Marcello Osimani

Role of Dynamic Contrast-Enhanced Magnetic Resonance (MR) Imaging and Proton MR Spectroscopic Imaging in the Detection of Local Recurrence after Radical Prostatectomy for Prostate Cancer

OBJECTIVES To assess the accuracy of magnetic resonance (MR) spectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced MR (DCEMR) in the depiction of local prostate cancer recurrence in patients with biochemical progression after radical prostatectomy (RP). MATERIALS AND METHODS 1H-MRSI and DCEMR were performed in 70 patients at high risk of local recurrence after RP. The population was divided on the basis of the clinical validation of MR results with the use of a transrectal ultrasound biopsy examination in a group of 50 patients (group A) and the prostate-specific antigen (PSA) serum level restitution after external beam radiotherapy, in a group of 20 patients (group B). RESULTS In group A, 1H-MRSI analysis alone showed a sensitivity of 84% and a specificity of 88%; the DCEMR analysis alone, a sensitivity of 71% and a specificity of 94%; combined 1HMRSI-DCEMR, a sensitivity of 87% and specificity of 94%. Areas under the receiver operating characteristic (ROC) curve for 1HMRSI, DCEMR, and combined 1HMRSI /DCEMR were 0.942, 0.93,1 and 0.964, respectively. In group B, 1HMRSI alone showed a sensitivity of 71% and a specificity of 83%; DCEMR, a sensitivity of 79% and a specificity of 100%; combined 1HMRSI and DCEMR, a sensitivity of 86% and a specificity of 100%. Areas under the ROC curve for each of these groups were 0.81, 0.923, and 0.94, respectively. CONCLUSION Our results show that combined 1H-MRSI and DCMRE is an accurate method to identify local prostate cancer recurrence in patients with biochemical progression after RP.

Epidemiology of isolated acromioclavicular joint dislocation.

Background. Acromioclavicular (AC) joint dislocation is a common shoulder problem. However, information about the basic epidemiological features of this condition is scarce. The aim of this study is to analyze the epidemiology of isolated AC dislocation in an urban population. Materials and Methods. A retrospective database search was performed to identify all patients with an AC dislocation over a 5-year period. Gender, age, affected side and traumatic mechanism were taken into account. X-rays were reviewed by two of the authors and dislocations were classified according to the Rockwoods criteria. Results. A total of 108 patients, with a mean age of 37.5 years were diagnosed with AC dislocation. 105 (97.2%) had an isolated AC dislocation, and 3 (2.8%) were associated with a clavicle fracture. The estimated incidence was 1.8 per 10000 inhabitants per year and the male-female ratio was 8.5 : 1. 50.5% of all dislocations occurred in individuals between the ages of 20 and 39 years. The most common traumatic mechanism was sport injury and the most common type of dislocation was Rockwood type III. Conclusions. Age between 20 and 39 years and male sex represent significant demographic risk factors for AC dislocation.

Magnetic resonance spectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced magnetic resonance (DCE-MRI): pattern changes from inflammation to prostate cancer.

PURPOSE To assess (1)H-magnetic resonance spectroscopic imaging ((1)H-MRSI) and dynamic contrast-enhanced magnetic resonance (DCE-MRI) features in histologically confirmed prostatic chronic inflammation, prostatic intraepithelial neoplasia (PIN), low grade prostate cancer (LGPCa), and high grade prostate cancer (HGPCa). MATERIALS AND METHODS Ninety-six men were selected, who showed at histology a diagnosis of chronic inflammation (Group B), high grade (HG) PIN (Group C), or prostate cancer (LGPCa = Group D and HGPCa = Group E). RESULTS ANOVA analysis shows that inflammation (Group B) displays no significantly (p >.05) different choline and citrate levels when compared to HGPIN and LGPCa. CONCLUSION our results suggest the potential for these MR imaging techniques in the description of inflammatory and proliferative lesions inside the prostate gland.

The optimal contrast media policy in CT of the liver. Part I: Technical notes

Latest developments of multidetector computed tomography (MDCT), which is today considered a real volumetric technique, have revolutionized abdominal imaging. Technological improvements such as higher spatial resolution, larger volume coverage and higher temporal resolution, have reduced scan times allowing CT studies of the abdomen within a single breath-hold. Furthermore, the increased number of slices, the submillimetric collimation, and the use of multiple dynamic post-contrast phases per single examination, may all contribute to increase the radiation exposure of single patients. The aim of this review is to discuss different parameters affecting contrast media enhancement, as vascular enhancement, parenchymal enhancement and timing, in order to minimize the amount of contrast medium injected and the radiation exposure.

Perfusion MDCT of prostate cancer: correlation of perfusion CT parameters and immunohistochemical markers of angiogenesis.

OBJECTIVE The aim of our study was to correlate perfusion MDCT parameters and immunohistochemical markers of angiogenesis in prostate cancer. SUBJECTS AND METHODS Twenty-two patients scheduled for radical surgical prostatectomy because of biopsy-proven prostate cancer underwent perfusion CT on a 64-MDCT scanner. Eight contiguous 5-mm sections were acquired at 1-second intervals for 45 seconds followed by three additional scans every 10 seconds after the administration of 80 mL of iodinated contrast medium (350 mg I/mL). Blood volume, blood flow, mean transit time, and permeability surface-area product were calculated, dividing each slice into nine square regions. Values obtained were correlated with the mean microvessel density (MVD) and mean vascular area of corresponding areas on histologic macrosections. RESULTS The mean values of the perfusion parameters detected on all square fields of patients with prostate cancer, benign hyperplasia, chronic prostatitis, and healthy tissue were, respectively, 18.36 ± 6.30, 19.49 ± 8.46, 19.67 ± 11.44, and 20.32 ± 4.53 mL/min/100 g for blood flow; 8.45 ± 2.75, 6.21 ± 4.32, 4.94 ± 2.31, and 5.44 ± 2.67 mL/100 mg for blood volume; 19.19 ± 4.45, 18.74 ± 4.91, 16.24 ± 4.12, and 16.37 ± 4.83 seconds for mean transit time; and 26.34 ± 11.88, 18.67 ± 9.15, 18.08 ± 7.72, and 19.93 ± 7.22 mL/min/100 g for permeability surface-area product. Both blood volume and the permeability surface-area product of cancerous squares showed the highest correlation with mean MVD and mean vascular area (0.618 [p < 0.01] and 0.614 [p < 0.01], respectively) and the highest area under the curve (0.769 and 0.708). CONCLUSION Our results show that blood volume and permeability surface-area product measurements obtained with perfusion CT have the highest correlation with immunohistochemical markers of angiogenesis in prostate cancer.

64-detector row CT cystography with virtual cystoscopy in the detection of bladder carcinoma: preliminary experience in selected patients

PurposeThis study was conducted to evaluate the role of computed tomography cystography (CTC) and virtual cystoscopy (VC) with 64-slice CT in diagnosing bladder lesions using flexible cystoscopy as the reference standard.Materials and methodsTwenty-eight patients with suspected bladder cancer and ten patients who had undergone transurethral resection of the bladder were studied by CTC and VC in both the supine and prone positions after distending the bladder with air. The patient population was divided into three groups based on lesion size at flexible cystoscopy. Results of the CT study were compared with those of flexible cystoscopy.ResultsFlexible cystoscopy depicted 88 bladder lesions in the 38 patients examined. Sensitivity and specificity values of CTC and VC alone were constantly lower than those of the combined-approach (group 1: 93.10% and 92.31%; group 2: 100% and 100%; group 3: 100% and 100%, respectively). Receiver operating characteristic (ROC) curve analysis showed that the combined approach decreases the lower dimensional threshold for lesion detection (1.4 mm).ConclusionsVC and CTC with 64-slice CT are promising diagnostic techniques for bladder cancers measuring 1–5 mm. Further studies on larger patient populations are required to validate our results.RiassuntoObiettivoValutare il ruolo della cistografia con TC (CTC) e della cistoscopia virtuale (CV) utilizzando una TC multidetettore a 64 strati (TCMD-64) nell’identificazione delle lesioni vescicali e confrontare i risultati ottenuti con la cistoscopia convenzionale.Materiali e metodiVentotto pazienti con sospetta neoplasia vescicale e 10 pazienti in follow-up dopo resezione trans-uretrale della vescica (TURB) sono stati sottoposti ad esame CTC e CV. I pazienti sono stati esaminati in posizione prona e supina previa distensione vescicale con aria e suddivisi in base alle dimensioni delle lesioni. I risultati dell’esame TC sono stati confrontati con quelli della cistoscopia convenzionale.RisultatiLa cistoscopia convenzionale ha visualizzato correttamente un totale di 88 lesioni fra i 38 soggetti esaminati. I valori di sensibilità e specificità delle singole metodiche CTC e CV sono stati costantemente inferiori rispetto a quelli riportati dalla valutazione combinata (gruppo I: 93,10%/92,31%; gruppo II: 100%/100%; gruppo III: 100%/100%). L’analisi ROC del primo gruppo ha individuato un limite dimensionale inferiore della metodica di 1,4 mm.ConclusioniLa CV e la CTC con TCMD-64 sono tecniche proponibili nell’identificazione delle neoplasie vescicali di dimensioni comprese tra 1 e 5 mm. Ulteriori studi necessitano di popolazioni più ampie.

The optimal contrast media policy in CT of the liver. Part II: Clinical protocols

The advent of multidetector computed tomography (MDCT) revolutionized abdominal imaging. In particular, the definitive assessment of CT injection protocols, for the evaluation of the liver parenchyma, is still a critical issue for radiologists. Over the last years, this feature encouraged several authors to address their efforts to find the most accurate delay between the contrast medium injection and the effective scan-start, for the identification and characterization of liver lesions. Technological developments of the present century such as number of slices, submillimetric collimation, and the use of multiple dynamic post-contrast phases per single examination, may all contribute to increase the radiation exposure of single patients. The aim of this review is to propose liver imaging protocols, taking into consideration different clinical needs such as patients with chronic liver disease, healthy patients with focal liver lesion, and oncological patients to minimize radiation exposure. Finally, two recent innovations in MDCT which illustrate the potential application of multi-energy computed tomography (MECT) and perfusion computed tomography (CTp) when evaluating liver parenchyma will be discussed in a short closing paragraph.

Classification of prostatic diseases by means of multivariate analysis on in vivo proton MRSI and DCE-MRI data.

Multivariate analysis has been applied on proton magnetic resonance spectroscopic imaging (1H‐MRSI) and dynamic contrast enhanced MRI (DCE‐MRI) data of patients with different prostatic diseases such as chronic inflammation, fibrosis and adenocarcinoma. Multivariate analysis offers a global view of the entire range of information coming from both the imaging and spectroscopic side of NMR technology, leading to an integrated picture of the system relying upon the entire metabolic and dynamic profile of the studied samples. In this study, we show how this approach, applied to 1H‐MRSI/DCE‐MRI results, allows us to differentiate among the various prostatic diseases in a non‐invasive way with a 100% accuracy. These findings suggest that multivariate analysis of 1H‐MRSI/DCE‐MRI can significantly improve the diagnostic accuracy for these pathological entities. From a more theoretical point of view, the complementation of a single biomarker approach with an integrated picture of the entire metabolic and dynamic profile allows for a more realistic appreciation of pathological entities. Copyright

Rotator Cuff Tear: Imaging

The use of modern diagnostic techniques as magnetic resonance allows you to overcome some discrepancies between the morphological and clinical data in patients with a suspected rotator cuff lesion. A musculoskeletal radiologist or an orthopedic surgeon may assess not only the presence and the type of a cuff lesion but also several tendon and muscle features as the thickness of the remaining tendon and the quality of the tendon margins and humeral bone, which are critical in choosing the type of surgical approach to be performed.

Transosseous or Transosseous-Equivalent Rotator Cuff Repair: The Difference

The rotator cuff healing process occurs in a special environment because it happens between the tendon and bone. Rotator cuff (RTC) re-tears after surgical repair continue to be a prevalent problem. Despite advances in surgical technique, re-tears occur at rates of 11%–57% (Le et al. 2014). Risk of re-tear has been attributed to many modifiable and non-modifiable factors, including patient age, size and pattern of initial tear, repair technique, and tendon quality (Le et al. 2014; Duquin et al. 2010; Millett et al. 2014; Nho et al. 2009; Chillemi et al. 2011). In a recent study (Chillemi et al. 2011), were detected and listed the most important histopathological findings of ruptured tendons, which consisted mainly in disarray (i.e., loss of structural organization), poor or absent neoangiogenesis, chondral metaplasia, and fibrosis. All these features may give to tendon tissue a low healing capability, so these aspects may therefore explain why the lesions of the rotator cuff are at high risk of re-tear. Taking into considerations these observations, was so introduced a new concept of rotator cuff tendon “non-healing” (i.e., a condition of healing failure) rather than re-tear.