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3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy

Posted Nov 30, 2017 Updated Apr 10, 2023
By Clément Orczyk MSc MD , Andrew B. Rosenkrantz MD , Artem Mikheev MSc , Arnauld Villers MD PhD , Myriam Bernaudin PhD , Samir S. Taneja MD , Samuel Valable PhD , Henry Rusinek PhD
16 min read

Rationale and Objectives

This study aimed to assess a novel method of three-dimensional (3D) co-registration of prostate magnetic resonance imaging (MRI) examinations performed before and after prostate cancer focal therapy.

Materials and Methods

We developed a software platform for automatic 3D deformable co-registration of prostate MRI at different time points and applied this method to 10 patients who underwent focal ablative therapy. MRI examinations were performed preoperatively, as well as 1 week and 6 months post treatment. Rigid registration served as reference for assessing co-registration accuracy and precision.

Results

Segmentation of preoperative and postoperative prostate revealed a significant postoperative volume decrease of the gland that averaged 6.49 cc ( P = .017). Applying deformable transformation based on mutual information from 120 pairs of MRI slices, we refined by 2.9 mm (max. 6.25 mm) the alignment of the ablation zone, segmented from contrast-enhanced images on the 1-week postoperative examination, to the 6-month postoperative T2-weighted images. This represented a 500% improvement over the rigid approach ( P = .001), corrected by volume. The dissimilarity by Dice index of the mapped ablation zone using deformable transformation vs rigid control was significantly ( P = .04) higher at the ablation site than in the whole gland.

Conclusions

Our findings illustrate our method’s ability to correct for deformation at the ablation site. The preliminary analysis suggests that deformable transformation computed from mutual information of preoperative and follow-up MRI is accurate in co-registration of MRI examinations performed before and after focal therapy. The ability to localize the previously ablated tissue in 3D space may improve targeting for image-guided follow-up biopsy within focal therapy protocols.

Introduction

Contemporary methods of multiparametric magnetic resonance imaging (mpMRI) of the prostate have greatly improved the ability of radiologists and urologists to detect prostate cancer . mpMRI allows physicians to diagnose clinically significant cancer in its early stage, to plan prostatectomy and radiation therapy, and to detect local recurrence.

Combined with the trend of earlier detection, noninvasive prostate cancer therapies are gaining interest. Focal therapies (FT) aim to combine oncologic benefit with preserved continence and erectile function. The use of this tissue-preservation approach is evolving, and FT are being applied to more aggressive disease than when initially proposed . Clinical FT trials depend on mpMRI for tumor localization, treatment planning, and posttreatment follow-up .

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Materials and Methods

Patients

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Image Acquisition

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Figure 1, Timeline of treatment and imaging examinations.

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Image Analysis

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Figure 2, Image analysis workflow.

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Co-registration Framework

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Figure 3, The dialog box defines the registration process.

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Estimating Transformations Within Examination and Across Examinations

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Error Analysis and Segmentation of Prostate Gland and Ablation Zone

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Figure 4, Illustrative case of affine registration between pretreatment (a) and posttreatment (photodynamic therapy) T2-weighted (T2W) volumes (c) . Panel (b) shows delayed dynamic contrast-enhanced (DCE) image of the treated area, with ablated gland shown as nonenhancing region. The bottom panel displays a postoperative T2W image overlayed with the corresponding preoperative image.

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Figure 5, Schematic illustration of various measures assessed in the current study. (a) Analysis of errors in whole-gland definition for rigid transform model M 2 vs M 2 ″; (b) analysis of errors for affine transform model M 2 vs M 2 ′; and (c) analysis of errors in defining AZ (AZ 2′ -AZ 2″ ) vs (M 2 ′-M 2 ″).

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Results

Volumetric Analysis

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TABLE 1

Distribution of Prostate Volumes Estimated from T2W Images Acquired Before and After Ablation (Late Control) and Distribution of Volume of Ablated Zone (AZ)

Prostate Volume From T2W Images Ablated Volume (cc) From DCE MRI Initial Volume (cc) Postablation Volume (cc) Difference D (cc) Median 51.64 46.73 6.70 7.88 Mean 46.49 39.99 6.50 13.82 SD 23.67 20.25 7.05 13.67 Min 8.42 6.80 −3.60 1.07 Max 87.16 65.52 21.64 37.35

DCE, dynamic contrast-enhanced; SD, standard deviation; T2W, T2-weighted.

Figure 6, Comparison between median preoperative and 6-month postoperative volumes of the prostate (orange bars). Comparison between median volume generated with rigid and nonrigid transforms (blue bars) shows that nonrigid transformation compensates better for volume loss due to focal therapy. (Color version of figure is available online.)

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Analysis of Image Co-registration

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Figure 7, Demonstration of high central processing unit core usage on a 12-core computer achieved during registration.

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TABLE 2

Comparison of Volumes Between Original T2WI and Their Transform Using Rigid and Deformable Methods

Transformed Volumes Rigid Preop Transform Volume (cc) Deformable Preop Transform Volume (cc) Median 50.71 48.22 Mean 45.41 43.23 SD 22.81 21.17 Min 7.99 7.17 Max 81.02 73.67

SD, standard deviation; T2W, T2-weighted image.

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TABLE 3

Alignment Between Whole Gland Obtained by Mapping From Preoperative to Postoperative T2W Image and Whole Gland Traced Directly on Postoperative Image: Comparison Between Rigid and Affine Co-registrations

Rigid Registration Tr Affine Registration Ta Hausdorff Distance (mm) Median 7.73 7.29 Mean 8.14 6.91 Max 9.46 9.98 Min 5.31 4.64 SD 1.45 1.60P value_P_ = .20

Dice Index Mean 0.82 0.84 Median 0.85 0.85 Max 0.91 0.92 Min 0.68 0.72 SD 0.08 0.06P value_P_ = .10

SD, standard deviation.

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Analysis of AZ

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TABLE 4

Compensation of the Local Deformation by Affine Algorithm: Comparison Between Mapping Accuracy of the Location of the Ablated Zone and the Whole Gland, Referring to Measures Shown in Figure 5c

Ta (AZ) vs Tr (AZ)Ta (M) vs Tr (M) Hausdorff Distance (mm) Median 1.99 3.83 Mean 2.99 3.84 Max 6.25 7.05 Min 1.10 1.10 SD 2.10 2.21

Normalized Hausdorff distance (mm/mL) Mean 0.72 0.15 Median 0.22 0.09 Max 1.09 0.55 Min 0.05 0.03 SD 0.57 0.17P value_P_ = .0019

Dice Index Mean 0.87 0.93 Median 0.87 0.92 Max 0.96 0.98 Min 0.59 0.88 SD 0.11 0.04P value_P_ = .046

SD, standard deviation.

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Figure 8, Postsurgical changes for a representative case involving dynamic phototherapy on the left lobe. (a,b) Three-dimensional (3D) rendering before and after treatment. Changes in shape and volume loss are observed in the left part of the gland. The pretreatment view shows in red the lesion 10 mm in axial diameter, Gleason 6 (3 + 3). The posttreatment view displays in yellow the location of the ablated zone. This yellow area needs to be sampled to rule out cancer at follow-up biopsy. The green line segment is the needle path for transperineal targeted biopsy. (c) Preoperative T2-weighted (T2W) image. (d) Preoperative apparent diffusion coefficient (ADC) map. (e) Preoperative dynamic contrast-enhanced (DCE) image through the cancer focus (white arrow). (f) Late postoperative T2W image. (g) Postoperative ADC map. (h) DCE image at the same level. Changes in shape and magnetic resonance imaging (MRI) signal are discernible at the site of ablation on the left side of the gland. (Color version of figure is available online.)

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Discussion

The Role of Image Registration in Prostate Cancer Pathway

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Challenge for Image Registration

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Posttreatment Volume Loss

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Co-registration Accuracy

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Limitations

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Clinical Implications

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Figure 9, Graphical summary of implementation of three-dimensional (3D) registration of multiparametric magnetic resonance imaging (mpMRI) into focal therapy of prostate cancer pathway. Overlays of the prostate segmentation are presented on the extreme right MRI image with the green line as the postablation segmentation, the blue the preoperative registered prostate using the nonrigid transformation, and the orange using the rigid registration. (Color version of figure is available online.)

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Academic Radiology, Volume 24, Issue 12
Journals General Radiology
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