Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

Catarina Dinis Fernandes; Ghazaleh Ghobadi; Henk G. van der Poel; Jeroen de Jong; Stijn W.T.P.J. Heijmink; Ivo Schoots; Iris Walraven; Petra J. van Houdt; Milena Smolic; Floris J. Pos; Uulke A. van der Heide

doi:10.1007/s00330-018-5819-y

Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

Catarina Dinis Fernandes
, Ghazaleh Ghobadi
, Henk G. van der Poel
, Jeroen de Jong
, Stijn W.T.P.J. Heijmink
, Ivo Schoots
, Iris Walraven
, Petra J. van Houdt
, Milena Smolic
, Floris J. Pos
, Uulke A. van der Heide^*

^*Corresponding author for this work

Netherlands Cancer Institute

Research output: Contribution to journal › Article › Academic › peer-review

16 Citations (Scopus)

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Abstract

Objectives:

Diagnosis of radio-recurrent prostate cancer using multi-parametric MRI (mp-MRI) can be challenging due to the presence of radiation effects. We aim to characterize imaging of prostate tissue after radiation therapy (RT), using histopathology as ground truth, and to investigate the visibility of tumor lesions on mp-MRI.

Methods:

Tumor delineated histopathology slides from salvage radical prostatectomy patients, primarily treated with RT, were registered to MRI. Median T2-weighted, ADC, K^trans, and k_ep values in tumor and other regions were calculated. Two radiologists independently performed mp-MRI-based tumor delineations which were compared with the true pathological extent. General linear mixed-effect modeling was used to establish the contribution of each imaging modality and combinations thereof in distinguishing tumor and benign voxels.

Results:

Nineteen of the 21 included patients had tumor in the available histopathology slides. Recurrence was predominantly multifocal with large tumor foci seen after external beam radiotherapy, whereas these were small and sparse after low-dose-rate brachytherapy. MRI-based delineations missed small foci and slightly underestimated tumor extent. The combination of T2-weighted, ADC, K^trans, and k_ep had the best performance in distinguishing tumor and benign voxels.

Conclusions:

Using high-resolution histopathology delineations, the real tumor extent and size were found to be underestimated on MRI. mp-MRI obtained the best performance in identifying tumor voxels. Appropriate margins around the visible tumor-suspected region should be included when designing focal salvage strategies. Recurrent tumor delineation guidelines are warranted.

Key Points:

• Compared to the use of individual sequences, multi-parametric MRI obtained the best performance in distinguishing recurrent tumor from benign voxels. • Delineations based on mp-MRI miss smaller foci and slightly underestimate tumor volume of local recurrent prostate cancer. • Focal salvage strategies should include appropriate margins around the visible tumor.

Original language	English
Pages (from-to)	4160-4168
Number of pages	9
Journal	European Radiology
Volume	29
Issue number	8
DOIs	https://doi.org/10.1007/s00330-018-5819-y
Publication status	Published - 1 Aug 2019
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2018, The Author(s).

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Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapyFinal published version, 7.71 MBLicence: CC BY

Cite this

Dinis Fernandes, C., Ghobadi, G., van der Poel, H. G., de Jong, J., Heijmink, S. W. T. P. J., Schoots, I., Walraven, I., van Houdt, P. J., Smolic, M., Pos, F. J., & van der Heide, U. A. (2019). Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy. European Radiology, 29(8), 4160-4168. https://doi.org/10.1007/s00330-018-5819-y

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title = "Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy",

abstract = "Objectives: Diagnosis of radio-recurrent prostate cancer using multi-parametric MRI (mp-MRI) can be challenging due to the presence of radiation effects. We aim to characterize imaging of prostate tissue after radiation therapy (RT), using histopathology as ground truth, and to investigate the visibility of tumor lesions on mp-MRI. Methods: Tumor delineated histopathology slides from salvage radical prostatectomy patients, primarily treated with RT, were registered to MRI. Median T2-weighted, ADC, Ktrans, and kep values in tumor and other regions were calculated. Two radiologists independently performed mp-MRI-based tumor delineations which were compared with the true pathological extent. General linear mixed-effect modeling was used to establish the contribution of each imaging modality and combinations thereof in distinguishing tumor and benign voxels. Results:Nineteen of the 21 included patients had tumor in the available histopathology slides. Recurrence was predominantly multifocal with large tumor foci seen after external beam radiotherapy, whereas these were small and sparse after low-dose-rate brachytherapy. MRI-based delineations missed small foci and slightly underestimated tumor extent. The combination of T2-weighted, ADC, Ktrans, and kep had the best performance in distinguishing tumor and benign voxels. Conclusions: Using high-resolution histopathology delineations, the real tumor extent and size were found to be underestimated on MRI. mp-MRI obtained the best performance in identifying tumor voxels. Appropriate margins around the visible tumor-suspected region should be included when designing focal salvage strategies. Recurrent tumor delineation guidelines are warranted. Key Points:• Compared to the use of individual sequences, multi-parametric MRI obtained the best performance in distinguishing recurrent tumor from benign voxels. • Delineations based on mp-MRI miss smaller foci and slightly underestimate tumor volume of local recurrent prostate cancer. • Focal salvage strategies should include appropriate margins around the visible tumor.",

author = "\{Dinis Fernandes\}, Catarina and Ghazaleh Ghobadi and \{van der Poel\}, \{Henk G.\} and \{de Jong\}, Jeroen and Heijmink, \{Stijn W.T.P.J.\} and Ivo Schoots and Iris Walraven and \{van Houdt\}, \{Petra J.\} and Milena Smolic and Pos, \{Floris J.\} and \{van der Heide\}, \{Uulke A.\}",

note = "Publisher Copyright: {\textcopyright} 2018, The Author(s).",

year = "2019",

month = aug,

day = "1",

doi = "10.1007/s00330-018-5819-y",

language = "English",

volume = "29",

pages = "4160--4168",

journal = "European Radiology",

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Dinis Fernandes, C, Ghobadi, G, van der Poel, HG, de Jong, J, Heijmink, SWTPJ, Schoots, I, Walraven, I, van Houdt, PJ, Smolic, M, Pos, FJ & van der Heide, UA 2019, 'Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy', European Radiology, vol. 29, no. 8, pp. 4160-4168. https://doi.org/10.1007/s00330-018-5819-y

TY - JOUR

T1 - Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

AU - Dinis Fernandes, Catarina

AU - Ghobadi, Ghazaleh

AU - van der Poel, Henk G.

AU - de Jong, Jeroen

AU - Heijmink, Stijn W.T.P.J.

AU - Schoots, Ivo

AU - Walraven, Iris

AU - van Houdt, Petra J.

AU - Smolic, Milena

AU - Pos, Floris J.

AU - van der Heide, Uulke A.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objectives: Diagnosis of radio-recurrent prostate cancer using multi-parametric MRI (mp-MRI) can be challenging due to the presence of radiation effects. We aim to characterize imaging of prostate tissue after radiation therapy (RT), using histopathology as ground truth, and to investigate the visibility of tumor lesions on mp-MRI. Methods: Tumor delineated histopathology slides from salvage radical prostatectomy patients, primarily treated with RT, were registered to MRI. Median T2-weighted, ADC, Ktrans, and kep values in tumor and other regions were calculated. Two radiologists independently performed mp-MRI-based tumor delineations which were compared with the true pathological extent. General linear mixed-effect modeling was used to establish the contribution of each imaging modality and combinations thereof in distinguishing tumor and benign voxels. Results:Nineteen of the 21 included patients had tumor in the available histopathology slides. Recurrence was predominantly multifocal with large tumor foci seen after external beam radiotherapy, whereas these were small and sparse after low-dose-rate brachytherapy. MRI-based delineations missed small foci and slightly underestimated tumor extent. The combination of T2-weighted, ADC, Ktrans, and kep had the best performance in distinguishing tumor and benign voxels. Conclusions: Using high-resolution histopathology delineations, the real tumor extent and size were found to be underestimated on MRI. mp-MRI obtained the best performance in identifying tumor voxels. Appropriate margins around the visible tumor-suspected region should be included when designing focal salvage strategies. Recurrent tumor delineation guidelines are warranted. Key Points:• Compared to the use of individual sequences, multi-parametric MRI obtained the best performance in distinguishing recurrent tumor from benign voxels. • Delineations based on mp-MRI miss smaller foci and slightly underestimate tumor volume of local recurrent prostate cancer. • Focal salvage strategies should include appropriate margins around the visible tumor.

AB - Objectives: Diagnosis of radio-recurrent prostate cancer using multi-parametric MRI (mp-MRI) can be challenging due to the presence of radiation effects. We aim to characterize imaging of prostate tissue after radiation therapy (RT), using histopathology as ground truth, and to investigate the visibility of tumor lesions on mp-MRI. Methods: Tumor delineated histopathology slides from salvage radical prostatectomy patients, primarily treated with RT, were registered to MRI. Median T2-weighted, ADC, Ktrans, and kep values in tumor and other regions were calculated. Two radiologists independently performed mp-MRI-based tumor delineations which were compared with the true pathological extent. General linear mixed-effect modeling was used to establish the contribution of each imaging modality and combinations thereof in distinguishing tumor and benign voxels. Results:Nineteen of the 21 included patients had tumor in the available histopathology slides. Recurrence was predominantly multifocal with large tumor foci seen after external beam radiotherapy, whereas these were small and sparse after low-dose-rate brachytherapy. MRI-based delineations missed small foci and slightly underestimated tumor extent. The combination of T2-weighted, ADC, Ktrans, and kep had the best performance in distinguishing tumor and benign voxels. Conclusions: Using high-resolution histopathology delineations, the real tumor extent and size were found to be underestimated on MRI. mp-MRI obtained the best performance in identifying tumor voxels. Appropriate margins around the visible tumor-suspected region should be included when designing focal salvage strategies. Recurrent tumor delineation guidelines are warranted. Key Points:• Compared to the use of individual sequences, multi-parametric MRI obtained the best performance in distinguishing recurrent tumor from benign voxels. • Delineations based on mp-MRI miss smaller foci and slightly underestimate tumor volume of local recurrent prostate cancer. • Focal salvage strategies should include appropriate margins around the visible tumor.

UR - https://www.scopus.com/pages/publications/85056358498

U2 - 10.1007/s00330-018-5819-y

DO - 10.1007/s00330-018-5819-y

M3 - Article

C2 - 30421016

AN - SCOPUS:85056358498

SN - 0938-7994

VL - 29

SP - 4160

EP - 4168

JO - European Radiology

JF - European Radiology

IS - 8

ER -

Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy

Abstract

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