ESUR prostate MR guidelines 2012

Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
European Radiology (Impact Factor: 4.01). 04/2012; 22(4):746-57. DOI: 10.1007/s00330-011-2377-y
Source: PubMed


The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated, but a compromise, reflected by “minimal” and “optimal” requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines for the optimal technique and three protocols for “detection”, “staging” and “node and bone” are presented. The use of endorectal coil vs. pelvic phased array coil and 1.5 vs. 3 T is discussed. Clinical indications and a PI-RADS classification for structured reporting are presented.

Key Points

• This report provides guidelines for magnetic resonance imaging (MRI) in prostate cancer.
• Clinical indications, and minimal and optimal imaging acquisition protocols are provided.
• A structured reporting system (PI-RADS) is described.

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Available from: J. O. Barentsz,
    • "However, the number, range, and position of b values used in prostate DWI studies have varied greatly among different studies. Recently, European Society of Urogenital Radiology (ESUR) guidelines recommended the use of at least 3 b values of 0, 100 and 800–1000 s/mm 2 for the monoexponential quantification of prostate DWI signal decay [11]. To our knowledge, clear scientific evidence supporting this recommendation is still missing. "
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    ABSTRACT: To evaluate the effect of b-value distribution on the repeatability and Gleason score (GS) prediction of prostate cancer (PCa). Fifty PCa patients underwent two repeated 3T diffusion weighted imaging (DWI) examinations using 12 b values in the range from 0 to 2000s/mm(2) and diffusion time of 20.3ms. Mean signal intensities of regions of interest, placed in PCa using whole mount prostatectomy sections as the reference, were fitted using monoexponential, kurtosis, stretched exponential, and biexponential models. In total, 4083 different b-value combinations consisting of 2 to 12 b values were evaluated. Repeatability was assessed by intraclass correlation coefficient, ICC(3,1), and coefficient of repeatability (CoR). Areas under receiver operating characteristic curve (AUCs) for PCa characterization were estimated while the correlation of the fitted values with GS groups (3+3, 3+4, >3+4) was evaluated by using the Spearman correlation coefficient (ρ). The parameters of monoexponential, kurtosis, and stretched exponential models estimated using only 4-5, 5-7, 5-7 b values, respectively, had similar ICC(3,1), CoR, AUC, and ρ values as the parameters estimated using all 12 b values. Optimized b-value distributions demonstrated improved ICC(3,1) and CoR values but failed to improve AUC and ρ values. The parameters of biexponential model demonstrated the worst repeatability and diagnostic performance. B-value distribution influences mainly the repeatability of DWI derived parameters rather than the diagnostic performance. Copyright © 2015. Published by Elsevier Inc.
    Magnetic Resonance Imaging 07/2015; 33(10). DOI:10.1016/j.mri.2015.07.004 · 2.09 Impact Factor
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    • "The standard imaging modality to evaluate the tumor (T) stage of the prostate cancer is currently transrectal ultrasound (TRUS). Recently, the use of magnetic resonance imaging (MRI) has been recommended for evaluating the T staging in patients with prostate cancer due to its high resolution (Turkbey et al. 2009; Barentsz et al. 2012; Kurhanewicz et al. 2008). However, the sensitivity and specificity of local staging with MRI vary considerably with technique and population; with rates ranging from 14 to 100% and 67 to 100%, respectively. "
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    ABSTRACT: To evaluate the modifications of the tumor stage and clinical target volume following a prostate magnetic resonance imaging (MRI) to evaluate the tumor (T) staging, and the clinical benefits for prostate cancer. A total of 410 patients with newly diagnosed and clinically localized prostate cancer were retrospectively analyzed. The patients were treated with definitive three-dimensional conformal radiotherapy (3D-CRT). In all of the patients, digital rectal examination, transrectal ultrasound, prostate biopsy and computed tomography were performed to evaluate the clinical stage. Of the 410 patients, 189 patients had undergone a prostate MRI study to evaluate the T staging, and 221 patients had not. Modification of the T stage after the prostate MRI was seen in 39 (25%) of the 157 evaluable patients, and a modification of the risk group was made in 14 (9%) patients. Eventually, a modification of the CTV in 3D-CRT planning was made in 13 (8%) patients, and 10 of these had extracapsular disease. Most of the other modifications of the T staging were associated with intracapsular lesions of prostate cancer which did not change the CTV. There were no significant differences in the biological relapse-free survival between the patients with and without a prostate MRI study. Modification of the CTV were recognized in only 8% of the patients, most of whom had extracapsular disease, although that of the T stage was seen in approximately one-quarter of the patients. Prostate MRI should only be selected for patients with a high probability of extracapsular involvement.
    SpringerPlus 07/2015; 4(1):347. DOI:10.1186/s40064-015-1138-9
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    • "Often, some or all of the MRI techniques are combined into multi-parametric MRI (mpMRI), used for a more accurate localization of prostate cancer [12]. Yet, despite the introduction of a standard scoring system (PI-RADS) [13], the interpretation of mpMRI datasets remains complex and subjective [14], [15]. TRUS, has proven its potential as an alternative to MRI for localizing prostate cancer, with the additional advantages of being less expensive and applicable at the bedside. "
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    ABSTRACT: Currently, nonradical treatment for prostate cancer is hampered by the lack of reliable diagnostics. Contrastultrasound dispersion imaging (CUDI) has recently shown great potential as a prostate cancer imaging technique. CUDI estimates the local dispersion of intravenously injected contrast agents, imaged by transrectal dynamic contrast-enhanced ultrasound (DCE-US), to detect angiogenic processes related to tumor growth. The best CUDI results have so far been obtained by similarity analysis of the contrast kinetics in neighboring pixels. To date, CUDI has been investigated in 2-D only. In this paper, an implementation of 3-D CUDI based on spatiotemporal similarity analysis of 4-D DCE-US is described. Different from 2-D methods, 3-D CUDI permits analysis of the entire prostate using a single injection of contrast agent. To perform 3-D CUDI, a new strategy was designed to estimate the similarity in the contrast kinetics at each voxel, and data processing steps were adjusted to the characteristics of 4-D DCE-US images. The technical feasibility of 4-D DCE-US in 3-D CUDI was assessed and confirmed. Additionally, in a preliminary validation in two patients, dispersion maps by 3-D CUDI were quantitatively compared with those by 2-D CUDI and with 12-core systematic biopsies with promising results.
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