Francesco Giganti1,2, Caroline M Moore3,4, Shonit Punwani5,6, Clare Allen5, Mark Emberton3,4, Alex Kirkham5. 1. Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK. f.giganti@ucl.ac.uk. 2. Division of Surgery and Interventional Science, University College London, London, UK. f.giganti@ucl.ac.uk. 3. Division of Surgery and Interventional Science, University College London, London, UK. 4. Department of Urology, University College London Hospital NHS Foundation Trust, London, UK. 5. Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK. 6. Centre for Medical Imaging, University College London, London, UK.
Abstract
BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) is being used increasingly in the setting of active surveillance (AS) for prostate cancer. We investigated changes in the mpMRI appearance of lesions on AS, to show the variability of volume measurements in visible lesions and assess change in lesion size according to grade. METHODS: We retrospectively retrieved 86 men on AS (NICE guidelines) with more than one mpMRI (the first before 2013). Two radiologists, in consensus, were blinded to patient demographics and date of scan. The scans were randomly reported to reduce any bias. For visible lesions, we measured volume by planimetry on the sequence best showing the most conspicuous (index) tumour and attributed a 5-point Likert score. RESULTS: 43/86 men did not have a visible lesion on the initial mpMRI (≤2/5). Of these, 5/43 had developed a lesion scoring ≥3/5 at a median of 3.6 years of follow up. 40/86 had a lesion scoring ≥3/5 on two or more scans. There was a significant increase in volume over 3.6 years by a median of 10% (p < 0.01)-by a median of 6% for Gleason 3+3 and 18% for 3+4 (p = 0.058). Thirty-five men had a visible lesion on two scans separated by <2 years; of these, 21/35 showed a 78% median increase in tumour size between the two scans and 11/35 showed an apparent 25% median decrease in lesion size. CONCLUSIONS: A total of 17% of men with no visible lesion developed a visible lesion at a median follow up of 3.6 years. It is possible to show significant growth in patients with a visible lesion, but variability in volume measurements between scans means that it is difficult to reliably detect increases of this order. This variability may inform the design of mpMRI protocols in AS and the time between follow up scans.
BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) is being used increasingly in the setting of active surveillance (AS) for prostate cancer. We investigated changes in the mpMRI appearance of lesions on AS, to show the variability of volume measurements in visible lesions and assess change in lesion size according to grade. METHODS: We retrospectively retrieved 86 men on AS (NICE guidelines) with more than one mpMRI (the first before 2013). Two radiologists, in consensus, were blinded to patient demographics and date of scan. The scans were randomly reported to reduce any bias. For visible lesions, we measured volume by planimetry on the sequence best showing the most conspicuous (index) tumour and attributed a 5-point Likert score. RESULTS: 43/86 men did not have a visible lesion on the initial mpMRI (≤2/5). Of these, 5/43 had developed a lesion scoring ≥3/5 at a median of 3.6 years of follow up. 40/86 had a lesion scoring ≥3/5 on two or more scans. There was a significant increase in volume over 3.6 years by a median of 10% (p < 0.01)-by a median of 6% for Gleason 3+3 and 18% for 3+4 (p = 0.058). Thirty-five men had a visible lesion on two scans separated by <2 years; of these, 21/35 showed a 78% median increase in tumour size between the two scans and 11/35 showed an apparent 25% median decrease in lesion size. CONCLUSIONS: A total of 17% of men with no visible lesion developed a visible lesion at a median follow up of 3.6 years. It is possible to show significant growth in patients with a visible lesion, but variability in volume measurements between scans means that it is difficult to reliably detect increases of this order. This variability may inform the design of mpMRI protocols in AS and the time between follow up scans.
Authors: Gregory T Chesnut; Emily A Vertosick; Nicole Benfante; Daniel D Sjoberg; Jonathan Fainberg; Taehyoung Lee; James Eastham; Vincent Laudone; Peter Scardino; Karim Touijer; Andrew Vickers; Behfar Ehdaie Journal: Eur Urol Date: 2019-12-23 Impact factor: 20.096
Authors: Francesco Giganti; Vasilis Stavrinides; Armando Stabile; Elizabeth Osinibi; Clement Orczyk; Jan Philipp Radtke; Alex Freeman; Aiman Haider; Shonit Punwani; Clare Allen; Mark Emberton; Alex Kirkham; Caroline M Moore Journal: Br J Radiol Date: 2020-09-21 Impact factor: 3.039
Authors: Francesco Giganti; Armando Stabile; Vasilis Stavrinides; Elizabeth Osinibi; Adam Retter; Clément Orczyk; Valeria Panebianco; Bruce J Trock; Alex Freeman; Aiman Haider; Shonit Punwani; Clare Allen; Alex Kirkham; Mark Emberton; Caroline M Moore Journal: Eur Radiol Date: 2020-09-30 Impact factor: 5.315