HomeRadiology: Imaging CancerVol. 5, No. 1 PreviousNext CommentaryNext-Generation Diffusion Imaging of Osseous MetastasesDaniel Margolis Daniel Margolis Author AffiliationsFrom the Department of Radiology, Weill Cornell Imaging, NewYork-Presbyterian, 525 E 68th St, Box 141, New York, NY 10021.Address correspondence to the author (email: [email protected]).Daniel Margolis Published Online:Jan 27 2023https://doi.org/10.1148/rycan.220167MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1. Trabulsi EJ, Rumble RB, Jadvar H, et al. Optimum imaging strategies for advanced prostate cancer: ASCO guideline. J Clin Oncol 2020;38(17):1963–1996. Crossref, Medline, Google Scholar2. Schlemmer HP, Schäfer J, Pfannenberg C, et al. Fast whole-body assessment of metastatic disease using a novel magnetic resonance imaging system: initial experiences. Invest Radiol 2005;40(2):64–71. Crossref, Medline, Google Scholar3. Costelloe CM, Kundra V, Ma J, . Fast Dixon whole-body MRI for detecting distant cancer metastasis: a preliminary clinical study. J Magn Reson Imaging 2012;35(2):399–408. Crossref, Medline, Google Scholar4. Ballon D, Watts R, Dyke JP, et al. Imaging therapeutic response in human bone marrow using rapid whole-body MRI. Magn Reson Med 2004;52(6):1234–1238. Crossref, Medline, Google Scholar5. Lecouvet FE, El Mouedden J, Collette L, et al. Can whole-body magnetic resonance imaging with diffusion-weighted imaging replace Tc 99m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer? Eur Urol 2012;62(1):68–75. Crossref, Medline, Google Scholar6. Padhani AR, Lecouvet FE, Tunariu N, et al. METastasis Reporting and Data System for Prostate Cancer: Practical Guidelines for Acquisition, Interpretation, and Reporting of Whole-body Magnetic Resonance Imaging-based Evaluations of Multiorgan Involvement in Advanced Prostate Cancer. Eur Urol 2017;71(1):81–92. Crossref, Medline, Google Scholar7. Shukla-Dave A, Obuchowski NA, Chenevert TL, et al. Quantitative imaging biomarkers alliance (QIBA) recommendations for improved precision of DWI and DCE-MRI derived biomarkers in multicenter oncology trials. J Magn Reson Imaging 2019;49(7):e101–e121. Crossref, Medline, Google Scholar8. Conlin CC, Feng CH, Digma LA, et al. A multicompartmental diffusion model for improved assessment of whole-body diffusion-weighted imaging data and evaluation of prostate cancer bone metastases. Radiol Imaging Cancer 2023;5(1):e210115. Link, Google Scholar9. McCammack KC, Schenker-Ahmed NM, White NS, et al. Restriction spectrum imaging improves MRI-based prostate cancer detection. Abdom Radiol (NY) 2016;41(5):946–953. Crossref, Medline, Google ScholarArticle HistoryReceived: Nov 21 2022Revision requested: Dec 2 2022Revision received: Dec 7 2022Accepted: Dec 12 2022Published online: Jan 27 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleA Multicompartmental Diffusion Model for Improved Assessment of Whole-Body Diffusion-weighted Imaging Data and Evaluation of Prostate Cancer Bone MetastasesJan 27 2023Radiology: Imaging CancerRecommended Articles Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of SpreadRadioGraphics2019Volume: 39Issue: 1pp. 186-212Prostate-specific Membrane Antigen PET in Prostate CancerRadiology2021Volume: 299Issue: 2pp. 248-260Effect of 18F-DCFPyL PET/CT on the Management of Patients with Recurrent Prostate Cancer: Results of a Prospective Multicenter Registry TrialRadiology2022Volume: 303Issue: 2pp. 414-422Clinical PET Imaging in Prostate CancerRadioGraphics2017Volume: 37Issue: 5pp. 1512-1536177Lu–Prostate-specific Membrane Antigen Radioligand Therapy in Patients with Metastatic Castration-resistant Prostate CancerRadiology2022Volume: 306Issue: 2See More RSNA Education Exhibits The Light From The Unknown - PSMA PET/MR Staging For Prostate CancerDigital Posters2021Practical Interpretation of 18F PSMA PET/CT: Spectrum of FindingsDigital Posters2022Uncommon Lymph Node Metastasis Of Prostate Cancer: Who Are They?Digital Posters2021 RSNA Case Collection Hydrogel infiltration into rectal wallRSNA Case Collection2020Locally advanced, metastatic prostate adenocarcinomaRSNA Case Collection2020Radioembolization of Liver Metastasis RSNA Case Collection2020 Vol. 5, No. 1 Metrics Altmetric Score PDF download

Epiphyseal, articular, and physeal cartilage play a crucial role in skeletal maturation. This chapter discusses growth and development of long bones highlighting the changing appearance of physeal and epiphyseal cartilage throughout childhood. The imaging appearance of normal structures will be described with a focus on MR (magnetic resonance) imaging. Optimal MR imaging sequences will be discussed as well as common injuries that affect maturing cartilage in children.

HomeRadiologyVol. 291, No. 3 PreviousNext Reviews and CommentaryFree AccessEditorialVying for Standardization of Bladder Cancer MRI Interpretation and Reporting: VI-RADSDaniel J. A. Margolis , Jim C. HuDaniel J. A. Margolis , Jim C. HuAuthor AffiliationsFrom the Departments of Radiology (D.J.A.M.) and Urology (J.C.H.), Weill Cornell Medical College/New York-Presbyterian Hospital, 525 E 68th St, Box 141, New York, NY 10021.Address correspondence to D.J.A.M. (e-mail: [email protected]).Daniel J. A. Margolis Jim C. HuPublished Online:Apr 23 2019https://doi.org/10.1148/radiol.2019190648MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In See also the article by Wang and Luo et al in this issue.IntroductionThe development of structured or standardized reporting systems has been an increasingly popular pursuit in the field of medical imaging. The archetype is the Breast Imaging–Reporting and Data System, or BI-RADS, which was developed to unify the performance, assessment, and reporting of mammography. The ability to provide a uniform method for communication of the suspicion level for breast cancer allowed mammography to be a proven tool for decreasing breast cancer mortality (1). This has transformed not only the concept of breast cancer screening but the role of the radiologist in management of patient care. Using BI-RADS as a template, this concept of improving the value of diagnostic reporting has been applied to lung cancer screening and many other disease processes, including liver, prostate, and bladder cancers.Bladder cancer is the eighth leading cause of cancer death in American men, with over 80 000 incident cases expected in 2019 (2). The management of bladder cancer hinges on the stage of the tumor at the time it is identified and the determination of whether it constitutes superficial versus muscle-invasive disease, as over 30% of incident bladder cancers fall into the latter category. Accurate assessment of the superficial versus muscle-invasive stage is crucial for choosing between therapies that are radically different: transurethral resection of bladder tumor, a superficial excision done during cystoscopy, versus partial or complete cystectomy with possible chemotherapy and radiation therapy, which is performed for muscle-invasive disease. A diagnostic technique that could accurately enable this determination could spare patients from additional invasive procedures and potentially unnecessary surgery. MRI, with excellent soft-tissue characterization and functional assessment using diffusion-weighted imaging and dynamic contrast material enhancement, is a prime candidate. Understanding the performance of MRI depends on a standardized method for acquiring, assessing, and reporting data. Thus, the "RADS" methodology has been applied to bladder cancer with the resultant paradigm of Vesical Imaging–Reporting and Data System (VI-RADS) (3).In this issue of Radiology, Wang and colleagues addressed the core question of whether MRI can help accurately categorize patients with bladder cancer based on what form of management is appropriate (4). This assessment scheme achieved very high performance, with an area under the receiver operating characteristic curve of 0.94, specificity (for VI-RADS score ≥ 3) of 96.5%, and, possibly just as importantly, an inter-reader kappa statistic of 0.92. Fifty-six of the 340 tumors were assigned a VI-RADS score of 4 or 5; all 56 had muscle-invasive disease. Conversely, none of the 29 tumors given a VI-RADS score of 1 had muscle-invasive disease. Fewer than 5% (11 of 228) of tumors assigned a VI-RADS score of 2 had muscle-invasive disease. Although fewer than 10% of tumors (27 of 340) were given a VI-RADS score of 3, performance in this group was expectedly less accurate, with two-thirds classified as muscle-invasive disease, and therefore was of limited utility to accurately predict stage.Given that all tumors assigned a VI-RADS score of 4 or 5 were associated with muscle-invasive disease, this score could justify definitive treatment of muscle-invasive tumors with positive findings at urine cytology. The average age at diagnosis of bladder cancer is 73 years, and many of these patients have clinically significant comorbidities, including coronary artery disease and emphysema. Thus, sparing these patients additional invasive procedures and sedation or general anesthesia may have a substantial impact on work-up–associated morbidity and their overall quality of life. That MRI provides the location and size of the tumor would be an added benefit to surgical planning, especially if the tumor's location would impact ureteral reimplantation. However, MRI has shown variable performance in identifying node-positive disease, with sensitivities ranging from 41% to 100% (5,6). In these cases, fluorine 18 fluorodeoxyglucose (FDG) PET/CT or PET/MRI could be considered for improved nodal staging. A study directly comparing MRI with FDG PET/MRI in 22 patients with bladder cancer found that FDG PET/MRI had greater accuracy in the detection of lymph node metastases (95% vs 76% for MRI alone) (7).Alternatively, a VI-RADS score of 1 or 2 may provide an extra degree of confidence for choosing conservative, superficial treatment. Generally, these patients would undergo transurethral resection of bladder tumor to both confirm the diagnosis and constitute definitive treatment; in that sense, MRI would not alter management. However, the added degree of confidence may alter follow-up, as the tumors for up to 48% of patients are understaged by the initial transurethral resection of bladder tumor (8). MRI could be considered as an alternative to the standard-of-care surveillance cystoscopy, especially for patients at greater risk from anesthesia.The study by Wang and colleagues is not without some limitations. Only the index lesion was evaluated. Bladder cancer is often a multifocal disease, with synchronous primary tumors estimated to occur in up to 30% of cases. If MRI is only effective at characterizing the index lesion, this may result in a degree of false confidence. This could be especially dangerous for focal therapies. Additionally, this was not a true screening-positive population; the study population was derived from patients referred for MRI of known bladder cancer. Therefore, the generalizability to a population with positive cytologic findings or even all patients with positive cystoscopic findings is unknown. Additionally, patients with recurrent disease were excluded from this analysis so its applicability to that patient group is similarly unclear. The investigators used intravenous contrast material in their analysis, as is recommended for VI-RADS characterization. However, the use of contrast material increases the cost and risk to the patient and, while the investigators report the number of muscle-invasive tumors for each category and the performance with contrast-enhanced imaging alone, the degree to which this influenced the overall categorization is not reported. While the sex and age distributions are similar to those in Western countries, the comorbidities, which might influence not only disease severity but choice of diagnostic and therapeutic techniques, are unavailable.These results reinforce the value of MRI for assessing bladder cancer stage. The interest in using MRI to stage bladder cancer dates back over 3 decades (9). A recent meta-analysis identified 30 studies of MRI for bladder cancer staging (10). The pooled specificity for stage T1 or lower versus stage T2 or higher (worse) was only 79%. The accuracy, however, was higher in studies at low risk of bias. Single-center studies using T2- and diffusion-weighted imaging with dynamic contrast enhancement have shown accuracy as high as 94% in 82 subjects, however.As impressive as the performance of MRI is, it is not without competing technologies—including visual inspection at cystoscopy itself. Cystoscopy is purported to be up to 93% accurate at predicting non–muscle-invasive cancers (11). Additionally, transabdominal US and fluorescence cystoscopy have shown improved value in predicting the stage of bladder cancer. Even in the aforementioned trial of PET/MRI versus MRI alone, PET improved accuracy for the primary bladder tumor from 77% to 86%. Randomized trials and cost-effectiveness studies are needed to compare new diagnostic modalities to established standards as well as to each other, particularly with the pivot toward value-based care in most systems nationally.Despite the aforementioned limitations, the study by Wang et al is a very promising single-center retrospective evaluation of a standardized method for evaluating MRI of bladder cancer to determine the stage of bladder wall invasion. It should stimulate practices not currently using MRI for bladder cancer staging to consider it. Hopefully, it will also kindle enthusiasm for prospective multicenter trials to confirm these encouraging findings. If this method for staging bladder cancer is validated, it would be a powerful prognostic tool for the management of this common disease.Disclosures of Conflicts of Interest: D.J.A.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed that his institution is the recipient of an in-kind research grant from Siemens Healthineers. J.C.H. disclosed no relevant relationships.J.C.H. supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.References1. Engel JM, Stankowski-Drengler TJ, Stankowski RV, Liang H, Doi SA, Onitilo AA. All-cause mortality is decreased in women undergoing annual mammography before breast cancer diagnosis. AJR Am J Roentgenol 2015;204(4):898–902. Crossref, Medline, Google Scholar2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017;67(1):7–30. Crossref, Medline, Google Scholar3. Panebianco V, Narumi Y, Altun E, et al. Multiparametric magnetic resonance imaging for bladder cancer: development of VI-RADS (Vesical Imaging-Reporting And Data System). Eur Urol 2018;74(3):294–306. Crossref, Medline, Google Scholar4. Wang H, Luo C, Zhang F, et al. Multiparametric MRI for bladder cancer: validation of VI-RADS for the detection of detrusor muscle invasion. Radiology 2019. https://doi.org/10.1148/radiol.2019182506. Published online April 23, 2019. Link, Google Scholar5. Daneshmand S, Ahmadi H, Huynh LN, Dobos N. Preoperative staging of invasive bladder cancer with dynamic gadolinium-enhanced magnetic resonance imaging: results from a prospective study. Urology 2012;80(6):1313–1318. Crossref, Medline, Google Scholar6. Persad R, Kabala J, Gillatt D, Penry B, Gingell JC, Smith PJ. Magnetic resonance imaging in the staging of bladder cancer. Br J Urol 1993;71(5):566–573. Crossref, Medline, Google Scholar7. Rosenkrantz AB, Friedman KP, Ponzo F, et al. Prospective pilot study to evaluate the incremental value of PET information in patients with bladder cancer undergoing 18F-FDG simultaneous PET/MRI. Clin Nucl Med 2017;42(1):e8–e15. Crossref, Medline, Google Scholar8. Ark JT, Keegan KA, Barocas DA, et al. Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy. BJU Int 2014;113(6):894–899. Crossref, Medline, Google Scholar9. Salo JO, Kivisaari L, Lehtonen T. Comparison of magnetic resonance imaging with computed tomography and intravesical ultrasound in staging bladder cancer. Urol Radiol 1988;10(4):167–172. Crossref, Medline, Google Scholar10. Gandhi N, Krishna S, Booth CM, et al. Diagnostic accuracy of magnetic resonance imaging for tumour staging of bladder cancer: systematic review and meta-analysis. BJU Int 2018;122(5):744–753. Crossref, Medline, Google Scholar11. Puneet A, Balagopal N, Ginil K, Georgie M, Sanjeevan KV, Appu T. Correlation of transabdominal ultrasonography and cystoscopy in follow-up of patients with non-muscle invasive bladder cancer. Indian J Surg Oncol 2017;8(4):548–553. Crossref, Medline, Google ScholarArticle HistoryReceived: Mar 20 2019Revision requested: Mar 26 2019Revision received: Apr 4 2019Accepted: Apr 4 2019Published online: Apr 23 2019Published in print: June 2019 FiguresReferencesRelatedDetailsCited ByDiagnostic Imaging: OnkologieAkram M.Shaaban, MadhuriRudolph2022French AFU Cancer Committee Guidelines - Update 2022-2024: Non-muscle-invasive bladder cancer (NMIBC)Y.Neuzillet, B.Pradère, E.Xylinas, Y.Allory, F.Audenet, Y.Loriot, A.Masson-Lecomte, M.Roumiguié, T.Seisen, O.Traxer, P.Leon, M.Roupret2022 | Progrès en Urologie, Vol. 32, No. 15Imagerie OncologiqueAkram M.Shaaban, MaryamRezvani, Philip R.Chapman2022Vesical Imaging-Reporting and Data System (VI-RADS®): experiencia inicial en la clasificación del cáncer de vejiga músculo-infiltranteJ.Etxano, B.Rodríguez-Vigil, F.Pérez, P.Beardo, A.Viguri, E.Tolosa, B.Martínez de Guereñu2021 | Actas Urológicas Españolas, Vol. 45, No. 4Vesical Imaging-Reporting and Data System (VI-RADS®): Initial experience in the classification of muscle-invasive bladder cancerJ.Etxano, B.Rodríguez-Vigil, F.Pérez, P.Beardo, A.Viguri, E.Tolosa, B.Martínez de Guereñu2021 | Actas Urológicas Españolas (English Edition), Vol. 45, No. 4Re: Yunjin Bai, Yubo Yang, and Yin Tang's Letter to the Editor re: Andrea Necchi, Marco Bandini, Giuseppina Calareso, et al. Multiparametric Magnetic Resonance Imaging as a Noninvasive Assessment of Tumor Response to Neoadjuvant Pembrolizumab in Muscle-invasive Bladder Cancer: Preliminary Findings from the PURE-01 Study. Eur Urol 2020;77:636–43. Eur Urol 2020;77:e158HelenaVila-Reyes, G. JoelDeCastro, James M.McKiernan2021 | European Urology, Vol. 79, No. 1Recommandations françaises du Comité de cancérologie de l'AFU – actualisation 2020–2022 : tumeurs de la vessieM.Rouprêt, G.Pignot, A.Masson-Lecomte, E.Compérat, F.Audenet, M.Roumiguié, N.Houédé, S.Larré, S.Brunelle, E.Xylinas, Y.Neuzillet, A.Méjean2020 | Progrès en Urologie, Vol. 30, No. 12Bedeutung der VI-RADS-Klassifikation für die Bildgebung beim Harnblasenkarzinom – Stand der DingeV.Hechler, M.Rink, D.Beyersdorff, M.Beer, A. J.Beer, V.Panebianco, M.Pecoraro, C.Bolenz, G.Salomon2019 | Der Urologe, Vol. 58, No. 12Accompanying This ArticleMultiparametric MRI for Bladder Cancer: Validation of VI-RADS for the Detection of Detrusor Muscle InvasionApr 23 2019RadiologyRecommended Articles Multiparametric MRI for Bladder Cancer: Validation of VI-RADS for the Detection of Detrusor Muscle InvasionRadiology2019Volume: 291Issue: 3pp. 668-674Multiparametric MRI Evaluation of VI-RADS for Bladder Tumors Located at the Ureteral OrificeRadiology2022Volume: 304Issue: 3pp. 593-599Delayed 18F FDG PET/CT Imaging in the Assessment of Residual Tumors after Transurethral Resection of Bladder CancerRadiology2019Volume: 293Issue: 1pp. 144-150The Diagnostic Value of MR Imaging in Differentiating T Staging of Bladder Cancer: A Meta-AnalysisRadiology2017Volume: 286Issue: 2pp. 502-511Amide Proton Transfer-weighted MRI in Predicting Histologic Grade of Bladder CancerRadiology2022Volume: 305Issue: 1pp. 127-134See More RSNA Education Exhibits Bladder Neoplasm Revisited: What the Surgeon Should KnowDigital Posters2020VIRADS In Bladder Cancer - A Practical ApproachDigital Posters2021Pearls and Pitfalls of VI-RADS (Vesical Imaging-Reporting and Data System)Digital Posters2020 RSNA Case Collection Malignancy on abbreviated screening breast MRIRSNA Case Collection2020Recurrent breast cancer on CEUSRSNA Case Collection2021Multifocal breast cancerRSNA Case Collection2020 Vol. 291, No. 3 Metrics Altmetric Score PDF download

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I1 Apr 2017PD28-07 TRACKING OF PRIOR POSITIVE SITES BY MRI/US FUSION IMPROVES DETECTION OF GLEASON SCORE UPGRADING Edward Chang, Tonye Jones, Daniel Margolis, Jiaoti Huang, Shyam Natarajan, Devi Sharma, Merdie Delfin, Frederick Dorey, and Leonard Marks Edward ChangEdward Chang More articles by this author , Tonye JonesTonye Jones More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Jiaoti HuangJiaoti Huang More articles by this author , Shyam NatarajanShyam Natarajan More articles by this author , Devi SharmaDevi Sharma More articles by this author , Merdie DelfinMerdie Delfin More articles by this author , Frederick DoreyFrederick Dorey More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1241AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason Score (GS) upgrading is seen during subsequent biopsy in up to one-third of men in active surveillance (A.S.) programs. Most A.S. biopsies have been performed in a blind fashion. Using MRI/US fusion biopsy, follow-up targeting of MRI lesions can now be performed. We sought to compare such MRI-targeted follow-up biopsies with biopsy of tumor spots outside of MRI-visible lesions. The latter biopsy method, called tracking biopsy, is another feature of MRI/US fusion but has been rarely reported. METHODS Subjects were 138 consecutive men (mean age 63.4 years) enrolled in A.S. (2009-2016), who had 2 subsequent MRI/US fusion (Artemis) biopsies: confirmatory (6-12 months after initial diagnosis) and surveillance (12 months after that). At confirmatory biopsy, MRI targets and a 12-core template were sampled. At surveillance biopsy, MRI lesions were sampled again and tumor spots detected previously by systematic biopsy were also re-sampled, using the 3D tracking function of the Artemis device (accurate within 3 mm) (Figure). At surveillance biopsy, approximately 5 cores were taken by targeting and 5 by tracking. All men had GS6 lesions at confirmatory biopsy. Upgrading to GS≥3+4 at surveillance biopsy was the endpoint. RESULTS At surveillance biopsy, mean PSA was 4.5 ng/ml (IQR 2.6-5.9) and prostate volume was 46.3 cc (IQR 34.5-59.0). Overall rate of upgrading was 19% (26/138). When MRI-visible lesions were resampled without any tracking biopsies being taken (N=59), upgrading was found in 8 (13%). When prior tumor was sampled by tracking an MRI-invisible lesion (N=23), upgrading was found in 6 (24%). When both targeted and tracking biopsies were performed (N=56), upgrading was found in 12 (21%). Of 56 men having both biopsy methods, upgrading in 12 was detected by targeting in 8 and by tracking in 8; however, 4 of the upgrades (50%) were not detected by each method. Upgrading beyond GS7 was only seen in one patient. CONCLUSIONS At surveillance biopsy for men on A.S., tracking biopsy detects GS upgrading as often as biopsies targeting MRI lesions. However, 50% of upgrading detected by one method were missed by the other. Combining methods increased detection of GS upgrading. Tracking of prior positive sites, even when outside of MRI-visible lesions, is a valuable addition to A.S. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e520 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Edward Chang More articles by this author Tonye Jones More articles by this author Daniel Margolis More articles by this author Jiaoti Huang More articles by this author Shyam Natarajan More articles by this author Devi Sharma More articles by this author Merdie Delfin More articles by this author Frederick Dorey More articles by this author Leonard Marks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Prostate Imaging-Reporting and Data System has been developed to standardize prostate MRI in terms of acquisition, interpretation and reporting. It received a major revision in late 2014 (PI-RADSv2). Recently, doubts have been raised on imaging facilities adherence to its acquisition protocol. With this systematic review, we assessed adherence to PI-RADSv2 minimum technical specifications in literature, to achieve a better understanding of issues limiting their diffusion.Multiple medical literature databases were extensively searched to retrieve original studies published after January 2016 performing prostate MRI. Information pertaining acquisition protocols and patient enrolment were recorded for analysis. Technical parameters were dichotomized in relation to adherence to the corresponding minimal technical requirements.A total of 150 studies were included for analysis. Only 5% reported every technical parameter specified in the PI-RADSv2 document requirements, none of which completely met guideline specifications. Overall, 19% were in line with PI-RADSv2 for all reported MRI acquisition parameters. The adherence was lowest for T2-weighted frequency in-plane resolution (12%), diffusion-weighted imaging field of view (40%), apparent diffusion coefficient map low b-value (27%) and dynamic contrast-enhanced imaging temporal resolution (43%). Considering its role in image interpretation, it must be highlighted that only 59% of studies reporting diffusion-weighted imaging high b-value follow recommendations.Adherence to PI-RADSv2 minimum technical standards is heterogeneous in the scientific community. Our findings endorse the need for greater diffusion of PI-RADSv2 guidelines to achieve protocol standardization and support the notion that some requirements might benefit from streamlining to improve clinical applicability.

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-13 INFORMING FOCAL THERAPY MARGINS THROUGH MRI-PATHOLOGY CORRELATION Alan Priester, Khoshnoodi Pooria, Shellee Ogawa, Jesse Le, James Garritano, Bryan Radosavcev, Daniel Margolis, Robert Reiter, Jiaoti Huang, Warren Grundfest, Shyam Natarajan, and Leonard Marks Alan PriesterAlan Priester More articles by this author , Khoshnoodi PooriaKhoshnoodi Pooria More articles by this author , Shellee OgawaShellee Ogawa More articles by this author , Jesse LeJesse Le More articles by this author , James GarritanoJames Garritano More articles by this author , Bryan RadosavcevBryan Radosavcev More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Robert ReiterRobert Reiter More articles by this author , Jiaoti HuangJiaoti Huang More articles by this author , Warren GrundfestWarren Grundfest More articles by this author , Shyam NatarajanShyam Natarajan More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2842AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multi-parametric MRI (mpMRI) appears to be a robust method for imaging prostate cancer (CaP) and guiding targeted interventions. However, the spatial relationship between MRI-visible regions of interest (ROIs) and areas of known CaP is incompletely understood. We aimed to clarify that relationship and characterize the treatment margins necessary for effective focal therapy. METHODS Prior to radical prostatectomy, 65 men underwent mpMRI, from which a radiologist contoured the prostate capsule and regions suspicious for CaP. A custom mold was then 3D printed from the patient′s MRI and used for precise sectioning of the surgical specimen. This mold facilitated accurate matching of the delineated slides (Fig 1A) with preoperative mpMRI (Fig 1B). All tumors found on pathology were digitally reconstructed in 3D and matched to corresponding MRI targets (n = 71). The geometric features of all surfaces and the maximum distance between each MRI target and matched tumor were determined using custom software. RESULTS Spatial features of ROIs and tumors are summarized in Table 1. The mean volume and longest axis of the prostate capsule corresponded closely with MRI measurements, yet the mean volume of CaP was 2.7 times greater than the ROI predictions. The mean longest axis on MRI was found to be 16.8 mm, whereas the mean longest axis on pathology was 27.5 mm. Due to tumor asymmetry, CaP extended an average of 15 mm beyond the ROI along at least one axis (Fig 1C). Retrospectively, only a minority of these tumor extensions was identifiable on MRI. CONCLUSIONS MRI underestimated CaP volume by a factor of 2.7 (0.9 cc on MRI vs 2.4 cc on pathology). Using MRI targeting alone, effective focal therapy would need to include substantial margins around the ROI (median 15 mm). In practice, this margin could be reduced using tracked biopsy information or better imaging to characterize tumor asymmetry. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e313 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alan Priester More articles by this author Khoshnoodi Pooria More articles by this author Shellee Ogawa More articles by this author Jesse Le More articles by this author James Garritano More articles by this author Bryan Radosavcev More articles by this author Daniel Margolis More articles by this author Robert Reiter More articles by this author Jiaoti Huang More articles by this author Warren Grundfest More articles by this author Shyam Natarajan More articles by this author Leonard Marks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy1 Apr 2016MP18-11 MR-GUIDED FOCAL LASER ABLATION OF INTERMEDIATE RISK PROSTATE CANCER: PHASE I TRIAL Shyam Natarajan, Steven Raman, Alan Priester, James Garritano, Daniel Margolis, Patricia Lieu, Maria Macairan, Jiaoti Huang, Warren Grundfest, and Leonard Marks Shyam NatarajanShyam Natarajan More articles by this author , Steven RamanSteven Raman More articles by this author , Alan PriesterAlan Priester More articles by this author , James GarritanoJames Garritano More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Patricia LieuPatricia Lieu More articles by this author , Maria MacairanMaria Macairan More articles by this author , Jiaoti HuangJiaoti Huang More articles by this author , Warren GrundfestWarren Grundfest More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2712AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Focal laser ablation (FLA) under MRI guidance is a promising method to treat prostate cancer (CaP), but available information is limited. Prior work is largely unpublished and consists mostly of transperineal FLA performed by radiologists in low-risk patients. Herein we describe 6-month results from a prospective Phase I trial of transrectal FLA in an intermediate risk population. METHODS 8 men (58-73 y.o.) with biopsy-proven intermediate risk CaP (all but one Gleason 3+4), located in one MRI target (Fig., A), were enrolled in an IRB-approved clinical trial. FLA was performed under MRI guidance (in bore) transrectally; MRI-compatible thermal probes were also placed into the prostate transperineally under US guidance to determine treatment temperatures at intra-prostatic sites, independent of MR thermometry (MRT) (Fig., B,C). A 980-nm, 15 W fiber-coupled laser system was used to treat each target (4-9 laser applications per patient). Multi-parametric MRI was obtained immediately following treatment to determine ablation effect (Fig., D). RESULTS In-bore transrectal FLA was well-tolerated under conscious sedation. All patients were discharged within 4 hours of FLA and have been followed ≥ 6 months without any grade 3 adverse events. The non-perfused tissue, i.e. ablation zone, was confined to the intended region (Fig. D) and measured a median volume of 3 cc (range, 1.9-8.9 cc). Critical structures (rectum, sphincter, capsule, neurovascular bundle) were unaffected, and no differences in IIEF-5 or IPSS were observed at 6-months compared to baseline values. At 6-month follow-up MRI/US fusion biopsy, cancer was not detected in the ablation zone in 5 of 8 men, but tumor foci were often seen outside treatment zone. CONCLUSIONS In-bore transrectal FLA of the prostate can be performed safely in men with intermediate risk CaP, without serious adverse events or changes in sexual and urinary function. Interstitial thermal probes confirmed the limited extent of laser heat within the prostate. Follow-up biopsy indicates that larger margins may be necessary for effective FLA. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e196-e197 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Shyam Natarajan More articles by this author Steven Raman More articles by this author Alan Priester More articles by this author James Garritano More articles by this author Daniel Margolis More articles by this author Patricia Lieu More articles by this author Maria Macairan More articles by this author Jiaoti Huang More articles by this author Warren Grundfest More articles by this author Leonard Marks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2016PD06-05 THE MRI-INVISIBLE PROSTATE CANCER: INCIDENCE AND SIGNIFICANCE Jason Wu, Daniel Margolis, Shyam Natarajan, Alan Priester, Jiaoti Huang, Maria Luz Macairan, Patricia Lieu, Devi Sharma, Frederick Dorey, and Leonard Marks Jason WuJason Wu More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Shyam NatarajanShyam Natarajan More articles by this author , Alan PriesterAlan Priester More articles by this author , Jiaoti HuangJiaoti Huang More articles by this author , Maria Luz MacairanMaria Luz Macairan More articles by this author , Patricia LieuPatricia Lieu More articles by this author , Devi SharmaDevi Sharma More articles by this author , Frederick DoreyFrederick Dorey More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2625AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Targeted prostate biopsy using multi-parametric MRI (mpMRI) guidance results in increased detection of clinically significant prostate cancers (csCaP). However, optimal sensitivity of the new method employs both targeted and systematic template biopsies, as some csCaP lies outside of MRI targets, i.e., is not visualized on MRI. Herein, we examine incidence and significance of the MRI-invisible csCaP. METHODS 322 (23%) of 1385 men with no suspicious lesion on mpMRI (UCLA Grade <3) from 2010-2015 were included in this study. The median age was 65±8, median PSA was 5.15 ng/mL (0.11-67.6) and mean prostate volume was 58.5±33.5 cc. All patients underwent MRI/US fusion biopsy using the 12-point mapping template of the Artemis device within 3 months of MRI. MRI was 3T body coil and interpreted by an expert reader (D.M.); biopsy was performed by an experienced fusion-device operator (L.M.). csCaP was defined as Gleason 3+3 with maximal cancer core length ≥ 4mm or ≥ Gleason 3+4. RESULTS 128 patients (40%) were found to have CaP in their biopsies: 61 patients (19%) had insignificant CaP and 67 patients (21%) had csCaP. 52 (78%) of 67 patients with missed csCaP had ≥ Gleason 3+4=7. 105 patients (32%) were in Active Surveillance at the time of their biopsies. Of these, 27 patients (26%) had csCaP with negative mpMRI. Logistic regression indicated that patients with high PCA3, high PSA density, a prior positive biopsy and smaller prostate volume are directly related to having csCaP in the presence of negative mpMRI (p<0.05). CONCLUSIONS Despite recent advancement of MRI technology, negative mpMRI cannot rule out csCaP completely. 40% of men with negative mpMRI were diagnosed with CaP. Of these, 21% of men harbored csCaP. All clinical factors should be considered before eliminating a systematic biopsy because the MRI is unrevealing. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e175-e176 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jason Wu More articles by this author Daniel Margolis More articles by this author Shyam Natarajan More articles by this author Alan Priester More articles by this author Jiaoti Huang More articles by this author Maria Luz Macairan More articles by this author Patricia Lieu More articles by this author Devi Sharma More articles by this author Frederick Dorey More articles by this author Leonard Marks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Diagnosis of prostate cancer (PCa) recurrence after therapy with curative intent currently depends primarily on biochemical serum analyses. When recurrence is suspected, further treatment decisions rely heavily on the confirmation of disease presence and determination of its extent. This is complicated by the fact that benign conditions can mimic biochemical recurrence, and serum studies do not reliably discriminate between local and distant recurrence. This review discusses the contemporary imaging paradigm for the evaluation of local PCa recurrence. The multidisciplinary implications for urologists, radiation oncologists and radiologists are examined. Emerging techniques and future directions of PCa imaging research are discussed.

You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2015PD30-01 MR-US FUSION BIOPSY TO DIAGNOSE PROSTATE CANCER: FIRST 1000 MEN AT UCLA Christopher Filson, Daniel Margolis, Jiaoti Huang, Shyam Natarajan, Patricia Lieu, Frederick Dorey, Robert Reiter, and Leonard Marks Christopher FilsonChristopher Filson More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Jiaoti HuangJiaoti Huang More articles by this author , Shyam NatarajanShyam Natarajan More articles by this author , Patricia LieuPatricia Lieu More articles by this author , Frederick DoreyFrederick Dorey More articles by this author , Robert ReiterRobert Reiter More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1822AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Use of MR-US guided biopsy to diagnose prostate cancer (CaP) is the subject of numerous studies, but many are of limited size, scope, and uniformity. Herein, we report results of men undergoing prostate biopsy using this approach in a large, prospective study with a uniform treatment protocol. METHODS In a prospective, IRB-approved protocol, a consecutive series of 1000 men underwent multi-parametric MRI (mpMRI) and MR-ultrasound fusion prostate biopsy (2009 – 2014). 3T trans-abdominal mpMRI was performed within 3 months of fusion biopsy; regions of interest (ROI) were delineated and graded 1 – 5 (Urol Oncol 29: 334, 2011) by an expert reader (DM). Uniformly, cores were obtained at 3 mm intervals from ROIs > grade 3, followed by 12-core mapping biopsy in all men. Biopsies were performed by a single operator (LM) using the Artemis system for MR-US fusion and biopsy guidance. Cores were submitted separately and read by a single uropathologist (JH). Primary outcome of interest was CaP with Gleason score (GS) ≥ 7. RESULTS Mean age was 65 years (SD +/- 8), median PSA was 5.9 ng/mL (IQR 4.0 – 8.7), and the mean prostate volume was 54±30 cc. Overall, 766 men (77%) had ≥ 1 ROI on mpMRI (grade 3 in 391, grade 4 in 291, and grade 5 in 84). 305 patients had GS ≥ 7 CaP (86 ROI only (29%), 94 mapping only (30%), and 125 ROI and mapping (41%)), with 77 patients (8% of total cohort) harboring GS ≥ 7 CaP in an anterior tumor. The mean PSA density for men with GS ≥ 7 CaP was 0.25 ng/mL/cc, compared to 0.12 ng/mL/cc for those without (p<0.01). Presence of GS ≥ 7 CaP was directly related to age, PSA, and ROI size, and inversely related to prostate volume (all p<0.01). Patients with a grade 5 ROI had over 20 times the odds of harboring GS 7 tumors compared to those with no ROIs (16% vs. 81%, OR 22.63, 95% CI 11.8 – 43.3, p<0.01, Figure). CONCLUSIONS Among the first 1000 men undergoing MR-US fusion biopsy at UCLA, the risk of finding GS ≥ 7 CaP was directly related to age, MRI grade, PSA, and PSAD. The most powerful predictor was the grade of the ROI on MRI: GS ≥ 7 CaP was found in most men with grade 5 lesions. Both mapping and targeted biopsy were required for maximal detection of GS ≥ 7 CaP. These data may be helpful for counseling of men considering prostate biopsy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e654 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Christopher Filson More articles by this author Daniel Margolis More articles by this author Jiaoti Huang More articles by this author Shyam Natarajan More articles by this author Patricia Lieu More articles by this author Frederick Dorey More articles by this author Robert Reiter More articles by this author Leonard Marks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Detection and Screening III1 Apr 2015PD38-08 PERFORMANCE OF IN-BORE MR-GUIDED TARGETED PROSTATE BIOPSY FOR DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER: A MULTICENTER STUDY Ely Felker, Stephanie Lee-Felker, John Feller, Stuart May, Robert Princenthal, Martin Cohen, David Lu, Daniel Margolis, Grace Kim, and Steven Raman Ely FelkerEly Felker More articles by this author , Stephanie Lee-FelkerStephanie Lee-Felker More articles by this author , John FellerJohn Feller More articles by this author , Stuart MayStuart May More articles by this author , Robert PrincenthalRobert Princenthal More articles by this author , Martin CohenMartin Cohen More articles by this author , David LuDavid Lu More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Grace KimGrace Kim More articles by this author , and Steven RamanSteven Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2429AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the safety and efficacy of in-bore MR-guided prostate biopsy (MRGB). METHODS In this IRB approved, HIPAA-compliant study, MRGB for prostate cancer (PCa) detection was evaluated from 2009–2014 at three centers. Multiparametric prostate MR (mpMRI) was performed with or without endorectal coil, using: T2WI, DWI with ADC, and post-gadolinium DCE on 1.5 or 3T systems. DCE sequences were processed with commercial software (DynaCAD, InVivo). Tumor suspicious regions (TSR) were stratified according to modified PI-RADS criteria. Biopsy targets were classified as intermediate or high probability for PCa. MRGB was performed using an FDA-approved needle guide (DynaTRIM; InVivo, Milwaukee, Wi) and dedicated 18G biopsy gun. At biopsy, multishot T2WI was performed for localization. Yield of MRGB for PCa and clinically significant disease (CSD) (Gleason 3+4 or higher) were calculated. RESULTS 511 men (mean age 66.9 years, mean PSA 10.1 ng/mL) with 829 TSR underwent MRGB for: abnormal PSA in 384 (75%), active surveillance in 83 (16%), and suspected recurrence in 44 (9%). 238 men (47%) had one or more prior negative transrectal ultrasound-guided (TRUS) biopsies. PCa was detected in 261 men (51%) and 315 TSR (38%). Of all positive MRBGs, 263 (83%) yielded clinically significant disease. 79 men (33%) with at least one prior negative TRUS biopsy had PCa on MRGB. Complications occurred in four of 511 (1%) men and included three cases of urosepsis and 1 case of hematuria complicated by urinary obstruction. CONCLUSIONS In-bore MRGB is safe and effective for detection of clinically significant PCa. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193 Issue 4S April 2015 Page: e827 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Ely Felker More articles by this author Stephanie Lee-Felker More articles by this author John Feller More articles by this author Stuart May More articles by this author Robert Princenthal More articles by this author Martin Cohen More articles by this author David Lu More articles by this author Daniel Margolis More articles by this author Grace Kim More articles by this author Steven Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2015MP11-05 MR-US FUSION BIOPSY: IMPORTANCE OF BOTH SYSTEMATIC AND TARGETED SAMPLING TO DIAGNOSE PROSTATE CANCER Christopher Filson, Daniel Margolis, Jiaoti Huang, Shyam Natarajan, Patricia Lieu, Frederick Dorey, and Leonard Marks Christopher FilsonChristopher Filson More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Jiaoti HuangJiaoti Huang More articles by this author , Shyam NatarajanShyam Natarajan More articles by this author , Patricia LieuPatricia Lieu More articles by this author , Frederick DoreyFrederick Dorey More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.386AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES MRI regions of interest in the prostate (ROI) are more likely to contain cancer (CaP) than other regions and may serve as targets for biopsy. However, CaP may be present in normal-appearing parts of the prostate. Herein we sought to determine frequency and nature of CaP found in the prostate apart from the ROI. METHODS Subjects were 463 of 1044 men (44%) prospectively enrolled in an IRB-approved registry with an MRI ROI of Grade 3 or higher, which was targeted with a biopsy and negative for CaP. Cores for each MR-US fusion biopsy were both targeted and 12-core systematic in all men. Multi-parametric MRI was 3T trans-abdominal, within 3 months of biopsy, and deemed negative by an expert reader (DM). Biopsy sites were determined by an operator (LM) using Artemis software for guidance. Cores were submitted separately and read by a uro-pathologist (JH). Outcome of interest was detection of CaP in systematic biopsy in men whose biopsy from ROI contained no CaP. RESULTS Mean age was 64±7.8 years, median PSA was 6.1 ng/dL (IQR 4.3 – 9 ng/mL), and median prostate volume was 48 cc (IQR 35 - 66 cc). 124 men (26%) were found to have CaP of GS ≥ 3+3=6 on systematic biopsy apart from ROI. 36 men (8%) had GS ≥ 7 CaP outside of target ROI. For the 14 men with a negative biopsy of a Grade 5 target, 5 (34%) had systematic biopsies with GS ≥ 7 (Figure, p<0.01). The risk of having a biopsy-negative ROI with GS ≥ 7 on mapping biopsy was inversely related to prostate volume (OR 0.98 per cc, 95% CI 0.96 – 0.99, p<0.01) and directly related to having a prior positive biopsy (OR 3.96, 95% CI 1.96 – 8.00, p<0.01). CONCLUSIONS One-quarter of men with no CaP in a biopsy from an MRI target (ROI) were found to have CaP outside the target on systematic biopsy. In 36 men, GS ≥ 7 CaP was detected only by systematic biopsy. When ROI was Grade 5, and the target biopsy was negative, more than 1/3 of men had GS ≥ 7 upon systematic biopsy. These data suggest that MRI-guided biopsy should include systematic, as well as ROI-targeted sampling and have important implications for biopsy schemes (e.g. ‘in-bore') that only obtain tissue from a ROI. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e120-e121 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Filson More articles by this author Daniel Margolis More articles by this author Jiaoti Huang More articles by this author Shyam Natarajan More articles by this author Patricia Lieu More articles by this author Frederick Dorey More articles by this author Leonard Marks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2014MP67-02 PROSTATE CANCER MISSED BY MULTI-PARAMETRIC MRI: CORRELATION WITH WHOLE-MOUNT PATHOLOGY Nelly Tan, Jesse Le, Daniel Margolis, David Lu, Kevin King, Reiter Robert, and Steven Raman Nelly TanNelly Tan More articles by this author , Jesse LeJesse Le More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , David LuDavid Lu More articles by this author , Kevin KingKevin King More articles by this author , Reiter RobertReiter Robert More articles by this author , and Steven RamanSteven Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2069AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The value of multi-parametric magnetic resonance imaging (mp-MRI) of the prostate has been demonstrated in improved diagnostic accuracy provided by targeted prostate biopsy, but systematic biopsy continues to reveal prostate cancer (CaP) in areas not deemed suspicious by MRI. Our objective was to characterize CaP tumor foci identified by whole-mount pathology that evaded detection by mp-MRI. METHODS A HIPAA-compliant, IRB-approved retrospective study of 122 patients with mp- MRI prior to radical prostatectomy between 10/2010-2/2013 was performed. Clinical (age, PSA, biopsy), MRI (T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging), and pathologic (Gleason score, GS; size of tumor; pathologic stage; extra-capsular extension) features were obtained. A genitourinary radiologist and pathologist collectively reviewed each case and matched each MRI lesion to its whole-mount pathology counterpart. A Likert-like scale (1-5) was used to classify level of suspicion by mp-MRI. Chi-square analysis was performed for categorical and t-test for continuous variables. RESULTS 135/283 histologically confirmed CaP tumors were identified by mp-MRI (48% sensitivity). Of 148/283 (52%) tumors in 74/122 (61%) men that missed MR detection, 110 (74%) were GS 6, 23 (16%) GS 3+4, 9 (6%) GS 4+3, 6 (4%) GS ≥8. Missed CaP foci were smaller in size (0.8 vs 1.8 cm, p<0.01) and lower grade (74% vs 29% GS 6), compared to those detected (p<0.01). Missed CaP had a higher proportion of tumors localized to one level of the prostate [apex (30% vs 10%), mid (37% vs 18%), base (9% vs 5%)] and lower proportion of foci involving multiple levels [apex to base (3% vs 20%), apex to mid (11% vs 26%), mid to base (10% vs 22%)] compared to detected CaP lesions (p<0.01). There was no difference in use of endorectal coil (87% vs 86%, p=0.86), PSA (7.7 vs 7.1 ng/ml, p=0.44) or prostate volume (41 vs 45 cc, p=0.12) between detected and missed CaP. CONCLUSIONS Prostate tumors that evaded MRI detection tended to be smaller, involved fewer prostate levels, and were of lower Gleason score compared to those detected by mp-MRI. Performance in CaP detection by mp-MRI was unaffected by PSA, prostate gland volume, or endorectal coil use. Hemorrhage, geometric distortion, or motion significantly may limit diagnostic confidence, and future studies are required to address the effect of these technical limitations on diagnostic performance. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e748-e749 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nelly Tan More articles by this author Jesse Le More articles by this author Daniel Margolis More articles by this author David Lu More articles by this author Kevin King More articles by this author Reiter Robert More articles by this author Steven Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-02 IMPACT OF MULTIFOCALITY ON PROSTATE CANCER DETECTION BY MULTI-PARAMETRIC MRI Nelly Tan, Jesse Le, Daniel Margolis, David Lu, Kevin King, Steven Raman, and Robert Reiter Nelly TanNelly Tan More articles by this author , Jesse LeJesse Le More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , David LuDavid Lu More articles by this author , Kevin KingKevin King More articles by this author , Steven RamanSteven Raman More articles by this author , and Robert ReiterRobert Reiter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1633AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Multi-parametric magnetic resonance imaging (mp-MRI) and targeted biopsy of prostate cancer (CaP) have improved diagnostic accuracy, but CaP is often multifocal. The objective of this study was to determine the impact of multifocality in CaP detection by mp-MRI. Methods A HIPAA-compliant, IRB-approved retrospective study was performed of 122 consecutive men who underwent mp-MRI prior to radical prostatectomy from 10/2010-2/2013. Clinical, MRI, and pathologic (e.g. Gleason score (GS), tumor size) features were obtained. Multifocality was defined as ≥2 tumors identified on whole mount pathology (WMP). The index tumor was defined as the lesion with the highest GS; if multiple tumors had the same GS, the largest was considered the index. A genitourinary radiologist and pathologist collectively reviewed each case and matched each lesion identified by MRI to WMP. Chi-square analysis was performed for categorical and t-test for continuous variables. Multivariate logistic regression was performed to determine the impact of multifocality on prostate cancer. Results 122 patients had 283 unique CaP lesions confirmed by WMP. Of 283 lesions, 149 (53%) were GS 3+3, 77 (27%) GS 3+4, 38 (13%) GS 4+3, and 19 (7%) GS ≥8. Mean tumor size was 1.3 cm (range 0.1-4.6 cm). 44/122 (36%) men had solitary and 78/122 (64%) had multifocal lesions [29/122 (24%) had 2 lesions, 24/122 (20%) had 3 lesions, and 25/122 (20%) had ≥4 lesions]. Of multifocal tumors, 140/239 (59%) were GS 3+3. 135/283 (48%) of lesions were detected by MRI. Of 148/283 (52%) lesions missed by MRI, 110/148 (74%) were GS 3+3. A higher proportion of solitary lesions were detected compared to multifocal [39/44 (89%) vs 96/239 (40%), p<0.01], respectively. On multivariate logistic regression using lesion size and GS as covariates, the odds reduction of CaP detection of multifocal lesions was 86% compared to solitary lesions after adjusting for size and grade (p<0.01). However, there was no difference in CaP detection between solitary index and index lesions with concomitant multifocal tumors (88.3% vs 78.4%, p=0.17). After adjusting for lesion size and grade, the odds of detection of solitary index lesions compared to index lesions with concomitant multifocal tumors was not significantly reduced (p=0.09). Conclusions The detection of the index tumor by mp-MRI was not affected by multifocality when adjusting for tumor size and grade, although overall tumor detection was lower in multifocal disease than for solitary tumors. These findings have important implications for future applications of mp-MRI such as focal therapy of CaP. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e588-e589 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nelly Tan More articles by this author Jesse Le More articles by this author Daniel Margolis More articles by this author David Lu More articles by this author Kevin King More articles by this author Steven Raman More articles by this author Robert Reiter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate cancer (PCa) is the second most common type of cancer among men in the United States. A major limitation in the management of PCa is an inability to distinguish, early on, cancers that will progress and become life threatening. One‐dimensional (1D) proton (1H) MRS of the prostate provides metabolic information such as levels of choline (Ch), creatine (Cr), citrate (Cit), and spermine (Spm) that can be used to detect and diagnose PCa. Ex vivo high‐resolution magic angle spinning (HR‐MAS) of PCa specimens has revealed detection of more metabolites such as myo‐inositol (mI), glutamate (Glu), and glutamine (Gln). Due to the J‐modulation and signal overlap, it is difficult to quantitate Spm and other resonances in the prostate clearly by single‐ and multivoxel‐based 1D MR spectroscopy. This limitation can be minimized by adding at least one more spectral dimension by which resonances can be spread apart, thereby increasing the spectral dispersion. However, recording of multivoxel‐based two‐dimensional (2D) MRS such as J‐resolved spectroscopy (JPRESS) and correlated spectroscopy (L‐COSY) combined with 2D or three‐dimensional (3D) magnetic resonance spectroscopic imaging (MRSI) using conventional phase‐encoding can be prohibitively long to be included in a clinical protocol. To reduce the long acquisition time required for spatial encoding, the echo‐planar spectroscopic imaging (EPSI) technique has been combined with correlated spectroscopy to give four‐dimensional (4D) echo‐planar correlated spectroscopic imaging (EP‐COSI) as well as J‐resolved spectroscopic imaging (EP‐JRESI) and the multi‐echo (ME) variants. Further acceleration can be achieved using non‐uniform undersampling (NUS) and reconstruction using compressed sensing (CS). Earlier versions of 2D MRS, theory of 2D MRS, spectral apodization filters, newer developments and the potential role of multidimensional MRS in PCa detection and management will be reviewed here. Copyright © 2013 John Wiley & Sons, Ltd.

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-01 PERFORMANCE OF MULTI-PARAMETRIC MRI FOR HIGH GRADE PROSTATE CANCER: CORRELATION WITH WHOLE-MOUNT PATHOLOGY Jesse Le, Nelly Tan, Susan Kerkoutian, Daniel Margolis, David Lu, Lorna Kwan, Steven Raman, and Robert Reiter Jesse LeJesse Le More articles by this author , Nelly TanNelly Tan More articles by this author , Susan KerkoutianSusan Kerkoutian More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , David LuDavid Lu More articles by this author , Lorna KwanLorna Kwan More articles by this author , Steven RamanSteven Raman More articles by this author , and Robert ReiterRobert Reiter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1632AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Higher Gleason score (GS) is associated with increased level of suspicion on multi-parametric magnetic resonance imaging (mp-MRI) of the prostate, but some tumors still evade detection by MRI. The objective of this study was to characterize the performance of mp-MRI for detection of high GS tumors and identify risk factors for missed tumor detection. Methods A retrospective study was performed of 122 consecutive men who underwent mp-MRI prior to radical prostatectomy from 10/2010-2/2013. Clinical, MRI, and pathologic features were obtained. A genitourinary radiologist and pathologist collectively reviewed each case and matched the MRI to whole-mount pathology lesions. Index tumor was defined as the highest GS tumor; in cases of multifocal tumors of identical GS, the largest tumor was considered the index. Chi-square or Fisher’s exact analysis was performed for categorical and t-test for continuous variables. Results 180 regions of interest were identified by mp-MRI and 283 tumors were histologically confirmed among 122 men. Among the 57 tumors determined to be GS ≥4+3, 15/57 tumors (26%) were missed by mp-MRI in 11/50 men (22%), corresponding to a sensitivity of 74%. Index tumor status, tumor size, number of whole mount levels involved, and presence of extra-capsular extension were all associated with tumor detection (p<0.05) (table). 37/44 (84%) of index tumors were correctly identified by mp-MRI. Missed tumors were: less likely to be index tumors (47% vs 88% of MRI-pathology concordant tumors); likely to be smaller (1.24 cm ±0.78 cm SD vs 2.41 ±2.06 SD), involving fewer whole-mount levels; and less likely to have extra-capsular extension (13% vs 55%). Of missed non-index tumors, 4/8 (50%) of the corresponding index tumors were detected by mp-MRI. Of the missed index tumors, no corresponding non-index tumors were detected; review of these slides demonstrated tumor infiltrating benign glands (3/7), small volume tumor within large overall prostate volume (3/7), or abundant foamy gland variant pathology (2/7) as possible reasons for missed tumor detection. Conclusions High Gleason score tumors evaded mp-MRI detection in 26% of cases. Smaller, non-index, organ-confined tumors were more likely to be missed; there may be a histologic basis for non-visualization of tumors by mp-MRI. Table. Characteristics of tumors missed versus detected by mp-MRI. Missed tumors, n=15 Detected tumors, n=42 P-value Mean (SD) Mean (SD) Age (years) 61.5 (5.4) 62.4 (6.2) 0.6258 PSA (ng/ml) 9.4 (6.7) 8.6 (5.0) 0.6338 Weeks from biopsy to MRI 23.2 (33.5) 18.4 (34.4) 0.6494 MRI prostate volume (cc) 52.5 (27.4) 41.4 (16.7) 0.1577 Pathology weight (gm) 60.0 (27.0) 50.7 (18.1) 0.2294 Tumor diameter (cm) 1.24 (0.78) 2.41 (2.06) 0.0004 N (%) N (%) Endorectal coil use 12 (80) 36 (86) 0.6851∗ Gleason score 4+3 9 (60) 29 (69) 0.7154∗ 4+4 5 (33) 9 (21) 4+5 1 (7) 4 (10) Whole mount levels Apex 2 (13) 2 (5) 0.0361∗ Mid 5 (33) 6 (14) Base 1 (7) 1 (2) Apex to mid 4 (27) 5 (12) Mid to base 1 (7) 15 (36) Apex to base 2 (13) 13 (31) Index tumor status 7 (47) 37 (88) 0.0025∗ Apical location 4 (27) 14 (33) 0.7531∗ Extra-capsular extension 2 (13) 23 (55) 0.0055 Seminal vesicle invasion 0 (0) 3 (7) 0.5586∗ Lymph node(s) positive 0 (0) 3 (7) 0.5586∗ T-test for continuous variables; chi-square test for categorical variables (Fisher's exact where noted with an asterisk∗). Standard deviation, SD. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e588 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jesse Le More articles by this author Nelly Tan More articles by this author Susan Kerkoutian More articles by this author Daniel Margolis More articles by this author David Lu More articles by this author Lorna Kwan More articles by this author Steven Raman More articles by this author Robert Reiter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...