• 대한영상의학회지
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• 제81권3호
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• pp.610-619
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• 2020

목적 본 연구는 방광암 환자에서 전립선 Prostate Imaging Reporting and Data System version 2 (이하 PI-RADS v2)가, 우연히 발견된 전립선암 또는 요로상피세포암종의 전립선침범을 예측하는데 도움이 되는지 분석하였다. 대상과 방법 3 Tesla 다중 매개 자기공명영상에서 수술 전 영상을 촬영한 후, 근치적 방광전립 선절제술을 시행한 72명의 방광암 환자가 연구에 포함되었다. 수술 전 영상 소견은 두 명의 영상의학과 의사가 분석하였고, 수술 검체는 한 명의 병리과 의사가 평가하였다. 그 후, 전립선 PI-RADS v2의 결과와 병리 소견을 비교 분석하였다. 결과 72명의 방광암 환자 중 29명이 전립선암(40.3%)이 있었고, 20명이 요로상피세포암종(27.8%)이 있었다. 스코어 4를 기준값으로 설정하였을 때, 전립선암을 예측하는 진단 정확도는 65.3%, 특이도는 90.7%, 양성 예측도는 66.7%였다. 또한 전립선암 또는 요로상피세포암종을 예측하는 진단 정확도는 47.2%, 특이도는 92.3%, 양성 예측도는 83.3%였다. 결론 정확도는 낮은 편이었지만, 양성 예측도와 특이도는 높은 편이었다. 따라서 전립선 PI-RADS v2에서 스코어 1, 2 또는 3에 해당되면 우연히 발견된 전립선암과 요로상피세포암종의 침범을 배제하는데 도움이 될 수 있다.

• Korean Journal of Radiology
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• 제21권12호
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• pp.1326-1333
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• 2020

Objective: To evaluate urologist satisfaction on structured prostate MRI reports, including report with tumor-node-metastasis (TNM) staging (report B) and with Prostate Imaging Reporting and Data System (PI-RADS) score with/without TNM staging (report C, report with PI-RADS score only [report C-a] and report with PI-RADS score and TNM staging [C-b]) compared with conventional free-text report (report A). Materials and Methods: This was a prospective comparative study. Altogether, 3015 prostate MRI reports including reports A, B, C-a, and C-b were rated by 13 urologists using a 5-point Likert Scale. A questionnaire was used to assess urologist satisfaction based on the following parameters: correctness, practicality, and urologist subjectivity. Kruskal-Wallis H-test followed by Nemenyi test was used to compare urologists' satisfaction parameters for each report type. The rate of urologist-radiologist recalls for each report type was calculated. Results: Reports B and C including its subtypes had higher ratings of satisfaction than report A for overall satisfaction degree, and parameters of correctness, practicality, and subjectivity (p < 0.05). There was a significant difference between report B and C (p < 0.05) in practicality score, but no statistical difference was found in overall satisfaction degree, and correctness and subjectivity scores (p > 0.05). Compared with report C-b (p > 0.05), report B and C-a (p < 0.05) showed a significant difference in overall satisfaction degree and parameters of practicality and subjectivity. In terms of correctness score, neither report C-a nor C-b had a significant difference with report B (p > 0.05). No statistical difference was found between report C-a and C-b in overall satisfaction degree and all three parameters (p > 0.05). The rate of urologist-radiologist recalls for reports A, B, C-a and C-b were 29.1%, 10.8%, 18.1% and 11.2%, respectively. Conclusion: Structured reports, either using TNM or PI-RADS are highly preferred over conventional free-text reports and lead to fewer report-related post-hoc inquiries from urologists.

• 대한비뇨기종양학회지
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• 제16권3호
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• pp.110-118
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• 2018

Purpose: The aim of this study is to confirm the detection rate of transperineal biopsy after multiparametric magnetic resonance imaging (mpMRI) and compared it to that of transrectal biopsy. We also examined the role of mpMRI and the rate of complications for each method. Materials and Methods: In a retrospective study, we analyzed 147 patients who underwent mpMRI before prostate biopsy because of elevated serum prostate-specific antigen and/or abnormal digital rectal examination findings at Korea University Hospital, Seoul, Korea from March 2017 to April 2018. Regions on the mpMRI that were suggestive of prostate cancer were categorized according to the Prostate Imaging-Reporting and Data System (PI-RADS v2). For transperineal biopsy, a 20-core saturation biopsy was performed by MRI-TRUS cognitive or fusion techniques and a 12-core biopsy was performed in transrectal biopsy. Results: Sixty-three and 84 patients were enrolled in transperineal group and transrectal group, respectively. The overall detection rate of prostate cancer in transperineal group was 27% higher than that in transrectal group. Classification according to PI-RADS score revealed a significant increase in detection rate in all patients, as the PI-RADS score increased. Frequency of complications using the Clavien-Dindo classifications revealed no significant differences in the total complications rate, but two patients in transrectal group received intensive care unit care due to urosepsis. Conclusions: Our results confirmed that transperineal biopsy is superior to transrectal biopsy for the detection of prostate cancer. From the complication point of view, this study confirmed that there were fewer severe complications in transperineal biopsy.

• Investigative and Clinical Urology
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• 제59권6호
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• pp.363-370
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• 2018

Purpose: The aim of this study is to describe the technique and to report early results of transperineal magnetic resonance imaging and ultrasonography (MRI-US) fusion biopsy. Materials and Methods: A total of 75 patients underwent MRI-US fusion transperineal biopsy. Targeted biopsy via MRI-US fusion imaging was carried out for cancer-suspicious lesions with additional systematic biopsy. Detection rates for overall and clinically significant prostate cancer (csPCa) were evaluated and compared between systematic and targeted biopsy. In addition, further investigation into the detection rate according to prostate imaging reporting and data system (PI-RADS) score was done. Results of repeat biopsies were also evaluated. Results: Overall cancer detection rate was 61.3% (46 patients) and the detection rate for csPCa was 42.7% (32 patients). Overall detection rates for systematic and targeted biopsy were 41.3% and 57.3% (p<0.05), respectively. Detection rates for csPCa were 26.7% and 41.3%, respectively (p<0.05). The cancer detection rates via MRI fusion target biopsy were 30.8% in PI-RADS 3, 62.1% in PI-RADS 4 and 89.4% in PI-RADS 5. Rates of csPCa missed by targeted biopsy and systematic biopsy were 0.0% and 25.0%, respectively. The cancer detection rate in repeat biopsies was 61.1% (11 among 18 patients) in which 55.5% of cancer suspected lesions were located in the anterior portion. Conclusions: Transperineal MRI-US fusion biopsy is useful for improving overall cancer detection rate and especially detection of csPCa. Transperineal MRI-US targeted biopsy show potential benefits to improve cancer detection rate in patients with high PIRADS score, tumor located at the anterior portion and in repeat biopsies.

• Korean Journal of Radiology
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• 제22권4호
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• pp.559-567
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• 2021

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imaging-reporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

• 대한영상의학회지
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• 제83권5호
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• pp.1059-1070
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• 2022

목적 계산형 확산강조영상 b2000과 실제 획득한 확산강조영상 b2000 사이에 전립선암 발견을 위한 민감도 및 관찰자 간 일치도를 비교하였다. 대상과 방법 근치적 전립선 절제술 및 확산강조영상(b, 0, 100, 1000, 2000 s/mm²)을 포함한 수술 전 3 Tesla 자기공명영상을 통해 전립선암으로 진단받은 총 88명의 환자가 연구에 포함되었다. 계산형 확산강조영상 b2000은 실제 획득한 확산강조영상 b0, 100, 1000으로부터 단일 지수 감쇠 모델에 의해 계산되었다. 두 명의 독립된 검토자가 4주 간격으로 무작위 순서로 두 영상 세트를 검토하여, 가장 큰 종양에 대해 관심 영역을 그렸고, Prostate Imaging-Reporting and Data System 2.1에 기반한 점수를 기록하였다. 전층 절편 조직 검사가 참고 기준으로 제공되었다. 결과 연구에 포함된 환자의 글리슨 점수는 6 (n = 16), 7 (n = 53), 8 (n = 9), 9 (n = 10)로 구성되었다. 두 명의 검토자 모두 계산형 확산강조영상 b2000과 실제 획득한 확산강조영상 b2000 간 전립선암 발견에 대한 민감도 차이는 없었다(검토자 1, 모두 94% [83/88]; 검토자 2, 모두 90% [79/88], 모두 p = 1.000). 관찰자 간 PI-RADS 점수에 대한 일치도는 계산형 확산강조영상에서 0.422 (95% 신뢰구간, 0.240-0.603), 실제 획득한 확산강조영상에서 0.495 (95% 신뢰구간, 0.308-0.683)였다. 결론 계산형 확산강조영상 b2000과 실제 획득한 확산강조영상 b2000은 전립선암 발견 민감도에 차이가 없고, 관찰자 간 일치도는 유지되었다.