Portal vein thrombosis (PVT) may not be an absolute contraindication for hepatic radiofrequency ablation (RFA). Although the data are sparse, PVT is commonly considered a contraindication to RFA. PVT ...has actually been described as a complication following RFA. RFA was used to treat a 3.9×2.9 cm primary hepatocellular carcinoma (HCC) in a patient with concomitant PVT without complication. RFA can be safely performed in this setting but further studies could clarify this issue.
Abstract Objectives To determine whether supplemental biopsy of hypoechoic ultrasound lesions (HUL) incidentally found during MRI-transrectal ultrasound (TRUS) fusion-targeted prostate biopsy results ...in improved prostate cancer (PCa) detection. Methods Patients underwent MRI-TRUS targeted biopsy as part of an ongoing prospective trial from August 2007 to February 2015. For men with HUL, the biopsy pathology of HUL and MRI lesions was classified according to the updated 2014 International Society of Urological Pathology (ISUP) grading system. The detection of PCa by MRI-targeted biopsy with and without HUL biopsy was compared. Results Of 1260 men in the trial, 106 underwent biopsy of 119 HUL. PCa was diagnosed in 52/106 men (49%) by biopsy of either MRI lesions or HUL. Biopsy of HUL in addition to MRI lesions resulted in 4 additional diagnoses of high-grade (ISUP Grade 3-5) PCa vs biopsy of MRI lesions alone (20 vs 16 men, p=0.046). Three of these cases were upgraded from lower grade (ISUP Grade 1-2) PCa on MRI-guided biopsy alone, and only 1 case (1% of cohort) was diagnosed that would have been missed by MRI-guided biopsy alone. Supplemental biopsy of HUL did not change the PCa risk category in 96% (102/106) of men with HUL. Conclusions Supplemental biopsy of HUL yields a small increase in the detection of higher grade PCa as compared to biopsy of MRI lesions alone. As upgrading is rare, routinely screening for HUL during MRI-targeted biopsy remains controversial.
• Prostate MRI is currently the best diagnostic imaging method for
detecting prostate cancer
• Magnetic Resonance Imaging-Ultrasound (MRI/US) fusion allows the
sensitivity and specificity of MRI to ...be combined with real time capabilities of
transrectal ultrasound (TRUS).
• Multiple approaches and techniques exist for MRI/US fusion and
include (1) direct “in bore” MR biopsies, (2) cognitive fusion,
and (3) MRI/US fusion via software-based image co-registration platforms.
Multi-parametric magnetic resonance imaging (mpMRI) permits non-invasive visualization and localization of clinically important cancers in the prostate. However, it cannot fully describe tumor ...heterogeneity and microstructures that are crucial for cancer management and treatment. Herein, we develop a deep learning framework that could predict epithelium density of the prostate in mpMRI. A deep convolutional neural network is built to estimate epithelium density per voxel-basis. Equipped with an advanced design of the neural network and loss function, the proposed method obtained a SSIM of 0.744 and a MAE of 6.448% in a cross-validation. It also outperformed the competing network. The results are promising as a potential tool to analyze tissue characteristics of the prostate in mpMRI.
We evaluated the indications, accuracy and impact of image guided biopsy of focal renal masses.
We retrospectively reviewed 79 image guided renal biopsies in 73 patients. Indications, imaging, and ...histological and clinical features were analyzed. We assumed that nephrectomy, partial nephrectomy or surgical biopsy of suspicious masses would be done when no percutaneous biopsy had been performed. A change in management was defined as surgical to nonsurgical.
Clinical management was altered due to results in 32 of the 79 biopsies (41%) in cases managed nonoperatively, including positive and negative biopsies in those followed clinically and with imaging. Of 79 biopsies 49 (62%) were diagnosed positive for malignancy, including 15 (31%) that were not and 34 (69%) that were renal cell carcinoma. The histological diagnosis was negative on 25 biopsies (32%) and positive or negative on 74 (94%). All 5 of the 79 false-negative biopsies (6%) were due to insufficient tissue and involved highly suspicious imaging findings that required further evaluation, such as repeat biopsy or surgery. Renal cell carcinoma was identified in 4 of the 5 cases. In 12 of the 24 patients (50%) with a pre-biopsy history of nonrenal cancer biopsies were diagnostic of nonrenal cancer. No patient had major complications and in 4 small hematomas were treated with observation only.
Image guided renal mass biopsy is safe, reliable and accurate, and it changes clinical management in many cases by avoiding nephrectomy or other surgical options. Radiologists should promote imaging guided biopsy as a potentially useful option for managing suspicious or indeterminate renal masses.
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