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Gao M, Li S, Yuan G, Qu W, He K, Liao Z, Yin T, Chen W, Chu Q, Li Z. Exploring the value of arterial spin labeling and six diffusion MRI models in differentiating solid benign and malignant renal tumors. Eur Radiol Exp 2024; 8:135. [PMID: 39636532 PMCID: PMC11621297 DOI: 10.1186/s41747-024-00537-y] [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: 08/05/2024] [Accepted: 11/12/2024] [Indexed: 12/07/2024] Open
Abstract
OBJECTIVE To explore the value of three-dimensional arterial spin labeling (ASL) and six diffusion magnetic resonance imaging (MRI) models in differentiating solid benign and malignant renal tumors. METHODS This retrospective study included 89 patients with renal tumors. All patients underwent ASL and ZOOMit diffusion-weighted imaging (DWI) examinations and were divided into three groups: clear cell renal cell carcinoma (ccRCC), non-ccRCC, and benign renal tumors (BRT). The mean and peak renal blood flow (RBFmean and RBFpeak) from ASL and fourteen diffusion parameters from mono-exponential DWI (Mono_DWI), intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI), stretched exponential model (SEM), fractional order calculus (FROC), and continuous-time random-walk (CTRW) model were analyzed. Binary logistic regression was used to determine the optimal parameter combinations. The diagnostic performance of various MRI-derived parameters and their combinations was compared. RESULTS Among the six diffusion models, the SEM model achieved the highest performance in differentiating ccRCC from non-ccRCC (area under the receiver operating characteristic curve [AUC] 0.880) and from BRT (AUC 0.891). IVIM model achieved the highest AUC (0.818) in differentiating non-ccRCC from BRT. Among all the MRI-derived parameters, RBFpeak combined with DKI_MK yielded the highest AUC (0.970) in differentiating ccRCC from non-ccRCC, and the combination of RBFpeak, SEM_DDC, and FROC_μ yielded the highest AUC (0.992) for differentiating ccRCC from BRT. CONCLUSION ASL and all diffusion models showed similar diagnostic performance in differentiating ccRCC from non-ccRCC or BRT, while the IVIM model performed better in distinguishing non-ccRCC from BRT. Combining ASL with diffusion models can provide additional value in predicting ccRCC. RELEVANCE STATEMENT Considering the increasing detection rate of incidental renal masses, accurate discrimination of benign and malignant renal tumors is crucial for decision-making. Combining ASL with diffusion MRI models offers a promising solution to this clinical issue. KEY POINTS All assessed models were effective for differentiating ccRCC from non-ccRCC or BRT. ASL and all diffusion models showed similar performance in differentiating ccRCC from non-ccRCC or BRT. Combining ASL with diffusion models significantly improved diagnostic efficacy in predicting ccRCC. IVIM model could better differentiate non-ccRCC from BRT.
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Affiliation(s)
- Mengmeng Gao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weinuo Qu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhouyan Liao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Yin
- MR Research Collaboration Team, Siemens Healthineers Ltd, Chengdu, China
| | - Wei Chen
- MR Research Collaboration Team, Siemens Healthineers Ltd, Wuhan, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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2
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Mir N, Fransen SJ, Wolterink JM, Fütterer JJ, Simonis FFJ. Recent Developments in Speeding up Prostate MRI. J Magn Reson Imaging 2024; 60:813-826. [PMID: 37982353 DOI: 10.1002/jmri.29108] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/21/2023] Open
Abstract
The increasing incidence of prostate cancer cases worldwide has led to a tremendous demand for multiparametric MRI (mpMRI). In order to relieve the pressure on healthcare, reducing mpMRI scan time is necessary. This review focuses on recent techniques proposed for faster mpMRI acquisition, specifically shortening T2W and DWI sequences while adhering to the PI-RADS (Prostate Imaging Reporting and Data System) guidelines. Speeding up techniques in the reviewed studies rely on more efficient sampling of data, ranging from the acquisition of fewer averages or b-values to adjustment of the pulse sequence. Novel acquisition methods based on undersampling techniques are often followed by suitable reconstruction methods typically incorporating synthetic priori information. These reconstruction methods often use artificial intelligence for various tasks such as denoising, artifact correction, improvement of image quality, and in the case of DWI, for the generation of synthetic high b-value images or apparent diffusion coefficient maps. Reduction of mpMRI scan time is possible, but it is crucial to maintain diagnostic quality, confirmed through radiological evaluation, to integrate the proposed methods into the standard mpMRI protocol. Additionally, before clinical integration, prospective studies are recommended to validate undersampling techniques to avoid potentially inaccurate results demonstrated by retrospective analysis. This review provides an overview of recently proposed techniques, discussing their implementation, advantages, disadvantages, and diagnostic performance according to PI-RADS guidelines compared to conventional methods. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Nida Mir
- Magnetic Detection and Imaging, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Stefan J Fransen
- Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jurgen J Fütterer
- Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Minimally Invasive Image-Guided Interventions Center, Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank F J Simonis
- Magnetic Detection and Imaging, Technical Medical Centre, University of Twente, Enschede, Netherlands
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3
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Rata M, De Paepe KN, Orton MR, Castagnoli F, d'Arcy J, Winfield JM, Hughes J, Stemmer A, Nickel MD, Koh DM. Evaluation of simultaneous multi-slice acquisition with advanced processing for free-breathing diffusion-weighted imaging in patients with liver metastasis. Eur Radiol 2024; 34:2457-2467. [PMID: 37776361 PMCID: PMC10957610 DOI: 10.1007/s00330-023-10234-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) acquisition and advanced processing can accelerate acquisition time and improve MR image quality. This study evaluated the image quality and apparent diffusion coefficient (ADC) measurements of free-breathing DWI acquired from patients with liver metastases using a prototype SMS-DWI acquisition (with/without an advanced processing option) and conventional DWI. METHODS Four DWI schemes were compared in a pilot 5-patient cohort; three DWI schemes were further assessed in a 24-patient cohort. Two readers scored image quality of all b-value images and ADC maps across the three methods. ADC measurements were performed, for all three methods, in left and right liver parenchyma, spleen, and liver metastases. The Friedman non-parametric test (post-hoc Wilcoxon test with Bonferroni correction) was used to compare image quality scoring; t-test was used for ADC comparisons. RESULTS SMS-DWI was faster (by 24%) than conventional DWI. Both readers scored the SMS-DWI with advanced processing as having the best image quality for highest b-value images (b750) and ADC maps; Cohen's kappa inter-reader agreement was 0.6 for b750 image and 0.56 for ADC maps. The prototype SMS-DWI sequence with advanced processing allowed a better visualization of the left lobe of the liver. ADC measured in liver parenchyma, spleen, and liver metastases using the SMS-DWI with advanced processing option showed lower values than those derived from the SMS-DWI method alone (t-test, p < 0.0001; p < 0.0001; p = 0.002). CONCLUSIONS Free-breathing SMS-DWI with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. CLINICAL RELEVANCE STATEMENT Free-breathing simultaneous multi-slice- diffusion-weighted imaging (DWI) with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. KEY POINTS • Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) can accelerate acquisition time and improve image quality. • Apparent diffusion coefficients (ADC) measured in liver parenchyma, spleen, and liver metastases using the simultaneous multi-slice DWI with advanced processing were significantly lower than those derived from the simultaneous multi-slice DWI method alone. • Simultaneous multi-slice DWI sequence with inline advanced processing was faster and demonstrated better image quality in liver patients.
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Affiliation(s)
- Mihaela Rata
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - Katja N De Paepe
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew R Orton
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Francesca Castagnoli
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - James d'Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Jessica M Winfield
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Julie Hughes
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alto Stemmer
- Siemens Healthcare GmbH, MR Application Predevelopment, Erlangen, Germany
| | | | - Dow-Mu Koh
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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4
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Barrett T, Lee KL, de Rooij M, Giganti F. Update on Optimization of Prostate MR Imaging Technique and Image Quality. Radiol Clin North Am 2024; 62:1-15. [PMID: 37973236 DOI: 10.1016/j.rcl.2023.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Prostate MR imaging quality has improved dramatically over recent times, driven by advances in hardware, software, and improved functional imaging techniques. MRI now plays a key role in prostate cancer diagnostic work-up, but outcomes of the MRI-directed pathway are heavily dependent on image quality and optimization. MR sequences can be affected by patient-related degradations relating to motion and susceptibility artifacts which may enable only partial mitigation. In this Review, we explore issues relating to prostate MRI acquisition and interpretation, mitigation strategies at a patient and scanner level, PI-QUAL reporting, and future directions in image quality, including artificial intelligence solutions.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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5
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Werner S, Zinsser D, Esser M, Nickel D, Nikolaou K, Othman AE. Enhanced Image Processing Using Complex Averaging in Diffusion-Weighted Imaging of the Prostate: The Impact on Image Quality and Lesion Detectability. Diagnostics (Basel) 2023; 13:2325. [PMID: 37510071 PMCID: PMC10378377 DOI: 10.3390/diagnostics13142325] [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: 06/03/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Diffusion-weighted images of the prostate can suffer from a "hazy" background in low signal-intensity areas. We hypothesize that enhanced image processing (EIP) using complex averaging reduces artifacts, noise, and distortion in conventionally acquired diffusion-weighted images and synthesized high b-value images, thus leading to higher image quality and better detection of potentially malignant lesions. Conventional DWI trace images with a b-value of 1000 s/mm2 (b1000), calculated images with a b-value of 2000 s/mm2 (cb2000), and ADC maps of 3T multiparametric prostate MRIs in 53 patients (age 68.8 ± 10 years) were retrospectively evaluated. Standard images were compared to images using EIP. In the standard images, 36 lesions were detected in the peripheral zone and 20 in the transition zone. In 13 patients, EIP led to the detection of 8 additional lesions and the upgrading of 6 lesions; 6 of these patients were diagnosed with prostate carcinoma Gleason 7 or 8. EIP improved qualitative ratings for overall image quality and lesion detectability. Artifacts were significantly reduced in the cb2000 images. Quantitative measurements for lesion detectability expressed as an SI ratio were significantly improved. EIP using complex averaging led to image quality improvements in acquired and synthesized DWI, potentially resulting in elevated diagnostic accuracy and management changes.
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Affiliation(s)
- Sebastian Werner
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, 72076 Tuebingen, Germany
| | - Dominik Zinsser
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, 72076 Tuebingen, Germany
| | - Michael Esser
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, 72076 Tuebingen, Germany
| | - Dominik Nickel
- MR Application Predevelopment, Siemens Healthineers, 91052 Erlangen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, 72076 Tuebingen, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center Mainz, 55131 Mainz, Germany
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6
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Klingebiel M, Weiland E, Boschheidgen M, Ullrich T, Arsov C, Radtke JP, Benkert T, Nickel M, Strecker R, Wittsack HJ, Albers P, Antoch G, Schimmöller L. Improved diffusion-weighted imaging of the prostate: Comparison of readout-segmented and zoomed single-shot imaging. Magn Reson Imaging 2023; 98:55-61. [PMID: 36649807 DOI: 10.1016/j.mri.2023.01.010] [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: 09/24/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Diffusion weighted imaging (DWI) is the most important sequence for detection and grading prostate cancer (PCa), but it is considerably prone to artifacts. New approaches like zoomed single-shot imaging (z-EPI) with advanced image processing or multi-shot readout segmentation (rs-EPI) try to improve DWI quality. This study evaluates objective and subjective image quality (IQ) of rs-EPI and z-EPI with and without advanced processing. MATERIALS AND METHODS Fifty-six consecutive patients (67 ± 8 years; median PSA 8.3 ng/ml) with mp-MRI performed at 3 Tesla between February and October 2019 and subsequently verified PCa by targeted plus systematic MRI/US-fusion biopsy were included in this retrospective single center cohort study. Rs-EPI and z-EPI were prospectively acquired in every patient. Signal intensities (SI) of PCa and benign tissue in ADC, b1000, and calculated high b-value images were analyzed. Endpoints were signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), PCa contrast intensity (CI), and subjective IQ on a 5-point scale evaluated by three blinded readers. Wilcoxon signed rank test, Friedman test and Cohen's kappa coefficient was calculated. RESULTS SNR, CNR, and PCa CI of z-EPI with and without advanced processing was superior to rs-EPI (p < 0.01), whereas no significant differences were observed between z-EPI with and without advanced processing. Subjective IQ was significantly higher for z-EPI with advanced processing compared rs-EPI for ADC, b1000, and calculated high b-values (p < 0.01). Compared to z-EPI without advanced processing, z-EPI with advanced processing was superior for ADC and calculated high b-values (p < 0.01), but no significant differences were shown for b1000 images. CONCLUSIONS Z-EPI with and without advanced processing was superior to rs-EPI regarding objective imaging parameters and z-EPI with advanced processing was superior to rs-EPI regarding subjective imaging parameters for the detection of PCa.
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Affiliation(s)
- M Klingebiel
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - E Weiland
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany.
| | - M Boschheidgen
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - T Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - C Arsov
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - J P Radtke
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - T Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany.
| | - M Nickel
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany.
| | - R Strecker
- Siemens Healthcare GmbH, Europe, Middle East & Africa, Karlheinz-Kaske-Str. 2, 91052 Erlangen, Germany.
| | - H J Wittsack
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - P Albers
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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7
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Mao W, Ding Y, Ding X, Fu C, Cao B, Kuehn B, Benkert T, Grimm R, Zhou J, Zeng M. Capability of arterial spin labeling and intravoxel incoherent motion diffusion-weighted imaging to detect early kidney injury in chronic kidney disease. Eur Radiol 2023; 33:3286-3294. [PMID: 36512040 DOI: 10.1007/s00330-022-09331-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To prospectively investigate the capability of arterial spin labeling (ASL) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the identification of early kidney injury in chronic kidney disease (CKD) patients with normal estimated glomerular filtration rate (eGFR). METHODS Fifty-four CKD patients confirmed by renal biopsy (normal eGFR group [eGFR ≥ 90 mL/min/1.73 m2]: n = 26; abnormal eGFR group [eGFR < 90 mL/min/1.73 m2]: n = 28) and 20 healthy volunteers (HV) were recruited. All subjects were examined by IVIM-DWI and ASL imaging. Renal blood flow (RBF) derived from ASL, true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) derived from IVIM-DWI were measured from the renal cortex. One-way analysis of variance was used to compare MRI parameters among the three groups. The correlation between eGFR and MRI parameters was evaluated by Spearman correlation analysis. Diagnostic performances of MRI parameters for detecting kidney injury were assessed by receiver operating characteristic (ROC) curves. RESULTS The renal cortical D, D*, f, and RBF values showed statistically significant differences among the three groups. eGFR was positively correlated with MRI parameters (D: r = 0.299, D*: r = 0.569, f: r = 0.733, RBF: r = 0.586). The areas under the curve (AUCs) for discriminating CKD patients from HV were 0.725, 0.752, 0.947, and 0.884 by D, D*, f, and RBF, respectively. D, D*, f, RBF, and eGFR identified CKD patients with normal eGFR with AUCs of 0.735, 0.612, 0.917, 0.827, and 0.733, respectively, and AUC of f value was significantly larger than that of eGFR. CONCLUSION IVIM-DWI and ASL were useful for detecting underlying pathologic injury in early CKD patients with normal eGFR. KEY POINTS • The renal cortical f and RBF values in the control group were significantly higher than those in the normal eGFR group. • A negative correlation was observed between the renal cortical D, D*, f, and RBF values and SCr and 24 h-UPRO, while eGFR was significantly positively correlated with renal cortical D, D*, f, and RBF values. • The AUC of renal cortical f values was statistically larger than that of eGFR for the discrimination between the CKD with normal eGFR group and the control group.
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Affiliation(s)
- Wei Mao
- Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Caixia Fu
- MR Applications Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, People's Republic of China
| | - Bohong Cao
- Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Bernd Kuehn
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
- Department of Radiology, Zhongshan Hospital, Xiamen Branch, Fudan University, Xiamen, People's Republic of China.
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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8
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Hu L, Fu C, Song X, Grimm R, von Busch H, Benkert T, Kamen A, Lou B, Huisman H, Tong A, Penzkofer T, Choi MH, Shabunin I, Winkel D, Xing P, Szolar D, Coakley F, Shea S, Szurowska E, Guo JY, Li L, Li YH, Zhao JG. Automated deep-learning system in the assessment of MRI-visible prostate cancer: comparison of advanced zoomed diffusion-weighted imaging and conventional technique. Cancer Imaging 2023; 23:6. [PMID: 36647150 PMCID: PMC9843860 DOI: 10.1186/s40644-023-00527-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Deep-learning-based computer-aided diagnosis (DL-CAD) systems using MRI for prostate cancer (PCa) detection have demonstrated good performance. Nevertheless, DL-CAD systems are vulnerable to high heterogeneities in DWI, which can interfere with DL-CAD assessments and impair performance. This study aims to compare PCa detection of DL-CAD between zoomed-field-of-view echo-planar DWI (z-DWI) and full-field-of-view DWI (f-DWI) and find the risk factors affecting DL-CAD diagnostic efficiency. METHODS This retrospective study enrolled 354 consecutive participants who underwent MRI including T2WI, f-DWI, and z-DWI because of clinically suspected PCa. A DL-CAD was used to compare the performance of f-DWI and z-DWI both on a patient level and lesion level. We used the area under the curve (AUC) of receiver operating characteristics analysis and alternative free-response receiver operating characteristics analysis to compare the performances of DL-CAD using f- DWI and z-DWI. The risk factors affecting the DL-CAD were analyzed using logistic regression analyses. P values less than 0.05 were considered statistically significant. RESULTS DL-CAD with z-DWI had a significantly better overall accuracy than that with f-DWI both on patient level and lesion level (AUCpatient: 0.89 vs. 0.86; AUClesion: 0.86 vs. 0.76; P < .001). The contrast-to-noise ratio (CNR) of lesions in DWI was an independent risk factor of false positives (odds ratio [OR] = 1.12; P < .001). Rectal susceptibility artifacts, lesion diameter, and apparent diffusion coefficients (ADC) were independent risk factors of both false positives (ORrectal susceptibility artifact = 5.46; ORdiameter, = 1.12; ORADC = 0.998; all P < .001) and false negatives (ORrectal susceptibility artifact = 3.31; ORdiameter = 0.82; ORADC = 1.007; all P ≤ .03) of DL-CAD. CONCLUSIONS Z-DWI has potential to improve the detection performance of a prostate MRI based DL-CAD. TRIAL REGISTRATION ChiCTR, NO. ChiCTR2100041834 . Registered 7 January 2021.
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Affiliation(s)
- Lei Hu
- grid.16821.3c0000 0004 0368 8293Department of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai, 200233 China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen magnetic Resonance Ltd., Shenzhen, China
| | - Xinyang Song
- grid.443573.20000 0004 1799 2448Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000 China
| | - Robert Grimm
- grid.5406.7000000012178835XMR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Heinrich von Busch
- grid.5406.7000000012178835XInnovation Owner Artificial Intelligence for Oncology, Siemens Healthcare GmbH, Erlangen, Germany
| | - Thomas Benkert
- grid.5406.7000000012178835XMR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Ali Kamen
- grid.415886.60000 0004 0546 1113Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ USA
| | - Bin Lou
- grid.415886.60000 0004 0546 1113Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ USA
| | - Henkjan Huisman
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Nijmegen, Netherlands
| | - Angela Tong
- grid.137628.90000 0004 1936 8753New York University, New York City, NY USA
| | - Tobias Penzkofer
- grid.6363.00000 0001 2218 4662Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Moon Hyung Choi
- grid.411947.e0000 0004 0470 4224Eunpyeong St. Mary’s Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | | | - David Winkel
- grid.410567.1Universitätsspital Basel, Basel, Switzerland
| | - Pengyi Xing
- grid.411525.60000 0004 0369 1599Changhai Hospital, Shanghai, China
| | | | - Fergus Coakley
- grid.5288.70000 0000 9758 5690Oregon Health and Science University, Portland, OR USA
| | - Steven Shea
- grid.411451.40000 0001 2215 0876Loyola University Medical Center, Maywood, IL USA
| | - Edyta Szurowska
- grid.11451.300000 0001 0531 3426Medical University of Gdansk, Gdansk, Poland
| | - Jing-yi Guo
- grid.16821.3c0000 0004 0368 8293Clinical Research Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233 China
| | - Liang Li
- grid.412632.00000 0004 1758 2270Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Yue-hua Li
- grid.16821.3c0000 0004 0368 8293Department of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai, 200233 China
| | - Jun-gong Zhao
- grid.16821.3c0000 0004 0368 8293Department of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai, 200233 China
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Kim YJ, Kim SH, Baek TW, Park H, Lim YJ, Jung HK, Kim JY. Comparison of Computed Diffusion-Weighted Imaging b2000 and Acquired Diffusion-Weighted Imaging b2000 for Detection of Prostate Cancer. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1059-1070. [PMID: 36276208 PMCID: PMC9574295 DOI: 10.3348/jksr.2022.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/05/2022] [Accepted: 03/21/2022] [Indexed: 11/15/2022]
Abstract
Purpose To compare the sensitivity of tumor detection and inter-observer agreement between acquired diffusion-weighted imaging (aDWI) b2000 and computed DWI (cDWI) b2000 in patients with prostate cancer (PCa). Materials and Methods Eighty-eight patients diagnosed with PCa by radical prostatectomy and having undergone pre-operative 3 Tesla-MRI, including DWI (b, 0, 100, 1000, 2000 s/mm2), were included in the study. cDWI b2000 was obtained from aDWI b0, b100, and b1000. Two independent reviewers performed a review of the aDWI b2000 and cDWI b2000 images in random order at 4-week intervals. A region of interest was drawn for the largest tumor on each dataset, and a Prostate Imaging-Reporting and Data System (PI-RADS) score based on PI-RADS v2.1 was recorded. Histologic topographic maps served as the reference standard. Results The study population's Gleason scores were 6 (n = 16), 7 (n = 53), 8 (n = 9), and 9 (n = 10). According to the reviewers, the sensitivities of cDWI b2000 and aDWI b2000 showed no significant differences (for reviewer 1, both 94% [83/88]; for reviewer 2, both 90% [79/88]; p = 1.000, respectively). The kappa values of cDWI b2000 and aDWI b2000 for the PI-RADS score were 0.422 (95% confidence interval [CI], 0.240-0.603) and 0.495 (95% CI, 0.308-0.683), respectively. Conclusion cDWI b2000 showed comparable sensitivity with aDWI b2000, in addition to sustained moderate inter-observer agreement, in the detection of PCa.
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Hu L, Wei L, Wang S, Fu C, Benker T, Zhao J. Better lesion conspicuity translates into improved prostate cancer detection: comparison of non-parallel-transmission-zoomed-DWI with conventional-DWI. Abdom Radiol (NY) 2021; 46:5659-5668. [PMID: 34514538 DOI: 10.1007/s00261-021-03268-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare advanced non-parallel transmission zoomed diffusion-weighted imaging (nonPTX zoom-DWI) to conventional DWI (conv-DWI) for the assessment of prostate cancer (PCa). METHODS This retrospective study included 98 patients who underwent conv-DWI, nonPTX zoom-DWI, and T2-weighted imaging of the prostate. The image qualities of the two DWI sets, including the distortion of the prostate and the existence of artifacts, were evaluated. To compare the overall PCa and clinically important PCa (ciPCa) detection ability between the sets, lesions were scored using the Prostate Imaging Reporting and Data System (PI-RADS) version 2. Apparent diffusion coefficient (ADC) values of the lesions were also measured and compared. The Mann-Whitney U test was used to compare continuous variables, and the χ2 test was used to compare categorical variables. Two-sided P values of < 0.05 were considered significant. RESULTS Non-PTX zoom-DWI yielded significantly better image quality and image analysis reproducibility than conv-DWI (all P < 0.001). Compared with conv-ADC, nonPTX zoom-ADC showed slightly better detection performance for overall PCa (AUC: 0.827 vs. 0.797; P = 0.55) and ciPCa (AUC: 0.822 vs. 0.749; P = 0.58). At a PI-RADS score of 4 as the cutoff value for PCa prediction, nonPTX zoom-DWI showed significantly higher diagnostic efficiency for overall PCa detection (sensitivity: 87.9% vs. 72.4%; specificity: 87.5% vs. 77.5%; both P < 0.05) and ciPCa detection (sensitivity: 86.3% vs. 74.5%; specificity: 72.3% vs. 63.8%; both P ≤ 0.001). CONCLUSION Non-PTX zoom-DWI yields better image quality and higher PCa detection performance than Conv-DWI.
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Giganti F, Kasivisvanathan V, Kirkham A, Punwani S, Emberton M, Moore CM, Allen C. Prostate MRI quality: a critical review of the last 5 years and the role of the PI-QUAL score. Br J Radiol 2021; 95:20210415. [PMID: 34233502 PMCID: PMC8978249 DOI: 10.1259/bjr.20210415] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
There is increasing interest in the use of multiparametric magnetic resonance imaging (mpMRI) in the prostate cancer pathway. The European Association of Urology (EAU) and the British Association of Urological Surgeons (BAUS) now advise mpMRI prior to biopsy, and the Prostate Imaging Reporting and Data System (PI-RADS) recommendations set out the minimal technical requirements for the acquisition of mpMRI of the prostate.The widespread and swift adoption of this technique has led to variability in image quality. Suboptimal image acquisition reduces the sensitivity and specificity of mpMRI for the detection and staging of clinically significant prostate cancer.This critical review outlines the studies aimed at improving prostate MR quality that have been published over the last 5 years. These span from the use of specific MR sequences, magnets and coils to patient preparation. The rates of adherence of prostate mpMRI to technical standards in different cohorts across the world are also discussed.Finally, we discuss the first standardised scoring system (i.e., Prostate Imaging Quality, PI-QUAL) that has been created to evaluate image quality, although further iterations of this score are expected in the future.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
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Hu L, Zhou DW, Fu CX, Benkert T, Jiang CY, Li RT, Wei LM, Zhao JG. Advanced zoomed diffusion-weighted imaging vs. full-field-of-view diffusion-weighted imaging in prostate cancer detection: a radiomic features study. Eur Radiol 2020; 31:1760-1769. [PMID: 32935192 DOI: 10.1007/s00330-020-07227-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/16/2020] [Accepted: 08/26/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES We aimed to compare the efficiency of prostate cancer (PCa) detection using a radiomics signature based on advanced zoomed diffusion-weighted imaging and conventional full-field-of-view DWI. METHODS A total of 136 patients, including 73 patients with PCa and 63 without PCa, underwent multi-parametric magnetic resonance imaging (mp-MRI). Radiomic features were extracted from prostate lesion areas segmented on full-field-of-view DWI with b-value = 1500 s/mm2 (f-DWIb1500), advanced zoomed DWI images with b-value = 1500 s/mm2 (z-DWIb1500), calculated zoomed DWI with b-value = 2000 s/mm2 (z-calDWIb2000), and apparent diffusion coefficient (ADC) maps derived from both sequences (f-ADC and z-ADC). Single-imaging modality radiomics signature, mp-MRI radiomics signature, and a mixed model based on mp-MRI and clinically independent risk factors were built to predict PCa probability. The diagnostic efficacy and the potential net benefits of each model were evaluated. RESULTS Both z-DWIb1500 and z-calDWIb2000 had significantly better predictive performance than f-DWIb1500 (z-DWIb1500 vs. f-DWIb1500: p = 0.048; z-calDWIb2000 vs. f-DWIb1500: p = 0.014). z-ADC had a slightly higher area under the curve (AUC) value compared with f-ADC value but was not significantly different (p = 0.127). For predicting the presence of PCa, the AUCs of clinical independent risk factors model, mp-MRI model, and mixed model were 0.81, 0.93, and 0.94 in training sets, and 0.74, 0.92, and 0.93 in validation sets, respectively. CONCLUSION Radiomics signatures based on the z-DWI technology had better diagnostic accuracy for PCa than that based on the f-DWI technology. The mixed model was better at diagnosing PCa and guiding clinical interventions for patients with suspected PCa compared with mp-MRI signatures and clinically independent risk factors. KEY POINTS • Advanced zoomed DWI technology can improve the diagnostic accuracy of radiomics signatures for PCa. • Radiomics signatures based on z-calDWIb2000 have the best diagnostic performance among individual imaging modalities. • Compared with the independent clinical risk factors and the mp-MRI model, the mixed model has the best diagnostic efficiency.
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Affiliation(s)
- Lei Hu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China
| | - Da Wei Zhou
- State Key Laboratory of Integrated Services Networks, School of Telecommunications Engineering, Xidian University, 2 South Taibai Road, Xi'an, 710071, Shaanxi, China
| | - Cai Xia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Chun Yu Jiang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China
| | - Rui Ting Li
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China
| | - Li Ming Wei
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China
| | - Jun Gong Zhao
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.
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