G. Simonetti

Malignant renal neoplasms: correlation between ADC values and cellularity in diffusion weighted magnetic resonance imaging at 3 T

PurposeThis study aimed at exploring the feasibility of high-field diffusion-weighted magnetic resonance imaging (DW-MRI) (3 T) and to correlate apparent diffusion coefficient (ADC) values with tumour cellularity in renal malignancies.Materials and methodsThirty-seven patients (ten healthy volunteers and 27 patients with suspected renal malignancy) underwent T1-, T2-weighted and T1-weighted contrast-enhanced magnetic resonance imaging (MRI). Diffusion-weighted images were obtained with a single-shot spin-echo echo-planar imaging (SE-EPI) sequence with a b value of 500 s/mm2. All lesions were surgically resected, and mean tumour cellularity was calculated. Comparison between tumour cellularity and mean ADC value was performed using simple linear regression analysis.ResultsThe mean ADC value in normal renal parenchyma was 2.35±0.31×10−3 mm2/s, whereas mean ADC value in renal malignancies was 1.72±0.21×10−3 mm2/s. In our population, there were no statistically significant differences between ADC values of different histological types. The analysis of mean ADC values showed an inverse linear correlation with cellularity in renal malignancies (r=−0.73, p<0.01).ConclusionsDW-MRI is able to differentiate between normal and neoplastic renal parenchyma on the basis of tissue cellularity.RiassuntoObiettivoValutare l’utilità dell’imaging RM ad alto campo (3T) con sequenze pesate in diffusione (DWI) nello studio delle neoplasie renali e correlare i valori del coefficiente apparente di diffusione (ADC) con la cellularità delle neoplasie.Materiali e metodiTrentasette pazienti (10 volontari sani e 27 con lesioni renali sospette) sono stati studiati con imaging RM e sequenze T1, T2 pesate e T1 pesate dopo somministrazione di bolo di contrasto paramagnetico. Le immagini pesate in diffusione (DWI) sono state acquisite con sequenza sSH SE-EPI e fattore b di 500 s/mm2. Per ogni lesione chirurgicamente asportata è stata valutata la cellularità media. L’analisi di regressione lineare semplice è stata utilizzata per valutare la correlazione fra cellularità tumorale e valore ADC.RisultatiL’ADC medio nel parenchima dei pazienti sani è stato 2,35±0,31×10−3 mm2/s. Il valore medio nei tumori renali maligni era di 1,72±0,21×10−3 mm2/s. Non è stata riscontrata una differenza statisticamente significativa tra i valori medi di ADC dei differenti istotipi neoplastici. È stata documentata una correlazione inversa fra il valore medio di ADC e la cellularità media nei tumori renali maligni (r=−0,73, p<0,01).ConclusioniL’imaging in diffusione consente una distinzione significativa tra parenchima renale normale e neoplastico. È possibile differenziare i tessuti neoplastici sulla base della cellularità.

In vivo measurement of the apparent diffusion coefficient in normal and malignant prostatic tissue using thin-slice echo-planar imaging.

Purpose.Diffusion is a physical process based on the random movement of water molecules, known as Brownian movement. Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that provides information on such biophysical properties of tissues as density, cell organisation and microstructure, which influence the diffusion of water molecules. The aim of this study was to evaluate the ability of MRI to obtain information on the diffusion of water molecules in normal and malignant prostate tissues.Materials and methods.Ten volunteers and 19 patients with prostate lesions diagnosed by transrectal ultrasound (TRUS) were enrolled in our study. Morphological imaging was obtained with T2-weighted turbo spin-echo (TSE) sequences with and without fat suppression [spectral presaturation with inversion recovery (SPIR)] and an axial dynamic T1-weighted SPIR fast-field echo (FFE) sequence during intravenous administration of contrast material. DWI was obtained with a high-spatial-resolution singleshot spin-echo echo planar imaging (EPI) inversion recovery (IR) sequence. The apparent diffusion coefficient (ADC) maps were analysed by positioning an 8-pixel region of interest (ROI) over different zones of the prostate, and the focal lesion when present. The tumour was confirmed by a TRUS-guided needle biopsy taken within 1 month of the MRI examination.Results.The mean ADC value of the central zones (1,512.07±124.85×10-3 mm2/s) was significantly lower than the mean ADC of the peripheral zones (1,984.11±226.23×10-3 mm2/s) (p<0.01). The mean ADC value of tumours (958.97±168.98×10-3 mm2/s) was significantly lower than the mean values of normal peripheral zones (p<0.01).Conclusions.Our preliminary results indicate that DWI is useful for characterising tissue in the different regions of the prostate gland and in distinguishing normal from cancerous tissues, given its ability to detect early changes in the structural organisation of prostate tissue.

Accuracy of early and delayed FDG PET-CT and of contrast-enhanced CT in the evaluation of lung nodules: a preliminary study on 30 patients

PurposeThe aim of our prospective study was to compare the diagnostic accuracy of early, delayed and dual-time-point positron emission tomography (PET) acquisition with contrast enhanced computed tomography (CT) within a PET-CT examination in the evaluation of pulmonary solitary nodules (SPNs).Materials and methodsThirty patients were enrolled in the study. All the patients underwent a dual-time-point PET-CT examination. Whole-body PET images were acquired at 50 min after fluorine18-fluorodeoxyglucose (18F-FDG) administration (early), followed by a chest acquisition (delayed). Lung nodules with maximum standardised uptake value SUVmax ≥2.5 were considered malignant. SUVmax was calculated on early and delayed images; SUV increasing ≥10% (Δ SUVmax) was considered suggestive of malignancy. Absence of significant lung nodule enhancement (<15 Δ HU) at CT was considered strongly predictive of benignity. For the CT morphological assessment, the irregularity of the shape of each lesion was rated. PET-CT results were related to histological assays and clinical records. Diagnostic accuracy was assessed by area under the receiveroperarting characteristic (ROC) curves analysis.ResultsEarly and delayed SUVmax of malignant nodules were significantly higher than those of benign disease. Early SUVmax sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 77%, 91%, 79.5% and 66.7%; delayed SUVmax corresponding values were 77%, 66%, 74% and 66%; dual-time-point SUVmax values were 83%, 67%, 75% and 74%; ΔHU values were 94%, 34%, 67%, 96%; CT morphologic evaluation values were 61%, 46%, 60%, 47%. Area under the curve (AUC) for early SUVmax was 0.79, for delayed SUVmax 0.80, for dual-time-point SUVmax 0.85, for ΔHU 0.63 and for CT morphologic assessment 0.58.ConclusionsIn our small series of patients, early and delayed SUVmax showed comparable accuracies, whereas morphological and contrast enhanced CT evaluations showed the lowest accuracies. Dual-time-point SUVmax showed the largest AUC. However, dual-time-point SUVmax was most sensitive, whereas single-time-point SUVmax was most specific.RiassuntoObiettivoScopo del nostro studio è stato quello di comparare l’accuratezza diagnostica dell’acquisizione PET in fase precoce, in fase tardiva e dual-time associata all’esecuzione di TC con mezzo di contrasto in un’unica sessione nella valutazione del nodulo polmonare solitario (SPN).Materiali e metodiPresso il nostro Dipartimento sono stati sottoposti a valutazione PET-TC dual-time con mezzo di contrasto 30 pazienti con nodulo polmonare solitario. Le immagini PET total-body sono state acquisite 50 minuti dopo la somministrazione di 18F-FDG (fase precoce) seguite da un’acquisizione del torace (fase tardiva). I noduli polmonari con SUVmax≥2,5 sono stati considerati maligni. È stato calcolato il valore di SUVmax sulle immagini precoci e tardive: l’incremento (Δ SUVmax) del SUVmax tra fase precoce e fase tardiva ≥10% è stato considerato suggestivo di malignita; in valutazione TC invece è stata considerato suggestivo di benignità l’assenza di un significativo incremento di densità (<15 HU) tra l’acquisizione basale e quella post-contrastografica. Le caratteristiche morfologiche dei noduli alla TC sono state analizzate quantificando l’irregolarità della forma della lesione in una scala da 1 a 4. I risultati della PET-TC sono stati correlati ai dati clinici e a campioni istologici. L’accuratezza diagnostica è stata misurata mediante curva ROC.RisultatiIl valore di SUVmax in fase precoce e tardiva nei noduli maligni è risultato significativamente più elevato di quello riscontrato per i noduli benigni. La sensibilità, la specificità, il VPP e il VPN del SUVmax ottenuto in fase precoce sono state del 77%, 91%, 79,5% e 66,7% rispettivamente; in fase tardiva abbiamo ottenuto valori di 83%, 67%, 75% e 74% rispettivamente. La differenza del valore in HU (ΔHU) tra acquisizione TC basale e quella post-contrastografica ha mostrato valori di sensibilità del 94%, di specificità del 34%, VPP del 67% e VPN del 96%. La valutazione TC morfologica ha riportato valori di sensibilita, specificita, di VPP e di VPN di 61%, 46%, 60%, 47%. La curva AUC del valore di SUVmax in fase precoce è stata di 0,79, in fase tardiva è stata di 0,80, riguardo all’acquisizione dual-time (Δ SUVmax) di 0,85 e riguardo al ΔHU di 0,63 e per quanto riguarda la valutazione morfologica di 0,58.ConclusioniNel nostro piccolo gruppo di pazienti il valore di SUVmax sia in fase precoce che tardiva ha mostrato accuratezza sovrapponibile, le valutazioni TC morfologica e contrastografica hanno mostrato l’accuratezza piu bassa. Il valore di SUVmax calcolato in dual-time (Δ SUVmax) ha mostrato l’accuratezza diagnostica maggiore. Tuttavia il valore di SUVmax in dual-time pur mostrandosi piu sensibile rispetto al valore di SUVmax ottenuto con singola acquisizione, è risultato meno specifico.

Solitary pulmonary nodules: morphological and metabolic characterisation by FDG-PET-MDCT

Purpose.This study was done to analyse the additional morphological and functional information provided by the integration of [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography ([18F]-FDG-PET) with contrast-enhanced multidetector computed tomography (MDCT) in the characterisation of indeterminate solitary pulmonary nodules (SPNs).Materials and methods.Fifty-six SPNs, previously classified as indeterminate, were evaluated using a Discovery ST16 PET/CT system (GE Medical Systems) with nonionic iodinated contrast material and [18F]-FDG as a positron emitter. Images were evaluated on a dedicated workstation. Semiquantitative parameters of [18F]-FDG uptake and morphological, volumetric and densitometric parameters before and after contrast administration were analysed. Results were correlated with the histological and follow-up findings.Results.Twenty-six SPNs were malignant and 30 were benign. Malignant lesions at both PET/CT and histology had a mean diameter of 1.8±1.2 cm, a volume doubling time (DT) of 222 days, a mean standardized uptake value (SUV) of 4.7 versus 1.08 in benign lesions and a mean postcontrast enhancement of 44.8 HU as opposed to 4.8 HU in benign nodules. Malignant lesions had a significantly shorter doubling time and significantly greater postcontrast enhancement compared with benign nodules. Based on the SUV and using a cut-off value of >2.5, PET/CT had a sensitivity of 76.9%, specificity of 100%, diagnostic accuracy of 89.2%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 83.3%. Based on doubling time (cut off <400 days), it had a sensitivity of 76.9%, specificity of 93.3%, accuracy of 85.7%, PPV of 90.9% and NPV of 82.3%. Based on postcontrast enhancement (cut off >15 HU), it had a sensitivity of 92.3%, specificity of 100%, accuracy of 96.4%, PPV of 100% and NPV of 93.7%.Conclusion.PET/CT allows accurate analysis of anatomical/morphological and metabolic/functional correlations of SPN, providing useful data for identifying and locating the disease, for differentiating between malignant and benign nodules and for establishing the aggressiveness and degree of vascularity of pulmonary lesions. Therefore, partly in view of the considerable reduction in time and cost of the single examinations, we believe that PET/CT will gain an increasingly dominant role in the diagnostic and therapeutic approach to lung cancer, especially in the preclinical phase.

Vertebroplasty and Kyphoplasty in the Treatment of Malignant Vertebral Fractures.

Summary The purpose of this retrospective study was to assess the effectiveness and safety of Percutaneous Vertebroplasty and Kyphoplasty, in the treatment of pain deriving from neoplastic vertebral compression fractures (VCF). We treated 33 oncologic patients with these new techniques (2 pts with aggressive haemangiomas, 8 pts with myelomas and 23 pts with metastases) suffering from severe motion pain in the back, notwithstanding conservative treatment with medication and corset therapy, in the absence of neurological signs. In 3 selected patients we associated radiofrequency heat ablation with vertebroplasty in the treatment of metastases. The aim is to destroy tumor tissue and to thrombose the paravertebral and intravertebral venous plexus before stabilizing the vertebra.

Combined morphological, [1H]-MR spectroscopic and contrast-enhanced imaging of human prostate cancer with a 3-Tesla scanner: preliminary experience

PurposeThe objective of this study was to explore the feasibility of combined morphological magnetic resonance imaging (MRI), [1H]magnetic resonance spectroscopic imaging (MRSI) and quantitative dynamic contrast-enhanced MRI (DCE-MRI) of human prostate cancer at 3 Tesla using a pelvic phased-array coil.Materials and methodsMRI, MRSI and DCE-MRI with a 3-Tesla whole-body scanner were performed in 30 patients with biopsy-proven prostate cancer before radical prostatectomy. High-resolution T2-weighted turbo spin echo (TSE) images were evaluated for visualisation of the peripheral zone, central gland, visibility of the cancer lesion, prostatic capsule delineation and overall image quality according to a five-point scale. Relative levels of the prostate metabolites citrate, choline and creatine were determined in cancer and in the normal peripheral zone (PZ) and central gland (CG). Spectra were also evaluated for the separation of the signal of citrate, choline and creatine and suppression of lipid and water signals. Time-intensity curves were obtained for prostatic cancer and healthy PZ and CG from DCE-MRI. Finally, time of arrival, time to peak, maximum enhancement and wash-in rate in cancer, normal PZ and CG were calculated.ResultsThe high signal-to-noise ratio (SNR) at 3 Tesla provided T2-weighted TSE images with excellent anatomical detail (in-plane voxel size of 0.22×0.22 mm) and good T2 contrast. The increased spectral resolution was sufficient to separate the choline and creatine resonances and allow delineation of the four peaks of citrate resonance. The (choline + creatine)/citrate ratio was elevated in cancer in comparison with PZ and CG (p<0.001). Dynamic contrast-enhanced images showed good temporal resolution. All parameters obtained from DCE-MRI showed a statistically significant (P<0.05) difference between cancer tissue and normal PZ and CG. Wash-in rate and (choline+creatine)/citrate ratio were significantly correlated (r=0.713, P=0.001) in PZ cancer, whereas the correlation was not significant (r=0.617, P=0.06) in CG and in PZ (r=0.530, P=0.08).ConclusionsIt is possible to perform MRI of prostate cancer at 3 Tesla using a pelvic phased-array coil with high spatial, temporal and spectral resolution. The combination of vascular information from DCE-MRI and metabolic data from MRSI has excellent potential for improved accuracy in delineating and staging prostate carcinoma. These results suggest that high magnetic field strengths offer the possibility of studying prostate cancer without use of an endorectal coil.RiassuntoObiettivoEsplorare la possibilità di effettuare uno studio combinato di risonanza magnetica del cancro prostatico di tipo morfologico (MRI), spettroscopico dell’idrogeno (MRSI) e dinamico postcontrastografico (DCE-MRI) a 3 Tesla utilizzando una bobina pelvica phased-array.Materiali e metodiTrenta pazienti con cancro prostatico dimostrato alla biopsia sono stati sottoposti a MRI, MRSI e DCE-MRI con apparecchiatura a 3 Tesla prima della prostatectomia radicale. Le immagini T2 pesate ad alta risoluzione sono state valutate in base ad una scala di 5 punti per la visualizzazione della zona periferica, della ghiandola centrale, della lesione tumorale, per la delineazione della capsula prostatica e per la qualità complessiva dell’immagine. Sono stati determinati i valori relativi dei metaboliti prostatici citrato, colina e creatina nel cancro, nella zona periferica normale (PZ) e nella ghiandola centrale (CG). Gli spettri sono stati anche valutati per la separazione del segnale del citrato, della colina e della creatina e la soppressione del segnale derivante dall’acqua e dai lipidi. Dai dati del DCE-MRI sono state generate curve intensità-tempo in corrispondenza del cancro, della PZ e della CG. Infine sono stati calcolati per il cancro, la PZ normale e la CG il time of arrival, time to peak, maximum enhancement e il wash in rate.RisultatiL’elevato rapporto segnale-rumore (SNR) a 3 Tesla ha permesso di ottenere immagini TSE T2 pesate con un eccellente dettaglio anatomico (dimensioni in piano del voxel di 0,22×0,22 mm) e buon contrasto T2. L’incrementata risoluzione spettrale è risultata sufficiente a separare la risonanza della colina e della creatina e ha permesso di delineare i 4 picchi della risonanza del citrato. Il rapporto (colina+creatina)/citrato è risultato più elevato nel cancro rispetto a quello individuato nella PZ e nella CG (p<0,001). Le immagini dell’acquisizione dinamica post-contrastografica hanno mostrato una buona risoluzione temporale. Tutti i parametri ottenuti dal DCE-MRI hanno mostrato una differenza statisticamente significativa (p<0,05) tra tessuto neoplastico e PZ normale e CG. Il wash in rate e il rapporto (colina+creatina)/citrato sono risultati significativamente correlati (r=0,713, p=0,001) nel cancro nella zona periferica, mentre la correlazione non è risultata significativa nella CG (r=0,617, p=0,06) e nella PZ (r=0,530, p=0,08).ConclusioniÈ possibile effettuare uno studio di risonanza magnetica del cancro prostatico a 3 Tesla con elevata risoluzione spaziale, temporale e spettrale utilizzando una bobina pelvica phased-array. La combinazione delle informazioni derivanti dal DCE-MRI e dai dati spettroscopici ha eccellenti possibilità di incrementare l’accuratezza nella definizione e stadiazione del cancro prostatico. Questi risultati suggeriscono come campi i magnetici ad elevata intensità offrano la possibilità di studiare il cancro prostatico senza l’uso di una bobina endorettale.

Amenorrhea after weight recover in anorexia nervosa: Role of body composition and endocrine abnormalities

Hypothalamic amenorrhea in anorexia nervosa often precedes weight loss and may persist after re-feeding and restoration of a stable normal weight. Aim: To assess the rate of persistent amenorrhea in anorexia nervosa (AN) after re-feeding and the relations of this condition with body composition changes and other endocrine parameters. Methods: A cohort of 250 female outpatients was studied to assess persistent amenorrhea prevalence after stable weight recovery. Among these, we selected 20 AN female patients (age 16.5–35), 10 with amenorrhea (group 1) and 10 with normal menses (group 2). We collected data such as age, age at menarche, age at onset of AN, actual body mass index (BMI) and at onset of AN, duration of disease. Physical activity has been evaluated as minute per day. The following data were obtained: prolactin, growth hormone, estradiol, luteinizing hormone, follicle stimulating hormone, thyroid stimulating hormone, free triiodothyronine, free thyroxine, free urinary cortisol, serum calcium and phosphates, urinary calcium, phosphaturia and alkaline phosphatase. Body composition was assessed with a dual energy x-ray absorptiometry (DEXA). Results: Thirty-five patients (14%) over a cohort of 250 where still amenorrhoic after stable weight recovery. No significance was found in the evaluation of blood biochemical tests of the 2 groups. Free urinary cortisol was significantly higher in amenorrhoic patients (58.14±0.4 vs 15.91±9.5), p=0.02. The analysis of body composition has shown a per-centage of fat of 22.23±5.32% in group 1 and of 26.03%±9.1% in group 2, respectively, showing no significant differences. Amenorrhoic patients carried on doing a significantly heavier physical activity than eumenorrhoic patients. Conclusions: An adequate body composition and a well represented fat mass are certainly a necessary but not sufficient condition for the return of the menstrual cycle. Such menstrual cycle recovery would probably need other conditions at present being studied and evaluated to occur, such as secretory patterns of leptin and its correlations with adrenal function.

Indications for breast magnetic resonance imaging. Consensus document “Attualità in senologia”, Florence 2007

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.RiassuntoLa RM mammaria è in fase di crescente utilizzo clinico, soprattutto per le applicazioni che richiedono la somministrazione di mezzo di contrasto (MdC) paramagnetico. Il presente documento propone una codificazione sintetica delle indicazioni accettabili con potenziale vantaggio per le donne, secondo la valutazione delle evidenze presenti in letteratura e l’opinione del gruppo di esperti estensori del documento. In generale si raccomanda che l’indagine sia eseguita presso centri che siano in grado di combinare l’esperienza senologica relativa all’imaging convenzionale e ai prelievi agobioptici con quella specifica in RM mammaria e che garantiscano l’esecuzione del second look ecografico per i reperti non rilevati all’imaging convenzionale pre-RM. Non si ritiene che vi siano evidenze in favore dell’utilizzo della RM quale approccio diagnostico nella caratterizzazione di reperti equivoci all’imaging convenzionale in tutte le situazioni nelle quali sia praticabile il prelievo agobioptico sotto guida ecografica o stereotassica né in favore dello studio di donne non ad alto rischio asintomatiche e con imaging convenzionale negativo. Sono qui definiti i requisiti tecnici e metodologici di esecuzione dell’indagine e indicazioni e limiti relativi a: sorveglianza delle donne ad alto rischio di tumore mammario; stadiazione locale pretrattamento chirurgico; valutazione dell’effetto della chemioterapia neoadiuvante; mammella trattata per carcinoma; carcinoma unknown primary syndrome; mammella secernente; protesi mammarie.

MR imaging-guided 10-gauge vacuum-assisted breast biopsy: histological characterisation

PurposeThe aim of this study was to evaluate a handheld vacuum-assisted device for magnetic resonance imaging (MRI)-guided breast biopsy.Materials and methodsIn 47 patients, a total of 47 suspicious breast lesions (mean maximum diameter 9 mm) seen with MRI (no suspicious changes on breast ultrasound or mammography) were sampled using a 10-gauge vacuum-assisted breast biopsy (VAB) device under MRI guidance. Histology of biopsy specimens was compared with final histology after surgery or with follow-up in benign lesions.ResultsTechnical success was achieved in all biopsies. Histological results from VAB revealed malignancy in 15 lesions (32%), atypical ductal hyperplasia in four lesions (8%) and benign findings in 28 lesions (60%). One of four lesions with atypical ductal hyperplasia was upgraded to ductal carcinoma in situ after surgery. One of seven lesions showing ductal carcinoma was upgraded to invasive carcinoma after surgery. Two lesions diagnosed as infiltrating carcinoma by VAB were not validated at excisional biopsy due to complete removal of the lesion during the procedure. During the follow-up (mean 18 months) of histologically benign lesions, we observed no cases of breast cancer development. Because of morphological changes on follow-up MRI scans, two lesions underwent surgical excision, which confirmed their benign nature. Besides minor complications (massive bleeding, n=1) requiring no further therapeutic intervention, no complications occurred.ConclusionsMRI-guided biopsy of breast lesions using a handheld vacuum-assisted device is a safe and effective method for the workup of suspicious lesions seen on breast MRI alone.RiassuntoObiettivoValutare l’accuratezza diagnostica dei prelievi con sistema portatile ad aspirazione retroazionata (VAB) 10 gauge sotto-guida RM nella caratterizzazione delle lesioni mammarie visibili unicamente alla RM.Materiali e metodi47 lesioni (diametro massimo 9 mm) visibili unicamente all’esame RM, sono state caratterizzate usando un sistema portatile ad aspirazione retroazionata (VAB) con ago da 10 Gauge, sotto guida RM. L’istologia delle biopsie VAB è stata confrontata con l’istologia definitiva dopo l’escissione chirurgica o con i reperti di follow-up.RisultatiIl successo tecnico è stato ottenuto in tutti i casi. I risultati istologici della biopsia VAB hanno mostrato 15 lesioni maligne (32%), 4 lesioni classificabili come iperplasia duttale atipica (ADH) (8%), e 28 lesioni come benigne (60%). Alla istologia definitiva una delle quattro lesioni classificate come ADH è stata riclassificata come carcinoma duttale in situ (DCIS), mentre una delle lesioni classificate come DCIS è stata riclassificata come carcinoma invasivo. Due lesioni diagnosticate al VAB come carcinoma infiltrante non sono state riscontrate alla istologia definitiva, probabilmente a causa della totale rimozione durante la procedura VAB. Il follow-up delle lesioni benigne ha confermato la benignità delle lesioni. Due lesioni benigne che all’Imaging RM hanno mostrato una modificazione della morfologia, sono andate incontro ad intervento chirurgico che ha confermato la benignità della lesione. Ad eccezione di un massivo sanguinamento in 1 caso, non si sono osservate complicanze.ConclusioniI prelievi VAB sotto-guida RM sono una mammetodica sicura ed efficace per la caratterizzazione delle lesioni mammarie visibili unicamente all’RM.

Magnetic resonance imaging of the prostate with spectroscopic imaging using a surface coil. Initial clinical experience

Purpose.The purpose of this study was to evaluate the diagnostic ability of proton magnetic resonance spectroscopic imaging (MRSI) in the detection and localisation of prostate cancer, prospectively compared with histopathologic findings.Materials and methods.Magnetic resonance imaging (MRI) and MRSI were performed on 39 patients with prostate-specific antigen (PSA) levels greater than 4 ng/ml and suspicious findings at trans-rectal ultrasound (TRUS). All patients underwent a TRUS ten-core biopsy within 30 days according to a subdivision of the prostate into octants. All studies were interpreted by a dedicated radiologist who reported the areas of interest as normal, equivocal or suspicious on MRI. At MRSI, cancer was defined as possible if the ratio of choline plus creatine to citrate exceeded mean normal peripheral zone values by two standard deviations (SD) or as definite if that ratio exceeded the normal value by three SD. MRI and MRSI findings were spatially correlated with findings obtained from individual biopsy sites.Results.MRI and MRSI alone had sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in the detection of prostate cancer equal to 85%, 75%; 53%, 89%; 65%, 88%; 77%, 74%; and 69%, 79%, respectively. These values were 70%, 89%, 88%, 74% and 79% when MRI and MRSI were combined. Site-by-site analysis of MRI and MRSI findings and biopsy results yielded no significant correlation.Conclusions.The combination of MRSI and MRI provides a significantly higher specificity in the detection of tumours as compared with MRI alone and can be recommended as a problem-solving modality before biopsy in patients with high PSA levels and suspicious TRUS.