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Eng SE, Basasie B, Lam A, John Semmes O, Troyer DA, Clarke GD, Sunnapwar AG, Leach RJ, Johnson-Pais TL, Sokoll LJ, Chan DW, Tosoian JJ, Siddiqui J, Chinnaiyan AM, Thompson IM, Boutros PC, Liss MA. Prospective comparison of restriction spectrum imaging and non-invasive biomarkers to predict upgrading on active surveillance prostate biopsy. Prostate Cancer Prostatic Dis 2024; 27:65-72. [PMID: 36097168 DOI: 10.1038/s41391-022-00591-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Protocol-based active surveillance (AS) biopsies have led to poor compliance. To move to risk-based protocols, more accurate imaging biomarkers are needed to predict upgrading on AS prostate biopsy. We compared restriction spectrum imaging (RSI-MRI) generated signal maps as a biomarker to other available non-invasive biomarkers to predict upgrading or reclassification on an AS biopsy. METHODS We prospectively enrolled men on prostate cancer AS undergoing repeat biopsy from January 2016 to June 2019 to obtain an MRI and biomarkers to predict upgrading. Subjects underwent a prostate multiparametric MRI and a short duration, diffusion-weighted enhanced MRI called RSI to generate a restricted signal map along with evaluation of 30 biomarkers (14 clinico-epidemiologic features, 9 molecular biomarkers, and 7 radiologic-associated features). Our primary outcome was upgrading or reclassification on subsequent AS prostate biopsy. Statistical analysis included operating characteristic improvement using AUROC and AUPRC. RESULTS The individual biomarker with the highest area under the receiver operator characteristic curve (AUC) was RSI-MRI (AUC = 0.84; 95% CI: 0.71-0.96). The best non-imaging biomarker was prostate volume-corrected Prostate Health Index density (PHI, AUC = 0.68; 95% CI: 0.53-0.82). Non-imaging biomarkers had a negligible effect on predicting upgrading at the next biopsy but did improve predictions of overall time to progression in AS. CONCLUSIONS RSI-MRI, PIRADS, and PHI could improve the predictive ability to detect upgrading in AS. The strongest predictor of clinically significant prostate cancer on AS biopsy was RSI-MRI signal output.
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Affiliation(s)
- Stefan E Eng
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
- Institute for Precision Health, UCLA, Los Angeles, CA, USA
- Department of Urology, UCLA, Los Angeles, CA, USA
| | - Benjamin Basasie
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Alfonso Lam
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
- Institute for Precision Health, UCLA, Los Angeles, CA, USA
- Department of Urology, UCLA, Los Angeles, CA, USA
| | - O John Semmes
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Dean A Troyer
- Department of Pathology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Geoffrey D Clarke
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Radiology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Abhijit G Sunnapwar
- Department of Radiology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Robin J Leach
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, TX, USA
| | | | - Lori J Sokoll
- Department of Pathology, Division of Clinical Chemistry, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel W Chan
- Department of Pathology, Division of Clinical Chemistry, Johns Hopkins University, Baltimore, MD, USA
| | | | - Javed Siddiqui
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Paul C Boutros
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA.
- Institute for Precision Health, UCLA, Los Angeles, CA, USA.
- Department of Urology, UCLA, Los Angeles, CA, USA.
- Department of Human Genetics, UCLA, Los Angeles, CA, USA.
- Broad Stem Cell Research Center, UCLA, Los Angeles, CA, USA.
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
| | - Michael A Liss
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA.
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX, USA.
- College of Pharmacy, University of Texas Austin, Austin, TX, USA.
- Department of Urology, South Texas Veterans Healthcare System, San Antonio, TX, USA.
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Abreu-Gomez J, Lim C, Haider MA. Contemporary Approach to Prostate Imaging and Data Reporting System Score 3 Lesions. Radiol Clin North Am 2024; 62:37-51. [PMID: 37973244 DOI: 10.1016/j.rcl.2023.06.008] [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] [Indexed: 11/19/2023]
Abstract
The aim of this article is to review the technical and clinical considerations encountered with PI-RADS 3 lesions, which are equivocal for clinically significant Prostate Cancer (csPCa) with detection rates ranging between 10% and 35%. The number of PI-RADS 3 lesions reported vary according to several factors including MRI quality and radiologist training/expertise among the most influential. PI-RADS v.2.1 updated definitions for scores 2 and 3 in the PZ and scores 1 and 2 in the TZ is reviewed. The role of DWI role is highlighted in the assessment of the TZ with the possibility of upgrading score 2 lesions to score 3 based on DWI score. Given the increased utilization for prostate MRI, biparametric MRI can be considered as an alternative for low-risk patients where there is a need to rule out csPCa acknowledging this technique may increase the number of indeterminate cases going for biopsies. Management of patients with equivocal lesions at mpMRI and factors influencing biopsy decision process remain as an unmet need and additional studies using molecular/imaging markers as well as artificial intelligence tools are needed to further address their role in proper patient selection for biopsy.
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Affiliation(s)
- Jorge Abreu-Gomez
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Avenue, Suite 3-920, Toronto, ON M5G 2M9, Canada.
| | - Christopher Lim
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AB 279, Toronto, ON M4N 3M5, Canada
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System and the Joint Department of Medical Imaging, Sinai Health System, Princess Margaret Hospital, University of Toronto, 600 University Avenue, Toronto, ON, Canada M5G 1X5
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Nuo Y, Li A, Yang L, Xue H, Wang F, Wang L. Efficacy of 68Ga-PSMA-11 PET/CT with biparametric MRI in diagnosing prostate cancer and predicting risk stratification: a comparative study. Quant Imaging Med Surg 2022; 12:53-65. [PMID: 34993060 DOI: 10.21037/qims-21-80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This retrospective study aimed to investigate the efficacy of the combined application of biparametric magnetic resonance imaging (bpMRI) and 68Ga-PSMA-11 positron emission computed tomography/computed tomography (bpMRI/PET) in the qualitative diagnosis of intermediate- to high-risk prostate cancer (PCa). METHODS The 105 patients with suspected PCa included in the study underwent bpMRI and PET/CT. BpMRI examinations included conventional sequences and diffusion-weighted imaging (DWI) sequences. Major lesions were qualitatively diagnosed according to the Prostate Imaging Reporting and Data System (PI-RADS). A PET/CT scan was started 60 min after intravenous 68Ga-PSMA-11 injection. The area with the highest radioactivity on PET/CT images was defined as the major lesion, and the maximum standard uptake value (SUVmax) was measured. All cases were confirmed by biopsy and pathology. Receiver operating characteristic curve (ROC) analysis was performed on the data to calculate sensitivity, specificity, and the Youden index. RESULTS Of the 105 patients, 68 patients were diagnosed with PCa, and 37 patients had benign prostatic lesions. With a PI-RADS score ≥3 as the diagnostic threshold, the accuracy of bpMRI in identifying benign and malignant prostate lesions was similar to that of PET/CT (SUVmax threshold ≥10.9), and the Youden indices were 0.60 and 0.64, respectively. The sensitivity and specificity of bpMRI in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 63% and 88%, respectively, and the Youden index was 0.51. With an SUVmax ≥12.9 as the diagnostic threshold, the sensitivity and specificity of PET/CT in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 74% and 94%, respectively, and the Youden index was 0.68. The sensitivity and specificity of bpMRI/PET in diagnosing PCa were 94% and 81%, respectively, and the Youden index was 0.75. The sensitivity and specificity of bpMRI/PET in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 80% and 88%, respectively, and the Youden index was 0.68. CONCLUSIONS The combined application of bpMRI and PET improves the accuracy of the qualitative diagnosis of prostate lesions, and its diagnostic efficacy for risk stratification in patients with intermediate- to high-risk PCa is similar to that of PET/CT and higher than that of bpMRI alone.
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Affiliation(s)
- Yi Nuo
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Aimei Li
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lulu Yang
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hailin Xue
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liwei Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Garmer M, Karpienski J, Groenemeyer DH, Wagener B, Kamper L, Haage P. Structured reporting in radiologic education - Potential of different PI-RADS versions in prostate MRI controlled by in-bore MR-guided biopsies. Br J Radiol 2021; 95:20210458. [PMID: 34914538 PMCID: PMC8978241 DOI: 10.1259/bjr.20210458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objectives: To evaluate the efficiency of structured reporting in radiologic education – based on the example of different PI-RADS score versions for multiparametric MRI (mpMRI) of the prostate. Methods: MpMRI of 688 prostate lesions in 180 patients were retrospectively reviewed by an experienced radiologist and by a student using PI-RADS V1 and V2. Data sets were reviewed for changes according to PI-RADS V2.1. The results were correlated with results obtained by MR-guided biopsy. Diagnostic potency was evaluated by ROC analysis. Sensitivity, specificity and correct-graded samples were evaluated for different cutpoints. The agreement between radiologist and student was determined for the aggregation of the PI-RADS score in three categories. The student’s time needed for evaluation was measured. Results: The area under curve of the ROC analysis was 0.782/0.788 (V1/V2) for the student and 0.841/0.833 (V1/V2) for the radiologist. The agreement between student and radiologist showed a Cohen‘s weighted κ coefficient of 0.495 for V1 and 0.518 for V2. Median student’s time needed for score assessment was 4:34 min for PI-RADSv1 and 2:00 min for PI-RADSv2 (p < 0.001). Re-evaluation for V2.1 changed the category in 1.4% of all ratings. Conclusion: The capacity of prostate cancer detection using PI-RADS V1 and V2 is dependent on the reader‘s experience. The results from the two observers indicate that structured reporting using PI-RADS and, controlled by histopathology, can be a valuable and quantifiable tool in students‘ or residents’ education. Herein, V2 was superior to V1 in terms of inter-observer agreement and time efficacy. Advances in knowledge: Structured reporting can be a valuable and quantifiable tool in radiologic education. Structured reporting using PI-RADS can be used by a student with good performance. PI-RADS V2 is superior to V1 in terms of inter-observer agreement and time efficacy.
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Affiliation(s)
- Marietta Garmer
- Witten/Herdecke University, Witten, Germany.,Clinical Radiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Dietrich Hw Groenemeyer
- Witten/Herdecke University, Witten, Germany.,Grönemeyer Institute of Microtherapy, Bochum, Germany
| | | | - Lars Kamper
- Witten/Herdecke University, Witten, Germany.,Clinical Radiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Patrick Haage
- Witten/Herdecke University, Witten, Germany.,Clinical Radiology, Helios University Hospital Wuppertal, Wuppertal, Germany
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In prostatic transition zone lesions (PI-RADS v2.1): which subgroup should be biopsied? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The study aimed to compare the diagnostic performance of T2-weighted imaging (T2WI) score 3 transition zone (TZ) lesions between Prostate Imaging and Reporting Data System (PI-RADS) v2.1 and modified PI-RADS v2.1-B.
Results
Among TZ lesions (n = 78), 47 (60.0%) had T2WI score of 3, and 16 of the 47 (34.0%) were malignant. The rate of malignancy was 8.8% in PI-RADS category 3A, 100% in PI-RADS category 3B, and 100% in PI-RADS category 4. The apparent diffusion coefficient value of PI-RADS category 3B (0.934 ± 0.158 × 10−3 mm2/s) showed significant difference with that of PI-RADS category 3A (1.098 ± 0.146 × 10−3 mm2/s) but none with PI-RADS category 4 (0.821 ± 0.091 × 10−3 mm2/s). There was no significant difference in the sensitivity and negative predictive value of PI-RADS v2.1 and PI-RADS v2.1-B. Specificity and positive predictive value of modified PI-RADS v2.1-B were much higher than those of PI-RADS v2.1 for both readers (p < .001). The area under the receiver operating characteristic curve tended to be higher with PI-RADS v2.1-B than with PI-RADS v2.1.
Conclusion
Biopsy for PI-RADS 3B lesion is necessary due to its superior malignancy potential than that of PI-RADS 3A lesion.
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Pharmacokinetic modeling of dynamic contrast-enhanced (DCE)-MRI in PI-RADS category 3 peripheral zone lesions: preliminary study evaluating DCE-MRI as an imaging biomarker for detection of clinically significant prostate cancers. Abdom Radiol (NY) 2021; 46:4370-4380. [PMID: 33818626 DOI: 10.1007/s00261-021-03035-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE To determine if pharmacokinetic modeling of DCE-MRI can diagnose CS-PCa in PI-RADS category 3 PZ lesions with subjective negative DCE-MRI. MATERIALS AND METHODS In the present IRB approved, bi-institutional, retrospective, case-control study, we identified 73 men with 73 PZ PI-RADS version 2.1 category 3 lesions with MRI-directed-TRUS-guided targeted biopsy yielding: 12 PZ CS-PCa (ISUP Grade Group 2; N = 9, ISUP 3; N = 3), 27 ISUP 1 PCa and 34 benign lesions. An expert blinded radiologist segmented lesions on ADC and DCE images; segmentations were overlayed onto pharmacokinetic DCE-MRI maps. Mean values were compared between groups using univariate analysis. Diagnostic accuracy was assessed by ROC. RESULTS There were no differences in age, PSA, PSAD or clinical stage between groups (p = 0.265-0.645). Mean and 10th percentile ADC did not differ comparing CS-PCa to ISUP 1 PCa and benign lesions (p = 0.376 and 0.598) but was lower comparing ISUP ≥ 1 PCa to benign lesions (p < 0.001). Mean Ktrans (p = 0.003), Ve (p = 0.003) but not Kep (p = 0.387) were higher in CS-PCa compared to ISUP 1 PCa and benign lesions. There were no differences in DCE-MRI metrics comparing ISUP ≥ 1 PCa and benign lesions (p > 0.05). AUC for diagnosis of CS-PCa using Ktrans and Ve were: 0.69 (95% CI 0.52-0.87) and 0.69 (0.49-0.88). CONCLUSION Pharmacokinetic modeling of DCE-MRI parameters in PI-RADS category 3 lesions with subjectively negative DCE-MRI show significant differences comparing CS-PCa to ISUP 1 PCa and benign lesions, in this study outperforming ADC. Studies are required to further evaluate these parameters to determine which patients should undergo targeted biopsy for PI-RADS 3 lesions.
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Cai GH, Yang QH, Chen WB, Liu QY, Zeng YR, Zeng YJ. Diagnostic Performance of PI-RADS v2, Proposed Adjusted PI-RADS v2 and Biparametric Magnetic Resonance Imaging for Prostate Cancer Detection: A Preliminary Study. ACTA ACUST UNITED AC 2021; 28:1823-1834. [PMID: 34065851 PMCID: PMC8161832 DOI: 10.3390/curroncol28030169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 12/04/2022]
Abstract
Purpose: To evaluate the diagnostic performance of PI-RADS v2, proposed adjustments to PI-RADS v2 (PA PI-RADS v2) and biparametric magnetic resonance imaging (MRI) for prostate cancer detection. Methods: A retrospective cohort of 224 patients with suspected prostate cancer was included from January 2016 to November 2018. All the patients underwent a multi-parametric MR scan before biopsy. Two radiologists independently evaluated the MR examinations using PI-RADS v2, PA PI-RADS v2, and a biparametric MRI protocol, respectively. Receiver operating characteristic (ROC) curves for the three different protocols were drawn. Results: In total, 90 out of 224 cases (40.18%) were pathologically diagnosed as prostate cancer. The area under the ROC curves (AUC) for diagnosing prostate cancers by biparametric MRI, PI-RADS v2, and PA PI-RADS v2 were 0.938, 0.935, and 0.934, respectively. For cancers in the peripheral zone (PZ), the diagnostic sensitivity was 97.1% for PI-RADS v2/PA PI-RADS v2 and 96.2% for biparametric MRI. Moreover, the specificity was 84.0% for biparametric MRI and 58.0% for PI-RADS v2/PA PI-RADS v2. For cancers in the transition zone (TZ), the diagnostic sensitivity was 93.4% for PA PI-RADS v2 and 88.2% for biparametric MRI/PI-RADS v2. Furthermore, the specificity was 95.4% for biparametric MRI/PI-RADS v2 and 78.0% for PA PI-RADS v2. Conclusions: The overall diagnostic performance of the three protocols showed minimal differences. For lesions assessed as being category 3 using the biparametric MRI protocol, PI-RADS v2, or PA PI-RADS v2, it was thought prostate cancer detection could be improved. Attention should be paid to false positive results when PI-RADS v2 or PA PI-RADS v2 are used.
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Affiliation(s)
- Guan-Hui Cai
- Radiology Department, Huizhou Municipal Central Hospital, Huizhou 516001, China; (G.-H.C.); (W.-B.C.); (Y.-R.Z.); (Y.-J.Z.)
| | - Qi-Hua Yang
- Radiology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China;
| | - Wen-Bo Chen
- Radiology Department, Huizhou Municipal Central Hospital, Huizhou 516001, China; (G.-H.C.); (W.-B.C.); (Y.-R.Z.); (Y.-J.Z.)
| | - Qing-Yu Liu
- The Seventh Affiliated Hospital, Sun Yat-sen University, 628 Zhenyuan Road, Xinhu Street, Guangming New District, Shenzhen 518107, China
- Correspondence: ; Tel.: +86-0755-81206502
| | - Yu-Rong Zeng
- Radiology Department, Huizhou Municipal Central Hospital, Huizhou 516001, China; (G.-H.C.); (W.-B.C.); (Y.-R.Z.); (Y.-J.Z.)
| | - Yu-Jing Zeng
- Radiology Department, Huizhou Municipal Central Hospital, Huizhou 516001, China; (G.-H.C.); (W.-B.C.); (Y.-R.Z.); (Y.-J.Z.)
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Tosun M, Uslu H. Prebiopsy multiparametric MRI and PI-RADS version 2.0 for differentiating histologically benign prostate disease from prostate cancer in biopsies: A retrospective single-center comparison. Clin Imaging 2021; 78:98-103. [PMID: 33773450 DOI: 10.1016/j.clinimag.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/24/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the diagnostic performance of Prostate Imaging-Reporting and Data System version 2.0 (PI-RADSv2.0) for differentiating clinically significant prostate cancer (csPCa) from benign prostate disease on prebiopsy multiparametric MRI stratified by total prostate specific antigen (PSA) concentration. MATERIALS AND METHODS 150 patients who had prebiopsy mpMRI, serum PSA concentration and subsequent biopsy were retrospectively analyzed. Patients were stratified by PSA concentration (Group1 ≥ 10 ng/mL; Group2 4.0-<10 ng/mL). MRI findings were assessed using PI-RADSv2.0 by two blinded radiologists. Lesions were graded histopathologically using the International Society of Urological Pathology (ISUP) score. Diagnostic performance of PI-RADSv2.0 was evaluated and compared to PSA and PSA Density (PSAD). The performance of the radiologists was compared including inter-observer agreement for PI-RADSv2.0. The correlation between imaging and histopathological biopsy results was analyzed. RESULTS The differences in total PSA, free/total PSA ratio and PSAD between benign (n = 78) and malignant (n = 72) groups were significant (p < 0.05). The PI-RADSv2.0 scores of the radiologists were strongly correlated (r = 0.912, p < 0.001) with excellent agreement, κ = 0.97 (95%CI: 0.90-1.03; p < 0.005). Receiver operating characteristics curve analysis showed significantly high predictive power for PI-RADSv2.0, total PSA and PSAD alone. Comparison of age, prostate volume, PSAD, free/total PSA ratio and total PSA values between ISUP1 and ISUP ≥ 2 cases revealed significantly increased PSAD (p < 0.001) and total PSA (p = 0.001) in the ISUP ≥ 2 group. CONCLUSION PI-RADSv2.0 had high diagnostic accuracy in both PSA groups. PI-RADSv2.0, PSAD and total PSA alone had significant high predictive power to detect csPCa. However, the combination of PI-RADSv2.0 and PSAD or total PSA for each reader showed no statistically significant improvement when compared to PI-RADSv2.0 alone.
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Affiliation(s)
- Mesude Tosun
- Department of Radiology, Kocaeli University Hospital, Kocaeli, Turkey.
| | - Hande Uslu
- Department of Radiology, Kocaeli University Hospital, Kocaeli, Turkey
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Comparison of PI-RADS version 2.1 and PI-RADS version 2 regarding interreader variability and diagnostic accuracy for transition zone prostate cancer. Abdom Radiol (NY) 2020; 45:4133-4141. [PMID: 32918577 DOI: 10.1007/s00261-020-02738-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/15/2020] [Accepted: 08/30/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare the diagnostic performance of PI-RADS version 2.1 (PI-RADS v2.1) and PI-RADS v2 for transition zone prostate cancer (TZPC), and analyse its performance for readers with different experience levels. METHODS Eighty-five patients with suspected prostate cancer who underwent biopsy after MRI scan between January and December 2017 were retrospectively enrolled. One junior radiologist (reader 1, 1 year of experience in using PI-RADS v2) and one senior radiologist (reader 2, 6 years of experience) independently reviewed and assigned a score for each lesion according to PI-RADS v2.1 and v2. The template-guided transperineal prostate biopsy was used for standard of reference. To compare the diagnostic performance of the two methods, the AUC was calculated. The sensitivity, specificity, and accuracy were calculated at predefined positive values (PI-RADS ≥ 3). The interreader agreement and frequency of prostate cancer for each PI-RADS category were also calculated. RESULTS Among the 85 patients, 27 had prostate cancers, and 25 were clinically significant prostate cancer (csPCa). The AUC values for diagnosing clinically significant prostate cancer significantly increased with PI-RADS v2.1 for reader 2 (0.766 vs. 0.902, P = 0.009). The specificity and accuracy for both readers also increased with PI-RADS v2.1 (specificity: reader 1, 41.7% vs. 78.3% and reader 2, 33.3% vs. 81.7%; accuracy: reader 1, 52.9% vs. 76.5% and reader 2, 48.2% vs. 83.5%, all P < 0.05). The interreader agreement was good for both versions. The percentage of prostate cancer decreased in lower PI-RADS categories (PI-RADS 2) and increased in higher PI-RADS categories (PI-RADS 3 ~ 4). CONCLUSION Compared with PI-RADS v2, PI-RADS v2.1 may improve radiologists' diagnostic performance for TZPC.
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Wadera A, Alabousi M, Pozdnyakov A, Kashif Al-Ghita M, Jafri A, McInnes MD, Schieda N, van der Pol CB, Salameh JP, Samoilov L, Gusenbauer K, Alabousi A. Impact of PI-RADS Category 3 lesions on the diagnostic accuracy of MRI for detecting prostate cancer and the prevalence of prostate cancer within each PI-RADS category: A systematic review and meta-analysis. Br J Radiol 2020; 94:20191050. [PMID: 33002371 DOI: 10.1259/bjr.20191050] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate Prostate Imaging Reporting and Data System (PI-RADS) category 3 lesions' impact on the diagnostic test accuracy (DTA) of MRI for prostate cancer (PC) and to derive the prevalence of PC within each PI-RADS category. METHODS MEDLINE and Embase were searched until April 10, 2020 for studies reporting on the DTA of MRI by PI-RADS category. Accuracy metrics were calculated using a bivariate random-effects meta-analysis with PI-RADS three lesions treated as a positive test, negative test, and excluded from the analysis. Differences in DTA were assessed utilizing meta-regression. PC prevalence within each PI-RADS category was estimated with a proportional meta-analysis. RESULTS In total, 26 studies reporting on 12,913 patients (4,853 with PC) were included. Sensitivities for PC in the positive, negative, and excluded test groups were 96% (95% confidence interval [CI] 92-98), 82% (CI 75-87), and 95% (CI 91-97), respectively. Specificities for the positive, negative, and excluded test groups were 33% (CI 23-44), 71% (CI 62-79), and 52% (CI 37-66), respectively. Meta-regression demonstrated higher sensitivity (p < 0.001) and lower specificity (p < 0.001) in the positive test group compared to the negative group. Clinically significant PC prevalences were 5.9% (CI 0-17.1), 11.4% (CI 6.5-17.3), 24.9% (CI 18.4-32.0), 55.7% (CI 47.8-63.5), and 81.4% (CI 75.9-86.4) for PI-RADS categories 1, 2, 3, 4 and 5, respectively. CONCLUSION PI-RADS category 3 lesions can significantly impact the DTA of MRI for PC detection. A low prevalence of clinically significant PC is noted in PI-RADS category 1 and 2 cases. ADVANCES IN KNOWLEDGE Inclusion or exclusion of PI-RADS category 3 lesions impacts the DTA of MRI for PC detection.
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Affiliation(s)
- Akshay Wadera
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Mostafa Alabousi
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Alex Pozdnyakov
- Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Ali Jafri
- Department of Medicine, New York Institute of Technology School of Osteopathic Medicine, Glen Head, NY, United States
| | - Matthew Df McInnes
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,Department of Radiology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Jean-Paul Salameh
- Department of Medicine, Clinical Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lucy Samoilov
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | | | - Abdullah Alabousi
- Department of Radiology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Lim CS, Abreu-Gomez J, Leblond MA, Carrion I, Vesprini D, Schieda N, Klotz L. When to biopsy Prostate Imaging and Data Reporting System version 2 (PI-RADSv2) assessment category 3 lesions? Use of clinical and imaging variables to predict cancer diagnosis at targeted biopsy. Can Urol Assoc J 2020; 15:115-121. [PMID: 33007183 DOI: 10.5489/cuaj.6781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION We aimed to determine if clinical and imaging features can stratify men at higher risk for clinically significant (CS, International Society of Urological Pathology [ISUP] grade group ≥2) prostate cancer (PCa) in equivocal Prostate Imaging and Data Reporting System (PI-RADS) category 3 lesions on magnetic resonance imaging (MRI). METHODS Approved by the institutional review board, this retrospective study involved 184 men with 198 lesions who underwent 3T-MRI and MRI-directed transrectal ultrasound biopsy for PI-RADS 3 lesions. Men were evaluated including clinical stage, prostate-specific antigen density (PSAD), indication, and MRI lesion size. Diagnoses for all men and by indication (no cancer, any PCa, CSPCa) were compared using multivariate logistic regression, including stage, PSAD, and lesion size. RESULTS We found an overall PCa rate of 31.8% (63/198) and 10.1% (20/198) CSPCa (13 grade group 2, five group 3, and two group 4). Higher stage (p=0.001), PSAD (p=0.007), and lesion size (p=0.015) were associated with CSPCa, with no association between CSPCa and age, PSA, or prostate volume (p>0.05). PSAD modestly predicted CSPCa area under the curve (AUC) 0.66 (95% confidence interval [CI] 0.518-0.794) in all men and 0.64 (0.487-0.799) for those on active surveillance (AS). Model combining clinical stage, PSAD, and lesion size improved accuracy for all men and AS (AUC 0.82 [0.736-0.910], p<0.001 and 0.785 [0.666-0.904], p<0.001). In men with prior negative biopsy and persistent suspicion, PSAD (0.90 [0.767-1.000]) was not different from the model (p>0.05), with optimal cutpoint of ≥0.215 ng/mL/cc achieving sensitivity/specificity of 85.7/84.4%. CONCLUSIONS PI-RADSv2 category 3 lesions are often not CSPCa. PSAD predicted CSPCa in men with a prior negative biopsy; however, PSAD alone had limited value, and accuracy improved when using a model incorporating PSAD with clinical stage and MRI lesion size.
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Affiliation(s)
- Christopher S Lim
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jorge Abreu-Gomez
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michel-Alexandre Leblond
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ivan Carrion
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nicola Schieda
- Department of Radiology, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Laurence Klotz
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Stabile A, Giganti F, Kasivisvanathan V, Giannarini G, Moore CM, Padhani AR, Panebianco V, Rosenkrantz AB, Salomon G, Turkbey B, Villeirs G, Barentsz JO. Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review. Eur Urol Oncol 2020; 3:145-167. [DOI: 10.1016/j.euo.2020.02.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 01/19/2023]
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Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility. Diagnostics (Basel) 2020; 10:diagnostics10030164. [PMID: 32192081 PMCID: PMC7151226 DOI: 10.3390/diagnostics10030164] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
The role of dynamic contrast-enhanced-MRI (DCE-MRI) for Prostate Imaging-Reporting and Data System (PI-RADS) scoring is a controversial topic. In this retrospective study, we aimed to measure the added value of DCE-MRI in combination with T2-weighted (T2W) and diffusion-weighted imaging (DWI) using PI-RADS v2.1, in terms of reproducibility and diagnostic accuracy, for detection of prostate cancer (PCa) and clinically significant PCa (CS-PCa, for Gleason Score ≥ 7). 117 lesions in 111 patients were identified as suspicion by multiparametric MRI (mpMRI) and addressed for biopsy. Three experienced readers independently assessed PI-RADS score, first using biparametric MRI (bpMRI, including DWI and T2W), and then multiparametric MRI (also including DCE). The inter-rater and inter-method agreement (bpMRI- vs. mpMRI-based scores) were assessed by Cohen's kappa (κ). Receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic accuracy for PCa and CS-PCa detection among the two scores. Inter-rater agreement was excellent for the three pairs of readers (κ ≥ 0.83), while the inter-method agreement was good (κ ≥ 0.73). Areas under the ROC curve (AUC) showed similar high-values (0.8 ≤ AUC ≤ 0.85). The reproducibility of PI-RADS v2.1 scoring was comparable and high among readers, without relevant differences, depending on the MRI protocol used. The inclusion of DCE did not influence the diagnostic accuracy.
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Byun J, Park KJ, Kim MH, Kim JK. Direct Comparison of PI-RADS Version 2 and 2.1 in Transition Zone Lesions for Detection of Prostate Cancer: Preliminary Experience. J Magn Reson Imaging 2020; 52:577-586. [PMID: 32045072 DOI: 10.1002/jmri.27080] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There appears to be less agreement in the identification of cancers in the transition zone (TZ), which is not as reliable as those in peripheral zone when using the Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2). In response to such shortcomings, the updated version 2.1 was introduced, which incorporated diffusion-weighted imaging (DWI) into category 2 and clarified lexicons. PURPOSE To compare the diagnostic performance for the detection of clinically significant TZ prostate cancers (csPCa) and interreader agreement between PI-RADS v2.1 and v2. STUDY TYPE Retrospective study. POPULATION In all, 142 patients, 201 TZ lesions. FIELD STRENGTH/SEQUENCE 3.0T; T2 -weighted image and DWI. ASSESSMENT Lesions were scored by three independent readers using PI-RADS v2 and v2.1. STATISTICAL TESTS The sensitivity and specificity at category ≥3 were compared between v2 and v2.1 using the generalized estimating equation model. Detection rates for csPCa of upgraded and downgraded lesions in the use of PI-RADS v2.1 from v2 were assessed. Interreader agreement was assessed using κ statistics. RESULTS PI-RADS v2.1 showed a higher sensitivity and specificity (94.5% and 60.9%) than v2 (91.8% and 56.3%) for category ≥3 lesions in the detection of csPCa, although not significantly. Of eight upgraded lesions from category 2 to 3 (2 + 1) with an incorporated DWI, 50% (4/8) were csPCa. This was significantly higher than category 2 lesions (4.4%; P = 0.003). No csPCa was detected among the 22.8% (46/201) downgraded lesions. There was a moderate interreader agreement for scores ≥3 (κ = 0.565) in v2.1, which was slightly higher than that for v2 (κ = 0.534), although not significantly. DATA CONCLUSION PI-RADS v2.1 provides moderate and comparable interreader agreement at category ≥3 than v2 in the TZ lesions. Upgraded lesions from category 2 to 3 demonstrated a higher detection rate of csPCa than category 2 lesions in v2.1. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:577-586.
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Affiliation(s)
- Jieun Byun
- Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Kon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ke Z, Yan X, Min X, Cai W, Zhang P, You H, Fan C, Wang L. Validation of SE-EPI-based T2 mapping for characterization of prostate cancer: a new method compared with the traditional CPMG method. Abdom Radiol (NY) 2019; 44:3432-3440. [PMID: 31218387 DOI: 10.1007/s00261-019-02105-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE We aim to compare the results of spin echo-echo planar imaging (SE-EPI)-based T2 mapping with those of the conventional Carr-Purcell-Meiboom-Gill (CPMG) method and to investigate the potential validity of SE-EPI-T2 mapping for the characterization of prostate cancer (PCa). METHODS Our retrospective study included 42 PCa patients and 42 noncancer patients who underwent 3.0T MRI with b values ranging from 0 to 2000 s/mm2 and echo times (TEs) ranging from 32 to 100 ms before biopsies. Bland-Altman analysis was used to compare the agreement between the two methods. The correlations between CPMG-T2 values and SE-EPI-T2 values at different b values were determined by Spearman's rho analysis or Pearson analysis. The Mann-Whitney U test and two-sample t tests were used to analyze the differences between the cancerous and noncancerous groups. RESULTS Substantial agreement regarding the measurements was observed between the two methods. The average correlation between the CPMG-T2 values and SE-EPI-T2 values was moderate and positive, and the best correlations were found at b = 200 s/mm2 in the noncancer group (r = 0.557, P = 0.000) and at b = 100 s/mm2 in the cancer group (r = 0.537, P = 0.000). In addition, statistically significant differences were found between the noncancer and cancer groups in T2 values and ADC values (diff TEs) (P = 0.000). CONCLUSIONS Substantial agreement in the measurements was found between the SE-EPI method and CPMG method. SE-EPI-based T2 mapping has potential clinical value for the prostate and can be considered an alternative to the traditional CPMG-T2 mapping method.
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Affiliation(s)
- Zan Ke
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China
| | - Xu Yan
- MR Collaboration NE Asia, Siemens Healthcare, Shanghai, 201321, China
| | - Xiangde Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China
| | - Wei Cai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China
| | - Peipei Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China
| | - Huijuan You
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China
| | - Chanyuan Fan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China.
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Liu C, Liu SL, Wang ZX, Yu K, Feng CX, Ke Z, Wang L, Zeng XY. Using the prostate imaging reporting and data system version 2 (PI-RIDS v2) to detect prostate cancer can prevent unnecessary biopsies and invasive treatment. Asian J Androl 2019; 20:459-464. [PMID: 29667616 PMCID: PMC6116681 DOI: 10.4103/aja.aja_19_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Prostate cancer (PCa) is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) to classify men with PCa, clinically significant PCa (CSPCa), or no PCa, especially among those with serum total prostate-specific antigen (tPSA) levels in the “gray zone” (4–10 ng ml−1). A total of 308 patients (355 lesions) were enrolled in this study. Diagnostic efficiency was determined. Univariate and multivariate analyses, receiver operating characteristic curve analysis, and decision curve analysis were performed to determine and compare the predictors of PCa and CSPCa. The results suggested that PI-RADS v2, tPSA, and prostate-specific antigen density (PSAD) were independent predictors of PCa and CSPCa. A PI-RADS v2 score ≥4 provided high negative predictive values (91.39% for PCa and 95.69% for CSPCa). A model of PI-RADS combined with PSA and PSAD helped to define a high-risk group (PI-RADS score = 5 and PSAD ≥0.15 ng ml-1 cm-3, with tPSA in the gray zone, or PI-RADS score ≥4 with high tPSA level) with a detection rate of 96.1% for PCa and 93.0% for CSPCa while a low-risk group with a detection rate of 6.1% for PCa and 2.2% for CSPCa. It was concluded that the PI-RADS v2 could be used as a reliable and independent predictor of PCa and CSPCa. The combination of PI-RADS v2 score with PSA and PSAD could be helpful in the prediction and diagnosis of PCa and CSPCa and, thus, may help in preventing unnecessary invasive procedures.
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Affiliation(s)
- Chang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shi-Liang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhi-Xian Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Kai Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chun-Xiang Feng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zan Ke
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiao-Yong Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Gupta RT, Mehta KA, Turkbey B, Verma S. PI‐RADS: Past, present, and future. J Magn Reson Imaging 2019; 52:33-53. [DOI: 10.1002/jmri.26896] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Rajan T. Gupta
- Department of RadiologyDuke University Medical Center Durham North Carolina USA
- Department of Surgery, Division of Urologic SurgeryDuke University Medical Center Durham North Carolina USA
- Duke Cancer Institute Center for Prostate and Urologic Cancers Durham North Carolina USA
| | - Kurren A. Mehta
- Department of RadiologyDuke University Medical Center Durham North Carolina USA
| | - Baris Turkbey
- National Cancer Institute, Center for Cancer Research Bethesda Maryland USA
| | - Sadhna Verma
- Cincinnati Veterans Hospital, University of Cincinnati Cancer InstituteUniversity of Cincinnati Medical Center Cincinnati Ohio USA
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Maggi M, Panebianco V, Mosca A, Salciccia S, Gentilucci A, Di Pierro G, Busetto GM, Barchetti G, Campa R, Sperduti I, Del Giudice F, Sciarra A. Prostate Imaging Reporting and Data System 3 Category Cases at Multiparametric Magnetic Resonance for Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2019; 6:463-478. [PMID: 31279677 DOI: 10.1016/j.euf.2019.06.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/12/2019] [Accepted: 06/21/2019] [Indexed: 11/25/2022]
Abstract
CONTEXT The Prostate Imaging Reporting and Data System (PI-RADS) 3 score represents a "grey zone" that need to be further investigated to solve the issue of whether to biopsy these equivocal cases or not. OBJECTIVE To critically analyze the current evidence on PI-RADS 3 cases. We evaluated the prevalence of PI-RADS 3 cases in the literature and detection rate of prostate cancer (PC) and clinically significant PC (csPC) at biopsy with regard to factors determining these rates. EVIDENCE ACQUISITION We searched in the Medline and Cochrane Library database from the literature from January 2009 to January 2019, following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. EVIDENCE SYNTHESIS A total of 28 studies were included in our analysis (total number of PI-RADS 3 cases: 1759, range 20-187). The prevalence of PI-RADS 3 cases reported in available studies was 17.3% (range 6.4-45.7%). The PC detection rate was 36% (95% confidence interval [CI] 33.8-37.4; range 10.3-55.8%), whereas that of csPC was 18.5% (95% CI 16.6-20.3; range 3.4-46.5%). Detection rates of PC and csPC were found to be similar in men who underwent a target biopsy versus those with a systematic biopsy (23.5% vs 23.9% and 11.4% vs 12.3%, respectively) and lower than the rates achieved with the combined strategy (36.9% and 19.6%, respectively). A prostate-specific antigen density (PSAD) of ≥0.15ng/ml/ml may represent an index to decide whether to submit a PI-RADS 3 case to biopsy. CONCLUSIONS In most investigations, PI-RADS 3 cases were not evaluated separately. A PI-RADS 3 lesion remains an equivocal lesion. Evaluation of clinical predictive factors in terms of csPC risk is a main aspect of helping clinicians in the biopsy decision process. PATIENT SUMMARY Management of Prostate Imaging Reporting and Data System 3 cases remains an unmet need, and the detection rate of clinically significant prostate cancer (csPC) among this population varies widely. Performing a combined target plus a systematic biopsy yields the highest detection of csPC. A prostate-specific antigen density of lower than 0.15ng/ml/ml may select patients for a follow-up strategy.
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Affiliation(s)
- Martina Maggi
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy.
| | - Valeria Panebianco
- Department of Radiology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Augusto Mosca
- Department of Urology, Frascati Hospital, Rome, Italy
| | - Stefano Salciccia
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | | | - Giovanni Di Pierro
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Gian Maria Busetto
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Giovanni Barchetti
- Department of Radiology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Riccardo Campa
- Department of Radiology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Alessandro Sciarra
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
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Schaudinn A, Gawlitza J, Mucha S, Linder N, Franz T, Horn LC, Kahn T, Busse H. Comparison of PI-RADS v1 and v2 for multiparametric MRI detection of prostate cancer with whole-mount histological workup as reference standard. Eur J Radiol 2019; 116:180-185. [PMID: 31153562 DOI: 10.1016/j.ejrad.2019.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/11/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to compare Prostate Imaging Reporting and Data System (PI-RADS) versions v1 and v2 for the detection of prostate cancer (PCa) in multiparametric MRI (mpMRI) using whole-mount histological workup as reference standard. MATERIAL AND METHODS MRI data of 40 patients with positive transrectal ultrasound-guided biopsy were analyzed retrospectively by two blinded readers (5 and 4 years' experience) with PI-RADS v1 and v2 for cancer-suspicious lesions. Prior to radical prostatectomy, patients had undergone IRB-approved mpMRI at 3 T according to PI-RADS recommendations: T2-weighted (T2w), diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) imaging. The reference standard was provided by whole-mount sections of the prostatectomy specimens. Versions v1 and v2 were compared with respect to sensitivity and positive predictive value (PPV) per lesion. Subgroups stratified by tumor location (peripheral vs. transition zone) and aggressiveness (high vs. low grade) were also analyzed. We also evaluated the concordance of the dominant MRI sequence in v2 (DWI or T2w) and the highest individual score under v1. Interobserver agreement for PI-RADS v1 and v2 was assessed by Cohen's kappa statistics. RESULTS Reader 1 (R1) described 66 and Reader 2 (R2) 72 MRI lesions. The average Gleason score of 58 PCa lesions was 6.5 (range: 6 = 3 + 3 to 8 = 4 + 4), most of them (65.5%) located in the peripheral zone. PI-RADS v2 showed a trend towards lower sensitivities, but differences were not significant for both readers: R1 72.4% (v1) vs. 63.8% (v2) (P = 0.426) and R2 77.6% (v1) vs. 69.0% (v2) (P = 0.402). The trends were more pronounced in the transition zone and for low-grade cancers but remained insignificant (p-values from 0.313 to 0.691). Likewise, the apparent PPV differences, overall as well as in each zone, were not significant. Agreement between high-score v1 and dominant v2 sequence was 48% for R1 and 53% for R2. Cohen's κ of PCa detection for two readers was 0.48 for both v1 and v2. CONCLUSION Our findings indicate that the simplified, zone-specific approach of PI-RADS v2 (2015) for MRI assessment of prostate cancer may not necessarily be better than the original v1 criteria (2012). In specific cases, a strict interpretation of v2 criteria may even lead to false-negative findings. Therefore, the current PI-RADS criteria should be reconsidered, despite the low statistical evidence here.
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Affiliation(s)
- Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Josephin Gawlitza
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Simone Mucha
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Nicolas Linder
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Toni Franz
- Department of Urology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Lars-Christian Horn
- Institute of Pathology, University of Leipzig, Liebigstr. 26, 04103 Leipzig, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Li W, Xin C, Zhang L, Dong A, Xu H, Wu Y. Comparison of diagnostic performance between two prostate imaging reporting and data system versions: A systematic review. Eur J Radiol 2019; 114:111-119. [DOI: 10.1016/j.ejrad.2019.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Alabousi M, Salameh JP, Gusenbauer K, Samoilov L, Jafri A, Yu H, Alabousi A. Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment-naïve patients: a diagnostic test accuracy systematic review and meta-analysis. BJU Int 2019; 124:209-220. [DOI: 10.1111/bju.14759] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Mostafa Alabousi
- Department of Radiology; McMaster University; Hamilton ON Canada
| | - Jean-Paul Salameh
- Department of Clinical Epidemiology and Public Health; University of Ottawa; Ottawa ON Canada
- The Ottawa Hospital Research Institute; Clinical Epidemiology Program; Ottawa ON Canada
| | | | - Lucy Samoilov
- Department of Medicine; Western University; London ON Canada
| | - Ali Jafri
- Department of Medicine; New York Institute of Technology School of Osteopathic Medicine; Glen Head NY USA
| | - Hang Yu
- Department of Medicine; McMaster University; Hamilton ON Canada
| | - Abdullah Alabousi
- Department of Radiology; St Joseph's Healthcare; McMaster University; Hamilton ON Canada
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Wu M, Krishna S, Thornhill RE, Flood TA, McInnes MD, Schieda N. Transition zone prostate cancer: Logistic regression and machine-learning models of quantitative ADC, shape and texture features are highly accurate for diagnosis. J Magn Reson Imaging 2019; 50:940-950. [DOI: 10.1002/jmri.26674] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mark Wu
- Department of Medical Imaging; Ottawa Hospital, University of Ottawa; Ontario Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging; University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto; Ontario Canada
| | - Rebecca E. Thornhill
- Department of Medical Imaging; Ottawa Hospital, University of Ottawa; Ontario Canada
| | - Trevor A. Flood
- Department of Anatomical Pathology; Ottawa Hospital, University of Ottawa; Ontario Canada
| | - Matthew D.F. McInnes
- Department of Medical Imaging; Ottawa Hospital, University of Ottawa; Ontario Canada
| | - Nicola Schieda
- Department of Medical Imaging; Ottawa Hospital, University of Ottawa; Ontario Canada
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Ke Z, Wang L, Min XD, Feng ZY, Kang Z, Zhang PP, Li BS, You HJ, Hou SC. Diagnostic Performance and Interobserver Consistency of the Prostate Imaging Reporting and Data System Version 2: A Study on Six Prostate Radiologists with Different Experiences from Half a Year to 17 Years. Chin Med J (Engl) 2018; 131:1666-1673. [PMID: 29998885 PMCID: PMC6048930 DOI: 10.4103/0366-6999.235872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: One of the main aims of the updated Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) is to diminish variation in the interpretation and reporting of prostate imaging, especially among readers with varied experience levels. This study aimed to retrospectively analyze diagnostic consistency and accuracy for prostate disease among six radiologists with different experience levels from a single center and to evaluate the diagnostic performance of PI-RADS v2 scores in the detection of clinically significant prostate cancer (PCa). Methods: From December 2014 to March 2016, 84 PCa patients and 99 benign prostatic shyperplasia patients who underwent 3.0T multiparametric magnetic resonance imaging before biopsy were included in our study. All patients received evaluation according to the PI-RADS v2 scale (1–5 scores) from six blinded readers (with 6 months and 2, 3, 4, 5, or 17 years of experience, respectively, the last reader was a reviewer/contributor for the PI-RADS v2). The correlation among the readers' scores and the Gleason score (GS) was determined with the Kendall test. Intra-/inter-observer agreement was evaluated using κ statistics, while receiver operating characteristic curve and area under the curve analyses were performed to evaluate the diagnostic performance of the scores. Results: Based on the PI-RADS v2, the median κ score and standard error among all possible pairs of readers were 0.506 and 0.043, respectively; the average correlation between the six readers' scores and the GS was positive, exhibiting weak-to-moderate strength (r = 0.391, P = 0.006). The AUC values of the six radiologists were 0.883, 0.924, 0.927, 0.932, 0.929, and 0.947, respectively. Conclusion: The inter-reader agreement for the PI-RADS v2 among the six readers with different experience is weak to moderate. Different experience levels affect the interpretation of MRI images.
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Affiliation(s)
- Zan Ke
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiang-De Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhao-Yan Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhen Kang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Pei-Pei Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Ba-Sen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Hui-Juan You
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Sheng-Chao Hou
- Department of Library, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Improving Diagnosis of Primary Prostate Cancer With Combined 68Ga–Prostate-Specific Membrane Antigen–HBED-CC Simultaneous PET and Multiparametric MRI and Clinical Parameters. AJR Am J Roentgenol 2018; 211:1246-1253. [DOI: 10.2214/ajr.18.19585] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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25
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Thai JN, Narayanan HA, George AK, Siddiqui MM, Shah P, Mertan FV, Merino MJ, Pinto PA, Choyke PL, Wood BJ, Turkbey B. Validation of PI-RADS Version 2 in Transition Zone Lesions for the Detection of Prostate Cancer. Radiology 2018; 288:485-491. [PMID: 29786491 PMCID: PMC6071681 DOI: 10.1148/radiol.2018170425] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose To determine the association between Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores and prostate cancer (PCa) in a cohort of patients undergoing biopsy of transition zone (TZ) lesions. Materials and Methods A total of 634 TZ lesions in 457 patients were identified from a prospectively maintained database of consecutive patients undergoing prostate magnetic resonance imaging. Prostate lesions were retrospectively categorized with the PI-RADS version 2 system by two readers in consensus who were blinded to histopathologic findings. The proportion of cancer detection for all PCa and for clinically important PCa (Gleason score ≥3+4) for each PI-RADS version 2 category was determined. The performance of PI-RADS version 2 in cancer detection was evaluated. Results For PI-RADS category 2 lesions, the overall proportion of cancers was 4% (one of 25), without any clinically important cancer. For PI-RADS category 3, 4, and 5 lesions, the overall proportion of cancers was 22.2% (78 of 352), 39.1% (43 of 110), and 87.8% (129 of 147), respectively, and the proportion of clinically important cancers was 11.1% (39 of 352), 29.1% (32 of 110), and 77.6% (114 of 147), respectively. Higher PI-RADS version 2 scores were associated with increasing likelihood of the presence of clinically important PCa (P < .001). Differences were found in the percentage of cancers in the PI-RADS category between PI-RADS 3 and those upgraded to PI-RADS 4 based on diffusion-weighted imaging for clinically important cancers (proportion for clinically important cancers for PI-RADS 3 and PI-RADS 3+1 were 11.1% [39 of 352] and 30.8% [28 of 91], respectively; P < .001). Conclusion Higher PI-RADS version 2 scores are associated with a higher proportion of clinically important cancers in the TZ. PI-RADS category 2 lesions rarely yield PCa, and their presence does not justify targeted biopsy.
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Affiliation(s)
- Janice N. Thai
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Harish A. Narayanan
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Arvin K. George
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - M. Minhaj Siddiqui
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Parita Shah
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Francesca V. Mertan
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Maria J. Merino
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Peter A. Pinto
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Peter L. Choyke
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Bradford J. Wood
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Baris Turkbey
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
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Effect of Combined 68Ga-PSMAHBED-CC Uptake Pattern and Multiparametric MRI Derived With Simultaneous PET/MRI in the Diagnosis of Primary Prostate Cancer: Initial Experience. AJR Am J Roentgenol 2018. [DOI: 10.2214/ajr.17.18881] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Diagnostic Performance of Monoexponential DWI Versus Diffusion Kurtosis Imaging in Prostate Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:358-368. [PMID: 29812977 DOI: 10.2214/ajr.17.18934] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to compare the diagnostic performance of monoexponential DWI and diffusion kurtosis imaging (DKI) for the detection of prostate cancer (PCa). MATERIALS AND METHODS A systematic literature search was conducted for studies evaluating the diagnostic value of monoexponential DWI and DKI for PCa in the same patient cohorts with sufficient data to construct 2 × 2 contingency tables. Qualities of the included studies were assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data were extracted to calculate pooled sensitivities and specificities. We constructed summary ROC curves and calculated AUCs to determine the performances of DKI parameters (diffusion coefficient and kurtosis characterizing the deviation from the monoexponential decay) and apparent diffusion coefficient (ADC) values in diagnosing PCa. RESULTS Five studies (463 patients) were included, with eight, nine, and 10 subsets of data available for analysis of ADC, diffusion, and kurtosis, respectively. Pooled sensitivities were 89% (95% CI, 80-94%) for ADC, 91% (95% CI, 84-95%) for diffusion, and 87% (95% CI, 83-91%) for kurtosis. Pooled specificities were 86% (95% CI, 80-90%) for ADC, 78% (95% CI, 71-84%) for diffusion, and 85% (95% CI, 81-89%) for kurtosis. According to the summary ROC analyses, the AUC was 0.93 (95% CI, 0.90-0.95) for ADC, 0.89 (95% CI, 0.86-0.92) for diffusion, and 0.93 (95% CI, 0.90-0.95) for kurtosis. There was no notable publication bias, but significant heterogeneity was observed. CONCLUSION Monoexponential DWI and DKI showed comparable diagnostic accuracies for PCa. DKI is a potentially helpful method for the diagnosis of PCa. Therefore, on the basis of current evidence, we do not recommend including DKI in routine clinical assessment of PCa for the moment.
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Smith CP, Türkbey B. PI-RADS v2: Current standing and future outlook. Turk J Urol 2018; 44:189-194. [PMID: 29733790 DOI: 10.5152/tud.2018.12144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 01/21/2023]
Abstract
The Prostate Imaging-Reporting and Data System (PI-RADS) was created in 2012 to establish standardization in prostate multiparametric magnetic resonance imaging (mpMRI) acquisition, interpretation, and reporting. In hopes of improving upon some of the PI-RADS v1 shortcomings, the PI-RADS Steering Committee released PI-RADS v2 in 2015. This paper reviews the accuracy, interobserver agreement, and clinical outcomes of PI-RADS v2 and comments on the limitations of the current literature. Overall, PI-RADS v2 shows improved sensitivity and similar specificity compared to PI-RADS v1. However, concerns exist regarding interobserver agreement and the heterogeneity of the study methodology.
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Affiliation(s)
- Clayton P Smith
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Barış Türkbey
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
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Benndorf M, Waibel L, Krönig M, Jilg CA, Langer M, Krauss T. Peripheral zone lesions of intermediary risk in multiparametric prostate MRI: Frequency and validation of the PI-RADSv2 risk stratification algorithm based on focal contrast enhancement. Eur J Radiol 2018; 99:62-67. [DOI: 10.1016/j.ejrad.2017.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 11/24/2022]
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Comparison of Prostate Imaging Reporting and Data System versions 1 and 2 for the Detection of Peripheral Zone Gleason Score 3 + 4 = 7 Cancers. AJR Am J Roentgenol 2017; 209:W365-W373. [PMID: 28981356 DOI: 10.2214/ajr.17.17964] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to compare Prostate Imaging Reporting and Data System version 1 (PI-RADSv1) and Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) for the detection of peripheral zone (PZ) Gleason score 3 + 4 = 7 cancers. MATERIALS AND METHODS Forty-seven consecutive patients with 52 PZ Gleason score 3 + 4 = 7 cancers that were 0.5 cm3 or larger underwent radical prostatectomy (RP) and 3-T MRI between 2012 and 2015. Two blinded radiologists (readers 1 and 2) retrospectively assigned PI-RADSv1 sequence (T2-weighted imaging, DWI, dynamic contrast-enhanced MRI [DCE-MRI]) and sum scores and PI-RADSv2 assessment categories. A third blinded radiologist (reader 3) measured apparent diffusion coefficient (ADC) ratio (ADC of tumor / ADC of normal PZ) using RP-MRI maps. Sensitivity, false-positive rate, and overall accuracy were compared using McNemar test. Pearson correlation was performed. RESULTS Using PI-RADSv1, reader 1 detected 86.5% (45/52) of the cancers and reader 2, 76.9% (40/52) of the cancers. Using PI-RADSv2, reader 1 detected 78.9% (41/52) and reader 2, 67.3% (35/52). Reader 1 detected 7.7% (4/52) and reader 2 detected 9.6% (5/52) more tumors using PI-RADSv1 due to T2-weighted imaging score ≥ 4 or DCE-MRI score ≥ 3. Sensitivity was higher for PI-RADSv1 (p = 0.01 and 0.03, readers 1 and 2). False-positive rates were higher with PI-RADSv1 than with PI-RADSv2 (1.8% vs 0.9% for reader 1; 3.6% vs 1.8% for reader 2) without significant differences in false-positive rate (p = 0.41 and 0.25) or overall accuracy (p = 0.06 and 0.23). PI-RADSv1 sum scores correlated strongly with PI-RADSv2 categories (B = 0.78-0.93, p < 0.0001). The mean ADC ratio was 0.61 ± 0.14 mm2/s with no difference between visible and nonvisible tumors (p = 0.06-0.5). Interobserver agreement was moderate for PI-RADSv2 (κ = 0.41) and ranged from slight to substantial for PI-RADSv1 (T2-weighted imaging, κ = 0.32; DWI, κ = 0.52; DCE-MRI, κ = 0.13). CONCLUSION There was no difference in overall detection of cancers comparing PI-RADSv1 and PI-RADSv2; however, PI-RADSv1 sequence scores on T2-weighted imaging and DCE-MRI detected approximately 10% more tumors that were otherwise underestimated on DWI and using PI-RADSv2 decision-tree rules.
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Shah TT, To WKL, Ahmed HU. Magnetic resonance imaging in the early detection of prostate cancer and review of the literature on magnetic resonance imaging-stratified clinical pathways. Expert Rev Anticancer Ther 2017; 17:1159-1168. [PMID: 28933973 DOI: 10.1080/14737140.2017.1383899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION With level 1 evidence now available on the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI) we must now utilise this data in developing an MRI-stratified diagnostic pathway for the early detection of prostate cancer. Areas covered: A literature review was conducted and identified seven randomised control trials (RCT's) assessing the diagnostic accuracy of such a pathway against the previously accepted systematic/random trans-rectal ultrasound guided (TRUS) biopsy pathway. The studies were heterogeneous in their design. Five studies assessed the addition of MRI-targeted biopsies to a standard care systematic TRUS biopsy pathway. Three of these studies showed either an increase in their diagnostic accuracy or the potential to remove systematic biopsies. Two studies looked specifically at a targeted biopsy only pathway and although the results were again mixed, there was no decrease in the diagnostic rate and overall significantly fewer biopsy cores were taken in the MRI group. Expert commentary: Results from these RCT's together with multiple retrospective and prospective studies point towards either an improved diagnostic rate for clinically significant cancer and/or a reduction in the need for systematic biopsies with a MRI-stratified pathway. The challenge for the urological community will be to implement pre-biopsy MRI into a routine clinical pathway with likely independent monitoring of standards.
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Affiliation(s)
- Taimur Tariq Shah
- a Division of Surgery, Department of Surgery and Cancer , Imperial College London , London , UK.,b Imperial Urology, Charing Cross Hospital , Imperial College Healthcare NHS Trust , London , UK.,c Division of Surgery and Interventional Sciences , University College London , London , UK.,d Department of Urology , Whittington Hospitals NHS Trust , London , UK
| | - Wilson King Lim To
- c Division of Surgery and Interventional Sciences , University College London , London , UK
| | - Hashim Uddin Ahmed
- a Division of Surgery, Department of Surgery and Cancer , Imperial College London , London , UK.,b Imperial Urology, Charing Cross Hospital , Imperial College Healthcare NHS Trust , London , UK
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Diagnostic performance and reproducibility of T2w based and diffusion weighted imaging (DWI) based PI-RADSv2 lexicon descriptors for prostate MRI. Eur J Radiol 2017; 93:9-15. [DOI: 10.1016/j.ejrad.2017.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/06/2017] [Accepted: 05/15/2017] [Indexed: 01/09/2023]
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Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Diagnostic Performance of Prostate Imaging Reporting and Data System Version 2 for Detection of Prostate Cancer: A Systematic Review and Diagnostic Meta-analysis. Eur Urol 2017; 72:177-188. [DOI: 10.1016/j.eururo.2017.01.042] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/25/2017] [Indexed: 12/18/2022]
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