Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement

Introduction. Significant improvement in the quality of visualization of the prostate using magnetic resonance imaging (MRI), as well as the development of technologies for virtual combination of MRI and ultrasound images opens new horizons in the diagnosis of prostate cancer. The introduction of the PI-RADS system has allowed the standardization of MRI findings, and the development of fusion biopsy systems seeks to make diagnostics more accurate and less operator-dependent. Materials and methods. In this literature review, we evaluate the effectiveness of various biopsy approaches and discuss the prospects for targeted biopsies. The search for publications was carried out in the databases PubMed, e-library, Web of Scince et al. For citation, 55 literature sources were selected that met the search criteria for the keywords, «prostate cancer», «biopsy», «MRI», «TRUS», «fusion». Results. Diagnosis of prostate cancer using MRI. Modern technologies for radiological diagnosis of prostate cancer using magnetic resonance imaging (MRI) are based on the standardized PI-RADS protocol, using different modes (T2, diffusion-weighted images and contrast enhancement), which provides the best visualization of tumor-suspicious nodes in the prostate gland, allowing determination of lesion localization and size for subsequent targeted biopsy. Options for performing a prostate biopsy to diagnose prostate cancer. A description of the methods and effectiveness of transrectal and transperineal biopsy under ultrasound guidance is carried out - due to the fact that ultrasound diagnostics of prostate cancer has a rather low sensitivity due to small differences in the ultrasound structure of normal and tumor tissue of the prostate, an extended template biopsy technique was proposed, which involves puncture of the prostate through a special lattice. It also describes the technology of fusion biopsy and also provides literature data comparing the diagnostic accuracy of standard TRUS and fusion prostate biopsy, as well as the importance of transrectal / transperineal access. Questions for further study. Given the desire to reduce the number of biopsies while maintaining or even increasing the accuracy of diagnosing prostate cancer, data from studies investigating the feasibility of combining polyfocal (non-targeted) and targeted (targeted) biopsies are presented. Conclusion. The existing methods of non-targeted biopsy (polyfocal, saturation, template) and targeted (fusion biopsy) have their advantages and disadvantages, which currently do not allow making certain recommendations for their use, but a significant number of authors prefer MRI-as sisted, fusion -biopsy.

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NIMG-33. CHANGES IN MAGNETIC RESONANCE IMAGING AFTER PROTON BOOST THERAPY FOR GLIOBLASTOMA WITH AND WITHOUT TUMOR TREATING FIELDS THERAPY

Neuro-Oncology ◽

10.1093/neuonc/noaa215.646 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii155-ii155

Author(s):

Hanna Goett ◽

Alexandra Jensen ◽

Tobias Struffert ◽

Eberhard Uhl ◽

Marco Stein

Keyword(s):

Magnetic Resonance Imaging ◽

Radiation Therapy ◽

Magnetic Resonance ◽

Contrast Enhancement ◽

Median Overall Survival ◽

Progressive Disease ◽

Tumor Resection ◽

Resonance Imaging ◽

Tumor Treating Fields ◽

Magnetic Resonance Imaging Mri

Abstract BACKGROUND Tumor treating fields (TTFields) are an approved glioblastoma (GBM) treatment modality that demonstrated a significant improved median overall survival in newly diagnosed GBM patients. Data about morphologic changes in serial magnetic resonance imaging (MRI) for patients with a combination therapy of TTFields and proton boost therapy does not exist. METHODS Twenty-two patients were included in this study. All patients were treated with initial tumor resection followed by combined chemo- and radiation therapy. Radiation therapy was performed with 50.0 Gy photons and a proton boost with 10 Gy equivalent (Gy(RBE)). 11 patients were additionally treated with TTFields. RESULTS A new increase in contrast enhancement and/or a progress in the T2 FLAIR hyperintensity was observed in 54.5% (N=12) at 3 months and in 31.8% (N=7) at 6 months. No differences were observed between patients with and without TTFields therapy at 3 months [63.6% (N=7) vs. 45.5% (N=5); P=0.392] and at 6 months [27.3 (N=3) vs. 36.3% (N=4); P=0.647). By the RANO criteria a progressive disease (PD) was observed in 6 patients (27.3%) at 3 months and in 7 patients (31.8%) at 6 months. Pseudoprogression (PP) was observed in in 36.4% (N=8) at months and in 27.3% (N=6) at 6 months. Neither for PD at 3 months [36.4% (N=4) vs. 18.2% (N=2); P=0.338] or at 6 months [36.4% (N=4) vs. 27.3% (N=3); P=0.647), nor for PP at 3 months [45.5% (N=5) vs. 27.2% (N=3); P=0.375] or at 6 months [18.2% (N=2) vs. 36.4% (N=4); P=0.338] differences for patients with and without TTFields therapy were found. CONCLUSION Increased contrast enhancement and/or increased T2 FLAIR MRI hyperintensity after proton boost therapy are common. Furthermore, the rates for new contrast enhancement, PD, and PP after photon therapy with and without additional TTFields therapy are comparable.

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