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Kesch C, Radtke JP, Distler F, Boxler S, Klein T, Hüttenbrink C, Hees K, Roth W, Roethke M, Schlemmer HP, Hohenfellner M, Hadaschik BA. [Multiparametric MRI and MRI-TRUS fusion biopsy in patients with prior negative prostate biopsy]. Urologe A 2017; 55:1071-7. [PMID: 27168038 DOI: 10.1007/s00120-016-0093-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/24/2022]
Abstract
BACKGROUND Multiparametric MRI (mpMRI) plays an increasingly important role in prostate cancer (PCa) diagnostics and is recommended in men with previously negative TRUS biopsy. The optimal biopsy method after mpMRI is under discussion. OBJECTIVE Prospective, PIRADS- and START-conform analysis of the relevance of mpMRI and MRI-TRUS fusion biopsy in patients with prior negative TRUS biopsy and comparison of the detection rates of fusion-targeted biopsies (tB) and systematic transperineal saturation biopsies (sB). MATERIALS AND METHODS Between 10/2012 and 09/2015, 287 patients with prior negative TRUS biopsy underwent mpMRI and software-assisted, rigid MRI-TRUS fusion biopsy. In addition to and strictly separated from sB (median cores n = 24), tB (median cores per patient n = 4, per lesion n = 3) were performed in case of suspicious MRI lesions (PIRADS ≥ 2). Both biopsy methods were compared by using McNemar's test. RESULTS Of the 287 patients, 148 (52 %) had positive biopsies. Of these, 108/287 (38 %) had significant PCa (Gleason Score [GS] = 3 + 3 and PSA ≥ 10 ng/ml or GS ≥ 3 + 4) and again 43/287 (15 %) had a GS ≥ 4 + 3 PCa. sB failed to diagnose 8/148 PCa (5.4 %) and 6/108 significant PCa (5.5 %), whereas tB failed to diagnose 48 (32.4 %) PCa (p < 0.0001) and 22 (20.4 %) significant PCa (p = 0.0046). Of the PCa missed by tB, 11 had a GS ≥ 3 + 4 and 5 of these a GS = 4 + 3. On a per patient basis, MRI failed to detect 5 significant PCa, whereby 17 of the significant PCa were missed by fusion-targeted cores alone. CONCLUSIONS In men with unsuspicious MRI (PIRADS < 3), there is a 11 % risk of significant PCa. In case of suspicious MRI lesions, the combination of both biopsy approaches offers maximum tumor detection.
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Affiliation(s)
- C Kesch
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - J P Radtke
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.,Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - F Distler
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - S Boxler
- Universitätsklinik für Urologie, Universität Bern, Bern, Schweiz
| | - T Klein
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - C Hüttenbrink
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - K Hees
- Institut für Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - W Roth
- Pathologisches Institut der Universität Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - M Roethke
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - H P Schlemmer
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - M Hohenfellner
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - B A Hadaschik
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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Radtke J, Bonekamp D, Kesch C, Freitag M, Alt C, Celik K, Distler F, Roth W, Wieczorek K, Duensing S, Roethke M, Teber D, Schlemmer H, Hohenfellner M, Hadaschik B. Kombination klinischer und MR-tomografischer Parameter zur Vorhersage signifikanter Prostatakarzinome und extrakapsulärer Tumorausdehnung. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Radtke
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - D Bonekamp
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - C Kesch
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - M Freitag
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - C Alt
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
| | - K Celik
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - F Distler
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - W Roth
- Ruprechts-Karl-Universität Heidelberg, Pathologisches Institut, Heidelberg
| | - K Wieczorek
- Ruprechts-Karl-Universität Heidelberg, Pathologisches Institut, Heidelberg
| | - S Duensing
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - M Roethke
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - D Teber
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - H Schlemmer
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - M Hohenfellner
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - B Hadaschik
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
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Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt C, Kesch C, Popeneciu IV, Huettenbrink C, Bergstraesser-Gasch C, Klein T, Duensing S, Roth S, Schlemmer HP, Roethke M, Hohenfellner M, Hadaschik B. Multiparametric magnetic resonance tomography and MRI/TRUS-fusion-biopsy for index lesion detection: correlation with radical prostatectomy specimen. Cancer Imaging 2015. [PMCID: PMC4601104 DOI: 10.1186/1470-7330-15-s1-s1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wolf MB, Roethke M, Pahernik S, Hadaschik B, Kuru T, Popeneciu IV, Hatiboglu G, Chin J, Billia M, Relle J, Hafron J, Nandalur K, Burtnyk M, Schlemmer HP. Localised prostate cancer treated with MRI-guided transurethral ultrasound ablation: phase I trial results. Cancer Imaging 2014. [PMCID: PMC4242781 DOI: 10.1186/1470-7330-14-s1-s3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Kickingereder P, Sahm F, Wiestler B, Roethke M, Heiland S, Schlemmer HP, Wick W, von Deimling A, Bendszus M, Radbruch A. Evaluation of microvascular permeability with dynamic contrast-enhanced MRI for the differentiation of primary CNS lymphoma and glioblastoma: radiologic-pathologic correlation. AJNR Am J Neuroradiol 2014; 35:1503-8. [PMID: 24722313 DOI: 10.3174/ajnr.a3915] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [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: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Dynamic contrast-enhanced MR imaging can provide in vivo assessment of the microvasculature in intracranial tumors. The aim of the present study was to evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging derived vascular permeability parameters, including the volume transfer constant, the volume of extravascular extracellular space, and the flux rate constant between the extravascular extracellular space and plasma, for the differentiation of primary CNS lymphoma and glioblastoma. MATERIALS AND METHODS Sixty glioblastomas and 11 primary central nervous system lymphomas were included. Pretreatment T1-weighted dynamic contrast-enhanced MR imaging with a 3D T1-weighted spoiled gradient-echo sequence was performed on a 3T MR imaging scanner. Perfusion parameters (volume transfer constant, the volume of extravascular extracellular space, and the flux rate constant) were measured on the basis of the Tofts-Kernmode model. The Mann-Whitney U test and receiver operating characteristic analysis were used to compare those parameters between primary central nervous system lymphoma and glioblastoma. Histopathologic correlation of dynamic contrast-enhanced MR imaging findings was performed by using reticulin staining and CD31 immunohistochemistry. RESULTS Median volume transfer constant and flux rate constant values were significantly higher in primary central nervous system lymphoma (0.145 ± 0.057 and 0.396 ± 0.088) than in glioblastoma (0.064 ± 0.021 and 0.230 ± 0.058) (P < .001, respectively). Median volume of extravascular extracellular space values did not differ significantly between primary central nervous system lymphoma (0.434 ± 0.165) and glioblastoma (0.319 ± 0.107). On receiver operating characteristic analysis, volume transfer constant had the best discriminative value for differentiating primary central nervous system lymphoma and glioblastoma (threshold, 0.093; sensitivity, 90.9%; specificity, 95.0%). Histopathologic evaluation revealed intact vascular integrity in glioblastoma despite endothelial proliferation, whereas primary central nervous system lymphoma demonstrated destroyed vessel architecture, thereby promoting vascular disintegrity. CONCLUSIONS Primary central nervous system lymphoma demonstrated significantly higher volume transfer constant and flux rate constant values compared with glioblastoma, implying a higher vascular permeability in primary central nervous system lymphoma. These findings confirm initial observations from perfusion CT and dynamic contrast-enhanced MR imaging studies, correlating with underlying histopathologic features, and may be useful in distinguishing primary central nervous system lymphoma from glioblastoma.
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Affiliation(s)
- P Kickingereder
- From the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)
| | - F Sahm
- Neuropathology (F.S., A.v.D.)German Cancer Consortium, Clinical Cooperation Unit Neuropathology (F.S., A.v.D.)
| | - B Wiestler
- Neuro-oncology (B.W., W.W.), Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, GermanyClinical Cooperation Unit Neuro-oncology (B.W., W.W.)
| | - M Roethke
- Department of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany
| | - S Heiland
- From the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)
| | - H-P Schlemmer
- Department of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany
| | - W Wick
- Neuro-oncology (B.W., W.W.), Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, GermanyClinical Cooperation Unit Neuro-oncology (B.W., W.W.)
| | - A von Deimling
- Neuropathology (F.S., A.v.D.)German Cancer Consortium, Clinical Cooperation Unit Neuropathology (F.S., A.v.D.)
| | - M Bendszus
- From the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)
| | - A Radbruch
- From the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)Department of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany
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Billia M, Burtnyk M, Kuru T, Pahernik S, Roethke M, Schlemmer H, Romagnoli C, Chin J. 1133 MRI-guided transurethral ultrasound ablation of prostate cancer: Preliminary outcomes of a phase I clinical trial. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/s1569-9056(14)61113-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Roethke M, Kaufmann S, Kniess M, Ketelsen D, Claussen C, Schlemmer H, Stenzl A, Schilling D. Seminal Vesicle Invasion: Accuracy and Analysis of Infiltration Patterns with High-Spatial Resolution T2-Weighted Sequences on Endorectal Magnetic Resonance Imaging. Urol Int 2014; 92:294-9. [DOI: 10.1159/000353968] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 06/20/2013] [Indexed: 11/19/2022]
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Roethke M, Anastasiadis AG, Lichy M, Werner M, Wagner P, Kruck S, Claussen CD, Stenzl A, Schlemmer HP, Schilling D. MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy. World J Urol 2011; 30:213-8. [PMID: 21512807 DOI: 10.1007/s00345-011-0675-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To investigate the positive biopsy rate of MRI-guided biopsy (MR-GB) in a routine clinical setting, identify factors predictive for positive biopsy findings and to report about the clinical significance of the diagnosed tumors. METHODS Patients with at least one negative trans-rectal-ultrasound-guided biopsy (TRUS-GB), persistently elevated or rising serum prostate specific antigen (PSA) and at least one lesion suspicious for PCa on diagnostic 1.5 Tesla endorectal coil MRI (eMR) were included. Biopsies were carried out using a 1.5 Tesla MRI and an 18 G biopsy gun. Clinical information and biopsy results were collected; logistic regression analysis was carried out. Definite pathology reports of patients with diagnosis of PCa and subsequent radical prostatectomy (RP) were analyzed for criteria of clinical significance. RESULTS One hundred patients were included, mean number of previous biopsies was 2 (range 1-9), mean PSA at time of biopsy was 11.7 ng/ml (1.0-65.0), and mean prostate volume was 46.7 ccm (range 13-183). In 52/100 (52.0%) patients, PCa was detected. Out of 52 patients, 27 patients with a positive biopsy underwent RP, 20 patients radiation therapy, and 5 patients active surveillance. In total, 80.8% of the patients revealed a clinically significant PCa. In univariate regression analysis, only serum PSA levels were predictive for a positive biopsy result. Number of preceding negative biopsies was not associated with the likelihood of a positive biopsy result. CONCLUSIONS MR-GB shows a high detection rate of clinically significant PCa in patients with previous negative TRUS-GB and persisting suspicion for PCa.
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Affiliation(s)
- M Roethke
- Department of Radiology, Comprehensive Cancer Center (CCC) Tübingen, Eberhard-Karls-Universität, Tübingen, Germany
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