A Single-Arm, Multicenter Validation Study of Prostate Cancer Localization and Aggressiveness With a Quantitative Multiparametric Magnetic Resonance Imaging Approach.

Objectives: The aims of this study were to assess the discriminative performance of quantitative multiparametric magnetic resonance imaging (mpMRI) between prostate cancer and noncancer tissues and between tumor grade groups (GGs) in a multicenter, single-vendor study, and to investigate to what extent site-specific differences affect variations in mpMRI parameters. Materials and Methods: Fifty patients with biopsy-proven prostate cancer from 5 institutions underwent a standardized preoperative mpMRI protocol. Based on the evaluation of whole-mount histopathology sections, regions of interest were placed on axial T2-weighed MRI scans in cancer and noncancer peripheral zone (PZ) and transition zone (TZ) tissue. Regions of interest were transferred to functional parameter maps, and quantitative parameters were extracted. Across-center variations in noncancer tissues, differences between tissues, and the relation to cancer grade groups were assessed using linear mixed-effects models and receiver operating characteristic analyses. Results: Variations in quantitative parameters were low across institutes (mean [maximum] proportion of total variance in PZ and TZ, 4% [14%] and 8% [46%], respectively). Cancer and noncancer tissues were best separated using the diffusion-weighted imaging-derived apparent diffusion coefficient, both in PZ and TZ (mean [95% confidence interval] areas under the receiver operating characteristic curve [AUCs]; 0.93 [0.89–0.96] and 0.86 [0.75–0.94]), followed by MR spectroscopic imaging and dynamic contrast-enhanced-derived parameters. Parameters from all imaging methods correlated significantly with tumor grade group in PZ tumors. In discriminating GG1 PZ tumors from higher GGs, the highest AUC was obtained with apparent diffusion coefficient (0.74 [0.57–0.90], P < 0.001). The best separation of GG1–2 from GG3–5 PZ tumors was with a logistic regression model of a combination of functional parameters (mean AUC, 0.89 [0.78–0.98]). Conclusions: Standardized data acquisition and postprocessing protocols in prostate mpMRI at 3 T produce equivalent quantitative results across patients from multiple institutions and achieve similar discrimination between cancer and noncancer tissues and cancer grade groups as in previously reported singlecenter studies

Elderly travel frequencies and transport mode choices in Greater Rotterdam, the Netherlands

Demographic ageing is a key societal challenge in Europe as well as in many other western and non-western societies. A crucial dimension concerns elderly daily mobility patterns. While still partaking fewer and shorter trips than younger generations, today’s elderly have been found increasingly (auto)mobile. Although the elderly benefit from the independence, freedom of movement, and social inclusion, concerns may rise regarding the environmental and accessibility impacts of this induced mobility. The present study adds to the expanding literature on elderly mobility, an integrated analysis of the effects of socio-demographic, health, trip, spatial and weather attributes on elderly mobility. Utilizing travel diary data for Greater Rotterdam, The Netherlands, trip frequencies and transport mode choices of the elderly are analysed by means of zero-inflated negative binomial models as well as multinomial logit regression models, and contrasted to the non-elderly subpopulation to explore (dis)similarities. While the results show common determinants, the models also highlight important differences in the magnitude of the estimated coefficients and factors only influencing transport patterns for the elderly. Embedded in the context of an aging population, the empirical findings assist policy-makers and planners in several respects: For transportation plans and programs it is critical to recognize mobility needs of the elderly. As the seniors are becoming increasingly automobile, the results call for strategies to encourage older people to use more physically active and environmentally friendly transport modes such as public transport, walking and cycling