The value of perineal punch biopsy in estimating the histological grade of carcinoma of the prostate

The degree of accuracy of the histological grade of carcinoma of the prostate obtained by perineal punch biopsy was analyzed by comparing the histological findings with those of radical prostatectomy specimens. Biopsy specimens of 97 of 100 patients who underwent radical prostatectomy between 1969 and 1979 were reevaluated. In 43% of the cases, perineal punch biopsy revealed a uniform architectural pattern, which was classified as well-differentiated adenocarcinoma in 21 cases and poorly differentiated adenocarcinoma in 22 cases. However, of the 21 cases determined by biopsy to be uniformly well-differentiated adenocarcinomas, only seven (33.3%) were confirmed by evaluation of the radical prostatectomy specimens. A uniform, poorly differentiated adenocarcinoma was ultimately found in only five operative specimens of the 22 patients with this preoperative diagnosis. As one case clearly demonstrated, multifocal origin of carcinoma of the prostate is the main source of the frequently occurring error encountered with perineal punch biopsy in determining the grade of differentiation.     

Visualisation of non-invasive coronary bypass imaging: 4-row vs. 16-row multidetector computed tomography

The purpose of this study was to investigate the image quality of coronary artery bypass graft visualization in 4- and 16-row multidetector CT using multiple imaging reformations. Material and Methods: One hundred sixteen patients underwent CT examination of the heart after receiving CABG. Group A (n=58) received 4-row MDCT; group B (n=58) received 16-row MDCT. Various bypass types such as LITA to LAD and venous grafts to the RCA and RCX were included in the study. A five-point Likert scale was used to grade image quality. Each bypass was reviewed under different imaging reformations: thin slap maximum intensity projection (MIP thin), multiplanar reformation (MPR) and volume rendering technique (VRT). Special attention was paid to the delineation of the distal anastomosis. Interobserver correlation was determined. Results: From 289 bypass grafts examined, 279 (96.54%) were classified as patent and 10 (3.46%) as not patent. Except for the distal anastomosis, 16-row MDCT showed significantly better results for all segments of bypasses. Comparison of reformations within group A and B showed that MIP thin (P<0.05) and VRT (P<0.05) displayed better visualization as compared to MPR. Conclusion: Significantly better imaging of all bypass types is possible using 16-row MDCT as compared to 4-row MDCT. Assessment of the distal anastomosis yields no difference between 4- and 16-row technology.This revised version was published online in October 2004 with a correction to the article title.     

Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy?

The objective is to evaluate different multidetector-row CT (MDCT) strategies for adequate classification of spinal and pelvic injuries. Seventy intubated patients after multiple trauma underwent conventional radiography (CR) and MDCT. Examinations included the pelvis (P), the lumbar spine (LS) and the thoracic spine (TS). Conventional radiographs, 3-mm (CT5) and 5-mm scans (CT3) and 3-mm and 5-mm scans combined with MPR (CT3R/CT5R) were compared to surgery, autopsy and clinical course. MDCT led to significantly better results than CR (P<0.01). Correlation coefficients were r=1.0 (CT3R), r=0.96 [TS] to r=1.0 [P/LS] (CT5R), r=0.8 [P] to r=1.0 [TS] (CT3), r=0.80 [P] to r=0.86 [TS] (CT5) and r=0.3 [TS] to r=0.69 [P] (CR). Fractures were identified by CT3R in 100% of cases, by CT5R in 95%, by CT3 in 90% [P]–100% [TS], by CT5 in 83.3% [LS]–90% [P] and by CR in 57.1% [TS]–87.2% [P]. Unstable fractures were identified in 100% by CT3R, CT5R and CT3, 85.7% [TS]–100% [P/LS] by CT5 and 57.1% [TS]–80% [P] by CR. Only overlapping thin-slice multiplanar reformation allows for an adequate classification of spinal and pelvic injuries and thus is highly emphasized in patients after severe blunt trauma.