Potential of 1H MR spectroscopic imaging to segregate patients who are likely to show malignancy of the peripheral zone of the prostate on biopsy

Purpose

To evaluate the potential of MR spectroscopic imaging (MRSI) to segregate patients who, upon prostate biopsy, are more likely to show a malignancy in the peripheral zone (PZ) of the prostate gland.

Materials and Methods

Before biopsy, MRSI was carried in 123 men with elevated prostate specific antigen level or an abnormal digital rectal examination. After the MRSI investigation, all patients underwent systematic transrectal ultrasound guided biopsy and were categorized using standard random number tables into the following two groups: (i) Group I, a 62 member training set; and (ii) Group II, a 61‐member test set. The cutoff value for the [citrate/(choline+creatine)] ratio for patients in the training set was obtained using the receiver operating characteristic (ROC) curve method. This value was then applied to the test set of patients as well.

Results

The ROC method gave a cutoff value of 1.2 for the [Citrate/(Choline+Creatine)] ratio. When applied as a malignancy‐predictor to the test group of patients (Group II), the ROC method generated the following results: sensitivity, 77%; specificity, 83%; negative predictive value, 93%; positive predictive value, 55% and accuracy, 82%.

Conclusion

The results indicate that patients who are deemed as malignancy‐positive in the PZ by MRSI using the ROC cutoff may be subjected to prostate biopsy to confirm the diagnosis of cancer. J. Magn. Reson. Imaging 2009. © 2009 Wiley‐Liss, Inc.     

Acute Compartment Syndrome After Rupture of the Medial Head of Gastrocnemius in a Child

Rupture of the gastrocnemius muscle is an uncommon injury, with most cases occurring in athletes and, typically, presenting with the acute onset of focal calf pain and ecchymosis after injury. Although gastrocnemius ruptures are usually treated symptomatically with good results, we present an unusual case of a medial head of gastrocnemius muscle tear complicated by acute compartment syndrome in a 7-year-old boy whose right calf was crushed in a fall. After confirmation of the diagnosis of compartment syndrome, the patient underwent emergency fasciotomy with evacuation of hematoma, and, thereafter, he recovered unremarkably. Clinicians and surgeons need to maintain a high index of suspicion for compartment syndrome associated with gastrocnemius muscle injury, so that timely surgical decompression can be undertaken and complications related to delayed diagnosis and treatment can be avoided.     

Meckel''s Cave Tuberculoma with Unusual Infratemporal Extension

The authors describe a rare case of intracranial tuberculoma of the Meckel's cave and cavernous sinus with extension into the infratemporal fossa causing widening of the foramen ovale and adjacent bone destruction. The rarity of the lesion and the unusual extension of the lesion are presented with a brief review of literature.     

Surgical approach to the spinal accessory nerve for brachial plexus reconstruction

An easy, safe, and less invasive surgical approach to the spinal accessory nerve for brachial plexus reconstruction is described. The technique avoids a longitudinal unsightly scar over the neck and preserves the branches innervating the upper part of the trapezius.