Betty Blocks
Eur Urol MET-RADS-P Standards Supplementary materialMETastasis Reporting and Data System for Prostate cancer (MET-RADS-P): Practical guidelines for acquisition, interpretation and reporting of WB-MRI based evaluations of multiorgan involvement in advanced prostate cancer Supplementary sectionsContentPages1Baseline assessments (methods and forms)1.1 Baseline regional template form1.2 Measurements template form2-72Follow-up assessments (methods and forms)2.1 & 2.2 Regional response assessment template forms (skeletal & soft tissues)8-113Overall assessments (methods and form)12-134Machine set-up, quality assurance & quality control14-175Sequence specifications18-206Suggested indications for WB-MRI in prostate cancer21-22References23-25Supplementary Table 1Typical whole body diffusion weighted MRI sequence parameters by machine manufacturer26Supplementary Table 2Regional discordant assessment grades27Supplementary Figure 1Hardware and software upgrades change image quality28Supplementary Figure 2Bone marrow growth factors obscuring the presence of metastases29Supplementary Figure 3Monitoring therapy response – effects of b-value choice on tumour volume segmentation and ADC values30-31Supplementary Figure 4Illustrated skeletal regional assessment template form32Working template forms for clinical research can be found in supplementary materials. 1. MET-RADS-P Baseline AssessmentsAll suspicious lesions seen on WB-MRI are mapped on the baseline regional template form and baseline measurements should also be recorded on the measurement template form.1.1 Baseline regional template form instructionsThis allows for clear clinical documentation of the involvement over 14 anatomic regions: Primary disease (1)Bone disease: Skull (2)Cervical spine (3)Dorsal spine (4)Thorax (5)Lumbo-sacral spine (6)Pelvis (7)Extremities (8)Visceral disease:Pelvic lymph nodes (9)Retroperitoneal nodes (10)Lymph nodes, other (11)Lungs (12)Liver (13)Other sites (14)After first deciding on whether there is evidence of involvement of each region, the reporting radiologist reports on the number of lesions for each bone and visceral region, on the baseline template reporting form. These values provide ranges and descriptors for the potential values to aid in later comparisons. The number system is designed to reduce the time taken to quantify large numbers of lesions within regions.InstructionsFor each region, involvement, lesion number and morphologic characteristics should be recorded. Diffuse disease is recorded as a separate category.Note also the presence/absence of primary disease and assess local complications – rectal, bladder and ureteric invasion.1.1. MET-RADS-P. Baseline regional reporting template formDateRegionInvolved:Y or N or N/ALesion numberDescriptionLocal diseasePrimary disease--Involvement of adjacent structures recorded hereBone disease 3SkullCervical spineDorsal spineLumbo-sacral spineThorax 1PelvisExtremities 2Visceral diseaseLymph nodes (pelvis)Lymph nodes (retroperitoneum)Lymph nodes (other)Liver 5Lung 4Other sitesComments:1 Thorax: ribs, sternum, scapula, clavicle. 2 Extremities includes proximal humeri and femora. 3Bone lesions: 1; 2; 3-5; 6-10; ≥10; diffuse. 4 Lungs: 1; 2; 3-5; 6-10; ≥10; diffuse. 5 Liver: 1; 2; 3-5; 6-10; ≥10; diffuse.1.2 Measurements template form instructionsThis template form is designed to collect objective dimensional measurements at baseline and on follow-up over time (mainly for clinical trials purposes).Lesion measurements should be undertaken on morphologic T1W and T2W images whenever possible. The large matrix size of DWI and ADC maps results in magnification of dimensions of lesions. Partial volume effects on DWI can also result in uncertainty regarding lesion dimensions particularly in low-contrast situations.The data is collected separately for local, nodal, visceral and bone disease.Measurements of bone lesions, lymph nodes and soft tissue assessment should also be undertaken using the measurement template form. Linear dimensions cannot be obtained in the setting of diffuse disease. Only discrete lesions should be evaluated in their longest dimension for local soft tissue disease, visceral disease and bones; short axis to be used for nodal disease (the plane of imaging will depend on the lesion location).Up to 5 bone, 5 nodes and 5 soft tissue lesions should be measured (15 lesions maximum).A ≥1.5cm threshold applies to all measured lesions (see preamble for exceptions).Only measurable disease as defined below can be included. Lesion locations including sequence and image numbers should be recorded to allow serial objective measurements on follow-up studies.Local prostate diseaseLocal disease is considered separately from nodal, bone and visceral disease Local recurrence ≥1.5cm is considered measurable. Local disease >1cm <1.5cm is considered evaluable but not measurable unless high resolution, small field of view images are obtained when >1cm can be considered measurable.NodesRecord pelvic, retroperitoneal and other nodes separately. Up to 5 nodes (all regions) are measured in total.Nodes ≥1.5cm in short axis diameters are considered measureable. Nodes ≥1.0cm and <1.5cm in short axis are considered pathologic but non-target (non-measureable). Nodes <1.0 cm are considered non-pathologic.Visceral lesionsVisceral disease to be separately recorded and distinguished from nodal and bone disease.Up to 5 visceral lesions should be recorded in total, not more than 2 lesions per organ.Lesions ≥1.5 cm in longest dimensions are considered measureable and can be chosen as target and non-target lesions for response assessments.Lesions <1.5 cm are considered non measureable.BonesUp to 5 bone lesions should be recorded in total with at least 1 lesion (≥1.5cm) in appendicular skeleton (when present).Where possible, not more than 2 lesions per bone (each hemi-pelvis counted separately). Lesions should be measured on T1W images in the longest dimension.Lesions ≥1.5cm is considered to be measurable (for exception see preamble).On follow-up studies, when focal lesions become diffuse and involve the entire bone marrow without extra-osseous soft-tissue, then measures of bone edge-to-edge should be undertaken.Signal intensity extent is a subjective assessment referring to extent (NOT intensity) of abnormalities consistent with cancer compared to immediate prior study, taking into account the caveats already described (not required at baseline).Diffuse bone diseaseDiffuse bone disease cannot be recorded for size measurements. Indicate ‘diffuse’ in the size column. Diffuse bone disease should have ADC measurements and their location noted (to include the entire involved bone, avoiding the outer cortical margin, neural foramina, and intraosseous vessels).2 bones representative of diffuse bone involvement should be chosen. Suggested locations include lower lumbar spinal vertebrae and posterior iliac bones (if free of artefacts).The anatomical sites for the measurements should be recoded.ADC measurements in bone diseaseADC measurements should only be obtained from bones when there is sufficient signal intensity detected on b-value images (including b0); otherwise the ADC values will be erroneous, reflecting only the noise in the images. The absence of tissue signal on high b800-1000 b-value images does not exclude the tissue from ADC measurements. Low and intermediate b-value images should be chosen instead ROI measurements. See Supplementary Figure 3 on the effectiveness of this approach to obtain more representative post therapy ADC values. 1.2. MET-RADS-P measurements template form (baseline and follow-up studies)Bone metastases measurementsLesion (location)DateSoft tissueY/NLesion 1sequence/imageSize(mm/cm) for "diffuse" infiltration indicate ADC – mean (in 10-6 mm2/s) diffuse disease indicate location Signal intensity extent (Increased, Decreased, Stable)(follow-up studies)Soft tissueY/NLesion 2sequence/imageSize(mm/cm) for "diffuse" infiltration indicate ADC – mean (in 10-6 mm2/s) diffuse disease indicate locationSignal intensity extent (Increased, Decreased, Stable)(follow-up studies)Soft tissueY/NLesion 3sequence/imageSize(mm/cm) for "diffuse" infiltration indicate ADC – mean (in 10-6 mm2/s) diffuse disease indicate locationSignal intensity extent (Increased, Decreased, Stable)(follow-up studies)Soft tissueY/NLesion 4sequence/imageSize(mm/cm) for "diffuse" infiltration indicate ADC – mean (in 10-6 mm2/s) diffuse disease indicate locationSignal intensity extent (Increased, Decreased, Stable)(follow-up studies)Soft tissueY/NLesion 5sequence/imageSize(mm/cm) for "diffuse" infiltration indicate ADC – mean (in 10-6 mm2/s) diffuse disease indicate location Signal intensity extent (Increased, Decreased, Stable)(follow-up studies)Soft tissue metastases measurementsImage referenceBaseline/Visit x(date)Target*1 description including Locationsequence/imageSize (mm/cm)2 description including Locationsequence/imageSize (mm/cm)3 description including Locationsequence/imageSize (mm/cm)4sequence/imageSize (mm/cm)5sequence/imageSize (mm/cm)678910Non-Target lesions**(list)description including LocationFollow-up visitsPresence/absenceIncrease/stable/decrease/resolvedNon-measureable lesions***(list)description including LocationFollow-up visitsPresence/absenceIncrease/stable/decrease/resolvedNew lesions(list)description including LocationNon-baseline studies onlysequence/imageLocal DiseaseDescriptionsequence/imageSize (mm/cm)*Include up to 5 lymph nodes and 5 visceral lesions. Not more 2 lesions per organ. No bone measurements (use prior form).**non-target: measurable disease that are not specifically measured*** non-measureable lesions: lesions/disease not qualified for measurements2. MET-RADS-P Follow-up AssessmentsFollow-up assessments methods instructionsFollow-up assessments use the measurements template form (1.2) and the follow-up regional assessment template forms 1 and 2 (2.1 and 2.2).Measurement template form (1.2)Detailed instructions are given in 1Regional response assessment template forms 2.1 & 2.2In order to complete template forms 2.1 and 2.2 the changes seen within each region are categorised according to the response assessment categories (RACs) shown in Supplementary Table 2.The RACs have been designed to enable regional assessments of treatment response to take place in a reproducible and semi-quantifiable way. RAC for regional assessments use a sliding scale. These RACs are to be applied to both soft tissues and to bone regions using the criteria given in table 3 of the main paper.There are five potential RACs on a sliding scale (highly likely to be responding, likely to be responding, stable, likely to be progressing and highly likely to be progressing).The PCWG modifications of RECIST v1.1 are built into the RACs for soft tissue assessments (table 3 – main paper) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1200/JCO.2015.64.2702", "ISSN" : "1527-7755", "PMID" : "26903579", "abstract" : "PURPOSE Evolving treatments, disease phenotypes, and biology, together with a changing drug development environment, have created the need to revise castration-resistant prostate cancer (CRPC) clinical trial recommendations to succeed those from prior Prostate Cancer Clinical Trials Working Groups. METHODS An international expert committee of prostate cancer clinical investigators (the Prostate Cancer Clinical Trials Working Group 3 [PCWG3]) was reconvened and expanded and met in 2012-2015 to formulate updated criteria on the basis of emerging trial data and validation studies of the Prostate Cancer Clinical Trials Working Group 2 recommendations. RESULTS PCWG3 recommends that baseline patient assessment include tumor histology, detailed records of prior systemic treatments and responses, and a detailed reporting of disease subtypes based on an anatomic pattern of metastatic spread. New recommendations for trial outcome measures include the time to event end point of symptomatic skeletal events, as well as time to first metastasis and time to progression for trials in the nonmetastatic CRPC state. PCWG3 introduces the concept of no longer clinically benefiting to underscore the distinction between first evidence of progression and the clinical need to terminate or change treatment, and the importance of documenting progression in existing lesions as distinct from the development of new lesions. Serial biologic profiling using tumor samples from biopsies, blood-based diagnostics, and/or imaging is also recommended to gain insight into mechanisms of resistance and to identify predictive biomarkers of sensitivity for use in prospective trials. CONCLUSION PCWG3 moves drug development closer to unmet needs in clinical practice by focusing on disease manifestations most likely to affect prognosis adversely for therapeutics tested in both nonmetastatic and metastatic CRPC populations. 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The definition of RAC 1 and RAC 5 for bone regions is based on the work of Lecouvet et al. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00330-013-2792-3", "ISSN" : "1432-1084", "PMID" : "23455764", "abstract" : "BACKGROUND Beyond lesion detection and characterisation, and disease staging, the quantification of the tumour load and assessment of response to treatment are daily expectations in oncology. METHODS Bone lesions have been considered \"non-measurable\" for years as opposed to lesions involving soft tissues and \"solid\" organs like the lungs or liver, for which response evaluation criteria are used in every day practice. This is due to the lack of sensitivity, specificity and measurement capabilities of imaging techniques available for bone assessment, i.e. skeletal scintigraphy (SS), radiographs and computed tomography (CT). RESULTS This paper reviews the possibilities and limitations of these techniques and highlights the possibilities of positron emission tomography (PET), but mainly concentrates on magnetic resonance imaging (MRI). CONCLUSION Practical morphological and quantitative approaches are proposed to evaluate the treatment response of bone marrow lesions using \"anatomical\" MRI. Recent developments of MRI, i.e. dynamic contrast-enhanced (DCE) imaging and diffusion-weighted imaging (DWI), are also covered. KEY POINTS \u2022 MRI offers improved evaluation of skeletal metastases and their response to treatment. \u2022 This new indication for MRI has wide potential impact on radiological practice. \u2022 MRI helps meet the expectations of the oncological community. \u2022 We emphasise the practical aspects, with didactic cases and illustrations.", "author" : [ { "dropping-particle" : "", "family" : "Lecouvet", "given" : "F E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Larbi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pasoglou", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Omoumi", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tombal", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michoux", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Malghem", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lhommel", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berg", "given" : "B C", "non-dropping-particle" : "Vande", "parse-names" : false, "suffix" : "" } ], "container-title" : "European radiology", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2013", "7", "1" ] ] }, "page" : "1986-97", "title" : "MRI for response assessment in metastatic bone disease.", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[2]", "plainTextFormattedCitation" : "[2]", "previouslyFormattedCitation" : "[2]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[2].InstructionsTemplate forms 2.1 & 2.2 pictorially represent the same 14 regions assessed at baseline. The methodology for completing these follow-up regional template forms is:Each of the 14 regions is separately assessed for evidence of disease involvement. If disease is present within a region then further assessment is made of the treatment response (within this region only) by comparison with the baseline scan, as described below.A primary RAC value (1-5) is assigned to the region based on dominant pattern of response within the region. This is defined as the response shown by more than half of the lesions within the region. RAC criteria are defined in Table 3 – main paper.A secondary RAC value (1-5) is assigned to the region to illustrate the second most frequent pattern of response seen within the region in question. A tertiary RAC value (4-5) is assigned to the region to illustrate that there is evidence of progressing disease (i.e. RAC 4-5) but that this is neither the dominant nor secondary pattern of response within the region (i.e. not captured by the primary or secondary RAC values).For a single lesion per region only the primary number category is assessed (see Supplementary Figure 4 for illustration of usage). Regions with multiple lesions all with the same pattern of response will have the same RAC value assigned as both the primary and secondary RACs.When >1 lesion is present and equal numbers of lesions are category RAC 4/5 as RAC 1/2/3, then the primary pattern allocation is reserved for RAC 4/5.Similarly, when >1 lesion is present and equal numbers of lesions are category RAC 2 as RAC 3, then the primary pattern allocation is reserved for RAC 3 (the higher category).The above methodology allows for the capture of discordant treatment responses within anatomical regions. For example, a region given a score of 1 + 3 shows a dominant pattern that is highly suggestive of response, with a secondary pattern showing no change. A worked-up example of documentation of regional responses is given in Supplementary Figure 4.2.1. MET-RADS-P Regional response assessment template form 1. Skeletal 2.2. MET-RADS-P Regional response assessment template form 2. Soft tissue 3. MET-RADS-P Overall AssessmentsInstructionsThe status of the primary disease, nodes, viscera and bone disease should be recorded separately using the overall response assessment template form. Unlike regional response assessments, overall response for the primary tumour, nodal and visceral disease should be categorical, thus following established guidelines (PCWG modifications of RECIST v1.1) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1200/JCO.2015.64.2702", "ISSN" : "1527-7755", "PMID" : "26903579", "abstract" : "PURPOSE Evolving treatments, disease phenotypes, and biology, together with a changing drug development environment, have created the need to revise castration-resistant prostate cancer (CRPC) clinical trial recommendations to succeed those from prior Prostate Cancer Clinical Trials Working Groups. METHODS An international expert committee of prostate cancer clinical investigators (the Prostate Cancer Clinical Trials Working Group 3 [PCWG3]) was reconvened and expanded and met in 2012-2015 to formulate updated criteria on the basis of emerging trial data and validation studies of the Prostate Cancer Clinical Trials Working Group 2 recommendations. RESULTS PCWG3 recommends that baseline patient assessment include tumor histology, detailed records of prior systemic treatments and responses, and a detailed reporting of disease subtypes based on an anatomic pattern of metastatic spread. New recommendations for trial outcome measures include the time to event end point of symptomatic skeletal events, as well as time to first metastasis and time to progression for trials in the nonmetastatic CRPC state. PCWG3 introduces the concept of no longer clinically benefiting to underscore the distinction between first evidence of progression and the clinical need to terminate or change treatment, and the importance of documenting progression in existing lesions as distinct from the development of new lesions. Serial biologic profiling using tumor samples from biopsies, blood-based diagnostics, and/or imaging is also recommended to gain insight into mechanisms of resistance and to identify predictive biomarkers of sensitivity for use in prospective trials. CONCLUSION PCWG3 moves drug development closer to unmet needs in clinical practice by focusing on disease manifestations most likely to affect prognosis adversely for therapeutics tested in both nonmetastatic and metastatic CRPC populations. 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The following categories should be assigned: complete response, partial response, stable disease, progressive disease and discordant. Note that progression assignments for soft tissues are based on measurements and should be from baseline or treatment induced nadir whichever is lower. Other progression assignments are as per RECIST v1.1 (e.g., new disease) (Table 3 – main paper) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S0959-8049(08)00873-3 [pii]\n10.1016/j.ejca.2008.10.026 [doi]", "ISBN" : "1879-0852 (Electronic)", "PMID" : "19097774", "abstract" : "BACKGROUND: Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics: both tumour shrinkage (objective response) and disease progression are useful endpoints in clinical trials. Since RECIST was published in 2000, many investigators, cooperative groups, industry and government authorities have adopted these criteria in the assessment of treatment outcomes. However, a number of questions and issues have arisen which have led to the development of a revised RECIST guideline (version 1.1). Evidence for changes, summarised in separate papers in this special issue, has come from assessment of a large data warehouse (>6500 patients), simulation studies and literature reviews. HIGHLIGHTS OF REVISED RECIST 1.1: Major changes include: Number of lesions to be assessed: based on evidence from numerous trial databases merged into a data warehouse for analysis purposes, the number of lesions required to assess tumour burden for response determination has been reduced from a maximum of 10 to a maximum of five total (and from five to two per organ, maximum). Assessment of pathological lymph nodes is now incorporated: nodes with a short axis of 15 mm are considered measurable and assessable as target lesions. The short axis measurement should be included in the sum of lesions in calculation of tumour response. Nodes that shrink to <10mm short axis are considered normal. Confirmation of response is required for trials with response primary endpoint but is no longer required in randomised studies since the control arm serves as appropriate means of interpretation of data. Disease progression is clarified in several aspects: in addition to the previous definition of progression in target disease of 20% increase in sum, a 5mm absolute increase is now required as well to guard against over calling PD when the total sum is very small. Furthermore, there is guidance offered on what constitutes 'unequivocal progression' of non-measurable/non-target disease, a source of confusion in the original RECIST guideline. Finally, a section on detection of new lesions, including the interpretation of FDG-PET scan assessment is included. Imaging guidance: the revised RECIST includes a new imaging appendix with updated recommendations on the optimal anatomical assessment of lesions. FUTURE WORK: A key question considered by the RECIST Working Group in developing RECIST 1.1 was whether it was appropriate to move from anatomic unidi\u2026", "author" : [ { "dropping-particle" : "", "family" : "Eisenhauer", "given" : "E A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Therasse", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bogaerts", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schwartz", "given" : "L H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sargent", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ford", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dancey", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arbuck", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gwyther", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mooney", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rubinstein", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shankar", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dodd", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kaplan", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lacombe", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verweij", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Cancer", "edition" : "2008/12/23", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "language" : "eng", "note" : "Eisenhauer, E A\nTherasse, P\nBogaerts, J\nSchwartz, L H\nSargent, D\nFord, R\nDancey, J\nArbuck, S\nGwyther, S\nMooney, M\nRubinstein, L\nShankar, L\nDodd, L\nKaplan, R\nLacombe, D\nVerweij, J\nPractice Guideline\nEngland\nEuropean journal of cancer (Oxford, England : 1990)\nEur J Cancer. 2009 Jan;45(2):228-47.", "page" : "228-247", "title" : "New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[3]", "plainTextFormattedCitation" : "[3]", "previouslyFormattedCitation" : "[3]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[3]. In contradistinction, the overall response of bone disease should be categorized on a scale of 1-5 indicating the likely overall response category: (1) highly likely to be responding, (2) likely to be responding, (3) stable, (4) likely to be progressing and (5) highly likely to be progressing. Bone disease uses the criteria given Table 3 – main paper. The type of progression (new disease versus growth of existing lesions) should be separately recorded; the location of progression should be obtainable from the regional response assessment template forms 2.1 & 2.2Discordant, progressive disease should also be separately reported for primary, nodal, viscera and bone; evaluation of regional discordant responses on forms 2.1 & 2.2 will enable the specific identification of the anatomic sites of mixed responses.Discordance indicates the presence of progressing bone/soft tissue disease, not meeting definite progression criteria in the primary category, that is, when the majority of disease is stable or responding. In each discordant case, indicate whether discordance is a secondary (ie, major discordance) or tertiary (ie, minor discordance) assessment (Supplementary Table 2). 3.0 MET-RADS-P Overall response assessment categoriesdatePatient labelNodal diseaseNo diseaseComplete responseResponseStableProgressionNewGrowthDiscordant[yes/no]-Responding-discordantMajor/minorStable-discordantMajor/minor-Visceral diseaseNo diseaseComplete responseResponseStableProgressionNewGrowthDiscordant[yes/no]-Responding-discordantMajor/minorStable-discordantMajor/minor-Local diseaseNo diseaseComplete responseResponseStableProgressionNewGrowthDiscordant[yes/no]-Responding-discordantMajor/minorStable-discordantMajor/minor-Bone diseaseNo diseaseResponseLikely RespondingStableLikely progressingDefinite progressionNewGrowthDiscordant[yes/no]Response-discordantMajor/minorResponding-discordantMajor/minorStable-discordantMajor/minor- 4. Machine set-up, quality assurance and quality controlThe radiologic literature, and machine manufacturer recommendations should be used by radiologists/technologists/physicists for machine set-up and to adapt imaging protocols for the level of machine software ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2214/AJR.11.7866", "ISSN" : "1546-3141", "PMID" : "22826385", "abstract" : "OBJECTIVE We examine the clinical impetus for whole-body diffusion-weighted MRI and discuss how to implement the technique with clinical MRI systems. We include practical tips and tricks to optimize image quality and reduce artifacts. The interpretative pitfalls are enumerated, and potential challenges are highlighted. CONCLUSION Whole-body diffusion-weighted MRI can be used for tumor staging and assessment of treatment response. Meticulous technique and knowledge of potential interpretive pitfalls will help to avoid mistakes and establish this modality in radiologic practice.", "author" : [ { "dropping-particle" : "", "family" : "Koh", "given" : "Dow-Mu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blackledge", "given" : "Matthew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Padhani", "given" : "Anwar R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Takahara", "given" : "Taro", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwee", "given" : "Thomas C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leach", "given" : "Martin O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "David J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "AJR. American journal of roentgenology", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2012", "8" ] ] }, "page" : "252-62", "title" : "Whole-body diffusion-weighted MRI: tips, tricks, and pitfalls.", "type" : "article-journal", "volume" : "199" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1148/radiol.11110474", "ISSN" : "1527-1315", "PMID" : "22095994", "abstract" : "Diffusion-weighted (DW) magnetic resonance (MR) imaging is emerging as a powerful clinical tool for directing the care of patients with cancer. Whole-body DW imaging is almost at the stage where it can enter widespread clinical investigations, because the technology is stable and protocols can be implemented for the majority of modern MR imaging systems. There is a continued need for further improvements in data acquisition and analysis and in display technologies. Priority areas for clinical research include clarification of histologic relationships between tissues of interest and DW MR imaging biomarkers at diagnosis and during therapy response. Because whole-body DW imaging excels at bone marrow assessments at diagnosis and for therapy response, it can potentially address a number of unmet clinical and pharmaceutical requirements. There are compelling needs to document and understand how common and novel treatments affect whole-body DW imaging results and to establish response criteria that can be tested in prospective clinical studies that incorporate measures of patient benefit.", "author" : [ { "dropping-particle" : "", "family" : "Padhani", "given" : "Anwar R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koh", "given" : "Dow-Mu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "David J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Radiology", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2011", "12" ] ] }, "page" : "700-18", "title" : "Whole-body diffusion-weighted MR imaging in cancer: current status and research directions.", "type" : "article-journal", "volume" : "261" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1097/RLI.0b013e3181afbb36", "ISBN" : "1536-0210 (Electronic)\r0020-9996 (Linking)", "PMID" : "19724232", "abstract" : "PURPOSE: To assess the value of whole-body magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), for the initial staging of malignant lymphoma, compared with computed tomography (CT). MATERIALS AND METHODS: Thirty-one consecutive patients with newly diagnosed malignant lymphoma prospectively underwent whole-body MRI (T1-weighted and short inversion time inversion recovery [n = 31], and DWI [n = 28]) and CT. Ann Arbor stages were assigned by 1 radiologist according to whole-body MRI findings, and by another radiologist according to CT findings. Differences in staging between whole-body MRI (without and with DWI) and CT were resolved using other (imaging) studies (including 18F-fluoro-2-deoxyglucose positron emission tomography and bone marrow biopsy) and follow-up studies as reference standard. RESULTS: Staging results of whole-body MRI without DWI were equal to those of CT in 74% (23/31), higher in 26% (8/31), and lower in 0% (0/31) of patients, with correct/incorrect/unresolved overstaging relative to CT in 3, 2, and 2 patients, respectively, and incorrect staging of both modalities in 1 patient. Staging results of whole-body MRI with DWI were equal to those of CT in 75% (21/28), higher in 25% (7/28), and lower in 0% (0/28) of patients, with correct/incorrect overstaging relative to CT in 6 and 1 patient(s), respectively. CONCLUSION: Our results suggest that initial staging of malignant lymphoma using whole-body MRI (without DWI and with DWI) equals staging using CT in the majority of patients, whereas whole-body MRI never understaged relative to CT. Furthermore, whole-body MRI mostly correctly overstaged relative to CT, with a possible advantage of using DWI.", "author" : [ { "dropping-particle" : "", "family" : "Kwee", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ufford", "given" : "H M", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beek", "given" : "F J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Takahara", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Uiterwaal", "given" : "C S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bierings", "given" : "M B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ludwig", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fijnheer", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nievelstein", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Invest Radiol", "edition" : "2009/09/03", "id" : "ITEM-3", "issue" : "10", "issued" : { "date-parts" : [ [ "2009" ] ] }, "language" : "eng", "note" : "Kwee, Thomas C\nvan Ufford, Henriette M E Quarles\nBeek, Frederik J\nTakahara, Taro\nUiterwaal, Cuno S\nBierings, Marc B\nLudwig, Inge\nFijnheer, Rob\nNievelstein, Rutger A J\nComparative Study\nResearch Support, Non-U.S. Gov't\nUnited States\nInvestigative radiology\nInvest Radiol. 2009 Oct;44(10):683-90.", "page" : "683-690", "title" : "Whole-body MRI, including diffusion-weighted imaging, for the initial staging of malignant lymphoma: comparison to computed tomography", "type" : "article-journal", "volume" : "44" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1007/s00330-013-3083-8", "ISBN" : "0033001330838", "ISSN" : "1432-1084", "PMID" : "24322510", "abstract" : "OBJECTIVES: To evaluate whole-body MRI with diffusion-weighted sequence (WB-DWI/MRI) for staging and assessing operability compared with CT and FDG-PET/CT in patients with suspected ovarian cancer.\n\nMETHODS: Thirty-two patients underwent 3-T WB-DWI/MRI, (18)\u2009F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and CT before diagnostic open laparoscopy (DOL). Imaging findings for tumour characterisation, peritoneal and retroperitoneal staging were correlated with histopathology after DOL and/or open surgery. For distant metastases, FDG-PET/CT or image-guided biopsies were the reference standards. For tumour characterisation and peritoneal staging, WB-DWI/MRI was compared with CT and FDG-PET/CT. Interobserver agreement for WB-DWI/MRI was determined.\n\nRESULTS: WB-DWI/MRI showed 94\u00a0% accuracy for primary tumour characterisation compared with 88\u00a0% for CT and 94\u00a0% for FDG-PET/CT. WB-DWI/MRI showed higher accuracy of 91\u00a0% for peritoneal staging compared with CT (75\u00a0%) and FDG-PET/CT (71\u00a0%). WB-DWI/MRI and FDG-PET/CT showed higher accuracy of 87\u00a0% for detecting retroperitoneal lymphadenopathies compared with CT (71\u00a0%). WB-DWI/MRI showed excellent correlation with FDG-PET/CT (\u03ba\u2009=\u20091.00) for detecting distant metastases compared with CT (\u03ba\u2009=\u20090.34). Interobserver agreement was moderate to almost perfect (\u03ba\u2009=\u20090.58-0.91).\n\nCONCLUSIONS: WB-DWI/MRI shows high accuracy for characterising primary tumours, peritoneal and distant staging compared with CT and FDG-PET/CT and may be valuable for assessing operability in ovarian cancer patients.\n\nKEY POINTS: \u2022 Whole-body MRI with diffusion weighting (WB-DWI/MRI) helps to assess the operability of suspected ovarian cancer. \u2022 Interobserver agreement is good for primary tumour characterisation, peritoneal and distant staging. \u2022 WB-DWI/MRI improves mesenteric/serosal metastatic spread assessment compared with CT and FDG-PET/CT. \u2022 Retroperitoneal/cervical-thoracic nodal staging using qualitative DWI criteria was reasonably accurate. \u2022 WB-DWI/MRI and FDG-PET/CT showed the highest diagnostic impact for detecting thoracic metastases.", "author" : [ { "dropping-particle" : "", "family" : "Michielsen", "given" : "Katrijn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vergote", "given" : "Ignace", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beeck", "given" : "Katya", "non-dropping-particle" : "Op de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Amant", "given" : "Frederic", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leunen", "given" : "Karin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moerman", "given" : "Philippe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deroose", "given" : "Christophe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Souverijns", "given" : "Geert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dymarkowski", "given" : "Steven", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Keyzer", "given" : "Frederik", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vandecaveye", "given" : "Vincent", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European radiology", "id" : "ITEM-4", "issue" : "4", "issued" : { "date-parts" : [ [ "2014", "4", "11" ] ] }, "page" : "889-901", "title" : "Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT.", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1016/j.eururo.2012.02.020", "ISSN" : "1873-7560", "PMID" : "22366187", "abstract" : "BACKGROUND: Technetium Tc 99m bone scintigraphy (BS) and contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis and abdomen are universally recommended for detecting prostate cancer (PCa) metastases in cancer of all stages. However, this two-step approach has limited sensitivity and specificity. OBJECTIVE: Evaluate the diagnostic accuracy of whole-body MRI (WBMRI) as a one-step screening test for PCa metastases. DESIGN, SETTING, AND PARTICIPANTS: One hundred consecutive PCa patients at high risk for metastases prospectively underwent WBMRI, CT, and BS completed with targeted x-rays (BS/TXR) in case of equivocal BS. Four independent reviewers reviewed the images. MEASUREMENTS: This study compares the diagnostic performance of WBMRI, CT, BS, and BS/TXR in detecting PCa metastases using area under the curve (AUC) receiver operator characteristics. A best valuable comparator (BVC) approach was used to adjudicate final metastatic status in the absence of pathologic evaluation. RESULTS AND LIMITATIONS: Based on the BVC, 68 patients had metastases. The sensitivity of BS/TXR and WBMRI for detecting bone metastases was 86% and 98-100%, respectively (p<0.04), and specificity was 98% and 98-100%, respectively. The first and second WBMRI readers respectively identified bone metastases in 7 and 8 of 55 patients with negative BS/TXR. The sensitivity of CT and WBMRI for detecting enlarged lymph nodes was similar, at 77-82% for both; specificity was 95-96% and 96-98%, respectively. The sensitivity of the combination of BS/TXR plus CT and WBMRI for detecting bone metastases and/or enlarged lymph nodes was 84% and 91-94%, respectively (p=0.03-0.10); specificities were 94-97% and 91-96%, respectively. The 95% confidence interval of the difference between the AUC of the worst WBMRI reading and the AUC of any of the BS/TXR plus CT lay within the noninferiority margin of \u00b110% AUC. CONCLUSIONS: WBMRI outperforms BS/TXR in detecting bone metastases and performs as well as CT for enlarged lymph node evaluation. WBMRI can replace the current multimodality metastatic work-up for the concurrent evaluation of bones and lymph nodes in high-risk PCa patients.", "author" : [ { "dropping-particle" : "", "family" : "Lecouvet", "given" : "Fr\u00e9d\u00e9ric E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mouedden", "given" : "Jawad", "non-dropping-particle" : "El", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collette", "given" : "Laurence", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Coche", "given" : "Emmanuel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Danse", "given" : "Etienne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jamar", "given" : "Fran\u00e7ois", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Machiels", "given" : "Jean-Pascal", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berg", "given" : "Bruno", "non-dropping-particle" : "Vande", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Omoumi", "given" : "Patrick", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tombal", "given" : "Bertrand", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European urology", "id" : "ITEM-5", "issue" : "1", "issued" : { "date-parts" : [ [ "2012", "7" ] ] }, "page" : "68-75", "title" : "Can whole-body magnetic resonance imaging with diffusion-weighted imaging replace Tc 99m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer?", "type" : "article-journal", "volume" : "62" }, "uris" : [ "" ] }, { "id" : "ITEM-6", "itemData" : { "DOI" : "10.1148/radiol.2016142084", "ISSN" : "1527-1315", "PMID" : "27089188", "abstract" : "Whole-body magnetic resonance (MR) imaging has been evaluated in many oncologic and rheumatologic indications and is emerging as a powerful tool for early diagnosis, quantification of disease extent, therapeutic decision making, and treatment monitoring. This development of whole-body MR imaging comes at a time marked by the rapid development of modern, powerful, but expensive and potentially toxic treatments. In oncology, the feasibility and diagnostic performance of diffusion-weighted imaging (DWI) applied to the whole body largely contribute to the effectiveness of whole-body MR imaging. The concurrent acquisition of both anatomic and functional DWI sequences provides an intrinsically \"hybrid\" dimension to whole-body MR imaging studies, allowing a sensitive and specific diagnosis of bone involvement by metastases, multiple myeloma, and lymphoma, and evaluation of treatment response, representing a promising biomarker. In arthritis of the axial skeleton, mainly spondyloarthropathies, whole-body MR imaging reveals additional lesions compared with limited axial (lumbar and pelvic) studies, especially in the thoracic spine and thoracic wall, pelvic and shoulder girdles, and peripheral entheses and joints. This article provides an overview of technical aspects of whole-body MR imaging and practical recommendations for the interpretation of whole-body MR imaging studies. It reviews the currently established and potential indications for whole-body MR imaging in oncology and rheumatology, discussing the diagnostic performance, advantages, and drawbacks of the technique, and its potential roles in comparison to other imaging modalities. (\u00a9) RSNA, 2016 Online supplemental material is available for this article.", "author" : [ { "dropping-particle" : "", "family" : "Lecouvet", "given" : "Fr\u00e9d\u00e9ric E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Radiology", "id" : "ITEM-6", "issue" : "2", "issued" : { "date-parts" : [ [ "2016", "5" ] ] }, "page" : "345-65", "title" : "Whole-Body MR Imaging: Musculoskeletal Applications.", "type" : "article-journal", "volume" : "279" }, "uris" : [ "" ] }, { "id" : "ITEM-7", "itemData" : { "DOI" : "10.1148/radiol.14141242", "ISBN" : "0033-8419", "ISSN" : "1527-1315", "PMID" : "25513855", "abstract" : "PURPOSE To develop and assess the diagnostic performance of a three-dimensional (3D) whole-body T1-weighted magnetic resonance (MR) imaging pulse sequence at 3.0 T for bone and node staging in patients with prostate cancer. MATERIALS AND METHODS This prospective study was approved by the institutional ethics committee; informed consent was obtained from all patients. Thirty patients with prostate cancer at high risk for metastases underwent whole-body 3D T1-weighted imaging in addition to the routine MR imaging protocol for node and/or bone metastasis screening, which included coronal two-dimensional (2D) whole-body T1-weighted MR imaging, sagittal proton-density fat-saturated (PDFS) imaging of the spine, and whole-body diffusion-weighted MR imaging. Two observers read the 2D and 3D images separately in a blinded manner for bone and node screening. Images were read in random order. The consensus review of MR images and the findings at prospective clinical and MR imaging follow-up at 6 months were used as the standard of reference. The interobserver agreement and diagnostic performance of each sequence were assessed on per-patient and per-lesion bases. RESULTS The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were significantly higher with whole-body 3D T1-weighted imaging than with whole-body 2D T1-weighted imaging regardless of the reference region (bone or fat) and lesion location (bone or node) (P < .003 for all). For node metastasis, diagnostic performance (area under the receiver operating characteristic curve) was higher for whole-body 3D T1-weighted imaging (per-patient analysis; observer 1: P < .001 for 2D T1-weighted imaging vs 3D T1-weighted imaging, P = .006 for 2D T1-weighted imaging + PDFS imaging vs 3D T1-weighted imaging; observer 2: P = .006 for 2D T1-weighted imaging vs 3D T1-weighted imaging, P = .006 for 2D T1-weighted imaging + PDFS imaging vs 3D T1-weighted imaging), as was sensitivity (per-lesion analysis; observer 1: P < .001 for 2D T1-weighted imaging vs 3D T1-weighted imaging, P < .001 for 2D T1-weighted imaging + PDFS imaging vs 3D T1-weighted imaging; observer 2: P < .001 for 2D T1-weighted imaging vs 3D T1-weighted imaging, P < .001 for 2D T1-weighted imaging + PDFS imaging vs 3D T1-weighted imaging). CONCLUSION Whole-body MR imaging is feasible with a 3D T1-weighted sequence and provides better SNR and CNR compared with 2D sequences, with a diagnostic performance that is as good or better for the detection of\u2026", "author" : [ { "dropping-particle" : "", "family" : "Pasoglou", "given" : "Vasiliki", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michoux", "given" : "Nicolas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peeters", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Larbi", "given" : "Ahmed", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tombal", "given" : "Bertrand", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Selleslagh", "given" : "Tom", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Omoumi", "given" : "Patrick", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berg", "given" : "Bruno C.", "non-dropping-particle" : "Vande", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lecouvet", "given" : "Fr\u00e9d\u00e9ric E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Radiology", "id" : "ITEM-7", "issue" : "1", "issued" : { "date-parts" : [ [ "2015", "4" ] ] }, "page" : "155-66", "title" : "Whole-body 3D T1-weighted MR imaging in patients with prostate cancer: feasibility and evaluation in screening for metastatic disease.", "type" : "article-journal", "volume" : "275" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[4\u201310]", "plainTextFormattedCitation" : "[4\u201310]", "previouslyFormattedCitation" : "[4\u201310]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[4–10]. 4.1 Machine set-up for clinical care and research WB-MRI performed at the field strength of 1.5 T has become the established platform, due to its robustness ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2214/AJR.11.7866", "ISSN" : "1546-3141", "PMID" : "22826385", "abstract" : "OBJECTIVE We examine the clinical impetus for whole-body diffusion-weighted MRI and discuss how to implement the technique with clinical MRI systems. We include practical tips and tricks to optimize image quality and reduce artifacts. The interpretative pitfalls are enumerated, and potential challenges are highlighted. CONCLUSION Whole-body diffusion-weighted MRI can be used for tumor staging and assessment of treatment response. Meticulous technique and knowledge of potential interpretive pitfalls will help to avoid mistakes and establish this modality in radiologic practice.", "author" : [ { "dropping-particle" : "", "family" : "Koh", "given" : "Dow-Mu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blackledge", "given" : "Matthew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Padhani", "given" : "Anwar R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Takahara", "given" : "Taro", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwee", "given" : "Thomas C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leach", "given" : "Martin O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "David J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "AJR. American journal of roentgenology", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2012", "8" ] ] }, "page" : "252-62", "title" : "Whole-body diffusion-weighted MRI: tips, tricks, and pitfalls.", "type" : "article-journal", "volume" : "199" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[4]", "plainTextFormattedCitation" : "[4]", "previouslyFormattedCitation" : "[4]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[4] and widespread availability; however, excellent results can also be obtained with increased SNR at 3T, on many modern systems, including wide bore systems ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.mric.2015.08.007", "ISSN" : "1557-9786", "PMID" : "26613874", "abstract" : "Advances in hardware and software enable high-quality body diffusion-weighted images to be acquired for oncologic assessment. 3.0 T affords improved signal/noise for higher spatial resolution and smaller field-of-view diffusion-weighted imaging (DWI). DWI at 3.0 T can be applied as at 1.5 T to improve tumor detection, disease characterization, and the assessment of treatment response. DWI at 3.0 T can be acquired on a hybrid PET-MR imaging system, to allow functional MR information to be combined with molecular imaging.", "author" : [ { "dropping-particle" : "", "family" : "Koh", "given" : "Dow-Mu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "Jeong-Min", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bittencourt", "given" : "Leonardo Kayat", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blackledge", "given" : "Matthew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "David J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Magnetic resonance imaging clinics of North America", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2016", "2" ] ] }, "page" : "31-44", "title" : "Body Diffusion-weighted MR Imaging in Oncology: Imaging at 3 T.", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[11]", "plainTextFormattedCitation" : "[11]", "previouslyFormattedCitation" : "[11]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[11].In the context of evaluating tumour response to treatments, whenever possible repeat examinations should be performed on the same machine (type and software version) during follow-up studies. We do not recommend same patient measurements at different field strengths, even from a single vendor with identical sequence software versions. See (Supplementary Fig. 1) for an example of marked image variations due to changes in magnetic field strength.There is unanimous consensus regarding the positive benefits of using surface coils to maximize signal-to-noise ratio (SNR) of images; signal reception with machine integrated body coil is thus not recommended, although the latter may be used according to the clinical situation, local expertise and the equipment available or for patient comfort. In these cases, the SNR loss resulting from a lack of surface coils will need to be countered by sequence adjustments such as increasing acquisition pixel size, increasing the number of averages and reduced pixel bandwidth, which will lead to penalties, including longer scan times and reduced spatial resolutions.MR clinical scientists working with experienced radiographers/technologists should undertake vendor specific WB-MRI set-ups. Sequences adjustments and optimization of measurement protocols should be undertaken using both volunteers and test objects ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1118/1.4937789", "ISSN" : "0094-2405", "abstract" : "Purpose: To develop methods for optimization of diffusion-weighted MRI (DW-MRI) in the abdomen and pelvis on 1.5 T MR scanners from three manufacturers and assess repeatability of apparent diffusion coefficient (ADC) estimates in a temperature-controlled phantom and abdominal and pelvic organs in healthy volunteers. Methods: Geometric distortion, ghosting, fat suppression, and repeatability and homogeneity of ADC estimates were assessed using phantoms and volunteers. Healthy volunteers (ten per scanner) were each scanned twice on the same scanner. One volunteer traveled to all three institutions in order to provide images for qualitative comparison. The common volunteer was excluded from quantitative analysis of the data from scanners 2 and 3 in order to ensure statistical independence, giving n = 10 on scanner 1 and n = 9 on scanners 2 and 3 for quantitative analysis. Repeatability and interscanner variation of ADC estimates in kidneys,liver, spleen, and uterus were assessed using within-patient coefficient of variation (wCV) and Kruskal\u2013Wallis tests, respectively. Results: The coefficient of variation of ADC estimates in the temperature-controlled phantom was 1%\u20134% for all scanners.Images of healthy volunteers from all scanners showed homogeneous fat suppression and no marked ghosting or geometric distortion. The wCV of ADC estimates was 2%\u20134% for kidneys, 3%\u20137% for liver, 6%\u20139% for spleen, and 7%\u201310% for uterus. ADC estimates in kidneys, spleen, and uterus showed no significant difference between scanners but a significant difference was observed in liver (p < 0.05). Conclusions: DW-MRI protocols can be optimized using simple phantom measurements to produce good quality images in the abdomen and pelvis at 1.5 T with repeatable quantitative measurements in a multicenter study.", "author" : [ { "dropping-particle" : "", "family" : "Winfield", "given" : "Jessica M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "David J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Priest", "given" : "Andrew N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Quest", "given" : "Rebecca A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Glover", "given" : "Alan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "Sally", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morgan", "given" : "Veronica A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freeman", "given" : "Susan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rockall", "given" : "Andrea", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "DeSouza", "given" : "Nandita M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Physics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "95-110", "title" : "A framework for optimization of diffusion-weighted MRI protocols for large field-of-view abdominal-pelvic imaging in multicenter studies", "type" : "article-journal", "volume" : "43" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1088/0031-9155/59/9/2235", "ISSN" : "1361-6560", "PMID" : "24710825", "abstract" : "We present the development and application of a phantom for assessment and optimization of fat suppression over a large field-of-view in diffusion-weighted magnetic resonance imaging at 1.5 T and 3 T. A Perspex cylinder (inner diameter 185 mm, height 300 mm) which contains a second cylinder (inner diameter 140 mm) was constructed. The inner cylinder was filled with water doped with copper sulphate and sodium chloride and the annulus was filled with corn oil, which closely matches the spectrum and longitudinal relaxation times of subcutaneous abdominal fat. Placement of the phantom on the couch at 45\u00b0 to the z-axis presented an elliptical cross-section, which was of a similar size and shape to axial abdominal images. The use of a phantom for optimization of fat suppression allowed quantitative comparison between studies without the differences introduced by variability between human subjects. We have demonstrated that the phantom is suitable for selection of inversion delay times, spectral adiabatic inversion recovery delays and assessment of combinatorial methods of fat suppression. The phantom is valuable in protocol development and the assessment of new techniques, particularly in multi-centre trials.", "author" : [ { "dropping-particle" : "", "family" : "Winfield", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Douglas", "given" : "N H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Desouza", "given" : "N M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physics in medicine and biology", "id" : "ITEM-2", "issue" : "9", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "2235-48", "title" : "Phantom for assessment of fat suppression in large field-of-view diffusion-weighted magnetic resonance imaging.", "type" : "article-journal", "volume" : "59" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[12,13]", "plainTextFormattedCitation" : "[12,13]", "previouslyFormattedCitation" : "[12,13]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[12,13]. Following agreements with responsible radiologists, the measurement protocol parameters including length of torso coverage, in-plane field of view (FOV), image matrix, corresponding voxel sizes, slice thickness, fat-suppression methods for diffusion sequences should be determined and fixed to enable intra- and inter-subject comparisons within study cohorts.? Care should be taken when employing vendor provided workflow optimisation software, which can unexpectedly change sequence parameters and image matrices without user notifications.????????Since effective fat suppression is a prerequisite for water ADC assessments in bone marrow both olefinic and aliphatic compounds require suppression, this is ideally realized using inversion recovery methods (STIR).? The effectiveness of fat-suppression should be evaluated in normal volunteers with a range of body mass index and suitable test objects as detailed below under the quality assurance section.?For research studies, it is additionally necessary to measure and document repeatability and reproducibility of diffusivity measures (including ADC) during trial set-up, using volunteers to evaluate various body tissues at each bed position in the midline and off-centre.4.2 Machine quality assurance (QA)The QA program should as far as possible be under the supervision of clinical scientists/medical physicists for research studies but maybe undertaken by trained experienced technologists/radiographers for routine clinical studies.Many clinical departments do not perform routine QA measurements, partly as there are no established tolerances to indicate at which point remedial action is to be taken. However, a general QA program should be established according to manufacturer recommendations, and extended to include DWI when quantitative ADC assessments measurements are being used for lesion detection, characterization and for response assessments ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "PMID" : "15152682", "abstract" : "This work describes the development of a quality control protocol, which can be implemented to assess the accuracy, precision and reproducibility of the apparent diffusion coefficient (ADC) measurement on a clinical magnetic resonance imaging (MRI) system. The precision and accuracy of the ADC measurement are analysed with regard to MRI system noise, signal reproducibility and differences between nominal and effective b values. Two aqueous test-solutions of CuSO4 and sucrose are prepared for the quality control protocol. ADC measurement with the CuSO4 solution is more sensitive to differences between nominal and effective b values, on account of the solution's high ADC. ADC measurement with the sucrose solution is more sensitive to signal reproducibility due to the solution's low baseline signal intensity. The ADC of the test-solutions is measured on an MRI system at our centre with a sequence used for clinical studies using diffusion imaging. Two parameters, Q and R, are defined for the analysis of the quality control ADC values. The Q parameter is the ratio of the standard deviation of the quality control mean ADC values over time to the optimal standard deviation, as derived from the effect of thermal noise on the ADC measurement uncertainty. Analysis with the Q parameter indicates that signal reproducibility errors contribute to ADC variations on our MRI system when imaging with high b values (b > 500 mm s(-2)), whereas differences between nominal and effective b values have a greater impact on the ADC measurement when imaging with low b values (b < 500 mm s(-2)). The R parameter is defined as the ratio of the directional variation of the ADC quality control values to the uncertainty of the ADC measurement. Analysis with the R parameter shows that the effect of directional variation of the ADC measurement on our MRI system is more pronounced when imaging with low b values. The quality control protocol identified a systematic error, which introduced a small system-induced anisotropy in the ADC measurement. This error is currently taken into account in the analysis of clinical studies employing the diffusion imaging sequence used in this quality control protocol.", "author" : [ { "dropping-particle" : "", "family" : "Delakis", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moore", "given" : "E M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leach", "given" : "M O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilde", "given" : "J P", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" } ], "container-title" : "Phys Med Biol", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "Journal Article\nResearch Support, Non-U.S. Gov't", "page" : "1409-1422", "title" : "Developing a quality control protocol for diffusion imaging on a clinical MRI system", "type" : "article-journal", "volume" : "49" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[14]", "plainTextFormattedCitation" : "[14]", "previouslyFormattedCitation" : "[14]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[14]. Initial set-up of quantitative WB-DWI measurements should include assessments of uniformity of ADC over large field of view in all three axes, evaluations of B0 distortions and measures of ghosting resulting from, EPI readout, parallel imaging and eddy currents. Test objects should be employed to optimize fat suppression over large fields of view should be used ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1088/0031-9155/59/9/2235", "ISSN" : "1361-6560", "PMID" : "24710825", "abstract" : "We present the development and application of a phantom for assessment and optimization of fat suppression over a large field-of-view in diffusion-weighted magnetic resonance imaging at 1.5 T and 3 T. A Perspex cylinder (inner diameter 185 mm, height 300 mm) which contains a second cylinder (inner diameter 140 mm) was constructed. The inner cylinder was filled with water doped with copper sulphate and sodium chloride and the annulus was filled with corn oil, which closely matches the spectrum and longitudinal relaxation times of subcutaneous abdominal fat. Placement of the phantom on the couch at 45\u00b0 to the z-axis presented an elliptical cross-section, which was of a similar size and shape to axial abdominal images. The use of a phantom for optimization of fat suppression allowed quantitative comparison between studies without the differences introduced by variability between human subjects. We have demonstrated that the phantom is suitable for selection of inversion delay times, spectral adiabatic inversion recovery delays and assessment of combinatorial methods of fat suppression. The phantom is valuable in protocol development and the assessment of new techniques, particularly in multi-centre trials.", "author" : [ { "dropping-particle" : "", "family" : "Winfield", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Douglas", "given" : "N H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Desouza", "given" : "N M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physics in medicine and biology", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "2235-48", "title" : "Phantom for assessment of fat suppression in large field-of-view diffusion-weighted magnetic resonance imaging.", "type" : "article-journal", "volume" : "59" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[13]", "plainTextFormattedCitation" : "[13]", "previouslyFormattedCitation" : "[13]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[13]. This applies equally to clinical and research uses. Detailed DWI QA measurements should be performed and documented at least monthly for research studies and more than 6 monthly for clinical applications. Consideration should be given to repeating routine and DWI QA measurements after repairs and routine maintenance, after cryogen fills, and whenever there are adjustments to the scanner default parameters. Extra QA checks are needed after software or hardware upgrades (Supplementary Fig. 1). Deviations in established measurement performance should be reported to a clinical scientist/medical physicist for evaluation and remedial action.To enable comparisons of diffusion weighted images between machines, QA measurements of b-value signal intensities, SNR and ADC measurements should be undertaken using biologic tissues with low variance in diffusion properties such as the brain, or test objects made of bioequivalent materials.Suitable test materials for ADC assessment include PVP (polymerpolyvinylpyrrolidone)-solutions or sucrose solutions ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/jmri.22363", "ISSN" : "1522-2586", "PMID" : "21928310", "abstract" : "PURPOSE To present the use of a quality control ice-water phantom for diffusion-weighted magnetic resonance imaging (DW-MRI). DW-MRI has emerged as an important cancer imaging biomarker candidate for diagnosis and early treatment response assessment. Validating imaging biomarkers through multicenter trials requires calibration and performance testing across sites. MATERIALS AND METHODS The phantom consisted of a center tube filled with distilled water surrounded by ice water. Following preparation of the phantom, \u224830 minutes was allowed to reach thermal equilibrium. DW-MRI data were collected at seven institutions, 20 MRI scanners from three vendors, and two field strengths (1.5 and 3T). The phantom was also scanned on a single system on 16 different days over a 25-day period. All data were transferred to a central processing site at the University of Michigan for analysis. RESULTS Results revealed that the variation of measured apparent diffusion coefficient (ADC) values between all systems tested was \u00b15%, indicating excellent agreement between systems. Reproducibility of a single system over a 25-day period was also found to be within \u00b15% ADC values. Overall, the use of an ice-water phantom for assessment of ADC was found to be a reasonable candidate for use in multicenter trials. CONCLUSION The ice-water phantom described here is a practical and universal approach to validate the accuracy of ADC measurements with ever changing MRI sequence and hardware design and can be readily implemented in multicenter clinical trial designs.", "author" : [ { "dropping-particle" : "", "family" : "Chenevert", "given" : "Thomas L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Galb\u00e1n", "given" : "Craig J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ivancevic", "given" : "Marko K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rohrer", "given" : "Susan E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Londy", "given" : "Frank J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwee", "given" : "Thomas C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meyer", "given" : "Charles R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "Timothy D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rehemtulla", "given" : "Alnawaz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ross", "given" : "Brian D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of magnetic resonance imaging : JMRI", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011", "10" ] ] }, "page" : "983-7", "title" : "Diffusion coefficient measurement using a temperature-controlled fluid for quality control in multicenter studies.", "type" : "article-journal", "volume" : "34" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[15]", "plainTextFormattedCitation" : "[15]", "previouslyFormattedCitation" : "[15]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[15], iced-water phantoms although designed for smaller FOV imaging maybe adapted for these purposes ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.drudis.2011.09.009", "ISBN" : "6176321972", "ISSN" : "1522-2586", "PMID" : "25667948", "abstract" : "PURPOSE To describe an efficient procedure to empirically characterize gradient nonlinearity and correct for the corresponding apparent diffusion coefficient (ADC) bias on a clinical magnetic resonance imaging (MRI) scanner. MATERIALS AND METHODS Spatial nonlinearity scalars for individual gradient coils along superior and right directions were estimated via diffusion measurements of an isotropicic e-water phantom. Digital nonlinearity model from an independent scanner, described in the literature, was rescaled by system-specific scalars to approximate 3D bias correction maps. Correction efficacy was assessed by comparison to unbiased ADC values measured at isocenter. RESULTS Empirically estimated nonlinearity scalars were confirmed by geometric distortion measurements of a regular grid phantom. The applied nonlinearity correction for arbitrarily oriented diffusion gradients reduced ADC bias from 20% down to 2% at clinically relevant offsets both for isotropic and anisotropic media. Identical performance was achieved using either corrected diffusion-weighted imaging (DWI) intensities or corrected b-values for each direction in brain and ice-water. Direction-average trace image correction was adequate only for isotropic medium. CONCLUSION Empiric scalar adjustment of an independent gradient nonlinearity model adequately described DWI bias for a clinical scanner. Observed efficiency of implemented ADC bias correction quantitatively agreed with previous theoretical predictions and numerical simulations. The described procedure provides an independent benchmark for nonlinearity bias correction of clinical MRI scanners.", "author" : [ { "dropping-particle" : "", "family" : "Malkyarenko", "given" : "Dariya I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chenevert", "given" : "Thomas L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of magnetic resonance imaging : JMRI", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2014", "12" ] ] }, "page" : "1487-95", "title" : "Practical estimate of gradient nonlinearity for implementation of apparent diffusion coefficient bias correction.", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1088/0031-9155/59/9/2235", "ISSN" : "1361-6560", "PMID" : "24710825", "abstract" : "We present the development and application of a phantom for assessment and optimization of fat suppression over a large field-of-view in diffusion-weighted magnetic resonance imaging at 1.5 T and 3 T. A Perspex cylinder (inner diameter 185 mm, height 300 mm) which contains a second cylinder (inner diameter 140 mm) was constructed. The inner cylinder was filled with water doped with copper sulphate and sodium chloride and the annulus was filled with corn oil, which closely matches the spectrum and longitudinal relaxation times of subcutaneous abdominal fat. Placement of the phantom on the couch at 45\u00b0 to the z-axis presented an elliptical cross-section, which was of a similar size and shape to axial abdominal images. The use of a phantom for optimization of fat suppression allowed quantitative comparison between studies without the differences introduced by variability between human subjects. We have demonstrated that the phantom is suitable for selection of inversion delay times, spectral adiabatic inversion recovery delays and assessment of combinatorial methods of fat suppression. The phantom is valuable in protocol development and the assessment of new techniques, particularly in multi-centre trials.", "author" : [ { "dropping-particle" : "", "family" : "Winfield", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Douglas", "given" : "N H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Desouza", "given" : "N M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physics in medicine and biology", "id" : "ITEM-2", "issue" : "9", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "2235-48", "title" : "Phantom for assessment of fat suppression in large field-of-view diffusion-weighted magnetic resonance imaging.", "type" : "article-journal", "volume" : "59" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[13,16]", "plainTextFormattedCitation" : "[13,16]", "previouslyFormattedCitation" : "[13,16]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[13,16]. Test-objects using corn oil [16] for fat fraction assessment and fat suppression maybe also used.Detailed recommendations on QA procedures for quantitative WB-DWI can be found on the UK Quantitative WB-DWI Technical Workgroup 2016 website (). 4.3 Image quality control (QA)It is important to emphasize the need for consistent patient preparation, patient positioning and scanning procedures in order to obtain consistent reproducible imaging, to allow comparisons between studies.Patients should be asked to lie on the MR table in a headfirst, supine position, with their head resting in the appropriate head-coil and their arms by their sides (where possible). Generally, if only the axial skeleton is to be scanned a leg-rest/knee support should be used as it provides patient comfort and improves patient compliance.In standard whole-body MRI, surface receiver coils should be placed on top of the patient ensuring the length of head-feet coverage. There should be no gaps in the coil coverage between these positions. The coils used should be site-specific and, should be the same for all patients.Attention to patient comfort and adequate pain control are essential, especially as comprehensive WB-MRI scans can take between 45-60 minutes to complete (depending on machine performance and anatomic imaging coverage required).Taking these factors into consideration, the supervising radiologist/technologist/clinical scientist should optimize imaging protocols in order to obtain the best and most consistent image quality possible on the MRI scanner(s) used at their institution/centre. Imaging sequences for WB-MRI are detailed in 5 and Table 2 of the main paper.Technologists performing the examination and/or supervising radiologists should review image quality at the time of acquisition. They should be trained to detect the most common image artefacts and the approaches to correct these problems. Consequently, if image quality of a measurement is compromised due to patient motion or for another reason, remedial measures may be untaken.Additional regional imaging should be undertaken to evaluate disease sites/anatomic regions as needed (for local tumour recurrence, dedicated small FOV images to evaluate spinal cord compression or neural foramina compromise, contrast enhancement for brain evaluations, etc)..5. Sequence specificationsWB-MRI studies should always include combinations of imaging sequences [T1-weighted (T1W), T2-weighted (T2W), short tau inversion recovery (STIR)] and diffusion weighted imaging (DWI). Bone marrow fat and water imaging using Dixon techniques, dedicated anatomic images of body parts and contrast medium enhancement maybe used as indicated in Table 2 of the main paper.T1W images are useful for detection of visceral, nodal and skeletal metastases. A combination of 2D spin-echo (SE) and gradient-recalled echo (GRE) techniques can be utilized as detailed in Table 2 of the main paper. In order to speed up SE sequences, a fast or turbo-spin echo (FSE/TSE) sequence with an echo-train length of 3-5 may be employed. When GRE sequences are used, we recommend the Dixon technique ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.mri.2012.10.017", "ISSN" : "1873-5894", "PMID" : "23290478", "abstract" : "PURPOSE: The purpose of the study was to evaluate the conspicuity of bone metastases on each of the numerous sequences produced by fast Dixon-based multisequence whole-body (WB) magnetic resonance imaging (MRI) scanning in order to determine the most clinically useful sequences overall and per anatomic region. MATERIALS AND METHODS: Twenty-seven breast cancer patients with bone metastases were prospectively studied with fast Dixon-based WB MRI including head/neck, chest, abdominal, pelvic, thigh, calf/feet and either cervical, thoracic and lumbar or cervical/thoracic and thoracic/lumbar regions. Sequences included coronal T2, axial T1 without and with intravenous gadolinium (+C), sagittal T1 spine+C, each associated fat-only (FO) and fat-saturated (FS) sequence, axial diffusion-weighted imaging (DWI) and short tau inversion recovery (STIR). Blinded reviewers evaluated lesion conspicuity, a surrogate of clinical utility, on a five-point scale per anatomic region. Sequences were compared using analysis of variance, differences were detected with Tukey's honestly significant difference test, and the four sequences with highest mean conspicuity were compared to the remainder overall and per anatomic region. RESULTS: Overall, a significant lesion conspicuity difference was found (P<.0001), and lesion conspicuity was significantly higher on FS T1+C, FO T1+C, T1+C sagittal and FS T1+C axial sequences (P<.0001). Per-region results were the same in the head/neck. Other sequences overlapped with these and included the following: chest/abdomen - FO T2, DWI; pelvis - DWI, FO T2; thigh - FS T2, FO T2, FO T1+C; calf/feet - FS T2, DWI, FO T2, STIR. CONCLUSION: Overall, bone lesions were most conspicuous on FS T1+C sagittal, FO T1+C sagittal, T1+C sagittal and FS T1+C axial fast Dixon WB MRI sequences.", "author" : [ { "dropping-particle" : "", "family" : "Costelloe", "given" : "Colleen M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Madewell", "given" : "John E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kundra", "given" : "Vikas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harrell", "given" : "Robyn K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bassett", "given" : "Roland L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ma", "given" : "Jingfei", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Magnetic Resonance Imaging", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2013", "6", "2" ] ] }, "page" : "669-75", "publisher" : "Elsevier B.V.", "title" : "Conspicuity of bone metastases on fast Dixon-based multisequence whole-body MRI: Clinical utility per sequence.", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/jmri.22815", "ISSN" : "1522-2586", "PMID" : "21990095", "abstract" : "PURPOSE To evaluate the feasibility of fast Dixon whole-body (WB) magnetic resonance imaging (MRI) for detecting bone and liver metastasis in clinical patients and to compare its performance with skeletal scintigraphy (SS) for detecting bone metastases using reference imaging with >1 year follow-up as the gold standard. MATERIALS AND METHODS Twenty-nine patients with bone metastases prospectively underwent WB MRI and SS. WB MRI included coronal T2, axial T1 with and without intravenous gadolinium (including triphasic liver sequences), and axial diffusion-weighted imaging, plus spinal sagittal postcontrast T1-weighted images. The skeleton was divided into 16 segments. Reviewers blinded to other images identified up to five lesions per segment and rated them using a five-point confidence scale for metastatic disease. Sensitivities and specificities were compared using the McNemar test. RESULTS The sensitivity of WB MRI and SS in detecting bone metastases was 70.8% and 59.6% (P = 0.003), respectively; specificity was 89.1% and 98.7% (P < 0.0001). WB MRI detected all livers with metastases (n = 8). One focal nodular hyperplasia was classified as a metastasis on WB MRI. CONCLUSION Fast Dixon WB MRI is feasible in clinical patients, highly specific, and more sensitive than SS in detecting bone metastases, and can detect metastases of the liver.", "author" : [ { "dropping-particle" : "", "family" : "Costelloe", "given" : "Colleen M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kundra", "given" : "Vikas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ma", "given" : "Jingfei", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chasen", "given" : "Beth a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rohren", "given" : "Eric M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bassett", "given" : "Roland L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Madewell", "given" : "John E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of magnetic resonance imaging : JMRI", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2012", "2", "11" ] ] }, "page" : "399-408", "title" : "Fast Dixon whole-body MRI for detecting distant cancer metastasis: a preliminary clinical study.", "type" : "article-journal", "volume" : "35" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[17,18]", "plainTextFormattedCitation" : "[17,18]", "previouslyFormattedCitation" : "[17,18]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[17,18] because it enables the calculation of bone marrow fat fraction ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/jmri.23741", "ISSN" : "1522-2586", "PMID" : "22777847", "author" : [ { "dropping-particle" : "", "family" : "Reeder", "given" : "Scott B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hu", "given" : "Houchun H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sirlin", "given" : "Claude B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of magnetic resonance imaging : JMRI", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012", "11", "6" ] ] }, "page" : "1011-4", "title" : "Proton density fat-fraction: a standardized MR-based biomarker of tissue fat concentration.", "type" : "article-journal", "volume" : "36" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/mrm.20291 [doi]", "ISBN" : "0740-3194 (Print)\r0740-3194 (Linking)", "PMID" : "15562475", "abstract" : "Whole-body imaging of therapeutic response in human bone marrow was achieved without introduced contrast agents using diffusion-weighted echo-planar magnetic resonance imaging of physiologic water. Bone marrow disease was identified relative to the strong overlying signals from water and lipids in other anatomy through selective excitation of the water resonance and generation of image contrast that was dependent upon differential nuclear relaxation times and self-diffusion coefficients. Three-dimensional displays were generated to aid image interpretation. The geometric distortion inherent in echo-planar imaging techniques was minimized through the acquisition of multiple axial slices at up to 12 anatomic stations over the entire body. Examples presented include the evaluation of therapeutic response in bone marrow during cytotoxic therapy for leukemia and metastatic prostate cancer and during cytokine administration for marrow mobilization prior to stem cell harvest.", "author" : [ { "dropping-particle" : "", "family" : "Ballon", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Watts", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dyke", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lis", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morris", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scher", "given" : "H I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ulug", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jakubowski", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Magn Reson Med", "edition" : "2004/11/25", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2004" ] ] }, "language" : "eng", "note" : "Ballon, Douglas\nWatts, Richard\nDyke, Jonathan P\nLis, Eric\nMorris, Michael J\nScher, Howard I\nUlug, Aziz M\nJakubowski, Ann A\nEB002070/EB/NIBIB NIH HHS/United States\nHL50139/HL/NHLBI NIH HHS/United States\nR01 EB002070-09/EB/NIBIB NIH HHS/United States\nR01 HL050139-05A1/HL/NHLBI NIH HHS/United States\nR01 HL050139-06/HL/NHLBI NIH HHS/United States\nR01 HL050139-07/HL/NHLBI NIH HHS/United States\nR01 HL050139-08/HL/NHLBI NIH HHS/United States\nResearch Support, U.S. Gov't, Non-P.H.S.\nResearch Support, U.S. Gov't, P.H.S.\nUnited States\nMagnetic resonance in medicine : official journal of the Society of Magnetic Resonance in Medicine / Society of Magnetic Resonance in Medicine\nMagn Reson Med. 2004 Dec;52(6):1234-8.", "page" : "1234-1238", "title" : "Imaging therapeutic response in human bone marrow using rapid whole-body MRI", "type" : "article-journal", "volume" : "52" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[19,20]", "plainTextFormattedCitation" : "[19,20]", "previouslyFormattedCitation" : "[19,20]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[19,20]. As an alternative to the 2D techniques above, a 3D TSE T1W sequences can be acquired instead if machine performance allows ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1148/radiol.14141242", "ISBN" : "0033-8419", "ISSN" : "1527-1315", "PMID" : "25513855", "abstract" : "PURPOSE To develop and assess the diagnostic performance of a three-dimensional (3D) whole-body T1-weighted magnetic resonance (MR) imaging pulse sequence at 3.0 T for bone and node staging in patients with prostate cancer. MATERIALS AND METHODS This prospective study was approved by the institutional ethics committee; informed consent was obtained from all patients. Thirty patients with prostate cancer at high risk for metastases underwent whole-body 3D T1-weighted imaging in addition to the routine MR imaging protocol for node and/or bone metastasis screening, which included coronal two-dimensional (2D) whole-body T1-weighted MR imaging, sagittal proton-density fat-saturated (PDFS) imaging of the spine, and whole-body diffusion-weighted MR imaging. Two observers read the 2D and 3D images separately in a blinded manner for bone and node screening. Images were read in random order. The consensus review of MR images and the findings at prospective clinical and MR imaging follow-up at 6 months were used as the standard of reference. The interobserver agreement and diagnostic performance of each sequence were assessed on per-patient and per-lesion bases. RESULTS The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were significantly higher with whole-body 3D T1-weighted imaging than with whole-body 2D T1-weighted imaging regardless of the reference region (bone or fat) and lesion location (bone or node) (P < .003 for all). For node metastasis, diagnostic performance (area under the receiver operating characteristic curve) was higher for whole-body 3D T1-weighted imaging (per-patient analysis; observer 1: P < .001 for 2D T1-weighted imaging vs 3D T1-weighted imaging, P = .006 for 2D T1-weighted imaging + PDFS imaging vs 3D T1-weighted imaging; observer 2: P = .006 for 2D T1-weighted imaging vs 3D T1-weighted imaging, P = .006 for 2D T1-weighted imaging + PDFS imaging vs 3D T1-weighted imaging), as was sensitivity (per-lesion analysis; observer 1: P < .001 for 2D T1-weighted imaging vs 3D T1-weighted imaging, P < .001 for 2D T1-weighted imaging + PDFS imaging vs 3D T1-weighted imaging; observer 2: P < .001 for 2D T1-weighted imaging vs 3D T1-weighted imaging, P < .001 for 2D T1-weighted imaging + PDFS imaging vs 3D T1-weighted imaging). CONCLUSION Whole-body MR imaging is feasible with a 3D T1-weighted sequence and provides better SNR and CNR compared with 2D sequences, with a diagnostic performance that is as good or better for the detection of\u2026", "author" : [ { "dropping-particle" : "", "family" : "Pasoglou", "given" : "Vasiliki", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michoux", "given" : "Nicolas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peeters", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Larbi", "given" : "Ahmed", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tombal", "given" : "Bertrand", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Selleslagh", "given" : "Tom", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Omoumi", "given" : "Patrick", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berg", "given" : "Bruno C.", "non-dropping-particle" : "Vande", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lecouvet", "given" : "Fr\u00e9d\u00e9ric E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Radiology", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2015", "4" ] ] }, "page" : "155-66", "title" : "Whole-body 3D T1-weighted MR imaging in patients with prostate cancer: feasibility and evaluation in screening for metastatic disease.", "type" : "article-journal", "volume" : "275" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[10]", "plainTextFormattedCitation" : "[10]", "previouslyFormattedCitation" : "[10]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[10]. T2W images are used to depict soft tissue anatomy, to assess visceral organs including the lungs, liver, kidneys, rectum and bladder for local and distant tumour spread and to assess complications induced by the primary tumour. Fat suppression of T2W images is not routinely recommended; low b-value DWI (b50-b100) can be used as an anatomic, fat-suppressed T2W imaging substitute if required (to detect bone or soft tissue oedema, for the detection of free fluid, or for co-registration of images). Both T2W and STIR sequences are helpful for assessing the spinal canal, for disease encroachment and spinal cord compression detection. Traditionally, whole body STIR imaging was undertaken as part of WB-MRI evaluations, but these are no longer recommended. Rarely, when the quality of the spinal STIR images are suboptimal, a T2W fat suppressed sequence can be used as an alternative, although uneven fat-suppression may occur. Alternate methods of fat suppression of the spine T2W images include Dixon sequences. Diffusion Weighted Imaging (DWI) of the whole body are considered essential for WB-MRI evaluations. Spin-echo echo-planar imaging (EPI) sequences at multiple stations are required, to cover the torso from the skull base to the mid-thighs in the axial plane. When needed, imaging can be extended cranially to include the entire skull. Typical parameters for the major manufacturers are given in Supplementary Table 1. There are a number of factors that need to be considered when choosing the b-values of DWI. There is a need to retain an outline of the body to enable registration of images to anatomy sequences and for subsequent comparisons. Image artefacts (e.g., distortion, susceptibility, and poor fat suppression) need to be minimized whilst maximizing tumour/bone marrow contrast to background ratio. There is a need to minimize perfusion and maximize sensitivity to bone marrow cellular content. Since high b-value images are also used to evaluate normal and pathologic soft tissues (liver, nodes etc), intermediate b-values may also be needed. Finally, there is an absolute need to obtain reliable estimates of apparent diffusion coefficient (ADC) values.Taking these considerations into account, two b-values are recommended as a minimum (b50-100 s/mm2 and b800-1000 s/mm2), with an intervening b500-600 s/mm2 image set obtained optionally, to stabilize ADC calculations and to provide improved SNR for the assessments of bone, liver and nodal disease.Acquisition of ultra-high b-value images (≥1000 s/mm2) is discouraged, due to greater image distortions and the need for longer echo-times (TE) resulting in poor SNR. However, ultra-high b-value images may be extrapolated from the “source” DWI images without scanner time penalty, to facilitate image segmentation of bone metastases ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pone.0091779", "ISSN" : "1932-6203", "PMID" : "24710083", "abstract" : "We describe our semi-automatic segmentation of whole-body diffusion-weighted MRI (WBDWI) using a Markov random field (MRF) model to derive tumor total diffusion volume (tDV) and associated global apparent diffusion coefficient (gADC); and demonstrate the feasibility of using these indices for assessing tumor burden and response to treatment in patients with bone metastases. WBDWI was performed on eleven patients diagnosed with bone metastases from breast and prostate cancers before and after anti-cancer therapies. Semi-automatic segmentation incorporating a MRF model was performed in all patients below the C4 vertebra by an experienced radiologist with over eight years of clinical experience in body DWI. Changes in tDV and gADC distributions were compared with overall response determined by all imaging, tumor markers and clinical findings at serial follow up. The segmentation technique was possible in all patients although erroneous volumes of interest were generated in one patient because of poor fat suppression in the pelvis, requiring manual correction. Responding patients showed a larger increase in gADC (median change = +0.18, range = -0.07 to +0.78 \u00d7 10(-3) mm2/s) after treatment compared to non-responding patients (median change = -0.02, range = -0.10 to +0.05 \u00d7 10(-3) mm2/s, p = 0.05, Mann-Whitney test), whereas non-responding patients showed a significantly larger increase in tDV (median change = +26%, range = +3 to +284%) compared to responding patients (median change = -50%, range = -85 to +27%, p = 0.02, Mann-Whitney test). Semi-automatic segmentation of WBDWI is feasible for metastatic bone disease in this pilot cohort of 11 patients, and could be used to quantify tumor total diffusion volume and median global ADC for assessing response to treatment.", "author" : [ { "dropping-particle" : "", "family" : "Blackledge", "given" : "Matthew D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collins", "given" : "David J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tunariu", "given" : "Nina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Orton", "given" : "Matthew R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Padhani", "given" : "Anwar R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leach", "given" : "Martin O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koh", "given" : "Dow-Mu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PloS one", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2014", "1" ] ] }, "page" : "e91779", "title" : "Assessment of treatment response by total tumor volume and global apparent diffusion coefficient using diffusion-weighted MRI in patients with metastatic bone disease: a feasibility study.", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[21]", "plainTextFormattedCitation" : "[21]", "previouslyFormattedCitation" : "[21]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[21]. ADC map calculations should as far as possible, not include b0 images (even if b0 images can be obtainable without incurring time penalties). ADC maps should be performed by mono-exponential fitting of the signal intensities of the acquired b-value images. Judicious use of a background image filter maybe helpful; too strong a noise filter applied before estimating the ADC map may result in a loss of anatomical detail; the outline of the body torso needs to be retained on ADC images. Bone marrow fat imagingDixon imaging is a chemical-shift technique that relies on phase differences between the resonance frequency of fat and water, to separate out tissue fat and water fractions. This is done by acquiring images at several echo-times (TE), each of which has a different resulting signal, attributable to fat (F) and water (W) fractions and the phase differences between these fractions. Thus, 4 sets of images are produced (in-phase, opposed phase, fat only (FO) and non-fat (water) only images), which can be used to calculate fat-fraction images (F%). We recommend using a 2-point (echo) Dixon technique recognizing that this method does not correct for T2* effects, which can be done by utilizing a multi-echo technique ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0740-3194", "PMID" : "9581611", "abstract" : "Spatial maps of the percentage cellularity in pelvic bone marrow were calculated at a resolution of 15.6 mm3 from six volunteers and 10 patients treated for documented hematologic disease using a three-point Dixon MRI pulse sequence. The percentage cellularity calculation was aided by analyzing a two-dimensional feature space consisting of the apparent water fraction (Wa), and the T2 relaxation time of water (T2w). An extracellular water fraction was assigned to each voxel on the basis of a two-component T2w algorithm. In six cases, the method was compared to results obtained from core biopsies or aspirates of the posterior iliac crest. The results indicate that segmentation schemes that combine high-quality phase-contrast imaging with nuclear relaxation time measurements can potentially identify the true fractional marrow volume occupied by hematopoietic elements in a variety of clinical situations.", "author" : [ { "dropping-particle" : "", "family" : "Ballon", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jakubowski", "given" : "a a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tulipano", "given" : "P K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Graham", "given" : "M C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schneider", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aghazadeh", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chen", "given" : "Q S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koutcher", "given" : "J a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Magnetic resonance in medicine : official journal of the Society of Magnetic Resonance in Medicine / Society of Magnetic Resonance in Medicine", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "1998", "5" ] ] }, "page" : "789-800", "title" : "Quantitative assessment of bone marrow hematopoiesis using parametric magnetic resonance imaging.", "type" : "article-journal", "volume" : "39" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1097/RLI.0b013e31822b124c", "ISSN" : "1536-0210", "PMID" : "21808200", "abstract" : "OBJECTIVE To investigate three-echo T2*-corrected Dixon magnetic resonance imaging (MRI) for noninvasively estimating hepatic fat content (HFC) compared with biopsy. MATERIALS AND METHODS One hundred patients (50 men, 50 women; mean age, 57.7\u00b114.2 years) underwent clinically indicated liver core biopsy (102 valid tissue samples) and liver MRI 24 to 72 hours later. MRI was performed at 1.5T (Magnetom Avanto, Siemens Healthcare, Erlangen, Germany) using Dixon imaging with T2* correction (work in progress, WIP-432.rev.1, Siemens Healthcare). An ultrafast breath-hold three-echo 3D-gradient echo sequence with TR/TE1/TE2/TE3 of 11/2.4/4.8/9.6 milliseconds, and online calculation of T2*-corrected water images (signal intensities of water [SIW]), fat images (SIF), and fat content map (SIFAT=10\u00d7SIF/(SIW+SIF)) was used. SIs of the calculated fat content map (SIFAT) were verified using the histologically quantified HFC (HFC(path)). Spearman correlation for HFC(path) and SIFAT was calculated. Stage of fibrosis, hepatic iron content, and patterns of liver fat (macrovesicular, microvesicular, mixed) and their influence on predicting HFC by MRI were determined. RESULTS Correlation between SIFAT and HFC(path) was rspearman=0.89. Agreement between HFC predicted by MRI and HFC(path) calculated by nonlinear saturation-growth regression was rspearman=0.89. Kruskal-Wallis analysis revealed no significant difference for SIFAT across fibrosis grades (P=0.90) and liver iron content (P=0.76). Regarding the cellular architecture of liver fat, the microvesicular pattern showed lower mean ranks in SI than macrovesicular and mixed patterns (P=0.01). CONCLUSION T2*-corrected Dixon MRI is a noninvasive tool for estimating HFC, showing excellent correlation with liver biopsy without being limited by liver iron content and fibrosis/cirrhosis.", "author" : [ { "dropping-particle" : "", "family" : "K\u00fchn", "given" : "Jens-Peter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Evert", "given" : "Matthias", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Friedrich", "given" : "Nele", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kannengiesser", "given" : "Stephan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mayerle", "given" : "Julia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thiel", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lerch", "given" : "Markus M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dombrowski", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mensel", "given" : "Birger", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hosten", "given" : "Norbert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Puls", "given" : "Ralf", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Investigative radiology", "id" : "ITEM-2", "issue" : "12", "issued" : { "date-parts" : [ [ "2011", "12" ] ] }, "page" : "783-9", "title" : "Noninvasive quantification of hepatic fat content using three-echo dixon magnetic resonance imaging with correction for T2* relaxation effects.", "type" : "article-journal", "volume" : "46" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[22,23]", "plainTextFormattedCitation" : "[22,23]", "previouslyFormattedCitation" : "[22,23]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[22,23]. Although multipoint, proton density weighted (PDW) Dixon sequences yield the most accurate F% images ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/jmri.23741", "ISSN" : "1522-2586", "PMID" : "22777847", "author" : [ { "dropping-particle" : "", "family" : "Reeder", "given" : "Scott B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hu", "given" : "Houchun H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sirlin", "given" : "Claude B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of magnetic resonance imaging : JMRI", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012", "11", "6" ] ] }, "page" : "1011-4", "title" : "Proton density fat-fraction: a standardized MR-based biomarker of tissue fat concentration.", "type" : "article-journal", "volume" : "36" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[19]", "plainTextFormattedCitation" : "[19]", "previouslyFormattedCitation" : "[19]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[19], the source images have poor image contrast and serve little diagnostic purpose, and so are not recommended. Instead, we suggest the use of a 2-point, T1W, Dixon sequence for the whole body, in the knowledge that there is a likely over-estimate of measured bone marrow F% (relative F%). Dixon T1-weighted images enable the detection of bone marrow and visceral metastases because marrow fat and liver are of higher signal intensity than metastases. Opposed phase images can be useful for bone lesion characterization. Since the bone marrow metastasis detection performance of T1W GRE sequences is slightly worse that (T)SE sequences ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.mri.2012.10.017", "ISSN" : "1873-5894", "PMID" : "23290478", "abstract" : "PURPOSE: The purpose of the study was to evaluate the conspicuity of bone metastases on each of the numerous sequences produced by fast Dixon-based multisequence whole-body (WB) magnetic resonance imaging (MRI) scanning in order to determine the most clinically useful sequences overall and per anatomic region. MATERIALS AND METHODS: Twenty-seven breast cancer patients with bone metastases were prospectively studied with fast Dixon-based WB MRI including head/neck, chest, abdominal, pelvic, thigh, calf/feet and either cervical, thoracic and lumbar or cervical/thoracic and thoracic/lumbar regions. Sequences included coronal T2, axial T1 without and with intravenous gadolinium (+C), sagittal T1 spine+C, each associated fat-only (FO) and fat-saturated (FS) sequence, axial diffusion-weighted imaging (DWI) and short tau inversion recovery (STIR). Blinded reviewers evaluated lesion conspicuity, a surrogate of clinical utility, on a five-point scale per anatomic region. Sequences were compared using analysis of variance, differences were detected with Tukey's honestly significant difference test, and the four sequences with highest mean conspicuity were compared to the remainder overall and per anatomic region. RESULTS: Overall, a significant lesion conspicuity difference was found (P<.0001), and lesion conspicuity was significantly higher on FS T1+C, FO T1+C, T1+C sagittal and FS T1+C axial sequences (P<.0001). Per-region results were the same in the head/neck. Other sequences overlapped with these and included the following: chest/abdomen - FO T2, DWI; pelvis - DWI, FO T2; thigh - FS T2, FO T2, FO T1+C; calf/feet - FS T2, DWI, FO T2, STIR. CONCLUSION: Overall, bone lesions were most conspicuous on FS T1+C sagittal, FO T1+C sagittal, T1+C sagittal and FS T1+C axial fast Dixon WB MRI sequences.", "author" : [ { "dropping-particle" : "", "family" : "Costelloe", "given" : "Colleen M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Madewell", "given" : "John E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kundra", "given" : "Vikas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harrell", "given" : "Robyn K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bassett", "given" : "Roland L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ma", "given" : "Jingfei", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Magnetic Resonance Imaging", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2013", "6", "2" ] ] }, "page" : "669-75", "publisher" : "Elsevier B.V.", "title" : "Conspicuity of bone metastases on fast Dixon-based multisequence whole-body MRI: Clinical utility per sequence.", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[17]", "plainTextFormattedCitation" : "[17]", "previouslyFormattedCitation" : "[17]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[17], we suggest that relative F% images are always reconstructed and evaluated with DWI, for the presence of disease. Contrast medium enhancement is not essential for WB-MRI when the aim is to obtain information on bone and nodal disease. Its value lies in evaluating the prostate gland for local tumour recurrence, and liver and brain for metastatic involvement. 6.Suggested indications for WB-MRI in prostate cancerHigh-risk prostate cancer (Gleason ≥8 and/or PSA ≥20 ng/ml) at presentation ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/nrurol.2015.242", "ISSN" : "1759-4812", "PMID" : "26481576", "author" : [ { "dropping-particle" : "", "family" : "Bjurlin", "given" : "Marc A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rosenkrantz", "given" : "Andrew B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beltran", "given" : "Luis S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raad", "given" : "Roy A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Taneja", "given" : "Samir S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nature Reviews Urology", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "1-12", "title" : "Imaging and evaluation of patients with high-risk prostate cancer", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[24]", "plainTextFormattedCitation" : "[24]", "previouslyFormattedCitation" : "[24]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[24]. The core WB-MRI protocol may be performed to substitute for the combined use of bone scan and a body CT scan ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.eururo.2012.02.020", "ISSN" : "1873-7560", "PMID" : "22366187", "abstract" : "BACKGROUND: Technetium Tc 99m bone scintigraphy (BS) and contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis and abdomen are universally recommended for detecting prostate cancer (PCa) metastases in cancer of all stages. However, this two-step approach has limited sensitivity and specificity. OBJECTIVE: Evaluate the diagnostic accuracy of whole-body MRI (WBMRI) as a one-step screening test for PCa metastases. DESIGN, SETTING, AND PARTICIPANTS: One hundred consecutive PCa patients at high risk for metastases prospectively underwent WBMRI, CT, and BS completed with targeted x-rays (BS/TXR) in case of equivocal BS. Four independent reviewers reviewed the images. MEASUREMENTS: This study compares the diagnostic performance of WBMRI, CT, BS, and BS/TXR in detecting PCa metastases using area under the curve (AUC) receiver operator characteristics. A best valuable comparator (BVC) approach was used to adjudicate final metastatic status in the absence of pathologic evaluation. RESULTS AND LIMITATIONS: Based on the BVC, 68 patients had metastases. The sensitivity of BS/TXR and WBMRI for detecting bone metastases was 86% and 98-100%, respectively (p<0.04), and specificity was 98% and 98-100%, respectively. The first and second WBMRI readers respectively identified bone metastases in 7 and 8 of 55 patients with negative BS/TXR. The sensitivity of CT and WBMRI for detecting enlarged lymph nodes was similar, at 77-82% for both; specificity was 95-96% and 96-98%, respectively. The sensitivity of the combination of BS/TXR plus CT and WBMRI for detecting bone metastases and/or enlarged lymph nodes was 84% and 91-94%, respectively (p=0.03-0.10); specificities were 94-97% and 91-96%, respectively. The 95% confidence interval of the difference between the AUC of the worst WBMRI reading and the AUC of any of the BS/TXR plus CT lay within the noninferiority margin of \u00b110% AUC. CONCLUSIONS: WBMRI outperforms BS/TXR in detecting bone metastases and performs as well as CT for enlarged lymph node evaluation. WBMRI can replace the current multimodality metastatic work-up for the concurrent evaluation of bones and lymph nodes in high-risk PCa patients.", "author" : [ { "dropping-particle" : "", "family" : "Lecouvet", "given" : "Fr\u00e9d\u00e9ric E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mouedden", "given" : "Jawad", "non-dropping-particle" : "El", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collette", "given" : "Laurence", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Coche", "given" : "Emmanuel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Danse", "given" : "Etienne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jamar", "given" : "Fran\u00e7ois", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Machiels", "given" : "Jean-Pascal", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berg", "given" : "Bruno", "non-dropping-particle" : "Vande", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Omoumi", "given" : "Patrick", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tombal", "given" : "Bertrand", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European urology", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2012", "7" ] ] }, "page" : "68-75", "title" : "Can whole-body magnetic resonance imaging with diffusion-weighted imaging replace Tc 99m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer?", "type" : "article-journal", "volume" : "62" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[8]", "plainTextFormattedCitation" : "[8]", "previouslyFormattedCitation" : "[8]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[8]. A chest CT scan may still be required if there are anaplastic features histologically.Equivocal bone scans in newly diagnosed patients to clarify the nature or extent of abnormalities detected. Here a dedicated MRI scan targeted to an abnormality detected by another modality could also suffice. Biochemical recurrence in patients at high risk of developing metastases with or without a prior negative CT and bone scan (various thresholds for higher sensitivity imaging including PET/CT are suggested in the literature including PSA >2ng/mL (post-prostatectomy) or >5 ng/mL (post radiotherapy); PSADT <6 months; and after PSA doubling following prior negative imaging ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.urology.2013.10.026", "ISSN" : "1527-9995", "PMID" : "24411213", "abstract" : "Prostate cancer is often associated with metastases to bone and/or soft tissue. The progression to metastatic castrate-resistant prostate cancer is a seminal event in disease progression affecting treatment decisions. A multidisciplinary group was convened to review the currently available imaging guidelines for metastatic disease in prostate cancer and found no consensus on eligibility criteria, type of imaging modality, and the frequency of scanning for detecting metastatic disease. The aim of this review was to present the recommendations from the group to identify optimal strategies for early identification of metastases in patients with prostate cancer.", "author" : [ { "dropping-particle" : "", "family" : "Crawford", "given" : "E David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stone", "given" : "Nelson N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yu", "given" : "Evan Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koo", "given" : "Phillip J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freedland", "given" : "Stephen J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Slovin", "given" : "Susan F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gomella", "given" : "Leonard G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berger", "given" : "E Roy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Keane", "given" : "Thomas E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sieber", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shore", "given" : "Neal D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Petrylak", "given" : "Daniel P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence (RADAR) Group", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Urology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2014", "3", "8" ] ] }, "page" : "664-9", "publisher" : "Elsevier Inc.", "title" : "Challenges and recommendations for early identification of metastatic disease in prostate cancer.", "type" : "article-journal", "volume" : "83" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/s00345-016-1803-9", "ISSN" : "1433-8726", "PMID" : "26988552", "abstract" : "BACKGROUND Guidelines on the clinical management of non-metastatic castrate-resistant prostate cancer (nmCRPC) generally focus on the need to continue androgen deprivation therapy and enrol patients into clinical trials of investigational agents. This guidance reflects the lack of clinical trial data with established agents in the nmCRPC patient population and the need for trials of new agents. AIM To review the evidence base and consider ways of improving the management of nmCRPC. CONCLUSION Upon the development of castrate resistance, it is essential to rule out the presence of metastases or micrometastases by optimising the use of bone scans and possibly newer procedures and techniques. When nmCRPC is established, management decisions should be individualised according to risk, but risk stratification in this diverse population is poorly defined. Currently, prostate-specific antigen (PSA) levels and PSA doubling time remain the best method of assessing the risk of progression and response to treatment in nmCRPC. However, optimising imaging protocols can also help assess the changing metastatic burden in patients with CRPC. Clinical trials of novel agents in nmCRPC are limited and have problems with enrolment, and therefore, improved risk stratification and imaging may be crucial to the improved management. The statements presented in this paper, reflecting the views of the authors, provide a discussion of the most recent evidence in nmCRPC and provide some advice on how to ensure these patients receive the best management available. However, there is an urgent need for more data on the management of nmCRPC.", "author" : [ { "dropping-particle" : "", "family" : "Rozet", "given" : "Francois", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roumegu\u00e8re", "given" : "Thierry", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Spahn", "given" : "Martin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beyersdorff", "given" : "Dirk", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hammerer", "given" : "Peter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "World journal of urology", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2016", "3", "17" ] ] }, "title" : "Non-metastatic castrate-resistant prostate cancer: a call for improved guidance on clinical management.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[25,26]", "plainTextFormattedCitation" : "[25,26]", "previouslyFormattedCitation" : "[25,26]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[25,26]. Here the aim is to detect oligo-metastatic disease (see below); the core WB-MRI protocol should be sufficient.M0-CRPC with or without a prior negative CT and bone scan (various thresholds for higher sensitivity imaging are suggested in the literature including PSA >2ng/mL or PSA doubling following prior negative imaging ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.urology.2013.10.026", "ISSN" : "1527-9995", "PMID" : "24411213", "abstract" : "Prostate cancer is often associated with metastases to bone and/or soft tissue. The progression to metastatic castrate-resistant prostate cancer is a seminal event in disease progression affecting treatment decisions. A multidisciplinary group was convened to review the currently available imaging guidelines for metastatic disease in prostate cancer and found no consensus on eligibility criteria, type of imaging modality, and the frequency of scanning for detecting metastatic disease. The aim of this review was to present the recommendations from the group to identify optimal strategies for early identification of metastases in patients with prostate cancer.", "author" : [ { "dropping-particle" : "", "family" : "Crawford", "given" : "E David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stone", "given" : "Nelson N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yu", "given" : "Evan Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koo", "given" : "Phillip J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freedland", "given" : "Stephen J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Slovin", "given" : "Susan F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gomella", "given" : "Leonard G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berger", "given" : "E Roy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Keane", "given" : "Thomas E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sieber", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shore", "given" : "Neal D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Petrylak", "given" : "Daniel P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence (RADAR) Group", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Urology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2014", "3", "8" ] ] }, "page" : "664-9", "publisher" : "Elsevier Inc.", "title" : "Challenges and recommendations for early identification of metastatic disease in prostate cancer.", "type" : "article-journal", "volume" : "83" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/s00345-016-1803-9", "ISSN" : "1433-8726", "PMID" : "26988552", "abstract" : "BACKGROUND Guidelines on the clinical management of non-metastatic castrate-resistant prostate cancer (nmCRPC) generally focus on the need to continue androgen deprivation therapy and enrol patients into clinical trials of investigational agents. This guidance reflects the lack of clinical trial data with established agents in the nmCRPC patient population and the need for trials of new agents. AIM To review the evidence base and consider ways of improving the management of nmCRPC. CONCLUSION Upon the development of castrate resistance, it is essential to rule out the presence of metastases or micrometastases by optimising the use of bone scans and possibly newer procedures and techniques. When nmCRPC is established, management decisions should be individualised according to risk, but risk stratification in this diverse population is poorly defined. Currently, prostate-specific antigen (PSA) levels and PSA doubling time remain the best method of assessing the risk of progression and response to treatment in nmCRPC. However, optimising imaging protocols can also help assess the changing metastatic burden in patients with CRPC. Clinical trials of novel agents in nmCRPC are limited and have problems with enrolment, and therefore, improved risk stratification and imaging may be crucial to the improved management. The statements presented in this paper, reflecting the views of the authors, provide a discussion of the most recent evidence in nmCRPC and provide some advice on how to ensure these patients receive the best management available. However, there is an urgent need for more data on the management of nmCRPC.", "author" : [ { "dropping-particle" : "", "family" : "Rozet", "given" : "Francois", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roumegu\u00e8re", "given" : "Thierry", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Spahn", "given" : "Martin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beyersdorff", "given" : "Dirk", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hammerer", "given" : "Peter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "World journal of urology", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2016", "3", "17" ] ] }, "title" : "Non-metastatic castrate-resistant prostate cancer: a call for improved guidance on clinical management.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[25,26]", "plainTextFormattedCitation" : "[25,26]", "previouslyFormattedCitation" : "[25,26]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[25,26]. Here the aim is to detect oligo-metastatic disease (see below); the core WB-MRI protocol should be sufficient.Detecting oligo-metastatic disease when radical therapy to metastatic disease may be an option, with the aim of postponing the onset of systemic treatments ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3389/fonc.2015.00101", "ISSN" : "2234-943X", "PMID" : "26000249", "abstract" : "OBJECTIVE Oligometastatic prostate cancer is a limited metastatic disease state in which potential long-term control is still possible with the use of targeted therapies such as surgery or stereotactic body radiation therapy (SBRT). SBRT may as well potentially prolong the time before the initiation of androgen deprivation therapy (ADT) and docetaxel chemotherapy for oligometastatic prostate cancer. The goal of this study is to outline prognostic factors associated with improved outcome with SBRT for metastatic prostate cancer and to quantify the effect of prior systemic treatments such as ADT and docetaxel on survival after SBRT. METHODS Twenty-four prostate cancer patients were treated with SBRT at the Philadelphia CyberKnife Center between August 2007 and April 2014. Retrospective data collection and analysis were performed for these patients on this Institutional Review Board approved study. Kaplan-Meier methodology was utilized to estimate and visually assess overall survival (OS) at the patient level, with comparisons accomplished using the log-rank test. Unadjusted hazard ratios were estimated using Cox proportional hazards regression modeling. RESULTS An improved median survival was noted for patients with oligometastatic disease defined as \u22644 lesions with median survival of >3 years compared with 11 months for polymetastases (p = 0.02). The use of docetaxel at some time in follow-up either before or after SBRT was associated with decreased survival with median survival of 9 months vs. >3 years (p = 0.01). CONCLUSION Prognosis was better for men with recurrent prostate cancer treated with SBRT if they had \u22644 metastases (oligometastases) or if docetaxel was not necessary for salvage treatment. The prolonged median OS for men with oligometastases in this population of heavily pretreated prostate cancer patients following SBRT may allow for improved quality of life because of a delay of more toxic salvage therapies.", "author" : [ { "dropping-particle" : "", "family" : "Azzam", "given" : "Gregory", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lanciano", "given" : "Rachelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arrigo", "given" : "Steve", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lamond", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ding", "given" : "William", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yang", "given" : "Jun", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanlon", "given" : "Alexandra", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Good", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brady", "given" : "Luther", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Frontiers in oncology", "id" : "ITEM-1", "issue" : "May", "issued" : { "date-parts" : [ [ "2015", "5", "5" ] ] }, "page" : "101", "title" : "SBRT: An Opportunity to Improve Quality of Life for Oligometastatic Prostate Cancer.", "type" : "article-journal", "volume" : "5" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.eururo.2015.07.004", "ISSN" : "1873-7560", "PMID" : "26189689", "abstract" : "UNLABELLED The literature on metastasis-directed therapy for oligometastatic prostate cancer (PCa) recurrence consists of small heterogeneous studies. This study aimed to reduce the heterogeneity by pooling individual patient data from different institutions treating oligometastatic PCa recurrence with stereotactic body radiotherapy (SBRT). We focussed on patients who were treatment naive, with the aim of determining if SBRT could delay disease progression. We included patients with three or fewer metastases. The Kaplan-Meier method was used to estimate distant progression-free survival (DPFS) and local progression-free survival (LPFS). Toxicity was scored using the Common Terminology Criteria for Adverse Events. In total, 163 metastases were treated in 119 patients. The median DPFS was 21 mo (95% confidence interval, 15-26 mo). A lower radiotherapy dose predicted a higher local recurrence rate with a 3-yr LPFS of 79% for patients treated with a biologically effective dose \u2264100Gy versus 99% for patients treated with >100Gy (p=0.01). Seventeen patients (14%) developed toxicity classified as grade 1, and three patients (3%) developed grade 2 toxicity. No grade \u22653 toxicity occurred. These results should serve as a benchmark for future prospective trials. PATIENT SUMMARY This multi-institutional study pools all of the available data on the use of stereotactic body radiotherapy for limited prostate cancer metastases. We concluded that this approach is safe and associated with a prolonged treatment progression-free survival.", "author" : [ { "dropping-particle" : "", "family" : "Ost", "given" : "Piet", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jereczek-Fossa", "given" : "Barbara Alicja", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "Van", "family" : "As", "given" : "Nicholas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zilli", "given" : "Thomas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Muacevic", "given" : "Alexander", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olivier", "given" : "Kenneth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henderson", "given" : "Daniel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Casamassima", "given" : "Franco", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Orecchia", "given" : "Roberto", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Surgo", "given" : "Alessia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "Lindsay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tree", "given" : "Alison", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Miralbell", "given" : "Raymond", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meerleer", "given" : "Gert", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" } ], "container-title" : "European urology", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2016", "1", "16" ] ] }, "page" : "9-12", "title" : "Progression-free Survival Following Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Treatment-naive Recurrence: A Multi-institutional Analysis.", "type" : "article-journal", "volume" : "69" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[27,28]", "plainTextFormattedCitation" : "[27,28]", "previouslyFormattedCitation" : "[27,28]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[27,28]; the core WB-MRI protocol should be sufficient.Rule out occult distant metastases in locally recurrent disease when salvage local therapy is being considered (confirm M0 disease); the core WB-MRI protocol should be sufficient.Known extensive spinal bone metastases on bone or CT scan - to detect clinically occult spinal cord compression (spinal examination only will suffice). A comprehensive WB-MRI protocol should be used as the designated follow-up method.To detect presence and volume of metastatic disease in castrate na?ve prostate cancer being considered for upfront combination hormonal therapy and docetaxel. Here a comprehensive WB-MRI protocol is recommended as WB-MRI is the preferred follow-up method.To monitor response in metastatic patients with bone disease (particularly PSA non- or oligo-secretory disease); baseline & follow-ups scans needed for each therapy instituted. Here a comprehensive WB-MRI protocol is recommended as WB-MRI is the preferred follow-up method.Patients deemed to have “anaplastic or neuro-endocrine features” on clinical/biochemical/imaging grounds (including exclusive visceral or predominantly lytic bone metastases, bulky tumour masses, those with low PSA levels relative to tumour burden and those who have short responses to primary androgen deprivation therapy) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1158/1078-R-12-3791", "ISSN" : "1078-0432", "PMID" : "23649003", "abstract" : "PURPOSE Clinical features characteristic of small-cell prostate carcinoma (SCPC), \"anaplastic,\" often emerge during the progression of prostate cancer. We sought to determine the efficacy of platinum-based chemotherapy in patients meeting at least one of seven prospectively defined \"anaplastic\" clinical criteria, including exclusive visceral or predominantly lytic bone metastases, bulky tumor masses, low prostate-specific antigen levels relative to tumor burden, or short response to androgen deprivation therapy. EXPERIMENTAL DESIGN A 120-patient phase II trial of first-line carboplatin and docetaxel (CD) and second-line etoposide and cisplatin (EP) was designed to provide reliable clinical response estimates under a Bayesian probability model with early stopping rules in place for futility and toxicity. RESULTS Seventy-four of 113 (65.4%) and 24 of 71 (33.8%) were progression free after four cycles of CD and EP, respectively. Median overall survival (OS) was 16 months [95% confidence interval (CI), 13.6-19.0 months]. Of the seven \"anaplastic\" criteria, bulky tumor mass was significantly associated with poor outcome. Lactic acid dehydrogenase strongly predicted for OS and rapid progression. Serum carcinoembryonic antigen (CEA) concentration strongly predicted OS but not rapid progression. Neuroendocrine markers did not predict outcome or response to therapy. CONCLUSION Our findings support the hypothesis that patients with \"anaplastic\" prostate cancer are a recognizable subset characterized by a high response rate of short duration to platinum-containing chemotherapies, similar to SCPC. Our results suggest that CEA is useful for selecting therapy in men with castration-resistant prostate cancer and consolidative therapies to bulky high-grade tumor masses should be considered in this patient population.", "author" : [ { "dropping-particle" : "", "family" : "Aparicio", "given" : "Ana M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harzstark", "given" : "Andrea L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Corn", "given" : "Paul G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wen", "given" : "Sijin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Araujo", "given" : "John C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tu", "given" : "Shi-Ming", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pagliaro", "given" : "Lance C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "Jeri", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Millikan", "given" : "Randall E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ryan", "given" : "Charles", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tannir", "given" : "Nizar M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zurita", "given" : "Amado J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mathew", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arap", "given" : "Wadih", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Troncoso", "given" : "Patricia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thall", "given" : "Peter F.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Logothetis", "given" : "Christopher J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical cancer research : an official journal of the American Association for Cancer Research", "id" : "ITEM-1", "issue" : "13", "issued" : { "date-parts" : [ [ "2013", "7", "1" ] ] }, "page" : "3621-30", "title" : "Platinum-based chemotherapy for variant castrate-resistant prostate cancer.", "type" : "article-journal", "volume" : "19" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[29]", "plainTextFormattedCitation" : "[29]", "previouslyFormattedCitation" : "[29]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[29], who are to be treated with chemotherapy. Here a comprehensive WB-MRI protocol is recommended as WB-MRI is the preferred follow-up method.To confirm bone predominant disease in symptomatic patients when considering Radium-223 treatment. Here a comprehensive WB-MRI protocol is recommended because visceral or bulky nodal disease are therapy contraindications ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMoa1213755", "ISSN" : "1533-4406", "PMID" : "23863050", "abstract" : "BACKGROUND Radium-223 dichloride (radium-223), an alpha emitter, selectively targets bone metastases with alpha particles. We assessed the efficacy and safety of radium-223 as compared with placebo, in addition to the best standard of care, in men with castration-resistant prostate cancer and bone metastases. METHODS In our phase 3, randomized, double-blind, placebo-controlled study, we randomly assigned 921 patients who had received, were not eligible to receive, or declined docetaxel, in a 2:1 ratio, to receive six injections of radium-223 (at a dose of 50 kBq per kilogram of body weight intravenously) or matching placebo; one injection was administered every 4 weeks. In addition, all patients received the best standard of care. The primary end point was overall survival. The main secondary efficacy end points included time to the first symptomatic skeletal event and various biochemical end points. A prespecified interim analysis, conducted when 314 deaths had occurred, assessed the effect of radium-223 versus placebo on survival. An updated analysis, when 528 deaths had occurred, was performed before crossover from placebo to radium-223. RESULTS At the interim analysis, which involved 809 patients, radium-223, as compared with placebo, significantly improved overall survival (median, 14.0 months vs. 11.2 months; hazard ratio, 0.70; 95% confidence interval [CI], 0.55 to 0.88; two-sided P=0.002). The updated analysis involving 921 patients confirmed the radium-223 survival benefit (median, 14.9 months vs. 11.3 months; hazard ratio, 0.70; 95% CI, 0.58 to 0.83; P<0.001). Assessments of all main secondary efficacy end points also showed a benefit of radium-233 as compared with placebo. Radium-223 was associated with low myelosuppression rates and fewer adverse events. CONCLUSIONS In this study, which was terminated for efficacy at the prespecified interim analysis, radium-223 improved overall survival. 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S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sartor", "given" : "O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "ALSYMPCA Investigators", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The New England journal of medicine", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2013", "7", "18" ] ] }, "page" : "213-23", "title" : "Alpha emitter radium-223 and survival in metastatic prostate cancer.", "type" : "article-journal", "volume" : "369" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[30]", "plainTextFormattedCitation" : "[30]", "previouslyFormattedCitation" : "[30]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[30]. ReferencesADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY [1]Scher HI, Morris MJ, Stadler WM, Higano C, Basch E, Fizazi K, et al. 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Urology 2014;83:664–9. doi:10.1016/j.urology.2013.10.026.[26]Rozet F, Roumeguère T, Spahn M, Beyersdorff D, Hammerer P. Non-metastatic castrate-resistant prostate cancer: a call for improved guidance on clinical management. World J Urol 2016. doi:10.1007/s00345-016-1803-9.[27]Azzam G, Lanciano R, Arrigo S, Lamond J, Ding W, Yang J, et al. SBRT: An Opportunity to Improve Quality of Life for Oligometastatic Prostate Cancer. Front Oncol 2015;5:101. doi:10.3389/fonc.2015.00101.[28]Ost P, Jereczek-Fossa BA, As N Van, Zilli T, Muacevic A, Olivier K, et al. Progression-free Survival Following Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Treatment-naive Recurrence: A Multi-institutional Analysis. Eur Urol 2016;69:9–12. doi:10.1016/j.eururo.2015.07.004.[29]Aparicio AM, Harzstark AL, Corn PG, Wen S, Araujo JC, Tu S-M, et al. Platinum-based chemotherapy for variant castrate-resistant prostate cancer. 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N Engl J Med 2013;369:213–23. doi:10.1056/NEJMoa1213755.Supplementary Table 1 – Whole body diffusion weighted MRI sequence parametersSiemens’ 1.5T Avanto system Philips 1.5T Intera systemGE 1.5T Signa systemImaging planeAxial AxialAxialField of View (cm)400400400Matrix Size128 - 150 128128Repetition time TR (ms)6000-800083226625Echo timeTE (ms)MinMinMinParallel imaging factor222No. of signals averaged for high b-value images4-5(reduce for low b-value if available)4 (b = 50)12 (b = 800-1000)4(reduce for low b-value if available)Section thickness (mm)5-7 contiguous5-7 contiguous5-7 contiguousDirection of motion probing gradients3 scan traceTraceAllReceiver bandwidth1800 Hz/pixel7.757 (water-fat shift/ px)976Hz/pixelFat SuppressionSTIR (TI = 180 ms)STIR (TI = 180 ms)STIR ( TI = 170 ms)b-values (s/mm2)Typically 50-100 and 800-1000Typically 50-100 and 800-1000Typically 50-100 and 800-1000Acquisition time per station4 mins 30 seconds4 mins 2 seconds4 minutesSupplementary Table 2 – Discordant assessments of primary, secondary and tertiary responsesPrimary pattern (first number)RAC 1-5Dominant (≥50%) pattern of response within regionSecondary pattern (second number) RAC 1-5Second most frequent pattern of response within regionTertiary pattern (third number)*RAC 4-5Evidence of progressing disease (only if not primary or secondary pattern)The five potential RACs are defined as: (1) highly likely to be responding, (2) likely to be responding, (3) stable, (4) likely to be progressing and (5) highly likely to be progressing.The maximum % of tertiary pattern 4 or 5 is 20%Supplementary Fig. 1 – Hardware and software upgrades change image quality.51-year-old female with metastatic breast cancer in clinical remission, on maintenance Trastuzumab emtansine treatment. Three examinations have been obtained on the dates indicated. The dates and sequence parameters have been left on the images for reader review.Images are inverted MIP images of b900 diffusion weighted images using inversion recovery fat-saturation sequences. Examination 1 and 2 were undertaken at 1.5T before and after a hardware and software upgrade. Examination 3 was undertaken a few days after examination 2, at 3T on the same manufacturer’s equipment.Note the dramatic difference with the 1.5T upgrade (higher SNR generally and the improved visibility of anterior structures (anterior ribs and groin nodes)). The examination undertaken at 3T a few days after examination 2, shows decreased visibility of the normal bone marrow which is due to the effects of increased susceptibility of trabecular bone encountered at 3T. Supplementary Fig. 2 – Bone marrow growth factors obscuring the presence of metastases.53 yrs old male with PSA oligosecretory mCRPC (PSA 6.1ng/mL), failed Abiraterone therapy. Pre and post 4 cycles of Docetaxel chemotherapy with granulocyte colony stimulating factor (G-CSF) support for all 4 cycles. PSA is 8.3 ng/mL after treatment.Left image pair: b900 MIP projections (inverted scale) shows background bone marrow hyperplasia in the axial skeleton after treatment. Individual deposits are no longer assessable for response.Middle image pair: T1W spine showing the replacement of bone marrow fat consistent with bone marrow hyperplasia. Individual deposits are difficult to assess for response. New lesions cannot be identified with confidence.Right image pair: T2W+FS showing mild increase in background signal consistent with bone marrow hyperplasia. Supplementary Fig. 3 – Monitoring therapy response – effects of b-value choice on tumour volume segmentation and ADC values.Clinical details: 65 yrs old male with mCRPC being treated with docetaxel chemotherapy for bone and nodal disease. Examinations were obtained at baseline (TP1: PSA 93.1 ng/mL) and after 4 cycles (TP2: PSA 9.9 ng/mL) on a 1.5T scanner.Segmented whole body MIP images at the 2 time points (TP1 and TP2) with identically applied signal intensity segmentation thresholds. Corresponding apparent diffusion coefficient (ADC) histograms. The x-axis is the ADC value (?m2/s) and y-axis is the relative frequency. TP1_900 and TP2_900 are the b900 MIP images with identically applied segmentation thresholds (Blue and Orange). The histograms of the corresponding outlined tumour volumes are labelled. Note how the application of the threshold to TP1 is successful at outlining bone and pelvic and retroperitoneal nodes. The pre-treatment (TP1_900) unimodal histogram (Blue) has a median ADC of 739 ?m2/s (5th - 95th centile range of 472-1209).The same threshold applied to TP2_900 image results in under-sampling of the bone marrow, with a post-treatment bimodal histogram, median ADC of 1127 ?m2/s (5th - 95th centile range of 694 – 2070). However, the same segmentation threshold applied to b600 MIP images at TP2 (TP2_600) (Green) is more successful at sampling the bone marrow, with a resulting post-treatment bimodal histogram, with a median ADC of 1787 ?m2/s (5th - 95th range of 687 – 2502). Note the improved appreciation of tumour response in the histogram shape and summary metrics.This example emphasizes the need to carefully choose b-value images that allow adequately sampling of the bone marrow in response assessment settings. Image analysis performed using prototype software (syngo.via Frontier MR Total Tumor Load; Siemens Healthcare, Erlangen, Germany).Supplementary Fig. 4 – Illustrated interpretations of skeletal regional bone assessment form.Example of completed MET-RADS-P Regional follow-up template form 1 (5.1) showing the documentation of concordant (e.g. Pelvis) and discordant (e.g. Ribs and shoulder girdle) responses. The ‘Comments’ are for illustrative purposes and are not required when completing the form. ................
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