scholarly journals Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility

Diagnostics ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 164 ◽  
Author(s):  
Valentina Brancato ◽  
Giuseppe Di Costanzo ◽  
Luca Basso ◽  
Liberatore Tramontano ◽  
Marta Puglia ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Multiparametric Mri ◽  
Added Value ◽  
Operating Characteristics ◽  
Dce Mri ◽  
Contrast Enhanced ◽  
Mri Protocol ◽  
Controversial Topic ◽  
Clinically Significant ◽  
Method Agreement

The role of dynamic contrast-enhanced-MRI (DCE-MRI) for Prostate Imaging-Reporting and Data System (PI-RADS) scoring is a controversial topic. In this retrospective study, we aimed to measure the added value of DCE-MRI in combination with T2-weighted (T2W) and diffusion-weighted imaging (DWI) using PI-RADS v2.1, in terms of reproducibility and diagnostic accuracy, for detection of prostate cancer (PCa) and clinically significant PCa (CS-PCa, for Gleason Score ≥ 7). 117 lesions in 111 patients were identified as suspicion by multiparametric MRI (mpMRI) and addressed for biopsy. Three experienced readers independently assessed PI-RADS score, first using biparametric MRI (bpMRI, including DWI and T2W), and then multiparametric MRI (also including DCE). The inter-rater and inter-method agreement (bpMRI- vs. mpMRI-based scores) were assessed by Cohen’s kappa (κ). Receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic accuracy for PCa and CS-PCa detection among the two scores. Inter-rater agreement was excellent for the three pairs of readers (κ ≥ 0.83), while the inter-method agreement was good (κ ≥ 0.73). Areas under the ROC curve (AUC) showed similar high-values (0.8 ≤ AUC ≤ 0.85). The reproducibility of PI-RADS v2.1 scoring was comparable and high among readers, without relevant differences, depending on the MRI protocol used. The inclusion of DCE did not influence the diagnostic accuracy.

scholarly journals Unenhanced breast MRI: could it replace dynamic breast MRI in detecting and characterizing breast lesions?

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Reham Khalil ◽  
Noha Mohamed Osman ◽  
Nivine Chalabi ◽  
Enas Abdel Ghany
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Breast Mri ◽  
Breast Lesions ◽  
Dce Mri ◽  
Contrast Enhanced ◽  
Mri Protocol ◽  
Sensitivity Specificity

Abstract Background We aimed to evaluate the unenhanced MRI of the breast (UE-MRI) as an effective substitute for dynamic contrast-enhanced breast MRI (DCE-MRI) in both detecting and characterizing breast lesions. We enrolled in our retrospective study 125 females (232 breasts, as 18 patients had unilateral mastectomy) with breast mass at MRI of variable pathologies. Routine DCE-MRI protocol of the breast was conducted. We compared the conventional unenhanced images including STIR, T2, and DWIs to the DCE-MRI by two blinded radiologists, to detect and characterize breast lesions, and then we compared their results with the final reference diagnoses supplied by the histopathology or serial negative follow-ups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and DCE-MRI were calculated. UE-MRI results of each observer were also compared with DCE- MRI. Results The calculated UE-MRI sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the first observer were 95%, 80%, 83%, 94%, and 89% respectively, and for the second observer, they were 94%, 79%, 81%, 93%, and 86%. On the other hand, those for the DCE-MRI by the first observer were 98%, 82%, 84%, 98%, and 90% and were 97%, 81%, 84%, 97%, and 89% by the second observer. The intraobserver agreement between the UE-MRI and DCE-MRI results of each observer was 94% and 95%, while the interobserver agreement for each section was 97.4% for UE-MRI and 98.3% for DCE-MRI. Conclusion UE-MRI of the breast can be a reliable and effective substitute for breast DCE-MRI. It can be used with comparable accuracy to DCE-MRI whenever contrast administration is not feasible or contraindicated.

scholarly journals Extended perfusion protocol for MS lesion quantification

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 520-530
Author(s):  
Eleftherios Kontopodis ◽  
Kostas Marias ◽  
Georgios C. Manikis ◽  
Katerina Nikiforaki ◽  
Maria Venianaki ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Magnetic Resonance ◽  
Goodness Of Fit ◽  
Accurate Determination ◽  
Acquisition Time ◽  
Minimal Extension ◽  
Dce Mri ◽  
Contrast Enhanced ◽  
Demyelinating Lesions ◽  
Mri Protocol

AbstractThis study aims to examine a time-extended dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) protocol and report a comparative study with three different pharmacokinetic (PK) models, for accurate determination of subtle blood–brain barrier (BBB) disruption in patients with multiple sclerosis (MS). This time-extended DCE-MRI perfusion protocol, called Snaps, was applied on 24 active demyelinating lesions of 12 MS patients. Statistical analysis was performed for both protocols through three different PK models. The Snaps protocol achieved triple the window time of perfusion observation by extending the magnetic resonance acquisition time by less than 2 min on average for all patients. In addition, the statistical analysis in terms of adj-R2 goodness of fit demonstrated that the Snaps protocol outperformed the conventional DCE-MRI protocol by detecting 49% more pixels on average. The exclusive pixels identified from the Snaps protocol lie in the low ktrans range, potentially reflecting areas with subtle BBB disruption. Finally, the extended Tofts model was found to have the highest fitting accuracy for both analyzed protocols. The previously proposed time-extended DCE protocol, called Snaps, provides additional temporal perfusion information at the expense of a minimal extension of the conventional DCE acquisition time.

scholarly journals Συμβολή νεότερων τεχνικών μαγνητικού συντονισμού στη διάγνωση και παρακολούθηση του θεραπευτικού αποτελέσματος στον καρκίνο του προστάτη

2014 ◽  
Author(s):  
Αναστάσιος Γυφτόπουλος
Keyword(s):  
Multiparametric Mri ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced

ΣΚΟΠΟΣ : Σκοπός της παρούσας διδακτορικής διατριβής ήταν η μελέτη ασθενών με διαγνωσμένο καρκίνο του προστάτη με νεότερες τεχνικές απεικόνισης (διάχυση (DWI), αιματική διήθηση), η συσχέτιση των απεικονιστικών με τα παθολογοανατομικά ευρήματα καθώς και η λειτουργική μελέτη του αδένα κατά τη διάρκεια της θεραπείας με σκοπό την εκτίμηση της ανταπόκρισης σε αυτή. Επιπρόσθετα η σύγκριση των παραμέτρων της πολυπαραμετρικής μαγνητικής τομογραφίας δηλαδή των ακολουθιών Τ2 προσανατολισμού, των ακολουθιών διάχυσης, της δυναμικής εξέτασης ή του συνδυασμού τους για την καλύτερη διάγνωση της κακοήθειας στον προστάτη.Σαν ελάχιστες προυποθέσεις για την πραγματοποίηση πολυπαραμετρικής Μαγνητικής Τομογραφίας είναι ο συνδυασμός ακολουθιών Τ1 και Τ2 προσανατολισμού με ακολουθίες διάχυσης (DWΙ) ή δυναμική εξέταση μετά χορήγηση παραμαγνητικής (dynamic contrast-enhanced MRΙ). ΥΛΙΚΟ-ΜΕΣΑ : Κατά τη διάρκεια των τελευταίων ετών της παρούσας μελέτης εξετάστηκαν στο Β’ Εργαστήριο Ακτινολογίας ασθενείς με υψηλά επίπεδα ειδικού προστατικού αντιγόνου (PSA) ορού αίματος στους οποίους είχε τεθεί η διάγνωση του καρκίνου του προστάτη με διορθική βιοψία. Τα παρακευάσματα των χειρουργηθέντων ασθενών τέμνονταν απο τον παθολογοανατόμο με εγκάρσιες τομές , σε αντιστοιχία με τα δεδομένα της εγκάρσιας ανατομίας όπως απεικονίζεται με την μαγνητική τομογραφία. Ορισμένοι ασθενείς υπεβλήθησαν σε ακτινοθεραπεία πραγματοποίησαν εξετάσεις πριν και μετά το πέρας της θεραπείας. ΑΠΟΤΕΛΕΣΜΑΤΑ: Η πολυπαραμετρική μελέτη είχε αυξημένη ευαισθησία ειδικότητα, μεγαλύτερη απο κάθε τεχνική ή συνδυασμό τους . Η αρνητική προγνωστική αξία του συνδυασμού των απεικονιστικών τεχνικών για την ανίχνευση του όγκου ήταν 88.3% . Η δυναμική εξέταση ( DCE ) είχε την υψηλότερη ευαισθησία στην μελέτη μας.Στη μελέτη μας φάνηκε οτι η ακτινοθεραπεία προκαλεί ελάττωση των τιμών στους χάρτες ADC απο τους πρώτους κύκλους θεραπείας. Το γεγονός αυτό συσχετίζεται με ανταπόκριση στη θεραπεία. Τα αποτελέσματα της ποσοτικής προσέγγισης αναδεικνύουν χαμηλότερες τιμές Τ2, ADC και υψηλότερες τιμές Ktrans στις περιοχές κακοήθειας με στατιστικά σημαντική διαφορά όσο αφορά τις δυο τελευταίες παραμέτρους. ΣΥΜΠΕΡΑΣΜΑ : Η πολυπαραμετρική Μαγνητική Τομογραφία (Multiparametric MRI) έχει την δυνατότητα να αλλάξει την συνηθισμένη διαγνωστική και θεραπευτική προσέγγιση της νόσου. Η προσθήκη τεχνικών όπως οι ακολουθίες διάχυσης (DWI), και η δυναμική μελέτη μετά την ενδοφλέβια χορήγηση παραμαγνητικής ουσίας (DCE-MRI) παρέχουν ανατομικές και λειτουργικές πληροφορίες και βοηθούν στον διαχωρισμό του φυσιολογικού απο τον παθολογικό ιστό. H πολυπαραμετρική μαγνητική τομογραφία είναι ένα εξαιρετικό εργαλείο για την διάγνωση ,τον καθορισμό της θεραπείας , την μελέτη του αποτελέσματός της καθώς και την παρακολούθηση των ασθενών με καρκίνο του προστάτη αδένα.

scholarly journals Multiparametric Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Prostate Biopsy: Diagnostic Accuracy from a Single Center Retrospective Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4833
Author(s):  
Andrea Fulco ◽  
Francesco Chiaradia ◽  
Luigi Ascalone ◽  
Vincenzo Andracchio ◽  
Antonio Greco ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Primary Outcome ◽  
Imaging Techniques ◽  
Added Value ◽  
Secondary Outcome ◽  
Transperineal Prostate Biopsy ◽  
Clinically Significant

The management of prostate biopsy in men with clinical suspicion of prostate cancer has changed in the last few years, especially with the introduction of imaging techniques, to overcome the low efficacy of risk stratification based on PSA levels. Here, we aimed to compare the diagnostic accuracy of multiparametric MRI with fusion ultrasound-guided prostate biopsy and standard biopsy, both performed through the transperineal route. To this end, we retrospectively analyzed 272 patients who underwent combined transperineal targeted and standard biopsy during the same session. The primary outcome was to compare the cancer detection rate between targeted and standard biopsy. The secondary outcome was to evaluate the added value of combined targeted and standard biopsy approach as compared to only targeted or standard biopsy. Results showed that a rate of 16.7% clinically significant tumors (International Society of Urological Pathology (ISUP) grade ≥ 2) would have been lost if only the standard biopsy had been used. The combined targeted and standard biopsy showed an added value of 10.3% and 9.9% in reducing the risk of prostate cancer missing after targeted or standard biopsy alone, respectively. The combined targeted and standard biopsy pathway is recommended to reduce the risk of missing clinically significant prostate cancer.

scholarly journals Limited role of DWI with apparent diffusion coefficient mapping in breast lesions presenting as non-mass enhancement on dynamic contrast-enhanced MRI

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Daly Avendano ◽  
Maria Adele Marino ◽  
Doris Leithner ◽  
Sunitha Thakur ◽  
Blanca Bernard-Davila ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Roc Curves ◽  
Breast Cancer Diagnosis ◽  
Breast Lesions ◽  
Mri Findings ◽  
Adc Value ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Mass Enhancement

Abstract Background Available data proving the value of DWI for breast cancer diagnosis is mainly for enhancing masses; DWI may be less sensitive and specific in non-mass enhancement (NME) lesions. The objective of this study was to assess the diagnostic accuracy of DWI using different ROI measurement approaches and ADC metrics in breast lesions presenting as NME lesions on dynamic contrast-enhanced (DCE) MRI. Methods In this retrospective study, 95 patients who underwent multiparametric MRI with DCE and DWI from September 2007 to July 2013 and who were diagnosed with a suspicious NME (BI-RADS 4/5) were included. Twenty-nine patients were excluded for lesion non-visibility on DWI (n = 24: 12 benign and 12 malignant) and poor DWI quality (n = 5: 1 benign and 4 malignant). Two readers independently assessed DWI and DCE-MRI findings in two separate randomized readings using different ADC metrics and ROI approaches. NME lesions were classified as either benign (> 1.3 × 10−3 mm2/s) or malignant (≤ 1.3 × 10−3 mm2/s). Histopathology was the standard of reference. ROC curves were plotted, and AUCs were determined. Concordance correlation coefficient (CCC) was measured. Results There were 39 malignant (59%) and 27 benign (41%) lesions in 66 (65 women, 1 man) patients (mean age, 51.8 years). The mean ADC value of the darkest part of the tumor (Dptu) achieved the highest diagnostic accuracy, with AUCs of up to 0.71. Inter-reader agreement was highest with Dptu ADC max (CCC 0.42) and lowest with the point tumor (Ptu) ADC min (CCC = − 0.01). Intra-reader agreement was highest with Wtu ADC mean (CCC = 0.44 for reader 1, 0.41 for reader 2), but this was not associated with the highest diagnostic accuracy. Conclusions Diagnostic accuracy of DWI with ADC mapping is limited in NME lesions. Thirty-one percent of lesions presenting as NME on DCE-MRI could not be evaluated with DWI, and therefore, DCE-MRI remains indispensable. Best results were achieved using Dptu 2D ROI measurement and ADC mean.

scholarly journals Contrast Enhanced Mammography: The added value in the assessment of Suspicious Breast Lesions

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
R Abdullah ◽  
L Abdelmonem ◽  
N Nasry ◽  
M Ayoub
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Malignant Tumors ◽  
High Energy ◽  
Added Value ◽  
Breast Lesions ◽  
Predictive Values ◽  
Dense Breasts ◽  
Contrast Enhanced

Abstract Background Breast cancer in women is a major public health problem throughout the world, being the second most common cancer worldwide. Sonomammography has been always recommended as the basic breast imaging modality for early detection and diagnosis of breast cancer. Some malignant tumors have been missed, specially in dense breasts, and high false-negative rate have been reported. Contrast enhanced spectral mammography is a new modality, used to depict the tumor vascularity and neoangiogenesis; a classic sign of malignant tumors. Aim of Work The purpose of this study is to determine the added value of dual energy contrast mammography to sono-mammography in the assessment of suspicious breast lesions. Patients and Methods 36 patients were included in the study, referred from outpatient clinics in private settings and from Demerdash Hospitals. Contrast enhanced spectral mammography CESM was performed by using a digital mammography unit (Seno DS; GE, Buc, France) that had been adapted to obtain two images for each view: a low-energy image (below the k edge of iodine, 33.2 keV) and a high-energy image (above the k edge of iodine) at 45 to 49 kVp. Results: CEDM versus sonomammography shows p (0.021) value less than 0.05. Also the area under the ROC curve was higher for MX+CEDM (94.4%) than that was for sonomammography (63.8%) compared to pathology analysis with 100% sensitivity, 88.2 % specificity, 90.48 %PPV and 100 % NPV in diagnosis of suspicious lesions. Conclusion The diagnostic accuracy of CEDM+ MX for the detection of breast carcinoma has proven to be superior to sonomammography alone. CEDM had a better diagnostic accuracy mainly due to improved positive and negative predictive values (Positive predictive value about 90.48, negative predictive value 100). The role of CEDM in detection of multifocal / multicentric carcinomas with particular interest for the assessment of the extent of disease specially in dense breasts is appreciated.

Is perfect the enemy of good? Weighing the evidence for biparametric MRI in prostate cancer

2021 ◽  
Author(s):  
Alexander P Cole ◽  
Bjoern J. Langbein ◽  
Francesco Giganti ◽  
Fiona M. Fennessy ◽  
Clare M. Tempany ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Multiparametric Mri ◽  
Benefit Analysis ◽  
Advantages And Disadvantages ◽  
Contrast Enhanced ◽  
Clinically Significant

The role of multiparametric MRI in diagnosis, staging and treatment planning for prostate cancer is well established. However there remain several challenges to widespread adoption. One such challenge is the duration and cost the examination. Abbreviated exams omitting contrast enhanced sequences may help address this challenge. In this review, we will discuss the rationale for biparametric MRI (bpMRI) for detection and characterization of clinically significant prostate cancer prior to biopsy and synthesize the published literature. We will weigh up the advantages and disadvantages to this approach and lay out a conceptual cost/benefit analysis regarding adoption of bpMRI.

Diagnostic accuracy of biparametric vs multiparametric MRI in clinically significant prostate cancer: Comparison between readers with different experience

2018 ◽  
Vol 101 ◽  
pp. 17-23 ◽  
Author(s):  
Eleonora Di Campli ◽  
Andrea Delli Pizzi ◽  
Barbara Seccia ◽  
Roberta Cianci ◽  
Martina d’Annibale ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Multiparametric Mri ◽  
Clinically Significant

Role of Various DW MRI and DCE MRI Parameters as Predictors of Malignancy in Solid Pulmonary Lesions

2020 ◽  
pp. 084653712091489
Author(s):  
Neeraj Kumar ◽  
Mini Sharma ◽  
Neeti Aggarwal ◽  
Sanjiv Sharma ◽  
Malay Sarkar ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diffusion Weighted Imaging ◽  
Breath Hold ◽  
Data Set ◽  
Predictive Values ◽  
Pulmonary Lesions ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Diffusion Weighted ◽  
Contrast Enhanced

Purpose: We aimed to evaluate various diffusion and dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) parameters in differentiating malignant from benign pulmonary lesions. Methods: We enrolled 31 (22 males) patients who had solid pulmonary lesion(s) >2 cm in our cross sectional study. Of these, 23 (74.2%) were found to be malignant on histopathology. Dynamic contrast-enhanced MRI was performed using 36 dynamic measurements (volumetric interpolated breath-hold examination). Diffusion-weighted MRI (DW MRI) performed at b value of 800 s/mm2. We measured different diffusion and perfusion parameters, for example, diffusion-weighted imaging (DWI) SI, mean apparent diffusion coefficient (ADC), minimum ADC, lesion-to-spinal cord ratio, DWI score, T2 score, Ktrans, Kep, and Ve. We stratified values of each parameter as high if it was >median of values observed in our data set and low if it was ≤median. Normally distributed data were compared by unpaired t test, whereas non-normal continuous data were compared by Kruskal Wallis-H test. We applied Wilson score method to calculate sensitivity, specificity, and predictive values of parameters that were statistically significant by type of lesion with reference to histopathological examination as gold standard. Results: Diffusion-weighted imaging SI, mean ADC, minimum ADC, DWI score and Ktrans values were found to be significantly different ( P value < .05) by type of lesion. Ktrans was found to have the highest diagnostic accuracy (74.2%) among these parameters. Conclusion: Ktrans and mean ADC had similar sensitivity of 65.2%. However, Ktrans had highest diagnostic accuracy among various DWI and DCE MRI parameters in predicting malignancy in solid pulmonary lesions. In our study, we found a cutoff value 0.251 min−1 for Ktrans as 100% specific.

scholarly journals The effect of gadolinium-based contrast agent administration on magnetic resonance fingerprinting-based T1 relaxometry in patients with prostate cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Nikita Sushentsev ◽  
Joshua D. Kaggie ◽  
Guido Buonincontri ◽  
Rolf F. Schulte ◽  
Martin J. Graves ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Contrast Agent ◽  
Transition Zone ◽  
Added Value ◽  
Mapping Technique ◽  
Post Contrast ◽  
Scanning Time ◽  
Mri Protocol ◽  
Clinically Significant

AbstractMagnetic resonance fingerprinting (MRF) is a rapidly developing fast quantitative mapping technique able to produce multiple property maps with reduced sensitivity to motion. MRF has shown promise in improving the diagnosis of clinically significant prostate cancer but requires further validation as part of a prostate multiparametric (mp) MRI protocol. mpMRI protocol mandates the inclusion of dynamic contrast enhanced (DCE) imaging, known for its significant T1 shortening effect. MRF could be used to measure both pre- and post-contrast T1 values, but its utility must be assessed. In this proof-of-concept study, we sought to evaluate the variation in MRF T1 measurements post gadolinium-based contrast agent (GBCA) injection and the utility of such T1 measurements to differentiate peripheral and transition zone tumours from normal prostatic tissue. We found that the T1 variation in all tissues increased considerably post-GBCA following the expected significant T1 shortening effect, compromising the ability of MRF T1 to identify transition zone lesions. We, therefore, recommend performing MRF T1 prior to DCE imaging to maintain its benefit for improving detection of both peripheral and transition zone lesions while reducing additional scanning time. Demonstrating the effect of GBCA on MRF T1 relaxometry in patients also paves the way for future clinical studies investigating the added value of post-GBCA MRF in PCa, including its dynamic analysis as in DCE-MRF.

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