In-Bore 3-T MR-guided Transrectal Targeted Prostate Biopsy: Prostate Imaging Reporting and Data System Version 2–based Diagnostic Performance for Detection of Prostate Cancer

Tan, Nelly; Lin, Woei; Khoshnoodi, Pooria; Asvadi, Nazanin H.; Yoshida, Jeffrey; Margolis, Daniel; Lu, David; Wu, Holden H.; Sung, Kyunghyun; Lu, David; Huang, J.; Raman, Steven S.

doi:10.1148/radiol.2016152827

Cited by 75 publications

(63 citation statements)

References 19 publications

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“…All of the studies were performed at a single institution, so the ADC threshold reported herein, which included a b value of 0 s/mm 2 in its calculation, may not be directly applicable to different scanners and platforms or calculations that do not include b values below 100 s/mm 2 . The clinically significant PCA detection rate of 15% among PI-RADSv2 category 3 TZ lesions in our cohort is slightly higher than that reported in previous publications [2, 3, 6] and could reflect enrichment of TZ lesions, given that they are more often occult at systematic biopsy and that nearly a quarter of our population had undergone at least one prior negative systematic biopsy. Last, although suggested by PI-RADSv2, the definition of clinically significant PCA that we used in this study (Gleason score ≥ 3 + 4) may not be universally agreed on because it does not account for tumor volume and is based on targeted biopsy rather than radical prostatectomy.…”

Section: Discussioncontrasting

confidence: 79%

“…In a multireader reproducibility study of PI-RADSv2, Rosenkrantz et al [6] reported an overall PCA detection rate of 15.4% among lesions with overall PI-RADSv2 category of less than 4, none of which was clinically significant PCA. Tan et al [3] reported an overall PCA detection rate of 19.4% among PI-RADSv2 category 3 lesions, less than 10% of which constituted clinically significant PCA. These results reaffirm what other authors had previously reported for PI-RADSv1 in terms of biopsy yield for lesions with a category of 3.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the rapid evolution of the field and some limitations of the initial iteration, PI-RADS version 2 (PI-RADSv2) was developed and released in December 2015 [2]. Only a few studies have attempted to validate PI-RADSv2 since its release [3–7]. Unlike BI-RADS on which PI-RADS was modeled, management recommendations are not included as part of PI-RADSv2.…”

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confidence: 99%

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Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?

Felker

Raman

Margolis

et al. 2017

American Journal of Roentgenology

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OBJECTIVE The objective of our study was to determine the clinical and MRI characteristics of clinically significant prostate cancer (PCA) (Gleason score ≥ 3 + 4) in men with Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) category 3 transition zone (TZ) lesions. MATERIALS AND METHODS From 2014 to 2016, 865 men underwent prostate MRI and MRI/ultrasound (US) fusion biopsy (FB). A subset of 90 FB-naïve men with 96 PI-RADSv2 category 3 TZ lesions was identified. Patients were imaged at 3 T using a body coil. Images were assigned a PI-RADSv2 category by an experienced radiologist. Using clinical data and imaging features, we performed univariate and multivariate analyses to identify predictors of clinically significant PCA. RESULTS The mean patient age was 66 years, and the mean prostate-specific antigen density (PSAD) was 0.13 ng/mL2. PCA was detected in 34 of 96 (35%) lesions, 14 of which (15%) harbored clinically significant PCA. In univariate analysis, DWI score, prostate volume, and PSAD were significant predictors (p < 0.05) of clinically significant PCA with a suggested significance for apparent diffusion coefficient (ADC) and prostate-specific antigen value (p < 0.10). On multivariate analysis, PSAD and lesion ADC were the most important covariates. The combination of both PSAD of 0.15 ng/mL2 or greater and an ADC value of less than 1000 mm2/s yielded an AUC of 0.91 for clinically significant PCA (p < 0.001). If FB had been restricted to these criteria, only 10 of 90 men would have undergone biopsy, resulting in diagnosis of clinically significant PCA in 60% with eight men (9%) misdiagnosed (false-negative). CONCLUSION The yield of FB in men with PI-RADSv2 category 3 TZ lesions for clinically significant PCA is 15% but significantly improves to 60% (AUC > 0.9) among men with PSAD of 0.15 ng/mL2 or greater and lesion ADC value of less than 1000 mm2/s.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?

Felker

Raman

Margolis

et al. 2017

American Journal of Roentgenology

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“…Gmax was limited to 76 mT/m and SRmax was limited to 50 T/m/s for ENCODE gradient waveform designs to limit peripheral nerve stimulation. Prostate DWI using MONO, BIPOLAR, and ENCODE with a single‐shot spin‐echo EPI acquisition were first evaluated using clinical standard parameters, including 1.6 × 1.6 mm 2 in‐plane resolution and partial Fourier (pF) factor 6/8 . In addition, two higher‐resolution protocols were evaluated: 1) in‐plane resolution increased to 1.0 × 1.0 mm 2 with pF = 6/8, and 2) in‐plane resolution 1.6 × 1.6 mm 2 with the pF factor set to 1 (ie, pF = off).…”

Section: Methodsmentioning

confidence: 99%

Prostate diffusion MRI with minimal echo time using eddy current nulled convex optimized diffusion encoding

Zhang

Moulin

Aliotta

et al. 2019

Magnetic Resonance Imaging

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Background: Prostate diffusion-weighted imaging (DWI) using monopolar encoding is sensitive to eddy-current-induced distortion artifacts. Twice-refocused bipolar encoding suppresses eddy current artifacts, but increases echo time (TE), leading to lower signal-to-noise ratio (SNR). Optimization of the diffusion encoding might improve prostate DWI. Purpose: To evaluate eddy current nulled convex optimized diffusion encoding (ENCODE) for prostate DWI with minimal TE. Study Type: Prospective cohort study. Population: A diffusion phantom, an ex vivo prostate specimen, 10 healthy male subjects (27 AE 3 years old), and five prostate cancer patients (62 AE 7 years old). Field Strength/Sequence: 3T; single-shot spin-echo echoplanar DWI. Assessment: Eddy-current artifacts, TE, SNR, apparent diffusion coefficient (ADC), and image quality scores from three independent readers were compared between monopolar, bipolar, and ENCODE prostate DWI for standard-resolution (1.6 × 1.6 mm 2 , partial Fourier factor [pF] = 6/8) and higher-resolution protocols (1.6 × 1.6 mm 2 , pF = off; 1.0 × 1.0 mm 2 , pF = 6/8). Statistical Testing: SNR and ADC differences between techniques were tested with Kruskal-Wallis and Wilcoxon signedrank tests (P < 0.05 considered significant). Results: Eddy current suppression with ENCODE was comparable to bipolar encoding (mean coefficient of variation across three diffusion directions of 9.4% and 9%). For a standard-resolution protocol, ENCODE achieved similar TE as monopolar and reduced TE by 14 msec compared to bipolar, resulting in 27% and 29% higher mean SNR in prostate transition zone (TZ) and peripheral zone (PZ) (P < 0.05) compared to bipolar, respectively. For higher-resolution protocols, ENCODE achieved the shortest TE (67 msec), with 17-21% and 58-70% higher mean SNR compared to monopolar (TE = 77 msec) and bipolar (TE = 102 msec) in PZ and TZ (P < 0.05). No significant differences were found in mean TZ (P = 0.91) and PZ ADC (P = 0.94) between the three techniques. ENCODE achieved similar or higher image quality scores than bipolar DWI in patients, with mean intraclass correlation coefficient of 0.77 for overall quality between three independent readers. Data Conclusion: ENCODE minimizes TE (improves SNR) and reduces eddy-current distortion for prostate DWI compared to monopolar and bipolar encoding. Level of Evidence: 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2020;51:1526-1539. P ROSTATE CANCER (PCa) is the most prevalent noncutaneous cancer diagnosed in men and the second leading cause of cancer-related death in men in the United States. 1 Multiparametric magnetic resonance imaging (mp-MRI) of the prostate, including T 2 -weighted MRI, diffusionweighted MRI (DWI), apparent diffusion coefficient (ADC) View this article online at wileyonlinelibrary.com.

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“…Moreover, Gleason scores (GSs) obtained from TRUS-guided systematic biopsies frequently underestimate prostate cancers compared with those obtained from prostatectomies [7][8][9]. Hence, magnetic resonance imaging (MRI)-TRUS fusion biopsy [10,11] and in-bore MRI-guided biopsy [12] have been introduced to precisely target significant cancers with fewer cores.…”

Section: Introductionmentioning

confidence: 99%

New Biopsy Techniques and Imaging Features of Transrectal Ultrasound for Targeting PI-RADS 4 and 5 Lesions

Park

2020

JCM

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Purpose: To introduce new biopsy techniques and imaging features of transrectal ultrasound (TRUS) for targeting Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 lesions Methods: TRUS-guided targeted and/or systematic biopsies were performed in 432 men with PI-RADS 4 and 5 lesions following magnetic resonance imaging examination. A TRUS operator who was familiar with the new techniques and imaging features performed lesion detection. Overall and significant cancer detection rates (CDRs) were compared among the men with PI-RADS 4 and 5 lesions. The CDRs in the peripheral and transition zones were compared. Additionally, we assessed whether targeted or systematic biopsies contributed to cancer detection. The standard reference was a biopsy examination. Results: The overall CDRs in the men with PI-RADS 4 and 5 lesions were 49.5% (139/281) and 74.8% (113/151) (p < 0.0001); significant CDRs were 33.1% (93/281) and 58.3% (88/151) (p < 0.0001); and CDRs in the peripheral and transition zones were 53.6% (187/349) and 78.3% (65/83) (p < 0.0001), respectively. Of the 139 men with clinically significant cancer PI-RADS 4 lesions, 107 (77.0%) were diagnosed by targeted biopsy, 5 (3.6%) by systematic biopsy, and 27 (19.4%) by both. Of the 113 men with clinically significant cancer PI-RADS 5 lesions, 97 (85.8%) were diagnosed by targeted biopsy, 3 (2.7%) by systematic biopsy, and 13 (11.5%) by both. Conclusions: Most PI-RADS 4 and 5 lesions can be targeted with TRUS if the new techniques and imaging features are applied.

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In-Bore 3-T MR-guided Transrectal Targeted Prostate Biopsy: Prostate Imaging Reporting and Data System Version 2–based Diagnostic Performance for Detection of Prostate Cancer

Cited by 75 publications

References 19 publications

Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?

Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?

Prostate diffusion MRI with minimal echo time using eddy current nulled convex optimized diffusion encoding

New Biopsy Techniques and Imaging Features of Transrectal Ultrasound for Targeting PI-RADS 4 and 5 Lesions

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