Subscapularis tendon tears: a common sonographic finding in symptomatic postarthroplasty shoulders.

PURPOSE: Subscapularis tendon tears can complicate shoulder arthroplasty because the subscapularis tendon is typically divided surgically to gain access to the joint. The purpose of this study is to document the prevalence of subscapularis tears on sonography of symptomatic postarthroplasty shoulders. METHODS: We retrospectively reviewed official reports of shoulder sonograms performed over an 11-year period by one experienced radiologist. Sonographic findings in 112 (mean age, 61.7 years; age range, 38-87 years; 40% female) symptomatic patients who had undergone either total shoulder arthroplasty or hemiarthroplasty were compared with findings in both a symptomatic control group consisting of 209 patients (mean age, 55.2 years; age range, 32-79 years; 37% female) who had undergone surgery for rotator cuff repair but no arthroplasty, and an asymptomatic control group consisting of 11 (mean age, 66 years; age range, 61-77 years; 45% female) volunteers who had shoulder arthroplasty but were without complaints. RESULTS: The prevalence of subscapularis tears in arthroplasty patients (51%, 57/112) was higher (p < 0.0001) than that of rotator cuff repair patients (16%, 33/209). In the asymptomatic volunteers, subscapularis tears (9%, 1/11) were less common (p < 0.01) than in the symptomatic patients. CONCLUSIONS: Subscapularis tendon tears are a common sonographic finding in symptomatic postarthroplasty shoulders.

Independent predictors of acute appendicitis on CT with pathologic correlation.

RATIONALE AND OBJECTIVES: To assess computed tomographic (CT) signs that have been described in published studies for the diagnosis of appendicitis to identify independent findings that predict appendicitis. METHODS AND MATERIALS: A retrospective database search identified 67 patients with a CT scan of the abdomen/pelvis and pathologic evaluation of the appendix, including 41 with appendicitis and 26 with a normal appendix on pathologic examination. Each computed tomogram was re-evaluated by three independent, blinded observers who evaluated appendix diameter, enhancement of the appendix, thickening of the appendix, presence of an appendicolith, infiltration of peri-appendiceal fat, focal cecal thickening, local lymphadenopathy, fluid collections, non-appendiceal bowel thickening, non-periappendiceal infiltration of fat, and comparison of peri-appendiceal fat infiltration to thickening of adjacent bowel loops. RESULTS: Mean diameter of the normal appendix (6.7 +/- 2.2 mm) was significantly lower than that of the inflamed appendix (12.1 +/- 4.3 mm; P < .001). Significant univariate predictors of appendicitis included appendix diameter >8 mm (odds ratio [OR] 34.8), enhancement of the appendix (OR 4.4), thickening of the appendix (OR 4.3), infiltration of peri-appendiceal fat (OR 5.5), focal cecal thickening (OR 5.1), non-appendiceal bowel thickening (OR 0.4), and non-periappendiceal infiltration of fat (OR = 0.3). Of these variables, only appendix diameter and enhancement of the appendix were significant independent predictors of appendicitis on multivariate analysis. An overall diagnostic impression based on all secondary signs was less accurate than a diagnosis based on appendix diameter alone (receiver-operating characteristic analysis: Az = 0.80 vs. Az = 0.91, P = .02). Sensitivity/specificity of appendix diameter was 84%/87% using a cutoff between 8 and 9 mm and 97%/48% using a cutoff between 6 and 7 mm. CONCLUSION: Appendix diameter is the best single diagnostic criterion for appendicitis on CT scan. A cutoff between 8 and 9 mm provided the best balance of sensitivity/specificity in our study population, whereas a cutoff between 6 and 7 mm improved sensitivity at the expense of specificity. The presence of appendiceal enhancement provided additional diagnostic information, but other secondary signs of appendicitis did not improve diagnostic accuracy.

Quantitative computed tomography perfusion of prostate cancer: correlation with whole-mount pathology.

PURPOSE: Microvessel density within the prostate is associated with presence of cancer, disease stage, and disease-specific survival. We evaluated multidetector computed tomography (CT) to estimate prostate perfusion and localize prostate cancer. PATIENTS AND METHODS: Ten subjects were evaluated with contrast enhanced CT before radical prostatectomy with the Mx8000IDT 16-slice scanner. Following baseline pelvic scan, 100 cc of Optiray 300 was administered intravenously (4 cc per second). Repeated dynamic scans through the prostate were obtained at 20, 30, 40, 50, and 60 seconds following initiation of contrast injection. Computed tomography perfusion was compared with pathologic findings of Gleason score and tumor volume on whole-mount prostatectomy specimens. RESULTS: Conventional adenocarcinoma (Gleason score, 6-10) was present in all subjects, including one who also demonstrated a mucinous variant of prostate cancer. Visible focal CT enhancement was noted in 1 patient with a high-volume tumor and a Gleason score of 10. A positive correlation between local estimates of CT perfusion and percent of prostate volume occupied by tumor in each sextant was found for half of the subjects (Pearson correlation coefficient, 0.3-0.95; mean, 0.48) but statistically significant correlation (P < 0.05; Pearson coefficient, 0.9-0.95) was present in only the 2 subjects with the highest Gleason scores (8 and 10) and the highest tumor volume (> or = 50% in > or = 1 sextant region). CONCLUSION: Visible enhancement of prostate cancer during dynamic CT is present in a minority of subjects. Correlation between quantitative CT perfusion and tumor location is statistically significant only in subjects with localized high-volume, poorly differentiated prostate cancer.

Effect of dutasteride therapy on Doppler US evaluation of prostate: preliminary results.

PURPOSE: To prospectively determine the effect of short-term therapy with dutasteride on the suppression of Doppler ultrasonographic (US) signal in benign prostate tissue and thus on improvement in the depiction of prostate cancer with Doppler US-guided core-needle biopsy. MATERIALS AND METHODS: After institutional review board approval and informed consent were obtained as part of this HIPAA-compliant study, 11 men (age range, 59-77 years) were evaluated with gray-scale, color, and power Doppler US at baseline and weekly for up to 3 weeks while taking 0.5 mg of dutasteride per day. Flow intensity in the periurethral, transition, and peripheral zones was subjectively scored by using a four-point scale. The Wilcoxon matched-pairs signed-ranks test was used to compare pre- and posttherapy scores. After flow was reduced to "diminished" or "none" with at least a 1-score difference on the four-point scale, up to four targeted cores were obtained from areas of persistent flow within the peripheral zone, followed by laterally directed sextant biopsy. RESULTS: Doppler US flow suppression occurred in 11 of 11 patients after 1 week of dutasteride therapy (P < .01). Further suppression was noted after 2 weeks in eight of 10 patients (P = .04) and after 3 weeks in two of two patients. Biopsy was performed after 1 (n = 1), 2 (n = 8), or 3 (n = 2) weeks of therapy. Flow suppression was greatest in the peripheral zones (mean decrease: 0.64 and 0.76 after weeks 1 and 2, respectively) and least in the periurethral zones (mean decrease: 0.30 after 1 week). Cancer was detected in eight (20%) of 40 targeted cores and in five (8%) of 66 sextant cores. Four patients had cancer at targeted biopsy, and three of these four patients had cancer at sextant biopsy. In the four men with cancer, targeted cores were 5.9 times more likely to be positive (P = .027). Selective suppression of flow in benign tissue was observed in two of the four men with cancer. CONCLUSION: Short-term dutasteride therapy reduces Doppler US flow in the prostate and may improve depiction of hypervascular cancer.