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Asuncion A, Walker PM, Bertaut A, Blanc J, Labarre M, Martin E, Bardet F, Cassin J, Cormier L, Crehange G, Loffroy R, Cochet A. Prediction of prostate cancer recurrence after radiation therapy using multiparametric magnetic resonance imaging and spectroscopy: assessment of prognostic factors on pretreatment imaging. Quant Imaging Med Surg 2022; 12:5309-5325. [PMID: 36465820 PMCID: PMC9703104 DOI: 10.21037/qims-22-184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2023]
Abstract
BACKGROUND To assess whether data from pre-therapeutic multiparametric magnetic resonance imaging (mpMRI) combined with three-dimensional magnetic resonance spectroscopy (3D MRS) provide prognostic factors of biochemical relapse in patients with localized prostate cancer treated by external radiotherapy or brachytherapy. METHODS In our single institution observational retrospective study we included a cohort of 230 patients treated by external radiotherapy or brachytherapy who had an initial mpMRI with 3D MRS from January 2008 to December 2015 for newly diagnosed localized prostatic cancer, proven histologically. Three trained radiologists recorded tumor characteristics, MRI T-stage and metabolic abnormalities from 3D MRS data. Univariate and multivariate Cox analyzes explored the relationship between clinical and imaging variables to highlight prognostic factors for recurrence, using biochemical relapse as the primary endpoint. RESULTS mpMRI data analysis allowed to reclassify 21.7% of the patients in a MRI National Comprehensive Cancer Network (NCCN) group higher than their initial clinical T-stage, but also to detect a lesion in 78% of the patients considered as clinically T1c. After a median of follow-up of 8.7 years (IQR, 6.6-10.1) following cancer diagnosis, 36 (16%) patients developed a biochemical relapse. The multivariate Cox analysis demonstrated the existence of 3 independent factors for prediction of biochemical recurrence: extracapsular extension (ECE) (HR =3.33; 95% CI: 1.93-5.73; P<0.01), choline/citrate ratio in healthy tissue in the transition zone (TZ) (HR =2.96; 95% CI: 1.06-8.28; P=0.04) and the NCCN Magnetic Resonance Imaging classification (intermediate versus low-risk, HR =3.06; 95% CI: 1.13-8.30; P<0.01). CONCLUSIONS Combination of mpMRI and 3DMRS could aid in the prognostic stratification of localized prostate cancer treated by radiotherapy or brachytherapy, by combining accurate evaluation of tumor extension, and quantification of prostate metabolism.
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Affiliation(s)
- Audrey Asuncion
- Department of Diagnostic & Interventional Radiology, University Hospital Dijon, Dijon, France
| | - Paul Michael Walker
- Department of Spectroscopy and Nuclear Magnetic Resonance, University Hospital Dijon, Dijon, France
- Laboratory of Imaging and Artificial Vision (ImVIA), IFTIM Team, EA 7535, University of Burgundy, Dijon, France
| | - Aurélie Bertaut
- Department of Methodology and biostatistics, Centre Georges-François-Leclerc, Dijon, France
| | - Julie Blanc
- Department of Methodology and biostatistics, Centre Georges-François-Leclerc, Dijon, France
| | - Maxime Labarre
- Department of Radiology, Centre Georges-François-Leclerc, Dijon, France
| | - Etienne Martin
- Department of Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Florian Bardet
- Department of Urology, University Hospital Dijon, Dijon, France
| | - Jeremy Cassin
- Department of Diagnostic & Interventional Radiology, University Hospital Dijon, Dijon, France
| | - Luc Cormier
- Department of Urology, University Hospital Dijon, Dijon, France
| | | | - Romaric Loffroy
- Department of Diagnostic & Interventional Radiology, University Hospital Dijon, Dijon, France
- Laboratory of Imaging and Artificial Vision (ImVIA), IFTIM Team, EA 7535, University of Burgundy, Dijon, France
| | - Alexandre Cochet
- Department of Spectroscopy and Nuclear Magnetic Resonance, University Hospital Dijon, Dijon, France
- Laboratory of Imaging and Artificial Vision (ImVIA), IFTIM Team, EA 7535, University of Burgundy, Dijon, France
- Department of Nuclear Medicine, Centre Georges-François-Leclerc, Dijon, France
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Mazaheri Y, Shukla-Dave A, Goldman DA, Moskowitz CS, Takeda T, Reuter VE, Akin O, Hricak H. Characterization of prostate cancer with MR spectroscopic imaging and diffusion-weighted imaging at 3 Tesla. Magn Reson Imaging 2018; 55:93-102. [PMID: 30176373 DOI: 10.1016/j.mri.2018.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To retrospectively measure metabolic ratios and apparent diffusion coefficient (ADC) values from 3-Tesla MR spectroscopic imaging (MRSI) and diffusion-weighted imaging (DWI) in benign and malignant peripheral zone (PZ) prostate tissue, assess the parameters' associations with malignancy, and develop and test rules for classifying benign and malignant PZ tissue using whole-mount step-section pathology as the reference standard. METHODS This HIPAA-compliant, IRB-approved study included 67 men (median age, 61 years; range, 41-74 years) with biopsy-proven prostate cancer who underwent preoperative 3 T endorectal multiparametric MRI and had ≥1 PZ lesion >0.1 cm3 at whole-mount histopathology. In benign and malignant PZ regions identified from pathology, voxel-based choline/citrate, polyamines/choline, polyamines/creatine, and (choline + polyamines + creatine)/citrate ratios were averaged, as were ADC values. Patients were randomly split into training and test sets; rules for separating benign from malignant regions were generated with classification and regression tree (CART) analysis and assessed on the test set for sensitivity and specificity. Odds ratios (OR) were evaluated using generalized estimating equations. RESULTS CART analysis of all parameters identified only ADC and (choline + polyamines + creatine)/citrate as significant predictors of cancer. Sensitivity and specificity, respectively, were 0.81 and 0.82 with MRSI-derived, 0.98 and 0.51 with DWI-derived, and 0.79 and 0.90 with MRSI + DWI-derived classification rules. Areas under the curves (AUC) in the test set were 0.93 (0.87-0.97) with ADC, 0.82 (0.72-0.91) with MRSI, and 0.96 (0.92-0.99) with MRSI + ADC. CONCLUSION We developed statistically-based rules for identifying PZ cancer using 3-Tesla MRSI, DWI, and MRSI + DWI and demonstrated the potential value of MRSI + DWI.
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Affiliation(s)
- Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Toshikazu Takeda
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Hoffner MKM, Huebner F, Scholtz JE, Zangos S, Schulz B, Luboldt W, Vogl TJ, Bodelle B. Impact of an endorectal coil for 1H-magnetic resonance spectroscopy of the prostate at 3.0T in comparison to 1.5T: Do we need an endorectal coil? Eur J Radiol 2016; 85:1432-8. [PMID: 27423684 DOI: 10.1016/j.ejrad.2016.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the influence of endorectal coil (ERC) regarding spectral quality and diagnostic suitability and diagnostic performance in 3.0T 1H-magnetic resonance spectroscopy imaging (MRSI) compared to 1.5T MRSI. MATERIALS AND METHODS The study was approved by the Institutional Review Board. MRSI of the prostate was performed on 19 patients at 1.5T with ERC (protocol 1), at 3.0T with a disabled ERC (protocol 2) and at 3.0T with ERC (protocol 3). Age, weight, body size, body-mass-index, prostate volume, time between measurements, diagnostic suitability of spectra, histopathological results after biopsy of cancer suspect lesions (CSL), sensitivity and specificity were evaluated. Signal-to-noise ratio (SNR) was calculated and compared using semiparametrical multiple Conover-comparisons. Correlations between SNR and prostate volume and BMI were indicated using Pearson correlation coefficient. Distribution of SNR was evaluated for prostate quadrants. RESULTS Diagnostic suitable spectra were achieved in 76 % (protocol 1, 100% in CSL), 32 % (protocol 2, 59% in CSL) and 50 % (protocol 3, 80% in CSL) of the voxels. SNR was significantly higher in protocol 3 compared to protocol 2 and 1 (93,729 vs. 27,836 vs. 32,897, p<0.0001) with significant difference between protocol 2 and 1 (p<0.023). Highest SNR was achieved in the dorsal prostate (protocols 1 and 3; p<0.0001). Sensitivity at 3.0T was higher with use of ERC. Specificity was highest at 1.5T with ERC. CONCLUSION The ERC improves the diagnostic suitability and the SNR in MRSI at 3.0T. Less voxels at 3.0T with disabled ERC are suitable for diagnosis compared to 1.5T with ERC. MRSI at 3.0T with ERC shows the highest SNR. SNR in dorsal quadrants of the prostate was higher using ERC.
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Affiliation(s)
- Maximilian K M Hoffner
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Frank Huebner
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Jan Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Stephan Zangos
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Boris Schulz
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Wolfgang Luboldt
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
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De Visschere P, Nezzo M, Pattyn E, Fonteyne V, Van Praet C, Villeirs G. Prostate magnetic resonance spectroscopic imaging at 1.5tesla with endorectal coil versus 3.0tesla without endorectal coil: comparison of spectral quality. Clin Imaging 2015; 39:636-41. [DOI: 10.1016/j.clinimag.2015.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 01/07/2023]
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Kumar V, Dwivedi DK, Jagannathan NR. High-resolution NMR spectroscopy of human body fluids and tissues in relation to prostate cancer. NMR IN BIOMEDICINE 2014; 27:80-89. [PMID: 23828638 DOI: 10.1002/nbm.2979] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 06/02/2023]
Abstract
High-resolution NMR spectroscopic studies of prostate tissue extracts, prostatic fluid, seminal fluid, serum and urine can be used for the detection of prostate cancer, based on the differences in their metabolic profiles. Useful diagnostic information is obtained by the detection or quantification of as many metabolites as possible and comparison with normal samples. Only a few studies have shown the potential of high-resolution in vitro NMR of prostate tissues. A survey of the literature has revealed that studies on body fluids, such as urine and serum, in relation to prostate cancer are rare. In addition, the potential of NMR of nuclei other than (1)H, such as (13)C and (31)P, has not been exploited fully. The metabolomic analysis of metabolites, detected by high-resolution NMR, may help to identify metabolites which could serve as useful biomarkers for prostate cancer detection. Such NMR-derived biomarkers would not only help in prostate cancer detection and in understanding the in vivo MRS metabolic profile, but also to investigate the biochemical and metabolic changes associated with cancer. Here, we review the published research work on body fluids in relation to prostate and prostate tissue extracts, and highlight the potential of such studies for future work.
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Affiliation(s)
- Virendra Kumar
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi, India
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Lagemaat MW, Scheenen TWJ. Role of high-field MR in studies of localized prostate cancer. NMR IN BIOMEDICINE 2014; 27:67-79. [PMID: 23703839 DOI: 10.1002/nbm.2967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 03/12/2013] [Accepted: 03/28/2013] [Indexed: 06/02/2023]
Abstract
Magnetic resonance imaging is attracting increasing attention from the uroradiological community as a modality to guide the management of prostate cancer. With the high incidence of prostate cancer it might come as a surprise that for a very long time (and in many places even at present) treatment decisions were being made without the use of detailed anatomical and functional imaging of the prostate gland at hand. Although T2 -weighted MRI can provide great anatomical detail, by itself it is not specific enough to discriminate cancer from benign disease, so other functional MRI techniques have been explored to aid in detection, localization, staging and risk assessment of prostate cancer. With the current evolution of clinical MR systems from 1.5 to 3 T it is important to understand the advantages and the challenges of the higher magnetic field strength for the different functional MR techniques most used in the prostate: T2 -weighted MRI, diffusion-weighted MRI, MR spectroscopic imaging and dynamic contrast-enhanced imaging. In addition to this, the use of the endorectal coil at different field strengths is discussed in this review, together with an outlook of the possibilities of ultra-high-field MR for the prostate.
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Affiliation(s)
- Miriam W Lagemaat
- Department of Radiology (766), Radboud University Nijmegen Medical Centre, The Netherlands
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