The role of MRI in the detection of local recurrence: Added value of multiparametric approach and Signal Intensity/Time Curve analysis

Objective: The aim of the study was to evaluate the accuracy of multiparametric Magnetic Resonance Imaging (mpMRI) in the detection of local recurrence of prostate cancer (PCa) with the evaluation of the added value of signal Intensity/Time (UT) curves.Materials and methods: A retrospective analysis of 22 patients undergoing mpMRI from 2015 to 2020 was carried out, with the following inclusion criteria: performing trans rectal ultrasound guided biopsy within 3 months in the case of positive or doubtful findings and undergoing biopsy and/or clinical follow-up for 24 months in the case of negative results. The images were reviewed, and the lesions were catalogued according to morphological, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) features.Results: The presence of local recurrence was detected in 11/22 patients (50%). Greater diameter, hyperintensity on DWI, positive contrast enhancement and type 2/3 signal UT curves were more frequently observed in patients with local recurrence (all p < 0.05). Of all the sequences, DCE was the most accurate; however, the combination of DCE and DWI showed the best results, with a sensitivity of 100%, a specificity of 82%, a negative predictive value of 100% and a positive predictive value of 85%.Conclusions: The utility of MRI in the detection of local recurrence is tied to the multiparametric approach, with all sequences providing useful information. A combination of DCE and DWI is particularly effective. Moreover, specificity could be additionally improved using analysis of the signal UT curves

Liver collision lesion: inflammatory hepatocellular adenoma within focal nodular hyperplasia

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Clinical Application of the New Prostate Imaging for Recurrence Reporting (PI-RR) Score Proposed to Evaluate the Local Recurrence of Prostate Cancer after Radical Prostatectomy

Simple Summary The aim of the new Prostate Imaging for Recurrence Reporting (PI-RR) is a standardization in reporting to assess the likelihood of relapse after radical prostatectomy. Our study documented an excellent inter-observer agreement in recurrence reporting when using the PI-RR score, demonstrating a wide reproducibility, thus supporting the wide use of the PI-RR score in the clinical practice. The diagnostic accuracy was 68.4%, with the detection rate influenced by the PSA values. Overall, the PI-RR score globally showed a higher detection rate than PET/CT scans for local recurrence. Background: We investigated the diagnostic accuracy of the new Prostate Imaging for Recurrence Reporting (PI-RR) score and its inter-observer variability. Secondly, we compared the detection rate of PI-RR and PET and analyzed the correlation between Prostate Specific Antigen (PSA) levels and the PI-RR score. Methods: We included in the analysis 134 patients submitted to multiparametric magnetic resonance imaging for suspected local recurrence. The images were independently reviewed by two radiologists, assigning a value from 1 to 5 to the PI-RR score. Inter-observer agreement and diagnostic accuracy of the PI-RR score (compared to histopathological data, available for 19 patients) were calculated. The detection rate was compared to those of choline PET/CT (46 patients) and PSMA PET/CT (22 patients). The distribution of the PSA values in relation to the PI-RR scores was also analyzed. Results: The accuracy of the PI-RR score was 68.4%. The reporting agreement was excellent (K = 0.884, p < 0.001). The PI-RR showed a higher detection rate than choline PET/CT (69.6% versus 19.6%) and PSMA PET-CT (59.1% versus 22.7%). The analysis of the PSA distribution documented an increase in the PI-RR score as the PSA value increased. Conclusion: The excellent reproducibility of the PI-RR score supports its wide use in the clinical practice to standardize recurrence reporting. The detection rate of PI-RR was superior to that of PET, but was linked to the PSA level

A case report of myoid gonadal stromal tumor treated with testis sparing surgery

Background: Myoid gonadal stromal tumors (MGST) of the testis represent a very rare finding. They are an emerging clinicopathological entity with specific features and identity. Nowadays, pathological recognition and diagnosis of MGSTs still represents a difficult challenge in most cases and there are no data of specific radiological features of these tumors expect for what seen by ultrasound; besides a conservative surgical approach was never performed to treat these lesions.Case Description: We present the case of a 20-year-old young man patient with symptoms suspicious for left varicocele, who was incidentally diagnosed with right testicular nodule via scrotal doppler ultrasound powered with contrast enhancement infusion and subsequent multiparametric magnetic resonance imaging. Then, lesion was treated through a testis sparing surgical approach. Histopathology, which included an external revision by an experienced Center, revealed a MGST with benign features, so that no further treatment was considered. 3 and 12 months after surgery a contrast enhancement ultrasound was performed with no evidence of recurrence.Conclusions: Previous reported cases of MGST were all difficult to characterize as a specific pathological entity; treatment usually applied was radical orchiectomy and a subsequent total Body CT was performed for staging purpose. No metastatic spreading nor recurrence were ever reported. Considering the favorable behavior of this pathologic entity, testis-sparing surgery with no radiation exposure during follow-up is a safe and effective strategy

Multiparametric magnetic resonance imaging for the differential diagnosis between granulomatous prostatitis and prostate cancer: a literature review to an intriguing diagnostic challenge

Multiparametric magnetic resonance imaging (mpMRI) is currently the most effective diagnostic tool for detecting prostate cancer (PCa) and evaluating adenocarcinoma-mimicking lesions of the prostate gland, among which granulomatous prostatitis (GP) represents the most interesting diagnostic challenge. GP consists of a heterogeneous group of chronic inflammatory lesions that can be differentiated into four types: idiopathic, infective, iatrogenic, and associated with systemic granulomatous disease. The incidence of GP is growing due to the increase in endourological surgical interventions and the adoption of intravesical instillation of Bacillus Calmette-Guerin in patients with non-muscle invasive bladder cancer; therefore, the difficulty lies in identifying specific features of GP on mpMRI to avoid the use of transrectal prostate biopsy as much as possible

MAGNETIC RESONANCE (MRI) AND COMPUTED TOMOGRAPHY (CT) FOR CHOLANGIOCARCINOMA

High quality cross-sectional Multidetector Computed Tomography and/or Magnetic Resonance Imaging play an important role in diagnosis, localization, and staging and planning of the optimal management of cholangiocarcinoma. Correct imaging helps to localize the tumor to either the intrahepatic, the perihilar or the distal bile ducts, each of which requires different management. It accurately stages the disease, identifying the presence of significant nodal and distant metastasis or major vascular encasement of the portal vein or the hepatic arteries, or depicts extensive involvement of the hepatic duct reaching up to second-order biliary radicals. It also helps to identify the extent of local tumor invasion, which has a major impact on management. This chapter presents the spectrum of appearances of cholangiocarcinomas at cross-sectional imaging and examines the possibilities of imaging modalities in the proper stage classification of bile duct tumors according to the recent staging systems

An unusual case of right retrocaval ureter associated with ipsilateral ureterocele

A 36-year-old man with right flank pain presented to our institution. Intravenous urography showed mild dilatation of the right pyelocaliceal system and large filling defect in the vesical lumen. Computed tomography revealed the right kidney to be smaller than the left, and with chronic pyelonephritis. The right ureter passed behind the inferior vena cava at the level of the pelvic-ureteral junction. The middle and lower ureter was dilated above a large ureterocele. Cystourethrography showed right vesicoureteral reflux. The patient underwent a resection of the ureterocele with reimplantation of the ureter. Follow-up at 3 months demonstrated resolution of the dilatation of the right ureter. \ua9 2012 Elsevier Inc

MANUALE DI DIAGNOSTICA PER IMMAGINI PER IL CORSO DI LAUREA IN MEDICINA E CHIRURGIA. DIAGNOSTICA PER IMMAGINI DEL FEGATO, DELLA MILZA, DEL PERITONEO E MESENTERE. 2\ub0edizione CAPITOLO 8 - 10 - 13

1) DIAGNOSTICA PER IMMAGINI DEL FEGATO di R. Golfieri, M. Renzulli, A. Cappelli (Capitolo 8 pag.157-218): Nello studio della patologia epatica hanno un ruolo essenziale l'ecografia (US) completata da eco-color Doppler (ECD) e da mdc (ecocontrastografia), la TC, la RM e la colangio-RM. La scintigrafia e l'angiografia hanno un ruolo in settori ben definiti. 2) DIAGNOSTICA PER IMMAGINI DELLA MILZA di R. Golfieri, A. Cappelli (Capitolo 10 pag. 245-270): II compito principale delle metodiche di imaging \ue8 quello di: determinare il volume splenico, individuare eventuali lesioni focali, fornire una definizione nosografia delle splenomegalie, associate o meno a ipersplenismo e riconoscere la rottura della milza secondo i gradi di gravit\ue0 3) DIAGNOSTICA PER IMMAGINI DEL PERITONEO E MESENTERE di R. Golfieri, V. Orsini, B. Corcioni (Capitolo 13 pag. 319-2342

Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay

Urogenital tuberculosis (UGTB) is the most common form of extrapulmonary TB and is responsible for a destructive inflammation of the renal parenchyma and urinary tract often leading to the loss of kidney function. For these reasons, the early diagnosis of this disease, once considered disappeared in developed countries, is very important to establish a prompt and efficient treatment. However, the subtle and non-specific symptoms, often represented by recurrent and persistent lower urinary tract symptoms, can confound and delay the diagnosis. Therefore, an adequate and comprehensive imaging study is necessary in patients with persistent urinary tract infections not responding to the antibiotics and can suggest the hypothesis although bacteriological and/or histologic analysis is required for a definitive diagnosis. In the past years, intravenous urography (IVU) has allowed a comprehensive study of the urinary excretory tract, promoting the knowledge of the radiological findings of this disease. Nowadays, computed tomography urography (CTU), with the implementation of multidetector (MD) technology, has replaced IVU in all its indications; the MDCTU improves the assessment of renal and urinary tract lesions using reformatted images [such as multiplanar reconstruction (MPR) and maximum intensity projection (MIP)]. Therefore, our paper aims to provide a guide for radiologist for searching the classic signs of UGTB on MDCTU, encouraging the use of the MPR and MIP reformatted images

Role of multiparametric magnetic resonance and ultrasound-guided/MR fusion biopsy in patients with low-risk prostate cancer suitable for active surveillance

BACKGROUND: To evaluate the impact of multiparametric magnetic resonance (mpMR) and fusion biopsy in patients with low-risk prostate cancer suitable for active surveillance (AS) in order to reduce cases of disease downstaging. METHODS: Between January 2016 and February 2018, 97 mpMRs were performed in patients with clinical indications for AS; the mpMR results were expressed using the PIRADS (Prostate Imaging Reporting and Data System) v2.1 score. Of the patients with equivocal or suspicious findings (PIRADS 653), 26 underwent transrectal ultrasound/MR fusion biopsy; the histological results were analysed and correlated to the MR data. RESULTS: Multiparametric magnetic resonance documented benign findings (i.e. PIRADS 1-2) in 42/97 patients (43.3%) while, in the remaining 55/97 (56.7%), abnormal findings were found: 39/97 (40.2%) PIRADS 3, 14/97 (14.4%) PIRADS 4 and 2/97 (2.1%) PIRADS 5. Twenty-six patients underwent fusion biopsy (17 with PIRADS 3, 7 with PIRADS 4, 2 with PIRADS 5); in 17/26 (65.4%), a Gleason Score 657 was found and, in particular, in 10/17 (58.8%) of the PIRADS 3, 5/7 (71.4%) of the PIRADS 4 and 2/2 (100%) of the PIRADS 5. CONCLUSIONS: More than half of the patients in AS showed MR abnormalities and the risk of upstaging increased as the PIRADS score increased; fusion biopsy allowed clarifying the importance of the MR findings, identifying a more aggressive prostate tumour in a high percentage of cases (65.4%). Therefore, MR with fusion biopsy should be proposed for all patients in AS for a correct diagnostic classification