Interobserver agreement in prostate cancer detection using multiparametric MRI.

PURPOSE: The purpose of this prospective observational study was to evaluate the diagnostic performance of multiparametric (mp) magnetic resonance imaging (MRI) for prostate cancer detection and to assess the interobserver variability, using the Prostate Imaging Reporting and Data Systems (PI-RADS). METHODS: 50 patients (mean age 68.42±6.58 years) with suspected prostate cancer fulfilling the inclusion criteria and without any exclusion criteria were enrolled. All patients were examined with mp-MRI protocol, as per European Society of Urogenital Radiology (ESUR) guidelines, before systematic transrectal ultrasound (TRUS)-guided biopsy. All examinations were read by three independent radiologists with 3-year experience in prostate MRI. Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were calculated. Interobserver agreement was evaluated using Kappa Cohen coefficient of agreement. RESULTS: mp-MRI and histopathological results of TRUSguided biopsy showed a very good agreement in prostate cancer detection. The overall Se, Sp, PPV and NPV ranged between 93.3-96.7%, 55.0-80.0%, 76.3-87.9% and 88.2-94.1%, respectively. The Kappa Cohen coefficient of interobserver agreement was 0.643 between Readers 1 and 2, 0.664 between Readers 1 and Reader 3 and 0.568 between Readers 2 and 3. CONCLUSIONS: Our results showed a high Se for the detection of prostate cancer with mp-MRI and a high NPV to rule out prostate malignancy. PI-RADS version 2 provides an adequate standardization of mp-MRI, allowing a good level of interobserver agreement.

MRI Evaluation of Complete and Near-Complete Response after Neoadjuvant Therapy in Patients with Locally Advanced Rectal Cancer.

Purpose To evaluate MRI performance in restaging locally advanced rectal cancers (LARC) after neoadjuvant chemoradiotherapy (nCRT) and interobserver agreement in identifying complete response (CR) and near-complete response (nCR). Methods 40 patients with CR and nCR on restaging MRI, surgery and/or endoscopy were enrolled. Two radiologists independently scored the restaging MRI and reported the presence of split scar sign (SSS) and MRI tumor regression grade (mrTRG). Diagnostic accuracy and ROC curves were calculated for single and combined sequences, with inter-reader agreement. Results Diagnostic performance was good for detecting CR and weaker for nCR. T2WI had the highest AUCs among individual sequences. There was a significant positive correlation between SSS and CR, with high Sp (89.5%/73.7%) and PPV (90%/79.2%) for both Readers. Similar accuracy rates were observed for the combination of sequences, with AUCs of 0.828-0.847 for CR and 0.690-0.762 for nCR. Interobserver agreement was strong for SSS, moderate for T2WI, weak for the combination of sequences. Conclusions Restaging MRI had good diagnostic performance in identifying CR and nCR. SSS had high Sp and PPV in diagnosing CR, with a strong level of interobserver agreement. T2WI with DWI was the optimal combination of sequences for selecting good responders.

Local staging of prostate cancer with multiparametric-MRI: accuracy and inter-reader agreement.

BACKGROUND: The accuracy of prostate cancer local staging at the time of diagnosis directly influences patient prognosis and treatment. AIM: To evaluate the diagnostic performance and interobserver variability of mp-MRI in local staging of prostate cancer, using the histopathologic findings at prostatectomy as the reference standard. METHODS: Fifty patients (mean age 64.4±7.2) with biopsy confirmed prostate cancer were included in this prospective study. All patients were examined with mp-MRI before radical prostatectomy and images were read by three independent radiologists. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy rate were calculated and compared for all three readers. Interobserver agreement was evaluated using Kappa Cohen coefficient of agreement. RESULTS: The overall Se, Sp, PPV, NPV and accuracy rates for detecting extraprostatic tumor extension (EPE) ranged between 76.5-94.1%, 45.5-84.9%, 43.8-76.2%, 83.3-96.6% and 58-88%. For evaluation of seminal vesicle invasion (SVI), the overall Se, Sp, PPV, NPV and accuracy rates ranged between 57.1-85.7%, 86.1-97.7%, 40.0-85.7%, 92.5-97.7% and 82-96%, respectively. The overall Kappa Cohen coefficient of agreement varied between 0.349-0.638 for EPE and between 0.507-0.668 for SVI. CONCLUSIONS: Our results showed that 1.5T mp-MRI is a reliable method for local staging of prostate cancer, with good diagnostic performance in detecting EPE and SVI. The overall interobserver agreement rates between readers with the same level of experience in prostate MRI ranged from fair to good in the evaluation of EPE and from moderate to good for the assessment of SVI.

Social jetlag and sleep deprivation are associated with altered activity in the reward-related brain areas: an exploratory resting-state fMRI study.

OBJECTIVE: The aim of this research was to assess the effect of social jetlag (SJL) and its interaction with partial sleep deprivation on resting-state brain activity using the fractional amplitude of low-frequency fluctuation (fALFF) during free-living conditions. METHODS: A total of 28 normal weight healthy subjects were enrolled in four study groups (with SJL [with sleep deprivation and without sleep deprivation] and without SJL [with sleep deprivation and without sleep deprivation]), matched 1:1:1:1 for age, gender, and body mass index (BMI). Resting-state functional magnetic resonance imaging (fMRI) scans were collected with SIEMENS 3T scanner while subjects were in a fasting state. RESULTS: Participants with SJL had significantly higher fALFF values in right lingual gyrus and right putamen and significantly lower fALFF values in left and right inferior parietal lobe in comparison with participants without SJL and without sleep deprivation. Subjects with sleep deprivation had significantly higher fALFF in the thalamus and left superior frontal gyrus. In those with both SJL and sleep deprivation, we observed higher fALFF values in right Brodmann Area (BA)18 and lower values in left and right parietal inferior lobe. Subjects with SJL alone had significantly lower fALFF values in left frontal mid gyrus (BA6) than those with sleep deprivation alone. CONCLUSIONS: SJL was associated with altered resting-state brain activity in regions that have been shown to be involved in hedonic feeding. The effect of SJL was independent of effects induced by short sleep duration. These alterations might represent the substrate for the increased risk of obesity observed in those with SJL.

A malignant phyllodes tumor with liposarcomatous differentiation case with 3-year follow-up.

Phyllodes tumors (PTs) are a group of rarely breast tumors of fibro-epithelial origin, counting for about 1% of the breast malignancies divided, based on histological features, in benign, borderline and malignant neoplasms, arising most of them in women in their 40's. Among this complex group of tumors, the liposarcomatous differentiation is an even more rare lesion, counting for about 0.3% of all primary sarcomas of the breast. This article presents a case of a 48-year-old woman with a breast malignant PT with liposarcomatous differentiation, diagnosed by guided core biopsy, treated by excision and subsequent simple mastectomy followed by radiotherapy, with a 3-year follow-up.

1.5-Tesla Multiparametric-Magnetic Resonance Imaging for the detection of clinically significant prostate cancer.

BACKGROUND AND AIM: Multiparametric-magnetic resonance imaging (mp-MRI) is the main imaging modality used for prostate cancer detection. The aim of this study is to evaluate the diagnostic performance of mp-MRI at 1.5-Tesla (1.5-T) for the detection of clinically significant prostate cancer. METHODS: In this ethical board approved prospective study, 39 patients with suspected prostate cancer were included. Patients with a history of positive prostate biopsy and patients treated for prostate cancer were excluded. All patients were examined at 1.5-T MRI, before standard transrectal ultrasonography-guided biopsy. RESULTS: The overall sensitivity, specificity, positive predictive value and negative predictive value for mp-MRI were 100%, 73.68%, 80% and 100%, respectively. CONCLUSION: Our results showed that 1.5 T mp-MRI has a high sensitivity for detection of clinically significant prostate cancer and high negative predictive value in order to rule out significant disease.

Not in one metric: Neuroticism modulates different resting state metrics within distinctive brain regions.

INTRODUCTION: Neuroticism is a complex personality trait encompassing diverse aspects. Notably, high levels of neuroticism are related to the onset of psychiatric conditions, including anxiety and mood disorders. Personality traits are stable individual features; therefore, they can be expected to be associated with stable neurobiological features, including the Brain Resting State (RS) activity as measured by fMRI. Several metrics have been used to describe RS properties, yielding rather inconsistent results. This inconsistency could be due to the fact that different metrics portray different RS signal properties and that these properties may be differently affected by neuroticism. To explore the distinct effects of neuroticism, we assessed several distinct metrics portraying different RS properties within the same population. METHOD: Neuroticism was measured in 31 healthy subjects using the Zuckerman-Kuhlman Personality Questionnaire; RS was acquired by high-resolution fMRI. Using linear regression, we examined the modulatory effects of neuroticism on RS activity, as quantified by the Amplitude of low frequency fluctuations (ALFF, fALFF), regional homogeneity (REHO), Hurst Exponent (H), global connectivity (GC) and amygdalae functional connectivity. RESULTS: Neuroticism modulated the different metrics across a wide network of brain regions, including emotional regulatory, default mode and visual networks. Except for some similarities in key brain regions for emotional expression and regulation, neuroticism affected different metrics in different ways. DISCUSSION: Metrics more related to the measurement of regional intrinsic brain activity (fALFF, ALFF and REHO), or that provide a parsimonious index of integrated and segregated brain activity (HE), were more broadly modulated in regions related to emotions and their regulation. Metrics related to connectivity were modulated across a wider network of areas. Overall, these results show that neuroticism affects distinct aspects of brain resting state activity. More in general, these findings indicate that a multiparametric approach may be required to obtain a more detailed characterization of the neural underpinnings of a given psychological trait.