{"title":"Intraprocedural Diffusion-weighted Imaging for Predicting Ablation Zone during MRI-guided Focused Ultrasound of Prostate Cancer.","authors":"Rachel R Bitton, Wei Shao, Yosef Chodakeiwitz, Ryan L Brunsing, Geoffery Sonn, Mirabela Rusu, Pejman Ghanouni","doi":"10.1148/rycan.240009","DOIUrl":null,"url":null,"abstract":"<p><p>Purpose To compare diffusion-weighted imaging (DWI) with thermal dosimetry as a noncontrast method to predict ablation margins in individuals with prostate cancer treated with MRI-guided focused ultrasound (MRgFUS) ablation. Materials and Methods This secondary analysis of a prospective trial (ClinicalTrials.gov no. NCT01657942) included 17 participants (mean age, 64 years ± 6 [SD]; all male) who were treated for prostate cancer using MRgFUS in whom DWI was performed immediately after treatment. Ablation contours from computed thermal dosimetry and DWI as drawn by two blinded radiologists were compared against the reference standard of ablation assessment, posttreatment contrast-enhanced nonperfused volume (NPV) contours. The ability of each method to predict the ablation zone was analyzed quantitively using Dice similarity coefficients (DSCs) and mean Hausdorff distances (mHDs). Results DWI revealed a hyperintense rim at the margin of the ablation zone. While DWI accurately helped predict treatment margins, thermal dose contours underestimated the extent of the ablation zone compared with the T1-weighted NPV imaging reference standard. Quantitatively, contour assessment between methods showed that DWI-drawn contours matched postcontrast NPV contours (mean DSC = 0.84 ± 0.05 for DWI, mHD = 0.27 mm ± 0.13) better than the thermal dose contours did (mean DSC = 0.64 ± 0.12, mHD = 1.53 mm ± 1.20) (<i>P</i> < .001). Conclusion This study demonstrates that DWI, which can visualize the ablation zone directly, is a promising noncontrast method that is robust to treatment-related bulk motion compared with thermal dosimetry and correlates better than thermal dosimetry with the reference standard T1-weighted NPV. <b>Keywords:</b> Interventional-Body, Ultrasound-High-Intensity Focused (HIFU), Genital/Reproductive, Prostate, Oncology, Imaging Sequences, MRI-guided Focused Ultrasound, MR Thermometry, Diffusionweighted Imaging, Prostate Cancer ClinicalTrials.gov Identifier no. NCT01657942 <i>Supplemental material is available for this article.</i> © RSNA, 2024.</p>","PeriodicalId":20786,"journal":{"name":"Radiology. Imaging cancer","volume":"6 5","pages":"e240009"},"PeriodicalIF":5.6000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449221/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiology. Imaging cancer","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1148/rycan.240009","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose To compare diffusion-weighted imaging (DWI) with thermal dosimetry as a noncontrast method to predict ablation margins in individuals with prostate cancer treated with MRI-guided focused ultrasound (MRgFUS) ablation. Materials and Methods This secondary analysis of a prospective trial (ClinicalTrials.gov no. NCT01657942) included 17 participants (mean age, 64 years ± 6 [SD]; all male) who were treated for prostate cancer using MRgFUS in whom DWI was performed immediately after treatment. Ablation contours from computed thermal dosimetry and DWI as drawn by two blinded radiologists were compared against the reference standard of ablation assessment, posttreatment contrast-enhanced nonperfused volume (NPV) contours. The ability of each method to predict the ablation zone was analyzed quantitively using Dice similarity coefficients (DSCs) and mean Hausdorff distances (mHDs). Results DWI revealed a hyperintense rim at the margin of the ablation zone. While DWI accurately helped predict treatment margins, thermal dose contours underestimated the extent of the ablation zone compared with the T1-weighted NPV imaging reference standard. Quantitatively, contour assessment between methods showed that DWI-drawn contours matched postcontrast NPV contours (mean DSC = 0.84 ± 0.05 for DWI, mHD = 0.27 mm ± 0.13) better than the thermal dose contours did (mean DSC = 0.64 ± 0.12, mHD = 1.53 mm ± 1.20) (P < .001). Conclusion This study demonstrates that DWI, which can visualize the ablation zone directly, is a promising noncontrast method that is robust to treatment-related bulk motion compared with thermal dosimetry and correlates better than thermal dosimetry with the reference standard T1-weighted NPV. Keywords: Interventional-Body, Ultrasound-High-Intensity Focused (HIFU), Genital/Reproductive, Prostate, Oncology, Imaging Sequences, MRI-guided Focused Ultrasound, MR Thermometry, Diffusionweighted Imaging, Prostate Cancer ClinicalTrials.gov Identifier no. NCT01657942 Supplemental material is available for this article. © RSNA, 2024.
用于预测磁共振成像引导下前列腺癌聚焦超声消融区的术中弥散加权成像。
目的 比较弥散加权成像 (DWI) 和热剂量测定作为一种非对比方法,对接受 MRI 引导下聚焦超声 (MRgFUS) 消融术治疗的前列腺癌患者的消融边缘进行预测。材料与方法 这是对一项前瞻性试验(ClinicalTrials.gov 编号:NCT01657942)的二次分析,共纳入了 17 名使用 MRgFUS 治疗前列腺癌的参与者(平均年龄为 64 岁 ± 6 [SD];均为男性),他们在治疗后立即进行了 DWI 检查。由两名盲人放射科医生绘制的计算热剂量计和 DWI 消融轮廓与消融评估的参考标准--治疗后对比增强非灌注容积 (NPV) 轮廓进行了比较。使用戴斯相似系数(DSC)和平均豪斯多夫距离(mHD)对每种方法预测消融区的能力进行了定量分析。结果 DWI 显示消融区边缘有一个高强度边缘。虽然 DWI 能准确预测治疗边缘,但与 T1 加权 NPV 成像参考标准相比,热剂量轮廓低估了消融区的范围。定量方面,不同方法之间的等高线评估显示,DWI 绘制的等高线与对比后 NPV 等高线(DWI 的平均 DSC = 0.84 ± 0.05,mHD = 0.27 mm ± 0.13)的匹配程度优于热剂量等高线(平均 DSC = 0.64 ± 0.12,mHD = 1.53 mm ± 1.20)(P < .001)。结论 本研究表明,DWI 可以直接观察消融区,是一种很有前途的非对比方法,与热剂量测定法相比,它对治疗相关的体动具有很强的鲁棒性,与热剂量测定法相比,它与参考标准 T1 加权 NPV 的相关性更好。关键词介入-全身 超声-高强度聚焦(HIFU) 生殖器/前列腺 肿瘤成像序列 MRI引导聚焦超声 MR热测量 扩散加权成像 前列腺癌 ClinicalTrials.gov Identifier no.本文有补充材料。© RSNA, 2024.
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