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T2*-weighted MRI as a non-contrast-enhanced method for assessment of focal laser ablation zone extent in prostate cancer thermotherapy

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Abstract

Objectives

To evaluate utility of T2*-weighted (T2*W) MRI as a tool for intra-operative identification of ablation zone extent during focal laser ablation (FLA) of prostate cancer (PCa), as compared to the current standard of contrast-enhanced T1-weighted (T1W) MRI.

Methods

Fourteen patients with biopsy-confirmed low- to intermediate-risk localized PCa received MRI-guided (1.5 T) FLA thermotherapy. Following FLA, axial multiple-TE T2*W images, diffusion-weighted images (DWI), and T2-weighted (T2W) images were acquired. Pre- and post-contrast T1W images were also acquired to assess ablation zone (n = 14) extent, as reference standard. Apparent diffusion coefficient (ADC) maps and subtracted contrast-enhanced T1W (sceT1W) images were calculated. Ablation zone regions of interest (ROIs) were outlined manually on all ablated slices. The contrast-to-noise ratio (CBR) of the ablation site ROI relative to the untreated contralateral prostate tissue was calculated on T2*W images and ADC maps and compared to that in sceT1W images.

Results

CBRs in ablation ROIs on T2*W images (TE = 32, 63 ms) did not differ (p = 0.33, 0.25) from those in sceT1W images. Bland–Altman plots of ROI size and CBR in ablation sites showed good agreement between T2*W (TE = 32, 63 ms) and sceT1W images, with ROI sizes on T2*W (TE = 63 ms) strongly correlated (r = 0.64, p = 0.013) and within 15% of those in sceT1W images.

Conclusions

In detected ablation zone ROI size and CBR, non-contrast-enhanced T2*W MRI is comparable to contrast-enhanced T1W MRI, presenting as a potential method for intra-procedural monitoring of FLA for PCa.

Key Points

• T2*-weighted MR images with long TE visualize post-procedure focal laser ablation zone comparably to the contrast-enhanced T1-weighted MRI.

• T2*-weighted MRI could be used as a plausible method for repeated intra-operative monitoring of thermal ablation zone in prostate cancer, avoiding potential toxicity due to heating of contrast agent.

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Abbreviations

ADC:

Apparent diffusion coefficient

CBR:

Contrast-to-background ratio

DWI:

Diffusion-weighted imaging

FLA:

Focal laser ablation

Pca:

Prostate cancer

ROI:

Region of interest

sceT1W:

Subtracted contrast-enhanced T1-weighted

T1W:

T1-weighted

T2*W:

T2*-weighted

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Funding

This study has received funding from Philips Healthcare and the National Institutes of Health (NIH R01 CA172801 and NIH 1S10OD018448-01 to Dr. Aytekin Oto)

Author information

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, No. 151, Yanjiang Road, Guangzhou, 510120, Guangdong, China

    Chongpeng Sun

  2. Department of Radiology, Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA

    Chongpeng Sun, Shiyang Wang, Aritrick Chatterjee, Milica Medved, Gregory S. Karczmar & Aytekin Oto

  3. Department of Medical Physics, University of Missouri, 1 Hospital Dr., Columbia, MO, 65202, USA

    Shiyang Wang

  4. Department of Urology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA

    Scott Eggener

Authors
  1. Chongpeng Sun
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  2. Shiyang Wang
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  4. Milica Medved
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  6. Gregory S. Karczmar
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  7. Aytekin Oto
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Corresponding author

Correspondence to Aytekin Oto.

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Guarantor

The scientific guarantor of this publication is Dr. Aytekin Oto.

Conflict of interest

Dr. Aytekin Oto declares relationships with the following companies: Research Grant, Koninklijke Philips NV Research Grant, Guerbet SA Research Grant, Profound Medical Inc. Medical Advisory Board, Profound Medical Inc. Speaker, and Bracco Group

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

The same cohort of this study was included in a former study by Wang et al in 2018 using complex post-processing methods (T2* maps and water resonance peak height images) to evaluate the feasibility of T2*-weighted MRI for identification of ablation zones after FLA of prostate cancers. We, however, are using T2*W MRI without any additional post-processing to reduce acquisition times. That paper was cited and discussed in this study.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Sun, C., Wang, S., Chatterjee, A. et al. T2*-weighted MRI as a non-contrast-enhanced method for assessment of focal laser ablation zone extent in prostate cancer thermotherapy. Eur Radiol 31, 325–332 (2021). https://doi.org/10.1007/s00330-020-07127-7

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  • DOI: https://doi.org/10.1007/s00330-020-07127-7

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