scholarly journals New TRUS Techniques and Imaging Features of PI-RADS 4 or 5: Influence on Tumor Targeting

2021 ◽  
Vol 11 ◽  
Author(s):  
Amy Inji Chang ◽  
Byung Kwan Park
Keyword(s):  
Tumor Targeting ◽  
Transrectal Ultrasound ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Prostate Imaging ◽  
Trus Biopsy ◽  
Trus Image ◽  
Systematic Biopsy ◽  
Target Biopsy

PurposeTo determine if the new transrectal ultrasound (TRUS) techniques and imaging features contribute to targeting Prostate Imaging and Reporting and Data System (PI-RADS) 4 or 5.Materials and MethodsBetween December 2018 and February 2020, 115 men underwent cognitive biopsy by radiologist A, who was familiar with the new TRUS findings and biopsy techniques. During the same period, 179 men underwent magnetic resonance imaging–TRUS image fusion or cognitive biopsy by radiologist B, who was unfamiliar with the new biopsy techniques. Prior to biopsy, both radiologists knew MRI findings such as the location, size, and shape of PI-RADS 4 or 5. We recorded how many target biopsies were performed without systematic biopsy and how many of these detected higher Gleason score (GS) than those detected by systematic biopsy. The numbers of biopsy cores were also obtained. Fisher Exact or Mann–Whitney test was used for statistical analysis.ResultsFor PI-RADS 4, target biopsy alone was performed in 0% (0/84) by radiologist A and 0.8% (1/127) by radiologist B (p>0.9999). Target biopsy yielded higher GSs in 57.7% (30/52) by radiologist A and 29.5% (23/78) by radiologist B (p = 0.0019). For PI-RADS 5, target biopsy alone was performed in 29.0% (9/31) by radiologist A and 1.9% (1/52) by radiologist B (p = 0.0004). Target biopsy yielded higher GSs in 50.0% (14/28) by radiologist A and 18.2% (8/44) by radiologist B (p = 0.0079). Radiologist A sampled fewer biopsy cores than radiologist B (p = 0.0008 and 0.0023 for PI-RADS 4 and 5), respectively.ConclusionsPI-RADS 4 or 5 can be more precisely targeted if the new TRUS biopsy techniques are applied.

scholarly journals Utilization of Multiparametric MRI of Prostate in Patients under Consideration for or Already in Active Surveillance: Correlation with Imaging Guided Target Biopsy

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 441
Author(s):  
Jinxing Yu ◽  
Ann S. Fulcher ◽  
Sarah Winks ◽  
Mary A. Turner ◽  
William Behl ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Active Surveillance ◽  
Gleason Score ◽  
Transrectal Ultrasound ◽  
Multiparametric Mri ◽  
Clinical Consideration ◽  
Ultrasound Guided ◽  
Prostate Imaging ◽  
Trus Biopsy ◽  
Target Biopsy

This study sought to assess the value of multiparametric magnetic resonance image (mp-MRI) in patients with a prostate cancer (PCa) Gleason score of 6 or less under consideration for or already in active surveillance and to determine the rate of upgrading by target biopsy. Three hundred and fifty-four consecutive men with an initial transrectal ultrasound-guided (TRUS) biopsy-confirmed PCa Gleason score of 6 or less under clinical consideration for or already in active surveillance underwent mp-MRI and were retrospectively reviewed. One hundred and nineteen of 354 patients had cancer-suspicious regions (CSRs) at mp-MRI. Each CSR was assigned a Prostate Imaging Reporting and Data System (PI-RADS) score based on PI-RADS v2. One hundred and eight of 119 patients underwent confirmatory imaging-guided biopsy for CSRs. Pathology results including Gleason score (GS) and percentage of specimens positive for PCa were recorded. Associations between PI-RADS scores and findings at target biopsy were evaluated using logistic regression. At target biopsy, 81 of 108 patients had PCa (75%). Among them, 77 patients had upgrading (22%, 77 of 354 patients). One hundred and forty-six CSRs in 108 patients had PI-RADS 3 n = 28, 4 n = 66, and 5 n = 52. The upgraded rate for each category of CSR was for PI-RADS 3 (5 of 28, 18%), 4 (47 of 66, 71%) and 5 (49 of 52, 94%). Using logistic regression analysis, differences in PI-RADS scores from 3 to 5 are significantly associated with the probability of disease upgrade (20%, 73%, and 96% for PI-RADS score of 3, 4, and 5, respectively). Adding mp-MRI to patients under consideration for or already in active surveillance helps to identify undiagnosed PCa of a higher GS or higher volume resulting in upgrading in 22%.

scholarly journals Usefulness of Prostate-Specific Antigen Density as an Indicator for Recommending Prebiopsy Magnetic Resonance Imaging to Prevent Missed Prostate Cancer Diagnoses

2021 ◽  
Vol 19 (3) ◽  
pp. 155-163
Author(s):  
Jin Hyung Jeon ◽  
Kyo Chul Koo ◽  
Byung Ha Chung ◽  
Kwang Suk Lee
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Resonance Imaging ◽  
Detection Rates ◽  
Psa Density ◽  
Systematic Biopsy ◽  
Target Biopsy

Purpose: To identify the indication for recommending prebiopsy magnetic resonance imaging (MRI) to prevent prostate cancer missed diagnoses in cases without prebiopsy MRI.Materials and Methods: Between January 2017 and September 2020, 585 patients suspected with prostate cancer underwent prostate biopsy after MRI. For patients with visible lesions, MRI-targeted biopsy using an image-based fusion program was performed in addition to the 12- core systematic biopsy. Patients for whom MRI was performed in other institutions (n=4) and patients who underwent target biopsy alone (n=7) were excluded.Results: Of 574 patients (median prostate-specific antigen [PSA] level, 6.88 ng/mL; mean age, 68.2 years), 342 (59.6%) were diagnosed with prostate cancer (visible lesions=312/449 [69.5%]; nonvisible lesions=30/123 [24.0%]). The detection rates of visible lesions stratified using the Prostate Imaging Reporting and Data System score (3 vs. 4 vs. 5) were 30.9% (54 of 175), 61.2% (150 of 245), and 90.1% (127 of 141), respectively. Multivariate analysis showed that PSA density was a significant factor for presence of visible lesions, prostate cancer, and significant prostate cancer diagnosis. Among patients with positive lesions, 27 (8.2%) were diagnosed with prostate cancer concomitant with negative systematic biopsy results. A PSA density of 0.15 ng/mL/cm<sup>3</sup> was identified as the significant cutoff value for predicting positive target biopsy in groups with negative systematic biopsy. Sixty of the negative target lesions (26.1%) were diagnosed using systematic biopsy.Conclusions: To maximize cancer detection rates, both targeted and systematic biopsies should be implemented. PSA density was identified as a useful factor for recommending prebiopsy MRI to patients suspected with prostate cancer.

scholarly journals 1.5 Tesla Magnetic Resonance Imaging Features of Canine Intracranial Intra-axial Hematomas

2021 ◽  
Vol 8 ◽  
Author(s):  
James Whitlock ◽  
Andrew Holdsworth ◽  
Carles Morales ◽  
Laurent Garosi ◽  
Inés Carrera
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
Clinical Signs ◽  
Border Region ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Mri Features ◽  
Mri Study

The differentiation of solitary intra-axial hematomas from hemorrhagic neoplasms based on their magnetic resonance imaging (MRI) features is challenging. The treatment and prognosis for these two disease entities are vastly different and distinction between them is often based on MRI findings alone. The aim of this study was to describe the 1.5 tesla MRI features of canine intra-axial hematomas and correlate these findings with the evolution of hemorrhages described in human brains. Retrospective evaluation of patient details, clinical signs, and MRI findings of dogs with intra-axial hematomas that were histopathologically confirmed or determined via repeat MRI study and/or resolution of neurological signs. Ten dogs met the inclusion criteria. All 10 hematoma lesions were determined to be 2–7 days in age. On MRI, all 10 hemorrhagic lesions were comprised of two distinct regions; a relatively thin T1-weighted (T1W), T2-weighted (T2W) and gradient echo (GRE) hypointense (9/10) peripheral border region and a large central region that was heterogenous but predominantly T1W, T2W and GRE hyperintense (8/10). The peripheral border region was complete in its integrity in all 10 cases on T2W and GRE sequences. Contrast enhancement was present in (6/10) hematoma lesions and was always peripheral in nature with no evidence of central enhancement associated with any of the lesions. An intra-axial hematoma should be suspected in solitary hemorrhagic space occupying lesions that have a complete hypointense peripheral rim, elicit a peripheral contrast enhancement pattern, and display the expected temporal pattern of hematoma evolution.

Accuracy of prostate imaging reporting and data system (PI-RADS v2) in the detection of prostate cancer (PCa).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17604-e17604
Author(s):  
David Michael Gill ◽  
Jay Bishoff ◽  
Steven C. Lynch ◽  
Bridget Foy ◽  
Jaden D. Evans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Healthcare System ◽  
False Negative ◽  
Transrectal Ultrasound ◽  
Detection Rates ◽  
Prostate Imaging ◽  
Trus Biopsy ◽  
Precision Study ◽  
Intermountain Healthcare ◽  
Independent Cohort

e17604 Background: MRI-targeted biopsy is increasingly utilized over standard 12-core transrectal ultrasound (TRUS) biopsy for men with MRI-visible prostate lesions. Some clinicians defer biopsy for PI-RADS v2 category 1 and 2 lesions per the PRECISION Study (Kasivisvanathan et. Al, NEJM, 2018). The aim of this study was to independently validate the accuracy of PI-RADS v2 in detecting prostate cancer (PCa) when applied to MRI/US fusion-guided biopsies in an independent cohort of 156 patients from a large integrated community health system. Methods: Men undergoing MRI/US fusion-guided biopsy from 2016-2020 in the Intermountain Healthcare system were consecutively analyzed in this retrospective study. MRI were interpreted from four abdominal fellowship trained radiologists all with at least 5 years of experience. Fusion biopsies were performed by two urologists. Men were stratified into groups based on their PI-RADS v2 category 1-5. Biopsies were considered positive when Gleason ≥3+3. Results: A total of 156 men had 258 lesions for which they underwent MRI/US fusion-guided biopsies in the Intermountain Healthcare system from 2016 to 2020. The PCa detection rate for PIRADSv2 category 1-2 was 29.8%, category 3 32.6%, and category 4-5 37.6%. PIRADS v2 category 1, 2, 3, 4, and 5 yielded any PCa in 25, 15.9, 23.8, 53.1, and 66.7%, respectively (Table). PIRADS v2 category 1-2, 3, and 4-5 yielded any PCa in 16.8%, 23.8%, and 57.7%, respectively. Conclusions: PI-RADS v2 categories generally correlate with PCa detection rates, however, to avoid biopsy, the test must be both sensitive and specific, with low false negative rates. In our institution, we show that PI-RADS 1, 2, and 3 do not rule out the presence of PCa, and therefore should not be used as the sole factor in determining the need for prostate lesion biopsy. [Table: see text]

scholarly journals Diagnostic performance of PI-RADS version 2.1 compared to version 2.0 for detection of peripheral and transition zone prostate cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Madhuri Monique Rudolph ◽  
Alexander Daniel Jacques Baur ◽  
Hannes Cash ◽  
Matthias Haas ◽  
Samy Mahjoub ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Transition Zone ◽  
Diagnostic Performance ◽  
Statistical Significance ◽  
Transrectal Ultrasound ◽  
Peripheral Zone ◽  
Fusion Biopsy ◽  
Prostate Imaging ◽  
Version 2.0 ◽  
Systematic Biopsy

Abstract The purpose of this study is to compare diagnostic performance of Prostate Imaging Reporting and Data System (PI-RADS) version (v) 2.1 and 2.0 for detection of Gleason Score (GS) ≥ 7 prostate cancer on MRI. Three experienced radiologists provided PI-RADS v2.0 scores and at least 12 months later v2.1 scores on lesions in 333 prostate MRI examinations acquired between 2012 and 2015. Diagnostic performance was assessed retrospectively by using MRI/transrectal ultrasound fusion biopsy and 10-core systematic biopsy as the reference. From a total of 359 lesions, GS ≥ 7 tumor was present in 135 lesions (37.60%). Area under the ROC curve (AUC) revealed slightly lower values for peripheral zone (PZ) and transition zone (TZ) scoring in v2.1, but these differences did not reach statistical significance. A significant number of score 2 lesions in the TZ were downgraded to score 1 in v2.1 showing 0% GS ≥ 7 tumor (0/11). The newly introduced diffusion-weighted imaging (DWI) upgrading rule in v2.1 was applied in 6 lesions from a total of 143 TZ lesions (4.2%). In summary, PI-RADS v2.1 showed no statistically significant differences in overall diagnostic performance of TZ and PZ scoring compared to v2.0. Downgraded BPH nodules showed favorable cancer frequencies. The new DWI upgrading rule for TZ lesions was applied in only few cases.

scholarly journals Spectrum of findings on magnetic resonance imaging of the brain in patients with neurological manifestations of dengue fever

2017 ◽  
Vol 50 (5) ◽  
pp. 285-290 ◽  
Author(s):  
Tejeshwar Singh Jugpal ◽  
Rashmi Dixit ◽  
Anju Garg ◽  
Swati Gupta ◽  
Virendra Jain ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebral Cortex ◽  
White Matter ◽  
Basal Ganglia ◽  
Magnetic Resonance ◽  
Dengue Fever ◽  
Imaging Features ◽  
Neurological Manifestations ◽  
Resonance Imaging ◽  
Mri Findings

Abstract Objective: To describe the spectrum of magnetic resonance imaging (MRI) findings in patients with neurological manifestations of dengue. Materials and Methods: We included nine patients with dengue fever (three females and six males; age range, 9–30 years), all of whom presented with neurological manifestations. The MRI examinations, performed in 1.5 T or 3 T scanners, included T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences. Diffusion-weighted imaging with apparent diffusion coefficient mapping was also employed. Fast low-angle shot and susceptibility-weighted gradient-recalled echo sequences, as well as contrast-enhanced T1-weighted scans, were also obtained in order to assess parenchymal enhancement. MRI scans were analyzed for lesion distribution and imaging features. Results: All patients showed areas of altered signal intensity that appeared as hyperintensity on T2-weighted and FLAIR sequences. The most commonly affected site was the basal ganglia-thalamus complex. Other affected sites were the cerebellum, cerebral cortex, white matter, and brainstem. In all cases, we observed patchy areas of restricted diffusion and focal areas of hemorrhage. Conclusion: Dengue encephalitis commonly affects the basal ganglia, thalamus, cerebellum, cerebral cortex, and white matter. Therefore, MRI should be an indispensable part of the evaluation of patients with neurological complications of dengue fever.

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