Abstract：
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.
UNASSIGNED: 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: The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting.
RESULTS: 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.
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.
UNASSIGNED: 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: The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting.
RESULTS: 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.
摘要：
目的：磁共振成像（MRI）可以检测前列腺癌局灶性治疗后的复发，但对其使用尚无可靠的指导。我们的目标是就MRI采集提出共识性建议,解释,并在局灶性治疗后报告。
方法：2022年7月进行了系统评价，以形成共识声明。然后进行了两轮共识练习，在2023年1月举行的一次共识会议上，来自欧洲和北美的23名小组成员对329份陈述进行了评分，放射学,和病理学，具有八种局部治疗方式的经验。使用兰德公司/加州大学洛杉矶分校的方法，局灶性治疗(TARGET)后MRI评估前列腺的跨大西洋建议基于对同意或不同意的陈述的共识.
■总共，该综述包括73项研究。所有20项报告可疑成像特征的研究（100％）均将局灶性对比增强视为可疑癌症复发。在31项报告MRI评估标准的研究中，前列腺成像报告和数据系统（PI-RADS）评分是最常用的方案（20项研究；65％），其次是5分Likert评分（6项研究；19%）。对于协商一致的工作，同意或不同意的陈述的共识从第一轮的295份陈述中的227份(76.9%)增加到第二轮的329份陈述中的270份(82.1%)。主要建议包括在12个月时使用符合PI-RADS2.1版标准的多参数协议执行常规MRI。应避免用于评估消融区内复发的PI-RADS类别评分。提出了一种替代的5点评分系统，该系统包括主要的动态对比增强（DCE）序列以及联合的次要扩散加权成像和T2加权序列。对于DCE序列，局灶性结节强烈的早期增强是最可疑的影像学发现。提出了结构化的最低报告数据集和最低报告标准，用于详细说明局灶性治疗后的MRI数据。
结论：TARGET共识建议可能会改善MRI采集，解释,并在前列腺癌局部治疗后报告，并为研究报告提供最低标准。
结果：磁共振成像（MRI）扫描可以检测局部治疗后前列腺癌的复发，但缺乏MRI用于此目的的指导。我们报告了可以改善实践的新专家建议。
方法：2022年7月进行了系统评价，以形成共识声明。然后进行了两轮共识练习，在2023年1月举行的一次共识会议上，来自欧洲和北美的23名小组成员对329份陈述进行了评分，放射学,和病理学，具有八种局部治疗方式的经验。使用兰德公司/加州大学洛杉矶分校的方法，局灶性治疗(TARGET)后MRI评估前列腺的跨大西洋建议基于对同意或不同意的陈述的共识.
■总共，该综述包括73项研究。所有20项报告可疑成像特征的研究（100％）均将局灶性对比增强视为可疑癌症复发。在31项报告MRI评估标准的研究中，前列腺成像报告和数据系统（PI-RADS）评分是最常用的方案（20项研究；65％），其次是5分Likert评分（6项研究；19%）。对于协商一致的工作，同意或不同意的陈述的共识从第一轮的295份陈述中的227份(76.9%)增加到第二轮的329份陈述中的270份(82.1%)。主要建议包括在12个月时使用符合PI-RADS2.1版标准的多参数协议执行常规MRI。应避免用于评估消融区内复发的PI-RADS类别评分。提出了一种替代的5点评分系统，该系统包括主要的动态对比增强（DCE）序列以及联合的次要扩散加权成像和T2加权序列。对于DCE序列，局灶性结节强烈的早期增强是最可疑的影像学发现。提出了结构化的最低报告数据集和最低报告标准，用于详细说明局灶性治疗后的MRI数据。
结论：TARGET共识建议可能会改善MRI采集，解释,并在前列腺癌局部治疗后报告，并为研究报告提供最低标准。
结果：磁共振成像（MRI）扫描可以检测局部治疗后前列腺癌的复发，但缺乏MRI用于此目的的指导。我们报告了可以改善实践的新专家建议。
