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, Oct 01, 2015
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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.
    IEEE Transactions on Ultrasonics Ferroelectrics and Frequency Control 05/2015; 62(5):839-851. DOI:10.1109/TUFFC.2014.006907 · 1.51 Impact Factor
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    • "The 3-point scale used in this study is compatible with the 5-point scale proposed in PI-RAD [9], and the translation between the 2 scales is reported in the methods section. We demonstrate that pathologic ECE can be predicted by MP- MRI findings that are considered suspicious or definitive for ECE. "
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    ABSTRACT: To define the accuracy of multiparametric magnetic resonance imaging (MP-MRI) for identifying focal and established extracapsular extension (ECE) in various zones of the prostate. Between 2010 and 2013, 342 patients underwent MP-MRI of the prostate (3T, no endorectal coil with axial perfusion and diffusion images). The findings of the images were reported as negative, suspicious, or positive for ECE by a single expert radiologist. Radical prostatectomy specimens were reviewed to confirm the size and the location of ECE and further defined as focal or established ECE. Established ECE included extension that was multifocal or involving more than 5 glands. The accuracy of MRI in localizing focal and established ECE to each zone of the prostate was determined. Regression analyses were performed to identify predictors of ECE. We identified 112 patients who underwent prostate MP-MRI and radical prostatectomy. MRI findings considered suspicious or definite for ECE accurately predicted pathologic ECE (P<0.001). MP-MRI identified established ECE but not focal ECE. Sensitivity, specificity, positive predictive value, and negative predictive value of MP-MRI for established ECE were 70.7%, 90.6%, 57.1%, and 95.1%, respectively. MRI identified ECE to the left vs. right side as well as each zone of the prostate; however, sensitivity was lowest at the apex. On multivariate analysis, MRI was a significant predictor of ECE that was independent of prostate-specific antigen level, Gleason score, and clinical stage. MP-MRI is useful for identifying established but not focal ECE in all zones of the prostate. MRI was a significant independent predictor of established ECE and may be a useful adjunct in staging prostate cancer. Copyright © 2014 Elsevier Inc. All rights reserved.
    Urologic Oncology 12/2014; 33(3). DOI:10.1016/j.urolonc.2014.11.007 · 2.77 Impact Factor
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