Voxel-level Classification of Prostate Cancer on Magnetic Resonance Imaging: Improving Accuracy Using Four-Compartment Restriction Spectrum Imaging.

Published on Mar 31, 2021in Journal of Magnetic Resonance Imaging3.954
· DOI :10.1002/JMRI.27623
Christine H. Feng5
Estimated H-index: 5
(UCSD: University of California, San Diego),
Christopher C. Conlin3
Estimated H-index: 3
(UCSD: University of California, San Diego)
+ 8 AuthorsTyler M. Seibert18
Estimated H-index: 18
(UCSD: University of California, San Diego)
BACKGROUND Diffusion magnetic resonance imaging (MRI) is integral to detection of prostate cancer (PCa), but conventional apparent diffusion coefficient (ADC) cannot capture the complexity of prostate tissues and tends to yield noisy images that do not distinctly highlight cancer. A four-compartment restriction spectrum imaging (RSI4 ) model was recently found to optimally characterize pelvic diffusion signals, and the model coefficient for the slowest diffusion compartment, RSI4 -C1 , yielded greatest tumor conspicuity. PURPOSE To evaluate the slowest diffusion compartment of a four-compartment spectrum imaging model (RSI4 -C1 ) as a quantitative voxel-level classifier of PCa. STUDY TYPE Retrospective. SUBJECTS Forty-six men who underwent an extended MRI acquisition protocol for suspected PCa. Twenty-three men had benign prostates, and the other 23 men had PCa. FIELD STRENGTH/SEQUENCE A 3 T, multishell diffusion-weighted and axial T2-weighted sequences. ASSESSMENT High-confidence cancer voxels were delineated by expert consensus, using imaging data and biopsy results. The entire prostate was considered benign in patients with no detectable cancer. Diffusion images were used to calculate RSI4 -C1 and conventional ADC. Classifier images were also generated. STATISTICAL TESTS Voxel-level discrimination of PCa from benign prostate tissue was assessed via receiver operating characteristic (ROC) curves generated by bootstrapping with patient-level case resampling. RSI4 -C1 was compared to conventional ADC for two metrics: area under the ROC curve (AUC) and false-positive rate for a sensitivity of 90% (FPR90 ). Statistical significance was assessed using bootstrap difference with two-sided α = 0.05. RESULTS RSI4 -C1 outperformed conventional ADC, with greater AUC (mean 0.977 [95% CI: 0.951-0.991] vs. 0.922 [0.878-0.948]) and lower FPR90 (0.032 [0.009-0.082] vs. 0.201 [0.132-0.290]). These improvements were statistically significant (P < 0.05). DATA CONCLUSION RSI4 -C1 yielded a quantitative, voxel-level classifier of PCa that was superior to conventional ADC. RSI classifier images with a low false-positive rate might improve PCa detection and facilitate clinical applications like targeted biopsy and treatment planning. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
#1Christopher C. Conlin (UCSD: University of California, San Diego)H-Index: 3
#2Christine H. Feng (UCSD: University of California, San Diego)H-Index: 5
Last. Anders M. Dale (UCSD: University of California, San Diego)H-Index: 166
view all 10 authors...
BACKGROUND Multicompartmental modeling outperforms conventional diffusion-weighted imaging (DWI) in the assessment of prostate cancer. Optimized multicompartmental models could further improve the detection and characterization of prostate cancer. PURPOSE To optimize multicompartmental signal models and apply them to study diffusion in normal and cancerous prostate tissue in vivo. STUDY TYPE Retrospective. SUBJECTS Forty-six patients who underwent MRI examination for suspected prostate cancer; 2...
1 CitationsSource
#1Aritrick Chatterjee (U of C: University of Chicago)H-Index: 7
#2Carla Harmath (U of C: University of Chicago)H-Index: 12
Last. Aytekin Oto (U of C: University of Chicago)H-Index: 50
view all 3 authors...
Prostate MRI has seen increasing interest in recent years and has led to the development of new MRI techniques and sequences to improve prostate cancer (PCa) diagnosis which are reviewed in this article. Numerous studies have focused on improving image quality (segmented DWI) and faster acquisition (compressed sensing, k-t-SENSE, PROPELLER). An increasing number of studies have developed new quantitative and computer-aided diagnosis methods including artificial intelligence (PROSTATEx challenge)...
5 CitationsSource
Abstract Background The use of 12-core systematic prostate biopsy is associated with diagnostic inaccuracy that contributes to both overdiagnosis and underdiagnosis of prostate cancer. Biopsies per...
97 CitationsSource
#1Baris TurkbeyH-Index: 10
#1Baris TurkbeyH-Index: 76
Last. Jeffrey C. Weinreb (Yale University)H-Index: 73
view all 14 authors...
Abstract The Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) was developed with a consensus-based process using a combination of published data, and expert observations and opinions. In the short time since its release, numerous studies have validated the value of PI-RADS v2 but, as expected, have also identified a number of ambiguities and limitations, some of which have been documented in the literature with potential solutions offered. To address these issues, the PI-RADS St...
302 CitationsSource
#1Ely R Felker (Ronald Reagan UCLA Medical Center)H-Index: 7
#2Steven S. Raman (Ronald Reagan UCLA Medical Center)H-Index: 1
Last. Leonard S. Marks (Ronald Reagan UCLA Medical Center)H-Index: 58
view all 13 authors...
OBJECTIVE. The purpose of this article is to evaluate restriction spectrum imaging (RSI) in men undergoing MRI-ultrasound fusion biopsy for suspected prostate cancer (PCa) and to compare the perfor...
5 CitationsSource
#1Edward W. JohnstonH-Index: 15
Last. Shonit PunwaniH-Index: 42
view all 27 authors...
The intracellular volume fraction derived from Vascular, Extracellular, and Restricted Diffusion for Cytometry in Tumors (VERDICT) MRI enables better differentiation of a Gleason 4 lesion from beni...
13 CitationsSource
#1Olivier RouvièreH-Index: 56
#2Philippe Puech (Lille University of Science and Technology)H-Index: 29
Last. Jochen WalzH-Index: 38
view all 50 authors...
Summary Background Whether multiparametric MRI improves the detection of clinically significant prostate cancer and avoids the need for systematic biopsy in biopsy-naive patients remains controversial. We aimed to investigate whether using this approach before biopsy would improve detection of clinically significant prostate cancer in biopsy-naive patients. Methods In this prospective, multicentre, paired diagnostic study, done at 16 centres in France, we enrolled patients aged 18–75 years with ...
242 CitationsSource
#1Andrew M. McDonald (UAB: University of Alabama at Birmingham)H-Index: 30
#2Michael C. Dobelbower (UAB: University of Alabama at Birmingham)H-Index: 17
Last. John B. Fiveash (UAB: University of Alabama at Birmingham)H-Index: 36
view all 11 authors...
Abstract Purpose To report the early toxicity results of a prospective clinical trial of prostate stereotactic body radiotherapy (SBRT) to the entire prostate with a simultaneous integrated boost (SIB) to MRI-defined focal lesions. Materials and Methods Eligible patients included men with biopsy-proven prostate adenocarcinoma stage T1c-T2c, Gleason score ≤ 7, and prostate specific antigen ≤ 20 ng/mL who had at least one focal lesion visible on MRI and total prostate volume no greater than 120 cc...
5 CitationsSource
#1Freddie Bray (IARC: International Agency for Research on Cancer)H-Index: 18
#1Freddie Bray (IARC: International Agency for Research on Cancer)H-Index: 119
Last. Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
view all 6 authors...
This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer...
25.8k CitationsSource
#1Veeru Kasivisvanathan (London North West Healthcare NHS Trust)H-Index: 4
#1Veeru Kasivisvanathan (Royal Free London NHS Foundation Trust)H-Index: 4
Last. Caroline M. Moore (London North West Healthcare NHS Trust)H-Index: 34
view all 41 authors...
Abstract Background Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography–guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited. Methods In a multicenter, randomized, noninferiority trial, we assigned men with a clinical suspicion of prostate cancer who had not undergone biopsy previously to under...
836 CitationsSource
Cited By1