Quantitative 3T multiparametric MRI of benign and malignant prostatic tissue in patients with and without local recurrent prostate cancer after external-beam radiation therapy

Catarina Dinis Fernandes, Petra J. van Houdt, Stijn W.T.P.J. Heijmink, Iris Walraven, Rick Keesman, Milena Smolic, Ghazaleh Ghobadi, Henk G. van der Poel, Ivo G. Schoots, Floris J. Pos, Uulke A. van der Heide (Corresponding author)

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10 Citations (Scopus)

Abstract

Background: Post-radiotherapy locally recurrent prostate cancer (PCa) patients are candidates for focal salvage treatment. Multiparametric MRI (mp-MRI) is attractive for tumor localization. However, radiotherapy-induced tissue changes complicate image interpretation. To develop focal salvage strategies, accurate tumor localization and distinction from benign tissue is necessary. Purpose: To quantitatively characterize radio-recurrent tumor and benign radiation-induced changes using mp-MRI, and investigate which sequences optimize the distinction between tumor and benign surroundings. Study Type: Prospective case–control. Subjects: Thirty-three patients with biochemical failure after external-beam radiotherapy (cases), 35 patients without post-radiotherapy recurrent disease (controls), and 13 patients with primary PCa (untreated). Field Strength/Sequences: 3T; quantitative mp-MRI: T2-mapping, ADC, and Ktrans and kep maps. Assessment: Quantitative image-analysis of prostatic regions, within and between cases, controls, and untreated patients. Statistical Tests: Within-groups: nonparametric Friedman analysis of variance with post-hoc Wilcoxon signed-rank tests; between-groups: Mann–Whitney tests. All with Bonferroni corrections. Generalized linear mixed modeling to ascertain the contribution of each map and location to tumor likelihood. Results: Benign imaging values were comparable between cases and controls (P = 0.15 for ADC in the central gland up to 0.91 for kep in the peripheral zone), both with similarly high peri-urethral Ktrans and kep values (min−1) (median [range]: Ktrans = 0.22 [0.14–0.43] and 0.22 [0.14–0.36], P = 0.60, kep = 0.43 [0.24–0.57] and 0.48 [0.32–0.67], P = 0.05). After radiotherapy, benign central gland values were significantly decreased for all maps (P ≤ 0.001) as well as T2, Ktrans, and kep of benign peripheral zone (all with P ≤ 0.002). All imaging maps distinguished recurrent tumor from benign peripheral zone, but only ADC, Ktrans, and kep were able to distinguish it from benign central gland. Recurrent tumor and peri-urethral Ktrans values were not significantly different (P = 0.81), but kep values were (P < 0.001). Combining all quantitative maps and voxel location resulted in an optimal distinction between tumor and benign voxels. Data Conclusion: Mp-MRI can distinguish recurrent tumor from benign tissue. Level of Evidence: 2. Technical Efficacy Stage: 2. J. Magn. Reson. Imaging 2019;50:269–278.

Original languageEnglish
Pages (from-to)269-278
Number of pages10
JournalJournal of Magnetic Resonance Imaging
Volume50
Issue number1
DOIs
Publication statusPublished - Jul 2019
Externally publishedYes

Bibliographical note

Funding Information:
Contract grant sponsor: Dutch Cancer Society; Contract grant number: NKI 2013–5937 and project 10088. The authors thank Susanne van der Sanden, Manon Verwijs, Corinne Tillier, Barry Doodeman, Gerbert Vrijenhoek, and Tineke Vijlbrief-Bosman for help with patient inclusion. We also thank Katarzyna Jozwiak for providing valuable statistical advice.

Publisher Copyright:
© 2018 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

Keywords

  • Biopsy
  • Case-Control Studies
  • Hormones/therapeutic use
  • Humans
  • Male
  • Multiparametric Magnetic Resonance Imaging
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local
  • Probability
  • Prospective Studies
  • Prostate/diagnostic imaging
  • Prostatic Neoplasms/diagnostic imaging
  • Salvage Therapy

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