Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients
Objectives: High-resolution prostate imaging may allow for detection of subtle changes in tumor size, decrease the reliance on biopsies, and help define tumor boundaries during ablation. This pilot clinical trial evaluates a novel high-resolution prostate MRI for detection of small, biopsy-proven pr...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2016-05-01
|
| Series: | EBioMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235239641630130X |
| _version_ | 1818028534866640896 |
|---|---|
| author | Ali-Reza Sharif-Afshar Christopher Nguyen Tom S. Feng Lucas Payor Zhaoyang Fan Rola Saouaf Debiao Li Hyung L. Kim |
| author_facet | Ali-Reza Sharif-Afshar Christopher Nguyen Tom S. Feng Lucas Payor Zhaoyang Fan Rola Saouaf Debiao Li Hyung L. Kim |
| author_sort | Ali-Reza Sharif-Afshar |
| collection | DOAJ |
| description | Objectives: High-resolution prostate imaging may allow for detection of subtle changes in tumor size, decrease the reliance on biopsies, and help define tumor boundaries during ablation. This pilot clinical trial evaluates a novel high-resolution prostate MRI for detection of small, biopsy-proven prostate tumors.
Methods: Our team developed a software that can be loaded on any modern MRI to generate high resolution diffusion-weighted imaging sequences (HR-DWI), which were compared to standard diffusion-weighted imaging sequence (S-DWI) in a prospective pilot trial in active surveillance patients. HR-DWI captures the entire volume of the prostate rather than sections, reducing streaking artifacts and geometric distortions. Multiple shots, rather than single shots, are used to differentiate signal and noise, enhancing resolution. All images were read by two radiologists. The primary outcome was the percent of biopsy-proven zones seen in 17 patients. The trial was powered to detect discordant proportions of 0.04 and 0.40 at one-sided alpha = 0.05.
Results: The resolution was defined using standard phantoms. HR-DWI produced a 5-fold improvement in spatial resolution when compared to S-DWI. Multiparametric (MP)-MRI incorporating S-DWI was useful for predicting biopsy results (AUC 0.72, Fisher's exact p < 0.001); however, using HR-DWI allowed MP-MRI to be more highly predictive of biopsy results (AUC 0.88, Fisher's exact p < 0.001). AUC for MP-MRI incorporating HR-DWI was significantly larger than MP-MRI incorporating S-DWI (p = 0.002). MP-MRI with HR-DWI had a sensitivity of 95.7% and identified tumor in 22 of 23 zones proven to have cancer on biopsy. In contrast, MP-MRI with S-DWI had a sensitivity of 60.9% and only identified 14 of 23 biopsy-positive zones (p = 0.004).
Conclusion: We developed a novel DWI and evaluated its improved resolution in a clinical setting. This technology has many potential applications and should be evaluated in future clinical trials as a patient management tool. |
| first_indexed | 2024-12-10T05:05:20Z |
| format | Article |
| id | doaj.art-a78b0c92c698498aa0faaf5a73563f10 |
| institution | Directory Open Access Journal |
| issn | 2352-3964 |
| language | English |
| last_indexed | 2024-12-10T05:05:20Z |
| publishDate | 2016-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EBioMedicine |
| spelling | doaj.art-a78b0c92c698498aa0faaf5a73563f102022-12-22T02:01:17ZengElsevierEBioMedicine2352-39642016-05-017C808410.1016/j.ebiom.2016.03.041Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer PatientsAli-Reza Sharif-Afshar0Christopher Nguyen1Tom S. Feng2Lucas Payor3Zhaoyang Fan4Rola Saouaf5Debiao Li6Hyung L. Kim7Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesBiomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesDivision of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesDepartment of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesBiomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesDepartment of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesBiomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesDivision of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesObjectives: High-resolution prostate imaging may allow for detection of subtle changes in tumor size, decrease the reliance on biopsies, and help define tumor boundaries during ablation. This pilot clinical trial evaluates a novel high-resolution prostate MRI for detection of small, biopsy-proven prostate tumors. Methods: Our team developed a software that can be loaded on any modern MRI to generate high resolution diffusion-weighted imaging sequences (HR-DWI), which were compared to standard diffusion-weighted imaging sequence (S-DWI) in a prospective pilot trial in active surveillance patients. HR-DWI captures the entire volume of the prostate rather than sections, reducing streaking artifacts and geometric distortions. Multiple shots, rather than single shots, are used to differentiate signal and noise, enhancing resolution. All images were read by two radiologists. The primary outcome was the percent of biopsy-proven zones seen in 17 patients. The trial was powered to detect discordant proportions of 0.04 and 0.40 at one-sided alpha = 0.05. Results: The resolution was defined using standard phantoms. HR-DWI produced a 5-fold improvement in spatial resolution when compared to S-DWI. Multiparametric (MP)-MRI incorporating S-DWI was useful for predicting biopsy results (AUC 0.72, Fisher's exact p < 0.001); however, using HR-DWI allowed MP-MRI to be more highly predictive of biopsy results (AUC 0.88, Fisher's exact p < 0.001). AUC for MP-MRI incorporating HR-DWI was significantly larger than MP-MRI incorporating S-DWI (p = 0.002). MP-MRI with HR-DWI had a sensitivity of 95.7% and identified tumor in 22 of 23 zones proven to have cancer on biopsy. In contrast, MP-MRI with S-DWI had a sensitivity of 60.9% and only identified 14 of 23 biopsy-positive zones (p = 0.004). Conclusion: We developed a novel DWI and evaluated its improved resolution in a clinical setting. This technology has many potential applications and should be evaluated in future clinical trials as a patient management tool.http://www.sciencedirect.com/science/article/pii/S235239641630130XMRIProstate cancerDiffusion weighted imaging |
| spellingShingle | Ali-Reza Sharif-Afshar Christopher Nguyen Tom S. Feng Lucas Payor Zhaoyang Fan Rola Saouaf Debiao Li Hyung L. Kim Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients EBioMedicine MRI Prostate cancer Diffusion weighted imaging |
| title | Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients |
| title_full | Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients |
| title_fullStr | Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients |
| title_full_unstemmed | Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients |
| title_short | Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients |
| title_sort | prospective pilot trial to evaluate a high resolution diffusion weighted mri in prostate cancer patients |
| topic | MRI Prostate cancer Diffusion weighted imaging |
| url | http://www.sciencedirect.com/science/article/pii/S235239641630130X |
| work_keys_str_mv | AT alirezasharifafshar prospectivepilottrialtoevaluateahighresolutiondiffusionweightedmriinprostatecancerpatients AT christophernguyen prospectivepilottrialtoevaluateahighresolutiondiffusionweightedmriinprostatecancerpatients AT tomsfeng prospectivepilottrialtoevaluateahighresolutiondiffusionweightedmriinprostatecancerpatients AT lucaspayor prospectivepilottrialtoevaluateahighresolutiondiffusionweightedmriinprostatecancerpatients AT zhaoyangfan prospectivepilottrialtoevaluateahighresolutiondiffusionweightedmriinprostatecancerpatients AT rolasaouaf prospectivepilottrialtoevaluateahighresolutiondiffusionweightedmriinprostatecancerpatients AT debiaoli prospectivepilottrialtoevaluateahighresolutiondiffusionweightedmriinprostatecancerpatients AT hyunglkim prospectivepilottrialtoevaluateahighresolutiondiffusionweightedmriinprostatecancerpatients |