Multiparametric MRI and Radiomics in Prostate Cancer: A Review of the Current Literature

Prostate cancer (PCa) represents the fourth most common cancer and the fifth leading cause of cancer death of men worldwide. Multiparametric MRI (mp-MRI) has high sensitivity and specificity in the detection of PCa, and it is currently the most widely used imaging technique for tumor localization and cancer staging. mp-MRI plays a key role in risk stratification of naive patients, in active surveillance for low-risk patients, and in monitoring recurrence after definitive therapy. Radiomics is an emerging and promising tool which allows a quantitative tumor evaluation from radiological images via conversion of digital images into mineable high-dimensional data. The purpose of radiomics is to increase the features available to detect PCa, to avoid unnecessary biopsies, to define tumor aggressiveness, and to monitor post-treatment recurrence of PCa. The integration of radiomics data, including different imaging modalities (such as PET-CT) and other clinical and histopathological data, could improve the prediction of tumor aggressiveness as well as guide clinical decisions and patient management. The purpose of this review is to describe the current research applications of radiomics in PCa on MR images

Nasal anomalies review with CT or MRI: from congenital to malignant.

Learning Objectives. To describe imaging findings of a wide spectrum of uncommon nasal cavity masses evaluated at our institution by CT, CBCT and MR imaging, clinically and pathologically proven. Background. In this work we present a succinct review of disease illustrated by a retrospective case series of nasalcavity masses, evaluated at our institution. between 2010 and 2013. Patients have been studied with different imaging modalities including multiraw computed tomography (CT), cone beam computed tomography (CBCT) and magnetic resonance imaging (MR) to illustrate the findings and to summarize the main diagnostic keypoints for the differential diagnosis of nasal masses. Clinicopathological correlation is also reported and imaging findings we present have been isthopathologically proven. Images aid in recognition and characterization of the lesions. Many different types of lesions may involve the nasal cavities and imaging studies, CBCT, CT and MR, provide anatomical details and could be helpful first in differentiating benign to malignant lesions and secondary in characterization of the lesion. Referring to non neoplastic lesions, rinoliths, piogenic granuloma and septal mucocele are reported. Referring to benign and borderline tumors osteoma, hamartoma, hemangioma, hemangiopericytoma, cemento-ossifying fibroma, antrochoanal polip and inverted papilloma are reported. Referring to malignant neoplasms intestinal type adenocarcinoma, esthesioneuroblastoma and Non-Hodgkin lymphoma are reported. CONCLUSION. This review of uncommon nasal masses studied with different imaging modalities (CT, CBCT and MRI)should be useful in differential diagnosis of the wide spectrum of nasal tumors and non tumors masses

Glioma Grading: The Role of Combined Perfusion MR Imaging and Single-Voxel MR Spectroscopy Compared to Conventional MR Imaging

Abstract Body: Purpose To assess the contribution of combined perfusion MR imaging (MRI) and single-voxel MR spectroscopy (MRS) in grading primary gliomas compared with conventional MRI. Materials & Methods Thirty-two patients with primary cerebral glioma underwent conventional MRI, dynamic contrast-enhanced T2*-weighted perfusion MRI and single-voxel proton MRS. Gliomas were graded as low or high based on conventional MRI. The rCBV measurements were obtained from regions of maximum perfusion normalized between tumor and healthy tissue. Metabolite ratios ( [Cho]/[Cr], [Cho]/[NAA], [NAA]/[Cr]) were measured with TE: 34 ms. Tumor grade determined with the three methods then was compared with that from histopathologic grading. Logistic regression and ROC analyses were performed to determine which parameters best increased diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) Results Statistically significant differences were found for rCBV tumor/normal tissue ratio, and NAA/Cr ratio in tumor and Cho/Cr ratio in tumor between low- and high-grade tumors. The best performing single parameter for glioma grading was normalized rCBV value. Combined rCBV tumor/normal tissue ratio and NAA/Cr tumor ratio increased overall accuracy in glioma grading. Receiver operating characteristic curves demonstrated a rCBV tumor/normal tissue ratio of >1.16 and NAA/Cr tumor ratio of <0.44 has the higher probability for a neoplasm to be a high-grade glioma. Conclusion The rCBV measurements and metabolite ratios both individually and in combination can increase the accuracy when compared with conventional MRI alone in determining glioma grade. The best performing parameter was found to be the rCBV measurements. Threshold values can provide a means for guiding treatment and predicting postoperative patient outcome

ROLE OF IMAGING IN THE PREOPERATIVE ASSESSMENT OF PELVIC AND EXTRAPELVIC ENDOMETRIOSIS: A PICTORIAL ESSAY

-To create a MR radiological template for endometriosis -To review MR reports and images in patients with endometriosis to assess the accurancy of the reports

SINCONAPP: A Computerized learning tool for CBCT normal anatomy and variants of the nose and paranasal sinuses

1. Purpose To supply an useful learning tool aimed to interactively display on mobile devices normal anatomy and variants of the nose and paranasal sinuses as seen on CBCT images. 2. Methods and Materials Images Images of the nose and paranasal sinuses were derived by a study series acquired by a CBCT device. CBCT studies of the paranasal sinuses were acquired in patients referred for nasal obstruction or sinusitis with the following parameters: 90 kVp, 12.5 mA, 20 s rotation time, FOV 13 x 14.5 cm, 0.25 x 0.25 x 0.25 mm voxel size. Software The application has been developed for iOS based mobile devices through the platform XCode provided by Apple®, and it is developed using the Objective-C programming language. The application has been configured as Master-Detail. This configuration splits the mobile device display in two panels. The left panel displays a list of the interesting items, while the right panel shows the relative details. Touching an item from the menu on the left panel, the textual description is shown on the same side, while the panel on the right will show the relative image. The application allows interactively navigation through normal anatomy and variants of the nose and paranasal sinuses, as represented on CBCT images in axial, sagittal and coronal planes. Cross-reference images to localize the same anatomic structures on different section planes are available. The navigation is intuitive, with multiple shortcuts. Different labels have been proposed in accordance with the specific anatomic lessic of the district and current literature references. High image quality with a zooming tool are available. 4. Conclusion An App for IOs devices was developed, that can represent an useful educational tool for medical students, residents and continuous medical education in radiology and other medical specialties dealing with nose and paranasal sinuses. This interactive atlas based on CBCT images could be also an useful option to be implemented on CBCT software

Videofluorography and MDCT findings in a case of pharyngeal perforation after anterior cervical spinal surgery with fusion (ACSF)

Purpose Anterior cervical spinal surgery with fusion (ACSF) is the most widely used technique in the management of cervical spondylosis or disc herniation. A case of pharyngeal perforation after ACSF demonstrated by videofluorography and MDCT is described. Methods A 39-year-old man, recently undergone to ACSF for interbody C3-C5 fusion with anterior cervical plate and screws, was submitted to a pharingoesophageal videofluorography and 64 row-MDCT of the neck before and after oral administration of iodine contrast medium for persistent high dysphagia. Results In the plain radiograph a fractured screw was detected, anterolaterally displaced on the right to the cervical spine, outside the pharingeal lumen. After high-density (250% weight/volume) barium suspension administration the screw floated outside the pharingeal lumen at C4-C6 level, and an extraluminal leak of barium was observed. On CT MPR and 3D reformatted images confirmed the screw was fractured and displaced outside the plate in the retropharingeal space, anteriorly to C4, and also the hypothesis of posterior pharingeal wall damage, for the presence of gas bubbles in the retropharingeal space, thickening of prevertebral soft tissues, and contrast medium leak through a pharyngeal break in the retropharingeal space. Conclusions Imaging can play a role to correctly address the cause of disphagya after ACSF

PATIENTS' KNOWLEDGE AND AWARENESS OF RADIATION DOSE AND RISKS FROM CT: DO PATIENTS NEED A PERSONALIZED COMMUNICATION OF DOSE BILL?

In the last decades exposure to ionizing radiations in computed tomography (CT) has constantly increased. Only a few years ago it was quite difficult to assess how much radiation had been delivered to a patient during a CT examination. Nowadays, the technical challenges of dose data reporting between CT scanners from different vendors have been met, making dose tracking a reality since these dose data are automatically stored in the picture achieving system of the radiology department. Most authors affirm communication of CT risk to patients should be personalized, but no studies investigate if a tailored communication is needed. Aim of our study is to understand how patients' characteristics may condition the comprehension of this information

Multi-scale analysis of apparent diffusion coefficient (ADC) predicts cervical nodal status in patients with head and neck squamous cell carcinoma

The study assess multi-scale diffusion parameters (median volumetric nodal region of interest values, inter-voxel histogram distributions, and intra-voxel diffusion heterogeneity as assessed by the stretched exponential model) as classifiers of nodal status in patients with head and neck squamous cell carcinoma (SCC). Low b value (0, 50, 100) derived nodal ADC (perfusion sensitive) was the key parameter facilitating discrimination of metastatic from benign nodes in patients with head and neck SCC. The stretched exponential derived α value together with histogram features of ADC provide an accurate decision tree model for classification of nodal disease

Role of the Apparent Diffusion Coefficient (ADC) values analysis in Diffusion Weighted Imaging (DWI-MR) in the characterization of prostatic disease on Multiparametric Magnetic Resonance Imaging (Mp-MRI) of the prostate.

Purpose To evaluate if apparent diffusion coefficient analysis on magnetic resonance imaging can differentiate between normal and pathological prostate tissue, including prostate cancer and precancerous conditions (ASAP and PIN). Materials and Methods Prostate MRI with endorectal coil was performed in 93 patients (mean age 65.4). Regions of interest were placed over suspicious areas, detected on MRI, and over areas with normal appearance, and ADC values were recorded. Statistical differences between ADC values of suspicious and normal areas were evaluated. Histopathological diagnosis, obtained from targeted biopsy in 51 patients and from prostatectomy in 42 patients, were correlated to ADC values. Results Histopathological diagnosis revealed 58 cases of prostate cancer (PCa), 16 of high-grade prostatic intraepithelial neoplasia (HG-PIN), 10 of atypical small acinar proliferation (ASAP) and 12 histologic alterations after radiotherapy. Significant statistical differences between mean ADC values of normal prostate tissue versus PCa (p<.01), HG-PIN (p<.01), ASAP (p<.05) and post-radiotherapy changes (p<.05) were found. Significant differences were observed between mean ADC values of PCa versus HG-PIN (p<.05) and ASAP (p<.01) with many overlapping values. Differences between mean ADC values of HG-PIN versus ASAP (p=0.17) and between post-radiotherapy alterations versus PCa (p=0.24), HG-PIN (p=0.76) and ASAP (p=0.69) were not significant. Conclusions The apparent diffusion coefficient analysis on DW-MRI allows a robust differentiation between normal prostate tissue and pathological conditions as PCa, ASAP and PIN. The discrimination of different pathological conditions within the intrapathological group and in post-radiotherapy fibrosis patients using apparent diffusion coefficient analysis, suffers of an excessive overlapping of the ADC values even if stastically significant differences have been reported