Radiological evaluation by magnetic resonance of the new anatomy of transsexual patients undergoing male to female sex reassignment surgery

none10noMagnetic resonance (MR) is the best way to assess the new anatomy of the pelvis after male to female (MtF) sex reassignment surgery. The aim of the study was to evaluate the radiological appearance of the small pelvis after MtF surgery and to compare it with the normal women's anatomy. Fifteen patients who underwent MtF surgery were subjected to pelvic MR at least 6 months after surgery. The anthropometric parameters of the small pelvis were measured and compared with those of ten healthy women (control group). Our personal technique (creation of the mons Veneris under the pubic skin) was performed in all patients. In patients who underwent MtF surgery, the mean neovaginal depth was slightly superior than in women (P=0.009). The length of the inferior pelvic aperture and of the inlet of pelvis was higher in the control group (P<0.005). The inclination between the axis of the neovagina and the inferior pelvis aperture, the thickness of the mons Veneris and the thickness of the rectovaginal septum were comparable between the two study groups. MR consents a detailed assessment of the new pelvic anatomy after MtF surgery. The anthropometric parameters measured in our patients were comparable with those of women.noneBRUNOCILLA E.;SOLI M;FRANCESCHELLI A;SCHIAVINA R;BORGHESI M;GENTILE G;PULTRONE CV;MARTORANA G;ORREI MG;COLOMBO FBRUNOCILLA E.;SOLI M;FRANCESCHELLI A;SCHIAVINA R;BORGHESI M;GENTILE G;PULTRONE CV;MARTORANA G;ORREI MG;COLOMBO

Radiological evaluation by magnetic resonance of the ‘new anatomy’ of transsexual patients undergoing male to female sex reassignment surgery

Magnetic resonance (MR) is the best way to assess the new anatomy of the pelvis after male to female (MtF) sex reassignment surgery. The aim of the study was to evaluate the radiological appearance of the small pelvis after MtF surgery and to compare it with the normal women's anatomy. Fifteen patients who underwent MtF surgery were subjected to pelvic MR at least 6 months after surgery. The anthropometric parameters of the small pelvis were measured and compared with those of ten healthy women (control group). Our personal technique (creation of the mons Veneris under the pubic skin) was performed in all patients. In patients who underwent MtF surgery, the mean neovaginal depth was slightly superior than in women (P=0.009). The length of the inferior pelvic aperture and of the inlet of pelvis was higher in the control group (P<0.005). The inclination between the axis of the neovagina and the inferior pelvis aperture, the thickness of the mons Veneris and the thickness of the rectovaginal septum were comparable between the two study groups. MR consents a detailed assessment of the new pelvic anatomy after MtF surgery. The anthropometric parameters measured in our patients were comparable with those of women

Accuracy of endorectal Magnetic Resonance Imaging (MRI) and Dynamic Contrast Enhanced-MRI (DCE-MRI) in the preoperative local staging of prostate cancer: a prospective study in 46 patients.

Purpose: To assess the accuracy of endorectal MRI in association with DCE-MRI in the preoperative local staging of prostate cancer (PCa). Methods and Materials: After at least 6 weeks from biopsy, 46 consecutive patients with biopsy-proven PCa at intermediate/high-risk were prospectively evaluated with MRI, within 2 weeks before radical prostatectomy (RP). Assessment of radiological images and RP specimens were performed on 14 regions: 12 prostatic locations and 2 seminal vesicle locations. The likelihood of extracapsular extension (ECE) and seminal vesicle invasion (SVI) was scored on a 5-point scale in each region. We assessed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy with ROC analysis of MRI, DCE-MRI and conventional staging methods using pathological findings as reference standard. Results: The mean values of age, PSA, prostate volume and pathological Gleason score were 65.7 years, 7.9 ng/ml, 65.7 ml and 7.45. At histopathology, 11/46 (24%) patients had pathological extraprostatic involvement: monolateral ECE (5), bilateral ECE (2), monolateral SVI (2) and bilateral SVI (2). Overall, 552 prostatic regions and 92 seminal vesicle regions were evaluated. The values of sensitivity, specificity, PPV, NPV and accuracy were: on a per-patient analysis, 81.8%, 91.4%, 75 %, 94.1%, 0.894; on a per-region analysis, 36.4%, 98.1%, 44.4%, 97.4%, 0.657. DCE-MRI did not improve the diagnostic accuracy of T2-weighted MRI in the evaluation of ECE/SVI. Conclusion: Endorectal-MRI adds important information regarding the preoperative local staging of PCa. However, the analysis region-by-region shows some limits of this imaging technique, in particular a low sensitivity, that must be considered before choosing a nerve-sparing approach

Art. 211 - (Pareri di precontenzioso dell'ANAC) - CODICE DEI CONTRATTI PUBBLICI. Commentario di dottrina e giurisprudenza

Art. 211 - (Pareri di precontenzioso dell'ANAC) - CODICE DEI CONTRATTI PUBBLICI. Commentario di dottrina e giurisprudenz