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Oerther B, Engel H, Nedelcu A, Strecker R, Benkert T, Nickel D, Weiland E, Mayrhofer T, Bamberg F, Benndorf M, Weiß J, Wilpert C. Performance of an ultra-fast deep-learning accelerated MRI screening protocol for prostate cancer compared to a standard multiparametric protocol. Eur Radiol 2024:10.1007/s00330-024-10776-7. [PMID: 38780766 DOI: 10.1007/s00330-024-10776-7] [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: 12/06/2023] [Revised: 02/23/2024] [Accepted: 03/30/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To establish and evaluate an ultra-fast MRI screening protocol for prostate cancer (PCa) in comparison to the standard multiparametric (mp) protocol, reducing scan time and maintaining adequate diagnostic performance. MATERIALS AND METHODS This prospective single-center study included consecutive biopsy-naïve patients with suspected PCa between December 2022 and March 2023. A PI-RADSv2.1 conform mpMRI protocol was acquired in a 3 T scanner (scan time: 25 min 45 sec). In addition, two deep-learning (DL) accelerated sequences (T2- and diffusion-weighted) were acquired, serving as a screening protocol (scan time: 3 min 28 sec). Two readers evaluated image quality and the probability of PCa regarding PI-RADSv2.1 scores in two sessions. The diagnostic performance of the screening protocol with mpMRI serving as the reference standard was derived. Inter- and intra-reader agreements were evaluated using weighted kappa statistics. RESULTS We included 77 patients with 97 lesions (mean age: 66 years; SD: 7.7). Diagnostic performance of the screening protocol was excellent with a sensitivity and specificity of 100%/100% and 89%/98% (cut-off ≥ PI-RADS 4) for reader 1 (R1) and reader 2 (R2), respectively. Mean image quality was 3.96 (R1) and 4.35 (R2) for the standard protocol vs. 4.74 and 4.57 for the screening protocol (p < 0.05). Inter-reader agreement was moderate (κ: 0.55) for the screening protocol and substantial (κ: 0.61) for the multiparametric protocol. CONCLUSION The ultra-fast screening protocol showed similar diagnostic performance and better imaging quality compared to the mpMRI in under 15% of scan time, improving efficacy and enabling the implementation of screening protocols in clinical routine. CLINICAL RELEVANCE STATEMENT The ultra-fast protocol enables examinations without contrast administration, drastically reducing scan time to 3.5 min with similar diagnostic performance and better imaging quality. This facilitates patient-friendly, efficient examinations and addresses the conflict of increasing demand for examinations at currently exhausted capacities. KEY POINTS Time-consuming MRI protocols are in conflict with an expected increase in examinations required for prostate cancer screening. An ultra-fast MRI protocol shows similar performance and better image quality compared to the standard protocol. Deep-learning acceleration facilitates efficient and patient-friendly examinations, thus improving prostate cancer screening capacity.
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Affiliation(s)
- B Oerther
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
| | - H Engel
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - A Nedelcu
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - R Strecker
- MR Application Predevelopment, Siemens Healthineers GmbH, Erlangen, Germany
- EMEA Scientific Partnerships, Siemens Healthineers GmbH, Erlangen, Germany
| | - T Benkert
- MR Application Predevelopment, Siemens Healthineers GmbH, Erlangen, Germany
| | - D Nickel
- MR Application Predevelopment, Siemens Healthineers GmbH, Erlangen, Germany
| | - E Weiland
- MR Application Predevelopment, Siemens Healthineers GmbH, Erlangen, Germany
| | - T Mayrhofer
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - F Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - M Benndorf
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - J Weiß
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - C Wilpert
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Simon BD, Merriman KM, Harmon SA, Tetreault J, Yilmaz EC, Blake Z, Merino MJ, An JY, Marko J, Law YM, Gurram S, Wood BJ, Choyke PL, Pinto PA, Turkbey B. Automated Detection and Grading of Extraprostatic Extension of Prostate Cancer at MRI via Cascaded Deep Learning and Random Forest Classification. Acad Radiol 2024:S1076-6332(24)00220-4. [PMID: 38670874 DOI: 10.1016/j.acra.2024.04.011] [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: 03/06/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
RATIONALE AND OBJECTIVES Extraprostatic extension (EPE) is well established as a significant predictor of prostate cancer aggression and recurrence. Accurate EPE assessment prior to radical prostatectomy can impact surgical approach. We aimed to utilize a deep learning-based AI workflow for automated EPE grading from prostate T2W MRI, ADC map, and High B DWI. MATERIAL AND METHODS An expert genitourinary radiologist conducted prospective clinical assessments of MRI scans for 634 patients and assigned risk for EPE using a grading technique. The training set and held-out independent test set consisted of 507 patients and 127 patients, respectively. Existing deep-learning AI models for prostate organ and lesion segmentation were leveraged to extract area and distance features for random forest classification models. Model performance was evaluated using balanced accuracy, ROC AUCs for each EPE grade, as well as sensitivity, specificity, and accuracy compared to EPE on histopathology. RESULTS A balanced accuracy score of .390 ± 0.078 was achieved using a lesion detection probability threshold of 0.45 and distance features. Using the test set, ROC AUCs for AI-assigned EPE grades 0-3 were 0.70, 0.65, 0.68, and 0.55 respectively. When using EPE≥ 1 as the threshold for positive EPE, the model achieved a sensitivity of 0.67, specificity of 0.73, and accuracy of 0.72 compared to radiologist sensitivity of 0.81, specificity of 0.62, and accuracy of 0.66 using histopathology as the ground truth. CONCLUSION Our AI workflow for assigning imaging-based EPE grades achieves an accuracy for predicting histologic EPE approaching that of physicians. This automated workflow has the potential to enhance physician decision-making for assessing the risk of EPE in patients undergoing treatment for prostate cancer due to its consistency and automation.
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Affiliation(s)
- Benjamin D Simon
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.); Institute of Biomedical Engineering, Department Engineering Science, University of Oxford, UK (B.D.S.)
| | - Katie M Merriman
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.)
| | - Stephanie A Harmon
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.)
| | | | - Enis C Yilmaz
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.)
| | - Zoë Blake
- Urology Oncology Branch, NCI, NIH, Bethesda, Maryland, USA (Z.B., S.G., P.A.P.)
| | - Maria J Merino
- Laboratory of Pathology, NCI, NIH, Bethesda, Maryland, USA (M.J.M.)
| | - Julie Y An
- Department of Radiology, University of California, San Diego, California, USA (J.Y.A.)
| | - Jamie Marko
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA (J.M.)
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore (Y.M.L.)
| | - Sandeep Gurram
- Urology Oncology Branch, NCI, NIH, Bethesda, Maryland, USA (Z.B., S.G., P.A.P.)
| | - Bradford J Wood
- Center for Interventional Oncology, NCI, NIH, Bethesda, Maryland, USA (B.J.W.); Department of Radiology, Clinical Center, NIH, Bethesda, Maryland, USA (B.J.W.)
| | - Peter L Choyke
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.)
| | - Peter A Pinto
- Urology Oncology Branch, NCI, NIH, Bethesda, Maryland, USA (Z.B., S.G., P.A.P.)
| | - Baris Turkbey
- Molecular Imaging Branch, NCI, NIH, Bethesda, Maryland, USA (B.D.S., K.M.M., S.A.H., E.C.Y., P.L.C., B.T.).
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Kim M, Kim SH, Hong S, Kim YJ, Kim HR, Kim JY. Evaluation of Extra-Prostatic Extension on Deep Learning-Reconstructed High-Resolution Thin-Slice T2-Weighted Images in Patients with Prostate Cancer. Cancers (Basel) 2024; 16:413. [PMID: 38254901 PMCID: PMC10814256 DOI: 10.3390/cancers16020413] [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: 12/15/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
The aim of this study was to compare diagnostic performance for extra-prostatic extension (EPE) and image quality among three image datasets: conventional T2-weighted images (T2WIconv, slice thickness, 3 mm) and high-resolution thin-slice T2WI (T2WIHR, 2 mm), with and without deep learning reconstruction (DLR) in patients with prostatic cancer (PCa). A total of 88 consecutive patients (28 EPE-positive and 60 negative) diagnosed with PCa via radical prostatectomy who had undergone 3T-MRI were included. Two independent reviewers performed a crossover review in three sessions, in which each reviewer recorded five-point confidence scores for the presence of EPE and image quality using a five-point Likert scale. Pathologic topographic maps served as the reference standard. For both reviewers, T2WIconv showed better diagnostic performance than T2WIHR with and without DLR (AUCs, in order, for reviewer 1, 0.883, 0.806, and 0.772, p = 0.0006; for reviewer 2, 0.803, 0.762, and 0.745, p = 0.022). The image quality was also the best in T2WIconv, followed by T2WIHR with DLR and T2WIHR without DLR for both reviewers (median, in order, 3, 4, and 5, p < 0.0001). In conclusion, T2WIconv was optimal in regard to image quality and diagnostic performance for the evaluation of EPE in patients with PCa.
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Affiliation(s)
- Mingyu Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Seung Ho Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Sujin Hong
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Yeon Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Hye Ri Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Joo Yeon Kim
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
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Mingels C, Loebelenz LI, Huber AT, Alberts I, Rominger A, Afshar-Oromieh A, Obmann VC. Literature review: Imaging in prostate cancer. Curr Probl Cancer 2023:100968. [PMID: 37336689 DOI: 10.1016/j.currproblcancer.2023.100968] [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: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
Imaging plays an increasingly important role in the detection and characterization of prostate cancer (PC). This review summarizes the key conventional and advanced imaging modalities including multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging and tries to instruct clinicians in finding the best image modality depending on the patient`s PC-stage. We aim to give an overview of the different image modalities and their benefits and weaknesses in imaging PC. Emphasis is put on primary prostate cancer detection and staging as well as on recurrent and castration resistant prostate cancer. Results from studies using various imaging techniques are discussed and compared. For the different stages of PC, advantages and disadvantages of the different imaging modalities are discussed. Moreover, this review aims to give an outlook about upcoming, new imaging modalities and how they might be implemented in the future into clinical routine. Imaging patients suffering from PC should aim for exact diagnosis, accurate detection of PC lesions and should mirror the true tumor burden. Imaging should lead to the best patient treatment available in the current PC-stage and should avoid unnecessary therapeutic interventions. New image modalities such as long axial field of view PET/CT with photon-counting CT and radiopharmaceuticals like androgen receptor targeting radiopharmaceuticals open up new possibilities. In conclusion, PC imaging is growing and each image modality is aiming for improvement.
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Affiliation(s)
- Clemens Mingels
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Laura I Loebelenz
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
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Teică RV, Șerbănescu MS, Florescu LM, Gheonea IA. Tumor Area Highlighting Using T2WI, ADC Map, and DWI Sequence Fusion on bpMRI Images for Better Prostate Cancer Diagnosis. Life (Basel) 2023; 13:life13040910. [PMID: 37109440 PMCID: PMC10146015 DOI: 10.3390/life13040910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Prostate cancer is the second most common cancer in men worldwide. The results obtained in magnetic resonance imaging examinations are used to decide the indication, type, and location of a prostate biopsy and contribute information about the characterization or aggressiveness of detected cancers, including tumor progression over time. This study proposes a method to highlight prostate lesions with a high and very high risk of being malignant by overlaying a T2-weighted image, apparent diffusion coefficient map, and diffusion-weighted image sequences using 204 pairs of slices from 80 examined patients. It was reviewed by two radiologists who segmented suspicious lesions and labeled them according to the prostate imaging-reporting and data system (PI-RADS) score. Both radiologists found the algorithm to be useful as a “first opinion”, and they gave an average score on the quality of the highlight of 9.2 and 9.3, with an agreement of 0.96.
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Yuan J, Poon DMC, Lo G, Wong OL, Cheung KY, Yu SK. A narrative review of MRI acquisition for MR-guided-radiotherapy in prostate cancer. Quant Imaging Med Surg 2022; 12:1585-1607. [PMID: 35111651 PMCID: PMC8739116 DOI: 10.21037/qims-21-697] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 08/24/2023]
Abstract
Magnetic resonance guided radiotherapy (MRgRT), enabled by the clinical introduction of the integrated MRI and linear accelerator (MR-LINAC), is a novel technique for prostate cancer (PCa) treatment, promising to further improve clinical outcome and reduce toxicity. The role of prostate MRI has been greatly expanded from the traditional PCa diagnosis to also PCa screening, treatment and surveillance. Diagnostic prostate MRI has been relatively familiar in the community, particularly with the development of Prostate Imaging - Reporting and Data System (PI-RADS). But, on the other hand, the use of MRI in the emerging clinical practice of PCa MRgRT, which is substantially different from that in PCa diagnosis, has been so far sparsely presented in the medical literature. This review attempts to give a comprehensive overview of MRI acquisition techniques currently used in the clinical workflows of PCa MRgRT, from treatment planning to online treatment guidance, in order to promote MRI practice and research for PCa MRgRT. In particular, the major differences in the MRI acquisition of PCa MRgRT from that of diagnostic prostate MRI are demonstrated and explained. Limitations in the current MRI acquisition for PCa MRgRT are analyzed. The future developments of MRI in the PCa MRgRT are also discussed.
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Affiliation(s)
- Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Darren M. C. Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Gladys Lo
- Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Oi Lei Wong
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Kin Yin Cheung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Siu Ki Yu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
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7
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Cha SY, Kim E, Park SY. Why Is a b-value Range of 1500-2000 s/mm² Optimal for Evaluating Prostatic Index Lesions on Synthetic Diffusion-Weighted Imaging? Korean J Radiol 2021; 22:922-930. [PMID: 33660462 PMCID: PMC8154789 DOI: 10.3348/kjr.2020.0836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/20/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Objective It is uncertain why a b-value range of 1500–2000 s/mm2 is optimal. This study was aimed at qualitatively and quantitatively analyzing the optimal b-value range of synthetic diffusion-weighted imaging (sDWI) for evaluating prostatic index lesions. Materials and Methods This retrospective study included 92 patients who underwent DWI and targeted biopsy for magnetic resonance imaging (MRI)-suggested index lesions. We generated sDWI at a b-value range of 1000–3000 s/mm2 using dedicated software and true DWI data at b-values of 0, 100, and 1000 s/mm2. We hypothesized that lesion conspicuity would be best when the background (i.e., MRI-suggested benign prostatic [bP] and periprostatic [pP] regions) signal intensity (SI) is suppressed and becomes homogeneous. To prove this hypothesis, we performed both qualitative and quantitative analyses. For qualitative analysis, two independent readers analyzed the b-value showing the best visual conspicuity of an MRI-suggested index lesion. For quantitative analysis, the readers assessed the b-value showing the same bP and pP region SI. The 95% confidence interval (CI) or interquartile range of qualitatively and quantitatively selected optimal b-values was assessed, and the mean difference between qualitatively and quantitatively selected b-values was investigated. Results The 95% CIs of optimal b-values from qualitative and quantitative analyses were 1761–1805 s/mm2 and 1640–1771 s/mm2 (median, 1790 s/mm2 vs. 1705 s/mm2; p = 0.003) for reader 1, and 1835–1895 s/mm2 and 1705–1841 s/mm2 (median, 1872 s/mm2 vs. 1763 s/mm2; p = 0.022) for reader 2, respectively. Interquartile ranges of qualitatively and quantitatively selected optimal b-values were 1735–1873 s/mm2 and 1573–1867 s/mm2 for reader 1, and 1775–1945 s/mm2 and 1591–1955 s/mm2 for reader 2, respectively. Bland–Altman plots consistently demonstrated a mean difference of less than 100 s/mm2 between qualitatively and quantitatively selected optimal b-values. Conclusion b-value range showing a homogeneous background signal may be optimal for evaluating prostatic index lesions on sDWI. Our qualitative and quantitative data consistently recommend b-values of 1500–2000 s/mm2.
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Affiliation(s)
- So Yeon Cha
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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8
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Prostate MRI: Practical guidelines for interpreting and reporting according to PI-RADS version 2.1. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Sánchez-Oro R, Nuez JT, Martínez-Sanz G, Ortega QG, Bleila M. Prostate MRI: practical guidelines for interpreting and reporting according to PI-RADS version 2.1. RADIOLOGIA 2020; 62:437-451. [PMID: 33268134 DOI: 10.1016/j.rx.2020.09.001] [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: 04/18/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
The increasing precision of multiparametric magnetic resonance imaging of the prostate, together with greater experience and standardization in its interpretation, has given this technique an important role in the management of prostate cancer, the most prevalent non-cutaneous cancer in men. This article reviews the concepts in PI-RADS version 2.1 for estimating the probability and zonal location of significant tumors of the prostate, using a practical approach that includes current considerations about the prerequisites for carrying out the test and recommendations for interpreting the findings. It emphasizes benign findings that can lead to confusion and the criteria for evaluating the probability of local spread, which must be included in the structured report.
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Affiliation(s)
- R Sánchez-Oro
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España.
| | - J Torres Nuez
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - G Martínez-Sanz
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - Q Grau Ortega
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
| | - M Bleila
- Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, España
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Gündoğdu E, Emekli E, Kebapçı M. Evaluation of relationships between the final Gleason score, PI-RADS v2 score, ADC value, PSA level, and tumor diameter in patients that underwent radical prostatectomy due to prostate cancer. Radiol Med 2020; 125:827-837. [PMID: 32266690 DOI: 10.1007/s11547-020-01183-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study aimed to investigate the relationship between the serum PSA level, Gleason score (GS), PI-RADS v2 score, tumor ADCmin value, and the largest tumor diameter in patients that underwent radical prostatectomy (RP) due to prostate cancer (PCa) and to comparatively evaluate the variables of these parameters in clinically significant and insignificant PCa groups. MATERIALS AND METHODS The mpMRI examinations of the patients who underwent RP due to PCa were retrospectively evaluated. According to the final GS, the lesions were divided into two groups as clinically significant (GS ≥ 7) and insignificant (GS ≤ 6). The PSA value, tumor ADCmin value, tumor diameter, and PI-RADS score were compared between the clinically significant and nonsignificant PCa groups using Student's t-test. The correlations between the serum PSA level, GS, PI-RADS v2 score, tumor ADCmin value, and tumor diameter were evaluated separately (Pearson's correlation analysis was used for peripheral gland tumors, and Spearman's correlation analysis for central gland tumors). A ROC analysis was undertaken to evaluate the efficacy of the tumor ADCmin, diameter and PSA values in differentiating clinically significant and nonsignificant tumors. RESULTS In both central and peripheral gland tumors, there was a correlation between the PSA level, tumor diameter, PI-RADS score, ADCmin value, and GS at various levels (poor, moderate, and high). In central gland tumors, there was no significant difference between the two groups in terms of the PSA value and PI-RADS scores (p > 0.05), but the ADCmin value and diameter of the tumor significantly differed (p < 0.05). For peripheral gland tumors, significant differences were observed in all parameters (p < 0.05). The cut-off values for the peripheral and central gland tumors are as follows: lesion diameter, 13.5 mm and 19 mm; tumor ADCmin, 0.709 × 10-3 mm2/s and 0.874 × 10-3 mm2/s; and PSA level, 8.47 ng/ml and 11.10 ng/ml, respectively. CONCLUSION The current PI-RADS v2 scoring system can be inadequate in distinguishing clinically significant and insignificant groups in central gland tumors. A separate cut-off value of the tumor diameter should be determined for central and peripheral gland tumors. Tumor ADCmin values can be used as a predictive parameter. The PSA cut-off value should be kept lower in peripheral gland tumors.
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Affiliation(s)
- Elif Gündoğdu
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey.
| | - Emre Emekli
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey
| | - Mahmut Kebapçı
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey
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Persistent Discordance in Grade, Stage, and NCCN Risk Stratification in Men Undergoing Targeted Biopsy and Radical Prostatectomy. Urology 2020; 135:117-123. [DOI: 10.1016/j.urology.2019.07.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022]
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12
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Sze C, Tsivian E, Tay KJ, Schulman AA, Davis LG, Gupta RT, Polascik TJ. Anterior gland focal cryoablation: proof-of-concept primary prostate cancer treatment in select men with localized anterior cancers detected by multi-parametric magnetic resonance imaging. BMC Urol 2019; 19:127. [PMID: 31805908 PMCID: PMC6896720 DOI: 10.1186/s12894-019-0562-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022] Open
Abstract
Background Due to their location away from the nerve bundles, anterior prostate cancers (APC) represent a rational target for image-guided cryoablation. This report describes the feasibility and short-term outcomes of anterior focal cryosurgery. Methods A retrospective review between 2012 and 2016 of patients with clinically localized APC treated with anterior gland cryoablation was performed. Descriptive statistics were used to report: age, PSA, prostate volume, prostate cancer grade group (PGG), median time to follow-up, and changes in functional status measured with the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) score. Results A total of 17 patients underwent anterior focal cryoablation with a median follow-up of 15 months. Median age and PSA at diagnosis were 67 years and 8.7 ng/mL. Pre-operative PGG1 was identified in 12 (71%) men and PGG2 in 5 (29%) men. Median (IQR) lesion volume was 2 mL(0.86, 3.1). Preoperative median IIEF-5 and IPSS scores were 19.5 and 5, and decreased to 19 and 4, post-operatively. All patients remained continent with no change in sexual function. All post-procedure targeted biopsies of the treated cancers were negative. Conclusion Our pilot study demonstrates the feasibility of treating APCs with image-guided targeted focal cryoablation as a good balance between short-term oncologic control and near complete preservation of genitourinary function. Further follow-up is necessary to examine the potential benefits long-term.
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Affiliation(s)
- Christina Sze
- Urologic Surgery, Duke University Medical Center and the Duke Cancer Institute, Durham, NC, USA. .,Division of Urology, Department of Surgery, Duke University Medical Center, Box 2804, Yellow Zone, Durham, NC, 27710, USA.
| | - Efrat Tsivian
- Urologic Surgery, Duke University Medical Center and the Duke Cancer Institute, Durham, NC, USA
| | - Kae Jack Tay
- Urologic Surgery, Duke University Medical Center and the Duke Cancer Institute, Durham, NC, USA.,Singapore General Hospital, Singapore, Singapore
| | - Ariel A Schulman
- Urologic Surgery, Duke University Medical Center and the Duke Cancer Institute, Durham, NC, USA
| | - Leah G Davis
- Urologic Surgery, Duke University Medical Center and the Duke Cancer Institute, Durham, NC, USA
| | - Rajan T Gupta
- Urologic Surgery, Duke University Medical Center and the Duke Cancer Institute, Durham, NC, USA.,Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Thomas J Polascik
- Urologic Surgery, Duke University Medical Center and the Duke Cancer Institute, Durham, NC, USA
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13
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Vidya Shankar R, Roccia E, Cruz G, Neji R, Botnar R, Prezzi D, Goh V, Prieto C, Dregely I. Accelerated 3D T 2 w-imaging of the prostate with 1-millimeter isotropic resolution in less than 3 minutes. Magn Reson Med 2019; 82:721-731. [PMID: 31006906 PMCID: PMC6563534 DOI: 10.1002/mrm.27764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/15/2019] [Accepted: 03/16/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To achieve 3D T2 w imaging of the prostate with 1-mm isotropic resolution in less than 3 min. METHODS We devised and implemented a 3D T2 -prepared multishot balanced steady state free precession (T2 prep-bSSFP) acquisition sequence with a variable density undersampled trajectory combined with a total variation regularized iterative SENSE (TV-SENSE) reconstruction. Prospectively undersampled images of the prostate (acceleration factor R = 3) were acquired in 11 healthy subjects in an institutional review board-approved study. Image quality metrics (subjective signal-to-noise ratio, contrast, sharpness, and overall prostate image quality) were evaluated by 2 radiologists. Scores of the proposed accelerated sequence were compared using the Wilcoxon signed-rank and Kruskal-Wallis non-parametric tests to prostate images acquired using a fully sampled 3D T2 prep-bSSFP acquisition, and with clinical standard 2D and 3D turbo spin echo (TSE) T2 w acquisitions. A P-value < 0.05 was considered significant. RESULTS The 3× accelerated 3D T2 prep-bSSFP images required a scan time (min:s) of 2:45, while the fully sampled 3D T2 prep-bSSFP and clinical standard 3D TSE images were acquired in 8:23 and 7:29, respectively. Image quality scores (contrast, sharpness, and overall prostate image quality) of the accelerated 3D T2 prep-bSSFP, fully sampled T2 prep-bSSFP, and clinical standard 3D TSE acquisitions along all 3 spatial dimensions were not significantly different (P > 0.05). CONCLUSION 3D T2 w images of the prostate with 1-mm isotropic resolution can be acquired in less than 3 min, with image quality that is comparable to a clinical standard 3D TSE sequence but only takes a third of the acquisition time.
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Affiliation(s)
- Rohini Vidya Shankar
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
| | - Elisa Roccia
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
| | - Gastao Cruz
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
- MR Research Collaborations, Siemens Healthcare LimitedFrimleyUnited Kingdom
| | - René Botnar
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
| | - Davide Prezzi
- Department of RadiologyGuy's and St Thomas' Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Vicky Goh
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
- Department of RadiologyGuy's and St Thomas' Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
| | - Isabel Dregely
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
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14
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Implementation of a 5-Minute Magnetic Resonance Imaging Screening Protocol for Prostate Cancer in Men With Elevated Prostate-Specific Antigen Before Biopsy. Invest Radiol 2019; 53:186-190. [PMID: 29077588 DOI: 10.1097/rli.0000000000000427] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The aims of this study were to establish a 5-minute magnetic resonance (MR) screening protocol for prostate cancer in men before biopsy and to evaluate effects on Prostate Imaging Reporting and Data System (PI-RADS) V2 scoring in comparison to a conventional, fully diagnostic multiparametric MR imaging (mpMRI) approach. MATERIALS AND METHODS Fifty-two patients with elevated prostate-specific antigen levels and without prior biopsy were prospectively included in this institutional review board-approved study. In all patients, an mpMRI protocol according to the PI-RADS recommendations was acquired on a 3 T MRI system. In addition, an accelerated diffusion-weighted imaging sequence was acquired using simultaneous multislice technique (DW-EPISMS). Two readers independently evaluated the images for the presence/absence of prostate cancer according to the PI-RADS criteria and for additional findings. In a first reading session, only the screening protocol consisting of axial T2-weighted and DW-EPISMS images was made available. In a subsequent reading session, the mpMRI protocol was assessed blinded to the results of the first reading, serving as reference standard. RESULTS Both readers successfully established a final diagnosis according to the PI-RADS criteria in the screening and mpMRI protocol. Mean lesion size was 1.2 cm in the screening and 1.4 cm in the mpMRI protocol (P = 0.4) with 35% (18/52) of PI-RADS IV/V lesions. Diagnostic performance of the screening protocol was excellent with a sensitivity and specificity of 100% for both readers with no significant differences in comparison to the mpMRI standard (P = 1.0). In 3 patients, suspicious lymph nodes were reported as additional finding, which were equally detectable in the screening and mpMRI protocol. CONCLUSIONS A 5-minute MR screening protocol for prostate cancer in men with elevated prostate-specific antigen levels before biopsy is applicable for clinical routine with similar diagnostic performance as the full diagnostic mpMRI approach.
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15
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Gholizadeh N, Fuangrod T, Greer PB, Lau P, Ramadan S, Simpson J. An inter-centre statistical scale standardisation for quantitatively evaluating prostate tissue on T2-weighted MRI. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:137-147. [PMID: 30637607 DOI: 10.1007/s13246-019-00720-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/04/2019] [Indexed: 12/28/2022]
Abstract
Magnetic resonance images (MRI) require intensity standardisation if they are used for the purpose of quantitative analysis as inherent variations in image intensity levels between different image sets are manifest due to technical factors. One approach is to standardise the image intensity values using a statistically applied biological reference tissue. The aim of this study is to compare the performance of differing candidate biological reference tissues for standardising T2WI intensity distributions. Fifty-one prostate cancer patients across two centres with different scanners were evaluated using the percentage interpatient coefficient of variation (%interCV) for four different biological references; femoral bone marrow, ischioanal fossa, obturator-internus muscle and bladder urine. The tissue with the highest reproducibility (lowest %interCV) in both centres was used for intensity standardisation of prostate T2WI using three different statistical measures (mean, Z-score, median + Interquartile Range). The performance of different standardisation methods was evaluated from the assessment of image intensity histograms and the percentage normalised root mean square error (%NRSME) of the healthy peripheral zone tissue. Ischioanal fossa as a reference tissue demonstrated the highest reproducibility with %interCV of 18.9 for centre1 and 11.2 for centre2. Using ischioanal fossa for statistical intensity standardisation and the median + Interquartile Range method demonstrated the lowest %NRMSE across centres for healthy peripheral zone tissues. This study demonstrates ischioanal fossa as a preferred reference tissue for standardising intensity values from T2WI of the prostate. Subsequent image standardisation using the median + Interquartile Range intensity of the reference tissue demonstrated a robust and reliable standardisation method for quantitative image assessment.
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Affiliation(s)
- Neda Gholizadeh
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia.
| | - Todsaporn Fuangrod
- School of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Peter B Greer
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, Newcastle, NSW, Australia.,School of Physics and Mathematics, University Of Newcastle, Callaghan, Newcastle, NSW, Australia
| | - Peter Lau
- Imaging Centre, Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia.,Department of Radiology, Calvary Mater Newcastle, Waratah, Newcastle, NSW, 2310, Australia
| | - Saadallah Ramadan
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia.,Imaging Centre, Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - John Simpson
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, Newcastle, NSW, Australia.,School of Physics and Mathematics, University Of Newcastle, Callaghan, Newcastle, NSW, Australia
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16
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Park SY, Cho NH, Jung DC, Oh YT. Prostate Imaging-Reporting and Data System Version 2: Beyond Prostate Cancer Detection. Korean J Radiol 2018. [PMID: 29520176 PMCID: PMC5840047 DOI: 10.3348/kjr.2018.19.2.193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The main purpose of Prostate Imaging-Reporting and Data System Version 2 (PI-RADSv2) is to effectively detect clinically significant prostate cancers (csPCa) using multiparametric magnetic resonance imaging. Since the first introduction of PI-RADSv2, researchers have validated its diagnostic performance in identifying csPCa, and these promising data have influenced biopsy and treatment schemes. However, in this article, we focused on the potential of PI-RADSv2 in relation to various aspects of PCa such as Gleason score, tumor volume, extraprostatic extension, lymph node metastasis, and postoperative biochemical recurrence, beyond prostate cancer detection.
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Affiliation(s)
- Sung Yoon Park
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dae Chul Jung
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Taik Oh
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
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17
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Abstract
Prostate cancer is the most common male malignant tumor in Germany, which thus places growing demands on differentiated imaging and risk-adapted therapeutic approaches. Multiparametric MRI (mpMRI) of the prostate enables reliable detection of clinically significant cancers and is currently the leading imaging modality for the detection, characterization, and local staging of prostate cancer. According to the German S3 guideline, mpMRI of the prostate is currently primarily recommended in patients with previous negative TRUS biopsies and persisting tumor suspicion. The serial use of mpMRI in the pretherapeutic setting can support individual therapy planning of patients with locally advanced prostate cancer in the near future.
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18
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Silverman SG, Megibow AJ, Fletcher JG. Society of Abdominal Radiology Disease-Focused Panel Program: rationale for its genesis and status report. Abdom Radiol (NY) 2017; 42:2033-2036. [PMID: 28349224 DOI: 10.1007/s00261-017-1115-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
| | - Alec J Megibow
- Department of Radiology, New York University School of Medicine, New York, NY, USA
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19
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Nörenberg D, Solyanik O, Schlenker B, Magistro G, Ertl-Wagner B, Clevert DA, Stief C, Reiser MF, D'Anastasi M. [MRI of the prostate]. Urologe A 2017; 56:665-677. [PMID: 28424829 DOI: 10.1007/s00120-017-0378-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
New clinical and technological advances in the field of magnetic resonance imaging (MRI) and targeted image-guided biopsy techniques have significantly improved the detection, localization and staging as well as active surveillance of prostate cancer in recent years. Multiparametric MRI (mpMRI) is currently the main imaging technique for the detection, characterization and diagnostics of metastasizing prostate cancer and is of high diagnostic importance for local staging within the framework of the detection of prostate cancer.
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Affiliation(s)
- D Nörenberg
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland.
| | - O Solyanik
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
| | - B Schlenker
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - G Magistro
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - B Ertl-Wagner
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
| | - D A Clevert
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
| | - C Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - M F Reiser
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
| | - M D'Anastasi
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
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20
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Sayyid R, Perlis N, Ahmad A, Evans A, Toi A, Horrigan M, Finelli A, Zlotta A, Kulkarni G, Hamilton R, Morash C, Fleshner N. Development and external validation of a biopsy-derived nomogram to predict risk of ipsilateral extraprostatic extension. BJU Int 2017; 120:76-82. [DOI: 10.1111/bju.13733] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rashid Sayyid
- Department of Surgical Oncology; University Health Network; University of Toronto; Toronto ON Canada
| | - Nathan Perlis
- Department of Surgical Oncology; University Health Network; University of Toronto; Toronto ON Canada
| | - Ardalanejaz Ahmad
- Department of Surgical Oncology; University Health Network; University of Toronto; Toronto ON Canada
| | - Andrew Evans
- Department of Pathology; Division of Urology; University Health Network; University of Toronto; Toronto ON Canada
| | - Ants Toi
- Joint Department of Medical Imaging; University Health Network; University of Toronto; Toronto ON Canada
| | | | - Antonio Finelli
- Department of Surgical Oncology; University Health Network; University of Toronto; Toronto ON Canada
| | - Alexandre Zlotta
- Department of Surgical Oncology; University Health Network; University of Toronto; Toronto ON Canada
| | - Girish Kulkarni
- Department of Surgical Oncology; University Health Network; University of Toronto; Toronto ON Canada
| | - Robert Hamilton
- Department of Surgical Oncology; University Health Network; University of Toronto; Toronto ON Canada
| | | | - Neil Fleshner
- Department of Surgical Oncology; University Health Network; University of Toronto; Toronto ON Canada
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