Magnetic Resonance Imaging In Management Research Articles

Reasons for Discordance between 68Ga-PSMA-PET and Magnetic Resonance Imaging in Men with Metastatic Prostate Cancer.

PSMA PET has emerged as a "gold standard" imaging modality for assessing prostate cancer metastases. However, it is not universally available, and this limits its impact. In contrast, whole-body MRI is much more widely available but misses more lesions. This study aims to improve the interpretation of whole-body MRI by comparing false negative scans retrospectively to PSMA PET. This study was a retrospective sub-analysis of a prospectively collected database of patients who participated in a clinical trial of PSMA PET/MRI comparing PSMA PET and whole-body MRI from 2018-2021. Subjects whose separately read PSMA PET and MRI diagnostic reports showed discrepancies ("false negative" MRI cases) were selected for sub-analysis. The cases were reviewed by the same attending radiologist who originally read the scans. The radiologist noted specific features on MRI indicating metastatic disease that were initially missed. Of 263 cases, 38 (14%) met the inclusion criteria and were reviewed. Six classes of mpMRI false negatives were identified: anatomically normal (18, 47%), atypical MRI appearance (6, 16%), mischaracterization (1, 3%), undercall (6, 16%), obscured (4, 11%), and no abnormality on MRI (3, 8%). Considering that the atypical and undercalled cases could have been adjusted in retrospect, and that 4 additional cases had positive lesions to the same extent and 11 further cases had disease confined to the pelvis, only 11 (4%) of the original 263 would have had disease outside of a conventional radiation treatment plan. Notably, almost 50% of the cases, including most lymph node metastases, were anatomically normal using standard criteria. This suggests that current anatomic criteria for evaluating prostate cancer lymph node metastases are not ideal, and there is a need for improved criteria. In addition, 32% of cases involved some element of human interpretive error, and, therefore, improving reader training may lead to more accurate results.

Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors

PurposeThe primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade ≥ 2).MethodsThis study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients.Results705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naïve (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1–2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG ≥ 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS ≥ 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively.ConclusionsExposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions.Trial registrationThe present study was registered at ClinicalTrials.gov number: NCT05078359.

Clinical Application of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Score for Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer.

The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) score has been developed to standardise prostate magnetic resonance imaging (MRI) reporting in men on active surveillance (AS) for prostate cancer (PCa). To evaluate the feasibility of PRECISE scoring and assess its diagnostic accuracy. All PCa patients on AS with a baseline MRI and at least one follow-up MRI scan between January 2008 and September 2022 at a single tertiary referral centre were included in a database. The follow-up protocol of the Prostate Cancer International Active Surveillance (PRIAS) study was used. All scans were retrospectively re-reported by a dedicated uroradiologist and appointed a Prostate Imaging Reporting and Data System (version 2.1) and PRECISE score. Clinically significant progression was defined by histopathological upgrading (on biopsy or radical prostatectomy) to grade group ≥3 and/or evolution to T3 stage. A survival analysis was performed to assess differential progression-free survival (PFS) according to the PRECISE score. A total of 188 patients were included for an analysis with a total of 358 repeat MRI scans and 144 repeat biopsies. The median follow-up was 46 mo (interquartile range 21-74). Radiological progression (PRECISE 4-5) had sensitivity, specificity, negative predictive value, and positive predictive value of, respectively, 78%, 70%, 90%, and 49% for clinically significant progression. Four-year PFS was 91% for PRECISE 1-3 versus 66% for PRECISE 4-5 (p<0.001). In total, 137 patients underwent a confirmation MRI scan within 18 mo after diagnosis. Four-year PFS in this group was 81% for PRECISE 1-3 versus 43% for PRECISE 4-5 (p<0.001). Limitations include retrospective design and no strict adherence to AS protocol. Implementation of PRECISE scoring for PCa patients on AS is feasible and offers a prognostic value. Patients with PRECISE score 4-5 on confirmation MRI within 18 mo after diagnosis have a three-fold higher risk of clinically significant progression after 4 yr. Patients with low-risk prostate cancer can be followed up carefully. In this study, we evaluate the standardised reporting of repeat magnetic resonance imaging scans (using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation [PRECISE] recommendations). PRECISE scoring is feasible and helps identify patients in need of further treatment.

An Evaluation of Screening Pathways Using a Combination of Magnetic Resonance Imaging and Prostate-specific Antigen: Results from the IP1-PROSTAGRAM Study

BackgroundThe use of prostate-specific antigen (PSA) testing to screen for prostate cancer has been fraught with under- and overdiagnosis. Short, noncontrast magnetic resonance imaging (MRI) might detect more grade group ≥2 cancers with similar rates of biopsy. ObjectiveTo evaluate strategies that combined PSA and MRI to select men based in the community for a prostate biopsy. Design, setting, and participantsIP1-PROSTAGRAM was a prospective, population-based, paired cohort study of 408 men aged 50–69 yr conducted at seven UK primary care practice and two imaging centres (from October 10, 2018 to May 15, 2019). InterventionAll participants underwent screening with a PSA test, MRI (T2-weighted and diffusion), and transrectal ultrasound (b-mode and elastography). If any test was screen positive, a systematic 12-core biopsy was performed. Additional image-fusion targeted biopsies were taken if the MRI or ultrasound was positive. Outcome measurements and statistical analysisWe conducted an analysis, set out in the statistical plan a priori, comparing 13 different pathways including PSA-alone, MRI-alone, and a range of PSA thresholds and MRI scores. The performance of each pathway was evaluated focusing on the trade-offs between biopsy referral rates and detection of grade group ≥2 cancers. A targeted biopsy was performed only where the PROSTAGRAM MRI showed a lesion score of 3, 4, or 5. Results and limitationsThe standard PSA pathway (PSA ≥3 ng/ml + systematic biopsy) would lead to 10% of men being referred for a biopsy and a 1.0% detection rate of grade group ≥2 cancers. Pathways that relied on MRI alone set at a threshold score of 3 for a biopsy led to higher biopsy rates, but with benefit of high cancer detection rates. The pathway that combined an initial low PSA threshold (≥1.0 ng/ml) and MRI score ≥4 accurately identified a high rate of grade group ≥2 cancers (2.5%, 95% confidence interval 1.3–4.6) while recommending fewer patients for a biopsy (7.1%, 95% confidence interval 4.9–10.2). The results are pertinent to only one screening round, the impact of repeat screening rounds is not evaluated, and the required MRI capacity is currently lacking. ConclusionsOur results highlight the trade-off that exists between reducing excessive numbers of biopsies and maintaining grade group ≥2 cancer detection rates. A pathway that combines PSA ≥1 ng/ml and MRI score ≥4 maintains the detection of grade group ≥2 cancers while recommending fewer men for biopsies and would be the preferred strategy to evaluate in future studies at the first screening round. Patient summaryThe IP1-PROSTAGRAM study shows that PROSTAGRAM magnetic resonance imaging in men with a prostate-specific antigen level of ≥1.0 ng/ml could be a promising pathway to evaluate in future screening trials.

MP38-11 IS THERE AN IMPACT OF THE CENTER PERFORMING BASELINE MULTIPARAMETRIC MRI ON ACTIVE SURVEILLANCE OUTCOMES IN PROSTATE CANCER PATIENTS?

You have accessJournal of UrologyCME1 Apr 2023MP38-11 IS THERE AN IMPACT OF THE CENTER PERFORMING BASELINE MULTIPARAMETRIC MRI ON ACTIVE SURVEILLANCE OUTCOMES IN PROSTATE CANCER PATIENTS? Riccardo Leni, Armando Stabile, Giorgio Gandaglia, Vito Cucchiara, Giuseppe Rosiello, Elio Mazzone, Gabriele Sorce, Francesco Pellegrino, Simone Scuderi, Daniele Robesti, Donato Cannoletta, Mario De Angelis, Leonardo Quarta, Paolo Zaurito, Giorgio Brembilla, Francesco De Cobelli, Francesco Montorsi, and Alberto Briganti Riccardo LeniRiccardo Leni More articles by this author , Armando StabileArmando Stabile More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Leonardo QuartaLeonardo Quarta More articles by this author , Paolo ZauritoPaolo Zaurito More articles by this author , Giorgio BrembillaGiorgio Brembilla More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI) of the prostate has been incorporated as a tool to confirm eligibility for active surveillance (AS). The impact of radiologist expertise on MRI diagnostic performance has been widely demonstrated. However, the increased number of centers performing MRI has increased the variability of both quality and performance. In this study, we assessed the diagnostic accuracy of MRI performed at a single high volume center vs external centers for patients under AS. METHODS: We identified 535 men on AS at our Institution with baseline MRI and at least one surveillance biopsy (sBx). MRIs were stratified according to centers performing the scan (high volume single center performing > 500 MRIs per year vs external centers) and to the detection of visible lesions (negative: PI-RADS 1-2, positive: PI-RADS 3-5). Reclassification was defined as increase in Gleason score at sBx, or higher disease volume ( >33% of involved cores, or >50% of a single core involved). Reclassification-free survival (RFS) was estimated with the Kaplan-Meier method. A Cox model tested the prognostic impact of the center performing MRI according to lesion visibility, after adjusting for covariates. RESULTS: Median age was 65 years (IQR 59-70), 52% (n=280) and 48% (n=255) of patients underwent baseline MRI at our Institution (internal) vs external Institutions. A lower proportion of negative scans was observed among the external MRI scans (18% vs 35%, p<0.001). After a median follow-up of 43 months, 47% (n=253) of men were reclassified. The 5-year RFS was 76% vs 40% for internal vs external negative MRI scans (p<0.001). A negative external MRI was associated with a 1.98-fold increased risk of reclassification compared to a negative internal MRI (95% CI 1.07-3.65, p=0.03). In contrast, the 5-year RFS was 37% vs 35% for internal vs external positive MRI scans, respectively (p=0.2). CONCLUSIONS: We demonstrated that the negative predictive value of MRI scans performed at high volume centers is significantly higher compared to MRIs performed externally. Our findings indirectly support the need for centralization of MRIs in men on AS, as well as the invariable need of follow-up biopsies for those with negative MRIs performed externally. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e528 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Leni More articles by this author Armando Stabile More articles by this author Giorgio Gandaglia More articles by this author Vito Cucchiara More articles by this author Giuseppe Rosiello More articles by this author Elio Mazzone More articles by this author Gabriele Sorce More articles by this author Francesco Pellegrino More articles by this author Simone Scuderi More articles by this author Daniele Robesti More articles by this author Donato Cannoletta More articles by this author Mario De Angelis More articles by this author Leonardo Quarta More articles by this author Paolo Zaurito More articles by this author Giorgio Brembilla More articles by this author Francesco De Cobelli More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinical application of the PRECISE score for reporting magnetic resonance imaging in men on active surveillance for prostate cancer

Clinical application of the PRECISE score for reporting magnetic resonance imaging in men on active surveillance for prostate cancer

Abstract 12820: Utilization of Cardiac Magnetic Resonance Imaging for Management of Coronary Chronic Total Occlusions

Introduction: Revascularization of coronary chronic total occlusions (CTOs) may be indicated for relief of medically refractory angina. Myocardial viability assessment by cardiac magnetic resonance (CMR) may help select patients for CTO intervention. Real-world practice is not well described. Methods: We identified patients who underwent coronary angiography between 2016-2020 at a large tertiary center and had ≥1 CTO. Patients with prior CABG were excluded. We examined rates of CMR and outcomes including revascularization and MACE. Myocardial segments were attributed to a CTO territory and adjudicated following angiographic review of coronary anatomy. Significant CMR viability was defined as &lt;50% transmural delayed enhancement in the CTO territory. Results: We identified 1279 patients (74.1% male, 28.1% Black) who met inclusion criteria. Of these, 36.0% had type 2 diabetes mellitus and 54.9% reported angina pectoris. Over half of patients had CTO of the RCA (56.5%), and 18.5% of patients had CTO in &gt;1 vessel. Non-invasive testing was performed in 38.4% of patients; 10.8% had CMR. Rates of CMR were higher in patients with severely reduced EF (≤35%) compared to those with normal EF (≥55%) (22.1% vs 11.1%; p&lt;0.001). Among those who had CMR, 84.8% of patients showed significant viability in the CTO territory (Fig). CTO PCI was performed in 12.5% of patients, CABG was performed in 24.9%, and 63.2% were managed medically. Patients who had CTO PCI had higher rates of angina versus those without CTO PCI (70.0% vs 52.8%; p&lt;0.001) and were more likely to be on ≥2 anti-anginal medications (30.6% vs 18.9%; p&lt;0.001). CTO PCI technical success was achieved in 69.5% of patients and MACE occurred in 2.3% of cases. Conclusions: Patients with coronary CTOs demonstrate high rates of viability in CTO territories based on CMR. Rates of viability testing and CTO revascularization remain low. Further work is needed to determine the role of CMR and other non-invasive testing in CTO management.

The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases.

Dynamic magnetic resonance imaging (MRI) of the cervical spine is extremely useful in assessing pathological changes at the spinal cord, vertebrae, discs, ligaments and facet joints. We attempted to document the radiological changes that the cervical spine undergoes during dynamic maneuvers and the effects of Dynamic MRI in management of cervical myelopathy, emphasizing on the changes in treatment protocol effected by the new findings discovered. Our work is based on 24 consecutive patients with cervical spondylotic myelopathy had cervical MR imaging in neutral position, in flexion and extension of the cervical spine between January 2021 and December 2021. The result found the mean age was 57.9 years (range 26-85 years). Among these 24 patients, there were 11 males and 13 females. Total number of levels of compression were 47 and the additional levels of involvement were 17. Additional levels of compression were noted in 12 patients, among these 17 new levels, 7 were in the posterior and 10 in the anterior. The most affected level was C5C6 with 16 cases. All additional levels of compression were noted in extension; Reduction of the cervical canal was observed in 20 patients only in extension. In the bending sequences we have noticed an increase of the canal diameter in 3 patients. The location of the compression is in 15 cases anterior, 2 cases posterior and 5 cases are mixed anterior and posterior Surgery was considered in 17 patients. Anterior procedures were 11 (ACDF/corpectomy and fusion) and Posterior surgeries were 6 (laminoplasty/laminectomy), and. The rest of the patients did not require surgery and was conservatively treated. A change of the signal was found in 3 patients during the acquisition in extension position a. Most studies have shown a reduction of the root canal with an increase of the compression level, which was the case in our study. MRI is a useful tool for diagnosis of CM, it does not give an exact idea as to which is the offending level in a multilevel compression that requires surgery. Even the approach and procedure cannot be decided on a static examination and hence are subject to significant interpractitioner the role of extension MRI in determining cervical compression levels. Thus, dynamic cervical spine MRI should be an important investigation before we decide to write off surgical treatment in patients with cervical myelopathy and cord signal changes without definitive compression on static MRI. Flexion and extension MRI is an important tool for decision making and planning appropriate management in cervical compressive myelopathy.

MRI thigh measurements predict whole‐body skeletal muscle mass in patients with type 2 diabetes: a comparison with DXA

AbstractBackgroundSarcopenia is an age‐related loss of skeletal muscle mass (SMM) and function, associated with falls, frailty, and functional decline. It is more prevalent and often accelerated in people with Type 2 diabetes (T2D), especially when co‐existing with obesity (sarcopenic obesity). Accurate whole‐body SMM measurement, feasible using dual‐energy X‐ray absorptiometry (DXA) or magnetic resonance imaging (MRI), has utility both in clinical practice and in epidemiological and mechanistic research, considering the dual mechanical and metabolic function of skeletal muscle. Compared with MRI, DXA may underestimate age‐related muscle mass by up to 30%, and so direct comparison of DXA/MRI‐derived SMM measurements may be invalid in patients with obesity and T2D, who have potentially even more pronounced sarcopenia/sarcopenic obesity. We aimed to validate single‐slice or multiple‐slice measures of SMM, using MRI, with whole‐body SMM measures derived from DXA scans of appendicular lean soft tissue, specifically in patients with obesity and T2D.MethodsWe undertook a cross‐sectional study in which we performed paired DXA and whole‐body 3.0‐T MRI on 36 people with T2D and obesity (body mass index [BMI] &gt; 30 kg/m2). Single‐slice and seven‐slice estimates of muscle mass, taken from mid‐thigh/thigh MRI images, respectively, were determined, and compared with whole‐body SMM derived from DXA scans of appendicular lean soft tissue, in men and women separately.ResultsSeventeen men (age 48.4 ± 8.2 years, BMI 37.5 ± 5.1 kg/m2, body fat 39.1 ± 6.0%) and 19 women (age 51.8 years ± 9.7, BMI 37.8 ± 5.8 kg/m2, body fat 47.6 ± 5.1%) were recruited. Whole‐body SMM estimated by seven‐slice thigh MRI correlated strongly with DXA‐derived SMM in both men (r = 0.94, P &lt; 0.001) and women (r = 0.94, P &lt; 0.001). Single‐slice thigh estimates of whole‐body SMM by MRI also showed strong relationships to DXA‐derived SMM in both men (r = 0.88, P &lt; 0.001) and women (r = 0.87, P &lt; 0.001). There was no evidence of a statistically significant difference when comparing the performance of using single‐slice vs. multiple‐slices to determine SMM (P = 0.10 for males and P = 0.13 for females).ConclusionsThis study demonstrates that accurate determination of whole‐body SMM is possible using either single‐slice mid‐thigh or seven‐slice thigh MRI in men and women with obesity and T2D in whom there may be significant alterations in body composition. Its application may be of use clinically and in obesity‐related, metabolic, and gerontological research where accurate assessments of body composition add mechanistic insight.

Practice-Level Variation in the Decision to Biopsy Prostate Imaging-Reporting and Data System 3 Lesions in Favorable-Risk Prostate Cancer Patients

ObjectiveTo examine practice-level variation in the management of magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions in men with favorable-risk prostate cancer (FRPC) considering or on active surveillance (AS). Patients and MethodsWe reviewed the Michigan Urological Surgery Improvement Collaborative registry for FRPC men (GG1 and low-volume GG2) undergoing MRI from January 2013 to March 2020. The primary outcome was to assess practice-level variation in time from MRI to biopsy and MRI to treatment for PI-RADS 3 lesions. Both MRIs obtained after the diagnostic biopsy and while on AS were included. The Kaplan-Meier method was used to estimate biopsy-free survival for time from MRI to surveillance biopsy and multivariable Cox proportional hazards models identified clinical and demographic factors associated with time obtaining a biopsy after finding PI-RADS 3 lesions. ResultsWe identified 3172 FRPC men with a MRI, of whom 473 had a PI-RADS 3. There was significant practice-level variation in biopsy rates among patients with PI-RADS 3 MRI results (log-rank test, P <.001), with biopsy-free probability at 6 months ranging from 28% to 69% (median: 59%). We were unable to identify factors with significant associations with time to biopsy. Conversely, there was less variation in time from PI-RADS 3 to treatment (log-rank test, P = .2), while several clinical factors had statistically-significant associations: age (P = .018), Prostate Specific Antigen-Density 0.1-0.2 (P = .035), ISUP-GG 2 (P = .002), and number of positive cores (P <.001), as expected. ConclusionUrology practice, rather than GG or extent of biopsy positivity, is the largest factor affecting the decision for biopsy of PI-RADS 3 lesions in FRPC men considering or on AS. Future work to assist with decision-making and reduce variability is needed.

3T magnetic resonance imaging in management of orbital venolymphatic malformations: two case reports

Vascular malformations may occur during the development of the arterial, venous, and lymphatic systems in isolation or in combination. Orbital venolymphatic malformations (OVLM) are particularly challenging to treat because they infiltrate and remodel normal structures within the tight orbital space and lead to substantial ocular discomfort, visual disability, and facial disfigurement. Herein, we report two cases of OVLMs with different presenting clinical features and treatment options. We compare the image qualities among computed tomography and 1.5T and 3T magnetic resonance imaging and discuss how better anatomical resolution in the latter aid in the management of OVLM.

Editorial Commentary.

No AccessUrology Practicethe Specialty1 Mar 2022Editorial CommentaryThis article comments on the following:IsoPSA® Reduces Provider Recommendations for Biopsy and Magnetic Resonance Imaging in Men with Total Prostate Specific Antigen ≥4 ng/ml: A Real-World Observational Clinical Utility Study Avi Baskin Avi BaskinAvi Baskin Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000291.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 9(2), p. 180 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology PracticeDec 20, 2021, 12:00:00 AMIsoPSA® Reduces Provider Recommendations for Biopsy and Magnetic Resonance Imaging in Men with Total Prostate Specific Antigen ≥4 ng/ml: A Real-World Observational Clinical Utility Study Volume 9Issue 2March 2022Page: 180-180 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avi Baskin Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California More articles by this author Expand All Advertisement PDF DownloadLoading ...

IsoPSA® Reduces Provider Recommendations for Biopsy and Magnetic Resonance Imaging in Men with Total Prostate Specific Antigen ≥4 ng/ml: A Real-World Observational Clinical Utility Study.

We assessed the impact of the IsoPSA® test for prostate cancer risk assessment on provider patient management decisions in a real-world clinical setting. A total of 38 providers, including advanced practice providers, fellowship trained oncologists and general urologists in the Cleveland Clinic health system including both community-based practices and academic locations, enrolled 900 men being evaluated for prostate cancer; 734 met inclusion criteria (age ≥50 years, total serum prostate specific antigen [PSA] ≥4 and <100 ng/ml and no history of prostate cancer) and IsoPSA indication for use. A standard template was used to document biopsy recommendation prior to and after receiving IsoPSA results. The primary outcome was the number of biopsy and magnetic resonance imaging recommendation changes occurring after IsoPSA testing. IsoPSA testing resulted in a 55% (284 vs 638) net reduction in recommendations for prostate biopsy for men with total PSA ≥4 ng/ml. Additionally, a 9% reduction in recommendations for magnetic resonance imaging was observed. There was strong concordance between IsoPSA results and provider recommendations for prostate biopsy, with 87% of patients with an IsoPSA index above the threshold recommended for biopsy and 92% of patients with an IsoPSA index below the threshold not recommended for biopsy. In a real-world clinical setting, providers from diverse training backgrounds and practice settings readily adopted IsoPSA with substantial reductions in the rate of recommended prostate biopsies in patients with elevated PSA values (≥4 ng/ml). There was a high concordance between recommendation for or against prostate biopsy and the IsoPSA result.

How to read biparametric MRI in men with a clinical suspicious of prostate cancer: Pictorial review for beginners with public access to imaging, clinical and histopathological database.

Prostate Magnetic Resonance Imaging (MRI) is increasingly being used in men with a clinical suspicion of prostate cancer (PCa). Performing prostate MRI without the use of an intravenous contrast (IV) agent in men with a clinical suspicion of PCa can lead to reduced MRI scan time. Enabling a large array of different medical providers (from mid-level to specialized radiologists) to evaluate and potentially report prostate MRI in men with a clinical suspicion of PCa with a high accuracy could be one way to enable wide adoption of prostate MRI in men with a clinical suspicion of PCa. The aim of this pictorial review is to provide an insight into acquisition, quality control and reporting of prostate MRI performed without IV contrast agent in men with a clinical suspicion of PCa, aimed specifically at radiologists starting reporting prostate MRI, urologists, urology/radiology residents and mid-level medical providers without experience in reporting prostate MRI. Free public access (http://petiv.utu.fi/improd/and http://petiv.utu.fi/multiimprod/) to complete datasets of 161 and 338 men is provided. The imaging datasets are accompanied by clinical, laboratory and histopathological findings. Several topics are simplified in order to provide a solid base for the development of skills needed for an unsupervised review and potential reporting of prostate MRI in men with a clinical suspicion of PCa. The current review represents the first step towards enabling a large array of different medical providers to review and report accurately prostate MRI performed without IV contrast agent in men with a clinical suspicion of PCa.

68Ga-PSMA-HBED-CC PET/MRI is superior to multiparametric magnetic resonance imaging in men with biochemical recurrent prostate cancer: A prospective single-institutional study

BackgroundThe primary objective was to compare the overall diagnostic performance, presented as detection rate of 68Ga-PSMA-HBED-CC positron emission tomography/magnetic resonance imaging (PSMA PET/MRI) versus conventional, multiparametric MRI (mpMRI) in a population of patients with biochemically recurrent prostate cancer. In conjunction with this analysis, secondary objectives included the evaluation of the detection rate stratified by PSA levels and primary treatment modality. MethodsA total of 165 PSMA PET MRI were performed from April 2018 to May 2021, of whom 108 were presenting for biochemical recurrent disease. The PSMA PET vertex to thigh were read by two different board-certified nuclear medicine physicians while the MRI head and neck, chest, abdomen, and pelvis (with dedicated, PI-RADS compliant multiparametric prostate MRI) were read by two board certified diagnostic radiologists. AnalysisPSMA PET/MRI had a higher detection rate than mpMRI when evaluating patients with biochemical recurrence (BCR) with similar results demonstrated when sub-analysis was performed using PSA levels, primary treatment modality, and time since androgen deprivation therapy. Our study also showed PSMA PET/MRI had a higher sensitivity than mpMRI. DiscussionOur findings demonstrate that PSMA PET/MRI is a better imaging modality in the detection of disease in the setting of BCR when compared to MRI alone. Combined utility with PSMA PET/MRI is a powerful tool which can aid in not only the detection of disease, but also guide in treatment planning for prostate cancer patients.

MP26-07 WHICH PROSTATE CANCERS ARE UNDETECTED BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING IN MEN WITH PRIOR PROSTATE BIOPSY? AN ANALYSIS FROM THE PICTURE STUDY

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP26)1 Sep 2021MP26-07 WHICH PROSTATE CANCERS ARE UNDETECTED BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING IN MEN WITH PRIOR PROSTATE BIOPSY? AN ANALYSIS FROM THE PICTURE STUDY Joseph Norris, Lucy Simmons, Abi Kanthabalan, Alex Freeman, Neil McCartan, Caroline Moore, Shonit Punwani, Hayley Whitaker, Mark Emberton, Bloomsbury, and Hashim Ahmed Joseph NorrisJoseph Norris More articles by this author , Lucy SimmonsLucy Simmons More articles by this author , Abi KanthabalanAbi Kanthabalan More articles by this author , Alex FreemanAlex Freeman More articles by this author , Neil McCartanNeil McCartan More articles by this author , Caroline MooreCaroline Moore More articles by this author , Shonit PunwaniShonit Punwani More articles by this author , Hayley WhitakerHayley Whitaker More articles by this author , Mark EmbertonMark Emberton More articles by this author , Bloomsbury Bloomsbury More articles by this author , and Hashim AhmedHashim Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002023.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Not all significant cancers are detected by multiparametric magnetic resonance imaging (mpMRI), when risk stratifying for suspected prostate cancer in both biopsy-naïve men, and those with prior biopsy. In the PICTURE study (Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation) all men underwent validation using 5mm transperineal sampling, thus providing the ideal setting to investigate cancer undetected by mpMRI, in men requiring repeat biopsy. METHODS: PICTURE was a paired-cohort confirmatory study in which patients requiring repeat biopsy underwent mpMRI, followed by 5mm transperineal template mapping biopsy (TTPM biopsy). Outcomes were overall and maximum Gleason scores, maximum cancer core length (MCCL) and prostate specific antigen density (PSAD). Four definitions of cancer were considered. RESULTS: When non-suspicious mpMRI was defined as Likert 1–2, mpMRI overlooked 2.9% (3/103; 95%CI 0.6–8.3%) of PROMIS definition 1 disease (Gleason ≥4+3 of any amount or MCCL ≥6 mm of any grade), 6.5% (11/168; 95%CI 3.3–11%) of PROMIS definition 2 disease (Gleason ≥3+4 of any amount or MCCL ≥4mm of any grade), 4.8% (7/146; 95%CI 2.0–9.6%) with any Gleason ≥7, and 9.3% (20/215; 95%CI 5.8–14%) with any cancer. The most significant cancers undetected by mpMRI (i.e. definition 1) were significantly lower in overall (Table 1) and maximum Gleason grades than cancer that was detected (p=0.02 and p=0.01, respectively). Cancer undetected by mpMRI had significantly shorter MCCL than cancer that was detected, for every definition (p=0.02, p=0.04, p=0.03, and p=0.0009, respectively). Finally, using a PSAD threshold of 0.15ng/mL/mL with non-suspicious mpMRI lowered the proportion with undetected disease to 0% (0/105; 95% CI 0–3.5%) for definition 1, and to 0.58% (1/ 171; 95% CI 0.01–3.2%) for definition 2 cancer. CONCLUSIONS: Few clinically significant prostate cancers are undetected by mpMRI in men requiring repeat prostate biopsy. Undetected tumours are of lower overall and maximum Gleason grade and shorter cancer length, compared to those that are detected, reaffirming the role of mpMRI as a triage tool to determine who undergoes repeat biopsy. Source of Funding: Medical Research Council (MR/S00680X/1) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e464-e465 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Norris More articles by this author Lucy Simmons More articles by this author Abi Kanthabalan More articles by this author Alex Freeman More articles by this author Neil McCartan More articles by this author Caroline Moore More articles by this author Shonit Punwani More articles by this author Hayley Whitaker More articles by this author Mark Emberton More articles by this author Bloomsbury More articles by this author Hashim Ahmed More articles by this author Expand All Advertisement Loading ...

A prospective study on role of magnetic resonance imaging in management of acute spinal trauma and assessing the extent of neurological deficit

Background: For Imaging neurological parts, like the spinal cord, magnetic resonance imaging (MRI) has been the gold standard. The use of magnetic resonance imaging (MRI) in the acute management of patients with spinal cord injuries has risen dramatically. Objectives: This study was conducted to evaluate the diagnostic role of magnetic resonance imaging in management of acute spinal trauma and to assess the extent of neurological deficit. Material and Methods: Thirty patients of spinal trauma. The patients undergoing MR imaging, magnetic resonance images were analysed and skeletal injuries, signal changes in vertebrae, ligaments, soft tissues were noted. Associated spinal cord injury findings were also noted, which helped in assessing the initial neurological deficit and compared with (ASIA) impairment scale. Results: Out of 30 patients of spinal trauma. 53.3 % injuries were in cervical region and 46.6% in thoracolumbar region. Most of the traumatic spinal injuries in cervical spine were unstable. (68.75%) and thoracolumbar spine were stable injuries (42.85%). Unstable spinal injuries (56.66%) in cervical and thoracolumbar were operated and stabilised. Cord oedema (36.6%) and next cord compression (33.3%) were common presentations of cord injuries; cord transection and compression have worse neurological deficit and presented with ASIA score A/B at the time of admission. Conclusion: CT provides superior depiction of bony anatomy but important limitation of this technique is inability to provide screening for ligamentous injury and spinal cord lesions. MRI is superior in this regard. Because of its high contrast resolution, absence of bony artifacts, multiplanar ability, and variety of pulse sequences, MRI allows for a more precise diagnosis of spinal trauma.

Which Prostate Cancers are Undetected by Multiparametric Magnetic Resonance Imaging in Men with Previous Prostate Biopsy? An Analysis from the PICTURE Study

BackgroundMultiparametric magnetic resonance imaging (mpMRI) has improved risk stratification for suspected prostate cancer in patients following prior biopsy. However, not all significant cancers are detected by mpMRI. The PICTURE study provides the ideal opportunity to investigate cancer undetected by mpMRI owing to the use of 5 mm transperineal template mapping (TTPM) biopsy. ObjectiveTo summarise attributes of cancers systematically undetected by mpMRI in patients with prior biopsy. Design, setting, and participantsPICTURE was a paired-cohort confirmatory study in which men requiring repeat biopsy underwent mpMRI followed by TTPM biopsy. Outcome measurements and statistical analysisAttributes were compared between cancers detected and undetected by mpMRI at the patient level. Four predefined histopathological thresholds were used as the target condition for TTPM biopsy. Application of prostate-specific antigen density (PSAD) was explored. Results and limitationsWhen nonsuspicious mpMRI was defined as Likert score 1–2, 2.9% of patients (3/103; 95% confidence interval [CI] 0.6–8.3%) with definition 1 disease (Gleason ≥ 4 + 3 of any length or maximum cancer core length [MCCL] ≥ 6 mm of any grade) had their cancer not detected by mpMRI. This proportion was 6.5% (11/168; 95% CI 3.3–11%) for definition 2 disease (Gleason ≥ 3 + 4 of any length or MCCL ≥ 4 mm of any grade), 4.8% (7/146; 95% CI 2.0–9.6%) for any amount of Gleason ≥ 3 + 4 cancer, and 9.3% (20/215; 95% CI 5.8–14%) for any cancer. Definition 1 cancers undetected by mpMRI had lower overall Gleason score (p = 0.02) and maximum Gleason score (p = 0.01) compared to cancers detected by mpMRI. Prostate cancers undetected by mpMRI had shorter MCCL than cancers detected by mpMRI for every cancer threshold: definition 1, 6 versus 8 mm (p = 0.02); definition 2, 5 versus 6 mm (p = 0.04); any Gleason ≥ 3 + 4, 5 versus 6 mm (p = 0.03); and any cancer, 3 versus 5 mm (p = 0.0009). A theoretical PSAD threshold of 0.15 ng/ml/ml reduced the proportion of patients with undetected disease on nonsuspicious mpMRI to 0% (0/105; 95% CI 0–3.5%) for definition 1, 0.58% (1/171; 95% CI 0.01–3.2%) for definition 2, and 0% (0/146) for any Gleason ≥ 3 + 4. ConclusionsFew significant cancers are undetected by mpMRI in patients requiring repeat prostate biopsy. Undetected tumours are of lower overall and maximum Gleason grade and shorter cancer length compared to cancers detected by mpMRI. Patient summaryIn patients with a previous prostate biopsy, magnetic resonance imaging (MRI) overlooks few prostate cancers, and these tend to be smaller and less aggressive than cancer that is detected.

P0903 - Which prostate cancers are undetected by multiparametric magnetic resonance imaging in men with previous prostate biopsy? An analysis from the PICTURE study

P0903 - Which prostate cancers are undetected by multiparametric magnetic resonance imaging in men with previous prostate biopsy? An analysis from the PICTURE study

Biochemical predictors of structural hypothalamus\u2013pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism

PurposeOrganic conditions underlying secondary hypogonadism (SH) may be ascertained by magnetic resonance imaging (MRI) of the hypothalamic–pituitary region that could not be systematically proposed to each patient. Based upon limited evidence, the Endocrine Society (ES) guidelines suggest total testosterone (T) < 5.2 nmol/L to identify patients eligible for MRI. The study aims to identify markers and their best threshold value predicting pathological MRI findings in men with SH.MethodsA consecutive series of 609 men seeking medical care for sexual dysfunction and with SH (total T < 10.5 nmol/L and LH ≤ 9.4 U/L) was retrospectively evaluated. An independent cohort of 50 men with SH was used as validation sample. 126 men in the exploratory sample and the whole validation sample underwent MRI.ResultsIn the exploratory sample, patients with pathological MRI findings (n = 46) had significantly lower total T, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prostate specific antigen (PSA) than men with normal MRI (n = 80). Receiver Operating Characteristics analysis showed that total T, LH, FSH and PSA are accurate in identifying men with pathologic MRI (accuracy: 0.62–0.68, all p < 0.05). The Youden index was used to detect the value with the best performance, corresponding to total T 6.1 nmol/L, LH 1.9 U/L, FSH 4.2 U/L and PSA 0.58 ng/mL. In the validation cohort, only total T ≤ 6.1 nmol/L and LH ≤ 1.9 U/L were confirmed as significant predictors of pathologic MRI.ConclusionIn men with SH, total T ≤ 6.1 nmol/L or LH ≤ 1.9 U/L should arise the suspect of hypothalamus/pituitary structural abnormalities, deserving MRI evaluation.