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Jariyawattanarat W, Thiravit S, Suvannarerg V, Srisajjakul S, Sutchritpongsa P. Bladder involvement in placenta accreta spectrum disorder with placenta previa: MRI findings and outcomes correlation. Eur J Radiol 2023; 160:110695. [PMID: 36657210 DOI: 10.1016/j.ejrad.2023.110695] [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: 05/02/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Placental accreta spectrum (PAS) disorder with bladder involvement can be associated with maternal and neonatal morbidity. Magnetic resonance imaging (MRI) may provide accurate preoperative diagnoses. OBJECTIVE This study had 2 aims: to retrospectively review the MRI findings for bladder involvement in PAS with placental previa and to correlate bladder involvement with maternal and neonatal outcomes. MATERIALS AND METHODS MRI images of 48 patients with severe PAS (increta and percreta) with placenta previa/low-lying placenta were evaluated by 2 experienced radiologists blinded to the final diagnoses. Nine MRI findings and stepwise logistic regression analysis were assessed to identify predictive MRI findings for bladder involvement. The correlations between PAS patients with bladder involvement and clinical outcomes were analyzed using Fisher's exact test. RESULTS Of the 48 patients, 27 did not have bladder involvement, while 21 did. Logistic regression analysis identified 2 predictive MRI features for bladder involvement. They were abnormal vascularization (OR,6.94; 95 %CI,1.05-45.75) and loss of the chemical shift line at the uterovesical interface (OR, 4.41; 95 %CI, 0.63-30.98). The sensitivity and specificity of the combined MRI features were 38.1 % and 100 %, respectively (p = 0.001). A significant correlation was found between bladder involvement and massive blood loss during surgery (p = 0.022). CONCLUSIONS PAS with bladder involvement was significantly correlated with massive surgical blood loss. Prenatally, the disorder was predicted with high specificity by the combination of loss of chemical shift artifacts in the steady-state free precession sequence and abnormal vascularization at the uterovesical interface on MRI.
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Affiliation(s)
- Watchaya Jariyawattanarat
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Shanigarn Thiravit
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Voraparee Suvannarerg
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Sitthipong Srisajjakul
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Pavit Sutchritpongsa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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Hosseiny M, Sung KH, Felker E, Suvannarerg V, Tubtawee T, Shafa A, Arora KR, Ching J, Gulati A, Azadikhah A, Zhong X, Sayre J, Lu D, Raman SS. Read-out Segmented Echo Planar Imaging with Two-Dimensional Navigator Correction (RESOLVE): An Alternative Sequence to Improve Image Quality on Diffusion-Weighted Imaging of Prostate. Br J Radiol 2022; 95:20211165. [PMID: 35671135 PMCID: PMC10162059 DOI: 10.1259/bjr.20211165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We aimed to investigate if the use of read-out segmented echoplanar imaging with additional two-dimensional navigator correction (Readout Segmentation of Long Variable Echo, RESOLVE) for acquiring prostate diffusion-weighted imaging (DWI) improves image quality, compared to single-shot echoplanar imaging (ss-EPI). METHODS This single-center prospective study cohort included 162 males with suspected prostate cancer, who underwent 3 Tesla multiparametric MRI (3T-mpMRI). Two abdominal radiologists, blinded to the clinical information, separately reviewed each 3T-mpMRI study to rank geometrical distortion, degree of rectal distention, lesion conspicuity, and anatomic details delineation first on ss-EPI-DWI and later on RESOLVE-DWI using 5-point scales (1 = excellent, 5 = poor). The average of the ranking scores given by two readers was generated and used as the final score. RESULTS There was good-to-excellent interreader agreement for scoring image quality parameters on both ss-EPI and RESOLVE. Geometrical distortion scores > 3 was seen in 12.3% (20/162) of ss-EPI images, with all having geometrical distortion score <3 on RESOLVE (p < .001). The mean image distortion score was significantly less on RESOLVE than ss-EPI (1.16 vs 1.61, p < .01 regardless of rectal gas, p< .05 when stratified by the degree of rectal distention ). RESOLVE was superior to ss-EPI for lesion conspicuity (mean 1.35 vs 1.53, p< .002) and anatomic delineation (2.60 vs 2.68, p< .001) of prostate on DWI. CONCLUSION Compared to conventional ss-EPI, the use of RESOLVE for acquisition of prostate DWI resulted in significantly enhanced image quality and reduced geometrical distortion. ADVANCES IN KNOWLEDGE RESOLVE could be an alternative or replacement of ss-EPI for acquiring prostate DWI with significantly less geometrical distortion and significantly improved lesion conspicuity and anatomic delineation.
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Affiliation(s)
- Melina Hosseiny
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Kyung Hyun Sung
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Ely Felker
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Voraparee Suvannarerg
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | | | - Ariel Shafa
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Krishan R. Arora
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Justin Ching
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Anjalie Gulati
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Afshin Azadikhah
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Xiaodong Zhong
- Siemens Healthcare, MR R&D Collaborations, Lilburn, Georgia, United States
| | - James Sayre
- Department of Bioinformatics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - David Lu
- Department of Radiology, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Sonni I, Felker ER, Lenis AT, Sisk AE, Bahri S, Allen-Auerbach M, Armstrong WR, Suvannarerg V, Tubtawee T, Grogan T, Elashoff D, Eiber M, Raman SS, Czernin J, Reiter RE, Calais J. Head-to-Head Comparison of 68Ga-PSMA-11 PET/CT and mpMRI with a Histopathology Gold Standard in the Detection, Intraprostatic Localization, and Determination of Local Extension of Primary Prostate Cancer: Results from a Prospective Single-Center Imaging Trial. J Nucl Med 2022; 63:847-854. [PMID: 34649942 PMCID: PMC9157724 DOI: 10.2967/jnumed.121.262398] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 04/18/2021] [Revised: 09/26/2021] [Indexed: 01/19/2023] Open
Abstract
The role of prostate-specific membrane antigen (PSMA)-targeted PET in comparison to multiparametric MRI (mpMRI) in the evaluation of intraprostatic cancer foci is not well defined. The aim of our study was to compare the diagnostic performance of 68Ga-PSMA-11 PET/CT (PSMA PET/CT), mpMRI, and PSMA PET/CT + mpMRI using 3 independent masked readers for each modality and with histopathology as the gold standard in the detection, intraprostatic localization, and determination of local extension of primary prostate cancer. Methods: Patients with intermediate- or high-risk prostate cancer who underwent PSMA PET/CT as part of a prospective trial (NCT03368547) and mpMRI before radical prostatectomy were included. Each imaging modality was interpreted by 3 independent readers who were unaware of the other modality result. A central majority rule was applied (2:1). Pathologic examination of whole-mount slices was used as the gold standard. Imaging scans and whole-mount slices were interpreted using the same standardized approach on a segment level and a lesion level. A "neighboring" approach was used to define imaging-pathology correlation for the detection of individual prostate cancer foci. Accuracy in determining the location, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) of prostate cancer foci was assessed using receiver-operating-characteristic curve analysis. Interreader agreement was calculated using intraclass correlation coefficient analysis. Results: The final analysis included 74 patients (14 [19%] with intermediate risk and 60 [81%] with high risk). The cancer detection rate (lesion-based analysis) was 85%, 83%, and 87% for PSMA PET/CT, mpMRI, and PSMA PET/CT + mpMRI, respectively. The change in AUC was statistically significant between PSMA PET/CT + mpMRI and the 2 imaging modalities alone for delineation of tumor localization (segment-based analysis) (P < 0.001) but not between PSMA PET/CT and mpMRI (P = 0.093). mpMRI outperformed PSMA PET/CT in detecting EPE (P = 0.002) and SVI (P = 0.001). In the segment-level analysis, intraclass correlation coefficient analysis showed moderate reliability among PSMA PET/CT and mpMRI readers using a 5-point Likert scale (range, 0.53-0.64). In the evaluation of T staging, poor reliability was found among PSMA PET/CT readers and poor to moderate reliability was found for mpMRI readers. Conclusion: PSMA PET/CT and mpMRI have similar accuracy in the detection and intraprostatic localization of prostate cancer foci. mpMRI performs better in identifying EPE and SVI. For the T-staging evaluation of intermediate to high-risk prostate cancer, mpMRI should still be considered the imaging modality of reference. Whenever available, PSMA PET/MRI or the coregistration or fusion of PSMA PET/CT and mpMRI (PSMA PET/CT + mpMRI) should be used as it improves tumor extent delineation.
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Affiliation(s)
- Ida Sonni
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Ely R. Felker
- Department of Radiology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | | | - Anthony E. Sisk
- Department of Pathology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Shadfar Bahri
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Martin Allen-Auerbach
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Wesley R. Armstrong
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Voraparee Suvannarerg
- Department of Radiology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teeravut Tubtawee
- Department of Radiology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Department of Radiology, Prince of Songkla University, Hat Yai, Thailand
| | - Tristan Grogan
- Department of Medicine Statistics Core, UCLA, Los Angeles, California
| | - David Elashoff
- Department of Medicine Statistics Core, UCLA, Los Angeles, California
| | - Matthias Eiber
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; and
| | - Steven S. Raman
- Department of Radiology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California
| | - Robert E. Reiter
- Department of Urology, UCLA, Los Angeles, California;,Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, Los Angeles, California;,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California
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Cao R, Zhong X, Afshari S, Felker E, Suvannarerg V, Tubtawee T, Vangala S, Scalzo F, Raman S, Sung K. Performance of Deep Learning and Genitourinary Radiologists in Detection of Prostate Cancer Using 3-T Multiparametric Magnetic Resonance Imaging. J Magn Reson Imaging 2021; 54:474-483. [PMID: 33709532 PMCID: PMC8812258 DOI: 10.1002/jmri.27595] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/11/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Several deep learning-based techniques have been developed for prostate cancer (PCa) detection using multiparametric magnetic resonance imaging (mpMRI), but few of them have been rigorously evaluated relative to radiologists' performance or whole-mount histopathology (WMHP). PURPOSE To compare the performance of a previously proposed deep learning algorithm, FocalNet, and expert radiologists in the detection of PCa on mpMRI with WMHP as the reference. STUDY TYPE Retrospective, single-center study. SUBJECTS A total of 553 patients (development cohort: 427 patients; evaluation cohort: 126 patients) who underwent 3-T mpMRI prior to radical prostatectomy from October 2010 to February 2018. FIELD STRENGTH/SEQUENCE 3-T, T2-weighted imaging and diffusion-weighted imaging. ASSESSMENT FocalNet was trained on the development cohort to predict PCa locations by detection points, with a confidence value for each point, on the evaluation cohort. Four fellowship-trained genitourinary (GU) radiologists independently evaluated the evaluation cohort to detect suspicious PCa foci, annotate detection point locations, and assign a five-point suspicion score (1: least suspicious, 5: most suspicious) for each annotated detection point. The PCa detection performance of FocalNet and radiologists were evaluated by the lesion detection sensitivity vs. the number of false-positive detections at different thresholds on suspicion scores. Clinically significant lesions: Gleason Group (GG) ≥ 2 or pathological size ≥ 10 mm. Index lesions: the highest GG and the largest pathological size (secondary). STATISTICAL TESTS Bootstrap hypothesis test for the detection sensitivity between radiologists and FocalNet. RESULTS For the overall differential detection sensitivity, FocalNet was 5.1% and 4.7% below the radiologists for clinically significant and index lesions, respectively; however, the differences were not statistically significant (P = 0.413 and P = 0.282, respectively). DATA CONCLUSION FocalNet achieved slightly lower but not statistically significant PCa detection performance compared with GU radiologists. Compared with radiologists, FocalNet demonstrated similar detection performance for a highly sensitive setting (suspicion score ≥ 1) or a highly specific setting (suspicion score = 5), while lower performance in between. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Ruiming Cao
- Department of Bioengineering, UC Berkeley, Berkeley, California, USA
| | - Xinran Zhong
- Department of Radiation Oncology, UT Southwestern, Dallas, Texas, USA
| | - Sohrab Afshari
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Ely Felker
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Voraparee Suvannarerg
- Department of Radiology, UCLA, Los Angeles, California, USA
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teeravut Tubtawee
- Department of Radiology, UCLA, Los Angeles, California, USA
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sitaram Vangala
- Department of Medicine Statistics Core, UCLA, Los Angeles, California, USA
| | - Fabien Scalzo
- Department of Neurology, UCLA, Los Angeles, California, USA
| | - Steven Raman
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiology, UCLA, Los Angeles, California, USA
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5
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Sonni I, Felker E, Lenis AT, Sisk AE, Bahri S, Auerbach MS, Armstrong WR, Suvannarerg V, Tubtawee T, Grogan T, Elashoff D, Czernin J, Raman S, Reiter RE, Calais J. Head-to-head comparison of 68Ga-PSMA-11 PET/CT and mpMRI in the detection, intra-prostatic localization, and local extension of primary prostate cancer: A single-center imaging study with histopathology gold-standard. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
193 Background: The local staging of prostate cancer relies on systematic or targeted biopsies and multiparametric magnetic resonance imaging (mpMRI). The role of prostate-specific membrane antigen (PSMA)-targeted PET in the evaluation of intraprostatic cancer foci and T-staging assessment is not well defined. The goal of this analysis was to compare the diagnostic performance of PSMA PET/CT, mpMRI and the combination of the two (PSMA PET/CT+mpMRI) in the detection, intra-prostatic localization and local extension of primary prostate cancer with histopathology as the gold standard.Methods: Patients with intermediate- or high-risk prostate cancer underwent a PSMA PET/CT scan and mpMRI prior to intended radical prostatectomy. Each imaging modality was interpreted by 3 blinded independent readers. A majority rule was applied (2:1). A standardized approach was used to assess presence, location and size of prostate cancer foci within the prostate. The analysis was conducted on a lesion- and segment-level. Whole mount pathology was interpreted by a Genito-Urinary pathologist using the same standardized method described above. Accuracy in determining the location, extra-capsular extension (ECE) and seminal vesicle invasion (SVI) of prostate cancer foci were assessed using receiver operating characteristic (ROC) analysis. A “raw-stringent” and “neighboring” approach were used to define imaging/pathology correlation for the detection of individual prostate cancer foci. Results: The final analysis included 74 patients. Detection rate was 75%, 79% and 82% using the “raw-stringent” approach, 86%, 83% and 87% using the “neighboring” approach for PSMA PET/CT, mpMRI and PSMA PET/CT+mpMRI, respectively. Differences in detection rates between PSMA PET/CT, mpMRI and PSMA PET/CT+mpMRI were not statistically significant. The two imaging modalities performed similarly (AUC = 0.70 vs 0.73, p = 0.09; AUC = 0.77 for the two together) in localizing prostate cancer. ΔAUC between PSMA PET/CT+mpMRI and the two imaging modalities alone was statistically significant (p < 0.001), but not between PSMA PET/CT and mpMRI (p = 0.093). mpMRI performed better than PSMA PET/CT in the T-staging assessment: ECE (AUC = 0.79 vs 0.59, p = 0.002) and SVI (AUC = 0.84 vs 0.63, p = 0.001). Conclusions: PSMA PET/CT and mpMRI have similar diagnostic accuracy in the detection and intra-prostatic localization of prostate cancer foci while mpMRI performs better in the assessment of ECE and SVI. The combination of the two imaging modalities improves performance of the two modalities alone, but this does not reach statistically significant levels on a lesion-level and might not justify changes in the current practices for local staging of prostate cancer.
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Affiliation(s)
| | - Ely Felker
- UCLA School of Medicine, Los Angeles, CA
| | | | - Anthony E Sisk
- University of California Los Angeles Department of Pathology, Los Angeles, CA
| | | | - Martin S. Auerbach
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA
| | - Wesley R Armstrong
- Ahmanson Translational Theranostics Division, University of California, Los Angeles, CA
| | | | | | | | | | | | - Steven Raman
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Robert Evan Reiter
- Institute of Urologic Oncology, University of California, Los Angeles, CA
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Hosseiny M, Felker ER, Azadikhah A, Suvannarerg V, Sayre J, Ponzini D, Ahuja P, Lu D, Raman SS. Efficacy of 3T Multiparametric MR Imaging followed by 3T in-Bore MR-Guided Biopsy for Detection of Clinically Significant Prostate Cancer Based on PIRADSv2.1 Score. J Vasc Interv Radiol 2020; 31:1619-1626. [PMID: 32921565 DOI: 10.1016/j.jvir.2020.03.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/17/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the diagnostic yield of 3T in-Bore magnetic resonance-guided biopsy (3T IB-MRGB) for detection of clinically significant prostate cancer (csPCa), based on assessment using the Prostate Imaging Reporting and Data System version 2.1 (PIRADSv2.1). MATERIALS AND METHODS This single-center study examined individuals who underwent 3T multiparametric prostate magnetic resonance (MR) imaging and subsequent 3T IB-MRGB. The final study cohort included 379 men (with 475 targets) divided into 3 subcohorts: biopsy-naïve men (n = 123), individuals with a history of negative trans-rectal-ultrasonography (TRUS) biopsy results (n = 106), and men with low-grade PCa under active surveillance (n = 150). csPCa was defined as having a Gleason score (GS) ≥3+4. RESULTS 3T IB-MRGB detected PCa and csPCa in 69.1% (262 of 379) and 50.3% (193 of 379) of patients, respectively. The PCa and csPCa detection rates per target were 64.2% (305 of 475) and 43.8% (208 of 475), respectively. The rate of urosepsis, treated with intravenous antibiotics, was 1% (4 patients). In TRUS biopsy negative results and biopsy-naïve subcohorts, csPCa was found in 36.8% (39 of 106) and 52.8% (65 of 123), respectively. In 50.7% (76 of 150) of the active surveillance subcohort, 3T IB-MRGB upgraded the GS assigned in prior TRUS biopsies. Positive predictive values of PIRADSv2.1 categories 3, 4, and 5 for csPCa detection were 24.8%, 44.4%, and 67.1%, respectively. Higher PIRADSv2.1 categories were significantly associated with PCa (odds ratio [OR], 3.97; 95% confidence interval [CI], 2.98-5.28) and csPCa (OR, 1.41; 95% CI, 1.03-1.94) detection. Of 137 PIRADSv2 category 3 lesions, 28 were downgraded to PIRADSv2.1 category 2, in which there were no occurrences of csPCa in histology. CONCLUSIONS Use of 3T IB-MRGB resulted in detection of csPCa in 50.9% of individuals. 3T IB-MRGB has a high diagnostic yield in individuals with negative TRUS biopsy results and those under active surveillance. The PIRADSv2.1 category is a strong predictor of PCa and csPCa detection.
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Affiliation(s)
- Melina Hosseiny
- Department of Radiology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Ely R Felker
- Department of Radiology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Afshin Azadikhah
- Department of Radiology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Voraparee Suvannarerg
- Department of Radiology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - James Sayre
- Department of Bioinformatics, University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Danielle Ponzini
- Department of Radiology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Preeti Ahuja
- Department of Radiology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David Lu
- Department of Radiology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Steven S Raman
- Department of Radiology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Urology, Ronald Reagan-University of California Los Angeles Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
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7
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Udompap P, Sukonrut K, Suvannarerg V, Pongpaibul A, Charatcharoenwitthaya P. Prospective comparison of transient elastography, point shear wave elastography, APRI and FIB-4 for staging liver fibrosis in chronic viral hepatitis. J Viral Hepat 2020; 27:437-448. [PMID: 31799740 DOI: 10.1111/jvh.13246] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/27/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022]
Abstract
Ultrasound-based elastography and serum indexes have been individually validated as noninvasive methods for staging liver fibrosis in chronic viral hepatitis. We aimed to compare the accuracy of transient elastography (TE), shear wave elastography (SWE), aspartate aminotransferase to platelet index (APRI) and Fibrosis-4 index (FIB-4) with the METAVIR liver fibrosis staging in viral hepatitis patients. We enrolled 121 treatment-naïve chronic hepatitis B and C monoinfected patients. All underwent liver biopsy had biochemistry tests and liver stiffness measurements by TE using M and XL probes followed by point SWE performed on the same day. The accuracy of each method for predicting different fibrosis stages was demonstrated as an area under the receiver operating characteristic (AUROC) curves. The AUROCs of TE using M and XL probes, SWE, APRI and FIB-4 were 0.771, 0.761, 0.700, 0.698 and 0.697, respectively, for significant fibrosis; 0.974, 0.973, 0.929, 0.738 and 0.859, respectively, for advanced fibrosis; and 0.954, 0.949, 0.962, 0.765 and 0.962, respectively, for cirrhosis. TE using the M probe was comparable to the XL probe in detecting all fibrosis stages. TE was superior to SWE for assessing significant fibrosis and advanced fibrosis. For cirrhosis, the performances of TE, SWE and FIB-4 were similar. APRI was least accurate in liver fibrosis staging. To conclude, for patients with viral hepatitis, TE using either M or XL probe is an effective noninvasive test for assessing liver fibrosis, particularly advanced fibrosis and cirrhosis, while SWE and FIB-4 possess an excellent accuracy in predicting cirrhosis.
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Affiliation(s)
- Prowpanga Udompap
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Kamonthip Sukonrut
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Voraparee Suvannarerg
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Pongpaibul
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phunchai Charatcharoenwitthaya
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Suvannarerg V, Chitchumnong P, Apiwat W, Lertdamrongdej L, Tretipwanit N, Pisarnturakit P, Sitthinamsuwan P, Thiravit S, Muangsomboon K, Korpraphong P. Diagnostic performance of qualitative and quantitative shear wave elastography in differentiating malignant from benign breast masses, and association with the histological prognostic factors. Quant Imaging Med Surg 2019; 9:386-398. [PMID: 31032186 DOI: 10.21037/qims.2019.03.04] [Citation(s) in RCA: 25] [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] [Indexed: 12/22/2022]
Abstract
Background To determine the diagnostic performance of qualitative and quantitative shear wave elastography (SWE) and the optimal cutoff values of the quantitative SWE parameters in differentiating malignant from benign breast masses, and to evaluate the association between the quantitative SWE parameters and histological prognostic factors. Methods A gray scale ultrasound and SWE were prospectively performed on a total of 244 breast masses (148 benign, and 96 malignant) in 228 consecutive patients before an ultrasound-guided needle biopsy. The qualitative SWE and quantitative SWE parameters (the mean elasticity, maximum elasticity, and elasticity ratio) were measured in each mass. The diagnostic performance of SWE and the optimal cutoff values of the quantitative SWE parameters were obtained. An association analysis of the parameters and histological prognostic factors was performed. Results The malignant masses had a more heterogeneous pattern on the qualitative SWE than benign masses (P<0.001). The quantitative SWE parameters of the malignant masses were higher than those of the benign masses (P<0.001); the mean elasticity, maximum elasticity, and elasticity ratio of the benign masses were 19.73 kPa, 23.98 kPa, and 2.78, respectively; and the mean elasticity, maximum elasticity, and elasticity ratio of the malignant masses were 88.13 kPa, 98.48 kPa, and 10.64, respectively. The optimal cutoff value of the mean elasticity was 30 kPa, of the maximum elasticity was 36 kPa, and of the elasticity ratio was 4.5. The maximum elasticity had the highest AUC. Combining the three SWE parameters to differentiate between the malignant and benign masses increased the negative predictive value (NPV), which correctly downgraded 72.73% of BI-RADS category 4A masses to BI-RADS category 3. No statistically significant association was found between the quantitative SWE parameters and the tumor grading, tumor types, axillary lymph node statuses, or molecular subtypes of the breast cancers (P>0.05). Conclusions The qualitative and quantitative SWE provided good diagnostic performance in differentiating malignant and benign masses. The maximum elasticity of the quantitative SWE parameters had the best diagnostic performance. Adding the three combined quantitative SWE parameters to the BI-RADS category 4A masses potentially downgraded them to BI-RADS category 3 and avoided unnecessary biopsies. No statistically significant association was found between the quantitative SWE parameters and the histological prognostic factors.
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Affiliation(s)
- Voraparee Suvannarerg
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyanuch Chitchumnong
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wipawan Apiwat
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lassanun Lertdamrongdej
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattinee Tretipwanit
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pongthep Pisarnturakit
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panitta Sitthinamsuwan
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shanigarn Thiravit
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kobkun Muangsomboon
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornpim Korpraphong
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Rujirachun P, Junyavoraluk A, Owattanapanich W, Suvannarerg V, Sirinvaravong S. Leukemic arthritis and severe hypercalcemia in a man with chronic myeloid leukemia: a case report and review of the literature. J Med Case Rep 2018; 12:257. [PMID: 30196795 PMCID: PMC6130082 DOI: 10.1186/s13256-018-1798-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
Background Patients with chronic myeloid leukemia typically present with high white blood cell counts revealed during annual checkups. Leukemic arthritis and hypercalcemia are rare manifestations in patients with chronic myeloid leukemia. Case presentation A 35-year-old Thai man who had been diagnosed with chronic myeloid leukemia in the chronic phase developed blast crisis while he was receiving ongoing treatment with imatinib at 400 mg/day. Initially, he presented with oligoarthritis in both knees and ankles. A bone scintigraphy showed a prominent bony uptake, with a symmetrical, increased uptake in many bone areas. Induction therapy with a 7 + 3 induction regimen was prescribed in conjunction with 600 mg of imatinib once daily before switching to 140 mg of dasatinib. He subsequently developed severe hypercalcemia (total serum calcium of 17.8 mg/dL), with generalized osteolytic lesions detected on a bone survey. His serum vitamin D level was 50.64 ng/mL, while the serum parathyroid hormone level was 9.82 pg/mL. Despite the administration of an aggressive intravenously administered hydration, intravenously administered calcitonin, and 600 mg/day of imatinib, the severe hypercalcemia was refractory. We therefore decided to prescribe 20 mg/day of intravenously administered dexamethasone; fortunately, his serum calcium level decreased dramatically to normal range within a few days. Conclusions Although leukemic arthritis and severe hypercalcemia are extraordinary presentations in patients with chronic myeloid leukemia, the advanced phase of the disease might bring on these symptoms. Apart from parathyroid hormone-related protein-related hypercalcemia, vitamin D is a mechanism of humoral-mediated hypercalcemia. Electronic supplementary material The online version of this article (10.1186/s13256-018-1798-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Voraparee Suvannarerg
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirinart Sirinvaravong
- Division of Endocrine and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Thiravit S, Lapatikarn S, Muangsomboon K, Suvannarerg V, Thiravit P, Korpraphong P. MRI of placenta percreta: differentiation from other entities of placental adhesive disorder. Radiol Med 2016; 122:61-68. [DOI: 10.1007/s11547-016-0689-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
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Keoplung S, Teerasamit W, Suvannarerg V. Diagnosis of bowel obstruction: added value of multiplanar reformations from multidetector CT in comparison with axial planes alone. J Med Assoc Thai 2013; 96:1569-1577. [PMID: 24511722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To retrospectively assess the benefit of multiplanar reformations from multidetector CT for diagnosis of bowel obstruction in comparison with axial planes alone. MATERIAL AND METHOD Between October 2008 and May 2010, included the consecutive 75 patients/76 CT studies who underwent multidetector CT at Siriraj Hospital to rule out bowel obstruction. Fifty-seven patients of 58 studies confirmed the final diagnosis of bowel obstruction by surgical proof or obstructive symptoms relief from conservative treatments; divided into 25 small bowel and 33 large bowel obstructions. Two independent readers, blinded to diagnosis, interpreted for bowel obstruction firstly using axial slices alone, then immediately scoring MPR images including axial, coronal, sagittal, and oblique reformations from the same study. Confidence score was applied In case of radiological diagnosis of bowel obstruction, the findings of transition point, cause, severity, and complication were also evaluated. RESULTS CT diagnosis of bowel obstruction was made 54 on axial image alones and 55 on axial image plus MPR, leading to the sensitivity of 93.1% and specificity of 77.8% on the axial scans alone and the sensitivity of 94.8% and specificity of 72.2% on the axial plus MPR, respectively. The axial plus MPR images helped correct diagnosis and increased confidence score in one case of low grade, small bowel obstruction. Accuracy in diagnosis of between large bowel obstruction and small bowel obstruction was 90% and 88.5% on axial scans alone and 90% and 92.3% on axial plus MPR scans, respectively. CONCLUSION The axial scan CT is an appropriate modality for the patients suspected bowel obstruction. The authors encourage using MPR as the adjunct tool to the axial images, especially in the case suspected small bowel obstruction. MPR help increasing diagnostic confidence and confirming the findings found on axial image.
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Affiliation(s)
- Shanigarn Keoplung
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanwarang Teerasamit
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Voraparee Suvannarerg
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Apisarnthanarak P, Suvannarerg V, Muangsomboon K, Taweemonkongsap T, Hargrove NS. Renal vascular variants in living related renal donors: evaluation with CT angiography. J Med Assoc Thai 2012; 95:941-948. [PMID: 22919990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Renal vascular variants may complicate the surgical techniques of living related renal transplantation. Renal computed tomographic (CT) angiography is now well accepted for preoperative renal vascular mapping in living related renal donors. OBJECTIVE To study the prevalence of renal vascular variants in living related renal donors using CT angiography. MATERIAL AND METHOD Preoperative renal CT angiography of 65 consecutive living related renal donors were retrospectively reviewed by two abdominal radiologists on a 3-D workstation. The number and branching patterns of bilateral renal arteries and veins, as well as the presence of renal arterial and venous variants were described. RESULTS Supernumerary renal arteries and early branching were present in 18.5% and 12.8% respectively on the right kidneys and 27.7% and 22.4% respectively on the left kidneys. The prevalence of precaval right renal artery was 4.6%. Supernumerary renal veins were present in 35.4% and 1.5% on the right and left kidneys, respectively. Late confluences of left renal veins were identified in 1.5% of left kidneys. Other venous anomalies included 1.5% duplicated inferior vena cava (IVC), 1.5% circumaortic left renal vein, 1.5% retroaortic left renal vein, 1.5% outsized left gonadal veins drained into the left renal vein, and 6.2% right gonadal vein drained into the right renal vein. CONCLUSION Renal vascular anatomical variants were common. The surgeons and the radiologists should be aware of these variants to prevent postoperative complications.
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Affiliation(s)
- Piyaporn Apisarnthanarak
- Department ofRadiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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