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Buss A, Radzina M, Liepa M, Birkenfelds E, Saule L, Miculis K, Mikelsone M, Vjaters E. Role of Apparent Diffusion Coefficient Value and Apparent Diffusion Coefficient Ratio as Prognostic Factors for Prostate Cancer Aggressiveness. Diagnostics (Basel) 2024; 14:2438. [PMID: 39518405 PMCID: PMC11545188 DOI: 10.3390/diagnostics14212438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 10/28/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Prostate cancer is one of the most prevalent cancers in the male population. To determine the aggressiveness of suspected lesions precisely, predictive models are increasingly being developed using quantitative MRI measurements, and particularly the ADC value. This study aimed to determine whether ADC values could be used to establish the aggressiveness of prostate cancer. METHODS A retrospective single-center study included 398 patients with prostate cancer who underwent a multiparametric MRI prior to radical prostatectomy. DWI ADC values were measured (µm2/s) using b values of 50 and 1000. The dominant lesion best visualized on MRI was analyzed. The ADC values of the index lesion and reference tissue were compared to tumor aggressivity according to the Gleason grade groups based on radical prostatectomy results. Statistical analysis was performed using the Mann-Whitney U test, Kruskal-Wallis H test, Spearman's rank correlation, and ROC curves. RESULTS A very strong negative correlation (rs = -0.846, p < 0.001) between ADC and GS was found. ROC analysis revealed an AUC of 0.958 and an ADC threshold value of 758 µm2/s in clinically significant prostate cancer diagnoses using the absolute ADC value, with no advantage of using the ADC ratio over the absolute ADC value being identified. CONCLUSION DWI ADC values and the calculated ADC ratio have a significant inverse correlation with GS. The findings indicate a strong capability in determining prostate cancer aggressiveness, as well as the possibility of assisting with assigning PI-RADS categories using ADC as quantitative metrics.
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Affiliation(s)
- Arvids Buss
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.L.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia;
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.L.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia;
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
| | - Mara Liepa
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.L.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia;
| | - Edgars Birkenfelds
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia;
| | - Laura Saule
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.L.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia;
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
| | - Karlis Miculis
- Center of Urology, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia;
| | - Madara Mikelsone
- Department of Statistics, Riga Stradins University, LV-1007 Riga, Latvia
| | - Egils Vjaters
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Center of Urology, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia;
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Dhiman A, Kumar V, Das CJ. Quantitative magnetic resonance imaging in prostate cancer: A review of current technology. World J Radiol 2024; 16:497-511. [PMID: 39494137 PMCID: PMC11525833 DOI: 10.4329/wjr.v16.i10.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 09/26/2024] [Accepted: 10/20/2024] [Indexed: 10/28/2024] Open
Abstract
Prostate cancer (PCa) imaging forms an important part of PCa clinical management. Magnetic resonance imaging is the modality of choice for prostate imaging. Most of the current imaging assessment is qualitative i.e., based on visual inspection and thus subjected to inter-observer disagreement. Quantitative imaging is better than qualitative assessment as it is more objective, and standardized, thus improving interobserver agreement. Apart from detecting PCa, few quantitative parameters may have potential to predict disease aggressiveness, and thus can be used for prognosis and deciding the course of management. There are various magnetic resonance imaging-based quantitative parameters and few of them are already part of PIRADS v.2.1. However, there are many other parameters that are under study and need further validation by rigorous multicenter studies before recommending them for routine clinical practice. This review intends to discuss the existing quantitative methods, recent developments, and novel techniques in detail.
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Affiliation(s)
- Ankita Dhiman
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Virendra Kumar
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Chandan Jyoti Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
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Bengtsson J, Thimansson E, Baubeta E, Zackrisson S, Sundgren PC, Bjartell A, Flondell-Sité D. Correlation between ADC, ADC ratio, and Gleason Grade group in prostate cancer patients undergoing radical prostatectomy: Retrospective multicenter study with different MRI scanners. Front Oncol 2023; 13:1079040. [PMID: 36890837 PMCID: PMC9986526 DOI: 10.3389/fonc.2023.1079040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
Background MRI is an important tool in the prostate cancer work-up, with special emphasis on the ADC sequence. This study aimed to investigate the correlation between ADC and ADC ratio compared to tumor aggressiveness determined by a histopathological examination after radical prostatectomy. Methods Ninety-eight patients with prostate cancer underwent MRI at five different hospitals prior to radical prostatectomy. Images were retrospectively analyzed individually by two radiologists. The ADC of the index lesion and reference tissues (contralateral normal prostatic, normal peripheral zone, and urine) was recorded. Absolute ADC and different ADC ratios were compared to tumor aggressivity according to the ISUP Gleason Grade Groups extracted from the pathology report using Spearman's rank correlation coefficient (ρ). ROC curves were used to evaluate the ability to discriminate between ISUP 1-2 and ISUP 3-5 and intra class correlation and Bland-Altman plots for interrater reliability. Results All patients had prostate cancer classified as ISUP grade ≥ 2. No correlation was found between ADC and ISUP grade. We found no benefit of using the ADC ratio over absolute ADC. The AUC for all metrics was close to 0.5, and no threshold could be extracted for prediction of tumor aggressivity. The interrater reliability was substantial to almost perfect for all variables analyzed. Conclusions ADC and ADC ratio did not correlate with tumor aggressiveness defined by ISUP grade in this multicenter MRI study. The result of this study is opposite to previous research in the field.
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Affiliation(s)
- Johan Bengtsson
- Department of Clinical Sciences, Radiology, Lund, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Erik Thimansson
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Radiology, Helsingborg Hospital, Helsingborg, Sweden
| | - Erik Baubeta
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sophia Zackrisson
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Pia Charlotte Sundgren
- Department of Clinical Sciences, Radiology, Lund, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- Lund Bioimaging Center (LBIC), Lund University, Lund, Sweden
| | - Anders Bjartell
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Despina Flondell-Sité
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Urology, Skåne University Hospital, Malmö, Sweden
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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] [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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Bai H, Xia W, Ji X, He D, Zhao X, Bao J, Zhou J, Wei X, Huang Y, Li Q, Gao X. Multiparametric Magnetic Resonance Imaging-Based Peritumoral Radiomics for Preoperative Prediction of the Presence of Extracapsular Extension With Prostate Cancer. J Magn Reson Imaging 2021; 54:1222-1230. [PMID: 33970517 DOI: 10.1002/jmri.27678] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Preoperative prediction of extracapsular extension (ECE) of prostate cancer (PCa) is important to guide clinical decision-making and improve patient prognosis. PURPOSE To investigate the value of multiparametric magnetic resonance imaging (mpMRI)-based peritumoral radiomics for preoperative prediction of the presence of ECE. STUDY TYPE Retrospective. POPULATION Two hundred eighty-four patients with PCa from two centers (center 1: 226 patients; center 2: 58 patients). Cases from center 1 were randomly divided into training (158 patients) and internal validation (68 patients) sets. Cases from center 2 were assigned to the external validation set. FIELD STRENGTH/SEQUENCE A 3.0 T MRI scanners (three vendors). Sequence: Pelvic T2-weighted turbo/fast spin echo sequence and diffusion weighted echo planar imaging sequence. ASSESSMENT The peritumoral region (PTR) was obtained by 3-12 mm (half of the tumor length) 3D dilatation of the intratumoral region (ITR). Single-MRI radiomics signatures, mpMRI radiomics signatures, and integrated models, which combined clinical characteristics with the radiomics signatures were built. The discrimination ability was assessed by area under the receiver operating characteristic curve (AUC) in the internal and external validation sets. STATISTICAL TESTS Fisher's exact test, Mann-Whitney U-test, DeLong test. RESULTS The PTR radiomics signatures demonstrated significantly better performance than the corresponding ITR radiomics signatures (AUC: 0.674 vs. 0.554, P < 0.05 on T2-weighted, 0.652 vs. 0.546, P < 0.05 on apparent diffusion coefficient, 0.682 vs. 0.556 on mpMRI in the external validation set). The integrated models combining the PTR radiomics signature with clinical characteristics performed better than corresponding radiomics signatures in the internal validation set (eg. AUC: 0.718 vs. 0.671, P < 0.05 on mpMRI) but performed similar in the external validation set (eg. AUC: 0.684, vs. 0.682, P = 0.45 on mpMRI). DATA CONCLUSION The peritumoral radiomics can better predict the presence of ECE preoperatively compared with the intratumoral radiomics and may have better generalization than clinical characteristics. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Honglin Bai
- School of Biomedical Engineering (Suzhou), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230026, China.,Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Wei Xia
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Xuefu Ji
- The School of Electro-Optical Engineering, Changchun University of Science and Technology, Changchun, 130013, China
| | - Dong He
- Department of Urology, The First Affiliated Hospital of SooChow University, Suzhou, 215006, China
| | - Xingyu Zhao
- School of Biomedical Engineering (Suzhou), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230026, China.,Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Jie Bao
- Department of Radiology, The First Affiliated Hospital of SooChow University, Suzhou, 215006, China
| | - Jian Zhou
- Department of Radiology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of SooChow University, Suzhou, 215006, China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of SooChow University, Suzhou, 215006, China
| | - Qiong Li
- Department of Radiology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xin Gao
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China.,Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, China
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6
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Sackett J, Shih JH, Reese SE, Brender JR, Harmon SA, Barrett T, Coskun M, Madariaga M, Marko J, Law YM, Turkbey EB, Mehralivand S, Sanford T, Lay N, Pinto PA, Wood BJ, Choyke PL, Turkbey B. Quality of Prostate MRI: Is the PI-RADS Standard Sufficient? Acad Radiol 2021; 28:199-207. [PMID: 32143993 PMCID: PMC8459209 DOI: 10.1016/j.acra.2020.01.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVE The Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) published a set of minimum technical standards (MTS) to improve image quality and reduce variability in multiparametric prostate MRI. The effect of PIRADSv2 MTS on image quality has not been validated. We aimed to determine whether adherence to PI-RADSv2 MTS improves study adequacy and perceived quality. MATERIALS AND METHODS Sixty-two prostate MRI examinations including T2 weighted (T2W) and diffusion weighted image (DWI) consecutively referred to our center from 62 different institutions within a 12-month period (September 2017 to September 2018) were included. Six readers assessed images as adequate or inadequate for use in PCa detection and a numerical image quality ranking was given using a 1-5 scale. The PI-RADSv2 MTS were synthesized into sets of seven and 10 rules for T2W and DWI, respectively. Image adherence was assessed using Digital Imaging and Communications in Medicine (DICOM) metadata. Statistical analysis of survey results and image adherence was performed based on reader quality scoring (Kendall Rank tau-b) and reader adequate scoring (Wilcoxon test for association) for T2 and DWI quality assessment. RESULTS Out of 62 images, 52 (83%) T2W and 38 (61%) DWIs were rated to be adequate by a majority of readers. Reader adequacy scores showed no significant association with adherence to PI-RADSv2. There was a weak (tau-b = 0.22) but significant (p value = 0.01) correlation between adherence to PIRADSv2 MTS and image quality for T2W. Studies following all PI-RADSv2 T2W rules achieved a higher median average quality score (3.58 for 7/7 vs. 3.0 for <7/7, p = 0.012). No statistical relationship with PI-RADSv2 MTS adherence and DWI quality was found. CONCLUSION Among 62 sites performing prostate MRI, few were considered of high quality, but the majority were considered adequate. DWI showed considerably lower rates of adequate studies in the sample. Adherence to PI-RADSv2 MTS did not increase the likelihood of having a qualitatively adequate T2W or DWI.
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Affiliation(s)
- Jonathan Sackett
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA; Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Joanna H Shih
- Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sarah E Reese
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Jeffrey R Brender
- Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stephanie A Harmon
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA; Leidos Biomedical Research, Inc., NCI Campus at Frederick, Clinical Research Directorate/Clinical Monitoring Research Program, Bethesda, MD, USA
| | - Tristan Barrett
- University of Cambridge School of Clinical Medicine, Cambridge UK
| | - Mehmet Coskun
- Department of Radiology, Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, University of Health Sciences, izmir, Turkey
| | | | - Jamie Marko
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Evrim B Turkbey
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Thomas Sanford
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Nathan Lay
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Bradford J Wood
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA; Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA.
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Eusebi L, Carpagnano FA, Sortino G, Bartelli F, Guglielmi G. Prostate Multiparametric MRI: Common Pitfalls in Primary Diagnosis and How to Avoid Them. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose of Review
To provide the radiologist with basic knowledge about normal and abnormal findings in the prostatic mp-MRI, taking a look at the possible diagnostic pitfalls commonly seen in daily clinical practice, allowing him to recognize and consequently avoid them.
Recent Findings
Prostate mp-MRI has now become commonly used in most diagnostic imaging centers, as a precise, accurate and above all non-invasive tool, useful in the diagnosis, staging and follow-up of prostate diseases, first of all prostatic carcinoma. For this reason, it is important to take into account the existence of numerous possible anatomic and pathologic processes which can mimick or masquerade as prostate cancer.
Summary
Through the combination of anatomical (T2WI) and functional sequences (DWI/ADC and DCE), the mp-MRI of the prostate provides all the information necessary for a correct classification of patients with prostate disease, cancer in particular. It is not uncommon, however, for the radiologist to make errors in the interpretation of imaging due to conditions, pathological or otherwise, that mimic prostate cancer and that, consequently, affect the diagnostic/therapeutic process of patients. The strategy, and what this pictorial review aims at, is to learn to recognize the potential pitfalls of the prostatic mp-MRI and avoid them.
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Shaish H. Structured prostate MRI reporting: how and why. Abdom Radiol (NY) 2020; 45:3969-3973. [PMID: 32918578 DOI: 10.1007/s00261-020-02720-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 01/02/2023]
Abstract
Over the past decade, the Prostate Imaging-Reporting and Data System (PI-RADS) has revolutionized the manner in which prostate cancer is screened for, detected, biopsied, and managed. The single greatest contribution of PI-RADS has been the standardization of interpretation and reporting of findings on MRI of the prostate. This standardization has led to the wide acceptance of the PI-RADS lexicon at a time when structured reporting templates are becoming more widespread in radiology and other medical fields. The author reviews the benefits of structured reporting templates with a focus on prostate MRI, prior studies on this topic, and details of a suggested template.
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Affiliation(s)
- Hiram Shaish
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10016, USA.
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Abstract
The role of prostate MRI in clinical practice has continued to broaden over time. Multiple iterations of PI-RADS reporting have aided in improving detection and reporting of prostate cancer. In addition, recent recommendations from the PI-RADS Steering Committee promote an MRI-first approach with an MRI-directed prostate cancer diagnostic pathway. It is imperative for radiologists to be knowledgeable and familiar with prostate MRI and PI-RADS recommendations, as there is an increasing demand for prostate imaging by clinicians and patients alike.
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Affiliation(s)
- Grace C Lo
- Division of Body Imaging, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY, 10065, USA.
| | - Daniel J A Margolis
- Division of Body Imaging, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY, 10065, USA
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Abstract
Multiparametric MRI (mpMRI) of the prostate has evolved to be an integral component for the diagnosis, risk stratification, staging, and targeting of prostate cancer. However, anatomic and histologic mimics of prostate cancer on mpMRI exist. Anatomic feature that mimic prostate cancer on mpMRI include anterior fibromuscular stroma, normal central zone, periprostatic venous plexus, and thickened surgical capsule (transition zone pseudocapsule). Benign conditions such as post-biopsy hemorrhage, prostatitis or inflammation, focal prostate atrophy, benign prostatic hyperplasia nodules, and prostatic calcifications can also mimic prostate cancer on mpMRI. Technical challenges and other pitfalls such as image distortion, motion artifacts, and endorectal coil placements can also limit the efficacy of mpMRI. Knowledge of prostate anatomy, location of the lesion and its imaging features on different sequences, and being familiar with the common pitfalls are critical for the radiologists who interpret mpMRI. Therefore, this article reviews the pitfalls (anatomic structures and technical challenges) and benign lesions or abnormalities that may mimic prostate cancer on mpMRI and how to interpret them.
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11
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Giganti F, Pecoraro M, Fierro D, Campa R, Del Giudice F, Punwani S, Kirkham A, Allen C, Emberton M, Catalano C, Moore CM, Panebianco V. DWI and PRECISE criteria in men on active surveillance for prostate cancer: A multicentre preliminary experience of different ADC calculations. Magn Reson Imaging 2020; 67:50-58. [PMID: 31899283 DOI: 10.1016/j.mri.2019.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/27/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE The PRECISE score estimates the likelihood of radiological progression in patients on active surveillance (AS) for prostate cancer (PCa) with serial multiparametric magnetic resonance imaging (mpMRI). A PRECISE score of 1 or 2 denotes radiological regression, PRECISE 3 indicates stability and PRECISE 4 or 5 implies progression. We evaluated the inter-reader reproducibility of different apparent diffusion coefficient (ADC) calculations and their relationship to the PRECISE score. MATERIAL AND METHODS Baseline and follow-up scans (on the same MR systems) of 30 patients with visible lesions from two different institutions (University College London and Sapienza University of Rome) were analysed by two radiologists (one from each site). The PRECISE score was initially assessed in consensus. At least six weeks later, to reduce the likelihood of being influenced by the consensus PRECISE reading, each radiologist independently calculated ADC for the following: lesion, non-cancerous tissue and urine in the bladder. Normalised ADC ratios were calculated with respect to normal prostatic tissue (npADC) and urine. Spearman's correlation (ρ), intraclass correlation coefficients (ICC), differences in ADC and ROC curves were computed. RESULTS Interobserver reproducibility was very good (ρ > 0.8; ICC > 0.90). Lesion ADC (0.91 vs 0.73 × 10-3 mm2/s; p=0.025) and npADC ratio (0.68 vs 0.53; p=0.012) at follow-up mpMRI were different between patients with radiological regression or stability vs progression. Cut-offs of 0.77 × 10-3 mm2/s (lesion ADC) and 0.59 (npADC ratio) could differentiate the two groups (area under the curve: 0.74 and 0.77, respectively). CONCLUSION The ADC, npADC ratio and the PRECISE score should be recorded for MRI-based AS.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Davide Fierro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Riccardo Campa
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | | | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Centre for Medical Imaging, University College London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
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12
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Caglic I, Barrett T. Optimising prostate mpMRI: prepare for success. Clin Radiol 2019; 74:831-840. [PMID: 30611559 DOI: 10.1016/j.crad.2018.12.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/06/2018] [Indexed: 01/06/2023]
Abstract
Multiparametric magnetic resonance imaging (MRI) now plays an essential role in prostate cancer diagnosis and management. The increasing use of MRI before biopsy makes obtaining images of the highest quality vital. The European Society of Urogenital Radiology (ESUR) 2012 guidelines and subsequent Prostate Imaging -Reporting Data System (PI-RADS) version 2 recommendations in 2015 address the technical considerations for optimising MRI acquisition; however, the quality of the multiparametric sequences employed depends not only on the hardware and software utilised and scanning parameters selected, but also on patient-related factors, for which current guidance is lacking. Patient preparation factors include bowel peristalsis, rectal distension, the presence of total hip replacement (THR), post-biopsy haemorrhage, and abstinence from ejaculation. New evidence has been accrued since the release of PI-RADS v2, and this review aims to explore the key issues of patient preparation and their potential to further optimise the image quality of mpMRI.
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Affiliation(s)
- I Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - T Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Kim SJ, Ryu JH, Yang SO, Lee JK, Jung TY, Kim YB. Does the Time Interval from Biopsy to Radical Prostatectomy Affect the Postoperative Oncologic Outcomes in Korean Men? J Korean Med Sci 2019; 34:e234. [PMID: 31559708 PMCID: PMC6763398 DOI: 10.3346/jkms.2019.34.e234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prostate cancer (PC) is the second most common type of cancer in men worldwide and the fifth most common cancer among Korean men. Although most PCs grow slowly, it is unclear whether a longer time interval from diagnosis to treatment causes worse outcomes. This study aimed to investigate whether the time interval from diagnosis to radical prostatectomy (RP) in men with clinically localized PC affects postoperative oncologic outcomes. METHODS We retrospectively analyzed data of 427 men who underwent RP for localized PC between January 2005 and June 2016. The patients were divided into two groups based on the cutoff median time interval (100 days) from biopsy to surgery. The associations between time interval from biopsy to surgery (< 100 vs. ≥ 100 days) and adverse pathologic outcomes such as positive surgical margin, pathologic upgrading, and upstaging were evaluated. Biochemical recurrence (BCR)-free survival rates were analyzed and compared based on the time interval from biopsy to surgery. RESULTS Pathologic upgrading of Gleason score in surgical specimens was more frequent in the longer time interval group and showed marginal significance (38.8% vs. 30.0%; P = 0.057). Based on multivariable analysis, an association was observed between time interval from biopsy to surgery and pathologic upgrading (odds ratio, 2.211; 95% confidence interval [CI], 1.342-3.645; P = 0.002). BCR-free survival did not differ based on time interval from biopsy to surgery, and significant association was not observed between time interval from biopsy to surgery and BCR on multivariable analysis (hazard ratio, 1.285; 95% CI, 0.795-2.077; P = 0.305). CONCLUSION Time interval ≥ 100 days from biopsy to RP in clinically localized PC increased the risk of pathologic upgrading but did not affect long-term BCR-free survival rates in Korean men.
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Affiliation(s)
- Sang Jin Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung Ok Yang
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Jeong Kee Lee
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea.
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Apparent Diffusion Coefficient (ADC) Ratio Versus Conventional ADC for Detecting Clinically Significant Prostate Cancer With 3-T MRI. AJR Am J Roentgenol 2019; 213:W134-W142. [DOI: 10.2214/ajr.19.21365] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Sun Y, Reynolds HM, Wraith D, Williams S, Finnegan ME, Mitchell C, Murphy D, Haworth A. Automatic stratification of prostate tumour aggressiveness using multiparametric MRI: a horizontal comparison of texture features. Acta Oncol 2019; 58:1118-1126. [PMID: 30994052 DOI: 10.1080/0284186x.2019.1598576] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Previous studies have identified apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) can stratify prostate cancer into high- and low-grade disease (HG and LG, respectively). In this study, we consider the improvement of incorporating texture features (TFs) from T2-weighted (T2w) multiparametric magnetic resonance imaging (mpMRI) relative to mpMRI alone to predict HG and LG disease. Material and methods: In vivo mpMRI was acquired from 30 patients prior to radical prostatectomy. Sequences included T2w imaging, DWI and dynamic contrast enhanced (DCE) MRI. In vivo mpMRI data were co-registered with 'ground truth' histology. Tumours were delineated on the histology with Gleason scores (GSs) and classed as HG if GS ≥ 4 + 3, or LG if GS ≤ 3 + 4. Texture features based on three statistical families, namely the grey-level co-occurrence matrix (GLCM), grey-level run length matrix (GLRLM) and the grey-level size zone matrix (GLSZM), were computed from T2w images. Logistic regression models were trained using different feature subsets to classify each lesion as either HG or LG. To avoid overfitting, fivefold cross validation was applied on feature selection, model training and performance evaluation. Performance of all models generated was evaluated using the area under the curve (AUC) method. Results: Consistent with previous studies, ADC was found to discriminate between HG and LG with an AUC of 0.76. Of the three statistical TF families, GLCM (plus select mpMRI features including ADC) scored the highest AUC (0.84) with GLRLM plus mpMRI similarly performing well (AUC = 0.82). When all TFs were considered in combination, an AUC of 0.91 (95% confidence interval 0.87-0.95) was achieved. Conclusions: Incorporating T2w TFs significantly improved model performance for classifying prostate tumour aggressiveness. This result, however, requires further validation in a larger patient cohort.
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Affiliation(s)
- Yu Sun
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- School of Physics, The University of Sydney, Sydney, Australia
| | - Hayley M. Reynolds
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Darren Wraith
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Scott Williams
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mary E. Finnegan
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Catherine Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Declan Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Annette Haworth
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- School of Physics, The University of Sydney, Sydney, Australia
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Samreen N, Lee C, Bhatt A, Carter J, Hieken T, Adler K, Zingula S, Glazebrook KN. A Clinical Approach to Diffusion-Weighted Magnetic Resonance Imaging in Evaluating Chest Wall Invasion of Breast Tumors. J Clin Imaging Sci 2019; 9:11. [PMID: 31448162 PMCID: PMC6702863 DOI: 10.25259/jcis_97_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/15/2019] [Indexed: 01/26/2023] Open
Abstract
Objective: The purpose of this study is to evaluate diffusion weighted magnetic rsonance imaging (MRI) acquisitions in delineating posterior extent of breast tumors and in predicting chest wall invasion prior to treatment. To our knowledge, there has not been any literature specifically evaluating the utility of diffusion-weighted acquisitions in chest wall invasion of breast tumors. Materials and Methods: A retrospective review of our breast imaging database for keywords “chest wall invasion” and “breast MRI” was performed over the last 14 years. Diffusion sequences, T1 sequences (pre and post contrast), and T2 sequences were evaluated. Apparent diffusion coefficient (ADC) values in tumor and chest wall were assessed. Imaging findings were correlated with surgical pathology. Results: 23 patients met inclusion criteria. All 23 had loss of fat plane on T2 sequences. 22/23 had loss of fat plane on postcontrast T1 sequences. Pectoralis muscle enhancement was present in 19/23 (83%) tumors and chest wall enhancement was present 9/23 (39%) tumors. Qualitative restricted diffusion within the pectoralis muscle was present in 18/23 (71%) tumors and in the chest wall was present in 8/23 (35%) tumors. Mean ADC values were 1.15 s/mm2 in the tumor and 1.29 s/mm2 in the chest wall. Sensitivity, specificity, positive predictive value and negative predictive value were 100%, 36%, 63%, and 100% for chest wall enhancement respectively and 69%, 36%, 61%, and 80% for chest wall diffusion-weighted imaging restriction respectively. Conclusion: Diffusion weighted sequences can be helpful in characterizing chest wall invasion of breast tumors.
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Affiliation(s)
| | - Christine Lee
- Department of Radiology, Mayo Clinic Rochester, MN USA
| | - Asha Bhatt
- Department of Radiology, Mayo Clinic Rochester, MN USA
| | - Jodi Carter
- Department of Radiology, Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN USA
| | - Tina Hieken
- Department of Radiology, Surgery, Mayo Clinic Rochester, MN USA
| | - Kalie Adler
- Department of Radiology, Mayo Clinic Rochester, MN USA
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Prostate Imaging Reporting and Data System Version 2 for MRI of Prostate Cancer: Can We Do Better? AJR Am J Roentgenol 2019; 212:1244-1252. [PMID: 30888865 DOI: 10.2214/ajr.19.21178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE. Although the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) has been widely adopted and is generally considered a success, it has clear limitations. The purpose of this article is to highlight the strengths and weaknesses of PI-RADSv2 and discuss ways that it can be improved. CONCLUSION. PI-RADSv2 has improved standardization of acquisition and interpretation of prostate MR images. Although it improves the detection of clinically significant cancers, its subjectivity and intrareader variability limit its accuracy and reproducibility, causing concerns regarding its reliability.
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18
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Surov A, Meyer HJ, Wienke A. Correlations between Apparent Diffusion Coefficient and Gleason Score in Prostate Cancer: A Systematic Review. Eur Urol Oncol 2019; 3:489-497. [PMID: 31412009 DOI: 10.1016/j.euo.2018.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/29/2018] [Accepted: 12/07/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Reported data regarding the associations between apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) and Gleason score in prostate cancer (PC) are inconsistent. OBJECTIVE The aim of the present systematic review was to analyze relationships between ADC and Gleason score in PC. DESIGN, SETTING, AND PARTICIPANTS MEDLINE library, SCOPUS, and EMBASE databases were screened for relationships between ADC and Gleason score in PC up to April 2018. Overall, 39 studies with 2457 patients were identified. Data on the following parameters were extracted from the literature: number of patients, cancer localization, and correlation coefficients between ADC and Gleason score. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations between ADC and Gleason score were analyzed by the Spearman's correlation coefficient. RESULTS AND LIMITATIONS In overall sample, the pooled correlation coefficient between ADC and Gleason score was -0.45 (95% confidence interval [CI]=[-0.50; -0.40]). In PC in the transitional zone, the pooled correlation coefficient was -0.22 (95% CI=[-0.47; 0.03]). In PC in the peripheral zone, the pooled correlation coefficient was -0.48 (95% CI=[-0.54; -0.42]). CONCLUSIONS In PC located in the peripheral zone, ADC correlated moderately with Gleason score. In PC located in the transitional zone, ADC correlated weakly with Gleason score. PATIENT SUMMARY We reviewed studies using apparent diffusion coefficient for the prediction of Gleason score in prostate cancer patients.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
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20
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Ertas G. Detection of high GS risk group prostate tumors by diffusion tensor imaging and logistic regression modelling. Magn Reson Imaging 2018; 50:125-133. [PMID: 29649574 DOI: 10.1016/j.mri.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the value of joint evaluation of diffusion tensor imaging (DTI) measures by using logistic regression modelling to detect high GS risk group prostate tumors. MATERIALS AND METHODS Fifty tumors imaged using DTI on a 3 T MRI device were analyzed. Regions of interests focusing on the center of tumor foci and noncancerous tissue on the maps of mean diffusivity (MD) and fractional anisotropy (FA) were used to extract the minimum, the maximum and the mean measures. Measure ratio was computed by dividing tumor measure by noncancerous tissue measure. Logistic regression models were fitted for all possible pair combinations of the measures using 5-fold cross validation. RESULTS Systematic differences are present for all MD measures and also for all FA measures in distinguishing the high risk tumors [GS ≥ 7(4 + 3)] from the low risk tumors [GS ≤ 7(3 + 4)] (P < 0.05). Smaller value for MD measures and larger value for FA measures indicate the high risk. The models enrolling the measures achieve good fits and good classification performances (R2adj = 0.55-0.60, AUC = 0.88-0.91), however the models using the measure ratios perform better (R2adj = 0.59-0.75, AUC = 0.88-0.95). The model that employs the ratios of minimum MD and maximum FA accomplishes the highest sensitivity, specificity and accuracy (Se = 77.8%, Sp = 96.9% and Acc = 90.0%). CONCLUSION Joint evaluation of MD and FA diffusion tensor imaging measures is valuable to detect high GS risk group peripheral zone prostate tumors. However, use of the ratios of the measures improves the accuracy of the detections substantially. Logistic regression modelling provides a favorable solution for the joint evaluations easily adoptable in clinical practice.
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Affiliation(s)
- Gokhan Ertas
- Department of Biomedical Engineering, Yeditepe University, Istanbul, Turkey.
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21
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Jung SI, Jeon HJ, Park HS, Yu MH, Kim YJ, Lee SE, Lim SD. Multiparametric MR imaging of peripheral zone prostate cancer: effect of postbiopsy hemorrhage on cancer detection according to Gleason score and tumour volume. Br J Radiol 2018; 91:20180001. [PMID: 29493284 DOI: 10.1259/bjr.20180001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To evaluate effect of postbiopsy hemorrhage on detection of peripheral zone (PZ) prostate cancer by multiparametric MR imaging according to Gleason score and tumor volume. METHODS This retrospective study included 54 biopsy-proven prostate cancer patients (median age, 67.0 years) who underwent multiparametric MR imaging. Two independent readers evaluated each sextant of the PZ using the PI-RADS v2. One reader recorded the presence or absence of hemorrhage per sextant on T1 weighted MR images. Areas under the receiver operating characteristic curves (AUCs) were used to evaluate cancer detection accuracy. RESULTS Postbiopsy hemorrhage was noted in 122 (37.7%) of 324 sextants of all patients. There was no significant difference in the AUC for detection of cancer with Gleason score ≥3 + 4 or volume ≥0.5 ml between sextants with and without hemorrhage (with hemorrhage, reader 1, 0.83 for Gleason score ≥3 + 4, 0.84 for tumor volume ≥0.5 ml; reader 2, 0.74 for Gleason score ≥3 + 4, 0.77 for tumor volume ≥0.5 ml; without hemorrhage, reader 1, 0.86 for Gleason score ≥3 + 4, 0.88 for tumor volume ≥0.5 ml; reader 2, 0.79 for Gleason score ≥3 + 4, 0.83 for tumor volume ≥0.5 ml; p > 0.2 for all). CONCLUSION Postbiopsy hemorrhage did not negatively affect the detection of clinically significant PZ prostate cancer on multiparametric MR imaging. Advances in knowledge: Under influence of postbiopsy hemorrhage, multiparametric MR can be useful for the detection of clinically significant PZ prostate cancer.
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Affiliation(s)
- Sung Il Jung
- 1 Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine , Seoul , Korea
| | - Hae Jeong Jeon
- 1 Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine , Seoul , Korea
| | - Hee Sun Park
- 1 Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine , Seoul , Korea
| | - Mi Hye Yu
- 1 Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine , Seoul , Korea
| | - Young Jun Kim
- 1 Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine , Seoul , Korea
| | - Seung Eun Lee
- 2 Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - So Dug Lim
- 2 Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
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23
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Furlan A, Borhani AA, Westphalen AC. Multiparametric MR imaging of the Prostate. Radiol Clin North Am 2018; 56:223-238. [DOI: 10.1016/j.rcl.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Evaluation of Peripheral Zone Prostate Cancer Aggressiveness Using the Ratio of Diffusion Tensor Imaging Measures. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:5678350. [PMID: 29097929 PMCID: PMC5635474 DOI: 10.1155/2017/5678350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/06/2017] [Indexed: 01/04/2023]
Abstract
Purpose To evaluate the aggressiveness of peripheral zone prostate cancer by correlating the Gleason score (GS) with the ratio of the diffusion tensor imaging (DTI) measures. Materials and Methods Forty-two peripheral zone prostate tumors were imaged using DTI. Regions of interest focusing on the center of tumor foci and noncancerous tissue were used to extract statistical measures of mean diffusivity (MD) and fractional anisotroy (FA). Measure ratio was calculated by dividing tumor measure by noncancerous tissue measure. Results Strong correlations are observable between GS and MD measures while weak correlations are present between GS and FA measures. Minimum tumor MD (MDmin) and the ratio of minimum MD (rMDmin) show the same highest correlation with GS (both ρ = −0.73). Between GS ≤ 7 (3 + 4) and GS ≥ 7 (4 + 3), differences are significant for all MD measures but for some FA measures. MD measures perform better than FA measures in discriminating GS ≥ 7 (4 + 3). Conclusion Ratios of MD measures can be used in evaluation of peripheral zone prostate cancer aggressiveness; however tumor MD measures alone perform similarly.
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Multiparametric MR Imaging for Detection and Locoregional Staging of Prostate Cancer. Top Magn Reson Imaging 2017; 25:109-17. [PMID: 27187165 DOI: 10.1097/rmr.0000000000000089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Detection and staging of prostate cancer (PCa) based on digital rectal examination, prostate-specific antigen levels, and systematic transrectal ultrasound-guided biopsies show notorious limitations in light of the current needs of PCa management. Multiparametric magnetic resonance imaging (mpMRI) has emerged as a useful noninvasive imaging technique for detection, staging, assessment of aggressiveness, and treatment monitoring of PCa, combining anatomic high-resolution T2-weighted images with functional techniques, such as diffusion-weighted imaging and dynamic contrast enhancement evaluation. In this article, the authors review the technical aspects and the current clinical role of mpMRI for detection and locoregional staging of PCa.
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Greer MD, Choyke PL, Turkbey B. PI-RADSv2: How we do it. J Magn Reson Imaging 2017; 46:11-23. [DOI: 10.1002/jmri.25645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/21/2016] [Indexed: 12/27/2022] Open
Affiliation(s)
- Matthew D. Greer
- Molecular Imaging Program, NCI; NIH; Bethesda Maryland USA
- Cleveland Clinic Lerner College of Medicine; Cleveland Ohio USA
| | | | - Baris Turkbey
- Molecular Imaging Program, NCI; NIH; Bethesda Maryland USA
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Abstract
Improvements in prostate MR imaging techniques and the introduction of MR imaging-targeted biopsies have had central roles in prostate cancer (PCa) management. The role of MR imaging has progressed from largely staging patients with biopsy-proven PCa to detecting, characterizing, and guiding the biopsy of suspected PCa. These diagnostic advances, combined with improved therapeutic interventions, have led to a more sophisticated and individually tailored approach to patients' unique PCa profile. This review discusses the MR imaging, a standardized reporting scheme, and the role of fusion-targeted prostate biopsy.
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Affiliation(s)
- Hiram Shaish
- Department of Radiology, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA.
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA
| | - Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA
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Barat M, Fohlen A, Cassinotto C, Jannot AS, Dautry R, Pelage JP, Boudiaf M, Pocard M, Eveno C, Taouli B, Soyer P, Dohan A. One-month apparent diffusion coefficient correlates with response to radiofrequency ablation of hepatocellular carcinoma. J Magn Reson Imaging 2016; 45:1648-1658. [PMID: 27766709 DOI: 10.1002/jmri.25521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess whether apparent diffusion coefficient (ADC) values at 1 and 3 months after radiofrequency ablation (RFA) may be associated with a favorable response to therapy for hepatocellular carcinoma (HCC) and liver metastases. MATERIALS AND METHODS Fifty-nine patients with HCC (n = 35) or liver metastases (n = 24) who underwent 1.5T diffusion-weighted magnetic resonance imaging (DWMRI) at 1 and 3 months post-RFA were included. ADC values of patients with local tumor recurrence were compared to those without local recurrence. A subgroup analysis was performed for HCC and metastases. RESULTS Thirty-eight HCC and 27 metastases were evaluated. The ADC value of HCC at 1 month after RFA was lower in recurrent tumors (0.957 ± 0.229 [SD] × 10-3 mm2 ) compared to tumors with complete response (1.414 ± 0.322 [SD] × 10-3 mm2 /s, P = 0.006). At multivariate analysis, ADC at 1 month was the single independent variable associated with recurrence for HCC (area under the receiver operating characteristic curve = 0.860). No significant association was observed for liver metastases (P = 0.089). CONCLUSION A low ADC value at 1 month after RFA is associated with an early local recurrence of HCC. This study does not confirm that such association exists for hepatic metastases. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1648-1658.
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Affiliation(s)
- Maxime Barat
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Audrey Fohlen
- CNRS, UMR 6301-ISTCT, CERVOxy, GIP CYCERON, Caen, France.,CEA, DSV/I2BM, UMR6301-ISTCT, Caen, France.,Normandie Université, France.,UNICAEN, UMR6301-ISTCT, Caen, France.,CHU de CAEN, Service d'Imagerie Diagnostique et de Radiologie Thérapeutique, Caen, France
| | - Christophe Cassinotto
- Department of Diagnostic and Interventional Imaging, Hôpîtal Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,INSERM U1053, Université Bordeaux, Bordeaux, France
| | - Anne Sophie Jannot
- INSERM-UMRS 1138 Team 22, Cordeliers Research Center, Paris, France.,Paris Descartes University, Paris, France.,Department of Medical Informatics and Public Health, European George Pompidou Hospital, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Jean-Pierre Pelage
- CNRS, UMR 6301-ISTCT, CERVOxy, GIP CYCERON, Caen, France.,CEA, DSV/I2BM, UMR6301-ISTCT, Caen, France.,Normandie Université, France.,UNICAEN, UMR6301-ISTCT, Caen, France.,CHU de CAEN, Service d'Imagerie Diagnostique et de Radiologie Thérapeutique, Caen, France
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Marc Pocard
- Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,Department of Digestive Surgery, Hôpital Lariboisière, Paris, France
| | - Clarisse Eveno
- Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,Department of Digestive Surgery, Hôpital Lariboisière, Paris, France
| | - Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Philippe Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France.,Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France
| | - Anthony Dohan
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France.,Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
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29
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Lee MS, Cho JY, Kim SY, Cheon GJ, Moon MH, Oh S, Lee J, Lee S, Woo S, Kim SH. Diagnostic value of integrated PET/MRI for detection and localization of prostate cancer: Comparative study of multiparametric MRI and PET/CT. J Magn Reson Imaging 2016; 45:597-609. [PMID: 27586519 DOI: 10.1002/jmri.25384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/23/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the diagnostic value of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) compared with conventional multiparametric MRI and PET/computed tomography (CT) for the detailed and accurate segmental detection/localization of prostate cancer. MATERIALS AND METHODS Thirty-one patients who underwent integrated PET/MRI using 18 F-choline and 18 F-FDG with an integrated PET/MRI scanner followed by radical prostatectomy were included. The prostate was divided into six segments (sextants) according to anatomical landmarks. Three radiologists noted the presence and location of cancer in each sextant on four different image interpretation modalities in consensus (1, multiparametric MRI; 2, integrated 18 F-FDG PET/MRI; 3, integrated 18 F-choline PET/MRI; and 4, combined interpretation of 1 and 18 F-FDG PET/CT). Sensitivity, specificity, accuracy, positive and negative predictive values, likelihood ratios, and diagnostic performance based on the DOR (diagnostic odds ratio) and NNM (number needed to misdiagnose) were evaluated for each interpretation modality, using the pathologic result as the reference standard. Detection rates of seminal vesicle invasion and extracapsular invasion were also evaluated. RESULTS Integrated 18 F-choline PET/MRI showed significantly higher sensitivity than did multiparametric MRI alone in high Gleason score patients (77.0% and 66.2%, P = 0.011), low Gleason score patients (66.7% and 47.4%, P = 0.007), and total patients (72.5% and 58.0%, P = 0.008) groups. Integrated 18 F-choline PET/MRI and 18 F-FDG PET/MRI showed similar sensitivity and specificity to combined interpretation of multiparametric MRI and 18 F-FDG PET/CT (for sensitivity, 58.0%, 63.4%, 72.5%, and 68.7%, respectively, and for specificity, 87.3%, 80.0%, 81.8%, 72.7%, respectively, in total patient group). However, integrated 18 F-choline PET/MRI showed the best diagnostic performance (as DOR, 11.875 in total patients, 27.941 in high Gleason score patients, 5.714 in low Gleason score groups) among the imaging modalities, regardless of Gleason score. Integrated 18 F-choline PET/MRI showed higher sensitivity and diagnostic performance than did integrated 18 F-FDG PET/MRI (as DOR, 6.917 in total patients, 15.143 in high Gleason score patients, 3.175 in low Gleason score groups) in all three patient groups. CONCLUSION Integrated PET/MRI carried out using a dedicated integrated PET/MRI scanner provides better sensitivity, accuracy, and diagnostic value for detection/localization of prostate cancer compared to multiparametric MRI. Generally, integrated 18 F-choline PET/MRI shows better sensitivity, accuracy, and diagnostic performance than does integrated 18 F-FDG PET/MRI as well as combined interpretation of multiparametric MRI with 18 F-FDG PET/CT. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:597-609.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sungmin Woo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Preoperative Evaluation of Prostate Cancer Aggressiveness: Using ADC and ADC Ratio in Determining Gleason Score. AJR Am J Roentgenol 2016; 207:114-20. [DOI: 10.2214/ajr.15.15894] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Gnep K, Fargeas A, Gutiérrez-Carvajal RE, Commandeur F, Mathieu R, Ospina JD, Rolland Y, Rohou T, Vincendeau S, Hatt M, Acosta O, de Crevoisier R. Haralick textural features onT2-weighted MRI are associated with biochemical recurrence following radiotherapy for peripheral zone prostate cancer. J Magn Reson Imaging 2016; 45:103-117. [DOI: 10.1002/jmri.25335] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/23/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Khémara Gnep
- INSERM, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Department of Radiotherapy; Centre Eugène Marquis; Rennes France
| | - Auréline Fargeas
- INSERM, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
| | | | | | - Romain Mathieu
- INSERM, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Department of Urology; Centre Hospitalier Universitaire Pontchaillou; Rennes France
| | - Juan D. Ospina
- INSERM, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
| | - Yan Rolland
- Department of Radiology; Centre Eugène Marquis; Rennes France
| | - Tanguy Rohou
- Department of Radiology; Centre Hospitalier Universitaire Pontchaillou; Rennes France
- Department of Radiology; Centre Eugène Marquis; Rennes France
| | - Sébastien Vincendeau
- Department of Urology; Centre Hospitalier Universitaire Pontchaillou; Rennes France
| | - Mathieu Hatt
- LaTIM, INSERM UMR 1101, University of Brest; France
| | - Oscar Acosta
- INSERM, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
| | - Renaud de Crevoisier
- INSERM, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Department of Radiotherapy; Centre Eugène Marquis; Rennes France
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Bhowmik NM, Yu J, Fulcher AS, Turner MA. Benign causes of diffusion restriction foci in the peripheral zone of the prostate: diagnosis and differential diagnosis. Abdom Radiol (NY) 2016; 41:910-8. [PMID: 27072933 PMCID: PMC4871918 DOI: 10.1007/s00261-016-0719-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Multiparametric-MRI is an important tool in the diagnosis of prostate cancer (PCa), particularly diffusion-weighted imaging for peripheral zone (PZ) cancer in the untreated prostate. However, there are many benign entities that demonstrate diffusion restriction in the PZ mimicking PCa resulting in diagnostic challenges. Fortunately, these benign entities usually have unique MR features that may help to distinguish them from PCa. The purpose of this pictorial review is to discuss benign entities with diffusion restriction in the PZ and to emphasize the key MR features of these entities that may help to differentiate them from PCa.
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Affiliation(s)
- Nirjhor M Bhowmik
- Department of Radiology, Virginia Commonwealth University Health System, Main Hospital, 3rd Floor, 401 North 12th Street, P.O. Box 980615, Richmond, VA, 23298, USA.
| | - Jinxing Yu
- Department of Radiology, Virginia Commonwealth University Health System, Main Hospital, 3rd Floor, 401 North 12th Street, P.O. Box 980615, Richmond, VA, 23298, USA
| | - Ann S Fulcher
- Department of Radiology, Virginia Commonwealth University Health System, Main Hospital, 3rd Floor, 401 North 12th Street, P.O. Box 980615, Richmond, VA, 23298, USA
| | - Mary A Turner
- Department of Radiology, Virginia Commonwealth University Health System, Main Hospital, 3rd Floor, 401 North 12th Street, P.O. Box 980615, Richmond, VA, 23298, USA
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33
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Panebianco V, Barchetti F, Grompone MD, Colarieti A, Salvo V, Cardone G, Catalano C. Magnetic resonance imaging for localization of prostate cancer in the setting of biochemical recurrence. Urol Oncol 2016; 34:303-10. [PMID: 27012939 DOI: 10.1016/j.urolonc.2016.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/20/2016] [Accepted: 01/23/2016] [Indexed: 01/26/2023]
Abstract
The clinical suspicion of local recurrence of prostate cancer after radical treatment is based on the onset of biochemical failure. The use of multiparametric magnetic resonance imaging (MRI) for prostate cancer has increased over recent years, mainly for detection, staging, and active surveillance. However, suspicion of recurrence in the set of biochemical failure is becoming a significant reason for clinicians to request multiparametric MRI. Radiologists should be able to recognize the normal posttreatment MRI findings. Fibrosis and atrophic remnant seminal vesicles (SV) after radical prostatectomy are often found and must be differentiated from local relapse. Moreover, brachytherapy, external beam radiotherapy, and focal therapies tend to diffusely decrease the signal intensity of the peripheral zone on T2-weighted images due to the loss of water content, consequently mimicking tumor and hemorrhage. The combination of T2-weighted images and functional studies like diffusion-weighted imaging and dynamic contrast-enhanced imaging improves the identification of local relapse. Tumor recurrence tends to restrict on diffusion images and avidly enhances after contrast administration. The authors provide a review of the normal findings and the signs of local tumor relapse after radical prostatectomy, external beam radiotherapy, brachytherapy and focal therapies.
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Affiliation(s)
- Valeria Panebianco
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| | - Flavio Barchetti
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | | | - Anna Colarieti
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Salvo
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | | | - Carlo Catalano
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
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34
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Barrett T, Priest AN, Lawrence EM, Goldman DA, Warren AY, Gnanapragasam VJ, Sala E, Gallagher FA. Ratio of Tumor to Normal Prostate Tissue Apparent Diffusion Coefficient as a Method for Quantifying DWI of the Prostate. AJR Am J Roentgenol 2015; 205:W585-93. [PMID: 26587948 DOI: 10.2214/ajr.15.14338] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the ability of the apparent diffusion coefficient (ADC) ratio of tumor to normal prostate tissue to overcome inherent variability based on choice of b values, with whole-mount histopathologic analysis as the reference standard for tumor identification. MATERIALS AND METHODS Thirty-nine patients with prostate cancer underwent 3-T MRI, including DWI with b values of 0, 150, 750, and 1000 s/mm(2). ADC maps were derived from four b value combinations. Histologically derived ROIs were defined for prostate tumor and benign prostate tissue to generate a ratio. The concordance correlation coefficient was used to evaluate agreement and reproducibility at different b values. Bland-Altman plots were used to evaluate the pattern of relative measurement difference between b value combinations. The relationship between ADC values and Gleason score was tested by Spearman rank correlation. RESULTS ADC values varied depending on the b value combination selected. The concordance correlation coefficient was higher for ADC ratios (0.883; 95% CI, 0.816-0.927) compared with absolute ADC values for normal tissue (0.873; 95% CI, 0.799-0.921) and tumor (0.792; 95% CI, 0.688-0.864). The ADC ratio concordance correlation coefficient for transition zone tumors was considerably higher than that for the peripheral zone in all cases. Bland-Altman analysis showed higher variation for ADC maps incorporating a b value of zero for both ratio and absolute values. There was a stronger inverse relationship to Gleason score for ADC ratios (rho, -0.354 to -0.456) compared with absolute ADC values (rho, -0.117 to -0.379). CONCLUSION The use of a simple ratio of prostate tumor ADC to normal tissue ADC improved the concordance between different b value combinations and could provide a more robust means of assessing restricted diffusion in the prostate.
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Affiliation(s)
- Tristan Barrett
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Andrew N Priest
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Edward M Lawrence
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Debra A Goldman
- 2 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anne Y Warren
- 3 Department of Histopathology, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom
| | - Vincent J Gnanapragasam
- 4 Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
- 5 Department of Oncology, Translational Prostate Cancer Group, University of Cambridge, Hutchinson-MRC Research Centre, Cambridge, United Kingdom
| | - Evis Sala
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
- 6 Present address: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ferdia A Gallagher
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
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35
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Latifoltojar A, Dikaios N, Ridout A, Moore C, Illing R, Kirkham A, Taylor S, Halligan S, Atkinson D, Allen C, Emberton M, Punwani S. Evolution of multi-parametric MRI quantitative parameters following transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis 2015; 18:343-51. [PMID: 26195470 PMCID: PMC4763162 DOI: 10.1038/pcan.2015.33] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/03/2015] [Accepted: 05/31/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND To determine the evolution of prostatic multi-parametric magnetic resonance imaging (mp-MRI) signal following transrectal ultrasound (TRUS)-guided biopsy. METHODS Local ethical permission and informed written consent was obtained from all the participants (n=14, aged 43-69, mean 64 years). Patients with a clinical suspicion of prostate cancer (PSA range 2.2-11.7, mean 6.2) and a negative (PIRAD 1-2/5) pre-biopsy mp-MRI (pre-contrast T1, T2, diffusion-weighted and dynamic-contrast-enhanced MRI) who underwent 10-core TRUS-guided biopsy were recruited for additional mp-MRI examinations performed at 1, 2 and 6 months post biopsy. We quantified mp-MRI peripheral zone (PZ) and transition zone (TZ) normalized T2 signal intensity (nT2-SI); T1 relaxation time (T10); diffusion-weighted MRI, apparent diffusion coefficient (ADC); dynamic contrast-enhanced MRI, maximum enhancement (ME); slope of enhancement (SoE) and area-under-the-contrast-enhancement-curve at 120 s (AUC120). Significant changes in mp-MRI parameters were identified by analysis of variance with Dunnett's post testing. RESULTS Diffuse signal changes were observed post-biopsy throughout the PZ. No significant signal change occurred following biopsy within the TZ. Left and right PZ mean nT2-SI (left PZ: 5.73, 5.16, 4.90 and 5.12; right PZ: 5.80, 5.10, 4.84 and 5.05 at pre-biopsy, 1, 2 and 6 months post biopsy, respectively) and mean T10 (left PZ: 1.02, 0.67, 0.78, 0.85; right PZ: 1.29, 0.64, 0.78, 0.87 at pre-biopsy, 1, 2 and 6 months post biopsy, respectively) were reduced significantly (P<0.05) from pre-biopsy values for up to 6 months post biopsy. Significant changes (P<0.05) of PZ-ME and AUC120 were observed at 1 month but resolved by 2 months post biopsy. PZ ADC did not change significantly following biopsy (P=0.23-1.0). There was no significant change of any TZ mp-MRI parameter at any time point following biopsy (P=0.1-1.0). CONCLUSIONS Significant PZ (but not TZ) T2 signal changes persist up to 6 months post biopsy, whereas PZ and TZ ADC is not significantly altered as early as 1 month post biopsy. Caution must be exercised when interpreting T1- and T2-weighted imaging early post biopsy, whereas ADC images are more likely to maintain clinical efficacy.
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Affiliation(s)
- A Latifoltojar
- Centre for Medical Imaging, University College London, London, UK
| | - N Dikaios
- Centre for Medical Imaging, University College London, London, UK
| | - A Ridout
- Department of Urology, University College London Hospital, London, UK
| | - C Moore
- Department of Urology, University College London Hospital, London, UK
| | - R Illing
- Department of Radiology, University College London Hospital, London, UK
| | - A Kirkham
- Department of Radiology, University College London Hospital, London, UK
| | - S Taylor
- Centre for Medical Imaging, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - S Halligan
- Centre for Medical Imaging, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - D Atkinson
- Centre for Medical Imaging, University College London, London, UK
| | - C Allen
- Department of Radiology, University College London Hospital, London, UK
| | - M Emberton
- Department of Urology, University College London Hospital, London, UK
| | - S Punwani
- Centre for Medical Imaging, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
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36
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Kitzing YX, Prando A, Varol C, Karczmar GS, Maclean F, Oto A. Benign Conditions That Mimic Prostate Carcinoma: MR Imaging Features with Histopathologic Correlation. Radiographics 2015; 36:162-75. [PMID: 26587887 DOI: 10.1148/rg.2016150030] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Multiparametric magnetic resonance (MR) imaging combines anatomic and functional imaging techniques for evaluating the prostate and is increasingly being used in diagnosis and management of prostate cancer. A wide spectrum of anatomic and pathologic processes in the prostate may masquerade as prostate cancer, complicating the imaging interpretation. The histopathologic and imaging findings of these potential mimics are reviewed. These entities include the anterior fibromuscular stroma, surgical capsule, central zone, periprostatic vein, periprostatic lymph nodes, benign prostatic hyperplasia (BPH), atrophy, necrosis, calcification, hemorrhage, and prostatitis. An understanding of the prostate zonal anatomy is helpful in distinguishing the anatomic entities from prostate cancer. The anterior fibromuscular stroma, surgical capsule, and central zone are characteristic anatomic features of the prostate with associated low T2 signal intensity due to dense fibromuscular tissue or complex crowded glandular tissue. BPH, atrophy, necrosis, calcification, and hemorrhage all have characteristic features with one or more individual multiparametric MR imaging modalities. Prostatitis constitutes a heterogeneous group of infective and inflammatory conditions including acute and chronic bacterial prostatitis, infective and noninfective granulomatous prostatitis, and malacoplakia. These entities are associated with variable clinical manifestations and are characterized by the histologic hallmark of marked inflammatory cellular infiltration. In some cases, these entities are indistinguishable from prostate cancer at multiparametric MR imaging and may even exhibit extraprostatic extension and lymphadenopathy, mimicking locally advanced prostate cancer. It is important for the radiologists interpreting prostate MR images to be aware of these pitfalls for accurate interpretation. Online supplemental material is available for this article.
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Affiliation(s)
- Yu Xuan Kitzing
- From the Departments of Medical Imaging (Y.X.K.) and Urology (C.V.), Macquarie University Hospital, Sydney, Australia; Department of Radiology, Hospital Vera Cruz, Campinas, Brazil (A.P.); Department of Radiology, University of Chicago, Chicago, Ill (G.S.K., A.O.); and Douglass Hanly Moir Pathology, Sydney, Australia (F.M.)
| | - Adilson Prando
- From the Departments of Medical Imaging (Y.X.K.) and Urology (C.V.), Macquarie University Hospital, Sydney, Australia; Department of Radiology, Hospital Vera Cruz, Campinas, Brazil (A.P.); Department of Radiology, University of Chicago, Chicago, Ill (G.S.K., A.O.); and Douglass Hanly Moir Pathology, Sydney, Australia (F.M.)
| | - Celi Varol
- From the Departments of Medical Imaging (Y.X.K.) and Urology (C.V.), Macquarie University Hospital, Sydney, Australia; Department of Radiology, Hospital Vera Cruz, Campinas, Brazil (A.P.); Department of Radiology, University of Chicago, Chicago, Ill (G.S.K., A.O.); and Douglass Hanly Moir Pathology, Sydney, Australia (F.M.)
| | - Gregory S Karczmar
- From the Departments of Medical Imaging (Y.X.K.) and Urology (C.V.), Macquarie University Hospital, Sydney, Australia; Department of Radiology, Hospital Vera Cruz, Campinas, Brazil (A.P.); Department of Radiology, University of Chicago, Chicago, Ill (G.S.K., A.O.); and Douglass Hanly Moir Pathology, Sydney, Australia (F.M.)
| | - Fiona Maclean
- From the Departments of Medical Imaging (Y.X.K.) and Urology (C.V.), Macquarie University Hospital, Sydney, Australia; Department of Radiology, Hospital Vera Cruz, Campinas, Brazil (A.P.); Department of Radiology, University of Chicago, Chicago, Ill (G.S.K., A.O.); and Douglass Hanly Moir Pathology, Sydney, Australia (F.M.)
| | - Aytekin Oto
- From the Departments of Medical Imaging (Y.X.K.) and Urology (C.V.), Macquarie University Hospital, Sydney, Australia; Department of Radiology, Hospital Vera Cruz, Campinas, Brazil (A.P.); Department of Radiology, University of Chicago, Chicago, Ill (G.S.K., A.O.); and Douglass Hanly Moir Pathology, Sydney, Australia (F.M.)
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37
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Liu X, Verma S. Common technical and anatomical pitfalls in the evaluation of multiparametric prostate magnetic resonance imaging. Semin Roentgenol 2015; 50:294-304. [PMID: 26542430 DOI: 10.1053/j.ro.2015.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Xiaozhou Liu
- University of Cincinnati College of Medicine, Cincinnati, OH; University of Cincinnati Medical Center, Cincinnati, OH
| | - Sadhna Verma
- Department of Radiology, Section of Abdominal Imaging, University of Cincinnati Medical Center, Cincinnati OH.
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Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, Thoeny HC, Verma S. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol 2015; 69:16-40. [PMID: 26427566 DOI: 10.1016/j.eururo.2015.08.052] [Citation(s) in RCA: 2189] [Impact Index Per Article: 218.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 08/29/2015] [Indexed: 12/13/2022]
Abstract
The Prostate Imaging - Reporting and Data System Version 2 (PI-RADS™ v2) is the product of an international collaboration of the American College of Radiology (ACR), European Society of Uroradiology (ESUR), and AdMetech Foundation. It is designed to promote global standardization and diminish variation in the acquisition, interpretation, and reporting of prostate multiparametric magnetic resonance imaging (mpMRI) examination, and it is based on the best available evidence and expert consensus opinion. It establishes minimum acceptable technical parameters for prostate mpMRI, simplifies and standardizes terminology and content of reports, and provides assessment categories that summarize levels of suspicion or risk of clinically significant prostate cancer that can be used to assist selection of patients for biopsies and management. It is intended to be used in routine clinical practice and also to facilitate data collection and outcome monitoring for research.
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Affiliation(s)
| | | | | | | | - Masoom A Haider
- University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | | | | | | | - Sadna Verma
- University of Cincinnati, Cincinnati, OH, USA
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Rosenkrantz AB, Khalef V, Xu W, Babb JS, Taneja SS, Doshi AM. Does normalisation improve the diagnostic performance of apparent diffusion coefficient values for prostate cancer assessment? A blinded independent-observer evaluation. Clin Radiol 2015; 70:1032-7. [PMID: 26126712 DOI: 10.1016/j.crad.2015.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/18/2015] [Accepted: 05/28/2015] [Indexed: 01/18/2023]
Abstract
AIM To evaluate the performance of normalised apparent diffusion coefficient (ADC) values for prostate cancer assessment when performed by independent observers blinded to histopathology findings. MATERIALS AND METHODS Fifty-eight patients undergoing 3 T phased-array coil magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI; maximal b-value 1000 s/mm(2)) before prostatectomy were included. Two radiologists independently evaluated the images, unaware of the histopathology findings. Regions of interest (ROIs) were drawn within areas showing visually low ADC within the peripheral zone (PZ) and transition zone (TZ) bilaterally. ROIs were also placed within regions in both lobes not suspicious for tumour, allowing computation of normalised ADC (nADC) ratios between suspicious and non-suspicious regions. The diagnostic performance of ADC and nADC were compared. RESULTS For PZ tumour detection, ADC achieved significantly higher area under the receiver operating characteristic curve (AUC; p=0.026) and specificity (p=0.021) than nADC for reader 1, and significantly higher AUC (p=0.025) than nADC for reader 2. For TZ tumour detection, nADC achieved significantly higher specificity (p=0.003) and accuracy (p=0.004) than ADC for reader 2. For PZ Gleason score >3+3 tumour detection, ADC achieved significantly higher AUC (p=0.003) and specificity (p=0.005) than nADC for reader 1, and significantly higher AUC (p=0.023) than nADC for reader 2. For TZ Gleason score >3+3 tumour detection, ADC achieved significantly higher specificity (p=0.019) than nADC for reader 1. CONCLUSION In contrast to prior studies performing unblinded evaluations, ADC was observed to outperform nADC overall for two independent observers blinded to the histopathology findings. Therefore, although strategies to improve the utility of ADC measurements in prostate cancer assessment merit continued investigation, caution is warranted when applying normalisation to improve diagnostic performance in clinical practice.
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Affiliation(s)
- A B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA.
| | - V Khalef
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - W Xu
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - J S Babb
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - S S Taneja
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - A M Doshi
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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Quon JS, Moosavi B, Khanna M, Flood TA, Lim CS, Schieda N. False positive and false negative diagnoses of prostate cancer at multi-parametric prostate MRI in active surveillance. Insights Imaging 2015; 6:449-63. [PMID: 26002487 PMCID: PMC4519810 DOI: 10.1007/s13244-015-0411-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/02/2015] [Accepted: 05/08/2015] [Indexed: 01/02/2023] Open
Abstract
Abstract MP-MRI is a critical component in active surveillance (AS) of prostate cancer (PCa) because of a high negative predictive value for clinically significant tumours. This review illustrates pitfalls of MP-MRI and how to recognise and avoid them. The anterior fibromuscular stroma and central zone are low signal on T2W-MRI/apparent diffusion coefficient (ADC), resembling PCa. Location, progressive enhancement and low signal on b ≥1000 mm²/s echo-planar images (EPI) are differentiating features. BPH can mimic PCa. Glandular BPH shows increased T2W/ADC signal, cystic change and progressive enhancement; however, stromal BPH resembles transition zone (TZ) PCa. A rounded morphology, low T2 signal capsule and posterior/superior location favour stromal BPH. Acute/chronic prostatitis mimics PCa at MP-MRI, with differentiation mainly on clinical grounds. Visual analysis of diffusion-weighted MRI must include EPI and appropriate windowing of ADC. Quantitative ADC analysis is limited by lack of standardization; the ADC ratio and ADC histogram analysis are alternatives to mean values. DCE lacks standardisation and has limited utility in the TZ, where T2W/DWI are favoured. Targeted TRUS-guided biopsies of MR-detected lesions are challenging. Lesions detected on MP-MRI may not be perfectly targeted with TRUS and this must be considered when faced with a suspicious lesion on MP-MRI and a negative targeted TRUS biopsy histopathological result. Keypoints • Multi-parametric MRI plays a critical role in prostate cancer active surveillance. • Low T2W signal intensity structures appear dark on ADC, potentially simulating cancer. • Stromal BPH mimics cancer at DWI and DCE. • Long b value trace EPI should be reviewed • Targeted biopsy of MR-detected lesions using TRUS guidance may be challenging.
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Affiliation(s)
- Jeffrey S Quon
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, ON, Canada, K1Y 4E9,
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Vignati A, Mazzetti S, Giannini V, Russo F, Bollito E, Porpiglia F, Stasi M, Regge D. Texture features on T2-weighted magnetic resonance imaging: new potential biomarkers for prostate cancer aggressiveness. Phys Med Biol 2015; 60:2685-701. [PMID: 25768265 DOI: 10.1088/0031-9155/60/7/2685] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To explore contrast (C) and homogeneity (H) gray-level co-occurrence matrix texture features on T2-weighted (T2w) Magnetic Resonance (MR) images and apparent diffusion coefficient (ADC) maps for predicting prostate cancer (PCa) aggressiveness, and to compare them with traditional ADC metrics for differentiating low- from intermediate/high-grade PCas. The local Ethics Committee approved this prospective study of 93 patients (median age, 65 years), who underwent 1.5 T multiparametric endorectal MR imaging before prostatectomy. Clinically significant (volume ≥0.5 ml) peripheral tumours were outlined on histological sections, contoured on T2w and ADC images, and their pathological Gleason Score (pGS) was recorded. C, H, and traditional ADC metrics (mean, median, 10th and 25th percentile) were calculated on the largest lesion slice, and correlated with the pGS through the Spearman correlation coefficient. The area under the receiver operating characteristic curve (AUC) assessed how parameters differentiate pGS = 6 from pGS ≥ 7. The dataset included 49 clinically significant PCas with a balanced distribution of pGS. The Spearman ρ and AUC values on ADC were: -0.489, 0.823 (mean); -0.522, 0.821 (median); -0.569, 0.854 (10th percentile); -0.556, 0.854 (25th percentile); -0.386, 0.871 (C); 0.533, 0.923 (H); while on T2w they were: -0.654, 0.945 (C); 0.645, 0.962 (H). AUC of H on ADC and T2w, and C on T2w were significantly higher than that of the mean ADC (p = 0.05). H and C calculated on T2w images outperform ADC parameters in correlating with pGS and differentiating low- from intermediate/high-risk PCas, supporting the role of T2w MR imaging in assessing PCa biological aggressiveness.
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Affiliation(s)
- A Vignati
- Department of Radiology of Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy
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Luczyńska E, Heinze-Paluchowska S, Domalik A, Cwierz A, Kasperkiewicz H, Blecharz P, Jereczek-Fossa B. The Utility of Diffusion Weighted Imaging (DWI) Using Apparent Diffusion Coefficient (ADC) Values in Discriminating Between Prostate Cancer and Normal Tissue. Pol J Radiol 2014; 79:450-5. [PMID: 25484999 PMCID: PMC4257483 DOI: 10.12659/pjr.890805] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/03/2014] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to investigate the utility of diffusion weighted imaging (DWI) using Apparent Diffusion Coefficient (ADC) values in discriminating between patients with tumors and normal prostate tissue before the initial systematic core biopsy. The relationship between histological grade of prostate cancer and ADC values in the peripheral zone was also investigated. Material/Methods Our study included 62 patients who underwent magnetic resonance imaging (MRI) of the pelvis. The examinations were performed in T1-, T2-weighted, DWI and T1 after dynamic contrast administration sequences. In all patients there were abnormal foci within the peripheral zone determined in DWI/ADC. ADC values were compared with the Gleason score (GS) after core needle biopsy (CNB) in patients with low, medium and high stage tumors. Results Within the examined group of patients, ADC was statistically higher for normal tissue than for cancerous tissue (p=0.00). Mean ADC values for patients with low, intermediate and high GS were 0.85±0.03, 0.72±0.03, and 0.61±0.04, respectively. Conclusions DWI/ADC is useful in differentiating high-risk patients from those at low and intermediate risk, since there is a significant correlation between ADC values determined in patients included in three different groups according to their Gleason score. This information may be helpful in the assessment of prostate cancer aggressiveness.
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Affiliation(s)
- Elżbieta Luczyńska
- Department of Radiology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Cracow, Poland
| | - Sylwia Heinze-Paluchowska
- Department of Radiology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Cracow, Poland
| | - Agnieszka Domalik
- Department of Radiology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Cracow, Poland
| | - Anna Cwierz
- Department of Radiology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Cracow, Poland
| | - Hanna Kasperkiewicz
- Department of Radiology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Cracow, Poland
| | - Paweł Blecharz
- Department of Gynecology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Cracow, Poland
| | - Barbara Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy ; Department of Health Sciences, University of Milan, Milan, Italy
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Boesen L, Chabanova E, Løgager V, Balslev I, Thomsen HS. Apparent diffusion coefficient ratio correlates significantly with prostate cancer gleason score at final pathology. J Magn Reson Imaging 2014; 42:446-53. [PMID: 25408104 DOI: 10.1002/jmri.24801] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/27/2014] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To evaluate the correlation between apparent diffusion coefficient measurements (ADCtumor and ADCratio ) and the Gleason score from radical prostatectomy specimens. MATERIALS AND METHODS Seventy-one patients with clinically localized prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric magnetic resonance imaging (MRI) was performed prior to prostatectomy and mean ADC values from both cancerous (ADCtumor ) and benign (ADCbenign ) tissue were measured to calculate the ADCratio (ADCtumor divided by ADCbenign ). The ADC measurements were correlated with the Gleason score from the prostatectomy specimens. RESULTS The association between ADC measurements and Gleason score showed a significant negative correlation (P < 0.001) with Spearman's rho for ADCtumor (-0.421) and ADCratio (-0.649). There was a statistically significant difference between ADC measurements and the Gleason score for all tumors (P = 0.001). Receiver operating characteristic curve analysis showed an overall area under the curve (AUC) of 0.73 (ADCtumor ) to 0.80 (ADCratio ) in discriminating Gleason score 6 from Gleason score ≥7 tumors. The AUC changed to 0.72 (ADCtumor ) and 0.90 (ADCratio ) when discriminating Gleason score ≤7(3+4) from Gleason score ≥7(4+3). CONCLUSION ADC measurements showed a significant correlation with tumor Gleason score at final pathology. The ADCratio demonstrated the best correlation compared to the ADCtumor value and radically improved accuracy in discriminating Gleason score ≤7(3+4) from Gleason score ≥7(4+3) tumors.
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Affiliation(s)
- Lars Boesen
- Department of Urology, Herlev University Hospital, Herlev, Denmark
| | | | - Vibeke Løgager
- Department of Radiology, Herlev University Hospital, Herlev, Denmark
| | - Ingegerd Balslev
- Department of Pathology, Herlev University Hospital, Herlev, Denmark
| | - Henrik S Thomsen
- Department of Radiology, Herlev University Hospital, Herlev, Denmark
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Ko YH, Song PH, Moon KH, Jung HC, Cheon J, Sung DJ. The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery. Asian J Androl 2014; 16:280-4. [PMID: 24407179 PMCID: PMC3955341 DOI: 10.4103/1008-682x.122190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging (MRI) on the accuracy of simple tumor localization, which is essential information that enables nerve-sparing surgery. We also sought to determine the optimal timing of a post-biopsy MRI. A total of 184 patients who had undergone MRI before radical prostatectomy at an institution without a predetermined schedule for MRI after a prostate biopsy were enrolled. The mean interval from the biopsy to the MRI was 30.8 ± 18.6 days. The accuracy of the MRI for simplified tumor location (right, left, bilateral and none) was 44.6%. In the group with discordant pathologic and MRI findings, the most common reason recorded was ‘MRI predicted a unilateral lesion, but pathology revealed bilateral lesions’ (58.3%), followed by ‘MRI predicted no lesion, but pathology revealed the presence of a lesion’ (32.0%). Multivariable analysis showed that the discordant group had a shorter interval (25.0 ± 14.3 vs 38.1 ± 20.6 days, P < 0.01) preceding the MRI and a higher rate of hemorrhage as observed by MRI (80.4% vs 54.8%, P < 0.01) in comparison with the accordant group. In receiver operating characteristics analysis, the area under the curve of the MRI interval in accurate prediction of the tumor location was 0.707 (P < 0.001). At the MRI interval's cutoff of 28.5 days, the sensitivity was 73.2% and the specificity was 63.7%. When the MRI was performed within 28 days, the accumulated accuracy was only 26.1% (23/88); however, when it was performed after 28 days, the reversely accumulated accuracy was 61.5% (59/96). These data support a waiting period of at least 4 weeks after a biopsy before performing an MRI for the purposes of surgical refinement.
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Affiliation(s)
| | | | | | | | | | - Deuk Jae Sung
- Department of Radiology, Korea University School of Medicine, Seoul, Korea
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Bjurlin MA, Meng X, Le Nobin J, Wysock JS, Lepor H, Rosenkrantz AB, Taneja SS. Optimization of prostate biopsy: the role of magnetic resonance imaging targeted biopsy in detection, localization and risk assessment. J Urol 2014; 192:648-58. [PMID: 24769030 PMCID: PMC4224958 DOI: 10.1016/j.juro.2014.03.117] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Optimization of prostate biopsy requires addressing the shortcomings of standard systematic transrectal ultrasound guided biopsy, including false-negative rates, incorrect risk stratification, detection of clinically insignificant disease and the need for repeat biopsy. Magnetic resonance imaging is an evolving noninvasive imaging modality that increases the accurate localization of prostate cancer at the time of biopsy, and thereby enhances clinical risk assessment and improves the ability to appropriately counsel patients regarding therapy. In this review we 1) summarize the various sequences that comprise a prostate multiparametric magnetic resonance imaging examination along with its performance characteristics in cancer detection, localization and reporting standards; 2) evaluate potential applications of magnetic resonance imaging targeting in prostate biopsy among men with no previous biopsy, a negative previous biopsy and those with low stage cancer; and 3) describe the techniques of magnetic resonance imaging targeted biopsy and comparative study outcomes. MATERIALS AND METHODS A bibliographic search covering the period up to October 2013 was conducted using MEDLINE®/PubMed®. Articles were reviewed and categorized based on which of the 3 objectives of this review was addressed. Data were extracted, analyzed and summarized. RESULTS Multiparametric magnetic resonance imaging consists of anatomical T2-weighted imaging coupled with at least 2 functional imaging techniques. It has demonstrated improved prostate cancer detection sensitivity up to 80% in the peripheral zone and 81% in the transition zone. A prostate cancer magnetic resonance imaging suspicion score has been developed, and is depicted using the Likert or PI-RADS (Prostate Imaging Reporting and Data System) scale for better standardization of magnetic resonance imaging interpretation and reporting. Among men with no previous biopsy, magnetic resonance imaging increases the frequency of significant cancer detection to 50% in low risk and 71% in high risk patients. In low risk men the negative predictive value of a combination of negative magnetic resonance imaging with prostate volume parameters is nearly 98%, suggesting a potential role in avoiding biopsy and reducing over detection/overtreatment. Among men with a previous negative biopsy 72% to 87% of cancers detected by magnetic resonance imaging guidance are clinically significant. Among men with a known low risk cancer, repeat biopsy using magnetic resonance targeting demonstrates a high likelihood of confirming low risk disease in low suspicion score lesions and of upgrading in high suspicion score lesions. Techniques of magnetic resonance imaging targeted biopsy include visual estimation transrectal ultrasound guided biopsy; software co-registered magnetic resonance imaging-ultrasound, transrectal ultrasound guided biopsy; and in-bore magnetic resonance imaging guided biopsy. Although the improvement in accuracy and efficiency of visual estimation biopsy compared to systematic appears limited, co-registered magnetic resonance imaging-ultrasound biopsy as well as in-bore magnetic resonance imaging guided biopsy appear to increase cancer detection rates in conjunction with increasing suspicion score. CONCLUSIONS Use of magnetic resonance imaging for targeting prostate biopsies has the potential to reduce the sampling error associated with conventional biopsy by providing better disease localization and sampling. More accurate risk stratification through improved cancer sampling may impact therapeutic decision making. Optimal clinical application of magnetic resonance imaging targeted biopsy remains under investigation.
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Affiliation(s)
- Marc A Bjurlin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York
| | - Xiaosong Meng
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York
| | - Julien Le Nobin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York
| | - James S Wysock
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York
| | - Herbert Lepor
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, New York
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York; Department of Radiology, New York University Langone Medical Center, New York, New York.
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Multiparametric MRI for recurrent prostate cancer post radical prostatectomy and postradiation therapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:316272. [PMID: 24967355 PMCID: PMC4055489 DOI: 10.1155/2014/316272] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/25/2014] [Indexed: 12/30/2022]
Abstract
The clinical suspicion of local recurrence of prostate cancer (PCa) after radical prostatectomy (RP) and after radiation therapy (RT) is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI) in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam). Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments.
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Abstract
BACKGROUND Imaging of prostate carcinoma is an important adjunct to clinical evaluation and prostate specific antigen measurement for detecting metastases and tumor recurrence. In the past, the ability to assess intraprostatic tumor was limited. METHODS Pertinent literature was reviewed to describe the capabilities and limitations of the currently available imaging techniques for assessing prostate carcinoma. Evaluation of primary tumor and metastatic disease by ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine techniques is discussed. RESULTS Ultrasonography and MRI have limited usefulness for local staging of prostate cancer because of suboptimal sensitivity and specificity for identifying tumor extent and capsular penetration. Additional MRI techniques such as magnetic resonance-based perfusion imaging, diffusion imaging, and spectroscopy may provide incremental benefit. CT and bone scanning provide an assessment of metastatic disease but are also limited by the poor sensitivity of lymph node size as a criterion for detecting metastases. Novel imaging techniques such as hybrid imaging devices in the form of single-photon emission CT/CT gamma cameras, positron emission tomography/CT cameras, and, in the near future, positron emission tomography/MRI combined with tumor specific imaging radiotracers may have a significant impact on tumor staging and treatment response. CONCLUSIONS Cross-sectional imaging and scintigraphy have an important role in assessing prostate carcinoma metastases and treatment response. Increasingly, the incremental value of primary tumor imaging through MRI is being realized.
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Affiliation(s)
- Eric K Outwater
- Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Utility of MRI features in differentiation of central renal cell carcinoma and renal pelvic urothelial carcinoma. AJR Am J Roentgenol 2014; 201:1260-7. [PMID: 24261365 DOI: 10.2214/ajr.13.10673] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the utility of various morphologic and quantitative MRI features in differentiating central renal cell carcinoma (RCC) from renal pelvic urothelial carcinoma. MATERIALS AND METHODS Sixty patients (39 men and 21 women; mean [± SD] age, 65 ± 14 years; 48 with central RCC and 12 with renal pelvic urothelial carcinoma) who underwent MRI, including diffusion-weighted imaging (b values, 0, 400, and 800 s/mm(2)) and dynamic contrast-enhanced imaging, before histopathologic confirmation were included. Tumor T2 signal intensity and apparent diffusion coefficients (ADCs) were measured and normalized to muscle and CSF (hereafter referred to as normalized T2 signal and normalized ADC, respectively) and then were compared using receiver operating characteristic analysis. Also, two blinded radiologists independently assessed all tumors for various qualitative features, which were compared with the Fisher exact test and unpaired Student t test. RESULTS Urothelial carcinoma exhibited significantly lower normalized ADC than did RCC (p = 0.008), but no significant difference was seen in ADC or normalized T2 signal intensity (p = 0.247-0.773). Normalized ADC had the highest area under the curve (0.757); normalized ADC below an optimal threshold of 0.451 was associated with sensitivity of 83% and specificity of 71% for diagnosing urothelial carcinoma. Features that were significantly more prevalent in urothelial carcinoma included global impression of urothelial carcinoma, location centered within the collecting system, collecting system defect, extension to the ureteropelvic junction, preserved renal shape, absence of cystic or necrotic areas, absence of hemorrhage, homogeneous enhancement, and hypovascularity (all p < 0.033). Increased T1 signal intensity suggestive of hemorrhage was significantly more prevalent in RCC (p = 0.02). Interreader agreement for the subjective features ranged from 61.7% to 98.3%. CONCLUSION In addition to various qualitative MRI parameters, normalized ADC has utility in differentiating central RCC from renal pelvic urothelial carcinoma. Such differentiation may assist decisions regarding possible biopsy and treatment planning.
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Radiologist, Be Aware: Ten Pitfalls That Confound the Interpretation of Multiparametric Prostate MRI. AJR Am J Roentgenol 2014; 202:109-20. [DOI: 10.2214/ajr.13.10699] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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