The role of MRI in the detection of local recurrence: Added value of multiparametric approach and Signal Intensity/Time Curve analysis

Objective: The aim of the study was to evaluate the accuracy of multiparametric Magnetic Resonance Imaging (mpMRI) in the detection of local recurrence of prostate cancer (PCa) with the evaluation of the added value of signal Intensity/Time (UT) curves.Materials and methods: A retrospective analysis of 22 patients undergoing mpMRI from 2015 to 2020 was carried out, with the following inclusion criteria: performing trans rectal ultrasound guided biopsy within 3 months in the case of positive or doubtful findings and undergoing biopsy and/or clinical follow-up for 24 months in the case of negative results. The images were reviewed, and the lesions were catalogued according to morphological, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) features.Results: The presence of local recurrence was detected in 11/22 patients (50%). Greater diameter, hyperintensity on DWI, positive contrast enhancement and type 2/3 signal UT curves were more frequently observed in patients with local recurrence (all p < 0.05). Of all the sequences, DCE was the most accurate; however, the combination of DCE and DWI showed the best results, with a sensitivity of 100%, a specificity of 82%, a negative predictive value of 100% and a positive predictive value of 85%.Conclusions: The utility of MRI in the detection of local recurrence is tied to the multiparametric approach, with all sequences providing useful information. A combination of DCE and DWI is particularly effective. Moreover, specificity could be additionally improved using analysis of the signal UT curves

Role of multiparametric magnetic resonance and ultrasound-guided/MR fusion biopsy in patients with low-risk prostate cancer suitable for active surveillance

BACKGROUND: To evaluate the impact of multiparametric magnetic resonance (mpMR) and fusion biopsy in patients with low-risk prostate cancer suitable for active surveillance (AS) in order to reduce cases of disease downstaging. METHODS: Between January 2016 and February 2018, 97 mpMRs were performed in patients with clinical indications for AS; the mpMR results were expressed using the PIRADS (Prostate Imaging Reporting and Data System) v2.1 score. Of the patients with equivocal or suspicious findings (PIRADS 653), 26 underwent transrectal ultrasound/MR fusion biopsy; the histological results were analysed and correlated to the MR data. RESULTS: Multiparametric magnetic resonance documented benign findings (i.e. PIRADS 1-2) in 42/97 patients (43.3%) while, in the remaining 55/97 (56.7%), abnormal findings were found: 39/97 (40.2%) PIRADS 3, 14/97 (14.4%) PIRADS 4 and 2/97 (2.1%) PIRADS 5. Twenty-six patients underwent fusion biopsy (17 with PIRADS 3, 7 with PIRADS 4, 2 with PIRADS 5); in 17/26 (65.4%), a Gleason Score 657 was found and, in particular, in 10/17 (58.8%) of the PIRADS 3, 5/7 (71.4%) of the PIRADS 4 and 2/2 (100%) of the PIRADS 5. CONCLUSIONS: More than half of the patients in AS showed MR abnormalities and the risk of upstaging increased as the PIRADS score increased; fusion biopsy allowed clarifying the importance of the MR findings, identifying a more aggressive prostate tumour in a high percentage of cases (65.4%). Therefore, MR with fusion biopsy should be proposed for all patients in AS for a correct diagnostic classification

Incremento dell\u2019attivit\ue0 di RM multiparametrica della prostata: esperienza di un centro a elevato volume di attivit\ue0

OBIETTIVO: Analizzare l\u2019incremento di attivit\ue0 di Risonanza Magnetica multiparametrica (RMmp) nella valutazione dei pazienti con tumore prostatico (CaP). METODI: Sono state catalogate le RMmp eseguite in un periodo di 25 mesi secondo le indicazioni cliniche (diagnosi, stadiazione, sorveglianza attiva e follow-up dopo trattamento primario). Sono stati valutati: i reperti PIRADS (Prostate Imaging Reporting and Data System) v. 2, nella diagnosi; la presenza di estensione extra-capsulare (EEC) ed infiltrazione delle vescicole seminali (IVS), nella stadiazione; la conferma di malattia indolente oppure l\u2019upgrade radiologico, nella sorveglianza attiva; la presenza di recidiva locale, nel follow-up. Per tutti questi valori sono stati riportati i dati di incremento assoluti e percentuali. RISULTATI: Sono state effettuate 1034 RMmp della prostata con incremento del 341%. Le indicazioni erano cos\uec suddivise: diagnosi (73%), stadiazione (9%), sorveglianza attiva (13%) e follow-up (5%). Nella diagnosi, i risultati in termini di PIRADS erano: categorie 1 e 2 (69%), categoria 3 (19%), categorie 4 e 5 (12%). Nella stadiazione, EEC era presente in 26 su 94 (28%) e IVS in 10 su 94 (11%) pazienti. Nella sorveglianza attiva, la RMmp ha confermato una malattia indolente in 66 su 138 (48%) pazienti e ha dimostrato un upgrade radiologico in 72 su 138 (52%) pazienti. Nel follow-up, la RMmp ha dimostrato recidiva locale in 20 su 52 (38%) pazienti. CONCLUSIONI: I risultati di questo studio hanno dimostrato un notevole incremento dell\u2019attivit\ue0 di RMmp nell\u2019arco di 25 mesi per tutte le indicazioni cliniche ed in particolare nella diagnosi, in cui essa viene usata sempre pi\uf9 come screening, e nella sorveglianza attiva, sebbene in questo contesto il suo ruolo non sia ancora chiaramente stabilito

PI-RADS version 2.1 for the evaluation of transition zone lesions: a practical guide for radiologists

Multiparametric magnetic resonance imaging has been established as the most accurate non-invasive diagnostic imaging tool for detecting prostate cancer (PCa) in both the peripheral zone and the transition zone (TZ) using the PI-RADS (Prostate Imaging Reporting and Data System) version 2.1 released in 2019 as a guideline to reporting. Transition zone PCa remains the most difficult to diagnose due to a markedly heterogeneous background and a wide variety of atypical imaging presentations as well as other anatomical and pathological processes mimicking PCa. The aim of this paper was to present a spectrum of PCa in the TZ, as a guide for radiologists