The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A Systematic Review and International Consensus Recommendations.

BACKGROUND AND OBJECTIVE: Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy. METHODS: A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement. KEY FINDINGS AND LIMITATIONS: In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented. CONCLUSIONS AND CLINICAL IMPLICATIONS: The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting. PATIENT SUMMARY: Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice.

Dual-energy CT for imaging of pulmonary hypertension: challenges and opportunities.

Computed tomography (CT) is routinely used in the evaluation of patients with pulmonary hypertension (PH) to assess vascular anatomy and parenchymal morphology. The introduction of dual-energy CT (DECT) enables additional qualitative and quantitative insights into pulmonary hemodynamics and the extent and variability of parenchymal enhancement. Lung perfusion assessed at pulmonary blood volume imaging correlates well with findings at scintigraphy, and pulmonary blood volume defects seen in pulmonary embolism studies infer occlusive disease with increased risk of right heart dysfunction. Similarly, perfusion inhomogeneities seen in patients with PH closely reflect mosaic lung changes and may be useful for severity assessment and prognostication. The use of DECT may increase detection of peripheral thromboembolic disease, which is of particular prognostic importance in patients with chronic thromboembolic PH with microvascular involvement. Other DECT applications for imaging of PH include low-kilovoltage images with greater inherent iodine conspicuity and iodine-selective color-coded maps of vascular perfusion (both of which can improve visualization of vascular enhancement), virtual nonenhanced imaging (which better depicts vascular calcification), and, potentially, ventricular perfusion maps (to assess myocardial ischemia). In addition, quantitative assessment of central vascular and parenchymal enhancement can be used to evaluate pulmonary hemodynamics in patients with PH. The current status and potential advantages and limitations of DECT for imaging of PH are reviewed, and current evidence is supplemented with data from a tertiary referral center for PH.