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Kalinen S, Kallonen T, Gunell M, Ettala O, Jambor I, Knaapila J, Syvänen KT, Taimen P, Poutanen M, Aronen HJ, Ollila H, Pietilä S, Elo LL, Lamminen T, Hakanen AJ, Munukka E, Boström PJ. Differences in Gut Microbiota Profiles and Microbiota Steroid Hormone Biosynthesis in Men with and Without Prostate Cancer. EUR UROL SUPPL 2024; 62:140-150. [PMID: 38500636 PMCID: PMC10946286 DOI: 10.1016/j.euros.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Background Although prostate cancer (PCa) is the most common cancer in men in Western countries, there is significant variability in geographical incidence. This might result from genetic factors, discrepancies in screening policies, or differences in lifestyle. Gut microbiota has recently been associated with cancer progression, but its role in PCa is unclear. Objective Characterization of the gut microbiota and its functions associated with PCa. Design setting and participants In a prospective multicenter clinical trial (NCT02241122), the gut microbiota profiles of 181 men with a clinical suspicion of PCa were assessed utilizing 16S rRNA sequencing. Outcome measurements and statistical analysis Sequences were assigned to operational taxonomic units, differential abundance analysis, and α- and β-diversities, and predictive functional analyses were performed. Plasma steroid hormone levels corresponding to the predicted microbiota steroid hormone biosynthesis profiles were investigated. Results and limitations Of 364 patients, 181 were analyzed, 60% of whom were diagnosed with PCa. Microbiota composition and diversity were significantly different in PCa, partially affected by Prevotella 9, the most abundant genus of the cohort, and significantly higher in PCa patients. Predictive functional analyses revealed higher 5-α-reductase, copper absorption, and retinol metabolism in the PCa-associated microbiome. Plasma testosterone was associated negatively with the predicted microbial 5-α-reductase level. Conclusions Gut microbiota of the PCa patients differed significantly compared with benign individuals. Microbial 5-α-reductase, copper absorption, and retinol metabolism are potential mechanisms of action. These findings support the observed association of lifestyle, geography, and PCa incidence. Patient summary In this report, we found that several microbes and potential functions of the gut microbiota are altered in prostate cancer compared with benign cases. These findings suggest that gut microbiota could be the link between environmental factors and prostate cancer.
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Affiliation(s)
- Sofia Kalinen
- Research Center for Infections and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Teemu Kallonen
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
- Clinical Microbiome Bank, Microbe Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Marianne Gunell
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
- Clinical Microbiome Bank, Microbe Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Otto Ettala
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, Turku University Hospital and University of Turku, Turku, Finland
- Enterprise Service Group - Radiology, Mass General Brigham, Boston, MA
| | - Juha Knaapila
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kari T. Syvänen
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Matti Poutanen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hannu J. Aronen
- Department of Diagnostic Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Helena Ollila
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Sami Pietilä
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Laura L. Elo
- Institute of Biomedicine, University of Turku, Turku, Finland
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Tarja Lamminen
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti J. Hakanen
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
- Clinical Microbiome Bank, Microbe Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Eveliina Munukka
- Clinical Microbiome Bank, Microbe Center, Turku University Hospital and University of Turku, Turku, Finland
- Biocodex: Biocodex Nordics, Espoo, Finland
| | - Peter J. Boström
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
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Dai Z, Jambor I, Taimen P, Pantelic M, Elshaikh M, Dabaja A, Rogers C, Ettala O, Boström PJ, Aronen HJ, Merisaari H, Wen N. Prostate cancer detection and segmentation on MRI using non-local mask R-CNN with histopathological ground truth. Med Phys 2023; 50:7748-7763. [PMID: 37358061 DOI: 10.1002/mp.16557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Automatic detection and segmentation of intraprostatic lesions (ILs) on preoperative multiparametric-magnetic resonance images (mp-MRI) can improve clinical workflow efficiency and enhance the diagnostic accuracy of prostate cancer and is an essential step in dominant intraprostatic lesion boost. PURPOSE The goal is to improve the detection and segmentation accuracy of 3D ILs in MRI by a proposed a deep learning (DL)-based algorithm with histopathological ground truth. METHODS This retrospective study included 262 patients with in vivo prostate biparametric MRI (bp-MRI) scans and were divided into three cohorts based on their data analysis and annotation. Histopathological ground truth was established by using histopathology images as delineation reference standard on cohort 1, which consisted of 64 patients and was randomly split into 20 training, 12 validation, and 32 testing patients. Cohort 2 consisted of 158 patients with bp-MRI based lesion delineation, and was randomly split into 104 training, 15 validation, and 39 testing patients. Cohort 3 consisted of 40 unannotated patients, used in semi-supervised learning. We proposed a non-local Mask R-CNN and boosted its performance by applying different training techniques. The performance of non-local Mask R-CNN was compared with baseline Mask R-CNN, 3D U-Net and an experienced radiologist's delineation and was evaluated by detection rate, dice similarity coefficient (DSC), sensitivity, and Hausdorff Distance (HD). RESULTS The independent testing set consists of 32 patients with histopathological ground truth. With the training technique maximizing detection rate, the non-local Mask R-CNN achieved 80.5% and 94.7% detection rate; 0.548 and 0.604 DSC; 5.72 and 6.36 95 HD (mm); 0.613 and 0.580 sensitivity for ILs of all Gleason Grade groups (GGGs) and clinically significant ILs (GGG > 2), which outperformed baseline Mask R-CNN and 3D U-Net. For clinically significant ILs, the model segmentation accuracy was significantly higher than that of the experienced radiologist involved in the study, who achieved 0.512 DSC (p = 0.04), 8.21 (p = 0.041) 95 HD (mm), and 0.398 (p = 0.001) sensitivity. CONCLUSION The proposed DL model achieved state-of-art performance and has the potential to help improve radiotherapy treatment planning and noninvasive prostate cancer diagnosis.
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Affiliation(s)
- Zhenzhen Dai
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan, USA
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine and FICAN West Cancer Centre, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Milan Pantelic
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mohamed Elshaikh
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan, USA
| | - Ali Dabaja
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Otto Ettala
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Peter J Boström
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Harri Merisaari
- Institute of Biomedicine and FICAN West Cancer Centre, University of Turku, Turku, Finland
| | - Ning Wen
- Department of Radiology, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
- The Global Institute of Future Technology, Shanghai Jiaotong University, Shanghai, China
- SJTU-Ruijin-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Falagario UG, Lantz A, Jambor I, Busetto GM, Bettocchi C, Finati M, Ricapito A, Luzzago S, Ferro M, Musi G, Totaro A, Racioppi M, Carbonara U, Checcucci E, Manfredi M, D'Aietti D, Porcaro AB, Nordström T, Björnebo L, Oderda M, Soria F, Taimen P, Aronen HJ, Perez IM, Ettala O, Marchioni M, Simone G, Ferriero M, Brassetti A, Napolitano L, Carmignani L, Signorini C, Conti A, Ludovico G, Scarcia M, Trombetta C, Claps F, Traunero F, Montanari E, Boeri L, Maggi M, Del Giudice F, Bove P, Forte V, Ficarra V, Rossanese M, Mucciardi G, Pagliarulo V, Tafuri A, Mirone V, Schips L, Antonelli A, Gontero P, Cormio L, Sciarra A, Porpiglia F, Bassi P, Ditonno P, Boström PJ, Messina E, Panebianco V, De Cobelli O, Carrieri G. Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors. World J Urol 2023; 41:2967-2974. [PMID: 37787941 PMCID: PMC10632288 DOI: 10.1007/s00345-023-04634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade ≥ 2). METHODS This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients. RESULTS 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naïve (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG ≥ 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS ≥ 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively. CONCLUSIONS Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions. TRIAL REGISTRATION The present study was registered at ClinicalTrials.gov number: NCT05078359.
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Affiliation(s)
- Ugo G Falagario
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
| | - Anna Lantz
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Carlo Bettocchi
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Marco Finati
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Anna Ricapito
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Angelo Totaro
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Umberto Carbonara
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Enrico Checcucci
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Damiano D'Aietti
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | | | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Björnebo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marco Oderda
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Francesco Soria
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Michele Marchioni
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Giuseppe Simone
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Mariaconsiglia Ferriero
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Aldo Brassetti
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Luigi Napolitano
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | | | | | - Giuseppe Ludovico
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | - Marcello Scarcia
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | | | | | | | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Valerio Forte
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | | | - Marta Rossanese
- Department of Urology, University of Messina, Messina, Italy
| | | | | | | | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Luigi Schips
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Alessandro Antonelli
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Luigi Cormio
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Ospedale L. Bonomo, Andria, Italy
| | - Alessandro Sciarra
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Porpiglia
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - PierFrancesco Bassi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Pasquale Ditonno
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Peter J Boström
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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Huhtanen JT, Nyman M, Sequeiros RB, Koskinen SK, Pudas TK, Kajander S, Niemi P, Löyttyniemi E, Aronen HJ, Hirvonen J. Discrepancies between Radiology Specialists and Residents in Fracture Detection from Musculoskeletal Radiographs. Diagnostics (Basel) 2023; 13:3207. [PMID: 37892028 PMCID: PMC10605667 DOI: 10.3390/diagnostics13203207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: The aim of this study was to compare the competence in appendicular trauma radiograph image interpretation between radiology specialists and residents. (2) Methods: In this multicenter retrospective cohort study, we collected radiology reports from radiology specialists (N = 506) and residents (N = 500) during 2018-2021. As a reference standard, we used the consensus of two subspecialty-level musculoskeletal (MSK) radiologists, who reviewed all original reports. (3) Results: A total of 1006 radiograph reports were reviewed by the two subspecialty-level MSK radiologists. Out of the 1006 radiographs, 41% were abnormal. In total, 67 radiographic findings were missed (6.7%) and 31 findings were overcalled (3.1%) in the original reports. Sensitivity, specificity, positive predictive value, and negative predictive value were 0.86, 0.92, 0.91 and 0.88 respectively. There were no statistically significant differences between radiology specialists' and residents' competence in interpretation (p = 0.44). However, radiology specialists reported more subtle cases than residents did (p = 0.04). There were no statistically significant differences between errors made in the morning, evening, or night shifts (p = 0.57). (4) Conclusions: This study found a lack of major discrepancies between radiology specialists and residents in radiograph interpretation, although there were differences between MSK regions and in subtle or obvious radiographic findings. In addition, missed findings found in this study often affected patient treatment. Finally, there are MSK regions where the sensitivity or specificity is below 90%, and these should raise concerns and highlight the need for double reading and should be taken into consideration in radiology education.
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Affiliation(s)
- Jarno T. Huhtanen
- Faculty of Health and Well-Being, Turku University of Applied Sciences, 20520 Turku, Finland
- Department of Radiology, University of Turku, 20014 Turku, Finland; (S.K.); (P.N.)
| | - Mikko Nyman
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland; (M.N.); (R.B.S.); (H.J.A.); (J.H.)
| | - Roberto Blanco Sequeiros
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland; (M.N.); (R.B.S.); (H.J.A.); (J.H.)
| | - Seppo K. Koskinen
- Terveystalo Inc., Jaakonkatu 3, 00100 Helsinki, Finland; (S.K.K.); (T.K.P.)
| | - Tomi K. Pudas
- Terveystalo Inc., Jaakonkatu 3, 00100 Helsinki, Finland; (S.K.K.); (T.K.P.)
| | - Sami Kajander
- Department of Radiology, University of Turku, 20014 Turku, Finland; (S.K.); (P.N.)
| | - Pekka Niemi
- Department of Radiology, University of Turku, 20014 Turku, Finland; (S.K.); (P.N.)
| | | | - Hannu J. Aronen
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland; (M.N.); (R.B.S.); (H.J.A.); (J.H.)
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland; (M.N.); (R.B.S.); (H.J.A.); (J.H.)
- Department of Radiology, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, 33100 Tampere, Finland
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Hirvonen J, Becker M, Aronen HJ. Resident education in radiology in Europe including entrustable professional activities: results of an ESR survey. Insights Imaging 2023; 14:139. [PMID: 37606861 PMCID: PMC10444922 DOI: 10.1186/s13244-023-01489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Entrustable professional activity (EPA) is a tool for comprehensively evaluating the level of confidence in resident performances across various competencies in medicine. The application of and attitudes towards EPAs in radiology across the European Society of Radiology (ESR) national institutional member societies is still to be determined. An online survey was conducted among ESR national institutional member societies to assess the current use of EPAs and other resident assessment forms among different countries.Although the primary focus was on the use of EPAs, additional questions also addressed the adherence of training programs to the European Training Curriculum (ETC), other methods of continuous assessment, and examinations. A total of 65 responses were received from 38 countries (81% response rate among national institutional member societies). EPAs were being used in radiology in 21% of countries and planned to be used in 26%. Most responders considered EPAs suitable for radiology and, regarding the future, preferred European-level guidelines on EPAs over national or institutional levels. The majority (63%) of national training programs were reported to be similar to or following the content of the ETC, and the majority (95%) of countries rated the requirements of the European Training Curriculum (ETC) to be adequate. In conclusion, EPAs are beginning to be used in radiology resident training programs across Europe, and their use is expected to increase. There seems to be a positive attitude toward using EPAs in radiology and toward a common European framework.Critical relevance statement As a result of this survey, we found positive attitudes towards using entrustable professional activities (EPA) in radiology among the institutional member societies of the European Society of Radiology (ESR).Key points• Twenty-one percent of national member societies use entrustable professional activities (EPA) in radiology.• There is a positive attitude toward using EPAs in radiology.• Majority of respondents preferred a common European framework for EPAs.• Majority of radiology training curricula adhere to the European Training Curriculum (ETC).
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Peters M, Eldred-Evans D, Kurver P, Falagario UG, Connor MJ, Shah TT, Verhoeff JJC, Taimen P, Aronen HJ, Knaapila J, Montoya Perez I, Ettala O, Stabile A, Gandaglia G, Fossati N, Martini A, Cucchiara V, Briganti A, Lantz A, Picker W, Haug ES, Nordström T, Tanaka MB, Reddy D, Bass E, van Rossum PSN, Wong K, Tam H, Winkler M, Gordon S, Qazi H, Boström PJ, Jambor I, Ahmed HU. Predicting the Need for Biopsy to Detect Clinically Significant Prostate Cancer in Patients with a Magnetic Resonance Imaging-detected Prostate Imaging Reporting and Data System/Likert ≥3 Lesion: Development and Multinational External Validation of the Imperial Rapid Access to Prostate Imaging and Diagnosis Risk Score. Eur Urol 2022; 82:559-568. [PMID: 35963650 DOI: 10.1016/j.eururo.2022.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/01/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although multiparametric magnetic resonance imaging (MRI) has high sensitivity, its lower specificity leads to a high prevalence of false-positive lesions requiring biopsy. OBJECTIVE To develop and externally validate a scoring system for MRI-detected Prostate Imaging Reporting and Data System (PIRADS)/Likert ≥3 lesions containing clinically significant prostate cancer (csPCa). DESIGN, SETTING, AND PARTICIPANTS The multicentre Rapid Access to Prostate Imaging and Diagnosis (RAPID) pathway included 1189 patients referred to urology due to elevated age-specific prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE); April 27, 2017 to October 25, 2019. INTERVENTION Visual-registration or image-fusion targeted and systematic transperineal biopsies for an MRI score of ≥4 or 3 + PSA density ≥0.12 ng/ml/ml. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Fourteen variables were used in multivariable logistic regression for Gleason ≥3 + 4 (primary) and Gleason ≥4 + 3, and PROMIS definition 1 (any ≥4 + 3 or ≥6 mm any grade; secondary). Nomograms were created and a decision curve analysis (DCA) was performed. Models with varying complexity were externally validated in 2374 patients from six international cohorts. RESULTS AND LIMITATIONS The five-item Imperial RAPID risk score used age, PSA density, prior negative biopsy, prostate volume, and highest MRI score (corrected c-index for Gleason ≥3 + 4 of 0.82 and 0.80-0.86 externally). Incorporating family history, DRE, and Black ethnicity within the eight-item Imperial RAPID risk score provided similar outcomes. The DCA showed similar superiority of all models, with net benefit differences increasing in higher threshold probabilities. At 20%, 30%, and 40% of predicted Gleason ≥3 + 4 prostate cancer, the RAPID risk score was able to reduce, respectively, 11%, 21%, and 31% of biopsies against 1.8%, 6.2%, and 14% of missed csPCa (or 9.6%, 17%, and 26% of foregone biopsies, respectively). CONCLUSIONS The Imperial RAPID risk score provides a standardised tool for the prediction of csPCa in patients with an MRI-detected PIRADS/Likert ≥3 lesion and can support the decision for prostate biopsy. PATIENT SUMMARY In this multinational study, we developed a scoring system incorporating clinical and magnetic resonance imaging characteristics to predict which patients have prostate cancer requiring treatment and which patients can safely forego an invasive prostate biopsy. This model was validated in several other countries.
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Affiliation(s)
- Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Piet Kurver
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martin J Connor
- Department of Imperial Prostate, Imperial College London, London, UK
| | - Taimur T Shah
- Department of Imperial Prostate, Imperial College London, London, UK
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pekka Taimen
- University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland
| | - Juha Knaapila
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | | | - Otto Ettala
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Armando Stabile
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Martini
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vito Cucchiara
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Lantz
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | | | | | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Deepika Reddy
- Department of Imperial Prostate, Imperial College London, London, UK
| | - Edward Bass
- Department of Imperial Prostate, Imperial College London, London, UK
| | - Peter S N van Rossum
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kathie Wong
- Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, UK
| | - Henry Tam
- Department of Imperial Prostate, Imperial College London, London, UK
| | - Mathias Winkler
- Department of Imperial Prostate, Imperial College London, London, UK
| | - Stephen Gordon
- Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, UK
| | - Hasan Qazi
- Department of Urology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
| | - Hashim U Ahmed
- Department of Imperial Prostate, Imperial College London, London, UK
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7
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Huhtanen JT, Nyman M, Doncenco D, Hamedian M, Kawalya D, Salminen L, Sequeiros RB, Koskinen SK, Pudas TK, Kajander S, Niemi P, Hirvonen J, Aronen HJ, Jafaritadi M. Deep learning accurately classifies elbow joint effusion in adult and pediatric radiographs. Sci Rep 2022; 12:11803. [PMID: 35821056 PMCID: PMC9276721 DOI: 10.1038/s41598-022-16154-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Joint effusion due to elbow fractures are common among adults and children. Radiography is the most commonly used imaging procedure to diagnose elbow injuries. The purpose of the study was to investigate the diagnostic accuracy of deep convolutional neural network algorithms in joint effusion classification in pediatric and adult elbow radiographs. This retrospective study consisted of a total of 4423 radiographs in a 3-year period from 2017 to 2020. Data was randomly separated into training (n = 2672), validation (n = 892) and test set (n = 859). Two models using VGG16 as the base architecture were trained with either only lateral projection or with four projections (AP, LAT and Obliques). Three radiologists evaluated joint effusion separately on the test set. Accuracy, precision, recall, specificity, F1 measure, Cohen’s kappa, and two-sided 95% confidence intervals were calculated. Mean patient age was 34.4 years (1–98) and 47% were male patients. Trained deep learning framework showed an AUC of 0.951 (95% CI 0.946–0.955) and 0.906 (95% CI 0.89–0.91) for the lateral and four projection elbow joint images in the test set, respectively. Adult and pediatric patient groups separately showed an AUC of 0.966 and 0.924, respectively. Radiologists showed an average accuracy, sensitivity, specificity, precision, F1 score, and AUC of 92.8%, 91.7%, 93.6%, 91.07%, 91.4%, and 92.6%. There were no statistically significant differences between AUC's of the deep learning model and the radiologists (p value > 0.05). The model on the lateral dataset resulted in higher AUC compared to the model with four projection datasets. Using deep learning it is possible to achieve expert level diagnostic accuracy in elbow joint effusion classification in pediatric and adult radiographs. Deep learning used in this study can classify joint effusion in radiographs and can be used in image interpretation as an aid for radiologists.
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Affiliation(s)
- Jarno T Huhtanen
- Faculty of Health and Well-Being, Turku University of Applied Sciences, Turku, Finland. .,Department of Radiology, University of Turku, Turku, Finland.
| | - Mikko Nyman
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Dorin Doncenco
- Faculty of Engineering and Business, Turku University of Applied Sciences, Turku, Finland
| | - Maral Hamedian
- Faculty of Engineering and Business, Turku University of Applied Sciences, Turku, Finland
| | - Davis Kawalya
- Faculty of Engineering and Business, Turku University of Applied Sciences, Turku, Finland
| | - Leena Salminen
- Department of Nursing Science, University of Turku and Director of Nursing (Part-Time) Turku University Hospital, Turku, Finland
| | | | | | - Tomi K Pudas
- Terveystalo Inc, Jaakonkatu 3, Helsinki, Finland
| | - Sami Kajander
- Department of Radiology, University of Turku, Turku, Finland
| | - Pekka Niemi
- Department of Radiology, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Mojtaba Jafaritadi
- Faculty of Engineering and Business, Turku University of Applied Sciences, Turku, Finland
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8
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Parekh S, Ratnani P, Falagario U, Lundon D, Kewlani D, Nasri J, Dovey Z, Stroumbakis D, Ranti D, Grauer R, Sobotka S, Pedraza A, Wagaskar V, Mistry L, Jambor I, Lantz A, Ettala O, Stabile A, Taimen P, Aronen HJ, Knaapila J, Perez IM, Gandaglia G, Martini A, Picker W, Haug E, Cormio L, Nordström T, Briganti A, Boström PJ, Carrieri G, Haines K, Gorin MA, Wiklund P, Menon M, Tewari A. The Mount Sinai Prebiopsy Risk Calculator for Predicting any Prostate Cancer and Clinically Significant Prostate Cancer: Development of a Risk Predictive Tool and Validation with Advanced Neural Networking, Prostate Magnetic Resonance Imaging Outcome Database, and European Randomized Study of Screening for Prostate Cancer Risk Calculator. EUR UROL SUPPL 2022; 41:45-54. [PMID: 35813258 PMCID: PMC9257660 DOI: 10.1016/j.euros.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 10/28/2022] Open
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9
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Jambor I, Martini A, Falagario UG, Ettala O, Taimen P, Knaapila J, Syvänen KT, Steiner A, Verho J, Perez IM, Merisaari H, Vainio P, Lamminen T, Saunavaara J, Carrieri G, Boström PJ, Aronen HJ. How to read biparametric MRI in men with a clinical suspicious of prostate cancer: Pictorial review for beginners with public access to imaging, clinical and histopathological database. Acta Radiol Open 2021; 10:20584601211060707. [PMID: 34868663 PMCID: PMC8638086 DOI: 10.1177/20584601211060707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Prostate Magnetic Resonance Imaging (MRI) is increasingly being used in men with a clinical suspicion of prostate cancer (PCa). Performing prostate MRI without the use of an intravenous contrast (IV) agent in men with a clinical suspicion of PCa can lead to reduced MRI scan time. Enabling a large array of different medical providers (from mid-level to specialized radiologists) to evaluate and potentially report prostate MRI in men with a clinical suspicion of PCa with a high accuracy could be one way to enable wide adoption of prostate MRI in men with a clinical suspicion of PCa. The aim of this pictorial review is to provide an insight into acquisition, quality control and reporting of prostate MRI performed without IV contrast agent in men with a clinical suspicion of PCa, aimed specifically at radiologists starting reporting prostate MRI, urologists, urology/radiology residents and mid-level medical providers without experience in reporting prostate MRI. Free public access (http://petiv.utu.fi/improd/and http://petiv.utu.fi/multiimprod/) to complete datasets of 161 and 338 men is provided. The imaging datasets are accompanied by clinical, laboratory and histopathological findings. Several topics are simplified in order to provide a solid base for the development of skills needed for an unsupervised review and potential reporting of prostate MRI in men with a clinical suspicion of PCa. The current review represents the first step towards enabling a large array of different medical providers to review and report accurately prostate MRI performed without IV contrast agent in men with a clinical suspicion of PCa.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Department of Radiology, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Alberto Martini
- Department of Oncology/Unit of
Urology, Urological Research Institute, IRCCS
Ospedale San Raffaele, Milan, Italy
| | - Ugo G Falagario
- Department of Urology and Organ
Transplantation, University of Foggia, Foggia, Italy
| | - Otto Ettala
- Department of Urology, University of Turku and Turku
University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku and Department of
Pathology, Turku University Hospital, Turku, Finland
| | - Juha Knaapila
- Department of Urology, University of Turku and Turku
University Hospital, Turku, Finland
| | - Kari T Syvänen
- Department of Urology, University of Turku and Turku
University Hospital, Turku, Finland
| | - Aida Steiner
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest
Finland, Turku University
Hospital, Turku, Finland
| | - Janne Verho
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest
Finland, Turku University
Hospital, Turku, Finland
| | - Ileana M Perez
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Paula Vainio
- Institute of Biomedicine, University of Turku and Department of
Pathology, Turku University Hospital, Turku, Finland
| | - Tarja Lamminen
- Department of Urology and Organ
Transplantation, University of Foggia, Foggia, Italy
| | - Jani Saunavaara
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Department of Medical Physics, Turku University
Hospital, Turku, Finland
| | - Giuseppe Carrieri
- Department of Urology and Organ
Transplantation, University of Foggia, Foggia, Italy
| | - Peter J Boström
- Department of Urology, University of Turku and Turku
University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Department of Oncology/Unit of
Urology, Urological Research Institute, IRCCS
Ospedale San Raffaele, Milan, Italy
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10
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Jambor I, Steiner A, Pesola M, Liimatainen T, Sucksdorff M, Rissanen E, Airas L, Aronen HJ, Merisaari H. Whole Brain Adiabatic T
1rho
and Relaxation Along a Fictitious Field Imaging in Healthy Volunteers and Patients With Multiple Sclerosis: Initial Findings. J Magn Reson Imaging 2021. [DOI: 10.1002/jmri.27231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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11
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Malaspina S, Anttinen M, Taimen P, Jambor I, Sandell M, Rinta-Kiikka I, Kajander S, Schildt J, Saukko E, Noponen T, Saunavaara J, Dean PB, Sequeiros RB, Aronen HJ, Kemppainen J, Seppänen M, Boström PJ, Ettala O. Prospective comparison of 18F-PSMA-1007 PET/CT, whole-body MRI and CT in primary nodal staging of unfavourable intermediate- and high-risk prostate cancer. Eur J Nucl Med Mol Imaging 2021; 48:2951-2959. [PMID: 33715033 PMCID: PMC8263440 DOI: 10.1007/s00259-021-05296-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively compare 18F-prostate-specific membrane antigen (PSMA)-1007 positron emission tomography (PET)/CT, whole-body magnetic resonance imaging (WBMRI) including diffusion-weighted imaging (DWI) and standard computed tomography (CT), in primary nodal staging of prostate cancer (PCa). METHODS Men with newly diagnosed unfavourable intermediate- or high-risk PCa prospectively underwent 18F-PSMA-1007 PET/CT, WBMRI with DWI and contrast-enhanced CT within a median of 8 days. Six readers (two for each modality) independently reported pelvic lymph nodes as malignant, equivocal or benign while blinded to the other imaging modalities. Sensitivity, specificity and accuracy were reported according to optimistic (equivocal lesions interpreted as benign) and pessimistic (equivocal lesions interpreted as malignant) analyses. The reference standard diagnosis was based on multidisciplinary consensus meetings where available histopathology, clinical and follow-up data were used. RESULTS Seventy-nine patients completed all the imaging modalities, except for one case of interrupted WBMRI. Thirty-one (39%) patients had pelvic lymph node metastases, which were detected in 27/31 (87%), 14/31 (45%) and 8/31 (26%) patients by 18F-PSMA-1007 PET/CT, WBMRI with DWI and CT, respectively (optimistic analysis). In 8/31 (26%) patients, only 18F-PSMA-1007 PET/CT detected malignant lymph nodes, while the other two imaging modalities were reported as negative. At the patient level, sensitivity and specificity values for 18F-PSMA-1007 PET/CT, WBMRI with DWI and CT in optimistic analysis were 0.87 (95%CI 0.71-0.95) and 0.98 (95%CI 0.89-1.00), 0.37 (95%CI 0.22-0.55) and 0.98 (95%CI 0.89-1.00) and 0.26 (95%CI 0.14-0.43) and 1.00 (95%CI 0.93-1.00), respectively. CONCLUSION 18F-PSMA-1007 PET/CT showed significantly greater sensitivity in nodal staging of primary PCa than did WBMRI with DWI or CT, while maintaining high specificity. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov ID: NCT03537391.
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Affiliation(s)
- Simona Malaspina
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
| | - Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine and Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Sandell
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Sami Kajander
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Jukka Schildt
- Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Ekaterina Saukko
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Noponen
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter B Dean
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Marko Seppänen
- Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
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12
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Montoya Perez I, Merisaari H, Jambor I, Ettala O, Taimen P, Knaapila J, Kekki H, Khan FL, Syrjälä E, Steiner A, Syvänen KT, Verho J, Seppänen M, Rannikko A, Riikonen J, Mirtti T, Lamminen T, Saunavaara J, Falagario U, Martini A, Pahikkala T, Pettersson K, Boström PJ, Aronen HJ. Detection of Prostate Cancer Using Biparametric Prostate MRI, Radiomics, and Kallikreins: A Retrospective Multicenter Study of Men With a Clinical Suspicion of Prostate Cancer. J Magn Reson Imaging 2021; 55:465-477. [PMID: 34227169 DOI: 10.1002/jmri.27811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Accurate detection of clinically significant prostate cancer (csPCa), Gleason Grade Group ≥ 2, remains a challenge. Prostate MRI radiomics and blood kallikreins have been proposed as tools to improve the performance of biparametric MRI (bpMRI). PURPOSE To develop and validate radiomics and kallikrein models for the detection of csPCa. STUDY TYPE Retrospective. POPULATION A total of 543 men with a clinical suspicion of csPCa, 411 (76%, 411/543) had kallikreins available and 360 (88%, 360/411) did not take 5-alpha-reductase inhibitors. Two data splits into training, validation (split 1: single center, n = 72; split 2: random 50% of pooled datasets from all four centers), and testing (split 1: 4 centers, n = 288; split 2: remaining 50%) were evaluated. FIELD STRENGTH/SEQUENCE A 3 T/1.5 T, TSE T2-weighted imaging, 3x SE DWI. ASSESSMENT In total, 20,363 radiomic features calculated from manually delineated whole gland (WG) and bpMRI suspicion lesion masks were evaluated in addition to clinical parameters, prostate-specific antigen, four kallikreins, MRI-based qualitative (PI-RADSv2.1/IMPROD bpMRI Likert) scores. STATISTICAL TESTS For the detection of csPCa, area under receiver operating curve (AUC) was calculated using the DeLong's method. A multivariate analysis was conducted to determine the predictive power of combining variables. The values of P-value < 0.05 were considered significant. RESULTS The highest prediction performance was achieved by IMPROD bpMRI Likert and PI-RADSv2.1 score with AUC = 0.85 and 0.85 in split 1, 0.85 and 0.83 in split 2, respectively. bpMRI WG and/or kallikreins demonstrated AUCs ranging from 0.62 to 0.73 in split 1 and from 0.68 to 0.76 in split 2. AUC of bpMRI lesion-derived radiomics model was not statistically different to IMPROD bpMRI Likert score (split 1: AUC = 0.83, P-value = 0.306; split 2: AUC = 0.83, P-value = 0.488). DATA CONCLUSION The use of radiomics and kallikreins failed to outperform PI-RADSv2.1/IMPROD bpMRI Likert and their combination did not lead to further performance gains. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ileana Montoya Perez
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Computing, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Computing, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Otto Ettala
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, Department of Pathology, University of Turku, Turku University Hospital, Turku, Finland
| | - Juha Knaapila
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland
| | - Henna Kekki
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Ferdhos L Khan
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Elise Syrjälä
- Department of Computing, University of Turku, Turku, Finland
| | - Aida Steiner
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Kari T Syvänen
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland
| | - Janne Verho
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Marjo Seppänen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Antti Rannikko
- Department of Urology, Helsinki University, Helsinki University Hospital, Helsinki, Finland
| | - Jarno Riikonen
- Department of Urology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Tarja Lamminen
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Ugo Falagario
- Department of Urology, University of Foggia, Foggia, Italy
| | - Alberto Martini
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Tapio Pahikkala
- Department of Computing, University of Turku, Turku, Finland
| | - Kim Pettersson
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
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Merisaari H, Laakso H, Liljenbäck H, Virtanen H, Aronen HJ, Minn H, Poutanen M, Roivainen A, Liimatainen T, Jambor I. Statistical Evaluation of Different Mathematical Models for Diffusion Weighted Imaging of Prostate Cancer Xenografts in Mice. Front Oncol 2021; 11:583921. [PMID: 34123770 PMCID: PMC8188898 DOI: 10.3389/fonc.2021.583921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/23/2021] [Indexed: 01/28/2023] Open
Abstract
Purpose To evaluate fitting quality and repeatability of four mathematical models for diffusion weighted imaging (DWI) during tumor progression in mouse xenograft model of prostate cancer. Methods Human prostate cancer cells (PC-3) were implanted subcutaneously in right hind limbs of 11 immunodeficient mice. Tumor growth was followed by weekly DWI examinations using a 7T MR scanner. Additional DWI examination was performed after repositioning following the fourth DWI examination to evaluate short term repeatability. DWI was performed using 15 and 12 b-values in the ranges of 0-500 and 0-2000 s/mm2, respectively. Corrected Akaike information criteria and F-ratio were used to evaluate fitting quality of each model (mono-exponential, stretched exponential, kurtosis, and bi-exponential). Results Significant changes were observed in DWI data during the tumor growth, indicated by ADCm, ADCs, and ADCk. Similar results were obtained using low as well as high b-values. No marked changes in model preference were present between the weeks 1−4. The parameters of the mono-exponential, stretched exponential, and kurtosis models had smaller confidence interval and coefficient of repeatability values than the parameters of the bi-exponential model. Conclusion Stretched exponential and kurtosis models showed better fit to DWI data than the mono-exponential model and presented with good repeatability.
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Affiliation(s)
- Harri Merisaari
- Department of Radiology, University of Turku, Turku, Finland.,Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Hanne Laakso
- Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, Kuopio, Finland
| | - Heidi Liljenbäck
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Helena Virtanen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Matti Poutanen
- Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Timo Liimatainen
- Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, Kuopio, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Clinical Radiology, Oulu University Hospital, Oulu, Finland.,Department of Radiology, University of Oulu, Oulu, Finland
| | - Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
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14
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Leo P, Janowczyk A, Elliott R, Janaki N, Bera K, Shiradkar R, Farré X, Fu P, El-Fahmawi A, Shahait M, Kim J, Lee D, Yamoah K, Rebbeck TR, Khani F, Robinson BD, Eklund L, Jambor I, Merisaari H, Ettala O, Taimen P, Aronen HJ, Boström PJ, Tewari A, Magi-Galluzzi C, Klein E, Purysko A, Nc Shih N, Feldman M, Gupta S, Lal P, Madabhushi A. Computer extracted gland features from H&E predicts prostate cancer recurrence comparably to a genomic companion diagnostic test: a large multi-site study. NPJ Precis Oncol 2021; 5:35. [PMID: 33941830 PMCID: PMC8093226 DOI: 10.1038/s41698-021-00174-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/05/2021] [Indexed: 01/04/2023] Open
Abstract
Existing tools for post-radical prostatectomy (RP) prostate cancer biochemical recurrence (BCR) prognosis rely on human pathologist-derived parameters such as tumor grade, with the resulting inter-reviewer variability. Genomic companion diagnostic tests such as Decipher tend to be tissue destructive, expensive, and not routinely available in most centers. We present a tissue non-destructive method for automated BCR prognosis, termed "Histotyping", that employs computational image analysis of morphologic patterns of prostate tissue from a single, routinely acquired hematoxylin and eosin slide. Patients from two institutions (n = 214) were used to train Histotyping for identifying high-risk patients based on six features of glandular morphology extracted from RP specimens. Histotyping was validated for post-RP BCR prognosis on a separate set of n = 675 patients from five institutions and compared against Decipher on n = 167 patients. Histotyping was prognostic of BCR in the validation set (p < 0.001, univariable hazard ratio [HR] = 2.83, 95% confidence interval [CI]: 2.03-3.93, concordance index [c-index] = 0.68, median years-to-BCR: 1.7). Histotyping was also prognostic in clinically stratified subsets, such as patients with Gleason grade group 3 (HR = 4.09) and negative surgical margins (HR = 3.26). Histotyping was prognostic independent of grade group, margin status, pathological stage, and preoperative prostate-specific antigen (PSA) (multivariable p < 0.001, HR = 2.09, 95% CI: 1.40-3.10, n = 648). The combination of Histotyping, grade group, and preoperative PSA outperformed Decipher (c-index = 0.75 vs. 0.70, n = 167). These results suggest that a prognostic classifier for prostate cancer based on digital images could serve as an alternative or complement to molecular-based companion diagnostic tests.
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Grants
- National Cancer Institute under award numbers 1U24CA199374-01, R01CA249992-01A1 R01CA202752-01A1 R01CA208236-01A1 R01CA216579-01A1 R01CA220581-01A1 1U01CA239055-01 1U01CA248226-01 1U54CA254566-01 National Heart, Lung and Blood Institute 1R01HL15127701A1, National Institute for Biomedical Imaging and Bioengineering 1R43EB028736-01, National Center for Research Resources 1 C06 RR12463-01, VA Merit Review Award IBX004121A from the United States Department of Veterans Affairs Biomedical Laboratory Research and Development Service, the Office of the Assistant Secretary of Defense for Health Affairs, through the Breast Cancer Research Program (W81XWH-19-1-0668), the Prostate Cancer Research Program (W81XWH-15-1-0558, W81XWH-20-1-0851), the Lung Cancer Research Program (W81XWH-18-1-0440, W81XWH-20-1-0595), the Peer Reviewed Cancer Research Program (W81XWH-18-1-0404), the Kidney Precision Medicine Project Glue Grant, the Ohio Third Frontier Technology Validation Fund, the Clinical and Translational Science Collaborative of Cleveland (UL1TR0002548) from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research, The Wallace H. Coulter Foundation Program in the Department of Biomedical Engineering at Case Western Reserve University,
- Sigrid Jusélius Foundation The Finnish Cancer Foundation
- Department of Defense Prostate Cancer Disparity Award (W81XWH-19-1-0720),
- National Science Foundation Graduate Research Fellowship Program (CON501692)
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Affiliation(s)
- Patrick Leo
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Andrew Janowczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Robin Elliott
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nafiseh Janaki
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Rakesh Shiradkar
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Xavier Farré
- Public Health Agency of Catalonia, Lleida, Catalonia, Spain
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Ayah El-Fahmawi
- Department of Urology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Mohammed Shahait
- Department of Urology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Jessica Kim
- Department of Urology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - David Lee
- Department of Urology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Kosj Yamoah
- Moffitt Cancer Center, Department of Radiation Oncology, University of South Florida, Tampa, FL, USA
| | - Timothy R Rebbeck
- T.H. Chan School of Public Health and Dana Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Francesca Khani
- Departments of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, NY, USA
| | - Brian D Robinson
- Departments of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, NY, USA
| | - Lauri Eklund
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
- Turku University Hospital, Medical Imaging Centre of Southwest Finland, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eric Klein
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Andrei Purysko
- Cleveland Clinic, Imaging Institute, Section of Abdominal Imaging, Cleveland, OH, USA
| | - Natalie Nc Shih
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Feldman
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjay Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA
| | - Priti Lal
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA.
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15
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Jambor I, Steiner A, Pesola M, Liimatainen T, Sucksdorff M, Rissanen E, Airas L, Aronen HJ, Merisaari H. Whole Brain Adiabatic T 1rho and Relaxation Along a Fictitious Field Imaging in Healthy Volunteers and Patients With Multiple Sclerosis: Initial Findings. J Magn Reson Imaging 2021; 54:866-879. [PMID: 33675564 DOI: 10.1002/jmri.27586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In preclinical models of multiple sclerosis (MS), both adiabatic T1rho (T1ρadiab ) and relaxation along a fictitious field (RAFF) imaging have demonstrated potential to noninvasively characterize MS. PURPOSE To evaluate the feasibility of whole brain T1ρadiab and RAFF imaging in healthy volunteers and patients with MS. STUDY TYPE Single institutional clinical trial. SUBJECTS 38 healthy volunteers (24-69 years) and 21 patients (26-59 years) with MS. Five healthy volunteers underwent a second MR examination performed within 8 days. Clinical disease severity (The Expanded Disability Status Scale [EDSS] and The Multiple Sclerosis Severity Score [MSSS]) was evaluated at baseline and 1-year follow-up (FU). FIELD STRENGTH/SEQUENCE RAFF in second rotating frame of reference (RAFF2) was performed at 3 T using 3D-fast-field echo with magnetization preparation, RF amplitude of 11.74 μT while the corresponding value for T1ρadiab was 13.50 μT. T1 -, T2 -, and FLAIR-weighted images were acquired with reconstruction voxel size 1.0 × 1.0 × 1.0 mm3 . ASSESSMENT The parametric maps of T1ρadiab and RAFF2 (TRAFF2 ) were calculated using a monoexponential model. Semi-automatic segmentation of MS lesions, white matter (WM), and gray matter (GM), and WM tracks was performed using T1 -, T2 -, and FLAIR-weighted images. STATISTICAL TESTS Regression analysis was used to evaluate correlation of T1ρadiab and TRAFF2 with age and disease severity while a Friedman test followed by Wilcoxon Signed Rank test for differences between tissue types. Short-term repeatability was evaluated on voxel level. RESULTS Both T1ρadiab and TRAFF2 demonstrated good short-term repeatability with relative differences on voxel level in the range of 6.1%-11.9%. Differences in T1ρadiab and TRAFF2 between the tissue types in MS patients were significant (P < 0.05). T1ρadiab and TRAFF2 correlated (P < 0.001) with baseline EDSS/MSSM and disease progression at FU (P < 0.001). DATA CONCLUSION Whole brain T1ρadiab and TRAFF2 at 3 T was feasible with significant differences in T1ρadiab and TRAFF2 values between tissues types and correlation with disease severity. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aida Steiner
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Marko Pesola
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, University of Oulu, Oulu, Finland
| | - Marcus Sucksdorff
- Department of Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Eero Rissanen
- Department of Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Laura Airas
- Department of Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland
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16
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Knaapila J, Jambor I, Perez IM, Ettala O, Taimen P, Verho J, Kiviniemi A, Pahikkala T, Merisaari H, Lamminen T, Saunavaara J, Aronen HJ, Syvänen KT, Boström PJ. Prebiopsy IMPROD Biparametric Magnetic Resonance Imaging Combined with Prostate-Specific Antigen Density in the Diagnosis of Prostate Cancer: An External Validation Study. Eur Urol Oncol 2020; 3:648-656. [DOI: 10.1016/j.euo.2019.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/26/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
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17
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Falagario UG, Jambor I, Lantz A, Ettala O, Stabile A, Taimen P, Aronen HJ, Knaapila J, Perez IM, Gandaglia G, Fossati N, Martini A, Cucchiara V, Picker W, Haug E, Ratnani P, Haines K, Lewis S, Sujit N, Selvaggio O, Sanguedolce F, Macarini L, Cormio L, Nordström T, Tewari A, Briganti A, Boström PJ, Carrieri G. Combined Use of Prostate-specific Antigen Density and Magnetic Resonance Imaging for Prostate Biopsy Decision Planning: A Retrospective Multi-institutional Study Using the Prostate Magnetic Resonance Imaging Outcome Database (PROMOD). Eur Urol Oncol 2020; 4:971-979. [PMID: 32972896 DOI: 10.1016/j.euo.2020.08.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Previous studies suggested that prostate-specific antigen (PSA) density (PSAd) combined with magnetic resonance imaging (MRI) may help avoid unnecessary prostate biopsy (PB) with a limited risk of missing clinically significant prostate cancer (csPCa; Gleason grade group [GGG] >1). OBJECTIVE To define optimal diagnostic strategies based on the combined use of PSAd and MRI in patients at risk of prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of the international multicenter Prostate MRI Outcome Database (PROMOD), including 2512 men having undergone PSAd and prostate MRI before PB between 2013 and 2019, was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Rates of avoided PB, missed GGG 1, and csPCa according to 10 strategies based on PSAd values and MRI reporting scores (Prostate Imaging Reporting and Data System [PI-RADS]/Likert/IMPROD biparametric prostate MRI Likert). Decision curve analysis (DCA) was used to statistically compare the net benefit of each strategy. Combined systematic and targeted biopsies were used for reference. RESULTS AND LIMITATIONS According to DCA, the best strategy in biopsy-naive patients was #7 (PI-RADS/Likert 4-5 or PI-RADS/Likert 3 if PSAd >0.2), which avoided 41.2% PBs while missed 44% of GGG 1 and 10.9% of csPCa cases. From a clinical standpoint, however, strategies with a lower risk of missing csPCa included #10 (PI-RADS/Likert 4-5 or PI-RADS 3 if PSAd >0.10 or PSAd >0.2), which avoided 27% PBs while missing 24.4% GGG 1 and 4% csPCa cases, or #5 (PI-RADS/Likert 3-5 or PSAd>0.15), which avoided 14.7% PBs while missing 9.3% GGG 1 and 1.7% csPCa cases. Similar results were found in patients with a previous negative biopsy. This study is limited by its retrospective nature, and no central review of MRI and histopathological findings. CONCLUSIONS Combined PSAd and MRI findings allows individualization of the decision to perform PB on the basis of the risk of missing PCa that both patients and clinicians are ready to accept to avoid this procedure. PATIENT SUMMARY We compared several biopsy strategies based on a combination of prostate magnetic resonance imaging findings and prostate-specific antigen density, providing a readily available tool for each center and practicing urologist to counsel patients about their individual risk of significant prostate cancer.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Armando Stabile
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland; Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Juha Knaapila
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Giorgio Gandaglia
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vito Cucchiara
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Erik Haug
- Section of Urology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nair Sujit
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oscar Selvaggio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | | | - Luca Macarini
- Department of Radiology, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy; Department of Urology, Bonomo Teaching Hospital, Andria, Italy
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Briganti
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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18
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Hiremath A, Shiradkar R, Merisaari H, Prasanna P, Ettala O, Taimen P, Aronen HJ, Boström PJ, Jambor I, Madabhushi A. Test-retest repeatability of a deep learning architecture in detecting and segmenting clinically significant prostate cancer on apparent diffusion coefficient (ADC) maps. Eur Radiol 2020; 31:379-391. [PMID: 32700021 DOI: 10.1007/s00330-020-07065-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/22/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate short-term test-retest repeatability of a deep learning architecture (U-Net) in slice- and lesion-level detection and segmentation of clinically significant prostate cancer (csPCa: Gleason grade group > 1) using diffusion-weighted imaging fitted with monoexponential function, ADCm. METHODS One hundred twelve patients with prostate cancer (PCa) underwent 2 prostate MRI examinations on the same day. PCa areas were annotated using whole mount prostatectomy sections. Two U-Net-based convolutional neural networks were trained on three different ADCm b value settings for (a) slice- and (b) lesion-level detection and (c) segmentation of csPCa. Short-term test-retest repeatability was estimated using intra-class correlation coefficient (ICC(3,1)), proportionate agreement, and dice similarity coefficient (DSC). A 3-fold cross-validation was performed on training set (N = 78 patients) and evaluated for performance and repeatability on testing data (N = 34 patients). RESULTS For the three ADCm b value settings, repeatability of mean ADCm of csPCa lesions was ICC(3,1) = 0.86-0.98. Two CNNs with U-Net-based architecture demonstrated ICC(3,1) in the range of 0.80-0.83, agreement of 66-72%, and DSC of 0.68-0.72 for slice- and lesion-level detection and segmentation of csPCa. Bland-Altman plots suggest that there is no systematic bias in agreement between inter-scan ground truth segmentation repeatability and segmentation repeatability of the networks. CONCLUSIONS For the three ADCm b value settings, two CNNs with U-Net-based architecture were repeatable for the problem of detection of csPCa at the slice-level. The network repeatability in segmenting csPCa lesions is affected by inter-scan variability and ground truth segmentation repeatability and may thus improve with better inter-scan reproducibility. KEY POINTS • For the three ADCm b value settings, two CNNs with U-Net-based architecture were repeatable for the problem of detection of csPCa at the slice-level. • The network repeatability in segmenting csPCa lesions is affected by inter-scan variability and ground truth segmentation repeatability and may thus improve with better inter-scan reproducibility.
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Affiliation(s)
- Amogh Hiremath
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Rakesh Shiradkar
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Harri Merisaari
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Prateek Prasanna
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, Ohio, USA
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Anttinen M, Ettala O, Malaspina S, Jambor I, Sandell M, Kajander S, Rinta-Kiikka I, Schildt J, Saukko E, Rautio P, Timonen KL, Matikainen T, Noponen T, Saunavaara J, Löyttyniemi E, Taimen P, Kemppainen J, Dean PB, Blanco Sequeiros R, Aronen HJ, Seppänen M, Boström PJ. A Prospective Comparison of 18F-prostate-specific Membrane Antigen-1007 Positron Emission Tomography Computed Tomography, Whole-body 1.5 T Magnetic Resonance Imaging with Diffusion-weighted Imaging, and Single-photon Emission Computed Tomography/Computed Tomography with Traditional Imaging in Primary Distant Metastasis Staging of Prostate Cancer (PROSTAGE). Eur Urol Oncol 2020; 4:635-644. [PMID: 32675047 DOI: 10.1016/j.euo.2020.06.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/08/2020] [Accepted: 06/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Computed tomography (CT) and bone scintigraphy (BS) are the imaging modalities currently used for distant metastasis staging of prostate cancer (PCa). OBJECTIVE To compare standard staging modalities with newer and potentially more accurate imaging modalities. DESIGN, SETTING, AND PARTICIPANTS This prospective, single-centre trial (NCT03537391) enrolled 80 patients with newly diagnosed high-risk PCa (International Society of Urological Pathology grade group ≥3 and/or prostate-specific antigen [PSA] ≥20 and/or cT ≥ T3; March 2018-June 2019) to undergo primary metastasis staging with two standard and three advanced imaging modalities. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The participants underwent the following five imaging examinations within 2 wk of enrolment and without a prespecified sequence: BS, CT, 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) single-photon emission computed tomography (SPECT)-CT, 1.5 T whole-body magnetic resonance imaging (WBMRI) using diffusion-weighted imaging, and 18F-prostate-specific membrane antigen-1007 (18F-PSMA-1007) positron emission tomography(PET)-CT. Each modality was reviewed by two independent experts blinded to the results of the prior studies, who classified lesions as benign, equivocal, or malignant. Pessimistic and optimistic analyses were performed to resolve each equivocal diagnosis. The reference standard diagnosis was defined using all available information accrued during at least 12 mo of clinical follow-up. Patients with equivocal reference standard diagnoses underwent MRI and/or CT to search for the development of anatomical correspondence. PSMA PET-avid lesions without histopathological verification were rated to be malignant only if there was a corresponding anatomical finding suspicious for malignancy at the primary or follow-up imaging. RESULTS AND LIMITATIONS Seventy-nine men underwent all imaging modalities except for one case of interrupted MRI. The median interval per patient between the first and the last imaging study was 8 d (interquartile range [IQR]: 6-9). The mean age was 70 yr (standard deviation: 7) and median PSA 12 ng/mL (IQR:7-23). The median follow-up was 435 d (IQR: 378-557). Metastatic disease was detected in 20 (25%) patients. The imaging modality 18F-PSMA-1007 PET-CT had superior sensitivity and highest inter-reader agreement. The area under the receiver-operating characteristic curve (AUC) values for bone metastasis detection with PSMA PET-CT were 0.90 (95% confidence interval [CI]: 0.85-0.95) and 0.91 (95% CI: 0.87-0.96) for readers 1 and 2, respectively, while the AUC values for BS, CT, SPECT-CT, and WBMRI were 0.71 (95% CI: 0.58-0.84) and 0.8 (95% CI: 0.67-0.92), 0.53 (95% CI: 0.39-0.67) and 0.66 (95% CI: 0.54-0.77), 0.77 (95% CI: 0.65-0.89) and 0.75 (95% CI: 0.62-0.88), and 0.85 (95% CI: 0.74-0.96) and 0.67 (95% CI: 0.54-0.80), respectively, for the other four pairs of readers. The imaging method 18F-PSMA-1007 PET-CT detected metastatic disease in 11/20 patients in whom standard imaging was negative and influenced clinical decision making in 14/79 (18%) patients. In 12/79 cases, false positive bone disease was reported only by PSMA PET-CT. Limitations included a nonrandomised study setting and few histopathologically validated suspicious lesions. CONCLUSIONS Despite the risk of false positive bone lesions, 18F-PSMA-1007 PET-CT outperformed all other imaging methods studied for the detection of primary distant metastasis in high-risk PCa. PATIENT SUMMARY In this report, we compared the diagnostic performance of conventional and advanced imaging. It was found that 18F-prostate-specific membrane antigen-1007 positron emission tomography/computed tomography (18F-PSMA-1007 PET-CT) was superior to the other imaging modalities studied for the detection of distant metastasis at the time of initial diagnosis of high-risk prostate cancer. PSMA PET-CT also appears to detect some nonmetastatic bone lesions.
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Affiliation(s)
- Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Simona Malaspina
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Minna Sandell
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Sami Kajander
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Jukka Schildt
- Department of Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ekaterina Saukko
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pentti Rautio
- Department of Clinical Physiology, North Karelia Central Hospital, Joensuu, Finland
| | - Kirsi L Timonen
- Department of Clinical Physiology and Nuclear Medicine, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuomas Matikainen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Noponen
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Pekka Taimen
- Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter B Dean
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Marko Seppänen
- Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
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20
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Knaapila J, Jambor I, Ettala O, Taimen P, Verho J, Perez IM, Kiviniemi A, Pahikkala T, Merisaari H, Lamminen T, Saunavaara J, Aronen HJ, Syvänen KT, Boström PJ. Negative Predictive Value of Biparametric Prostate Magnetic Resonance Imaging in Excluding Significant Prostate Cancer: A Pooled Data Analysis Based on Clinical Data from Four Prospective, Registered Studies. Eur Urol Focus 2020; 7:522-531. [PMID: 32418878 DOI: 10.1016/j.euf.2020.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/05/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiparametric prostate magnetic resonance imaging (mpMRI) can be considered the gold standard in prostate magnetic resonance imaging (MRI). Biparametric prostate MRI (bpMRI) is faster and could be a feasible alternative to mpMRI. OBJECTIVE To determine the negative predictive value (NPV) of Improved Prostate Cancer Diagnosis (IMPROD) bpMRI as a whole and in clinical subgroups in primary diagnostics of clinically significant prostate cancer (CSPCa). DESIGN, SETTING, AND PARTICIPANTS This is a pooled data analysis of four prospective, registered clinical trials investigating prebiopsy IMPROD bpMRI. Men with a clinical suspicion of prostate cancer (PCa) were included. INTERVENTION Prebiopsy IMPROD bpMRI was performed, and an IMPROD bpMRI Likert scoring system was used. If suspicious lesions (IMPROD bpMRI Likert score 3-5) were visible, targeted biopsies in addition to systematic biopsies were taken. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Performance measures of IMPROD bpMRI in CSPCa diagnostics were evaluated. NPV was also evaluated in clinical subgroups. Gleason grade ≥3 + 4 in any biopsy core taken was defined as CSPCa. RESULTS AND LIMITATIONS A total of 639 men were included in the analysis. The mean age was 64 yr, mean prostate-specific antigen level was 8.9 ng/ml, and CSPCa prevalence was 48%. NPVs of IMPROD bpMRI Likert scores 3-5 and 4-5 for CSPCa were 0.932 and 0.909, respectively, and the corresponding positive predictive values were 0.589 and 0.720. Only nine of 132 (7%) men with IMPROD bpMRI Likert score 1-2 had CSPCa and none with Gleason score >7. Thus, 132 of 639 (21%) study patients could have avoided biopsies without missing a single Gleason >7 cancer in the study biopsies. In the subgroup analysis, no clear outlier was present. The limitation is uncertainty of the true CSPCa prevalence. CONCLUSIONS IMPROD bpMRI demonstrated a high NPV to rule out CSPCa. IMPROD bpMRI Likert score 1-2 excludes Gleason >7 PCa in the study biopsies. PATIENT SUMMARY We investigated the feasibility of prostate magnetic resonance imaging (MRI) with the Improved Prostate Cancer Diagnosis (IMPROD) biparametric MRI (bpMRI) protocol in excluding significant prostate cancer. In this study, highly aggressive prostate cancer was excluded using the publicly available IMPROD bpMRI protocol (http://petiv.utu.fi/multiimprod/).
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Affiliation(s)
- Juha Knaapila
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland.
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Janne Verho
- Department of Diagnostic Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Diagnostic Radiology, University of Turku, Turku, Finland; Department of Future Technologies, University of Turku, Turku, Finland
| | - Aida Kiviniemi
- Department of Diagnostic Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Tapio Pahikkala
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland; Department of Future Technologies, University of Turku, Turku, Finland
| | - Tarja Lamminen
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Kari T Syvänen
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
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21
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Knaapila J, Autio V, Jambor I, Ettala O, Verho J, Kiviniemi A, Taimen P, Perez IM, Aronen HJ, Syvänen KT, Boström PJ. Impact of biparametric prebiopsy prostate magnetic resonance imaging on the diagnostics of clinically significant prostate cancer in biopsy naïve men. Scand J Urol 2020; 54:7-13. [PMID: 31914846 DOI: 10.1080/21681805.2019.1711161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The objective of this study was to compare the prevalence of clinically significant prostate cancer (CSPCa) in men with biparametric prebiopsy prostate magnetic resonance imaging (MRI) and lesion-targeted biopsies (TBs) to the group of men without prebiopsy MRI in an initial biopsy session.Methods: The MRI group consists of men enrolled into four prospective clinical trials investigating a biparametric MRI (bpMRI) and TB while the non-MRI group was a retrospective cohort of men collected from an era prior to a clinical use of a prostate MRI. All men had standard biopsies (SBs). In the MRI group, men had additional TBs from potential cancer-suspicious lesions. CSPCa was defined as Gleason score ≥3 + 4 in any biopsy core taken. All the patients were prostate biopsy naïve.Results: The MRI group consists of 507 while the non-MRI group 379 men. Mean age and prostate specific antigen (PSA) level differed significantly (p < 0.05) between the groups: In the MRI group, 64 years and 7.6 ng/ml, respectively, and in the non-MRI group 68 years and 8.2 ng/ml, respectively. Significantly (p < 0.05) more CSPCa was diagnosed with initial biopsies in the MRI group (48%) compared to non-MRI group (34%). In men with no CSPCa diagnosed during the initial biopsies, significantly fewer (p < 0.05) men had upgrading re-biopsies in the MRI group (5%) than in the non-MRI group (19%) during the follow up.Conclusions: Prebiopsy bpMRI with TBs combined with SBs could lead to earlier diagnoses of CSPCa compared with men without prebiopsy prostate MRI used in initial PCa diagnostics.
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Affiliation(s)
- Juha Knaapila
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.,Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Venla Autio
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Janne Verho
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Aida Kiviniemi
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Pathology, Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Kari T Syvänen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
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22
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Perez IM, Jambor I, Kauko T, Verho J, Ettala O, Falagario U, Merisaari H, Kiviniemi A, Taimen P, Syvänen KT, Knaapila J, Seppänen M, Rannikko A, Riikonen J, Kallajoki M, Mirtti T, Lamminen T, Saunavaara J, Pahikkala T, Boström PJ, Aronen HJ. Qualitative and Quantitative Reporting of a Unique Biparametric MRI: Towards Biparametric MRI‐Based Nomograms for Prediction of Prostate Biopsy Outcome in Men With a Clinical Suspicion of Prostate Cancer (IMPROD and MULTI‐IMPROD Trials). J Magn Reson Imaging 2019; 51:1556-1567. [DOI: 10.1002/jmri.26975] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ileana Montoya Perez
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of Future TechnologiesUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Ivan Jambor
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
- Department of RadiologyIcahn School of Medicine at Mount Sinai New York New York USA
| | - Tommi Kauko
- Auria Clinical InformaticsTurku University Hospital Turku Finland
| | - Janne Verho
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Otto Ettala
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Ugo Falagario
- Department of UrologyUniversity of Foggia Foggia Italy
- Department of UrologyIcahn School of Medicine at Mount Sinai New York New York USA
| | - Harri Merisaari
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of Future TechnologiesUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Aida Kiviniemi
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Pekka Taimen
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| | - Kari T. Syvänen
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Juha Knaapila
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Marjo Seppänen
- Department of SurgerySatakunta Central Hospital Pori Finland
| | - Antti Rannikko
- Department of UrologyHelsinki University and Helsinki University Hospital Helsinki Finland
| | - Jarno Riikonen
- Department of UrologyTampere University Hospital and University of Tampere Tampere Finland
| | - Markku Kallajoki
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| | - Tuomas Mirtti
- Department of PathologyUniversity of Helsinki Helsinki Finland
| | - Tarja Lamminen
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Jani Saunavaara
- Department of Medical PhysicsTurku University Hospital Turku Finland
| | - Tapio Pahikkala
- Department of Future TechnologiesUniversity of Turku Turku Finland
| | - Peter J. Boström
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Hannu J. Aronen
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
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23
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Merisaari H, Taimen P, Shiradkar R, Ettala O, Pesola M, Saunavaara J, Boström PJ, Madabhushi A, Aronen HJ, Jambor I. Repeatability of radiomics and machine learning for DWI: Short-term repeatability study of 112 patients with prostate cancer. Magn Reson Med 2019; 83:2293-2309. [PMID: 31703155 DOI: 10.1002/mrm.28058] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate repeatability of prostate DWI-derived radiomics and machine learning methods for prostate cancer (PCa) characterization. METHODS A total of 112 patients with diagnosed PCa underwent 2 prostate MRI examinations (Scan1 and Scan2) performed on the same day. DWI was performed using 12 b-values (0-2000 s/mm2 ), post-processed using kurtosis function, and PCa areas were annotated using whole mount prostatectomy sections. A total of 1694 radiomic features including Sobel, Kirch, Gradient, Zernike Moments, Gabor, Haralick, CoLIAGe, Haar wavelet coefficients, 3D analogue to Laws features, 2D contours, and corner detectors were calculated. Radiomics and 4 feature pruning methods (area under the receiver operator characteristic curve, maximum relevance minimum redundancy, Spearman's ρ, Wilcoxon rank-sum) were evaluated in terms of Scan1-Scan2 repeatability using intraclass correlation coefficient (ICC)(3,1). Classification performance for clinically significant and insignificant PCa with Gleason grade groups 1 versus >1 was evaluated by area under the receiver operator characteristic curve in unseen random 30% data split. RESULTS The ICC(3,1) values for conventional radiomics and feature pruning methods were in the range of 0.28-0.90. The machine learning classifications varied between Scan1 and Scan2 with % of same class labels between Scan1 and Scan2 in the range of 61-81%. Surface-to-volume ratio and corner detector-based features were among the most represented features with high repeatability, ICC(3,1) >0.75, consistently high ranking using all 4 feature pruning methods, and classification performance with area under the receiver operator characteristic curve >0.70. CONCLUSION Surface-to-volume ratio and corner detectors for prostate DWI led to good classification of unseen data and performed similarly in Scan1 and Scan2 in contrast to multiple conventional radiomic features.
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Affiliation(s)
- Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Pathology, Turku University Hospital, Turku, Finland
| | - Rakesh Shiradkar
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Marko Pesola
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Jani Saunavaara
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Montoya Perez I, Jambor I, Pahikkala T, Airola A, Merisaari H, Saunavaara J, Alinezhad S, Väänänen RM, Tallgrén T, Verho J, Kiviniemi A, Ettala O, Knaapila J, Syvänen KT, Kallajoki M, Vainio P, Aronen HJ, Pettersson K, Boström PJ, Taimen P. Prostate Cancer Risk Stratification in Men With a Clinical Suspicion of Prostate Cancer Using a Unique Biparametric MRI and Expression of 11 Genes in Apparently Benign Tissue: Evaluation Using Machine-Learning Techniques. J Magn Reson Imaging 2019; 51:1540-1553. [PMID: 31588660 DOI: 10.1002/jmri.26945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Accurate risk stratification of men with a clinical suspicion of prostate cancer (cSPCa) remains challenging despite the increasing use of MRI. PURPOSE To evaluate the diagnostic accuracy of a unique biparametric MRI protocol (IMPROD bpMRI) combined with clinical and molecular markers in men with cSPCa. STUDY TYPE Prospective single-institutional clinical trial (NCT01864135). SUBJECTS Eighty men with cSPCa. FIELD STRENGTH/SEQUENCE 3T, surface array coils. Two T2 -weighted and three diffusion-weighted imaging (DWI) acquisitions: 1) b-values 0, 100, 200, 300, 500 s/mm2 ; 2) b-values 0,1500 s/mm2 ; 3) b-values 0, 2000 s/mm2 . ASSESSMENT IMPROD bpMRI examinations were qualitatively (IMPROD bpMRI Likert score) and quantitatively (DWI-based Gleason grade score) prospectively reported. Men with IMPROD bpMRI Likert 3-5 had two targeted biopsies followed by 12-core systematic biopsies (SB); those with IMPROD bpMRI Likert 1-2 had only SB. Additionally, 2-core from normal-appearing prostate areas were obtained for the mRNA expression of ACSM1, AMACR, CACNA1D, DLX1, PCA3, PLA2G7, RHOU, SPINK1, SPON2, TMPRSS2-ERG, and TDRD1 measured by quantitative reverse-transcription polymerase chain reaction. STATISTICAL TESTS Univariate and multivariate analysis using regularized least-squares, feature selection and tournament leave-pair-out cross-validation (TLPOCV), as well as 10 random splits of the data in training-testing sets, were used to evaluate the mRNA, clinical and IMPROD bpMRI parameters in detecting clinically significant prostate cancer (SPCa) defined as Gleason score ≥ 3 + 4. The evaluation metric was the area under the curve (AUC). RESULTS IMPROD bpMRI Likert demonstrated the highest TLPOCV AUC of 0.92. The tested clinical variables had AUC 0.56-0.73, while the mRNA and additional IMPROD bpMRI parameters had AUC 0.50-0.67 and 0.65-0.89 respectively. The combination of clinical and mRNA biomarkers produced TLPOCV AUC of 0.87, the highest TLPOCV performance without including IMPROD bpMRI Likert. DATA CONCLUSION The qualitative IMPROD bpMRI Likert score demonstrated the highest accuracy for SPCa detection compared with the tested clinical variables and mRNA biomarkers. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1540-1553.
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Affiliation(s)
- Ileana Montoya Perez
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Tapio Pahikkala
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Antti Airola
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Saeid Alinezhad
- Department of Biotechnology, University of Turku, Turku, Finland
| | | | - Terhi Tallgrén
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Janne Verho
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Aida Kiviniemi
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Juha Knaapila
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Kari T Syvänen
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Markku Kallajoki
- Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Paula Vainio
- Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Kim Pettersson
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
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Toivonen J, Montoya Perez I, Movahedi P, Merisaari H, Pesola M, Taimen P, Boström PJ, Pohjankukka J, Kiviniemi A, Pahikkala T, Aronen HJ, Jambor I. Radiomics and machine learning of multisequence multiparametric prostate MRI: Towards improved non-invasive prostate cancer characterization. PLoS One 2019; 14:e0217702. [PMID: 31283771 PMCID: PMC6613688 DOI: 10.1371/journal.pone.0217702] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/16/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To develop and validate a classifier system for prediction of prostate cancer (PCa) Gleason score (GS) using radiomics and texture features of T2-weighted imaging (T2w), diffusion weighted imaging (DWI) acquired using high b values, and T2-mapping (T2). Methods T2w, DWI (12 b values, 0–2000 s/mm2), and T2 data sets of 62 patients with histologically confirmed PCa were acquired at 3T using surface array coils. The DWI data sets were post-processed using monoexponential and kurtosis models, while T2w was standardized to a common scale. Local statistics and 8 different radiomics/texture descriptors were utilized at different configurations to extract a total of 7105 unique per-tumor features. Regularized logistic regression with implicit feature selection and leave pair out cross validation was used to discriminate tumors with 3+3 vs >3+3 GS. Results In total, 100 PCa lesions were analysed, of those 20 and 80 had GS of 3+3 and >3+3, respectively. The best model performance was obtained by selecting the top 1% features of T2w, ADCm and K with ROC AUC of 0.88 (95% CI of 0.82–0.95). Features from T2 mapping provided little added value. The most useful texture features were based on the gray-level co-occurrence matrix, Gabor transform, and Zernike moments. Conclusion Texture feature analysis of DWI, post-processed using monoexponential and kurtosis models, and T2w demonstrated good classification performance for GS of PCa. In multisequence setting, the optimal radiomics based texture extraction methods and parameters differed between different image types.
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Affiliation(s)
- Jussi Toivonen
- Dept. of Diagnostic Radiology, University of Turku, Turku, Finland
- Dept. of Future Technologies, University of Turku, Turku, Finland
- * E-mail:
| | - Ileana Montoya Perez
- Dept. of Diagnostic Radiology, University of Turku, Turku, Finland
- Dept. of Future Technologies, University of Turku, Turku, Finland
| | - Parisa Movahedi
- Dept. of Diagnostic Radiology, University of Turku, Turku, Finland
- Dept. of Future Technologies, University of Turku, Turku, Finland
| | - Harri Merisaari
- Dept. of Diagnostic Radiology, University of Turku, Turku, Finland
- Dept. of Future Technologies, University of Turku, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Marko Pesola
- Dept. of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku and Dept. of Pathology, Turku University Hospital, Turku, Finland
| | | | | | - Aida Kiviniemi
- Dept. of Diagnostic Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Tapio Pahikkala
- Dept. of Future Technologies, University of Turku, Turku, Finland
| | - Hannu J. Aronen
- Dept. of Diagnostic Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Dept. of Diagnostic Radiology, University of Turku, Turku, Finland
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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26
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Jambor I, Verho J, Ettala O, Knaapila J, Taimen P, Syvänen KT, Kiviniemi A, Kähkönen E, Perez IM, Seppänen M, Rannikko A, Oksanen O, Riikonen J, Vimpeli SM, Kauko T, Merisaari H, Kallajoki M, Mirtti T, Lamminen T, Saunavaara J, Aronen HJ, Boström PJ. Validation of IMPROD biparametric MRI in men with clinically suspected prostate cancer: A prospective multi-institutional trial. PLoS Med 2019; 16:e1002813. [PMID: 31158230 PMCID: PMC6546206 DOI: 10.1371/journal.pmed.1002813] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/25/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) combined with targeted biopsy (TB) is increasingly used in men with clinically suspected prostate cancer (PCa), but the long acquisition times, high costs, and inter-center/reader variability of routine multiparametric prostate MRI limit its wider adoption. METHODS AND FINDINGS The aim was to validate a previously developed unique MRI acquisition and reporting protocol, IMPROD biparametric MRI (bpMRI) (NCT01864135), in men with a clinical suspicion of PCa in a multi-institutional trial (NCT02241122). IMPROD bpMRI has average acquisition time of 15 minutes (no endorectal coil, no intravenous contrast use) and consists of T2-weighted imaging and 3 separate diffusion-weighed imaging acquisitions. Between February 1, 2015, and March 31, 2017, 364 men with a clinical suspicion of PCa were enrolled at 4 institutions in Finland. Men with an equivocal to high suspicion (IMPROD bpMRI Likert score 3-5) of PCa had 2 TBs of up to 2 lesions followed by a systematic biopsy (SB). Men with a low to very low suspicion (IMPROD bpMRI Likert score 1-2) had only SB. All data and protocols are freely available. The primary outcome of the trial was diagnostic accuracy-including overall accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value-of IMPROD bpMRI for clinically significant PCa (SPCa), which was defined as a Gleason score ≥ 3 + 4 (Gleason grade group 2 or higher). In total, 338 (338/364, 93%) prospectively enrolled men completed the trial. The accuracy and NPV of IMPROD bpMRI for SPCa were 70% (113/161) and 95% (71/75) (95% CI 87%-98%), respectively. Restricting the biopsy to men with equivocal to highly suspicious IMPROD bpMRI findings would have resulted in a 22% (75/338) reduction in the number of men undergoing biopsy while missing 4 (3%, 4/146) men with SPCa. The main limitation is uncertainty about the true PCa prevalence in the study cohort, since some of the men may have PCa despite having negative biopsy findings. CONCLUSIONS IMPROD bpMRI demonstrated a high NPV for SPCa in men with a clinical suspicion of PCa in this prospective multi-institutional clinical trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02241122.
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Affiliation(s)
- Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Janne Verho
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Juha Knaapila
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Kari T. Syvänen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Aida Kiviniemi
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Esa Kähkönen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Marjo Seppänen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Antti Rannikko
- Department of Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Outi Oksanen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Jarno Riikonen
- Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | | | - Tommi Kauko
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Radiology, University of Turku, Turku, Finland
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Markku Kallajoki
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Tarja Lamminen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Hannu J. Aronen
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Peter J. Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
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Merisaari H, Jambor I, Ettala O, Boström PJ, Montoya Perez I, Verho J, Kiviniemi A, Syvänen K, Kähkönen E, Eklund L, Pahikkala T, Vainio P, Saunavaara J, Aronen HJ, Taimen P. IMPROD biparametric MRI in men with a clinical suspicion of prostate cancer (IMPROD Trial): Sensitivity for prostate cancer detection in correlation with whole‐mount prostatectomy sections and implications for focal therapy. J Magn Reson Imaging 2019; 50:1641-1650. [DOI: 10.1002/jmri.26727] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- Harri Merisaari
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of Future TechnologiesUniversity of Turku Turku Finland
| | - Ivan Jambor
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of RadiologyIcahn School of Medicine at Mount Sinai New York New York USA
| | - Otto Ettala
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Peter J. Boström
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Ileana Montoya Perez
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of Future TechnologiesUniversity of Turku Turku Finland
| | - Janne Verho
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Aida Kiviniemi
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Kari Syvänen
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Esa Kähkönen
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Lauri Eklund
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| | - Tapio Pahikkala
- Department of Future TechnologiesUniversity of Turku Turku Finland
| | - Paula Vainio
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| | - Jani Saunavaara
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Hannu J. Aronen
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Pekka Taimen
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
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Jambor I, Kuisma A, Kähkönen E, Kemppainen J, Merisaari H, Eskola O, Teuho J, Perez IM, Pesola M, Aronen HJ, Boström PJ, Taimen P, Minn H. Prospective evaluation of 18F-FACBC PET/CT and PET/MRI versus multiparametric MRI in intermediate- to high-risk prostate cancer patients (FLUCIPRO trial). Eur J Nucl Med Mol Imaging 2017; 45:355-364. [PMID: 29147764 DOI: 10.1007/s00259-017-3875-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/03/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study was to evaluate 18F-FACBC PET/CT, PET/MRI, and multiparametric MRI (mpMRI) in detection of primary prostate cancer (PCa). METHODS Twenty-six men with histologically confirmed PCa underwent PET/CT immediately after injection of 369 ± 10 MBq 18F-FACBC (fluciclovine) followed by PET/MRI started 55 ± 7 min from injection. Maximum standardized uptake values (SUVmax) were measured for both hybrid PET acquisitions. A separate mpMRI was acquired within a week of the PET scans. Logan plots were used to calculate volume of distribution (VT). The presence of PCa was estimated in 12 regions with radical prostatectomy findings as ground truth. For each imaging modality, area under the curve (AUC) for detection of PCa was determined to predict diagnostic performance. The clinical trial registration number is NCT02002455. RESULTS In the visual analysis, 164/312 (53%) regions contained PCa, and 41 tumor foci were identified. PET/CT demonstrated the highest sensitivity at 87% while its specificity was low at 56%. The AUC of both PET/MRI and mpMRI significantly (p < 0.01) outperformed that of PET/CT while no differences were detected between PET/MRI and mpMRI. SUVmax and VT of Gleason score (GS) >3 + 4 tumors were significantly (p < 0.05) higher than those for GS 3 + 3 and benign hyperplasia. A total of 442 lymph nodes were evaluable for staging, and PET/CT and PET/MRI demonstrated true-positive findings in only 1/7 patients with metastatic lymph nodes. CONCLUSIONS Quantitative 18F-FACBC imaging significantly correlated with GS but failed to outperform MRI in lesion detection. 18F-FACBC may assist in targeted biopsies in the setting of hybrid imaging with MRI.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, FI-20521, Turku, Finland.
- Department of Radiology, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
- Turku PET Centre, Turku, Finland.
| | - Anna Kuisma
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Esa Kähkönen
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, FI-20521, Turku, Finland
- Turku PET Centre, Turku, Finland
- Department of Information Technology, University of Turku, Turku, Finland
| | | | | | - Ileana Montoya Perez
- Department of Diagnostic Radiology, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, FI-20521, Turku, Finland
- Department of Information Technology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Marko Pesola
- Department of Diagnostic Radiology, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, FI-20521, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, FI-20521, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Heikki Minn
- Turku PET Centre, Turku, Finland
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
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Ginsburg SB, Algohary A, Pahwa S, Gulani V, Ponsky L, Aronen HJ, Boström PJ, Böhm M, Haynes AM, Brenner P, Delprado W, Thompson J, Pulbrock M, Taimen P, Villani R, Stricker P, Rastinehad AR, Jambor I, Madabhushi A. Radiomic features for prostate cancer detection on MRI differ between the transition and peripheral zones: Preliminary findings from a multi-institutional study. J Magn Reson Imaging 2016; 46:184-193. [PMID: 27990722 DOI: 10.1002/jmri.25562] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/03/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate in a multi-institutional study whether radiomic features useful for prostate cancer (PCa) detection from 3 Tesla (T) multi-parametric MRI (mpMRI) in the transition zone (TZ) differ from those in the peripheral zone (PZ). MATERIALS AND METHODS 3T mpMRI, including T2-weighted (T2w), apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced MRI (DCE-MRI), were retrospectively obtained from 80 patients at three institutions. This study was approved by the institutional review board of each participating institution. First-order statistical, co-occurrence, and wavelet features were extracted from T2w MRI and ADC maps, and contrast kinetic features were extracted from DCE-MRI. Feature selection was performed to identify 10 features for PCa detection in the TZ and PZ, respectively. Two logistic regression classifiers used these features to detect PCa and were evaluated by area under the receiver-operating characteristic curve (AUC). Classifier performance was compared with a zone-ignorant classifier. RESULTS Radiomic features that were identified as useful for PCa detection differed between TZ and PZ. When classification was performed on a per-voxel basis, a PZ-specific classifier detected PZ tumors on an independent test set with significantly higher accuracy (AUC = 0.61-0.71) than a zone-ignorant classifier trained to detect cancer throughout the entire prostate (P < 0.05). When classifiers were evaluated on MRI data from multiple institutions, statistically similar AUC values (P > 0.14) were obtained for all institutions. CONCLUSION A zone-aware classifier significantly improves the accuracy of cancer detection in the PZ. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:184-193.
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Affiliation(s)
- Shoshana B Ginsburg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ahmad Algohary
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shivani Pahwa
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Vikas Gulani
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lee Ponsky
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Maret Böhm
- Garvan Institute of Medical Research, Sydney, Australia
| | | | - Phillip Brenner
- Department of Urology, St. Vincent's Hospital, Sydney, Australia
| | | | | | | | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Robert Villani
- Department of Radiology, Hofstra North Shore-LIJ, New Hyde Park, New York, USA
| | - Phillip Stricker
- Department of Urology, St. Vincent's Hospital, Sydney, Australia
| | - Ardeshir R Rastinehad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Manhattan, New York, USA
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Helenius J, Perkiö J, Soinne L, Østergaard L, Carano RAD, Salonen O, Savolainen S, Kaste M, Aronen HJ, Tatlisumak T. Cerebral hemodynamics in a healthy population measured by dynamic susceptibility contrast MR imaging. Acta Radiol 2016; 44:538-46. [PMID: 14510762 DOI: 10.1080/j.1600-0455.2003.00104.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To establish reference data and to study age-dependency for cerebral perfusion in various regions of the brain in a healthy population. Material and Methods: Eighty healthy subjects of both genders from 22 to 85 years of age were studied with spin echo echo-planar dynamic susceptibility contrast MR imaging (DSC MRI) at 1.5 T. Cerebral blood volume (CBV), cerebral blood flow (CBF), and contrast agent mean transit time (MTT) were calculated bilaterally for 20 distinct neuroanatomic structures. Results: In gray matter, the following values were found (mean ± SD): CBV (4.6 ± 1.0 ml/100 g), CBF (94.2 ± 23.0 ml/100 g/min), and MTT (3.0 ± 0.6 s), and in white matter: CBV (1.3 ± 0.4 ml/100 g), CBF (19.6 ± 5.8 ml/100 g/min), and MTT (4.3 ± 0.7 s). The perfusion parameters did not change with age, except for a tendency to an increase in gray matter MTT and CBV. Males exhibited higher MTT and CBV than females. No hemispheric difference was found in either gender. Conclusion: Cerebral hemodynamics can be assessed with DSC MRI. Age itself seems to have only a marginal effect on cerebral perfusion in healthy population.
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Affiliation(s)
- J Helenius
- Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290 Helsinki, Finland
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Ginsburg SB, Taimen P, Merisaari H, Vainio P, Boström PJ, Aronen HJ, Jambor I, Madabhushi A. Patient-specific pharmacokinetic parameter estimation on dynamic contrast-enhanced MRI of prostate: Preliminary evaluation of a novel AIF-free estimation method. J Magn Reson Imaging 2016; 44:1405-1414. [PMID: 27285161 DOI: 10.1002/jmri.25330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/20/2016] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To develop and evaluate a prostate-based method (PBM) for estimating pharmacokinetic parameters on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) by leveraging inherent differences in pharmacokinetic characteristics between the peripheral zone (PZ) and transition zone (TZ). MATERIALS AND METHODS This retrospective study, approved by the Institutional Review Board, included 40 patients who underwent a multiparametric 3T MRI examination and subsequent radical prostatectomy. A two-step PBM for estimating pharmacokinetic parameters exploited the inherent differences in pharmacokinetic characteristics associated with the TZ and PZ. First, the reference region model was implemented to estimate ratios of Ktrans between normal TZ and PZ. Subsequently, the reference region model was leveraged again to estimate values for Ktrans and ve for every prostate voxel. The parameters of PBM were compared with those estimated using an arterial input function (AIF) derived from the femoral arteries. The ability of the parameters to differentiate prostate cancer (PCa) from benign tissue was evaluated on a voxel and lesion level. Additionally, the effect of temporal downsampling of the DCE MRI data was assessed. RESULTS Significant differences (P < 0.05) in PBM Ktrans between PCa lesions and benign tissue were found in 26/27 patients with TZ lesions and in 33/38 patients with PZ lesions; significant differences in AIF-based Ktrans occurred in 26/27 and 30/38 patients, respectively. The 75th and 100th percentiles of Ktrans and ve estimated using PBM positively correlated with lesion size (P < 0.05). CONCLUSION Pharmacokinetic parameters estimated via PBM outperformed AIF-based parameters in PCa detection. J. Magn. Reson. Imaging 2016;44:1405-1414.
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Affiliation(s)
- Shoshana B Ginsburg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Information Technology, University of Turku, Turku, Finland
| | - Paula Vainio
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Merisaari H, Movahedi P, Perez IM, Toivonen J, Pesola M, Taimen P, Boström PJ, Pahikkala T, Kiviniemi A, Aronen HJ, Jambor I. Fitting methods for intravoxel incoherent motion imaging of prostate cancer on region of interest level: Repeatability and gleason score prediction. Magn Reson Med 2016; 77:1249-1264. [PMID: 26924552 DOI: 10.1002/mrm.26169] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate different fitting methods for intravoxel incoherent motion (IVIM) imaging of prostate cancer in the terms of repeatability and Gleason score prediction. METHODS Eighty-one patients with histologically confirmed prostate cancer underwent two repeated 3 Tesla diffusion-weighted imaging (DWI) examinations performed using 14 b-values in the range of 0-500 s/mm2 and diffusion time of 19.004 ms. Mean signal intensities of regions-of-interest were fitted using five different fitting methods for IVIM as well as monoexponential, kurtosis, and stretched exponential models. The fitting methods and models were evaluated in the terms of fitting quality [Akaike information criteria (AIC)], repeatability, and Gleason score prediction. Tumors were classified into three groups (3 + 3, 3 + 4, > 3 + 4). Machine learning algorithms were used to evaluate the performance of the combined use of the parameters. Simulation studies were performed to evaluate robustness of the fitting methods against noise. RESULTS Monoexponential model was preferred over IVIM based on AIC. The "pseudodiffusion" parameters demonstrated low repeatability and clinical value. Median "pseudodiffusion" fraction values were below 8.00%. Combined use of the parameters did not outperform the monoexponential model. CONCLUSION Monoexponential model demonstrated the highest repeatability and clinical values in the regions-of-interest based analysis of prostate cancer DWI, b-values in the range of 0-500 s/mm2 . Magn Reson Med 77:1249-1264, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Parisa Movahedi
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.,Department of Information Technology, University of Turku, Turku, Finland
| | - Ileana M Perez
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.,Department of Information Technology, University of Turku, Turku, Finland
| | - Jussi Toivonen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.,Department of Information Technology, University of Turku, Turku, Finland
| | - Marko Pesola
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Tapio Pahikkala
- Department of Information Technology, University of Turku, Turku, Finland
| | - Aida Kiviniemi
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland.,Department of Information Technology, University of Turku, Turku, Finland
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Merisaari H, Toivonen J, Pesola M, Taimen P, Boström PJ, Pahikkala T, Aronen HJ, Jambor I. Diffusion-weighted imaging of prostate cancer: effect of b-value distribution on repeatability and cancer characterization. Magn Reson Imaging 2015. [PMID: 26220861 DOI: 10.1016/j.mri.2015.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the effect of b-value distribution on the repeatability and Gleason score (GS) prediction of prostate cancer (PCa). METHODS Fifty PCa patients underwent two repeated 3T diffusion-weighted imaging (DWI) examinations using 12 b values in the range from 0 to 2000s/mm(2) and diffusion time of 20.3ms. Mean signal intensities of regions of interest, placed in PCa using whole mount prostatectomy sections as the reference, were fitted using monoexponential, kurtosis, stretched exponential, and biexponential models. In total, 4083 different b-value combinations consisting of 2 to 12 b values were evaluated. Repeatability was assessed by intraclass correlation coefficient, ICC(3,1), and coefficient of repeatability (CoR). Areas under receiver operating characteristic curve (AUCs) for PCa characterization were estimated while the correlation of the fitted values with GS groups (3+3, 3+4, >3+4) was evaluated by using the Spearman correlation coefficient (ρ). RESULTS The parameters of monoexponential, kurtosis, and stretched exponential models estimated using only 4-5, 5-7, 5-7 b values, respectively, had similar ICC(3,1), CoR, AUC, and ρ values as the parameters estimated using all 12 b values. Optimized b-value distributions demonstrated improved ICC(3,1) and CoR values but failed to improve AUC and ρ values. The parameters of biexponential model demonstrated the worst repeatability and diagnostic performance. CONCLUSION B-value distribution influences mainly the repeatability of DWI-derived parameters rather than the diagnostic performance.
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Affiliation(s)
- Harri Merisaari
- Department of Information Technology, University of Turku, Turku, Finland; Turku PET Centre, University of Turku, Turku, Finland
| | - Jussi Toivonen
- Department of Information Technology, University of Turku, Turku, Finland; Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Marko Pesola
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Tapio Pahikkala
- Department of Information Technology, University of Turku, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.
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Jambor I, Pesola M, Merisaari H, Taimen P, Boström PJ, Liimatainen T, Aronen HJ. Relaxation along fictitious field, diffusion-weighted imaging, and T2 mapping of prostate cancer: Prediction of cancer aggressiveness. Magn Reson Med 2015; 75:2130-40. [PMID: 26094849 DOI: 10.1002/mrm.25808] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the performance of relaxation along a fictitious field (RAFF) relaxation time (TRAFF ), diffusion-weighted imaging (DWI)-derived parameters, and T2 relaxation time values for prostate cancer (PCa) detection and characterization. METHODS Fifty patients underwent 3T MR examination using surface array coils before prostatectomy. DWI was performed using 14 and 12 b values in the ranges of 0-500 s/mm(2) and 0-2000 s/mm(2) , respectively. Repeated MR examination was performed in 16 patients. TRAFF , DWI-derived parameters (monoexponential, kurtosis, biexponential models), and T2 values were measured and averaged over regions of interest placed in PCa and normal tissue. Repeatability of TRAFF and DWI-derived parameters were assessed by coefficient of repeatability and intraclass correlation coefficient ICC(3,1). Areas under the receiver operating characteristic curve (AUCs) for PCa detection and Gleason score classification were estimated. The parameters were correlated with Gleason score groups using Spearman correlation coefficient (ρ). RESULTS ICC(3,1) values for TRAFF were in the range of 0.82-0.92. TRAFF values had higher AUC values for Gleason score classification compared with DWI-derived parameters and T2 . The RAFF method demonstrated the highest ρ value (-0.65). CONCLUSION In a quantitative region of interest-based analysis, RAFF outperformed DWI ("low" and "high" b values) and T2 mapping in the characterization of PCa.
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Affiliation(s)
- Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
| | - Marko Pesola
- Department of Radiology, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Information Technology, University of Turku, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Timo Liimatainen
- Department of Biotechnology and Molecular Medicine, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
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Jambor I, Kuisma A, Ramadan S, Huovinen R, Sandell M, Kajander S, Kemppainen J, Kauppila E, Auren J, Merisaari H, Saunavaara J, Noponen T, Minn H, Aronen HJ, Seppänen M. Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial. Acta Oncol 2015; 55:59-67. [PMID: 25833330 DOI: 10.3109/0284186x.2015.1027411] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Detection of bone metastases in breast and prostate cancer patients remains a major clinical challenge. The aim of the current trial was to compare the diagnostic accuracy of (99m)Tc-hydroxymethane diphosphonate ((99m)Tc-HDP) planar bone scintigraphy (BS), (99m)Tc-HDP SPECT, (99m)Tc-HDP SPECT/CT, (18)F-NaF PET/CT and whole body 1.5 Tesla magnetic resonance imaging (MRI), including diffusion weighted imaging, (wbMRI+DWI) for the detection of bone metastases in high risk breast and prostate cancer patients. MATERIAL AND METHODS Twenty-six breast and 27 prostate cancer patients at high risk of bone metastases underwent (99m)Tc-HDP BS, (99m)Tc-HDP SPECT, (99m)Tc-HDP SPECT/CT, (18)F-NaF PET/CT and wbMRI+DWI. Five independent reviewers interpreted each individual modality without the knowledge of other imaging findings. The final metastatic status was based on the consensus reading, clinical and imaging follow-up (minimal and maximal follow-up time was 6, and 32 months, respectively). The bone findings were compared on patient-, region-, and lesion-level. RESULTS (99m)Tc-HDP BS was false negative in four patients. In the region-based analysis, sensitivity values for (99m)Tc-HDP BS, (99m)Tc-HDP SPECT, (99m)Tc-HDP SPECT/CT, (18)F-NaF PET/CT, and wbMRI+DWI were 62%, 74%, 85%, 93%, and 91%, respectively. The number of equivocal findings for (99m)Tc-HDP BS, (99m)Tc-HDP SPECT, (99m)Tc-HDP SPECT/CT, (18)F-NaF PET/CT and wbMRI+DWI was 50, 44, 5, 6, and 4, respectively. CONCLUSION wbMRI+DWI showed similar diagnostic accuracy to (18)F-NaF PET/CT and outperformed (99m)Tc-HDP SPECT/CT, and (99m)Tc-HDP BS.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Anna Kuisma
- Department of Oncology and Radiotherapy, University of Turku, Turku, Finland
| | - Susan Ramadan
- Department of Oncology and Radiotherapy, University of Turku, Turku, Finland
| | - Riikka Huovinen
- Department of Oncology and Radiotherapy, University of Turku, Turku, Finland
| | - Minna Sandell
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | | | | | - Esa Kauppila
- Department of Clinical Physiology and Nuclear Medicine, North-Karelia Central Hospital, Joensuu, Finland
| | - Joakim Auren
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | | | - Jani Saunavaara
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Tommi Noponen
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- Department of Oncology and Radiotherapy, University of Turku, Turku, Finland
- Turku PET Centre, Turku, Finland
| | - Hannu J. Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Marko Seppänen
- Turku PET Centre, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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Jambor I, Pesola M, Taimen P, Merisaari H, Boström PJ, Minn H, Liimatainen T, Aronen HJ. Rotating frame relaxation imaging of prostate cancer: Repeatability, cancer detection, and Gleason score prediction. Magn Reson Med 2015; 75:337-44. [PMID: 25733132 DOI: 10.1002/mrm.25647] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/08/2014] [Accepted: 01/12/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate relaxation along a fictitious field (RAFF) and continuous wave (cw) T1ρ imaging of prostate cancer (PCa) in the terms of repeatability, PCa detection, and characterization. METHODS Thirty-six patients (PSA 11.6 ± 7.6 ng/mL, mean ± standard deviation) with histologically confirmed PCa underwent two repeated 3T MR examinations using surface array coils before prostatectomy. Relaxation along fictitious field, cw T1ρ, and T2 relaxation times (TRAFF, T1ρcw, T2) were measured and averaged over regions of interest placed in PCa, normal peripheral zone (PZ), and normal central gland (CG) positioned using whole-mount prostatectomy sections and anatomical T2-weighted images. Receiver operating characteristic curve analysis with area under the curve (AUC) was calculated to distinguish PCa from PZ/CG and PCa with Gleason score (GS) of 3+3 from GS of 3+4/≥ 3+4. RESULTS TRAFF and T1ρcw relaxation times were repeatable with coefficients of repeatability as a percentage of median value in the range of 7.8-23.2%. AUC (mean, 95% confidence interval) in the differentiation of PCa with GS of 3+3 from PCa with CS of ≥ 3+4 were 0.88 (0.72-0.99), 0.69 (0.46-0.90), and 0.68 (0.45-0.88), for TRAFF, T1ρcw, and T2, respectively. CONCLUSION In quantitative region of interest based analysis, TRAFF outperformed T1ρcw and T2 in PCa detection and characterization.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Marko Pesola
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Harri Merisaari
- Department of Information Technology, University of Turku, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - Peter J Boström
- Department of Surgery, Division of Urology, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Timo Liimatainen
- Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
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Toivonen J, Merisaari H, Pesola M, Taimen P, Boström PJ, Pahikkala T, Aronen HJ, Jambor I. Mathematical models for diffusion-weighted imaging of prostate cancer using b values up to 2000 s/mm2
: Correlation with Gleason score and repeatability of region of interest analysis. Magn Reson Med 2014; 74:1116-24. [PMID: 25329932 DOI: 10.1002/mrm.25482] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Jussi Toivonen
- Department of Diagnostic Radiology; University of Turku; Turku Finland
- Department of Information Technology; University of Turku; Turku Finland
| | - Harri Merisaari
- Department of Information Technology; University of Turku; Turku Finland
- Turku PET Centre; University of Turku; Turku Finland
| | - Marko Pesola
- Department of Diagnostic Radiology; University of Turku; Turku Finland
| | - Pekka Taimen
- Department of Pathology; University of Turku and Turku University Hospital; Turku Finland
| | | | - Tapio Pahikkala
- Department of Information Technology; University of Turku; Turku Finland
| | - Hannu J. Aronen
- Department of Diagnostic Radiology; University of Turku; Turku Finland
- Medical Imaging Centre of Southwest Finland; Turku University Hospital; Turku Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology; University of Turku; Turku Finland
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Jambor I, Merisaari H, Taimen P, Boström P, Minn H, Pesola M, Aronen HJ. Evaluation of different mathematical models for diffusion-weighted imaging of normal prostate and prostate cancer using high b-values: a repeatability study. Magn Reson Med 2014; 73:1988-98. [PMID: 25046482 DOI: 10.1002/mrm.25323] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/16/2014] [Accepted: 05/26/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate monoexponential, stretched exponential, kurtosis, and biexponential models for diffusion-weighted imaging (DWI) of normal prostate and prostate cancer (PCa), using b-values up to 2000 s/mm(2) , in terms of fitting quality and repeatability. METHODS Eight healthy volunteers and 16 PCa patients underwent a total of four repeated 3T DWI examinations using 16 and 12 b-values, respectively. The highest b-value was 2000 s/mm(2) . The normalized mean signal intensities of regions of interest, placed in normal tissue and PCa using anatomical images and prostatectomy sections, were fitted using the four models. The fitting quality was evaluated using Akaike information criteria and F-ratio. Repeatability of the fitted parameters was evaluated using intraclass correlation coefficient ICC(3,1). RESULTS The biexponential model provided the best fit to normal prostate and PCa DWI data. The parameters of the monoexponential, kurtosis, and stretched exponential (with the exception of the α parameter) models had higher ICC(3,1) values compared with the biexponential model. The kurtosis model provided a better fit to DWI data of normal prostate and PCa than the monoexponential model, whereas these models had comparable reliability and repeatability based on ICC(3,1) values. CONCLUSION Considering the model fit and repeatability, the kurtosis model seems to be the preferred model for characterization of normal prostate and PCa DWI using b-values up to 2000 s/mm(2) .
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
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Jambor I, Kähkönen E, Taimen P, Merisaari H, Saunavaara J, Alanen K, Obsitnik B, Minn H, Lehotska V, Aronen HJ. Prebiopsy multiparametric 3T prostate MRI in patients with elevated PSA, normal digital rectal examination, and no previous biopsy. J Magn Reson Imaging 2014; 41:1394-404. [PMID: 24956412 DOI: 10.1002/jmri.24682] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/06/2014] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To find the diagnostic accuracy of 3T multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted transrectal ultrasound (TRUS)-guided biopsy using visual coregistration (TB) in patients with elevated prostate-specific antigen (PSA), normal digital rectal examination, and no previous biopsy. MATERIALS AND METHODS Fifty-five patients at two institutions underwent mpMRI, consisting of anatomical T2 -weighted imaging (T2 W), diffusion-weighted imaging (DWI), proton magnetic resonance spectroscopy ((1) H-MRS), and dynamic contrast-enhanced MRI (DCE-MRI), followed by TB in addition to 12 core systematic TRUS-guided biopsy (SB). Histopathological scorings of biopsy (n = 38) and prostatectomy (n = 17) specimens were used as the reference standard for calculation of diagnostic accuracy values. Clinically significant prostate cancer (SPCa) was defined as 3 mm core length of Gleason score 3+3 or any Gleason grade 4. RESULTS The sensitivity, specificity, accuracy, and area under the curve (AUC) values for the detection of SPCa on the sextant level for T2 W+DWI+(1) H-MRS+DCE-MRI were 72%, 89%, 85%, and 0.81, respectively. The corresponding values for T2 wi+DWI were 61%, 96%, 87%, and 0.79, respectively. The overall PCa detection rate per core in 53 patients was 21% (138 of 648 cores) for SB and 43% (33 of 77 cores) for TB (P < 0.001). CONCLUSION Prebiopsy mpMRI is an accurate tool for PCa detection and biopsy targeting in patients with elevated PSA.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
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Jambor I, Merisaari H, Aronen HJ, Järvinen J, Saunavaara J, Kauko T, Borra R, Pesola M. Optimization of b-value distribution for biexponential diffusion-weighted MR imaging of normal prostate. J Magn Reson Imaging 2013; 39:1213-22. [DOI: 10.1002/jmri.24271] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 05/16/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology; University of Turku; Turku Finland
- 2nd Department of Radiology; Comenius University and St. Elisabeth Oncology Institute; Bratislava Slovakia
| | - Harri Merisaari
- Turku PET Centre; University of Turku; Turku Finland
- Department of Information Technology; University of Turku; Turku Finland
| | - Hannu J. Aronen
- Department of Diagnostic Radiology; University of Turku; Turku Finland
- Medical Imaging Centre of Southwest Finland; Turku University Hospital; Turku Finland
| | - Jukka Järvinen
- Department of Diagnostic Radiology; University of Turku; Turku Finland
- Medical Imaging Centre of Southwest Finland; Turku University Hospital; Turku Finland
| | - Jani Saunavaara
- Medical Imaging Centre of Southwest Finland; Turku University Hospital; Turku Finland
| | - Tommi Kauko
- Department of Biostatistics; University of Turku; Turku Finland
| | - Ronald Borra
- Department of Diagnostic Radiology; University of Turku; Turku Finland
- Medical Imaging Centre of Southwest Finland; Turku University Hospital; Turku Finland
| | - Marko Pesola
- Department of Diagnostic Radiology; University of Turku; Turku Finland
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Toivonen P, Könönen M, Niskanen E, Vaurio O, Repo-Tiihonen E, Seppänen A, Aronen HJ, Vanninen R, Tiihonen J, Laakso MP. Cavum septum pellucidum and psychopathy. Br J Psychiatry 2013; 203:152-3. [PMID: 23908342 DOI: 10.1192/bjp.bp.112.123844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The presence of cavum septum pellucidum (CSP) has been reported to be a neurodevelopmental marker of psychopathy. We scanned 26 violent offenders and 25 controls; 2 offenders and 2 controls had CSP (8% in both groups). Thus, the presence of CSP is not a common or a unique feature of antisocial personality disorder or psychopathy.
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Boccardi M, Bocchetta M, Aronen HJ, Repo-Tiihonen E, Vaurio O, Thompson PM, Tiihonen J, Frisoni GB. Atypical nucleus accumbens morphology in psychopathy: another limbic piece in the puzzle. Int J Law Psychiatry 2013; 36:157-167. [PMID: 23399314 PMCID: PMC3603572 DOI: 10.1016/j.ijlp.2013.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Psychopathy has been associated with increased putamen and striatum volumes. The nucleus accumbens - a key structure in reversal learning, less effective in psychopathy - has not yet received specific attention. Moreover, basal ganglia morphology has never been explored. We examined the morphology of the caudate, putamen and accumbens, manually segmented from magnetic resonance images of 26 offenders (age: 32.5 ± 8.4) with medium-high psychopathy (mean PCL-R=30 ± 5) and 25 healthy controls (age: 34.6 ± 10.8). Local differences were statistically modeled using a surface-based radial distance mapping method (p<0.05; multiple comparisons correction through permutation tests). In psychopathy, the caudate and putamen had normal global volume, but different morphology, significant after correction for multiple comparisons, for the right dorsal putamen (permutation test: p=0.02). The volume of the nucleus accumbens was 13% smaller in psychopathy (p corrected for multiple comparisons <0.006). The atypical morphology consisted of predominant anterior hypotrophy bilaterally (10-30%). Caudate and putamen local morphology displayed negative correlation with the lifestyle factor of the PCL-R (permutation test: p=0.05 and 0.03). From these data, psychopathy appears to be associated with an atypical striatal morphology, with highly significant global and local differences of the accumbens. This is consistent with the clinical syndrome and with theories of limbic involvement.
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Affiliation(s)
- Marina Boccardi
- LENITEM Laboratory of Epidemiology, Neuroimaging, & Telemedicine - IRCCS San Giovanni di Dio-FBF, Brescia, Italy
- AFaR (Associazione Fatebenefratelli per la Ricerca), Rome, Italy
| | | | - Hannu J. Aronen
- Department of Radiology, University of Turku, Finland
- Department of Radiology, Turku University Central Hospital, Turku, Finland
| | - Eila Repo-Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland and Niuvanniemi Hospital, Kuopio, Finland
| | - Olli Vaurio
- Department of Forensic Psychiatry, University of Eastern Finland and Niuvanniemi Hospital, Kuopio, Finland
| | - Paul M. Thompson
- Laboratory of NeuroImaging, Department of Neurology & Psychiatry, UCLA School of Medicine, Los Angeles, CA, USA
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland and Niuvanniemi Hospital, Kuopio, Finland
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
- National Institute for Health and Welfare, Helsinki, Finland
| | - Giovanni B. Frisoni
- LENITEM Laboratory of Epidemiology, Neuroimaging, & Telemedicine - IRCCS San Giovanni di Dio-FBF, Brescia, Italy
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Jambor I, Borra R, Kemppainen J, Lepomäki V, Parkkola R, Dean K, Alanen K, Arponen E, Nurmi M, Aronen HJ, Minn H. Improved detection of localized prostate cancer using co-registered MRI and 11C-acetate PET/CT. Eur J Radiol 2012; 81:2966-72. [PMID: 22342610 DOI: 10.1016/j.ejrad.2011.12.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 12/25/2011] [Accepted: 12/26/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We aimed to study the ability of contrast enhanced MRI at 1.5 T and 11C-acetate PET/CT, both individually and using fused data, to detect localized prostate cancer. METHODS Thirty-six men with untreated prostate cancer and negative for metastatic disease on pelvic CT and bone scan were prospectively enrolled. A pelvic 11C-acetate PET/CT scan was performed in all patients, and a contrast enhanced MRI scan in 33 patients (6 examinations using both endorectal coil and surface coils, and 27 examinations using surface coils only). After the imaging studies 10 patients underwent prostatectomy and 26 were treated by image guided external beam radiation treatment. Image fusion of co-registered PET and MRI data was performed based on anatomical landmarks visible on CT and MRI using an advanced in-house developed software package. PET/CT, MRI and fused PET/MRI data were evaluated visually and compared with biopsy findings on a lobar level, while a sextant approach was used for patients undergoing prostatectomy. RESULTS When using biopsy samples as method of reference, the sensitivity, specificity and accuracy for visual detection of prostate cancer on a lobar level by contrast enhanced MRI was 85%, 37%, 73% and that of 11C-acetate PET/CT 88%, 41%, 74%, respectively. Fusion of PET with MRI data increased sensitivity, specificity and accuracy to 90%, 72% and 85%, respectively. CONCLUSIONS Fusion of sequentially obtained PET/CT and MRI data for the localization of prostate cancer is feasible and superior to the performance of each individual modality alone.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, and Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.
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Boccardi M, Frisoni GB, Hare RD, Cavedo E, Najt P, Pievani M, Rasser PE, Laakso MP, Aronen HJ, Repo-Tiihonen E, Vaurio O, Thompson PM, Tiihonen J. Cortex and amygdala morphology in psychopathy. Psychiatry Res 2011; 193:85-92. [PMID: 21676597 DOI: 10.1016/j.pscychresns.2010.12.013] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 12/01/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
Abstract
Psychopathy is characterized by abnormal emotional processes, but only recent neuroimaging studies have investigated its cerebral correlates. The study aim was to map local differences of cortical and amygdalar morphology. Cortical pattern matching and radial distance mapping techniques were used to analyze the magnetic resonance images of 26 violent male offenders (age: 32±8) with psychopathy diagnosed using the Psychopathy Checklist-Revised (PCL-R) and no schizophrenia spectrum disorders, and in matched controls (age: 35± sp="0.12"/>11). The cortex displayed up to 20% reduction in the orbitofrontal and midline structures (corrected p<0.001 bilaterally). Up to 30% tissue reduction in the basolateral nucleus, and 10-30% enlargement effects in the central and lateral nuclei indicated abnormal structure of the amygdala (corrected p=0.05 on the right; and symmetrical pattern on the left). Psychopathy features specific morphology of the main cerebral structures involved in cognitive and emotional processing, consistent with clinical and functional data, and with a hypothesis of an alternative evolutionary brain development.
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Affiliation(s)
- Marina Boccardi
- LENITEM Laboratory of Epidemiology, Neuroimaging, & Telemedicine - IRCCS San Giovanni di Dio-FBF, via Pilastroni, 4, 25100, Brescia, Italy
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Polvikoski TM, van Straaten ECW, Barkhof F, Sulkava R, Aronen HJ, Niinistö L, Oinas M, Scheltens P, Erkinjuntti T, Kalaria RN. Frontal lobe white matter hyperintensities and neurofibrillary pathology in the oldest old. Neurology 2010; 75:2071-8. [PMID: 21048201 DOI: 10.1212/wnl.0b013e318200d6f9] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Current studies suggest an interaction between vascular mechanisms and neurodegenerative processes that leads to late-onset Alzheimer disease (AD). We tested whether AD pathology was associated with white matter hyperintensities (WMH) or cerebral infarcts in the oldest old individuals. METHODS Brains from 132 subjects over 85 years old, who came to autopsy from the Vantaa 85+ population-based cohort, were scanned by postmortem MRI and examined for neuropathologic changes. Coronal images were analyzed to determine the degree of frontal and parietal periventricular WMH (PVWMH) and deep WMH (DWMH) and cerebral infarcts. Neuropathologic variables included Consortium to Establish a Registry for Alzheimer's Disease scores for neuritic plaques and Braak staging among subjects in 5 groups: normal aging (NA), borderline with insufficient AD pathology, AD, AD plus other pathology, and other primary degenerative diseases. RESULTS Frontal DWMH were detected in >50% of the sample. Both frontal PVWMH and DWMH were significantly more extensive in the AD group compared to the NA group or the NA and borderline groups combined. Frontal PVWMH and DWMH were also associated with increased Braak staging (p = 0.03) and the neuritic plaque load (p = 0.01). Further analysis revealed there were a greater number of cerebral infarcts associated with frontal DWMH (p = 0.03) but not with frontal PVWMH. CONCLUSIONS Our study showed an association between neurofibrillary pathology and frontal PVWMH and DWMH (rather than parietal), as a surrogate of small vessel disease, particularly in very old community-dwelling individuals.
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Affiliation(s)
- T M Polvikoski
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Jambor I, Borra R, Kemppainen J, Lepomäki V, Parkkola R, Dean K, Alanen K, Arponen E, Nurmi M, Aronen HJ, Minn H. Functional imaging of localized prostate cancer aggressiveness using 11C-acetate PET/CT and 1H-MR spectroscopy. J Nucl Med 2010; 51:1676-83. [PMID: 20956477 DOI: 10.2967/jnumed.110.078667] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED We assessed the ability of (11)C-acetate PET/CT, MRI, and proton MR spectroscopy ((1)H-MRS) to image localized prostate cancer and detect its aggressiveness, using qualitative and quantitative approaches. METHODS Twenty-one patients with untreated localized prostate cancer, diagnosed using transrectal ultrasound-guided biopsy, were prospectively enrolled. Cancer laterality was based on the percentage of cancer and the highest Gleason score determined from biopsies. In addition to PET/CT, 3-dimensional (1)H-MRS of the entire prostate volume using a quantitative approach was performed. The imaging and histologic findings of 8 patients undergoing subsequent prostatectomy were compared on a sextant level. For each lobe and sextant, standardized uptake values (SUVs) and (choline + creatine + polyamines)-to-citrate (CCP/C) ratios were obtained from (11)C-acetate PET/CT and (1)H-MRS, respectively. The visual and quantitative findings on PET/CT and MRI data were compared with cancer laterality and aggressiveness based on the Gleason score and with prostate-specific antigen (PSA) velocity and international risk group classification. RESULTS The sensitivity, specificity, and accuracy, on a lobar level using visual analysis, of (11)C-acetate PET/CT were 80%, 29%, 71%, respectively, and 89%, 29%, 79%, respectively, using contrast-enhanced MRI. The sensitivity and accuracy of (11)C-acetate PET/CT decreased to 64% and 63% and specificity increased to 62% when sextant analysis was performed. The agreement between prostate cancer laterality based on biopsy findings and visual interpretation of (11)C-acetate PET/CT and contrast-enhanced MRI was similar at 71%. The mean SUV maximum and CCP/C maximum for the dominant tumor lesion were 5.5 and 1.48, respectively, and did not differ significantly from values in the nondominant lobe. The dominant-lesion SUVs or CCP/C values were not associated with histologically determined prostate cancer aggressiveness, nor did PSA velocity correlate with the SUV or CCP/C values from the entire gland. CONCLUSION (11)C-acetate PET/CT, MRI, and (1)H-MRS enable detection of localized prostate cancer with comparable and limited accuracy but fail to provide information on cancer aggressiveness.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
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Boccardi M, Ganzola R, Rossi R, Sabattoli F, Laakso MP, Repo-Tiihonen E, Vaurio O, Könönen M, Aronen HJ, Thompson PM, Frisoni GB, Tiihonen J. Abnormal hippocampal shape in offenders with psychopathy. Hum Brain Mapp 2010; 31:438-47. [PMID: 19718651 DOI: 10.1002/hbm.20877] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Posterior hippocampal volumes correlate negatively with the severity of psychopathy, but local morphological features are unknown. The aim of this study was to investigate hippocampal morphology in habitually violent offenders having psychopathy. Manual tracings of hippocampi from magnetic resonance images of 26 offenders (age: 32.5 +/- 8.4), with different degrees of psychopathy (12 high, 14 medium psychopathy based on the Psychopathy Checklist Revised), and 25 healthy controls (age: 34.6 +/- 10.8) were used for statistical modelling of local changes with a surface-based radial distance mapping method. Both offenders and controls had similar hippocampal volume and asymmetry ratios. Local analysis showed that the high psychopathy group had a significant depression along the longitudinal hippocampal axis, on both the dorsal and ventral aspects, when compared with the healthy controls and the medium psychopathy group. The opposite comparison revealed abnormal enlargement of the lateral borders in both the right and left hippocampi of both high and medium psychopathy groups versus controls, throughout CA1, CA2-3 and the subicular regions. These enlargement and reduction effects survived statistical correction for multiple comparisons in the main contrast (26 offenders vs. 25 controls) and in most subgroup comparisons. A statistical check excluded a possible confounding effect from amphetamine and polysubstance abuse. These results indicate that habitually violent offenders exhibit a specific abnormal hippocampal morphology, in the absence of total gray matter volume changes, that may relate to different autonomic modulation and abnormal fear-conditioning.
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Affiliation(s)
- Marina Boccardi
- LENITEM Laboratory of Epidemiology, Neuroimaging, and Telemedicine, IRCCS San Giovanni di Dio-Fatebenefratelli, Brescia, Italy
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Boccardi M, Frisoni GB, Najt P, Pievani M, Ganzola R, Rossi R, Laakso MP, Aronen HJ, Vaurio O, Perez J, Repo-Tiihonen E, Thompson PM, Tiihonen J. Abnormal Cortical Morphology in Offenders with Psychopathy. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)72027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Vuontela V, Steenari MR, Aronen ET, Korvenoja A, Aronen HJ, Carlson S. Brain activation and deactivation during location and color working memory tasks in 11–13-year-old children. Brain Cogn 2009; 69:56-64. [DOI: 10.1016/j.bandc.2008.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 03/14/2008] [Accepted: 05/15/2008] [Indexed: 10/21/2022]
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Tiihonen J, Rossi R, Laakso MP, Hodgins S, Testa C, Perez J, Repo-Tiihonen E, Vaurio O, Soininen H, Aronen HJ, Könönen M, Thompson PM, Frisoni GB. Brain anatomy of persistent violent offenders: more rather than less. Psychiatry Res 2008; 163:201-12. [PMID: 18662866 DOI: 10.1016/j.pscychresns.2007.08.012] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 05/30/2007] [Accepted: 08/26/2007] [Indexed: 11/19/2022]
Abstract
Most violent crimes in Western societies are committed by a small group of men who display antisocial behavior from an early age that remains stable across the life-span. It is not known if these men display abnormal brain structure. We compared regional brain volumes of 26 persistently violent offenders with antisocial personality disorder and substance dependence and 25 healthy men using magnetic resonance imaging volumetry and voxel-based morphometry (VBM). The violent offenders, as compared with the healthy men, had markedly larger white matter volumes, bilaterally, in the occipital and parietal lobes, and in the left cerebellum, and larger grey matter volume in right cerebellum (effect sizes up to 1.24, P<0.001). Among the offenders, volumes of these areas were not associated with psychopathy scores, substance abuse, psychotropic medication, or global IQ scores. By contrast, VBM analyses of grey matter revealed focal, symmetrical, bilateral areas of atrophy in the postcentral gyri, frontopolar cortex, and orbitofrontal cortex among the offenders as compared with the healthy men (z-scores as high as 5.06). Offenders with psychopathy showed the smallest volumes in these areas. The larger volumes in posterior brain areas may reflect atypical neurodevelopmental processes that underlie early-onset persistent antisocial and aggressive behavior.
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Affiliation(s)
- Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Kuopio, Kuopio, Finland.
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