3755

The effect of hormone therapy on T1 mapping-related values obtained from MR fingerprinting-derived images of prostate cancer patients
Nikita Sushentsev1, Joshua D Kaggie1, Guido Buonincontri2,3, Rolf Schulte4, Vincent J Gnanapragasam5,6,7, Martin J Graves1, and Tristan Barrett1,8
1Department of Radiology, University of Cambridge, Cambridge, United Kingdom, 2IRCCS Stella Maris, Piza, Italy, 3Imago7 Foundation, Piza, Italy, 4GE Healthcare, Munich, Germany, 56) Cambridge Urology Translational Research and Clinical Trials Office, University of Cambridge, Cambridge, United Kingdom, 6Academic Urology Group, Department of Surgery & Oncology, University of Cambridge, Cambridge, United Kingdom, 7Department of Urology, University of Cambridge, Cambridge, United Kingdom, 82) CamPARI Prostate Cancer Group, Addenbrooke's Hospital, Cambridge, United Kingdom

Synopsis

This study investigates the effect of hormone therapy for prostate cancer on T1 mapping values obtained from MR Fingerprinting. No differences were observed between tumour T1 values before and after treatment. However, lower T1 MRF values were noted in prostate lesions compared to normal peripheral and transition zones, which is consistent with current literature. Moreover, a significant decrease in T1 values was observed in normal transition zone (TZ) following treatment, which may justify the need of using T1 mapping in contrast-enhanced MRI studies aimed at calculating quantitative TZ-derived parameters.

Introduction

Prostate cancer (PCa) is the second commonest male cancer and the fifth leading cause of cancer mortality worldwide. 1 Following the results of several prospective trials including UK-led PROMIS and PRECISION, the 2019 European Association of Urology and UK NICE guidelines now recommend multiparametric MRI (mpMRI) as the first-line investigation for patients with suspected clinically localised PCa. Although mpMRI has outperformed conventional PSA-TRUS biopsy pathway, mpMRI still has its limitations, namely poor PPV at 49.9% pooled for PI-RADS ≥3 lesions and undercalling 24% Gleason score 7 cancers. 2-8 Developing quantitative MR mapping techniques may be beneficial to overcome these limitations.
Magnetic resonance fingerprinting (MRF) is a novel technique allowing for rapid, simultaneous T1 and T2 mapping in human tissues. 9 MRF-derived T1 and T2 values in combination with standard ADC maps have been shown to enable successful differentiation between both peripheral and transition zone lesions and normal prostate tissue, as well as between tumours with different Gleason scores. 10,11 However, to our knowledge, there have been no previous reports of the impact of hormone therapy on MRF values in both normal and malignant prostate tissues. Hence, the aim of this study was to evaluate the effect of antiandrogen therapy on MRF-derived T1 values in patients with prostate cancer.

Methods

Seven MRF-derived T1 maps were analysed from patients with histopathologically proven PCa, and who underwent treatment with apalutamide were analysed in this study. Patient images were acquired on a standard 3.0 T MRI system using a 32-channel abdominal coil. The MRI protocol consisted of standard qualitative clinical sequences followed by a 2-D steady-state-free precession (SSFP) MRF sequence 9,12,13 A total of 10 prostate lesions were included in the analysis. T1 values for lesions, normal peripheral zone (NPZ), normal transition zone (NTZ) and normal m. gluteus maximus were calculated from ROIs drawn by a single fellowship-trained uro-radiologist using the open-source segmentation software ITK-SNAP. Shapiro-Wilk test was performed to assess the distribution of the measured parameters with their further comparison performed using Welch’s t-test. The data are presented as mean ± SD.

Results

No difference was noted between T1 MRF values obtained from prostate lesions before and after treatment (1.789 ± 0.201 seconds vs 1.783 ± 0.091 s, respectively; p = 0.95). However, in pre-treatment scans, tumour T1 values were significantly lower compared to corresponding NPZ or NTZ (1.789 ± 0.201 s vs 2.370 ± 0.305 s; p = 0.0008). No significant difference between the parameters was observed in the post-treatment scans although the same trend was noted in terms of mean values (1.783 ± 0.091 s vs 2.467 ± 0.478 s; p = 0.09).

No difference was observed in NPZ-derived T1 MRF values between pre- and post-treatment scans (2.541 ± 0.194 vs 2.668 ± 0.314; p = 0.5784). However, a significant decrease in NTZ-derived T1 values was noted in post-treatment scans (2.182 ± 0.211 vs 1.795 ± 0.060; p = 0.03).

There was no difference between pre- and post-treatment T1 MRF values in m. gluteus maximus (1.147 ± 0.029 vs 1.141 ± 0.121; p = 0.9388).

Discussion

To our knowledge, this is the first study that investigates the impact of anti-androgen treatment on MRF-derived T1 values in patients with prostate cancer. Although no difference was observed between tumour-derived values pre- and post-treatment, prostate lesions exhibited significantly lower T1 MRF values compared to normal prostate tissue, which is consistent with literature. 10,11 This was observed both before and after treatment, although the latter observation lacked statistical significance, which may be due to small sample size.
It is of note that NPZ had significantly lower T1 MRF values post-treatment, which may reflect its higher anatomical heterogeneity that undergoes more prominent changes following anti-androgen therapy. 14 As apalutamide has no reported effect on skeletal muscle, the unchanged T1 values of m. gluteus maximus were expected.

Conclusions

Anti-androgen treatment has no effect on tumour-derived T1 MRF values in patients with prostate cancer. However, the effect of hormone treatment on T1 values in NTZ suggest that T1 mapping should not be omitted when contrast-enhanced follow-up MRI scans are performed to evaluate quantitative characteristics such as Ktrans and Kep.

Acknowledgements

The authors acknowledge support from Cancer Research UK, National Institute of Health Research Cambridge Biomedical Research Centre, Cancer Research UK and the Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester, the Cambridge Experimental Cancer Medicine Centre and Addenbrooke's Charitable Trust.

References

1. Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019;10(2):63-89.

2. NICE. Recommendations | Prostate cancer: diagnosis and management | Guidance | NICE: NICE; 2019. https://www.nice.org.uk/guidance/ng131/chapter/Recommendations#assessment-and-diagnosis. Accessed November 2019.

3. American Urological Association SoAR. Standard Operating Procedure for Multiparametric Magnetic Resonance Imaging in the Diagnosis, Staging and Management of Prostate Cancer - American Urological Association 2019 [Available from: https://www.auanet.org/guidelines/mri-of-the-prostate-sop.

4. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815-22.

5. Kasivisvanathan V, Emberton M, Moore CM. MRI-Targeted Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;379(6):589-90.

6. van der Leest M, Cornel E, Israel B, Hendriks R, Padhani AR, Hoogenboom M, et al. Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-naive Men with Elevated Prostate-specific Antigen: A Large Prospective Multicenter Clinical Study. Eur Urol. 2019;75(4):570-8.

7. Rouviere O, Puech P, Renard-Penna R, Claudon M, Roy C, Mege-Lechevallier F, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol. 2019;20(1):100-9.

8. Serrao EM, Barrett T, Wadhwa K, Parashar D, Frey J, Koo BC, et al. Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy. Can Urol Assoc J. 2015;9(11-12):E853-8.

9. Ma D, Gulani V, Seiberlich N, Liu K, Sunshine JL, Duerk JL, et al. Magnetic Resonance Fingerprinting. Nature. 2013;495(7440):187-92.

10. Yu AC, Badve C, Ponsky LE, Pahwa S, Dastmalchian S, Rogers M, et al. Development of a Combined MR Fingerprinting and Diffusion Examination for Prostate Cancer. Radiology. 2017;283(3):729-38.

11. Panda A, Obmann VC, Lo WC, Margevicius S, Jiang Y, Schluchter M, et al. MR Fingerprinting and ADC Mapping for Characterization of Lesions in the Transition Zone of the Prostate Gland. Radiology. 2019;292(3):685-94.

12. Kaggie JD, Deen S, Kessler DA, McLean MA, Buonincontri G, Schulte RF, et al. Feasibility of Quantitative Magnetic Resonance Fingerprinting in Ovarian Tumors for T1 and T2 Mapping in a PET/MR Setting. IEEE Trans Rad Plas Med Sci. 2019;3(4).

13. Cencini M, Biagi L, Kaggie JD, Schulte RF, Tosetti M, Buonincontri G. Magnetic resonance fingerprinting with dictionary-based fat and water separation (DBFW MRF): A multi-component approach. Magn Reson Med. 2019;81(5):3032-45.

14. Lee JJ, Thomas IC, Nolley R, Ferrari M, Brooks JD, Leppert JT. Biologic Differences Between Peripheral and Transition Zone Prostate Cancer. Prostate. 2015;75(2):183-90.

Proc. Intl. Soc. Mag. Reson. Med. 28 (2020)
3755