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Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
3D high-resolution diffusion-weighted MRI at 3T: Preliminary application in prostate cancer patients undergoing
Christopher Nguyen1,2, Ali-Reza Sharif-Afshar3, Zhaoyang Fan1
1Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Purpose:
To improve spatial resolution and image quality of diffusion-weighted (DW) MRI in detecting low-risk prostate cancer (lrPC) in patients undergoing active surveillance protocol (AS-PC), we propose the application of a diffusion-prepared balanced steady-state free precession (bSSFP) technique capable of multishot acquisition.
Methods:
Diffusion-prepared bSSFP was compared with single-shot DW echo planar imaging (SS-DW-EPI) at two prescribed resolutions (2.1 × 2.1 × 3.5mm(3) , 0.9 × 0.9 × 3.5 mm(3) ) in nine healthy subjects and nine AS-PC patients. Geometric distortion and susceptibility artifacts were quantitatively assessed in all subjects. In AS-PC patients, lesion detection via blinded multiparametric MRI including T1-weighted, T2-weighted, dynamic contrast-enhanced imaging, and along with either of two DW methods were evaluated against 12-point biopsy.
Results:
Geometric distortion and susceptibility artifacts were significantly less for diffusion-prepared bSSFP at both prescribed spatial resolutions than SS-DW-EPI. Apparent diffusion coefficients of healthy prostate tissue were concordant between the two DW methods at both spatial resolutions. In AS-PC patients, multiparametric MRI with diffusion-prepared bSSFP had greater sensitivity (94%, 63%), accuracy (76%, 67%), positive-predictive value (54%, 48%), negative-predictive value (97%, 82%), and area under the curve (0.80, 0.67) than with SS-DW-EPI.
Conclusions:
The proposed diffusion-prepared technique with higher spatial resolution and improved image quality over SS-DW-EPI resulted in better multiparametric MRI detection of lrPC in AS-PC patients.
Insights
A new diffusion-prepared balanced steady-state free precession (bSSFP) MRI technique improves detection of low-risk prostate cancer (lrPC) in patients on active surveillance. This method offers higher spatial resolution and better image quality than standard diffusion-weighted echo planar imaging (DW-EPI).
Area of Science:
- Radiology and Medical Imaging
- Oncology
- Prostate Cancer Diagnostics
Background:
- Active surveillance protocols for low-risk prostate cancer (lrPC) require accurate imaging for monitoring.
- Current diffusion-weighted (DW) MRI techniques, particularly single-shot DW echo planar imaging (SS-DW-EPI), face limitations in spatial resolution and image quality for detecting subtle cancerous lesions.
Purpose of the Study:
- To enhance spatial resolution and image quality of DW MRI for improved detection of lrPC in patients undergoing active surveillance (AS-PC).
- To evaluate the efficacy of a novel diffusion-prepared balanced steady-state free precession (bSSFP) technique for this purpose.
Main Methods:
- A diffusion-prepared bSSFP sequence was developed and compared against SS-DW-EPI at two different spatial resolutions.
- The study included nine healthy subjects and nine AS-PC patients, with quantitative assessment of geometric distortion and susceptibility artifacts.
- Lesion detection in AS-PC patients was evaluated using multiparametric MRI (including T1-weighted, T2-weighted, dynamic contrast-enhanced imaging, and DW imaging) against 12-point biopsy results.
Main Results:
- Diffusion-prepared bSSFP demonstrated significantly reduced geometric distortion and susceptibility artifacts compared to SS-DW-EPI at both resolutions.
- Apparent diffusion coefficients in healthy prostate tissue were consistent between the two DW methods.
- In AS-PC patients, multiparametric MRI utilizing diffusion-prepared bSSFP showed superior sensitivity (94% vs. 63%), accuracy (76% vs. 67%), positive-predictive value (54% vs. 48%), negative-predictive value (97% vs. 82%), and AUC (0.80 vs. 0.67) compared to SS-DW-EPI.
Conclusions:
- The proposed diffusion-prepared bSSFP technique offers improved spatial resolution and image quality over SS-DW-EPI.
- This advancement leads to superior detection of lrPC in AS-PC patients when incorporated into multiparametric MRI protocols.
- Diffusion-prepared bSSFP represents a promising advancement for prostate cancer surveillance and diagnosis.
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