A 66-year-old biopsy-naïve patient with a PSA level of 7.3 ng/mL undergoes multiparametric prostate MRI. Despite a preparatory clear-fluid diet and rectal enema, rectal gas renders evaluation of the posterior prostate suboptimal on all sequences. The anterior prostate is unaffected by the artifact and appears normal. What do you recommend? _______________.

Objectives:To assess the agreement of the three methods of coronary plaque burden assessment approved by the Coronary Artery Disease-Reporting and Data System classification (CAD-RADS 2.0): coronary artery calcium (CAC) testing, segment involvement score (SIS), and visual estimate. Methods:Patients with stable chest pain who underwent coronary computed tomography angiography (CCTA) and showed signs of coronary artery disease were included in the current retrospective study. The CCTAs were independently evaluated by two board-certified radiologists. Differing results were resolved in consensus. Three separate estimates of plaque burden (P) were performed for each examination: P(CAC), P(SIS) and P(visual). Linearly weighted kappa was used to assess the agreement of the three methods. Results:The study included 132 patients (mean age 66.6 years, 68.2% male). The mean CAC score was 503.6 ± 1023.5 [SD]. CAD-RADS was 1 in 47/132 patients (35.6%), 2 in 40/132 patients (30.3%), 3 in 18/132 patients (13.6%), 4 in 24/132 cases (18.2%) and 5 in 3/132 cases (2.3%). Weighted Kappa values for method agreement were κ= 0.56 (95% CI: 0.48-0.65) for agreement between P(CAC) and P(SIS), κ= 0.67 (95% CI: 0.59-0.75) for agreement between P(CAC) and P(visual), and κ= 0.72 (95% CI: 0.64-0.80) for agreement between P(SIS) and P(visual), signifying moderate to substantial agreement. Conclusion:Results for plaque burden in CAD-RADS 2.0 are clearly influenced by the choice of assessment method. When reporting plaque burden in CAD-RADS 2.0, the method of assessment should be unequivocally named, as the three proposed methods are not interchangeable and describe different aspects of plaque burden.

Objectives:This work aimed to investigate the role of surgeon experience on operating time and detection rate of clinically significant prostate cancer (csPCa) in a large contemporary cohort undergoing transperineal (TP) MRI-targeted prostate biopsy. Materials and Methods:We retrospectively reviewed patients who underwent TP MRI-guided prostate biopsies between 10/2018 and 04/2024. Patients with suspicious MRI lesions (PI-RADS 3, 4 and 5) formed the study cohort. All patients underwent MRI-targeted biopsies of suspicious lesions combined with a standard 12-core systematic biopsy. Caseloads-both total and in increments of 50 cases-were calculated for each surgeon. We employed univariable and multivariable Poisson regression models to analyse biopsy duration, and logistic regression models to assess csPCa detection. Results:Out of 3336 MRI-guided TP biopsies, 1148 (34%) involved PI-RADS 3, 1398 (42%) PI-RADS4 and 790 (24%) PI-RADS 5 as index lesions. Most patients (55%) had one suspicious lesion. The median caseload per surgeon was 63 (IQR [interquartile range]: 30-110). Biopsy duration significantly decreased after the first 50 procedures (13 min [95% CI: 10-18] to 10 min [95% CI: 8-15]) and plateaued thereafter. Multivariable Poisson regression demonstrated increased caseload independently associated with shorter biopsy duration (IRR 0.891 [95% CI: 0.833-0.899], p < 0.001). The overall csPCa detection rate was 43%, with no significant correlation to caseload. These findings were consistent across subgroup analyses based on PI-RADS score. Conclusions:This large, contemporary study demonstrated that biopsy duration decreased significantly after approximately 50 cases, indicating a learning curve without compromising the detection rate of csPCa.

Markerless navigation in minimally invasive surgery is still an unsolved challenge. Many proposed navigation systems for minimally invasive surgeries rely on stereoscopic images, while in clinical practice oftentimes monocular endoscopes are used. Combined with the lack of automatic video-based navigation systems for prostatectomies, this paper explores methods to tackle both research gaps at the same time for robot-assisted prostatectomies. In order to realize a semi-automatic augmented reality overlay for navigated prostatectomy, the camera pose w.r.t. the prostate needs to be estimated. We developed a method where visual cues are drawn on top of the organ after an initial manual alignment, simultaneously creating matching landmarks on the 2D and 3D data. Starting from this key frame, the cues are then tracked in the endoscopic video. Both PnPRansac and differentiable rendering are then explored to perform 2D–3D registration for each frame. We performed experiments on synthetic and in vivo data. On synthetic data differentiable rendering can achieve a median target registration error of 6.11 mm. Both PnPRansac and differentiable rendering are feasible methods for 2D–3D registration. We demonstrated a video-based markerless augmented reality overlay for navigated prostatectomy, using visual cues as an anchor.

The cell adhesion protein nectin-4 emerged as a valid therapeutic target for antibody- and peptide-drug conjugates in cancer. To support patient stratification for such targeted therapies, there is a clinical need for molecular imaging agents capable of quantifying nectin-4 levels noninvasively in vivo. For this purpose, we developed 64Cu- and 68Ga-labeled ligands derived from bicyclic peptide-drug conjugate BT8009. A library of peptides was prepared with a major focus on the bioisosteric replacement of the original methionine residue due to its susceptibility to oxidation. The peptides were characterized for their binding behavior to nectin-4, and radiopharmacological characterization of selected radioligands was performed using urothelial carcinoma cell lines and tumor xenograft models derived thereof. The suitability of the most promising ligand from the preclinical studies, NECT-224, for PET imaging purposes was also demonstrated in a first-in-human application using [68Ga]Ga-NECT-224. The results suggest its further clinical development, but also that of [64Cu]Cu-NECT-224.

BACKGROUND:Accurate assessment of left ventricular (LV) myocardial mass is critical for guiding treatment decisions. Measurements based on echocardiography are limited by operator variability. Artificial intelligence (AI)-based methods promise improved precision and reproducibility, but they require validation against high-resolution reference standards such as computed tomography (CT). OBJECTIVES:The aim of this study is to compare the accuracy of AI-based vs expert manual echocardiography LV mass measurements using CT as the reference and to evaluate real-world test-retest reliability. METHODS:In 218 patients undergoing echocardiography and CT, the authors analyzed LV mass, interventricular septal diameter (IVSD), end-diastolic diameter, posterior wall diameter (PWD), and end-diastolic volume. LV mass was assessed by the conventional linear method as well as a novel hybrid method combining end-diastolic tracings with mean wall thickness. AI- and expert-based (Expert) echocardiographic measurements were compared with CT using intraclass correlation coefficient (ICC) and mean absolute percentage error (MAPE). Increased relative wall thickness (RWT >0.42;+) and abnormal LV mass was evaluated using receiver-operating characteristic analysis (area under the curve [AUC]). Test-retest reliability was assessed in a bedside cohort (n = 40) using coefficient of variation. RESULTS:AI echocardiography showed strongest agreement with CT for LV mass assessment using the hybrid method (ICC: 0.76; MAPE: 0.16) and lower agreement for the linear method (ICC: 0.49; MAPE: 0.44). Nevertheless, compared with Expert echocardiography, AI reduced measurement error by ∼20%, mainly due to more consistent IVSD and PWD measurements, and reclassified 34% of RWT+ cases. Diagnostic accuracy for detecting increased LV mass was higher with AI echocardiography than with Expert echocardiography (AUC: 0.78 vs 0.71 for linear; 0.84 vs 0.77 for hybrid). Test-retest reliability was highest with AI echocardiography for both mass methods (coefficient of variation: 7.8% and 8.1%), and reproducibility of manual assessment varied with operator skills. CONCLUSIONS:AI echocardiography provides superior accuracy, diagnostic performance, and reproducibility for LV mass assessment compared with expert evaluation, supporting its clinical integration to improve standardization in cardiac imaging.

Personalized treatment strategies based on non-invasive biomarkers have potential to improve patient management in patients with newly diagnosed glioblastoma (GBM). The residual tumour burden after surgery in GBM patients is a prognostic imaging biomarker. However, in clinical patient management, its assessment is a manual and time-consuming process that is at risk of inter-rater variability. Furthermore, the prediction of patient outcome prior to radiotherapy may identify patient subgroups that could benefit from escalated radiotherapy doses. Therefore, in this study, we investigate the capabilities of traditional radiomics and 3D convolutional neural networks for automatic detection of the residual tumour status and to prognosticate time-to-recurrence (TTR) and overall survival (OS) in GBM using postoperative [ 11 C] methionine positron emission tomography (MET-PET) and gadolinium-enhanced T1-w magnetic resonance imaging (MRI). On the independent test data, the 3D-DenseNet model based on MET-PET achieved the best performance for residual tumour detection, while the logistic regression model with conventional radiomics features performed best for T1c-w MRI (AUC: MET-PET 0.95, T1c-w MRI 0.78). For the prognosis of TTR and OS, the 3D-DenseNet model based on MET-PET integrated with age and MGMT status achieved the best performance (Concordance-Index: TTR 0.68, OS 0.65). In conclusion, we showed that both deep-learning and conventional radiomics have potential value for supporting image-based assessment and prognosis in GBM. After prospective validation, these models may be considered for treatment personalization.

INTRODUCTION:Prostate cancer (PCa) risk stratification is essential in guiding therapeutic decision. Multiparametric magnetic resonance tomography (mpMRI) holds promise in the prediction of adverse pathologies (AP) after prostatectomy (RP). This study aims to identify clinical and imaging markers in the prediction of adverse pathology.METHODS:Patients with PCa, diagnosed by targeted biopsy after mpMRI and undergoing RP, were included. The predictive accuracy of mpMRI for extraprostatic extension (ECE), seminal vesicle infiltration (SVI), and lymph node positivity was calculated from the final histopathology.RESULTS:846 patients were involved. Independent risk parameters include imaging findings such as ECE (OR 3.12), SVI (OR 2.55), and PI-RADS scoring (4: OR 2.01 and 5: OR 4.34). mpMRI parameters such as ECE, SVI, and lymph node metastases showed a high prognostic accuracy (73.28% vs. 95.35% vs. 93.38%) with moderate sensitivity compared to the final histopathology. The ROC analysis of our combined scoring system (D'Amico classification, PSA density, and MRI risk factors) improves the prediction of adverse pathology (AUC: 0.73 vs. 0.69).CONCLUSION:Our study supports the use of mpMRI for comprehensive pretreatment risk assessment in PCa. Due to the high accuracy of factors like ECE, SVI, and PI-RADS scoring, utilizing mpMRI data enabled accurate prediction of unfavorable pathology after RP.

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD26)1 May 2024PD26-07 MRI-GUIDED ACTIVE SURVEILLANCE IN PATIENTS WITH ISUP 1 PROSTATE CANCER—A MULTI-INSTITUTIONAL VALIDATION OF THE DISCRIMINATION OF THE PRECISE SCORE Nikita Sushentsev, Manuel Wiesenfarth, Martin Dixius, Christof Kastner, Angelika Borkowetz, Ivan Platzek, Christian Thomas, Claudia Kesch, Lale Umutlu, Henning Reis, Tilmann Rau, Lotte Lenders, Martin Spahn, Matthias Boschheidgen, Gerald Antoch, Peter Albers, Tristan Barrett, Lars Schimmöller, Boris Hadaschik, and Jan Philipp Radtke Nikita SushentsevNikita Sushentsev , Manuel WiesenfarthManuel Wiesenfarth , Martin DixiusMartin Dixius , Christof KastnerChristof Kastner , Angelika BorkowetzAngelika Borkowetz , Ivan PlatzekIvan Platzek , Christian ThomasChristian Thomas , Claudia KeschClaudia Kesch , Lale UmutluLale Umutlu , Henning ReisHenning Reis , Tilmann RauTilmann Rau , Lotte LendersLotte Lenders , Martin SpahnMartin Spahn , Matthias BoschheidgenMatthias Boschheidgen , Gerald AntochGerald Antoch , Peter AlbersPeter Albers , Tristan BarrettTristan Barrett , Lars SchimmöllerLars Schimmöller , Boris HadaschikBoris Hadaschik , and Jan Philipp RadtkeJan Philipp Radtke View All Author Informationhttps://doi.org/10.1097/01.JU.0001008556.20565.76.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is evidence that multiparametric magnetic resonance imaging (mpMRI) may avoid repeat prostate biopsies in monitoring of patients during active surveillance (AS) for prostate cancer (PC). Particularly, serial MR scans are widely investigated using the PRECISE criteria. To assess the ability of PRECISE criteria to predict ISUP GG upgrading of men with ISUP GG1 on AS in a multi-institutional cohort. METHODS: Retrospective analysis of men from four centers (Cambridge, Düsseldorf, Dresden, Essen). After AS inclusion with mpMRI and MRI/TRUS fusion-guided biopsy, all men underwent serial mpMRI and MRI/TRUS fusion-guided biopsy subsequently. Patients with at least 2 MR scans and two biopsies (baseline and follow-up, the latter after the 2nd scan) were included. PRECISE recommendations evaluate the radiological change on serial imaging using a 1-to-5 scale in which PRECISE 1 or 2 indicates radiological regression, PRECISE 3 stability and PRECISE 4 or 5 imply progression. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of MRI progress (PRECISE≥4) for ISUP GG upgrading were calculated and plotted using Cumulative incidence curves, including log-rank tests for equality of cumulative incidence curve. RESULTS: In total, 396 men were available for analysis. Median follow-up was 36 months. Histopathological progression occurred in n=73 men (18%). For PRECISE 1-2 (n=27, 7% of cases) no progression occurred. In PRECISE 3 (n=254, 69%) progression rate was 4% and in PRECISE 4-5 (n=87, 24%) 36%. Sensitivity, specificity, PPV and NPV for PRECISE≥4 was 74%, 88%, 57% and 94%. Accuracy was 85%. Cumulative incidence curves are given in the Figure 1. Log-Rank-test demonstrated statistical significance (p<0.001) for PRECISE 4-5. CONCLUSIONS: This multi-institutional study has validated that a dedicated MRI-based scoring system of serial MRI scans can reliably aid to predict histopathological progress of men on AS within a median follow-up timespan of 36 months. In particular, men with MR progression are significantly at risk of ISUP GG upgrading. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e547 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nikita Sushentsev More articles by this author Manuel Wiesenfarth More articles by this author Martin Dixius More articles by this author Christof Kastner More articles by this author Angelika Borkowetz More articles by this author Ivan Platzek More articles by this author Christian Thomas More articles by this author Claudia Kesch More articles by this author Lale Umutlu More articles by this author Henning Reis More articles by this author Tilmann Rau More articles by this author Lotte Lenders More articles by this author Martin Spahn More articles by this author Matthias Boschheidgen More articles by this author Gerald Antoch More articles by this author Peter Albers More articles by this author Tristan Barrett More articles by this author Lars Schimmöller More articles by this author Boris Hadaschik More articles by this author Jan Philipp Radtke More articles by this author Expand All Advertisement PDF downloadLoading ...

Background and purpose:Motion mitigation is of crucial importance in particle therapy (PT) of patients with abdominal tumors to ensure high-precision irradiation. Magnetic resonance imaging (MRI) is an excellent modality for target volume delineation and motion estimation of mobile soft-tissue tumors. Thus, the aims of this study were to develop an MRI- and PT-compatible abdominal compression device, to investigate its effect on pancreas motion reduction, and to evaluate patient tolerability and acceptance.Materials and methods:In a prospective clinical study, 16 patients with abdominal tumors received an individualized polyethylene-based abdominal corset. Pancreas motion was analyzed using time- and phase resolved MRI scans (orthogonal 2D-cine and 4D MRI) with and without compression by the corset. The pancreas was manually segmented in each MRI data set and the population-averaged center-of-mass motion in inferior-superior (IS), anterior-posterior (AP) and left-right (LR) directions was determined. A questionnaire was developed to investigate the level of patient acceptance of the corset, which the patients completed after acquisition of the planning computed tomography (CT) and MRI scans.Results:The corset was found to reduce pancreas motion predominantly in IS direction by on average 47 % - 51 % as found in the 2D-cine and 4D MRI data, respectively, while motion in the AP and LR direction was not significantly reduced. Most patients reported no discomfort when wearing the corset.Conclusion:An MRI- and PT-compatible individualized abdominal corset was presented, which substantially reduced breathing-induced pancreas motion and can be safely applied with no additional discomfort for the patients. The corset has been successfully integrated into our in-house clinical workflow for PT of tumors of the upper abdomen.

PURPOSE:To evaluate the effect of contrast timing, contrast volume, and contrast flow rate on the image quality of pulmonary arteries in computed tomography angiography (CTA) and to assess if bolus-tracking region of interest (ROI) positioning in the left atrium, which is used for triple-rule-out CTA, allows for sufficient depiction of the pulmonary arteries.METHODS:In this retrospective single-center study, data were collected for patients who underwent thoracic CTA during a specific period. Two groups of 121 patients each were created based on bolus-tracking ROI positioning in the main pulmonary artery or left atrium using propensity score matching. Image quality of the pulmonary arteries was evaluated using quantitative and qualitative scores. Subgroups were formed to examine the influence of contrast volume and flow rate. Two radiologists determined if pulmonary embolism was present, if pulmonary embolism could be excluded with certainty, and from which level pulmonary embolism could be excluded with certainty. Interrater reliability also was evaluated.RESULTS:ROI positioning in the main pulmonary artery scored significantly higher compared with the left atrium. There was no significant difference in subgroups of patients who were examined with 60 mL or more contrast volume and less than 4 mL/s flow rate; scores were similar or better than in the overall study population. Pulmonary embolism was not able to be excluded with certainty for each 1 patient in these subgroups compared with a high percentage in the overall study population.DISCUSSION:ROI positioning in the left atrium in combination with the 60 mL or more contrast volume and less than 4 mL/s flow rate does not adversely affect depiction of the pulmonary arteries compared with conventional ROI positioning in the main pulmonary artery.CONCLUSION:When using 60 mL or more contrast volume and less than 4 mL/s flow rate, ROI positioning in the left atrium, which is used in triple-rule-out CTA, is sufficient for the assessment of pulmonary arteries.