Characteristics of recurrent acute urinary retention in BPH patients in the United States: Retrospective analysis of US-based insurance claims database.

PURPOSE: The objective of this study is to analyze characteristics of recurrent acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH), utilizing a population based data set. Also, we sought to report on how AUR was treated, specifically regarding the need and length of catheterization and types of procedures utilized for mitigation. MATERIALS & METHODS: A retrospective observational cohort study was performed using Optum's deidentified Clinformatics® Data Mart Database. We compared two groups, BPH patients with AUR (n = 180,737) and BPH patients without AUR (n = 1,139,760) from January 1, 2003 to December 31, 2017. Also, we analyzed the factors affecting the development of multiple episodes of AUR through age-adjusted multivariate analysis. RESULTS: In contrast to the 47.7% of patients who had a single AUR episode, 33.5% of AUR patients developed 3 or more subsequent episodes of retention. For age matched patients, the risks of additional episodes of retention increase significantly with older age, Caucasian race, diabetes, neurologic conditions, or low income. Overall, the rate of BPH surgery in AUR patients over the study period decreased and the most common procedure was transurethral resection of the prostate. CONCLUSIONS: Risk factors for multiple episodes of AUR included age (60 and older), Caucasian race, lower income socioeconomic status, diabetes, and neurological disorders. Patients with a high probability of developing recurrent episodes of AUR are recommended to receive preemptive BPH medication before such AUR occurrences. Also, more expeditious surgical treatment should be considered rather than temporary catheterization when AUR occurs.

CT-based preoperative risk assessment of prolonged urine leak in patients undergoing partial nephrectomy.

OBJECTIVES: This study aims to evaluate risk factors of prolonged urine leak following partial nephrectomy (PN) to identify objective imaging characteristics on preoperative CT. METHODS: A total of 865 patients who underwent PN and had preoperative CT and postoperative imaging were included. We set a twofold size-matched control group without urine leak, with all tumors located ≤ 4 mm to the collecting system to identify imaging parameters that increase the risk of urine leak other than tumor size and location. Four CT parameters that show the relationship of the tumor and collecting system, namely, curvilinear border length, protruding distance, margin at the interface, and pelvicalyceal contact, were analyzed. Multivariate logistic regression analyses were performed to identify significant predictors of urine leak. The diagnostic performance of the significant parameters was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS: Fifty-three of 865 patients (6.1%) demonstrated urine leak. Compared with the control group, urine leak group showed longer curvilinear border length, longer protruding distance, frequent non-smooth contact interface, and frequent direct pelvicalyceal contact (p < 0.05 for all). In the multivariate analysis, pelvicalyceal contact was the independent predictor of urine leak (OR = 2.62; 95% C.I 1.02-6.63). Combining four CT parameters, an AUC of 0.70 with a sensitivity of 58.5% and a specificity of 79.2% for identifying urine leak after PN could be obtained. CONCLUSIONS: The four CT features that describe the relationship between the tumor and collecting system might be useful for evaluating the risk of urine leak before PN. KEY POINTS: • Four CT parameters (curvilinear border length, protruding distance, margin at the interface, and pelvicalyceal contact) were significantly associated with postoperative urine leak after partial nephrectomy. • A comprehensive preoperative imaging evaluation of the relationship between the tumor and renal sinus may help in selecting the optimal surgical options and afford better patient counseling of complication risk.

Fully automatic volume measurement of the adrenal gland on CT using deep learning to classify adrenal hyperplasia.

OBJECTIVES: To develop a fully automated deep learning model for adrenal segmentation and to evaluate its performance in classifying adrenal hyperplasia. METHODS: This retrospective study evaluated automated adrenal segmentation in 308 abdominal CT scans from 48 patients with adrenal hyperplasia and 260 patients with normal glands from 2010 to 2021 (mean age, 42 years; 156 women). The dataset was split into training, validation, and test sets at a ratio of 6:2:2. Contrast-enhanced CT images and manually drawn adrenal gland masks were used to develop a U-Net-based segmentation model. Predicted adrenal volumes were obtained by fivefold splitting of the dataset without overlapping the test set. Adrenal volumes and anthropometric parameters (height, weight, and sex) were utilized to develop an algorithm to classify adrenal hyperplasia, using multilayer perceptron, support vector classification, a random forest classifier, and a decision tree classifier. To measure the performance of the developed model, the dice coefficient and intraclass correlation coefficient (ICC) were used for segmentation, and area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used for classification. RESULTS: The model for segmenting adrenal glands achieved a Dice coefficient of 0.7009 for 308 cases and an ICC of 0.91 (95% CI, 0.90-0.93) for adrenal volume. The models for classifying hyperplasia had the following results: AUC, 0.98-0.99; accuracy, 0.948-0.961; sensitivity, 0.750-0.813; and specificity, 0.973-1.000. CONCLUSION: The proposed segmentation algorithm can accurately segment the adrenal glands on CT scans and may help clinicians identify possible cases of adrenal hyperplasia. KEY POINTS: • A deep learning segmentation method can accurately segment the adrenal gland, which is a small organ, on CT scans. • The machine learning algorithm to classify adrenal hyperplasia using adrenal volume and anthropometric parameters (height, weight, and sex) showed good performance. • The proposed segmentation algorithm may help clinicians identify possible cases of adrenal hyperplasia.

Prediction of acute rejection in renal allografts using shear-wave dispersion slope.

OBJECTIVES: To evaluate the role of shear-wave dispersion slope for predicting renal allograft dysfunction. METHODS: We retrospectively reviewed 128 kidney transplant recipients (median age, 55 years [interquartile range, 43-62 years]; male, 68) who underwent biopsy for allograft evaluation from November 2022 to February 2023. Cortex and renal sinus fat stiffness and shear-wave dispersion slope were obtained at shear-wave elastography (SWE). Cortex-to-sinus stiffness ratio (SR) and dispersion slope ratio (DSR)-related clinical and pathologic factors were evaluated using multivariable linear regression analysis. We conducted univariate and multivariate analyses for multiparametric ultrasound (US) parameters for identifying acute rejection and calculated the area under the receiver operating curve (AUC) values. RESULTS: Of 128 patients, 31 (24.2%) demonstrated acute rejection. The SR value did not differ between patient groups (1.21 vs. 1.20, p = 0.47). Patients with acute rejection demonstrated a higher DSR than those without rejection (1.4 vs. 1.21, p < 0.01). Interstitial fibrosis and tubular atrophy grade (IFTA; coefficient, 0.11/grade; p = 0.04) and renal transplant and biopsy interval (coefficient, 0.00007/day; p = 0.03) were SR determinant factors, whereas only IFTA grade (coefficient, 0.10/grade; p = 0.01) for DSR. Multivariate analysis revealed mean resistive index (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02-1.14, p = 0.01) and DSR value (OR 16.0, 95% CI 3.0-85.8, p = 0.001) as independent factors for predicting acute rejection. An AUC of 0.74 for detecting acute rejection was achieved by combining the resistive index and DSR value. CONCLUSION: Shear-wave dispersion slope obtained at SWE may help identify renal allograft dysfunction. CLINICAL RELEVANCE STATEMENT: Acute rejection in renal allografts is a major cause of allograft failure, but noninvasive diagnosis is a challenge. Shear-wave dispersion slope can identify acute rejection non-invasively. KEY POINTS: • The interstitial fibrosis and tubular atrophy grade was a determinant factor for stiffness ratio and shear-wave dispersion slope ratio between cortex and renal sinus fat. • Shear-wave dispersion slope ratio between cortex and renal sinus fat could identify acute rejection in renal allografts. • A shear-wave dispersion slope has a potential to reduce unnecessary renal biopsy for evaluating renal allografts.

Quantitative magnetic resonance imaging of chronic kidney disease: an experimental in vivo study using rat chronic kidney disease models.

BACKGROUND: Recent advances in magnetic resonance imaging (MRI) may allow it to be an alternative emerging tool for the non-invasive evaluation of renal parenchymal disease. PURPOSE: To validate the usefulness of quantitative multiparametric MRI protocols and suggest the suitable quantitative MR sequence protocol to evaluate parenchymal fibrosis using an animal model of chronic kidney disease (CKD) by long-term adenine intake. MATERIAL AND METHODS: In this prospective animal study, 16 male Wistar rats were analyzed and categorized into three groups. Rats in the CKD groups underwent 0.25% adenine administration for three or six weeks. Quantitative MRI protocols, including diffusion-weighted imaging (DWI), T1ρ (T1 rho), and T2* mapping were performed using a 9.4-T animal MR scanner. A semi-quantitative histopathologic analysis for renal fibrosis was conducted. Quantitative MR values measured from anatomic regions of kidneys underwent intergroup comparative analyses. RESULTS: The apparent diffusion coefficient (ADC) and T1 (T1 rho) values were significantly increased in all CKD groups. Values measured from the cortex and outer medulla showed significant intergroup differences. Total ADC values tended to increase according to periods, and T1ρ values increased in three weeks and decreased in six weeks. CONCLUSION: Quantitative MRI protocols could be a non-invasive assessment modality in the diagnosis and evaluation of CKD. Particularly, T1ρ may be a suitable MR sequence to quantitatively assess renal parenchymal fibrosis.

Synergetic effects of Mo2C sphere/SCN nanocatalysts interface for nanomolar detection of uric acid and folic acid in presence of interferences.

Till to date, the application of sulfur-doped graphitic carbon nitride supported transition metal carbide interface for electrochemical sensor fabrication was less explored. In this work, we designed a simple synthesis of molybdenum carbide sphere embedded sulfur doped graphitic carbon nitride (Mo2C/SCN) catalyst for the nanomolar electrochemical sensor application. The synthesized Mo2C/SCN nanocatalyst was systematically characterized using X-ray diffraction (XRD) and scanning electron microscopy (SEM) with elemental mapping. The SEM images show that the porous SCN network adhered uniformly on Mo2C, causing a loss of crystallinity in the diffractogram. The corresponding elemental mapping of Mo2C/SCN shows distinct peaks for carbon (41.47%), nitrogen (32.54%), sulfur (1.37%), and molybdenum (24.62%) with no additional impurity peaks, reflecting the successful synthesis. Later, the glassy carbon electrode (GCE) was modified by Mo2C/SCN nanocatalyst for simultaneous sensing of uric acid (UA) and folic acid (FA). The fabricated Mo2C/SCN/GCE is capable of simultaneous and interference free electrochemical detection of UA and FA in a binary mixture. The limit of detection (LOD) calculated at Mo2C/SCN/GCE for UA and FA was 21.5 nM (0.09 - 47.0 µM) and 14.7 nM (0.09 - 167.25 µM) respectively by differential pulse voltammetric (DPV) technique. The presence of interferons has no significant effect on the sensor's performance, making it suitable for real sample analysis. The present method can be extended to fabricate an electrochemical sensor for various molecules.

Metabolic Dysfunction-Associated Fatty Liver Disease and Subsequent Development of Adverse Pregnancy Outcomes.

BACKGROUND & AIMS: Recently, metabolic dysfunction-associated fatty liver disease (MAFLD), rather than nonalcoholic fatty liver disease (NAFLD), was proposed to better describe liver disease associated with metabolic dysfunction (MD). In this study, we attempted to investigate the impact of MAFLD on pregnancy complications. METHODS: The current study is a secondary analysis of a multicenter prospective cohort designed to examine the risk of NAFLD during pregnancy. In the first trimester, enrolled pregnant women were evaluated for hepatic steatosis by liver ultrasonography, and blood samples were collected for biochemical measurements. The study population was divided into 3 groups: no NAFLD, hepatic steatosis but without metabolic dysfunction (non-MD NAFLD), and MAFLD. The primary outcome was the subsequent development of adverse pregnancy outcomes, including gestational diabetes mellitus, pregnancy-associated hypertension, preterm birth, and fetal growth abnormalities. RESULTS: The study population consisted of 1744 pregnant women, including 1523 with no NAFLD, 43 with non-MD NAFLD, and 178 with MAFLD. The risk of subsequent development of adverse pregnancy outcomes was higher in MAFLD than in non-MD NAFLD (adjusted odds ratio, 4.03; 95% CI, 1.68-9.67), whereas the risk was not significantly different between no NAFLD and non-MD NAFLD. Among women with no NAFLD, the presence of MD increased the risk of adverse pregnancy outcomes. However, women with MAFLD were at higher risk for adverse pregnancy outcomes than women with no NAFLD without MD or those with no NAFLD with MD. CONCLUSIONS: In pregnant women, MAFLD may be associated with an increased risk of subsequent adverse pregnancy outcomes.

Impact of no residual disease on postoperative computed tomography on survival in patients with optimally debulked advanced high-grade serous ovarian cancer during upfront surgery.

OBJECTIVE: We sought to investigate the impact of size of residual tumors as determined by postoperative computed tomography (CT) on survival of patients with advanced, high-grade serous ovarian carcinoma (HGSC) who achieved residual disease less than 1 cm after primary debulking surgery (PDS). METHODS: We collected data of patients with stage III HGSC who had residual tumor less than 1 cm after PDS between 2013 and 2018. Surgeon-assessed residual disease during surgery was defined as sR0 (no gross residual) or sR1 (gross residual <1 cm), and radiologist-assessed residual disease on postoperative CT was defined as rR0 (no evidence of disease) or rRany (existing residual disease). All patients were classified into the following groups: sR0/rR0, sR1/rR0, sR0/rRany, and sR1/rRany. RESULTS: A total of 436 patients was placed into the sR0/rR0 (n = 187, 42.9%), sR1/rR0 (n = 59, 13.5%), sR0/rRany (n = 79, 18.1%), or sR1/rRany group (n = 111, 25.5%). Discrepancies between surgical and radiological assessments were recorded for 176 patients (40.4%) including 38 cases of sR1/rRany group with discordant residual tumor location indicated between two methods. During multivariate analysis, patients with ascites on preoperative CT, sR0/rRany group inclusion, and sR1/rRany group inclusion showed unfavorable progression-free and overall survival. CONCLUSIONS: The incorporation of surgical and radiological evaluations for determining the size of residual tumors was more accurate than surgical evaluation only for predicting survival among patients with advanced ovarian cancer who underwent PDS to residual disease less than 1 cm.

Reduction of cycles of neoadjuvant chemotherapy for advanced epithelial ovarian, fallopian or primary peritoneal cancer (ROCOCO): study protocol for a phase III randomized controlled trial.

BACKGROUND: Primary debulking surgery (PDS) and adjuvant chemotherapy is the standard treatment for advanced ovarian, fallopian or primary peritoneal cancer. However, neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) has been introduced as an alternative, showing similar efficacy and decreased postoperative complications compared with PDS. Although there is still no evidence for whether three or four cycles of NAC used clinically could be adequate, reducing one cycle of NAC is expected to remove more visible tumours and thereby improve prognosis. Thus, we proposed with this study to evaluate the efficacy and safety of reducing one cycle of NAC for advanced ovarian, fallopian or primary peritoneal cancer. METHODS: This study is a prospective, multi-centre, open-label, randomized phase III trial. A total of 298 patients with advanced ovarian, fallopian or primary peritoneal cancer will be recruited and randomly assigned to either three (control group) or two cycles of NAC (experimental group). After the NAC, we will conduct IDS with maximal cytoreduction and then administer the remaining three or four cycles for a total of six cycles of adjuvant chemotherapy. The primary end point is progression-free survival, and the secondary end points are time to tumour progression, overall survival, tumour response after NAC, IDS and adjuvant chemotherapy, radiologic investigation after IDS, tumour response by positron emission tomography-computed tomography after NAC, quality of life, adverse events, success rate of optimal cytoreduction, surgical complexity, postoperative complications and safety of IDS. We will assess these factors at screening, at every cycle of chemotherapy, at IDS, after the completion of chemotherapy, every 3 months for the first 2 years after the planned treatment and every 6 months thereafter for 3 years. DISCUSSION: We hypothesize that reducing one cycle of NAC will contribute to more resection of visible tumours despite 10% reduction of optimal cytoreduction, which could improve survival. Moreover, two cycles of NAC may increase postoperative complications by 5% compared with three cycles, which may be acceptable. TRIAL REGISTRATION: This study has been prospectively registered at ClinicalTrials.gov on Oct. 2nd, 2018 (NCT03693248, URL: https://clinicaltrials.gov/ct2/show/NCT03693248).

The risk of pregnancy-associated hypertension in women with nonalcoholic fatty liver disease.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is an independent predictor of cardiovascular disease (CVD) in non-pregnant adults. Although the biological mechanisms underlying this association are not completely understood, metabolic factors, inflammation, and endothelial dysfunction are likely all involved. The association between NAFLD and pregnancy-associated hypertension (HTN) has not been systematically examined. The aim of this study is to assess the risk of pregnancy-associated HTN in pregnant women with NAFLD. METHODS: This is secondary analysis of a prospective study of healthy pregnant women. Liver ultrasonography was performed at 10-14 weeks of gestation and maternal blood was taken for the measurement of selenoprotein P (SeP), a hepatokine independently associated with both NAFLD and CVD. Pregnancy-associated HTN was defined as the development of gestational HTN, preeclampsia, or eclampsia. RESULTS: Among 877 pregnant women, the risk of developing pregnancy-associated HTN was significantly increased in women with NAFLD compared to those without NAFLD. Grade 2-3 steatosis was a significant predictor of pregnancy-associated HTN, even after adjustment for metabolic risk factors. Circulating levels of SeP were significantly higher in women with versus those without NAFLD (P = .001) and was significantly higher also in women who subsequently developed pregnancy-associated HTN compared with those who did not (P < .005). CONCLUSIONS: Sonographic evidence of NAFLD at 10-14 weeks is an independent predictor of pregnancy-associated HTN. Circulating levels of SeP at that same gestational age are significantly increased in pregnant women with NAFLD who subsequently develop pregnancy-associated HTN.

Population response modeling and habitat suitability of Cobitis choii fish species in South Korea for climate change adaptation.

Endangered species ecosystems require appropriate monitoring for assessing population growth related to the emerging pollutants in their habitat conditions. The response of population growth of Cobitis choii, an endangered fish species, under the exposure to emerging pollutants present in the Geum River Basin of South Korea was studied. Toxicity models of concentration addition (CA), independent action (IA), and concentration addition-independent action (CAIA) were implemented utilizing the concentration of a set of 25 chemicals recorded in the study area. Thus, a population-level response analysis was developed based on the abundance of Cobitis choii for period 2011-2015. The results were compared showing that the CA and IA models were the most conservative approaches for the prediction of growth rate. Further, a standard abnormality index (SAI) and habitat suitability (HS) indicators based on the climate, habitat, and abundance data were presented to completely analyze the population growth of the species. Suitability of the species growth was most probable for year 2015 for the variables of air temperature and land surface temperature. A spatial analysis was complementarily presented to visualize the correlation of variables for the best suitability of the species growth. This study presents a methodology for the analysis of the ecosystem's suitability for Cobitis choii growth and its assessment of the chemicals present in Geum River stream.

Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus.

AIMS/HYPOTHESIS: Although there is substantial evidence that non-alcoholic fatty liver disease (NAFLD) is associated with impaired glucose homeostasis, the clinical significance of NAFLD in pregnant women has not been well determined. This study investigates the relationship between NAFLD in the first trimester and the subsequent development of gestational diabetes mellitus (GDM). METHODS: A multicentre, prospective cohort study was conducted in which singleton pregnant Korean women were assessed for NAFLD at 10-14 weeks using liver ultrasound, fatty liver index (FLI) and hepatic steatosis index (HSI). Maternal plasma adiponectin and selenoprotein P concentrations were measured. Participants were screened for GDM using the two-step approach at 24-28 weeks. RESULTS: Six hundred and eight women were included in the final analysis. The prevalence of NAFLD was 18.4% (112/608) and 5.9% (36/608) developed GDM. Participants who developed GDM had a higher prevalence of radiological steatosis (55.6% vs 16.1%; p < 0.001) and higher FLI (40.0 vs 10.7; p < 0.001) and HSI (35.5 vs 29.0; p < 0.001). The risk of developing GDM was significantly increased in participants with NAFLD and was positively correlated with the severity of steatosis. This relationship between NAFLD and GDM remained significant after adjustment for metabolic risk factors, including measures of insulin resistance. Maternal plasma adiponectin and selenoprotein P levels were also correlated with both NAFLD severity and the risk of developing GDM. CONCLUSIONS/INTERPRETATION: NAFLD in early pregnancy is an independent risk factor for GDM. Adiponectin may be a useful biomarker for predicting GDM in pregnant women.

The Efficacy of Lymph Node Embolization Using N-Butyl Cyanoacrylate Compared to Ethanol Sclerotherapy in the Management of Symptomatic Lymphorrhea after Pelvic Surgery.

PURPOSE: To compare the efficacy of lymph node (LN) embolization using N-butyl cyanoacrylate versus ethanol sclerotherapy in the management of symptomatic postoperative pelvic lymphorrhea. MATERIALS AND METHODS: Thirty-three patients with 40 instances of symptomatic postoperative lymphorrhea were treated with either LN embolization or sclerotherapy at Seoul National University Hospital from January 2009 to July 2017 and were retrospectively included (LN embolization group: 24 lymphoceles of 19 patients, mean age of 59.29 years; sclerotherapy group: 16 lymphoceles of 14 patients, mean age of 60.95 years). The types of operations were hysterectomy and bilateral oophorectomy with pelvic lymph node dissection (n = 9), radical prostatectomy (n = 3), and renal transplantation (n = 2) for the sclerotherapy group and radical prostatectomy (n = 10) and hysterectomy and bilateral oophorectomy with pelvic lymph node dissection (n = 9) for the LN embolization group. The 3 most common indications of treatment were lower extremity edema (n = 11), pain (n = 11), and fever (n = 8). The amount of leak before treatment (initial daily drainage) and clinical outcomes, including the clinical success rate in 3 weeks, treatment period, and complication rate were compared between both groups. RESULTS: LN embolization showed a higher 3-week clinical success rate than sclerotherapy in a univariate analysis (83.3% and 43.8%, P = .026). There was no statistically significant difference in the treatment period and the complication rate (7.1 days and 12.3 days, P = .098; 8.3% and 25.0%, P = .184). CONCLUSIONS: LN embolization is more effective for treating postoperative pelvic lymphorrhea than sclerotherapy with similar safety.

Transparent Film-Type Vibrotactile Actuator Array and Its Haptic Rendering Using Beat Phenomenon.

The most important thing in a thin and soft haptic module with an electroactive polymer actuator array is to increase its vibrotactile amplitude and to create a variety of vibrotactile sensations. In this paper, we introduce a thin film-type electroactive polymer actuator array capable of stimulating two types of human mechanoreceptors simultaneously, and we present a haptic rendering method that maximizes the actuators' vibrational force without improving the array's haptic performance. The increase in vibrational amplitude of the soft electroactive polymer actuator array is achieved by creating a beat vibration, which is an interference pattern of two vibrations with slightly different frequencies. The textures of a target object are translated into haptic stimuli using the proposed method. We conducted qualitative and quantitative experiments to evaluate the performance of the proposed rendering method. The results showed that this method not only amplifies the vibration's amplitude but also haptically simulates various objects' surfaces.

Pheochromocytoma as a frequent false-positive in adrenal washout CT: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the proportion of pheochromocytomas meeting the criteria for adenoma on adrenal washout CT and the diagnostic performance of adrenal washout CT for differentiating adenoma from pheochromocytoma. METHODS: MEDLINE and EMBASE were searched to 28 March 2017. We included studies that used adrenal washout CT for characterisation of pheochromocytomas. Two independent reviewers assessed the methodological quality using Quality Assessment of Diagnostic Accuracy Studies-2. Proportions were pooled using an inverse variance method for calculating weights (random-effects). Sensitivity and specificity were pooled using hierarchical logistic regression modelling and plotted in a hierarchical summary receiver-operating-characteristics (HSROC) plot. RESULTS: Ten studies (114 pheochromocytomas) were included. The pooled proportion of pheochromocytomas meeting the criteria for adenomas was 35 % (95 % CI 20-51). For eight studies providing information on diagnostic performance, the pooled sensitivity and specificity for differentiating adenoma from pheochromocytoma were 0.97 (95 % CI 0.93-0.99) and 0.67 (95 % CI 0.44-0.84), respectively. The area under the HSROC curve was 0.97 (95 % CI 0.95-0.98). CONCLUSIONS: There was a non-negligible proportion of pheochromocytomas meeting the criteria for adenoma on adrenal washout CT. Although overall diagnostic performance was excellent for differentiating adenoma from pheochromocytoma, specificity was relatively low. KEY POINTS: • Non-negligible proportion of pheochromocytomas can be mistaken for adenoma. • Adrenal washout CT showed good sensitivity (97%) but relatively low specificity (67%). • Findings other than washout percentage should be used when diagnosing pheochromocytomas.

Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: An updated systematic review and meta-analysis of the literature between 2012 and 2016.

OBJECTIVE: To review the diagnostic performance of MRI for detection of parametrial invasion (PMI) in cervical cancer patients. METHODS: MEDLINE and EMBASE databases were searched for studies providing diagnostic performance of MRI for detecting PMI in patients with cervical cancer. Studies published between 2012 and 2016 using surgico-pathological results as reference standard were included. Study quality was evaluated using QUADAS-2. Sensitivity and specificity of all studies were calculated. Results were pooled and plotted in a hierarchical summary receiver operating characteristic plot. Meta-regression and subgroup analyses were performed. RESULTS: Fourteen studies (1,028 patients) were included. Study quality was generally moderate. Pooled sensitivity was 0.76 (95% CI 0.67-0.84) and specificity was 0.94 (95% CI 0.91-0.95). The possibility of heterogeneity was considered low: Cochran's Q-test (p = 0.471), Tau2 (0.240), Higgins I2 (0%). With meta-regression analysis, magnet strength, use of DWI, and antispasmodic drugs were significant factors affecting heterogeneity (p < 0.01). Subgroup analysis for studies solely using radical hysterectomy as reference standard yielded pooled sensitivity and specificity of 0.73 (95% CI 0.60-0.83) and 0.93 (95% CI 0.90-0.95), respectively. CONCLUSIONS: MRI shows good performance for detection of PMI in cervical cancer. Using 3-T scanners and DWI may improve diagnostic performance. KEY POINTS: • MRI shows good performance for detection of parametrial invasion in cervical cancer. • Subgroup of studies using only radical hysterectomy showed consistent results. • Using 3-Tesla scanners and diffusion-weighted imaging may improve diagnostic performance.

The Diagnostic Performance of MRI for Detection of Lymph Node Metastasis in Bladder and Prostate Cancer: An Updated Systematic Review and Diagnostic Meta-Analysis.

OBJECTIVE: The purpose of this article is to review the diagnostic performance of MRI for the detection of pelvic lymph node (LN) metastasis in patients with bladder and prostate cancer. MATERIALS AND METHODS: MEDLINE and EMBASE were searched up to January 13, 2017. We included diagnostic accuracy studies that used MRI for pelvic LN detection in patients with bladder or prostate cancer, using histopathologic analyses published since 2000 as the reference standard. Two independent reviewers assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity and specificity of all studies were calculated. Per-patient and per-LN results were pooled and plotted in a hierarchic summary ROC plot. Metaregression, sensitivity, and subgroup analyses were performed. RESULTS: Twenty-four studies (2928 patients) were included. Pooled per-patient sensitivity (n = 21) was 0.56 (95% CI, 0.42-0.69) with a specificity of 0.94 (95% CI, 0.90-0.96). Per-LN pooled estimates (n = 9) showed consistent results: sensitivity of 0.57 (95% CI, 0.29-0.82) and specificity of 0.97 (95% CI, 0.94-0.98). At metaregression analysis, type of cancer, magnet field strength, and use of ultrasmall superparamagnetic particles of iron oxide (USPIO) were significant factors affecting heterogeneity (p ≤ 0.01). Sensitivity analyses showed that specificity estimates were comparable (range, 0.87-0.95), but sensitivity estimates showed significant differences. Studies that used USPIO (n = 4) had higher sensitivity (0.86; 95% CI, 0.62-0.96) than did those not using USPIO (n = 17; 0.46; 95% CI, 0.35-0.58). CONCLUSION: MRI shows high specificity but poor and heterogeneous sensitivity for detecting pelvic LN metastasis in patients with bladder and prostate cancer. Using USPIO can improve sensitivity.

Head-To-Head Comparison Between High- and Standard-b-Value DWI for Detecting Prostate Cancer: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to perform a head-to-head comparison between high-b-value (> 1000 s/mm2) and standard-b-value (800-1000 s/mm2) DWI regarding diagnostic performance in the detection of prostate cancer. MATERIALS AND METHODS: The MEDLINE and EMBASE databases were searched up to April 1, 2017. The analysis included diagnostic accuracy studies in which high- and standard-b-value DWI were used for prostate cancer detection with histopathologic examination as the reference standard. Methodologic quality was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies tool. Sensitivity and specificity of all studies were calculated and were pooled and plotted in a hierarchic summary ROC plot. Meta-regression and multiple-subgroup analyses were performed to compare the diagnostic performances of high- and standard-b-value DWI. RESULTS: Eleven studies (789 patients) were included. High-b-value DWI had greater pooled sensitivity (0.80 [95% CI, 0.70-0.87]) (p = 0.03) and specificity (0.92 [95% CI, 0.87-0.95]) (p = 0.01) than standard-b-value DWI (sensitivity, 0.78 [95% CI, 0.66-0.86]); specificity, 0.87 [95% CI, 0.77-0.93] (p < 0.01). Multiple-subgroup analyses showed that specificity was consistently higher for high- than for standard-b-value DWI (p ≤ 0.05). Sensitivity was significantly higher for high- than for standard-b-value DWI only in the following subgroups: peripheral zone only, transition zone only, multiparametric protocol (DWI and T2-weighted imaging), visual assessment of DW images, and per-lesion analysis (p ≤ 0.04). CONCLUSION: In a head-to-head comparison, high-b-value DWI had significantly better sensitivity and specificity for detection of prostate cancer than did standard-b-value DWI. Multiple-subgroup analyses showed that specificity was consistently superior for high-b-value DWI.

Head-to-Head Comparison Between Biparametric and Multiparametric MRI for the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to perform a systematic review and meta-analysis of a head-to-head comparison between the performance of biparametric MRI (bpMRI; only T2-weighted imaging and DWI) and that of multiparametric MRI (mpMRI; T2-weighted imaging, DWI, dynamic contrast-enhanced MRI) for the diagnosis of prostate cancer. MATERIALS AND METHODS: The PubMed and Embase databases were searched up to November 11, 2017. The search included diagnostic test accuracy studies that compared bpMRI and mpMRI for prostate cancer diagnosis with histopathologic findings from biopsy or radical prostatectomy as the reference standard. Methodologic quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies tool. Sensitivity and specificity were pooled by means of bivariate and hierarchic summary ROC (HSROC) modeling and graphically presented with HSROC plots. Meta-regression analysis and multiple subgroup analyses were used to compare the diagnostic performances of bpMRI and mpMRI. RESULTS: Twenty studies (2142 patients) were included. Pooled sensitivity and specificity were 0.74 (95% CI, 0.66-0.81) and 0.90 (95% CI, 0.86-0.93) for bpMRI and 0.76 (95% CI, 0.69-0.82) and 0.89 (95% CI, 0.85-0.93) for mpMRI. MRI protocol (bpMRI vs mpMRI) was not a significant factor in heterogeneity (p = 0.83). In 26 subgroups evaluated on the basis of stratification to clinicopathologic, study, and MRI characteristics, MRI protocol (bpMRI vs mpMRI) was not a significant factor in heterogeneity in any subgroup (p = 0.25-0.97). CONCLUSION: A head-to-head comparison showed that the performance of bpMRI was similar to that of mpMRI in the diagnosis of prostate cancer. Consistent results were found in multiple subgroup analyses.

Differentiation between papillary renal cell carcinoma and fat-poor angiomyolipoma: a preliminary study assessing detection of intratumoral hemorrhage with chemical shift MRI and T2*-weighted gradient echo.

Background Recent literature suggests that intratumoral hemorrhage detection may be helpful in differentiating papillary renal cell carcinoma (pRCC) from fat-poor angiomyolipoma (fpAML). Purpose To determine whether intratumoral hemorrhage detected using chemical shift magnetic resonance imaging (MRI) and T2*-weighted (T2*W) gradient echo (GRE) can be used to differentiate pRCC from fpAML. Material and Methods This retrospective study included 42 patients with pRCC (n = 28) and fpAML (n = 14) who underwent MRI followed by surgery. Two blinded radiologists independently assessed the presence of intratumoral hemorrhage using chemical shift MRI (decrease in signal intensity from opposed- to in-phase) and T2*W GRE ("blooming"). Consensus reading was determined for discrepant cases. MRI findings were compared using Chi-square test. Inter-observer agreement was assessed using kappa statistics. Results Inter-observer agreement was substantial for both sequences ( k = 0.622 and 0.793, P < 0.001). For chemical shift MRI, the prevalence of intratumoral hemorrhage was significantly greater in pRCC than in fpAML (71.4% versus 28.6%, P = 0.019 for reader 1; 64.3% versus 14.3%, P = 0.003 for reader 2; and 75% versus 21.4%, P = 0.002 for the consensus). T2*W GRE showed a similar tendency (46.4% versus 14.3%, P = 0.049 for both readers; and 50% versus 14.3%, P = 0.042 for the consensus). Using the consensus reading, sensitivity and specificity of determining pRCC were 75% and 78.6% for chemical shift MRI and 50% and 85.7% for T2*W GRE. Conclusion The prevalence of intratumoral hemorrhage identified from chemical shift MRI or T2*W GRE was significantly different between pRCC and fpAML. These hemorrhage-sensitive MRI sequences may be used as an adjunctive tool for discriminating between the two entities.