Department of Radiology (E010), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
Eur Radiol. 2019 Jan;29(1):299-308. doi: 10.1007/s00330-018-5584-y. Epub 2018 Jun 25.
To quantitatively assess 12-month prostate volume (PV) reduction based on T2-weighted MRI and immediate post-treatment contrast-enhanced MRI non-perfused volume (NPV), and to compare measurements with predictions of acute and delayed ablation volumes based on MR-thermometry (MR-t), in a central radiology review of the Phase I clinical trial of MRI-guided transurethral ultrasound ablation (TULSA) in patients with localized prostate cancer.
Treatment day MRI and 12-month follow-up MRI and biopsy were available for central radiology review in 29 of 30 patients from the published institutional review board-approved, prospective, multi-centre, single-arm Phase I clinical trial of TULSA. Viable PV at 12 months was measured as the remaining PV on T2-weighted MRI, less 12-month NPV, scaled by the fraction of fibrosis in 12-month biopsy cores. Reduction of viable PV was compared to predictions based on the fraction of the prostate covered by the MR-t derived acute thermal ablation volume (ATAV, 55°C isotherm), delayed thermal ablation volume (DTAV, 240 cumulative equivalent minutes at 43°C thermal dose isocontour) and treatment-day NPV. We also report linear and volumetric comparisons between metrics.
After TULSA, the median 12-month reduction in viable PV was 88%. DTAV predicted a reduction of 90%. Treatment day NPV predicted only 53% volume reduction, and underestimated ATAV and DTAV by 36% and 51%.
Quantitative volumetry of the TULSA phase I MR and biopsy data identifies DTAV (240 CEM43 thermal dose boundary) as a useful predictor of viable prostate tissue reduction at 12 months. Immediate post-treatment NPV underestimates tissue ablation.
• MRI-guided transurethral ultrasound ablation (TULSA) achieved an 88% reduction of viable prostate tissue volume at 12 months, in excellent agreement with expectation from thermal dose calculations. • Non-perfused volume on immediate post-treatment contrast-enhanced MRI represents only 64% of the acute thermal ablation volume (ATAV), and reports only 60% (53% instead of 88% achieved) of the reduction in viable prostate tissue volume at 12 months. • MR-thermometry-based predictions of 12-month prostate volume reduction based on 240 cumulative equivalent minute thermal dose volume are in excellent agreement with reduction in viable prostate tissue volume measured on pre- and 12-month post-treatment T2w-MRI.
在中央影像学审查中，基于 T2 加权 MRI 和即刻治疗后对比增强 MRI 非灌注体积（NPV）定量评估 12 个月前列腺体积（PV）减少，并比较基于 MRI 测温（MR-t）的急性和延迟消融体积预测的测量值，用于经尿道超声消融（TULSA）治疗局部前列腺癌患者的 I 期临床试验。
在发表的机构审查委员会批准的前瞻性多中心单臂 TULSA I 期临床试验中，29 例患者中的 30 例可用于中央影像学审查，有治疗日 MRI 和 12 个月随访 MRI 和活检。12 个月时的存活 PV 测量为 T2 加权 MRI 上剩余的 PV，减去 12 个月 NPV，乘以 12 个月活检芯中纤维化的分数。将存活 PV 的减少与基于 MR-t 得出的急性热消融体积（ATAV，55°C 等温线）、延迟热消融体积（DTAV，43°C 热剂量等剂量线 240 累积等效分钟）和治疗日 NPV 预测值进行比较。我们还报告了度量之间的线性和体积比较。
在 TULSA 治疗后，存活 PV 的中位数 12 个月减少了 88%。DTAV 预测减少了 90%。治疗日 NPV 仅预测 53%的体积减少，低估了 ATAV 和 DTAV 分别为 36%和 51%。
TULSA I 期 MRI 和活检数据的定量容积分析表明，DTAV（240 CEM43 热剂量边界）是 12 个月时存活前列腺组织减少的有用预测因子。即刻治疗后 NPV 低估了组织消融。
• MRI 引导下经尿道超声消融（TULSA）在 12 个月时实现了 88%的存活前列腺组织体积减少，与热剂量计算的预期非常吻合。• 即刻治疗后对比增强 MRI 上的非灌注体积仅代表急性热消融体积（ATAV）的 64%，仅报告 12 个月时存活前列腺组织体积减少的 60%（53%，而非 88%）。• 基于 240 累积等效分钟热剂量体积的基于 MR-thermometry 的 12 个月前列腺体积减少预测与治疗前和 12 个月后 T2w-MRI 测量的存活前列腺组织体积减少非常吻合。
