prostate cancer - center for biomedical imaging · 2013-03-31 · 5.1 imaging modalities (cont.)...
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Prostate Cancer – Facts, Diagnosis, Use of Medical Images in
Guiding Biopsy and Improving Cancer Detection
Yangming OuSBIA @ UPENNApril, 10, 2007
Literature Review
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Outline
• Prostate• Prostate Cancer• Diagnosis of Prostate Cancer• Biopsy Strategies• Imaging/Image Analysis to aid diagnosis
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1. Prostate
Fig 1. Sagittal view of prostate and peripheral organs[1].
Fig 2. Prostate zonal anatomy[2].
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2. Prostate Cancer (1)
• Definition: adenocarcinoma (glandular cancer)• Symptoms: urination & ejaculation problems
Normal[3]
Infection[3] Enlargement[3]
(Benign Prostate Hyperlasia)Cancer[4]
mild severe
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2. Prostate Cancer (2)
• Causes: unknown• Epidemiology
age[5], genetics (race[5], family history) diet, lifestyle, medication, etc.
• Riskmetastasis [8]
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2. Prostate Cancer (2)
• Causes: unknown• Epidemiology
age[5], genetics (race[5], family history) diet, lifestyle, medication, etc.
• Riskmetastasis [8]
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2. Prostate Cancer (2)
• Causes: unknown• Epidemiology
age[5], genetics (race[5], family history) diet, lifestyle, medication, etc.
• Riskmetastasis [8]
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2. Prostate Cancer (2)
• Causes: unknown• Epidemiology
age[5], genetics (race[5], family history) diet, lifestyle, medication, etc.
• Riskmetastasis [8]
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2. Prostate Cancer (3)Incidence Rate [5] Fatality Rate [5]
Cancer Statistics[5]. 2007
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3. Diagnosis of Prostate Cancer[6]
• No symptom at early stage• Prostate-specific antigen (PSA) test• Digital rectal exam (DRE)• Biopsy• Staging• Imaging for diagnosis and staging
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3.1 Prostate-Specific Antigen (PSA) test
• Antigen• PSA• PSA test [1] (unit: ng/ml)
< 4 (or, <6.5 for 65 or older): normal4-10: 25% chances>10: 50 chances
• Problem
3. Diagnosis of Prostate Cancer
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3.2 Digital Rectal Exam (DRE)[6]
• Check the size, shape and texture of the prostate
• Able to find cancers in men with normal PSA
• However, DRE only find advanced cancer – no effect in early diagnosis
3. Diagnosis of Prostate Cancer
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3.3 Biopsy• The only test to confirm diagnosis
cut-out
inner stylet
outer core
3. Diagnosis of Prostate Cancer
Trans-Rectal UltraSound (TRUS) guided biopsy[7]
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3.4 Prostate Cancer Grading/Staging
• Conducted if prostate cancer confirmed in biopsy• Tumor/Nodes/Metastases (TNM) system, T1-T4• Gleason System, score 2-10
Staging by TNM system. [7]
3. Diagnosis of Prostate Cancer
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3.5 Imaging
TRUS, sagittal
CT
MRI, T2-weighted, fast spin-echo. 1.5T. Left to right: Axia/Coronal/Sagittal
Hricak et al, Med. Physics, 2007 [8]
3. Diagnosis of Prostate Cancer
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4. Biopsy Strategies
• Motivation
To optimize the needle biopsy placement with 1) maximum prostate cancer detection rate2) minimum number of biopsy cores
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4.1 Random Systematic Method4. Biopsy Strategies
Biopsy Plane [9] The most increasing point is 10-core biopsy. [9]
Noguchi et al, 2006
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4.2 Computerized Biopsy Strategies• Zeng et al, 2000. & Mazal et al, 2001.
- divide the prostate into 48 (or 64 in Mazal’s work) boxes
- analyze statistical cancer occurrence in those boxes- place needles in a subset of those boxes
• Shen et al, 2004.- voxel-wise registration by AFDM- search k independent locations with
maximum statistical cancer occurrence
4. Biopsy Strategies
They are all based on statistical cancer distribution of a large number of prostate specimens, or, population-based cancer information.
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4.3 Possible improvement • Patient-specific biopsy protocols• How?
a) suspicious cancer tissues in a patient’s own image-- patient-specific cancer information
b) statistical cancer distribution in a large number of prostate specimens-- population-based cancer information
• So, patient-specific + population-based information • Challenge:
Can we detect prostate cancer in images and achieve desirable accuracy?
4. Biopsy Strategies
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5. Imaging/Image Analysis to aid diagnosis
• Imaging Modalities- T2-Weighted (T2W)- Diffusion Weighted Imaging (DWI)- Dynamic Contrast Enhanced Imaging (DCE)- MR Spectroscopy (MRS)
• Image Analysis literature
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5.1.1 T2-weighted image
5.1. Imaging Modalities
Hricak et al, Radiology. 2007
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5.1.1 T2-weighted image (cont.)5.1. Imaging Modalities
Kirkham et al, European Urology. 2006
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5.1.2 Diffusion Weighted Image (DWI)
Conclusion: T2W+DWI > T2W
Shimofusa et al, J. Comput. Assist. Tomogr., 2005
T2W DWI
5.1. Imaging Modalities
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5.1.3 Apparent Diffusion Coefficient (ADC)
Desouza et al, The British Journal of Radiology, 2007
5.1. Imaging Modalities
Conclusion from 33 patients:ADC values are significantly lower in malignant area than normal area.
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5.1.4 Dynamic Contrast Enhanced MR
• Four parameters on time-concentration curve:- start of enhancement (onset)- time to peak enhancement- peak enhancement- washout time
• Challenge: Spatial-temporal tradeoff
5.1. Imaging Modalities
Futterer et al, Radiology, 2005
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5.1.4 DCE-MR (cont.)
T2W DEC-1
DEC-2 Histological
Conclusion: T2W+DCE > DCE > T2W
Futterer et al, Radiology, 2005
5.1. Imaging Modalities
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5.1.3 DCE-MR (cont.)5.1. Imaging Modalities
Kirkham et al, European Urology. 2006
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5.1.5 MR Spectroscopy (MRS)• MRS provides metabolic
information of tissues• It displays relative
concentration of citrate, creatine, choline and polyamines for each voxel.
• (Cho+Cr)/Cit
5.1. Imaging Modalities
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5.1.6 Multi-modality Analysis
Futterer et al, Radiology. 2006
Conclusion: T2W+DEC+spectroscopy
T2W DCE-1
DCE-2 DCE-3
Spectroscopy
5.1. Imaging Modalities
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5.1.6 Multi-modality Analysis (cont.)
Tanimoto et al, J. MRI. 2007
Conclusion: T2W+DWI+ADC+DEC > each separately
DWI ADCT2W
DCE-1 DCE-2
5.1. Imaging Modalities
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5.1 Imaging Modalities (cont.)• Choi, JY, et al. Functional MR imaging of prostate cancer. Radiographics. 2007 Jan-
Feb;27(1):63-75 • Prando, A. Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of
localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. Int Braz J Urol. 2006 Nov-Dec;32(6):727-8.
• Girouin, N, et al. Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria: is it reasonable? Eur Radiol. 2006 Nov 28
• Villers, A, et al. Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol. 2006 Dec;176(6 Pt 1):2432-7.
• Futterer, JJ, et al. Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology. 2006 Nov;241(2):449-58.
• Kozlowksi, P, et al. Combined diffusion-weighted and dynamic contrast-enhanced MRI for prostate cancer diagnosis--correlation with biopsy and histopathology. J Magn Reson Imaging. 2006 Jul;24(1):108-13.
• Kim, CK, et al. Localization of prostate cancer using 3T MRI: comparison of T2-weighted and dynamic contrast-enhanced imaging. J Comput Assist Tomogr. 2006 Jan-Feb;30(1):7-11
5. Imaging/Image Analysis to aid diagnosis
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5.1 Imaging Modalities - Summary• Available modalities
- functional MR: DCE + DWI/ADC + Spectroscopy- structural MR: T2W- functional + structural MR
• Research Trends- Information fusion + automated cancer detection- which modality is more important- Multi-modality used in cancer staging- 1.5T or 3T?
5.1. Imaging Modalities
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5.2 Image Analysis in Prostate Cancer Diagnosis
5. Imaging/Image Analysis to aid diagnosis
Prostate Cancer Detection in ex vivo T2 MR images- Texture feature: GLCM + Gabor- Tissue Classification - Average 42.35% detection accuracy
Madabhushi et al, TMI. 2005
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5.2 Image Analysis in Prostate Cancer Diagnosis (cont.)
5. Imaging/Image Analysis to aid diagnosis
Chan et al. Med. Physics. 2003
T2W ADC
T2W
Training schemeProbability Map
Feature: GLCM + DCTClassifier: FLD or SVMGround Truth: manual + biopsy validation
PD
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6. Summary
• Prostate cancer is a big issue• Early diagnosis is very important• Biopsy is the gold-standard to confirm diagnosis• To optimize biopsy, patient-specific and
population-based cancer info. can be utilized• Multi-channel MR (T2W+DWI+ADC+DCE+MRS)
has stronger differentiation ability than single MR modality
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Reference• [1] Wiki. http://en.wikipedia.org/wiki/Prostate_cancer• [2] http://www.prostate-cancer.org.uk/images/info/prostateZones.gif• [3] U.S. Food & Drug Administration (FDA)
http://www.fda.gov/fdac/features/2006/306_prostate.html• [4] http://www.malecare.org/prostate-cancer_42.htm• [5] A. Jemel, et al. Cancer Statistics. CA Cancer J Clin. 2007; 57:43-66 • [6] American Cancer Society: How is prostate cancer found?• [7] Prostate Cancer Grading. http://edoc.hu-berlin.de/dissertationen/kaiser-simone-2004-06-
10/HTML/chapter1.html• [8] hricak et al, Imaging Prostate Cancer: A Multidisciplinary Perspective. Radiology. 243(1): 28-
52.• [9] Noguchi et al. International Journal of Urology. 2006 (13):1296-1303.• [10] Shimofusa et al, J. Comput. Assist. Tomogr., 2005• [11] Futterer et al, Radiology, 2005• [12] Futterer et al, Radiology. 2006• [13] Tanimoto et al, J. MRI. 2007• [14] Choi et al, RadioGraphics. 2007• [15] Madabhushi et al, TMI. 2005• [16] Chan et al. Med. Physics. 2003• [17] Zeng et al. Comput. Graph. 2000• [18] Shen et al. Medical Image Analysis. 2004.• [19] Mazal et al. European Urology. 2001.