1.Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance
Joseba SALGUERO ; Enrique GÓMEZ-GÓMEZ ; José VALERO-ROSA ; Julia CARRASCO-VALIENTE ; Juan MESA ; Cristina MARTIN ; Juan Pablo CAMPOS-HERNÁNDEZ ; Juan Manuel RUBIO ; Daniel LÓPEZ ; María José REQUENA
Korean Journal of Radiology 2021;22(4):559-567
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 imagingreporting 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.
2.Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance
Joseba SALGUERO ; Enrique GÓMEZ-GÓMEZ ; José VALERO-ROSA ; Julia CARRASCO-VALIENTE ; Juan MESA ; Cristina MARTIN ; Juan Pablo CAMPOS-HERNÁNDEZ ; Juan Manuel RUBIO ; Daniel LÓPEZ ; María José REQUENA
Korean Journal of Radiology 2021;22(4):559-567
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 imagingreporting 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.
3.Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability
Kanta TANAKA ; Hiroshi YAMAGAMI ; Muhammad M. QURESHI ; Kazutaka UCHIDA ; James E. SIEGLER ; Raul G. NOGUEIRA ; Shinichi YOSHIMURA ; Nobuyuki SAKAI ; Nicolas MARTINEZ-MAJANDER ; Simon NAGEL ; Jelle DEMEESTERE ; Volker PUETZ ; Diogo C. HAUSSEN ; Mohamad ABDALKADER ; Marta OLIVE-GADEA ; Mahmoud H. MOHAMMADEN ; João Pedro MARTO ; Anne DUSART ; Simon WINZER ; Liisa TOMPPO ; Francois CAPARROS ; Hilde HENON ; Flavio BELLANTE ; João Nuno RAMOS ; Santiago ORTEGA-GUTIERREZ ; Sunil A. SHETH ; Stefania NANNONI ; Johannes KAESMACHER ; Lieselotte VANDEWALLE ; Sergio SALAZAR-MARIONI ; Mudassir FAROOQUI ; Pekka VIRTANEN ; Rita VENTURA ; Syed ZAIDI ; Alicia C. CASTONGUAY ; Ajit S. PURI ; Behzad FARZIN ; Hesham E. MASOUD ; Piers KLEIN ; Jessica JESSER ; Manuel REQUENA ; Tomas DOBROCKY ; Daniel P.O. KAISER ; Erno PELTOLA ; Davide STRAMBO ; Markus A. MÖHLENBRUCH ; Eugene LIN ; Peter A. RINGLEB ; Osama O. ZAIDAT ; Charlotte CORDONNIER ; Daniel ROY ; Robin LEMMENS ; Marc RIBO ; Daniel STRBIAN ; Urs FISCHER ; Patrik MICHEL ; Jean RAYMOND ; Thanh N. NGUYEN
Journal of Stroke 2024;26(2):269-279
Background:
and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability.
Methods:
In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1).
Results:
A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995).
Conclusion
A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.