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Patel KR, van der Heide UA, Kerkmeijer LGW, Schoots IG, Turkbey B, Citrin DE, Hall WA. Target Volume Optimization for Localized Prostate Cancer. Pract Radiat Oncol 2024; 14:522-540. [PMID: 39019208 PMCID: PMC11531394 DOI: 10.1016/j.prro.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition. METHODS Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer. RESULTS Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes of the prostate improves biochemical control without significantly increasing toxicity. Still, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes. CONCLUSION Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo G Schoots
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William A Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
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Vieira E Brito D, Fereira A, Pereira J, Pereira-Lourenço M, Godinho R, Pereira B, Peralta P, Conceiçao P, Reis Mario A, Paula Rabaça C. Prior MRI-imaging impact of patients submitted to brachytherapy for prostate cancer. Actas Urol Esp 2023; 47:503-508. [PMID: 37086843 DOI: 10.1016/j.acuroe.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Brachytherapy for the treatment of prostate cancer is a well-established option. Use of Multiparametric Magnetic Resonance Imaging (mpMRI) for staging and diagnosis of prostate cancer has come to change the current paradigm. In this study we aim to assess the impact of performing mpMRI to evaluate the presence of extracapsular lesions before brachytherapy in patients with prostate cancer concerning biochemical recurrence and time to nadir. METHODS Review data from 73 patients submitted to brachytherapy. The following factors were evaluated: age, initial PSA, MRI local staging results, ISUP, nadir, time to nadir, PSA at one-year, biochemical recurrence, and time to recurrence. RESULTS Median age was 68 years (51-72) and median follow-up 53 months (30-72). Concerning imaging modality 30,1% (n = 22) patients performed mpMRI. In the mpMRI group, 90.9% (n = 20) had at least one suspect lesion on mpMRI. Time to nadir was 27 months (3-64) in patients where mpMRI was not performed and 23.5 months (2-48) in patients submitted to mpMRI (P = .244). The median value of nadir was 0.42 ng/mL (<0.001-2) in patients submitted to mpMRI and vs 0.28 ng/mL (<0.001-4) in patients without MRI (P = .062) Recurrence utilizing Phoenix criteria was 9% (n = 2) in patients with MRI and 9.2% (n = 5) without mpMRI (P = .456), median follow-up of 43 months (12-72) for the MRI group with 58 months (30-78) for the non-mpMRI group. Both groups were statistically similar. CONCLUSION Our results allow us to conclude that in our series MRI did not influence biochemical recurrence, time to nadir, or nadir value.
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Affiliation(s)
- D Vieira E Brito
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal.
| | - A Fereira
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal
| | - J Pereira
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal
| | - M Pereira-Lourenço
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal
| | - R Godinho
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal
| | - B Pereira
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal
| | - P Peralta
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal
| | - P Conceiçao
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal
| | - A Reis Mario
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal; Servicio de Radioterapia, Instituto Portugués de Oncología, Coimbra, Portugal
| | - C Paula Rabaça
- Servicio de Urología, Instituto Portugués de Oncología, Coimbra, Portugal
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Calimano-Ramirez LF, Virarkar MK, Hernandez M, Ozdemir S, Kumar S, Gopireddy DR, Lall C, Balaji KC, Mete M, Gumus KZ. MRI-based nomograms and radiomics in presurgical prediction of extraprostatic extension in prostate cancer: a systematic review. Abdom Radiol (NY) 2023; 48:2379-2400. [PMID: 37142824 DOI: 10.1007/s00261-023-03924-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Prediction of extraprostatic extension (EPE) is essential for accurate surgical planning in prostate cancer (PCa). Radiomics based on magnetic resonance imaging (MRI) has shown potential to predict EPE. We aimed to evaluate studies proposing MRI-based nomograms and radiomics for EPE prediction and assess the quality of current radiomics literature. METHODS We used PubMed, EMBASE, and SCOPUS databases to find related articles using synonyms for MRI radiomics and nomograms to predict EPE. Two co-authors scored the quality of radiomics literature using the Radiomics Quality Score (RQS). Inter-rater agreement was measured using the intraclass correlation coefficient (ICC) from total RQS scores. We analyzed the characteristic s of the studies and used ANOVAs to associate the area under the curve (AUC) to sample size, clinical and imaging variables, and RQS scores. RESULTS We identified 33 studies-22 nomograms and 11 radiomics analyses. The mean AUC for nomogram articles was 0.783, and no significant associations were found between AUC and sample size, clinical variables, or number of imaging variables. For radiomics articles, there were significant associations between number of lesions and AUC (p < 0.013). The average RQS total score was 15.91/36 (44%). Through the radiomics operation, segmentation of region-of-interest, selection of features, and model building resulted in a broader range of results. The qualities the studies lacked most were phantom tests for scanner variabilities, temporal variability, external validation datasets, prospective designs, cost-effectiveness analysis, and open science. CONCLUSION Utilizing MRI-based radiomics to predict EPE in PCa patients demonstrates promising outcomes. However, quality improvement and standardization of radiomics workflow are needed.
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Affiliation(s)
- Luis F Calimano-Ramirez
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, 32209, USA
| | - Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, 32209, USA
| | - Mauricio Hernandez
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, 32209, USA
| | - Savas Ozdemir
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, 32209, USA
| | - Sindhu Kumar
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, 32209, USA
| | - Dheeraj R Gopireddy
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, 32209, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, 32209, USA
| | - K C Balaji
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, 32209, USA
| | - Mutlu Mete
- Department of Computer Science and Information System, Texas A&M University-Commerce, Commerce, TX, 75428, USA
| | - Kazim Z Gumus
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, 32209, USA.
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Vieira e Brito D, Fereira A, Pereira J, Pereira-Lourenço M, Godinho R, Pereira B, Peralta P, Conceiçao P, Reis Mario A, Paula Rabaça C. Impacto de la realización de RMmp antes de la braquiterapia en pacientes con cáncer de próstata. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Wibmer AG, Kattan MW, Alessandrino F, Baur ADJ, Boesen L, Franco FB, Bonekamp D, Campa R, Cash H, Catalá V, Crouzet S, Dinnoo S, Eastham J, Fennessy FM, Ghabili K, Hohenfellner M, Levi AW, Ji X, Løgager V, Margolis DJ, Moldovan PC, Panebianco V, Penzkofer T, Puech P, Radtke JP, Rouvière O, Schlemmer HP, Sprenkle PC, Tempany CM, Vilanova JC, Weinreb J, Hricak H, Shukla-Dave A. International Multi-Site Initiative to Develop an MRI-Inclusive Nomogram for Side-Specific Prediction of Extraprostatic Extension of Prostate Cancer. Cancers (Basel) 2021; 13:cancers13112627. [PMID: 34071842 PMCID: PMC8198352 DOI: 10.3390/cancers13112627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 05/21/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To develop an international, multi-site nomogram for side-specific prediction of extraprostatic extension (EPE) of prostate cancer based on clinical, biopsy, and magnetic resonance imaging- (MRI) derived data. METHODS Ten institutions from the USA and Europe contributed clinical and side-specific biopsy and MRI variables of consecutive patients who underwent prostatectomy. A logistic regression model was used to develop a nomogram for predicting side-specific EPE on prostatectomy specimens. The performance of the statistical model was evaluated by bootstrap resampling and cross validation and compared with the performance of benchmark models that do not incorporate MRI findings. RESULTS Data from 840 patients were analyzed; pathologic EPE was found in 320/840 (31.8%). The nomogram model included patient age, prostate-specific antigen density, side-specific biopsy data (i.e., Gleason grade group, percent positive cores, tumor extent), and side-specific MRI features (i.e., presence of a PI-RADSv2 4 or 5 lesion, level of suspicion for EPE, length of capsular contact). The area under the receiver operating characteristic curve of the new, MRI-inclusive model (0.828, 95% confidence limits: 0.805, 0.852) was significantly higher than that of any of the benchmark models (p < 0.001 for all). CONCLUSIONS In an international, multi-site study, we developed an MRI-inclusive nomogram for the side-specific prediction of EPE of prostate cancer that demonstrated significantly greater accuracy than clinical benchmark models.
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Affiliation(s)
- Andreas G. Wibmer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (H.H.); (A.S.-D.)
- Correspondence: ; Tel.: +1-646-888-5409
| | - Michael W. Kattan
- Department of Quantitative Health Sciences in the Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (M.W.K.); (X.J.)
| | - Francesco Alessandrino
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (F.B.F.); (F.M.F.); (C.M.T.)
| | | | - Lars Boesen
- Herlev Gentofte University Hospital, 2730 Herlev, Denmark; (L.B.); (V.L.)
| | - Felipe Boschini Franco
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (F.B.F.); (F.M.F.); (C.M.T.)
| | - David Bonekamp
- DKFZ German Cancer Research Center, 69120 Heidelberg, Germany; (D.B.); (J.P.R.); (H.-P.S.)
| | - Riccardo Campa
- Department of Radiological Sciences, Oncology & Pathology, Sapienza University of Rome, 00185 Rome, Italy; (R.C.); (V.P.)
| | - Hannes Cash
- Charité University Hospital, 10117 Berlin, Germany; (A.D.J.B.); (H.C.); (T.P.)
- Department of Urology, University Magdeburg, 39120 Magdeburg, Germany
| | - Violeta Catalá
- Department of Radiology, Fundació Puigvert, 08025 Barcelona, Spain;
- Department of Uro-Radiology, Creu Blanca, 08034 Barcelona, Spain
| | - Sebastien Crouzet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France; (S.C.); (P.C.M.); (O.R.)
| | - Sounil Dinnoo
- Genitourinary and Women’s Imaging Departments, Lille University Hospital, 59037 Lille, France; (S.D.); (P.P.)
| | - James Eastham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Fiona M. Fennessy
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (F.B.F.); (F.M.F.); (C.M.T.)
| | - Kamyar Ghabili
- Department of Urology, Yale School of Medicine, New Haven, CT 06510, USA; (K.G.); (P.C.S.)
| | - Markus Hohenfellner
- Department of Urology, University Hospital of Heidelberg, 69120 Heidelberg, Germany;
| | - Angelique W. Levi
- Department of Pathology, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Xinge Ji
- Department of Quantitative Health Sciences in the Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (M.W.K.); (X.J.)
| | - Vibeke Løgager
- Herlev Gentofte University Hospital, 2730 Herlev, Denmark; (L.B.); (V.L.)
| | - Daniel J. Margolis
- Weill Cornell Medicine, Weill Cornell Imaging, New York-Presbyterian Hospital, New York, NY 10021, USA;
| | - Paul C. Moldovan
- Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France; (S.C.); (P.C.M.); (O.R.)
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology & Pathology, Sapienza University of Rome, 00185 Rome, Italy; (R.C.); (V.P.)
| | - Tobias Penzkofer
- Charité University Hospital, 10117 Berlin, Germany; (A.D.J.B.); (H.C.); (T.P.)
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Philippe Puech
- Genitourinary and Women’s Imaging Departments, Lille University Hospital, 59037 Lille, France; (S.D.); (P.P.)
| | - Jan Philipp Radtke
- DKFZ German Cancer Research Center, 69120 Heidelberg, Germany; (D.B.); (J.P.R.); (H.-P.S.)
- Department of Urology, University Hospital of Heidelberg, 69120 Heidelberg, Germany;
| | - Olivier Rouvière
- Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France; (S.C.); (P.C.M.); (O.R.)
- Faculté de Médecine Lyon Est, Université de Lyon, 69003 Lyon, France
| | - Heinz-Peter Schlemmer
- DKFZ German Cancer Research Center, 69120 Heidelberg, Germany; (D.B.); (J.P.R.); (H.-P.S.)
| | - Preston C. Sprenkle
- Department of Urology, Yale School of Medicine, New Haven, CT 06510, USA; (K.G.); (P.C.S.)
| | - Clare M. Tempany
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (F.B.F.); (F.M.F.); (C.M.T.)
| | - Joan C. Vilanova
- Clínica Girona, Institute Catalan of Health-IDI, University of Girona, 17004 Girona, Spain;
| | - Jeffrey Weinreb
- Department of Radiology, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (H.H.); (A.S.-D.)
| | - Amita Shukla-Dave
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (H.H.); (A.S.-D.)
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Alshehri SZ, Alshahrani OS, Almsaoud NA, Al-Ghamdi MA, Alqahtani AM, Almurayyi MM, Autwdi AS, Al-Ghamdi SA, Zogan MM, Alamri AM. The role of multiparametric magnetic resonance imaging and magnetic resonance-guided biopsy in active surveillance for low-risk prostate cancer: A systematic review. Ann Med Surg (Lond) 2020; 57:171-178. [PMID: 32774849 PMCID: PMC7398967 DOI: 10.1016/j.amsu.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 11/29/2022] Open
Abstract
The performance of multiparametric magnetic resonance imaging (mpMRI) and subsequent biopsy in monitoring prostate cancer in men on active surveillance (AS) have not been defined clearly. In this systematic review, we aimed to review current literature about the usage of MRI examination in men with low-risk prostate cancer during active surveillance. For that, we searched seven databases to include all studies reporting magnetic resonance imaging in the AS of low-risk prostate cancer. We finally included 11 studies with 1237 patients included. Our results showed an adequate sensitivity and specificity of both modalities to detect disease progression; including disease upgrading and upstaging. However, the performance in the prediction of unfavorable disease was inferior to the detection of upgrading and upstaging. In terms of MRGB, the previous literature agreed on the superiority of using a combination of different biopsy schemes to get a better progression section. Noteworthy, mp-MRI and MRGB had a good predictive value limited to the first year, with TRUSGB showing a superior role in detecting patients with a GS ≥ 7, after that. In conclusion, both of mpMRI and MRGB have shown an adequate performance on assessing disease progression in the AS of low-risk prostate cancer patients. They can be used for disease staging and grading for successful treatment planning.
In comparison to the literature, few papers discuss the benefit of MRI screening in low-risk prostate cancer groups. Biopsy is considered more invasive than MRI, thus reducing the burden of such methods on the patients. PSA values can be misinterpreted especially that it can rise in other diseases such as Benign Prostatic Hyperplasia.
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Affiliation(s)
- Sultan Zaher Alshehri
- Department of Urology, Aseer Central Hospital, Abha, Saudi Arabia
- Corresponding author. Department of Urology, Aseer Central Hospital, Al Rabwah, 7663, Abha, Saudi Arabia.
| | - Omar Safar Alshahrani
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Nazal Ahmed Almsaoud
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | | | | | - Ali Salem Autwdi
- Department of Urology, King Fahad Central Hospital, Jazan, Saudi Arabia
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Turkbey B. Local staging of prostate cancer with imaging: can hybrid imaging be the solution? Transl Androl Urol 2020; 9:834-836. [PMID: 32420194 PMCID: PMC7214973 DOI: 10.21037/tau.2020.03.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Sun Y, Reynolds HM, Parameswaran B, Wraith D, Finnegan ME, Williams S, Haworth A. Multiparametric MRI and radiomics in prostate cancer: a review. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:3-25. [PMID: 30762223 DOI: 10.1007/s13246-019-00730-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/22/2019] [Indexed: 12/30/2022]
Abstract
Multiparametric MRI (mpMRI) is an imaging modality that combines anatomical MR imaging with one or more functional MRI sequences. It has become a versatile tool for detecting and characterising prostate cancer (PCa). The traditional role of mpMRI was confined to PCa staging, but due to the advanced imaging techniques, its role has expanded to various stages in clinical practises including tumour detection, disease monitor during active surveillance and sequential imaging for patient follow-up. Meanwhile, with the growing speed of data generation and the increasing volume of imaging data, it is highly demanded to apply computerised methods to process mpMRI data and extract useful information. Hence quantitative analysis for imaging data using radiomics has become an emerging paradigm. The application of radiomics approaches in prostate cancer has not only enabled automatic localisation of the disease but also provided a non-invasive solution to assess tumour biology (e.g. aggressiveness and the presence of hypoxia). This article reviews mpMRI and its expanding role in PCa detection, staging and patient management. Following that, an overview of prostate radiomics will be provided, with a special focus on its current applications as well as its future directions.
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Affiliation(s)
- Yu Sun
- University of Sydney, Sydney, Australia. .,Peter MacCallum Cancer Centre, Melbourne, Australia.
| | | | | | - Darren Wraith
- Queensland University of Technology, Brisbane, Australia
| | - Mary E Finnegan
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
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Preoperative staging using magnetic resonance imaging and risk of positive surgical margins after prostate-cancer surgery. Prostate Cancer Prostatic Dis 2018; 22:391-398. [DOI: 10.1038/s41391-018-0116-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/10/2018] [Accepted: 11/03/2018] [Indexed: 11/09/2022]
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10
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Mazaheri Y, Shukla-Dave A, Goldman DA, Moskowitz CS, Takeda T, Reuter VE, Akin O, Hricak H. Characterization of prostate cancer with MR spectroscopic imaging and diffusion-weighted imaging at 3 Tesla. Magn Reson Imaging 2018; 55:93-102. [PMID: 30176373 DOI: 10.1016/j.mri.2018.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To retrospectively measure metabolic ratios and apparent diffusion coefficient (ADC) values from 3-Tesla MR spectroscopic imaging (MRSI) and diffusion-weighted imaging (DWI) in benign and malignant peripheral zone (PZ) prostate tissue, assess the parameters' associations with malignancy, and develop and test rules for classifying benign and malignant PZ tissue using whole-mount step-section pathology as the reference standard. METHODS This HIPAA-compliant, IRB-approved study included 67 men (median age, 61 years; range, 41-74 years) with biopsy-proven prostate cancer who underwent preoperative 3 T endorectal multiparametric MRI and had ≥1 PZ lesion >0.1 cm3 at whole-mount histopathology. In benign and malignant PZ regions identified from pathology, voxel-based choline/citrate, polyamines/choline, polyamines/creatine, and (choline + polyamines + creatine)/citrate ratios were averaged, as were ADC values. Patients were randomly split into training and test sets; rules for separating benign from malignant regions were generated with classification and regression tree (CART) analysis and assessed on the test set for sensitivity and specificity. Odds ratios (OR) were evaluated using generalized estimating equations. RESULTS CART analysis of all parameters identified only ADC and (choline + polyamines + creatine)/citrate as significant predictors of cancer. Sensitivity and specificity, respectively, were 0.81 and 0.82 with MRSI-derived, 0.98 and 0.51 with DWI-derived, and 0.79 and 0.90 with MRSI + DWI-derived classification rules. Areas under the curves (AUC) in the test set were 0.93 (0.87-0.97) with ADC, 0.82 (0.72-0.91) with MRSI, and 0.96 (0.92-0.99) with MRSI + ADC. CONCLUSION We developed statistically-based rules for identifying PZ cancer using 3-Tesla MRSI, DWI, and MRSI + DWI and demonstrated the potential value of MRSI + DWI.
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Affiliation(s)
- Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Toshikazu Takeda
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Eure G, Fanney D, Lin J, Wodlinger B, Ghai S. Comparison of conventional transrectal ultrasound, magnetic resonance imaging, and micro-ultrasound for visualizing prostate cancer in an active surveillance population: A feasibility study. Can Urol Assoc J 2018; 13:E70-E77. [PMID: 30169149 DOI: 10.5489/cuaj.5361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Active surveillance monitoring of prostate cancer is unique in that most patients have low-grade disease that is not well-visualized by any common imaging technique. High-resolution (29 MHz) micro-ultrasound is a new, real-time modality that has been demonstrated to be sensitive to significant prostate cancer and effective for biopsy targeting. This study compares micro-ultrasound imaging with magnetic resonance imaging (MRI) and conventional ultrasound for visualizing prostate cancer in active surveillance. METHODS Nine patients on active surveillance were imaged with multiparametric (mp) MRI prior to biopsy. During the biopsy procedure, imaging and target identification was first performed using conventional ultrasound, then using micro-ultrasound. The mpMRI report was then unblinded and used to determine cognitive fusion targets. Using micro-ultrasound, biopsy samples were taken from targets in each modality, plus 12 systematic samples. RESULTS mpMRI and micro-ultrasound both demonstrated superior sensitivity to Gleason sum 7 or higher cancer compared to conventional ultrasound (p=0.02 McNemar's test). Micro-ultrasound detected 89% of clinically significant cancer, compared to 56% for mpMRI. CONCLUSIONS Micro-ultrasound may provide similar sensitivity to clinically significant prostate cancer as mpMRI and visualize all significant mpMRI targets. Unlike mpMRI, micro-ultrasound is performed in the office, in real-time during the biopsy procedure, and so is expected to maintain the cost-effectiveness of conventional ultrasound. Larger studies are needed before these results may be applied in a clinical setting.
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Affiliation(s)
- Gregg Eure
- Urology of Virginia, Virginia Beach, VA, United States
| | - Daryl Fanney
- MRI & CT Diagnostics, Virginia Beach, VA, United States
| | - Jefferson Lin
- Urology of Virginia, Virginia Beach, VA, United States
| | | | - Sangeet Ghai
- Joint Department of Medical Imaging, University of Toronto, University Health Network-Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, Toronto, ON, Canada
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12
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Schiavina R, Bianchi L, Borghesi M, Dababneh H, Chessa F, Pultrone CV, Angiolini A, Gaudiano C, Porreca A, Fiorentino M, De Groote R, D'Hondt F, De Naeyer G, Mottrie A, Brunocilla E. MRI Displays the Prostatic Cancer Anatomy and Improves the Bundles Management Before Robot-Assisted Radical Prostatectomy. J Endourol 2018; 32:315-321. [PMID: 29256639 DOI: 10.1089/end.2017.0701] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate the impact of multiparametric magnetic0 resonance imaging (mpMRI) to guide the nerve-sparing (NS) surgical plan in prostate cancer (PCa) patients referred to robot-assisted radical prostatectomy (RARP). METHODS One hundred thirty-seven consecutive PCa patients were submitted to RARP between September 2016 and February 2017 at two high-volume European centers. Before RARP, each patient was referred to 1.5T or 3T mpMRI. NS was recorded as Grade 1, Grade 2, Grade 3, and Grade 4 according to Tewari and colleagues classification. A preliminary surgical plan to determinate the extent of NS approach was recorded based on clinical data. The final surgical plan was reassessed after mpMRI revision. The appropriateness of surgical plan change was considered based on the presence of extracapsular extension or positive surgical margins (PSMs) at level of neurovascular bundles area at final pathology. Furthermore, we analyzed a control group during the same period of 166 PCa patients referred to RARP in both institutions without preoperative mpMRI to assess the impact of the use of mpMRI on the surgical margins. RESULTS Considering 137 patients with preoperative mpMRI, the mpMRI revision induced the main surgeon to change the NS surgical plan in 46.7% of cases on patient-based and 56.2% on side-based analysis. The surgical plan change results equally assigned between the direction of more radical and less radical approach both on patient-based (54.7% vs 54.3%) and on side-based levels (50% vs 50%), resulting an overall appropriateness of 75%. Moreover, patients staged with mpMRI revealed significant lower overall PSMs compared with control group with no mpMRI (12.4% vs 24.1%; p ≤ 0.01). CONCLUSIONS mpMRI induces robotic surgeons to change the surgical plan in almost half of individuals, thus tailoring the NS approach, without compromising the oncologic outcomes. Compared to patients treated without mpMRI, the use of preoperative mpMRI can significantly reduce the overall PSMs.
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Affiliation(s)
- Riccardo Schiavina
- 1 Department of Urology, University of Bologna , Bologna, Italy
- 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna , Bologna, Italy
| | - Lorenzo Bianchi
- 1 Department of Urology, University of Bologna , Bologna, Italy
- 3 Department of Urology, OLV , Aalst, Belgium
- 4 ORSI Academy , Melle, Belgium
| | - Marco Borghesi
- 1 Department of Urology, University of Bologna , Bologna, Italy
- 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna , Bologna, Italy
| | - Hussam Dababneh
- 1 Department of Urology, University of Bologna , Bologna, Italy
| | | | - Cristian Vincenzo Pultrone
- 1 Department of Urology, University of Bologna , Bologna, Italy
- 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna , Bologna, Italy
| | | | | | - Angelo Porreca
- 6 Department of Urology, Abano Terme Hospital , Abano Terme, Italy
| | - Michelangelo Fiorentino
- 7 Laboratory of Oncologic and Transplantation Molecular Pathology, S. Orsola-Malpighi Hospital, University of Bologna , Bologna, Italy
| | | | | | | | - Alexandre Mottrie
- 3 Department of Urology, OLV , Aalst, Belgium
- 4 ORSI Academy , Melle, Belgium
- 5 Department of Radiology, University of Bologna , Bologna, Italy
| | - Eugenio Brunocilla
- 1 Department of Urology, University of Bologna , Bologna, Italy
- 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna , Bologna, Italy
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13
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Mazaheri Y, Akin O, Hricak H. Dynamic contrast-enhanced magnetic resonance imaging of prostate cancer: A review of current methods and applications. World J Radiol 2017; 9:416-425. [PMID: 29354207 PMCID: PMC5746645 DOI: 10.4329/wjr.v9.i12.416] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/03/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
In many areas of oncology, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has proven to be a clinically useful, non-invasive functional imaging technique to quantify tumor vasculature and tumor perfusion characteristics. Tumor angiogenesis is an essential process for tumor growth, proliferation, and metastasis. Malignant lesions demonstrate rapid extravasation of contrast from the intravascular space to the capillary bed due to leaky capillaries associated with tumor neovascularity. DCE-MRI has the potential to provide information regarding blood flow, areas of hypoperfusion, and variations in endothelial permeability and microvessel density to aid treatment selection, enable frequent monitoring during treatment and assess response to targeted therapy following treatment. This review will discuss the current status of DCE-MRI in cancer imaging, with a focus on its use in imaging prostate malignancies as well as weaknesses that limit its widespread clinical use. The latest techniques for quantification of DCE-MRI parameters will be reviewed and compared.
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Affiliation(s)
- Yousef Mazaheri
- Department of Medical Physics and Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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Abstract
MR imaging is an important part of prostate cancer diagnosis. Variations in quality and skill in general practice mean results are not as impressive as they were in academic centers. This observation provides an impetus to improve the method. Improved quality assurance will likely result in better outcomes. Improved characterization of clinically significant prostate cancer may assist in making MR imaging more useful. Improved methods of registering MR imaging with transrectal ultrasound imaging and robotic arms controlling the biopsy can reduce the impact of inexperienced operators and make the entire system of MR imaging-guided biopsies more robust.
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Affiliation(s)
- Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B69, Bethesda, MD 20892, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B69, Bethesda, MD 20892, USA.
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15
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Tanaka U, Ueno Y, Morinaga Y, Miyake H, Kyotani K, Ueda Y, Kitajima K, Sofue K, Suenaga Y, Sugimura K, Takahashi S. Value of three-dimensional T2-weighted turbo spin-echo imaging with tissue-specific variable refocusing flip angle for 3-T magnetic resonance imaging of prostate cancer: comparison with conventional two- and three-dimensional T2-weighted turbo spin-echo imaging. Jpn J Radiol 2017; 35:707-717. [DOI: 10.1007/s11604-017-0684-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/20/2017] [Indexed: 01/24/2023]
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16
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[Indications and limits of ablative therapies in prostate cancer]. Prog Urol 2017; 27:865-886. [PMID: 28918871 DOI: 10.1016/j.purol.2017.08.004] [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: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To perform a state of the art about indications and limits of ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 107 articles were analysed. RESULTS The objective to combine reduction of side effects and oncological control has induced recent development of several ablative therapies. Beyond this heterogeneity, some preferential indications appear: unilateral cancer of low risk (but with significant volume, excluding active surveillance) or intermediate risk (excluding majority of grade 4); treatment targeted the index lesion, by quarter or hemi-ablation, based on biopsy and mpMRI. In addition, indications must considered specific limits of each energy, such as gland volume and tumor localization. CONCLUSION Based on new imaging and biopsy, ablative therapies will probably increased its role in the future in management of localize prostate cancer. The multiple ongoing trials will certainly be helpful to better define their indications and limits.
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17
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van Kalleveen IML, Hoogendam JP, Raaijmakers AJE, Visser F, Arteaga de Castro CS, Verheijen RHM, Luijten PR, Zweemer RP, Veldhuis WB, Klomp DWJ. Boosting the SNR by adding a receive-only endorectal monopole to an external antenna array for high-resolution, T 2 -weighted imaging of early-stage cervical cancer with 7-T MRI. NMR IN BIOMEDICINE 2017; 30:e3750. [PMID: 28574604 DOI: 10.1002/nbm.3750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate the signal-to-noise ratio (SNR) gain in early-stage cervical cancer at ultrahigh-field MRI (e.g. 7 T) using a combination of multiple external antennas and a single endorectal antenna. In particular, we used an endorectal monopole antenna to increase the SNR in cervical magnetic resonance imaging (MRI). This should allow high-resolution, T2 -weighted imaging and magnetic resonance spectroscopy (MRS) for metabolic staging, which could facilitate the local tumor status assessment. In a prospective feasibility study, five healthy female volunteers and six patients with histologically proven stage IB1-IIB cervical cancer were scanned at 7 T. We used seven external fractionated dipole antennas for transmit-receive (transceive) and an endorectally placed monopole antenna for reception only. A region of interest, containing both normal cervix and tumor tissue, was selected for the SNR measurement. Separated signal and noise measurements were obtained in the region of the cervix for each element and in the near field of the monopole antenna (radius < 30 mm) to calculate the SNR gain of the endorectal antenna in each patient. We obtained high-resolution, T2 -weighted images with a voxel size of 0.7 × 0.8 × 3.0 mm3 . In four cases with optimal placement of the endorectal antenna (verified on the T2 -weighted images), a mean gain of 2.2 in SNR was obtained at the overall cervix and tumor tissue area. Within a radius of 30 mm from the monopole antenna, a mean SNR gain of 3.7 was achieved in the four optimal cases. Overlap between the two different regions of the SNR calculations was around 24%. We have demonstrated that the use of an endorectal monopole antenna substantially increases the SNR of 7-T MRI at the cervical anatomy. Combined with the intrinsically high SNR of ultrahigh-field MRI, this gain may be employed to obtain metabolic information using MRS and to enhance spatial resolutions to assess tumor invasion.
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Affiliation(s)
| | - J P Hoogendam
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | | | - F Visser
- Department of Radiology, UMC Utrecht, the Netherlands
| | | | - R H M Verheijen
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | - P R Luijten
- Department of Radiology, UMC Utrecht, the Netherlands
| | - R P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | - W B Veldhuis
- Department of Radiology, UMC Utrecht, the Netherlands
| | - D W J Klomp
- Department of Radiology, UMC Utrecht, the Netherlands
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18
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Gawlitza J, Reiss-Zimmermann M, Thörmer G, Schaudinn A, Linder N, Garnov N, Horn LC, Minh DH, Ganzer R, Stolzenburg JU, Kahn T, Moche M, Busse H. Impact of the use of an endorectal coil for 3 T prostate MRI on image quality and cancer detection rate. Sci Rep 2017; 7:40640. [PMID: 28145525 PMCID: PMC5286427 DOI: 10.1038/srep40640] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/09/2016] [Indexed: 11/16/2022] Open
Abstract
This work aims to assess the impact of an additional endorectal coil on image quality and cancer detection rate within the same patients. At a single academic medical center, this transversal study included 41 men who underwent T2- and diffusion-weighted imaging at 3 T using surface coils only or in combination with an endorectal coil in the same session. Two blinded readers (A and B) randomly evaluated all image data in separate sessions. Image quality with respect to localization and staging was rated on a five-point scale. Lesions were classified according to their prostate imaging reporting and data system (PIRADS) score version 1. Standard of reference was provided by whole-mount step-section analysis. Mean image quality scores averaged over all localization-related items were significantly higher with additional endorectal coil for both readers (p < 0.001), corresponding staging-related items were only higher for reader B (p < 0.001). With an endorectal coil, the rate of correctly detecting cancer per patient was significantly higher for reader B (p < 0.001) but not for reader A (p = 0.219). The numbers of histologically confirmed tumor lesions were rather similar for both settings. The subjectively rated 3-T image quality was improved with an endorectal coil. In terms of diagnostic performance, the use of an additional endorectal coil was not superior.
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Affiliation(s)
- Josephin Gawlitza
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
| | - Martin Reiss-Zimmermann
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
| | - Gregor Thörmer
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
| | - Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
| | - Nicolas Linder
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
| | - Nikita Garnov
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
| | - Lars-Christian Horn
- Institute of Pathology, Leipzig University Hospital, Liebigstraße 24 Leipzig, Germany
| | - Do Hoang Minh
- Department of Urology, Liebigstraße 20 Leipzig University Hospital, Leipzig, Germany
| | - Roman Ganzer
- Department of Urology, Liebigstraße 20 Leipzig University Hospital, Leipzig, Germany
| | - Jens-Uwe Stolzenburg
- Department of Urology, Liebigstraße 20 Leipzig University Hospital, Leipzig, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20 Leipzig, Germany
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de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol 2016. [DOI: 10.1016/j.eururo.2015.07.029] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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20
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Prostate Magnetic Resonance Imaging and Magnetic Resonance Imaging Targeted Biopsy in Patients with a Prior Negative Biopsy: A Consensus Statement by AUA and SAR. J Urol 2016; 196:1613-1618. [PMID: 27320841 DOI: 10.1016/j.juro.2016.06.079] [Citation(s) in RCA: 249] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE After an initial negative biopsy there is an ongoing need for strategies to improve patient selection for repeat biopsy as well as the diagnostic yield from repeat biopsies. MATERIALS AND METHODS As a collaborative initiative of the AUA (American Urological Association) and SAR (Society of Abdominal Radiology) Prostate Cancer Disease Focused Panel, an expert panel of urologists and radiologists conducted a literature review and formed consensus statements regarding the role of prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a negative biopsy, which are summarized in this review. RESULTS The panel recognizes that many options exist for men with a previously negative biopsy. If a biopsy is recommended, prostate magnetic resonance imaging and subsequent magnetic resonance imaging targeted cores appear to facilitate the detection of clinically significant disease over standardized repeat biopsy. Thus, when high quality prostate magnetic resonance imaging is available, it should be strongly considered for any patient with a prior negative biopsy who has persistent clinical suspicion for prostate cancer and who is under evaluation for a possible repeat biopsy. The decision of whether to perform magnetic resonance imaging in this setting must also take into account the results of any other biomarkers and the cost of the examination, as well as the availability of high quality prostate magnetic resonance imaging interpretation. If magnetic resonance imaging is done, it should be performed, interpreted and reported in accordance with PI-RADS version 2 (v2) guidelines. Experience of the reporting radiologist and biopsy operator are required to achieve optimal results and practices integrating prostate magnetic resonance imaging into patient care are advised to implement quality assurance programs to monitor targeted biopsy results. CONCLUSIONS Patients receiving a PI-RADS assessment category of 3 to 5 warrant repeat biopsy with image guided targeting. While transrectal ultrasound guided magnetic resonance imaging fusion or in-bore magnetic resonance imaging targeting may be valuable for more reliable targeting, especially for lesions that are small or in difficult locations, in the absence of such targeting technologies cognitive (visual) targeting remains a reasonable approach in skilled hands. At least 2 targeted cores should be obtained from each magnetic resonance imaging defined target. Given the number of studies showing a proportion of missed clinically significant cancers by magnetic resonance imaging targeted cores, a case specific decision must be made whether to also perform concurrent systematic sampling. However, performing solely targeted biopsy should only be considered once quality assurance efforts have validated the performance of prostate magnetic resonance imaging interpretations with results consistent with the published literature. In patients with negative or low suspicion magnetic resonance imaging (PI-RADS assessment category of 1 or 2, respectively), other ancillary markers (ie PSA, PSAD, PSAV, PCA3, PHI, 4K) may be of value in identifying patients warranting repeat systematic biopsy, although further data are needed on this topic. If a repeat biopsy is deferred on the basis of magnetic resonance imaging findings, then continued clinical and laboratory followup is advised and consideration should be given to incorporating repeat magnetic resonance imaging in this diagnostic surveillance regimen.
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Polanec S, Helbich TH, Bickel H, Pinker-Domenig K, Georg D, Shariat SF, Aulitzky W, Susani M, Baltzer PA. Head-to-head comparison of PI-RADS v2 and PI-RADS v1. Eur J Radiol 2016; 85:1125-31. [DOI: 10.1016/j.ejrad.2016.03.025] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 01/15/2023]
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Role of multiparametric MRI in the diagnosis of prostate cancer: update. Urologia 2016; 83:61-7. [PMID: 26350047 DOI: 10.5301/uro.5000138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 01/04/2023]
Abstract
Prostate cancer is the most common malignancy of the male gender. The role of magnetic resonance imaging has evolved very rapidly over the years to be currently recognized as a fundamental tool in the diagnosis, treatment and follow-up of prostate cancer.
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23
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Van Holsbeeck A, Degroote A, De Wever L, Vanhoutte E, De Keyzer F, Van Poppel H, Oyen R. Staging of prostatic carcinoma at 1.5-T MRI: correlation of a simplified MRI exam with whole-mount radical prostatectomy specimens. Br J Radiol 2016; 89:20160101. [PMID: 27181821 DOI: 10.1259/bjr.20160101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To retrospectively analyze the accuracy of simplified multiparametric MRI at 1.5 T for local staging by using whole-mount-section histopathological analysis as the standard of reference. METHODS 123 consecutive patients underwent T2 weighted, T1 weighted and diffusion-weighted MRI without endorectal coil prior to radical prostatectomy. The accuracy of predicting extracapsular extension (ECE) (T3a) was assessed using direct signs or the combination of direct and indirect signs of extraprostatic extension. The accuracy of predicting seminal vesicle invasion (T3b) was evaluated, taking into account different routes of seminal vesicle involvement. Finally, adjacent organ invasion (T4) was evaluated in this patient population. RESULTS Histopathology showed T3a, T3b and T4 in 61, 28 and 9 cases, respectively. The use of direct signs of extraprostatic extension showed a sensitivity of 57.4% and specificity of 91.9%. The combination of direct signs and indirect signs improved sensitivity (85.2%) at the expense of moderate loss of specificity (83.9%). MR sensitivity for the detection of seminal vesicle invasion was low (53.6%); however, it was dependent on the route of seminal vesicle tumour infiltration. MR sensitivity and specificity for adjacent organ invasion were 88.9% and 99.1%. CONCLUSION Simplified MRI study at 1.5 T provides a relatively high sensitivity for detecting ECE (T3a) when using the combination of indirect and direct signs. However, this high sensitivity reading is at the cost of a moderate loss of specificity. Invasion of the seminal vesicles (T3b) occurs most often along the ejaculatory duct complex with low MR sensitivity. ADVANCES IN KNOWLEDGE Simplified MRI study at 1.5 T without endorectal coil could be used for the local T staging of prostate cancer.
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Affiliation(s)
| | - Annemarie Degroote
- 2 Department of Histopathology, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth De Wever
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Els Vanhoutte
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Raymond Oyen
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Gupta RT, Spilseth B, Patel N, Brown AF, Yu J. Multiparametric prostate MRI: focus on T2-weighted imaging and role in staging of prostate cancer. Abdom Radiol (NY) 2016; 41:831-43. [PMID: 27193786 DOI: 10.1007/s00261-015-0579-5] [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] [Indexed: 12/26/2022]
Abstract
Multiparametric MRI (mpMRI) represents a growing modality for the non-invasive evaluation of prostate cancer (PCa) and is increasingly being used for patients with persistently elevated PSA and prior negative biopsies, for monitoring patients in active surveillance protocols, for preoperative characterization of cancer for surgical planning, and in planning for MRI-targeted biopsy. The focus of this work is twofold. First, we review the key role of T2-weighted imaging (T2WI) in mpMRI, specifically outlining how it is used for anatomic evaluation of the prostate, detection of clinically significant PCa, assessment of extraprostatic extension (EPE), and mimics of PCa on this sequence. We will also discuss optimal technical acquisition parameters for this sequence and recent technical advancements in T2WI. Second, we will delineate the role that mpMRI plays in the staging of PCa and describe the implications of the information that mpMRI can provide in determining the most appropriate management plan for the patient with PCa.
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25
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Rosenkrantz AB, Shanbhogue AK, Wang A, Kong MX, Babb JS, Taneja SS. Length of capsular contact for diagnosing extraprostatic extension on prostate MRI: Assessment at an optimal threshold. J Magn Reson Imaging 2015; 43:990-7. [PMID: 26395278 DOI: 10.1002/jmri.25040] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/20/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the length of capsular contact of dominant lesions on multiparametric prostate magnetic resonance imaging (MRI) for predicting extraprostatic extension (EPE) and to determine a threshold value to apply in clinical practice. MATERIALS AND METHODS Ninety patients undergoing 3T prostate MRI before prostatectomy were included. Two independent readers (R1, R2) recorded for each lobe the presence or absence of capsular irregularity on T2 -weighted imaging (T2 WI) and of overt measurable EPE. Readers also recorded the length of capsular contact of each lobe's dominant lesion for T2 WI and the apparent diffusion coefficient (ADC) map. Based on prostatectomy specimens, EPE was recorded for each lobe and classified as focal (single focus ≤0.5 mm in depth) vs. established. Receiver operating characteristic analysis, logistic regression, and kappa coefficients were used to assess interpretive approaches on a side-specific basis. RESULTS The optimal thresholds were 6 mm and 7 mm of contact using T2 WI and ADC for any EPE, and 10 mm and 7 mm using T2 WI and ADC for nonfocal EPE (AUCs 81.0-82.5%). Capsular contact had higher sensitivity, yet lower specificity, than subjective interpretations for any EPE and for nonfocal EPE (all P ≤ 0.018, aside from any EPE for R2 using ADC). Length of contact exhibited more substantial gains in sensitivity (9-20% for any EPE; 34-41% for nonfocal EPE) than losses in specificity (6-13% for any EPE; 17-27% for nonfocal EPE) compared with subjective interpretations. Interreader agreement: 0.70 for assessments based on length of contact; 0.49-0.59 for subjective assessments. CONCLUSION Length of capsular contact of dominant lesions can improve interreader agreement and sensitivity for EPE compared with subjective features, with relatively mild specificity loss.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Alampady K Shanbhogue
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Annie Wang
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Max Xiangtian Kong
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - James S Babb
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Samir S Taneja
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
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Prediction of Micrometastasis (< 1 cm) to Pelvic Lymph Nodes in Prostate Cancer: Role of Preoperative MRI. AJR Am J Roentgenol 2015; 205:W328-34. [DOI: 10.2214/ajr.14.14138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Lim C, Flood TA, Hakim SW, Shabana WM, Quon JS, El-Khodary M, Thornhill RE, El Hallani S, Schieda N. Evaluation of apparent diffusion coefficient and MR volumetry as independent associative factors for extra-prostatic extension (EPE) in prostatic carcinoma. J Magn Reson Imaging 2015; 43:726-36. [DOI: 10.1002/jmri.25033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/05/2015] [Indexed: 12/24/2022] Open
Affiliation(s)
- Christopher Lim
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Trevor A. Flood
- The Ottawa Hospital, The University of Ottawa Department of Anatomical Pathology; Ottawa Ontario Canada
| | - Shaheed W. Hakim
- The Ottawa Hospital, The University of Ottawa Department of Anatomical Pathology; Ottawa Ontario Canada
| | - Wael M. Shabana
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Jeffrey S. Quon
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Mohamed El-Khodary
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Rebecca E. Thornhill
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Soufiane El Hallani
- The Ottawa Hospital, The University of Ottawa Department of Anatomical Pathology; Ottawa Ontario Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
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Kayat Bittencourt L, Litjens G, Hulsbergen-van de Kaa CA, Turkbey B, Gasparetto EL, Barentsz JO. Prostate Cancer: The European Society of Urogenital Radiology Prostate Imaging Reporting and Data System Criteria for Predicting Extraprostatic Extension by Using 3-T Multiparametric MR Imaging. Radiology 2015; 276:479-89. [DOI: 10.1148/radiol.15141412] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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You JY, Lee HJ, Hwang SI, Bae YJ, Kim H, Hong H, Choe G. Value of T1/T2-weighted magnetic resonance imaging registration to reduce the postbiopsy hemorrhage effect for prostate cancer localization. Prostate Int 2015; 3:80-6. [PMID: 26473149 PMCID: PMC4588389 DOI: 10.1016/j.prnil.2015.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to evaluate the value of T1/T2-weighted imaging (T1/T2WI) registration to reduce the postbiopsy hemorrhage effect for prostate cancer localization on prostate magnetic resonance imaging (MRI). Methods Twenty-one men with pathology-proven prostate cancer who underwent preoperative MRI in a single institution were selected. The zonal anatomy was divided into 16 sections. T2WI, T1/T2-weighted registered imaging (T1/T2RI), T2WI combined with diffusion-weighted imaging (T2WI + DWI), and T1/T2RI combined with DWI (T1/T2RI + DWI) were scored for the likelihood of cancer by two radiology faculty members and two trainees, and were compared with histology results. Areas under the receiver operating characteristics curve (AUCs) were used to assess diagnostic accuracy. Results For the trainees (Reader 3 and Reader 4), the AUC values were significantly higher (P < 0.05) for T1/T2RI (0.60 and 0.62, respectively) than for T2WI (0.54 and 0.56, respectively) in tumor detection, whereas no significant difference was observed for faculty members. There was no significant difference in AUC values between T1/T2RI and T2WI + DWI for all readers except for Reader 1. There was no additional diagnostic benefit for adding DWI with T1/T2RI for all readers. Conclusions T1/T2WI registration is a feasible technique. For less experienced readers, T1/T2RI is better than T2WI in localization of prostate cancer.
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Affiliation(s)
- Ja Yeon You
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea ; Program in Nano Science and Technology, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Suwon, South Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hannah Kim
- Department of Computer Science and Engineering, Seoul Women's University, Seoul, South Korea
| | - Helen Hong
- Department of Multimedia Engineering, Seoul Women's University, Seoul, South Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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De Visschere P, Nezzo M, Pattyn E, Fonteyne V, Van Praet C, Villeirs G. Prostate magnetic resonance spectroscopic imaging at 1.5tesla with endorectal coil versus 3.0tesla without endorectal coil: comparison of spectral quality. Clin Imaging 2015; 39:636-41. [DOI: 10.1016/j.clinimag.2015.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 01/07/2023]
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Özcan A, Türkbey B, Choyke PL, Akin O, Aras Ö, Mun SK. Interactive Feature Space Explorer© for multi-modal magnetic resonance imaging. Magn Reson Imaging 2015; 33:804-15. [PMID: 25868623 PMCID: PMC4458231 DOI: 10.1016/j.mri.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/14/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
Wider information content of multi-modal biomedical imaging is advantageous for detection, diagnosis and prognosis of various pathologies. However, the necessity to evaluate a large number images might hinder these advantages and reduce the efficiency. Herein, a new computer aided approach based on the utilization of feature space (FS) with reduced reliance on multiple image evaluations is proposed for research and routine clinical use. The method introduces the physician experience into the discovery process of FS biomarkers for addressing biological complexity, e.g., disease heterogeneity. This, in turn, elucidates relevant biophysical information which would not be available when automated algorithms are utilized. Accordingly, the prototype platform was designed and built for interactively investigating the features and their corresponding anatomic loci in order to identify pathologic FS regions. While the platform might be potentially beneficial in decision support generally and specifically for evaluating outlier cases, it is also potentially suitable for accurate ground truth determination in FS for algorithm development. Initial assessments conducted on two different pathologies from two different institutions provided valuable biophysical perspective. Investigations of the prostate magnetic resonance imaging data resulted in locating a potential aggressiveness biomarker in prostate cancer. Preliminary findings on renal cell carcinoma imaging data demonstrated potential for characterization of disease subtypes in the FS.
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Affiliation(s)
- Alpay Özcan
- Arlington Innovation Center: Health Research, Virginia Polytechnic Institute and State University, 900 N. Glebe Road, Arlington VA 22203, USA.
| | - Barış Türkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Bldg. 10, Rm. 1B40, Bethesda, MD 20892-1088, USA.
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Bldg. 10, Rm. 1B40, Bethesda, MD 20892-1088, USA.
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, 1275 York Ave C276, New York, NY 10065, USA.
| | - Ömer Aras
- Memorial Sloan Kettering Cancer Center, 1275 York Ave C276, New York, NY 10065, USA.
| | - Seong K Mun
- Arlington Innovation Center: Health Research, Virginia Polytechnic Institute and State University, 900 N. Glebe Road, Arlington VA 22203, USA.
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Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology. Eur Radiol 2014; 25:1776-85. [DOI: 10.1007/s00330-014-3543-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/23/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Couñago F, Recio M, Del Cerro E, Cerezo L, Díaz Gavela A, Marcos FJ, Murillo R, Rodriguez Luna JM, Thuissard IJ, Martin JLR. Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology. Clin Transl Oncol 2014; 16:993-999. [PMID: 24865628 DOI: 10.1007/s12094-014-1186-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/23/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the accuracy of preoperative 3T multiparametric magnetic resonance imaging (3TmMRI) for local staging of prostate cancer and its influence on the decision to change the clinical target volume (CTV), total dose and hormonal therapy when treating prostate cancer patients with radiotherapy. METHODS From 2009 to 2013, 150 patients, who had confirmed prostate cancer and underwent a 3TmMRI before treatment with radical prostatectomy or radical radiation therapy, were included. Radiation therapy treatment (CTV, total dose and hormonal therapy) was initially determined on the basis of the clinical information, and radiation therapy plan was reevaluated after 3TmMRI review. The value of preoperative 3TmMRI in local staging and in the decision of radiotherapy treatment according to NCCN risk classification was analyzed. RESULTS 3TmMRI performed correct, over- and under staging in 78.7 % (37/47), 6.3 % (3/47), 14.8 % patients (7/47), respectively. 3TmMRI identified 6 cT2a, 7 cT2b, 28 cT2c, 3 cT3a, 3 cT3b tumors. At final pathology, 5 tumors were classified as pT2a, 5 as pT2b, 30 as pT2c, 4 as pT3a, 3 as pT3b. After reviewing the MRI reports, the initial radiotherapy and hormonal therapy plan was changed in 33.9 % patients (35/103). CONCLUSIONS In our group of patients, 3TmMRI has been a reliable technique providing an optimal staging for prostate cancer. Its routine use could induce important changes in radiation therapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue.
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Affiliation(s)
- F Couñago
- Department of Radiation Oncology, Hospital Universitario Quirón Madrid, Calle Diego de Velázquez, 2, Pozuelo de Alarcón, 28223, Madrid, Spain,
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Haq NF, Kozlowski P, Jones EC, Chang SD, Goldenberg SL, Moradi M. A data-driven approach to prostate cancer detection from dynamic contrast enhanced MRI. Comput Med Imaging Graph 2014; 41:37-45. [PMID: 25060941 DOI: 10.1016/j.compmedimag.2014.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
Magnetic resonance imaging (MRI), particularly dynamic contrast enhanced (DCE) imaging, has shown great potential in prostate cancer diagnosis and staging. In the current practice of DCE-MRI, diagnosis is based on quantitative parameters extracted from the series of T1-weighted images acquired after the injection of a contrast agent. To calculate these parameters, a pharmacokinetic model is fitted to the T1-weighted intensities. Most models make simplistic assumptions about the perfusion process. Moreover, these models require accurate estimation of the arterial input function, which is challenging. In this work we propose a data-driven approach to characterization of the prostate tissue that uses the time series of DCE T1-weighted images without pharmacokinetic modeling. This approach uses a number of model-free empirical parameters and also the principal component analysis (PCA) of the normalized T1-weighted intensities, as features for cancer detection from DCE MRI. The optimal set of principal components is extracted with sparse regularized regression through least absolute shrinkage and selection operator (LASSO). A support vector machine classifier was used with leave-one-patient-out cross validation to determine the ability of this set of features in cancer detection. Our data is obtained from patients prior to radical prostatectomy and the results are validated based on histological evaluation of the extracted specimens. Our results, obtained on 449 tissue regions from 16 patients, show that the proposed data-driven features outperform the traditional pharmacokinetic parameters with an area under ROC of 0.86 for LASSO-isolated PCA parameters, compared to 0.78 for pharmacokinetic parameters. This shows that our novel approach to the analysis of DCE data has the potential to improve the multiparametric MRI protocol for prostate cancer detection.
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Affiliation(s)
| | | | | | | | | | - Mehdi Moradi
- University of British Columbia, Vancouver, BC, Canada.
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Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy. Urol Oncol 2014; 32:1292-9. [PMID: 24863013 DOI: 10.1016/j.urolonc.2014.04.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/20/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of our study was to test our hypothesis that multiparametric magnetic resonance imaging (mpMRI) may have a higher prognostic accuracy than the Partin tables in predicting organ-confined (OC) prostate cancer and extracapsular extension (ECE) after radical prostatectomy (RP). METHODS AND MATERIALS After institutional review board approval, we retrospectively reviewed 60 patients who underwent 3-T mpMRI before RP. mpMRI was used to assess clinical stage and the updated version of the Partin tables was used to calculate the probability of each patient to harbor OC disease. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in detecting OC and ECE were calculated. Logistic regression models predicting OC pathology were created using either clinical stage at mpMRI or Partin tables probability. The area under the curve was used to calculate the predictive accuracy of each model. RESULTS Median prostate-specific antigen level at diagnosis was 5 ng/ml (range: 4.1-6.7 ng/ml). Overall, 52 (86.7%) men had cT1 disease, 7 (11.7%) had cT2a/b, and 1 (1.6%) had cT3b at digital rectal examination. Biopsy Gleason score was 6, 3+4 = 7, 4+3 = 7, 8, and 9 to 10 in 28 (46.7%), 15 (25%), 3 (5%), 10 (16.7%), and 4 (6.6%) patients, respectively. At mpMRI, clinical stage was defined as cT2a/b, cT2c, cT3a, and cT3b in 11 (18.3%), 23 (38.3%), 21 (35%), and 5 (8.4%) patients, respectively. At final pathology, 38 men (63.3%) had OC disease, whereas 18 (30%) had ECE and 4 (6.7%) had seminal vesicle invasion. The sensitivity, specificity, PPV, and NPV of mpMRI in detecting OC disease were 81.6%, 86.4%, 91.2%, and 73.1%, respectively, whereas in detecting ECE were 77.8%, 83.4%, 66.7%, and 89.7%, respectively. At logistic regression, both the Partin tables-derived probability and the mpMRI clinical staging were significantly associated with OC disease (all P<0.01). The area under the curves of the model built using the Partin tables and that of the mpMRI model were 0.62 and 0.82, respectively (P = 0.04). CONCLUSIONS The predictive accuracy of mpMRI in predicting OC disease on pathological analysis is significantly greater than that of the Partin tables. mpMRI had a high PPV (91.2%) when predicting OC disease and a high NPV (89.7%) with regard to ECE. mpMRI should be considered when planning prostate cancer treatment in addition to readily available clinical parameters.
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Value of 3-T Multiparametric Magnetic Resonance Imaging and Magnetic Resonance–Guided Biopsy for Early Risk Restratification in Active Surveillance of Low-Risk Prostate Cancer. Invest Radiol 2014; 49:165-72. [PMID: 24220253 DOI: 10.1097/rli.0000000000000008] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Park BH, Jeon HG, Jeong BC, Seo SI, Lee HM, Choi HY, Jeon SS. Influence of magnetic resonance imaging in the decision to preserve or resect neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. J Urol 2014; 192:82-8. [PMID: 24440235 DOI: 10.1016/j.juro.2014.01.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE We evaluated the accuracy of preoperative multiparametric 3.0-T magnetic resonance imaging for local staging of prostate cancer and its influence in the decision to preserve neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS The study included 353 patients who had confirmed prostate cancer and underwent preoperative magnetic resonance imaging and robotic assisted laparoscopic radical prostatectomy between 2008 and 2011. The extent of neurovascular bundle sparing was initially determined on the basis of the clinical information and the nerve sparing surgical plan was reevaluated after review of the magnetic resonance imaging report. The value of preoperative magnetic resonance imaging in the prediction of extracapsular extension and in the decision of surgical plan according to D'Amico risk classification was analyzed. RESULTS The magnetic resonance imaging performed correct staging, over staging and under staging in 261 (73.9%), 43 (12.2%), and 49 (13.9%) patients, respectively. After review of the magnetic resonance imaging reports, the initial surgical plan was not changed in 260 patients (74%) and was changed in 93 patients (26%). Robotic assisted laparoscopic radical prostatectomy was changed to a more preservable neurovascular bundle sparing procedure in 53 patients (57%) and changed to a more aggressive neurovascular bundle resecting procedure in 40 patients (43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of magnetic resonance imaging in predicting extracapsular extension showed a tendency to increase from low to high risk groups (33%, 46%, 80%, respectively, p <0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients (of 129, 31%) and 27 patients (of 67, 40%), respectively. CONCLUSIONS Preoperative magnetic resonance imaging significantly improves the decision making to preserve or resect the neurovascular bundle at robotic assisted laparoscopic radical prostatectomy, which lacks haptic feedback.
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Affiliation(s)
- Bong Hee Park
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Tombal B, Alcaraz A, James N, Valdagni R, Irani J. Can we improve the definition of high-risk, hormone naïve, non-metastatic prostate cancer? BJU Int 2014; 113:189-99. [DOI: 10.1111/bju.12469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Bertrand Tombal
- Department of Urology; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - Antonio Alcaraz
- Department of Urology; IDIBAPS; Hospital Clinic - Universitat de Barcelona; Barcelona Spain
| | - Nicholas James
- Department of Clinical Oncology; School of Cancer Sciences; University of Birmingham; Birmingham UK
| | - Riccardo Valdagni
- Prostate Cancer Program and Department of Radiation Oncology; Fondazione IRCCS; Istituto Nazionale dei Tumori; Milan Italy
| | - Jacques Irani
- Department of Urology; Centre Hospitalier Universitaire La Miletrie; Poitiers France
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40
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Fütterer JJ, Barentsz JO, Heijmijnk STWPJ. Imaging modalities for prostate cancer. Expert Rev Anticancer Ther 2014; 9:923-37. [DOI: 10.1586/era.09.63] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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41
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Clinical Comparison Between a Currently Available Single-Loop and an Investigational Dual-Channel Endorectal Receive Coil for Prostate Magnetic Resonance Imaging. Invest Radiol 2014; 49:15-22. [DOI: 10.1097/rli.0b013e3182a56678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kobus T, Wright AJ, Scheenen TWJ, Heerschap A. Mapping of prostate cancer by 1H MRSI. NMR IN BIOMEDICINE 2014; 27:39-52. [PMID: 23761200 DOI: 10.1002/nbm.2973] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/08/2013] [Accepted: 04/13/2013] [Indexed: 06/02/2023]
Abstract
In many studies, it has been demonstrated that (1)H MRSI of the human prostate has great potential to aid prostate cancer management, e.g. in the detection and localisation of cancer foci in the prostate or in the assessment of its aggressiveness. It is particularly powerful in combination with T2 -weighted MRI. Nevertheless, the technique is currently mainly used in a research setting. This review provides an overview of the state-of-the-art of three-dimensional MRSI, including the specific hardware required, dedicated data acquisition sequences and information on the spectral content with background on the MR-visible metabolites. In clinical practice, it is important that relevant MRSI results become available rapidly, reliably and in an easy digestible way. However, this functionality is currently not fully available for prostate MRSI, which is a major obstacle for routine use by inexperienced clinicians. Routine use requires more automation in the processing of raw data than is currently available. Therefore, we pay specific attention in this review on the status and prospects of the automated handling of prostate MRSI data, including quality control. The clinical potential of three-dimensional MRSI of the prostate is illustrated with literature examples on prostate cancer detection, its localisation in the prostate, its role in the assessment of cancer aggressiveness and in the selection and monitoring of therapy.
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Affiliation(s)
- Thiele Kobus
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Lagemaat MW, Scheenen TWJ. Role of high-field MR in studies of localized prostate cancer. NMR IN BIOMEDICINE 2014; 27:67-79. [PMID: 23703839 DOI: 10.1002/nbm.2967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 03/12/2013] [Accepted: 03/28/2013] [Indexed: 06/02/2023]
Abstract
Magnetic resonance imaging is attracting increasing attention from the uroradiological community as a modality to guide the management of prostate cancer. With the high incidence of prostate cancer it might come as a surprise that for a very long time (and in many places even at present) treatment decisions were being made without the use of detailed anatomical and functional imaging of the prostate gland at hand. Although T2 -weighted MRI can provide great anatomical detail, by itself it is not specific enough to discriminate cancer from benign disease, so other functional MRI techniques have been explored to aid in detection, localization, staging and risk assessment of prostate cancer. With the current evolution of clinical MR systems from 1.5 to 3 T it is important to understand the advantages and the challenges of the higher magnetic field strength for the different functional MR techniques most used in the prostate: T2 -weighted MRI, diffusion-weighted MRI, MR spectroscopic imaging and dynamic contrast-enhanced imaging. In addition to this, the use of the endorectal coil at different field strengths is discussed in this review, together with an outlook of the possibilities of ultra-high-field MR for the prostate.
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Affiliation(s)
- Miriam W Lagemaat
- Department of Radiology (766), Radboud University Nijmegen Medical Centre, The Netherlands
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Imaging and Markers as Novel Diagnostic Tools in Detecting Insignificant Prostate Cancer: A Critical Overview. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:243080. [PMID: 27351008 PMCID: PMC4897503 DOI: 10.1155/2014/243080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/19/2014] [Indexed: 11/22/2022]
Abstract
Recent therapeutic advances for managing low-risk prostate cancer include the active surveillance and focal treatment. However, locating a tumor and detecting its volume by adequate sampling is still problematic. Development of predictive biomarkers guiding individual therapeutic choices remains an ongoing challenge. At the same time, prostate cancer magnetic resonance imaging is gaining increasing importance for prostate diagnostics. The high morphological resolution of T2-weighted imaging and functional MRI methods may increase the specificity and sensitivity of diagnostics. Also, recent studies founded an ability of novel biomarkers to identify clinically insignificant prostate cancer, risk of progression, and association with poor differentiation and, therefore, with clinical significance. Probably, the above mentioned methods would improve tumor characterization in terms of its volume, aggressiveness, and focality. In this review, we attempted to evaluate the applications of novel imaging techniques and biomarkers in assessing the significance of the prostate cancer.
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Muller BG, Fütterer JJ, Gupta RT, Katz A, Kirkham A, Kurhanewicz J, Moul JW, Pinto PA, Rastinehad AR, Robertson C, de la Rosette J, Sanchez-Salas R, Jones JS, Ukimura O, Verma S, Wijkstra H, Marberger M. The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel. BJU Int 2013; 113:218-27. [PMID: 24215670 DOI: 10.1111/bju.12243] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy. METHODS Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors. Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of ≥0.5 mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy? RESULTS Consensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist. Structured and standardised reporting of prostate MRI is paramount. State of the art mpMRI is capable of localising small tumours for focal therapy. State of the art mpMRI is the technique of choice for follow-up of focal ablation. CONCLUSIONS The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumour aggressiveness. Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy.
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Affiliation(s)
- Berrend G Muller
- Department of Urology, AMC University Hospital, Amsterdam, the Netherlands
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Somford D, Hamoen E, Fütterer J, van Basten J, Hulsbergen-van de Kaa C, Vreuls W, van Oort I, Vergunst H, Kiemeney L, Barentsz J, Witjes J. The Predictive Value of Endorectal 3 Tesla Multiparametric Magnetic Resonance Imaging for Extraprostatic Extension in Patients with Low, Intermediate and High Risk Prostate Cancer. J Urol 2013; 190:1728-34. [DOI: 10.1016/j.juro.2013.05.021] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Affiliation(s)
- D.M. Somford
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E.H. Hamoen
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J.J. Fütterer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J.P. van Basten
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - W. Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - I.M. van Oort
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - H. Vergunst
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - L.A. Kiemeney
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J.O. Barentsz
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J.A. Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Comparison of Interreader Reproducibility of the Prostate Imaging Reporting and Data System and Likert Scales for Evaluation of Multiparametric Prostate MRI. AJR Am J Roentgenol 2013; 201:W612-8. [DOI: 10.2214/ajr.12.10173] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zöllner FG, Weisser G, Reich M, Kaiser S, Schoenberg SO, Sourbron SP, Schad LR. UMMPerfusion: an open source software tool towards quantitative MRI perfusion analysis in clinical routine. J Digit Imaging 2013; 26:344-52. [PMID: 22832894 DOI: 10.1007/s10278-012-9510-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To develop a generic Open Source MRI perfusion analysis tool for quantitative parameter mapping to be used in a clinical workflow and methods for quality management of perfusion data. We implemented a classic, pixel-by-pixel deconvolution approach to quantify T1-weighted contrast-enhanced dynamic MR imaging (DCE-MRI) perfusion data as an OsiriX plug-in. It features parallel computing capabilities and an automated reporting scheme for quality management. Furthermore, by our implementation design, it could be easily extendable to other perfusion algorithms. Obtained results are saved as DICOM objects and directly added to the patient study. The plug-in was evaluated on ten MR perfusion data sets of the prostate and a calibration data set by comparing obtained parametric maps (plasma flow, volume of distribution, and mean transit time) to a widely used reference implementation in IDL. For all data, parametric maps could be calculated and the plug-in worked correctly and stable. On average, a deviation of 0.032 ± 0.02 ml/100 ml/min for the plasma flow, 0.004 ± 0.0007 ml/100 ml for the volume of distribution, and 0.037 ± 0.03 s for the mean transit time between our implementation and a reference implementation was observed. By using computer hardware with eight CPU cores, calculation time could be reduced by a factor of 2.5. We developed successfully an Open Source OsiriX plug-in for T1-DCE-MRI perfusion analysis in a routine quality managed clinical environment. Using model-free deconvolution, it allows for perfusion analysis in various clinical applications. By our plug-in, information about measured physiological processes can be obtained and transferred into clinical practice.
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Affiliation(s)
- Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Eberhardt SC, Carter S, Casalino DD, Merrick G, Frank SJ, Gottschalk AR, Leyendecker JR, Nguyen PL, Oto A, Porter C, Remer EM, Rosenthal SA. ACR Appropriateness Criteria prostate cancer--pretreatment detection, staging, and surveillance. J Am Coll Radiol 2013; 10:83-92. [PMID: 23374687 DOI: 10.1016/j.jacr.2012.10.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 10/31/2012] [Indexed: 01/01/2023]
Abstract
Prostate cancer is the most common noncutaneous male malignancy in the United States. The use of serum prostate-specific antigen as a screening tool is complicated by a significant fraction of nonlethal cancers diagnosed by biopsy. Ultrasound is used predominately as a biopsy guidance tool. Combined rectal examination, prostate-specific antigen testing, and histology from ultrasound-guided biopsy provide risk stratification for locally advanced and metastatic disease. Imaging in low-risk patients is unlikely to guide management for patients electing up-front treatment. MRI, CT, and bone scans are appropriate in intermediate-risk to high-risk patients to better assess the extent of disease, guide therapy decisions, and predict outcomes. MRI (particularly with an endorectal coil and multiparametric functional imaging) provides the best imaging for cancer detection and staging. There may be a role for prostate MRI in the context of active surveillance for low-risk patients and in cancer detection for undiagnosed clinically suspected cancer after negative biopsy results. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Maas MC, Vos EK, Lagemaat MW, Bitz AK, Orzada S, Kobus T, Kraff O, Maderwald S, Ladd ME, Scheenen TWJ. Feasibility of T2 -weighted turbo spin echo imaging of the human prostate at 7 tesla. Magn Reson Med 2013; 71:1711-9. [PMID: 23798333 DOI: 10.1002/mrm.24818] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/03/2013] [Accepted: 05/02/2013] [Indexed: 11/09/2022]
Abstract
PURPOSE To demonstrate that high quality T2 -weighted (T2w) turbo spin-echo (TSE) imaging of the complete prostate can be achieved routinely and within safety limits at 7 T, using an external transceive body array coil only. METHODS Nine healthy volunteers and 12 prostate cancer patients were scanned on a 7 T whole-body system. Preparation consisted of B0 and radiofrequency shimming and localized flip angle calibration. T1 and T2 relaxation times were measured and used to define the T2w-TSE protocol. T2w imaging was performed using a TSE sequence (pulse repetition time/echo time 3000-3640/71 ms) with prolonged excitation and refocusing pulses to reduce specific absorption rate. RESULTS High quality T2w TSE imaging was performed in less than 2 min in all subjects. Tumors of patients with gold-standard tumor localization (MR-guided biopsy or prostatectomy) were well visualized on 7 T imaging (n = 3). The number of consecutive slices achievable within a 10-g averaged specific absorption rate limit of 10 W/kg was ≥28 in all subjects, sufficient for full prostate coverage with 3-mm slices in at least one direction. CONCLUSION High quality T2w TSE prostate imaging can be performed routinely and within specific absorption rate limits at 7 T with an external transceive body array.
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Affiliation(s)
- Marnix C Maas
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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