Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T

Objectives

To compare the diagnostic accuracy of diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for detecting cervical stromal invasion in endometrial cancer.

Methods

Eighty-three consecutive women with endometrial cancer underwent preoperative evaluation in a 3-T unit, including T2-weighted, DW (b?=?0 and 1000 s/mm²), and DCE MR imaging. Two radiologists independently assessed presence of cervical stromal invasion, with histopathological reference as gold standard.

Results

For assessing cervical stromal invasion, the diagnostic accuracy, sensitivity, and specificity, respectively for Reader 1/Reader 2, were as follows: DW MR imaging— 95.2 %/91.6 %, 91.7 %/100 %, and 95.8 %/90.1 %; DCE MR imaging— 91.6 %/88 %, 58.3 %/50 %, and 97.2 %/94.4 %. The diagnostic performance of DW MR imaging (Reader 1: areas under the receiver operating characteristic curve (AUC)?=?0.98; Reader 2: AUC?=?0.97) was significantly higher than that of DCE MR imaging (p?=?0.009 for Reader 2) or T2-weighted MR imaging (Reader 1: p?=?0.006; Reader 2: p?=?0.013). Patients with cervical stromal invasion showed a significantly greater canal width (p?<?0.0001) and myometrial invasion extent (p?=?0.006).

Conclusions

DW MR imaging has superior diagnostic performance compared with DCE MR imaging in the detection of cervical stromal invasion.

Key Points

? DWI demonstrates a higher accuracy than DCE in detecting cervical stromal invasion. ? Tumour ADC values are similar between patients without or with cervical invasion. ? Canal widening causes false-negativity on DCE and T2W but not on DWI.

     

Pancreatic adenocarcinomas without secondary signs on multiphasic multidetector CT: association with clinical and histopathologic features

Purpose

To determine the clinical, histopathologic and imaging features of pancreatic adenocarcinomas without secondary signs on dynamic CT.

Materials and Methods

Seventy patients (mean age 70 years) with histologically proven pancreatic adenocarcinoma underwent preoperative contrast material-enhanced multiphasic multidetector CT before pancreatic resection. In each patient, clinical data including carbohydrate antigen 19–9, frequency of isoattenuating tumours, and presence of secondary signs and histopathologic findings such as tumour location, tumour stage, and microscopic infiltrative growth grade were evaluated.

Results

Ten tumours (14 %) were without secondary signs, and 60 (86 %) were with secondary signs. Tumours without and with secondary signs were located in the uncinate process in 5 (50 %) and 3 (5 %), head in 3 (30 %) and 29 (48 %), body in 2 (20 %) and 22 (37 %), and tail in 0 (0 %) and 6 (10 %), respectively (p?=?.001). The frequency of isoattenuating pancreatic adenocarcinomas without secondary signs was significantly higher than those with secondary signs (p?=?0.034). The tumour stage of pancreatic adenocarcinomas without secondary signs was earlier than that in tumours with secondary signs (p?=?0.041).

Conclusions

Pancreatic adenocarcinomas without secondary signs is characterized by the presence of uncinate and isoattenuating tumours and earlier tumour stage compared to tumours with secondary signs.

Key Points

? Frequency of pancreatic adenocarcinomas without secondary signs on multiphasic CT is 14?%.? Pancreatic adenocarcinomas without secondary signs are common in the uncinate process.? Pancreatic adenocarcinomas without secondary signs are common in isoattenuating tumours.? Pancreatic adenocarcinomas without secondary signs are characterized by earlier-stage tumours.

     

Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy

Objectives

To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy.

Methods

Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher’s exact test.

Results

Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00.

Conclusions

Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions.

Key Points

? Multiparametric MRIs were more often called negative in subspecialist reads (41 % vs 20 %).? Second readings of prostate mpMRIs by subspecialist uroradiologists significantly improved NPV and PPV.? Reporter experience may reduce overcalling and avoid overtargeting of lesions.? Greater education and training of radiologists in prostate MRI interpretation is advised.

     

Shear wave elastography of focal salivary gland lesions: preliminary experience in a routine head and neck US clinic

Objectives

To evaluate shear wave elastography (SWE) for focal lesions in major salivary glands.

Methods

Sixty lesions (49 parotid, 11 submandibular) undergoing routine ultrasound (grey scale and Doppler) also underwent SWE before US-guided needle aspiration for cytology. Quantitative indices of the shear elastic modulus (stiffness) were compared with cytological results.

Results

Fifty-five lesions were benign (21 pleomorphic adenomas, 18 Warthin’s tumours; 16 others) and 5 malignant (2 mucoepidermoid carcinomas, 1 myoepithelial carcinoma, 1 B-cell lymphoma, 1 nodal metastasis). Shear modulus of benign lesions, median 18.3 kPa, overlapped appreciably with malignant lesions, median 13.5 kPa. However, 2 mucoepidermoid carcinomas had the highest stiffness values (81.9 kPa, 132.0 kPa). Stiffness of pleomorphic adenomas (median 22.5 kPa) was higher than Warthin’s tumours (16.9 kPa) (P?=?0.05 Mann–Whitney U-test). The standard deviation of stiffness values within a lesion, used as an indicator of spatial heterogeneity, was highest in mucoepidermoid cancers (median 44.2 kPa), followed by pleomorphic adenomas (median 12.4 kPa) and remaining lesions (medians 1.4–10.3 kPa).

Conclusion

This study shows a degree of clustering of SWE indices according to pathology although it appears that SWE has suboptimal performance for ruling out malignancy, thus limiting its use in routine practice.

Key Points

? Shear wave elastography is a feasible technique for focal salivary gland lesions.? Elastographic artefacts aggravated by the regional anatomy may hinder this technique.? Elastographic indices vary according to pathology but there is appreciable overlap.? Overlapping indices for malignant and benign lesions limit its utility.? Pleomorphic adenomas have higher elasticity indices, i.e. are stiffer, than Warthin’s tumours.

     

Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer

Objectives

To assess the impact of sarcopenia and alterations in body composition parameters (BCPs) on survival after surgery for oesophageal and gastro-oesophageal junction cancer (OC).

Methods

200 consecutive patients who underwent resection for OC between 2006 and 2013 were selected. Preoperative CTs were used to assess markers of sarcopenia and body composition (total muscle area [TMA], fat-free mass index [FFMi], fat mass index [FMi], subcutaneous, visceral and retrorenal fat [RRF], muscle attenuation). Cox regression was used to assess the primary outcome parameter of overall survival (OS) after surgery.

Results

130 patients (65 %) had sarcopenia based on preoperative CT examinations. Sarcopenic patients showed impaired survival compared to non-sarcopenic individuals (hazard ratio [HR] 1.87, 95 % confidence interval [CI] 1.15–3.03, p?=?0.011). Furthermore, low skeletal muscle attenuation (HR 1.91, 95 % CI 1.12–3.28, p?=?0.019) and increased FMi (HR 3.47, 95 % CI 1.27–9.50, p?=?0.016) were associated with impaired outcome. In the multivariate analysis, including a composite score (CSS) of those three parameters and clinical variables, only CSS, T-stage and surgical resection margin remained significant predictors of OS.

Conclusion

Patients who show signs of sarcopenia and alterations in BCPs on preoperative CT images have impaired long-term outcome after surgery for OC.

Key Points

? Sarcopenia is associated with impaired OS after surgery for oesophageal cancer.? Other body composition parameters are also associated with impaired survival.? This influence on survival is independent of established clinical parameters.? Sarcopenia provides a better estimation of cachexia than BMI.? Sarcopenia assessment could be considered in risk/benefit stratification before oesophagectomy.

     

Acute effect of static exercise in patients with aortic regurgitation assessed by cardiovascular magnetic resonance: role of left ventricular remodelling

Objective

In patients with aortic regurgitation (AR), the effect of static exercise (SE) on global ventricular function and AR severity has not been previously studied.

Methods

Resting and SE cardiovascular magnetic resonance (CMR) were prospectively performed in 23 asymptomatic patients with AR.

Results

During SE, we observed a decrease in regurgitant volume in both end-diastolic (EDV) and end-systolic (ESV) volume in both ventricles, as well as a slight decrease in LV ejection fraction (EF). Interestingly, responses varied depending on the degree of LV remodelling. Among patients with a greater degree of LV remodelling, we observed a decrease in LVEF (56?±?4 % at rest vs 48?±?7 % during SE, p?=?0.001) as a result of a lower decrease in LVESV (with respect to LVEDV. Among patients with a lower degree of LV remodelling, LVEF remained unchanged. RVEF remained unchanged in both groups.

Conclusions

In patients with AR, SE provoked a reduction in preload, LV stroke volume, and regurgitant volume. In those patients with higher LV remodelling, we observed a decrease in LVEF, suggesting a lower LV contractile reserve.

Key points

? In patients with aortic regurgitation, static exercise reduced preload volume.? In patients with aortic regurgitation, static exercise reduced stroke volume.? In patients with aortic regurgitation, static exercise reduced regurgitant volume.? In patients with greater remodelling, static exercise unmasked a lower contractile reserve.? Effect of static exercise on aortic regurgitation was assessed by cardiac MR.

     

The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer

Objectives

To assess the use of MRI-determined tumour regression grading (TRG) in local response assessment and detection of salvageable early local relapse after chemoradiotherapy (CRT) in patients with anal squamous cell carcinoma (ASCC).

Methods

From a prospective database of patients with ASCC managed through a centralised multidisciplinary team, 74 patients who completed routine post-CRT 3- and 6-month MRIs (2009–2012) were reviewed. Two radiologists blinded to the outcomes consensus read and retrospectively assigned TRG scores [1 (complete response) to 5 (no response)] and related these to early local relapse (within 12 months) and disease-free survival (DFS).

Results

Seven patients had early local relapse. TRG 1/2 scores at 3 and 6 months had a 100 % negative predictive value; TRG 4/5 scores at 6 months had a 100 % positive predictive value. All seven patients underwent salvage R0 resections. We identified a novel ‘tram-track’ sign on MRI in over half of patients, with an NPV for early local relapse of 83 % at 6 months. No imaging characteristic or TRG score independently prognosticated for late relapse or 3-year DFS.

Conclusions

Post-CRT 3- and 6-month MRI-determined TRG scores predicted salvageable R0 early local relapses in patients with ASCC, challenging current clinical guidelines.

Key Points

? Post-chemoradiotherapy MRI (3 and 6 months) helps local response assessment in ASCC.? The MRI-TRG system can be used reproducibly in patients with ASCC.? The TRG system facilitates patient selection for examination under anaesthesia and biopsy.? The use of MRI-TRG predicts for detection of salvageable early local relapses.? The TRG system allows for a standardised follow-up pathway.

     

Whole brain analysis of postmortem density changes of grey and white matter on computed tomography by statistical parametric mapping

Objectives

This study examined the usefulness of statistical parametric mapping (SPM) for investigating postmortem changes on brain computed tomography (CT).

Methods

This retrospective study included 128 patients (23???100 years old) without cerebral abnormalities who underwent unenhanced brain CT before and after death. The antemortem CT (AMCT) scans and postmortem CT (PMCT) scans were spatially normalized using our original brain CT template, and postmortem changes of CT values (in Hounsfield units; HU) were analysed by the SPM technique.

Results

Compared with AMCT scans, 58.6 % and 98.4 % of PMCT scans showed loss of the cerebral sulci and an unclear grey matter (GM)–white matter (WM) interface, respectively. SPM analysis revealed a significant decrease in cortical GM density within 70 min after death on PMCT scans, suggesting cytotoxic brain oedema. Furthermore, there was a significant increase in the density of the WM, lenticular nucleus and thalamus more than 120 min after death.

Conclusions

The SPM technique demonstrated typical postmortem changes on brain CT scans, and revealed that the unclear GM–WM interface on early PMCT scans is caused by a rapid decrease in cortical GM density combined with a delayed increase in WM density. SPM may be useful for assessment of whole brain postmortem changes.

Key Points

? The original brain CT template achieved successful normalization of brain morphology.? Postmortem changes in the brain were independent of sex.? Cortical GM density decreased rapidly after death.? WM and deep GM densities increased following cortical GM density change.? SPM could be useful for assessment of whole brain postmortem changes.

     

Early quantitative CT perfusion parameters variation for prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage

Objectives

To prospectively evaluate the predictive value of cerebral perfusion–computerized tomography (CTP) parameters variation between day0 and day4 after aneurysmal subarachnoid haemorrhage (aSAH).

Methods

Mean transit time (MTT) and cerebral blood flow (CBF) values were compared between patients with delayed cerebral ischemia (DCI+ group) and patients without DCI (DCI- group) for previously published optimal cutoff values and for variations of MTT (ΔMTT) and of CBF (ΔCBF) values between day0 and day4. DCI+ was defined as a cerebral infarction on 3-months follow-up MRI.

Results

Among 47 included patients, 10 suffered DCI+. Published optimal cutoff values did not predict DCI, either at day0 or at day4. Conversely, ΔMTT and ΔCBF significantly differed between the DCI+ and DCI- groups, with optimal ΔMTT and ΔCBF values of 0.91 seconds (83.9 % sensitivity, 79.5 % specificity, AUC 0.84) and -7.6 mL/100 g/min (100 % sensitivity, 71.4 % specificity, AUC 0.86), respectively. In multivariate analysis, ΔCBF (OR?=?1.91, IC95% 1.13–3.23 per each 20 % decrease of ΔCBF) and ΔMTT values (OR?=?14.70, IC95% 4.85–44.52 per each 20 % increase of ΔMTT) were independent predictors of DCI.

Conclusions

Assessment of MTT and CBF value variations between day0 and day4 may serve as an early imaging surrogate for prediction of DCI in aSAH.

Key points

? CT perfusion values are an imaging surrogate for prediction of DCI.? Early variations (day0–day4) after aneurysmal subarachnoid haemorrhage predicted DCI.? A CBF decrease of 7.6 mL/min/100 g predicted DCI with 100?% sensitivity.? An MTT increase of 0.91 seconds predicted DCI with 83.9?% sensitivity.? DCI risk multiplied by 2 per 20?% ΔCBF decrease and by 15 per 20?% ΔMTT increase.

     

Percutaneous endovascular management of chronic superior vena cava syndrome of benign causes : long-term follow-up

Background

The vast majority of superior vena cava (SVC) syndromes are of malignant causes, but with growing use of indwelling central catheters and implanted cardiac devices, benign SVC syndromes are becoming more frequent. The main objective of this study is to evaluate long term outcome in patients treated for benign SVC syndrome by endovascular techniques.

Methods

Forty-four patients, 26 men and 18 women, mean age 56, treated for benign SVC syndrome using endovascular techniques between 2002 and 2015 were included. Type of obstruction was classified according to the site of disease and degree of occlusion. Complications and recurrence of symptoms were analyzed.

Results

Technical and clinical success were achieved in all but one patient. Four patients (9 %) were treated by angioplasty alone and 40 (91 %) required stent implantation. Mean clinical follow-up was 1275 days. Nine patients had at least one episode of recurrence after a mean of 385 days. Four minor and two major complications were reported.

Conclusion

Percutaneous endovascular techniques to treat benign SVC syndrome are safe with good long term patency. Recurrence of symptoms can easily be addressed by repeat procedure.

Key Points

? Malposition of indwelling central catheter can cause superior vena cava obstruction.? Image-guided catheter placement helps prevent superior vena cava obstruction.? Imaging and superior vena cava obstruction classification allows adequate procedure planning.? Endovascular techniques are safe and effective for superior vena cava syndrome treatment.

     

Diffusion-Weighted Imaging-guided MR Spectroscopy in Breast Lesions using Readout-Segmented Echo-Planar Imaging

Purpose

To investigate the feasibility and effectiveness of diffusion-weighted imaging (DWI)-guided magnetic resonance spectroscopy (MRS) using readout-segmented echo-planar imaging (RS-EPI) to characterise breast lesions.

Materials and methods

A total of 258 patients with 258 suspicious breast lesions larger than 1 cm in diameter were examined using DWI-guided, single-voxel MRS with RS-EPI. The mean total choline-containing compound (tCho) signal-to-noise ratio (SNR) and concentration were used for the interpretation of MRS data. T-tests, χ²-tests, receiver operating characteristic (ROC) curve analyses and Pearson correlations were conducted for statistical analysis.

Results

Histologically, 183 lesions were malignant, and 75 lesions were benign. Both the mean tCho SNR and concentration of malignant lesions were higher than those of benign lesions (6.23?±?3.30 AU/mL vs. 1.26?±?1.75 AU/mL and 3.17?±?2.03 mmol/kg vs. 0.86?±?0.83 mmol/kg, respectively; P?<?0.0001). For a tCho SNR of 2.0 AU/mL and a concentration of 1.76 mmol/kg, the corresponding areas under the ROC curves were 0.93 and 0.90, respectively. The mean tCho SNR and concentration negatively correlated with apparent diffusion coefficients calculated from RS-EPI, with correlation coefficients of ?0.54 and ?0.48, respectively.

Conclusion

DWI-guided MRS using RS-EPI is feasible and accurate for characterising breast lesions.

Key Points

? The mean tCho SNR and concentration negatively correlated with ADCs.? DWI-guided MRS using RS-EPI is feasible.? DWI-guided MRS using RS-EPI accurately characterises breast lesions.

     

Coronary calcium screening with dual-source CT: reliability of ungated,high-pitch chest CT in comparison with dedicated calcium-scoring CT

Purpose

To investigate the reliability of ungated, high-pitch dual-source CT for coronary artery calcium (CAC) screening.

Materials and methods

One hundred and eighty-five smokers underwent a dual-source CT examination with acquisition of two sets of images during the same session: (a) ungated, high-pitch and high-temporal resolution acquisition over the entire thorax (i.e., chest CT); (b) prospectively ECG-triggered acquisition over the cardiac cavities (i.e., cardiac CT).

Results

Sensitivity and specificity of chest CT for detecting positive CAC scores were 96.4 % and 100 %, respectively. There was excellent inter-technique agreement for determining the quantitative CAC score (ICC = 0.986). The mean difference between the two techniques was 11.27, representing 1.81 % of the average of the two techniques. The inter-technique agreement for categorizing patients into the four ranks of severity was excellent (weighted kappa?=?0.95; 95 % CI 0.93–0.98). The inter-technique differences for quantitative CAC scores did not correlate with BMI (r?=?0.05, p?=?0.575) or heart rate (r?=?–0.06, p?=?0.95); 87.2 % of them were explained by differences at the level of the right coronary artery (RCA: 0.8718; LAD: 0.1008; LCx: 0.0139; LM: 0.0136).

Conclusion

Ungated, high-pitch dual-source CT is a reliable imaging mode for CAC screening in the conditions of routine chest CT examinations.

Key points

? CAC is an independent risk factor for major cardiac events.? ECG-gated techniques are the reference standard for calcium scoring.? Great interest is directed toward calcium scoring on non-gated chest CT examinations.? Reliable calcium scoring can be obtained with dual-source CT in a high-pitch mode.

     

Renal cell carcinoma associated with Xp11.2 translocation/TFE gene fusion: imaging findings in 21 patients

Objectives

To characterize imaging features of renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE gene fusion.

Methods

Twenty-one patients with Xp11.2/TFE RCC were retrospectively evaluated. Tumour location, size, density, cystic or solid appearance, calcification, capsule sign, enhancement pattern and metastases were assessed.

Results

Fourteen women and seven men were identified with 12 being 25 years old or younger. Tumours were solitary and cystic-solid (76.2 %) masses with a capsule (76.2 %); 90.5 % were located in the medulla. Calcifications and lymph node metastases were each observed in 24 %. On unenhanced CT, tumour attenuation was greater than in normal renal parenchyma (85.7 %). Tumour enhancement was less than in normal renal cortex on all enhanced phases, greater than in normal renal medulla on cortical and medullary phases, but less than in normal renal medulla on delayed phase. On MR, the tumours were isointense on T1WI, heterogeneously hypointense on T2WI and slightly hyperintense on diffusion-weighted imaging.

Conclusion

Xp11.2/TFE RCC usually occurs in young women. It is a cystic-solid, hyperdense mass with a capsule. It arises from the renal medulla with enhancement less than in the cortex but greater than in the medulla in all phases except the delayed phase, when it is lower than in the medulla.

Key Points

? Xp11.2/TFE RCC was more prevalent in young women.? On unenhanced CT, Xp11.2/TFE RCC attenuation was greater than in renal parenchyma.? Xp111/2TFE RCC arises primarily from the renal medulla.? Xp11.2/TFE RCC enhancement was less than in the cortex on all phases.? Enhancement was greater than in the medulla in arterial and corticomedullary phase.

     

Breast dose reduction for chest CT by modifying the scanning parameters based on the pre-scan size-specific dose estimate (SSDE)

Objective

To investigate the usefulness of modifying scanning parameters based on the size-specific dose estimate (SSDE) for a breast-dose reduction for chest CT.

Materials and methods

We scanned 26 women with a fixed volume CT dose index (CTDI_vol) (15 mGy) and another 26 with a fixed SSDE (15 mGy) protocol (protocol 1 and 2, respectively). In protocol 2, tube current was calculated based on the patient habitus obtained on scout images. We compared the mean breast dose and the inter-patient breast dose variability and performed linear regression analysis of the breast dose and the body mass index (BMI) of the two protocols.

Results

The mean breast dose was about 35 % lower under protocol 2 than protocol 1 (10.9 mGy vs. 16.8 mGy, p?<?0.01). The inter-patient breast dose variability was significantly lower under protocol 2 than 1 (1.2 mGy vs. 2.5 mGy, p?<?0.01). We observed a moderate negative correlation between the breast dose and the BMI under protocol 1 (r?=?0.43, p?<?0.01); there was no significant correlation (r?=?0.06, p?=?0.35) under protocol 2.

Conclusion

The SSDE-based protocol achieved a reduction in breast dose and in inter-patient breast dose variability.

Key Points

? CT scan parameters can be modified based on the pre-scan SSDE.? The pre-scan SSDE is useful for a breast dose reduction.? The fixed SSDE protocol reduced individual variations in the breast dose.

     

Malignancy rates and diagnostic performance of the Bosniak classification for the diagnosis of cystic renal lesions in computed tomography – a systematic review and meta-analysis

Objective

To systematically review the literature on the Bosniak classification system in CT to determine its diagnostic performance to diagnose malignant cystic lesions and the prevalence of malignancy in Bosniak categories.

Methods

A predefined database search was performed from 1 January 1986 to 18 January 2016. Two independent reviewers extracted data on malignancy rates in Bosniak categories and several covariates using predefined criteria. Study quality was assessed using QUADAS-2. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias.

Results

A total of 35 studies, which included 2,578 lesions, were investigated. Data on observer experience, inter-observer variation and technical CT standards were insufficiently reported. The pooled rate of malignancy increased from Bosniak I (3.2 %, 95 % CI 0–6.8, I²?=?5 %) to Bosniak II (6 %, 95 % CI 2.7–9.3, I²?=?32 %), IIF (6.7 %, 95 % CI 5–8.4, I²?=?0 %), III (55.1 %, 95 % CI 45.7–64.5, I²?=?89 %) and IV (91 %, 95 % CI 87.7–94.2, I²?=?36). Several study design-related influences on malignancy rates and subsequent diagnostic performance indices were identified.

Conclusion

The Bosniak classification is an accurate tool with which to stratify the risk of malignancy in renal cystic lesions.

Key points

? The Bosniak classification can accurately rule out malignancy.? Specificity remains moderate at 74?% (95?% CI 64–82).? Follow-up examinations should be considered in Bosniak IIF and Bosniak II cysts.? Data on the influence of reader experience and inter-reader variability are insufficient.? Technical CT standards and publication year did not influence diagnostic performance.

     

Application of ultrasound-guided core biopsy to minimize the non-diagnostic results and the requirement of diagnostic surgery in extrapulmonary tuberculosis of the head and neck

Purpose

Head and neck extrapulmonary tuberculosis (ETB) presenting as lymphadenopathy poses a great threat by potentially increasing the deterioration of clinical outcomes. Tissue sampling for diagnostic confirmation of ETB is the only invasive procedure during the entire clinical course. It is, therefore, necessary to establish ETB sampling methods with accuracy and minimal invasiveness.

Methods

From 2009 to 2014, consecutive patients suspected of ETB receiving ultrasound-guided core biopsy (USCB), fine needle aspiration (FNA), and open biopsy (OB) were enrolled for comparison.

Results

There were 52 cases in the USCB group, 58 cases in the FNA group, and 78 cases in the OB group. For USCB, FNA, and OB groups, the diagnostic rates were 84.6 %, 8.6 %, and 100 % and the positive rates of acid-fast stain were 28.6 %, 0 %, and 37.5 %, respectively. The diagnostic rates of culture were 9.6 %, 0 %, and 50 %, respectively. For head and neck ETB, USCB procedure is timesaving, without leaving poor-healing wounds, scars, and the need for general anaesthesia and hospitalization.

Conclusions

This study helps to optimize the ETB sampling method in head and neck based on diagnostic accuracy and minimal invasiveness. USCB can serve as the first-line diagnostic tool for ETB by reducing non-diagnostic results and the need for diagnostic surgery.

Key Points

? USCB shows higher diagnostic accuracy of ETB than FNA (84.6?% vs. 8.6?%).? USCB diminishes wound complications caused by surgical intervention for ETB.? USCB avoids general anaesthesia and hospitalization for diagnosing ETB.? USCB saves time and reduces the medical costs of diagnosing ETB.

     

Evaluation of chronic inflammatory demyelinating polyneuropathy: 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (3D SHINKEI)

Objective

To evaluate the usefulness of 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (SHINKEI) in patients with chronic inflammatory demyelinating polyneuropathy (CIDP).

Methods

This institutional review board-approved retrospective study included 14 CIDP patients and nine normal subjects. The signal-to-noise ratio (SNR), contrast ratio (CR), and the size of the cervical ganglions and roots were measured by two raters.

Results

The SNRs of the ganglions and roots were larger in patients with CIDP (9.55?±?3.87 and 9.81?±?3.64) than in normal subjects (7.21?±?2.42 and 5.70?±?2.14, P?<?0.0001, respectively). The CRs of the ganglions and roots were larger in patients with CIDP (0.77?±?0.08 and 0.68?±?0.12) than in normal subjects (0.72?±?0.07 and 0.53?±?0.11, P?<?0.0001, respectively). The sizes of the ganglions and the roots were larger in patients with CIDP (6.44?±?1.61 mm and 4.89?±?1.94 mm) than in normal subjects (5.24?±?1.02 mm and 3.39?±?0.80 mm, P?<?0.0001, respectively).

Conclusions

Patients with CIDP could be distinguished from controls on 3D SHINKEI.

Key points

? 3D SHINKEI could visualize brachial plexus with high spatial resolution.? CIDP patients showed increased SNR, CR, and the size of brachial plexus.? 3D SHINKEI could discriminate CIDP patients from normal subjects.

     

Meralgia paraesthetica: Ultrasound-guided injection at multiple levels with 12-month follow-up

Objectives

To evaluate the efficacy of ultrasound (US)-guided injections around the lateral femoral cutaneous nerve (LFCN) at different levels in meralgia paraesthetica (MP) patients.

Methods

The study was approved by the university ethics committee and informed oral and written consent were obtained from all patients. Between June 2008 and August 2013, 20 patients with symptoms of MP, including nine men (mean age, 61.33 years) and 11 women (mean age 61.18 years), were treated with US-guided injection of steroids along the LFCN at three different levels in a mean of 2.25 sessions. A visual analogue scale (VAS) was used to measure symptoms before, immediately after and 12 months after treatment.

Results

Complete resolution of symptoms was documented in 15/20 patients (mean VAS decreased from 82 to 0), and partial resolution in the remaining five (mean VAS decreased from 92 to 42), which was confirmed at 12-month follow-up. By using the different levels of injection approach overall significantly better symptom relief was obtained (p?<?0.05).

Conclusion

The outcome of US-guided injection along the LFCN can be further improved by injections at different levels (p?<?0.05), which was confirmed at 12-month long-term follow-up.

Key Points

? Meralgia paraesthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve.? Ultrasound proved effective in diagnosis and in guiding injection therapy.? Injection at the anterior superior iliac spine has been used previously.? Multiple injections along the nerve course were used in this study.? Long-term follow-up (12 months) confirmed the results.

     

Second-Opinion Interpretations of Gynecologic Oncologic MRI Examinations by Sub-Specialized Radiologists Influence Patient Care

Purpose

To determine if second-opinion review of gynaecologic oncologic (GynOnc) magnetic resonance imaging (MRI) by sub-specialized radiologists impacts patient care.

Methods

469 second-opinion MRI interpretations rendered by GynOnc radiologists were retrospectively compared to the initial outside reports. Two gynaecologic surgeons, blinded to the reports’ origins, reviewed all cases with discrepancies between initial and second-opinion MRI reports and recorded whether these discrepancies would have led to a change in patient management defined as a change in treatment approach, counselling, or referral. Histopathology or minimum 6-month imaging follow-up were used to establish the diagnosis.

Results

Second-opinion review of GynOnc MRIs would theoretically have affected management in 94/469 (20 %) and 101/469 (21.5 %) patients for surgeons 1 and 2, respectively. Specifically, second-opinion review would have theoretically altered treatment approach in 71/469 (15.1 %) and 60/469 (12.8 %) patients for surgeons 1 and 2, respectively. According to surgeons 1 and 2, these treatment changes would have prevented unnecessary surgery in 35 (7.5 %) and 31 (6.6 %) patients, respectively, and changed surgical procedure type/extent in 19 (4.1 %) and 12 (2.5 %) patients, respectively. Second-opinion interpretations were correct in 103 (83 %) of 124 cases with clinically relevant discrepancies between initial and second-opinion reports.

Conclusions

Expert second-opinion review of GynOnc MRI influences patient care.

Key points

? Outside gynaecologic oncologic MRI examinations are often submitted for a second-opinion review.? One-fifth of MRIs had important discrepancies between initial and second-opinion interpretations.? Second-opinion review of gynaecologic oncologic MRI is a valuable clinical service.