Bpx 30

Imaging was performed using a combination of an endorectal coil (BPX-30, Medrad) and a 16-channel cardiac surface coil (SENSE, Philips Healthcare) using a 3.0 T (Achieva, Philips Healthcare) scanner as previously described [15 (link)]. Sequences used for image interpretation comprised T1-weighted image, T2-weighted image, and diffusion-weighted image with apparent diffusion coefficient mapping, multivoxel 3D localized magnetic resonance spectroscopy, and axial 3D fast-field echodynamic contrast-enhanced MRI. Images were prospectively read by 2 experienced radiologists (B.T. and P.L.C. with prostate MRI experience of 8 and 16 years, respectively) to localize dominant prostate lesions. Suspicion for EPE on mpMRI was defined using conventional criteria of capsular obliteration, irregularity, bulging, neurovascular bundle asymmetry, or periprostatic fat extension. All included mpMRIs were reviewed to identify tumors in contact with the prostate capsule. TCL (mm) was measured (using axial T2-weighted image) by a research fellow under direct supervision of a radiologist dedicated to prostate MRI (B.T.) using the picture archiving and communication system freehand curved distance measurement tool (Fig. 1). In cases (6.2%, 24/384) where there was more than 1 lesion with capsular contact, the average of the TCLs was obtained. Lesions with no capsular contact were assigned a TCL of zero.

The prostate mpMRI scans were acquired on a 3T scanner (Achieva 3.0T-TX, Philips Healthcare, Best, Netherlands) using an endorectal coil (BPX-30, Medrad, Pittsburgh, PA) filled with 45 mL fluorinert (3M, Maplewood, MN) and the anterior half of a 32-channel cardiac SENSE coil (InVivo, Gainesville, FL). Table 1 contains the sequences and MRI acquisition parameters used in this study.

All patients underwent a multiparametric MRI as previously described.^{15 (link)} Briefly, MRIs were performed using a 3.0 T magnet (Achieva, Philips Healthcare) with an endorectal coil (BPX-30, Medrad^®) for all initial evaluation scans. For most subsequent followup scans after the initial evaluation scan, endorectal coil was not used. Prostate MRI studies underwent standardized radiological evaluation by 2 highly experienced genitourinary radiologists. All lesions subsequent to April 2015 were assigned an assessment category using the standardized PI-RADS^™ guidelines.^{16 (link)} Lesions identified before the adoption of the PI-RADS system were graded using the National Institutes of Health suspicion score system, previously demonstrated to correlate to the PI-RADS system.^{17 (link),18 (link)} In preparation for biopsy, lesions were identified, labeled and segmented by 1 radiologist using DynaCAD^® software.

Each patient referred for PCa management underwent mpMRI of the prostate at 3 Tesla (Achieva; Phillips Healthcare) with endorectal coil (BPX-30; Medrad, Pittsburgh, PA) and 16-channel cardiac surface coil (SENSE; Phillips Healthcare), as previously described (15 (link)). mpMRI sequences consisted of triplanar T2-weighted, diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC) mapping, and dynamic contrast enhancement (DCE). Two radiologists identified prostatic lesions and assigned suspicion levels for PCa based on a previously validated in-house scoring system (SS) and, when available, the prostate imaging reporting and data system (PIRADS) version 2 scoring system. Each FB session consisted of a SB and targeted biopsy of any detectable lesions (at least two targeted cores per lesion) as described previously.(16 (link)) All biopsies were performed by a single urologist or interventional radiologist with more than 10 years’ experience.

MRI studies were performed using an endorectal (BPX-30, Medrad, Pittsburgh, PA) and a 16-channel anterior cardiac coil (SENSE, Philips Medical Systems, Best, The Netherlands) on a 3 T magnet (Achieva, Philips Medical Systems, Best, the Netherlands) without prior bowel preparation. The endorectal coil was inserted using a semi-anesthetic gel (Lidocaine, Akorn Inc., Lake Forest, IL) while the patient was in the left lateral decubitus position. The balloon surrounding the coil was distended with perfluorocarbon (Fluorinert FC-770, 3 M, St. Paul, MN) to a volume of approximately 45 mL. The MRI protocol included tri-planar T2 W turbo spin echo (TSE), diffusion weighted (DW) MRI (ADC maps and b2000 DW MRI), axial pre-contrast T1 W, axial 3D T1-weighted fast field echo dynamic contrast-enhanced MRI (DCE MRI) sequences [16 (link)].

All MRI studies were performed using a combination of an endorectal coil (BPX-30; Medrad, Pittsburgh, Pa) tuned to 127.8 MHz and a 16-channel cardiac coil (SENSE; Philips Medical Systems, Best, The Netherlands) on a 3-T magnet (Achieva; Philips Medical Systems, Best, The Netherlands) without previous bowel preparation. The endorectal coil was inserted using a semianesthetic gel (Lidocaine; AstraZeneca, Wilmington, Del) while the patient was in the left lateral decubitus position. The balloon surrounding the coil was distended with perfluorocarbon (3 mol/L-Fluorinert; 3M, St Paul, Minn) to a volume of approximately 45 mL to reduce susceptibility artifacts induced by air in the coil's balloon. The MRI protocol included triplanar T2W turbo spin echo, DW MRI (5 b values evenly spaced between 0 and 750 s/mm²), 3-dimensional MR spectroscopy, axial precontrast T1W, axial 3-dimensional T1W fast field echo dynamic contrast-enhanced MRI (DCE MRI) sequences, and their detailed sequence parameters are listed in Table 1. Dynamic contrast-enhanced MRI had 5.6-second temporal resolution, with Magnevist (Bayer, Whippany, NJ) injected after first 3 phases. An additional lower flip angle of 2° dataset was acquired before the DCE sequence for per-voxel T1 relaxation rate calculation to be used for quantitative DCE postprocessing.