Diagnostic Accuracy of a MR Protocol Acquired with and without Endorectal Coil for Detection of Prostate Cancer: A Multicenter Study

Introduction The purpose of this study was to compare diagnostic accuracy of a prostate multiparametric magnetic resonance imaging (mpMRI) protocol for detection of prostate cancer between images acquired with and without en-dorectal coil (ERC). Materials This study was approved by the regional ethics committee. Between 2014 and 2015, 33 patients (median age 51.3 years; range 42.1-77.3 years) who underwent prostate-MRI at 3T scanners at 2 different institutions, acquired with (mpMRI) and without (mpMRI) ERC and who received radical prostatectomy, were included in this retrospective study. Two expert readers (R1, R2) attributed a PI-RADS version 2 score for the most suspect (i. e. index) lesion for mpMRI and mpMRI. Sensitivity and positive predictive value for detection of index lesions were assessed using 2 × 2 contingency tables. Differences between groups were tested using the McNemar test. Whole-mount histopathology served as reference standard. Results On a quadrant-basis cumulative sensitivity ranged between 0.61-0.67 and 0.76-0.88 for mpMRI and mpMRI protocols, respectively (p > 0.05). Cumulative positive predictive value ranged between 0.80-0.81 and 0.89-0.91 for mpMRI and mpMRI protocols, respectively. The differences were not statistically significant for R1 (p = 0.267) or R2 (p = 0.508). Conclusion Our results suggest that there may be no significant differences for detection of prostate cancer between images acquired with and without an ERC

Simultaneous multislice diffusion-weighted imaging of the kidney: a systematic analysis of image quality

OBJECTIVES The aims of this study were to implement a protocol for simultaneous multislice (SMS) accelerated diffusion-weighted imaging (DWI) of the kidneys and to perform a systematic analysis of image quality of the data sets. MATERIALS AND METHODS Ten healthy subjects and 5 patients with renal masses underwent DWI of the kidney in this prospective institutional review board-approved study on a 3 T magnetic resonance scanner. Simultaneous multislice DWI echo-planar sequences (acceleration factors [AFs] 2 and 3) were compared with conventional echo-planar DWI as reference standard for each acquisition scheme. The following 3 acquisition schemes were applied: comparison A, with increased number of acquisitions at constant scan time; comparison B, with reduction of acquisition time; and comparison C, with increased slice resolution (constant acquisition time, increasing number of slices). Interreader reliability was analyzed by calculating the intraclass correlation coefficient (ICC). Qualitative image quality features were evaluated by 2 independent radiologists on a 5-point Likert scale. Quantification accuracy of the apparent diffusion coefficients (ADCs) and signal-to-noise ratios (SNRs) were assessed by region of interest analysis. Furthermore, lesion conspicuity in the 5 patients was assessed using a 5-point Likert scale by 2 independent radiologists. RESULTS Interreader agreement was substantial with an ICC of 0.68 for the overall image quality and an ICC of 0.73 for the analysis of artifacts. In comparison A, AF2 resulted in increased SNR (P < 0.05) by 21% at stable image quality scores (image quality: P = 0.76, artifacts: P = 0.21). In comparison B, applying AF2, the scan time could be reduced by 46% without significant reduction in qualitative image quality scores (P = 0.059) or SNR (P = 0.126). In comparison C, slice resolution could be improved by 28% using AF2 with stable image quality scores and SNR. In general, AF3 resulted in reduced image quality and SNR. Significantly reduced ADC values were observed for AF3 in comparison C (cortex: P = 0.003; medulla: P = 0.001) compared with the standard echo-planar imaging sequence. The conventional DWI and the SMS DWI with AF2 showed stable lesion conspicuity ([AF1/AF2]: reader 1 [1.8/1.4] and reader 2 [1.8/1.4]). The lesion conspicuity was lower using AF3 (reader 1: 2.2 and reader 2: 1.8). CONCLUSIONS In conclusion, SMS DWI of the kidney is a potential tool to substantially reduce scan time without negative effects on SNR, ADC quantification accuracy, and image quality if an AF2 is used. Although AF3 results in even higher scan time reduction, a negative impact on image quality, SNR, ADC quantification accuracy, and lesion conspicuity must be considered

Combined intra- and extraperitoneal urinary bladder rupture - a rare seat-belt injury: a case report

INTRODUCTION: While isolated traumatic urinary bladder injuries are rare, combined intra- and extraperitoneal traumatic urinary bladder ruptures without an underlying fracture are an absolute rarity. PRESENTATION OF CASE: We report a case of combined intra- and extraperitoneal urinary bladder rupture without an underlying fracture resulting from blunt abdominal trauma during a high velocity car accident. A midline laparotomy was performed, and the intra- and extraperitoneal bladder ruptures were surgically treated. DISCUSSION: Based on the presented case the anatomical peculiarities of the urinary bladder and the different trauma mechanisms as well as the resulting lesions, the diagnostic modalities and the treatment options are discussed. CONCLUSION: Despite the rarity of traumatic urinary bladder injuries, and especially in the absence of an underlying fracture, physicians should maintain a high level of suspicion for urologic injuries in the presence of nonspecific lower abdominal pain, gross haematuria and the inability to urinate

Traumatic nonanastomotic axilloprofundal PTFE-bypass rupture: a case report

A 76-year-old male patient was admitted to our emergency department with painful swelling of the right lateral chest after a fall. Imaging revealed a hematoma, secondary to rupture of a synthetic axilloprofundal bypass. In an emergency surgical procedure, the spelled hematoma was evacuated and the graft legs were successfully ligated. The patient was discharged after an uneventful hospital stay. Traumatic bypass rupture because of blunt trauma is an exceedingly rare event; however, it must be taken into consideration in a patient with bypass surgery in his/her history

Value of bowel preparation techniques for prostate MRI: a preliminary study

BACKGROUND Bowel preparation before multiparametric MRI (mpMRI) of the prostate is performed widely, despite contradictory or no evidence for efficacy. PURPOSE To investigate the value of hyoscine N-butylbromide (HBB), microenema (ME) and 'dietary restrictions' (DR) for artifact reduction and image quality (IQ) in mpMRI of the prostate. STUDY TYPE Retrospective. POPULATION Between 10/2018 and 02/2020 treatment-naïve men (median age, 64.9; range 39.8-87.3) who underwent mpMRI of the prostate were included. The total patient sample comprised of n = 180 patients, who received either HBB, ME, were instructed to adhere to DR, or received a combination of those measures prior to the MR scan. FIELD STRENGTH/SEQUENCE T2-weighted imaging (T2w), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) scanned on two 3T systems. ASSESSMENT A radiologist specialized in urogenital imaging (R1) and a senior radiology resident (R2) visually assessed IQ parameters on transversal T2w, DWI and ADC maps on a 5-point Likert-like scale. STATISTICAL TESTS Group comparison between IQ parameters was performed on reader level using Kruskal-Wallis and Mann-Whitney U tests. Binary univariate logistic regression analysis was used to assess independent predictors of IQ. Interrater agreement was assessed using Intraclass Correlation Coefficient (ICC). RESULTS 'DWI geometric distortion' was significantly more pronounced in the HBB+/ME-/DR- (R1, 3.6 and R2, 4.0) as compared to the HBB-/ME+/DR- (R1, 4.2 and R2, 4.6) and HBB+/ME+/DR- (R1, 4.3 and R2, 4.7) cohort, respectively. Parameters 'DWI IQ' and 'Whole MRI IQ' were rated similarly by both readers. ME was a significant independent predictor of 'good IQ' for the whole MRI for R1 [b = 1.09, OR 2.98 (95% CI 1.29, 6.87)] and R2 [b = 1.01, OR 2.73 (95% CI 1.24, 6.04)], respectively. DATA CONCLUSION ME seems to significantly improve image quality of DWI and the whole mpMRI image set of the prostate. HBB and DR did not have any benefit

Impact of different phased-array coils on the quality of prostate magnetic resonance images

Purpose To evaluate the influence of body phased-array (BPA) receive coil setups on signal-to-noise ratio (SNR) and image quality (IQ) in prostate MRI. Methods This prospective study evaluated axial T2-weighted images (T2W-TSE) and DWI of the prostate in ten healthy volunteers with 18-channel (18CH), 30-channel and 60-channel (60CH) BPA receive coil setups. SNR and ADC values were assessed in the peripheral and transition zones (TZ). Two radiologists rated IQ features. Differences in qualitative and quantitative image features between BPA receive coil setups were compared. After correction for multiple comparisons, p-values <0.004 for quantitative and p-values <0.017 for qualitative image analysis were considered statistically significant. Results Significantly higher SNR was found in T2W-TSE images in the TZ using 60CH BPA compared to 18CH BPA coil setups (15.20 ± 4.22 vs. 7.68 ± 2.37; p = 0.001). There were no significant differences between all other quantitative (T2W-TSE, p = 0.007-0.308; DWI, p = 0.024-0.574) and qualitative image features (T2W-TSE, p = 0.083-1.0; DWI, p = 0.046-1.0). Conclusion 60CH BPA receive coil setup showed marginal SNR improvement in T2W-TSE images. Good IQ could be achieved with 18CH BPA coil setups

Diffusion-weighted imaging of the prostate: image quality and geometric distortion of readout-segmented versus selective-excitation accelerated acquisitions

OBJECTIVE: To compare image quality and geometric distortion between readout-segmented diffusion-weighted imaging (rs-DWI) and selective-excitation accelerated reduced-field of view (FOV) DWI (sTX-DWI) of the prostate. MATERIALS AND METHODS: Sixty-five patients underwent 3-T MRI of the prostate including rs-DWI and sTX-DWI (b values, 0, 50, and 1000 seconds/mm; FOV, 150 × 150 mm and 77 ×150 mm for rs-DWI and sTX-DWI; slice thickness, 3 mm; acquisition time, 8:18 min and 1:37 min for rs-DWI and sTX-DWI). Two readers evaluated aspects of image quality and geometric distortion on a 5-point Likert scale. Quantitative analysis of geometric distortion was assessed by measurements of anteroposterior and left-right diameters and compared to T2-weighted turbo-spin echo sequence using intraclass correlation coefficient (ICC). RESULTS: There was no significant difference in resolution, capsule demarcation, and zonal anatomy (P = 0.111-0.866). Overall image quality was rated "above average" by reader 1 (4.09 ± 0.66 and 4.03 ± 0.79; P = 0.433) and reader 2 (3.86 ± 0.66 and 3.80 ± 0.74; P = 0.465) for rs-DWI and sTX-DWI. Reader 1 (0.74 ± 0.67 and 1.17 ± 0.84; P < 0.001) and reader 2 (0.55 ± 0.64 and 1.09 ± 0.95; P < 0.001) rated the level of geometric distortion significantly lower for rs-DWI than sTX-DWI. Readout-segmented DWI (0.9 ± 2.2 mm) and sTX-DWI (2.1 ± 3.8 mm) overestimated the anteroposterior diameter of the prostate compared to T2-weighted turbo-spin echo sequence (P < 0.001), the difference being more pronounced for sTX-DWI [ICC, 0.89 (95% confidence interval, 0.83-0.93)] compared to rs-DWI [ICC, 0.96 (95% confidence interval, 0.94-0.96)]. CONCLUSION: Selective-excitation accelerated reduced-FOV DW images (sTX-DWI) of the prostate can be acquired more than 5 times faster than rs-DWI with comparable image quality, at the expense of significantly increased geometric distortion

Comparison of image quality and patient discomfort in prostate MRI: pelvic phased array coil vs. endorectal coil

PURPOSE: To compare image quality (IQ) and patient discomfort during prostate MRI using a pelvic phased array (PPA) coil and an endorectal (ER) coil. MATERIALS AND METHODS: Ninety-eight patients (median age, 65.7; range 42.1-78.1) underwent prostate MRI on a 3T scanner including T2w and DWI acquired with PPA and an ER coil within the same exam. Acquisition time was kept similar for both acquisitions. Two radiologists evaluated aspects of IQ on a 5-point Likert scale and classified image artifacts. All patients completed a questionnaire on discomfort/pain regarding the ER coil using a visual analogue scale from 1 to 10. RESULTS: There was no significant difference in overall IQ for T2w images for both readers (reader 1, 3.27 ± 0.91 and 3.07 ± 0.84, p = 0.057; reader 2, 3.70 ± 0.75 and 3.77 ± 0.81, p = 0.555) for PPA and ER coils, respectively. Overall IQ for DWI acquired with PPA and ER coils was rated similar by reader 1 (3.03 ± 1.10 and 3.08 ± 0.80, respectively, (p = 0.67)), while reader 2 preferred ER coil images (3.27 ± 0.81 and 3.66 ± 0.85 (p < 0.05)). Susceptibility artifacts were more frequent in ER than in PPA coil images (109 vs. 75). Discomfort and pain experienced during insertion of the ER coil was low altogether (VAS score, 3.5 ± 2.1 for "discomfort" and 2.4 ± 2.4 for "pain"). CONCLUSION: T2-weighted images may be acquired with comparable IQ using a PPA coil as compared to an ER coil, while DWI images showed better IQ using the ER coil for one of two readers. The insertion of the ER coil caused low to moderate discomfort and pain in patients