Computerized tomography (CT) is considered the gold standard for the evaluation of total skeletal muscle quantity. Skeletal muscle assessments at the L3 vertebra level revealed significantly ...correlated with total body muscle measurements. Clinicians need cut-offs to evaluate low muscle mass in various patients who already had CT imaging without any additional cost. This assessment is important to help the physicians to stratify the patients for mortality and other complications. It may also enable the diagnosis of malnutrition by the GLIM criteria. Few studies reported cut-offs in different populations. We aimed to provide cut-off values for total skeletal muscle index (SMI) and psoas muscle mass index (PMI) at the L3 vertebra level in the Turkish population.
We assessed the preoperative plain CT images of living adult liver donors who were admitted to a single transplantation center between June 2010 and April 2018. We derived cut-off values with two alternative methods, the 5th percentile value or mean minus two standard deviations and from two groups of study participants, i.e. the total study population and the younger subgroup aged between 18 and 40.
The study population involved 601 subjects with a mean age of 32.5 ± 9 (range: 18–59 years) and 326 (54.2%) was male. The younger subgroup was composed of 482 individuals with a mean age of 28.8 ± 5.9 and 55.6% male. In patients aged between 18 and 40, PMI and SMI cut-offs by using the 5th percentile were 5.40 cm2/m2, 41.42 cm2/m2 for males; and 3.56 cm2/m2, 30.70 cm2/m2 for females; respectively. The cut-offs of PMI and SMI by using mean minus two standard deviations were 4.62 cm2/m2, 38.67 cm2/m2 for males; and 2.66 cm2/m2, 27.8 cm2/m2 for females; respectively. These cut-offs were comparable to the other populations.
Our study provided cut-offs to be used in CT images for PMI and SMI. There is a need for further longitudinal studies to verify whether these cut-offs are successful in predicting mortality or other adverse outcomes associated with low muscle mass.
Purpose
Extraprostatic extension (EPE) is an unfavorable prognostic factor and the grade of EPE is also shown to be correlated with the prognosis of prostate cancer. The current study assessed the ...value of prostate magnetic resonance imaging (MRI) in measuring the radial distance (RD) of EPE and the role of T2 WI signs in predicting the grade of EPE.
Materials and methods
A total of 110 patients who underwent prostate MRI before radical prostatectomy are enrolled in this retrospective study. Eighty-four patients have organ confined disease and the remaining twenty-six patients have EPE all verified by histopathology. Prostate MRI examinations were conducted with 3T MRI scanner and phased array coil with the following sequences: T2 WI, T1 WI, DCE, DWI with ADC mapping, and high
b
-value at
b
= 1500 s/mm
2
. The likelihood of EPE with 5-point Likert scale was assigned, several MRI features were extracted for each dominant tumor identified by using T2 WI. Tumors with Likert scales 4–5 were evaluated further to obtain MRI-based RD. The relationship between pathological and MRI-determined RD was tested. Univariate and multivariate logistic regression models were developed to detect the grade of pathological EPE. The inputs were among the 2 clinical parameters and 4 MRI features.
Results
There is a moderate correlation between pathological RD and MRI-determined RD (
ρ
= 0.45,
P
< 0.01). In univariate and multivariate models, MRI features and clinical parameters possess varying significance levels (univariate models;
P
= 0.048–0.788, multivariate models;
P
= 0.173–0.769). Multivariate models perform better than the univariate models by offering fair to good performances (AUC = 0.69–0.85). The multivariate model that employs the MRI features offers better performance than the model employs clinical parameters (AUC = 0.81 versus 0.69).
Conclusion
Co-existence of T2 WI signs provide higher diagnostic value even than clinical parameters in predicting the grade of EPE. Combined use of clinical parameters and MRI features deliver slightly superior performance than MRI features alone.
To evaluate diffusion-weighted imaging (DWI) features and signal intensity values at T2-weighted magnetic resonance (MR) imaging for differential diagnosis of benign retroperitoneal fibrosis (RPF) ...and plaque-like retroperitoneal malignant neoplasms.
Institutional review board approval and informed consent were obtained for this retrospective study. Fifty-one patients with plaque-like confluent retroperitoneal soft-tissue masses were divided into three groups: group I, 25 patients with malignant RPF and retroperitoneal malignant neoplasm; group II, 16 patients with chronic RPF; and group III, 10 patients with active RPF. On T1-weighted (unenhanced and contrast material-enhanced), T2-weighted, and DWI (b = 1000 sec/mm(2)) images, apparent diffusion coefficient (ADC) values and quotients of postcontrast signal intensities between lesions and psoas muscle were evaluated. The χ(2) test was used to compare categorical values; one-way analysis of variance and Kruskal-Wallis tests were used to compare groups.
Overall sensitivity, specificity, and positive and negative predictive values of DWI findings were 92% (23 of 25 patients), 62% (16 of 26 patients), 70% (23 of 33 patients), and 89% (16 of 18 patients), respectively. Mean ADC values were 0.79 ± 0.19 in group I, 1.43 ± 0.16 in group II, and 0.91 ± 0.14 in group III. When comparing values, differences between groups I and II (ADC values, P < .0001; DWI quotients, P < .0001; postcontrast quotients, P = .001) and groups II and III (ADC values, P < .0001; DWI quotients, P = .016; postcontrast quotients, P = .04) were significant. There was no significant difference between groups I and III or between the three groups when T2-weighted values were compared.
ADC of chronic RPF was higher than that for active RPF or malignant RPF and retroperitoneal malignant neoplasm. DWI can contribute to differential diagnosis of chronic RPF and malignant neoplasms with RPF morphology. Lesions in the malignant group and active RPF group had similar enhancement patterns, while those in the chronic RPF group demonstrated less enhancement. Signal intensity values on T2-weighted images were not useful for differentiating these conditions.
Background Many publications have examined the relationship between apparent diffusion coefficient (ADC) values and tumor grade in endometrial cancer. Nevertheless, none were designed to evaluate ...according to the histopathological type of endometrioid and non-endometrioid tumors. Purpose To evaluate the role of diffusion-weighted imaging (DWI) in the differential diagnosis of endometrioid and non-endometrioid cancer of the uterus, by comparing them with contrast-enhanced magnetic resonance imaging (MRI) findings. Material and Methods Institutional review board approval and informed consent were obtained. The MRI findings of 63 patients with endometrial cancer were retrospectively evaluated and divided into four groups: Grades I, II, and III endometrioid tumors, and non-endometrioid tumors. ADC values, DWI quotients ( b = 1000 s/mm
), and post-contrast signal intensities between lesions and the myometrium (b1000q-Cq values) were evaluated. The one-way-ANOVA, student's t-test, Kruskal-Wallis test, and receiver operating characteristic (ROC) analysis were used for statistical evaluation. Results Mean ADC values were 0.86 ± 0.14 in Grade I, 0.80 ± 0.7 in Grade II, 0.71 ± 0.14 in Grade III for endometrioid tumors, and 0.70 ± 0.12 in non-endometrioid tumors. There was a significant difference in ADC values between Grade I and Grade III ( P = 0.006), and non-endometrioid tumors ( P = 0.003). The difference was also significant between Grades I + II and Grade III ( P = 0.009), and non-endometrioid tumors ( P = 0.004). Besides, there was a significant difference between endometrioid and non-endometrioid tumors ( P = 0.022). However, when considering b1000q (F = 0.640, P = 0.593) and Cq (χ
= 6.233; P = 0.101), no significant difference was detected among the groups. Conclusion The difference in ADC values between the endometrioid and non-endometrioid tumors was statistically significant. However, the difference in DWI and contrast-enhancement findings were not statistically significant. Furthermore, the mean ADC values had an inverse relationship with tumor grade in the endometrioid cancer group.
Radiologists inspect CT scans and record their observations in reports to communicate with physicians. These reports may suffer from ambiguous language and inconsistencies resulting from subjective ...reporting styles, which present challenges in interpretation. Standardization efforts, such as the lexicon RadLex for radiology terms, aim to address this issue by developing standard vocabularies. While such vocabularies handle consistent annotation, they fall short in sufficiently processing reports for intelligent applications. To support such applications, the semantics of the concepts as well as their relationships must be modeled, for which, ontologies are effective. They enable the software to make inferences beyond what is present in the reports. This paper presents the open-source ontology ONLIRA (Ontology of the Liver for Radiology), which is developed to support such intelligent applications, such as identifying and ranking similar liver patient cases. ONLIRA is introduced in terms of its concepts, properties, and relations. Examples of real liver patient cases are provided for illustration purposes. The ontology is evaluated in terms of its ability to express real liver patient cases and address semantic queries.
: The objective of this study was to investigate the impact of the characteristics of a single visible tumor (Prostate Imaging-Reporting and Data System PI-RADS≥3) on upgrading and adverse pathology ...at radical prostatectomy (RP) in biopsy naïve low risk prostate cancer (PCa) patients.
: We retrospectively reviewed 64 biopsy naïve patients from 3 different referral centers between 2018 and 2020 with a PSA<10, cT1c disease, a single PI-RADS≥ 3 index lesion in multiparametric-MRI (mp-MRI), all bearing a GG 1 tumor sampled software fusion biopsy, who underwent RP. Preoperative clinical variables including the localization, number and tumor burden of positive cores for each PI-RADS category were related to upgrading and adverse pathology (GG>2 and/or pT3 and/or lymph node positive disease) at RP.
: Overall 37 patients (57.8%) were upgraded with a significant difference of upgrading in PI-RADS3 (30.0%) versus PI-RADS 4 (67.6%) (P = .007) and PI-RADS 4-5 (70.5%) lesions (P = .002). Thirty-three of 37 GG1 tumors were upgraded to GG2, while 6 of these 33 (18.2%) had adverse pathology as well. Overall 9 patients (14.1%) had adverse pathology at RP all harboring PI-RADS4-5 lesions. The number of positive cores differed significantly between the upgraded and nonupgraded patients. Adverse pathology group had significantly higher tumor volume at RP.
: PI-RADS4-5 lesions are the independent predictors of upgrading and adverse pathology in low risk PCa with visible tumors. Upgrading and adverse pathology were closely related to the number of positive combined cores reflecting the role of tumor volume. This should be kept in mind in shared decision making of an individual patient with low risk disease and a visible tumor.
Deciding on the management of prostate cancer (PCa), especially GG1 PCa, is quite difficult. The most important thing that will help us in making active surveillance or definitive treatment decision is whether the tumor is a clinically significant tumor. To understand this, we discussed in this article that multiparametric MR, PI-RADS scoring and targeted biopsy can be used.
Abstract Purpose The aim of our study is to demonstrate the feasibility of body diffusion weighted (DW) MR imaging in the evaluation of pancreatic islet cell tumors (ICTs) and to define apparent ...diffusion coefficient (ADC) values for these tumors. Materials and methods 12 normal volunteers and 12 patients with histopathologically proven pancreatic ICT by surgery were included in the study. DW MR images were obtained by a body-phased array coil using a multisection single-shot echo planar sequence on the axial plane without breath holding. In addition, the routine abdominal imaging protocol for pancreas was applied in the patient group. We measured the ADC value within the normal pancreas in control group, pancreatic ICT, and surrounding pancreas parenchyma. Mann–Whitney U -test has been used to compare ADC values between tumoral tissues and normal pancreatic tissues of the volunteers. Wilcoxon Signed Ranks Test was preferred to compare ADC values between tumoral tissues and surrounding pancreatic parenchyma of the patients. Results In 11 patients out of 12, conventional MR sequences were able to demonstrate ICTs succesfully. In 1 patient an indistinct suspicious lesion was noted at the pancreatic tail. DW sequence was able to demonstrate the lesions in all of the 12 patients. On the DW images, all ICTs demonstrated high signal intensity relative to the surrounding pancreatic parenchyma. The mean and standard deviations of the ADC values (×10−3 mm2 /s) were as follows: ICT ( n = 12), 1.51 ± 0.35 (0.91–2.11), surrounding parenchyma ( n = 11) 0.76 ± 0.15 (0.51–1.01) and normal pancreas in normal volunteers ( n = 12), 0.80 ± 0.06 (0.72–0.90). ADC values of the ICT were significantly higher compared with those of surrounding parenchyma ( p < 0.01) and normal pancreas ( p < 0.001). Conclusion DW MR imaging does not appear to provide significant contribution to routine MR imaging protocol in the evaluation of pancreatic islet cell tumors. But it can be added to MR imaging protocol to detect the lesion in a limited number of patients with clinical suspicion for pancreatic ICT with negative or suspicious imaging findings.
Background. Renal anastomosing hemangioma (RAH) is a very rare distinct entity composed of anastomosing sinusoidal (spleen-like) capillary-sized vessels lined by flat or hobnail endothelial cells. ...Most of the published cases of RAH occurred in the setting of end-stage renal disease (ESRD). Methods. We present 2 cases of RAH in ESRD along with a literature review. We compared clinicopathologic features of RAHs in end-stage and non–end-stage kidneys. A meta-analysis was conducted with PubMed and a manual search through references of relevant publications. Individual patient data gathered from the literature were used in the analysis. Results. Our systematic review revealed 49 RAHs, including our 2 cases. Thirty-two (65.3%) cases were in ESRD, only 17 (34.7%) were in patients with non-ESRD. RAHs in ESRD were in younger patients, smaller in size, multifocal, and seen more with renal epithelial neoplasms when compared with RAHs in non-ESRD (P < .05). Extramedullary hematopoiesis was seen mostly in RAHs in ESRD kidneys (85% vs 41.7%) (P = .018). Follow-up data were available for 25 cases with a mean follow-up of 24.58 ± 38.54 months. Recurrence, metastasis, or death have never been described related to RAH in any patients. Conclusions. In conclusion, RAHs are rare and mostly arise in kidneys with end-stage damage. RAHs in ESRD and non-ESRD differ in terms of clinicopathologic features.
In prostate cancer, extraprostatic extension (EPE) is an unfavorable prognostic factor, and the grade of EPE is correlated with the prognosis. This study aims to evaluate the utility of length of ...capsular contact (LCC ) in predicting the grade of EPE by correlating the measurements from MRI images and the measurements performed from radical prostatectomy specimens.
MR images and specimens of 110 tumors are analyzed retrospectively. The specimens are used as reference to validate the presence of EPE and to measure the ground truth LCC. MR images are evaluated by two radiologists to identify the presence of EPE and to predict the LCC indirectly. Reliability, accuracy, sensitivity, and specificity of the evaluations are analyzed in comparison with the findings obtained from the specimens.
In detection of EPE existence, the radiologists achieve almost the same performance (all AUCs = 0.73) with optimal cut-off values lead to moderate sensitivity and specificity pairs (For cut-off = 15.8 mm; Se = 0.69, Sp = 0.68 and for cut-off of 14.5 mm: Se = 0.77, Sp = 0.62). In distinguishing high-grade EPE from low-grade EPE, the radiologists accomplish very similar performances (AUCs = 0.73 and 0.72) Optimal thresholds of 20.0 mm and 18.5 mm for the readers retrospectively reveal medium sensitivity and specificity pairs (Se = 0.64, Sp = 0.67; Se = 0.64, Sp = 0.67).
Consistent LCC estimates can be obtained from MR images providing a beneficial metric for detecting the existence of EPE and for discriminating the grades of EPE.
Objectives: Gallium-68 (Ga-68) prostate specific membrane antigen (PSMA) positron emission tomography (PET) has been shown to be more
accurate than multiparametric prostate magnetic resonance imaging ...(MRI) in detection of primary prostate lesions. Using hybrid PET/MRI we aim
to detect the correlation between SUVmax and apparent diffusion coefficient (ADC) in primary prostate lesions and to assess their prognostic value
in detection of lymph node (LN) metastasis.
Methods: Twenty-six patients, who were diagnosed as having prostate cancer with biopsy and underwent Ga-68 PSMA PET/MRI together with
biparametric prostate MRI (bpMRI) were included. SUVmax, SUVmean and ADC were recorded for index lesions drawing a region of interest (ROI) of
1 cm2 around the pixel with the highest SUVmax (ROI-1) and another ROI following borders of prostate tumor detected by bpMRI (ROI-2). Presence
of LN metastasis was recorded according to PSMA PET/MRI.
Results: SUVmax was inversely correlated with ADC (ROI-1: p=0.010; ROI-2: p=0.017 for b=800). SUVmax and SUVmeans were both higher in patients
with LN metastasis and ADC was lower in patients with LN metastasis for ROI-1. SUVmax cut-off value of 19.8 for ROI-1 and 20.9 for ROI-2 had
sensitivity and specificity of 77.8% and 76.5%, respectively for detection of LN metastasis, whereas ADC (b=800) cut-off value of 0.92x10-3 mm2/s
had sensitivity and specificity of 87.5% and 76.5%, respectively. SUVmax/ADC (b=800) ratio increased the sensitivity and specificity to 100% and
82.4%, respectively.
Conclusion: SUV and ADC values are inversely correlated in primary prostate lesions and the combined use of both values increases the diagnostic
accuracy of hybrid PET/MRI in the detection of primary prostate lesions.
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