Locally advanced prostate cancer: three-dimensional magnetic resonance spectroscopy to monitor prostate response to therapy.

Purpose: To correlate results of three-dimensional magnetic resonance spectroscopic imaging (MRSI) with prostate-specific antigen (PSA) levels and time since external beam irradiation (EBRT) in patients treated with long-term hormone therapy (HT) and EBRT for locally advanced disease to verify successful treatment by documenting the achievement of metabolic atrophy (MA). Methods and Materials: Between 2006 and 2008, 109 patients were consecutively enrolled. MA was assessed by choline and citrate peak area-to-noise-ratio <5:1. Cancerous metabolism (CM) was defined by choline-to-creatine ratio >1.5:1 or choline signal-to-noise-ratio >5:1. To test the strength of association between MRSI results and the time elapsed since EBRT (TEFRT), PSA levels, Gleason score (GS), and stage, logistic regression (LR) was performed. p value <0.05 was statistically significant. The patients’ outcomes were verified in 2011. Results: MRSI documented MA in 84 of 109 and CM in 25 of 109 cases. LR showed that age, GS, stage, and initial and recent PSA had no significant impact on MRSI results which were significantly related to PSA values at the time of MRSI and to TEFRT. Patients were divided into three groups according to TEFRT: 2 years. MA was detected in 54.1% of patients of group 1, 88.9% of group 2, and in 94.5% of group 3 (100% when PSA nadir was reached). CM was detected in 50% of patients with reached PSA nadir in group 1. Local relapse was found in 3 patients previously showing CM at long TEFRT. Conclusion: MA detection, indicative of successful treatment because growth of normal or abnormal cells cannot occur without metabolism, increases with decreasing PSA levels and increasing time on HT after EBRT. This supports long-term HT in advanced prostate cancer. Larger study series are needed to assess whether MRSI could predict local relapse by detecting CM at long TEFRT. 2012 Elsevier In

Diagnostica per immagini nei pazienti affetti da morbo di Preiser

La necrosi avascolare dello scafoide (Morbo di Preiser) è una rara patologia di patogenesi incerta talora conseguente a microtraumi ripetuti, pregressi interventi chirurgici, terapie mediche. La diagnostica per immagini, e particolarmente la Risonanza Magnetica, riveste un ruolo fondamentale nell’inquadramento della patologia. Nello studio vengono analizzati i reperti rilevati in una casistica di 8 pazienti affetti da Morbo di Preiser; tali dati sono stati confrontati con quelli della letteratura scientifica

Magnetic resonance imaging in women with pelvic pain from gynaecological causes: a pictorial review

Abstract This article illustrates causes of pelvic pain in girls and women that may be inadequately diagnosed by ultrasound (US) and more adequately assessed by magnetic resonance imaging (MRI). We describe MRI features necessary for detecting disease and helpful in differential diagnosis. Special attention is paid to correlating age and pathology by subdividing the population into four categories: girls up to prepubertal age, pubertal girls, women of reproductive age and postmenopausal women. US is the first-line imaging modality in children and women with pelvic pain, and computed tomography (CT) is usually requested, especially in emergency settings, in patients in whom US is inadequate for diagnosis. However, MRI should be considered at least in urgent, if not in emergent, care given the wide range of female pelvic disorders that can be correctly assessed thanks to the excellent soft-tissue contrast, high spatial resolution and ability to depict blood products. Moreover, MRI should be preferred in children and women of reproductive age because of the absence of radiation exposur

Detection of bone erosions in early rheumatoid arthritis: 3D ultrasonography versus computed tomography

Three-dimensional (3D) volumetric ultrasonography (US) is an interesting tool that could improve the traditional approach to musculoskeletal US in rheumatology, due to its virtual operator independence and reduced examination time. The aim of this study was to investigate the performance of 3DUS in the detection of bone erosions in hand and wrist joints of early rheumatoid arthritis (ERA) patients, with computed tomography (CT) as the reference method. Twenty ERA patients without erosions on standard radiography of hands and wrists underwent 3DUS and CT evaluation of eleven joints: radiocarpal, intercarpal, ulnocarpal, second to fifth metacarpo-phalangeal (MCP), and second to fifth proximal interphalangeal (PIP) joints of dominant hand. Eleven (55.0%) patients were erosive with CT and ten of them were erosive also at 3DUS evaluation. In five patients, 3DUS identified cortical breaks that were not erosions at CT evaluation. Considering CT as the gold standard to identify erosive patients, the 3DUS sensitivity, specificity, PPV, and NPV were 0.9, 0.55, 0.71, and 0.83, respectively. A total of 32 erosions were detected with CT, 15 of them were also observed at the same sites with 3DUS, whereas 17 were not seen on 3DUS evaluation. The majority of these 3DUS false-negative erosions were in the wrist joints. Furthermore, 18 erosions recorded by 3DUS were false positive. The majority of these 3DUS false-positive erosions were located at PIP joints. This study underlines the limits of 3DUS in detecting individual bone erosion, mostly at the wrist, despite the good sensitivity in identifying erosive patients