Improving multiparametric MR-transrectal ultrasound guided fusion prostate biopsies with hyperpolarized 13C pyruvate metabolic imaging: A technical development study
Hsin-Yu Chen
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorRobert A. Bok
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorMatthew R. Cooperberg
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorHao G. Nguyen
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorKatsuto Shinohara
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorAntonio C. Westphalen
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorZhen J. Wang
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorMichael A. Ohliger
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorDaniel Gebrezgiabhier
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorLucas Carvajal
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorJeremy W. Gordon
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorPeder E. Z. Larson
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorRahul Aggarwal
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorJohn Kurhanewicz
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorCorresponding Author
Daniel B. Vigneron
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Correspondence
Daniel B. Vigneron, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1700 Fourth Street, Byers Hall Suite 102, San Francisco, CA 94158.
Email: [email protected]
Search for more papers by this authorHsin-Yu Chen
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorRobert A. Bok
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorMatthew R. Cooperberg
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorHao G. Nguyen
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorKatsuto Shinohara
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorAntonio C. Westphalen
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorZhen J. Wang
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorMichael A. Ohliger
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorDaniel Gebrezgiabhier
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorLucas Carvajal
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorJeremy W. Gordon
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorPeder E. Z. Larson
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorRahul Aggarwal
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorJohn Kurhanewicz
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Search for more papers by this authorCorresponding Author
Daniel B. Vigneron
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States
Correspondence
Daniel B. Vigneron, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1700 Fourth Street, Byers Hall Suite 102, San Francisco, CA 94158.
Email: [email protected]
Search for more papers by this authorCorrection added after online publication 1 September 2022. Due to a production error, Figures 4, 5, and 6 appeared out of order and are correct in this version.
This work was supported by the National Institutes of Health (NIH) grants U01CA232320, U01EB026412, R01CA238379, and P41EB013598; and the American Cancer Society (ACS) grant 131715-RSG-18-005-01-CCE.
Funding information: Daniel B. Vigneron, Grant/Award Numbers: P41EB013598; R01CA238379; U01CA232320; U01EB026412; Zhen J. Wang, Grant/Award Number: 131715-RSG-18-005-01-CCE
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Abstract
Purpose
To develop techniques and establish a workflow using hyperpolarized carbon-13 (13C) MRI and the pyruvate-to-lactate conversion rate (kPL) biomarker to guide MR-transrectal ultrasound fusion prostate biopsies.
Methods
The integrated multiparametric MRI (mpMRI) exam consisted of a 1-min hyperpolarized 13C-pyruvate EPI acquisition added to a conventional prostate mpMRI exam. Maps of kPL values were calculated, uploaded to a picture archiving and communication system and targeting platform, and displayed as color overlays on T2-weighted anatomic images. Abdominal radiologists identified 13C research biopsy targets based on the general recommendation of focal lesions with kPL >0.02(s−1), and created a targeting report for each study. Urologists conducted transrectal ultrasound-guided MR fusion biopsies, including the standard 1H–mpMRI targets as well as 12–14 core systematic biopsies informed by the research 13C-kPL targets. All biopsy results were included in the final pathology report and calculated toward clinical risk.
Results
This study demonstrated the safety and technical feasibility of integrating hyperpolarized 13C metabolic targeting into routine 1H–mpMRI and transrectal ultrasound fusion biopsy workflows, evaluated via 5 men (median age 71 years, prostate-specific antigen 8.4 ng/mL, Cancer of the Prostate Risk Assessment score 2) on active surveillance undergoing integrated scan and subsequent biopsies. No adverse event was reported. Median turnaround time was less than 3 days from scan to 13C-kPL targeting, and scan-to-biopsy time was 2 weeks. Median number of 13C targets was 1 (range: 1–2) per patient, measuring 1.0 cm (range: 0.6–1.9) in diameter, with a median kPL of 0.0319 s−1 (range: 0.0198–0.0410).
Conclusions
This proof-of-concept work demonstrated the safety and feasibility of integrating hyperpolarized 13C MR biomarkers to the standard mpMRI workflow to guide MR-transrectal ultrasound fusion biopsies.
Supporting Information
| Filename | Description |
|---|---|
| mrm29399-sup-0001-Supinfo.pdfPDF document, 501.6 KB | FIGURE S1. (A) An example case showing the comparison of kPL in the 13C targeted lesion versus segmented prostate outside of the lesion. Pathological diagnosis of the biopsy tissue was Gleason 3 + 3 tumor with 16% involvement. (B) kPL dichotomy between pathologist-defined low-grade prostate cancer (PCa) (Gleason ≤3 + 4), and high-grade prostate cancer (Gleason score ≥4 + 3). *p = 0.034; **p = 0.0003. The recommended kPL threshold = 0.02(s−1) used in our study was corrected for the different MR sequence echo times between the EPSI acquisition in the cited reference versus the EPI in our study.24 Figure reproduced with permission17 TABLE S1. Summary of the clinical characteristics and biopsy findings from Patient 4 and 5 |
| mrm29399-sup-0002-VideoS1.mp4MPEG-4 video, 2.7 MB | VIDEO S1. This video illustrates the protocol to create 13C-kPL/T2 fusion overlays. The new 13C biopsy targeting feature takes advantage of the existing overlay and lesion outlining functions on a commercial, out-of-the-box prostate mpMRI processing and targeting platform (Dynacad). This not only enabled easy deployment of the 13C biopsy targeting capabilities on any PACS workstation within our radiology network - without the burden of additional software installations or modifications, but also allows directly exporting the 13C targets from the PACS/Dynacad to the fusion biopsy platform (UroNav) |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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