Novel radiological approaches for diagnosis and treatment of diseases in the pelvic region. Applications in the uterus and the prostate.
Bengtsson, Johan LU
(2024)
In Lund University, Faculty of Medicine Doctoral Dissertation Series
- Abstract
- Background: Continuous advancements in interventional and diagnostic radiological techniques are mandatory to meet the increasing demands of patients and health care professionals. This thesis aims to contribute to the development of more effective interventional and diagnostic radiological methods for pelvic diseases. Ultimately, these advancements can lead to improved patient outcomes, optimised treatment strategies, and enhanced precision in diagnosing and managing conditions affecting the uterus and prostate.
Aim: The overarching aim of this thesis is to investigate both interventional and diagnostic radiological methods for pelvic diseases, and specifically for the uterus and the prostate. Specifically, we aim... (More) - Background: Continuous advancements in interventional and diagnostic radiological techniques are mandatory to meet the increasing demands of patients and health care professionals. This thesis aims to contribute to the development of more effective interventional and diagnostic radiological methods for pelvic diseases. Ultimately, these advancements can lead to improved patient outcomes, optimised treatment strategies, and enhanced precision in diagnosing and managing conditions affecting the uterus and prostate.
Aim: The overarching aim of this thesis is to investigate both interventional and diagnostic radiological methods for pelvic diseases, and specifically for the uterus and the prostate. Specifically, we aim to address the feasibility, usability and effectiveness of a new degradable starch microsphere (DSM) intended for use in transarterial embolisation of the uterus and prostate (papers I and II), and prostate MRI features with applications on estimations of tumour aggressiveness and prostate volume (papers III and IV).
Methods: The experimental trial of papers I and II was performed on sheep that underwent transarterial uterine artery embolisation with either a DSM or a permanent commercially available permanent sphere, trisacryl gelatine microspheres (TGMS) in a blinded randomised controlled trial. Two weeks after embolisation, a follow-up angiogram was performed to assess recanalisation, and thereafter the animals were euthanised, and organs were collected for histopathology. The primary outcome measures were the occurrence of recanalisation of the embolised arteries and the presence of ischaemic changes in the embolised organs. Papers III and IV were retrospective cohort studies of men diagnosed with prostate cancer who had an MRI prior to prostatectomy. In paper III, we evaluated the correlation of absolute tumour apparent diffusion coefficient (ADC) and ADC ratios with pathology-based tumour aggressiveness in terms of ISUP grade group according to the International Society of Urological Pathology five-grade scale. Two experienced radiologists, independently from each other, measured the ADC values of 98 men that met the inclusion criteria. In paper IV, 124 men from the same main cohort as in paper III were included. Different MRI-based and ultrasound-based methods, including one machine learning MRI-based method for prostate volume, were compared to two different gold standards: weight volume from
pathology and volume from manual planimetry, by an experienced radiologist on MRI.
Results: The ischaemic effect according to histopathology of the DSM in papers I and II was comparable with the commercially available market-leading equivalent. A significantly higher number of recanalised vessels were found in the DSM group as well as less vasculitis of the embolised arteries and a similar ischaemic effect of the embolised organs. In paper III, no correlation was seen between ADC and ISUP grade and no benefit of using ADC ratio over absolute ADC was found. The interrater reliability was substantial to almost perfect for all variables analysed. In paper IV we found that the machine learning software was more stringent than manual methods in calculating prostate volume, and no systematic error was found.
Conclusion: Our study showcases the efficacy of embolisation using the new DSM, offering potential for recanalisation and blood flow restoration. Moreover, embolisation with DSM demonstrates comparable tissue effects to TGMS with less vascular inflammation and enhanced recanalisation. Our findings also challenge previous assumptions by revealing no correlation between ADC metrics and ISUP grade, while affirming the reliability of deep learning algorithms for prostate volume assessment. These insights underscore the evolving landscape of interventional procedures and imaging techniques that will shape future clinical practices. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/ff33374b-e104-4f3c-99d5-52d0c44ce611
- author
- Bengtsson, Johan
LU
- supervisor
- opponent
-
- Associate Professor Leonhardt, Henrik, University of Gothenburg
- organization
- publishing date
- 2024
- type
- Thesis
- publication status
- published
- subject
- keywords
- Embolization, Uterine fibroid,, Benign prostate hyperplaisa, Magnetic resonance imaging (MRI), Prostate neoplasms, Deep Learning, Diffusion weighted imaging
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- issue
- 2024:82
- pages
- 105 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Segerfalksalen, BMC A10, Sölvegatan 17 i Lund
- defense date
- 2024-06-14 09:09:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-577-0
- language
- English
- LU publication?
- yes
- id
- ff33374b-e104-4f3c-99d5-52d0c44ce611
- date added to LUP
- 2024-05-07 18:56:21
- date last changed
- 2024-05-13 11:16:13
@phdthesis{ff33374b-e104-4f3c-99d5-52d0c44ce611,
abstract = {{<b>Background: </b>Continuous advancements in interventional and diagnostic radiological techniques are mandatory to meet the increasing demands of patients and health care professionals. This thesis aims to contribute to the development of more effective interventional and diagnostic radiological methods for pelvic diseases. Ultimately, these advancements can lead to improved patient outcomes, optimised treatment strategies, and enhanced precision in diagnosing and managing conditions affecting the uterus and prostate. <br/><br/><b>Aim:</b> The overarching aim of this thesis is to investigate both interventional and diagnostic radiological methods for pelvic diseases, and specifically for the uterus and the prostate. Specifically, we aim to address the feasibility, usability and effectiveness of a new degradable starch microsphere (DSM) intended for use in transarterial embolisation of the uterus and prostate (papers I and II), and prostate MRI features with applications on estimations of tumour aggressiveness and prostate volume (papers III and IV). <br/><br/><b>Methods:</b> The experimental trial of papers I and II was performed on sheep that underwent transarterial uterine artery embolisation with either a DSM or a permanent commercially available permanent sphere, trisacryl gelatine microspheres (TGMS) in a blinded randomised controlled trial. Two weeks after embolisation, a follow-up angiogram was performed to assess recanalisation, and thereafter the animals were euthanised, and organs were collected for histopathology. The primary outcome measures were the occurrence of recanalisation of the embolised arteries and the presence of ischaemic changes in the embolised organs. Papers III and IV were retrospective cohort studies of men diagnosed with prostate cancer who had an MRI prior to prostatectomy. In paper III, we evaluated the correlation of absolute tumour apparent diffusion coefficient (ADC) and ADC ratios with pathology-based tumour aggressiveness in terms of ISUP grade group according to the International Society of Urological Pathology five-grade scale. Two experienced radiologists, independently from each other, measured the ADC values of 98 men that met the inclusion criteria. In paper IV, 124 men from the same main cohort as in paper III were included. Different MRI-based and ultrasound-based methods, including one machine learning MRI-based method for prostate volume, were compared to two different gold standards: weight volume from<br/>pathology and volume from manual planimetry, by an experienced radiologist on MRI. <br/><br/><b>Results:</b> The ischaemic effect according to histopathology of the DSM in papers I and II was comparable with the commercially available market-leading equivalent. A significantly higher number of recanalised vessels were found in the DSM group as well as less vasculitis of the embolised arteries and a similar ischaemic effect of the embolised organs. In paper III, no correlation was seen between ADC and ISUP grade and no benefit of using ADC ratio over absolute ADC was found. The interrater reliability was substantial to almost perfect for all variables analysed. In paper IV we found that the machine learning software was more stringent than manual methods in calculating prostate volume, and no systematic error was found. <br/><br/><b>Conclusion:</b> Our study showcases the efficacy of embolisation using the new DSM, offering potential for recanalisation and blood flow restoration. Moreover, embolisation with DSM demonstrates comparable tissue effects to TGMS with less vascular inflammation and enhanced recanalisation. Our findings also challenge previous assumptions by revealing no correlation between ADC metrics and ISUP grade, while affirming the reliability of deep learning algorithms for prostate volume assessment. These insights underscore the evolving landscape of interventional procedures and imaging techniques that will shape future clinical practices.}},
author = {{Bengtsson, Johan}},
isbn = {{978-91-8021-577-0}},
issn = {{1652-8220}},
keywords = {{Embolization; Uterine fibroid,; Benign prostate hyperplaisa; Magnetic resonance imaging (MRI); Prostate neoplasms; Deep Learning; Diffusion weighted imaging}},
language = {{eng}},
number = {{2024:82}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Novel radiological approaches for diagnosis and treatment of diseases in the pelvic region. Applications in the uterus and the prostate.}},
url = {{https://lup.lub.lu.se/search/files/183015133/Avhandling_Johan_Bengtsson_LUCRIS.pdf}},
year = {{2024}},
}