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Boschheidgen M, Ullrich T, Al-Monajjed R, Ziayee F, Michalski R, Steuwe A, Minko P, Albers P, Antoch G, Schimmöller L. Value of magnetic resonance angiography before prostatic artery embolization for intervention planning. Sci Rep 2024; 14:7758. [PMID: 38565890 PMCID: PMC10987590 DOI: 10.1038/s41598-024-58207-3] [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: 04/28/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
Knowledge about anatomical details seems to facilitate the procedure and planning of prostatic artery embolization (PAE) in patients with symptomatic benign prostatic hyperplasia (BPS). The aim of our study was the pre-interventional visualization of the prostatic artery (PA) with MRA and the correlation of iliac elongation and bifurcation angles with technical success of PAE and technical parameters. MRA data of patients with PAE were analysed retrospectively regarding PA visibility, PA type, vessel elongation, and defined angles were correlated with intervention time, fluoroscopy time, dose area product (DAP), cumulative air kerma (CAK), contrast media (CM) dose and technical success of embolization. T-test, ANOVA, Pearson correlation, and Kruskal-Wallis test was applied for statistical analysis. Between April 2018 and March 2021, a total of 78 patients were included. MRA identified the PA origin in 126 of 147 cases (accuracy 86%). Vessel elongation affected time for catheterization of right PA (p = 0.02), fluoroscopy time (p = 0.05), and CM dose (p = 0.02) significantly. Moderate correlation was observed for iliac bifurcation angles with DAP (r = 0.30 left; r = 0.34 right; p = 0.01) and CAK (r = 0.32 left; r = 0.36 right; p = 0.01) on both sides. Comparing the first half and second half of patients, median intervention time (125 vs. 105 min.) and number of iliac CBCT could be reduced (p < 0.001). We conclude that MRA could depict exact pelvic artery configuration, identify PA origin, and might obviate iliac CBCT. Vessel elongation of pelvic arteries increased intervention time and contrast media dose while the PA origin had no significant influence on intervention time and/or technical success.
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Affiliation(s)
- Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Tim Ullrich
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Rouvier Al-Monajjed
- Department of Urology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Farid Ziayee
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Rene Michalski
- Department of Urology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Peter Albers
- Department of Urology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
- Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
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Nowier A, Mazhar H, Salah R, Shabayek M. Performance of multi-parametric magnetic resonance imaging through PIRADS scoring system in biopsy naïve patients with suspicious prostate cancer. Arab J Urol 2022; 20:121-125. [PMID: 35935910 PMCID: PMC9354643 DOI: 10.1080/2090598x.2022.2067615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Use of multi-parametric magnetic resonance imaging (mp-MRI) and Prostate Imaging Reporting and Data System (PI-RADS) scoring system allowed more precise detection of prostate cancer (PCa). Our study aimed at evaluating the diagnostic performance of mp-MRI in detection of PCa. Methods Eighty-six patients suspected to have prostate cancer were enrolled. All patients underwent mp-MRI followed by systematic and targeted trans-rectal ultrasound (TRUS) guided prostate biopsies. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of mp-MRI were evaluated. Results Forty-six patients (53.5%) had prostate cancer on targeted and systematic TRUS biopsies. On mp-MRI, 96.6% of lesions with PI-RADS < 3 revealed to be benign by TRUS biopsy, 73.3% of lesions with PI-RADS 4 showed ISUP grades ≥1, whereas all PI-RADS 5 lesions showed high ISUP grades ≥ 3. For PI-RADS 3 lesions, 62.5% of them revealed to be benign and 37.5% showed ISUP grades ≥1 by TRUS biopsy. PI-RADS scores ˃3 had 69.57% sensitivity and 85% specificity for detection of PCa. On adding the equivocal PI-RADS 3 lesions, PI-RADS scores ≥3 had higher sensitivity (97.83%), but at the cost of lower specificity (32.5%). Conclusion Mp-MRI using PI-RADS V2 scoring system categories ≤3 and >3 could help in detection of PCa. PI-RADS 3 lesions are equivocal. Including PI-RADS lesions ≥3 demonstrated higher sensitivity, but at the cost of lower specificity for mp-MRI in diagnosis for Pca. Abbreviations CDR: cancer detection rates; DRE: digital rectal examination; ISUP: international society of urological pathology; mp-MRI: multi-parametric magnetic resonance imaging; NPV: negative predictive value; PCa: prosatate cancer; PI-RADS: Prostate Imaging Reporting and Data System; PPV: Positive predictive value; PSA: prostate specific antigen; TRUS: transrectal ultrasound.
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Affiliation(s)
- Amr Nowier
- Department of Urology, Faculty of Medicine Ain-Shams University, Cairo, Egypt
| | - Hesham Mazhar
- Department of Urology, Faculty of Medicine Ain-Shams University, Cairo, Egypt
| | - Rasha Salah
- Department of Radiology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Mohamed Shabayek
- Department of Urology, Faculty of Medicine Ain-Shams University, Cairo, Egypt
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Valentin B, Arsov C, Ullrich T, Demetrescu D, Morawitz J, Al-Monajjed R, Quentin M, Kirchner J, Esposito I, Albers P, Antoch G, Schimmöller L. Comparison of 3 T mpMRI and pelvic CT examinations for detection of lymph node metastases in patients with prostate cancer. Eur J Radiol 2022; 147:110110. [DOI: 10.1016/j.ejrad.2021.110110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/19/2021] [Accepted: 12/12/2021] [Indexed: 01/21/2023]
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Falaschi Z, Valenti M, Lanzo G, Attanasio S, Valentini E, García Navarro LI, Aquilini F, Stecco A, Carriero A. Accuracy of ADC ratio in discriminating true and false positives in multiparametric prostatic MRI. Eur J Radiol 2020; 128:109024. [PMID: 32387923 DOI: 10.1016/j.ejrad.2020.109024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Our goal was to evaluate the usefulness of apparent diffusion coefficient (ADC) ratios in discriminating true from false positives in multiparametric (mp) prostate MRI in clinical practice. METHODS We retrospectively evaluated 98 prostate lesions in a series of 73 patients who had undergone prostate mpMRI and standard 12-core prostatic biopsy in our institution from 2016 to 2018. Two experienced radiologists performed double blind ADC value quantifications of both MRI-identified lesions and apparently benign contralateral prostatic parenchyma in a circular region of interest (ROI) of ∼10 mm2. The ratios between the mean values of both measurements (i.e., ADC ratio mean) and between the minimum value of the lesion and the maximum value of the benign parenchyma (i.e., ADC ratio min-max) were automatically calculated. The malignancy of all lesions was determined through biopsy according to Gleason score (GS ≥ 6) and localization. RESULTS For Reader 1, the area under the ROC curve (AUC) of ADC ratio mean and ADC ratio min-max were 0.72 and 0.67, respectively, whereas for Reader 2 these values were 0.74 and 0.71, respectively. The best cut-off values for ADC ratio means were ≥ 0.5 (Reader 1) and ≥ 0.6 (Reader 2), with a sensitivity of 76.3 % and 84.2 % and a specificity of 51.7 % and 50 %, respectively. Moreover, based on a threshold of 0.6, no clinically significant prostate cancer (csPCa) was missed by Reader 1, while only one went unnoticed by Reader 2. CONCLUSION The ADC ratio is a useful and moderately accurate complementary tool to diagnose prostate cancer in the mp-MRI.
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Affiliation(s)
- Zeno Falaschi
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy.
| | - Martina Valenti
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
| | - Giuseppe Lanzo
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
| | - Silvia Attanasio
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
| | - Eleonora Valentini
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
| | | | | | - Alessandro Stecco
- Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, NO, Italy
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Latifoltojar A, Appayya MB, Barrett T, Punwani S. Similarities and differences between Likert and PIRADS v2.1 scores of prostate multiparametric MRI: a pictorial review of histology-validated cases. Clin Radiol 2019; 74:895.e1-895.e15. [PMID: 31627804 DOI: 10.1016/j.crad.2019.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/27/2019] [Indexed: 12/21/2022]
Abstract
The UK National Institute for Health and Care Excellence (NICE) 2019 "Prostate cancer: diagnosis and management" guidelines have recommended that all patients suspected of prostate cancer undergo multiparametric magnetic resonance imaging (mpMRI) prior to biopsy. The Likert scoring system is advocated for mpMRI reporting based on multicentre studies that have demonstrated its effectiveness within the National Health Service (NHS). In recent years, there has been considerable drive towards standardised prostate reporting, which led to the development of "Prostate Imaging-Reporting And Data System" (PI-RADS). The PI-RADS system has been adopted by the majority of European countries and within the US. This paper reviews these systems indicating the similarities and specific differences that exist between PI-RADS and Likert assessment through a series of histologically proven clinical cases.
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Affiliation(s)
- A Latifoltojar
- Centre for Medical Imaging, University College London, Division of Medicine, Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - M B Appayya
- Centre for Medical Imaging, University College London, Division of Medicine, Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - T Barrett
- Department of Radiology, Addenbrooke's Hospital, 277 Hills Rd, Cambridge CB2 0QQ, UK; Cambridge Biomedical Research Centre, 277 Hills Road Cambridge CB2 0QQ, UK
| | - S Punwani
- Centre for Medical Imaging, University College London, Division of Medicine, Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK.
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Cristel G, Esposito A, Damascelli A, Briganti A, Ambrosi A, Brembilla G, Brunetti L, Antunes S, Freschi M, Montorsi F, Del Maschio A, De Cobelli F. Can DCE-MRI reduce the number of PI-RADS v.2 false positive findings? Role of quantitative pharmacokinetic parameters in prostate lesions characterization. Eur J Radiol 2019; 118:51-57. [PMID: 31439258 DOI: 10.1016/j.ejrad.2019.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/16/2019] [Accepted: 07/01/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To test the potential impact of pharmacokinetic parameters, derived from DCE-MRI analysis, on the diagnostic performance of PI-RADSv.2 classification in prostate lesions characterization. METHOD Among patients who underwent multiparametric prostate MRI (mpMRI) (January 2016-March 2018) followed by histological evaluation (targeted biopsies/prostatectomy), 103 men were retrospectively selected. For each patient the index lesion was identified and pharmacokinetic parameters (Ktrans, Kep, Ve, Vp) were assessed. MRI diagnostic performance in the detection of significant tumors [Gleason Score (GS)≥7] was assessed, considering PI-RADS≥3 as positive. RESULTS GS ≥ 7 (n = 59) showed higher Ktrans (p < 0.01) and Kep (p = 0.01) compared to GS < 7. At ROC curve analysis, a Ktrans cut-off of 191 × 10-3/min was identified to predict the presence of GS ≥ 7 (AUC:0.75; sensitivity:95%; specificity:61%). Sensitivity and PPV of mpMRI using PI-RADSv.2 were 98% and 61%. Reclassifying PI-RADS≥3 lesions according to Ktrans cut-off, 22 false positives were shifted to true negatives with 3 false negative findings; PPV raised to 79%. Appling Ktrans cut-off to PI-RADS 3 lesions of peripheral zone (n = 18), 12 true negatives, 4 true positives, 2 false positives were identified. CONCLUSIONS Despite its high sensitivity prostate mpMRI generates many false positive cases: Ktrans in addition to PIRADS v.2 seems to improve MRI-PPV and may help in avoiding redundant biopsies.
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Affiliation(s)
- Giulia Cristel
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
| | - Antonio Esposito
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Anna Damascelli
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Alberto Briganti
- Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy; Department of Urology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Alessandro Ambrosi
- Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Giorgio Brembilla
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Lisa Brunetti
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Sofia Antunes
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Massimo Freschi
- Department of Pathology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Francesco Montorsi
- Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy; Department of Urology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
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Campa R, Del Monte M, Barchetti G, Pecoraro M, Salvo V, Ceravolo I, Indino EL, Ciardi A, Catalano C, Panebianco V. Improvement of prostate cancer detection combining a computer-aided diagnostic system with TRUS-MRI targeted biopsy. Abdom Radiol (NY) 2019; 44:264-271. [PMID: 30054684 DOI: 10.1007/s00261-018-1712-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To validate a novel consensus method, called target-in-target, combining human analysis of mpMRI with automated CAD system analysis, with the aim to increasing the prostate cancer detection rate of targeted biopsies. METHODS A cohort of 420 patients was enrolled and 253 patients were rolled out, due to exclusion criteria. 167 patients, underwent diagnostic 3T MpMRI. Two expert radiologists evaluated the exams adopting PI-RADSv2 and CAD system. When a CAD target overlapped with a radiologic one, we performed the biopsy in the overlapping area which we defined as target-in-target. Targeted TRUS-MRI fusion biopsy was performed in 63 patients with a total of 212 targets. The MRI data of all targets were quantitatively analyzed, and diagnostic findings were compared to pathologist's biopsy reports. RESULTS CAD system diagnostic performance exhibited sensitivity and specificity scores of 55.2% and 74.1% [AUC = 0.63 (0.54 ÷ 0.71)] , respectively. Human readers achieved an AUC value, in ROC analysis, of 0.71 (0.63 ÷ 0.79). The target-in-target method provided a detection rate per targeted biopsy core of 81.8 % vs. a detection rate per targeted biopsy core of 68.6 % for pure PI-RADS based on target definitions. The higher per-core detection rate of the target-in-target approach was achieved irrespective of the presence of technical flaws and artifacts. CONCLUSIONS A novel consensus method combining human reader evaluation with automated CAD system analysis of mpMRI to define prostate biopsy targets was shown to improve the detection rate per biopsy core of TRUS-MRI fusion biopsies. Results suggest that the combination of CAD system analysis and human reader evaluation is a winning strategy to improve targeted biopsy efficiency.
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Affiliation(s)
- Riccardo Campa
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Maurizio Del Monte
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Giovanni Barchetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Vincenzo Salvo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Isabella Ceravolo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Elena Lucia Indino
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Antonio Ciardi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy.
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Wei C, Jin B, Szewczyk-Bieda M, Gandy S, Lang S, Zhang Y, Huang Z, Nabi G. Quantitative parameters in dynamic contrast-enhanced magnetic resonance imaging for the detection and characterization of prostate cancer. Oncotarget 2018; 9:15997-16007. [PMID: 29662622 PMCID: PMC5882313 DOI: 10.18632/oncotarget.24652] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/25/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives to assess the diagnostic accuracy of quantitative parameters of DCE-MRI in multi-parametric MRI (mpMRI) in comparison to the histopathology (including Gleason grade) of prostate cancer. Patients and methods 150 men with suspected prostate cancer (abnormal digital rectum examination and or elevated prostate-specific antigen) received pre-biopsy 3T mpMRI and were recruited into peer-reviewed, protocol-based prospective study. The DCE-MRI quantitative parameters (Ktrans (influx transfer constant) and kep (efflux rate constant)) of the cancerous and normal areas were recorded using four different kinetic models employing Olea Sphere (Olea Medical, La Ciotat, France). The correlation between these parameters and the histopathology of the lesions (biopsy and in a sub-cohort 41 radical prostatectomy specimen) was assessed. Results The quantitative parameters showed a significant difference between non-cancerous (benign) and cancerous lesions (Gleason score≥3+3) in the prostate gland. The cut-off values for prostate cancer differentiation were: Ktrans (0.205 min−1) and kep (0.665 min−1) in the extended Tofts model (ET) and Ktrans(0.205 min−1 and kep (0.63 min−1) in the Lawrence and Lee delay (LD) models respectively. The mean Ktrans value also showed a difference between low-grade cancer (Gleason score=3+3) and high-grade cancer (Gleason score ≥ 3+4). With the addition of DCE-MRI quantitative parameters, the sensitivity of the PIRAD scoring system was increased from 56.6% to 92.1% (Ktrans_ET), 93.1% (kep_ET), 91.0%, (Ktrans_LD) and 89.4% (kep_LD). Conclusion Quantitative DCE-MRI parameters improved the diagnostic performance of conventional MRI in distinguishing normal and prostate cancers, including characterization of grade of cancers. The ET and LD models in post-image processing analysis provided better cut-off values for prostate cancer differentiation than the other quantitative DCE-MRI parameters.
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Affiliation(s)
- Cheng Wei
- Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Bowen Jin
- Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK.,School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Magdalena Szewczyk-Bieda
- Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK.,Department of Clinical Radiology, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Stephen Gandy
- Department of Medical Physics, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Stephen Lang
- Department of Pathology, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Yilong Zhang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Zhihong Huang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Ghulam Nabi
- Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
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Clinical Application of Biparametric MRI Texture Analysis for Detection and Evaluation of High-Grade Prostate Cancer in Zone-Specific Regions. AJR Am J Roentgenol 2018; 210:549-556. [PMID: 29220213 DOI: 10.2214/ajr.17.18494] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the performance of biparametric MRI texture analysis (TA) in detecting and evaluating high-grade prostate cancer in zone-specific regions. MATERIALS AND METHODS A retrospective study included 184 consecutively registered biopsy-naive patients in whom prostate cancer was suspected who were undergoing multiparametric prostate MRI. MR images were scored and evaluated by two readers using the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and biparametric MRI TA in separate sessions. Interobserver agreement on PI-RADSv2 score and textural parameters of biparametric MRI was evaluated. The logistic regression model based on TA was built for different zones of the prostate. ROC analysis was used to compare the TA-based model with other parameters alone. The correlation of each parameter with Gleason score of high-grade prostate cancer was also assessed. RESULTS Reader reliability ranged from moderate to good for PI-RADSv2 (Cohen κ = 0.525-0.616) and from good to excellent for textural metrics (intraclass correlation coefficient, 0.745-0.925). Diagnostic performance was significantly improved by use of the TA-based model (transition zone AUC, 0.87; peripheral zone AUC, 0.89) in comparison with PI-RADSv2 and other texture parameters alone. For the transition zone, entropy had moderate to good correlation with the Gleason score of high-grade prostate cancer (r = 0.562, p = 0.004). In the peripheral zone, entropy (r = 0.614, p = 0.003) and inertia (r = 0.663, p = 0.002) had moderate to good correlations with Gleason score. CONCLUSION The results of this clinical study indicate that a TA-based model that includes biparametric MRI can be used for identifying high-grade prostate cancer and that specific parameters extracted from TA may be additional tools for assessing tumor aggressiveness.
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Polanec SH, Lazar M, Wengert GJ, Bickel H, Spick C, Susani M, Shariat S, Clauser P, Baltzer PAT. 3D T2-weighted imaging to shorten multiparametric prostate MRI protocols. Eur Radiol 2017; 28:1634-1641. [PMID: 29134351 PMCID: PMC5834556 DOI: 10.1007/s00330-017-5120-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/24/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022]
Abstract
Objectives To determine whether 3D acquisitions provide equivalent image quality, lesion delineation quality and PI-RADS v2 performance compared to 2D acquisitions in T2-weighted imaging of the prostate at 3 T. Methods This IRB-approved, prospective study included 150 consecutive patients (mean age 63.7 years, 35–84 years; mean PSA 7.2 ng/ml, 0.4–31.1 ng/ml). Two uroradiologists (R1, R2) independently rated image quality and lesion delineation quality using a five-point ordinal scale and assigned a PI-RADS score for 2D and 3D T2-weighted image data sets. Data were compared using visual grading characteristics (VGC) and receiver operating characteristics (ROC)/area under the curve (AUC) analysis. Results Image quality was similarly good to excellent for 2D T2w (mean score R1, 4.3 ± 0.81; R2, 4.7 ± 0.83) and 3D T2w (mean score R1, 4.3 ± 0.82; R2, 4.7 ± 0.69), p = 0.269. Lesion delineation was rated good to excellent for 2D (mean score R1, 4.16 ± 0.81; R2, 4.19 ± 0.92) and 3D T2w (R1, 4.19 ± 0.94; R2, 4.27 ± 0.94) without significant differences (p = 0.785). ROC analysis showed an equivalent performance for 2D (AUC 0.580–0.623) and 3D (AUC 0.576–0.629) T2w (p > 0.05, respectively). Conclusions Three-dimensional acquisitions demonstrated equivalent image and lesion delineation quality, and PI-RADS v2 performance, compared to 2D in T2-weighted imaging of the prostate. Three-dimensional T2-weighted imaging could be used to considerably shorten prostate MRI protocols in clinical practice. Key points • 3D shows equivalent image quality and lesion delineation compared to 2D T2w. • 3D T2w and 2D T2w image acquisition demonstrated comparable diagnostic performance. • Using a single 3D T2w acquisition may shorten the protocol by 40%. • Combined with short DCE, multiparametric protocols of 10 min are feasible.
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Affiliation(s)
- Stephan H Polanec
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Wien, Vienna, Austria
| | - Mathias Lazar
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Wien, Vienna, Austria
| | - Georg J Wengert
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Wien, Vienna, Austria
| | - Hubert Bickel
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Wien, Vienna, Austria
| | - Claudio Spick
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Wien, Vienna, Austria
| | - Martin Susani
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna (AKH), Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Wien, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Wien, Vienna, Austria.
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.
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Multiparametric magnetic resonance imaging for transition zone prostate cancer: essential findings, limitations, and future directions. Abdom Radiol (NY) 2017; 42:2732-2744. [PMID: 28702787 DOI: 10.1007/s00261-017-1184-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Review the multiparametric MRI (mpMRI) findings of transition zone (TZ) prostate cancer (PCa) using T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) MRI and to integrate mpMRI findings with clinical history, laboratory values, and histopathology. CONCLUSION TZ prostate tumors are challenging to detect clinically and at MRI. mpMRI using the combination of sequences has the potential to improve accuracy of TZ cancer detection and staging.
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Del Monte M, Leonardo C, Salvo V, Grompone MD, Pecoraro M, Stanzione A, Campa R, Vullo F, Sciarra A, Catalano C, Panebianco V. MRI/US fusion-guided biopsy: performing exclusively targeted biopsies for the early detection of prostate cancer. Radiol Med 2017; 123:227-234. [PMID: 29075977 DOI: 10.1007/s11547-017-0825-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/09/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to validate the role of MR/Ultrasound Fusion-Guided Targeted Biopsy as a first diagnostic modality in subjects with clinical suspicion of prostate cancer (PCa). MATERIALS AND METHODS 108 men (age range 46-78 years) with clinical suspicion for PCa (PSA > 4 ng/mL) underwent multiparametric MRI of the prostate (mpMRI) and, when suspicious lesion were found (according to the PIRADSv2 scoring system), targeted biopsy was performed. All patients without significant alteration patterns at mpMRI have been referred for follow-up at 1 year. RESULTS 91/108 patients showed on the mpMRI highly suspicious lesions (PIRADS 4 and 5); the remaining 17/108 patients revealed no significant alteration consistent with PCa (PIRADS 3). Among the first group of patients, 58/91 proved to be positive for PCa on the pathology report: 24 patients had a Gleason Score (GS) 6 (3 + 3); 18 patients GS 7 of which 7 (3 + 4) and 11 (4 + 3); 14 patients GS 8 (4 + 4); two patients GS 9 (5 + 4); 33 proved to be negative. Overall cancer detection rate (CDR) was 63%. However, the CDR rises significantly, up to 77%, after the 53 initial consecutive biopsies that were performed (p < 0,05) and thus identified as part of the learning curve. Patients of the second group (17/108) have been followed with serial PSA assessments, clinical reevaluation, and follow-up mpMRI. CONCLUSION Performing exclusively targeted MR/Ultrasound Fusion-Guided biopsies for the diagnosis of PCa in patients with suspicious PSA levels (> 4 ng/mL) increases the detection rate of clinically significant cancer, changing both the therapeutic options and the prognosis.
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Affiliation(s)
- Maurizio Del Monte
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Vincenzo Salvo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Marcello Domenico Grompone
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Martina Pecoraro
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Riccardo Campa
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Francesco Vullo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Carlo Catalano
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Valeria Panebianco
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy.
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13
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Polanec SH, Andrzejewski P, Baltzer PAT, Helbich TH, Stiglbauer A, Georg D, Karanikas G, Susani M, Wadsak W, Margreiter M, Mitterhauser M, Brader P, Pinker K. Multiparametric [11C]Acetate positron emission tomography-magnetic resonance imaging in the assessment and staging of prostate cancer. PLoS One 2017; 12:e0180790. [PMID: 28719629 PMCID: PMC5515396 DOI: 10.1371/journal.pone.0180790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 06/21/2017] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this study was to evaluate whether MP [11C]Acetate PET-MRI enables an accurate differentiation of benign and malignant prostate tumors as well as local and distant staging. Materials and methods Fifty-six consecutive patients fulfilling the following criteria were included in this IRB-approved prospective study: elevated PSA levels or suspicious findings at digital rectal examination or TRUS; and histopathological verification. All patients underwent MP [11C]Acetate PET-MRI of the prostate performed on separate scanners with PET/CT using [11C]Acetate and 3T MP MR imaging. Appropriate statistical tests were used to determine diagnostic accuracy, local and distant staging. Results MP imaging with two MRI parameters (T2w and DWI) achieved the highest sensitivity, specificity, and diagnostic accuracy of 95%, 68.8%, and 88%, with an AUC of 0.82 for primary PCa detection. Neither assessments with a single parameter (AUC, 0.54–0.79), nor different combinations with up to five parameters (AUC, 0.67–0.79) achieved equally good results. MP [11C]Acetate PET-MRI improved local staging with a sensitivity, specificity, and diagnostic accuracy of 100%, 96%, and 97% compared to MRI alone with 72.2%, 100%, and 95.5%. MP [11C]Acetate PET-MRI correctly detected osseous and liver metastases in five patients. Conclusions MP [11C]Acetate PET-MRI merges morphologic with functional information, and allows insights into tumor biology. MP [11C]Acetate PET-MRI with two MRI-derived parameters (T2 and DWI) yields the highest diagnostic accuracy. The addition of more parameters does not improve diagnostic accuracy of primary PCa detection. MP [11C]Acetate PET-MRI facilitates improved local and distant staging, providing “one-stop” staging in patients with primary PCa, and therefore has the potential to improve therapy. Patient summary In this report we investigated MP [11C]Acetate PET-MRI for detection, local and distant staging of prostate cancer. We demonstrate that MP [11C]Acetate PET-MRI with two MRI-derived parameters (T2 and DWI) achieves the best diagnostic accuracy for primary prostate cancer detection and that MP [11C]Acetate PET-MRI enables an improved local and distant staging.
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Affiliation(s)
- Stephan H. Polanec
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Piotr Andrzejewski
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
- Department of Radiation Oncology, Division of Medical Radiation Physics, Medical University of Vienna, Vienna, Austria
| | - Pascal A. T. Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Thomas H. Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Alexander Stiglbauer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Dietmar Georg
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
- Department of Radiation Oncology, Division of Medical Radiation Physics, Medical University of Vienna, Vienna, Austria
| | - Georgios Karanikas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Susani
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Margreiter
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Brader
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Hyoscine butylbromide significantly decreases motion artefacts and allows better delineation of anatomic structures in mp-MRI of the prostate. Eur Radiol 2017; 28:17-23. [DOI: 10.1007/s00330-017-4940-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 12/19/2022]
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Zhang L, Tang M, Chen S, Lei X, Zhang X, Huan Y. A meta-analysis of use of Prostate Imaging Reporting and Data System Version 2 (PI-RADS V2) with multiparametric MR imaging for the detection of prostate cancer. Eur Radiol 2017; 27:5204-5214. [PMID: 28656462 DOI: 10.1007/s00330-017-4843-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/13/2017] [Accepted: 04/04/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This meta-analysis was undertaken to review the diagnostic accuracy of PI-RADS V2 for prostate cancer (PCa) detection with multiparametric MR (mp-MR). METHODS A comprehensive literature search of electronic databases was performed by two observers independently. Inclusion criteria were original research using the PI-RADS V2 system in reporting prostate MRI. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data necessary to complete 2 × 2 contingency tables were obtained from the included studies. RESULTS Thirteen studies (2,049 patients) were analysed. This is an initial meta-analysis of PI-RADs V2 and the overall diagnostic accuracy in diagnosing PCa was as follows: pooled sensitivity, 0.85 (0.78-0.91); pooled specificity, 0.71 (0.60-0.80); pooled positive likelihood ratio (LR+), 2.92 (2.09-4.09); pooled negative likelihood ratio (LR-), 0.21 (0.14-0.31); pooled diagnostic odds ratio (DOR), 14.08 (7.93-25.01), respectively. Positive predictive values ranged from 0.54 to 0.97 and negative predictive values ranged from 0.26 to 0.92. CONCLUSION Currently available evidence indicates that PI-RADS V2 appears to have good diagnostic accuracy in patients with PCa lesions with high sensitivity and moderate specificity. However, no recommendation regarding the best threshold can be provided because of heterogeneity. KEY POINTS • PI-RADS V2 shows good diagnostic accuracy for PCa detection. • Initially pooled specificity of PI-RADS v2 remains moderate. • PCa detection is increased by experienced radiologists. • There is currently a high heterogeneity in prostate diagnostics with MRI.
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Affiliation(s)
- Li Zhang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 17 Changle Road, Xi'an, Shaanxi, 710032, China.,Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710032, China
| | - Min Tang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710032, China
| | - Sipan Chen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 17 Changle Road, Xi'an, Shaanxi, 710032, China.,Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710032, China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710032, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710032, China
| | - Yi Huan
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 17 Changle Road, Xi'an, Shaanxi, 710032, China.
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16
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Magnetic resonance imaging of the prostate at 1.5 versus 3.0 T: A prospective comparison study of image quality. Eur J Radiol 2017; 90:192-197. [DOI: 10.1016/j.ejrad.2017.02.044] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 01/09/2023]
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17
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Abstract
A successful paradigm shift toward personalized management strategies for patients with prostate cancer (PCa) is heavily dependent on the availability of noninvasive diagnostic tools capable of accurately establishing the true extent of disease at the time of diagnosis and estimating the risk of subsequent disease progression and related mortality. Although there is still considerable scope for improvement in its diagnostic, predictive, and prognostic capabilities, multiparametric prostate magnetic resonance imaging (MRI) is currently regarded as the imaging modality of choice for local staging of PCa. A negative MRI, that is, the absence of any MRI-visible intraprostatic lesion, has a high negative predictive value for the presence of clinically significant PCa and can substantiate the consideration of active surveillance as a preferred initial management approach. MRI-derived quantitative and semi-quantitative parameters can be utilized to noninvasively characterize MRI-visible prostate lesions and identify those patients who are most likely to benefit from radical treatment, and differentiate them from patients with benign or indolent prostate pathology that may also be visible on MRI. This literature review summarizes current strategies how MRI can be used to determine a tailored management strategy for an individual patient.
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18
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Wang X, Wang JY, Li CM, Zhang YQ, Wang JL, Wan B, Zhang W, Chen M, Li SY, Wan G, Liu M. Evaluation of the Prostate Imaging Reporting and Data System for Magnetic Resonance Imaging Diagnosis of Prostate Cancer in Patients with Prostate-specific Antigen <20 ng/ml. Chin Med J (Engl) 2017; 129:1432-8. [PMID: 27270538 PMCID: PMC4910366 DOI: 10.4103/0366-6999.183419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The European Society of Urogenital Radiology has built the Prostate Imaging Reporting and Data System (PI-RADS) for standardizing the diagnosis of prostate cancer (PCa). This study evaluated the PI-RADS diagnosis method in patients with prostate-specific antigen (PSA) <20 ng/ml. Methods: A total of 133 patients with PSA <20 ng/ml were prospectively recruited. T2-weighted (T2WI) and diffusion-weighted (DWI) magnetic resonance images of the prostate were acquired before a 12-core transrectal prostate biopsy. Each patient's peripheral zone was divided into six regions on the images; each region corresponded to two of the 12 biopsy cores. T2WI, DWI, and T2WI + DWI scores were computed according to PI-RADS. The diagnostic accuracy of the PI-RADS score was evaluated using histopathology of prostate biopsies as the reference standard. Results: PCa was histologically diagnosed in 169 (21.2%) regions. Increased PI-RADS score correlated positively with increased cancer detection rate. The cancer detection rate for scores 1 to 5 was 2.8%, 15.0%, 34.6%, 52.6%, and 88.9%, respectively, using T2WI and 12.0%, 20.2%, 48.0%, 85.7%, and 93.3%, respectively, using DWI. For T2WI + DWI, the cancer detection rate was 1.5% (score 2), 13.5% (scores 3–4), 41.3% (scores 5–6), 75.9% (scores 7–8), and 92.3% (scores 9–10). The area under the curve for cancer detection was 0.700 (T2WI), 0.735 (DWI) and 0.749 (T2WI + DWI). The sensitivity and specificity were 53.8% and 89.2%, respectively, when using scores 5–6 as the cutoff value for T2WI + DWI. Conclusions: The PI-RADS score correlates with the PCa detection rate in patients with PSA <20 ng/ml. The summed score of T2WI + DWI has the highest accuracy in detection of PCa. However, the sensitivity should be further improved.
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Affiliation(s)
- Xuan Wang
- Department of Urology, Beijing Hospital, Beijing 100730, China
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, Beijing 100730, China
| | - Chun-Mei Li
- Department of Radiology, Beijing Hospital, Beijing 100730, China
| | - Ya-Qun Zhang
- Department of Urology, Beijing Hospital, Beijing 100730, China
| | - Jian-Long Wang
- Department of Urology, Beijing Hospital, Beijing 100730, China
| | - Ben Wan
- Department of Urology, Beijing Hospital, Beijing 100730, China
| | - Wei Zhang
- Department of Pathology, Beijing Hospital, Beijing 100730, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, Beijing 100730, China
| | - Sa-Ying Li
- Department of Radiology, Beijing Hospital, Beijing 100730, China
| | - Gang Wan
- Department of Medical Statistics, Beijing Ditan Hospital, Beijing 100015, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, Beijing 100730, China
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19
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Feng ZY, Wang L, Min XD, Wang SG, Wang GP, Cai J. Prostate Cancer Detection with Multiparametric Magnetic Resonance Imaging: Prostate Imaging Reporting and Data System Version 1 versus Version 2. Chin Med J (Engl) 2017; 129:2451-2459. [PMID: 27748338 PMCID: PMC5072258 DOI: 10.4103/0366-6999.191771] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Prostate Imaging Reporting and Data System (PI-RADS) is a globally acceptable standardization for multiparametric magnetic resonance imaging (mp-MRI) in prostate cancer (PCa) diagnosis. The American College of Radiology revised the PI-RADS to address the limitations of version 1 in December 2014. This study aimed to determine whether the PI-RADS version 2 (PI-RADS v2) scoring system improves the diagnostic accuracy of mp-MRI of the prostate compared with PI-RADS v1. Methods: This retrospective study was approved by the institutional review board. A total of 401 consecutive patients, with clinically suspicious PCa undergoing 3.0 T mp-MRI (T2-weighted imaging + diffusion-weighted imaging + DCE) before transrectal ultrasound-guided biopsy between June 2013 and July 2015, were included in the study. All patients were scored using the 5-point PI-RADS scoring system based on either PI-RADS v1 or v2. Receiver operating characteristics were calculated for statistical analysis. Sensitivity, specificity, and diagnostic accuracy were compared using McNemar's test. Results: PCa was present in 150 of 401 (37.41%) patients. When we pooled data from both peripheral zone (PZ) and transition zone (TZ), the areas under the curve were 0.889 for PI-RADS v1 and 0.942 for v2 (P = 0.0001). Maximal accuracy was achieved with a score threshold of 4. At this threshold, in the PZ, similar sensitivity, specificity, and accuracy were achieved with v1 and v2 (all P > 0.05). In the TZ, sensitivity was higher for v2 than for v1 (96.36% vs. 76.36%, P = 0.003), specificity was similar for v2 and v1 (90.24% vs. 84.15%, P = 0.227), and accuracy was higher for v2 than for v1 (92.70% vs. 81.02%, P = 0.002). Conclusions: Both v1 and v2 showed good diagnostic performance for the detection of PCa. However, in the TZ, the performance was better with v2 than with v1.
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Affiliation(s)
- Zhao-Yan Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiang-De Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Shao-Gang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Guo-Ping Wang
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jie Cai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Niu XK, He WF, Zhang Y, Das SK, Li J, Xiong Y, Wang YH. Developing a new PI-RADS v2-based nomogram for forecasting high-grade prostate cancer. Clin Radiol 2017; 72:458-464. [PMID: 28069159 DOI: 10.1016/j.crad.2016.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/04/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
AIM To establish a predictive nomogram for high-grade prostate cancer (HGPCa) in biopsy-naive patients based on the Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2), magnetic resonance imaging (MRI)-based prostate volume (PV), MRI-based PV-adjusted prostate-specific antigen density (PSAD), and other classical parameters. MATERIAL AND METHODS Between August 2014 and August 2015, 158 men who were eligible for analysis were included as the training cohort. A prediction model for HGPCa was built using backward logistic regression and was presented on a nomogram. The prediction model was evaluated by a validation cohort between September 2015 and March 2016 (n=89). Histology of all lesions was obtained with MRI-directed transrectal ultrasound (TRUS)-guided targeted and sectoral biopsy. RESULTS The multivariate analysis revealed that patient age, PI-RADS v2 score, and adjusted PSAD were independent predictors for HGPCa. The most discriminative cut-off value for the logistic regression model was 0.33; the sensitivity, specificity, positive predictive value, and negative predictive value were 83.3%, 87.4%, 88.4%, and 81.2%, respectively. The diagnostic performance measures retained similar values in the validation cohort (AUC=0.83). CONCLUSION The nomogram for forecasting HGPCa is effective and potentially reducing harm from unnecessary prostate biopsy and over-diagnosis.
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Affiliation(s)
- X-K Niu
- Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, 610081, China
| | - W-F He
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Sichuan 637000, China
| | - Y Zhang
- Department of Radiology, Deyang City People's Hospital, 618000, China
| | - S K Das
- Department of Interventional Radiology, Tenth People's Hospital of Tongji University, Shanghai 200072, China.
| | - J Li
- Department of General Surgery, Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Y Xiong
- Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, 610081, China
| | - Y-H Wang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, 610081, China
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Purysko AS, Rosenkrantz AB, Barentsz JO, Weinreb JC, Macura KJ. PI-RADS Version 2: A Pictorial Update. Radiographics 2016; 36:1354-72. [DOI: 10.1148/rg.2016150234] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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22
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Auer T, Edlinger M, Bektic J, Nagele U, Herrmann T, Schäfer G, Aigner F, Junker D. Performance of PI-RADS version 1 versus version 2 regarding the relation with histopathological results. World J Urol 2016; 35:687-693. [PMID: 27510762 DOI: 10.1007/s00345-016-1920-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/04/2016] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Aim of this study was to compare the diagnostic performance of PI-RADS version 1 (v1) and version 2 (v2) in the detection of prostate cancer (PCa). METHODS Multiparametric MRIs (mpMRI) of 50 consecutive patients with biopsy proven PCa, which had originally been evaluated according to PIRADS v1, were now retrospectively re-evaluated, comparing PI-RADS v1 and v2. MpMRI data were evaluated in comparison with histopathological whole-mount step-section slides. MRI examinations included T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI. RESULTS Overall PI-RADS v1 showed a significantly larger discriminative ability of tumor detection: PI-RADS v1 AUC 0.96 (95 % CI 0.94-0.98) and v2 AUC 0.90 (95 % CI 0.86-0.94). For peripheral zone lesions, PI-RADS v1 showed a significantly larger ability of PCa discrimination: v1 AUC 0.97 (95 % CI 0.95-0.99) and v2 AUC 0.92 (95 % CI 0.88-0.96). For transition zone lesions, PI-RADS v1 showed more discrimination: v1 AUC 0.96 (95 % CI 0.92-1.00) and v2 0.90 (95 % CI 0.83-0.97), but the difference was not significant. PI-RADS v2 resulted in significantly more false negative results (3 % in v1, 14 % in v2) and a comparable number of true positive results (82 % in v1, 80 % in v2). CONCLUSION PI-RADS v2 uses a simplified approach, but shows a lower diagnostic accuracy. This could lead to a higher rate of false negative results with the risk of missing tumors within low PI-RADS score levels. Therefore, its use cannot be recommended unconditionally, and further improvement should be considered.
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Affiliation(s)
- Thomas Auer
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Edlinger
- Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Schöpfstraße 41/1, 6020, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Udo Nagele
- Landeskrankenhaus Hall, Abteilung für Urologie und Andrologie, Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Thomas Herrmann
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Georg Schäfer
- Department of Pathology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Daniel Junker
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Polanec S, Helbich TH, Bickel H, Pinker-Domenig K, Georg D, Shariat SF, Aulitzky W, Susani M, Baltzer PA. Head-to-head comparison of PI-RADS v2 and PI-RADS v1. Eur J Radiol 2016; 85:1125-31. [DOI: 10.1016/j.ejrad.2016.03.025] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 01/15/2023]
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Meier-Schroers M, Kukuk G, Wolter K, Decker G, Fischer S, Marx C, Traeber F, Sprinkart AM, Block W, Schild HH, Willinek W. Differentiation of prostatitis and prostate cancer using the Prostate Imaging-Reporting and Data System (PI-RADS). Eur J Radiol 2016; 85:1304-11. [PMID: 27235878 DOI: 10.1016/j.ejrad.2016.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/25/2016] [Accepted: 04/28/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine if prostate cancer (PCa) and prostatitis can be differentiated by using PI-RADS. MATERIALS AND METHODS 3T MR images of 68 patients with 85 cancer suspicious lesions were analyzed. The findings were correlated with histopathology. T2w imaging (T2WI), diffusion weighted imaging (DWI), dynamic contrast enhancement (DCE), and MR-Spectroscopy (MRS) were acquired. Every lesion was given a single PI-RADS score for each parameter, as well as a sum score and a PI-RADS v2 score. Furthermore, T2-morphology, ADC-value, perfusion type, citrate/choline-level, and localization were evaluated. RESULTS 44 of 85 lesions showed PCa (51.8%), 21 chronic prostatitis (24.7%), and 20 other benign tissue such as hyperplasia or fibromuscular tissue (23.5%). The single PI-RADS score for T2WI, DWI, DCE, as well as the aggregated score including and not including MRS, and the PI-RADS v2-score were all significantly higher for PCa than for prostatitis or other tissue (p<0.001). The single PI-RADS score for MRS and the PI-RADS sum score including MRS were significantly higher for prostatitis than for other tissue (p=0.029 and p=0.020), whereas the other parameters were not different. Prostatitis usually presented borderline pathological PI-RADS scores, showed restricted diffusion with ADC≥900mm(2)/s in 100% of cases, was more often indistinctly hypointense on T2WI (66.7%), and localized in the transitional zone (57.1%). An ADC≥900mm(2)/s achieved the highest predictive value for prostatitis (AUC=0.859). CONCLUSION Prostatitis can be differentiated from PCa using PI-RADS, since all available parameters are more distinct in cases of cancer. However, there is significant overlap between prostatitis and other benign findings, thus PI-RADS is only suitable to a limited extent for the primary assessment of prostatitis. Restricted diffusion with ADC≥900mm(2)/s is believed to be a good indicator for prostatitis. MRS can help to distinguish between prostatitis and other tissue.
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Affiliation(s)
- Michael Meier-Schroers
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Guido Kukuk
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Karsten Wolter
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Georges Decker
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Stefan Fischer
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Christian Marx
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Frank Traeber
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Alois Martin Sprinkart
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Wolfgang Block
- Department of Radiology, University of Bonn, Sigmund-Freud-Str 25, 53127 Bonn, Germany
| | - Hans Heinz Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Winfried Willinek
- Department of Radiology, Neuroradiology, Sonography and Nuclear Medicine, Hospital of the Barmherzige Brüder Trier, Nordallee 1, 54292 Trier, Germany.
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Kasel-Seibert M, Lehmann T, Aschenbach R, Guettler FV, Abubrig M, Grimm MO, Teichgraeber U, Franiel T. Assessment of PI-RADS v2 for the Detection of Prostate Cancer. Eur J Radiol 2016; 85:726-31. [DOI: 10.1016/j.ejrad.2016.01.011] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/31/2015] [Accepted: 01/16/2016] [Indexed: 01/21/2023]
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Schimmöller L, Quentin M, Blondin D, Dietzel F, Hiester A, Schleich C, Thomas C, Rabenalt R, Gabbert HE, Albers P, Antoch G, Arsov C. Targeted MRI-guided prostate biopsy: are two biopsy cores per MRI-lesion required? Eur Radiol 2016; 26:3858-3864. [PMID: 26920391 DOI: 10.1007/s00330-016-4266-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/19/2016] [Accepted: 02/01/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE This study evaluates the feasibility of performing less than two core biopsies per MRI-lesion when performing targeted MR-guided in-bore prostate biopsy. METHODS Retrospectively evaluated were 1545 biopsy cores of 774 intraprostatic lesions (two cores per lesion) in 290 patients (66 ± 7.8 years; median PSA 8.2 ng/ml) regarding prostate cancer (PCa) detection, Gleason score, and tumor infiltration of the first (FBC) compared to the second biopsy core (SBC). Biopsies were acquired under in-bore MR-guidance. RESULTS For the biopsy cores, 491 were PCa positive, 239 of 774 (31 %) were FBC and 252 of 771 (33 %) were SBC (p = 0.4). Patient PCa detection rate based on the FBC vs. SBC were 46 % vs. 48 % (p = 0.6). For clinically significant PCa (Gleason score ≥4 + 3 = 7) the detection rate was 18 % for both, FBC and SBC (p = 0.9). Six hundred and eighty-seven SBC (89 %) showed no histologic difference. On the lesion level, 40 SBC detected PCa with negative FBC (7.5 %). Twenty SBC showed a Gleason upgrade from 3 + 3 = 6 to ≥3 + 4 = 7 (2.6 %) and 4 to ≥4 + 3 = 7 (0.5 %). CONCLUSION The benefit of a second targeted biopsy core per suspicious MRI-lesion is likely minor, especially regarding PCa detection rate and significant Gleason upgrading. Therefore, a further reduction of biopsy cores is reasonable when performing a targeted MR-guided in-bore prostate biopsy. KEY POINTS • Higher PI-RADS overall score (IV-V) correlated well with PCa detection rate • In more than 80 % SBC was concordant regarding overall PCa detection • In almost 90 % there was no Gleason upgrading by the SBC • Only 2/54 (3.7 %) csPCa was missed when the SBC was omitted • For IB-GB a further reduction of biopsy cores is reasonable.
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Affiliation(s)
- L Schimmöller
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - M Quentin
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
| | - D Blondin
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - F Dietzel
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - A Hiester
- Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - C Schleich
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - C Thomas
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - R Rabenalt
- Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - H E Gabbert
- Medical Faculty, Department of Pathology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - P Albers
- Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - G Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
| | - C Arsov
- Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany
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Multiparametric MRI of the prostate at 3 T: limited value of 3D 1H-MR spectroscopy as a fourth parameter. World J Urol 2015; 34:649-56. [DOI: 10.1007/s00345-015-1670-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/10/2015] [Indexed: 12/19/2022] Open
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Prostate cancer gene 3 (PCA3) is of additional predictive value in patients with PI-RADS grade III (intermediate) lesions in the MR-guided re-biopsy setting for prostate cancer. World J Urol 2015; 34:509-15. [DOI: 10.1007/s00345-015-1655-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022] Open
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Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies. Eur Urol 2015; 68:713-20. [PMID: 26116294 DOI: 10.1016/j.eururo.2015.06.008] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/09/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND A significant proportion of prostate cancers (PCas) are missed by conventional transrectal ultrasound-guided biopsy (TRUS-GB). It remains unclear whether the combined approach using targeted magnetic resonance imaging (MRI)-ultrasound fusion-guided biopsy (FUS-GB) and systematic TRUS-GB is superior to targeted MRI-guided in-bore biopsy (IB-GB) for PCa detection. OBJECTIVE To compare PCa detection between IB-GB alone and FUS-GB + TRUS-GB in patients with at least one negative TRUS-GB and prostate-specific antigen ≥4 ng/ml. DESIGN, SETTING, AND PARTICIPANTS Patients were prospectively randomized after multiparametric prostate MRI to IB-GB (arm A) or FUS-GB + TRUS-GB (arm B) from November 2011 to July 2014. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The study was powered at 80% to demonstrate an overall PCa detection rate of ≥60% in arm B compared to 40% in arm A. Secondary endpoints were the distribution of highest Gleason scores, the rate of detection of significant PCa (Gleason ≥7), the number of biopsy cores to detect one (significant) PCa, the positivity rate for biopsy cores, and tumor involvement per biopsy core. RESULTS AND LIMITATIONS The study was halted after interim analysis because the primary endpoint was not met. The trial enrolled 267 patients, of whom 210 were analyzed (106 randomized to arm A and 104 to arm B). PCa detection was 37% in arm A and 39% in arm B (95% confidence interval for difference, -16% to 11%; p=0.7). Detection rates for significant PCa (29% vs 32%; p=0.7) and the highest percentage tumor involvement per biopsy core (48% vs 42%; p=0.4) were similar between the arms. The mean number of cores was 5.6 versus 17 (p<0.001). A limitation is the limited number of patients because of early cessation of accrual. CONCLUSIONS This trial failed to identify an important improvement in detection rate for the combined biopsy approach over MRI-targeted biopsy alone. A prospective comparison between MRI-targeted biopsy alone and systematic TRUS-GB is justified. PATIENT SUMMARY Our randomized study showed similar prostate cancer detection rates between targeted prostate biopsy guided by magnetic resonance imaging and the combination of targeted biopsy and systematic transrectal ultrasound-guided prostate biopsy. An important improvement in detection rates using the combined biopsy approach can be excluded.
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Muller BG, Shih JH, Sankineni S, Marko J, Rais-Bahrami S, George AK, de la Rosette JJMCH, Merino MJ, Wood BJ, Pinto P, Choyke PL, Turkbey B. Prostate Cancer: Interobserver Agreement and Accuracy with the Revised Prostate Imaging Reporting and Data System at Multiparametric MR Imaging. Radiology 2015; 277:741-50. [PMID: 26098458 DOI: 10.1148/radiol.2015142818] [Citation(s) in RCA: 267] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate accuracy and interobserver variability with the use of the Prostate Imaging Reporting and Data System (PI-RADS) version 2.0 for detection of prostate cancer at multiparametric magnetic resonance (MR) imaging in a biopsy-naïve patient population. MATERIALS AND METHODS This retrospective HIPAA-compliant study was approved by the local ethics committee, and written informed consent was obtained from all patients for use of their imaging and histopathologic data in future research studies. In 101 biopsy-naïve patients with elevated prostate-specific antigen levels who underwent multiparametric MR imaging of the prostate and subsequent transrectal ultrasonography (US)-MR imaging fusion-guided biopsy, suspicious lesions detected at multiparametric MR imaging were scored by five readers who were blinded to pathologic results by using to the newly revised PI-RADS and the scoring system developed in-house. Interobserver agreement was evaluated by using κ statistics, and the correlation of pathologic results with each of the two scoring systems was evaluated by using the Kendall τ correlation coefficient. RESULTS Specimens of 162 lesions in 94 patients were sampled by means of transrectal US-MR imaging fusion biopsy. Results for 87 (54%) lesions were positive for prostate cancer. Kendall τ values with the PI-RADS and the in-house-developed scoring system, respectively, at T2-weighted MR imaging in the peripheral zone were 0.51 and 0.17 and in the transitional zone, 0.45 and -0.11; at diffusion-weighted MR imaging, 0.42 and 0.28; at dynamic contrast material-enhanced MR imaging, 0.23 and 0.24, and overall suspicion scores were 0.42 and 0.49. Median κ scores among all possible pairs of readers for PI-RADS and the in-house-developed scoring system, respectively, for T2-weighted MR images in the peripheral zone were 0.47 and 0.15; transitional zone, 0.37 and 0.07; diffusion-weighted MR imaging, 0.41 and 0.57; dynamic contrast-enhanced MR imaging, 0.48 and 0.41; and overall suspicion scores, 0.46 and 0.55. CONCLUSION Use of the revised PI-RADS provides moderately reproducible MR imaging scores for detection of clinically relevant disease.
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Affiliation(s)
- Berrend G Muller
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Joanna H Shih
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Sandeep Sankineni
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Jamie Marko
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Soroush Rais-Bahrami
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Arvin Koruthu George
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Jean J M C H de la Rosette
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Maria J Merino
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Bradford J Wood
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Peter Pinto
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Peter L Choyke
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Baris Turkbey
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
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Mendez MH, Joh DY, Gupta R, Polascik TJ. Current Trends and New Frontiers in Focal Therapy for Localized Prostate Cancer. Curr Urol Rep 2015; 16:35. [DOI: 10.1007/s11934-015-0513-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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