Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer.

Imaging has traditionally played a minor role in the diagnosis and staging of prostate cancer. However, recent controversies generated by the use of prostate-specific antigen (PSA) screening followed by random biopsy have encouraged the development of new imaging methods for prostate cancer. Multiparametric magnetic resonance imaging (mpMRI) has emerged as the imaging method best able to detect clinically significant prostate cancers and to guide biopsies. Here, the authors explain what mpMRI is and how it is used clinically, especially with regard to high-risk populations, and we discuss the impact of mpMRI on treatment decisions for men with prostate cancer. CA Cancer J Clin 2016;66:326-336. © 2015 American Cancer Society.

A Self-Supervised Deep Learning Reconstruction for Shortening the Breathhold and Acquisition Window in Cardiac Magnetic Resonance Fingerprinting.

The aim of this study is to shorten the breathhold and diastolic acquisition window in cardiac magnetic resonance fingerprinting (MRF) for simultaneous T1, T2, and proton spin density (M0) mapping to improve scan efficiency and reduce motion artifacts. To this end, a novel reconstruction was developed that combines low-rank subspace modeling with a deep image prior, termed DIP-MRF. A system of neural networks is used to generate spatial basis images and quantitative tissue property maps, with training performed using only the undersampled k-space measurements from the current scan. This approach avoids difficulties with obtaining in vivo MRF training data, as training is performed de novo for each acquisition. Calculation of the forward model during training is accelerated by using GRAPPA operator gridding to shift spiral k-space data to Cartesian grid points, and by using a neural network to rapidly generate fingerprints in place of a Bloch equation simulation. DIP-MRF was evaluated in simulations and at 1.5 T in a standardized phantom, 18 healthy subjects, and 10 patients with suspected cardiomyopathy. In addition to conventional mapping, two cardiac MRF sequences were acquired, one with a 15-heartbeat(HB) breathhold and 254 ms acquisition window, and one with a 5HB breathhold and 150 ms acquisition window. In simulations, DIP-MRF yielded decreased nRMSE compared to dictionary matching and a sparse and locally low rank (SLLR-MRF) reconstruction. Strong correlation (R2 > 0.999) with T1 and T2 reference values was observed in the phantom using the 5HB/150 ms scan with DIP-MRF. DIP-MRF provided better suppression of noise and aliasing artifacts in vivo, especially for the 5HB/150 ms scan, and lower intersubject and intrasubject variability compared to dictionary matching and SLLR-MRF. Furthermore, it yielded a better agreement between myocardial T1 and T2 from 15HB/254 ms and 5HB/150 ms MRF scans, with a bias of -9 ms for T1 and 2 ms for T2. In summary, this study introduces an extension of the deep image prior framework for cardiac MRF tissue property mapping, which does not require pre-training with in vivo scans, and has the potential to reduce motion artifacts by enabling a shortened breathhold and acquisition window.

Detection of extraprostatic disease and seminal vesicle invasion in patients undergoing magnetic resonance imaging-targeted prostate biopsies.

BACKGROUND: Finding incidental extraprostatic extension (EPE) or seminal vesicle invasion (SVI) by prostate cancer (PCa) is rare on standard prostate biopsy. We evaluated the clinical-pathologic features associated with EPE and SVI on multiparametric magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided targeted biopsy (TB). METHODS: A retrospective review was performed from 2014-2017, selecting patients who had undergone TB. Clinical, pathologic, and radiologic features were evaluated. RESULTS: Five out of 333 (1.5%) patients who had PCa detected on TB had EPE and/or SVI. The average age and prostate-specific antigen (PSA) was 71 years and 17 ng/mL, respectively. The average number of cores taken on TB was 4.2. Two patients had a prior negative SB and two patients had a prior positive SB, one of which underwent radiation therapy. All patients had a PIRADSv2 suspicion score of 4 or 5. Four out of five (80%) patients underwent both SB and concurrent TB, of which 3/4 (75%) had EPE identified only on TB. One out of four (25%) patients also had both EPE and SVI, identified only on TB. One patient underwent only TB for MRI suspicion of SVI, which was pathologically confirmed on TB. On TB, one patient had Grade Group 3, two patients had Grade Group 4, and two patients had Grade Group 5 PCa. Perineural invasion (PNI) was present in 4/5 (80%) patients on TB. CONCLUSIONS: Based on our small series, we hypothesize that MRI/US fusion TB outperforms SB in the identification of EPE and SVI. However, given the small sample size and the overall rarity of these pathologic findings on prostate biopsy, further validation is needed.