Optimal protocol design for diffusion-weighted imaging of the prostate: an estimation theory examination of parameter estimate variance

Conlin, Christopher C.; Seibert, Tyler M.; Dale, Anders M.

doi:10.1101/2022.02.26.22271561

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…The development of advanced DWI methods such as RSI 3c lays the foundation for a quantitative, easily implemented, and cost-efficient framework for clinical use. The multi-component RSI 3c model uses globally determined, fixed component ADCs, thereby enabling rapid fitting ( 34 ) of the diffusion signal making it suitable for application as a turn-key processing stream on multiple MRI platforms ( 14 ). Acquisition-wise RSI 3c uses high b -value ranges (up to 4000 s/mm 2 in this study with a scan time of 4 minutes and 25 seconds) which only requires simple modifications to clinical breast MRI protocols which typically include low- and mid b -values (500-1000 s/mm 2 ).…”

Section: Discussionmentioning

confidence: 99%

Restriction spectrum imaging with elastic image registration for automated evaluation of response to neoadjuvant therapy in breast cancer

Andreassen,

Loubrie,

Tong

et al. 2023

Front. Oncol.

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PurposeDynamic contrast-enhanced MRI (DCE) and apparent diffusion coefficient (ADC) are currently used to evaluate treatment response of breast cancer. The purpose of the current study was to evaluate the three-component Restriction Spectrum Imaging model (RSI3C), a recent diffusion-weighted MRI (DWI)-based tumor classification method, combined with elastic image registration, to automatically monitor breast tumor size throughout neoadjuvant therapy.Experimental designBreast cancer patients (n=27) underwent multi-parametric 3T MRI at four time points during treatment. Elastically-registered DWI images were used to generate an automatic RSI3C response classifier, assessed against manual DCE tumor size measurements and mean ADC values. Predictions of therapy response during treatment and residual tumor post-treatment were assessed using non-pathological complete response (non-pCR) as an endpoint.ResultsTen patients experienced pCR. Prediction of non-pCR using ROC AUC (95% CI) for change in measured tumor size from pre-treatment time point to early-treatment time point was 0.65 (0.38-0.92) for the RSI3C classifier, 0.64 (0.36-0.91) for DCE, and 0.45 (0.16-0.75) for change in mean ADC. Sensitivity for detection of residual disease post-treatment was 0.71 (0.44-0.90) for the RSI3C classifier, compared to 0.88 (0.64-0.99) for DCE and 0.76 (0.50-0.93) for ADC. Specificity was 0.90 (0.56-1.00) for the RSI3C classifier, 0.70 (0.35-0.93) for DCE, and 0.50 (0.19-0.81) for ADC.ConclusionThe automatic RSI3C classifier with elastic image registration suggested prediction of response to treatment after only three weeks, and showed performance comparable to DCE for assessment of residual tumor post-therapy. RSI3C may guide clinical decision-making and enable tailored treatment regimens and cost-efficient evaluation of neoadjuvant therapy of breast cancer.

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Section: Discussionmentioning

confidence: 99%

Restriction spectrum imaging with elastic image registration for automated evaluation of response to neoadjuvant therapy in breast cancer

Andreassen,

Loubrie,

Tong

et al. 2023

Front. Oncol.

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Advanced Restriction imaging and reconstruction Technology for Prostate MRI (ART-Pro): Study protocol for a multicenter, multinational trial evaluating biparametric MRI and advanced, quantitative diffusion MRI for detection of prostate cancer

Baxter,

Conlin,

Bagrodia

et al. 2024

Preprint

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BackgroundMultiparametric MRI (mpMRI) is strongly recommended by current clinical guidelines for improved detection of clinically significant prostate cancer (csPCa). However, major limitations of mpMRI are the need for intravenous (IV) contrast and dependence on reader expertise. Efforts to address these issues include use of biparametric MRI (bpMRI) and advanced, quantitative MRI techniques. One such advanced technique is the Restriction Spectrum Imaging restriction score (RSIrs), an imaging biomarker that has been shown to improve quantitative accuracy of patient-level csPCa detection.PurposeTo evaluate whether IV contrast can be avoided in the setting of standardized, state-of-the-art image acquisition, with or without addition of RSIrs, and to evaluate characteristics of RSIrs as a stand-alone, quantitative biomarker.Design, setting, and participantsART-Pro is a multisite, multinational trial that will be conducted in two stages, evaluating bpMRI, mpMRI, and RSIrs on accuracy of expert (ART-Pro-1) and non-expert (ART-Pro-2) radiologists’ detection of csPCa. Additionally, RSIrs will be evaluated as a stand-alone, quantitative, objective biomarker (ART-Pro-1). This study will include a total of 500 patients referred for a multiparametric prostate MRI with a clinical suspicion of prostate cancer at any of the five participating sites (100 patients per site).InterventionIn ART-Pro-1, patients receive standard of care mpMRI, with addition of the RSI sequence, and subsets of the patients’ images are read separately by two expert radiologists, one of whom is the standard of care radiologist (Reader 1). Three research reports are generated using: bpMRI only (Reader 1), mpMRI (Reader 1), and bpMRI + RSIrs (Reader 2). The clinical report is submitted by Reader 1. Patients’ future prostate cancer management will be recorded and used to evaluate the performance of the MRI techniques being tested.In ART-Pro-2, the dataset created in ART-Pro-1 will be retrospectively reviewed by radiologists of varying experience level (novice, basic, and expert). Radiologists will be assigned to read cases and record research reports while viewing subsets of either mpMRI only or RSIrs + mpMRI. Patient cases will be read by two readers from each experience level (6 reads total), and findings will be evaluated against the expertly created dataset from ART-Pro-1.Outcome measurements and statistical analysisThe primary endpoint is to evaluate if bpMRI is non-inferior to mpMRI among expert radiologists (ART-Pro-1) and non-expert radiologists (ART-Pro-2) for detection of grade group (GG) ≥2 csPCa. We will conduct one-sided non-inferiority tests of correlated proportions (ART-Pro-1) and use McNemar’s test and AUC to test the null hypothesis of non-inferiority (ART-Pro-1 and ART-Pro-2).ConclusionsThis trial is registered in the US National Library of Medicine Trial Registry (NCT number:NCT06579417) atClinicalTrials.gov. Patient accrual at the first site (UC San Diego) began in December 2023. The expected trial timeline is three years to complete accrual with a six-month endpoint.

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Optimal protocol design for diffusion-weighted imaging of the prostate: an estimation theory examination of parameter estimate variance

Cited by 2 publications

References 22 publications

Restriction spectrum imaging with elastic image registration for automated evaluation of response to neoadjuvant therapy in breast cancer

Restriction spectrum imaging with elastic image registration for automated evaluation of response to neoadjuvant therapy in breast cancer

Advanced Restriction imaging and reconstruction Technology for Prostate MRI (ART-Pro): Study protocol for a multicenter, multinational trial evaluating biparametric MRI and advanced, quantitative diffusion MRI for detection of prostate cancer

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