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Fennessy FM, Maier SE. Quantitative diffusion MRI in prostate cancer: Image quality, what we can measure and how it improves clinical assessment. Eur J Radiol 2023; 167:111066. [PMID: 37651828 PMCID: PMC10623580 DOI: 10.1016/j.ejrad.2023.111066] [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: 07/05/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
Diffusion-weighted imaging is a dependable method for detection of clinically significant prostate cancer. In prostate tissue, there are several compartments that can be distinguished from each other, based on different water diffusion decay signals observed. Alterations in cell architecture, such as a relative increase in tumor infiltration and decrease in stroma, will influence the observed diffusion signal in a voxel due to impeded random motion of water molecules. The amount of restricted diffusion can be assessed quantitatively by measuring the apparent diffusion coefficient (ADC) value. This is traditionally calculated using a monoexponential decay formula represented by the slope of a line produced between the logarithm of signal intensity decay plotted against selected b-values. However, the choice and number of b-values and their distribution, has a significant effect on the measured ADC values. There have been many models that attempt to use higher-order functions to better describe the observed diffusion signal decay, requiring an increased number and range of b-values. While ADC can probe heterogeneity on a macroscopic level, there is a need to optimize advanced diffusion techniques to better interrogate prostate tissue microstructure. This could be of benefit in clinical challenges such as identifying sparse tumors in normal prostate tissue or better defining tumor margins. This paper reviews the principles of diffusion MRI and novel higher order diffusion signal analysis techniques to improve the detection of prostate cancer.
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Affiliation(s)
- Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Stephan E Maier
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hoang-Dinh A, Nguyen-Quang T, Bui-Van L, Gonindard-Melodelima C, Souchon R, Rouvière O. Reproducibility of apparent diffusion coefficient measurement in normal prostate peripheral zone at 1.5T MRI. Diagn Interv Imaging 2022; 103:545-554. [PMID: 35773099 DOI: 10.1016/j.diii.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to quantify the influence of factors of variability on apparent diffusion coefficient (ADC) estimation in the normal prostate peripheral zone (PZ). MATERIALS AND METHODS Fifty healthy volunteers underwent in 2017 (n = 17) or 2020 (n = 33) two-point (0, 800 s/mm²) prostate diffusion-weighted imaging in the morning on 1.5 T scanners A and B from different manufacturers. Additional five-point (50, 150, 300, 500, 800 s/mm²) acquisitions were performed on scanner B in the morning and evening. ADC was measured in PZ at midgland using ADC maps reconstructed with various b-value combinations. ADC distributions from 2017 and 2020 were compared using Wilcoxon rank sum test. ADC obtained in the same volunteers were compared using Bland Altman methodology. The 95% confidence interval upper limit of the repeatability/reproducibility coefficient defined the lowest detectable ADC difference. RESULTS Forty-nine participants with a mean age of 24.6 ± 3.8 [SD] years (range: 21-37 years) were finally included. ADC distributions from 2017 and 2020 were not significantly different and were combined. Despite high individual variability, there was no significant bias (10 × 10-6 mm²/s, P = 0.58) between ADC measurements made on both scanners. On scanner B, differences in lowest b-values chosen within the 0-500 s/mm² range for two-point ADC computation induced significant biases (56-109 × 10-6 mm²/s, P < 0.0001). ADC was significantly lower in the morning (bias: 33 × 10-6 mm²/s, P = 0.006). The number of b-values had little influence on ADC values. The lowest detectable ADC difference varied from 85 × 10-6 to 311 × 10-6 mm²/s across scanners, b-value combinations and periods of the day. CONCLUSIONS The MRI scanner, the lowest b-value used and the period of the day induce substantial variability in ADC computation.
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Affiliation(s)
- Au Hoang-Dinh
- Hanoï Medical University Hospital, Dong Da, Hanoi, Viet Nam
| | | | - Lenh Bui-Van
- Hanoï Medical University Hospital, Dong Da, Hanoi, Viet Nam
| | | | | | - Olivier Rouvière
- LabTAU, INSERM, U1032, 69000, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Vascular and Urinary Imaging, 69000, Lyon, France; Université de Lyon, Lyon 69003, France; Université Lyon 1, Lyon France; Faculté de Médecine, Lyon Est, 69003, Lyon, France.
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Bates DDB, Golia Pernicka JS, Fuqua JL, Paroder V, Petkovska I, Zheng J, Capanu M, Schilsky J, Gollub MJ. Diagnostic accuracy of b800 and b1500 DWI-MRI of the pelvis to detect residual rectal adenocarcinoma: a multi-reader study. Abdom Radiol (NY) 2020; 45:293-300. [PMID: 31690966 DOI: 10.1007/s00261-019-02283-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the sensitivity, specificity and intra-observer and inter-observer agreement of pelvic magnetic resonance imaging (MRI) b800 and b1500 s/mm2 sequences in the detection of residual adenocarcinoma after neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer (LARC). INTRODUCTION Detection of residual adenocarcinoma after neoadjuvant CRT for LARC has become increasingly important and relies on both MRI and endoscopic surveillance. Optimal MRI diffusion b values have yet to be established for this clinical purpose. METHODS From our MRI database between 2018 and 2019, we identified a cohort of 28 patients after exclusions who underwent MRI of the rectum before and after neoadjuvant chemoradiation with a protocol that included both b800 and b1500 s/mm2 diffusion sequences. Four radiologists experienced in rectal MRI interpreted the post-CRT MRI studies with either b800 DWI or b1500 DWI, and a minimum of 2 weeks later re-interpreted the same studies using the other b value sequence. Surgical pathology or endoscopic follow-up for 1 year without tumor re-growth was used as the reference standard. Descriptive statistics compared accuracy for each reader and for all readers combined between b values. Inter-observer agreement was assessed using kappa statistics. A p value of 0.05 or less was considered significant. RESULTS Within the cohort, 19/28 (67.9%) had residual tumor, while 9/28 (32.1%) had a complete response. Among four readers, one reader had increased sensitivity for detection of residual tumor at b1500 s/mm2 (0.737 vs. 0.526, p = 0.046). There was no significant difference between detection of residual tumor at b800 and at b1500 for the rest of the readers. With all readers combined, the pooled sensitivity was 0.724 at b1500 versus 0.605 at b800, but this was not significant (p = 0.119). There was no difference in agreement between readers at the two b value settings (67.8% at b800 vs. 72.0% at b1500), or for any combination of individual readers. CONCLUSION Aside from one reader demonstrating increased sensitivity, no significant difference in accuracy parameters or inter-observer agreement was found between MR using b800 and b1500 for the detection of residual tumor after neoadjuvant CRT for LARC. However, there was a suggestion of a trend towards increased sensitivity with b1500, and further studies using larger cohorts may be needed to further investigate this topic.
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Diagnostic accuracy of b800 and b1500 DWI-MRI of the pelvis to detect residual rectal adenocarcinoma: a multi-reader study. Abdom Radiol (NY) 2020. [PMID: 31690966 DOI: 10.1007/s00261-019-02283-x.pmid:31690966;pmcid:pmc7386086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
PURPOSE To compare the sensitivity, specificity and intra-observer and inter-observer agreement of pelvic magnetic resonance imaging (MRI) b800 and b1500 s/mm2 sequences in the detection of residual adenocarcinoma after neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer (LARC). INTRODUCTION Detection of residual adenocarcinoma after neoadjuvant CRT for LARC has become increasingly important and relies on both MRI and endoscopic surveillance. Optimal MRI diffusion b values have yet to be established for this clinical purpose. METHODS From our MRI database between 2018 and 2019, we identified a cohort of 28 patients after exclusions who underwent MRI of the rectum before and after neoadjuvant chemoradiation with a protocol that included both b800 and b1500 s/mm2 diffusion sequences. Four radiologists experienced in rectal MRI interpreted the post-CRT MRI studies with either b800 DWI or b1500 DWI, and a minimum of 2 weeks later re-interpreted the same studies using the other b value sequence. Surgical pathology or endoscopic follow-up for 1 year without tumor re-growth was used as the reference standard. Descriptive statistics compared accuracy for each reader and for all readers combined between b values. Inter-observer agreement was assessed using kappa statistics. A p value of 0.05 or less was considered significant. RESULTS Within the cohort, 19/28 (67.9%) had residual tumor, while 9/28 (32.1%) had a complete response. Among four readers, one reader had increased sensitivity for detection of residual tumor at b1500 s/mm2 (0.737 vs. 0.526, p = 0.046). There was no significant difference between detection of residual tumor at b800 and at b1500 for the rest of the readers. With all readers combined, the pooled sensitivity was 0.724 at b1500 versus 0.605 at b800, but this was not significant (p = 0.119). There was no difference in agreement between readers at the two b value settings (67.8% at b800 vs. 72.0% at b1500), or for any combination of individual readers. CONCLUSION Aside from one reader demonstrating increased sensitivity, no significant difference in accuracy parameters or inter-observer agreement was found between MR using b800 and b1500 for the detection of residual tumor after neoadjuvant CRT for LARC. However, there was a suggestion of a trend towards increased sensitivity with b1500, and further studies using larger cohorts may be needed to further investigate this topic.
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Ueno YR, Tamada T, Takahashi S, Tanaka U, Sofue K, Kanda T, Nogami M, Ohno Y, Hinata N, Fujisawa M, Murakami T. Computed Diffusion-Weighted Imaging in Prostate Cancer: Basics, Advantages, Cautions, and Future Prospects. Korean J Radiol 2018; 19:832-837. [PMID: 30174471 PMCID: PMC6082756 DOI: 10.3348/kjr.2018.19.5.832] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
Computed diffusion-weighted MRI is a recently proposed post-processing technique that produces b-value images from diffusion-weighted imaging (DWI), acquired using at least two different b-values. This article presents an argument for computed DWI for prostate cancer by viewing four aspects of DWI: fundamentals, image quality and diagnostic performance, computing procedures, and future uses.
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Affiliation(s)
- Yoshiko R Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki 701-0192, Japan
| | - Satoru Takahashi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Utaru Tanaka
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Tomonori Kanda
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.,Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Nobuyuki Hinata
- Department of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Godley KC, Syer TJ, Toms AP, Smith TO, Johnson G, Cameron D, Malcolm PN. Accuracy of high b-value diffusion-weighted MRI for prostate cancer detection: a meta-analysis. Acta Radiol 2018; 59:105-113. [PMID: 28376634 DOI: 10.1177/0284185117702181] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The diagnostic accuracy of diffusion-weighted imaging (DWI) to detect prostate cancer is well-established. DWI provides visual as well as quantitative means of detecting tumor, the apparent diffusion coefficient (ADC). Recently higher b-values have been used to improve DWI's diagnostic performance. Purpose To determine the diagnostic performance of high b-value DWI at detecting prostate cancer and whether quantifying ADC improves accuracy. Material and Methods A comprehensive literature search of published and unpublished databases was performed. Eligible studies had histopathologically proven prostate cancer, DWI sequences using b-values ≥ 1000 s/mm2, less than ten patients, and data for creating a 2 × 2 table. Study quality was assessed with QUADAS-2 (Quality Assessment of diagnostic Accuracy Studies). Sensitivity and specificity were calculated and tests for statistical heterogeneity and threshold effect performed. Results were plotted on a summary receiver operating characteristic curve (sROC) and the area under the curve (AUC) determined the diagnostic performance of high b-value DWI. Results Ten studies met eligibility criteria with 13 subsets of data available for analysis, including 522 patients. Pooled sensitivity and specificity were 0.59 (95% confidence interval [CI], 0.57-0.61) and 0.92 (95% CI, 0.91-0.92), respectively, and the sROC AUC was 0.92. Subgroup analysis showed a statistically significant ( P = 0.03) improvement in accuracy when using tumor visual assessment rather than ADC. Conclusion High b-value DWI gives good diagnostic performance for prostate cancer detection and visual assessment of tumor diffusion is significantly more accurate than ROI measurements of ADC.
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Affiliation(s)
- Keith Craig Godley
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Andoni Paul Toms
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Thon A, Teichgräber U, Tennstedt-Schenk C, Hadjidemetriou S, Winzler S, Malich A, Papageorgiou I. Computer aided detection in prostate cancer diagnostics: A promising alternative to biopsy? A retrospective study from 104 lesions with histological ground truth. PLoS One 2017; 12:e0185995. [PMID: 29023572 PMCID: PMC5638330 DOI: 10.1371/journal.pone.0185995] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) diagnosis by means of multiparametric magnetic resonance imaging (mpMRI) is a current challenge for the development of computer-aided detection (CAD) tools. An innovative CAD-software (Watson Elementary™) was proposed to achieve high sensitivity and specificity, as well as to allege a correlate to Gleason grade. AIM/OBJECTIVE To assess the performance of Watson Elementary™ in automated PCa diagnosis in our hospital´s database of MRI-guided prostate biopsies. METHODS The evaluation was retrospective for 104 lesions (47 PCa, 57 benign) from 79, 64.61±6.64 year old patients using 3T T2-weighted imaging, Apparent Diffusion Coefficient (ADC) maps and dynamic contrast enhancement series. Watson Elementary™ utilizes signal intensity, diffusion properties and kinetic profile to compute a proportional Gleason grade predictor, termed Malignancy Attention Index (MAI). The analysis focused on (i) the CAD sensitivity and specificity to classify suspect lesions and (ii) the MAI correlation with the histopathological ground truth. RESULTS The software revealed a sensitivity of 46.80% for PCa classification. The specificity for PCa was found to be 75.43% with a positive predictive value of 61.11%, a negative predictive value of 63.23% and a false discovery rate of 38.89%. CAD classified PCa and benign lesions with equal probability (P 0.06, χ2 test). Accordingly, receiver operating characteristic analysis suggests a poor predictive value for MAI with an area under curve of 0.65 (P 0.02), which is not superior to the performance of board certified observers. Moreover, MAI revealed no significant correlation with Gleason grade (P 0.60, Pearson´s correlation). CONCLUSION The tested CAD software for mpMRI analysis was a weak PCa biomarker in this dataset. Targeted prostate biopsy and histology remains the gold standard for prostate cancer diagnosis.
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Affiliation(s)
- Anika Thon
- Institute of Diagnostic and Interventional Radiology, Department of Experimental Radiology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
- Institute of Radiology, Suedharz Hospital Nordhausen gGmbH, Nordhausen, Germany
| | - Ulf Teichgräber
- Institute of Diagnostic and Interventional Radiology, Department of Experimental Radiology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | | | - Stathis Hadjidemetriou
- Department of Electrical Engineering and Informatics, Cyprus University of Technology, Limassol, Cyprus
| | - Sven Winzler
- Institute of Radiology, Suedharz Hospital Nordhausen gGmbH, Nordhausen, Germany
| | - Ansgar Malich
- Institute of Radiology, Suedharz Hospital Nordhausen gGmbH, Nordhausen, Germany
| | - Ismini Papageorgiou
- Institute of Radiology, Suedharz Hospital Nordhausen gGmbH, Nordhausen, Germany
- * E-mail:
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Kwon MR, Kim CK, Kim JH. PI-RADS version 2: evaluation of diffusion-weighted imaging interpretation between b = 1000 and b = 1500 s mm -2. Br J Radiol 2017; 90:20170438. [PMID: 28830221 DOI: 10.1259/bjr.20170438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the variability of diffusion-weighted imaging (DWI) interpretation of Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) in evaluating prostate cancer (PCa). METHODS 154 patients with PCa underwent multiparametric 3T MRI, followed by radical prostatectomy. DWI with different b values (b = 0, 100, 1000 and 1500 s mm-2) was obtained. Using the PI-RADS v2, two radiologists independently scored suspicious lesions in each patient and compared DWI of b = 1000 (DWI1000) with 1500 (DWI1500) s mm-2. RESULTS On DWI1000 and DWI1500, the intermethod and interobserver agreements of DWI scores were excellent in all patients (κ ≥ 0.873). In each peripheral zone and transition zone DWI scores, both observers showed excellent intermethod agreement between DWI1000 and DWI1500 (κ ≥ 0.897), and interobserver agreement for DWI1000 and DWI1500 was good to excellent (κ ≥ 0.796). For estimating clinically significant cancer, the area under receiver operating characteristics curves of DWI1000 and DWI1500 were 0.710 and 0.724 for observer 1 (p = 0.11), and 0.649 and 0.656 for observer 2 (p = 0.12), respectively. CONCLUSION The PI-RADS v2 scoring at 3T shows excellent agreement between DWI1000 and DWI1500 in evaluating PCa, with excellent inter-observer agreement. Advance in knowledge: DWI using b = 1000 s mm-2 instead of b = 1500 s mm-2 reduces examination time or image distortion, with improved the signal-to-noise ratio.
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Affiliation(s)
- Mi-Ri Kwon
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,2 Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jae-Hun Kim
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Head-To-Head Comparison Between High- and Standard-b-Value DWI for Detecting Prostate Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2017; 210:91-100. [PMID: 28952806 DOI: 10.2214/ajr.17.18480] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this study was to perform a head-to-head comparison between high-b-value (> 1000 s/mm2) and standard-b-value (800-1000 s/mm2) DWI regarding diagnostic performance in the detection of prostate cancer. MATERIALS AND METHODS The MEDLINE and EMBASE databases were searched up to April 1, 2017. The analysis included diagnostic accuracy studies in which high- and standard-b-value DWI were used for prostate cancer detection with histopathologic examination as the reference standard. Methodologic quality was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies tool. Sensitivity and specificity of all studies were calculated and were pooled and plotted in a hierarchic summary ROC plot. Meta-regression and multiple-subgroup analyses were performed to compare the diagnostic performances of high- and standard-b-value DWI. RESULTS Eleven studies (789 patients) were included. High-b-value DWI had greater pooled sensitivity (0.80 [95% CI, 0.70-0.87]) (p = 0.03) and specificity (0.92 [95% CI, 0.87-0.95]) (p = 0.01) than standard-b-value DWI (sensitivity, 0.78 [95% CI, 0.66-0.86]); specificity, 0.87 [95% CI, 0.77-0.93] (p < 0.01). Multiple-subgroup analyses showed that specificity was consistently higher for high- than for standard-b-value DWI (p ≤ 0.05). Sensitivity was significantly higher for high- than for standard-b-value DWI only in the following subgroups: peripheral zone only, transition zone only, multiparametric protocol (DWI and T2-weighted imaging), visual assessment of DW images, and per-lesion analysis (p ≤ 0.04). CONCLUSION In a head-to-head comparison, high-b-value DWI had significantly better sensitivity and specificity for detection of prostate cancer than did standard-b-value DWI. Multiple-subgroup analyses showed that specificity was consistently superior for high-b-value DWI.
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Park JE, Han K, Sung YS, Chung MS, Koo HJ, Yoon HM, Choi YJ, Lee SS, Kim KW, Shin Y, An S, Cho HM, Park SH. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal. Korean J Radiol 2017; 18:888-897. [PMID: 29089821 PMCID: PMC5639154 DOI: 10.3348/kjr.2017.18.6.888] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test. Materials and Methods Sixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis. Results Thirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies. Conclusion Greater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Mi Sun Chung
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Youngbin Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Suah An
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyo-Min Cho
- Korea Research Institute of Standards and Science, Daejeon 34113, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Adubeiro N, Nogueira ML, Nunes RG, Ferreira HA, Ribeiro E, La Fuente JMF. Apparent diffusion coefficient in the analysis of prostate cancer: determination of optimal b-value pair to differentiate normal from malignant tissue. Clin Imaging 2017; 47:90-95. [PMID: 28917137 DOI: 10.1016/j.clinimag.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Determining optimal b-value pair for differentiation between normal and prostate cancer (PCa) tissues. METHODS Forty-three patients with diagnosis or PCa symptoms were included. Apparent diffusion coefficient (ADC) was estimated using minimum and maximum b-values of 0, 50, 100, 150, 200, 500s/mm2 and 500, 800, 1100, 1400, 1700 and 2000s/mm2, respectively. Diagnostic performances were evaluated when Area-under-the-curve (AUC)>95%. RESULTS 15 of the 35 b-values pair surpassed this AUC threshold. The pair (50, 2000s/mm2) provided the highest AUC (96%) with ADC cutoff 0.89×10-3mm2/s, sensitivity 95.5%, specificity 93.2% and accuracy 94.4%. CONCLUSIONS The best b-value pair was b=50, 2000s/mm2.
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Affiliation(s)
- Nuno Adubeiro
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Department of Radiology, School of Health of Porto/Polytechnic Institute of Porto (ESS/IPP), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal.
| | - Maria Luísa Nogueira
- Department of Radiology, School of Health of Porto/Polytechnic Institute of Porto (ESS/IPP), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
| | - Rita G Nunes
- Institute for Systems and Robotics and Department of Bioengineering, LARSyS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Hugo Alexandre Ferreira
- Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016 Lisboa, Portugal
| | - Eduardo Ribeiro
- Department of Radiology, MRI Unit, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal; Department of Radiology, School of Health of Porto (ESS), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
| | - José Maria Ferreira La Fuente
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.; Department of Urology, Center Hospitalar Porto (CHP), Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
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Helfrich O, Puech P, Betrouni N, Pinçon C, Ouzzane A, Rizk J, Marcq G, Randazzo M, Durand M, Lakroum S, Leroy X, Villers A. Quantified analysis of histological components and architectural patterns of gleason grades in apparent diffusion coefficient restricted areas upon diffusion weighted MRI for peripheral or transition zone cancer locations. J Magn Reson Imaging 2017; 46:1786-1796. [PMID: 28383776 DOI: 10.1002/jmri.25716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/14/2017] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To quantify and compare the histological components and architectural patterns of Gleason grades in cancerous areas with restriction on apparent diffusion coefficient (ADC) maps. MATERIALS AND METHODS Twelve consecutive cases with 14 separate ADC restriction areas, positive for cancer in the peripheral zone (PZ) and transition zone (TZ) were included. All had 3 Tesla MRI and radical prostatectomy. Ten regions of interest (ROIs) within and outside the 14 ADC restriction areas positive for cancer were selected. For each ROI, we performed quantitative analysis of (a) prostate benign and malignant histological component surface ratios, including stroma, glands, epithelium, lumen, cellular nuclei; (b) percent of Gleason grades and measures of ADC values. Means of histological components according to ADC restriction for cancerous area were compared with analyses of variance with repeated measures. RESULTS Independent predictors of the probability of cancer were median epithelium/ROI ratio (P = 0.001) and nuclei/ROI ratio (P = 0.03). Independent predictors of the probability of ADC restriction were malignant glands/ROI and luminal space/ROI (P < 0.0001). Effect of malignant glands/ROI area was different according to the localization of the ROI (P = 0.03). We observed an overall difference between the means for all of the histological components for the comparison of true positive and false negative (P < 0.0001), except for the percent of Gleason grade 4 (P = 0.18). In TZ cancers, a predominant grade 3 pattern was associated with low ADC values. In PZ cancers, a predominant grade 4 pattern was associated with low ADC values. CONCLUSION Determinants of low ADC were high ratio of malignant glands/ROI area which may be seen in Gleason grades 3 or 4 cancers. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1786-1796.
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Affiliation(s)
- Olivier Helfrich
- Department of Urology, CHRU Lille, Lille university, Lille, France.,Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Philippe Puech
- Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France.,Department of Radiology, CHRU Lille, Lille university, Lille, France
| | - Nacim Betrouni
- Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Claire Pinçon
- EA 2694 - Lille university, Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Adil Ouzzane
- Department of Urology, CHRU Lille, Lille university, Lille, France.,Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Jérome Rizk
- Department of Urology, CHRU Lille, Lille university, Lille, France.,Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Gauthier Marcq
- Department of Urology, CHRU Lille, Lille university, Lille, France
| | - Marco Randazzo
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Matthieu Durand
- Department of Urology, CHU Nice, Nice-Sophia-Antipolis University, France
| | - Said Lakroum
- Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Xavier Leroy
- Department of Pathology, CHRU Lille, Lille university, Lille, France
| | - Arnauld Villers
- Department of Urology, CHRU Lille, Lille university, Lille, France.,Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
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El-Samei HAEKA, Amin MF, Hassan EE. Assessment of the accuracy of multi-parametric MRI with PI-RADS 2.0 scoring system in the discrimination of suspicious prostatic focal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Choi YJ, Chung MS, Koo HJ, Park JE, Yoon HM, Park SH. Does the Reporting Quality of Diagnostic Test Accuracy Studies, as Defined by STARD 2015, Affect Citation? Korean J Radiol 2016; 17:706-14. [PMID: 27587959 PMCID: PMC5007397 DOI: 10.3348/kjr.2016.17.5.706] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 05/29/2016] [Indexed: 01/30/2023] Open
Abstract
Objective To determine the rate with which diagnostic test accuracy studies that are published in a general radiology journal adhere to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015, and to explore the relationship between adherence rate and citation rate while avoiding confounding by journal factors. Materials and Methods All eligible diagnostic test accuracy studies that were published in the Korean Journal of Radiology in 2011–2015 were identified. Five reviewers assessed each article for yes/no compliance with 27 of the 30 STARD 2015 checklist items (items 28, 29, and 30 were excluded). The total STARD score (number of fulfilled STARD items) was calculated. The score of the 15 STARD items that related directly to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was also calculated. The number of times each article was cited (as indicated by the Web of Science) after publication until March 2016 and the article exposure time (time in months between publication and March 2016) were extracted. Results Sixty-three articles were analyzed. The mean (range) total and QUADAS-2-related STARD scores were 20.0 (14.5–25) and 11.4 (7–15), respectively. The mean citation number was 4 (0–21). Citation number did not associate significantly with either STARD score after accounting for exposure time (total score: correlation coefficient = 0.154, p = 0.232; QUADAS-2-related score: correlation coefficient = 0.143, p = 0.266). Conclusion The degree of adherence to STARD 2015 was moderate for this journal, indicating that there is room for improvement. When adjusted for exposure time, the degree of adherence did not affect the citation rate.
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Affiliation(s)
- Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Mi Sun Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Radiotherapy Boost for the Dominant Intraprostatic Cancer Lesion—A Systematic Review and Meta-Analysis. Clin Genitourin Cancer 2016; 14:189-97. [DOI: 10.1016/j.clgc.2015.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 12/14/2022]
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16
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Grant KB, Agarwal HK, Shih JH, Bernardo M, Pang Y, Daar D, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. Comparison of calculated and acquired high b value diffusion-weighted imaging in prostate cancer. ACTA ACUST UNITED AC 2015; 40:578-86. [PMID: 25223523 DOI: 10.1007/s00261-014-0246-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine whether the performance of calculated high b value diffusion-weighted images (DWI) derived from regular lower b value DWI using exponential diffusion decay models (intravoxel incoherent motion = IVIM and diffusional kurtosis = DK) is comparable to acquired high b value DWI in prostate cancer detection. MATERIALS AND METHODS One hundred six patients underwent diagnostic multiparametric prostate MRI at 3T using an endorectal coil. Five b value (b = 0, 188, 375, 563, 750 s/mm(2)) DWI and high b value (b = 0, 1000 and 2000 s/mm(2)) DWI were acquired. Calculated high b value (b = 1000 s/mm(2) and b = 2000 s/mm(2)) DWI were derived from the DWI dataset using DK and IVIM models. Calculated and acquired high b value DWI images were compared for lesion visibility and image quality by two experienced radiologists (1 and 6 years of experience). GEE with Wald test was used to compare the image quality among the four calculated high b value DWI by comparing the proportion of lesions in each model which were comparable to the acquired images. This comparison was done for all lesions and by lesion location (PZ or CG; low apical/anterior or apical/mid/base) RESULTS More lesions were visible on acquired b = 2000 s/mm(2) compared to b = 1000 s/mm(2) DWI. Calculated high b value DWI using the IVIM model had approximately the same number of lesions as acquired high b value DWI, whereas the DK model had fewer lesions than acquired images. The image quality of calculated high b value DWI was comparable to that of acquired images, and the highest quality images were obtained with b1000IVIM. The image quality of calculated b1000IVIM was the same as that of acquired DWI in apical/mid/base (98%) locations and comparable in low apical and anterior (95.4%) locations. The image quality of calculated b2000IVIM was inferior in both apical/mid/base (86.2%) locations and comparable in low apical and anterior (83.9%) locations. CONCLUSION Calculated high b value DWI obtained using IVIM model has same lesion visibility as that of acquired DWI. The image quality of calculated high b value DWI relative to corresponding acquired DWI decreases with increase in b value.
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Affiliation(s)
- Kinzya B Grant
- Molecular Imaging Program, National Cancer Institute (NCI), NIH 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD, 20892-1088, USA
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Barrett T, Priest AN, Lawrence EM, Goldman DA, Warren AY, Gnanapragasam VJ, Sala E, Gallagher FA. Ratio of Tumor to Normal Prostate Tissue Apparent Diffusion Coefficient as a Method for Quantifying DWI of the Prostate. AJR Am J Roentgenol 2015; 205:W585-93. [PMID: 26587948 DOI: 10.2214/ajr.15.14338] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the ability of the apparent diffusion coefficient (ADC) ratio of tumor to normal prostate tissue to overcome inherent variability based on choice of b values, with whole-mount histopathologic analysis as the reference standard for tumor identification. MATERIALS AND METHODS Thirty-nine patients with prostate cancer underwent 3-T MRI, including DWI with b values of 0, 150, 750, and 1000 s/mm(2). ADC maps were derived from four b value combinations. Histologically derived ROIs were defined for prostate tumor and benign prostate tissue to generate a ratio. The concordance correlation coefficient was used to evaluate agreement and reproducibility at different b values. Bland-Altman plots were used to evaluate the pattern of relative measurement difference between b value combinations. The relationship between ADC values and Gleason score was tested by Spearman rank correlation. RESULTS ADC values varied depending on the b value combination selected. The concordance correlation coefficient was higher for ADC ratios (0.883; 95% CI, 0.816-0.927) compared with absolute ADC values for normal tissue (0.873; 95% CI, 0.799-0.921) and tumor (0.792; 95% CI, 0.688-0.864). The ADC ratio concordance correlation coefficient for transition zone tumors was considerably higher than that for the peripheral zone in all cases. Bland-Altman analysis showed higher variation for ADC maps incorporating a b value of zero for both ratio and absolute values. There was a stronger inverse relationship to Gleason score for ADC ratios (rho, -0.354 to -0.456) compared with absolute ADC values (rho, -0.117 to -0.379). CONCLUSION The use of a simple ratio of prostate tumor ADC to normal tissue ADC improved the concordance between different b value combinations and could provide a more robust means of assessing restricted diffusion in the prostate.
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Affiliation(s)
- Tristan Barrett
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Andrew N Priest
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Edward M Lawrence
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Debra A Goldman
- 2 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anne Y Warren
- 3 Department of Histopathology, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom
| | - Vincent J Gnanapragasam
- 4 Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
- 5 Department of Oncology, Translational Prostate Cancer Group, University of Cambridge, Hutchinson-MRC Research Centre, Cambridge, United Kingdom
| | - Evis Sala
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
- 6 Present address: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ferdia A Gallagher
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
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Wetter A, Nensa F, Lipponer C, Guberina N, Olbricht T, Schenck M, Schlosser TW, Gratz M, Lauenstein TC. High and ultra-high b-value diffusion-weighted imaging in prostate cancer: a quantitative analysis. Acta Radiol 2015; 56:1009-15. [PMID: 25168023 DOI: 10.1177/0284185114547900] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is routinely used in magnetic resonance imaging (MRI) of prostate cancer. However, the routine use of b values higher than 1000 s/mm(2) is not clear up to present. Moreover, the complex diffusion behavior of malignant and benign prostate tissues hampers precise predictions of contrast in DWI images and apparent diffusion coefficient (ADC) maps. PURPOSE To quantitatively analyze DWI with different b values in prostate cancer and to identify b values best suitable for cancer detection. MATERIAL AND METHODS Forty-one patients with histologically proven prostate cancer were examined with high resolution T2-weighted imaging and DWI at 3 Tesla. Five different b values (0, 800, 1000, 1500, 2000 s/mm(2)) were applied. ADC values of tumors and reference areas were measured on ADC maps derived from different pairs of b values. Furthermore, signal intensities of DW images of tumors and reference areas were measured. For analysis, contrast ratios of ADC values and signal intensities of DW images were calculated and compared. RESULTS No significant differences were found between contrast ratios measured on ADC maps of all analyzed b value pairs (P = 0.43). Contrast ratios calculated from signal intensities of DW images were highest at b values of 1500 and 2000 s/mm(2) and differed significantly from contrast ratios at b values of 800 and 1000 s/mm(2) (P < 0.01). CONCLUSION Whereas contrast in ADC maps does not significantly change with different b values, contrast ratios of DW images are significantly higher at b-values of 1500 and 2000 s/mm(2) in comparison to b values of 800 and 1000 s/mm(2). Therefore, diagnostic performance of DWI in prostate cancer might be increased by application of b values higher than 1000 s/mm(2).
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Affiliation(s)
- Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christine Lipponer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Tobias Olbricht
- Department of Urology and Paediatric Urology, University Hospital Essen, Essen, Germany
| | - Marcus Schenck
- Department of Urology and Paediatric Urology, University Hospital Essen, Essen, Germany
| | - Thomas W Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Gratz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Thomas C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Hedgire SS, Eberhardt SC, Borczuk R, McDermott S, Harisinghani MG. Interpretation and reporting multiparametric prostate MRI: a primer for residents and novices. ACTA ACUST UNITED AC 2015; 39:1036-51. [PMID: 24566965 DOI: 10.1007/s00261-014-0097-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multiparametric MRI has developed as a tool for prostate cancer lesion detection, characterization, staging, surveillance, and imaging of local recurrence. Given the disease frequency and the growing importance of imaging, as reliance on PSA declines, radiologists involved in prostate MRI imaging must become proficient with the fundamentals of multiparametric prostate MRI (T2WI, DWI, DCE-MRI, and MR spectroscopy). Interpretation and reporting must yield accuracy, consistency, and add value to clinical care. This review provides a primer to novices and trainees learning about multiparametric prostate MRI. MRI technique is presented along with the use of particular MRI sequences. Relevant prostate anatomy is outlined and imaging features of prostate cancer with staging are discussed. Finally structured reporting is introduced, and some limitations of prostate MRI are discussed.
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Affiliation(s)
- Sandeep S Hedgire
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA,
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Tsili AC, Giannakis D, Sylakos A, Ntorkou A, Astrakas LG, Sofikitis N, Argyropoulou MI. Apparent diffusion coefficient values of normal testis and variations with age. Asian J Androl 2014; 16:493-7. [PMID: 24556745 PMCID: PMC4023385 DOI: 10.4103/1008-682x.122865] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The usefulness of diffusion-weighted magnetic resonance imaging (DWI) in the evaluation of scrotal pathology has recently been reported. A standard reference of normal testicular apparent diffusion coefficient (ADC) values and their variations with age is necessary when interpreting normal testicular anatomy and pathology. We evaluated 147 normal testes using DWI, including 71 testes from 53 men aged 20-39 years (group 1), 67 testes from 42 men aged 40-69 years (group 2) and nine testes from six men older than 70 years (group 3). DWI was performed along the axial plane, using a single shot, multislice spin-echo planar diffusion pulse sequence and b-values of 0 and 900 s mm-2 . The mean and standard deviation of the ADC values of normal testicular parenchyma were calculated for each age group separately. Analysis of variance (ANOVA) followed by post hoc analysis (Dunnett T3) was used for statistical purposes. The ADC values (× 10-3 mm 2 s-1 ) of normal testicular tissue were different among age groups (group 1: 1.08 ± 0.13; group 2: 1.15 ± 0.15 and group 3: 1.31 ± 0.22). ANOVA revealed differences in mean ADC among age groups (F = 11.391, P < 0.001). Post hoc analysis showed differences between groups 1 and 2 (P = 0.008) and between groups 1 and 3 (P = 0.043), but not between groups 2 and 3 (P = 0.197). Our findings suggest that ADC values of normal testicular tissue increase with advancing age.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, University of Ioannina, Ioannina, Greece
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Assessment of early renal allograft dysfunction with blood oxygenation level-dependent MRI and diffusion-weighted imaging. Eur J Radiol 2014; 83:2114-2121. [DOI: 10.1016/j.ejrad.2014.09.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/16/2014] [Accepted: 09/22/2014] [Indexed: 11/19/2022]
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Jie C, Rongbo L, Ping T. The value of diffusion-weighted imaging in the detection of prostate cancer: a meta-analysis. Eur Radiol 2014; 24:1929-41. [PMID: 24865693 PMCID: PMC4082652 DOI: 10.1007/s00330-014-3201-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/17/2014] [Accepted: 04/23/2014] [Indexed: 02/05/2023]
Abstract
Objectives To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) as a single non-invasive method in detecting prostate cancer (PCa) and to deduce its clinical utility. Methods A systematic literature search was performed to identify relevant original studies. Quality of included studies was assessed by QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). Data were extracted to calculate sensitivity and specificity as well as running the test of heterogeneity and threshold effect. The summary receiver operating characteristic (SROC) curve was drawn and area under SROC curve (AUC) served as a determination of the diagnostic performance of DWI for the detection of PCa. Results A total of 21 studies were included, with 27 subsets of data available for analysis. The pooled sensitivity and specificity with corresponding 95 % confidence interval (CI) were 0.62 (95 % CI 0.61–0.64) and 0.90 (95 % CI 0.89–0.90), respectively. Pooled positive likelihood ratio and negative likelihood ratio were 5.83 (95 % CI 4.61–7.37) and 0.30 (95 % CI 0.23–0.39), respectively. The AUC was 0.8991. Significant heterogeneity was observed. There was no notable publication bias. Conclusions DWI is an informative MRI modality in detecting PCa and shows moderately high diagnostic accuracy. General clinical application was limited because of the absence of standardized DW-MRI techniques. Key points • DWI provides incremental information for the detection and evaluation of PCa • DWI has moderately high diagnostic accuracy in detecting PCa • Patient condition, imaging protocols and study design positively influence diagnostic performance • General clinical application requires optimization of image acquisition and interpretation
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Affiliation(s)
- Chen Jie
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
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Tamada T, Kanomata N, Sone T, Jo Y, Miyaji Y, Higashi H, Yamamoto A, Ito K. High b value (2,000 s/mm2) diffusion-weighted magnetic resonance imaging in prostate cancer at 3 Tesla: comparison with 1,000 s/mm2 for tumor conspicuity and discrimination of aggressiveness. PLoS One 2014; 9:e96619. [PMID: 24802652 PMCID: PMC4011860 DOI: 10.1371/journal.pone.0096619] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/09/2014] [Indexed: 12/18/2022] Open
Abstract
Objective The objective of our study was to investigate tumor conspicuity and the discrimination potential for tumor aggressiveness on diffusion-weighted magnetic resonance imaging (DW-MRI) with high b value at 3-T. Materials and Methods The institutional review board approved this study and waived the requirement for informed consent. A total of 50 patients with prostate cancer (69 cancer foci; 48 in the PZ, 20 in the TZ, and one in whole prostate) who underwent multiparametric prostate MRI including DW-MRI (b values: 0, 1000 s/mm2 and 0, 2000 s/mm2) on a 3-T system were included. Lesion conspicuity score (LCS) using visual assessment (1 = invisible for surrounding normal site; 2 = slightly high intensity; 3 = moderately high; and 4 = very high) and tumor-normal signal intensity ratio (TNR) were assessed, and apparent diffusion coefficient (ADC, ×10−3 mm2/s) of the tumor regions and normal regions were measured. Results Mean LCS and TNR at 0, 2000 s/mm2 was significantly higher than those at 0, 1000 s/mm2 (p<0.001 for both). In addition, ADC at both 0, 1000 and 0, 2000 s/mm2 was found to distinguish intermediate or high risk cancer with Gleason score ≥7 from low risk cancer with Gleason score ≤6 (p<0.001 for both). Furthermore, ADC of tumor regions correlated with Gleason score at both 0, 1000 s/mm2 (ρ = −0.602; p<0.001) and 0, 2000 s/mm2 (ρ = −0.645; p<0.001). Conclusions For tumor conspicuity and characterization of prostate cancer on DW-MRI of 3-T MRI, b = 0, 2000 s/mm2 is more useful than b = 0, 1000 s/mm2.
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Affiliation(s)
- Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki city, Okayama, Japan
- * E-mail:
| | - Naoki Kanomata
- Department of Pathology, Kawasaki Medical School, Kurashiki city, Okayama, Japan
| | - Teruki Sone
- Department of Radiology, Kawasaki Medical School, Kurashiki city, Okayama, Japan
| | - Yoshimasa Jo
- Department of Urology, Kawasaki Medical School, Kurashiki city, Okayama, Japan
| | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki city, Okayama, Japan
| | - Hiroki Higashi
- Department of Radiology, Kawasaki Medical School, Kurashiki city, Okayama, Japan
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki city, Okayama, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Kawasaki Medical School, Kurashiki city, Okayama, Japan
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DWI of Prostate Cancer: Optimal b-Value in Clinical Practice. Prostate Cancer 2014; 2014:868269. [PMID: 24693438 PMCID: PMC3945287 DOI: 10.1155/2014/868269] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 11/17/2022] Open
Abstract
Aim. To compare the diagnostic performance of diffusion weighted imaging (DWI) using b-values of 1000 s/mm2 and 2000 s/mm2 at 3 Tesla (T) for the evaluation of clinically significant prostate cancer. Matherials and Methods. Seventy-eight prostate cancer patients underwent a 3T MRI scan followed by radical prostatectomy. DWI was performed using b-values of 0, 1000, and 2000 s/mm2 and qualitatively analysed by two radiologists. ADC maps were obtained at b-values of 1000 and 2000 s/mm2 and quantitatively analyzed in consensus. Results. For diagnosis of 78 prostate cancers the accuracy of DWI for the young reader was significantly greater at b = 2000 s/mm2 for the peripheral zone (PZ) but not for the transitional zone (TZ). For the experienced reader, DWI did not show significant differences in accuracy between b-values of 1000 and 2000 s/mm2. The quantitative analysis in the PZ and TZ was substantially superimposable between the two b-values, albeit with a higher accuracy with a b-value of 2000 s/mm2. Conclusions. With a b-value of 2000 s/mm2 at 3T both readers differentiated clinical significant cancer from benign tissue; higher b-values can be helpful for the less experienced readers.
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Evaluation of the PI-RADS scoring system for classifying mpMRI findings in men with suspicion of prostate cancer. BIOMED RESEARCH INTERNATIONAL 2013; 2013:252939. [PMID: 24396825 PMCID: PMC3876774 DOI: 10.1155/2013/252939] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/31/2013] [Accepted: 11/02/2013] [Indexed: 11/17/2022]
Abstract
Purpose. To evaluate the ESUR scoring system (PI-RADS) for multiparametric MRI of the prostate in clinical routine and to define a reliable way to generate an overall PI-RADS score. Methods. Retrospective analysis of all patients with a history of negative prebiopsies, who underwent 3 Tesla multiparametric MRI from October 2011 to April 2013 (n = 143): PI-RADS scores for each single modality were defined. To generate the overall PI-RADS score, an algorithm based approach summing up each single-modality score to a sum-score was compared to a more subjective approach, weighting the single modalities dependent on the radiologist's impression. Because of ongoing cancer suspicion 73 patients underwent targeted mpMRI-ultrasound image fusion rebiopsy. For this group thresholds for tumor incidences and malignancy were calculated. Results. 39 (53%) out of 73 targeted rebiopsies were cancer positive. The PI-RADS score correlated well with tumor incidence (AUC of 0.86, 95% CI 0.78 to 0.94) and malignancy (AUC 0.84, 95% CI 0.68 to 0.99). Regarding the sum-score a threshold of ≥10 turned out to be reliable for cancer detection (sensitivity 90%, specificity 62%) and for ≥13 for indicating higher malignancy (Gleason ≥4 + 3) (sensitivity 80%, specificity 86%). To generate the overall PI-RADS score, the use of an algorithm based approach was more reliable than that of the approach based on the radiologist's impression. Conclusion. The presented scoring system correlates well with tumor incidence and malignancy. To generate the overall PI-RADS score, it seems to be advisable to use an algorithm based instead of a subjective approach.
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Esen M, Onur MR, Akpolat N, Orhan I, Kocakoc E. Utility of ADC measurement on diffusion-weighted MRI in differentiation of prostate cancer, normal prostate and prostatitis. Quant Imaging Med Surg 2013; 3:210-6. [PMID: 24040617 DOI: 10.3978/j.issn.2223-4292.2013.08.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 08/27/2013] [Indexed: 01/01/2023]
Abstract
To determine the utility of apparent diffusion coefficient (ADC) values in differentiation of prostate cancer from normal prostate parenchyma and prostatitis we obtained ADC values of 50 patients at b 100, 600 and 1,000 s/mm(2) diffusion gradients. The ADC values of prostate cancer group were significantly lower than normal prostate and prostatitis group at b 600 and 1,000 s/mm(2) gradients. The ADC values at high diffusion gradients may be used in differentiation prostate cancer from normal prostate and prostatitis.
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Affiliation(s)
- Meltem Esen
- Department of Radiology, Inegol Government Hospital, Bursa, Turkey
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Akgun V, Karaman B, Battal B, Sari S. Re: diffusion-weighted imaging of prostate cancer: how can we use it accurately? Korean J Radiol 2013; 14:865. [PMID: 24043989 PMCID: PMC3772275 DOI: 10.3348/kjr.2013.14.5.865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/20/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Veysel Akgun
- Department of Radiology, Gulhane Military Medical School, Etlik-06018, Ankara, Turkey
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