MyT3 15 - Genitourinary

Purpose:

The incidence of infectious complications following transrectal ultrasound (TRUS)-guided prostate biopsies is on the rise. In this study, we compared post-biopsy infection rates in patients who underwent mp-MRI targeted vs non-targeted TRUS-guided biopsies, and also aimed to identify other predictors of infectious complications.

Methods and materials:

Retrospective review was performed on 525 patients who underwent TRUS biopsies in Beaumont Hospital between 1/01/2017 and 31/07/2018. Infection rates in both targeted and non-targeted biopsy groups were compared using Pearson’s chi-square test. Other characteristics of patients with and without infections were compared using Mann-Whitney U test, Pearson’s chi-square test and Fisher’s exact test as appropriate. Binomial logistic regression analyses were then performed to identify possible predictors of infectious complications.

Results:

Infectious complications occurred in 20 (3.8%) out of 525 patients. A total of 209 (39.8%) biopsies were targeted. Of the 20 patients who developed infectious complications, seven (35%) underwent targeted biopsies. The difference in infection rates in targeted and non-targeted biopsy groups was not statistically significant. Analysis of other associated patient characteristics revealed significantly higher median prostate-specific antigen (PSA) values in patients who developed infectious complications (p<0.05). On binomial logistic regression, none of the variables investigated were found to be significant predictors of infectious complications in our institution.

Conclusion:

Rising infection rates post TRUS-guided biopsies is a concerning trend with significant implications. While our study did not identify any statistically significant predictors of infectious complications in our institution, it had helped uncover areas of research that could be explored further to help shape future policies.

Limitations:

This study was limited by (1) small sample size, (2) retrospective nature of the study which affected accessibility of some data, and (3) that it is a single centre study.

Ethics committee approval

Approved audit.

Funding:

No funding was received for this work.

Purpose:

It was intended to compare interventional super-selective embolisation regarding renal parameters, clinical course and outcome to other therapeutical options and by that improving the approach to the treatment of acute renal bleedings of arterial origin.

Methods and materials:

Patients with renal injuries due to bleeding of arterial origin, pseudoaneurysms or arteriovenous fistulas underwent transcatheter arterial embolisation. The analysis included data of the technical and clinical success of embolotherapy, differences performing endovascular treatment during the clinical course and whether the post-interventional modified parenchymal renal volume amplifies the risk of developing renovascular hypertonia and chronic kidney disease.

Results:

A total of 167 patients was included. The technical success rate was 100 % and a clinical success rate of 92.5 % was achieved. Recurrent bleeding occurred in 14 patients (8.4 %). 6 (42.9 %) were re-embolised and 5 (35.7 %) underwent total nephrectomy. Recurrent bleedings tended to occur in correlation with subcapsular haematomas (p < 0.001). Renal function was measured by glomerular filtration rate and creatinine several times. It revealed no significant changes (p > 0.05). Patients with discontinuity of renal fascia were at a higher risk of parenchymal loss (p = 0.0237). The post-interventional renal volume loss was insignificantly low and over a period of 15 years, neither contributed to the progression of renovascular hypertonia nor to deterioration of renal parameters.

Conclusion:

This study verified that there was neither a positive correlation between a reduced post-interventional parenchymal renal volume and a progression of renovascular hypertonia nor deteriorating renal laboratory parameters. Furthermore, the choice of embolisation material and the appropriate catheter-technique are decisive for reducing fluoroscopy time.

Limitations:

Not all the patients' data was available.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To evaluate the role of colour Doppler sonography in the evaluation of pregnancy with intrauterine growth restriction. The uteroplacental circulation, which are the two maternal uterine arteries. The foeto-placental circulation, which is the umbilical artery. The foetal circulation, which includes the foetal middle cerebral artery.

Methods and materials:

The study included 30 antenatal women who were diagnosed as having a foetus with intrauterine growth restriction based on greyscale ultrasound findings and referred for obstetric Doppler ultrasound if the following inclusion criteria and exclusion criteria were met. The inclusion criteria were: singleton pregnancy with a gestational age of more than 28 weeks. Women with reliable dating of pregnancy confirmed by an early first-trimester ultrasound examination using CRL or BPD or with known LMP will be selected. Multiple pregnancies and foetuses with congenital anomalies. Doppler US evaluation was performed following a detailed clinical history and US biometry. The scanners and transducers used: the greyscale real-time ultrasonographic examinations were performed using ALOKA PROSOUND SSD – 3500SX and PHILIPS HD 11XE. The transducers used for the study were 3.5MHz convex array transducer.

Results:

The sensitivity of uterine artery Doppler study to detect adverse perinatal outcome was 83% when two Doppler parameters were considered.

Conclusion:

Assessment of both the uteroplacental circulation and the fetoplacental circulations together is more sensitive to predict a perinatal outcome, than the assessment of each alone. In suspected IUGR, cerebro-umbilical ratio (MCA/UA PI) is a better predictor of adverse perinatal outcome than an abnormal MCA PI or umbilical artery PI. Best results are obtained when we use MCA/UA PI ratio, rather than PIs of a middle cerebral artery and umbilical artery separately.

Limitations:

This study is limited by the lack of patient follow-up.

Ethics committee approval

Not applicable.

Funding:

No funding was received for this work.

Purpose:

The aim of our study was to compare the efficacy of PET and MRI in detecting the intraductal component and cribriform pattern in patients with clinically significant prostate cancer who underwent radical prostatectomy.

Methods and materials:

Thirty patients who underwent radical prostatectomy between June 2015 and April 2018 were included in the study. The intraductal component and cribriform pattern of each tumour focus were also identified with whole-mount histopathologic analysis correlation.

Results:

The presence of intraductal component did not create a statistically significant difference in visibility of the index tumour on MRI and PET. However, in terms of total tumoral lesions, the visibility on MRI is statistically significant. The presence of cribriform pattern did not show a statistically significant difference in detection of the tumour on MRI and PET.

Conclusion:

Cribriform pattern was found to be less visible than intraductal carcinoma by MRI.

Limitations:

Our study was retrospective. It has a limited number of patients. Thirty patients were evaluated according to 67 clinically significant tumour foci.

Ethics committee approval

This study is approved by the institutional review board.

Funding:

No funding was received for this work.

Purpose:

To evaluate the usefulness of various apparent diffusion coefficient (ADC) ratios vs ADC in determining the aggressiveness of prostate cancer (PCa).

Methods and materials:

261 consecutive patients who underwent 3T MRI on a single scanner followed by MRI-transrectal US fusion biopsy within one month were included. A board-certified radiologist retrospectively reviewed all MRIs blinded to clinical information and placed 3D regions of interest (ROI) on focal lesions. Mean ADC (mADC) of each lesion and reference regions: normal-appearing peripheral zone (PZNL) and transition zone (TZNL), right and left internal obturator muscle (RIOM, LIOM), and the urinary bladder were calculated. Different ADC ratios were calculated as mADC/reference. Clinically significant PCa (sPC) was defined as Gleason Grade Group≥2. Independent t-test was used to differentiate the ADC metrics between sPC and non-sPC. Receiver operating characteristics (ROC), and the DeLong test was used to assess the differences of the area under the curve (AUC, 95%-CI).

Results:

392 lesions (302 in the peripheral zone) found in 253 men were included in the final study cohort. ADC metrics except ADC ratio (RIOM,LIOM) (p=0.43 and 0.53) showed a statistically significant difference between sPC and non-sPC (P<0.01). mADC showed the highest ROC-AUC of 0.67([0.61;0.72] ),followed by ADC ratio PZNL with ROC-AUC of 0.66([0.60;0.71]) while, e.g. ADC ratio TZNL had ROC-AUC of 0.60 ([0.54;0.66]) which was significantly lower compared to mADC (p=0.002).

Conclusion:

A highly standardised single-scanner ADC measurement could not be improved upon using any of the ADC ratio parameters.

Limitations:

ADC ratios may still be advantageous when comparing data from multiple scanners and institutions.

Ethics committee approval

The institutional ethics committee approved the study and waived written informed consent (S-156/2018).

Funding:

No funding was received for this work.

Purpose:

To retrospectively evaluate the mid-term outcomes of percutaneous radio-frequency ablation (RFA) with multitined expandable electrodes externally cooled with saline solution in patients with T1 renal cell carcinoma (RCC).

Methods and materials:

In this retrospective study, we evaluated 53 RCC in 47 patients treated with CT-guided RFA in 56 procedures (2015-2019). All patients were staged T1, N0, M0 prior to RFA. Mean tumour size was 23.79 mm. A 4-tined expandable RFA electrode cooled with pump-circulating saline was used. Efficacy was evaluated verifying complete tumour necrosis (no contrast enhancement on imaging) at the end of the procedure and on subsequent controls. Follow-up observation period was 5 years. Minor/major complications, hospitalization days, serum creatinine before-after RFA (compared using paired t-test) and pain (evaluated with NRS) were considered as safety indicators. Overall survival was also calculated (Kaplan-Meier method).

Results:

Of 47 patients, 40/47 had 1 treatment (primary effectiveness rate 87,5%), 5/47 had 2 treatments and 1/47 had 3 treatments for residual disease, 1/47 had 3 treatments for multiple RCC. There were no relapses, no mid-long term complications; 5 minor (8,9%) and 1 major (1,7%) complications during the perioperative period were reported. Mean before and after RFA serum creatinine rates were respectively 1.08 mg/dl and 1.11 mg/dl (p-value: 0.4117). NRS median value: 0.8. Hospitalisation days median value: [2.8 ± 1.9] days. 91,4 % of all patients survived, with a median overall survival time of 65 months.

Conclusion:

Mid-term results show that CT-guided RFA with multitined expandable electrodes externally cooled with saline solution is an effective and safe treatment in patients with RCC staged T1N0M0. Data reported in our study are in line with data reported in the literature from patients treated with other devices.

Limitations:

This is a monocentric study, observing few cases.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

Patients with ADPKD (autosomal dominant polycystic kidney disease) show a progression disease hard to predict with common prognosis factors. We know the gradual expansion of the cysts increases the renal volume. A prognostic classification based on the renal volume measured with magnetic resonance imaging (MRI) corrected for height and age (HtTKV, height-adjusted total kidney volume) was developed. The proposed classification defines 5 classes (from A to E) of patients with a different risk of GFR decline based on renal growth rate and annual GFR reduction.

Methods and materials:

25 patients (age 24-57) with ADPKD (14F / 11M) were followed clinically and radiologically with abdominal MRI (GE 1.5T, T1, T2, DWI). The MRI was used to calculate HtTKV. The renal volume was calculated by the Mayo clinic's web-based programme and MRI images by an algorithm based on the ellipsoid equation (π / 6xLxWxD), 4 major measurements (L,W,D,coronal, sagittal ,axial sequences), then correlating these values to the patient's age and height, GFR, we obtained the patient class.

Results:

The GFR range was (12-128) and the HtTKV (230 and 2078 mL/m). The patients were divided in 5 classes (4 class A, 7 B, 6 C, 5 D, 3 E). Patients in class A had normal value, 1/7 class B (GFR <60 ml / min / 1.73m2), class C: 4/6 (GFR <60 ml / min / 1.73m2).

Conclusion:

Our study shows the utility of renal MRI-based volume in patients with ADPKD to analyse prediction factors.

Limitations:

This study was limited by the number of patients due to a rare genetic disease.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

68Ga-PSMA PET/CT is being increasingly used for prostate cancer recurrence identification, however, the detection rate among patients varies from 66% to 85%. The aim of our study was to analyse the influence of several variables on the detection rate, some of them with possible influence on PSMA expression.

Methods and materials:

This was a retrospective study of 312 men with biochemical failure after radical prostatectomy or radiation therapy, with or without ongoing androgen deprivation therapy (ADT), who received a 68Ga-PSMA PET/CT between 05/2018 and 08/2019. The goal was to determine the relationship among pre-scan PSA level, PSA doubling time, PSA velocity, Gleason score, ADT and the probability of identifying PSMA-avid disease. For statistical analysis, a p-value of <0.05 was considered statistically significant. Univariate and multivariate logistic regression analysis was applied.

Results:

In 77% of patients, at least a single lesion with characteristics suggestive of recurrent PCa was detected. A positive 68Ga-PSMA PET/CT scan was associated with PSA doubling time and ADT.

Conclusion:

We think that blockade of androgen receptor (AR) signalling oncogenic pathway activates phosphoinositide 3-kinase (PI3K) pathway, which leads to rapid PSA increasing and PSMA overexpression. So, in a patient with ADT we can detect a very small amount of tumour cells. But AR and PI3K signalling pathways have the reciprocal negative feedback loop, so activated AR inhibits PSMA expression. Therefore, patients without ongoing ADT have less PSMA on tumour cells, and detection thereof using a PSMA-ligand requires more tumour volume. Probably due to this fact we miss small tumour lesions in patients with low PSA values and without ongoing ADT using 68Ga-PSMA PET/CT.

Limitations:

Not all variables were available for all patient.

Ethics committee approval

Written informed consent was obtained.

Funding:

Purpose:

To (1) assess the ability of MRI to identify the normal female pelvic floor structures, (2) compare the changes between normal individuals and symptomatic patients, (3) ascertain the utility of MR-defecography in a subset of patients with posterior compartment symptoms.

Methods and materials:

30 women (age>40 years) each in symptomatic (S) and asymptomatic (AS) group. 16 patients from S-group with posterior compartment symptoms, referred for MR-defecography were labelled as defecography (D) group. Imaging was done in four phases - at rest, pelvic-floor contraction, straining, and defecation. Parameters studied were pubococcygeal line (PCL), H-line, M-line, Levator-Plate (LP) angle, anorectal (ARA) angle, levator-hiatus width and puborectalis-sling thickness on both sides. The descent of the bladder-base, anterior-cervical lip and anorectal junction below the PCL was recorded along with the presence of any other pathology. Statistical analysis was done using SPSSv16.

Results:

MRI was able to define important pelvic floor structures in the majority of participants. The best visualised urethral ligament was periurethral ligament. There was a significant difference in H-line (p=0.040), M-line (p=0.001), LPA (p<0.000), the position of bladder-base and anorectal junction - between S and AS-group. The difference in anorectal angle and position of the anterior-cervical lip was not found to be statistically significant. All the above parameters significantly changed in defecation phase. In D group (n=16), defecation phase revealed 14 rectoceles, 10 cystoceles, 5 peritoneoceles, 4 enteroceles and 7 uterine/vaginal vault prolapse. None of these findings were present at rest. Two cases each of pelvic floor dyssynergia and descending perineal syndrome and four cases of intrarectal intussusception were also seen.

Conclusion:

MR-defecography provides a non-invasive, accurate evaluation of the morphology and function of the structures involved in pelvic floor dynamics. It is able to reveal multi-compartment abnormalities which makes it an important adjunct to the surgical work-up of patients with pelvic floor disorders.

Limitations:

This study was limited by small sample size.

Ethics committee approval

The ethics committee approval was taken.

Funding:

No funding was received for this work.

Purpose:

The aim of this study was to assess the effectiveness of 3T MRI in the detection of peritoneal carcinomatosis from ovarian cancer using intraoperative findings as a reference.

Methods and materials:

25 patients diagnosed with ovarian cancer, aged between 35 and 69 (mean age - 54), underwent MRI examinations at our institution between March 2017 and November 2018. The inclusion criteria were: pathologically confirmed diagnosis of ovarian cancer, preoperative 3T MRI examination performed at our institution, potentially resectable peritoneal metastases, eligibility to cytoreductive surgery (CRS, potentially followed by HIPEC procedure). The examinations were performed using a 3T MRI scanner. The MRI protocol included T1W-sequences (coronal and axial) before and after administration of gadolinium-based contrast agent, T2W-sequences (coronal and axial) and axial DWI/ADC scans. The patients underwent surgical exploration of the peritoneal cavity and the findings were reported according to PCI-scale (Peritoneal Carcinomatosis Index). The studies were retrospectively analysed by an experienced radiologist with a special interest in urogenital radiology and PCI scores were assigned and compared region to region to the results of the surgical evaluation.

Results:

The overall sensitivity and the overall specificity of MRI were 60,00% and 73.94, respectively. MRI proved to be the most sensitive in region 6 (pelvis, 91,67%), 1 (right upper region, 83,33%) and 4 (left flank, 72,73%), whereas the lowest sensitivity was noted in small bowel and small bowel mesentery (regions 9- 25%, 10- 37.50%, 11- 25% and 12 - 42.86%).

Conclusion:

The preoperative 3T MRI proved to be moderately effective, yet still useful, in the detection of peritoneal carcinomatosis from ovarian cancer.

Limitations:

The limitations of this study were: retrospective design, relatively small sample.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

Improving the efficiency of diagnostics of cystocele and stress urinary incontinence (SUI) using methods of diagnostic radiology.

Methods and materials:

A comprehensive examination of the data of 73 patients with genital prolapse (GP) with the help of a modified Pad-test and MRI.

Results:

We modified the well-known Pad-test by intravenous injecting of solution of indigocarmine and an iodine-containing contrast preparation. After the test, a visual assessment of the sanitary pad and it’s radiography was done. The main advantage of the modification is the ability to visually confirm the fact of involuntary loss of minimal volumes of urine by detecting the spot of indigocarmine on the sanitary pad and the contrast stain on the x-ray film of the pad after Pad-test. A colored spot on the pad and a contrasting shadow on the roentgenogram of the gasket is a documentary confirmation of the involuntary loss of the contents of the bladder – a sign of SUI. The procedure was used in 21 patients who suspected a minimal SUI. A positive Pad-test is a documentary confirmation of minimum volume SUI and an indication for MRI investigation. If, according to the results of static MRI, damage of the ligaments of the urethra and/or value of the urethral inclination angle (UIA) is more than 30º, a dynamic MRI needs to be done. At values of UIA according to the results of dynamic MRI over 35º, cystocele is diagnosed and classified.

Conclusion:

The modified Pad-test confirms and documents the minimum SUI. An MRI of the pelvis detects and documents all cases of the presence of SUI in women with GP, allows for an objective diagnosis of the cystocele.

Limitations:

No limitations identified.

Ethics committee approval

The positive decision of the ethics committee obtained.

Funding:

No funding was received for this work.