Accuracy Of Multiparametric MRI Research Articles

The Accuracy of Multiparametric MRI in Identification of Intraprostatic Tumor Deposits after Local Prostate Radiation Therapy

<h3>Purpose/Objective(s)</h3> To determine the accuracy of multiparametric (mp) MRI in identification of intraprostatic tumor deposits in prostate cancer patients previously treated with local radiation therapy (RT) using a systematic and targeted MR-guided transperineal prostate biopsy technique as a reference to guide and improve clinical workflow processes. <h3>Materials/Methods</h3> Twenty-three patients with localized prostate cancer who had been previously treated with external beam RT, brachytherapy, or combined external beam RT and brachytherapy, underwent a combined systematic and targeted MRI-guided prostate biopsy using a transperineal approach under general anesthesia. For each patient, a pre-biopsy mpMRI scan was obtained and imported into a prostate biopsy planning system. Transverse T2-weighted images were then reoriented from the supine to dorsal lithotomy position. Dividing the prostate into an apical and base section, a systematic array of transperineal biopsies spaced approximately 10mm apart was planned with additional biopsies targeting any mpMRI-identified PI-RADS 3, 4, or 5 lesions. Biopsy procedures were carried out in the dorsal lithotomy position using a transrectal ultrasound with stepper-stabilizer and template grid. Matching of the planning mpMRI images to live ultrasound images was achieved using the template grid as a reference. <h3>Results</h3> All patients successfully underwent their biopsy procedure as planned. The median PSA prior to biopsy was 5.5 ng/mL (range 2.1-24.6). The median number of biopsy specimens obtained per patient was 21 (range 13-34). Overall, the positive predictive value (PPV) of any PI-RADS 3-5 lesion (based on pathologic confirmation) was 81% (21/26). The individual PPV of PI-RADS 3, 4 and 5 lesions were 25% (1/4), 89% (16/18), and 100% (4/4), respectively. Forty-eight percent (11/23) of patients harbored mpMRI-unidentified prostate cancer. Thirty-five percent (8/23) of patients harbored mpMRI-unidentified GS≥7 disease. <h3>Conclusion</h3> Using prostate mpMRI to identify intraprostatic tumor deposits after local radiation therapy results in a high PPV, particularly for PI-RADS 4 and 5 lesions. However, given the high rate of mpMRI-unidentified prostate cancer, the addition of systematic transperineal prostate biopsy information appears necessary to improve the accuracy of mpMRI identification of intraprostatic tumor deposits.

Exploring the accuracy of multiparametric MRI in prostate cancer staging: An institutional retrospective study.

e17056 Background: Multiparametric Magnetic Resonance Imaging (mpMRI) has been increasingly utilized in prostate cancer (PCa) diagnosis and staging. While there is Level 1 data supporting MRI utility in identifying clinically significant PCa and guiding PCa diagnosis, there is little data on its ability to predict surgical outcomes and its utility as a staging study. We aimed to evaluate the accuracy of mpMRI in predicting common surgical pathology outcomes in patients who underwent radical prostatectomy (RP). Methods: Men who underwent either open radical prostatectomy (ORP) or robotic assisted laparoscopic prostatectomy (RALP) for prostate adenocarcinoma from January-December 2021 at a single tertiary level care academic medical center were identified. Chart review for relevant patient demographics, mpMRI related variables and final surgical pathology was completed. In patients who had pre-operative mpMRI, we evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mpMRI in predicting relevant surgical outcomes, including presence of pT2N0 organ confined disease (OCD), extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node involvement (LNI), and bladder neck invasion (BNI). Results: 168 eligible patients were identified in a 12-month period. The mean age was 63.5±6.24 years and mean Prostate Specific Antigen (PSA) was 11.4±23.7, with 166 (98.8%) patients undergoing RALP and 115 (68.5%) having pre-operative mpMRI. Median GGG was 2 in both MRI and CT subsets (p = 0.580), and patients who had pre-op MRI were more likely to have higher PSA (12.7 ±28.1 vs 8.38± 6.32, p = 0.073) and clinically node positive disease (p &lt; 0.001) than those with CT. However, there was no significant difference in final surgical pathology or positive surgical margin rates between these two groups. On subset analysis of the MRI subset, Table summarizes the sensitivity, specificity, PPV, and NPV of pre-op MRI to predict OCD, ECE, SVI, LNI, and BNI. While specificity of pre-op MRI was adequate for all outcomes (89.1-100%), sensitivity (2.9-49.2%), PPV (40-100%), and NPV (56.3-94.3%) were poor. Conclusions: At present, pre-op MRI of the prostate does not appear to be accurate in its ability to predict important pathologic outcomes at the time of radical prostatectomy and should be used cautiously as a local staging tool. More work is needed before MRI can be used as a reliable staging tool for PCa.[Table: see text]

Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy.

Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1–5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77–0.86). The AUC was 0.76 (95% CI: 0.64–0.88), 0.78 (0.72–0.84), and 0.92 (0.88–0.96) for biparametric scans, PI-QUAL 1–3, and PI-QUAL 4–5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system.

Diagnostic accuracy of Multiparametric MRI in detection of prostate cancer compared with histopathology obtained by MRI directed TRUS guided cognitive fusion biopsy are T2WI, DWI and DCE enough for Indian scenario

Background: The incidence of prostatic carcinoma is increasing worldwide. With its high resolution, ability to provide excellent tissue characterization and multiplanar imaging capabilities, multi-parametric magnetic resonance imaging (mpMRI) plays a crucial role in detection, local staging and follow-up of carcinoma prostate. It also helps guide targeted biopsies in initial biopsy negative patient. Objectives: Study diagnostic accuracy of mp-MRI and primarily that of the three MR sequences T2, DWI and DCE in detection of prostatic cancer by correlating them with histopathology and thus whether it is feasible for a short MRI of 3 sequences to be used on a large scale in Indian scenario. Materials and Methods: A prospective study was done at a tertiary care hospital between April 2017 to November 2018 in which 50 patients who presented with suspicion of prostate cancer were referred to radiology department for evaluation using MRI. MRIexamination was done using 3T Siemens Magnetom Verio. Followed by this MRI directed TRUS guided cognitive fusion biopsy was done from the prostate. Samples were sent for histopathology. Results: Out of 50 cases studied, 24 cases (48%) were found to be malignant and 26 cases (52 %) were benign on histopathology. In our study, combined T2 + DWI + DCE gave sensitivity of 95.83 %, specificity of 57.69%, positive predictive value of 68.21 % and negative predictive value of 93.75%. Conclusion: Multiparametric MRI using T2, DWI and DCE has a high diagnostic accuracy for evaluation of prostatic cancer.

Accuracy of multi-parametric MRI and TRUS biopsy in diagnosing prostate cancer: A prospective study

Accuracy of multi-parametric MRI and TRUS biopsy in diagnosing prostate cancer: A prospective study

Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve

PurposeTo estimate the diagnostic accuracy of multiparametric MRI (mpMRI) for the detection of locally advanced prostate cancer (T-stage 3–4) prior to radical prostatectomy, in a multicenter cohort representing daily clinical practice. In addition, the radiologic learning curve for the detection of locally advanced disease is evaluated.MethodsPreoperative mpMRI findings of 430 patients (2012–2016) were compared to pathology results following radical prostatectomy. The diagnostic accuracy (sensitivity, specificity, PPV, and NPV) for the detection of locally advanced disease was calculated and compared for all years separately, to evaluate the presence of a radiological learning curve.ResultsOf all 137 patients with locally advanced disease, 62 patients were preoperatively detected with mpMRI [sensitivity 45.3% (95% CI 36.9–53.6%), specificity 75.8% (CI 70.9–80.7%), PPV 46.6% (CI 38.1–55.1%), and NPV 74.7% (CI 69.8–79.7%)]. The diagnostic accuracy did not improve significantly over time (sensitivity p = 0.12; specificity p = 0.57).ConclusionsIn daily clinical practice, the diagnostic accuracy of mpMRI for the detection of locally advanced prostate cancer remains limited. It, therefore, seems questionable whether mpMRI is adequate to guide preoperative decision-making. No significant radiologic learning curve for the detection of locally advance disease was observed.

MP20-08 PROSTATE CANCER LOCI WITH NEGATIVE MULTIPARAMETRIC MRI FOR PROSTATE CANCER: CORRELATION WITH PROSTATECTOMY SPECIMENS

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2017MP20-08 PROSTATE CANCER LOCI WITH NEGATIVE MULTIPARAMETRIC MRI FOR PROSTATE CANCER: CORRELATION WITH PROSTATECTOMY SPECIMENS Katsuhiro Ito, Takashi Kobayashi, Akihiro Furuta, Yuki Teramoto, Naoki Terada, Shusuke Akamatsu, Toshinari Yamasaki, Takahiro Inoue, and Osamu Ogawa Katsuhiro ItoKatsuhiro Ito More articles by this author , Takashi KobayashiTakashi Kobayashi More articles by this author , Akihiro FurutaAkihiro Furuta More articles by this author , Yuki TeramotoYuki Teramoto More articles by this author , Naoki TeradaNaoki Terada More articles by this author , Shusuke AkamatsuShusuke Akamatsu More articles by this author , Toshinari YamasakiToshinari Yamasaki More articles by this author , Takahiro InoueTakahiro Inoue More articles by this author , and Osamu OgawaOsamu Ogawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.640AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Precise localization of tumor locus is critically important for successful focal therapy in prostate cancer. The accuracy of multiparametric MRI (mpMRI) for prostate cancer localization is still unknown. METHODS We retrospectively analyzed 176 prostate cancer patients who underwent preoperative 3.0T multiparametric MRI (mpMRI) followed by radical prostatectomy (RP) without neoadjuvant androgen deprivation. Images of mpMRI was evaluated by a single radiologist based on PI-RADS version 2. PI-RADS score 4 or greater was considered positive. Tumor distribution was evaluated on radical prostatectomy specimen sliced at 5-mm thick and tumor volume was estimated based on planimetry. RESULTS Of the 176 study patients, 79 (45%) had negative mpMRI. Patients with negative mpMRI had smaller index tumor compared with those with positive mpMRI with a marginal significance (1.79 ± 0.25 vs 20.5 ± 0.22 cc., p = 0.05, Figure and Table). They were also more likely to have clinically insignificant cancer (Gleason score ≤6 and tumor volume <0.5 cc.) compared with those with positive mpMRI (Tables). However, the sensitivity and specificity for clinically significant prostate cancer was only 60% and 57%, respectively, indicating that mpMRI missed 40% of clinically significant cancer. CONCLUSIONS Although negative mpMRI is associated with favorable pathological findings in prostate cancer patients who underwent radical prostatectomy, mpMRI could not safely exclude clinically significant index tumor. Further improvement in the accuracy for tumor localization is warranted for the possible application of mpMRI to plan focal therapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e242 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Katsuhiro Ito More articles by this author Takashi Kobayashi More articles by this author Akihiro Furuta More articles by this author Yuki Teramoto More articles by this author Naoki Terada More articles by this author Shusuke Akamatsu More articles by this author Toshinari Yamasaki More articles by this author Takahiro Inoue More articles by this author Osamu Ogawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD61-07 ACCURACY OF PREOPERATIVE MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING FOR PREDICTION OF UNFAVORABLE PATHOLOGY IN PATIENTS WITH LOCALIZED PROSTATE CANCER UNDERGOING RADICAL PROSTATECTOMY

Introduction We investigated the accuracy of multiparametric MRI (mpMRI) for preoperative staging and its influence on the determination of neurovascular bundle sparing and disease prognosis in patients with localized prostate cancer.

A model for predicting focal ablation candidates in patients with prostate cancer based on MRI and biopsy criteria.

31 Background: To determine the accuracy of multiparametric MRI (mpMRI) and fusion biopsy in predicting focal therapy candidates by correlating agreement between patients’ pre-prostatectomy MRI and biopsy findings with whole mount pathology. Methods: Patients who underwent mpMRI and biopsy followed by prostatectomy between 2010-2015 were included in the study. Patients were considered good candidates for focal therapy if they had intermediate risk cancer (max Gleason 3+4 or 4+3 on biopsy) in only one hemisphere of the prostate, and if they had an mpMRI visible lesion(s) on one hemisphere that did not cross midline. Patients were considered poor candidates for focal therapy if they had either low risk cancer (Gleason 6), high risk cancer (Gleason 8, 9 and 10), intermediate risk cancer bilaterally, MRI visible lesions that cross the midline, or contained extracapsular extension or seminal vesicle invasion. Whole mounts of patients considered good candidates were then examined histologically for maximum tumor involvement. Results: 501 patients who underwent prostatectomy between 2010 and 2015 were included in the study, with mean age 60.0 (±10.0) and PSA 6.21 (±6.0). 395 patients were considered poor focal candidates, and 106 were considered good focal candidates. Of these 106, 66 patients had whole mounts available for analysis (14 random biopsy, 52 fusion biopsy). 42/66 (63.6%) patients were confirmed as candidates (6/14 (42.9%) who had random biopsy and 36/52 (68.0%) who had fusion). Candidates failed prediction due to Gleason upgrade in final histopathology in 20/24 (83.3%), and for significant Gleason detection bilaterally in 4/24 (16.7%). Conclusions: Our results suggest that application of mpMRI and biopsy criteria to predict focal therapy candidates may result in undertreatment of a large portion of patients with significant cancer. Results from mpMRI guided targeted biopsy were shown to be a more accurate tool for predicting candidates for focal therapy than results from random biopsy alone. More accurate predictive capability is needed before focal therapy can be widely accepted.

498 The UCL PICTURE trial: A prospective cohort validating study evaluating the accuracy of multi-parametric MRI and prostate HistoScanning compared to transperineal template mapping biopsies in patients requiring risk stratification after prior transrectal prostate biopsy

498 The UCL PICTURE trial: A prospective cohort validating study evaluating the accuracy of multi-parametric MRI and prostate HistoScanning compared to transperineal template mapping biopsies in patients requiring risk stratification after prior transrectal prostate biopsy

The accuracy of multiparametric MRI in men with negative biopsy and elevated PSA level—Can it rule out clinically significant prostate cancer?

PurposeTo assess the performance of multiparametric magnetic resonance imaging (mp-MRI) in patients with previous negative transrectal ultrasound (TRUS) guided prostate biopsy. Materials and methodsFifty-four patients with at least 1 previous negative TRUS prostate biopsy underwent mp-MRI in the form of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging. This was followed by transperineal template systematic prostate biopsies. Analysis was done based on 2 sectors per prostate, right and left (108 sectors out of 54 prostates). mp-MRI was scored using an ordinal scale 1 to 5 based on the suspicion of the presence of clinically significant disease. We used 6 different definitions for clinically significant disease and tested the performance of mp-MRI at each single definition. ResultsMedian age was 64 (range, 39–75), median PSA level was 10 (range, 2–23), and median number of biopsies was 45 (range, 21–137). Cancer of any volume and any grade was detected in 34 of 54 (63%) patients. mp-MRI accuracy at detection of clinically significant cancer using University College London (UCL) definition 2 (any Gleason score of 4 or maximum cancer core length of ≥4mm or both) showed sensitivity of 76%, specificity of 42%, positive predictive value of 38%, and negative predictive value of 79%. For a different definition of significant tumor (UCL definition 1; dominant Gleason score 4 or maximum cancer core length ≥6mm or both), the sensitivity was 90%, specificity 42%, positive predictive value 26%, and negative predictive value 95%. Conclusionsmp-MRI showed good performance at both detection and ruling out clinically significant disease, according to the definition used. mp-MRI can then be used as a triage test in the population with persistently elevated or rising PSA levels to select patients that can avoid unnecessary prostate biopsy.

TRUS–MRI image registration: a paradigm shift in the diagnosis of significant prostate cancer

Accuracy of multiparametric MRI has greatly improved the ability of localizing tumor foci of prostate cancer. This property can be used to perform a TRUS-MR image registration, new technological advance, which allows for an overlay of an MRI onto a TRUS image to target a prostate biopsy toward a suspicious area Three types of registration have been developed: cognitive-based, sensor-based, and organ-based registration. Cognitive registration consists of aiming a suspicious area during biopsy with the knowledge of the lesion location identified on multiparametric MRI. Sensor-based registration consists of tracking in real time the TRUS probe with a magnetic device, achieving a global positioning system which overlays in real-time prostate image on both modalities. Its main limitation is that it does not take into account prostate and patient motion during biopsy. Two systems (Artemis and Uronav) have been developed to partially circumvent this drawback. Organ-based registration (Koelis) does not aim to track the TRUS probe, but the prostate itself to compute in a 3D acquisition the TRUS prostate shape, allowing for a registration with the corresponding 3D MRI shape. This system is not limited by prostate/patient motion and allows for a deformation of the organ during registration. Pros and cons of each technique and the rationale for a targeted biopsy only policy are discussed.

219 Diagnostic accuracy of multiparametric MRI in detection of clinically significant prostate cancer

219 Diagnostic accuracy of multiparametric MRI in detection of clinically significant prostate cancer