [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: 03/27/2023] [Revised: 04/30/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To identify clinical and multiparametric magnetic resonance imaging (mpMRI) factors predicting false positive target biopsy (FP-TB) of prostate imaging reporting and data system version 2.1 (PI-RADSv2.1) ≥ 3 findings. METHOD We retrospectively included 221 men with and without previous negative prostate biopsy who underwent 3.0 T/1.5 T mpMRI for suspicious clinically significant prostate cancer (csPCa) between April 2019-July 2021. A study coordinator revised mpMRI reports provided by one of two radiologists (experience of > 1500/>500 mpMRI examinations, respectively) and matched them with the results of transperineal systematic biopsy plus fusion target biopsy (TB) of PI-RADSv2.1 ≥ 3 lesions or PI-RADSv2.1 ≤ 2 men with higher clinical risk. A multivariable model was built to identify features predicting FP-TB of index lesions, defined as the absence of csPCa (International Society of Urogenital Pathology [ISUP] ≥ 2). The model was internally validated with the bootstrap technique, receiving operating characteristics (ROC) analysis, and decision analysis. RESULTS Features significantly associated with FP-TB were age < 65 years (odds ratio [OR] 2.77), prostate-specific antigen density (PSAD) < 0.15 ng/mL/mL (OR 2.45), PI-RADS 4/5 category vs. category 3 (OR 0.15/0.07), and multifocality (OR 0.46), with a 0.815 area under the curve (AUC) in assessing FP-TB. When adjusting PI-RADSv2.1 categorization for the model, mpMRI showed 87.5% sensitivity and 79.9% specificity for csPCa, with a greater net benefit in triggering biopsy compared to unadjusted categorization or adjustment for PSAD only at decision analysis, from threshold probability ≥ 15%. CONCLUSION Adjusting PI-RADSv2.1 categories for a multivariable risk of FP-TB is potentially more effective in triggering TB of index lesions than unadjusted PI-RADS categorization or adjustment for PSAD alone.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Maria De Martino
- Division of Medical Statistics, Department of Medicine (DAME), University of Udine, Udine, Italy, pl.le Kolbe, 4, 33100 Udine, Italy
| | - Elena Caregnato
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
| | - Matteo Soligo
- Urology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Davide Rozze
- Pathology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Stefano Pizzolitto
- Pathology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Miriam Isola
- Division of Medical Statistics, Department of Medicine (DAME), University of Udine, Udine, Italy, pl.le Kolbe, 4, 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
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Girometti R, Giannarini G, Peruzzi V, Amparore D, Pizzolitto S, Zuiani C. MRI-informed prostate biopsy: What the radiologist should know on quality in biopsy planning and biopsy acquisition. Eur J Radiol 2023; 164:110852. [PMID: 37167683 DOI: 10.1016/j.ejrad.2023.110852] [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: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
Quality is currently recognized as the pre-requisite for delivering the clinical benefits expected by magnetic resonance imaging (MRI)-informed prostate biopsy (MRI-i-PB) in patients with a suspicion for clinically significant prostate cancer (csPCa). The "quality chain" underlying MRI-i-PB is multidisciplinary in nature, and depends on several factors related to the patient, imaging technique, image interpretation and biopsy procedure. This review aims at making the radiologist aware of biopsy-related factors impacting on MRI-i-PB quality, both in terms of biopsy planning (threshold for biopsy decisions, association with systematic biopsy and number of targeted cores) and biopsy acquisition (biopsy route, targeting technique, and operator's experience). While there is still space for improvement and better standardization of several biopsy-related procedures, current evidence suggests that high-quality MRI-i-PB can be delivered by acquiring and increased the number of biopsy cores targeted to suspicious imaging findings and perilesional area ("focal saturation biopsy"). On the other hand, uncertainty still exists as to whether software-assisted fusion of MRI and transrectal ultrasound images can outperform cognitive fusion strategy. The role for operator's experience and quality assurance/quality control procedures are also discussed.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Torino, Italy.
| | - Stefano Pizzolitto
- Unit of Pathology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
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Bridging the experience gap in prostate multiparametric magnetic resonance imaging using artificial intelligence: A prospective multi-reader comparison study on inter-reader agreement in PI-RADS v2.1, image quality and reporting time between novice and expert readers. Eur J Radiol 2023; 161:110749. [PMID: 36812699 DOI: 10.1016/j.ejrad.2023.110749] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE The aim of the study was to determine the impact of using a semi-automatic commercially available AI-assisted software (Quantib® Prostate) on inter-reader agreement in PI-RADS scoring at different PI-QUAL ratings and grades of reader confidence and on reporting times among novice readers in multiparametric prostate MRI. METHODS A prospective observational study, with a final cohort of 200 patients undergoing mpMRI scans, was performed at our institution. An expert fellowship-trained urogenital radiologist interpreted all 200 scans based on PI-RADS v2.1. The scans were divided into four equal batches of 50 patients. Four independent readers evaluated each batch with and without the use of AI-assisted software, blinded to expert and individual reports. Dedicated training sessions were held before and after each batch. Image quality rated according to PI-QUAL and reporting times were recorded. Readers' confidence was also evaluated. A final evaluation of the first batch was conducted at the end of the study to assess for any changes in performance. RESULTS The overall kappa coefficient differences in PI-RADS scoring agreement without and with Quantib® were 0.673 to 0.736 for Reader 1, 0.628 to 0.483 for Reader 2, 0.603 to 0.292 for Reader 3 and 0.586 to 0.613 for Reader 4. Using PI-RADS ≥ 4 as cut-off for biopsy, the AUCs with AI ranged from 0.799 (95 % CI: 0.743, 0.856) to 0.820 (95 % CI: 0.765, 0.874). Inter-reader agreements at different PI-QUAL scores were higher with the use of Quantib, particularly for readers 1 and 4, with Kappa coefficient values showing moderate to slight agreement. CONCLUSION Quantib® Prostate could potentially be useful in improving inter-reader agreement among less experienced to completely novice readers if used as a supplement to PACS.
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Vilanova JC, Pérez de Tudela A, Thio-Henestrosa S, Barceló J, Boada M, Planas M, Sala S, Artazkoz J, García-Figueiras R, Baleato-González S, Vilanova C, Puig J. Usefulness of balanced SSFP sequence in robot-assisted MRI-guided prostate biopsy: Beyond scouting. Eur J Radiol 2023; 160:110707. [PMID: 36689791 DOI: 10.1016/j.ejrad.2023.110707] [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: 10/24/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine whether bSSFP images are useful for visualizing prostatic lesionsin MRI-guided in-bore transrectal biopsy. METHODS This retrospective studyincluded 67 men witha single suspected cancer on MRI (PI-RADS 2.1 category ≥ 3) who underwent in-bore transrectal MRI-guided biopsy. Two uroradiologists independently rated lesion conspicuity on a 3-point scale (1:non-visible, 2:slightly visible, 3:clearly visible) on T2WI, DWI, and balanced SSFP.We used measures of frequency to compare lesion conspicuity in 3 sequences. We used Cohen's kappa to assess inter-rater reliability. RESULTS Lesions were rated (1) non-visible in 18 % (12/67) of T2WI, 5 % (3/67) of DWI, and 10 % (7/67) of balanced SSFP images, (2) slightly visible in 56 % (37/67) on T2WI, 13 % (9/67) on DWI, and 48 % (32/67) on bSSFP, and (3) clearly visible in 27 %(18/67) on T2WI, 82 % (55/67) on DWI, and 42 % (28/67) on bSSFP. Lesions classified as prostate cancer at histology were slightly-clearly visible in 85 % (41/48) on T2WI, 100 % (48/48) on DWI, and 94 % (45/48) on bSSFP. Lesions classified as PI-RADS ≥ 4 were visible in 87 % (47/54) of T2WI, 100 % (54/54) of DWI, and 93 % (50/54) of bSSFP. Gleason ≥ 3 + 4 lesions were visible in 85 % (37/43) of T2WI, 100 % (43/43) of DWI, and 95 % (41/43) of bSSFP. Inter-rater agreement was excellent for T2WI (k = 0.97) and bSSFP (k = 0.94), and good for DWI (k = 0.75). CONCLUSION Balanced SSFP is useful for visualizing prostatic lesions. Replacing T2WI with balanced SSFP can reduce the duration of in-bore transrectal MRI-guided biopsy.
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Affiliation(s)
- Joan C Vilanova
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain; Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology (Girona Biomedical Research Institute) IDIBGI, Hospital Universitari Dr. Josep Trueta, 17007 Girona, Spain; Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003 Girona, Spain.
| | | | - Santiago Thio-Henestrosa
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, 17003 Girona, Spain
| | - Joaquim Barceló
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain; Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology (Girona Biomedical Research Institute) IDIBGI, Hospital Universitari Dr. Josep Trueta, 17007 Girona, Spain; Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003 Girona, Spain
| | - Maria Boada
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain; Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003 Girona, Spain
| | - Montse Planas
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain
| | - Sònia Sala
- Department of Magnetic Resonance, Clinica Girona, 17005 Girona, Spain
| | - Juanjo Artazkoz
- Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003 Girona, Spain
| | - Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706. Spain
| | - Sandra Baleato-González
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706. Spain
| | - Cristina Vilanova
- Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Josep Puig
- Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology (Girona Biomedical Research Institute) IDIBGI, Hospital Universitari Dr. Josep Trueta, 17007 Girona, Spain
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Krilaviciute A, Albers P, Lakes J, Radtke JP, Herkommer K, Gschwend J, Peters I, Kuczyk M, Koerber SA, Debus J, Kristiansen G, Schimmöller L, Antoch G, Makowski M, Wacker F, Schlemmer H, Benner A, Giesel F, Siener R, Arsov C, Hadaschik B, Becker N, Kaaks R. Adherence to a risk-adapted screening strategy for prostate cancer: First results of the PROBASE trial. Int J Cancer 2023; 152:854-864. [PMID: 36121664 DOI: 10.1002/ijc.34295] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 01/11/2023]
Abstract
PROBASE is a population-based, randomized trial of 46 495 German men recruited at age 45 to compare effects of risk-adapted prostate cancer (PCa) screening starting either immediately at age 45, or at a deferred age of 50 years. Based on prostate-specific antigen (PSA) levels, men are classified into risk groups with different screening intervals: low-risk (<1.5 ng/ml, 5-yearly screening), intermediate-risk (1.5-2.99 ng/ml, 2 yearly), and high risk (>3 ng/ml, recommendation for immediate biopsy). Over the first 6 years of study participation, attendance rates to scheduled screening visits varied from 70.5% to 79.4%, depending on the study arm and risk group allocation, in addition 11.2% to 25.4% of men reported self-initiated PSA tests outside the PROBASE protocol. 38.5% of participants had a history of digital rectal examination or PSA testing prior to recruitment to PROBASE, frequently associated with family history of PCa. These men showed higher rates (33% to 57%, depending on subgroups) of self-initiated PSA testing in-between PROBASE screening rounds. In the high-risk groups (both arms), the biopsy acceptance rate was 64% overall, but was higher among men with screening PSA ≥4 ng/ml (>71%) and with PIRADS ≥3 findings upon multiparameter magnetic resonance imaging (mpMRI) (>72%), compared with men with PSA ≥3 to 4 ng/ml (57%) or PIRADS score ≤ 2 (59%). Overall, PROBASE shows good acceptance of a risk-adapted PCa screening strategy in Germany. Implementation of such a strategy should be accompanied by a well-structured communication, to explain not only the benefits but also the harms of PSA screening.
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Affiliation(s)
- Agne Krilaviciute
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Albers
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Jale Lakes
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Kathleen Herkommer
- Department of Urology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Jürgen Gschwend
- Department of Urology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Inga Peters
- Department of Urology, Medical University Hannover, Hannover, Germany.,Department of Urology, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Markus Kuczyk
- Department of Urology, Medical University Hannover, Hannover, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany
| | | | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, Technical University Munich, München, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Medical University Hannover, Hannover, Germany
| | - Heinz Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Giesel
- Department of Nuclear Medicine, Medical Faculty, Duesseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Roswitha Siener
- Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany.,Department of Urology, University Hospital Bonn, Bonn, Germany
| | - Christian Arsov
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Boris Hadaschik
- Department of Urology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany
| | - Nikolaus Becker
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Resonancia magnética en la detección, estadificación y seguimiento del cáncer de próstata: síntesis de las guías PI-RADS v2.1, MET-RADS, PRECISE y PI-RR. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Index lesion detection in multifocal prostate cancer: Simplified PI-RADS biparametric MRI vs PI-RADS v2.1 multiparametric MRI. Clin Imaging 2023; 94:108-115. [PMID: 36527796 DOI: 10.1016/j.clinimag.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
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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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Kortenbach KC, Løgager V, Thomsen HS, Boesen L. Comparison of PSA density and lesion volume strategies for selecting men with equivocal PI-RADS 3 lesions on bpMRI for biopsies. Abdom Radiol (NY) 2023; 48:688-693. [PMID: 36318331 PMCID: PMC9902318 DOI: 10.1007/s00261-022-03720-0] [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: 09/07/2022] [Revised: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare two strategies: Prostate-specific antigen density (PSAd) and lesion volume measurement in ruling out significant prostate cancer (sPCa) in men with equivocal Prostate Imaging Reporting and Data System (PI-RADS) category 3 index lesions on biparametric magnetic resonance imaging. METHODS In total, 130 men from our database had index lesions with PI-RADS scores of 3. Prostate volume was measured using the ellipsoid method, in accordance with PI-RADS version 2.1 criteria. Index lesion volumes were also measured using the ellipsoidal formula on the diffusion-weighted imaging sequence with the highest b-value and sagittal T2 sequences. RESULTS Among 130 men with PI-RADS category 3 index lesions, 23 (18%) had sPCa. In total, 6 of the 89 men with PSAd < 0.15 ng/mL2 (7%) had sPCa, whereas 8 of the 49 men with index lesion volumes < 0.5 mL (16%) had sPCa. The difference was statistically significant (McNemar, p < 0.0001). CONCLUSION The PSAd strategy performed better than the lesion volume strategy in ruling out sPCa in men with equivocal PI-RADS category 3 index lesions.
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Affiliation(s)
- Karen-Cecilie Kortenbach
- Department of Radiology, Herlev Gentofte University Hospital, Borgmester Ib Juuls Vej 17, 2730, Herlev, Denmark.
| | - Vibeke Løgager
- Department of Radiology, Herlev Gentofte University Hospital, Borgmester Ib Juuls Vej 17, 2730 Herlev, Denmark
| | - Henrik S. Thomsen
- Department of Radiology, Herlev Gentofte University Hospital, Borgmester Ib Juuls Vej 17, 2730 Herlev, Denmark
| | - Lars Boesen
- Department of Radiology, Herlev Gentofte University Hospital, Borgmester Ib Juuls Vej 17, 2730 Herlev, Denmark ,Department of Urological Research, Herlev Gentofte University Hospital, Herlev, Denmark
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Evaluating the Downstream Revenues of a Self-Pay Bi-Parametric Prostate MRI Program. Urology 2023; 171:109-114. [PMID: 36195163 DOI: 10.1016/j.urology.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/24/2022] [Accepted: 09/25/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To quantify downstream healthcare utilization and revenue associated with a self-pay bi-parametric prostate MRI (bpMRI) program. METHODS Medical records of 592 patients who underwent bpMRI between August 2017 and March 2020 were examined for follow-up clinical activities. These include prostate biopsy, radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, CT Chest, Abdomen and Pelvis, PET/CT, MRI Pelvis, and Nuclear Medicine Bone Scans. The charges for each clinical activity were derived from the Medicare Physician Fee Schedule to conservatively estimate revenues. This patient population was further divided into four groups: Group A, patients who demonstrated an MRI lesion and underwent prostatectomy; Group B, patients who did not demonstrate lesion but underwent prostatectomy; Group C, patients who demonstrated lesion but did not undergo prostatectomy; and Group D, patients who neither demonstrated lesion nor underwent prostatectomy. Revenues for each group were categorized by Urology, Radiation Oncology and Radiology subspecialties. RESULTS Conservative estimates yielded $520 of downstream revenue per patient who underwent bpMRI. Group A patients yielded 47% of total revenue ($1974 per patient). Group B patients, the smallest group, yielded $1828 per patient. Group C patients made up the largest group and grossed $398 per patient. Group D demonstrated the lowest per patient revenue of $179. Groups A and B yielded most relative revenue for Urology. Group C yielded most relative revenue for Radiation Oncology, and Group D yielded most relative revenue for Radiology. CONCLUSION A self-pay bpMRI program has the potential to improve patient access to prostate cancer screening while remaining financial sustainable.
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Barrett T, de Rooij M, Giganti F, Allen C, Barentsz JO, Padhani AR. Quality checkpoints in the MRI-directed prostate cancer diagnostic pathway. Nat Rev Urol 2023; 20:9-22. [PMID: 36168056 DOI: 10.1038/s41585-022-00648-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
Multiparametric MRI of the prostate is now recommended as the initial diagnostic test for men presenting with suspected prostate cancer, with a negative MRI enabling safe avoidance of biopsy and a positive result enabling MRI-directed sampling of lesions. The diagnostic pathway consists of several steps, from initial patient presentation and preparation to performing and interpreting MRI, communicating the imaging findings, outlining the prostate and intra-prostatic target lesions, performing the biopsy and assessing the cores. Each component of this pathway requires experienced clinicians, optimized equipment, good inter-disciplinary communication between specialists, and standardized workflows in order to achieve the expected outcomes. Assessment of quality and mitigation measures are essential for the success of the MRI-directed prostate cancer diagnostic pathway. Quality assurance processes including Prostate Imaging-Reporting and Data System, template biopsy, and pathology guidelines help to minimize variation and ensure optimization of the diagnostic pathway. Quality control systems including the Prostate Imaging Quality scoring system, patient-level outcomes (such as Prostate Imaging-Reporting and Data System MRI score assignment and cancer detection rates), multidisciplinary meeting review and audits might also be used to provide consistency of outcomes and ensure that all the benefits of the MRI-directed pathway are achieved.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK
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Rouvière O, Jaouen T, Baseilhac P, Benomar ML, Escande R, Crouzet S, Souchon R. Artificial intelligence algorithms aimed at characterizing or detecting prostate cancer on MRI: How accurate are they when tested on independent cohorts? – A systematic review. Diagn Interv Imaging 2022; 104:221-234. [PMID: 36517398 DOI: 10.1016/j.diii.2022.11.005] [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: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to perform a systematic review of the literature on the diagnostic performance, in independent test cohorts, of artificial intelligence (AI)-based algorithms aimed at characterizing/detecting prostate cancer on magnetic resonance imaging (MRI). MATERIALS AND METHODS Medline, Embase and Web of Science were searched for studies published between January 2018 and September 2022, using a histological reference standard, and assessing prostate cancer characterization/detection by AI-based MRI algorithms in test cohorts composed of more than 40 patients and with at least one of the following independency criteria as compared to the training cohort: different institution, different population type, different MRI vendor, different magnetic field strength or strict temporal splitting. RESULTS Thirty-five studies were selected. The overall risk of bias was low. However, 23 studies did not use predefined diagnostic thresholds, which may have optimistically biased the results. Test cohorts fulfilled one to three of the five independency criteria. The diagnostic performance of the algorithms used as standalones was good, challenging that of human reading. In the 12 studies with predefined diagnostic thresholds, radiomics-based computer-aided diagnosis systems (assessing regions-of-interest drawn by the radiologist) tended to provide more robust results than deep learning-based computer-aided detection systems (providing probability maps). Two of the six studies comparing unassisted and assisted reading showed significant improvement due to the algorithm, mostly by reducing false positive findings. CONCLUSION Prostate MRI AI-based algorithms showed promising results, especially for the relatively simple task of characterizing predefined lesions. The best management of discrepancies between human reading and algorithm findings still needs to be defined.
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Affiliation(s)
- Olivier Rouvière
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Vascular and Urinary Imaging, Lyon 69003, France; Université Lyon 1, Faculté de médecine Lyon Est, Lyon 69003, France; LabTAU, INSERM, U1032, Lyon 69003, France.
| | | | - Pierre Baseilhac
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Vascular and Urinary Imaging, Lyon 69003, France
| | - Mohammed Lamine Benomar
- LabTAU, INSERM, U1032, Lyon 69003, France; University of Ain Temouchent, Faculty of Science and Technology, Algeria
| | - Raphael Escande
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Vascular and Urinary Imaging, Lyon 69003, France
| | - Sébastien Crouzet
- Université Lyon 1, Faculté de médecine Lyon Est, Lyon 69003, France; LabTAU, INSERM, U1032, Lyon 69003, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Urology, Lyon 69003, France
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Alver KH, Yagci AB, Utebey AR, Turk NS, Ufuk F. Comparison of Multiparametric and Fast MRI Protocols in Detecting Clinically Significant Prostate Cancer and a Detailed Cost Analysis. J Magn Reson Imaging 2022; 56:1437-1447. [PMID: 35274792 DOI: 10.1002/jmri.28142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/20/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Due to the long acquisition time and high cost of multiparametric magnetic resonance imaging (mpMRI), biparametric and, more recently, fast prostate magnetic resonance imaging (fpMRI) protocols have been described. However, there is insufficient data about the diagnostic performance and cost of fpMRI. PURPOSE To compare the diagnostic performances and cost analysis of fpMRI and mpMRI in clinically significant prostate cancer (csPCA). STUDY TYPE Retrospective. POPULATION A total of 103 patients (63 had csPCA) with a mean age of 66.83 (± 7.22) years were included. FIELD STRENGTH/SEQUENCE A 1.5-T; T1- and T2-weighted turbo spin-echo imaging (T1WI and T2WI), echo-planar diffusion-weighted images, and dynamic contrast-enhanced T1W imaging. ASSESSMENT Three readers independently evaluated the fpMRI and mpMRI images in different sessions blinded to all patient information. Diagnostic performances of fpMRI and mpMRI were evaluated. Kappa coefficient (κ) was used to determine the interreader and intrareader agreement. A detailed cost analysis was performed for each protocol. STATISTICAL TESTS Receiver operating characteristics analysis, area under the curve (AUC), and κ test were used. Diagnostic performance parameters were also calculated. RESULTS Of the 63 malignant index lesions (csPCA), 53/63 of those (84.1%) originated from the peripheral zone and 10/63 lesions (15.9%) originated from the transition zone. The AUC values for fpMRI were 0.878 for reader 1, 0.937 for reader 2, and 0.855 for reader 3. For mpMRI, the AUC values were 0.893 for reader 1, 0.94 for reader 2, and 0.862 for reader 3. Inter and intrareader agreements were moderate to substantial (κ range, 0.5-0.79). The total cost per examination was calculated as €12.39 and €30.10 for fpMRI and mpMRI, respectively. DATA CONCLUSIONS Fast MRI protocol has similar diagnostic performance with mpMRI in detecting csPCA, and fpMRI can be considered an alternative protocol that could create a lower financial burden on health-care systems. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 6.
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Affiliation(s)
- Kadir Han Alver
- Department of Radiology, School of Medicine, University of Pamukkale, Denizli, Turkey
| | - Ahmet Baki Yagci
- Department of Radiology, School of Medicine, University of Pamukkale, Denizli, Turkey
| | - Ayse Ruksan Utebey
- Department of Radiology, School of Medicine, University of Pamukkale, Denizli, Turkey
| | - Nilay Sen Turk
- Department of Pathology, School of Medicine, University of Pamukkale, Denizli, Turkey
| | - Furkan Ufuk
- Department of Radiology, School of Medicine, University of Pamukkale, Denizli, Turkey
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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Kim H, Margolis DJA, Nagar H, Sabuncu MR. Pulse Sequence Dependence of a Simple and Interpretable Deep Learning Method for Detection of Clinically Significant Prostate Cancer Using Multiparametric MRI. Acad Radiol 2022; 30:966-970. [PMID: 36334976 DOI: 10.1016/j.acra.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for risk stratification and localization of prostate cancer (PCa). Thanks to the great success of deep learning models in computer vision, the potential application for early detection of PCa using mpMRI is imminent. MATERIALS AND METHODS Deep learning analysis of the PROSTATEx dataset. RESULTS In this study, we show a simple convolutional neural network (CNN) with mpMRI can achieve high performance for detection of clinically significant PCa (csPCa), depending on the pulse sequences used. The mpMRI model with T2-ADC-DWI achieved 0.90 AUC score in the held-out test set, not significantly better than the model using Ktrans instead of DWI (AUC 0.89). Interestingly, the model incorporating T2-ADC- Ktrans better estimates grade. We also describe a saliency "heat" map. Our results show that csPCa detection models with mpMRI may be leveraged to guide clinical management strategies. CONCLUSION Convolutional neural networks incorporating multiple pulse sequences show high performance for detection of clinically-significant prostate cancer, and the model including dynamic contrast-enhanced information correlates best with grade.
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Affiliation(s)
- Heejong Kim
- School of Electrical & Computer Engineering, Cornell University and Cornell Tech, New York, NY, USA
| | | | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Mert R Sabuncu
- School of Electrical & Computer Engineering, Cornell University and Cornell Tech, New York, NY, USA
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Abstract
Prostate MRI is now established as a first-line investigation for individuals presenting with suspected localized or locally advanced prostate cancer. Successful delivery of the MRI-directed pathway for prostate cancer diagnosis relies on high-quality imaging as well as the interpreting radiologist's experience and expertise. Radiologist certification in prostate MRI may help limit interreader variability, optimize outcomes, and provide individual radiologists with documentation of meeting predefined standards. This AJR Expert Panel Narrative Review summarizes existing certification proposals, recognizing variable progress across regions in establishing prostate MRI certification programs. To our knowledge, Germany is the only country with a prostate MRI certification process that is currently available for radiologists. However, prostate MRI certification programs have also recently been proposed in the United States and United Kingdom and by European professional society consensus panels. Recommended qualification processes entail a multifaceted approach, incorporating components such as minimum case numbers, peer learning, course participation, continuing medical education credits, and feedback from pathology results. Given the diversity in health care systems, including in the provision and availability of MRI services, national organizations will likely need to take independent approaches to certification and accreditation. The relevant professional organizations should begin developing these programs or continue existing plans for implementation.
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Duan H, Iagaru A. The use of advanced imaging in guiding the further investigation and treatment of primary prostate cancer. Cancer Imaging 2022; 22:45. [PMID: 36057766 PMCID: PMC9441085 DOI: 10.1186/s40644-022-00481-3] [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: 05/17/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
In the era of precision medicine, oncological imaging techniques are advancing at a rapid pace, particularly molecular imaging with promising new targets for prostate cancer (PC) such as gastrin releasing peptide receptors (GRPR) along the established and indispensable prostate specific membrane antigen (PSMA). As PC is characterized by heterogenous tumor biology ranging from indolent to aggressive disease, distinguishing clinically significant tumors from indolent disease is critical. Multiparametric MRI- and PET-targeted prostate biopsies mitigate the shortcomings and risks of standard systematic template biopsy by identifying more significant cancers.Focal treatment for localized disease is a minimally invasive approach that targets the index tumor - the lesion of the highest grade - while sparing the surrounding healthy tissue. Real-time MRI-guidance and thermal control with MR-thermometry, improves treatment accuracy and results in lower rates of functional side effects. PET imaging could be an useful tool to assess response to treatment compared to invasive prostate biopsies.In this comprehensive review, we focus on the image-guided detection and treatment of localized primary prostate cancer, its current status and future perspectives.
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Affiliation(s)
- Heying Duan
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA.
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Liu Y, Wang S, Xiang LH, Xu G, Dong L, Sun Y, Ye B, Zhang Y, Xu H. The potential of a nomogram combined PI-RADS v2.1 and contrast-enhanced ultrasound (CEUS) to reduce unnecessary biopsies in prostate cancer diagnostics. Br J Radiol 2022; 95:20220209. [PMID: 35877385 PMCID: PMC9815734 DOI: 10.1259/bjr.20220209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/20/2022] [Accepted: 07/18/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To develop a nomogram prediction model based on Prostate Imaging Reporting and Data System v.2.1 (PI-RADS v2.1) and contrast-enhanced ultrasound (CEUS) for predicting prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in males with prostate-specific antigen (PSA) 4-10 ng ml-1 to avoid unnecessary biopsy. METHODS A total of 490 patients who underwent prostate biopsy for PSA 4-10 ng ml-1 were enrolled and randomly divided into a pilot cohort (70%) and a validation cohort (30%). Univariate and multivariate logistic regression models were constructed to select potential predictors of PCa and csPCa, and a nomogram was created. The area under receiver operating characteristic (ROC) curve (AUC) was calculated, and compared using DeLong's test. The diagnostic performance and unnecessary biopsy rate of the nomogram prediction model were also assessed. Hosmer-Lemeshow goodness-of-fit test was employed to test for model fitness. RESULTS The multivariate analysis revealed that features independently associated with PCa and csPCa were age, PI-RADS score and CEUS manifestations. Incorporating these factors, the nomogram achieved good discrimination performance of AUC 0.843 for PCa, 0.876 for csPCa in the pilot cohort, and 0.818 for PCa, 0.857 for csPCa in the validation cohort, respectively, and had well-fitted calibration curves. And the diagnostic performance of the nomogram was comparable to the model including all the parameters (p > 0.05). Besides, the nomogram prediction model yielded meaningful reduction in unnecessary biopsy rate (from 74.8 to 21.1% in PCa, and from 83.7 to 5.4% in csPCa). CONCLUSIONS The nomogram prediction model based on age, PI-RADS v2.1 and CEUS achieved an optimal prediction of PCa and csPCa. Using this model, the PCa risk for an individual patient can be estimated, which can lead to a rational biopsy choice. ADVANCES IN KNOWLEDGE This study gives an account of improving pre-biopsy risk stratification in males with "gray zone" PSA level through PI-RADS v2.1 and CEUS.
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de Rooij M, van Poppel H, Barentsz JO. Risk Stratification and Artificial Intelligence in Early Magnetic Resonance Imaging-based Detection of Prostate Cancer. Eur Urol Focus 2022; 8:1187-1191. [PMID: 34922897 DOI: 10.1016/j.euf.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/18/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022]
Abstract
Magnetic resonance imaging (MRI) has transformed the diagnostic pathway for prostate cancer and now plays an upfront role before prostate biopsies. If a suspicious lesion is found on MRI, the subsequent biopsy can be targeted. A sharp increase is expected in the number of men who will undergo prostate MRI. The challenge is to provide good image quality and diagnostic accuracy while meeting the demands of the expected higher workload. A possible solution to this challenge is to include a suitable risk stratification tool before imaging. Other solutions, such as smarter and shorter MRI protocols, need to be explored. For most of these solutions, artificial intelligence (AI) can play an important role. AI applications have the potential to improve the diagnostic quality of the prostate MRI pathway and speed up the work. PATIENT SUMMARY: The use of prostate magnetic resonance imaging (MRI) for diagnosis of prostate cancer is increasing. Risk stratification of patients before imaging and the use of shorter scan protocols can help in managing MRI resources. Artificial intelligence can also play a role in automating some tasks.
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Affiliation(s)
- Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hendrik van Poppel
- Department of Development and Regeneration, University Hospital KU Leuven, Leuven, Belgium
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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