Biparametric prostate MRI: impact of a deep learning-based software and of quantitative ADC values on the inter-reader agreement of experienced and inexperienced readers

Objective To investigate the impact of an artificial intelligence (AI) software and quantitative ADC (qADC) on the inter-reader agreement, diagnostic performance, and reporting times of prostate biparametric MRI (bpMRI) for experienced and inexperienced readers. Materials and methods A total of 170 multiparametric MRI (mpMRI) of patients with suspicion of prostate cancer (PCa) were retrospectively reviewed by one experienced and one inexperienced reader three times, following a wash-out period. First, only the bpMRI sequences, including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) sequences, and apparent diffusion coefficient (ADC) maps, were used. Then, bpMRI and quantitative ADC values were used. Lastly, bpMRI and the AI software were used. Inter-reader agreement between the two readers and between each reader and the mpMRI original reports was calculated. Detection rates and reporting times were calculated for each group. Results Inter-reader agreement with respect to mpMRI was moderate for bpMRI, Quantib, and qADC for both the inexperienced (weighted k of 0.42, 0.45, and 0.41, respectively) and the experienced radiologists (weighted k of 0.44, 0.46, and 0.42, respectively). Detection rate of PCa was similar between the inexperienced (0.24, 0.26, and 0.23) and the experienced reader (0.26, 0.27 and 0.27), for bpMRI, Quantib, and qADC, respectively. Reporting times were lower for Quantib (8.23, 7.11, and 9.87 min for the inexperienced reader and 5.62, 5.07, and 6.21 min for the experienced reader, for bpMRI, Quantib, and qADC, respectively). Conclusions AI and qADC did not have a significant impact on the diagnostic performance of both readers. The use of Quantib was associated with lower reporting times

Le facies evaporitiche della crisi di salinità messiniana: radioattività naturale della Formazione Gessoso-Solfifera della Maiella (Abruzzo, Italia centrale)

È stata misurata la radioattività naturale (NRD) di tre successionistratigrafiche del Messiniano nella Maiella nord-occidentale(Trovigliano-Abbateggio, PE). Complessivamente, le tre successionianalizzate (cava Buzzi-Unicem; cava Lafargessi; cava Colle di Votta)comprendono tutto il Messiniano evaporitico e la base di quello postevaporitico.I differenti valori di radioattività misurati corrispondonoalle principali litofacies che caratterizzano la Formazione Gessoso-Solfifera affiorante nell’area di studio. In particolare, il profilodell’emissione gamma, acquisito sul terreno, mostra picchi di attivitàin corrispondenza delle argille euxiniche, alla base della successioneevaporitica, e in corrispondenza degli orizzonti sapropelitici intercalatialle bancate di gesso. All’interno di queste ultime, la bassa radioattivitàtende ad aumentare in presenza di componente carbonatica,che può costituire la matrice delle bancate di gesso e/o può esserepresente in livelli o strati.I valori maggiori di radioattività sono stati misurati nei depositimessiniani post-evaporitici, in corrispondenza di marne laminate dicolore marrone e di calcari brecciati.Il contributo dei radioelementi naturali (238U, 232Th e 40K) varianelle diverse litofacies analizzate. In particolare, mentre i sapropelsono caratterizzati da rapporti Thppm/Uppm ≥ 1, i gessi e le faciescarbonatiche hanno rapporti Thppm/Uppm <<1. I diversi rapportiThppm/Uppm sono stati messi in relazione con la variazione dell’apportodetritico nel bacino di sedimentazione e con la possibile presenzadi minerali autigeni dell’uranio

Utilization of imaging for staging in bladder cancer: is there a role for MRI or PET-computed tomography?

PURPOSE OF REVIEW: Accurate staging of bladder cancer is essential to guide appropriate management. In this review, we discuss the principles, applications and performance of multiparametric MRI (mpMRI) and PET-computer tomography (PET-CT) for local and distant staging of bladder cancer. RECENT FINDINGS: Bladder mpMRI has a high diagnostic performance in local staging of bladder cancer, superior to other imaging modalities. It can accurately differentiate muscle invasive bladder cancer (MIBC) from non-MIBC (NMIBC), as well as ≤T2 from ≥T3 stages. mpMRI can be used to assess pelvic lymph nodes, although its sensitivity is relatively low. For the assessment of the upper urinary tract, CT urography is the imaging modality of choice. magnetic resonance urography is a viable alternative to CT in selected cases. Although PET-CT is accurate for nodal and distant staging of bladder cancer, there is no clear evidence on its superior diagnostic performance compared with contrast-enhanced CT. SUMMARY: mpMRI is the most accurate imaging modality for local staging of bladder cancer, capable to accurately distinguish MIBC from NMIBC. Nodal and distant staging relies primarily on contrast-enhanced CT

Overview of VI-RADS in Bladder Cancer

OBJECTIVE. The purpose of this article is to review the natural history and management of bladder cancer, with insight into MRI applications for the assessment of muscle invasiveness of bladder cancer using the newly developed Vesical Imaging Reporting and Data System (VI-RADS) score. CONCLUSION. Multiparametric MRI and the VI-RADS score have been consistently validated across several different institutions as appropriate tools for local staging of bladder cancer and have been proven to contribute to the diagnostic workup and management of urinary bladder cancer

The Messinian/Zanclean boundary in the Northern Apennines

TheMiocene-Pliocene boundary in the Northern Apennine was the object of several studies prior to the definition of the GSSP of the Zanclean stage in the Eraclea Minoa section (Sicily, Italy). This definition came at the end of the ’90s, after an accurate and Mediterranean wide high resolution biostratigraphic study of the basal Pliocene deposits. Since then calcareous plankton biostratigraphy allows to correlate the very base of the Zanclean through the occurrence of two consecutive sinistrally coiled Neogloboquadrina acostaensis influxes, respectively placed within the 1st/2nd cycle and the 2nd/3rd cycle from the base astronomically dated at 5.33Ma (insolation peak 510). Besides these bioevents, the classical Spheroidinellopsis spp. acme interval, the base of subchron Thvera and the cyclic signal of both biota and lithology help recognize the base of the Zanclean stage. Several sections and boreholes were studied in an east (Marche region) to west (Emilia region) transect along the Northern Apennine. Despite different sampling resolution, the two N. acostaensis sinistral influxes were recognized in each sites except the Montepetra borehole were the definition of the Zanclean base was achieved through cyclostratigraphic features. Some nannofossil bioevents, such as the drop of abundance of D. variabilis and the beginning of a paracme interval of R. pseudoumbilicus, revealed to be useful for a better constraining of the basal Zanclean. Thus the sedimentary succession across the Messinian – Zanclean boundary was recognized to be continuous and the base of the Zanclean stage coeval to its GSSP at Eraclea Minoa, thus dated at 5.33 Ma. This demonstrates that the Zanclean restoration of marine condition that ended the Messinian salinity crisis was a synchronous event, geologically speaking within the present resolution power, throughout the entire Mediterranea region

Bridging the experience gap in prostate multiparametric magnetic resonance imaging using artificial intelligence: A prospective multi-reader comparison study on inter-reader agreement in PI-RADS v2.1, image quality and reporting time between novice and expert readers

Purpose: The aim of the study was to determine the impact of using a semi-automatic commercially available AI-assisted software (Quantib® Prostate) on inter-reader agreement in PI-RADS scoring at different PI-QUAL ratings and grades of reader confidence and on reporting times among novice readers in multiparametric prostate MRI. Methods: A prospective observational study, with a final cohort of 200 patients undergoing mpMRI scans, was performed at our institution. An expert fellowship-trained urogenital radiologist interpreted all 200 scans based on PI-RADS v2.1. The scans were divided into four equal batches of 50 patients. Four independent readers evaluated each batch with and without the use of AI-assisted software, blinded to expert and individual reports. Dedicated training sessions were held before and after each batch. Image quality rated according to PI-QUAL and reporting times were recorded. Readers' confidence was also evaluated. A final evaluation of the first batch was conducted at the end of the study to assess for any changes in performance. Results: The overall kappa coefficient differences in PI-RADS scoring agreement without and with Quantib® were 0.673 to 0.736 for Reader 1, 0.628 to 0.483 for Reader 2, 0.603 to 0.292 for Reader 3 and 0.586 to 0.613 for Reader 4. Using PI-RADS&nbsp;≥&nbsp;4 as cut-off for biopsy, the AUCs with AI ranged from 0.799 (95&nbsp;% CI: 0.743, 0.856) to 0.820 (95&nbsp;% CI: 0.765, 0.874). Inter-reader agreements at different PI-QUAL scores were higher with the use of Quantib, particularly for readers 1 and 4, with Kappa coefficient values showing moderate to slight agreement. Conclusion: Quantib® Prostate could potentially be useful in improving inter-reader agreement among less experienced to completely novice readers if used as a supplement to PACS

MRI of bladder cancer: local and nodal staging

Accurate staging of bladder cancer (BC) is critical, with local tumor staging directly influencing management decisions and affecting prognosis. However, clinical staging based on clinical examination, including cystoscopy and transurethral resection of bladder tumor (TURBT), often understages patients compared to final pathology at radical cystectomy and lymph node (LN) dissection, mainly due to underestimation of the depth of local invasion and the presence of LN metastasis. MRI has now become established as the modality of choice for the local staging of BC and can be additionally utilized for the assessment of regional LN involvement and tumor spread to the pelvic bones and upper urinary tract (UUT). The recent development of the Vesical Imaging-Reporting and Data System (VI-RADS) recommendations has led to further improvements in bladder MRI, enabling standardization of image acquisition and reporting. Multiparametric magnetic resonance imaging (mpMRI) incorporating morphological and functional imaging has been proven to further improve the accuracy of primary and recurrent tumor detection and local staging, and has shown promise in predicting tumor aggressiveness and monitoring response to therapy. These sequences can also be utilized to perform radiomics, which has shown encouraging initial results in predicting BC grade and local stage. In this article, the current state of evidence supporting MRI in local, regional, and distant staging in patients with BC is reviewed. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2

MRI of Bladder Cancer: Local and Nodal Staging.

Accurate staging of bladder cancer (BC) is critical, with local tumor staging directly influencing management decisions and affecting prognosis. However, clinical staging based on clinical examination, including cystoscopy and transurethral resection of bladder tumor (TURBT), often understages patients compared to final pathology at radical cystectomy and lymph node (LN) dissection, mainly due to underestimation of the depth of local invasion and the presence of LN metastasis. MRI has now become established as the modality of choice for the local staging of BC and can be additionally utilized for the assessment of regional LN involvement and tumor spread to the pelvic bones and upper urinary tract (UUT). The recent development of the Vesical Imaging-Reporting and Data System (VI-RADS) recommendations has led to further improvements in bladder MRI, enabling standardization of image acquisition and reporting. Multiparametric magnetic resonance imaging (mpMRI) incorporating morphological and functional imaging has been proven to further improve the accuracy of primary and recurrent tumor detection and local staging, and has shown promise in predicting tumor aggressiveness and monitoring response to therapy. These sequences can also be utilized to perform radiomics, which has shown encouraging initial results in predicting BC grade and local stage. In this article, the current state of evidence supporting MRI in local, regional, and distant staging in patients with BC is reviewed. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:649-667