MRI u ginekološkoj onkologiji

The use of magnetic resonance imaging ( MRI) in gynecological oncology is rapidly expanding. Pelvic MRI has excellent soft tissue contrast and multiplanar imaging ability to demonstrate either normal or pathological processes. In gynecological oncology the rapidly evolving role of MRI includes not only diagnosis but also disease staging, planning of therapy and monitoring response to treatment. We perform around 350 preoperative gynecology MRI annually, mostly in patients with suspected malignancy. In this paper we review the role of MRI in endometrial, cervical and ovarian cancerSvakodnevno raste uporaba magnetske rezonancije (MR) u ginekološkoj onkologiji. MR zdjelice ima odličnu prostornu i kontrastnu rezoluciju za prikaz kako fi zioloških tako i patoloških procesa. Sve je veća uključenost MR pregleda ne samo u dijagnostici već i u određivanju stadija bolest i praćenju terapije. U našem radiološkom odjelu obavi se oko 350 preoperativnih ginekoloških MR pregleda godišnje, najčešće kod pacijenata sa sumnjom na malignu bolest. U ovom radu osvrnuti ćemo se na ulogu MR u karcinomima endometrija, grlića maternice i jajnika

Biopsije koštanih lezija pod kontrolom ct-a, naša iskustva iz 2018. I 2019.

To present our results from 2018 and 2019 and to present the clinical data of the accuracy and clinical usefulness of computed tomography (CT)-guided biopsy for diagnosing suspicious bone lesion. The retrospective study included 98 consecutive patients who underwent CT-guided bone lesion biopsy from January 2018 to December 2019. The localization of the bone lesions, the adequacy of the sample for histopathological analysis, histopathological results, and the procedure’s complications were analyzed. The specimens collected from 76 patients/lesions (77.6%) were considered appropriate for diagnosis. Histological analysis of bone samples showed 52 (68.4%) metastatic lesions. The most common primary tumor origins were breast carcinoma 28 (53.8%) and lung carcinoma six (11.5%). In three patients (4%), the infection was confirmed. No tumor cells were found in 17 (22.4%) patients. There were no post-procedural complications. CT-guided bone lesion biopsy is a safe and effective method for diagnosing suspicious bone lesions that has a great effect in clinical practice without any significant complications.Cilj rada je predstaviti naše rezultate iz 2018. i 2019. i dodati saznanja kliničkim podatcima o točnosti i kliničkoj korisnosti biopsije vođene kompjuteriziranom tomografijom kod dijagnosticiranja suspektnih koštanih lezija. Retrospektivno istraživanje obuhvatilo je 98 uzastopnih bolesnika koji su podvrgnuti biopsiji koštanih lezija pod kontrolom CT-a od siječnja 2018. do prosinca 2019. Analizirani su lokalizacija koštanih lezija, adekvatnost uzorka za patohistološku analizu, patohistološki rezultati i komplikacije postupka. Uzorci prikupljeni od 76 pacijentata iz 76 lezija (77,6%) smatrani su prikladnima za dijagnozu. Histološka analiza uzoraka kostiju pokazala je 52 (68,4%) presadničke lezije. Najčešći izvor primarnog tumora bio je rak dojke 28 (53,8%), a rak pluća 6 (11,5%). U 3 bolesnika (4%) potvrđena je infekcija. U 17 (22,4%) bolesnika nisu pronađene tumorske stanice. Biopsija koštanih oštećenja pod kontrolom CT-a sigurna je i učinkovita metoda bez ozbiljnijih komplikacija

Multiparametrijska magnetska rezonancija u procjeni karcinoma prostate

Multiparametric magnetic resonance is assuming an increasingly important role in the diagnosis, initial assessment and monitoring of patients with prostate cancer. This paper offers a more complex insight into the application of magnetic resonance imaging with prostate cancer, with a current literature overview. The focus is on the problem of initial prostate cancer evaluation which strongly affects further decision-making and therapeutic interventions. Clinical suggestions based on the current guidelines are also offered.Multiparametrijska magnetska rezonancija preuzima sve značajniju ulogu u dijagnostici, inicijalnoj procjeni, kao i praćenju pacijenata s karcinomom prostate. Ovaj rad nudi složeniji uvid u pitanje primjene magnetske rezonancije kod karcinoma prostate, uz pregled trenutne literature iz područja. Posebno težište je stavljeno na problem inicijalne procjene karcinoma prostate koje uvelike determinira daljnje odlučivanje i terapijsko postupanje. Ponuđene su i preporuke temeljene na trenutnim smjernicama

DIJAGNOSTIČKI ZNAČAJ BIOPSIJE PROSTATE VOĐENE KOGNITIVNOM FUZIJOM MULTIPARAMETRIJSKE MAGNETNE REZONANCE I TRANSREKTALNOG ULTRAZVUKA (mpmri-TRUS) KOD BOLESNIKA S PRETHODNO NEGATIVNOM TRUS VOĐENOM BIOPSIJOM

The aim of this prospective clinical study was to determine the detection rate of prostate cancers by multiparametric magnetic resonance and transrectal ultrasound (mpMRI-TRUS) cognitive fusion biopsies in patients with a previously negative TRUS-guided biopsy. Between 1 October 2016 and 1 July 2017, in 101 consecutive patients with elevated antigen (PSA) and/or positive digital rectal examination and after a negative first TRUS biopsy, a second, repeated prostate biopsy was performed. In 24 patients, cognitive fusion mpMRI-TRUS biopsy of the prostate with 8-10 system cores and 1-3 target biopsies was performed, in line with the European Association of Urology guidelines. In 77 patients, only a classic, repeated TRUS guided biopsy was performed. In patients with mpMRI, the detection rate according to PIRADS-v2 reporting system was: PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%); and PIRADS 5, n = 2/3 (67%). In the group of patients with MR-TRUS cognitive fusion biopsy, the prostate cancer detection rate was 8/24 (33%), while in the control group the detection rate was 12/77 (16%), which was statistically significant (t test, p = 0.037, CI 95% is 0.01 to 0.37). Patients with PIRADS ≤ 3 (54%) could have avoided the biopsy.U ovoj prospektivnoj kliničkoj studiji cilj je odrediti stopu detekcije raka prostate biopsije vođene kognitivnom fuzijom multiparametrijske magnetne rezonance i transrektalnog ultrazvuka (mpMRI-TRUS) kod bolesnika s prethodno negativnom TRUS vođenom biopsijom. U razdoblju od 1. 10. 2016. do 1. 7. 2017. kod 101 uzastopnog bolesnika s povišenim prostata specifičnim antigenom (PSA) i/ili pozitivnim digitorektalnim pregledom, a nakon negativne prve TRUS biopsije je učinjena druga, ponovljena biopsija prostate. Kod 24 bolesnika učinjena je, u skladu sa Smjernicama Europskog urološkog društva, prethodna mpMRI i potom kognitivna fuzijska biopsija prostate s 8-10 sistemskih cilindara i 1-3 ciljane biopsije prema mpMRI nalazu. Kod 77 bolesnika je učinjena samo klasična, ponovljena TRUS biopsija bez prethodne slikovne obrade. Kod bolesnika s mpMRI, stopa detekcije raka prema PIRADSU-v2 je PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%) i PIRADS 5, n = 2/3 (67%). U skupini bolesnika s MR-TRUS kognitivnom fuzijskom biopsijom stopa detekcije raka prostate je 8/24 (33%), dok je u kontrolnoj skupini stopa detekcije 12/77 (16%), što se pokazalo statistički značajnom razlikom (t test; p=0.037, CI 95% je 0.01 to 0.37). Bolesnici s PIRADS ≤ 3 (54%) su mogli izbjeći biopsiju

Analiza isplativosti uvođenja biopsije prostate navođene multiparametrijskom magnetskom rezonancom

Continuous increase of the cost of medical services around the world has become a major topic in the world today. Multiparametric prostate MRI has recently become a new standard in prostate cancer detection, especially in repeated biopsy settings. The method, although superior in cancer detection rates, is costly and requires additional training and equipment. The purpose of our study was to determine the costs and benefits that arise when introducing this method in prostate cancer diagnostics. Repeated prostate biopsy was performed in 101 consecutive patients in the period from 1 October 2016 to 1 July 2017. Patients were divided into two groups based on whether prostate mp-MRI was performed or not. The prices of specific procedures were obtained from the billing service of the Sestre milosrdnice University Hospital Center and patient models were created to determine financial costs and benefits. The cost of the entire diagnostic process per patient in the non-MRI group was HRK 1.931,05 and HRK 1.848,42 in the mpMRI group, or 4.28% less. Prostate mpMRI and subsequent mpMRI guided biopsies can reduce the overall cost in prostate cancer diagnostics despite the procedure itself being an additional cost. This is achieved by omitting prostate biopsies in patients with low malignancy risk.Kontinuirani rast troškova medicinskih postupaka aktualna je tema i razlog zabrinutosti u cijelome svijetu. Ciljana, multiparametrijskim magnetom (mpMRI) navođena biopsija prostate polako postaje standard u dijagnostici karcinoma prostate, pogotovo kod ponovljene biopsije. Iako superiorna klasičnoj, sistemskoj biopsiji prostate, navedena metoda zahtijeva skupu dodatnu opremu i vješte, educirane kliničare. Naš cilj je analizirati ekonomsku isplativost uvođenja multiparametrijske magnetne rezonance prostate i posljedične kognitivno mpMRI-om navođene biopsije prostate u dijagnostički protokol bolesnika sa inicijalno negativnom sistemskom biopsijom prostate, kod kojih postoji daljnja klinička sumnja na karcinom prostate. U periodu od 01.10.2016. do 01.07.2017 kod 101 uzastopnog bolesnika s povišenim PSA i/ili pozitivnim DRP, a nakon negativne prve TRUS biopsije učinjena je druga, ponovljena biopsija prostate. Bolesnici su podijeljeni u dvije skupine ovisno o tome dali je učinjen mpMRI prostate ili ne. Učinjena je analiza broja i troškova posjeta specijalisti urologu kao i broja i troškova ordiniranih pretraga za svaku skupinu. Tijek kliničkih postupaka standardiziran je na temelju prosjeka za pojedine promatrane skupine te preračunat na 100 bolesnika za svaku skupinu radi lakše usporedbe rezultata. Kalkulacije su vršene na temelju dobivenih modela. Prosječna cijena obrade bolesnika u skupini bez mpMRI-a iznosi 1931,05 HRK dok u sa mpMRI-em iznosi 1848,42 HRK tj. 4,28% manje. Iako mpMRI prostate pojedinačno predstavlja značajan dodatan trošak u dijagnostici karcinoma prostate, kod bolesnika sa inicijalno negativnom biopsijom prostate isti omogućava velikom broju bolesnika izbjegavanje biopsije te posljedično smanjenje ukupnog troška

Clinical guidelines for radiological diagnosis and monitoring of patients with breast cancer

Rak dojke najčešća je zloćudna novotvorina u žena u Republici Hrvatskoj. Osnovne radiološke pretrage u dijagnostici bolesti dojke jesu mamografija, ultrazvuk i magnetska rezonancija. U radu su prikazane radiološke smjernice za radiološku dijagnostičku i intervencijsku obradu bolesti dojke i praćenje bolesnica oboljelih od raka dojke u Republici Hrvatskoj. Razrađen je algoritam radiološke obrade kod simptomatskih bolesnica, trudnica i dojilja, bolesnica prosječnog i povećanog rizika za razvoj karcinoma dojke, te kod bolesnica s radiološkim nalazom upalnih promjena (mastitisa).Breast carcinoma is the most common neoplasm in the female population of Croatia. The main imaging breast diagnostic modalities are mammography, ultrasound, and magnetic resonance. This paper reviews radiological guidelines for breast diagnostic and interventional procedures, and monitoring of breast cancer patients in the Republic of Croatia. An algorithm for radiological assessment is presented for symptomatic patients, pregnant and lactating women, patients with average and increased risk of developing breast cancer, and patients with radiological findings of mastitis

Role of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Assessment

Multiparametric magnetic resonance is assuming an increasingly important role in the diagnosis, initial assessment and monitoring of patients with prostate cancer. This paper offers a more complex insight into the application of magnetic resonance imaging with prostate cancer, with a current literature overview. The focus is on the problem of initial prostate cancer evaluation which strongly affects further decision-making and therapeutic interventions. Clinical suggestions based on the current guidelines are also offered

Cost-Benefit Analysis of the Introduction of Mp-Mri Guided Biopsies in Croatia

Continuous increase of the cost of medical services around the world has become a major topic in the world today. Multiparametric prostate MRI has recently become a new standard in prostate cancer detection, especially in repeated biopsy settings. The method, although superior in cancer detection rates, is costly and requires additional training and equipment. The purpose of our study was to determine the costs and benefits that arise when introducing this method in prostate cancer diagnostics. Repeated prostate biopsy was performed in 101 consecutive patients in the period from 1 October 2016 to 1 July 2017. Patients were divided into two groups based on whether prostate mp-MRI was performed or not. The prices of specific procedures were obtained from the billing service of the Sestre milosrdnice University Hospital Center and patient models were created to determine financial costs and benefits. The cost of the entire diagnostic process per patient in the non-MRI group was HRK 1.931,05 and HRK 1.848,42 in the mpMRI group, or 4.28% less. Prostate mpMRI and subsequent mpMRI guided biopsies can reduce the overall cost in prostate cancer diagnostics despite the procedure itself being an additional cost. This is achieved by omitting prostate biopsies in patients with low malignancy risk

Diagnostic Value of Cognitive-Registration Multiparametric Magnetic Resonance Guided Biopsy for the Detection of Prostate Cancer after Initial Negative Biopsy

The aim of this prospective clinical study was to determine the detection rate of prostate cancers by multiparametric magnetic resonance and transrectal ultrasound (mpMRI-TRUS) cognitive fusion biopsies in patients with a previously negative TRUS-guided biopsy. Between 1 October 2016 and 1 July 2017, in 101 consecutive patients with elevated antigen (PSA) and/or positive digital rectal examination and after a negative first TRUS biopsy, a second, repeated prostate biopsy was performed. In 24 patients, cognitive fusion mpMRI-TRUS biopsy of the prostate with 8-10 system cores and 1-3 target biopsies was performed, in line with the European Association of Urology guidelines. In 77 patients, only a classic, repeated TRUS guided biopsy was performed. In patients with mpMRI, the detection rate according to PIRADS-v2 reporting system was: PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%); and PIRADS 5, n = 2/3 (67%). In the group of patients with MR-TRUS cognitive fusion biopsy, the prostate cancer detection rate was 8/24 (33%), while in the control group the detection rate was 12/77 (16%), which was statistically significant (t test, p = 0.037, CI 95% is 0.01 to 0.37). Patients with PIRADS ≤ 3 (54%) could have avoided the biopsy