Low-Risk Prostate Cancer: The Accuracy of Multiparametric MR Imaging for Detection

Kim, Jin Young; Kim, See Hyung; Kim, Young Hwan; Lee, Hee Jung; Kim, Mi Jeong; Choi, Mi Sun

doi:10.1148/radiol.13130801

Cited by 48 publications

(31 citation statements)

References 28 publications

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“…9 Dynamic contrast-enhanced computed tomography (CT) has demonstrated its ability for the noninvasive assessment of angiogenesis by determining functional parameters of tissue microcirculation in different malignant lesions. 15Y21 There are also potential roles for DCE CT in prostate cancer, such as the initial tumor assessment, follow-up, and monitoring of therapy response in patients with contraindications to MRI, such as pacemakers or ferromagnetic vascular coils.…”

Section: Y14mentioning

confidence: 99%

“…15Y21 There are also potential roles for DCE CT in prostate cancer, such as the initial tumor assessment, follow-up, and monitoring of therapy response in patients with contraindications to MRI, such as pacemakers or ferromagnetic vascular coils. 9,22Y25 The prostate, however, is comparably difficult to assess with CT-perfusion (CTP) because of artifacts from neighboring pelvic bones and the usually small volume of prostate cancer as well as coexisting benign prostatic hyperplasia and chronic prostatitis. On the other hand, several tumor spots of varying grades may coexist or even diffusely infiltrate the prostate parenchyma rather than form circumscribed compounds.…”

Section: Y14mentioning

confidence: 99%

“…Assessment of prostate cancer with dynamic contrast-enhanced computed tomography using an en bloc approach. Investigative Radiology, 49 (9):571-578. DOI: https://doi.org/10.1097/RLI.0000000000000055 1 Its comparably low mortality is attributed to an overall early detection, to varying tumor behaviors from almost benign to rare highly aggressive subtypes, as well as to several effective therapeutic options.…”

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Assessment of Prostate Cancer With Dynamic Contrast-Enhanced Computed Tomography Using an En Bloc Approach

Huellner¹,

Pauli²,

Mattei³

et al. 2014

Investigative Radiology

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OBJECTIVES The aim of this study was to assess the performance of dynamic contrastenhanced computed tomography of the prostate in patients with biopsy-proven prostate cancer. MA-TERIAL AND METHODS A total of 46 male patients (median age, 65 years; range, 49-73 years) with biopsy-proven prostate cancer underwent an en bloc computed tomography perfusion (CTP) scan of the prostate before surgery. The perfusion parameters mean transit time (MTT), blood flow (BF), and blood volume (BV), as well as the microvessel density (MVD) of surgical specimens were determined. Differences in CTP parameters and MVD among postsurgical Gleason score (sGS) and postsurgical combined Gleason grade (sGG) groups were analyzed. Spearman correlation coefficients were determined between CTP parameters and presurgical biopsy-derived Gleason score (bGS), presurgical biopsy-derived combined Gleason grade (bGG), sGS, sGG, MVD, and pathological tumor stage. A linear regression analysis was carried out for exogenous variables BF, BV, MTT, bGS, and presurgical biopsy-derived combined Gleason grade and endogenous variables sGS, sGG, MVD, and T stage. A receiver operating characteristics analysis was performed to analyze the discriminating performance of CTP parameters and bGS between intermediate-and high-grade tumors. RESULTS The mean perfusion parameters within the prostate tissue were as follows: BF, 39.1 ± 13.4 mL/100 mL min; BV, 4.9 ± 2.4 mL/100 mL; and MTT, 8.9 ± 3.7 seconds. The mean MVD of the tumor tissue was 144.3 ± 55.6/mm. Computed tomography perfusion parameters and MVD were significantly higher in patients with high-grade tumors compared with those with intermediate-grade tumors (P < 0.01 for BF, BV, and MVD). Only BV and MVD were significantly different among sGS and sGG groups. Moderate correlations were found between BF and sGS (0.38) and between BV and sGS (0.43). Linear relations of BV to sGS and to sGG were found.

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Section: Y14mentioning

confidence: 99%

Section: Y14mentioning

confidence: 99%

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Assessment of Prostate Cancer With Dynamic Contrast-Enhanced Computed Tomography Using an En Bloc Approach

Huellner¹,

Pauli²,

Mattei³

et al. 2014

Investigative Radiology

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“…[34][35][36] Indeed, MRI is known to be poor at detecting low-grade, low-volume cancer, lacking sensitivity even in cases where the predominant Gleason pattern is 4, but the cancer volume is <0.2 cm 3 . [36][37][38] These factors reflect the need for further advances in imaging to detect such lesions. We found that anterior lesions were more likely to be missed than lesions elsewhere within the prostate, which reflects the known difficulty in identifying cancer within the heterogeneous transition zone (TZ) and fibromuscular stroma.…”

Section: Discussionmentioning

confidence: 99%

Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

Serrao

Barrett

Wadhwa

et al. 2015

CUAJ

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Introduction: We characterized false negative prostate magnetic resonance imaging (MRI) reporting by using histology derived from MRI-transrectal ultrasound (TRUS)-guided transperineal (MTTP) fusion biopsies.Methods: In total, 148 consecutive patients were retrospectively reviewed. Men underwent multiparametric MRI (mpMRI), reported by a consultant/attending radiologist in line with European Society of Urogenital Radiology (ESUR) standards. MTTP biopsy of the lesions was performed according to the Ginsburg recommendations. Cases with an MRI-histology mismatch were identified and underwent a second read by an experienced radiologist. A third review was performed with direct histology comparison to determine a true miss from an MRI-occult cancer. Statistical analysis was performed with McNemar's test. Results: False negative lesions were identified in 29 MRI examinations (19.6%), with a total of 46 lesions. Most false negative lesions (21/46) were located in the anterior sectors of the prostate. The second read led to a significant decrease of false-negative lesions with 7/29 further studies identified as positive on a patientby-patient basis (24.1% of studies, p = 0.016) and 11/46 lesions (23.9%; p = 0.001). Of these, 30 lesions following the first read and 23 lesions after the second read were considered significant cancer according to the University College London criteria. However, on direct comparison with histology, most lesions were MRI occult. Conclusion: We demonstrate that MRI can fail to detect clinically relevant lesions. Improved results were achieved with a second read but despite this, a number of lesions remain MRI-occult. Further advances in imaging are required to reduce false negative results. IntroductionCurrent methods for risk stratification of prostate cancer, including serum prostate-specific antigen (PSA) and transrectal ultrasound (TRUS)-guided biopsies, are limited by sampling error and low sensitivity and specificity.1-3 TRUSbiopsy can lead to inaccurate grading of 32% to 42% of cancers, 4-6 and may fail to detect 30% to 50% of cancers, particularly tumours in the anterior portion of the prostate. 7-12The improvement in multiparametric magnetic resonance imaging (mpMRI) in detecting prostate cancer has led to its recommendation in high-risk patients following a negative TRUS biopsy.13 MRI can then be used to guide subsequent biopsy either cognitively, in-bore (direct MRI-targeting), or by using MRI-TRUS fusion techniques.14-17 The latter combines anatomical MRI localization with the real-time guidance of ultrasound. Repeat biopsy is often undertaken by the transperineal (TP) route as this offers potential advantages over a transrectal route, including better sampling of the anterior and apical regions of the prostate, reduced false negative results, and a sterile approach. 18 mpMRI has the potential to accurately exclude prostate cancer and reduce biopsy burden. 19,20 To achieve this, it must have a high negative predictive value (NPV) on a patient-by-patient basis and maintain ...

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“…Recent studies reported a sensitivity and specificity by MRI of 84.2 and 66.6% respectively in the detection of clinically low-risk PCa with Gleason scores less than or equal to 6. In contrast, cancers with higher Gleason grades, i.e., clinically significant tumors, had a detection accuracy of about 90 % (Kim et al 2014) and a negative predictive value of up to 95 % (Arumainayagam et al 2013). Other research groups found diffusion-weighted imaging (DWI) at 3 Tesla (T) alone detecting significant PCa with a sensitivity and specificity ranging from 89 to 91 % and 77 to 81 %, respectively (Bains et al 2014).…”

Section: The Role Of Magnetic Resonance Imaging (Mri) In the Diagnosimentioning

confidence: 99%

MR Imaging and MR Spectroscopy in Prostate Cancer

Willinek

Decker

Träber

2014

Radiotherapy in Prostate Cancer

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Low-Risk Prostate Cancer: The Accuracy of Multiparametric MR Imaging for Detection

Abstract: Detection of prostate cancer in patients with clinically low-risk cancer with multiparametric MR imaging is highly accurate, and larger cancer volume and higher Gleason grade are associated with higher detection accuracy.

Cited by 48 publications

References 28 publications

Assessment of Prostate Cancer With Dynamic Contrast-Enhanced Computed Tomography Using an En Bloc Approach

Assessment of Prostate Cancer With Dynamic Contrast-Enhanced Computed Tomography Using an En Bloc Approach

Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

MR Imaging and MR Spectroscopy in Prostate Cancer

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