Ultrasound Magnetic Resonance Imaging Research Articles

Is it worth carrying out ultrasound-magnetic resonance imaging fusion targeted biopsy on Prostate Imaging Reporting and Data System score3 prostate lesions?

To evaluate the use of ultrasound-magnetic resonance imaging fusion targeted biopsy for Prostate Imaging Reporting and Data System3 prostate lesions. We identified 227 patients with prostate-specific antigen levels ≥4ng/mL who underwent concurrent transrectal ultrasound-guided systemic biopsy and fusion biopsy. Suspicious prostatic lesions were assessed in accordance with Prostate Imaging Reporting and Data System version 2.0. We compared ultrasound-magnetic resonance imaging fusion targeted biopsy and ultrasound-guided biopsy cancer detection rates in Prostate Imaging Reporting and Data System3 lesions with those in other Prostate Imaging Reporting and Data System score lesions. In Prostate Imaging Reporting and Data System3 patients, we identified clinically significant prostate cancer risk factors by logistic regression analysis. In total, 2770 transrectal ultrasound-guided and 867 fusion biopsy cores were obtained; where 332 (12.0%) and 194 (22.4%) cores were prostate cancer-positive, respectively (P<0.001). The fusion biopsy cancer detection rate (8.0%) in Prostate Imaging Reporting and Data System3 lesions was similar to that in Prostate Imaging Reporting and Data System1-2 lesions, but was lower than that of Prostate Imaging Reporting and Data System4 (30.0%; P<0.001) and 5 lesions (65.2%; P<0.001), and ultrasound-guided biopsy (12.0%; P=0.023). For clinically significant prostate cancer detection, fusion biopsy in Prostate Imaging Reporting and Data System3 lesions was inferior to that in Prostate Imaging Reporting and Data System4 and 5 lesions, and non-superior to ultrasound-guided biopsy. Cancer detection rate trends were similar in biopsy-naïve patients. In Prostate Imaging Reporting and Data System3 patients, prostate-specific antigen density was the only significant predictor of clinically significant prostate cancer. The present findings do not support the use of ultrasound-magnetic resonance imaging fusion targeted biopsy for Prostate Imaging Reporting and Data System3 lesions. Thus, we recommend the use of transrectal ultrasound-guided systemic biopsy for patients with Prostate Imaging Reporting and Data System3 index lesions.

Detecting Rotator Cuff Tears: A Network Meta-analysis of 144 Diagnostic Studies.

Background:Many imaging techniques have been developed for the detection of rotator cuff tears (RCTs). Despite numerous quantitative diagnostic studies, their relative accuracy remains inconclusive.Purpose:To determine which of 3 commonly used imaging modalities is optimal for the diagnosis of RCTs.Study Design:Systematic review; Level of evidence, 4.Methods:Studies evaluating the performance of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and ultrasound (US) used in the detection of RCTs were retrieved from the PubMed/MEDLINE and Embase databases. Diagnostic data were extracted from articles that met the inclusion/exclusion criteria. A network meta-analysis was performed using an arm-based model to pool the absolute sensitivity and specificity, relative sensitivity and specificity, and diagnostic odds ratio as well as the superiority index for ranking the probability of these techniques.Results:A total of 144 studies involving 14,059 patients (14,212 shoulders) were included in this network meta-analysis. For the detection of full-thickness (FT) tears, partial-thickness (PT) tears, or any tear, MRA had the highest sensitivity, specificity, and superiority index. For the detection of any tear, MRI had better performance than US (sensitivity: 0.84 vs 0.81, specificity: 0.86 vs 0.82, and superiority index: 0.98 vs 0.22, respectively). With regard to FT tears, MRI had a higher sensitivity and superiority index than US (0.91 vs 0.87 and 0.67 vs 0.28, respectively) and a similar specificity (0.88 vs 0.88, respectively). The results for PT tears were similar to the detection of FT tears. A sensitivity analysis was performed by removing studies involving only 1 arm for FT tears, PT tears, or any tear, and the results remained stable.Conclusion:This network meta-analysis of diagnostic tests revealed that high-field MRA had the highest diagnostic value for detecting any tear, followed by low-field MRA, high-field MRI, high-frequency US, low-field MRI, and low-frequency US. These findings can help guide clinicians in deciding on the appropriate imaging modality.

Comparative study on the diagnostic value of multiparametric transrectal ultrasound and multiparametric MRI in prostate cancer

Objective The aim of the study is to compare the diagnostic value of multiparametric transrectal ultrasound(TRUS) and multiparametric magnetic resonance imaging (MRI) in prostate cancer. Methods The clinical data of 102 patients who received multiparametric TRUS (including conventional transrectal ultrasound, shear wave sonoelastography and contrast enhanced ultrasound), multiparametric MRI(including T2 weighted diffusion weighted, and dynamic contrast enhanced MRI) and laboratory tests from April 2016 to May 2018 were retrospectively analyzed. The average age was 66.1 years old, ranging 38.0-85.0 years old. The average PSA was 30.1 ng/ml, ranging 0.4-227.0 ng/ml. The average PSAD was 0.67 ng/ml2, ranging 0.02-4.27 ng/ml2. The pathology results from TRUS guided biopsy or surgical operation were chosen as gold standard. Diagnostic performance including sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), accuracy and area under the receiver operating characteristic curve(AUROC)of multiparametric TRUS and multiparametric MRI in prostate cancer were analyzed. Results There were 62 prostate cancer and 40 BPH patients in our study. Parallel multiparametric TRUS diagnosed 63 prostate cancer and 39 BPH, and multiparametric MRI diagnosed 75 prostate cancer and 27 BPH. The sensitivity, specificity and accuracy of parallel multiparametric TRUS were 98.4%, 70.0% and 87.3%, respectively. And those of multiparametric MRI were 95.2%, 60.0% and 81.4%, respectively. The AUROC of parallel multiparametric TRUS and multiparametric MRI were 0.842 and 0.776, with no significant differences(P=0.208). Conclusion The diagnostic value of multiparametric TRUS was not inferior to multiparametric MRI in prostate cancer. Key words: Prostatic neoplasms; Prostate cancer; Magnetic resonance imaging; Transrectal ultrasound; Multiparametric

Verification of needle guidance accuracy in pelvic phantom using registered ultrasound and MRI images for intracavitary/interstitial gynecologic brachytherapy

PurposeIn combined intracavitary/interstitial (IC/IS) gynecologic brachytherapy, trackers attached to interstitial needles of localize real-time needle trajectories, and intraoperative ultrasound (US) images provide updated anatomy information during needle insertions. To achieve an effective visualization and image guidance, real-time needle trajectories and US images can be unified in preoperative magnetic resonance imaging (MRI) image space together. This study evaluates the rigid registration accuracy between US images and MRI images as well as the registration accuracy between US images and real-time needle trajectories in a pelvic phantom.Material and methodsA method for US probe calibration and accomplished rigid registration between MRI images and US images was proposed. An IC/IS applicator was designed. Micro electromagnetic sensor to track and localize real-time needle trajectories in 3D MRI image space was used. Marker validation to test the accuracy of US probe calibration and pelvic phantom validation to test the registration accuracy between US images and MRI images was conducted as well as and pelvic phantom study to verify the registration accuracy between real-time needle trajectories and needle trajectories in registered US images.ResultsUS probe calibration accuracy was 0.80 ±0.23 mm (n = 60). Registration accuracy between US images and MRI images were 1.01 ±0.22 mm in the axial plane (n = 60) and 1.14 ±0.20 mm in the sagittal plane (n = 24). Registration accuracy between real-time needle trajectories and needle trajectories in registered US images were 1.25 ±0.31 mm (n = 40) and 1.61 ±0.28 degrees (n = 5), respectively.ConclusionsIn this study, we showed that under ideal conditions, rigid registration between MRI images and US images obtained high accuracy for real-time image guidance. Additionally, registered US images provided accurate image guidance during visual needle insertion in IC/IS gynecologic brachytherapy to achieve a combination of effective visualization and image guidance.

True Brachial Artery Aneurysm in Non-smoker Woman

Aneurism is a stretch, convexity and sacs in artery which is caused by abnormally congenital connective tissue, infection, arterial inflammation or artery wall trauma. True brachial artery aneurysm is relatively rare. There are only some cases that have been reported previously in medical literature. Brachial artery aneurysm might be asymptomatic or revealed by a brachial mass with beating pulse or peripheral ischemia. The diagnosis usually relies on ultrasound and arterial scan or magnetic resonance imaging (MRI). The main treatment is the surgery which allows cutting the aneurysm and grafted with a part of great saphenous vein by two end-to-end anastomoses. We present a case report of true aneurysm of brachial artery in a 40 years old woman who was treated in Thai Binh Medical University Hospital.

Can Combined Screening of Ultrasound and Elastography Improve Breast Cancer Identification Compared with MRI in Women with Dense Breasts-a Multicenter Prospective Study.

Objectives: To assess the performance of elastography (ES) and ultrasound (US) in predicting the malignancy of breast lesions and to compare their combined diagnostic value with that of magnetic resonance imaging (MRI).Materials and Methods: The study prospectively enrolled 242 female patients with dense breasts treated in 35 heath care facilities in China between November 2018 and October 2019. Based on conventional US and elastography, radiologists classified the degree of suspicion of breast lesions according to the US Breast Imaging Reporting and Data System (BI-RADS) criteria. The diagnostic value was compared between US BI-RADS and MRI BI-RADS, with pathological results used as the reference standard.Results: The results demonstrated that irregular tumor shape, a nonparallel growth orientation, indistinct margins, angular contours, microcalcifications, color Doppler flow and ES score on US imaging were significantly related to breast cancer in dense breasts (P=0.001; P=0.001; P=0.008; P<0.001; P=0.019; P=0.008; P=0.002, respectively). The sensitivity, specificity, PPV, NPV, accuracy and AUC of US BI-RADS category were 94.7%, 90.7%, 95.8%, 88.0%, 93.4% and 0.93 (95%CI, 0.88-0.97), respectively, while those of MRI BI-RADS category were 98.2%, 57.5%, 84.3%, 83.3%, 86.0% and 0.78 (95%CI, 0.71-0.85), respectively. MRI BI-RADS showed a significantly higher sensitivity than US BI-RADS (98.2% vs 94.7%, P=0.043), whereas US BI-RADS showed significantly higher specificity (90.7% vs 57.5%, P<0.001). US BI-RADS showed better diagnostic efficiency in differentiating nodules in dense breasts than MRI BI-RADS (AUC 0.93 vs 0.78, P<0.001).Conclusion: By combining the use of ES and conventional US, US BI-RADS had better diagnostic efficiency in differentiating nodules in dense breasts than MRI. For the diagnosis of malignant tumors in patients with dense breasts, MRI and US BI-RADS can be used as supplemental diagnostic tools to detect lesions, with US BI-RADS considered the preferred adjunctive resource.

The comparative study of antenatal magnetic resonance imaging and ultrasound in the evaluation of fetal central nervous system abnormalities

Background: The role of fetal magnetic resonance imaging (MRI) was studied in antenatal anomalies detected by ultrasound. Materials and Methods: The study was conducted in the Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, over a period of 12 months including all pregnant women with suspected fetal anomalies on ultrasonography (US). Results: In 9/23 cases (39.1%), the US findings and MRI findings were similar. MRI changed the diagnosis in 11/23 cases (47.8%). MRI provided additional information than US in 2/23 cases (8.69%), and there was 1/23 (4.3%) cases in which US provided additional information to that provided by MRI in terms of intrauterine growth restriction. Conclusions: US and MRI are complementary to each other in reaching a diagnosis in the fetal central nervous system abnormalities, and MRI is a major problem-solving modality where the US findings are inconclusive. The major role for fetal MRI was found in confirmation of inconclusive sonographic findings and the evaluation of sonographically occult diagnoses.

Application of Dual Modality Contrast Agent Combined with Multi-Scale Representation in Ultrasound-Magnetic Resonance Imaging Registration Scheme

Application of Dual Modality Contrast Agent Combined with Multi-Scale Representation in Ultrasound-Magnetic Resonance Imaging Registration Scheme

Assessment of Radiomics and Deep Learning for the Segmentation of Fetal and Maternal Anatomy in Magnetic Resonance Imaging and Ultrasound

Recent advances in fetal imaging open the door to enhanced detection of fetal disorders and computer-assisted surgical planning. However, precise segmentation of womb's tissues is challenging due to motion artifacts caused by fetal movements and maternal respiration during acquisition. This work aims to efficiently segment different intrauterine tissues in fetal magnetic resonance imaging (MRI) and 3D ultrasound (US). First, a large set of ninety-four radiomic features are extracted to characterize the mother uterus, placenta, umbilical cord, fetal lungs, and brain. The optimal features for each anatomy are identified using both K-best and Sequential Forward Feature Selection techniques. These features are then fed to a Support Vector Machine with instance balancing to accurately segment the intrauterine anatomies. To the best of our knowledge, this is the first time that "Radiomics" is expanded from classification tasks to segmentation purposes to deal with challenging fetal images. In addition, we evaluate several state-of-the-art deep learning-based segmentation approaches. Validation is extensively performed on a set of 60 axial MRI and 3D US images from pathological and clinical cases. Our results suggest that combining the selected 10 radiomic features per anatomy along with DeepLabV3+ or BiSeNet architectures for MRI, and PSPNet or Tiramisu for 3D US, can lead to the highest fetal / maternal tissue segmentation performance, robustness, informativeness, and heterogeneity. Therefore, this work opens new avenues for advancement of segmentation techniques and, in particular, for improved fetal surgical planning.

Quantifying the effect of biopsy lateral decubitus patient positioning compared to supine prostate magnetic resonance image scanning on prostate translocation and distortion.

More than a quarter of tumors are missed by magnetic resonance imaging/ultrasound (MRI/US) fusion-guided biopsy, the majority due to software-based misregistration. Transrectal approaches to biopsy are typically performed in the lateral decubitus position; conversely, diagnostic MRI is performed with the patient lying supine. Any position-related difference in prostate location or gland deformation could potentially exacerbate misregistration at subsequent biopsy. Fifteen healthy male volunteers (mean age 35.9 years, range 27-53) were included in this prospective, institutional review board-approved study. Each volunteer had an MRI performed in the supine position, followed by the second in the lateral decubitus position (mimicking a typical biopsy position). MRI images were co-registered and analyzed in order to assess prostate translocation and distortion. Whole prostate translocation of ≥5 mm was observed in 20% of patients and of ≥3 mm in 60% of patients. When dividing the prostate into prostatic sectors, the prostatic base demonstrated the largest positional difference. When plotting the translocation directions with relative volume difference, there was a moderate negative correlation trend in the latero-lateral direction. Only minimal distortion was observed, with similar distortion among all prostatic sectors. Positional change affects the prostate translocation, however, the effect on prostate distortion appears to be negligible. Prostate translocation in latero-lateral direction can be minimized with larger bladder volumes. Prostate translocation needs to be considered alongside software misregistration error; however, positional change should not affect software registration of MRI/US fusion-guided prostate biopsy.

P077 - Comparison of cancer detection rates in micro-ultrasound biopsies versus robotic ultrasound-magnetic resonance imaging fusion biopsies for prostate cancer

P077 - Comparison of cancer detection rates in micro-ultrasound biopsies versus robotic ultrasound-magnetic resonance imaging fusion biopsies for prostate cancer

The use of image fusion in prenatal medicine.

Fusion imaging (FI), the simultaneous display of the same anatomical region using two imaging modalities, has been used in other areas of medicine for both diagnosis and guiding interventions. Examples include positron emission tomography-computed tomography (PET-CT) imaging in oncology and ultrasound-magnetic resonance imaging (US-MRI) fusion in biopsies of the prostate gland. The underlying principle is to take advantage of the complementary information in each modality to improve accuracy, be it diagnostic accuracy or targeting accuracy in biopsies. For example, PET-CT overlays the metabolic activity of lesions on the superb spatial and anatomical detail of CT. While the historical mainstay of fetal imaging has been ultrasound, advances in ultrafast MR imaging together with advances in fetal MRI over the past two decades, have resulted in the opportunity to explore fusion imaging in fetal medicine. We present an overview of the principles of US-MRI fusion imaging in prenatal medicine, report our local experience, and review the literature in this emerging area. We share our perspective on how FI can improve diagnostic confidence, be used as an educational tool, and potentially enhance guidance in certain fetal procedures.

Effect of Preoperative Administration of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor on Carotid Artery Stenting

Perioperative embolic stroke is one of the most serious complications during carotid artery stenting (CAS). Proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) is a low-density lipoprotein-lowering drug that inhibits proprotein convertase subtilisin/kexin type 9, which normally binds to the low-density lipoprotein cholesterol (LDL-C) receptor. Its combination with statin significantly decreases LDL-C levels. PCSK9i is expected to achieve lower LDL-C levels than single use of statin. This study aimed to investigate whether perioperative PCSK9i administration stabilizes carotid artery plaque and reduces perioperative complications of CAS. Nine patients with symptomatic stenosis (North American Symptomatic Carotid Endarterectomy Trial [NASCET] 50%) or asymptomatic stenosis (NASCET ≥ 80%) were included. PCSK9i was administered at least twice (once in 2 weeks) in the outpatient clinic before CAS. Perioperative complications; results from blood tests, magnetic resonance imaging (MRI), magnetic resonance angiography, and carotid ultrasonography (US); and modified Rankin scale score at discharge were assessed. High intensity on diffusion-weighted imaging was not observed in 8 patients. Changes in carotid plaque characteristics were found with MRI and/or carotid US in 7 patients. The plaque to muscle ratio decreased in 3 patients. The carotid plaque became hyperechoic in 2 patients, and the fibrous cap was seen more clearly on carotid US. Two patients had findings of stabilized plaque on MRI and carotid US, which indicates that plaque transformation was more stable. Lowering LDL-C level could reduce ischemic complications, and low LDL-C level affects plaque stability and antithrombus formation. PCSK9i can possibly stabilize carotid plaque and reduce perioperative complications of CAS.

Diagnostic des ruptures distales du tendon Biceps brachial : imagerie en résonance magnétique versus échographie

IntroductionThe severity of distal biceps tendon (DBT) injuries ranges from partial to complete tears leading to various clinical manifestation. Accuracy of early diagnosis and selection of treatment are critical to long-term recovery outcomes. Magnetic resonance imaging (MRI) or ultrasonography (US) are two commonly modalities for pre-operative diagnosis. The objective of this study was to determine the efficiency of MRI and ultrasonography US in the diagnosis of DBT rupture confirmed by operative findings. HypothesisMRI and US are equally effective in terms of accuracy, sensitivity and specificity. Material and methodsA total of 31 patients with DBT avulsion and surgical treatment were recruited for this retrospective study. All these patients received both US and MRI examinations prior to surgery. DBT avulsion was classified into partial tear and complete tear. Diagnosis outcomes by MRI and US were analyzed and compared statistically for the accuracy, sensitivity, and specificity in discriminating partial and complete DBT tears. ResultsThe accuracy of MRI and US was 86.4% and 45.5% in diagnosis of complete DBT rupture, respectively. Accuracy rate of MRI (66.7%) was the same as US in diagnosis of partial tear. Overall accuracy rate of MRI (80.6%) was higher than US (51.6%) in diagnosis all DBT avulsion with an odds ratio of 3.9. Sensitivity and specificity of MRI were 76.0% and 50.0%, while that of ultrasonography were 62.5% and 20.0%. ConclusionsThe findings of this study suggest that MRI is a more accurate imaging modality at correctly identifying the type of DBT tear although US is more cost-effective.Level of evidence III, Cohort study, Diagnosis study.

Symmetric and ventrally conjoined twins: prenatal evaluation by ultrasound and magnetic resonance imaging and postnatal outcomes

Objective To review the perinatal and long-term outcomes of symmetric and ventrally conjoined twins evaluated prenatally by ultrasound and fetal magnetic resonance imaging (MRI). Methods From March 2010 to January 2019, cases of symmetric and ventrally conjoined twins, who were prenatally diagnosed and referred to the Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil, for prenatal evaluation by ultrasound and MRI were selected. The postnatal information was collected from hospitals where the twins were born and/or treated and from parents’ verbal and written information. Results Four cases of symmetrical and ventrally conjoined twins were selected. Of these, two were omphalopagi and two thoracopagi. One pair of thoracomphalopagus died early in utero and the other died 6 days after birth. The outcome of the two omphalopagus pairs were separation in emergency surgeries after birth, with neonatal demise of one of the twins due to congenital malformations. In cases of omphalopagi, fetal MRI presented important information of the twins’ anatomy before emergency separation of both pairs. Conclusion Despite the apparently similar conditions of twins with ventral fusion, ventrally attached twins have very different outcomes, most adverse for thoracomphalopagus and related to the singular anatomy of the pair, associated malformations and the extension of the adhesion, requiring individual evaluation of the cases. Fetal MRI is as an important tool for the postnatal surgery management of twin neonates, providing crucial information in cases where urgent separation is required.

Validity of Ultrasound Imaging Versus Magnetic Resonance Imaging for Measuring Anterior Thigh Muscle, Subcutaneous Fat, and Fascia Thickness.

The aim of the present study was to determine the validity of ultrasound (US) imaging versus magnetic resonance imaging (MRI) for measuring anterior thigh muscle, subcutaneous adipose tissue (SAT), and fascia thickness. Twenty healthy, moderately active participants (aged 49.1 ± 9.74 (36–64) years), underwent imaging of the anterior thigh, using ultrasound and MRI modalities on the same day. Images were analyzed offline to assess the level of agreement between US and MRI measurements. Pearson’s correlation coefficient showed an excellent relationship between US imaging and MRI for measuring muscle (r = 0.99, p < 0.01), SAT (r = 0.99, p < 0.01), and non-contractile tissue (SAT combined with perimuscular fascia) thickness (r = 0.99, p < 0.01). Perimuscular fascia thickness measurement showed a poor correlation between modalities (r = 0.39, p < 0.01). Intra-class correlation coefficients (ICC3,1) also showed excellent correlation of the measurements with ICC = 0.99 for muscle thickness, SAT, and non-contractile tissue, but not for perimuscular fascia, which showed poor agreement ICC = 0.36. Bland and Altman plots demonstrated excellent agreement between US imaging and MRI measurements. Criterion validity was demonstrated for US imaging against MRI, for measuring thickness of muscle and SAT, but not perimuscular fascia alone on the anterior thigh. The US imaging technique is therefore applicable for research and clinical purposes for muscle and SAT.

Prediction of Postprostatectomy Biochemical Recurrence Using Quantitative Ultrasound Shear Wave Elastography Imaging.

Objectives: To determine the prognostic significance of tissue stiffness measurement using transrectal ultrasound shear wave elastography in predicting biochemical recurrence following radical prostatectomy for clinically localized prostate cancer.Patients and Methods: Eligible male patients with clinically localized prostate cancer and extraperitoneal laparoscopic radical prostatectomy between November 2013 and August 2017 were retrospectively selected. Information of potential biochemical recurrence predictors, including imaging (ultrasound shear wave elastography and magnetic resonance imaging), clinicopathological characteristics, and preoperative prostate specific antigen (PSA) levels were obtained. Recurrence-free survival (Kaplan–Meier curve) and a multivariate model were constructed using Cox regression analysis to evaluate the impact of shear wave elastography as a prognostic marker for biochemical recurrence.Results: Patients experienced biochemical recurrence in an average of 26.3 ± 16.3 months during their follow-up. A cutoff of 144.85 kPa for tissue stiffness measurement was estimated for recurrence status at follow-up with a sensitivity of 74.4% and a specificity of 61.7%, respectively (p < 0.05). In univariate analysis, shear wave elastography performed well in all preoperative factors compared to biopsy Gleason Score, PSA and magnetic resonance imaging; in multivariate analysis with postoperative pathological factors, shear wave elastography was statistically significant in predicting postoperative biochemical recurrence, which improved the C-index of predictive nomogram significantly (0.74 vs. 0.70, p < 0.05).Conclusions: The study revealed that quantitative ultrasound shear wave elastography-measured tissue stiffness was a significant imaging marker that enhanced the predictive ability with other clinical and histopathological factors in prognosticating postoperative biochemical recurrence following radical prostatectomy for clinically localized prostate cancer.

Re: 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.

No AccessJournal of UrologyUrological Survey1 Jul 2019Re: 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 Samir S. TanejaMD Samir S. TanejaSamir S. Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557757.85458.f2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: 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." The Journal of Urology, 202(1), pp. 34–35 Suggested Reading : The institutional learning curve of magnetic resonance imaging-ultrasound fusion targeted prostate biopsy: temporal improvements in cancer detection in 4 years. J Urol 2018; 200: 1022. Link, Google Scholar : Is it time to perform only magnetic resonance imaging targeted cores? Our experience with 1,032 men who underwent prostate biopsy. J Urol 2018; 200: 774. Link, Google Scholar : Magnetic resonance imaging-ultrasound fusion targeted prostate biopsy in a consecutive cohort of men with no previous biopsy: reduction of over detection through improved risk stratification. J Urol 2015; 194: 1601. Link, Google Scholar : Detection of significant prostate cancer with magnetic resonance targeted biopsies—should transrectal ultrasound-magnetic resonance imaging fusion guided biopsies alone be a standard of care?J Urol 2015; 193: 1198. Link, Google Scholar © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 202Issue 1July 2019Page: 34-35 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samir S. Taneja More articles by this author Expand All Advertisement Loading ...

Comparison of Adrenal Tumor Size in Ultrasound Examinations with and without the Use of a Contrast Agent.

Background and objectives: Patients diagnosed with incidentally found adrenal tumors (incidentaloma) that do not meet the criteria for surgical treatment require follow-ups with repeated imaging. The aim of this study is to compare the accuracy of the measurements of the adrenal tumor size in ultrasound (US) with and without contrast in comparison to computed tomography (CT) or magnetic resonance (MRI). Further, this study attempts to answer the question of whether contrast-enhanced ultrasound (CEUS) can improve imaging accuracy and replace CT/MRI in the monitoring of patients with adrenal tumors. Materials and Methods: The retrospective analysis included 79 adult patients with adrenal incidentalomas not exceeding a dimension of 6 cm who underwent a CT or MRI scan, US, and CEUS with the use of SonoVue in two-dimensional (2D) and three-dimensional (3D) projections and Doppler techniques. Tumor vascularization in CEUS was classified as follows: peripheral, peripheral-central, central, or poor. Results: Of 79 adrenal tumors, 48.1% showed peripheral, 29.1% showed poor, 21.5% showed peripheral-central, and only 1.3% showed central vascularization. The median volume of tumors detected with CEUS (69.9 cm3) was significantly higher than with US (44.5 cm3) and CT or MRI (57.1 cm3). The relative error of the adrenal volume with CEUS compared with CT or MRI was significantly higher than with standard US, regardless of the type of tumor vascularization. Conclusions: CEUS does not improve the accuracy of adrenal tumor size assessment regardless of the type of vascularization.

Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging.

BACKGROUNDPatients with pancreatic cystic neoplasms (PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime image-based surveillance follow-up. In these patients, the current European evidenced-based guidelines advise magnetic resonance imaging (MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound (US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by US.AIMTo report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of MRI.METHODSWe retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US findings. In this communication, we reported the clinical results of this alternative follow-up, and the results of a comparative cost-analysis between our surveillance protocol (abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance protocol.RESULTSIn the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients (1%) because of the appearance of suspicious features at imaging (with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN appearance in 28 patients (14%). These comprised main pancreatic duct dilatation (n = 1), increased size of the main cyst (n = 14) and increased number of PNC (n = 13). In all of these patients, MRI confirmed US findings, without adding more information. The bi-annual MRI identified evolution of the lesions not identified by US in only 11 patients with intraductal papillary mucinous neoplasms (5.5%), largely consisting of an increased number of very small PCN (P = 0.14). The overall mean cost of surveillance, based on a theoretical use of the European evidenced-based exclusive MRI surveillance in the same group of patients, would have been 1158.9 ± 798.6 € per patient, in contrast with a significantly lower cost of 366.4 ± 348.7 € (P < 0.0001) incurred by the US-restricted MRI surveillance used at our institution.CONCLUSIONIn patients with non-surgical PCN at the time of diagnosis, US surveillance could be a safe complementary approach to MRI, delaying and reducing the numbers of second level examinations and therefore reducing the costs.