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Wendy B Demartini - One of the best experts on this subject based on the ideXlab platform.
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factors affecting image quality and lesion evaluability in breast diffusion weighted mri observations from the ecog acrin cancer research group multisite trial a6702
Journal of Biogeography, 2021Co-Authors: Jennifer G Whisenant, Wendy B Demartini, Justin Romanoff, Habib Rahbar, Averi E Kitsch, Sara M Harvey, Linda Moy, Basak E Dogan, Wei T Yang, Lilian C WangAbstract:Objective The A6702 multisite trial confirmed that apparent diffusion coefficient (ADC) measures can improve breast MRI accuracy and reduce unnecessary biopsies, but also found that technical issues rendered many lesions non-evaluable on diffusion-weighted imaging (DWI). This secondary analysis investigated factors affecting lesion evaluability and impact on diagnostic performance. Methods The A6702 protocol was IRB-approved at 10 institutions; participants provided informed consent. In total, 103 women with 142 MRI-detected breast lesions (BI-RADS Assessment Category 3, 4, or 5) completed the study. DWI was acquired at 1.5T and 3T using a four b-value, echo-planar imaging sequence. Scans were reviewed for multiple quality factors (artifacts, signal-to-noise, misregistration, and fat suppression); lesions were considered non-evaluable if there was low confidence in ADC measurement. Associations of lesion evaluability with imaging and lesion characteristics were determined. Areas under the receiver operating characteristic curves (AUCs) were compared using bootstrapping. Results Thirty percent (42/142) of lesions were non-evaluable on DWI; 23% (32/142) with image quality issues, 7% (10/142) with conspicuity and/or localization issues. Misregistration was the only factor associated with non-evaluability (P = 0.001). Smaller (≤10 mm) lesions were more commonly non-evaluable than larger lesions (p <0.03), though not significant after multiplicity correction. The AUC for differentiating benign and malignant lesions increased after excluding non-evaluable lesions, from 0.61 (95% CI: 0.50-0.71) to 0.75 (95% CI: 0.65-0.84). Conclusion Image quality remains a technical challenge in breast DWI, particularly for smaller lesions. Protocol optimization and advanced acquisition and post-processing techniques would help to improve clinical utility.
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acr bi rads Assessment Category 4 subdivisions in diagnostic mammography utilization and outcomes in the national mammography database
Radiology, 2018Co-Authors: Mai Elezaby, Elizabeth S Burnside, Mythreyi Bhargavanchatfield, Wendy B DemartiniAbstract:In our study of 125 447 Category 4 diagnostic mammograms in the National Mammography Database, subdivisions (4A–C) resulted in improved stratification of likelihood of malignancy within Breast Imaging Reporting and Data System–specified ranges.
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utility of bi rads Assessment Category 4 subdivisions for screening breast mri
American Journal of Roentgenology, 2017Co-Authors: Roberta M Strigel, Elizabeth S Burnside, Mai Elezaby, Amy M Fowler, Frederick Kelcz, Lonie R Salkowski, Wendy B DemartiniAbstract:OBJECTIVE. BI-RADS for mammography and ultrasound subdivides Category 4 Assessments by likelihood of malignancy into categories 4A (> 2% to ≤ 10%), 4B (> 10% to ≤ 50%), and 4C (> 50% to < 95%). Category 4 is not subdivided for breast MRI because of a paucity of data. The purpose of the present study is to determine the utility of categories 4A, 4B, and 4C for MRI by calculating their positive predictive values (PPVs) and comparing them with BI-RADS–specified rates of malignancy for mammography and ultrasound. MATERIALS AND METHODS. All screening breast MRI examinations performed from July 1, 2010, through June 30, 2013, were included in this study. We identified in medical records prospectively assigned MRI BI-RADS categories, including Category 4 subdivisions, which are used routinely in our practice. Benign versus malignant outcomes were determined by pathologic analysis, findings from 12 months or more clinical or imaging follow-up, or a combination of these methods. Distribution of BI-RADS categories ...
Ottavio De Cobelli - One of the best experts on this subject based on the ideXlab platform.
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low pi rads Assessment Category excludes extraprostatic extension pt3a of prostate cancer a histology validated study including 301 operated patients
European Radiology, 2019Co-Authors: Sarah Alessi, Paola Pricolo, Paul Summers, Marco Femia, Elena Tagliabue, Giuseppe Renne, Roberto Bianchi, Gennaro Musi, Ottavio De CobelliAbstract:To evaluate whether low PI-RADS v2 Assessment categories are effective at excluding extraprostatic extension (EPE) of prostate cancer (≥pT3a PCa). The local institutional ethics committee approved this retrospective analysis of 301 consecutive PCa patients. Patients were classified as low- or intermediate/high-risk based on clinical parameters and underwent pre-surgical multiparametric magnetic resonance imaging. A PI-RADS v2 Assessment Category and ESUR EPE score were assigned for each lesion by two readers working in consensus. Histopathologic analysis of the whole-mount radical prostatectomy specimen was the reference standard. Univariate and multivariate analyses were performed to evaluate the association of PI-RADS v2 Assessment Category with final histology ≥pT3a PCa. For a PI-RADS v2 Assessment Category threshold of 3, the overall performance for ruling out (sensitivity, negative predictive value, negative likelihood ratio) ≥pT3a PCa was 99%/98%/0.04 and was similar in both the low-risk (96%/97%/0.12; N = 137) and the intermediate/high-risk groups (100%/100%/0.0; N = 164). In univariate analysis, all clinical and tumor characteristics except age were significantly associated with ≥pT3a PCa. In multivariate analysis, PI-RADS v2 Assessment categories ≤ 3 had a protective effect relative to categories 4 and 5. The inclusion of ESUR EPE score improved the AUC of ≥pT3a PCa prediction (from 0.73 to 0.86, p = 0.04 in the overall cohort). The impact of PI-RADS v2 Assessment Category is reflected in a nomogram derived on the basis of our cohort. In our cohort, low PI-RADS v2 Assessment categories of 3 or less confidently ruled out the presence of ≥pT3a PCa irrespective of clinical risk group. • Our analysis of 301 mp-MRI and RARP specimens showed that the addition of PI-RADS v2 Assessment categories to clinical parameters improves the exclusion of ≥pT3a (extraprostatic) prostate cancer. • PI-RADS v2 Assessment categories of 1 to 3 are useful for excluding ≥pT3a prostate cancer with a NPV of 98%; such patients can be considered as candidates for less invasive approaches. • The ability to exclude ≥pT3a prostate cancer may improve confidence in choosing nerve-sparing surgery or in avoiding pelvic nodal dissections, and similarly for patients undergoing radiotherapy, in adopting short-course adjuvant hormonal therapy or foregoing prophylactic nodal irradiation.
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Low PI-RADS Assessment Category excludes extraprostatic extension (≥pT3a) of prostate cancer : a histology-validated study including 301 operated patients
'Springer Science and Business Media LLC', 2019Co-Authors: Sarah Alessi, Paola Pricolo, Paul Summers, Marco Femia, Elena Tagliabue, Giuseppe Renne, Roberto Bianchi, Gennaro Musi, Ottavio De Cobelli, B.a. Jereczek-fossaAbstract:Objectives: To evaluate whether low PI-RADS v2 Assessment categories are effective at excluding extraprostatic extension (EPE) of prostate cancer ( 65pT3a PCa). Methods: The local institutional ethics committee approved this retrospective analysis of 301 consecutive PCa patients. Patients were classified as low- or intermediate/high-risk based on clinical parameters and underwent pre-surgical multiparametric magnetic resonance imaging. A PI-RADS v2 Assessment Category and ESUR EPE score were assigned for each lesion by two readers working in consensus. Histopathologic analysis of the whole-mount radical prostatectomy specimen was the reference standard. Univariate and multivariate analyses were performed to evaluate the association of PI-RADS v2 Assessment Category with final histology 65pT3a PCa. Results: For a PI-RADS v2 Assessment Category threshold of 3, the overall performance for ruling out (sensitivity, negative predictive value, negative likelihood ratio) 65pT3a PCa was 99%/98%/0.04 and was similar in both the low-risk (96%/97%/0.12; N = 137) and the intermediate/high-risk groups (100%/100%/0.0; N = 164). In univariate analysis, all clinical and tumor characteristics except age were significantly associated with 65pT3a PCa. In multivariate analysis, PI-RADS v2 Assessment categories 64 3 had a protective effect relative to categories 4 and 5. The inclusion of ESUR EPE score improved the AUC of 65pT3a PCa prediction (from 0.73 to 0.86, p = 0.04 in the overall cohort). The impact of PI-RADS v2 Assessment Category is reflected in a nomogram derived on the basis of our cohort. Conclusions: In our cohort, low PI-RADS v2 Assessment categories of 3 or less confidently ruled out the presence of 65pT3a PCa irrespective of clinical risk group. Key Points: \u2022 Our analysis of 301 mp-MRI and RARP specimens showed that the addition of PI-RADS v2 Assessment categories to clinical parameters improves the exclusion of 65pT3a (extraprostatic) prostate cancer. \u2022 PI-RADS v2 Assessment categories of 1 to 3 are useful for excluding 65pT3a prostate cancer with a NPV of 98%; such patients can be considered as candidates for less invasive approaches. \u2022 The ability to exclude 65pT3a prostate cancer may improve confidence in choosing nerve-sparing surgery or in avoiding pelvic nodal dissections, and similarly for patients undergoing radiotherapy, in adopting short-course adjuvant hormonal therapy or foregoing prophylactic nodal irradiation
Nicola Schieda - One of the best experts on this subject based on the ideXlab platform.
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when to biopsy prostate imaging and data reporting system version 2 pi radsv2 Assessment Category 3 lesions use of clinical and imaging variables to predict cancer diagnosis at targeted biopsy
Cuaj-canadian Urological Association Journal, 2020Co-Authors: Christopher S Lim, Jorge Abreugomez, Nicola Schieda, Michelalexandre Leblond, Ivan Carrion, Danny Vesprini, Laurence KlotzAbstract:Introduction We aimed to determine if clinical and imaging features can stratify men at higher risk for clinically significant (CS, International Society of Urological Pathology [ISUP] grade group ≥2) prostate cancer (PCa) in equivocal Prostate Imaging and Data Reporting System (PI-RADS) Category 3 lesions on magnetic resonance imaging (MRI). Methods Approved by the institutional review board-approved, this retrospective study involved 184 men with 198 lesions who underwent 3T-MRI and MRI-directed transrectal ultrasound biopsy for PI-RADS 3 lesions. Men were evaluated including clinical stage, prostate-specific antigen density (PSAD), indication, and MRI lesion size. Diagnoses for all men and by indication (no cancer, any PCa, CSPCa) were compared using multivariate logistic regression, including stage, PSAD, and lesion size. Results We found an overall PCa rate of 31.8% (63/198) and 10.1% (20/198) CSPCa (13 grade group 2, five group 3, and two group 4). Higher stage (p=0.001), PSAD (p=0.007), and lesion size (p=0.015) were associated with CSPCa, with no association between CSPCa and age, PSA, or prostate volume (p>0.05). PSAD modestly predicted CSPCa area under the curve (AUC) 0.66 (95% confidence interval [CI] 0.518-0.794) in all men and 0.64 (0.487-0.799) for those on active surveillance (AS). Model combining clinical stage, PSAD, and lesion size improved accuracy for all men and AS (AUC 0.82 [0.736-0.910], p 0.05), with optimal cutpoint of ≥0.215 ng/mL/cc achieving sensitivity/specificity of 85.7/84.4%. Conclusions PI-RADSv2 Category 3 lesions are often not CSPCa. PSAD predicted CSPCa in men with a prior negative biopsy; however, PSAD alone had limited value, and accuracy improved when using a model incorporating PSAD with clinical stage and MR lesion size.
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effect of observation size and apparent diffusion coefficient adc value in pi rads v2 1 Assessment Category 4 and 5 observations compared to adverse pathological outcomes
European Radiology, 2020Co-Authors: Jorge Abreugomez, Daniel Walker, Tareq Alotaibi, Matthew D F Mcinnes, Trevor A Flood, Nicola SchiedaAbstract:To compare observation size and apparent diffusion coefficient (ADC) values in Prostate Imaging Reporting and Data System (PI-RADS) v2.1 Category 4 and 5 observations to adverse pathological features. With institutional review board approval, 267 consecutive men with 3-T MRI before radical prostatectomy (RP) between 2012 and 2018 were evaluated by two blinded radiologists who assigned PI-RADS v2.1 scores. Discrepancies were resolved by consensus. A third blinded radiologist measured observation size and ADC (ADC.mean, ADC.min [lowest ADC within an observation], ADC.ratio [ADC.mean/ADC.peripheral zone {PZ}]). Size and ADC were compared to pathological stage and Gleason score (GS) using t tests, ANOVA, Pearson correlation, and receiver operating characteristic (ROC) analysis. Consensus review identified 267 true positive Category 4 and 5 observations representing 83.1% (222/267) PZ and 16.9% (45/267) transition zone (TZ) tumors. Inter-observer agreement for PI-RADS v2.1 scoring was moderate (K = 0.45). Size was associated with extra-prostatic extension (EPE) (19 ± 8 versus 14 ± 6 mm, p < 0.001) and seminal vesicle invasion (SVI) (24 ± 9 versus 16 ± 7 mm, p < 0.001). Size ≥ 15 mm optimized the accuracy for EPE with area under the ROC curve (AUC) and sensitivity/specificity of 0.68 (CI 0.62–0.75) and 63.2%/65.6%. Size ≥ 19 mm optimized the accuracy for SVI with AUC/sensitivity/specificity of 0.75 (CI 0.66–0.83)/69.4%/70.6%. ADC metrics were not associated with pathological stage. Larger observation size (p = 0.032), lower ADC.min (p = 0.010), and lower ADC.ratio (p = 0.010) were associated with higher GS. Size correlated better to higher Gleason scores (p = 0.002) compared to ADC metrics (p = 0.09–0.11). Among PI-RADS v2.1 Category 4 and 5 observations, size was associated with higher pathological stage whereas ADC metrics were not. Size, ADC.minimum, and ADC.ratio differed in tumors stratified by Gleason score. • Among PI-RADS Category 4 and 5 observations, size but not ADC can differentiate between tumors by pathological stage. • An observation size threshold of 15 mm and 19 mm optimized the accuracy for diagnosis of extra-prostatic extension and seminal vesicle invasion. • Among PI-RADS Category 4 and 5 observations, size, ADC.minimum, and ADC.ratio differed comparing tumors by Gleason score.
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multiparametric magnetic resonance imaging transrectal ultrasound guided cognitive fusion biopsy of the prostate clinically significant cancer detection rates stratified by the prostate imaging and data reporting system version 2 Assessment Category
Cuaj-canadian Urological Association Journal, 2018Co-Authors: Susan John, Trevor A Flood, Steven Cooper, Rodney H Breau, Ilias Cagiannos, Luke T Lavallee, Christopher Morash, Joseph Osullivan, Nicola SchiedaAbstract:Introduction: We aimed to report the clinically significant prostate cancer (PCa) detection rate in men undergoing magnetic resonance imaging-transrectal ultrasound (MRI-TRUS)-cognitive fusion (CF) targeted biopsies stratified by the Prostate Imaging and Data Reporting System (PI-RADS) version 2 (v2) scores. Methods: With a quality assurance waiver from the institutional review board, we identified a cohort of men who underwent MRITRUS- CF and synchronous template biopsy from 2015–2017. MRI (PI-RADS v2 score, lesion size, lesion location [peripheral or transition zone (PZ/TZ)]), and CF-TRUS biopsy (operator experience, TRUS visibility, and number of biopsies) features were extracted. The primary outcome was diagnosis of clinically significant (Gleason score ≥3+4=7 or International Society of Urological Pathology [ISUP] grade group ≥2) PCa. Results: During the study period, 131 men (with 142 PI-RADS v2 score ≥3 lesions) met inclusion criteria; 98 men had previously negative template biopsy and 33 were on active surveillance for previously detected low-grade PCa. In total, 41.9% (55/131) men had clinically significant PCa — 17.6% (23/131) detected on targeted biopsy only, 8.4% (11/131) on template biopsy only, and 16.0% (21/131) on both targeted and template biopsy. Clinically significant PCa detection stratified by PI-RADS v2 scores were: 11.1% (3/27) for score 3 (indeterminate), 42.9% (24/56) for score 4 (significant cancer likely), and 35.6% (21/59) for score 5 (significant cancer very likely). Clinically significant PCa detection rates in targeted biopsies were better among PZ (41.8% [33/79]) compared to TZ (23.8% [15/63]) lesions (p=0.025) in TRUS-visible lesions (p=0.033) and in the most experienced radiologists (p=0.05), with no difference by lesion size or number of additional core biopsies performed (all p>0.05). Conclusions: CF-MRI-TRUS-guided targeted biopsy yielded substantially lower rates of clinically significant cancer in PI-RADS v2 score 4 and 5 lesions when compared to published results using in-bore MR-guided or automated MRI-TRUS fusion guidance systems. Cancer detection was worst for TZ lesions.
Pawel Rajwa - One of the best experts on this subject based on the ideXlab platform.
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the prognostic association of prostate mri pi rads v2 Assessment Category and risk of biochemical recurrence after definitive local therapy for prostate cancer a systematic review and meta analysis
The Journal of Urology, 2021Co-Authors: Pawel Rajwa, Keiichiro Mori, Nicolai A Huebner, Darryl T Martin, Preston C Sprenkle, Jeffrey C Weinreb, Guillaume Ploussard, Benjamin PradereAbstract:Purpose:Although the Prostate Imaging–Reporting and Data System™ version 2 (PI-RADS™ v2) is a reliable diagnostic tool for significant prostate cancer, less is known about the prognostic significan...
Teruki Sone - One of the best experts on this subject based on the ideXlab platform.
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comparison of pi rads version 2 and pi rads version 2 1 for the detection of transition zone prostate cancer
European Journal of Radiology, 2019Co-Authors: Tsutomu Tamada, Ayumu Kido, Mitsuru Takeuchi, Akira Yamamoto, Yoshiyuki Miyaji, Naoki Kanomata, Teruki SoneAbstract:Abstract 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.
