Purpose
To compare the predictive roles of qualitative (PI-RADSv2) and quantitative assessment (ADC metrics), in differentiating Gleason pattern (GP) 3 + 4 from the more aggressive GP 4 + 3 prostate ...cancer (PCa) using radical prostatectomy (RP) specimen as the reference standard.
Methods
We retrospectively identified treatment-naïve peripheral (PZ) and transitional zone (TZ) Gleason Score 7 PCa patients who underwent multiparametric 3T prostate MRI (DWI with
b
value of 0,1400 and where unavailable, 0,500) and subsequent RP from 2011 to 2015. For each lesion identified on MRI, a PI-RADSv2 score was assigned by a radiologist blinded to pathology data. A PI-RADSv2 score ≤ 3 was defined as “low risk,” a PI-RADSv2 score ≥ 4 as “high risk” for clinically significant PCa. Mean tumor ADC (ADC
T
), ADC of adjacent normal tissue (ADC
N
), and ADC
ratio
(ADC
T
/ADC
N
) were calculated. Stepwise regression analysis using tumor location, ADC
T
and ADC
ratio
,
b
value, low vs. high PI-RADSv2 score was performed to differentiate GP 3 + 4 from 4 + 3.
Results
119 out of 645 cases initially identified met eligibility requirements. 76 lesions were GP 3 + 4, 43 were 4 + 3. ADC
ratio
was significantly different between the two GP groups (
p
= 0.001). PI-RADSv2 score (“low” vs. “high”) was not significantly different between the two GP groups (
p
= 0.17). Regression analysis selected ADC
T
(
p
= 0.03) and ADC
ratio
(
p
= 0.0007) as best predictors to differentiate GP 4 + 3 from 3 + 4. Estimated sensitivity, specificity, and accuracy of the predictive model in differentiating GP 4 + 3 from 3 + 4 were 37, 82, and 66%, respectively.
Conclusions
ADC metrics could differentiate GP 3 + 4 from 4 + 3 PCa with high specificity and moderate accuracy while PI-RADSv2, did not differentiate between these patterns.
The evolution of ultrasound (US) techniques has greatly improved the evaluation of many parameters in dialysis vascular access, which is typically achieved through an arteriovenous fistula (AVF) or ...graft (AVG). These techniques include grayscale B-mode, color Doppler, power Doppler, spectral Doppler, non-Doppler US flow imaging techniques, contrast-enhanced US, and elastography. In conjunction with a patient’s medical history and physical examination, US provides crucial information about the native vascular bed prior to the surgical creation of an arteriovenous anastomosis. It also tracks the maturation progress of the newly created AVF or AVG and aids in diagnosing potential complications of the vascular access. These complications include thrombosis, steal syndrome, aneurysms, pseudoaneurysms, hematomas, infection, ischemic neuropathy, exacerbation of preexisting congestive heart failure, and stenosis.
Background
Superior Hypogastric nerve Block (SHNB) has been shown to be an effective pain management technique after Uterine Fibroid Embolization (UFE), reducing the need for opiates and allowing ...same-day discharge after UFE. In this technical note we discuss relevant anatomy and technical details in performing SHNB.
Main body
The Superior hypogastric plexus (SHP) is the part of the abdominopelvic sympathetic nervous system that provides a targeted intervention to sympathetic-mediated pain pathways of pelvic organs and a target for an anterior approach Superior Hypogastric nerve Block after embolization. Vascular structures are in close relation to the intended site of target of the SHP at the L5 vertebral body include aortic bifurcation and IVC confluence, hence a detailed knowledge of this is essential. A step by step technical approach to SHNB includes patient positioning for the block, image guidance and needle positioning, choice and technique of anesthetic injection. Traversing a large fibroid uterus, inadvertent vascular opacification and Local anesthetic systemic toxicity present challenges to performing the block and are addressed.
Conclusion
Superior Hypogastric nerve Block (SHNB) can be a useful tool in the Interventional armamentarium to make UFE a better experience for patients with fibroids, allowing for better pain control as well as facilitating same day discharge. Performing SHNB appear to be can be performed with technical ease for an interventional radiologist.
Fluorodeoxyglucose (FDG)-PET/computed tomography (CT) has been increasingly used in bone and soft tissue sarcomas and provides advantages in the initial tumor staging, tumor grading, therapy ...assessment, and recurrence detection. FDG-PET/CT metabolic parameters are reliable predictors of survival in sarcomas and could be implemented in risk stratification models along with other prognostic factors in these patients.
"Fluorodeoxyglucose (FDG) PET/computed tomography (CT) is used most frequently in the surveillance of iodine-refractory differentiated thyroid cancer with increased thyroglobulin level after therapy. ...This article evaluates the impact of FDG-PET/CT on clinical management and the prognostic implications of a positive scan. In the studies reviewed, FDG-PET/CT changed the course of management in 14% to 78% of patients with suspected recurrence, and a positive scan was associated with poorer survival. Similar conclusions are supported in the literature for anaplastic and medullary thyroid cancers, although these are based on fewer studies on account of the lower prevalence of these subtypes."
Objective: Different indices and formulas of CBC parameters have been suggested as indicators of early stage screenings to detect couples with β-thalassemia minor (BTM). In this study, we evaluated ...the accuracy of five previous published formulas and compared them to our new formula (│80-MCV│×│27-MCH│) in screening of β-thalassemia.Methods: All couples in the premarital β-thalassemia screening program of Roodbar, Iran, for whom molecular analysis had been done were selected during two years. The red blood cell indices were applied to each formula, and a ROC curve was plotted for each one to check discriminative effectiveness in β-thalassemia detection.Result: None of the studied indices demonstrated 100% precision. However, we found that the Shine–Lal formula and our formula had the highest sensitivity in identifying BTM individuals. The highest specificity belonged to our formula and Sirdah formula.Conclusion: Previous studies reported different sensitivities and specificities for the formulas. This can be attributed to different kinds of β-gene mutations in various populations. As a result of this variation, RBC indices and mathematical formulas are variable in different populations. Undoubtedly, physicians in different areas should evaluate the accuracy of published formulas for their own populations in the discrimination of BTM from other causes of microcytic hypochromic anemia.
Introduction.
This study compared the diagnostic test accuracy of magnetic resonance imaging (MRI) with that of 18F‐fluoro‐2‐glucose‐positron emission tomography/computed tomography (FDG‐PET/CT) ...imaging in assessment of response to neoadjuvant chemotherapy (NAC) in breast cancer.
Methods.
A systematic search was performed in PubMed and EMBASE (last updated in June 2015). Studies investigating the performance of MRI and FDG‐PET or FDG‐PET/CT imaging during or after completion of NAC in patients with histologically proven breast cancer were eligible for inclusion. We considered only studies reporting a direct comparison between these imaging modalities to establish precise summary estimates in the same setting of patients. Pathologic response was considered as the reference standard. Two authors independently screened and selected studies that met the inclusion criteria and extracted the data.
Results.
A total of 10 studies were included. The pooled estimates of sensitivity and specificity across all included studies were 0.71 and 0.77 for FDG‐PET/CT (n = 535) and 0.88 and 0.55 for MRI (n = 492), respectively. Studies were subgrouped according to the time of therapy assessment. In the intra‐NAC setting, FDG‐PET/CT imaging outperformed MRI with fairly similar pooled sensitivity (0.91 vs. 0.89) and higher specificity (0.69 vs. 0.42). However, MRI appeared to have higher diagnostic accuracy than FDG‐PET/CT imaging when performed after the completion of NAC, with significantly higher sensitivity (0.88 vs. 0.57).
Conclusion.
Analysis of the available studies of patients with breast cancer indicates that the timing of imaging for NAC‐response assessment exerts a major influence on the estimates of diagnostic accuracy. FDG‐PET/CT imaging outperformed MRI in intra‐NAC assessment, whereas the overall performance of MRI was higher after completion of NAC, before surgery.
Implications for Practice:
The timing of therapy assessment imaging exerts a major influence on overall estimates of diagnostic accuracy. 18F‐fluoro‐2‐glucose‐positron emission tomography (FDG‐PET)/computed tomography (CT) imaging outperformed magnetic resonance imaging (MRI) in intra‐neoadjuvant chemotherapy assessment with fairly similar pooled sensitivity and higher specificity. However, MRI appeared to be more accurate than FDG‐PET/CT in predicting pathologic response when used in the post‐therapy setting.
The diagnostic test accuracy of magnetic resonance imaging (MRI) was compared with that of 18F‐fluoro‐2‐glucose‐positron emission tomography/computed tomography (FDG‐PET/CT) imaging in assessment of response to neoadjuvant chemotherapy (NAC) in breast cancer. In the intra‐NAC setting, FDG‐PET/CT imaging outperformed MRI with fairly similar pooled sensitivity and higher specificity. However, MRI appeared to have higher diagnostic accuracy than FDG‐PET/CT imaging when performed after the completion of NAC, with significantly higher sensitivity.
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