Multi-parametric MRI (mp-MRI) is considered the best non-invasive imaging modality for diagnosing prostate cancer (PCa). However, mp-MRI for PCa diagnosis is currently limited by the qualitative or semi-quantitative interpretation criteria, leading to inter-reader variability and a suboptimal ability to assess lesion aggressiveness. Convolutional neural networks (CNNs) are a powerful method to automatically learn the discriminative features for various tasks, including cancer detection. We propose a novel multi-class CNN, FocalNet, to jointly detect PCa lesions and predict their aggressiveness using Gleason score (GS). FocalNet characterizes lesion aggressiveness and fully utilizes distinctive knowledge from mp-MRI. We collected a prostate mp-MRI dataset from 417 patients who underwent 3T mp-MRI exams prior to robotic-assisted laparoscopic prostatectomy (RALP). FocalNet is trained and evaluated in this large study cohort with 5-fold cross-validation. In the free-response receiver operating characteristics (FROC) analysis for lesion detection, FocalNet achieved 89.7% and 87.9% sensitivity for index lesions and clinically significant lesions at 1 false positive per patient, respectively. For GS classification, evaluated by the receiver operating characteristics (ROC) analysis, FocalNet received the area under the curve (AUC) of 0.81 and 0.79 for the classifications of clinically significant PCa (GS≥3+4) and PCa with GS≥4+3, respectively. With the comparison to the prospective performance of radiologists using the current diagnostic guideline, FocalNet demonstrated comparable detection sensitivity for index lesions and clinically significant lesions, only 3.4% and 1.5% lower than highly experienced radiologists without statistical significance.
GENITOURINARY IMAGINGM ultiparametric MRI is an important tool in the diagnosis of prostate cancer (PCa) (1,2). However, multiparametric MRI still misses PCa in up to 45% of men and faces challenges in distinguishing clinically significant PCa from indolent PCa (2,3). Thus, histopathologic examination of PCa remains the reference standard. A Gleason score based on the microscopic appearance of PCa is assigned to indicate its aggressiveness (4).Diffusion-weighted MRI is a critical component of multiparametric MRI and is sensitive to tissue microstructure changes in PCa (5). However, current clinical analysis using a monoexponential signal model to calculate apparent diffu-Materials and Methods: Men with PCa who underwent 3-T MRI and robotic-assisted radical prostatectomy between June 2018 and January 2019 were prospectively studied. After prostatectomy, the fresh whole prostate specimens were imaged in patient-specific threedimensionally printed molds by using 3-T MRI with DR-CSI and were then sliced to create coregistered WMHP slides. The DR-CSI spectral signal component fractions (f A , f B , f C ) were compared with epithelial, stromal, and luminal area fractions (f epithelium , f stroma , f lumen ) quantified in PCa and benign tissue regions. A linear mixed-effects model assessed the correlations between (f A , f B , f C ) and (f epithelium , f stroma , f lumen ), and the strength of correlations was evaluated by using Spearman correlation coefficients. Differences between PCa and benign tissues in terms of DR-CSI signal components and microscopic tissue compartments were assessed using two-sided t tests.Results: Prostate specimens from nine men (mean age, 65 years 6 7 [standard deviation]) were evaluated; 20 regions from 17 PCas, along with 20 benign tissue regions of interest, were analyzed. Three DR-CSI spectral signal components (spectral peaks) were consistently identified. The f A , f B , and f C were correlated with f epithelium , f stroma , and f lumen (all P , .001), with Spearman correlation coefficients of 0.74 (95% confidence interval [CI]: 0.62, 0.83), 0.80 (95% CI: 0.66, 0.89), and 0.67 (95% CI: 0.51, 0.81), respectively. PCa exhibited differences compared with benign tissues in terms of increased f A (PCa vs benign, 0.37 6 0.05 vs 0.27 6 0.06; P , .001), decreased f C (PCa vs benign, 0.18 6 0.06 vs 0.31 6 0.13; P = .01), increased f epithelium (PCa vs benign, 0.44 6 0.13 vs 0.26 6 0.16; P , .001), and decreased f lumen (PCa vs benign, 0.14 6 0.08 vs 0.27 6 0.18; P = .004). Conclusion:Diffusion-relaxation correlation spectrum imaging signal components correlate with microscopic tissue compartments in the prostate and differ between cancer and benign tissue.
According to the results of this study, c-kit mutations have intense, harmful effects on the relapse and white blood cell increase in CBF-AML adults. However, these mutations have no significant prognostic effects on patients.
Prevention programs are considered to be a top priority in Iran because beta-thalassemia (beta-thal) major (TM) is the most common autosomal disorder in Iran, and in the Mazandaran Province in particular. The main strategies comprise providing appropriate information for the public and professionals, screening and counseling of families at-risk and screening of general population prior to marriage. Providing laboratories for prenatal diagnosis was the most recent step in the program. We report the results of our prevention campaign for the period 1993-2006 in order to assess the effectiveness of all actions in controlling thalassemia major. In 1993, 500 TM patients were registered at the clinic of the Boo Ali Sina Hospital, Sari, Mazandaran, Iran. From 1993 to 1996, on average of 50 new cases were added to the cohort annually, whereas from 1995 to 2005 the number of new cases declined to 35 per year. Furthermore, the patients' average age increased. Overall, 51% of couples at-risk, who received genetic counseling, decided not to marry. All at-risk couples who are married were counseled for prevention of unplanned pregnancies. Currently, 64% are using safe contraceptive methods of family planning, and 14% are no longer at-risk for further pregnancies, the rest remained at-risk for unplanned pregnancies. In conclusion, at the relatively low cost of premarital screening and genetic counseling, we have offered at-risk couples the possibility of preventing the birth of at least 600 undesired TM patients. Thus, a great deal of suffering and an unbearable financial burden has been prevented to patients and their families.
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