Multiparametric MR imaging in diagnosis of chronic prostatitis and its differentiation from prostate cancer

AbstractChronic prostatitis is a heterogeneous condition with high prevalence rate. Chronic prostatitis has overlap in clinical presentation with other prostate disorders and is one of the causes of high serum prostate specific antigen (PSA) level. Chronic prostatitis, unlike acute prostatitis, is difficult to diagnose reliably and accurately on the clinical grounds alone. Not only this, it is also challenging to differentiate chronic prostatitis from prostate cancer with imaging modalities like TRUS and conventional MR Imaging, as the findings can mimic those of prostate cancer. Even biopsy doesn't play promising role in the diagnosis of chronic prostatitis as it has limited sensitivity and specificity. As a result of this, chronic prostatitis may be misdiagnosed as a malignant condition and end up in aggressive surgical management resulting in increased morbidity. This warrants the need of reliable diagnostic tool which has ability not only to diagnose it reliably but also to differentiate it from the prostate cancer. Recently, it is suggested that multiparametric MR Imaging of the prostate could improve the diagnostic accuracy of the prostate cancer. This review is based on the critically published literature and aims to provide an overview of multiparamateric MRI techniques in the diagnosis of chronic prostatitis and its differentiation from prostate cancer

Macrophage-targeted chitosan anchored PLGA nanoparticles bearing doxorubicin and amphotericin B against visceral leishmaniasis

Novel chitosan-coated nanoparticles with a high payload of amphotericin B (AmB) and doxorubicin (Dox) were formulated employing a nanoprecipitation technique and evaluated for antileishmanial activity against Leishmania donovani. FTIR, DSC and TG-DTA analysis ensured the physicochemical compatibility of drugs and polymers. The chitosan-coated optimized nanoparticle formulation resulted in a mean particle size; 374.4 ± 4.8 nm, PDI; 0.227 ± 0.035 and zeta potential; (+) 32.9 ± 1.10 mV. The entrapment efficiency was determined to be 70.2 ± 4.76 and 93.86 ± 2.61% for AmB and Dox respectively. An in vitro drug release study demonstrated the release of 27.29 and 36.93% AmB and Dox, respectively after 24 h from chitosan-coated PLGA nanoparticles which is slower than the release obtained from uncoated PLGA nanoparticles of AmB and Dox (32.82 and 57.93% AmB and Dox respectively after 24 h). Stability studies confirmed no remarkable alterations in the physicochemical properties of nanoparticles. Cs-PLGA-ABDx was less hemotoxic (22.87 ± 0.487%) than PLGA-ABDx (36.71 ± 2.08%) and the ABDx suspension (97.04 ± 5.01%) at 42.78 μg mL⁻¹ AmB and 80 μg mL⁻¹ Dox. Cell uptake investigation showed the mean florescence intensity of chitosan-coated PLGA-FITC was 2.02 fold higher than uncoated PLGA-FITC nanoparticles. The cytotoxicity in J774A.1 cells revealed Cs-PLGA-ABDx was less cytotoxic compared to the ABDx suspension and PLGA-ABDx, whereas the IC₅₀ of Cs-PLGA-ABDx against infected macrophages was significantly (p < 0.05) lower than PLGA-ABDx indicating the effectiveness of Cs-PLGA-ABDx. No significant increase in the biomedical markers AST, BUN and PC was observed in Cs-PLGA-ABDx treated groups at 1 and 3 mg kg⁻¹ dose. These experimental findings put forward Cs-PLGA-ABDx to be a suitable alternative in the management of visceral leishmaniasis

Evaluation of different mathematical models and different b-value ranges of diffusion-weighted imaging in peripheral zone prostate cancer detection using b-value up to 4500 s/mm²

<div><p>Objectives</p><p>To evaluate the diagnostic performance of different mathematical models and different b-value ranges of diffusion-weighted imaging (DWI) in peripheral zone prostate cancer (PZ PCa) detection.</p><p>Methods</p><p>Fifty-six patients with histologically proven PZ PCa who underwent DWI-magnetic resonance imaging (MRI) using 21 b-values (0–4500 s/mm²) were included. The mean signal intensities of the regions of interest (ROIs) placed in benign PZs and cancerous tissues on DWI images were fitted using mono-exponential, bi-exponential, stretched-exponential, and kurtosis models. The b-values were divided into four ranges: 0–1000, 0–2000, 0–3200, and 0–4500 s/mm², grouped as A, B, C, and D, respectively. ADC, , D*, f, DDC, α, D_app, and K_app were estimated for each group. The adjusted coefficient of determination (R²) was calculated to measure goodness-of-fit. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of the parameters.</p><p>Results</p><p>All parameters except D* showed significant differences between cancerous tissues and benign PZs in each group. The area under the curve values (AUCs) of ADC were comparable in groups C and D (<i>p</i> = 0.980) and were significantly higher than those in groups A and B (<i>p</i>< 0.05 for all). The AUCs of ADC and K_app in groups B and C were similar (<i>p</i> = 0.07 and <i>p</i> = 0.954), and were significantly higher than the other parameters (<i>p</i>< 0.001 for all). The AUCs of ADC in group D was slightly higher than K_app (<i>p</i> = 0.002), and both were significantly higher than the other parameters (<i>p</i>< 0.001 for all).</p><p>Conclusions</p><p>ADC derived from conventional mono-exponential high b-value (3200 s/mm²) models is an optimal parameter for PZ PCa detection.</p></div

Prostate cancer in a 61-year-old patient with high serum PSA level of 19.43 ng/ml.

<p>(a)Transverse T2-weighted anatomical image shows a hypointense lesion (white arrow) in the right middle peripheral zone of the prostate; (b) A series of b-value images are shown with the corresponding location to the transverse T2-weighted (unites, s/mm²); (c) Measured signal and fitted curves of cancerous tissue and the opposite side benign tissue using maximum b-value of 4500 s/mm² (group D).</p

Evaluation of different mathematical models and different b-value ranges of diffusion-weighted imaging in peripheral zone prostate cancer detection using b-value up to 4500 s/mm² - Fig 3

<p><b>Boxplot of diffusion parameters calculated using different b-value ranges (groups A, B, C and D)</b>. (a-b, d-g), the mean values of ADC, , f, DDC, α, and D_app were significantly lower in cancerous tissues than in benign PZs in each group (h). The K_app in cancerous tissues was significantly higher than in benign PZs in each group. The value of D*, which had a large standard deviation, showed no significant difference between cancerous tissues and benign PZs in groups A and D but was significantly different in groups B and C(c).</p

Diagnostic performance of parameters calculated with different b-value ranges.

<p>Diagnostic performance of parameters calculated with different b-value ranges.</p

Graph showing variations in the adjusted R² values of the mono-exponential, bi-exponential, stretched-exponential and kurtosis models with an increase in b-value.

<p>The mean value of the adjusted R² of the mono-exponential model decreased with the increase of b-value, while the mean value of the adjusted R² of the bi-exponential, stretched-exponential and kurtosis models were stable and excellent with the increase of b-value (It should be noted that, because the adjusted R² values of the bi-exponential and stretched-exponential models were close, their curves have been superimposed).</p

ROC curve analyses show the diagnostic accuracy of the diffusion parameters in distinguishing between cancerous tissues and benign PZs.

<p>In group A, K_app had the largest AUC (0.940), but the AUCs of ADC and K_app were not significantly different (<i>p</i> = 0.070). In groups B and C, the AUCs of ADC and K_app were comparable and significantly higher than those of the other parameters. In group D, the AUCs of ADC was slightly higher than that of K_app (0.957 vs 0.953, <i>p</i> = 0.002), and both were significantly higher than those of other parameters (<i>p</i>< 0.001 for all).</p

Mean values and standard deviation of the adjusted R².

<p>Mean values and standard deviation of the adjusted R².</p