ESUR/ESUI consensus statements on multi-parametric MRI for the detection of clinically significant prostate cancer: quality requirements for image acquisition, interpretation and radiologists’ training

Objectives: This study aims to define consensus-based criteria for acquiring and reporting prostate MRI and establishing prerequisites for image quality. Methods: A total of 44 leading urologists and urogenital radiologists who are experts in prostate cancer imaging from the European Society of Urogenital Radiology (ESUR) and EAU Section of Urologic Imaging (ESUI) participated in a Delphi consensus process. Panellists completed two rounds of questionnaires with 55 items under three headings: image quality assessment, interpretation and reporting, and radiologists’ experience plus training centres. Of 55 questions, 31 were rated for agreement on a 9-point scale, and 24 were multiple-choice or open. For agreement items, there was consensus agreement with an agreement ≥ 70% (score 7–9) and disa

Assessment of intracochlear electrode position and correlation with behavioural thresholds in CII and 90K cochlear implants

Conclusion. The image quality of 64-MDCT provided excellent definition of the fine osseous structures and individual electrode contacts. Evaluation of electrode distances revealed a more focused stimulation for the Helix contacts, with better optimization of pulse width and frequency of stimulation. Objectives. A multi-slice CT scan was performed postoperatively to evaluate electrode distance from the modiolus and variability of fitting parameters ( M level) for two different types of cochlear implant electrode carriers, CII and 90K implants with 1J and Helix electrode carriers. Materials and methods. The electrode's position in different cochlear implant (CI) electrodes, Advanced Bionics 90K 1J and Helix, was assessed postoperatively in 20 adult patients by means of a 64-MDCT scanner. Axial, coronal, and oblique 0.3 mm multiplanar reconstructions ( MPRs) were obtained and datasets were analyzed to assess the intracochlear position and distance from the surface of the electrodes to the bony edge of the modiolus. Patients' fitting characteristics were gathered at the time the CT was performed and correlated to intracochlear measurements. Results. Determination of contact distances confirmed smaller average values for the Helix at the apex and medial segments. Helix electrodes were closer to the modiolus in all segments. Likewise, M level determination showed lower values for the Helix carrier, confirming a more focused stimulation and better optimization of pulse width and frequency of stimulation

Radiology information and image management system: new approach to PACS with hypermedia capabilities of personal computers

A system for archiving patient data and images was developed, installed, and evaluated in a radiology department. The system was developed with a relational database program for use with commercially available computers linked with an Ethernet network. The main options of the system are those of a conventional radiology information system: scheduling, registration, examination execution, reporting, archives and statistics, and system administration. However, the main feature of the system is the image archiving capability. Images are associated with patient records after capture by direct acquisition of the video signal or by scanning. Only relevant pathologic images are archived and a commonly employed compression algorithm is used, reducing the total memory requirement for each case to 200-600 kbytes. The diagnosis is still made by reading the original images. The low-resolution images stored in the system have an important role in teaching and consultation and as a first-line archive. Good results have been obtained with this system, which is used by medical and nonmedical staff without any special training

[The information management of a radiology department: the development of a new type of software for the archiving of alphanumeric data and images]

The authors report the main characteristics and the goals of the development of the RIS of the II Chair of the Institute of Radiology, La Sapienza University, Rome. The system was developed with a commercial software (4th Dimension), for use with an Ethernet network and Macintosh Apple computers. One of the main problems was to obtain a user-friendly system. The main options of our system are: booking, registration, exam execution, reporting, archives and statistics and system administration. The main characteristics of our RIS is that it allows important images to be archived in limited number and at low resolution. The aim is to use images for consultation and teaching purposes, not for diagnosis which is made on the original images. Low resolution images permit to use limited storage space. Image quality is very similar to that of the original images for the equipment connected on line with the RIS--i.e., US and MR units in our institute. Conventional radiographic and CT images are digitalized by two scanners with maximum resolution of 4k x 4k x 11 bits. To date, good results have been obtained. Our RIS has been used by the medical and non-medical staffs, without any particular instruction and has allowed us to organize and make faster department management and reporting

PCA3 urinary test versus 1H-MRSI and DCEMR in the detection of prostate cancer foci in patients with biochemical alterations

Aim: To compare the prostate antigen 3 (PCA3) test with 1H-magnetic resonance spectroscopic imaging (1HMRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCEMR) combined examination in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen (PSA) levels and prior negative random transrectal ultrasound (TRUS)-guided biopsy. Patients and Methods: Forty-three patients with a first random biopsy negative for prostate adenocarcinoma, persistent elevated PSA and negative digital rectal examination were recruited. All the patients were submitted to MRSI examination (MRSI-DCEMR) and were submitted to an attentive prostate massage in order to perform PCA3 assay. Afterwards, 10-core laterally-directed random TRUSguided prostate biopsy was performed. Results: The overall sensitivity and specificity of a PCA3 score ≥35 for positive biopsy were 76.9% and 66.6%, respectively, with a positive predictive value (PPV) of 80% and a negative predictive value (NPV) of 62.5%; as for MRSI sensitivity and specificity were, respectively, 92.8% and 86.6% with a PPV of 92.8% and a NPV of 86.6%. Receiver operating characteristic (ROC) analysis rates were 0.755 for PCA3 and 0.864 for MRSI. Conclusion: Combined MRSI/DCEMR can better improve the cancer detection rate in patients with prior negative TRUSguided biopsy and altered PSA serum levels than PCA3. Optimization of MRSI will allow more precise diagnosis of local invasion and improved bioptical procedures

PCA3 urinary test versus 1H-MRSI and DCEMR in the detection of prostate cancer foci in patients with biochemical alterations

Aim: To compare the prostate antigen 3 (PCA3) test with 1H-magnetic resonance spectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCEMR) combined examination in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen (PSA) levels and prior negative random transrectal ultrasound (TRUS)-guided biopsy. Patients and Methods: Forty-three patients with a first random biopsy negative for prostate adenocarcinoma, persistent elevated PSA and negative digital rectal examination were recruited. All the patients were submitted to MRSI examination (MRSI-DCEMR) and were submitted to an attentive prostate massage in order to perform PCA3 assay. Afterwards, 10-core laterally-directed random TRUS-guided prostate biopsy was performed. Results: The overall sensitivity and specificity of a PCA3 score ≥35 for positive biopsy were 76.9% and 66.6%, respectively, with a positive predictive value (PPV) of 80% and a negative predictive value (NPV) of 625%; as for MRSI sensitivity and specificity were, respectively, 92.8% and 86.6% with a PPV of 92.8% and a NPV of 86.6%. Receiver operating characteristic (ROC) analysis rates were 0.755 for PCA3 and 0.864 for MRSI. Conclusion: Combined MRSI/DCEMR can better improve the cancer detection rate in patients with prior negative TRUS-guided biopsy and altered PSA serum levels than PCA3. Optimization of MRSI will allow more precise diagnosis of local invasion and improved bioptical procedures

Current diagnostic procedure on neuroendocrine differentiation of prostate cancer

Chromogranin A (CgA) is considered as a major specific neuroendocrine tumor marker. It belongs to the secretogranin family, which is present in the gastrointestinal tract, respiratory system, endocrine glands and in a group of endocrine cells such us pancreas and thyroid. Serum levels of CgA could reflect the neuroendocrine activity and could be used when evaluating advance prostate carcinoma. Moreover, there are also several factors that may increase the serum level of CgA: treatment with proton-pump inhibitors or H2-receptor blockers, chronic atrophic gastritis, rheumatoid arthritis, liver and renal failure. Another method to evaluate NE differentiation is scintigraphy with the 111In-labeled somatostatin analogue (DTPA-D-Phe)-octrotide, (Octreoscan). This method takes advantage of the overexpression of type II somatostatin receptors on the cell surface of NE tumors. With this technique the presence of NE differentiation can be detected both at the primary (prostate) and the metastatic sites. A more specific system to detect NE cell activity is obtained by analyzing CgA gene expression in prostate tissue by a semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR)

Focus on the Quality of Prostate Multiparametric Magnetic Resonance Imaging: Synopsis of the ESUR/ESUI Recommendations on Quality Assessment and Interpretation of Images and Radiologists’ Training

Objectives This study aims to define consensus-based criteria for acquiring and reporting prostate MRI and establishing prerequisites for image quality. Methods A total of 44 leading urologists and urogenital radiologists who are experts in prostate cancer imaging from the European Society of Urogenital Radiology (ESUR) and EAU Section of Urologic Imaging (ESUI) participated in a Delphi consensus process. Panellists completed two rounds of questionnaires with 55 items under three headings: image quality assessment, interpretation and reporting, and radiologists’ experience plus training centres. Of 55 questions, 31 were rated for agreement on a 9-point scale, and 24 were multiple-choice or open. For agreement items, there was consensus agreement with an agreement ≥ 70% (score 7–9) and disagreement of ≤ 15% of the panellists. For the other questions, a consensus was considered with ≥ 50% of votes. Results Twenty-four out of 31 of agreement items and 11/16 of other questions reached consensus. Agreement statements were (1) reporting of image quality should be performed and implemented into clinical practice; (2) for interpretation performance, radiologists should use self-performance tests with histopathology feedback, compare their interpretation with expert-reading and use external performance assessments; and (3) radiologists must attend theoretical and hands-on courses before interpreting prostate MRI. Limitations are that the results are expert opinions and not based on systematic reviews or meta-analyses. There was no consensus on outc