Abstract Context Comparative reviews of whole-body magnetic resonance imaging (WB-MRI) and positron emission tomography/computed tomography (CT; with different radiotracers) have shown that ...metastasis detection in advanced cancers is more accurate than with currently used CT and bone scans. However, the ability of WB-MRI and positron emission tomography/CT to assess therapeutic benefits has not been comprehensively evaluated. There is also considerable variability in the availability and quality of WB-MRI, which is an impediment to clinical development. Expert recommendations for standardising WB-MRI scans are needed, in order to assess its performance in advanced prostate cancer (APC) clinical trials. Objective To design recommendations that promote standardisation and diminish variations in the acquisition, interpretation, and reporting of WB-MRI scans for use in APC. Evidence acquisition An international expert panel of oncologic imagers and oncologists with clinical and research interests in APC management assessed biomarker requirements for clinical care and clinical trials. Key requirements for a workable WB-MRI protocol, achievable quality standards, and interpretation criteria were identified and synthesised in a white paper. Evidence synthesis The METastasis Reporting and Data System for Prostate Cancer guidelines were formulated for use in all oncologic manifestations of APC. Conclusions Uniformity in imaging data acquisition, quality, and interpretation of WB-MRI are essential for assessing the test performance of WB-MRI. The METastasis Reporting and Data System for Prostate Cancer standard requires validation in clinical trials of treatment approaches in APC. Patient summary METastasis Reporting and Data System for Prostate Cancer represents the consensus recommendations on the performance, quality standards, and reporting of whole-body magnetic resonance imaging, for use in all oncologic manifestations of advanced prostate cancer. These new criteria require validation in clinical trials of established and new treatment approaches in advanced prostate cancer.
Multimodality Imaging of Prostate Cancer Ghafoor, Soleen; Burger, Irene A; Vargas, Alberto H
Journal of Nuclear Medicine,
10/2019, Letnik:
60, Številka:
10
Journal Article
Recenzirano
Odprti dostop
Prostate cancer is a very heterogeneous disease, and contemporary management is focused on identification and treatment of the prognostically adverse high-risk tumors while minimizing overtreatment ...of indolent, low-risk tumors. In recent years, imaging has gained increasing importance in the detection, staging, posttreatment assessment, and detection of recurrence of prostate cancer. Several imaging modalities including conventional and functional methods are used in different clinical scenarios with their very own advantages and limitations. This continuing medical education article provides an overview of available imaging modalities currently in use for prostate cancer followed by a more specific section on the value of these different imaging modalities in distinct clinical scenarios, ranging from initial diagnosis to advanced, metastatic castration-resistant prostate cancer. In addition to established imaging indications, we will highlight some potential future applications of contemporary imaging modalities in prostate cancer.
Vaccination-associated adenopathy is a frequent imaging finding after administration of COVID-19 vaccines that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in ...whom it may be indistinguishable from malignant nodal involvement. To help the medical community address this concern in the absence of studies and evidence-based guidelines, this special report offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States. According to these recommendations, some routine imaging examinations, such as those for screening, should be scheduled before or at least 6 weeks after the final vaccination dose to allow for any reactive adenopathy to resolve. However, there should be no delay of other clinically indicated imaging (eg, for acute symptoms, short-interval treatment monitoring, urgent treatment planning or complications) due to prior vaccination. The vaccine should be administered on the side contralateral to the primary or suspected cancer, and both doses should be administered in the same arm. Vaccination information-date(s) administered, injection site(s), laterality, and type of vaccine-should be included in every preimaging patient questionnaire, and this information should be made readily available to interpreting radiologists. Clear and effective communication between patients, radiologists, referring physician teams, and the general public should be considered of the highest priority when managing adenopathy in the setting of COVID-19 vaccination.
Provide evidence- and expert-based recommendations for optimal use of imaging in advanced prostate cancer. Due to increases in research and utilization of novel imaging for advanced prostate cancer, ...this guideline is intended to outline techniques available and provide recommendations on appropriate use of imaging for specified patient subgroups.
An Expert Panel was convened with members from ASCO and the Society of Abdominal Radiology, American College of Radiology, Society of Nuclear Medicine and Molecular Imaging, American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology to conduct a systematic review of the literature and develop an evidence-based guideline on the optimal use of imaging for advanced prostate cancer. Representative index cases of various prostate cancer disease states are presented, including suspected high-risk disease, newly diagnosed treatment-naïve metastatic disease, suspected recurrent disease after local treatment, and progressive disease while undergoing systemic treatment. A systematic review of the literature from 2013 to August 2018 identified fully published English-language systematic reviews with or without meta-analyses, reports of rigorously conducted phase III randomized controlled trials that compared ≥ 2 imaging modalities, and noncomparative studies that reported on the efficacy of a single imaging modality.
A total of 35 studies met inclusion criteria and form the evidence base, including 17 systematic reviews with or without meta-analysis and 18 primary research articles.
One or more of these imaging modalities should be used for patients with advanced prostate cancer: conventional imaging (defined as computed tomography CT, bone scan, and/or prostate magnetic resonance imaging MRI) and/or next-generation imaging (NGI), positron emission tomography PET, PET/CT, PET/MRI, or whole-body MRI) according to the clinical scenario.
Cancers of unknown primary (CUP) have traditionally been treated empirically, with a dismal prognosis. Compared with standard diagnostic tests, including CT and MRI, imaging with ...18F-fluorodeoxyglucose (FDG) PET or PET/CT has shown the capacity to better identify the primary tumour site and detect additional sites of metastasis. However, its clinical impact is not well established. We performed a systematic review and meta-analysis of prior studies to assess the impact of FDG-PET or PET/CT on the management of patients with CUP.
Pubmed and EMBASE databases were searched up to 4th February 2021. Studies that reported the proportion of patients with CUP who experienced a management change after FDG-PET or PET/ computed tomography (CT) were included and the proportions were pooled using the random-effects model. Study quality was assessed using QUADAS-2. Subgroup analysis was conducted to explore heterogeneity.
Thirty-eight studies (involving 2795 patients) were included. The pooled proportion of patients with management changes was 35% (95% confidence interval 31%–40%). There was substantial heterogeneity among the studies (Q-test, p < 0.01; I2 = 82%). The specific reason for management change was more commonly detection of the primary site (22% 95% CI 18–28%) than detection of additional metastatic sites (14% 95% CI 10–19%). The pooled proportions of patients with management changes were similar among numerous subgroups (range, 32.8%–38.2%).
FDG-PET or PET/CT had a meaningful impact on the management of patients with CUP. Approximately, a third of patients had their management changed because of FDG-PET or PET/CT results, and this finding was consistent across numerous subgroups.
•In 38 studies with cancer of unknown primary, 18F-fluoro-2-deoxyglucose positron emission tomography changed management 35%.c.•These were related to find the primary site (22%) or additional metastatic sites (14%).•Similar pooled proportions were seen across subgroups (32.8–38.2%).
There is increasing scrutiny from healthcare organizations towards the utility and associated costs of imaging. MRI has traditionally been used as a high‐end modality, and although shown extremely ...important for many types of clinical scenarios, it has been suggested as too expensive by some. This editorial will try and explain how value should be addressed and gives some insights and practical examples of how value of MRI can be increased. It requires a global effort to increase accessibility, value for money, and impact on patient management. We hope this editorial sheds some light and gives some indications of where the field may wish to address some of its research to proactively demonstrate the value of MRI.
Level of Evidence: 5
Technical Efficacy: Stage 5
J. Magn. Reson. Imaging 2019;49:e14–e25.
Accurate survival estimates are important for cancer control planning. Although observed survival estimates are unavailable for many countries, where they are available, wide variations are reported. ...Understanding the impact of specific treatment and imaging modalities can help decision makers to effectively allocate resources to improve cancer survival in their local context.
We developed a microsimulation model of stage-specific cancer survival in 200 countries and territories for 11 cancers (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate) comprising 60% of global diagnosed cancer cases. The model accounts for country-specific availability of treatment (chemotherapy, surgery, radiotherapy, and targeted therapy) and imaging modalities (ultrasound, x-ray, CT, MRI, PET, single-photon emission CT), as well as quality of care. We calibrated the model to reported survival estimates from CONCORD-3 (which reports global trends in cancer survival in 2000–14). We estimated 5-year net survival for diagnosed cancers in each country or territory and estimated potential survival gains from increasing the availability of individual treatment and imaging modalities, and more comprehensive packages of scale-up of these interventions. We report the mean and 95% uncertainty intervals (UIs) for all outcomes, calculated as the 2·5 and 97·5 percentiles of the simulation results.
The estimated global 5-year net survival for all 11 cancers combined is 42·6% (95% uncertainty interval 40·3–44·3), with survival in high-income countries being an average of 12 times (range 4–17) higher than that in low-income countries. Expanding availability of surgery or radiotherapy or improving quality of care would yield the largest survival gains in low-income (2·5–3·4 percentage point increase in survival) and lower-middle-income countries (2·4–6·1 percentage point increase), whereas upper-middle-income and high-income countries are more likely to benefit from improved availability of targeted therapy (0·7 percentage point increase for upper-middle income and 0·4 percentage point increase for high income). Investing in medical imaging will also be necessary to achieve substantial survival gains, with traditional modalities estimated to provide the largest gains in low-income settings, while MRI and PET would yield the largest gains in higher-income countries. Simultaneous expansion of treatment, imaging, and quality of care could improve 5-year net survival by more than ten times in low-income countries (3·8% 95% UI 0·5–9·2 to 45·2% 40·2–52·1) and could more than double 5-year net survival in lower-middle-income countries (20·1% 7·2–31·7 to 47·1% 42·8–50·8).
Scaling up both treatment and imaging availability could yield synergistic survival gains for patients with cancer. Expanding traditional modalities in lower-income settings might be a feasible pathway to improve survival before scaling up more modern technologies.
Harvard T H Chan School of Public Health.
Tumor cure with conventional fractionated radiotherapy is 65%, dependent on tumor cell-autonomous gradual buildup of DNA double-strand break (DSB) misrepair. Here we report that single-dose ...radiotherapy (SDRT), a disruptive technique that ablates more than 90% of human cancers, operates a distinct dual-target mechanism, linking acid sphingomyelinase-mediated (ASMase-mediated) microvascular perfusion defects to DNA unrepair in tumor cells to confer tumor cell lethality. ASMase-mediated microcirculatory vasoconstriction after SDRT conferred an ischemic stress response within parenchymal tumor cells, with ROS triggering the evolutionarily conserved SUMO stress response, specifically depleting chromatin-associated free SUMO3. Whereas SUMO3, but not SUMO2, was indispensable for homology-directed repair (HDR) of DSBs, HDR loss of function after SDRT yielded DSB unrepair, chromosomal aberrations, and tumor clonogen demise. Vasoconstriction blockade with the endothelin-1 inhibitor BQ-123, or ROS scavenging after SDRT using peroxiredoxin-6 overexpression or the SOD mimetic tempol, prevented chromatin SUMO3 depletion, HDR loss of function, and SDRT tumor ablation. We also provide evidence of mouse-to-human translation of this biology in a randomized clinical trial, showing that 24 Gy SDRT, but not 3×9 Gy fractionation, coupled early tumor ischemia/reperfusion to human cancer ablation. The SDRT biology provides opportunities for mechanism-based selective tumor radiosensitization via accessing of SDRT/ASMase signaling, as current studies indicate that this pathway is tractable to pharmacologic intervention.
•Study shows chronobiological trends in PI-RADS assessment of prostate MRI reports.•Higher malignancy scores are assigned towards the end of the working day.•Factors such as fatigue, workload, and ...circadian rhythms may influence decision-making.•This suggests potential for AI assistance to offset human fatigue and other influences.•Further research is needed to understand these temporal effects and develop mitigation strategies.
To investigate the associations between the hour of the day and Prostate Imaging–Reporting and Data System (PI-RADS) scores assigned by radiologists in prostate MRI reports.
Retrospective single-center collection of prostate MRI reports over an 8-year period. Mean PI-RADS scores assigned between 0800 and 1800 h were examined with a regression model.
A total of 35′004 prostate MRI interpretations by 26 radiologists were included. A significant association between the hour of day and mean PI-RADS score was identified (β2 = 0.005, p < 0.001), with malignant scores more frequently assigned later in the day.
These findings suggest chronobiological factors may contribute to variability in radiological assessments. Though the magnitude of the effect is small, this may potentially add variability and impact diagnostic accuracy.
The aims of this study were to determine whether ComBat harmonization improves multiclass radiomics-based tissue classification in technically heterogeneous MRI data sets and to compare the ...performances of 2 ComBat variants.
One hundred patients who had undergone T1-weighted 3D gradient echo Dixon MRI (2 scanners/vendors; 50 patients each) were retrospectively included. Volumes of interest (2.5 cm 3 ) were placed in 3 disease-free tissues with visually similar appearance on T1 Dixon water images: liver, spleen, and paraspinal muscle. Gray-level histogram (GLH), gray-level co-occurrence matrix (GLCM), gray-level run-length matrix (GLRLM), and gray-level size-zone matrix (GLSZM) radiomic features were extracted. Tissue classification was performed on pooled data from the 2 centers (1) without harmonization, (2) after ComBat harmonization with empirical Bayes estimation (ComBat-B), and (3) after ComBat harmonization without empirical Bayes estimation (ComBat-NB). Linear discriminant analysis with leave-one-out cross-validation was used to distinguish among the 3 tissue types, using all available radiomic features as input. In addition, a multilayer perceptron neural network with a random 70%:30% split into training and test data sets was used for the same task, but separately for each radiomic feature category.
Linear discriminant analysis-based mean tissue classification accuracies were 52.3% for unharmonized, 66.3% for ComBat-B harmonized, and 92.7% for ComBat-NB harmonized data. For multilayer perceptron neural network, mean classification accuracies for unharmonized, ComBat-B-harmonized, and ComBat-NB-harmonized test data were as follows: 46.8%, 55.1%, and 57.5% for GLH; 42.0%, 65.3%, and 71.0% for GLCM; 45.3%, 78.3%, and 78.0% for GLRLM; and 48.1%, 81.1%, and 89.4% for GLSZM. Accuracies were significantly higher for both ComBat-B- and ComBat-NB-harmonized data than for unharmonized data for all feature categories (at P = 0.005, respectively). For GLCM ( P = 0.001) and GLSZM ( P = 0.005), ComBat-NB harmonization provided slightly higher accuracies than ComBat-B harmonization.
ComBat harmonization may be useful for multicenter MRI radiomics studies with nonbinary classification tasks. The degree of improvement by ComBat may vary among radiomic feature categories, among classifiers, and among ComBat variants.
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