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Zhang T, Zhou Z, Li W, Xu C, Zhao S, Wei H, Huang Z, Zhao X. Application value of magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer. Sci Rep 2024; 14:22278. [PMID: 39333720 PMCID: PMC11437187 DOI: 10.1038/s41598-024-73605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/19/2024] [Indexed: 09/29/2024] Open
Abstract
Magnetic resonance spectroscopy (MRSI) can distinguish between benign and malignant prostate diseases. This study investigated the potential of MRSI for diagnosing prostate cancer and guiding prostate biopsy. We retrospectively reviewed 234 patients with suspected prostate cancer who underwent MRSI with targeted prostate biopsy. Patients were divided into two groups according to their puncture pathology: prostate cancer (n = 103, 44.02%) and benign prostatic disease (n = 131, 55.98%). The t-test, Mann-Whitney U test, or chi-square test was used to compare the groups. The diagnostic abilities of MRSI, prostate-specific antigen level, digital rectal examination, and magnetic resonance imaging without contrast for prostate cancer were compared using the area under the receiver operating characteristic curve (AUC-ROC); the ARC-ROC values were 0.831, 0.768, 0.692, and 0.656, respectively. The AUC-ROC value for diagnosing prostate cancer using the CC/c ratio was 0.853. CC/c ratio > 0.97 was identified as the optimal threshold for diagnosing prostate cancer (sensitivity, 86.5%; specificity, 78.6%; Youden index, 0.651). Spearman correlation analysis revealed a correlation between the CC/c ratio and Gleason score (r = 0.737, p < 0.001). Using the CC/c ratio of MRSI as an adjunct to targeted prostate biopsy can improve the detection rate of positive biopsies and evaluate prostate cancer invasiveness.
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Affiliation(s)
- Tianhe Zhang
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Zhiyong Zhou
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Wuxue Li
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Changbao Xu
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Shuailin Zhao
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Haiyang Wei
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Zhiheng Huang
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Xinghua Zhao
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China.
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Stamatelatou A, Bertinetto CG, Jansen JJ, Postma G, Selnaes KM, Bathen TF, Heerschap A, Scheenen TWJ. A multivariate curve resolution analysis of multicenter proton spectroscopic imaging of the prostate for cancer localization and assessment of aggressiveness. NMR IN BIOMEDICINE 2024; 37:e5062. [PMID: 37920145 DOI: 10.1002/nbm.5062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023]
Abstract
In this study, we investigated the potential of the multivariate curve resolution alternating least squares (MCR-ALS) algorithm for analyzing three-dimensional (3D) 1 H-MRSI data of the prostate in prostate cancer (PCa) patients. MCR-ALS generates relative intensities of components representing spectral profiles derived from a large training set of patients, providing an interpretable model. Our objectives were to classify magnetic resonance (MR) spectra, differentiating tumor lesions from benign tissue, and to assess PCa aggressiveness. We included multicenter 3D 1 H-MRSI data from 106 PCa patients across eight centers. The patient cohort was divided into a training set (N = 63) and an independent test set (N = 43). Singular value decomposition determined that MR spectra were optimally represented by five components. The profiles of these components were extracted from the training set by MCR-ALS and assigned to specific tissue types. Using these components, MCR-ALS was applied to the test set for a quantitative analysis to discriminate tumor lesions from benign tissue and to assess tumor aggressiveness. Relative intensity maps of the components were reconstructed and compared with histopathology reports. The quantitative analysis demonstrated a significant separation between tumor and benign voxels (t-test, p < 0.001). This result was achieved including voxels with low-quality MR spectra. A receiver operating characteristic analysis of the relative intensity of the tumor component revealed that low- and high-risk tumor lesions could be distinguished with an area under the curve of 0.88. Maps of this component properly identified the extent of tumor lesions. Our study demonstrated that MCR-ALS analysis of 1 H-MRSI of the prostate can reliably identify tumor lesions and assess their aggressiveness. It handled multicenter data with minimal preprocessing and without using prior knowledge or quality control. These findings indicate that MCR-ALS can serve as an automated tool to assess the presence, extent, and aggressiveness of tumor lesions in the prostate, enhancing diagnostic capabilities and treatment planning of PCa patients.
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Affiliation(s)
- Angeliki Stamatelatou
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jeroen J Jansen
- Department of Analytical Chemistry & Chemometrics, Radboud University, Nijmegen, The Netherlands
| | - Geert Postma
- Department of Analytical Chemistry & Chemometrics, Radboud University, Nijmegen, The Netherlands
| | - Kirsten Margrete Selnaes
- Department of Circulation and Medical Imaging, Norwegian University of Technology and Science, Trondheim, Norway
| | - Tone F Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Technology and Science, Trondheim, Norway
- Department of radiology and nuclear medicine, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Arend Heerschap
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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Reesink DJ, Arteaga de Castro CS, Van der Velden T, Van Vooren J, Oost P, Jonges TGN, Lam MGEH, de Keizer B, Willemse PPM, Meijer RP, Klomp DWJ. Feasibility of clinical studies of chemical exchange saturation transfer magnetic resonance imaging of prostate cancer at 7 T. NMR IN BIOMEDICINE 2023; 36:e4958. [PMID: 37094995 DOI: 10.1002/nbm.4958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
Chemical exchange saturation transfer (CEST) has been explored for differentiation between tumour and benign tissue in prostate cancer (PCa) patients. With ultrahigh field strengths such as 7-T, the increase of spectral resolution and sensitivity could allow for selective detection of amide proton transfer (APT) at 3.5 ppm and a group of compounds that resonate at 2 ppm (i.e., [poly]amines and/or creatine). The potential of 7-T multipool CEST analysis of the prostate and the detection of PCa was studied in patients with proven localised PCa who were scheduled to undergo robot-assisted radical prostatectomy (RARP). Twelve patients were prospectively included (mean age 68.0 years, mean serum prostate-specific antigen 7.8ng/mL). A total of 24 lesions larger than 2 mm were analysed. Used were 7-T T2-weighted (T2W) imaging and 48 spectral CEST points. Patients received 1.5-T/3-T prostate magnetic resonance imaging and galium-68-prostate-specific membrane antigen-positron emission tomography/computerised tomography to determine the location of the single-slice CEST. Based on the histopathological results after RARP, three regions of interest were drawn on the T2W images from a known malignant zone and benign zone in the central and peripheral zones. These areas were transposed to the CEST data, from which the APT and 2-ppm CEST were calculated. The statistical significance of the CEST between the central zone, the peripheral zone, and tumour was calculated using a Kruskal-Wallis test. The z-spectra showed that APT and even a distinct pool that resonated at 2 ppm were detectable. This study showed a difference trend in the APT levels, but no difference in the 2-ppm levels when tested between the central zone, the peripheral zone, and tumour (H(2) = 4.8, p = 0.093 and H(2) = 0.86, p = 0.651, respectively). Thus, to conclude, we could most likely detect APT and amines and/or creatine levels noninvasively in prostate using the CEST effect. At group level, CEST showed a higher level of APT in the peripheral versus the central zone; however, no differences of APT and 2-ppm levels were observed in tumours.
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Affiliation(s)
- Daan J Reesink
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catalina S Arteaga de Castro
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tijl Van der Velden
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanette Van Vooren
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petri Oost
- Department of Urology, Tergooi Hospital Hilversum, Hilversum, The Netherlands
| | - Trudy G N Jonges
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter-Paul M Willemse
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W J Klomp
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Tenbergen CJA, Ruhm L, Ypma S, Heerschap A, Henning A, Scheenen TWJ. Improving the Effective Spatial Resolution in 1H-MRSI of the Prostate with Three-Dimensional Overdiscretized Reconstructions. Life (Basel) 2023; 13:life13020282. [PMID: 36836640 PMCID: PMC9967259 DOI: 10.3390/life13020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
In in vivo 1H-MRSI of the prostate, small matrix sizes can cause voxel bleeding extending to regions far from a voxel, dispersing a signal of interest outside that voxel and mixing extra-prostatic residual lipid signals into the prostate. To resolve this problem, we developed a three-dimensional overdiscretized reconstruction method. Without increasing the acquisition time from current 3D MRSI acquisition methods, this method is aimed to improve the localization of metabolite signals in the prostate without compromising on SNR. The proposed method consists of a 3D spatial overdiscretization of the MRSI grid, followed by noise decorrelation with small random spectral shifts and weighted spatial averaging to reach a final target spatial resolution. We successfully applied the three-dimensional overdiscretized reconstruction method to 3D prostate 1H-MRSI data at 3T. Both in phantom and in vivo, the method proved to be superior to conventional weighted sampling with Hamming filtering of k-space. Compared with the latter, the overdiscretized reconstructed data with smaller voxel size showed up to 10% less voxel bleed while maintaining higher SNR by a factor of 1.87 and 1.45 in phantom measurements. For in vivo measurements, within the same acquisition time and without loss of SNR compared with weighted k-space sampling and Hamming filtering, we achieved increased spatial resolution and improved localization in metabolite maps.
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Affiliation(s)
- Carlijn J. A. Tenbergen
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Correspondence:
| | - Loreen Ruhm
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, 72076 Tübingen, Germany
| | - Sjoerd Ypma
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Anke Henning
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, 72076 Tübingen, Germany
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Tom W. J. Scheenen
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Stamatelatou A, Scheenen TWJ, Heerschap A. Developments in proton MR spectroscopic imaging of prostate cancer. MAGMA (NEW YORK, N.Y.) 2022; 35:645-665. [PMID: 35445307 PMCID: PMC9363347 DOI: 10.1007/s10334-022-01011-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/04/2022] [Accepted: 03/22/2022] [Indexed: 10/25/2022]
Abstract
In this paper, we review the developments of 1H-MR spectroscopic imaging (MRSI) methods designed to investigate prostate cancer, covering key aspects such as specific hardware, dedicated pulse sequences for data acquisition and data processing and quantification techniques. Emphasis is given to recent advancements in MRSI methodologies, as well as future developments, which can lead to overcome difficulties associated with commonly employed MRSI approaches applied in clinical routine. This includes the replacement of standard PRESS sequences for volume selection, which we identified as inadequate for clinical applications, by sLASER sequences and implementation of 1H MRSI without water signal suppression. These may enable a new evaluation of the complementary role and significance of MRSI in prostate cancer management.
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Affiliation(s)
- Angeliki Stamatelatou
- Department of Medical Imaging (766), Radboud University Medical Center Nijmegen, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Tom W J Scheenen
- Department of Medical Imaging (766), Radboud University Medical Center Nijmegen, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Medical Imaging (766), Radboud University Medical Center Nijmegen, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Joy A, Nagarajan R, Saucedo A, Iqbal Z, Sarma MK, Wilson N, Felker E, Reiter RE, Raman SS, Thomas MA. Dictionary learning compressed sensing reconstruction: pilot validation of accelerated echo planar J-resolved spectroscopic imaging in prostate cancer. MAGNETIC RESONANCE MATERIALS IN PHYSICS, BIOLOGY AND MEDICINE 2022; 35:667-682. [PMID: 35869359 PMCID: PMC9363346 DOI: 10.1007/s10334-022-01029-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
Objectives This study aimed at developing dictionary learning (DL) based compressed sensing (CS) reconstruction for randomly undersampled five-dimensional (5D) MR Spectroscopic Imaging (3D spatial + 2D spectral) data acquired in prostate cancer patients and healthy controls, and test its feasibility at 8x and 12x undersampling factors. Materials and methods Prospectively undersampled 5D echo-planar J-resolved spectroscopic imaging (EP-JRESI) data were acquired in nine prostate cancer (PCa) patients and three healthy males. The 5D EP-JRESI data were reconstructed using DL and compared with gradient sparsity-based Total Variation (TV) and Perona-Malik (PM) methods. A hybrid reconstruction technique, Dictionary Learning-Total Variation (DLTV), was also designed to further improve the quality of reconstructed spectra. Results The CS reconstruction of prospectively undersampled (8x and 12x) 5D EP-JRESI data acquired in prostate cancer and healthy subjects were performed using DL, DLTV, TV and PM. It is evident that the hybrid DLTV method can unambiguously resolve 2D J-resolved peaks including myo-inositol, citrate, creatine, spermine and choline. Conclusion Improved reconstruction of the accelerated 5D EP-JRESI data was observed using the hybrid DLTV. Accelerated acquisition of in vivo 5D data with as low as 8.33% samples (12x) corresponds to a total scan time of 14 min as opposed to a fully sampled scan that needs a total duration of 2.4 h (TR = 1.2 s, 32 \documentclass[12pt]{minimal}
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\begin{document}$${t}_{1}$$\end{document}t1). Supplementary Information The online version contains supplementary material available at 10.1007/s10334-022-01029-z.
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Urine-Based Metabolomics and Machine Learning Reveals Metabolites Associated with Renal Cell Carcinoma Stage. Cancers (Basel) 2021; 13:cancers13246253. [PMID: 34944874 PMCID: PMC8699523 DOI: 10.3390/cancers13246253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Urine metabolomics profiling has potential for non-invasive RCC staging, in addition to providing metabolic insights into disease progression. In this study, we utilized liquid chromatography-mass spectrometry (LC-MS), nuclear magnetic resonance (NMR), and machine learning (ML) for the discovery of urine metabolites associated with RCC progression. Two machine learning questions were posed in the study: Binary classification into early RCC (stage I and II) and advanced RCC stages (stage III and IV), and RCC tumor size estimation through regression analysis. A total of 82 RCC patients with known tumor size and metabolomic measurements were used for the regression task, and 70 RCC patients with complete tumor-nodes-metastasis (TNM) staging information were used for the classification tasks under ten-fold cross-validation conditions. A voting ensemble regression model consisting of elastic net, ridge, and support vector regressor predicted RCC tumor size with a R2 value of 0.58. A voting classifier model consisting of random forest, support vector machines, logistic regression, and adaptive boosting yielded an AUC of 0.96 and an accuracy of 87%. Some identified metabolites associated with renal cell carcinoma progression included 4-guanidinobutanoic acid, 7-aminomethyl-7-carbaguanine, 3-hydroxyanthranilic acid, lysyl-glycine, glycine, citrate, and pyruvate. Overall, we identified a urine metabolic phenotype associated with renal cell carcinoma stage, exploring the promise of a urine-based metabolomic assay for staging this disease.
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Gholizadeh N, Greer PB, Simpson J, Goodwin J, Fu C, Lau P, Siddique S, Heerschap A, Ramadan S. Diagnosis of transition zone prostate cancer by multiparametric MRI: added value of MR spectroscopic imaging with sLASER volume selection. J Biomed Sci 2021; 28:54. [PMID: 34281540 PMCID: PMC8290561 DOI: 10.1186/s12929-021-00750-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/10/2021] [Indexed: 12/24/2022] Open
Abstract
Background Current multiparametric MRI (mp-MRI) in routine clinical practice has poor-to-moderate diagnostic performance for transition zone prostate cancer. The aim of this study was to evaluate the potential diagnostic performance of novel 1H magnetic resonance spectroscopic imaging (MRSI) using a semi-localized adiabatic selective refocusing (sLASER) sequence with gradient offset independent adiabaticity (GOIA) pulses in addition to the routine mp-MRI, including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and quantitative dynamic contrast enhancement (DCE) for transition zone prostate cancer detection, localization and grading. Methods Forty-one transition zone prostate cancer patients underwent mp-MRI with an external phased-array coil. Normal and cancer regions were delineated by two radiologists and divided into low-risk, intermediate-risk, and high-risk categories based on TRUS guided biopsy results. Support vector machine models were built using different clinically applicable combinations of T2WI, DWI, DCE, and MRSI. The diagnostic performance of each model in cancer detection was evaluated using the area under curve (AUC) of the receiver operating characteristic diagram. Then accuracy, sensitivity and specificity of each model were calculated. Furthermore, the correlation of mp-MRI parameters with low-risk, intermediate-risk and high-risk cancers were calculated using the Spearman correlation coefficient. Results The addition of MRSI to T2WI + DWI and T2WI + DWI + DCE improved the accuracy, sensitivity and specificity for cancer detection. The best performance was achieved with T2WI + DWI + MRSI where the addition of MRSI improved the AUC, accuracy, sensitivity and specificity from 0.86 to 0.99, 0.83 to 0.96, 0.80 to 0.95, and 0.85 to 0.97 respectively. The (choline + spermine + creatine)/citrate ratio of MRSI showed the highest correlation with cancer risk groups (r = 0.64, p < 0.01). Conclusion The inclusion of GOIA-sLASER MRSI into conventional mp-MRI significantly improves the diagnostic accuracy of the detection and aggressiveness assessment of transition zone prostate cancer.
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Affiliation(s)
- Neda Gholizadeh
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Peter B Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Radiation Oncology Department, Newcastle, NSW, Australia
| | - John Simpson
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Radiation Oncology Department, Newcastle, NSW, Australia
| | - Jonathan Goodwin
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Radiation Oncology Department, Newcastle, NSW, Australia
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Peter Lau
- Radiology Department, Calvary Mater Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute (HMRI) Imaging Centre, New Lambton Heights, NSW, Australia
| | - Saabir Siddique
- Radiology Department, Calvary Mater Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute (HMRI) Imaging Centre, New Lambton Heights, NSW, Australia
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia. .,Hunter Medical Research Institute (HMRI) Imaging Centre, New Lambton Heights, NSW, Australia.
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Gholizadeh N, Pundavela J, Nagarajan R, Dona A, Quadrelli S, Biswas T, Greer PB, Ramadan S. Nuclear magnetic resonance spectroscopy of human body fluids and in vivo magnetic resonance spectroscopy: Potential role in the diagnosis and management of prostate cancer. Urol Oncol 2020; 38:150-173. [PMID: 31937423 DOI: 10.1016/j.urolonc.2019.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/22/2019] [Accepted: 10/31/2019] [Indexed: 01/17/2023]
Abstract
Prostate cancer is the most common solid organ cancer in men, and the second most common cause of male cancer-related mortality. It has few effective therapies, and is difficult to diagnose accurately. Prostate-specific antigen (PSA), which is currently the most effective diagnostic tool available, cannot reliably discriminate between different pathologies, and in fact only around 30% of patients found to have elevated levels of PSA are subsequently confirmed to actually have prostate cancer. As such, there is a desperate need for more reliable diagnostic tools that will allow the early detection of prostate cancer so that the appropriate interventions can be applied. Nuclear magnetic resonance (NMR) spectroscopy and magnetic resonance spectroscopy (MRS) are 2 high throughput, noninvasive analytical procedures that have the potential to enable differentiation of prostate cancer from other pathologies using metabolomics, by focusing specifically on certain metabolites which are associated with the development of prostate cancer cells and its progression. The value that this type of approach has for the early detection, diagnosis, prognosis, and personalized treatment of prostate cancer is becoming increasingly apparent. Recent years have seen many promising developments in the fields of NMR spectroscopy and MRS, with improvements having been made to hardware as well as to techniques associated with the acquisition, processing, and analysis of related data. This review focuses firstly on proton NMR spectroscopy of blood serum, urine, and expressed prostatic secretions in vitro, and then on 1- and 2-dimensional proton MRS of the prostate in vivo. Major advances in these fields and methodological principles of data collection, acquisition, processing, and analysis are described along with some discussion of related challenges, before prospects that proton MRS has for future improvements to the clinical management of prostate cancer are considered.
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Affiliation(s)
- Neda Gholizadeh
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Jay Pundavela
- Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rajakumar Nagarajan
- Human Magnetic Resonance Center, Institute for Applied Life Sciences, University of Massachusetts Amherst, MA, USA
| | - Anthony Dona
- Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
| | - Scott Quadrelli
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia; Radiology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tapan Biswas
- Department of Instrumentation and Electronics Engineering, Jadavpur University, Kolkata, India
| | - Peter B Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia; Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia; Imaging Centre, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
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10
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Philips BWJ, van Uden MJ, Rietsch SHG, Orzada S, Scheenen TWJ. A multitransmit external body array combined with a 1 H and 31 P endorectal coil to enable a multiparametric and multimetabolic MRI examination of the prostate at 7T. Med Phys 2019; 46:3893-3905. [PMID: 31274201 PMCID: PMC6852321 DOI: 10.1002/mp.13696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/15/2019] [Accepted: 06/21/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose In vivo1H and 31P magnetic resonance spectroscopic imaging (MRSI) provide complementary information on the biology of prostate cancer. In this work we demonstrate the feasibility of performing multiparametric imaging (mpMRI) and 1H and 31P spectroscopic imaging of the prostate using a 31P and 1H endorectal radiofrequency coil (ERC) in combination with a multitransmit body array at 7 Tesla (T). Methods An ERC with a 31P transceiver loop coil and 1H receive (Rx) asymmetric microstrip (31P/1H ERC) was designed, constructed and tested in combination with an external 8‐channel 1H transceiver body array coil (8CH). Electromagnetic field simulations and measurements and in vivo temperature measurements of the ERC were performed for safety validation. In addition, the signal‐to‐noise (SNR) benefit of the 1H microstrip with respect to the 8CH was evaluated. Finally, the feasibility of the setup was tested in one volunteer and three patients with prostate cancer by performing T2‐weighted and diffusion‐weighted imaging in combination with 1H and 31P spectroscopic imaging. Results Electromagnetic field simulations of the 31P loop coil showed no differences in the E‐ and B‐fields of the 31P/1H ERC compared with a previously safety validated ERC without 1H microstrip. The hotspot of the specific absorption rate (SAR) at the feed point of the 31P/1H ERC loop coil was 9.42 W/kg when transmitting on 31P at 1 W. Additional in vivo measurements showed a maximum temperature increase at the SAR hotspot of 0.7°C over 6 min on 31P at 1.9 W transmit (Tx) power, indicating safe maximum power levels. When transmitting with the external 1H body array at 40W for 2:30 min, the temperature increase around the ERC was < 0.3°C. Up to 3.5 cm into the prostate the 1H microstrip of the ERC provided higher SNR than the 8CH. The total coil combination allowed acquisition of an mpMRI protocol and the assessment of 31P and 1H metabolites of the prostate in all test subjects. Conclusion We developed a setup with a 31P transceiver and 1H Rx endorectal coil in combination with an 8‐channel transceiver external body array coil and demonstrated its safety and feasibility for obtaining multiparametric imaging and 1H and 31P MRSI at 7T in patients with prostate cancer within one MR examination.
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Affiliation(s)
- Bart W J Philips
- Department of Radiology and Nuclear Medicine (766), Radboud university medical center, P.O. Box 9101, Nijmegen, The Netherlands
| | - Mark J van Uden
- Department of Radiology and Nuclear Medicine (766), Radboud university medical center, P.O. Box 9101, Nijmegen, The Netherlands
| | - Stefan H G Rietsch
- Erwin L Hahn Institute for Magnetic Resonance Imaging, UNESCO World Cultural, Heritage Zollverein, Kokereiallee 7, Building C84, D-45141, Essen, Germany.,High Field and Hybrid MR Imaging, University Hospital Essen, D-45147, Essen, Germany
| | - Stephan Orzada
- Erwin L Hahn Institute for Magnetic Resonance Imaging, UNESCO World Cultural, Heritage Zollverein, Kokereiallee 7, Building C84, D-45141, Essen, Germany
| | - Tom W J Scheenen
- Department of Radiology and Nuclear Medicine (766), Radboud university medical center, P.O. Box 9101, Nijmegen, The Netherlands.,Erwin L Hahn Institute for Magnetic Resonance Imaging, UNESCO World Cultural, Heritage Zollverein, Kokereiallee 7, Building C84, D-45141, Essen, Germany
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11
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Gholizadeh N, Greer PB, Simpson J, Fu C, Al-Iedani O, Lau P, Heerschap A, Ramadan S. Supervised risk predictor of central gland lesions in prostate cancer using 1 H MR spectroscopic imaging with gradient offset-independent adiabaticity pulses. J Magn Reson Imaging 2019; 50:1926-1936. [PMID: 31132193 DOI: 10.1002/jmri.26803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Due to the histological heterogeneity of the central gland, accurate detection of central gland prostate cancer remains a challenge. PURPOSE To evaluate the efficacy of in vivo 3D 1 H MR spectroscopic imaging (3D 1 H MRSI) with a semi-localized adiabatic selective refocusing (sLASER) sequence and gradient-modulated offset-independent adiabatic (GOIA) pulses for detection of central gland prostate cancer. Additionally four risk models were developed to differentiate 1) normal vs. cancer, 2) low- vs. high-risk cancer, 3) low- vs. intermediate-risk cancer, and 4) intermediate- vs. high-risk cancer voxels. STUDY TYPE Prospective. SUBJECTS Thirty-six patients with biopsy-proven central gland prostate cancer. FIELD STRENGTH/SEQUENCE 3T MRI / 3D 1 H MRSI using GOIA-sLASER. ASSESSMENT Cancer and normal regions of interest (ROIs) were selected by an experienced radiologist and 1 H MRSI voxels were placed within the ROIs to calculate seven metabolite signal ratios. Voxels were split into two subsets, 80% for model training and 20% for testing. STATISTICAL TESTS Four support vector machine (SVM) models were built using the training dataset. The accuracy, sensitivity, and specificity for each model were calculated for the testing dataset. RESULTS High-quality MR spectra were obtained for the whole central gland of the prostate. The normal vs. cancer diagnostic model achieved the highest predictive performance with an accuracy, sensitivity, and specificity of 96.2%, 95.8%, and 93.1%, respectively. The accuracy, sensitivity, and specificity of the low- vs. high-risk cancer and low- vs. intermediate-risk cancer models were 82.5%, 89.2%, 70.2%, and 73.0%, 84.7%, 60.8%, respectively. The intermediate- vs. high-risk cancer model yielded an accuracy, sensitivity, and specificity lower than 55%. DATA CONCLUSION The GOIA-sLASER sequence with an external phased-array coil allows for fast assessment of central gland prostate cancer. The classification offers a promising diagnostic tool for discriminating normal vs. cancer, low- vs. high-risk cancer, and low- vs. intermediate-risk cancer. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1926-1936.
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Affiliation(s)
- Neda Gholizadeh
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Peter B Greer
- Radiation Oncology Department, Calvary Mater Newcastle, Newcastle, NSW, Australia.,School of Mathematical and Physical Sciences, University of Newcastle, NSW, Australia
| | - John Simpson
- Radiation Oncology Department, Calvary Mater Newcastle, Newcastle, NSW, Australia.,School of Mathematical and Physical Sciences, University of Newcastle, NSW, Australia
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Oun Al-Iedani
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Peter Lau
- Radiation Oncology Department, Calvary Mater Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute (HMRI) Imaging Centre, New Lambton Heights, NSW, Australia
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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12
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Tayari N, Obels J, Kobus T, Scheenen TWJ, Heerschap A. Simple and broadly applicable automatic quality control for 3D 1 H MR spectroscopic imaging data of the prostate. Magn Reson Med 2018; 81:2887-2895. [PMID: 30506721 DOI: 10.1002/mrm.27616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/13/2018] [Accepted: 10/31/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Quality control (QC) is a prerequisite for clinical MR spectroscopic imaging (MRSI) to avoid that bad spectra hamper data interpretation. The aim of this work was to present a simple automatic QC for prostate 1 H MRSI that can handle data obtained with different commonly used pulse sequences, echo times, field strengths, and MR platforms. METHODS A QC method was developed with a ratio (Qratio) where the numerator and the denominator are functions of several signal heights, logically combined for their positive or negative contribution to spectral quality. This Qratio was tested on 4 data sets obtained at 1.5, 3, and 7T, with and without endorectal coil and different localization sequences and echo times. Spectra of 25,248 voxels in 26 prostates were labeled as acceptable or unacceptable by MRS experts as gold standard. A threshold value was determined for Qratio from a subset of voxels, labeled in consensus by 4 experts, for an optimal accuracy to separate spectra. RESULTS Applying this Qratio threshold to the remaining test voxels, an automatic separation of good and bad spectra was possible with an accuracy of 0.88, similar to manual separation between the 2 classes. Qratio values were used to generate maps representing spectral quality on a binary or continuous scale. CONCLUSION Automated QC of prostate 1 H MRSI by Qratio is fast, simple, easily transferable and more practical than supervised feature extraction methods and therefore easy to integrate into different clinical MR systems. Moreover, quality maps can be generated to read the reliability of spectra in each voxel.
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Affiliation(s)
- Nassim Tayari
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jiri Obels
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thiele Kobus
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Abstract
Magnetic resonance spectroscopy (MRS) can be performed in vivo using commercial MRI systems to obtain biochemical information about tissues and cancers. Applications in brain, prostate and breast aid lesion detection and characterisation (differential diagnosis), treatment planning and response assessment. Multi-centre clinical trials have been performed in all these tissues. Single centre studies have been performed in many other tissues including cervix, uterus, musculoskeletal and liver. While generally MRS is used to study endogenous metabolites it has also been used in drug studies, for example those that include 19F as part of their structure. Recently the hyperpolarisation of compounds enriched with 13C such as [1-13C] pyruvate has been demonstrated in animal models and now in preliminary clinical studies, permitting the monitoring of biochemical processes with unprecedented sensitivity. This review briefly introduces the underlying methods and then discusses the current status of these applications.
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Affiliation(s)
- Geoffrey S Payne
- University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
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14
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Lovegrove CE, Matanhelia M, Randeva J, Eldred-Evans D, Tam H, Miah S, Winkler M, Ahmed HU, Shah TT. Prostate imaging features that indicate benign or malignant pathology on biopsy. Transl Androl Urol 2018; 7:S420-S435. [PMID: 30363462 PMCID: PMC6178322 DOI: 10.21037/tau.2018.07.06] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Accurate diagnosis of clinically significant prostate cancer is essential in identifying patients who should be offered treatment with curative intent. Modifications to the Gleason grading system in recent years show that accurate grading and reporting at needle biopsy can improve identification of clinically significant prostate cancers. Extracapsular extension of prostate cancer has been demonstrated to be an adverse prognostic factor with greater risk of metastatic spread than organ-confined disease. Tumor volume may be an independent prognostic factor and should be considered in conjunction with other factors. Multi-parametric magnetic resonance imaging (MP-MRI) has become an increasingly important tool in the diagnosis and characterization of prostate cancer. MP-MRI allows T2-weighted (T2W) anatomical imaging to be combined with functional and physiological assessment. Diffusion-weighted imaging (DWI) has shown greater sensitivity, specificity and negative predictive value compared to prostate specific antigen (PSA) testing and T2W imaging alone and has a more positive correlation with Gleason score and tumour volume. Dynamic gadolinium contrast-enhanced (DCE) imaging can exhibit difficulties in distinguishing prostatitis from malignancy in the peripheral zone, and between benign prostatic hyperplasia (BPH) and malignancies in the transition zone (TZ). Computer aided diagnosis utilizes software to aid radiologists in detecting and diagnosing abnormalities from diagnostic imaging. New techniques of quantitative MRI, such as VERDICT MRI use tissue-specific factors to delineate different cellular and microstructural phenotypes, characterizing tissue properties with greater detail. Proton MR spectroscopic imaging (MRSI) is a more technically challenging imaging modality than DCE and DWI MRI. Over the last decade, choline and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) have developed as better tools for staging than conventional imaging. While hyperpolarized MRI shows promise in improving the imaging and differentiation of benign and malignant lesions there is further work required. Accurate reading and interpretation of diagnostic investigations is key to accurate identification of abnormal areas requiring biopsy, sparing those in whom benign or indolent disease can be managed by non-invasive means. Embracing and advancing existing technologies is essential in furthering this process.
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Affiliation(s)
- Catherine Elizabeth Lovegrove
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mudit Matanhelia
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jagpal Randeva
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - David Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Henry Tam
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Saiful Miah
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mathias Winkler
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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15
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High-Quality 3-Dimensional 1H Magnetic Resonance Spectroscopic Imaging of the Prostate Without Endorectal Receive Coil Using A Semi-LASER Sequence. Invest Radiol 2018. [PMID: 28632688 DOI: 10.1097/rli.0000000000000395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Inclusion of 3-dimensional H magnetic resonance spectroscopic imaging (3D-H-MRSI) in routine multiparametric MRI of the prostate requires good quality spectra and easy interpretable metabolite maps of the whole organ obtained without endorectal coil in clinically feasible acquisition times. We evaluated if a semi-LASER pulse sequence with gradient offset independent adiabaticity refocusing pulses (GOIA-sLASER) for volume selection can meet these requirements. MATERIALS AND METHODS Thirteen patients with suspicion of prostate cancer and 1 patient known to have prostate cancer were examined at 3 T with a multichannel body-receive coil. A 3D-H-MRSI sequence with GOIA-sLASER volume selection (echo time, 88 milliseconds) was added to a routine clinical multiparametric MRI examination of these patients. Repetition times from 630 to 1000 milliseconds and effective voxel sizes of approximately 0.9 and 0.6 cm were tested. Spectral components were quantified by LCModel software for quality assessment and to construct choline and citrate maps. RESULTS Three-dimensional MRSI of the prostate was successfully performed in all patients in measurement times of 5 to 10 minutes. Analysis of the multiparametric MRI examination or of biopsies did not reveal malignant tissue in the prostate of the 13 patients. In 1404 evaluated voxels acquired from 13 patients, the citrate resonance could be fitted with a high reliability (Cramér-Rao lower bound <30%), 100% for 7 × 7 × 7-mm voxels and 96 ± 7 in 6 × 6 × 6-mm voxels. The percentage of 7 × 7 × 7-mm voxels in which the choline signal was fitted with Cramér-Rao lower bound of less than 30% was approximately 50% at a TR of 630 milliseconds and increased to more than 80% for TRs of 800 milliseconds and above. In the patient with prostate cancer, choline was detectable throughout the prostate in spectra recorded at a TR of 700 milliseconds. The homogeneous B1 field over the prostate of the receive coil enabled the generation of whole organ metabolite maps, revealing choline and citrate variations between areas with normal prostate tissue, seminal vesicles, proliferative benign prostatic hyperplasia, and tumor. CONCLUSIONS The good signal-to-noise ratio and low chemical shift artifacts of GOIA-sLASER at an echo time of 88 milliseconds enable acquisition of high-quality 3D-H-MRSI of the prostate without endorectal coil in less than 10 minutes. This facilitates reconstruction of easy interpretable, quantitative metabolite maps for routine clinical applications of prostate MRSI.
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16
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Mikkelsen M, Barker PB, Bhattacharyya PK, Brix MK, Buur PF, Cecil KM, Chan KL, Chen DYT, Craven AR, Cuypers K, Dacko M, Duncan NW, Dydak U, Edmondson DA, Ende G, Ersland L, Gao F, Greenhouse I, Harris AD, He N, Heba S, Hoggard N, Hsu TW, Jansen JFA, Kangarlu A, Lange T, Lebel RM, Li Y, Lin CYE, Liou JK, Lirng JF, Liu F, Ma R, Maes C, Moreno-Ortega M, Murray SO, Noah S, Noeske R, Noseworthy MD, Oeltzschner G, Prisciandaro JJ, Puts NAJ, Roberts TPL, Sack M, Sailasuta N, Saleh MG, Schallmo MP, Simard N, Swinnen SP, Tegenthoff M, Truong P, Wang G, Wilkinson ID, Wittsack HJ, Xu H, Yan F, Zhang C, Zipunnikov V, Zöllner HJ, Edden RAE. Big GABA: Edited MR spectroscopy at 24 research sites. Neuroimage 2017; 159:32-45. [PMID: 28716717 PMCID: PMC5700835 DOI: 10.1016/j.neuroimage.2017.07.021] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/20/2017] [Accepted: 07/11/2017] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is the only biomedical imaging method that can noninvasively detect endogenous signals from the neurotransmitter γ-aminobutyric acid (GABA) in the human brain. Its increasing popularity has been aided by improvements in scanner hardware and acquisition methodology, as well as by broader access to pulse sequences that can selectively detect GABA, in particular J-difference spectral editing sequences. Nevertheless, implementations of GABA-edited MRS remain diverse across research sites, making comparisons between studies challenging. This large-scale multi-vendor, multi-site study seeks to better understand the factors that impact measurement outcomes of GABA-edited MRS. An international consortium of 24 research sites was formed. Data from 272 healthy adults were acquired on scanners from the three major MRI vendors and analyzed using the Gannet processing pipeline. MRS data were acquired in the medial parietal lobe with standard GABA+ and macromolecule- (MM-) suppressed GABA editing. The coefficient of variation across the entire cohort was 12% for GABA+ measurements and 28% for MM-suppressed GABA measurements. A multilevel analysis revealed that most of the variance (72%) in the GABA+ data was accounted for by differences between participants within-site, while site-level differences accounted for comparatively more variance (20%) than vendor-level differences (8%). For MM-suppressed GABA data, the variance was distributed equally between site- (50%) and participant-level (50%) differences. The findings show that GABA+ measurements exhibit strong agreement when implemented with a standard protocol. There is, however, increased variability for MM-suppressed GABA measurements that is attributed in part to differences in site-to-site data acquisition. This study's protocol establishes a framework for future methodological standardization of GABA-edited MRS, while the results provide valuable benchmarks for the MRS community.
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Affiliation(s)
- Mark Mikkelsen
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Peter B Barker
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Pallab K Bhattacharyya
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Radiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Maiken K Brix
- Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Pieter F Buur
- Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly L Chan
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Y-T Chen
- Department of Radiology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Alexander R Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT - Norwegian Center for Mental Disorders Research, University of Bergen, Bergen, Norway
| | - Koen Cuypers
- Department of Kinesiology, KU Leuven, Leuven, Belgium; REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Michael Dacko
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Niall W Duncan
- Brain and Consciousness Research Centre, Taipei Medical University, Taipei, Taiwan
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - David A Edmondson
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Mannheim, Germany
| | - Lars Ersland
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT - Norwegian Center for Mental Disorders Research, University of Bergen, Bergen, Norway; Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Fei Gao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Ian Greenhouse
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Stefanie Heba
- Department of Neurology, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Nigel Hoggard
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Tun-Wei Hsu
- Department of Radiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jacobus F A Jansen
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alayar Kangarlu
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Yan Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Jy-Kang Liou
- Department of Radiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Feng Liu
- New York State Psychiatric Institute, New York, NY, USA
| | - Ruoyun Ma
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Celine Maes
- Department of Kinesiology, KU Leuven, Leuven, Belgium
| | | | - Scott O Murray
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Sean Noah
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
| | | | - Michael D Noseworthy
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - James J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Nicolaas A J Puts
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Timothy P L Roberts
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Markus Sack
- Department of Neuroimaging, Central Institute of Mental Health, Mannheim, Germany
| | - Napapon Sailasuta
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Muhammad G Saleh
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - Nicholas Simard
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Stephan P Swinnen
- Department of Kinesiology, KU Leuven, Leuven, Belgium; Leuven Research Institute for Neuroscience & Disease (LIND), KU Leuven, Leuven, Belgium
| | - Martin Tegenthoff
- Department of Neurology, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Truong
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Guangbin Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Iain D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Hongmin Xu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Helge J Zöllner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA.
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17
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Tayari N, Heerschap A, Scheenen TW, Kobus T. In vivo MR spectroscopic imaging of the prostate, from application to interpretation. Anal Biochem 2017; 529:158-170. [DOI: 10.1016/j.ab.2017.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 12/23/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
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18
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Rodrigues LM, Uribe-Lewis S, Madhu B, Honess DJ, Stubbs M, Griffiths JR. The action of β-hydroxybutyrate on the growth, metabolism and global histone H3 acetylation of spontaneous mouse mammary tumours: evidence of a β-hydroxybutyrate paradox. Cancer Metab 2017; 5:4. [PMID: 28261475 PMCID: PMC5331634 DOI: 10.1186/s40170-017-0166-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Ketone bodies have both metabolic and epigenetic roles in cancer. In several studies, they showed an anti-cancer effect via inhibition of histone deacetylases; however, other studies observed faster tumour growth. The related molecule butyrate also inhibits growth of some cancer cells and accelerates it in others. This "butyrate paradox" is thought to be due to butyrate mediating histone acetylation and thus inhibiting cell proliferation in cancers that preferentially utilise glucose (the Warburg effect); whereas in cells that oxidise butyrate as a fuel, it fails to reach inhibitory concentrations and can stimulate growth. METHODS We treated transgenic mice bearing spontaneous MMTV-NEU-NT mammary tumours with the ketone body β-hydroxybutyrate (β-OHB) and monitored tumour growth, metabolite concentrations and histone acetylation. In a cell line derived from these tumours, we also measured uptake of β-OHB and glucose, and lactate production, in the absence and presence of β-OHB. RESULTS β-OHB administration accelerated growth of MMTV-NEU-NT tumours, and their metabolic profile showed significant increases in ATP, glutamine, serine and choline-related metabolites. The β-OHB concentration within the treated tumours, 0.46 ± 0.05 μmol/g, had no effect on histone acetylation as shown by western blots. Cultured tumour cells incubated with 0.5 mM β-OHB showed β-OHB uptake that would be equivalent to 54% of glycolytic ATP phosphorylation and no significant change in glucose consumption or lactate production. CONCLUSIONS These results suggest that a β-OHB paradox may occur in these mammary tumours in a manner analogous to the butyrate paradox. At low β-OHB concentrations (<1 mM, as observed in our tumour model post-treatment), and in the absence of a Warburg effect, β-OHB is consumed and thus acts as an oxidative energy source and not as an epigenetic factor. This would explain the increase in tumour growth after treatment, the metabolic profiles and the absence of an effect on histone H3 acetylation.
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Affiliation(s)
- Loreta M. Rodrigues
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 ORE UK
| | - Santiago Uribe-Lewis
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 ORE UK
| | - Basetti Madhu
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 ORE UK
| | - Davina J. Honess
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 ORE UK
| | - Marion Stubbs
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 ORE UK
| | - John R. Griffiths
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 ORE UK
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Dwivedi DK, Kumar R, Bora GS, Thulkar S, Sharma S, Gupta SD, Jagannathan NR. Stratification of the aggressiveness of prostate cancer using pre-biopsy multiparametric MRI (mpMRI). NMR IN BIOMEDICINE 2016; 29:232-238. [PMID: 26730884 DOI: 10.1002/nbm.3452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 06/05/2023]
Abstract
Risk stratification, based on the Gleason score (GS) of a prostate biopsy, is an important decision-making tool in prostate cancer management. As low-grade disease may not need active intervention, the ability to identify aggressive cancers on imaging could limit the need for prostate biopsies. We assessed the ability of multiparametric MRI (mpMRI) in pre-biopsy risk stratification of men with prostate cancer. One hundred and twenty men suspected to have prostate cancer underwent mpMRI (diffusion MRI and MR spectroscopic imaging) prior to biopsy. Twenty-six had cancer and were stratified into three groups based on GS: low grade (GS ≤ 6), intermediate grade (GS = 7) and high grade (GS ≥ 8). A total of 910 regions of interest (ROIs) from the peripheral zone (PZ, range 25-45) were analyzed from these 26 patients. The metabolite ratio [citrate/(choline + creatine)] and apparent diffusion coefficient (ADC) of voxels were calculated for the PZ regions corresponding to the biopsy cores and compared with histology. The median metabolite ratios for low-grade, intermediate-grade and high-grade cancer were 0.29 (range: 0.16, 0.61), 0.17 (range: 0.13, 0.32) and 0.13 (range: 0.05, 0.23), respectively (p = 0.004). The corresponding mean ADCs (×10(-3) mm(2) /s) for low-grade, intermediate-grade and high-grade cancer were 0.99 ± 0.08, 0.86 ± 0.11 and 0.69 ± 0.12, respectively (p < 0.0001). The combined ADC and metabolite ratio model showed strong discriminatory ability to differentiate subjects with GS ≤ 6 from subjects with GS ≥ 7 with an area under the curve of 94%. These data indicate that pre-biopsy mpMRI may stratify PCa aggressiveness noninvasively. As the recent literature data suggest that men with GS ≤ 6 cancer may not need radical therapy, our data may help limit the need for biopsy and allow informed decision making for clinical intervention. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Durgesh Kumar Dwivedi
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Girdhar S Bora
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
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Mocioiu V, Ortega-Martorell S, Olier I, Jablonski M, Starcukova J, Lisboa P, Arús C, Julià-Sapé M. From raw data to data-analysis for magnetic resonance spectroscopy--the missing link: jMRUI2XML. BMC Bioinformatics 2015; 16:378. [PMID: 26552737 PMCID: PMC4640235 DOI: 10.1186/s12859-015-0796-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022] Open
Abstract
Background Magnetic resonance spectroscopy provides metabolic information about living tissues in a non-invasive way. However, there are only few multi-centre clinical studies, mostly performed on a single scanner model or data format, as there is no flexible way of documenting and exchanging processed magnetic resonance spectroscopy data in digital format. This is because the DICOM standard for spectroscopy deals with unprocessed data. This paper proposes a plugin tool developed for jMRUI, namely jMRUI2XML, to tackle the latter limitation. jMRUI is a software tool for magnetic resonance spectroscopy data processing that is widely used in the magnetic resonance spectroscopy community and has evolved into a plugin platform allowing for implementation of novel features. Results jMRUI2XML is a Java solution that facilitates common preprocessing of magnetic resonance spectroscopy data across multiple scanners. Its main characteristics are: 1) it automates magnetic resonance spectroscopy preprocessing, and 2) it can be a platform for outputting exchangeable magnetic resonance spectroscopy data. The plugin works with any kind of data that can be opened by jMRUI and outputs in extensible markup language format. Data processing templates can be generated and saved for later use. The output format opens the way for easy data sharing- due to the documentation of the preprocessing parameters and the intrinsic anonymization - for example for performing pattern recognition analysis on multicentre/multi-manufacturer magnetic resonance spectroscopy data. Conclusions jMRUI2XML provides a self-contained and self-descriptive format accounting for the most relevant information needed for exchanging magnetic resonance spectroscopy data in digital form, as well as for automating its processing. This allows for tracking the procedures the data has undergone, which makes the proposed tool especially useful when performing pattern recognition analysis. Moreover, this work constitutes a first proposal for a minimum amount of information that should accompany any magnetic resonance processed spectrum, towards the goal of achieving better transferability of magnetic resonance spectroscopy studies. Electronic supplementary material The online version of this article (doi:10.1186/s12859-015-0796-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victor Mocioiu
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, UAB, Cerdanyola del Vallès, Barcelona, 08193, Spain. .,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina CIBER-BBN, Cerdanyola del Vallès, Barcelona, Spain. .,Institut de Biotecnologia i Biomedicina (IBB), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain.
| | - Sandra Ortega-Martorell
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina CIBER-BBN, Cerdanyola del Vallès, Barcelona, Spain. .,School of Computing and Mathematical Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Iván Olier
- Institute of Biotechnology, The University of Manchester, Manchester, UK.
| | - Michal Jablonski
- Institute of Scientific Instruments of the CAS, v. v. i, Brno, Czech Republic.
| | - Jana Starcukova
- Institute of Scientific Instruments of the CAS, v. v. i, Brno, Czech Republic.
| | - Paulo Lisboa
- School of Computing and Mathematical Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Carles Arús
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, UAB, Cerdanyola del Vallès, Barcelona, 08193, Spain. .,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina CIBER-BBN, Cerdanyola del Vallès, Barcelona, Spain. .,Institut de Biotecnologia i Biomedicina (IBB), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain.
| | - Margarida Julià-Sapé
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, UAB, Cerdanyola del Vallès, Barcelona, 08193, Spain. .,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina CIBER-BBN, Cerdanyola del Vallès, Barcelona, Spain. .,Institut de Biotecnologia i Biomedicina (IBB), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain.
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Ma C, Chen L, Scheenen TWJ, Lu J, Wang J. Three-dimensional proton magnetic resonance spectroscopic imaging with and without an endorectal coil: a prostate phantom study. Acta Radiol 2015; 56:1342-9. [PMID: 25348479 DOI: 10.1177/0284185114556704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/25/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Proton magnetic resonance spectroscopic imaging (MRSI) of the prostate has been used with only a combination of external surface coils. The quality of spectral fitting of the (choline + creatine)/citrate ([Cho + Cr]/Cit) ratio at different field strengths and different coils is important for quantitative/semi-quantitative diagnosis of prostate cancer. PURPOSE To evaluate the quality of spectral fitting of the (Cho + Cr)/Cit ratio of a prostate phantom using MRSI at different field strengths and various coils. MATERIAL AND METHODS Experiments were using 1.5-T and 3.0-T MR systems. Measurements were taken on a homemade prostate phantom with different coils: spinal array; abdominal array; and endorectal. The signal-to-noise ratio (SNR) of choline, creatine, and citrate peaks as well as the (Cho + Cr)/Cit ratio in each voxel were compared among groups using multi-way analysis of variance. RESULTS Magnetic field strength, coils, and plane position had a significant effect on the SNR or (Cho + Cr)/Cit ratio, and there were interactions among groups (all P = 0.000). The 1.5-T (0.228 ± 0.044) exhibited a higher (Cho + Cr)/Cit ratio than the 3.0-T (0.125 ± 0.041) magnetic field strength (F = 3238, P = 0.000). The (Cho + Cr)/Cit ratio of both surface coils (0.183 ± 0.065) and all coils (0.181 ± 0.057) was significantly lower than that of the endorectal coil (0.195 ± 0.077) (both P < 0.05), but significant differences in the mean (Cho + Cr)/Cit ratio were not observed if surface coils and all coils were used (P > 0.05). No significant differences were found among the (Cho + Cr)/Cit ratios of all voxels in the middle planes by the post-hoc analyses (all P > 0.05). CONCLUSION Three-dimensional proton MRSI of prostate metabolites in a phantom using surface coils is feasible and reliable, but (Cho + Cr)/Cit ratios acquired at different magnetic fields and coils were different. This difference should be taken into account when calculating this ratio in a field strength-independent way.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, Shanghai, PR China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, Shanghai, PR China
| | - Tom WJ Scheenen
- Department of Radiology, Radboud University Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, Shanghai, PR China
| | - Jian Wang
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, Shanghai, PR China
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Busch MHJ, Vollmann W, Mateiescu S, Stolze M, Deli M, Garmer M, Grönemeyer DHW. Reproducibility of brain metabolite concentration measurements in lesion free white matter at 1.5 T. BMC Med Imaging 2015; 15:40. [PMID: 26420249 PMCID: PMC4588462 DOI: 10.1186/s12880-015-0085-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Post processing for brain spectra has a great influence on the fit quality of individual spectra, as well as on the reproducibility of results from comparable spectra. This investigation used pairs of spectra, identical in system parameters, position and time assumed to differ only in noise. The metabolite amplitudes of fitted time domain spectroscopic data were tested on reproducibility for the main brain metabolites. Methods Proton spectra of white matter brain tissue were acquired with a short spin echo time of 30 ms and a moderate repetition time of 1500 ms at 1.5 T. The pairs were investigated with one time domain post-processing algorithm using different parameters. The number of metabolites, the use of prior knowledge, base line parameters and common or individual damping were varied to evaluate the best reproducibility. Results The protocols with most reproducible amplitudes for N-acetylaspartate, creatine, choline, myo-inositol and the combined Glx line of glutamate and glutamine in lesion free white matter have the following common features: common damping of the main metabolites, a baseline using only the points of the first 10 ms, no additional lipid/macromolecule lines and Glx is taken as the sum of separately fitted glutamate and glutamine. This parameter set is different to the one delivering the best individual fit results. Discussion All spectra were acquired in “lesion free” (no lesion signs found in MR imaging) white matter. Spectra of brain lesions, for example tumors, can be drastically different. Thus the results are limited to lesion free brain tissue. Nevertheless the application to studies is broad, because small alterations in brain biochemistry of lesion free areas had been detected nearby tumors, in patients with multiple sclerosis, drug abuse or psychiatric disorders. Conclusion Main metabolite amplitudes inside healthy brain can be quantified with a normalized root mean square deviation around 5 % using CH3 of creatine as reference. Only the reproducibility of myo-inositol is roughly twice as bad. The reproducibility should be similar using other references like internal or external water for an absolute concentration evaluation and are not influenced by relaxation corrections with literature values.
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Affiliation(s)
- Martin H J Busch
- Grönemeyer Institut für Mikrotherapie, Universitätsstraße 142, D-44799, Bochum, Germany.
| | - Wolfgang Vollmann
- Beuth Hochschule für Technik Berlin, Luxemburger Straße 10, D-13353, Berlin, Germany.
| | - Serban Mateiescu
- Grönemeyer Institut für Mikrotherapie, Universitätsstraße 142, D-44799, Bochum, Germany.
| | - Manuel Stolze
- Ruhr Universität Bochum, Universitätsstraße 150, D-44801, Bochum, Germany.
| | - Martin Deli
- Amedo Smart Tracking Solutions, Universitätsstraße 142, D-44799, Bochum, Germany.
| | - Marietta Garmer
- Grönemeyer Institut für Mikrotherapie, Universitätsstraße 142, D-44799, Bochum, Germany.
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Kuru TH, Fütterer JJ, Schiffmann J, Porres D, Salomon G, Rastinehad AR. Transrectal Ultrasound (US), Contrast-enhanced US, Real-time Elastography, HistoScanning, Magnetic Resonance Imaging (MRI), and MRI-US Fusion Biopsy in the Diagnosis of Prostate Cancer. Eur Urol Focus 2015; 1:117-126. [PMID: 28723422 DOI: 10.1016/j.euf.2015.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/13/2015] [Accepted: 06/02/2015] [Indexed: 11/17/2022]
Abstract
CONTEXT Debates on overdiagnosis and overtreatment of prostate cancer (PCa) are ongoing and there is still huge uncertainty regarding misclassification of prostate biopsy results. Several imaging techniques that have emerged in recent years could overcome over- and underdiagnosis in PCa. OBJECTIVE To review the literature on transrectal ultrasound (TRUS)-based techniques (contrast enhancement, HistoScanning, elastography) and magnetic resonance imaging (MRI)-based techniques for a nonsystematic overview of their benefits and limitations. EVIDENCE ACQUISITION A comprehensive search of the PubMed database between August 2004 and August 2014 was performed. Studies assessing grayscale TRUS, contrast-enhanced (CE)-TRUS, elastography, HistoScanning, multiparametric MRI (mpMRI), and MRI-TRUS fusion biopsy were included. Publications before 2004 were included if they reported the principle or the first clinical results for these techniques. EVIDENCE SYNTHESIS Grayscale TRUS alone cannot detect PCa foci (detection rate 23-29%). TRUS-based (elastography) and MRI-based techniques (MRI-TRUS fusion biopsy) have significantly improved PCa diagnostics, with sensitivity of 53-74% and specificity of 72-95%. HistoScanning does not provide convincing or homogeneous results (specificity 19-82%). CE-TRUS seems to be user dependent; it is used in a low number of high-volume centers and has wide ranges for sensitivity (54-79%) and specificity (42-95%). For all the techniques reviewed, prospective multicenter studies with consistent definitions are lacking. CONCLUSIONS Standard grayscale TRUS is unreliable for PCa detection. Among the techniques reviewed, mpMRI and MRI-TRUS fusion biopsy seem to be suitable for enhancing PCa diagnostics. Elastography shows promising results according to the literature. CE-TRUS yields very inhomogeneous results and might not be the ideal technique for clinical practice. The value of HistoScanning must be questioned according to the literature. PATIENT SUMMARY New imaging modalities such as elastography and magnetic resonance imaging/transrectal ultrasound fusion biopsies have improved the detection of prostate cancer. This may lower the burden of overtreatment as a result of more precise diagnosis.
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Affiliation(s)
- Timur H Kuru
- Department of Urology, RWTH University, Aachen, Germany.
| | - Jurgen J Fütterer
- Department of Radiology, Radboud University, Nijmegen, The Netherlands
| | - Jonas Schiffmann
- Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Porres
- Department of Urology, RWTH University, Aachen, Germany
| | - Georg Salomon
- Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
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Hedgire SS, Eberhardt SC, Borczuk R, McDermott S, Harisinghani MG. Interpretation and reporting multiparametric prostate MRI: a primer for residents and novices. ACTA ACUST UNITED AC 2015; 39:1036-51. [PMID: 24566965 DOI: 10.1007/s00261-014-0097-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multiparametric MRI has developed as a tool for prostate cancer lesion detection, characterization, staging, surveillance, and imaging of local recurrence. Given the disease frequency and the growing importance of imaging, as reliance on PSA declines, radiologists involved in prostate MRI imaging must become proficient with the fundamentals of multiparametric prostate MRI (T2WI, DWI, DCE-MRI, and MR spectroscopy). Interpretation and reporting must yield accuracy, consistency, and add value to clinical care. This review provides a primer to novices and trainees learning about multiparametric prostate MRI. MRI technique is presented along with the use of particular MRI sequences. Relevant prostate anatomy is outlined and imaging features of prostate cancer with staging are discussed. Finally structured reporting is introduced, and some limitations of prostate MRI are discussed.
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Affiliation(s)
- Sandeep S Hedgire
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA,
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Riches SF, Payne GS, Morgan VA, Dearnaley D, Morgan S, Partridge M, Livni N, Ogden C, deSouza NM. Multivariate modelling of prostate cancer combining magnetic resonance derived T2, diffusion, dynamic contrast-enhanced and spectroscopic parameters. Eur Radiol 2015; 25:1247-56. [PMID: 25749786 DOI: 10.1007/s00330-014-3479-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 10/23/2014] [Accepted: 10/28/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objectives are determine the optimal combination of MR parameters for discriminating tumour within the prostate using linear discriminant analysis (LDA) and to compare model accuracy with that of an experienced radiologist. METHODS Multiparameter MRIs in 24 patients before prostatectomy were acquired. Tumour outlines from whole-mount histology, T2-defined peripheral zone (PZ), and central gland (CG) were superimposed onto slice-matched parametric maps. T2, Apparent Diffusion Coefficient, initial area under the gadolinium curve, vascular parameters (K(trans),Kep,Ve), and (choline+polyamines+creatine)/citrate were compared between tumour and non-tumour tissues. Receiver operating characteristic (ROC) curves determined sensitivity and specificity at spectroscopic voxel resolution and per lesion, and LDA determined the optimal multiparametric model for identifying tumours. Accuracy was compared with an expert observer. RESULTS Tumours were significantly different from PZ and CG for all parameters (all p < 0.001). Area under the ROC curve for discriminating tumour from non-tumour was significantly greater (p < 0.001) for the multiparametric model than for individual parameters; at 90 % specificity, sensitivity was 41 % (MRSI voxel resolution) and 59 % per lesion. At this specificity, an expert observer achieved 28 % and 49 % sensitivity, respectively. CONCLUSION The model was more accurate when parameters from all techniques were included and performed better than an expert observer evaluating these data. KEY POINTS • The combined model increases diagnostic accuracy in prostate cancer compared with individual parameters • The optimal combined model includes parameters from diffusion, spectroscopy, perfusion, and anatominal MRI • The computed model improves tumour detection compared to an expert viewing parametric maps.
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Affiliation(s)
- S F Riches
- CRUK & EPSRC Cancer Imaging Centre, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK,
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Multiparametric MR imaging in diagnosis of chronic prostatitis and its differentiation from prostate cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jrid.2015.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, Taneja SS, Thoeny H, Villeirs G, Villers A. Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature. Eur Urol 2015; 68:1045-53. [PMID: 25656808 DOI: 10.1016/j.eururo.2015.01.013] [Citation(s) in RCA: 601] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/13/2015] [Indexed: 12/19/2022]
Abstract
CONTEXT Detection of clinically significant prostate cancer (PCa) is a major challenge. It has been shown that multiparametric magnetic resonance imaging (mpMRI) facilitates localisation of PCa and can help in targeting prostate biopsy. OBJECTIVE To systematically review the literature to determine the diagnostic accuracy of mpMRI in the detection of clinically significant PCa. EVIDENCE ACQUISITION The Pubmed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from January 1, 2000 to September 30, 2014, using the search criteria "prostate OR Pca OR PSA OR prostatic OR prostate cancer" AND "MR OR NMR OR NMRI OR MRI OR magnetic resonance OR ADC OR DWI OR DCE OR diffusion weighted OR dynamic contrast OR multiparametric OR MRSI OR MR spectroscopy". Two reviewers independently assessed 1729 records. Two independent reviewers assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) 2 tool. EVIDENCE SYNTHESIS Twelve articles were eventually selected. Patients had a median age of 62-65 yr (range 39-83 yr), a median prostate-specific antigen (PSA) level of 5.1-13.4 ng/ml (range 1.2-228 ng/ml), and Gleason score of 6-10. Various definitions of clinical significance were used, mainly based on maximum cancer core length and grade at biopsy, number of positive cores, and PSA. Detection of clinically significant PCa using mpMRI ranged from 44% to 87% in biopsy-naïve males and men with prior negative biopsies using prostate biopsy or definitive pathology of a radical prostatectomy specimen as the reference standard. The negative predictive value for exclusion of significant disease ranged from 63% to 98%. CONCLUSIONS mpMRI is able to detect significant PCa in biopsy-naïve males and men with prior negative biopsies. The negative predictive value of mpMRI is important to the clinician because mpMRI could be used to rule out significant disease. This may result in fewer or no systematic or targeted biopsies in patients with PSA suspicious for prostate cancer. PATIENT SUMMARY We reviewed the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer (PCa). We conclude that mpMRI is able to detect significant PCa and may used to target prostate biopsies.
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Affiliation(s)
- Jurgen J Fütterer
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Mark Emberton
- Research Department of Urology, University College London, London, UK
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Alex Kirkham
- Department of Radiology, University College London Hospital, London, UK
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Harriet Thoeny
- Department of Radiology, Neuroradiology and Nuclear Medicine, University of Bern, Inselspital, Bern, Switzerland
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Arnauld Villers
- Department of Urology, Lille University Medical Centre, University Lille Nord de France, Lille, France
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Arteaga de Castro CS, Boer VO, Luttje MP, van der Velden TA, Bhogal A, van Vulpen M, Luijten PR, van der Heide UA, Klomp DWJ. Temporal B0 field variation effects on MRSI of the human prostate at 7 T and feasibility of correction using an internal field probe. NMR IN BIOMEDICINE 2014; 27:1353-1360. [PMID: 25212868 DOI: 10.1002/nbm.3197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/05/2014] [Accepted: 07/30/2014] [Indexed: 06/03/2023]
Abstract
Spectral degradations as a result of temporal field variations are observed in MRSI of the human prostate. Moving organs generate substantial temporal and spatial field fluctuations as a result of susceptibility mismatch with the surrounding tissue (i.e. periodic breathing, cardiac motion or random bowel motion). Nine patients with prostate cancer were scanned with an endorectal coil (ERC) on a 7-T MR scanner. Temporal B0 field variations were observed with fast dynamic B0 mapping in these patients. Simulations of dynamic B0 corrections were performed using zero- to second-order shim terms. In addition, the temporal B0 variations were applied to simulated MR spectra causing, on average, 15% underestimation of the choline/citrate ratio. Linewidth distortions and frequency shifts (up to 30 and 8 Hz, respectively) were observed. To demonstrate the concept of observing local field fluctuations in real time during MRSI data acquisition, a field probe (FP) tuned and matched for the (19) F frequency was incorporated into the housing of the ERC. The data acquired with the FP were compared with the B0 field map data and used to correct the MRSI datasets retrospectively. The dynamic B0 mapping data showed variations of up to 30 Hz (0.1 ppm) over 72 s at 7 T. The simulated zero-order corrections, calculated as the root mean square, reduced the standard deviation (SD) of the dynamic variations by an average of 41%. When using second-order corrections, the reduction in the SD was, on average, 56%. The FP data showed the same variation range as the dynamic B0 data and the variation patterns corresponded. After retrospective correction, the MRSI data showed artifact reduction and improved spectral resolution. B0 variations can degrade the MRSI substantially. The simple incorporation of an FP into an ERC can improve prostate cancer MRSI without prior knowledge of the origin of the dynamic field distortions.
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Steinseifer IK, van Asten JJ, Weiland E, Scheenen TW, Maas MC, Heerschap A. Improved volume selective1H MR spectroscopic imaging of the prostate with gradient offset independent adiabaticity pulses at 3 tesla. Magn Reson Med 2014; 74:915-24. [DOI: 10.1002/mrm.25476] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/14/2014] [Accepted: 09/05/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Isabell K. Steinseifer
- Department of Radiology and Nuclear Medicine (766); Radboud University Medical Center; Nijmegen The Netherlands
| | - Jack J.A. van Asten
- Department of Radiology and Nuclear Medicine (766); Radboud University Medical Center; Nijmegen The Netherlands
| | - Elisabeth Weiland
- MR Applications Development, Siemens AG, Healthcare Sector; Erlangen Germany
| | - Tom W.J. Scheenen
- Department of Radiology and Nuclear Medicine (766); Radboud University Medical Center; Nijmegen The Netherlands
| | - Marnix C. Maas
- Department of Radiology and Nuclear Medicine (766); Radboud University Medical Center; Nijmegen The Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine (766); Radboud University Medical Center; Nijmegen The Netherlands
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Coffey AM, Kovtunov KV, Barskiy DA, Koptyug IV, Shchepin RV, Waddell KW, He P, Groome KA, Best QA, Shi F, Goodson BM, Chekmenev EY. High-resolution low-field molecular magnetic resonance imaging of hyperpolarized liquids. Anal Chem 2014; 86:9042-9. [PMID: 25162371 PMCID: PMC4165454 DOI: 10.1021/ac501638p] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We demonstrate the feasibility of microscale molecular imaging using hyperpolarized proton and carbon-13 MRI contrast media and low-field (47.5 mT) preclinical scale (38 mm i.d.) 2D magnetic resonance imaging (MRI). Hyperpolarized proton images with 94 × 94 μm(2) spatial resolution and hyperpolarized carbon-13 images with 250 × 250 μm(2) in-plane spatial resolution were recorded in 4-8 s (largely limited by the electronics response), surpassing the in-plane spatial resolution (i.e., pixel size) achievable with micro-positron emission tomography (PET). These hyperpolarized proton and (13)C images were recorded using large imaging matrices of up to 256 × 256 pixels and relatively large fields of view of up to 6.4 × 6.4 cm(2). (13)C images were recorded using hyperpolarized 1-(13)C-succinate-d2 (30 mM in water, %P(13C) = 25.8 ± 5.1% (when produced) and %P(13C) = 14.2 ± 0.7% (when imaged), T1 = 74 ± 3 s), and proton images were recorded using (1)H hyperpolarized pyridine (100 mM in methanol-d4, %P(H) = 0.1 ± 0.02% (when imaged), T1 = 11 ± 0.1 s). Both contrast agents were hyperpolarized using parahydrogen (>90% para-fraction) in an automated 5.75 mT parahydrogen induced polarization (PHIP) hyperpolarizer. A magnetized path was demonstrated for successful transportation of a (13)C hyperpolarized contrast agent (1-(13)C-succinate-d2, sensitive to fast depolarization when at the Earth's magnetic field) from the PHIP polarizer to the 47.5 mT low-field MRI. While future polarizing and low-field MRI hardware and imaging sequence developments can further improve the low-field detection sensitivity, the current results demonstrate that microscale molecular imaging in vivo is already feasible at low (<50 mT) fields and potentially at low (~1 mM) metabolite concentrations.
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Affiliation(s)
- Aaron M Coffey
- Vanderbilt University Institute of Imaging Science (VUIIS) and Department of Radiology, Vanderbilt University , Nashville, Tennessee 37232, United States
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Bittencourt LK, Attenberger UI, Lima D, Strecker R, Oliveira AD, Schoenberg SO, Gasparetto EL, Hausmann D. Feasibility study of computed vs measured high b-value (1400 s/mm²) diffusion-weighted MR images of the prostate. World J Radiol 2014; 6:374-380. [PMID: 24976938 PMCID: PMC4072822 DOI: 10.4329/wjr.v6.i6.374] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the impact of computed b = 1400 s/mm2 (C-b1400) vs measured b = 1400 s/mm2 (M-b1400) diffusion-weighted images (DWI) on lesion detection rate, image quality and quality of lesion demarcation using a modern 3T-MR system based on a small-field-of-view sequence (sFOV).
METHODS: Thirty patients (PSA: 9.5 ± 8.7 ng/mL; 68 ± 12 years) referred for magnetic resonance imaging (MRI) of the prostate were enrolled in this study. All measurements were performed on a 3T MR system. For DWI, a single-shot EPI diffusion sequence (b = 0, 100, 400, 800 s/mm²) was utilized. C-b1400 was calculated voxelwise from the ADC and diffusion images. Additionally, M-b1400 was acquired for evaluation and comparison. Lesion detection rate and maximum lesion diameters were obtained and compared. Image quality and quality of lesion demarcation were rated according to a 5-point Likert-type scale. Ratios of lesion-to-bladder as well as prostate-to-bladder signal intensity (SI) were calculated to estimate the signal-to-noise-ratio (SNR).
RESULTS: Twenty-four lesions were detected on M-b1400 images and compared to C-b1400 images. C-b1400 detected three additional cancer suspicious lesions. Overall image quality was rated significantly better and SI ratios were significantly higher on C-b1400 (2.3 ± 0.8 vs 3.1 ± 1.0, P < 0.001; 5.6 ± 1.8 vs 2.8 ± 0.9, P < 0.001). Comparison of lesion size showed no significant differences between C- and M-b1400 (P = 0.22).
CONCLUSION: Combination of a high b-value extrapolation and sFOV may contribute to increase diagnostic accuracy of DWI without an increase of acquisition time, which may be useful to guide targeted prostate biopsies and to improve quality of multiparametric MRI (mMRI) especially under economical aspects in a private practice setting.
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Kobus T, Wright AJ, Weiland E, Heerschap A, Scheenen TWJ. Metabolite ratios in 1H MR spectroscopic imaging of the prostate. Magn Reson Med 2014; 73:1-12. [PMID: 24488656 DOI: 10.1002/mrm.25122] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/18/2013] [Accepted: 12/17/2013] [Indexed: 12/24/2022]
Abstract
In (1)H MR spectroscopic imaging ((1)H-MRSI) of the prostate the spatial distribution of the signal levels of the metabolites choline, creatine, polyamines, and citrate are assessed. The ratio of choline (plus spermine as the main polyamine) plus creatine over citrate [(Cho+(Spm+)Cr)/Cit] is derived from these metabolites and is used as a marker for the presence of prostate cancer. In this review, the factors that are of importance for the metabolite ratio are discussed. This is relevant, because the appearance of the metabolites in the spectrum depends not only on the underlying anatomy, metabolism, and physiology of the tissue, but also on acquisition parameters. These parameters influence especially the spectral shapes of citrate and spermine resonances, and consequently, the (Cho+(Spm+)Cr)/Cit ratio. Both qualitative and quantitative approaches can be used for the evaluation of (1)H-MRSI spectra of the prostate. For the quantitative approach, the (Cho+(Spm+)Cr)/Cit ratio can be determined by integration or by a fit based on model signals. Using the latter, the influence of the acquisition parameters on citrate can be taken into account. The strong overlap between the choline, creatine, and spermine resonances complicates fitting of the individual metabolites. This overlap and (unknown, possibly tissue-related) variations in T1, T2, and J-modulation hamper the application of corrections needed for a "normalized" (Cho+(Spm+)Cr)/Cit ratio that would enable comparison of spectra measured with different prostate MR spectroscopy protocols. Quantitative (Cho+(Spm+)Cr)/Cit thresholds for the evaluation of prostate cancer are therefore commonly established per institution or per protocol. However, if the same acquisition and postprocessing protocol were used, the ratio and the thresholds would be institution-independent, promoting the clinical usability of prostate (1)H-MRSI.
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Affiliation(s)
- Thiele Kobus
- Radboud University Medical Centre, Radiology Department, Nijmegen, The Netherlands
| | - Alan J Wright
- Radboud University Medical Centre, Radiology Department, Nijmegen, The Netherlands
| | | | - Arend Heerschap
- Radboud University Medical Centre, Radiology Department, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Radboud University Medical Centre, Radiology Department, Nijmegen, The Netherlands
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1.5-T magnetic resonance-guided transgluteal biopsies of the prostate in patients with clinically suspected prostate cancer: technique and feasibility. Invest Radiol 2014; 48:458-63. [PMID: 23385402 DOI: 10.1097/rli.0b013e31827c394b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to examine the feasibility and safety of magnetic resonance-guided prostate biopsy (MRGBx) with a transgluteal approach in patients with cancer suspicious prostatic lesions. MATERIALS AND METHODS This study was approved by the ethical committee. A total of 25 men with clinically suspected prostate cancer with increased prostate-specific antigen levels and at least 1 previous negative transrectal ultrasound-guided prostatic biopsy (TRUSBx) underwent diagnostic magnetic resonance (MR) imaging of the prostate. Cancer suspicious regions (CSR) were identified, and MRGBx with a transgluteal approach in a large closed-bore 1.5-T MR system was manually performed in coaxial technique, using transversal fat-suppressed T2-weighted true fast imaging with steady-state free precession sequences. Success rate, biopsy findings, side effects, procedure time, number of acquisitions for the repositioning of the needle guide, and length of the biopsy channel were documented. Follow-up was performed 24 months after the procedure. RESULTS In diagnostic MR imaging of the prostate, a total of 40 CSRs were detected in 25 patients. All MRGBx procedures were technically successful and all CSRs were biopsied. The mean number of core biopsies per CSR was 3.3 ± 1.5 (range, 1-7). Histopathological analysis revealed adenocarcinoma in 35% (14/40), acute or chronic prostatitis in 30% (12/40), adenofibromyomatous changes in 22.5% (9/40), and no identifiable pathology in 17.5% (7/40) of CSRs, with a pathological overlap for chronic prostatitis and adenofibromyomatous changes in 1 patient with biopsies in 2 CSRs. No missed prostate cancer after MR-guided biopsy in clinical follow-up was detected. Mean procedure time was 31 ± 7 minutes (range, 21-46 minutes). Side effects were hematuria (n = 7), hematospermia (n = 3), combined hematuria/hematospermia (n = 2), and infection (n=1). CONCLUSION Magnetic resonance-guided prostate biopsy of the prostate gland with a transgluteal approach is feasible, safe, and a promising technique for histological clarification of cancer suspicious lesions in patients with increased prostate-specific antigen levels after negative TRUSBx. Magnetic resonance-guided prostate biopsy offers a reasonable alternative to repeated TRUSBx for histological clarification of prostate cancer.
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Penzkofer T, Tempany-Afdhal CM. Prostate cancer detection and diagnosis: the role of MR and its comparison with other diagnostic modalities--a radiologist's perspective. NMR IN BIOMEDICINE 2014; 27:3-15. [PMID: 24000133 PMCID: PMC3851933 DOI: 10.1002/nbm.3002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 06/16/2013] [Accepted: 06/18/2013] [Indexed: 05/07/2023]
Abstract
It is now universally recognized that many prostate cancers are over-diagnosed and over-treated. The European Randomized Study of Screening for Prostate Cancer from 2009 evidenced that, to save one man from death from prostate cancer, over 1400 men need to be screened, and 48 need to undergo treatment. The detection of prostate cancer is traditionally based on digital rectal examination (DRE) and the measurement of serum prostate-specific antigen (PSA), followed by ultrasound-guided biopsy. The primary role of imaging for the detection and diagnosis of prostate cancer has been transrectal ultrasound (TRUS) guidance during biopsy. Traditionally, MRI has been used primarily for the staging of disease in men with biopsy-proven cancer. It has a well-established role in the detection of T3 disease, planning of radiation therapy, especially three-dimensional conformal or intensity-modulated external beam radiation therapy, and planning and guiding of interstitial seed implant or brachytherapy. New advances have now established that prostate MRI can accurately characterize focal lesions within the gland, an ability that has led to new opportunities for improved cancer detection and guidance for biopsy. Two new approaches to prostate biopsy are under investigation. Both use pre-biopsy MRI to define potential targets for sampling, and the biopsy is performed either with direct real-time MR guidance (in-bore) or MR fusion/registration with TRUS images (out-of-bore). In-bore and out-of-bore MRI-guided prostate biopsies have the advantage of using the MR target definition for the accurate localization and sampling of targets or suspicious lesions. The out-of-bore method uses combined MRI/TRUS with fusion software that provides target localization and increases the sampling accuracy of TRUS-guided biopsies by integrating prostate MRI information with TRUS. Newer parameters for each imaging modality, such as sonoelastography or shear wave elastography, contrast-enhanced ultrasound and MRI elastography, show promise to further enrich datasets.
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Affiliation(s)
- Tobias Penzkofer
- Division of MRI and Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen, Germany
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Kobus T, Wright AJ, Scheenen TWJ, Heerschap A. Mapping of prostate cancer by 1H MRSI. NMR IN BIOMEDICINE 2014; 27:39-52. [PMID: 23761200 DOI: 10.1002/nbm.2973] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/08/2013] [Accepted: 04/13/2013] [Indexed: 06/02/2023]
Abstract
In many studies, it has been demonstrated that (1)H MRSI of the human prostate has great potential to aid prostate cancer management, e.g. in the detection and localisation of cancer foci in the prostate or in the assessment of its aggressiveness. It is particularly powerful in combination with T2 -weighted MRI. Nevertheless, the technique is currently mainly used in a research setting. This review provides an overview of the state-of-the-art of three-dimensional MRSI, including the specific hardware required, dedicated data acquisition sequences and information on the spectral content with background on the MR-visible metabolites. In clinical practice, it is important that relevant MRSI results become available rapidly, reliably and in an easy digestible way. However, this functionality is currently not fully available for prostate MRSI, which is a major obstacle for routine use by inexperienced clinicians. Routine use requires more automation in the processing of raw data than is currently available. Therefore, we pay specific attention in this review on the status and prospects of the automated handling of prostate MRSI data, including quality control. The clinical potential of three-dimensional MRSI of the prostate is illustrated with literature examples on prostate cancer detection, its localisation in the prostate, its role in the assessment of cancer aggressiveness and in the selection and monitoring of therapy.
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Affiliation(s)
- Thiele Kobus
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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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: 1.2] [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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Luttje MP, Italiaander MGM, Arteaga de Castro CS, van der Kemp WJM, Luijten PR, van Vulpen M, van der Heide UA, Klomp DWJ. (31) P MR spectroscopic imaging combined with (1) H MR spectroscopic imaging in the human prostate using a double tuned endorectal coil at 7T. Magn Reson Med 2013; 72:1516-21. [PMID: 24357271 DOI: 10.1002/mrm.25070] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE Improved diagnostic sensitivity could be obtained in cancer detection and staging when individual compounds of the choline pool can be detected. Therefore, a novel coil design is proposed, providing the ability to acquire both (1) H and (31) P magnetic resonance spectroscopic imaging (MRSI) in patients with prostate cancer. METHODS A two-element (1) H/(31) P endorectal coil was designed by adjusting a commercially available 3T endorectal coil. The two-element coil setup was interfaced as a transceiver to a whole body 7T MR scanner. Simulations and phantom measurements were performed to compare the efficiency of the coil. (1) H MRSI and (31) P MRSI were acquired in vivo in prostate cancer patients. RESULTS The efficiency of the (1) H/(31) P coil is comparable to the dual channel (1) H coil previously published. Individually distinguishable phospholipid metabolites in the in vivo (31) P spectra were: phosphoethanolamine, phosphocholine, phosphate, glycerophosphoethanolamine, glycerophosphocholine, phosphocreatine, and adenosine triposphate. (1) H MRSI was performed within the same scan session, visualizing choline, polyamines, creatine, and citrate. CONCLUSION (1) H MRSI and (31) P MRSI can be acquired in the human prostate at 7T within the same scan session using an endorectal coil matched and tuned for (1) H (quadrature) and (31) P (linear) without the need of cable traps and with negligible efficiency losses in the (1) H and (31) P channel.
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Affiliation(s)
- Mariska P Luttje
- Imaging Division, University Medical Center, Utrecht, Netherlands
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Current Technological Advances in Magnetic Resonance With Critical Impact for Clinical Diagnosis and Therapy. Invest Radiol 2013; 48:869-77. [DOI: 10.1097/01.rli.0000434380.71793.d3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hegde JV, Mulkern RV, Panych LP, Fennessy FM, Fedorov A, Maier SE, Tempany CMC. Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer. J Magn Reson Imaging 2013; 37:1035-54. [PMID: 23606141 DOI: 10.1002/jmri.23860] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 09/04/2012] [Indexed: 12/15/2022] Open
Abstract
Magnetic resonance (MR) examinations of men with prostate cancer are most commonly performed for detecting, characterizing, and staging the extent of disease to best determine diagnostic or treatment strategies, which range from biopsy guidance to active surveillance to radical prostatectomy. Given both the exam's importance to individual treatment plans and the time constraints present for its operation at most institutions, it is essential to perform the study effectively and efficiently. This article reviews the most commonly employed modern techniques for prostate cancer MR examinations, exploring the relevant signal characteristics from the different methods discussed and relating them to intrinsic prostate tissue properties. Also, a review of recent articles using these methods to enhance clinical interpretation and assess clinical performance is provided. J. Magn. Reson. Imaging 2013;37:1035-1054. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- John V Hegde
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Selnaes KM, Gribbestad IS, Bertilsson H, Wright A, Angelsen A, Heerschap A, Tessem MB. Spatially matched in vivo and ex vivo MR metabolic profiles of prostate cancer -- investigation of a correlation with Gleason score. NMR IN BIOMEDICINE 2013; 26:600-606. [PMID: 23280546 DOI: 10.1002/nbm.2901] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 11/06/2012] [Accepted: 11/09/2012] [Indexed: 06/01/2023]
Abstract
MR metabolic profiling of the prostate is promising as an additional diagnostic approach to separate indolent from aggressive prostate cancer. The objective of this study was to assess the relationship between the Gleason score and the metabolic biomarker (choline + creatine + spermine)/citrate (CCS/C) measured by ex vivo high-resolution magic angle spinning MRS (HR-MAS MRS) and in vivo MRSI, and to evaluate the correlation between in vivo- and ex vivo-measured metabolite ratios from spatially matched prostate regions. Patients (n = 13) underwent in vivo MRSI prior to radical prostatectomy. A prostate tissue slice was snap-frozen shortly after surgery and the locations of tissue samples (n = 40) collected for ex vivo HR-MAS were matched to in vivo MRSI voxels (n = 40). In vivo MRSI was performed on a 3T clinical MR system and ex vivo HR-MAS on a 14.1T magnet. Relative metabolite concentrations were calculated by LCModel fitting of in vivo spectra and by peak integration of ex vivo spectra. Spearman's rank correlations (ρ) between CCS/C from in vivo and ex vivo MR spectra, and with their corresponding Gleason score, were calculated. There was a strong positive correlation between the Gleason score and CCS/C measured both in vivo and ex vivo (ρ = 0.77 and ρ = 0.69, respectively; p < 0.001), and between in vivo and ex vivo metabolite ratios from spatially matched regions (ρ = 0.67, p < 0.001). Our data indicate that MR metabolic profiling is a potentially useful tool for the assessment of cancer aggressiveness. Moreover, the good correlation between in vivo- and ex vivo-measured CCS/C demonstrates that our method is able to bridge MRSI and HR-MAS molecular analysis.
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Affiliation(s)
- Kirsten M Selnaes
- MI Lab, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
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A historical overview of magnetic resonance imaging, focusing on technological innovations. Invest Radiol 2013; 47:725-41. [PMID: 23070095 DOI: 10.1097/rli.0b013e318272d29f] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Magnetic resonance imaging (MRI) has now been used clinically for more than 30 years. Today, MRI serves as the primary diagnostic modality for many clinical problems. In this article, historical developments in the field of MRI will be discussed with a focus on technological innovations. Topics include the initial discoveries in nuclear magnetic resonance that allowed for the advent of MRI as well as the development of whole-body, high field strength, and open MRI systems. Dedicated imaging coils, basic pulse sequences, contrast-enhanced, and functional imaging techniques will also be discussed in a historical context. This article describes important technological innovations in the field of MRI, together with their clinical applicability today, providing critical insights into future developments.
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Wright AJ, Kobus T, Selnaes KM, Gribbestad IS, Weiland E, Scheenen TWJ, Heerschap A. Quality control of prostate 1 H MRSI data. NMR IN BIOMEDICINE 2013; 26:193-203. [PMID: 22806985 DOI: 10.1002/nbm.2835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/11/2012] [Accepted: 06/11/2012] [Indexed: 06/01/2023]
Abstract
MRSI of prostate cancer provides a potential clinical tool to aid in the detection and characterisation of this disease, but its clinical use is limited by the need for the specialist training of radiologists to read these datasets. An essential part of this reading is the assessment of the usability and reliability of MRSI spectra because they can be affected by artefacts such as poor signal to noise, lipid signal contamination and broad resonances that could cause errors of interpretation. We have developed an automated quality control algorithm that classifies every voxel of an MRSI dataset as either acceptable or unacceptable for further analysis, based on the spectral profile alone. The method was trained and tested based on a gold standard of agreement of four experts. It was highly accurate: testing with a novel set of data from MRSI patients produced agreement with the experts' consensus decisions with a specificity of 0.95 and sensitivity of 0.95. This method provides fast quality control of three-dimensional MRSI datasets of the prostate, removing the need for radiologists to perform this time consuming, but necessary, task prior to further analysis.
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Affiliation(s)
- Alan J Wright
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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Apparent Diffusion Coefficient and Sodium Concentration Measurements in Human Prostate Tissue via Hydrogen-1 and Sodium-23 Magnetic Resonance Imaging in a Clinical Setting at 3 T. Invest Radiol 2012; 47:677-82. [DOI: 10.1097/rli.0b013e318267bc6f] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Peripheral Zone Prostate Cancer Localization by Multiparametric Magnetic Resonance at 3 T. Invest Radiol 2012; 47:624-33. [DOI: 10.1097/rli.0b013e318263f0fd] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Awwad HM, Geisel J, Obeid R. The role of choline in prostate cancer. Clin Biochem 2012; 45:1548-53. [PMID: 22921309 DOI: 10.1016/j.clinbiochem.2012.08.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/06/2012] [Accepted: 08/10/2012] [Indexed: 01/18/2023]
Abstract
Choline is an essential nutrient that is necessary for cell membrane synthesis and phospholipid metabolism and functions as an important methyl donor. Multiple roles for choline in cancer development have been suggested. Choline can affect DNA methylation and lead to a disruption of DNA repair. It can also modify cell signaling that is mediated by intermediary phospholipid metabolites, and it can support the synthesis of cell membranes and thus support cell proliferation. A higher intake or status of choline in plasma and tissues has been related to higher cancer risks. Prostate cancer shows elevated levels of choline uptake and levels of certain choline metabolites. Choline metabolites can be used as potential prognostic biomarkers for the management of prostate cancer patients. Targeting certain enzymes, which are related to choline metabolism, provides promising therapeutic opportunities for tumor growth arrest. This review summarizes the potential role of choline metabolism in cancer, especially in prostate cancer.
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Affiliation(s)
- Hussain Mohamad Awwad
- Saarland University Hospital, Department of Clinical Chemistry and Laboratory Medicine, Building 57, 66421 Homburg/Saar, Germany.
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Kobus T, Vos PC, Hambrock T, De Rooij M, Hulsbergen-Van de Kaa CA, Barentsz JO, Heerschap A, Scheenen TWJ. Prostate cancer aggressiveness: in vivo assessment of MR spectroscopy and diffusion-weighted imaging at 3 T. Radiology 2012; 265:457-67. [PMID: 22843767 DOI: 10.1148/radiol.12111744] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the individual and combined performance of magnetic resonance (MR) spectroscopic imaging and diffusion-weighted (DW) imaging at 3 T in the in vivo assessment of prostate cancer aggressiveness by using histopathologically defined regions of interest on radical prostatectomy specimens to define the prostate cancer regions to be investigated. MATERIALS AND METHODS The local institutional ethics review board approved this retrospective study and waived the informed consent requirement. Fifty-four patients with biopsy-proved prostate cancer underwent clinical MR spectroscopic imaging followed by prostatectomy. Guided by the histopathologic map, all spectroscopy voxels that contained tumor tissue were selected, and metabolite ratios (choline [Cho] plus creatine [Cr]-to-citrate [Cit] and Cho/Cr ratios) were derived. For each spectroscopic voxel, 25th percentile apparent diffusion coefficient (ADC) of the region corresponding to that voxel was determined, representing the most aberrant tumor part on the ADC map, which was often smaller than spectroscopic imaging voxels. Maximum metabolic ratios and minimum 25th percentile ADC of each tumor were related to tumor aggressiveness and were used to differentiate aggressiveness classes. A logistic regression model (LRM) was used to combine data from both modalities. RESULTS Significant correlation was found between aggressiveness classes and maximum Cho+Cr/Cit ratio (ρ=0.36), maximum Cho/Cr ratio (ρ=0.35), and minimum 25th percentile ADC (ρ=-0.63) in the peripheral zone (PZ). In the transition zone (TZ), the correlation was significant for only Cho+Cr/Cit and Cho/Cr ratios (ρ=0.58 and ρ=0.60, respectively). For differentiation between aggressiveness classes, LRM use did not result in significantly improved differentiation over any individual variables. CONCLUSION These findings enabled confirmation that MR spectroscopic imaging and DW imaging offer potential for in vivo noninvasive assessment of prostate cancer aggressiveness, and both modalities have comparable performance. The combination did not result in better performance. Nonetheless, the better performances of metabolite ratios in the TZ and of ADCs in the PZ suggest that they have complementary value.
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Affiliation(s)
- Thiele Kobus
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands.
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Zechmann CM, Menze BH, Kelm BM, Zamecnik P, Ikinger U, Giesel FL, Thieke C, Delorme S, Hamprecht FA, Bachert P. Automated vs. manual pattern recognition of 3D (1)H MRSI data of patients with prostate cancer. Acad Radiol 2012; 19:675-84. [PMID: 22578226 DOI: 10.1016/j.acra.2012.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 11/14/2011] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to assess (1) automated analysis methods versus manual evaluation by human experts of three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) data from patients with prostate cancer and (2) the contribution of spatial information to decision making. MATERIALS AND METHODS Three-dimensional proton MRSI was applied at 1.5 T. MRSI data from 10 patients with histologically proven prostate adenocarcinoma, scheduled either for prostatectomy or intensity-modulated radiation therapy, were evaluated. First, two readers manually labeled spectra using spatial information to identify the localization of spectra and neighborhood information, establishing the reference set of this study. Then, spectra were labeled again manually in a blinded and randomized manner and evaluated automatically using software that applied spectral line fitting as well as pattern recognition routines. Statistical analysis of the results of the different approaches was performed. RESULTS Altogether, 1018 spectra were evaluable by all methods. Numbers of evaluable spectra differed significantly depending on patient and evaluation method. Compared to automated analysis, the readers made rather binary decisions, using information from neighboring spectra in ambiguous cases, when evaluating MRSI data as a whole. Differences between anatomically blinded and unblinded evaluation were larger than differences between evaluations using blinded data and automated techniques. CONCLUSIONS An automated approach, which evaluates each spectrum individually, can be as good as an anatomy-blinded human reader. Spatial information is routinely used by human experts to support their final decisions. Automated procedures that consider anatomic information for spectral evaluation will enhance the diagnostic impact of MRSI of the human prostate.
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Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, Heijmink SW, Hoskin P, Kirkham AP, Padhani AR, Persad R, Puech P, Punwani S, Sohaib A, Tombal B, Villers A, Emberton M. Scoring systems used for the interpretation and reporting of multiparametric MRI for prostate cancer detection, localization, and characterization: could standardization lead to improved utilization of imaging within the diagnostic pathway? J Magn Reson Imaging 2012; 37:48-58. [DOI: 10.1002/jmri.23689] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 03/30/2012] [Indexed: 01/06/2023] Open
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