MRI in Prostate Cancer: New Evidences and Future Perspectives

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 10607

Special Issue Editor

Centre for Medical Imaging, University College London, London, United Kingdom
Interests: quantitaive multi-parametric MRI in cancer imaging; whole-body MRI Hyperpolarised MRI in prostrate cancer detection; novel MRI Technologies

Special Issue Information

Dear Colleagues,

Advances in MRI have enabled a paradigm shift in the diagnosis and management of prostate cancer. Multi-parametric MRI (mp-MRI) of the prostate is now routinely used to guide biopsy, avoid unnecessary biopsies and reduce the number of insignificant cancer diangoses. Strategies for using mp-MRI to provide the best management outcomes are developing. Whole-body MRI is also implemented in expert centres for metastatic disease staging. New advances in MRI methods that can now evalaute tissue micostructure in more detail and provide real-time metabolic information on cancer. In this special issue we highlight ongoing resesarch in the field of prostate MRI, both technological advances and also their implemetnation within clinical pathways. 

Prof. Dr. Shonit Punwani
Guest Editor

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Published Papers (5 papers)

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Research

12 pages, 1593 KiB  
Article
Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics
by Karl-Dietrich Sievert, Torsten Hansen, Barbara Titze, Birte Schulz, Ahmad Omran, Lukas Brockkötter, Alfons Gunnemann and Ulf Titze
Diagnostics 2022, 12(5), 1146; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051146 - 05 May 2022
Cited by 2 | Viewed by 1906
Abstract
Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. [...] Read more.
Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa. Full article
(This article belongs to the Special Issue MRI in Prostate Cancer: New Evidences and Future Perspectives)
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14 pages, 1663 KiB  
Article
Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy
by Eoin Dinneen, Clare Allen, Tom Strange, Daniel Heffernan-Ho, Jelena Banjeglav, Jamie Lindsay, John-Patrick Mulligan, Tim Briggs, Senthil Nathan, Ashwin Sridhar, Jack Grierson, Aiman Haider, Christos Panayi, Dominic Patel, Alex Freeman, Jonathan Aning, Raj Persad, Imran Ahmad, Lorenzo Dutto, Neil Oakley, Alessandro Ambrosi, Tom Parry, Veeru Kasivisvanathan, Francesco Giganti, Greg Shaw and Shonit Punwaniadd Show full author list remove Hide full author list
Diagnostics 2022, 12(5), 1057; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051057 - 23 Apr 2022
Cited by 13 | Viewed by 2202
Abstract
Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a [...] Read more.
Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1–5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77–0.86). The AUC was 0.76 (95% CI: 0.64–0.88), 0.78 (0.72–0.84), and 0.92 (0.88–0.96) for biparametric scans, PI-QUAL 1–3, and PI-QUAL 4–5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system. Full article
(This article belongs to the Special Issue MRI in Prostate Cancer: New Evidences and Future Perspectives)
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13 pages, 677 KiB  
Article
Urethral Sphincter Length but Not Prostatic Apex Shape in Preoperative MRI Is Associated with Mid-Term Continence Rates after Radical Prostatectomy
by Benedikt Hoeh, Mike Wenzel, Matthias Müller, Clarissa Wittler, Eva Schlenke, Jan L. Hohenhorst, Jens Köllermann, Thomas Steuber, Markus Graefen, Derya Tilki, Simon Bernatz, Pierre I. Karakiewicz, Felix Preisser, Andreas Becker, Luis A. Kluth, Philipp Mandel and Felix K. H. Chun
Diagnostics 2022, 12(3), 701; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030701 - 13 Mar 2022
Cited by 4 | Viewed by 2069
Abstract
Background: To test the impact of urethral sphincter length (USL) and anatomic variants of prostatic apex (Lee-type classification) in preoperative multiparametric magnet resonance imaging (mpMRI) on mid-term continence in prostate cancer patients treated with radical prostatectomy (RP). Methods: We relied on an institutional [...] Read more.
Background: To test the impact of urethral sphincter length (USL) and anatomic variants of prostatic apex (Lee-type classification) in preoperative multiparametric magnet resonance imaging (mpMRI) on mid-term continence in prostate cancer patients treated with radical prostatectomy (RP). Methods: We relied on an institutional tertiary-care database to identify patients who underwent RP between 03/2018 and 12/2019 with preoperative mpMRI and data available on mid-term (>6 months post-surgery) urinary continence, defined as usage 0/1 (-safety) pad/24 h. Univariable and multivariable logistic regression models were fitted to test for predictor status of USL and prostatic apex variants, defined in mpMRI measurements. Results: Of 68 eligible patients, rate of mid-term urinary continence was 81% (n = 55). Median coronal (15.1 vs. 12.5 mm) and sagittal (15.4 vs. 11.1 mm) USL were longer in patients reporting urinary continence in mid-term follow-up (both p < 0.01). No difference was recorded for prostatic apex variants distribution (Lee-type) between continent vs. incontinent patients (p = 0.4). In separate multivariable logistic regression models, coronal (odds ratio (OR): 1.35) and sagittal (OR: 1.67) USL, but not Lee-type, were independent predictors for mid-term continence. Conclusion: USL, but not apex anatomy, in preoperative mpMRI was associated with higher rates of urinary continence at mid-term follow-up. Full article
(This article belongs to the Special Issue MRI in Prostate Cancer: New Evidences and Future Perspectives)
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10 pages, 251 KiB  
Article
Diagnostic Accuracy of Abbreviated Bi-Parametric MRI (a-bpMRI) for Prostate Cancer Detection and Screening: A Multi-Reader Study
by Giorgio Brembilla, Francesco Giganti, Harbir Sidhu, Massimo Imbriaco, Sue Mallett, Armando Stabile, Alex Freeman, Hashim U. Ahmed, Caroline Moore, Mark Emberton and Shonit Punwani
Diagnostics 2022, 12(2), 231; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020231 - 18 Jan 2022
Cited by 6 | Viewed by 1713
Abstract
(1) Background: There is currently limited evidence on the diagnostic accuracy of abbreviated biparametric MRI (a-bpMRI) protocols for prostate cancer (PCa) detection and screening. In the present study, we aim to investigate the performance of a-bpMRI among multiple readers and its potential application [...] Read more.
(1) Background: There is currently limited evidence on the diagnostic accuracy of abbreviated biparametric MRI (a-bpMRI) protocols for prostate cancer (PCa) detection and screening. In the present study, we aim to investigate the performance of a-bpMRI among multiple readers and its potential application to an imaging-based screening setting. (2) Methods: A total of 151 men who underwent 3T multiparametric MRI (mpMRI) of the prostate and transperineal template prostate mapping biopsies were retrospectively selected. Corresponding bpMRI (multiplanar T2WI, DWI, ADC maps) and a-bpMRI (axial T2WI and b 2000 s/mm2 DWI only) dataset were derived from mpMRI. Three experienced radiologists scored a-bpMRI, standard biparametric MRI (bpMRI) and mpMRI in separate sessions. Diagnostic accuracy and interreader agreement of a-bpMRI was tested for different positivity thresholds and compared to bpMRI and mpMRI. Predictive values of a-bpMRI were computed for lower levels of PCa prevalence to simulate a screening setting. The primary definition of clinically significant PCa (csPCa) was Gleason ≥ 4 + 3, or cancer core length ≥ 6 mm. (3) Results: The median age was 62 years, the median PSA was 6.8 ng/mL, and the csPCa prevalence was 40%. Using a cut off of MRI score ≥ 3, the sensitivity and specificity of a-bpMRI were 92% and 48%, respectively. There was no significant difference in sensitivity compared to bpMRI and mpMRI. Interreader agreement of a-bpMRI was moderate (AC1 0.58). For a low prevalence of csPCa (e.g., <10%), higher cut offs (MRI score ≥ 4) yield a more favourable balance between the predictive values and positivity rate of MRI. (4) Conclusion: Abbreviated bpMRI protocols could match the diagnostic accuracy of bpMRI and mpMRI for the detection of csPCa. If a-bpMRI is used in low-prevalence settings, higher cut-offs for MRI positivity should be prioritised. Full article
(This article belongs to the Special Issue MRI in Prostate Cancer: New Evidences and Future Perspectives)
11 pages, 1590 KiB  
Article
Comparison of Accuracies between Real-Time Nonrigid and Rigid Registration in the MRI–US Fusion Biopsy of the Prostate
by Sung Il Hwang, Hyungwoo Ahn, Hak Jong Lee, Sung Kyu Hong, Seok-Soo Byun, Sangchul Lee, Gheeyoung Choe, Jun-Sung Park and Yuri Son
Diagnostics 2021, 11(8), 1481; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11081481 - 16 Aug 2021
Cited by 1 | Viewed by 1646
Abstract
Magnetic resonance imaging (MRI) is increasingly important in the detection and localization of prostate cancer. Regarding suspicious lesions on MRI, a targeted biopsy using MRI fused with ultrasound (US) is widely used. To achieve a successful targeted biopsy, a precise registration between MRI [...] Read more.
Magnetic resonance imaging (MRI) is increasingly important in the detection and localization of prostate cancer. Regarding suspicious lesions on MRI, a targeted biopsy using MRI fused with ultrasound (US) is widely used. To achieve a successful targeted biopsy, a precise registration between MRI and US is essential. The purpose of our study was to show any decrease in errors using a real-time nonrigid registration technique for prostate biopsy. Nineteen patients with suspected prostate cancer were prospectively enrolled in this study. Registration accuracy was calculated by the measuring distance of corresponding points by rigid and nonrigid registration between MRI and US, and compared for rigid and nonrigid registration methods. Overall cancer detection rates were also evaluated by patient and by core. Prostate volume was measured automatically from MRI and manually from US, and compared to each other. Mean distances between the corresponding points in MRI and US were 5.32 ± 2.61 mm for rigid registration and 2.11 ± 1.37 mm for nonrigid registration (p < 0.05). Cancer was diagnosed in 11 of 19 patients (57.9%), and in 67 of 266 biopsy cores (25.2%). There was no significant difference in prostate-volume measurement between the automatic and manual methods (p = 0.89). In conclusion, nonrigid registration reduces targeting errors. Full article
(This article belongs to the Special Issue MRI in Prostate Cancer: New Evidences and Future Perspectives)
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