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To investigate whether longitudinal changes in multiparametric MRI can predict early response to neoadjuvant chemotherapy (NAC) for HER2-positive breast cancer (BC) and to further establish quantitative models based on these features. A total of 164 HER2-positive BC patients from three centers were included. MRI was performed at baseline and after two cycles of NAC (early post-NAC). Clinicopathological characteristics were enrolled. MRI features were evaluated at baseline and early post-NAC, as well as longitudinal changes in multiparametric MRI, including changes in the largest diameter (LD) of the tumor (ΔLD), apparent diffusion coefficient (ADC) values (ΔADC), and time–signal intensity curve (TIC) (ΔTIC). The patients were divided into a training set (n = 95), an internal validation set (n = 31), and an independent external validation set (n = 38). Univariate and multivariate logistic regression analyses were used to identify the independent indicators of pCR, which were then used to establish the clinicopathologic model and combined model. The AUC was used to evaluate the predictive power of the different models and calibration curves were used to evaluate the consistency of the prediction of pCR in different models. Additionally, decision curve analysis (DCA) was employed to determine the clinical usefulness of the different models. Two models were enrolled in this study, including the clinicopathologic model and the combined model. The LD at early post-NAC (OR=0.913, 95 % CI=0.953–0.994 p = 0.026), ΔADC (OR=1.005, 95 % CI=1.005–1.008, p = 0.007), and ΔTIC (OR=3.974, 95 % CI=1.276–12.358, p = 0.017) were identified as the best predictors of NAC response. The combined model constructed by the combination of LD at early post-NAC, ΔADC, and ΔTIC showed good predictive performance in the training set (AUC=0.87), internal validation set (AUC=0.78), and external validation set (AUC=0.79), which performed better than the clinicopathologic model in all sets. The changes in multiparametric MRI can predict early treatment response for HER2-positive BC and may be helpful for individualized treatment planning. [ABSTRACT FROM AUTHOR]

To develop and validate an artificial intelligence (AI) application in a clinical setting to decide whether dynamic contrast-enhanced (DCE) sequences are necessary in multiparametric prostate MRI. This study was approved by the institutional review board and requirement for study-specific informed consent was waived. A mobile app was developed to integrate AI-based image quality analysis into clinical workflow. An expert radiologist provided reference decisions. Diagnostic performance parameters (sensitivity and specificity) were calculated and inter-reader agreement was evaluated. Fully automated evaluation was possible in 87% of cases, with the application reaching a sensitivity of 80% and a specificity of 100% in selecting patients for multiparametric MRI. In 2% of patients, the application falsely decided on omitting DCE. With a technician reaching a sensitivity of 29% and specificity of 98%, and resident radiologists reaching sensitivity of 29% and specificity of 93%, the use of the application allowed a significant increase in sensitivity. The presented AI application accurately decides on a patient-specific MRI protocol based on image quality analysis, potentially allowing omission of DCE in the diagnostic workup of patients with suspected prostate cancer. This could streamline workflow and optimize time utilization of healthcare professionals. [ABSTRACT FROM AUTHOR]

• Need for standardized monitoring methodology after focal prostate treatment. • Clinical application of MRI-based PI-FAB score for follow-up after HIFU treatment. • High specificity and NPV in detecting post-HIFU residual/recurrent prostate cancer. • Potential of PI-FAB score in supporting non-invasive post-HIFU patient monitoring. To investigate inter-reader agreement, and diagnostic performance of the Prostate Imaging after Focal Ablation (PI-FAB) score applied to multiparametric MRI (mpMRI) in patients who underwent focal high-intensity focused ultrasound (HIFU) therapy for localized prostate cancer. In this retrospective, IRB-approved, single-center study, 73 men, who underwent focal HIFU treatment and received follow-up mpMRIs with subsequent prostate biopsies, were included. The PI-FAB score was applied to follow-up MRIs at 6, 12, and 36 months post-HIFU by two radiologists with different experience levels. Inter-reader agreement was assessed using Gwet's AC1, and the diagnostic performance of the PI-FAB score was assessed in relation to histopathologic results of subsequent prostate biopsies for each reader. PI-FAB scores showed substantial to almost perfect inter-reader agreement (AC1: 0.80–0.95) and demonstrated high specificity (Reader 1: 90–98 %, Reader 2: 87–98 %) and NPVs (Reader 1: 91–100 %, Reader 2: 88–97 %) in ruling out residual or recurrent in-field prostate cancer post-HIFU. Sensitivity (Reader 1: ≥43 %, Reader 2: ≥14 %) and PPVs (Reader 1: ≥33 %, Reader 2: ≥14 %) were mostly relatively lower, with notable disparities between the two readers, indicating the potential influence of radiologist experience. The PI-FAB score provides a consistent and reliable tool for post-HIFU monitoring of prostate cancer using mpMRI. It demonstrates substantial to almost perfect inter-reader agreement and is particularly effective in excluding in-field residual or recurrent prostate cancer post-HIFU treatment. Its application can potentially enhance post-treatment patient care, emphasizing its value as a non-invasive MRI-based monitoring approach after focal ablative therapy of the prostate. [ABSTRACT FROM AUTHOR]

• This study constitutes a pioneering advancement as the first systematic review and meta -analysis assessing the diagnostic efficacy of 68Ga-PSMA-11 PET/CT and mpMRI for prostate cancer in a head-to-head comparison. • This meta -analysis concludes that both 68Ga-PSMA-11 PET/CT and mpMRI have similar diagnostic performance in detecting primary prostate cancer. • Clinicians should carefully consider the advantages and limitations associated with each imaging technique when making decisions about the most appropriate method to employ. The goal of this study was to evaluate the effectiveness of two diagnostic methods, 68Ga-PSMA-11 PET/CT and mpMRI, in detecting primary prostate cancer without limitations on the Gleason score. We conducted a comprehensive literature review, searching databases such as PubMed, Embase, and Web of Science until June 2023. Our objective was to identify studies that compared the efficacy of 68Ga-PSMA-11 PET/CT and mpMRI in detecting primary prostate cancer. To determine heterogeneity, the I2 statistic was used. Meta-regression analysis and leave-one-out sensitivity analysis were conducted to identify potential sources of heterogeneity. Initially, 1286 publications were found, but after careful evaluation, only 16 studies involving 1227 patients were analyzed thoroughly. The results showed that the 68Ga-PSMA-11 PET/CT method had a pooled sensitivity and specificity of 0.87 (95 % CI: 0.80–0.92) and 0.80 (95 % CI: 0.69–0.89), respectively, for diagnosing prostatic cancer. Similarly, the values for mpMRI were determined as 0.84 (95 % CI: 0.75–0.92) and 0.74 (95 % CI: 0.61–0.86), respectively. There were no significant differences in diagnostic effectiveness observed when comparing two primary prostate cancer methodologies (pooled sensitivity P = 0.62, pooled specificity P = 0.50). Despite this, the funnel plots showed symmetry and the Egger test results (P values > 0.05) suggested there was no publication bias. After an extensive meta -analysis, it was found that both 68Ga-PSMA-11 PET/CT and mpMRI demonstrate similar diagnostic effectiveness in detecting primary prostate cancer. Future larger prospective studies are warranted to investigate this issue further. [ABSTRACT FROM AUTHOR]

The development of different imaging modalities of the prostate has significantly improved tumor detection, patient risk stratification, and quality of care. Among these, multiparametric magnetic resonance imaging (mp-MRI) has emerged as the most sensitive tool. It is useful in the diagnosis, localization, risk stratification, and staging of clinically significant prostate cancer, PCa. As a result, mp-MRI of the prostate is recommended as the initial diagnostic test for men with suspected PCa. A multidisciplinary approach is crucial in the diagnosis and management of prostate cancer and mp-MRI plays a fundamental role in this scenario. While many aspects of image quality certainly fall within the purview of radiology, it is important to recognize that urologists must also be attentive to imaging quality when utilizing mp-MRI to facilitate PCa management. We present our viewpoint as urologists on how image quality impacts the management of men diagnosed with PCa and attempt to identify the factors that impact mp-MRI image quality, consequences of poor image quality, and finally suggestions for improvements. [ABSTRACT FROM AUTHOR]

• Analysis of missed PCa and csPCa in men with prior negative mpMRI. • Significance of MR image quality scores (PI-QUAL, PSHS) and clinical parameters. • Lower PI-QUAL score is an independent predictor of missed csPCa. • Integration of image quality scoring systems into standard prostate MRI reports. To identify predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in men with prior false-negative multiparametric MRI (mpMRI), focusing on image quality scoring systems and clinical parameters. In this IRB-approved retrospective single-center study, patients with a negative mpMRI (PI-RADS score ≤2) and subsequent prostate biopsies were included. Histopathological results served as reference standard. Welch's t-Test was conducted to identify significant differences in image quality scores (PI-QUAL and PSHS) between patients with and without PCa/csPCA. In addition, clinical parameters (age, BMI, PSA density) and image quality scores (PI-QUAL and PSHS) were examined as potential predictors of PCa/csPCa detection after a false-negative mpMRI in uni- and multivariate analyses. Among 96 patients with negative mpMRI results, 44.8 % had PCa and 16.7 % had csPCa upon biopsy with histopathological confirmation. PI-QUAL scores were significantly lower in patients with PCa (p = 0.03) and csPCa (p = 0.005). PSHS scores were lower in patients with csPCa, but the difference was not statistically significant (p = 0.1). Higher age (p = 0.035) and a lower PI-QUAL score (p < 0.004) were predictors of subsequent csPCa detection upon biopsy, however, a lower PI-QUAL score was the only independent predictor of missed csPCa in false-negative mpMRIs. Lower image quality scores were associated with missed PCa/csPCa in patients with false-negative mpMRIs, with PI-QUAL being an independent predictor of failed csPCa detection. This highlights the importance of image quality for prostate MRI and advocats the inclusion of its measurement into the standardized report. [ABSTRACT FROM AUTHOR]

• Characteristics of prostatitis on MRI can be T2w hypointensity and DCE enhancement, but they seem not specific and/or correlated to the histopathologic quantity of prostatitis. • Presence of atrophy and/or prostatitis is frequent and was increased with higher PI-RADS classifications. Thus, knowledge about the influence on PI-RADS scores seems essential to avoid false positive cases. • Based on our subcohort younger men tend to have lower incidence of prostatitis and atrophy, yet can exhibit likely age-related T2w hypointensity and DCE enhancement. To analyse multiparametric magnetic resonance imaging (mpMRI) characteristics and appearance of histopathologically proven non-cancerous intraprostatic findings focussing on quantity of prostatitis and atrophy in the peripheral zone. In this retrospective analysis consecutive patients with mpMRI followed by MRI/TRUS-fusion biopsy comprising targeted (TB) and systematic biopsy (SB) cores without prostate cancer (PC) at histopathology were included. Subgroup analysis was performed in younger men (≤50 years). The proportions of prostatitis and atrophy were quantified for each biopsy core based on histopathology. MRI findings in the peripheral zone (PZ) and index lesions (IL, most suspicious/representative lesion) were characterized regarding changes in T2w, ADC value, and enhancement of dynamic contrast enhancement (DCE) and correlated with quantity of prostatitis and atrophy. Seventy-two patients were analysed. The median baseline characteristics were PSA 5.4 ng/ml (4.0–7.9), PI-RADS classification 3 (2–4), prostate volume 43 ml (33–57), and PSA density 0.13 ng/ml2 (0.10–0.19). Prostatitis was found in 44 % (n = 32) and atrophy in 65 % (n = 47) of cases. The quantity of atrophy demonstrated a significant correlation to T2w changes, ADC increase and DCE enhancement (p = 0.05, p = 0.05, p = 0.01), whereas quantity of prostatitis did not show any significant correlation to the MRI changes (p = 0.68, p = 0.58, p = 0.95). Quantity of prostatitis and atrophy increased with PI-RADS classification. Younger men had lower PSA (4.4 vs. 7.8 ml/ng; p < 0.001), smaller prostate volume (40 vs. 59 ml; p = 0.001), and lower PI-RADS classification (2–3 vs. 3–4; p = 0.005) and prostatitis and atrophy were less frequently observed (p ≤ 0.01, p = 0.03). Quantity of atrophy and prostatitis had different influence on MRI characteristics and increased within higher PI-RADS classification. Younger men had diffuse hypointense changes at T2w images, but less quantity of prostatitis and atrophy. [ABSTRACT FROM AUTHOR]

Purpose: Patients with skull base chordoma and chondrosarcoma have different prognoses and are not readily differentiated preoperatively on imaging. Multiparametric magnetic resonance imaging (MRI) is a routine diagnostic tool that can noninvasively characterize the salient characteristics of tumors. In the present study, we developed and validated a preoperative multiparametric MRI-based radiomic signature for differentiating these tumors.Method: This retrospective study enrolled 210 patients and consecutively divided them into the primary and validation cohorts. A total of 1941 radiomic features were acquired from preoperative T1-weighted imaging, T2-weighted imaging and contrast-enhanced T1-weighted imaging for each patient. The most discriminative features were selected by minimum-redundancy maximum-relevancy and recursive feature elimination algorithms in the primary cohort. The multiparametric and single-sequence MRI signatures were constructed with the selected features using a support vector machine model in the primary cohort. The ability of the novel radiomic signatures to differentiate chordoma from chondrosarcoma were assessed using receiver operating characteristic curve analysis in the validation cohort.Results: The multiparametric radiomic signature, which consisted of 11 selected features, reached an area under the receiver operating characteristic curve of 0.9745 and 0.8720 in the primary and validation cohorts, respectively. Moreover, compared with each single-sequence MRI signature, the multiparametric radiomic signature exhibited better classification performance with significant improvement (p <  0.05, Delong's test) in the primary cohorts.Conclusion: By combining features from three MRI sequences, the multiparametric radiomics signature can accurately and robustly differentiate skull base chordoma from chondrosarcoma. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare Prostate Imaging Reporting and Data System (PI-RADS) versions v1 and v2 for the detection of prostate cancer (PCa) in multiparametric MRI (mpMRI) using whole-mount histological workup as reference standard.Material and Methods: MRI data of 40 patients with positive transrectal ultrasound-guided biopsy were analyzed retrospectively by two blinded readers (5 and 4 years' experience) with PI-RADS v1 and v2 for cancer-suspicious lesions. Prior to radical prostatectomy, patients had undergone IRB-approved mpMRI at 3 T according to PI-RADS recommendations: T2-weighted (T2w), diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) imaging. The reference standard was provided by whole-mount sections of the prostatectomy specimens. Versions v1 and v2 were compared with respect to sensitivity and positive predictive value (PPV) per lesion. Subgroups stratified by tumor location (peripheral vs. transition zone) and aggressiveness (high vs. low grade) were also analyzed. We also evaluated the concordance of the dominant MRI sequence in v2 (DWI or T2w) and the highest individual score under v1. Interobserver agreement for PI-RADS v1 and v2 was assessed by Cohen's kappa statistics.Results: Reader 1 (R1) described 66 and Reader 2 (R2) 72 MRI lesions. The average Gleason score of 58 PCa lesions was 6.5 (range: 6 = 3 + 3 to 8 = 4 + 4), most of them (65.5%) located in the peripheral zone. PI-RADS v2 showed a trend towards lower sensitivities, but differences were not significant for both readers: R1 72.4% (v1) vs. 63.8% (v2) (P = 0.426) and R2 77.6% (v1) vs. 69.0% (v2) (P = 0.402). The trends were more pronounced in the transition zone and for low-grade cancers but remained insignificant (p-values from 0.313 to 0.691). Likewise, the apparent PPV differences, overall as well as in each zone, were not significant. Agreement between high-score v1 and dominant v2 sequence was 48% for R1 and 53% for R2. Cohen's κ of PCa detection for two readers was 0.48 for both v1 and v2.Conclusion: Our findings indicate that the simplified, zone-specific approach of PI-RADS v2 (2015) for MRI assessment of prostate cancer may not necessarily be better than the original v1 criteria (2012). In specific cases, a strict interpretation of v2 criteria may even lead to false-negative findings. Therefore, the current PI-RADS criteria should be reconsidered, despite the low statistical evidence here. [ABSTRACT FROM AUTHOR]

Objective: This meta-analysis aimed to compare the diagnostic performance of positron emission tomography (PET)/MRI using various radiotracers with multiparametric (mp) MRI for detection of primary prostate cancer (PCa).Methods: A systematic literature search up to January 2019 was performed to identify studies that evaluated the diagnostic value of PET/MRI and mpMRI for detection of PCa in the same patient cohorts and had sufficient data to construct 2 × 2 contingency tables for true-positive (TP), false-positive (FP), false-negative (FN), and true-negative (TN) results. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and pooled sensitivity (SEN) and specificity (SPE) were calculated. Summary receiver operating characteristic (ROC) curves and area under the curves (AUCs) were used to compare the performances of PET/MRI and mpMRI.Results: We identified 9 eligible studies that included a total of 353 patients. PET/MRI had a SEN of 0.783 (95% CI, 0.758-0.807) and a SPE of 0.899 (95% CI, 0.879-0.917), and mpMRI had a SEN of 0.603 (95% CI, 0.574-0.631) and a SPE of 0.887 (95% CI, 0.866-0.906). PET/MRI had a higher AUC than mpMRI (0.9311, 95% CI, 0.8990-0.9632 vs. 0.8403, 95% CI, 0.7864-0.8942; P =  0.0036). There was no notable publication bias, but there was medium heterogeneity in outcomes. The meta-regression analysis showed the major potential cause of heterogeneity was the use of region-based rather than lesion-based analysis.Conclusion: PET/MRI has very good diagnostic performance and outperforms mpMRI for the diagnosis of primary PCa. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the disease detection rate, diagnostic performance and interobserver agreement of fluciclovine (18F) PET-CT and multiparametric magnetic resonance imaging (mpMR) in recurrent prostate cancer.Methods: Twenty-four patients with biochemical failure after non-prostatectomy definitive therapy, 16/24 of whom had undergone brachytherapy, underwent fluciclovine PET-CT and mpMR with interpretation by expert readers blinded to patient history, PSA and other imaging results. Reference standard was established via a multidisciplinary truth panel utilizing histology and clinical follow-up (22.9 ± 10.5 months) and emphasizing biochemical control. The truth panel was blinded to investigative imaging results. Diagnostic performance and interobserver agreement (kappa) for the prostate and extraprostatic regions were calculated for each of 2 readers for PET-CT (P1 and P2) and 2 different readers for mpMR (M1 and M2).Results: On a whole body basis, the detection rate for fluciclovine PET-CT was 94.7% (both readers), while it ranged from 31.6-36.8% for mpMR. Kappa for fluciclovine PET-CT was 0.90 in the prostate and 1.0 in the extraprostatic regions. For mpMR, kappa was 0.25 and 0.74, respectively. In the prostate, 22/24 patients met the reference standard with 13 malignant and 9 benign results. Sensitivity, specificity and positive predictive value (PPV) were 100.0%, 11.1% and 61.9%, respectively for both PET readers. For mpMR readers, values ranged from 15.4-38.5% for sensitivity, 55.6-77.8% for specificity and 50.0-55.6% for PPV. For extraprostatic disease determination, 18/24 patients met the reference standard. Sensitivity, specificity and PPV were 87.5%, 90.0% and 87.5%, respectively, for fluciclovine PET-CT, while for mpMR, sensitivity ranged from 50 to 75%, specificity 70-80% and PPV 57-75%.Conclusion: The disease detection rate for fluciclovine PET-CT in non-prostatectomy patients with biochemical failure was 94.7% versus 31.6-36.8% for mpMR. For extraprostatic disease detection, fluciclovine PET-CT had overall better diagnostic performance than mpMR. For the treated prostate, fluciclovine PET-CT had high sensitivity though low specificity for disease detection, while mpMR had higher specificity, though low sensitivity. Interobserver agreement was also higher with fluciclovine PET-CT compared with mpMR. [ABSTRACT FROM AUTHOR]

Purpose: to simultaneously evaluate interreader agreement and diagnostic accuracy in the of PI-RADS v2 and compare it to v1.Methods: A total of 67 patients (median age 65.3 y, range 51.2-78.2 y; PSA 6.8μg/L, 0.2-33μg/L) undergoing MRI of the prostate and subsequent transperineal template biopsy within ≤6 months from MRI were included. Four readers from two institutions evaluated the likelihood of prostate cancer using PI-RADS v1 and v2 in two separate reading sessions ≥3 months apart. Interreader agreement was assessed for each pulse-sequence and for total PI-RADS scores using the intraclass correlation coefficient (ICC). Differences were considered significant for non-overlapping 95%-confidence intervals. Diagnostic accuracy was assessed with the area under the receiver operating characteristic curve (AZ). A p-value <0.05 was considered statistically significant.Results: Interreader agreement for DCE-scores was good in v2 (ICC2=0.70; 95% CI: 0.66-0.74) and slightly lower in v1 (ICC1=0.64, 0.59-0.69). Agreement for DWI scores (ICC1=0.77, ICC2=0.76) as well as final PI-RADS scores per quadrant were nearly identical (ICC1=ICC2=0.71). Diagnostic accuracy showed no significant differences (p=0.09-0.93) between v1 and v2 in any of the readers (range: AZ=0.78-0.88).Conclusion: PI-RADS scores show similar interreader agreement in v2 and v1 at comparable diagnostic performance. The simplification of the DCE interpretation in v2 might slightly improve agreement while not negatively affecting diagnostic performance. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of rectal distension on the quality of anatomical and functional prostate multiparametric (mp) MRI.Materials and Methods: Multiparametric (mp) 3T-MRI images of 173 patients were independently evaluated by two radiologists in this retrospective study. Planimetry rectal volumes were derived and a subjective assessment of rectal distension was made using a 5-point Likert scale (1=no stool/gas, 5=large amount of stool/gas). Image quality of diffusion-weighted imaging (DWI) was evaluated using a 5-point Likert scale. DWI was further scored for distortion and artefact. T2W images were evaluated for image sharpness and the presence of motion artefact. The stability of the dynamic contrast-enhancement acquisition was assessed by recording the number of corrupt data points during the wash-out phase.Results: There was a strong correlation between subjective scoring of rectal loading and objectively measured rectal volume (r=0.82), p<0.001. A significant correlation was shown between increased rectal distension and both reduced DW image quality (r=-0.628, p<0.001), and increased DW image distortion (r=0.814, p<0.001). There was also a significant trend for rectal distension to increase artefact at DWI (r=0.154, p=0.042). Increased rectal distension led to increased motion artefact on T2 (p=0.0096), but did not have a significant effect on T2-sharpness (p=0.0638). There was no relationship between rectal distension and DCE image quality (p=0.693). 63 patients underwent lesion-targeted biopsy post MRI, there was a trend to higher positive predictive values in patients with minor rectal distension (34/38, 89.5%) compared to those with moderate/marked distension (18/25, 72%), p=0.09.Conclusion: Rectal distension has a significant negative effect on the quality of both T2W and DW images. Consideration should therefore be given to bowel preparation prior to prostate mpMRI to optimise image quality. [ABSTRACT FROM AUTHOR]

• Accuracy of prostate MRI in the detection of clinically-significant cancer is dependent on image quality. Different scoring systems exists, each assessing different aspects of image quality. • This study assesses the ability of these scoring systems in the assessment of factors limiting diagnostic accuracy of prostate MRI. • The PSHS and PI-QUAL scoring systems performed well in assessing the effect of image quality on detection rates. To evaluate different image quality scoring systems in the assessment of factors limiting diagnostic accuracy of prostate MRI. This retrospective IRB-approved study included 281 patients undergoing prostate MRI prior to biopsy. Four readers (2 experienced, 2 novice) independently reviewed all MRI examinations (n = 295) and assigned scores for subjective image quality (1–5; 1:poor, 5:excellent), the PI-QUAL and the PSHS scoring system. The original PI-RADS scores were extracted from the report and transperineal template saturation biopsy served as histopathological reference. Inter-reader agreement was found to be good, with PSHS showing highest agreement (kappa: 0.65). The PSHS scoring system performed well assessing the influence of image quality on sensitivity of MR for clinically-significant cancer for the experienced readers using a PI-RADS score cut-off ≥ 3/≥4, as did the PI-QUAL scoring system with a PI-RADS cut-off ≥ 4. For the less experienced radiologist, this was true for PSHS (clinically-significant and all cancers) and PI-QUAL scores (clinically-significant cancers) for a PI-RADS score ≥ 3. PSHS scores were positively associated with the detection of clinically-significant cancer based on a PI-RADS cut-off ≥ 4, OR 1.86 (95 % CI 1.22–2.82), and had the highest Somers' D. The PSHS scoring system performed well in assessing the effect of image quality on detection rates, as did the PI-QUAL system. Since both systems focus on different aspects of image quality, their incorporation into prostate MRI reports could further enhance standardization and allow for a reliable assessment of image quality as a potential confounder in prostate MRI. [ABSTRACT FROM AUTHOR]

Purpose: To compare the reproducibility and diagnostic performance of PI-RADS version 2 (v2) and version 1 (v1) for the diagnosis of prostate cancer (PCa) on multiparametric MRI. Methods: This IRB-approved retrospective study included 65 consecutive biopsy-naïve or biopsy-negative patients suspicious for PCa (mean age: 65 years, mean PSA: 10.8ng/ml) who were undergoing MR-guided biopsy after multiparametric 3T prostate MRI (T2w, DWI, DCE). Two independent readers (R1; R2) scored the prostate lesions according to the v2 score and the v1 sum score. Diagnostic measures (sensitivity, specificity, and area under the ROC-curve) were compared for all cases and stratified by location (transitional zone, TZ, peripheral zone, PZ). Inter-reader agreement was assessed by kappa statistics. Results: Inter reader agreement for v2 and v1 was substantial to almost perfect (kappa v2: 0.71, v1: 0.81). Overall, sensitivity between both readers and methods did not differ (p>0.05). Overall specificity was higher using v1 compared to v2 (R1: p=0.0078, R2: p=0.0313) In the TZ, v2 showed a higher AUC (0.81-0.84) compared to v1 (AUC 0.77-0.78). Here, the sensitivity of v2 (87.5-100%) was higher than that of v1 (75%) while v2 specificity (50%-56.3%) was lower than that of v1 (68.8-75%). In the PZ, AUCs were higher using v1 (AUC 0.82-0.83) compared to v2 (AUC 0.61-0.63). The specificity for v1 was higher (43.8-62.3%) than that for v2 (12.5-18.8%) while both v2 and v1 achieved 100% sensitivity. Conclusion: PI-RADS v2 and v1 inter-reader agreement is excellent, but their diagnostic performance differs. While v2 appears to be the preferable method for the evaluation of TZ lesions, v1 performs better in the PZ. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic accuracy of dynamic contrast enhanced breast MRI (DCE-MRI) combined with diffusion weighted imaging (DWI) and 1H single-voxel magnetic resonance spectroscopy (1HMRS) in differentiating malignant from benign breast lesions.Methods: One hundred twenty-nine patients with 138 lesions were included in the study. Multiparametric MRI of the breast was performed with a 3T unit. A DWI is followed by DCE-MRI and 1HMRS. All lesions were biopsied within one week after MRI. Histopathologic findings were accepted as the standard of reference. Probability of malignancy was assessed according to BI-RADS for DCE-MRI. ADC values were measured for DWI and choline peaks were assessed using a semi-quantitative method in 1HMRS. Two blinded radiologists evaluated findings in consensus. Diagnostic performance of DCE-MRI, DWI and 1HMRS alone or in combination for multiparametric imaging were statistically evaluated.Results: Histopathology revealed malignancy in 54.4% of lesions (75/138). DCE-MRI showed the highest AUC (0.978), sensitivity (97.33%) and specificity (88.89%) compared to DWI and 1HMRS. Sensitivity was 100% when a positive result from any one of three techniques was accepted as malignancy, albeit with a trade-off for 65.1% specificity. Highest specificity (98.4%) was attained when all three techniques were required to be positive, though with a lower sensitivity (82.7%) as trade-off. Logistic regression analysis confirmed significant association with DCE-MRI (p<0.001) and 1H MRS (p=0.009) but not with DWI (p=0.127). There was one case of fat necrosis which was false positive in all three techniques.Conclusions: Multiparametric imaging with combination of DCE-MRI, DWI and 1HMRS does not improve, and may even reduce the diagnostic accuracy of breast MRI. Although, the specificity may be improved with a trade-off for lower sensitivity, we have not set a convenient algorithm for the combined use of these techniques. [ABSTRACT FROM AUTHOR]

Objectives: DWI and dynamic contrast enhanced (DCE) MR imaging are techniques that allow insight to tumor vascularity and cellularity. We evaluated the diagnostic performance of multiparametric MRI (mp-MRI) in distinguishing benign from malignant orbital masses using standard anatomic imaging (sAI), DWI and DCE.Materials and Methods: This prospective IRB approved study with written informed consent included 65 patients. mp-MRI at 3 Tesla including DWI and DCE was performed in all patients. Parametric maps were generated for obtaining the perfusion parameters including K(trans), kep, ve and iAUC and time-signal intensity curves were recorded to determine the curve pattern. Two radiologists rated the likelihood of malignancy on a five-point scale in three separate, randomized reading sessions (initially only sAI, afterwards sAI+either DWI or DCE and finally sAI+DWI+DCE). Data was statistically analyzed.Results: 33 Patients had malignant orbital masses and 32 patients had benign orbital masses (reference standard histopathology in 35 cases and clinical follow-up in 30 patients). The mean ADC of malignant masses differed significantly from the mean (SD) ADC of benign masses (0.825 [0.437]×10(-3)mm(2)/s and 1.257 [0.576]×10(-3)mm(2)/s, respectively) (p=0.001). K(trans), kep and iAUC were significantly higher in malignant masses (p<0.01). The reading of sAI only resulted in a moderate specificity but poor sensitivity in differentiating benign from malignant lesions. Adding DWI and DCE images improved specificity and sensitivity considerably, being the highest for the combined reading of all sequences.Conclusion: mp-MRI is a helpful tool in differentiating malignant orbital lesions from benign masses and should therefore be included in the routine diagnostic protocol for orbital imaging. [ABSTRACT FROM AUTHOR]

Background: Multi-parametric magnetic resonance imaging (mp-MRI) is emerging as a useful tool for prostate cancer (PCa) detection but currently has unaddressed limitations. Computer aided diagnosis (CAD) systems have been developed to address these needs, but many approaches used to generate and validate the models have inherent biases.Method: All clinically significant PCa on histology was mapped to mp-MRI using a previously validated registration algorithm. Shape and size matched non-PCa regions were selected using a proposed sampling algorithm to eliminate biases towards shape and size. Further analysis was performed to assess biases regarding inter-zonal variability.Results: A 5-feature Naïve-Bayes classifier produced an area under the receiver operating characteristic curve (AUC) of 0.80 validated using leave-one-patient-out cross-validation. As mean inter-class area mismatch increased, median AUC trended towards positively biasing classifiers to producing higher AUCs. Classifiers were invariant to differences in shape between PCa and non-PCa lesions (AUC: 0.82 vs 0.82). Performance for models trained and tested only in the peripheral zone was found to be lower than in the central gland (AUC: 0.75 vs 0.95).Conclusion: We developed a radiomics based machine learning system to classify PCa vs non-PCa tissue on mp-MRI validated on accurately co-registered mid-gland histology with a measured target registration error. Potential biases involved in model development were interrogated to provide considerations for future work in this area. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the European Society of Urogenital Radiology (ESUR) score, the Likert scale, tumor contact length (TCL) > 1 cm, and EPE (extraprostatic extension) grade in predicting EPE at multiparametric magnetic resonance imaging (mp-MRI).Methods: Seventy-nine patients who underwent 3-T MRI and were histopathologically confirmed by microblocks were enrolled in this retrospective study. The index lesions were interpreted by two experienced radiologists. Apparent diffusion coefficient (ADC) values were also noted. Weighted κ statistics were used to compare interreader agreement. Univariate logistic regression analysis was performed to define independent predictors of EPE status. Multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed to compare the MRI-based methods and clinical variables (ISUP grade, prostate volume and PSA density) + MRI-based methods for pathologic EPE prediction by using the area under the curve (AUC) value.Results: The mean age was 64.5 years ± 6.2. 33/79 (41.8%) patients had pathologic EPE. As ESUR score showed weak interreader agreement (κ = 0.537), Likert scale, TCL, and EPE grade showed moderate agreement (κ = 0.608, κ = 0.747, κ = 0.647 respectively). Univariate ROC analysis result showed that all MRI-based score systems, mean ADC value, the ISUP grade, prostate volume, PSA density were the best variables in predicting EPE. ROC analysis results of four MRI-based methods showed good diagnostic performance. At multivariate analysis, all clinical models showed excellent diagnostic performance.Conclusion: All four MRI-based methods had good diagnostic performance. Furthermore, consisting of both qualitative and quantitative parameters and being less reader experience dependent, EPE grade was a promising method in predicting EPE. All clinical models showed excellent diagnostic performance. [ABSTRACT FROM AUTHOR]

Purpose: To determine the diagnostic yield of magnetic resonance imaging (MRI) guided in-bore biopsy in patients with high likelihood multiparametric MRI (mpMRI) findings, regarding overall and clinically significant prostate cancer (csPCa) detection rates and concordance of biopsy and radical prostatectomy (RP) Gleason scores (GS).Methods: This retrospective study consisted of 277 Prostate Imaging Reporting and Data System (PI-RADS) assessment category 4 and 5 targets in 246 patients (mean age, 65.7 years; median prostate specific antigen value, 7.75 ng/mL) who had undergone in-bore biopsy at our institution between 2012 and 2020. Eighty-one patients who underwent RP were eligible for the concordance analysis of biopsy and RP specimen GS.Results: Overall PCa detection rates were 80.5 % per patient (198/246) and 78 % per target (216/277) and 83.5 % and 67.4 % in primary (biopsy naive) and secondary (at least one negative prior biopsy) settings. csPCa was found in 63 % overall, 66 % of patients (132/200) in the primary, and 50 % of patients (23/46) in the secondary biopsy settings (p < 0.001). The prostate cancer detection rate was 68 % and 92 % in PI-RADS 4 and 5, respectively (p < 0.001). In the radical prostatectomy subcohort, 27.2 % of patients were upgraded, 8.6 % of patients were downgraded from needle biopsy. Significant complications occurred in 1.2 % of patients.Conclusions: MRI-guided in-bore prostate biopsy has a high detection rate of csPCa in primary and secondary biopsy cohorts. Biopsy results were satisfactory in terms of the number of positive cores, cancer percentage in positive cores, and concordance of GS in needle biopsy and RP specimen. [ABSTRACT FROM AUTHOR]

Purpose: To determine the diagnostic performance of the Kaiser score and to compare it with the BI-RADS-based multiparametric classification system (MCS).Method: Two breast radiologists, blinded to the clinical and pathological information, separately evaluated a database of 499 consecutive patients with structural 3.0 T breast MRI and 697 histopathologically verified lesions. The Kaiser scores and corresponding MCS categories were recorded. The sensitivity and specificity of the Kaiser score and the MCS categories to differentiate benign from malignant lesions were calculated. The interobserver reproducibility and receiver operating characteristic (ROC) parameters were analysed.Results: The sensitivity and specificity of the MCS were 100 % and 12 %, respectively, and those of the Kaiser score were 98.5 % and 34.8 % for reader 1 and 98.7 % and 47.5 % for reader 2. The area under the ROC-curve was 85.9 and 87.6 for readers 1 and 2. The interobserver intraclass correlation coefficient was excellent at 0.882. Reader 1 upgraded six lesions from BI-RADS 3 to a Kaiser score of >4, and reader 2 upgraded seven lesions. When applying the Kaiser score to 158 benign lesions readers 1 and 2 would have reduced the biopsy rate by 22.8 % and 35.4 %, respectively.Conclusions: The Kaiser score showed high diagnostic accuracy with excellent interobserver reproducibility. The MCS had perfect sensitivity but low specificity. Although the Kaiser score had slightly lower sensitivity, its specificity was 3-4 times greater than that of the MCS. Thus, the Kaiser score has the potential to considerably reduce the biopsy rate for true negative lesions. [ABSTRACT FROM AUTHOR]

Background: Mean ADC has high predictive value for the presence of clinically significant prostate cancer (sPC). Measurement variability is introduced by different scanners, protocols, intra-and inter-patient variation. Internal calibration by ADC ratios can address such fluctuations however can potentially lower the biological value of quantitative ADC determination by being sensitive to deviations in reference tissue signal.Purpose: To better understand the predictive value of quantitative ADC measurements in comparison to internal reference ratios when measured in a single scanner, single protocol setup.Materials and Methods: 284 consecutive patients who underwent 3 T MRI on a single scanner followed by MRI-transrectal ultrasound fusion biopsy were included. A board-certified radiologist retrospectively reviewed all MRIs blinded to clinical information and placed regions of interest (ROI) on all focal lesions and the following reference regions: normal-appearing peripheral zone (PZNL) and transition zone (TZNL), the urinary bladder (BLA), and right and left internal obturator muscle (RIOM, LIOM). ROI-based mean ADC and ADC ratios to the reference regions were compared regarding their ability to predict the aggressiveness of prostate cancer. Spearman's rank correlation coefficient was used to estimate the correlation between ADC parameters, Gleason score (GS) and ADC ratios. The primary endpoint was presence of sPC, defined as a GS ≥ 3 + 4. Univariable and multivariable logistic regression models were constructed to predict sPC. Receiver operating characteristics curves (ROC) were used for visualization; DeLong test was used to evaluate the differences of the area under the curve (AUC). Bias-corrected AUC values and corresponding 95 %-CI were calculated using bootstrapping with 100 bootstrap samples.Results: After exclusion of patients who received prior treatment, 259 patients were included in the final cohort of which 220 harbored 351 MR lesions. Mean ADC and ADC ratios demonstrated a negative correlation with the GS. Mean ADC had the strongest correlation with ρ of -0.34, followed by ADCratioPZNL (ρ=-0.32). All ADC parameters except ADCratioLIOM (p = 0.07) were associated with sPC p<0.05). Mean ADC and ADCratioPZNL had the highest ROC AUC of all parameters (0.68). Multivariable models with mean ADC improve predictive performance.Conclusions: A highly standardized single-scanner mean ADC measurement could not be improved upon using any of the single ADC ratio parameters or combinations of these parameters in predicting the aggressiveness of prostate cancer. [ABSTRACT FROM AUTHOR]

• A multiparemetric evaluation of suspicious lesions is needed in breast MRI. • Our proposed categorisation of findings is comparable to the BI-RADS recommendations. • The proposed system helps in avoiding unnecessary follow-ups or biopsies. To validate a new categorisation scheme for suspicious breast lesions according to the well-defined Breast Imaging Reporting and Data System (BI-RADS) magnetic resonance imaging (MRI) lexicon descriptors, apparent diffusion coefficients (ADC), T2-weighted signal intensity (SI), and kinetic curve assessment categories. The MRI descriptors and ADC were analysed in 697 lesions detected in 499 subjects. The descriptors were classified into Minor, Intermediate, and Major findings, and were divided into the BI-RADS subcategories 3, 4A, 4B, 4C, and 5 according to the number of descriptors. Positive predictive values (PPV) were calculated for each descriptor. The descriptors were then fitted into a multinomial logistic regression model to determine the odds ratio for a malignant diagnosis. The PPV were measured for the new categories and compared with the assigned PPV of the BI-RADS descriptors. The PPV for MRI descriptors ranged from 17.9%–100%. Of the 697 lesions assessed, 19 (2.7 %) were categorized as BI-RADS 3, 27 (3.9 %) as 4A, 53 (7.6 %) as 4B, 174 (25.0 %) as 4C, and 424 (60.8 %) as 5. None of the subjects in BI-RADS category 3 had a malignant diagnosis. The PPV for malignancy increased progressively with increasing BI-RADS category (4A, 11.1 %; 4B, 28.3 %; 4C, 64.4 %; 5, 94.8 %). All descriptor groups were significant in the logistic regression model. This study shows that using BI-RADS MRI descriptors together with ADC and T2-weighted SI in a multiparametric classification system can yield an applicable categorisation of lesions with PPV values within the recommended ranges for BI-RADS categories. [ABSTRACT FROM AUTHOR]

Purpose: To compare the diagnostic performance of PI-RADS v2 and v2.1 for detecting transition zone prostate cancer (TZPC) on multiparametric prostate MRI (mpMRI).Method: Fifty-eight patients with elevated PSA levels underwent mpMRI at 3 T including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), and subsequent MRI-transrectal ultrasonography fusion-guided prostate-targeted biopsy (MRGB). The standard of reference was MRGB-derived histopathology. Two readers independently assessed each TZ lesion, assigning a score of 1-5 for T2WI, a score of 1-5 for DWI, and the overall PI-RADS assessment category according to PI-RADS v2 and v2.1. The diagnostic performance of the two methods was compared in terms of inter-reader agreement, diagnostic sensitivity, diagnostic specificity, and area under the ROC curve (AUC).Results: Of the 58 patients, 26 were diagnosed with PC (GS = 3 + 3, n = 9; GS = 3 + 4, n = 9; GS = 3 + 5, n = 1; GS = 4 + 3, n = 4; GS = 4 + 4, n = 3) and 32 with benign lesions. Regarding inter-reader agreement of overall PI-RADS assessment category, the kappa value was 0.580 for v2 and 0.645 for v2.1. For both readers, there was no difference in diagnostic sensitivity between the versions (p ≥ 0.500). For reader 1, the diagnostic specificity was higher for v2.1 (p = 0.002), and was similar for reader 2 (p = 1.000). For both readers, AUC tended to be higher for v2.1 than for v2, but the difference was not significant (0.786 vs. 0.847 for reader 1, p = 0.052; and 0.808 vs. 0.858 for reader 2, p = 0.197).Conclusions: These results suggest that compared with PI-RADS v2, PI-RADS v2.1 could be preferable for evaluating TZ lesions. [ABSTRACT FROM AUTHOR]

The future clinical use of the combination of positron emission tomography (PET) with 2-Fluoro[F-18]-2-Deoxy-d-Glucose (FDG)and MRI is still unclear. If a patient requires a PET and breast DCE-MRI for staging purposes, both scans can be done in the same visit. In the breast, DCE-MRI is better at lesion detection (sensitivity), margin evaluation, and has a higher specificity than CT. The potential for multiparametric qualitative and quantitative imaging is also an advantage of PET/MRI which provides opportunity to improve tumor characterization and may ultimately lead to outcome prediction. This review discusses technical and clinical aspects of this emerging technology in breast cancer patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the disease detection rate, diagnostic performance and interobserver agreement of fluciclovine ( 18 F) PET-CT and multiparametric magnetic resonance imaging (mpMR) in recurrent prostate cancer., Methods: Twenty-four patients with biochemical failure after non-prostatectomy definitive therapy, 16/24 of whom had undergone brachytherapy, underwent fluciclovine PET-CT and mpMR with interpretation by expert readers blinded to patient history, PSA and other imaging results. Reference standard was established via a multidisciplinary truth panel utilizing histology and clinical follow-up (22.9 ± 10.5 months) and emphasizing biochemical control. The truth panel was blinded to investigative imaging results. Diagnostic performance and interobserver agreement (kappa) for the prostate and extraprostatic regions were calculated for each of 2 readers for PET-CT (P1 and P2) and 2 different readers for mpMR (M1 and M2)., Results: On a whole body basis, the detection rate for fluciclovine PET-CT was 94.7% (both readers), while it ranged from 31.6-36.8% for mpMR. Kappa for fluciclovine PET-CT was 0.90 in the prostate and 1.0 in the extraprostatic regions. For mpMR, kappa was 0.25 and 0.74, respectively. In the prostate, 22/24 patients met the reference standard with 13 malignant and 9 benign results. Sensitivity, specificity and positive predictive value (PPV) were 100.0%, 11.1% and 61.9%, respectively for both PET readers. For mpMR readers, values ranged from 15.4-38.5% for sensitivity, 55.6-77.8% for specificity and 50.0-55.6% for PPV. For extraprostatic disease determination, 18/24 patients met the reference standard. Sensitivity, specificity and PPV were 87.5%, 90.0% and 87.5%, respectively, for fluciclovine PET-CT, while for mpMR, sensitivity ranged from 50 to 75%, specificity 70-80% and PPV 57-75%., Conclusion: The disease detection rate for fluciclovine PET-CT in non-prostatectomy patients with biochemical failure was 94.7% versus 31.6-36.8% for mpMR. For extraprostatic disease detection, fluciclovine PET-CT had overall better diagnostic performance than mpMR. For the treated prostate, fluciclovine PET-CT had high sensitivity though low specificity for disease detection, while mpMR had higher specificity, though low sensitivity. Interobserver agreement was also higher with fluciclovine PET-CT compared with mpMR., (Copyright © 2018 Elsevier B.V. All rights reserved.)