Role of DWI at prostatic lesions at 3T-MRI in the discrimination of grading: correlation of imaging, quantitative analysis and pathology at 189 MR-guided prostate biopsies Poster No.: B-0553 Congress: ECR 2015 Type: Scientific Paper Authors: A. Malich; Nordhausen/DE Keywords: Genital / Reproductive system male, Computer applications, Oncology, MR-Diffusion/Perfusion, CAD, Computer ApplicationsDetection, diagnosis, Decision analysis, Technology assessment, Tissue characterisation, Cancer, Quality assurance DOI: 10.1594/ecr2015/B-0553 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 22
Purpose The detection of high grade prostatic cancer with a high Gleason-score is of major importance. The discrimination of differently graded prostatce cancers is still a diagnostic challenge. This problem can yield to overdiagnosis, overtreatment but also underestimation of the aggressiveness of the prostatce cancer. Study aimed to analyse the diagnostic potential of DWI and ADC-mapping at lesions which were histologically proven by 3T-based MR-guided biopsy. Images for this section: Fig. 2: Purpose of the study Page 2 of 22
Fig. 3: Study aim Page 3 of 22
Methods and materials 189 prostatic lesions were histologicaly verified by MR-guided biopsy (3T MRI Philips Ingenia) after inconclusive ultrasound guided biopsy and after multiparametric MRI incl. T2w, dynamic analysis (>5min, single dynamic scan <13s, calculation using DynaCAD and Confirma-CAD) and DWI-analysis (b-value up to 1000) and a PI-RADS score of 4 or 5. PI-RADs-scheme of all single diagnostic features was matched to histopathologic outcome. The needle was imaged during the bioptic procedure. The position of the needle tip was matched with the ADC/DWI images obtained. The ADC-values were scored semiautomated by quantification using PACS but also by CAD using Sentinelsoftware and ADC-mapping. Biopsies were performed using an endorectal device (DynaCAD), access was planned using CAD-solution (DynaCAD) and manual calculation as well. An 18 gauge needle was used, 2-3 samples per lesion were taken. Images for this section: Page 4 of 22
Fig. 4: Methods 1 Fig. 5: CAD-Solutions for dynamic Analysis and quantitative ADC mapping Page 5 of 22
Fig. 6: PIRADS: DWI 5 points Page 6 of 22
Fig. 7: PIRADS: DIW 4 points Page 7 of 22
Fig. 8: PIRADS: DWI 3 points Page 8 of 22
Fig. 9: PIRADS: DWI 2 points Page 9 of 22
Fig. 10: PIRADS: DWI 1 point Page 10 of 22
Fig. 11: Preparation for biopsy Page 11 of 22
Fig. 12: MR-guided endorectal biopsy Page 12 of 22
Fig. 13: MR-guided biopsy: Hardware Page 13 of 22
Fig. 14: MR-guided biopsy: Patient positioning Page 14 of 22
Fig. 15: MR-guided biopsy: Indications Page 15 of 22
Results 71/189 lesions were proven invasive-malignant and 14/189 lesions as ASAP. 39/189 lesions were verified as prostatitis, 31/189 as hyperplasia, 29/189 as atrophic prostatic tissue or other benign prostatic pathology. In 5/189 biopsies paraglandular tissue was found Mean ADC-values were obtained as: 905 (invasive malignant lesions); 1403 (ASAP); 1151 (prostatitis); 1282 (Hyperplasia and other benign entities). Gleason-score 5 malignancies had a mean ADC-value of 1032; Gleason 6: 947; Gleason 7: 826; Gleason 8: 898; Gleason 9: 724, whereas ASAP-lesions had a value of 1403 in mean. No side effect or complication was observed. No bleeding occured. Mean duration of a biopsy was about 30 minutes. There was no abortion of any biopsy. All except one biopsy were performed in an outpatient setting. Images for this section: Page 16 of 22
Fig. 16: Outcome Page 17 of 22
Fig. 17: Outcome 2 Page 18 of 22
Fig. 18: ADC-values vs. HIstopathology Page 19 of 22
Fig. 19: ADC-mapping vs. Gleason Page 20 of 22
Conclusion ADC-mapping is of outstanding relevance to discriminate prostatic lesions and especially to discriminate aggressive from less aggressive malignancies. A comparison score of the lesion vs. the entire gland might be helpful to overcome MRI-related technical influences. Images for this section: Fig. 20: Conclusion Page 21 of 22
Personal information It would be a pleasure to get in contact with you. Thynk you for your interest. Please contact me as follows: Prof. Dr. med. habil Ansgar Malich Dr.-R.-Koch-Str. 39 99734 Nordhausen Institute of Radiology Sueharz-HOspital Nordhausen Germany ansgar.malich@shk-ndh.de fon: ++49 3631412858 References For detailed data please send me an e-mail Page 22 of 22