MRI-TRUS fusion guided prostate biopsy - initial experience and assessment of the role of contralateral lobe systematic biopsy.

AIMS: To present our initial experience and results of MRI-TRUS fusion guided prostate biopsy and assess the role of contralateral lobe systematic biopsy. MATERIAL AND METHOD: A number of 119 patients with clinical or biochemical suspicion for prostate cancer (PCa) were included. All patients harbored at least one PIRADS score ≥ 3 lesion and underwent MRI-TRUS fusion guided biopsy, as well as a concurrent systematic biopsy. The biopsy was performed by the same operator, using a rigidregistration software system. RESULTS: The mean age of the patients was 62.2 years. The mean pre-biopsy PSA was 9.15 ng/dl. The diagnosis rate of MRI-TRUS fusion guided biopsy was 47% for overall PCa and 29.4% for clinically significant (cs) PCa. A higher PIRADS score was significantly associated with the presence of overall and csPCa. MRI-TRUS fusion guided biopsy had a higher percentage of positive biopsy cores (51% vs 29%), higher likelihood of csPCa (OR 5.36, p=0.008) and upgrading (14.8%) in comparison with systematic biopsy but missed 6.7% csPCa. The contralateral lobe systematic biopsy could have been avoided without losing the PCa diagnosis all patients with PIRADS score 5, both in initial and repeat biopsy setting. Anterior and transitional lesions were more likely to be diagnosed only by targeted cores. CONCLUSION: MRI-TRUS guided prostate biopsy improves the detection of PCa, but systematic biopsy is still essential. In selected cases (PIRADS 5), contralateral lobe systematic biopsy can safely be avoided. Pre-biopsy mpMRI might reduce the number of biopsy sessions in patients with anterior and transitional lesions.

Quantitative assessment of the masseter muscle's elasticity using Acoustic Radiation Force Impulse.

AIMS: The study proposes Acoustic Radiation Force Impulse (ARFI) assessment of the masseter muscle elasticity in the healthy population and in patients who have undergone head and neck radiation therapy. PATIENTS AND METHODS: Twenty-five healthy controls constituted group A, and 13 patients who had underwent radiotherapy (35Gy minimum) formed group B. ARFI was performed bilaterally in the periphery (P) and the muscle center (C), in relaxation and contraction. Means and standard deviations were obtained for the recorded shear waves velocities (SWV). RESULTS: For group A: in the relaxed right muscle C = 1.87±0.52 m/s and P = 1.96 ±0.55 m/s and in the left muscle C = 1.66 +/- 0.47 m/s, P = 1.67 +/-0.53 m/s. For group B, in relaxation, the right side presented C = 1.67 +/-0.6 m/s, P 1.72 +/-0.56 m/s, the left muscle C = 1.6 +/-0.34 m/s, P = 1.73 +/-0.37 m/s. There were no differences (p> 0.05) between P and C of both groups, regardless of the muscle state. The values for relaxation and contraction in A and B (merged values of the right and left) presented no differences (1.79+/-0.52 m/s vs 1.72 +/-0.73 m/s, p = 0.72 and 1.70 +/-0.48 m/s and vs 1.59 +/-0.77 m/s, p = 0.98). All measurements of group A vs B were not different (1.79 +/-0.52 m/s vs 1.65 +/-0.63 m/s, p = 0.78). CONCLUSIONS: ARFI with SWV measurement enables the quantification of normal and post irradiation elasticity of the masseter. Further studies on a larger population are required to validate the normal and pathologic values.