Detection of recurrent prostate cancer after primary radiation therapy: An evaluation of the role of multiparametric 3T magnetic resonance imaging with endorectal coil

Zattoni, Fabio; Kawashima, Akira; Morlacco, Alessandro; Davis, Brian J.; Nehra, Avinash; Mynderse, Lance A.; Froemming, Adam T.; Karnes, R. Jeffrey

doi:10.1016/j.prro.2016.06.003

Cited by 18 publications

(37 citation statements)

References 22 publications

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“…Thus, multi-parametric MRI (mp-MRI) with diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI is often preferred. Zattoni et al [11] reported 3-T mp-MRI to have good accuracy in detecting recurrent disease extension. Conversely, Donati et al [12] found no additional benefit of DCE when added to T2w and DWI.…”

Section: Introductionmentioning

confidence: 99%

Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

et al. 2018

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Objectives Diagnosis of radio-recurrent prostate cancer using multi-parametric MRI (mp-MRI) can be challenging due to the presence of radiation effects. We aim to characterize imaging of prostate tissue after radiation therapy (RT), using histopathology as ground truth, and to investigate the visibility of tumor lesions on mp-MRI. Methods Tumor delineated histopathology slides from salvage radical prostatectomy patients, primarily treated with RT, were registered to MRI. Median T2-weighted, ADC, K trans , and k ep values in tumor and other regions were calculated. Two radiologists independently performed mp-MRI-based tumor delineations which were compared with the true pathological extent. General linear mixed-effect modeling was used to establish the contribution of each imaging modality and combinations thereof in distinguishing tumor and benign voxels. Results Nineteen of the 21 included patients had tumor in the available histopathology slides. Recurrence was predominantly multifocal with large tumor foci seen after external beam radiotherapy, whereas these were small and sparse after low-dose-rate brachytherapy. MRI-based delineations missed small foci and slightly underestimated tumor extent. The combination of T2-weighted, ADC, K trans , and k ep had the best performance in distinguishing tumor and benign voxels. Conclusions Using high-resolution histopathology delineations, the real tumor extent and size were found to be underestimated on MRI. mp-MRI obtained the best performance in identifying tumor voxels. Appropriate margins around the visible tumor-suspected region should be included when designing focal salvage strategies. Recurrent tumor delineation guidelines are warranted. Key Points • Compared to the use of individual sequences, multi-parametric MRI obtained the best performance in distinguishing recurrent tumor from benign voxels. • Delineations based on mp-MRI miss smaller foci and slightly underestimate tumor volume of local recurrent prostate cancer. • Focal salvage strategies should include appropriate margins around the visible tumor. Electronic supplementary material The online version of this article (10.1007/s00330-018-5819-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

et al. 2018

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“…published a study on recurrent PCa after failure of primary radiation therapy using histopathology as reference standard for LN detection by contrast enhanced 3T MRI applying an endorectal coil. They reported a sensitivity and specificity of 60.0% and 85.7%, respectively, for an unknown number of LN 15 . A further study from Zhang et al .…”

Section: Discussionmentioning

confidence: 99%

“…Regarding MRI, especially T1 and T2 sequences are known to provide excellent anatomical information to demarcate structures and are commonly used for evaluation of local tumor infiltrations for instance in the seminal vesicles as well as local LN evaluation 5–12 . With the introduction of 3T scanners into the clinical setting, higher signal to noise ratios could be realized and a more reliable detection of LN metastases could be achieved 5,13–15 .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of standard clinical 3T prostate MRI for pelvic lymph node staging: Comparison to 68Ga-PSMA PET-CT

Meißner

Janssen

Prasad

et al. 2019

Sci Rep

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The aim was to assess the performance of prostate 3T MRI for pelvic lymph node (LN) staging in prostate cancer (PCa), in comparison to 68 Gallium-prostate specific membrane antigen PET-CT ( 68 Ga-PSMA PET-CT) as reference standard for LN detection. 130 patients with PCa underwent non-contrast-enhanced multiparametric prostate 3T MRI and 68 Ga-PSMA-PET-CT within 180 days at our institution. Overall, 187 LN metastases (n = 43 patients) detected by 68 Ga-PSMA-PET-CT were characterized by calculating maximum standardized uptake value (SUVmax), area, diameter and anatomical location including iliac, obturator, presacral and inguinal region. MRI achieved an overall sensitivity, specificity, positive and negative predictive value of 81.6% (CI 71.1–88.9%), 98.6% (CI 97.6–99.2%), 73.5% (CI 52.1–87.6%) and 99.5% (CI 98.8–99.8%), respectively. On a region-based analysis, detection rates differed non-significantly (ps > 0.12) in the anatomical regions. On a size-dependent analysis, detection of LN > 10 mm did not differ significantly (ps > 0.09) from LN ≤ 10 mm. In comparison to single T1 sequence evaluation, additional use of the T2 weighted sequences did not improve the overall performance significantly (p > 0.05). 3T prostate MRI represented an accurate tool for the detection of LN compared to 68 Ga-PSMA-PET-CT. Especially for LN metastases smaller than 10 mm, MRI was less accurate compared to 68 Ga-PSMA-PET-CT.

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“…Specifically, multiparametric magnetic resonance imaging and 11C-choline positron emission tomography (PET)/computed tomography (CT) (CholPET) have provided independent and combined additive value in anatomic evaluation of BCR. 12 , 13 , 14 , 15 , 16 , 17 Moreover, a recent multivariate analysis documented that multiparametric magnetic resonance imaging and CholPET may provide a significant advantage over prior imaging methods, with increasing time from BCR to abnormal imaging independently associated with local-only disease recurrence. 16 Other PET agents, including Ga-68 prostate-specific membrane antigen and 18F-fluciclovine have had sensitivity similar or superior to that of 11C-choline and are of interest but are outside the scope of the present study.…”

Section: Introductionmentioning

confidence: 99%

“…Advanced diagnostic imaging for CaP BCR recently was validated in accurate localization of disease recurrence. Specifically, multiparametric magnetic resonance imaging and 11C-choline positron emission tomography (PET)/computed tomography (CT) (CholPET) have provided independent and combined additive value in anatomic evaluation of BCR 12, 13, 14, 15, 16, 17. Moreover, a recent multivariate analysis documented that multiparametric magnetic resonance imaging and CholPET may provide a significant advantage over prior imaging methods, with increasing time from BCR to abnormal imaging independently associated with local-only disease recurrence 16 .…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Image-Guided Nodal Biopsy After 11C-Choline PET/CT for Biochemically Recurrent Prostate Cancer: Imaging Predictors of Disease and Clinical Implications

Welch

Packard

Atwell

et al. 2019

Advances in Radiation Oncology

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PurposeManagement of recurrent prostate cancer necessitates timely diagnosis and accurate localization of the sites of recurrent disease. The purpose of this study was to assess predictors of histologic outcomes after 11C-choline positron emission tomography/computed tomography (CholPET) to increase the positive predictive value and specificity of CholPET in identifying imaging predictors of malignant and benign nodal disease to better inform clinical decision making regarding local therapy planning.Materials and MethodsRetrospective review of patients undergoing CholPET followed by percutaneous core needle biopsy between January 1, 2010 and January 1, 2016. A total of 153 patients were identified who underwent 166 biopsy procedures. Patient, CholPET, procedural, and pathologic characteristics were recorded.ResultsA total of 157 biopsies were technically successful, and 110 (70.1%; 95% confidence interval, 62.2-77.1) yielded histologic results abnormal for metastatic prostate cancer. Lesion location, lesion maximum standardized uptake value (SUVmax), SUV ratio (calculated as the ratio of SUVmax to SUV mean in the right atrium), prostate-specific antigen, lesion short axis length, total Gleason score, and castration resistance were all associated with abnormal biopsy results (P values <.001, <.001, <.001, .02, .02, .02, and .015, respectively). External iliac, common iliac, and inguinal sites were associated with much lower rates of histologic positivity (mean [95% confidence interval], 51.2% [35.1-67.1], 46.2% [19.2-74.9], and 33.3% [7.5-70.1]), respectively.ConclusionsIn a cohort of patients in whom core needle biopsy was performed after CholPET, characteristics of choline localization including node location, SUVmax, lesion–to–blood pool SUV ratio, prostate-specific antigen, total Gleason score, and castration resistance were significantly associated with abnormal biopsy results for metastatic disease on CholPET. Relatively high false positive rates were found in common iliac, external iliac, and inguinal lymph node locations. Histologic confirmation of these sites should be strongly considered in the appropriate clinical scenario before designing additional local therapy plans.

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Detection of recurrent prostate cancer after primary radiation therapy: An evaluation of the role of multiparametric 3T magnetic resonance imaging with endorectal coil

Cited by 18 publications

References 22 publications

Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

Accuracy of standard clinical 3T prostate MRI for pelvic lymph node staging: Comparison to 68Ga-PSMA PET-CT

Percutaneous Image-Guided Nodal Biopsy After 11C-Choline PET/CT for Biochemically Recurrent Prostate Cancer: Imaging Predictors of Disease and Clinical Implications

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