Ronaldo Hueb Baroni

MR classification of renal masses with pathologic correlation

To perform a feature analysis of malignant renal tumors evaluated with magnetic resonance (MR) imaging and to investigate the correlation between MR imaging features and histopathological findings. MR examinations in 79 malignant renal masses were retrospectively evaluated, and a feature analysis was performed. Each renal mass was assigned to one of eight categories from a proposed MRI classification system. The sensitivity and specificity of the MRI classification system to predict the histologic subtype and nuclear grade was calculated. Subvoxel fat on chemical shift imaging correlated to clear cell type (p < 0.05); sensitivity = 42%, specificity = 100%. Large size, intratumoral necrosis, retroperitoneal vascular collaterals, and renal vein thrombosis predicted high-grade clear cell type (p < 0.05). Small size, peripheral location, low intratumoral SI on T2-weighted images, and low-level enhancement were associated with low-grade papillary carcinomas (p < 0.05). The sensitivity and specificity of the MRI classification system for diagnosing low grade clear cell, high-grade clear cell, all clear cell, all papillary, and transitional carcinomas were 50% and 94%, 93% and 75%, 92% and 83%, 80% and 94%, and 100% and 99%, respectively. The MRI feature analysis and proposed classification system help predict the histological type and nuclear grade of renal masses.

Pancreatic sarcoidosis: MRI features

Pancreatic sarcoidosis is a rare entity, and few reports in the literature describe the CT aspects of the disease. We report the MR features of a pathologically‐confirmed case of pancreatic sarcoidosis, which presented as multiple pancreatic masses with low signal intensity on T1‐weighted images, mild high signal intensity on T2‐weighted images, and decreased enhancement compared to the normal pancreas after administration of gadolinium. Pancreatic sarcoidosis should therefore be included in the differential diagnosis of multiple pancreatic masses with these MRI features. J. Magn. Reson. Imaging 2004;20:889–893.

Magnetic resonance/transrectal ultrasound fusion biopsy of the prostate compared to systematic 12-core biopsy for the diagnosis and characterization of prostate cancer: Multi-institutional retrospective analysis of 389 patients

OBJECTIVE To determine the incremental diagnostic value of targeted biopsies added to an extended sextant biopsy scheme on a per-patient, risk-stratified basis in 2 academic centers using different multiparametric magnetic resonance imaging (MRI) protocols, a large group of radiologists, multiple biopsy systems, and different biopsy operators. MATERIALS AND METHODS All patients with suspected prostate cancer (PCa) who underwent multiparametric MRI of the prostate in 2 academic centers between February 2013 and January 2015 followed by systematic and targeted MRI-transrectal ultrasound fusion biopsy were reviewed. Risk-stratified detection rate using systematic biopsies was compared with targeted biopsies on a per-patient basis. The McNemar test was used to compare diagnostic performance of the 2 approaches. RESULTS A total of 389 men met eligibility criteria. PCa was diagnosed in 47% (182/389), 52%(202/389), and 60%(235/389) of patients using the targeted, systematic, and combined (targeted plus systematic) approach, respectively. Compared with systematic biopsy, targeted biopsy diagnosed 11% (37 vs. 26) more intermediate-to-high risk (P<0.0001) and 16% (10 vs. 16) fewer low-risk tumors (P<0.0001). These results were replicated when data from each center, biopsy-naïve patients, and men with previous negative biopsies were analyzed separately. CONCLUSION Targeted MRI-transrectal ultrasound fusion biopsy consistently improved the detection of clinically significant PCa in a large patient cohort with diverse equipment, protocols, radiologists, and biopsy operators as can be encountered in clinical practice.

Acute and chronic mesenteric ischemia: MDCT findings

A isquemia mesenterica e causada pela reducao do fluxo sanguineo mesenterico. Essa patologia pode ser dividida em aguda e cronica, baseada na rapidez e no grau em que o fluxo sanguineo esta sendo comprometido. Os autores retrospectivamente revisaram 22 casos de isquemia mesenterica, diagnosticados por tomografia computadorizada com mutidetectores (TCMD) em nosso servico, e confirmados por cirurgia ou seguimento clinico. Os achados diagnosticos de isquemia aguda e cronica e sua frequencia foram avaliados. Os avancos na TCMD 3D (tridimensional) permitiram o acesso detalhado aos vasos mesentericos. Alem disso, e possivel demonstrar alteracoes nos segmentos intestinais, auxiliando na identificacao da causa primaria da doenca e podendo identificar as complicacoes associadas a isquemia mesenterica e cronica.

Prostate cancer detection using multiparametric 3 – tesla MRI and fusion biopsy: preliminary results

ABSTRACT Objective: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) biopsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clinically significant tumors according to histological criteria. Materials and Methods: A total of 189 consecutive US/MRI fusion biopsies were performed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria. Results: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively. There was a statistically significant difference in terms of biopsy results between different levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different levels of suspicion on mpMRI (p-value <0.05 in both analyzes). Conclusion: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI.

Are Dynamic Contrast-Enhanced Images Necessary for Prostate Cancer Detection on Multiparametric Magnetic Resonance Imaging?

Micro‐Abstract The purpose of our study was to compare the results of magnetic resonance imaging with and without contrast for the detection of prostate cancer. A total of 118 patients were included in the present study, and clinically significant cancer was found in 48. The magnetic resonance imaging findings on both analyses had no statistically significant differences. The use of contrast provided no increased value for the detection of prostate cancer. Background: To compare the results of magnetic resonance imaging (MRI) with and without contrast‐enhanced sequences for the detection of clinically significant prostate cancer. The value of contrast in the MRI protocol for the detection of prostate tumors has been discussed in previous studies. Materials and Methods: We performed an institutional review board‐approved, retrospective study of patients who had undergone prostate MRI followed by fusion biopsy during a 16‐month period. The patients had undergone MRI on a 3‐Tesla scanner with a phased‐array coil using a routine multiparametric protocol: T2‐weighted, diffusion, and dynamic postcontrast enhancement sequences. The examination films were read independently by 2 readers in 2 sessions: first without contrast‐enhanced images and second with contrast‐enhanced images. The images were graded according to the suspicion of clinically significant prostate cancer (scale, 1‐5). The kappa coefficient was used to compare the readings with and without contrast. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for both readers were calculated using the biopsy findings as a reference standard. The level for statistical significance was set at P < .05. Results: A total of 118 patients were included, and clinically significant prostate cancer was found in 48 patients (40.7%). The MRI findings on both contrast‐enhanced and noncontrast‐enhanced images had no statistically significant differences for either reader (P > .05 for all levels of suspicion). The sensitivity ranged from 68.3% to 80.7%, specificity from 57.1% to 77.1%, positive predictive value from 29.9% to 38.8%, negative predictive value from 88.0% to 91.3%, and accuracy from 60.6% to 73.0%. Conclusion: Our results show that contrast‐enhanced sequences provide minimal or no increased value for the detection of clinically significant prostate cancer.

Malignancy Rate, Histologic Grade, and Progression of Bosniak Category III and IV Complex Renal Cystic Lesions

OBJECTIVE The primary purpose of this study is to determine the malignancy rate, histologic grade, and initial stage of surgically treated complex renal cysts classified as Bosniak category III or IV. For nonsurgical lesions, a secondary objective was to evaluate lesion progression on follow-up examinations. MATERIALS AND METHODS We searched our database for cystic lesions classified as Bosniak III or IV category on CT or MRI from January 2008 to April 2016. Surgically resected lesions, per category, were correlated with information on pathologic reports to obtain malignancy rates. For malignant lesions, histologic grade and initial stage were evaluated. Imaging follow-up of at least 2 years was used to evaluate progression of clinically followed lesions. RESULTS We included 86 lesions in 85 patients in the final analysis. Of the 60 surgically resected lesions (70%), 46 (77%) were malignant and 14 (23%) were benign. Malignancy rates were 72% for Bosniak category III lesions and 86% for Bosniak category IV lesions. Most malignant cysts were early-stage (pT1) cysts with low histologic grades (89% of Bosniak III lesions and 91% of Bosniak IV lesions). Follow-up studies of the surgically resected lesions did not show local recurrence, metastasis, or lymph node enlargement. Among patients with lesions managed by watchful waiting (n = 26), all lesions remained unchanged in terms of size and complexity after at least 2-years of follow-up. CONCLUSION Although high malignancy rates were observed for both Bosniak category III and IV lesions, our results suggest that such malignant cysts are usually early-stage tumors with a low histologic grade. Lesions that underwent follow-up remained unchanged on control examinations. These findings may indicate low aggressiveness of these lesions, supporting the idea that more conservative approaches may be used.

Predictive factors for pelvic magnetic resonance in response to arterial embolization of a uterine leiomyoma

OBJECTIVE: Minimally invasive methods are used as alternatives to treat leiomyomas and include uterine artery embolization, which has emerged as a safe, effective method. This study aims to evaluate the magnetic resonance imaging predictors for a reduction in leiomyoma volume in patients undergoing uterine artery embolization. METHODS: This prospective longitudinal study was performed at a university hospital. We followed 50 symptomatic premenopausal women with uterine leiomyomas who underwent uterine artery embolization. We examined 179 leiomyomas among these patients. Magnetic resonance imaging was performed one month before and six months after uterine artery embolization. Two radiologists who specialized in abdominal imaging independently interpreted the images. Main Outcome Measures: The magnetic resonance imaging parameters were the uterus and leiomyomas volumes, their localizations, contrast perfusion pattern and node-to-muscle ratio. RESULTS: Six months after treatment, the average uterine volume reduction was 38.91%, and the leiomyomas were reduced by 55.23%. When the leiomyomas were submucosal and/or had a higher node-to-muscle ratio in the T2 images, the volume reduction was even greater (greater than 50%). Other parameters showed no association. CONCLUSIONS: We conclude that symptomatic uterine leiomyomas in patients undergoing uterine artery embolization exhibit volume reductions greater than 50% by magnetic resonance imaging when the leiomyomas are submucosal and/or had a high node-to-muscle ratio in the T2 images.

Incremental diagnostic value of targeted biopsy using mpMRI-TRUS fusion versus 14-fragments prostatic biopsy: a prospective controlled study

ObjectivesTo compare the incremental diagnostic value of targeted biopsy using real-time multiparametric magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) fusion to conventional 14-cores biopsy.Patients and MethodsUni-institutional, institutional review board (IRB) approved prospective blinded study comparing TRUS-guided random and targeted biopsy using mpMRI-TRUS fusion, in 100 consecutive men. We included men with clinical-laboratorial suspicious for prostate cancer and Likert score ≥ 3 mp-MRI. Patients previously diagnosed with prostate cancer were excluded. All patients were submitted to 14-cores TRUS-guided biopsy (mpMRI data operator-blinded), followed by targeted biopsy using mpMRI-TRUS fusion.ResultsThere was an overall increase in cancer detection rate, from 56% with random technique to 62% combining targeted biopsy using mpMRI-TRUS fusion; incremental diagnosis was even more relevant for clinically significant lesions (Gleason ≥ 7), diagnosing 10% more clinically significant lesions with fusion biopsy technique. Diagnosis upgrade occurred in 5 patients that would have negative results in random biopsies and had clinically significant tumours with the combined technique, and in 5 patients who had the diagnosis of significant tumours after fusion biopsy and clinically insignificant tumours in random biopsies(p=0.0010).ConclusionsTargeted biopsy using mpMRI-TRUS fusion has incremental diagnostic value in comparison to conventional random biopsy, better detecting clinically significant prostate cancers.Key Points• mpMRI-TRUS targeted biopsy increases overall cancer detection rate, but not statistically significant.• mpMRI-TRUS targeted biopsy actually improves the diagnosis of clinically significant PCa.• There was no evidence to acquire the mpMRI-TRUS fusion cores alone.

Lead pipe sign in ulcerative colitis

A particular imaging feature that helps in the differentiation between UC and CD is the pattern of bowel wall involvement: the first tends to be limited to the superficial layers in a continuous fashion, while the latter tends to present transmural involvement, interweaving healthy mucosa and inflamed areas [1]. Hypertrophy of muscularis mucosae secondary to continuous regeneration promotes loss of haustration and reduction of the usual colon caliber. Fat proliferation due to chronic inflammation also can contribute to this pattern of continuous colonic involvement [2]. Classically described on barium enema exams (Fig. 1) almost a century ago [3], this appearance of smooth, ahaustral contour was compared to a water or gas pipe (Figs. 1, 2), and later also applied to computed tomography enterography and Magnetic Resonance enterography (Figs. 3, 4). Despite its correlation with UC, the ‘‘Lead Pipe’’ can also be found in other forms of inflammatory bowel diseases, and even in CD. It occasionally accompanies infectious colitides such as tuberculosis and amebiasis, and can be a sign of cathartic colon. The lead pipe sign, while not is not disease-specific, provides an indicator of chronic colonic pathology [1–4].