BACKGROUND Prostate cancer(PCa)is one of the most common cancers among men.Various strategies for targeted biopsy based on multiparametric magnetic resonance imaging(mp-MRI)have emerged,which may improve the accuracy ...BACKGROUND Prostate cancer(PCa)is one of the most common cancers among men.Various strategies for targeted biopsy based on multiparametric magnetic resonance imaging(mp-MRI)have emerged,which may improve the accuracy of detecting clinically significant PCa in recent years.AIM To investigate the diagnostic efficiency of a template for cognitive MRIultrasound fusion transperineal targeted plus randomized biopsy in detecting PCa.METHODS Data from patients with an increasing prostate-specific antigen(PSA)level but less than 20 ng/mL and at least one lesion suspicious for PCa on MRI from December 2015 to June 2018 were retrospectively analyzed.All patients underwent cognitive fusion transperineal template-guided targeted biopsy followed by randomized biopsy outside the targeted area.A total of 127 patients with complete data were included in the final analysis.A multivariable logistic regression analysis was conducted,and a two-sided P<0.05 was considered statistically significant.RESULTS PCa was detected in 66 of 127 patients,and 56 cases presented clinically significant PCa.Cognitive fusion targeted biopsy alone detected 59/127 cases of PCa,specifically 52/59 cases with clinically significant PCa and 7/59 cases with clinically insignificant PCa.A randomized biopsy detected seven cases of PCa negative on targeted biopsy,and four cases had clinically significant PCa.PSA density(OR:1.008,95%CI:1.003-1.012,P=0.001;OR:1.006,95%CI:1.002-1.010,P=0.004)and Prostate Imaging-Reporting and Data System(PI-RADS)scores(both P<0.001)were independently associated with the results of cognitive fusion targeted biopsy combined with randomized biopsy and targeted biopsy alone.CONCLUSION This single-centered study proposed a feasible template for cognitive MRIultrasound fusion transperineal targeted plus randomized biopsy.Patients with higher PSAD and PI-RADS scores were more likely to be diagnosed with PCa.展开更多
Prostate cancer is a major public health burden throughout the world.The high incidence of prostate cancer,combined with earlier detection and downstaging at the time of diagnosis,and the slow natural progression and ...Prostate cancer is a major public health burden throughout the world.The high incidence of prostate cancer,combined with earlier detection and downstaging at the time of diagnosis,and the slow natural progression and biological heterogeneity of the disease,has made its management a complex and controversial issue.There is growing demand for patient-specific therapies that can minimize treatment morbidity while maximizing treatment benefits.There are a number of clinical parameters and clinical nomograms to help with the choice of treatment.Magnetic resonance imaging(MRI)is a technique which makes safer,more individualized therapies possible due to high spatial resolution,superior contrast resolution,multiplanar capability,and a large field of view.Other MRI techniques such as MR spectroscopic imaging,dynamic contrast-enhanced MRI or perfusion MRI,and diffusion-weighted imaging complement MRI by reflecting tissue biochemistry,Brownian motion of water molecules,and capillary wall permeability,respectively.This editorial review highlights the incremental value of MRI in the advanced management of prostate cancer to non-invasively improve cancer staging,biologic potential,treatment planning,therapy response,local recurrence,and to guide target biopsy for clinical suspected cancer with previous negative biopsy.Finally,some future prospects for MRI in prostate cancer management are given.展开更多
AIM: To evaluate the impact of computed b = 1400 s/mm2(C-b1400) vs measured b = 1400 s/mm2(M-b1400) diffusion-weighted images(DWI) on lesion detection rate, image quality and quality of lesion demarcation using a mode...AIM: To evaluate the impact of computed b = 1400 s/mm2(C-b1400) vs measured b = 1400 s/mm2(M-b1400) diffusion-weighted images(DWI) on lesion detection rate, image quality and quality of lesion demarcation using a modern 3T-MR system based on a small-field-of-view sequence(sFOV). METHODS: Thirty patients(PSA: 9.5 ± 8.7 ng/mL; 68 ± 12 years) referred for magnetic resonance imaging(MRI) of the prostate were enrolled in this study. All measurements were performed on a 3T MR system.For DWI, a single-shot EPI diffusion sequence(b = 0, 100, 400, 800 s/mm2) was utilized. C-b1400 was cal-culated voxelwise from the ADC and diffusion images. Additionally, M-b1400 was acquired for evaluation and comparison. Lesion detection rate and maximum lesion diameters were obtained and compared. Image quality and quality of lesion demarcation were rated accord-ing to a 5-point Likert-type scale. Ratios of lesion-to-bladder as well as prostate-to-bladder signal intensity(SI) were calculated to estimate the signal-to-noise-ratio(SNR). RESULTS: Twenty-four lesions were detected on M-b1400 images and compared to C-b1400 images. C-b1400 detected three additional cancer suspicious lesions. Overall image quality was rated significantly better and SI ratios were significantly higher on C-b1400(2.3 ± 0.8 vs 3.1 ± 1.0, P < 0.001; 5.6 ± 1.8 vs 2.8 ± 0.9, P < 0.001). Comparison of lesion size showed no significant differences between C- and M-b1400(P = 0.22). CONCLUSION: Combination of a high b-value extrap-olation and sFOV may contribute to increase diagnostic accuracy of DWI without an increase of acquisition time, which may be useful to guide targeted prostate biopsies and to improve quality of multiparametric MRI(mMRI) especially under economical aspects in a pri-vate practice setting.展开更多
To obtain improved accuracy in predicting extracapsular extension （ECE） and seminal vesicle invasion （SVI）, we evaluated the variables affecting the predictability of staging magnetic resonance imaging （MRI, phas...To obtain improved accuracy in predicting extracapsular extension （ECE） and seminal vesicle invasion （SVI）, we evaluated the variables affecting the predictability of staging magnetic resonance imaging （MRI, phased-array coil） and estimated their impact on accuracy between preoperative MRI staging and histological outcome. A total of 121 patients with localized or locally advanced prostate cancer who underwent robotic radical prostatectomy （RALP） were included. Following transrectal biopsy, all enrolled patients had undergone MRI for staging work-up. After RALP, only 43.8% （53/121） of the patients were matched with the MRI predicted stage. Compared to the matched group in the prediction of ECE, the unmatched group had significantly higher initial prostate-specific antigen （PSA, 12.8 ng m1-1 versus 8.1 ng m1-1, P=0.048）. In the prediction of SVI, initial PSA （8.1 ng ml- 1 versus 17.3 ng ml- 1, P=0.009） and biopsy Gleason score （6.5 versus 7.6, P=0.035） were significantly higher in the unmatched group. When applying clinical cutoffs of initial PSA of 10 and 20 ng ml-1, the accuracy of MRI in the prediction of ECE was decreased in the group with PSA over 20 ng ml- 1 （75.6, 64.5 and 37.5%, P=0.01）, and this group had significantly decreased accuracy of MRI in the prediction of SVI （91.5, 77.4 and 37.5%, P〈0.01）. Applying the clinical cutoff of a Gleason score of 7, the accuracy of MRI in the prediction of SVI was decreased in the higher G leason score group （93.9, 82.1 and 62.9%, P= 0.01）. Thus, for these patient groups, to obtain margin negativity during radical prostatectomy, operative findings, rather than post-biopsy MRI images, may provide substantial information, implying a clinical advantage in conducting MRI before prostate biopsy.展开更多
基金the Beijing Hospital Clinical Research 121 Project(BJ-2018-090 to Ming Liu).
文摘BACKGROUND Prostate cancer(PCa)is one of the most common cancers among men.Various strategies for targeted biopsy based on multiparametric magnetic resonance imaging(mp-MRI)have emerged,which may improve the accuracy of detecting clinically significant PCa in recent years.AIM To investigate the diagnostic efficiency of a template for cognitive MRIultrasound fusion transperineal targeted plus randomized biopsy in detecting PCa.METHODS Data from patients with an increasing prostate-specific antigen(PSA)level but less than 20 ng/mL and at least one lesion suspicious for PCa on MRI from December 2015 to June 2018 were retrospectively analyzed.All patients underwent cognitive fusion transperineal template-guided targeted biopsy followed by randomized biopsy outside the targeted area.A total of 127 patients with complete data were included in the final analysis.A multivariable logistic regression analysis was conducted,and a two-sided P<0.05 was considered statistically significant.RESULTS PCa was detected in 66 of 127 patients,and 56 cases presented clinically significant PCa.Cognitive fusion targeted biopsy alone detected 59/127 cases of PCa,specifically 52/59 cases with clinically significant PCa and 7/59 cases with clinically insignificant PCa.A randomized biopsy detected seven cases of PCa negative on targeted biopsy,and four cases had clinically significant PCa.PSA density(OR:1.008,95%CI:1.003-1.012,P=0.001;OR:1.006,95%CI:1.002-1.010,P=0.004)and Prostate Imaging-Reporting and Data System(PI-RADS)scores(both P<0.001)were independently associated with the results of cognitive fusion targeted biopsy combined with randomized biopsy and targeted biopsy alone.CONCLUSION This single-centered study proposed a feasible template for cognitive MRIultrasound fusion transperineal targeted plus randomized biopsy.Patients with higher PSAD and PI-RADS scores were more likely to be diagnosed with PCa.
文摘Prostate cancer is a major public health burden throughout the world.The high incidence of prostate cancer,combined with earlier detection and downstaging at the time of diagnosis,and the slow natural progression and biological heterogeneity of the disease,has made its management a complex and controversial issue.There is growing demand for patient-specific therapies that can minimize treatment morbidity while maximizing treatment benefits.There are a number of clinical parameters and clinical nomograms to help with the choice of treatment.Magnetic resonance imaging(MRI)is a technique which makes safer,more individualized therapies possible due to high spatial resolution,superior contrast resolution,multiplanar capability,and a large field of view.Other MRI techniques such as MR spectroscopic imaging,dynamic contrast-enhanced MRI or perfusion MRI,and diffusion-weighted imaging complement MRI by reflecting tissue biochemistry,Brownian motion of water molecules,and capillary wall permeability,respectively.This editorial review highlights the incremental value of MRI in the advanced management of prostate cancer to non-invasively improve cancer staging,biologic potential,treatment planning,therapy response,local recurrence,and to guide target biopsy for clinical suspected cancer with previous negative biopsy.Finally,some future prospects for MRI in prostate cancer management are given.
文摘AIM: To evaluate the impact of computed b = 1400 s/mm2(C-b1400) vs measured b = 1400 s/mm2(M-b1400) diffusion-weighted images(DWI) on lesion detection rate, image quality and quality of lesion demarcation using a modern 3T-MR system based on a small-field-of-view sequence(sFOV). METHODS: Thirty patients(PSA: 9.5 ± 8.7 ng/mL; 68 ± 12 years) referred for magnetic resonance imaging(MRI) of the prostate were enrolled in this study. All measurements were performed on a 3T MR system.For DWI, a single-shot EPI diffusion sequence(b = 0, 100, 400, 800 s/mm2) was utilized. C-b1400 was cal-culated voxelwise from the ADC and diffusion images. Additionally, M-b1400 was acquired for evaluation and comparison. Lesion detection rate and maximum lesion diameters were obtained and compared. Image quality and quality of lesion demarcation were rated accord-ing to a 5-point Likert-type scale. Ratios of lesion-to-bladder as well as prostate-to-bladder signal intensity(SI) were calculated to estimate the signal-to-noise-ratio(SNR). RESULTS: Twenty-four lesions were detected on M-b1400 images and compared to C-b1400 images. C-b1400 detected three additional cancer suspicious lesions. Overall image quality was rated significantly better and SI ratios were significantly higher on C-b1400(2.3 ± 0.8 vs 3.1 ± 1.0, P < 0.001; 5.6 ± 1.8 vs 2.8 ± 0.9, P < 0.001). Comparison of lesion size showed no significant differences between C- and M-b1400(P = 0.22). CONCLUSION: Combination of a high b-value extrap-olation and sFOV may contribute to increase diagnostic accuracy of DWI without an increase of acquisition time, which may be useful to guide targeted prostate biopsies and to improve quality of multiparametric MRI(mMRI) especially under economical aspects in a pri-vate practice setting.
文摘To obtain improved accuracy in predicting extracapsular extension （ECE） and seminal vesicle invasion （SVI）, we evaluated the variables affecting the predictability of staging magnetic resonance imaging （MRI, phased-array coil） and estimated their impact on accuracy between preoperative MRI staging and histological outcome. A total of 121 patients with localized or locally advanced prostate cancer who underwent robotic radical prostatectomy （RALP） were included. Following transrectal biopsy, all enrolled patients had undergone MRI for staging work-up. After RALP, only 43.8% （53/121） of the patients were matched with the MRI predicted stage. Compared to the matched group in the prediction of ECE, the unmatched group had significantly higher initial prostate-specific antigen （PSA, 12.8 ng m1-1 versus 8.1 ng m1-1, P=0.048）. In the prediction of SVI, initial PSA （8.1 ng ml- 1 versus 17.3 ng ml- 1, P=0.009） and biopsy Gleason score （6.5 versus 7.6, P=0.035） were significantly higher in the unmatched group. When applying clinical cutoffs of initial PSA of 10 and 20 ng ml-1, the accuracy of MRI in the prediction of ECE was decreased in the group with PSA over 20 ng ml- 1 （75.6, 64.5 and 37.5%, P=0.01）, and this group had significantly decreased accuracy of MRI in the prediction of SVI （91.5, 77.4 and 37.5%, P〈0.01）. Applying the clinical cutoff of a Gleason score of 7, the accuracy of MRI in the prediction of SVI was decreased in the higher G leason score group （93.9, 82.1 and 62.9%, P= 0.01）. Thus, for these patient groups, to obtain margin negativity during radical prostatectomy, operative findings, rather than post-biopsy MRI images, may provide substantial information, implying a clinical advantage in conducting MRI before prostate biopsy.
