Correlation between brain cortex metabolic and perfusion functions in subjective idiopathic tinnitus.

OBJECTIVES: Subjective tinnitus has associated with abnormal brain metabolism and perfusion found in functional imaging studies by fluorodeoxyglucose (FDG) and technetium99m (TC99m). But there is no study evaluating the association of brain metabolism and perfusion abnormalities in a group of these subjects. The aim of this study was to investigate if there is any significant correlation between the brain perfusion and metabolism abnormalities in subjects with tinnitus. MATERIALS AND METHODS: In this cross-sectional study, 52 patients were undergone TC99m-ECD single photon emission computerized tomography (SPECT) scan and F18-FDG positron emission tomography (PET). The results of PET and SPECT scanning were fused with MRI to accurate anatomical localization of abnormalities. The analysis was performed using Kendal's correlation, t-test and chi square. RESULTS: Assessing these 52 tinnitus subjects (containing 42 males [76.4%]) showed that a significant correlation was found between the brain metabolic function and perfusion (p value 0.001).

PI-RADS Version 2 Is an Excellent Screening Tool for Clinically Significant Prostate Cancer as Designated by the Validated International Society of Urological Pathology Criteria: A Retrospective Analysis.

OBJECTIVES: To assess the utility of multiparametric MRI in detecting clinically significant prostate cancer (csPCa) by comparing PI-RADSv2 scores with International Society of Urological Pathology (ISUP) pathologic grading criteria. METHODS: Data from 137 patients were retrospectively analyzed. PI-RADSv2 scores were compared with pathologic grade using ISUP criteria. Pathologic grades were divided into clinically significant (groups 3-5) and clinically insignificant lesions (groups 1-2). Chi-squared analysis was performed for to assess correlation. RESULTS: Sensitivity and specificity of PI-RADSv2 score 3-5 lesions for detecting csPCa was 100% and 18.5%, respectively. Negative predictive value (NPV) is 100% for these lesions. When considering only PI-RADSv2 score 4-5 lesions, sensitivity decreases to 90% and specificity increases to 67.5%, with a NPV of 98.5%. When only PI-RADSv2 score 5 lesions are considered, sensitivity decreases to 50% and specificity increases to 90%, with a NPV of 95%. CONCLUSIONS: Multiparametric MRI has excellent sensitivity for detecting csPCa. Specificity is poor for PI-RADSv2 score 3 lesions but improves significantly for PI-RADSv2 score 4 and 5 lesions. Overall, mpMRI is an excellent screening tool for csPCa, as designated by the recently validated ISUP criteria. ADVANCES IN KNOWLEDGE: Multiple limitations of the longstanding Gleason pathologic scoring system have led to the development of new ISUP pathologic criteria, which is more focused on the clinical significance of lesions. There are currently insufficient studies evaluating and validating the ISUP criteria with PIRADS v2 evaluation of the prostate.

The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia.

BACKGROUND: The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding. OBJECTIVES: To determine the incidence of major bleeding in patients with suspected HIT. METHODS: We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT-) and exposure to an alternative anticoagulant (Tx+ or Tx-). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality. RESULTS: The incidence of major bleeding was high in the HIT+Tx+, HIT- Tx+, and HIT-Tx- groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P = .24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44-3.47), platelet count < 25 × 109 /L (HR 2.13, 1.10-4.12), and renal dysfunction (HR 1.56, 1.06-2.27); 35.7% of HIT+Tx+, 13.8% HIT-Tx+, and 9.3% of HIT-Tx- patients experienced new or progressive thrombosis. Mortality was similar among the three groups (26.2% HIT+Tx+, 34.5% HIT-Tx+, and 26.7% of HIT-Tx- [P = .34]). CONCLUSIONS: Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.

Utility of quantitative apparent diffusion coefficient measurements and normalized apparent diffusion coefficient ratios in the diagnosis of clinically significant peripheral zone prostate cancer.

OBJECTIVE: The aim of this study is to evaluate the utility of quantitative apparent diffusion coefficient (ADC) measurements and normalized ADC ratios in multiparametric MRI for the diagnosis of clinically significant peripheral zone (PZ) prostate cancer particularly among equivocally suspicious prostate lesions. METHODS: A retrospective analysis of 95 patients with PZ lesions by PI-RADSv2 criteria, and who underwent subsequent MRI-US fusion biopsy, was approved by an institutional review board. Two radiologists independently measured ADC values in regions of interest (ROIs) of PZ lesions and calculated normalized ADC ratio based on ROIs in the bladder lumen. Diagnostic performance was evaluated using ROC. Inter observer variability was assessed using intraclass correlation coefficient (ICC). RESULTS: Mean ADC and normalized ADC ratios for clinically significant and non-clinically significant lesions were 0.763 × 10-3 mm2 s-1, 29.8%; and 1.135 × 10-3 mm2 s-1, 47.2% (p < 0.001), respectively. Area under the ROC curve (AUC) was 0.880 [95% CI (0.816-0.944) and 0.885 (95% CI (0.814-0.955)] for ADC and ADC ratio, respectively. Optimal AUC threshold for ADC was 0.843 × 10-3 mm2 s-1 (Sn 70.5%, Sp 88.2%) and for normalized ADC was 33.1% (Sn 75.0%, Sp 95.7%). intraclass correlation coefficient was high at 0.889. CONCLUSION: Quantitative ADC measurement in PZ prostate lesions demonstrates excellent diagnostic performance in differentiating clinically significant from non-clinically significant prostate cancer with high inter observer correlation. Advances In knowledge: Quantitative ADC is presented as an additional method to evaluate lesions in mpMRI of the prostate. This technique may be incorporated in new and existing methods to improve detection and discrimination of clinically significant prostate cancer.

Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia.

The HIT Expert Probability (HEP) score compared favorably with the 4Ts score in a retrospective study. We assessed the diagnostic accuracy of the HEP score compared with the 4Ts score in a prospective cohort of 310 patients with suspected heparin-induced thrombocytopenia (HIT). A member of the clinical team calculated the HEP score and 4Ts score. An independent panel adjudicated HIT status based on a clinical summary as well as the results of HIT laboratory testing. The prevalence of HIT in the study population was 14.7%. At a cutoff of ≥3, the HEP score was 95.3% sensitive (95% confidence interval [CI], 84.2-99.4) and 35.7% specific (95% CI, 29.8-42.0) for HIT. A 4Ts score of ≥4 had a sensitivity of 97.7% (95% CI, 86.2-99.8) and specificity of 32.9% (95% CI, 27.2-39.1). The areas under the receiver operating characteristic (ROC) curves (AUCs) for the HEP score and 4Ts score were similar (0.81 [95% CI, 0.74-0.87] vs 0.76 [95% CI, 0.69-0.83]; P = .12). The HEP score exhibited a significantly higher AUC than the 4Ts score in patients in the intensive care unit (ICU) (0.86 vs 0.79; P = .03). Among trainee scorers, the HEP score performed significantly better than the 4Ts score (AUC, 0.80 vs 0.73; P = .03). Our data suggest that either the 4Ts score or the HEP score may be used in clinical practice. The HEP score may be preferable in ICU patients and among less experienced clinicians.

Personalized Management Approaches in Lymphoma: Utility of Fluorodeoxyglucose-PET Imaging.

PET/computed tomography (CT) imaging has gained a prominent role in the diagnosis and staging of malignancies. In lymphoma the role of PET/CT imaging continues to evolve as the understanding of its use in prognostication and response assessment improves. Currently, many groups are studying the potential function of PET/CT imaging in helping to direct management decisions for treating clinicians. This article summarizes the most up-to-date literature surrounding the topic of PET/CT-adaptive treatment of different lymphoma subjects. Although more studies are necessary to solidify the role of PET/CT, it is clear that this imaging modality holds much promise for the development of response-adaptive treatment algorithms in the future.