Magnet Before the Needle Commentary on: MRI-targeted or Standard Biopsy for Prostate-cancer Diagnosis (PRECISION Trial)

Merrett, Christopher; Mannas, Miles; Black, Peter C.; Zargar, Homayoun

doi:10.1016/j.urology.2018.04.024

“…Reducing the volume over which the field must be generated may also reduce power needs 29 . Furthermore, prostate MRI is a rapidly growing application, as it is increasingly recognized as a cost-effective step following elevated PSA [31][32][33][34][35][36][37] . Therefore, this was chosen for a first and ideal organ to benefit from this class of device.…”

Section: Appendix I)mentioning

confidence: 99%

Feasibility of Diffusion Weighting with a Local Inside-Out Nonlinear Gradient Coil for Prostate MRI

Bhuiyan

¹

,

Dewdney

²

,

Weinreb

³

et al. 2021

Preprint

0

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Purpose: Prostate cancer remains the 2nd leading cancer killer of men, yet it is also a disease with a high rate of overtreatment. Diffusion weighted imaging (DWI) has shown promise as a reliable, grade-sensitive imaging method, but it is limited by low image quality. Currently, DWI image quality is directly related to low gradient ampli-tudes, since weak gradients must be compensated with long echo times. Methods: We propose a new type of MRl accessory, an "inside-out" and nonlinear gradient, whose sole purpose is to deliver diffusion encoding to a region of interest. Performance was simulated in OPERA and the resulting fields were used to simulate DWI with two compartment and kurtosis models. Experiments with a nonlinear head gradient prove the accuracy of DWI and ADC maps diffusion encoded with nonlinear gradients. Results: Simulations validated thermal and mechanical safety while showing a 5 to 10-fold increase in gradient strength over prostate. With these strengths, lesion CNR in ADC maps approximately doubled for a range of anatomical positions. Proof-of-principle experiments show that spatially varying b-values can be corrected for accurate DWI and ADC. Conclusions: Dedicated nonlinear diffusion encoding hardware could improve prostate DWI.

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“…Reducing the volume over which the field must be generated may also reduce power needs 29 . Furthermore, prostate MRI is a rapidly growing application, as it is increasingly recognized as a cost-effective step following elevated PSA [31][32][33][34][35][36][37] . Therefore, this was chosen for a first and ideal organ to benefit from this class of device.…”

Section: Appendix I)mentioning

confidence: 99%

Feasibility of Diffusion Weighting with a Local Inside-Out Nonlinear Gradient Coil for Prostate MRI

Bhuiyan¹,

Dewdney²,

Weinreb³

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: Prostate cancer remains the 2nd leading cancer killer of men, yet it is also a disease with a high rate of overtreatment. Diffusion weighted imaging (DWI) has shown promise as a reliable, grade-sensitive imaging method, but it is limited by low image quality. Currently, DWI image quality is directly related to low gradient ampli-tudes, since weak gradients must be compensated with long echo times. Methods: We propose a new type of MRl accessory, an "inside-out" and nonlinear gradient, whose sole purpose is to deliver diffusion encoding to a region of interest. Performance was simulated in OPERA and the resulting fields were used to simulate DWI with two compartment and kurtosis models. Experiments with a nonlinear head gradient prove the accuracy of DWI and ADC maps diffusion encoded with nonlinear gradients. Results: Simulations validated thermal and mechanical safety while showing a 5 to 10-fold increase in gradient strength over prostate. With these strengths, lesion CNR in ADC maps approximately doubled for a range of anatomical positions. Proof-of-principle experiments show that spatially varying b-values can be corrected for accurate DWI and ADC. Conclusions: Dedicated nonlinear diffusion encoding hardware could improve prostate DWI.

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“…In 2019 the EAU guidelines based on several trials (PRECISION, MRI-FIRST…) recommended the use of MRI in all patients at increased risk of PCa 35,36 . The use of MRI in first set biopsies improves the detection of clinically significant cancer and is cost effective.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The role of immune PSA complex (iXip) in the prediction of prostate cancer

Lombardo

¹

,

Tema

²

,

Albanesi

³

et al. 2020

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PURPOSE:To analyze the performance of iXip in the prediction of prostate cancer (PCa) and high-grade prostate cancer. METHODS:A consecutive series of men undergoing MRI/FUSION prostate biopsies were enrolled in one center. Indications for prostate biopsy included abnormal prostate specific antigen levels (PSA>4ng/ml) and/or abnormal digital rectal examination (DRE) and/or abnormal MRI. All patients underwent the evaluation of serum PSA-IgM concentration and the iXip ratio was calculated. Accuracy iXip for the prediction of prostate cancer was evaluated using multivariable binary regression analysis and receiver operator characteristics (ROC) curves. RESULTS:Overall 160 patients with a median age of 65 (62/73) years were enrolled.Overall, 42% patients were diagnosed with prostate cancer and 75% of them had highgrade cancer (Epstein ≥3). Patients with prostate cancer were older and presented higher PSA levels, higher PIRADS scores and lower prostate volumes. On ROC analysis iXip presented an area under the curve (AUC) of 0,57 in the prediction of PCa and of 0,54 for the prediction of high-grade prostate cancer. CONCLUSION:In our experience, immune PSA complexes are not predictors of PCa. iXip analysis should not be included in the diagnostic pathway of patients at increased risk of PCa.

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Magnet Before the Needle Commentary on: MRI-targeted or Standard Biopsy for Prostate-cancer Diagnosis (PRECISION Trial)

Cited by 7 publications

References 7 publications

Feasibility of Diffusion Weighting with a Local Inside-Out Nonlinear Gradient Coil for Prostate MRI

Feasibility of Diffusion Weighting with a Local Inside-Out Nonlinear Gradient Coil for Prostate MRI

Feasibility of Diffusion Weighting with a Local Inside-Out Nonlinear Gradient Coil for Prostate MRI

The role of immune PSA complex (iXip) in the prediction of prostate cancer

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