V. Panebianco

2D and 3D T2-weighted MR sequences for the assessment of neurovascular bundle changes after nerve-sparing radical retropubic prostatectomy with erectile function correlation

The aim of this study was to assess the capability of a 3D isotropic MRI T2-weighted sequence (3D T2 ISO) in the depiction of changes of neurovascular bundles (NVBs) after bilateral nerve-sparing radical retropubic prostatectomy (RRP). Furthermore, our aim was also to introduce a new MRI classification score of the NVB alteration patterns using the International Index Erectile Function Five-Item (IIEF-5) score as standard of reference. Fifty-three consecutive patients were postoperatively submitted to two MR examinations, including both 2D TSE T2-weighted (2D T2) and 3D T2 ISO sequences. Image findings were scored using a relative five-point classification and correlated with the postoperative IIEF-5 score. Radiologists attributed 13.2% of patients to class 0, 11.3% to class I, 34% to class II, 24.5% to class III, and 16.9% to class IV. With 3D T2 ISO images, the same radiologists determined 43.3% class 0, 32% class I, 11.4% class II, 7.5% class III, and 5.7% class IV. In all cases, the correlation and regression analysis between the 3D T2 ISO and IIEF-5 score resulted in higher coefficients values. The 3D sequence correlated most closely with patients’ grading of erectile function.

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.

Role of magnetic resonance spectroscopic imaging ([1H]MRSI) and dynamic contrast-enhanced MRI (DCE-MRI) in identifying prostate cancer foci in patients with negative biopsy and high levels of prostate-specific antigen (PSA)

PurposeThe purpose of this study was to evaluate the role of magnetic resonance spectroscopic imaging (MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in detecting tumour foci in patients with elevated prostate-specific antigen (PSA) and negative transrectal ultrasonography (TRUS)-guided biopsy.Materials and methodsThis prospective randomised trial was conducted on 150 patients who underwent [1H]MRSI and DCE-MRI and targeted biopsies of suspicious areas on MRI associated with random biopsies.ResultsAfter the second biopsy, the diagnosis of prostate adenocarcinoma was made in 64/150 cases. On a perpatient basis, MRSI had 82.8% sensitivity, 91.8% specificity, 88.3% positive predictive value (PPV), 87.8% negative predictive value (NPV) and 85.7% diagnostic accuracy. The sensitivity, specificity, PPV, NPV and accuracy for DCE-MRI was 76.5%, 89.5%, 84.5%, 83.7% and 82%, respectively. The combination of MRSI and DCE-MRI yielded 93.7% sensitivity, 90.7% specificity, 88.2% PPV, 95.1% NPV and 90.9% accuracy in detecting prostate carcinoma.ConclusionsThe combined study with [1H]MRSI and DCE-MRI showed promising results in guiding the biopsy of cancer foci in patients with an initial negative TRUS-guided biopsy.RiassuntoObiettivoScopo del nostro lavoro è stato valutare il ruolo della risonanza magnetica (RM) con spettroscopia (MRSI) e studio dinamico (DCEMR) nell’individuazione di foci tumorali in pazienti con elevati valori di antigene prostatico specifico (PSA) e biopsia prostatica guidata tramite TRUS (trans-rectal-ultrasound)-guidata negativa.Materiali e metodiLo studio è stato di tipo prospettico randomizzato. Abbiamo esaminato 150 pazienti. Tutti sono stati sottoposti ad esame di 1H-MRSI e DCEMR ed a prelievi mirati nelle zone sospette alla RM, associate a biopsie random.RisultatiDopo la seconda biopsia, la diagnosi di adenocarcinoma prostatico è stata effettuata in 64/150 casi. Nella nostra popolazione, su una base patient by patient, l’MRSI ha mostrato i seguenti valori: sensibilità 82,8%; specificità 91,8%; valore predittivo positivo (PPV) 88,3%; valore predittivo negativo (NPV) 87,8%; accuratezza 85,7%. La DCEMR ha mostrato i seguenti valori: sensibilità 76,5%; specificità 89,5%; PPV 84,5%; NPV 83,7%; accuratezza 82%. L’associazione delle due metodiche, MRSI e DCEMR, aumenta la sensibilità (93,7%), la specificità (90,7%), il PPV (88,2%), il PNV (95,1%) e l’accuratezza (90,9%) nel predire l’individuazione del carcinoma prostatico se paragonata alla sola metodica MRSI o DCEMR.ConclusioniLo studio combinato ha mostrato risultati promettenti nella guida alla biopsia dei foci tumorali in pazienti con prima biopsia TRUS-guidata negativa.

342 Use of multiparametric MR with neurovascular bundle evaluation to optimize the oncological and functional management of patients considered for nerve sparing radical prostatectomy

Introduction. To obtain the best results with radical prostatectomy, either from an oncological or a functional point of view, a correct selection of cases and planning of surgery are crucial. Multiparametric magnetic resonance imaging (MRI) promises to make it a successful imaging tool for improving many aspects of prostate cancer management. Aim. The aim of this study is to evaluate whether a modern multiparametric MRI can help either to better select prostate cancer cases for a nerve-sparing radical prostatectomy or to improve the functional evaluation related to neurovascular bundles preservation. Main Outcome Measures. The effect of preoperative MRI on neurovascular bundle management was examined for the frequency and the appropriateness of changes of the surgical plane on the basis of MRI indications. Methods. In a prospective study, 125 consecutive patients with biopsy proven prostate cancer who were scheduled to undergo bilateral nerve-sparing surgery. All patients included into the study were submitted to a preoperative multiparametric MRI. On the basis of MRI evaluation, patients were divided into two groups. Patients in group A were then submitted to a bilateral nerve-sparing (NS) radical prostatectomy (RP), whereas patients in group B were submitted to unilateral NS or non-NS RP. Results. In group A, the confirmation from the MRI study to perform a bilateral NS procedure was appropriate in 70 of 73 cases (95.9%), whereas in group B, the surgical plan was appropriate in 28 of 32 cases (87.5%). On the contrary, MRI findings suggested a change in the initial surgical plan (group B) for 32 of 105 cases (30.5%). Of these 32 cases in group B, MRI suggested to perform a unilateral NS procedure in 21 of 32 cases (65.6%) and a non-NS procedure in 11 of 32 cases (34.4%). Conclusions. Multiparametric MRI analysis can significantly improve the standard selection and management of prostate carcinoma cases considered for an NS RP. Panebianco V, Salciccia S, Cattarino S, Minisola F, Gentilucci A, Alfarone A, Ricciuti GP, Marcantonio A, Lisi D, Gentile V, Passariello R, and Sciarra A. Use of multiparametric MR with neurovascular bundle evaluation to optimize the oncological and functional management of patients considered for nerve-sparing radical prostatectomy. J Sex Med 2012;9:2157-2166.

Early Diagnosis of Failure After Primary Treatment: Multiparametric MRI Versus PET-TC

Prostate cancer (PC) is the most common tumour type among men and is the second leading cause of cancer-related deaths following lung cancer [1].

Prostate Cancer Units: How and Why

Prostate cancer (PC) is established as one of the most important medical problems affecting the male population. PC is the most common solid neoplasm and the second most common cause of cancer death in men. Its management involves several complex issues for both clinicians and patients. An early diagnosis is necessary to implement well-balanced therapeutic options, and the correct evaluation can reduce the risk of overtreatment with its consequential adverse effects. The paradigm of the patient consulting a multidisciplinary medical team has been an established standard approach in treating breast cancer. Such multidisciplinary approach can offer the same optional care for men with PC as it does for women with breast cancer. A multidisciplinary team (MDT) comprises healthcare professionals from different disciplines whose goal of providing optimal patient care is achieved through coordination and communication with one another. A Prostate Cancer Unit is a place where men can be cared for by specialists in PC, working together within a multi-professional team. The MTD approach guarantees a higher probability for the PC patient to receive adequate information on the disease and on all possible therapeutic strategies, balancing advantages and related side effects. The future of PC patients relies on a successful multidisciplinary collaboration between experienced physicians, which can lead to important advantages in all the phases and aspects of PC management.

Modern Imaging in the Initial Diagnosis: The Role of the Radiologist in an MDT

Despite recent advances in prostate cancer (PC) detection and treatment, PC continues to be one of the leading causes of cancer-related mortality in men. Thus, accurate diagnosis and appropriate treatment are crucial. The detection of PC is traditionally based on digital rectal examination (DRE), clinical stage and the measurement of serum prostate-specific antigen (PSA), followed by transrectal ultrasound (TRUS)-guided biopsies. However, PSA has a poor specificity and low predictive value, and therefore, many biopsies may be tumour negative. Moreover, with the current biopsy scheme, only a small portion of the prostate gland is sampled, with the risk of missing a significant lesion. Random TRUS-guided biopsy misses about 30 % of cancerous lesions, 23 % of which are high risk of PC [1]. Nowadays, there is a real need for clinicians to base therapeutic decisions not only on PSA serum level, DRE and TRUS-biopsy results, but also on imaging findings. In recent years, various imaging modalities have been developed to improve diagnosis, staging and localisation of early-stage PC. Conventional TRUS is mainly used to guide prostate biopsy. Contrast-enhanced US (CEUS) is based on the assumption that PC tissue is hypervascularised and might be better identified after intravenous injection of a microbubble contrast agent. Real-time elastography (RTE) seems to have higher sensitivity (Se), specificity (Spe) and positive predictive value (PPV) than conventional TRUS. However, the method still awaits prospective validation.

Role of magnetic resonance spectroscopic imaging (( 1 H)MRSI) and dynamic contrast-enhanced MRI (DCE-MRI) in identifying prostate cancer foci in patients with negative biopsy and high levels of prostate- specific antigen (PSA) Ruolo della risonanza magnetica con spettroscopia ( 1 H-MRSI) e con studio dinamico (DCEMR) nell'identificazione dei foci di adenocarcinoma prostatico in pazienti con biopsia negativa ed elevati valori di antigene prostatico specifico (PSA)

PurposeThe purpose of this study was to evaluate the role of magnetic resonance spectroscopic imaging (MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in detecting tumour foci in patients with elevated prostate-specific antigen (PSA) and negative transrectal ultrasonography (TRUS)-guided biopsy.Materials and methodsThis prospective randomised trial was conducted on 150 patients who underwent [1H]MRSI and DCE-MRI and targeted biopsies of suspicious areas on MRI associated with random biopsies.ResultsAfter the second biopsy, the diagnosis of prostate adenocarcinoma was made in 64/150 cases. On a perpatient basis, MRSI had 82.8% sensitivity, 91.8% specificity, 88.3% positive predictive value (PPV), 87.8% negative predictive value (NPV) and 85.7% diagnostic accuracy. The sensitivity, specificity, PPV, NPV and accuracy for DCE-MRI was 76.5%, 89.5%, 84.5%, 83.7% and 82%, respectively. The combination of MRSI and DCE-MRI yielded 93.7% sensitivity, 90.7% specificity, 88.2% PPV, 95.1% NPV and 90.9% accuracy in detecting prostate carcinoma.ConclusionsThe combined study with [1H]MRSI and DCE-MRI showed promising results in guiding the biopsy of cancer foci in patients with an initial negative TRUS-guided biopsy.RiassuntoObiettivoScopo del nostro lavoro è stato valutare il ruolo della risonanza magnetica (RM) con spettroscopia (MRSI) e studio dinamico (DCEMR) nell’individuazione di foci tumorali in pazienti con elevati valori di antigene prostatico specifico (PSA) e biopsia prostatica guidata tramite TRUS (trans-rectal-ultrasound)-guidata negativa.Materiali e metodiLo studio è stato di tipo prospettico randomizzato. Abbiamo esaminato 150 pazienti. Tutti sono stati sottoposti ad esame di 1H-MRSI e DCEMR ed a prelievi mirati nelle zone sospette alla RM, associate a biopsie random.RisultatiDopo la seconda biopsia, la diagnosi di adenocarcinoma prostatico è stata effettuata in 64/150 casi. Nella nostra popolazione, su una base patient by patient, l’MRSI ha mostrato i seguenti valori: sensibilità 82,8%; specificità 91,8%; valore predittivo positivo (PPV) 88,3%; valore predittivo negativo (NPV) 87,8%; accuratezza 85,7%. La DCEMR ha mostrato i seguenti valori: sensibilità 76,5%; specificità 89,5%; PPV 84,5%; NPV 83,7%; accuratezza 82%. L’associazione delle due metodiche, MRSI e DCEMR, aumenta la sensibilità (93,7%), la specificità (90,7%), il PPV (88,2%), il PNV (95,1%) e l’accuratezza (90,9%) nel predire l’individuazione del carcinoma prostatico se paragonata alla sola metodica MRSI o DCEMR.ConclusioniLo studio combinato ha mostrato risultati promettenti nella guida alla biopsia dei foci tumorali in pazienti con prima biopsia TRUS-guidata negativa.