Progressive Sarcopenia in Patients With Colorectal Cancer Predicts Survival.

OBJECTIVE: The purpose of this study was to evaluate the relationship between sarcopenia and overall and progression-free survival in patients with colorectal cancer. MATERIALS AND METHODS: This study was retrospective and complied with HIPAA. Patients with colorectal cancer who underwent CT at the time of and 6-18 months after diagnosis were included. Patients were followed for at least 5 years after diagnosis. Skeletal muscle index (SMI) and mean muscle attenuation of the psoas and paraspinal muscles at the L4 level determined the degree of sarcopenia. Composite measurements combining psoas and paraspinal muscles (total muscle) were also obtained. Univariate and multivariate Cox proportional hazard analysis was performed to evaluate the association between survival and changes in SMI and changes in attenuation. Kaplan-Meier analysis was also performed. RESULTS: A total of 101 patients were included (mean age ± SD, 63.7 ± 13.7 years; 68 men, 33 women). The hazard ratios for overall survival were 2.27, 1.68, and 1.54 for changes in SMI of the psoas muscle, paraspinal muscle, and total muscle (all p < 0.05). The hazard ratios for overall survival were 1.14, 1.18, and 1.24 for changes in attenuation of the psoas muscle, paraspinal muscle, and total muscle, respectively (all p < 0.05). The hazard ratios for progression-free survival were 1.33, 1.41, and 1.23 for changes in SMI of the psoas muscle, paraspinal muscle, and total muscle (not statistically significant). The hazard ratios for progression-free survival were 1.10, 1.21, and 1.23 for changes in attenuation of the psoas muscle, paraspinal muscle, and total muscle, respectively (p < 0.05). Kaplan-Meier analysis showed significant differences in overall and progression-free survival based on sex-specific quartiles of muscle quantity and quality. CONCLUSION: Progressive sarcopenia after diagnosis of colorectal cancer has a significant negative prognostic association with overall and progression-free survival.

Safety of omitting routine bleeding tests prior to image-guided musculoskeletal core needle biopsy.

PURPOSE: To evaluate the safety of withholding preprocedure international normalized ratio (INR) and platelet testing in patients undergoing musculoskeletal (MSK) core needle biopsy (CNB). MATERIAL AND METHODS: Initially, a retrospective review of 1,162 consecutive patients undergoing MSK CNB with preprocedural INR and platelet testing was performed. Clinical (age, gender, bleeding disorder, liver disease, anticoagulation use, INR > 2, platelet count <50,000/ul) and biopsy factors (imaging modality, lesion type, biopsy needle gauge, number biopsy samples) were tested for association with bleeding complications. During the second phase, an additional 188 biopsies performed without preprocedural coagulation testing were studied. Categorical variables were compared using Chi-squared or Fisher's exact tests, continuous variables with a student t-test. Multivariate analysis was performed using logistic regression. RESULTS: In the first phase, there was a complication rate of 2.6%, 30/1162. Of the 11 clinical and biopsy factors, soft tissue lesions (p = 0.029) and lesions biopsied under ultrasound (p = 0.048) had a higher rate of bleeding than bone lesions or lesions biopsied under CT, respectively. Only three patients had an INR >2, 0.3% (3/1162) and only four patients had platelet count <50,000/ul, 0.3% (4/1162). No patient with a bleeding complication had an abnormal preprocedure bleeding test. In the second phase, there was a bleeding complication rate of 1.1% (2/188). CONCLUSION: Bleeding complications from MSK biopsy are low, even when preprocedure coagulation testing is omitted.

Effect of sarcopenia on clinical and surgical outcome in elderly patients with proximal femur fractures.

PURPOSE: To investigate the relationship between sarcopenia with short-term surgical outcome in elderly patients with proximal femur fractures. METHODS AND MATERIALS: Following Institutional Review Board approval, a database of patients receiving a pelvis CT scan for acute trauma between January 2000-August 2016 was screened for an isolated proximal femur fracture. Patients were excluded if they were: < 50 years old, had conditions predisposing to sarcopenia (renal failure, congestive heart failure, muscular dystrophies), had undergone no surgical treatment, had other major traumatic injuries, or had a pathologic femur fracture. The paraspinal muscle density (PSD) at the L4 level was measured in Hounsfield units. The skeletal muscle index (SMI) was measured as the total skeletal muscle area at L4 divided by patient height.2 PSD and SMI were tested for association with surgical outcome measures: length of hospital stay, perioperative mortality, medical complications, in-hospital blood transfusion volume, and 90-day readmission rate, using multiple variable regression analysis. Pearson correlation of PSD and SMI was performed. RESULTS: Controlling for age, gender, body mass index (BMI), and fracture type, low PSD and SMI were both independently associated with longer length of hospitalization (p = 0.008 and p = 0.032, respectively). Low PSD was associated with a higher amount of blood transfusion volume during the perioperative period (p = 0.004). Pearson correlation revealed moderate positive correlation between the SMI and PSD (r = 0.579, p < 0.001). CONCLUSION: In proximal femur fractures, elderly patients with sarcopenia are more likely to have prolonged hospitalization following surgery and require more blood transfusion volume during the perioperative period.

JOURNAL CLUB: Utility of Repeat Core Needle Biopsy of Musculoskeletal Lesions With Initially Nondiagnostic Findings.

OBJECTIVE: The purpose of the present study is to assess the utility of repeat image-guided core needle biopsy (CNB) of musculoskeletal lesions in the setting of initially nondiagnostic CNB findings. MATERIALS AND METHODS: A retrospective review was conducted of 1302 consecutive CNBs performed on bone or soft-tissue lesions at a single institution. Pediatric cases and spine lesions were not included. All cases for which a repeat biopsy of the same lesion was performed because biopsy results were nondiagnostic were included in the study. Tumor characteristics, such as lesion size and type (i.e., bone vs soft tissue), were correlated with the diagnostic yield on repeat biopsy. Technical factors, including the modality used, the number of passes performed, the gauge of the biopsy device, the time between biopsies, the radiologist performing the procedure, and the portion of the lesion biopsied, were also correlated. RESULTS: Twenty-six of the 1302 CNBs (2.0%) performed had been referred for repeat biopsy. A diagnosis was obtained for 10 of these 26 cases (38.5%) after repeat CNB. For five of the cases (19.2%), repeat CNB yielded a diagnosis of malignancy. Overall, 11 cases ultimately had histologic findings indicating malignancy, and five of these cases (45.4%) had diagnostic findings after rebiopsy. Of the 14 cases that were found to be benign, five (35.7%) had diagnostic findings after rebiopsy. One case was lost to follow-up. A statistically significant difference in the diagnostic yield was found in association with an increase in the number of passes (p = 0.047) and an increase in time (p = 0.020) between biopsies. CONCLUSION: Repeat CNB of musculoskeletal lesions with initially nondiagnostic biopsy findings can be useful. Increasing the number of passes on the second biopsy attempt is recommended.

The Extensor Mechanism: Imaging and Intervention.

We present an overview of imaging and intervention of the extensor mechanism of the knee. Particular focus is placed on the evaluation of patellofemoral tracking disorders, patellar and quadriceps tendinosis and tears, patellar fracture, lateral patellar condyle patellar friction syndrome, and prepatellar bursitis. Anatomical and biomechanical factors contributing to these disorders are considered. Imaging evaluation is presented in a clinical context, and therapeutic options for these disorders are discussed. Image-guided therapy options for symptomatic patellar tendinosis are also described and illustrated.

Comparison of Battery-Powered and Manual Bone Biopsy Systems for Core Needle Biopsy of Sclerotic Bone Lesions.

OBJECTIVE: The purpose of this study was to compare manual and battery-powered bone biopsy systems for diagnostic yield and procedural factors during core needle biopsy of sclerotic bone lesions. MATERIALS AND METHODS: A total of 155 consecutive CT-guided core needle biopsies of sclerotic bone lesions were performed at one institution from January 2006 to November 2014. Before March 2012, lesions were biopsied with manual bone drill systems. After March 2012, most biopsies were performed with a battery-powered system and either noncoaxial or coaxial biopsy needles. Diagnostic yield, crush artifact, CT procedure time, procedure radiation dose, conscious sedation dose, and complications were compared between the manual and battery-powered core needle biopsy systems by Fisher exact test and t test. One-way ANOVA was used for subgroup analysis of the two battery-powered systems for procedure time and radiation dose. RESULTS: The diagnostic yield for all sclerotic lesions was 60.0% (93/155) and was significantly higher with the battery-powered system (73.0% [27/37]) than with the manual systems (55.9% [66/118]) (p = 0.047). There was no significant difference between the two systems in terms of crush artifact, procedure time, radiation dose, conscious sedation administered, or complications. In subgroup analysis, the coaxial battery-powered biopsies had shorter procedure times (p = 0.01) and lower radiation doses (p = 0.002) than the coaxial manual systems, but the noncoaxial battery-powered biopsies had longer average procedure times and higher radiation doses than the coaxial manual systems. CONCLUSION: In biopsy of sclerotic bone lesions, use of a battery-powered bone drill system improves diagnostic yield over use of a manual system.

Cystic Fibrosis below the Diaphragm: Abdominal Findings in Adult Patients.

Cystic fibrosis (CF) is the most common lethal autosomal recessive disease in the white population. Mutation of the CF transmembrane conductance regulator gene on chromosome 7 results in production of abnormally viscous mucus and secretions in the lungs of patients with CF. A similar pathologic process occurs in the gastrointestinal tract, pancreas, and hepatobiliary system. Inspissated mucus causes luminal obstruction and resultant clinical and radiologic complications associated with the disease process. Pancreatic involvement can result in exocrine and endocrine insufficiency, pancreatic atrophy, fatty replacement, or lipomatous pseudohypertrophy. Acute and chronic pancreatitis, pancreatic calcification, cysts, and cystosis also occur. Hepatic manifestations include hepatic steatosis, focal biliary and multilobular cirrhosis, and portal hypertension. Biliary complications include cholelithiasis, microgallbladder, and sclerosing cholangitis. The entire digestive tract can be involved. Distal ileal obstruction syndrome, intussusception, appendicitis, chronic constipation, colonic wall thickening, fibrosing colonopathy, pneumatosis intestinalis, gastroesophageal reflux, and peptic ulcer disease have been described. Renal manifestations include nephrolithiasis and secondary amyloidosis. The educational objectives of this review are to reveal the abdominal manifestations of CF to facilitate focused analysis of cross-sectional imaging in adult patients. Life expectancy in patients with CF continues to improve because of a combination of aggressive antibiotic treatment, improved emphasis on nutrition and physiotherapy, and development of promising new CF transmembrane conductance regulator modulators. As lung function and survival improve, extrapulmonary conditions, including hepatic and gastrointestinal malignancy, will be an increasing cause of morbidity and mortality. Awareness of the expected abdominal manifestations of CF may assist radiologists in identifying acute inflammatory or neoplastic conditions. (©)RSNA, 2015.

Femoral head avascular necrosis: a frequently missed incidental finding on multidetector CT.

AIM: To determine the incidence of missed femoral head avascular necrosis (AVN) on pelvic computed tomography (CT) performed for clinical indications other than assessment for AVN. MATERIALS AND METHODS: The study was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. The picture archiving and communication system (PACS) database was queried for patients with diagnosis of femoral head AVN on magnetic resonance imaging (MRI), who also underwent pelvic multidetector CT after or <30 days before the MRI examination. The MRI and CT images of 144 hips of 72 patients (39 patients with reported AVN on MRI and 33 age-matched controls; mean age = 60 years, 28 male, 44 female), were reviewed in consensus by two readers in a randomized, blinded manner. Using MRI-proven CT-visible AVN as a reference standard, the incidence of missed AVN on initial CT interpretation was determined. RESULTS: Readers confirmed AVN in 33 patients on the MRI images. Nine hips with AVN underwent joint replacement of the affected joint(s) prior to subsequent CT and were excluded. Forty-three MRI-proven AVN cases in 28 patients (15 bilateral, 13 unilateral) were available for analysis. The study readers diagnosed 35/43 (81%) MRI-proven AVN cases in 22/28 (79%) patients. Four of the 35 (11%) cases of MRI-proven, CT-visible AVN were prospectively reported in 3/22 (14%) patients at initial clinical interpretation, with a miss rate of 89% per hip and 86% per patient. CONCLUSION: Multidetector CT has high accuracy for detection of AVN; however, this is frequently missed as an incidental finding (89% missed in the present study). Assessment for signs of femoral AVN should be part of routine search pattern in interpretation of pelvic CT.

Automated computer-derived prostate volumes from MR imaging data: comparison with radiologist-derived MR imaging and pathologic specimen volumes.

PURPOSE: To compare prostate gland volume (PV) estimation of automated computer-generated multifeature active shape models (MFAs) performed with 3-T magnetic resonance (MR) imaging with that of other methods of PV assessment, with pathologic specimens as the reference standard. MATERIALS AND METHODS: All subjects provided written informed consent for this HIPAA-compliant and institutional review board-approved study. Freshly weighed prostatectomy specimens from 91 patients (mean age, 59 years; range, 42-84 years) served as the reference standard. PVs were manually calculated by two independent readers from MR images by using the standard ellipsoid formula. Planimetry PV was calculated from gland areas generated by two independent investigators by using manually drawn regions of interest. Computer-automated assessment of PV with an MFA was determined by the aggregate computer-calculated prostate area over the range of axial T2-weighted prostate MR images. Linear regression, linear mixed-effects models, concordance correlation coefficients, and Bland-Altman limits of agreement were used to compare volume estimation methods. RESULTS: MFA-derived PVs had the best correlation with pathologic specimen PVs (slope, 0.888). Planimetry derived volumes produced slopes of 0.864 and 0.804 for two independent readers when compared with specimen PVs. Ellipsoid formula-derived PVs had slopes closest to one when compared with planimetry PVs. Manual MR imaging and MFA PV estimates had high concordance correlation coefficients with pathologic specimens. CONCLUSION: MFAs with axial T2-weighted MR imaging provided an automated and efficient tool with which to assess PV. Both MFAs and MR imaging planimetry require adjustments for optimized PV accuracy when compared with prostatectomy specimens.

High-resolution proton density weighted three-dimensional fast spin echo (3D-FSE) of the knee with IDEAL at 1.5 Tesla: comparison with 3D-FSE and 2D-FSE--initial experience.

PURPOSE: To assess the feasibility of combining three-dimensional fast spin echo (3D-FSE) and Iterative-decomposition-of water-and-fat-with-echo asymmetry-and-least-squares-estimation (IDEAL) at 1.5 Tesla (T), generating a high-resolution 3D isotropic proton density-weighted image set with and without "fat-suppression" (FS) in a single acquisition, and to compare with 2D-FSE and 3D-FSE (without IDEAL). MATERIALS AND METHODS: Ten asymptomatic volunteers prospectively underwent sagittal 3D-FSE-IDEAL, 3D-FSE, and 2D-FSE sequences at 1.5T (slice thickness [ST]: 0.8 mm, 0.8 mm, and 3.5 mm, respectively). 3D-FSE and 2D-FSE were repeated with frequency-selective FS. Fluid, cartilage, and muscle signal-to-noise ratio (SNR) and fluid-cartilage contrast-to-noise ratio (CNR) were compared among sequences. Three blinded reviewers independently scored quality of menisci/cartilage depiction for all sequences. "Fat-suppression" was qualitatively scored and compared among sequences. RESULTS: 3D-FSE-IDEAL fluid-cartilage CNR was higher than in 2D-FSE (P < 0.05), not different from 3D-FSE (P = 0.31). There was no significant difference in fluid SNR among sequences. 2D-FSE cartilage SNR was higher than in 3D FSE-IDEAL (P < 0.05), not different to 3D-FSE (P = 0.059). 2D-FSE muscle SNR was higher than in 3D-FSE-IDEAL (P < 0.05) and 3D-FSE (P < 0.05). Good or excellent depiction of menisci/cartilage was achieved using 3D-FSE-IDEAL in the acquired sagittal and reformatted planes. Excellent, homogeneous "fat-suppression" was achieved using 3D-FSE-IDEAL, superior to FS-3D-FSE and FS-2D-FSE (P < 0.05). CONCLUSION: 3D FSE-IDEAL is a feasible approach to acquire multiplanar images of diagnostic quality, both with and without homogeneous "fat-suppression" from a single acquisition.

Lymphatic metastases from pelvic tumors: anatomic classification, characterization, and staging.

The spread of pelvic tumors to lymph nodes is an important means of tumor dissemination. Nodal metastases have important management and prognostic impact. Pelvic tumors usually metastasize first to regional lymph nodes, which are specific groups of nodes for each tumor, and are classified according to the TNM system as N-stage disease. If a pelvic tumor spreads to a lymph node outside of the defined regional nodes, this is considered M-stage disease, which usually results in upstaging of the disease to overall stage IV cancer and may potentially affect the patient's treatment options. Knowledge of the regional nodal spread of each tumor is essential in formulating effective search strategies for cross-sectional imaging studies performed for staging. Also important is correct description of the nomenclature of nodal metastases to facilitate proper staging. In this review, the patterns of regional nodal spread and N-stage classification are presented for carcinomas of the anus, bladder, cervix, endometrium, ovary, penis, prostate, rectum, testis, vagina, and vulva. Pelvic lymph node anatomy and nomenclature are reviewed with schematic illustrations and clinical examples from patients with pelvic tumors.

MR imaging of scrotal tumors and pseudotumors.

Magnetic resonance (MR) imaging is an important imaging technique in the evaluation of scrotal masses, providing a useful adjunct to ultrasonography (US). Although US is the modality of choice for initial evaluation of scrotal pathologic conditions because of its wide availability, low cost, and high sensitivity for detection of testicular and paratesticular disease processes, US findings may occasionally be inconclusive. MR imaging may provide additional information in these cases, often affecting patient management. This article reviews and illustrates the MR imaging features of solid extratesticular and intratesticular benign and malignant scrotal tumors, as well as nonneoplastic lesions that can mimic neoplasia. Normal scrotal MR anatomic features and optimal MR imaging technique are also presented.

Case report: Longitudinal stress fracture of the humerus: imaging features and pitfalls.

Longitudinal stress fractures are an uncommon injury in which a diaphyseal fracture line occurs parallel to the long axis of a bone in the absence of direct trauma. They have been described in the tibia and less commonly in the femur but apparently not in the upper limb. We report a longitudinal stress fracture occurring in the humerus of a 62-year-old woman who had a history of osteoporosis and had undergone recent surgery of the contralateral wrist. We present the radiographic, MRI, and CT features of the case and emphasize the difficulties in diagnosis caused by negative findings on early radiographs and by nonspecific bone marrow edema pattern on MRI. The risk of a contralateral upper extremity stress fracture from activities of daily living in a patient with osteoporosis whose other upper extremity is immobilized also is highlighted.

The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of malignant common bile duct strictures: a critically appraised topic.

BACKGROUND: The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the investigation of malignant common bile duct (CD) strictures were evaluated using "evidence-based practice" (EBP) methodology. METHODS: A focused clinical question was constructed. A structured search of primary and secondary evidence was performed. Retrieved studies were appraised for validity, strength and level of evidence (Oxford/CEBM scale: 1-5). RESULTS: Three studies were eligible for inclusion; there were 2 level 3b and 1 level 4 papers. One paper included a patient group appropriate to the question and contained sufficient data to allow analysis. Sensitivity and specificity of MRCP and EUS were (90%, 65%) and (80%, 80%), respectively. CONCLUSION: In the diagnosis of malignant CD strictures, EUS is more specific than MRCP and may allow cytology to be obtained via a trans-duodenal approach. A multi modality imaging approach is recommended.

The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of common bile duct calculi: a critically appraised topic.

INTRODUCTION: The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the investigation of common bile duct (CD) calculi were evaluated using "evidence-based practice" (EBP) methods. METHODS: A focused clinical question was constructed. A structured search of primary and secondary evidence was performed. Retrieved studies were appraised for validity, strength and level of evidence (Oxford/CEBM scale: 1-5). Retrieved literature was divided into group A; MRCP slice thickness >or=5 mm, group B; MRCP slice thickness = 3 mm or 3D-MRCP sequences. RESULTS: Six studies were eligible for inclusion (3 = level 1b, 3 = level 3b). Group A: sensitivity and specificity of MRCP and EUS were (40%, 96%) and (80%, 95%), respectively. Group B: sensitivity and specificity of MRCP and EUS were (87%, 95%) and (90%, 99%), respectively. CONCLUSION: MRCP should be the first-line investigation for CD calculi and EUS should be performed when MRCP is negative in patients with moderate or high pre-test probability.

Magnetic resonance imaging in locoregional staging of rectal adenocarcinoma.

A comprehensive overview of the current status of magnetic resonance imaging (MRI) in the locoregional assessment and management of rectal adenocarcinoma is presented. Staging systems for rectal cancer and treatment strategies in its management are discussed to give the reader the context that shapes MRI acquisition techniques and interpretation. Findings on MRI are detailed and their accuracy reviewed based on currently available evidence. Optimization of MRI acquisition and relevant pelvic anatomy are reviewed. A detailed description of our approach in interpreting MRI for locoregional staging of rectal cancer is given and future directions are also introduced.

Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain.

PURPOSE: To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients. METHOD AND MATERIALS: Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting. The frontal chest radiograph and dedicated rib series were sequentially reviewed in consensus by two fellowship-trained musculoskeletal radiologists blinded to the initial report. The consensus interpretation of the dedicated rib series was used as the gold standard. Multiple variable logistic regression analysis assessed clinical and radiological factors associated with rib fractures. Fisher exact test was used to assess differences in medical treatment between the 2 groups. RESULTS: Of the 339 patients, 53 (15.6%) had at least 1 rib fracture. Only 20 of the 53 (37.7%) patients' fractures could be identified on the frontal chest radiograph. The frontal chest radiograph had a sensitivity of 38% and specificity of 100% when using the rib series as the reference standard. No pneumothorax, new mediastinal widening or pulmonary contusion was identified. Multiple variable logistic regression analysis of clinical factors associated with the presence of rib fractures revealed a significant association of trauma history (odds ratio 5.7 [p < 0.05]) and age ≥40 (odds radio 3.1 [p < 0.05]). Multiple variable logistic regression analysis of radiographic factors associated with rib fractures in this population demonstrated a significant association of pleural effusion with rib fractures (odds ratio 18.9 [p < 0.05]). Patients with rib fractures received narcotic analgesia in 47.2% of the cases, significantly more than those without rib fractures (21.3%, p < 0.05). None of the patients required hospitalization. CONCLUSION: In the stable outpatient setting, rib fractures have a higher association with a history of minor trauma and age ≥40 in the adult population. Radiographic findings associated with rib fractures include pleural effusion. The frontal chest radiograph alone has low sensitivity in detecting rib fractures. The dedicated rib series detected a greater number of rib fractures. Although no patients required hospitalization, those with rib fractures were more likely to receive narcotic analgesia.

Oxygen tolerance of an implantable polymer/enzyme composite glutamate biosensor displaying polycation-enhanced substrate sensitivity.

Biosensors were fabricated at neutral pH by sequentially depositing the polycation polyethyleneimine (PEI), the stereoselective enzyme L-glutamate oxidase (GluOx) and the permselective barrier poly-ortho-phenylenediamine (PPD) onto 125-microm diameter Pt wire electrodes (Pt/PEI/GluOx/PPD). These devices were calibrated amperometrically at 0.7 V versus SCE to determine the Michaelis-Menten parameters for enzyme substrate, l-glutamate (Glu) and co-substrate, dioxygen. The presence of PEI produced a 10-fold enhancement in the detection limit for Glu (approximately 20 nM) compared with the corresponding PEI-free configurations (Pt/GluOx/PPD), without undermining their fast response time (approximately 2 s). Most remarkable was the finding that, although some designs of PEI-containing biosensors showed a 10-fold increase in linear region sensitivity to Glu, their oxygen dependence remained low.

Diagnostic yield of percutaneous biopsy for sclerotic bone lesions: Influence of mean Hounsfield units.

PURPOSE: To identify whether there was an association between Hounsfield units of sclerotic bone lesions and diagnostic yield of biopsy. METHOD: All core needle biopsies of sclerotic bone lesion were identified from a database. Pathology reports were reviewed to determine whether the biopsy was diagnostic or non-diagnostic. RESULTS: 91 patients were included in the study group. The yield for lesions with mean HU≥500 was significantly lower than those with a mean HU≤500 (40% vs. 69.6%, p<0.05). CONCLUSION: Lesions with a mean HU>500 are more likely to have a non-diagnostic biopsy than a diagnostic biopsy.

MRI-directed cognitive fusion-guided biopsy of the anterior prostate tumors.

PURPOSE: We aimed to evaluate the efficacy of magnetic resonance imaging (MRI)-directed cognitive fusion transrectal ultrasonography (TRUS)-guided anterior prostate biopsy for diagnosis of anterior prostate tumors and to illustrate this technique. METHODS: A total of 39 patients with previous negative TRUS biopsy, but high clinical suspicion of occult prostate cancer, prospectively underwent prostate MRI including diffusion-weighted imaging (DWI). Patients with a suspicious anterior lesion on MRI underwent targeted anterior gland TRUS-guided biopsy with cognitive fusion technique using sagittal probe orientation. PIRADS version 1 scores (T2, DWI, and overall), lesion size, prostate-specific antigen (PSA), PSA density, and prostate gland volume were compared between positive and negative biopsy groups and between clinically significant cancer and remaining cases. Logistic regression analysis of imaging parameters and prostate cancer diagnosis was performed. RESULTS: Anterior gland prostate adenocarcinoma was diagnosed in 18 patients (46.2%) on targeted anterior gland TRUS-guided biopsy. Clinically significant prostate cancer was diagnosed in 13 patients (33.3%). MRI lesion size, T2, DWI, and overall PIRADS scores were significantly higher in patients with positive targeted biopsies and those with clinically significant cancer (P < 0.05). Biopsies were positive in 90%, 33%, and 29% of patients with overall PIRADS scores of 5, 4, and 3 respectively. Overall PIRADS score was an independent predictor of all prostate cancer diagnosis and of clinically significant prostate cancer diagnosis. CONCLUSION: Targeted anterior gland TRUS-guided biopsy with MRI-directed cognitive fusion enables accurate sampling and may improve tumor detection yield of anterior prostate cancer.