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Xing Z, Pan L, Yu A, Zhang J, Dong C, Chen J, Xing W, He X, Zhang Z. Value of ultra-high b-value diffusion-weighted imaging for the evaluation of renal ischemia-reperfusion injury. Magn Reson Imaging 2024; 111:1-8. [PMID: 38574980 DOI: 10.1016/j.mri.2024.03.040] [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: 03/03/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
To explore the feasibility of ultra-high b-value diffusion-weighted imaging (ubDWI) in assessment of renal IRI. Thirty-five rabbits were randomized into a control group (n = 7) and a renal IRI group (n = 28). The rabbits in the renal IRI group underwent left renal artery clamping for 60 min. Rabbits underwent axial ubDWI before and at 1, 12, 24, and 48 h after IRI. Apparent diffusion coefficient (ADCst) were calculated from ubDWI with two b-values (b = 0, 1000 s/mm2). Triexponential fits were applied to calculate the pure diffusion coefficients (D), perfusion-related diffusion coefficient (D⁎), and ultra-high ADC (ADCuh). The interobserver reproducibility were evaluated. The repeated measurement analysis of variance and Spearman correlation analysis was used for statistical analysis. The ADCst, D, and ADCuh values showed good reproducibility. The ADCst, D, and D⁎ values of renal Cortex (CO) and outer medulla (OM) significantly decreased after IRI (all P < 0.05). The ADCuh values significantly increased from pre-IRI to 1 h after IRI (P < 0.05) and significantly declined at 24 h and 48 h after IRI (all P < 0.05). ADCuh was strongly positively correlated with AQP-1 in the renal CO and OM (ρ = 0.643, P < 0.001; ρ = 0.662, P < 0.001, respectively). ubDWI can be used to non-invasively evaluate early renal IRI, ADCuh may be adopted to reflect AQP-1 expression.
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Affiliation(s)
- Zhaoyu Xing
- Department of Urology, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Liang Pan
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Anding Yu
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jinggang Zhang
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Congsong Dong
- Department of Radiology, Affiliated Hospital 6 of Nantong University (Yancheng Third People's Hospital), Yancheng, China
| | - Jie Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiaozhou He
- Department of Urology, Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
| | - Zhiping Zhang
- Department of Radiology, Affiliated Hospital 6 of Nantong University (Yancheng Third People's Hospital), Yancheng, China.
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Zhang Z, Zha T, Jiang Z, Pan L, Liu Y, Dong C, Chen J, Xing W. Using Ultrahigh b -Value Diffusion-Weighted Imaging to Noninvasively Assess Renal Fibrosis in a Rabbit Model of Renal Artery Stenosis. J Comput Assist Tomogr 2023; 47:713-720. [PMID: 37707400 DOI: 10.1097/rct.0000000000001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to investigate the feasibility of diffusion-weighted imaging with ultrahigh b values ( ub DWI) for the evaluation of renal fibrosis (RF) induced by renal artery stenosis (RAS) in a rabbit model. METHODS Thirty-two rabbits underwent left RAS operation, whereas 8 rabbits received sham surgery. All rabbits underwent ub DWI ( b = 0-4500 s/mm 2 ). The standard apparent diffusion coefficient (ADC st ), molecular diffusion coefficient ( D ), perfusion fraction ( f ), perfusion-related diffusion coefficient ( D *) and ultrahigh apparent diffusion coefficient (ADC uh ) were longitudinally assessed before operation and at weeks 2, 4, and 6 after operation. The degree of interstitial fibrosis and the expression of aquaporin (AQP) 1 and AQP2 were determined through pathological examination. RESULTS In the stenotic kidney, the ADC st , D , f , and ADC uh values of the renal parenchyma significantly decreased compared with those at baseline (all P < 0.05), whereas the D * values significantly increased after RAS induction ( P < 0.05). The ADC st , D , D *, and f were weakly to moderately correlated with interstitial fibrosis as well as with the expression of AQP1 and AQP2. Furthermore, the ADC uh negatively correlated with interstitial fibrosis ( ρ = -0.782, P < 0.001) and positively correlated with AQP1 and AQP2 expression ( ρ = 0.794, P < 0.001, and ρ = 0.789, P < 0.001, respectively). CONCLUSIONS Diffusion-weighted imaging with ultrahigh b values shows the potential for noninvasive assessment of the progression of RF in rabbits with unilateral RAS. The ADC uh derived from ub DWI could reflect the expression of AQPs in RF.
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Affiliation(s)
| | - Tingting Zha
- From the Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Zhenxing Jiang
- From the Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Liang Pan
- From the Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Yang Liu
- Department of Radiology, Yancheng Third People's Hospital, Yancheng, China
| | - Congsong Dong
- Department of Radiology, Yancheng Third People's Hospital, Yancheng, China
| | - Jie Chen
- From the Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Wei Xing
- From the Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou
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Semi-Automatic MRI Feature Assessment in Small- and Medium-Volume Benign Prostatic Hyperplasia after Prostatic Artery Embolization. Diagnostics (Basel) 2022; 12:diagnostics12030585. [PMID: 35328138 PMCID: PMC8946889 DOI: 10.3390/diagnostics12030585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: To assess the treatment response of benign prostatic syndrome (BPS) following prostatic artery embolization (PAE) using a semi-automatic software analysis of magnetic resonance imaging (MRI) features and clinical indexes. (2) Methods: Prospective, monocenter study of MRI and clinical data of n = 27 patients with symptomatic BPS before and (1, 6, 12 months) after PAE. MRI analysis was performed using a dedicated semi-automatic software for segmentation of the central and the total gland (CG, TG), respectively; signal intensities (SIs) of T1-weighted (T1w), T2-weighted (T2w), and diffusion-weighted images (DWI), as well as intravesical prostatic protrusion (IPP) and prostatic volumes (CGV, TGV), were evaluated at each time point. The semi-automatic assessed TGV was compared to conventional TGV by an ellipse formula. International prostate symptom score (IPSS) and international consultation on incontinence questionnaire−urinary incontinence short form (ICIQ-UI SF) questionnaires were used as clinical indexes. Statistical testing in the form of ANOVA, pairwise comparisons using Bonferroni correction, and multiple linear correlations, were conducted using SPSS. (3) Results: TGV was significantly reduced one, six, and 12 months after PAE as assessed by the semi-automatic approach and conventional ellipse formula (p = 0.005; p = 0.025). CGV significantly decreased after one month (p = 0.038), but showed no significant differences six and 12 months after PAE (p = 0.191; p = 0.283). IPP at baseline was demonstrated by 25/27 patients (92.6%) with a significant decrease one, six, and 12 months after treatment (p = 0.028; p = 0.010; p = 0.008). Significant improvement in IPSS and ICIQ-UI SF (p = 0.002; p = 0.016) after one month correlated moderately with TGV reduction (p = 0.031; p = 0.05, correlation coefficients 0.52; 0.69). Apparent diffusion coefficient (ADC) values of CG significantly decreased one month after embolization (p < 0.001), while there were no significant differences in T1w and T2w SIs before and after treatment at each time point. (4) Conclusions: The semi-automatic approach is appropriate for the assessment of volumetric and morphological changes in prostate MRI following PAE, able to identify significantly different ADC values post-treatment without the need for manual identification of infarct areas. Semi-automatic measured TGV reduction is significant and comparable to the TGV calculated by the conventional ellipse formula, confirming the clinical response after PAE.
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Lee CC, Chang KH, Chiu FM, Ou YC, Hwang JI, Hsueh KC, Fan HC. Using IVIM Parameters to Differentiate Prostate Cancer and Contralateral Normal Tissue through Fusion of MRI Images with Whole-Mount Pathology Specimen Images by Control Point Registration Method. Diagnostics (Basel) 2021; 11:diagnostics11122340. [PMID: 34943577 PMCID: PMC8700385 DOI: 10.3390/diagnostics11122340] [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: 11/14/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
The intravoxel incoherent motion (IVIM) model may enhance the clinical value of multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa). However, while past IVIM modeling studies have shown promise, they have also reported inconsistent results and limitations, underscoring the need to further enhance the accuracy of IVIM modeling for PCa detection. Therefore, this study utilized the control point registration toolbox function in MATLAB to fuse T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) MRI images with whole-mount pathology specimen images in order to eliminate potential bias in IVIM calculations. Sixteen PCa patients underwent prostate MRI scans before undergoing radical prostatectomies. The image fusion method was then applied in calculating the patients’ IVIM parameters. Furthermore, MRI scans were also performed on 22 healthy young volunteers in order to evaluate the changes in IVIM parameters with aging. Among the full study cohort, the f parameter was significantly increased with age, while the D* parameter was significantly decreased. Among the PCa patients, the D and ADC parameters could differentiate PCa tissue from contralateral normal tissue, while the f and D* parameters could not. The presented image fusion method also provided improved precision when comparing regions of interest side by side. However, further studies with more standardized methods are needed to further clarify the benefits of the presented approach and the different IVIM parameters in PCa characterization.
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Affiliation(s)
- Cheng-Chun Lee
- Division of Diagnostic Radiology, Department of Medical Imaging, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan; (C.-C.L.); (J.-I.H.)
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan;
- Center for General Education, China Medical University, Taichung 404, Taiwan
- General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
| | - Feng-Mao Chiu
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan;
| | - Jen-I. Hwang
- Division of Diagnostic Radiology, Department of Medical Imaging, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan; (C.-C.L.); (J.-I.H.)
- Department of Radiology, National Defense Medical Center, Taipei 11490, Taiwan
| | - Kuan-Chun Hsueh
- Division of General Surgery, Department of Surgery, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan;
| | - Hueng-Chuen Fan
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan;
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Taichung 43503, Taiwan
- Department of Life Sciences, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Correspondence: ; Tel.: +886-426-581-919 (ext. 4301)
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Bura V, Caglic I, Snoj Z, Sushentsev N, Berghe AS, Priest AN, Barrett T. MRI features of the normal prostatic peripheral zone: the relationship between age and signal heterogeneity on T2WI, DWI, and DCE sequences. Eur Radiol 2021; 31:4908-4917. [PMID: 33398421 PMCID: PMC8213603 DOI: 10.1007/s00330-020-07545-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/30/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the multiparametric MRI (mpMRI) appearances of normal peripheral zone (PZ) across age groups in a biopsy-naïve population, where prostate cancer (PCa) was subsequently excluded, and propose a scoring system for background PZ changes. METHODS This retrospective study included 175 consecutive biopsy-naïve patients (40-74 years) referred with a suspicion of PCa, but with subsequent negative investigations. Patients were grouped by age into categories ≤ 54, 55-59, 60-64, and ≥ 65 years. MpMRI sequences (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC], and dynamic contrast-enhanced imaging [DCE]) were independently evaluated by two uro-radiologists on a proposed 4-point grading scale for background change on each sequence, wherein score 1 mirrored PIRADS-1 change and score 4 represented diffuse background change. Peripheral zone T2WI signal intensity and ADC values were also analyzed for trends relating to age. RESULTS There was a negative correlation between age and assigned background PZ scores for each mpMRI sequence: T2WI: r = - 0.52, DWI: r = - 0.49, DCE: r = - 0.45, p < 0.001. Patients aged ≤ 54 years had mean scores of 3.0 (T2WI), 2.7 (DWI), and 3.1 (DCE), whilst patients ≥ 65 years had significantly lower mean scores of 1.7, 1.4, and 1.9, respectively. There was moderate inter-reader agreement for all scores (range κ = 0.43-0.58). Statistically significant positive correlations were found for age versus normalized T2WI signal intensity (r = 0.2, p = 0.009) and age versus ADC values (r = 0.33, p = 0.001). CONCLUSION The normal PZ in younger patients (≤ 54 years) demonstrates significantly lower T2WI signal intensity, lower ADC values, and diffuse enhancement on DCE, which may hinder diagnostic interpretation in these patients. The proposed standardized PZ background scoring system may help convey the potential for diagnostic uncertainty to clinicians. KEY POINTS • Significant, positive correlations were found between increasing age and higher normalized T2-weighted signal intensity and mean ADC values of the prostatic peripheral zone. • Younger men exhibit lower T2-weighted imaging signal intensity, lower ADC values, and diffuse enhancement on dynamic contrast-enhanced imaging, which may hinder MRI interpretation. • A scoring system is proposed which aims towards a standardized assessment of the normal background PZ. This may help convey the potential for diagnostic uncertainty to clinicians.
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Affiliation(s)
- Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital, Cluj-Napoca, Cluj, Romania
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ziga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Alexandra S Berghe
- Department of Radiology, County Clinical Emergency Hospital, Cluj-Napoca, Cluj, Romania
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK.
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Li M, Guo J, Hu P, Jiang H, Chen J, Hu J, Asbach P, Sack I, Li W. Tomoelastography Based on Multifrequency MR Elastography for Prostate Cancer Detection: Comparison with Multiparametric MRI. Radiology 2021; 299:362-370. [PMID: 33687285 DOI: 10.1148/radiol.2021201852] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Multiparametric MRI is used for depiction of prostate cancer (PCa) but without consideration of the mechanical alteration of prostatic tissue by cancer. Purpose To investigate the diagnostic performance of stiffness and fluidity quantified with tomoelastography, a multifrequency MR elastography technique, for depiction of PCa compared with multiparametric MRI with Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. Materials and Methods Prospective participants suspected to have PCa and healthy controls (HCs) underwent multiparametric MRI and tomoelastography between March 2019 and July 2020. Tomoelastography maps of shear-wave speed (c) and loss angle (φ) quantified stiffness and fluidity, respectively, for PCa and benign prostatic disease and for the peripheral and transition zones in HCs. Differences between entities and regions were analyzed by using analysis of variance or Kruskal-Wallis test. Diagnostic performance was assessed with area under the receiver operating characteristic curve (AUC) analysis. Results There were 73 participants with PCa (mean age, 72 years ± 7 [standard deviation]), 82 with benign prostatic disease (66 years ± 7), and 53 HCs (41 years ± 14). Mean ± standard deviation of c and φ were higher in PCa (3.4 m/sec ± 0.6 and 1.3 radian ± 0.2, respectively) than in benign prostatic disease (2.6 m/sec ± 0.3 and 1.0 radian ± 0.2, respectively; P < .001) and age-matched HCs (2.2 m/sec ± 0.1 and 0.8 radian ± 0.1, respectively; P < .001). Incorporating c and φ (AUC, 0.95; 95% CI: 0.92, 0.98) improved the diagnostic performance of PI-RADS version 2.1 (AUC, 0.85; 95% CI: 0.80, 0.91; P < .001). Multiparametric MRI combined with c and φ enabled detection of PCa with 95% (78 of 82 non-PCa) specificity, which was significantly higher than with use of multiparametric MRI alone (77% [63 of 82 non-PCa]; P < .001). In regional analysis, c combined with φ enabled differentiation of transition zone PCa from benign prostatic hyperplasia (AUC, 0.91; 95% CI: 0.83, 0.98) and peripheral zone PCa from chronic prostatitis (AUC, 0.94; 95% CI: 0.88, 1.00). Conclusion Use of tomoelastography-quantified stiffness and fluidity improved the diagnostic performance of multiparametric MRI with Prostate Imaging Reporting and Data System version 2.1 in detecting cancer in both the peripheral and transition zones. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Hectors and Lewis in this issue. An earlier incorrect version of this article appeared online. This article was corrected on March 24, 2021.
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Affiliation(s)
- Mengsi Li
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
| | - Jing Guo
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
| | - Ping Hu
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
| | - Huichuan Jiang
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
| | - Juan Chen
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
| | - Jiaxi Hu
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
| | - Patrick Asbach
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
| | - Ingolf Sack
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
| | - Wenzheng Li
- From the Departments of Radiology (M.L., P.H., J.C., J.H., W.L.) and Urology (H.J.), Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, 410008 Changsha, Hunan Province, China; and Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.G., P.A., I.S.)
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Wang X, Hielscher T, Radtke JP, Görtz M, Schütz V, Kuder TA, Gnirs R, Schwab C, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D. Comparison of single-scanner single-protocol quantitative ADC measurements to ADC ratios to detect clinically significant prostate cancer. Eur J Radiol 2021; 136:109538. [PMID: 33482592 DOI: 10.1016/j.ejrad.2021.109538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mean ADC has high predictive value for the presence of clinically significant prostate cancer (sPC). Measurement variability is introduced by different scanners, protocols, intra-and inter-patient variation. Internal calibration by ADC ratios can address such fluctuations however can potentially lower the biological value of quantitative ADC determination by being sensitive to deviations in reference tissue signal. PURPOSE To better understand the predictive value of quantitative ADC measurements in comparison to internal reference ratios when measured in a single scanner, single protocol setup. MATERIALS AND METHODS 284 consecutive patients who underwent 3 T MRI on a single scanner followed by MRI-transrectal ultrasound fusion biopsy were included. A board-certified radiologist retrospectively reviewed all MRIs blinded to clinical information and placed regions of interest (ROI) on all focal lesions and the following reference regions: normal-appearing peripheral zone (PZNL) and transition zone (TZNL), the urinary bladder (BLA), and right and left internal obturator muscle (RIOM, LIOM). ROI-based mean ADC and ADC ratios to the reference regions were compared regarding their ability to predict the aggressiveness of prostate cancer. Spearman's rank correlation coefficient was used to estimate the correlation between ADC parameters, Gleason score (GS) and ADC ratios. The primary endpoint was presence of sPC, defined as a GS ≥ 3 + 4. Univariable and multivariable logistic regression models were constructed to predict sPC. Receiver operating characteristics curves (ROC) were used for visualization; DeLong test was used to evaluate the differences of the area under the curve (AUC). Bias-corrected AUC values and corresponding 95 %-CI were calculated using bootstrapping with 100 bootstrap samples. RESULTS After exclusion of patients who received prior treatment, 259 patients were included in the final cohort of which 220 harbored 351 MR lesions. Mean ADC and ADC ratios demonstrated a negative correlation with the GS. Mean ADC had the strongest correlation with ρ of -0.34, followed by ADCratioPZNL (ρ=-0.32). All ADC parameters except ADCratioLIOM (p = 0.07) were associated with sPC p<0.05). Mean ADC and ADCratioPZNL had the highest ROC AUC of all parameters (0.68). Multivariable models with mean ADC improve predictive performance. CONCLUSIONS A highly standardized single-scanner mean ADC measurement could not be improved upon using any of the single ADC ratio parameters or combinations of these parameters in predicting the aggressiveness of prostate cancer.
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Affiliation(s)
- Xianfeng Wang
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiology, Affiliated Hospital of Guilin Medical University, Guangxi, Guilin, PR China
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Philipp Radtke
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Tristan Anselm Kuder
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Regula Gnirs
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany.
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Billdal DC, While PT, Selnaes KM, Sunoqrot MRS, Langørgen S, Bertilsson H, Bathen TF, Elschot M. Relative Enhanced Diffusivity in Prostate Cancer: Protocol Optimization and Diagnostic Potential. J Magn Reson Imaging 2019; 51:1900-1910. [PMID: 31794113 DOI: 10.1002/jmri.27011] [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: 09/20/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Relative enhanced diffusivity (RED) is a potential biomarker for indirectly measuring perfusion in tissue using diffusion-weighted magnetic resonance imaging (MRI) with 3 b values. PURPOSE To optimize the RED MRI protocol for the prostate, and to investigate its potential for prostate cancer (PCa) diagnosis. STUDY TYPE Prospective. POPULATION Ten asymptomatic healthy volunteers and 35 patients with clinical suspicion of PCa. SEQUENCE 3T T2 - and diffusion-weighted MRI with b values: b = 0, 50, [100], 150, [200], 250, [300], 400, 800 s/mm2 (values in brackets were only used for patients). ASSESSMENT Monte Carlo simulations were performed to assess noise sensitivity of RED as a function of intermediate b value. Volunteers were scanned 3 times to assess repeatability of RED. Patient data were used to investigate RED's potential for discriminating between biopsy-confirmed cancer and healthy tissue, and between true and false positive radiological findings. STATISTICAL TESTS Within-subject coefficient of variation (WCV) to assess repeatability and receiver-operating characteristic curve analysis and logistic regression to assess diagnostic performance of RED. RESULTS The repeatability was acceptable (WCV = 0.2-0.3) for all intermediate b values tested, apart from b = 50 s/mm2 (WCV = 0.3-0.4). The simulated RED values agreed well with the experimental data, showing that an intermediate b value between 150-250 s/mm2 minimizes noise sensitivity in both peripheral zone (PZ) and transition zone (TZ). RED calculated with the b values 0, 150 and 800 s/mm2 was significantly higher in tumors than in healthy tissue in both PZ (P < 0.001, area under the curve [AUC] = 0.85) and PZ + TZ (P < 0.001, AUC = 0.84). RED was shown to aid apparent diffusion coefficient (ADC) in differentiating between false-positive findings and true-positive PCa in the PZ (AUC; RED = 0.71, ADC = 0.74, RED+ADC = 0.77). DATA CONCLUSION RED is a repeatable biomarker that may have value for prostate cancer diagnosis. An intermediate b value in the range of 150-250 s/mm2 minimizes the influence of noise and maximizes repeatability. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:1900-1910.
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Affiliation(s)
- Daniel C Billdal
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Peter T While
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kirsten M Selnaes
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mohammed R S Sunoqrot
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sverre Langørgen
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Helena Bertilsson
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tone F Bathen
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mattijs Elschot
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Assessing the Clinical Value of Positive Multiparametric Magnetic Resonance Imaging in Young Men with a Suspicion of Prostate Cancer. Eur Urol Oncol 2019; 4:594-600. [PMID: 31204312 DOI: 10.1016/j.euo.2019.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/29/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a lack of evidence on the ability of magnetic resonance imaging (MRI) of the prostate to detect clinically significant prostate cancer (csPCa) in young patients. OBJECTIVE We hypothesised that the diagnostic performance of MRI for csPCa varies according to patient's age. To address this, we assessed the variation in the csPCa detection rate of MRI targeted biopsy (MRI-TBx) versus systematic random biopsy (SBx) across different patient ages. DESIGN, SETTING, AND PARTICIPANTS We retrospectively identified 930 patients who underwent prostate MRI and subsequent biopsy at two referral centres between 2013 and 2018. The Prostate Imaging Reporting and Data System (PI-RADS) was used for MRI reporting. INTERVENTION A lesion with a PI-RADS score of ≥3 detected at MRI received an MRI-TBx in addition to an SBx during the same session. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The outcome of our study was the relationship between age and csPCa detection rate at MRI-TBx and SBx, respectively. Clinically significant prostate cancer (PCa) was defined as the presence of PCa with Gleason score ≥3+4. Multivariable logistic regression analyses (MVAs) predicting csPCa detection were assessed for both MRI-TBx and SBx. Covariates were age, prostate-specific antigen density, PI-RADS score, previous biopsy status, digital rectal examination, and the number of targeted and systematic cores. The hypothesis that MRI accuracy in detecting csPCa differed by age was finally tested with a nonparametric loess analysis. RESULTS AND LIMITATIONS The overall rate of csPCa was 54% (n=506). Overall, 325 (35%) and 461 (50%) patients had csPCa at SBx and MRI-TBx, respectively. The median numbers of SBx and MRI-TBx cores were 12 (interquartile range [IQR]: 10-13) and 5 (IQR: 4-7), respectively. At MVA, age at biopsy was an independent predictor of csPCa at MRI-TBx only (odds ratio: 1.05), after accounting for confounders. In men aged less than roughly 50yr, SBx had a higher probability of detecting csPCa relative to MRI-TBx (25% vs 16% at 40yr). Conversely, in patients aged >50yr, the probability of csPCa was higher in MRI-TBx than in SBx, reaching the highest difference for very elderly patients (48% vs 68% at 80yr). The main limitations were the retrospective design and the small number of young patients. CONCLUSIONS In this study, we reported the performance of MRI and MRI-TBx in detecting csPCa changes according to patients' age. PATIENT SUMMARY In young patients, the performance of a systematic random biopsy in detecting clinically significant prostate cancer (csPCa) is higher relative to magnetic resonance imaging targeted biopsy (MRI-TBx), reflecting the lower accuracy of MRI in younger men. Conversely, in older patients, MRI-TBx showed a clinical benefit with a higher csPCa detection rate compared with SBx, suggesting an increase of MRI accuracy with the increase of age.
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10
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MRI features after prostatic artery embolization for the treatment of medium- and large-volume benign hyperplasia. Radiol Med 2018; 123:727-734. [PMID: 29752646 DOI: 10.1007/s11547-018-0904-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/02/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To assess magnetic resonance imaging (MRI) features after prostatic artery embolization (PAE) for the treatment of medium- and large-volume benign prostatic hyperplasia and to correlate prostate volume with clinical indexes. METHODS We retrospectively evaluated 28 patients who underwent PAE. MRI examinations of the prostate were performed to evaluate signal intensity changes and the characteristics of infarcted areas. Prostate volume and the apparent diffusion coefficient (ADC) were measured at an average of 10 days post-PAE and at 1, 3, 6, and 12 months post-PAE. Some clinical indexes were evaluated before and 12 months after PAE. The paired t test, ANOVA, and multiple linear correlation analyses were performed by using the statistical software, SPSS. RESULTS All patients experienced prostatic infarction. The prostate volume decreased continuously (p < 0.05). The ADC values before and after 1, 3, 6, or 12 months of embolization (b = 1000 and 2000 s/mm2) were statistically significantly different. The ADC values (b = 3000 s/mm2) were also statistically significantly different before and at each interval time after embolization (p < 0.05). Prostate volume changes correlated significantly with patient age and post-void residual urine volume (p < 0.05). CONCLUSIONS MRI can be used for assessing changes in signal intensity and ADC values of infarction as well as the volume of the prostate after PAE. After PAE, ultrahigh b value diffusion-weighted imaging (DWI) can show early infarction better than lower b value DWI.
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