Utility of Prostate Health Index Density for Biopsy Strategy in Biopsy-Naïve Patients With PI-RADS v2.1 Category 3 Lesions.

BACKGROUND: Category 3 lesions in PI-RADSv2.1 pose diagnostic challenges, complicating biopsy decisions. Recent biomarkers like prostate health index (PHI) have shown higher specificity in detecting clinically significant prostate cancer (csPCa) than prostate-specific antigen (PSA). Yet their integration with MRI remains understudied. PURPOSE: To evaluate the utility of PSA and PHI with its derivatives for detecting csPCa in biopsy-naïve patients with category 3 lesion on initial prostate MRI scan. STUDY TYPE: Retrospective. POPULATION: One hundred ninety-three biopsy-naïve patients who underwent MRI, PSA, and PHI testing, followed by both targeted and systematic biopsies. FIELD STRENGTH/SEQUENCE: Turbo spin-echo T2-weighted imaging, diffusion-weighted single-shot echo-planar imaging, and dynamic contrast-enhanced T1-weighted fast field echo sequence imaging in 3 T. ASSESSMENT: PHI density (PHID) and PSA density (PSAD) derived by dividing serum PHI and PSA with prostate volume (MRI based methodology suggested by PI-RADSv2.1). Risk-stratified models to evaluate the utility of markers in triaging patients for biopsy, including low-, intermediate-, and high-risk groups. STATISTICAL TESTS: Independent t-test, Mann-Whitney U test, Mantel-Haenszel test, generalized estimating equation, and receiver operating characteristic (ROC) curve analysis were used. Statistical significance defined as P < 0.05. RESULTS: CsPCa was found in 16.6% (32/193) of patients. PHID had the highest area under the ROC curve (AUROC) of 0.793, followed by PHI of 0.752, PSAD of 0.750, and PSA of 0.654. PHID with two cut-off points (0.88/mL and 1.82/mL) showed the highest potential biopsy avoidance of 47.7% (92/193) with 5% missing csPCa, and the lowest intermediate-risk group (borderline decision group) at 38.9% (75/193), compared to PSA and PHI. DATA CONCLUSION: PHID demonstrated better potential in triaging patients with category 3 lesions, possibly aiding more selective and confident biopsy decisions for csPCa detection, than traditional markers. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 5.

Yield of concurrent systemic biopsy during MRI-targeted biopsy according to Prostate Imaging Reporting and Data System version 2 in patients with suspected prostate cancer.

OBJECTIVES: To investigate the yield of concurrent systemic biopsy (SB) during MRI-targeted biopsy (MRTB) as Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) interpretations in patients with suspected prostate cancer (PCa). METHODS: A total of 285 patients with suspected PCa underwent prebiopsy 3-T MRI, followed by MRI-transrectal ultrasound fusion targeted biopsy and concurrent standard SB for lesions with PI-RADS v2 scores 3-5. Detection rates and positive core rates of PCa and clinically significant cancer (CSC) were evaluated. RESULTS: In concurrent MRTB and SB, PCa and CSC detection rates were 18.9% and 9.4% for PI-RADS score 3, 45.9% and 32.4% for PI-RADS score 4, and 82.1% and 72.6% for PI-RADS score 5, respectively. Overall detection rate of CSCs (40.0%) for concurrent MRTB and SB was significantly higher than that of MRTB (34.4%, p = 0.004) or SB alone (27.7%, p < 0.001): an increase of 5.6% (16 patients) compared with MRTB alone. For patients with PI-RADS score 4 or 5, the CSC detection rate of concurrent MRTB and SB was 47.0%, an increase of 6.1% when compared with MRTB (40.9%) only (p < 0.001). Of the 110 patients with both MRTB- and SB-positive findings, 22 (20.0%) had the highest Gleason score in SB compared with that in MRTB. In 9.5% (27/285) patients including 12 patients with CSCs, only SB was positive, with negative MRTB. CONCLUSION: Concurrent SB with MRTB based on PI-RADS v2 can yield a higher CSC detection rate compared with MRTB alone in patients with suspected PCa. KEY POINTS: • Concurrent SB with MRTB yields an increase of 5.6% CSC detection compared with MRTB alone. • Of both MRTB- and SB-positive findings, 20.0% patients have upgraded Gleason score in SB. • In 18.4% patients, only SB was positive, with negative MRTB. Adding MRTB to SB is helpful for adequate risk stratification, reducing diagnostic uncertainty of PCa.

Utility of diffusion-weighted imaging in association with pathologic upgrading in biopsy-proven grade I endometrial cancer.

BACKGROUND: Prediction of pathologic upgrading is clinically meaningful to identify the optimal candidate of fertility-preserving hormonal treatment in the young patients with biopsy-proven grade I endometrial cancer. PURPOSE: To investigate the utility of diffusion-weighted imaging (DWI) in association with pathologic upgrading in endometrial cancer. STUDY TYPE: Retrospective. SUBJECTS: Preoperative MRI datasets of 221 patients with grade I endometrial cancer on endometrial biopsy (n = 146), dilatation and curettage (n = 66), or either (n = 9). FIELD STRENGTH/SEQUENCE: 3.0T, including T2 -weighted imaging, DWI with a b-value of 1000 s/mm2 , and dynamic contrast enhanced imaging. ASSESSMENT: The tumor size was determined as the longest diameter of the lesion. The minimum apparent diffusion coefficient (ADCmin ) was calculated using histogram analysis of the entire tumor. STATISTICAL TESTS: Mann-Whitney U-test, Pearson's chi-square test, Fisher's exact test, intraclass correlation coefficient (ICC) analysis, receiver operating characteristic (ROC) curve analysis, univariate and multivariate logistic regression analysis. RESULTS: Pathologic upgrading was identified in 42 patients (19.0%). Patients with pathologic upgrading had larger tumors and showed lower ADCmin values than those without pathologic upgrading (both P < 0.001). The area under the ROC curve of ADCmin and tumor size was 0.812 and 0.758, respectively. On multivariate analysis, tumor ADCmin ≤0.600 × 10-3 mm2 /s (odds ratio [OR], 11.8; P < 0.001) and tumor size on MRI >3 cm (OR, 3.24; P = 0.009) were independently associated with pathologic upgrading. Upgrading occurred in 23 of 31 patients (74.2%) with ADCmin ≤0.600 × 10-3 mm2 /s and tumor size >3 cm, and in 7 of 114 patients (6.1%) with ADCmin >0.600 × 10-3 mm2 /s and tumor size ≤3 cm. DATA CONCLUSION: Tumor ADC and tumor size on MRI may be useful parameters in association with pathologic upgrading in biopsy-proven grade I endometrial cancer. LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2020;51:117-123.

Stretchable and Transparent Kirigami Conductor of Nanowire Percolation Network for Electronic Skin Applications.

Recent research progress of relieving discomfort between electronics and human body involves serpentine designs, ultrathin films, and extraordinary properties of nanomaterials. However, these strategies addressed thus far each face own limitation for achieving desired form of electronic-skin applications. Evenly matched mechanical properties anywhere on the body and imperceptibility of electronics are two essentially required characteristics for future electronic-skin (E-skin) devices. Yet accomplishing these two main properties simultaneously is still very challenging. Hence, we propose a novel fabrication method to introduce kirigami approach to pattern a highly conductive and transparent electrode into diverse shapes of stretchable electronics with multivariable configurability for E-skin applications. These kirigami engineered patterns impart tunable elasticity to the electrodes, which can be designed to intentionally limit strain or grant ultrastretchability depending on applications over the range of 0 to over 400% tensile strain with strain-invariant electrical property and show excellent strain reversibility even after 10 000 cycles stretching while exhibiting high optical transparency (>80%). The versatility of this work is demonstrated by ultrastretchable transparent kirigami heater for personal thermal management and conformal transparent kirigami electrophysiology sensor for continuous health monitoring of human body conditions. Finally, by integrating E-skin sensors with quadrotor drones, we have successfully demonstrated human-machine-interface using our stretchable transparent kirigami electrodes.

Postoperative Outcome of Cystic Renal Cell Carcinoma Defined on Preoperative Imaging: A Retrospective Study.

PURPOSE: We evaluated the postoperative outcome of cystic renal cell carcinoma defined on preoperative computerized tomography. We also sought to find the optimal cutoff of the cystic proportion in association with patient prognosis. MATERIAL AND METHODS: In this institutional review board approved study with waiver of informed consent, 1,315 patients were enrolled who underwent surgery for a single renal cell carcinoma with preoperative computerized tomography. The cystic proportion of renal cell carcinoma was determined on computerized tomography. The optimal cutoff of the cystic proportion was explored regarding cancer specific survival. Renal cell carcinomas were categorized as cystic or noncystic renal cell carcinoma according to a conventional cutoff (ie cystic proportion 75% or greater) and an optimal cutoff. Postoperative outcomes were then compared between the 2 groups. Multivariate Cox regression analysis was performed to determine the independent predictor of cancer specific survival. RESULTS: Of the 1,315 lesions 107 (8.1%) were identified as cystic renal cell carcinoma according to a conventional cutoff. The postoperative outcome of cystic renal cell carcinoma was significantly better than that of noncystic renal cell carcinoma (p <0.001). Neither metastasis nor recurrence developed after surgery in patients with cystic renal cell carcinoma. In association with the cancer specific survival rate, the optimal cutoff of the cystic proportion was 45% and 197 cases (15.0%) were accordingly defined as cystic renal cell carcinoma. On Cox regression analysis, a cystic proportion of 45% or greater of the renal cell carcinoma was an independent predictor of a favorable outcome regarding cancer specific survival (HR 0.34, p = 0.03). CONCLUSIONS: Cystic renal cell carcinoma defined on preoperative computerized tomography is associated with low metastatic potential and favorable outcomes after surgery. Particularly, a cystic proportion of 45% or greater is an independent prognostic factor for favorable survival.

Role of PI-RADSv2 with multiparametric MRI in determining who needs active surveillance or definitive treatment according to PRIAS.

PURPOSE: To evaluate the role of Prostate Imaging Reporting and Data System v. 2 (PI-RADSv2) in triaging patients with prostate cancer according to Prostate Cancer Research International: Active Surveillance (PRIAS). MATERIALS AND METHODS: Between January 2012 and December 2014, 456 patients with biopsy-proven cancer underwent multiparametric 3T magnetic resonance imaging (MRI) using T2 -weighted, diffusion-weighted, and dynamic contrast-enhanced MRI sequences, and then radical prostatectomy. Two radiologists independently reviewed MR images using PI-RADSv2. For AS, PRIAS required clinical stage

Evaluation of extracapsular extension in prostate cancer using qualitative and quantitative multiparametric MRI.

PURPOSE: To investigate the value of multiparametric magnetic resonance imaging (mpMRI) for extracapsular extension (ECE) in prostate cancer (PCa). MATERIALS AND METHODS: In all, 292 patients who received radical prostatectomy and underwent preoperative mpMRI at 3T were enrolled retrospectively. For determining the associations with ECE, the likelihood of ECE was assessed qualitatively on T2 -weighted imaging (T2 WI) and combined T2 WI and diffusion-weighted imaging (DWI) or dynamic contrast-enhanced imaging (DCEI). Quantitative MRI parameters were measured in PCa based on histopathological findings. Two models for detecting ECE including imaging and clinical parameters were developed using multivariate analysis: Model 1 excluding combined T2 WI and DWI and DCEI and Model 2 excluding combined T2 WI and DWI, and combined T2 WI and DCEI. Diagnostic performance of imaging parameters and models was evaluated using the area under the receiver operating characteristics curve (Az). RESULTS: For detecting ECE, the specificity, accuracy, and Az of combined T2 WI and DWI or DCEI were statistically better than those of T2 WI (P < 0.05), and all quantitative MRI parameters showed a statistical difference between the patients with and without ECE (P < 0.05). On multivariate analysis, significant independent markers in Model 1 were combined T2 WI and DWI, combined T2 WI and DCEI, and Ktrans (P < 0.05). In Model 2, significant markers were combined T2 WI and DWI and DCEI, Ktrans , Kep , and Ve (P < 0.05). The Az values of models 1 and 2 were 0.944 and 0.957, respectively. CONCLUSION: mpMRI may be useful to improve diagnostic accuracy of the models for determining the associations with ECE in PCa. LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1760-1770.

Small (< 4 cm) Renal Tumors With Predominantly Low Signal Intensity on T2-Weighted Images: Differentiation of Minimal-Fat Angiomyolipoma From Renal Cell Carcinoma.

OBJECTIVE: The purpose of this study was to retrospectively investigate the utility of multiparametric MRI in differentiating minimal-fat angiomyolipoma (AML) from renal cell carcinoma (RCC) in small renal tumors with predominantly low signal intensity on T2-weighted MR images. MATERIALS AND METHODS: Fifty-six patients with pathologically identified renal tumors (1-4 cm) with predominantly low signal intensity on T2-weighted images without visible fat on unenhanced CT images were enrolled. Clinical and MRI variables (tumor-to-renal cortex signal intensity [SI] ratio on T2-weighted images [T2 ratio], apparent diffusion coefficient [ADC], and SI index) on chemical-shift images were evaluated. RESULTS: The ADC was significantly lower in RCC than in minimal-fat AML (p = 0.001). The T2 ratio and signal intensity index were not significantly different between RCC (p = 0.31) and minimal-fat AML (p = 0.74). Multivariate analysis showed that ADC (odds ratio [OR], 0.01; p = 0.02) and male sex (OR, 46.7; p < 0.001) were the independent predictors of RCC. For differentiating minimal-fat AML from RCC, the ROC AUC of ADC was 0.781. When ADC and sex were combined, the AUC significantly increased to 0.937 with a cutoff value of 1.129 × 10-3 mm2/s. For making the diagnosis of minimal-fat AML if the ADC was greater than the threshold, sensitivity was 89.7% and specificity was 88.2% (p = 0.02). CONCLUSION: In small renal tumors with predominantly low SI on T2-weighted images, ADC is useful for differentiating minimal-fat AML from RCC. Combining ADC with male sex increases the accuracy of RCC prediction.

Single-phase DECT with VNCT compared with three-phase CTU in patients with haematuria.

OBJECTIVE: To retrospectively evaluate the diagnostic performance of single-phase dual-energy CT (DECT) with virtual non-contrast CT (VNCT) compared with three-phase CT urography (CTU) in patients with haematuria. METHODS: A total of 296 patients underwent three-phase CTU (NCT at 120 kVp; nephrographic phase and excretory phase DECTs at 140 kVp and 80 kVp) owing to haematuria. Diagnostic performances of CT scans were compared for detecting urothelial tumours and urinary stones. Dose-length product (DLP) was compared in relation to single-phase DECT and three-phase CTU Dose-length product (DLP) was compared in relation to single-phase DECT and three-phase CTU. RESULTS: Sensitivity and specificity for tumour were 95 % (19/20) and 98.9 % (273/276) on CTU, 95 % (19/20) and 98.2 % (271/276) on nephrographic phase DECT, and 90 % (18/20) and 98.2 % (271/276) on excretory phase DECT (P > 0.1). Of the 148 stones detected on NCT, 108 (73 %) and 100 (67.6 %) were detected on nephrographic phase and excretory phase VNCTs, respectively. The mean size of stones undetected on nephrographic and excretory VNCTs was measured as 1.5 ± 0.5 mm and 1.6 ± 0.6 mm, respectively. The mean DLPs of three-phase CTU, nephrographic phase DECT and excretory phase DECT were 1076 ± 248 mGy · cm, 410 ± 98 mGy · cm, and 360 ± 87 mGy · cm, respectively (P < 0.001). CONCLUSIONS: Single-phase DECT has a potential to replace three-phase CTU for detecting tumours with a lower radiation dose. KEY POINTS: • Single-phase DECT with virtual NCT may replace three-phase CTU for detecting tumours. • Virtual NCT cannot replace NCT for detecting small urinary stones. • Single-phase DECT may reduce the radiation dose by 62-67 % compared to three-phase CTU. • Nephrographic phase DECT is superior to excretory phase DECT for assessing haematuria.

Prediction of disease progression following concurrent chemoradiotherapy for uterine cervical cancer: value of post-treatment diffusion-weighted imaging.

OBJECTIVE: To investigate the value of post-treatment diffusion-weighted imaging (DWI) for predicting disease progression following concurrent chemoradiotherapy (CCRT) for cervical cancer. METHODS: This retrospective study included 100 consecutive patients with locally advanced cervical cancer who underwent T2-weighted imaging (T2WI) and DWI 1 month after completing CCRT. The presence of residual tumour was independently determined on T2WI and T2WI plus DWI. The imaging findings were compared regarding prediction of disease progression. RESULTS: Disease progressed in 24 patients during follow-up. Forty-one and 22 patients were determined as having residual tumour on T2WI and T2WI plus DWI, respectively. Regarding prediction of disease progression, positive predictive values of imaging findings on T2WI and T2WI plus DWI were 32.7 % and 54.4 %, respectively, 1 year after treatment (P = 0.004), 37.2 % and 73.0 %, respectively, 2 years after treatment (P < 0.001), and 39.3 % and 72.7 %, respectively, 3 years after treatment (P = 0.001). Multivariate Cox regression analysis revealed that the presence of residual tumour on T2WI plus DWI was the independent predictor of disease progression (hazard ratio = 6.34, P < 0.001). CONCLUSION: Post-treatment DWI offers an incremental value to T2WI in predicting disease progression after CCRT of cervical cancer. KEY POINTS: • T2WI alone has limited prognostic value after CCRT of cervical cancer. • Adding DWI to T2WI improves prediction of disease progression after CCRT. • Residual tumour on post-treatment T2WI plus DWI is associated with disease progression.

Prostate diffusion-weighted imaging at 3T: effect of intravenous gadobutrol administration.

OBJECTIVE: To investigate whether gadolinium-based contrast agent (GBCA) administration significantly affects diffusion-weighted imaging (DWI) at 3 T in the evaluation of prostate cancer and benign tissue. METHOD: Thirty-four consecutive patients with surgically proven prostate cancer underwent preoperative DWI at 3 T before and after GBCA administration. Exponential apparent diffusion coefficient (EADC) and ADC maps were developed from DWI data. The ADC and EADC values pre- and post-contrast were measured in the cancer and benign tissue, respectively. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were evaluated on pre- and post-contrast DWI. RESULTS: The ADC and EADC values of the cancer and benign transition zone were not significantly different between pre- and post-contrast, respectively (P > 0.05), while those in the benign peripheral zone were significantly different (P = 0.030 and 0.037, respectively). In all tissues, the SNRs and CNRs of the DWI, ADC map and EADC map were not significantly different between pre- and post-contrast (P > 0.05). Between pre- and post-contrast, ADC and EADC values showed excellent agreement (intraclass correlation coefficient ≥ 0.894) and variability of ≤3.2 %. CONCLUSION: Prostate 3 T-DWI after GBCA administration may be used without a significant difference in SNR or CNR, with minimal variability of the cancer ADC and EADC values. KEY POINTS: • ADCs and EADCs have excellent agreement before and after gadobutrol administration. • SNRs of prostate DWI are similar before and after gadobutrol administration. • CNRs of cancers are similar between pre- and post-contrast DWI.

Ultrasound-Guided Transvaginal Core Biopsy of Pelvic Masses: Feasibility, Safety, and Short-Term Follow-Up.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic accuracy and safety of ultrasound (US)-guided transvaginal core biopsy of pelvic masses. MATERIALS AND METHODS: Fifty-five pelvic masses in 55 consecutive women who underwent US-guided transvaginal core biopsy were enrolled in our study. All lesions were detected on CT or MRI before biopsy. The procedure was performed with local anesthesia using a transvaginal US probe equipped with a guide and an 18-gauge needle with an automatic biopsy gun. We evaluated the diagnostic accuracy and complication rate of the procedure. RESULTS: All acquired specimens were adequate for the histopathologic analysis. The overall diagnostic accuracy of US-guided transvaginal core biopsy was 93% (51/55). Of the 55 lesions, 46 (84%) were confirmed to be either benign or malignant tumors, and five (9%) were diagnosed as active or chronic inflammatory lesions. Four lesions (7%) were not histopathologically diagnosed after biopsy: two were confirmed as fibrothecoma and leiomyosarcoma after surgery, and the remaining two were clinically determined to be recurrent cancer. In terms of minor complications, vaginal bleeding occurred in 10 patients (18%), and gross hematuria occurred in two patients (4%). These complications resolved spontaneously in all patients without further workup or treatment. CONCLUSION: US-guided transvaginal core biopsy seems to be safe and reliable procedure for the histopathologic diagnosis of pelvic masses.

Unenhanced CT and MRI Parameters That Can Be Used to Reliably Predict Fat-Invisible Angiomyolipoma.

OBJECTIVE: The objective of our study was to determine unenhanced CT and MRI parameters that can be used to reliably predict fat-invisible angiomyolipoma (AML). MATERIALS AND METHODS: A total of 152 patients with 155 histologically proven renal cell carcinomas (RCCs) and 16 patients with 18 histologically proven AMLs were included. No AML measured less than -20 HU on CT images. The tumor-to-cortex ratio was measured on unenhanced CT, T2-weighted MRI, and T1-weighted MRI to compare fat-invisible AML and RCC. On chemical-shift MRI, the signal intensity (SI) index and tumor-to-spleen ratio were calculated to compare these lesions. The unpaired t test and ROC with AUC were used for statistical analysis. The reference standard was pathologic examination. RESULTS: The mean tumor-to-cortex ratios on unenhanced CT of AML and RCC were 1.37 ± 0.66 (SD) and 0.83 ± 0.47, respectively (p < 0.001). However, the tumor-to-cortex ratio on unenhanced CT of AML was not different from that of chromophobe RCC (p = 0.093). The mean tumor-to-cortex ratios on T2-weighted MRI of AML and RCC were 0.75 ± 0.15 and 1.21 ± 0.41, respectively (p < 0.001). However, the tumor-to-cortex ratio on T2-weighted MRI of AML was not different from that of papillary RCC (p = 0.161). The tumor-to-spleen ratio on chemical-shift MRI, tumor-to-cortex ratio on T1-weighted MRI, and SI index on chemical-shift MRI of AML were not different from those of RCC (p = 0.104-0.670). The AUCs of the tumor-to-cortex ratio on T2-weighted MRI and the tumor-to-cortex ratio on unenhanced CT were 0.862 and 0.835, respectively. CONCLUSION: The tumor-to-cortex ratio on T2-weighted MRI and the tumor-to-cortex ratio on unenhanced CT are good parameters to differentiate fat-invisible AML from clear cell RCC. Nevertheless, percutaneous biopsy is necessary because these parameters are not reliable in differentiating fat-invisible AML from non-clear cell RCC.

Differentiation of Adrenal Hyperplasia From Adenoma by Use of CT Densitometry and Percentage Washout.

OBJECTIVE: The purpose of this study was to quantitatively differentiate adrenal hyperplasia from adenoma with the use of adrenal CT protocols. MATERIALS AND METHODS: Between January 2004 and November 2012, a total of 156 patients (69 men and 87 women; mean age, 48.9 years) underwent unenhanced CT, early contrast-enhanced CT, and delayed contrast-enhanced CT before undergoing adrenalectomy. Of these patients, 142 had 144 adenomas and 14 had nodular (n = 12) or diffuse (n = 2) hyperplasia. An ROI was placed on 144 adenomas and 27 hyperplastic nodules that were 1 cm or larger or on the four thickest areas of both adrenal glands. The number of each type of lesion and the attenuation value, absolute percentage washout (APW), and relative percentage washout (RPW) associated with hyperplasia and adenoma were compared. The reference standard was pathologic examination. A mixed model and the Fisher exact test were used for statistical analysis. RESULTS: On unenhanced CT, the mean (± SD) attenuation value for hyperplasia and adenoma was 18.8 ± 10.8 HU and 13.7 ± 15.6 HU, respectively (p = 0.375). When a threshold of 10 HU or lower was used, 22.6% of hyperplastic lesions (7/31) were misdiagnosed as adenomas. The mean APW associated with hyperplasia and adenoma was 73.7% ± 9.3% and 67.3% ± 26.2%, respectively (p = 0.449), whereas the mean RPW for hyperplasia and adenoma was 61.2% ± 9.2% and 59.9% ± 23.0%, respectively (p = 0.625). When an APW threshold of 60% or higher or an RPW threshold of 40% or higher was used, 100% of hyperplastic lesions (31/31) were misdiagnosed as adenoma. Three or more nodules were detected in 33.3% of patients with nodular hyperplasia (4/12) but in none of the patients with adenoma (p < 0.001). CONCLUSION: Adrenal hyperplasia cannot be quantitatively differentiated from adenoma because there is significant overlap in findings from CT densitometry and assessment of percentage washout. However, the presence of three or more nodules increases the likelihood of nodular hyperplasia.

Synthesis and biological evaluation of 3-substituted 5-benzylidene-1-methyl-2-thiohydantoins as potent NADPH oxidase (NOX) inhibitors.

We report the synthesis of novel 3-substituted 5-benzylidene-1-methyl-2-thiohydantoins 3, and their biological evaluation using NADPH oxidase (NOX) 1 and 4. Based on structural and pharmacophore analyses of known inhibitors such as hydroxypyrazole 2, we envisioned interesting 2-thiohydantoin compounds, 3-substituted 5-benzylidene-1-methyl-2-thiohydantoins 3 that would be expected to well match the structural features in 2. Efficient synthesis of eighteen target compounds 3 were achieved through the synthetic pathway of 4→11→3, established after consideration of several plausible synthetic pathways. The inhibitory activities of compounds 3 against NOX 1 and 4 were measured, with some of the target compounds showing similar or higher activities compared with reference 2; in particular, compounds 3bz, 3cz, and 3ez were found to be promising inhibitors of both NOX 1 and 4 with modest isozyme selectivities, which highlights the significance of the 2-thiohydantoin substructure for inhibition of NOX 1 and 4. This marks the first time these compounds have been applied to the inhibition of NOX enzymes.

Long-term Outcomes of MRI Stage IIB Cervical Cancer.

OBJECTIVE: Magnetic resonance imaging (MRI) can be used to assess parametrial invasion (PMI) in cervical cancer. Discordance between MRI findings and International Federation of Gynecology and Obstetrics (FIGO) staging is not uncommon because FIGO staging depends on physical examination. The purpose of this study was to retrospectively evaluate the long-term outcomes of MRI stage IIB cervical cancer. METHODS: A total of 312 patients with MRI stage IIB cervical cancer were retrospectively found between 2002 and 2011. Of these patients, 171 (group 1) were FIGO stage IIB cervical cancers and 141 (group 2) were MRI stage IIB cervical cancers that were negative PMI on physical examination. Group 1 was treated with chemotherapy and/or radiation therapy, and group 2 was treated with radical hysterectomy and lymph node dissection. The FIGO stages and pathologic findings of group 2 were recorded. Groups 1 and 2 were compared regarding 5-year overall survival rate. RESULTS: The FIGO stages of group 2 were IB1 in 51 (36.2%), IB2 in 28 (19.9%), and IIA in 62 (44%), whereas those of group 1 were all IIB. Group 2 showed lymphovascular space invasion in 71 (50.4%), lymph node metastasis in 48 (34.0%), PMI in 46 (32.6%), and vagina invasion in 9 (6.4%). Five-year overall survival rates of groups 1 and 2 were 73.7% and 84.5%, respectively (P = 0.013). CONCLUSIONS: Magnetic resonance imaging stage IIB cervical cancers with negative PMI on physical examination should be surgically treated because of better survival rate than FIGO stage IIB cervical cancers.

Assessment of Early Therapeutic Changes to Concurrent Chemoradiotherapy in Uterine Cervical Cancer Using Blood Oxygenation Level-Dependent Magnetic Resonance Imaging.

OBJECTIVE: This study aimed to investigate blood oxygenation level-dependent magnetic resonance imaging (MRI) in assessing early therapeutic changes in cervical cancers to concurrent chemoradiotherapy (CCRT). METHODS: Fifteen consecutive patients with cervical cancer treated with CCRT were evaluated with blood oxygenation level-dependent MRI at 3 T. Magnetic resonance imaging examinations were performed before treatment (preTx), 1 week after treatment (postT1) and 4 weeks after treatment (postT2). At each time, the rate of spin dephasing (R2*) values were measured in tumor and in normal uterus. RESULTS: Tumor R2* increased from preTx to postT2 (P < 0.01). In pairwise comparisons of tumor R2*, postT2 was significantly higher than preTx or postT1 (P < 0.01), whereas postT1 was not significantly different from preTx (P > 0.05). A significant difference in R2* was found between the tumors and normal uterus at preTx (P = 0.001), postT1 (P < 0.001), and postT2 (P < 0.001). CONCLUSIONS: Blood oxygenation level-dependent MRI may demonstrate early therapeutic changes of cervical cancers to CCRT.

Salvage computed tomography-guided transhepatic radiofrequency ablation for unresected aldosteronoma of adrenohepatic fusion after adrenalectomy.

Adrenalectomy is a treatment of choice for functioning adrenocortical adenoma. We experienced a case of unresected aldosteronoma after right adrenalectomy. Computed tomography-guided transhepatic radiofrequency ablation was carried out to treat the unresected functioning adenoma. The purpose of our case report was to show the clinical findings, computed tomography imaging features and computed tomography-guided transhepatic ablation techniques for adrenocortical adenoma arising from adrenohepatic fusion.

Parametrial invasion in cervical cancer: fused T2-weighted imaging and high-b-value diffusion-weighted imaging with background body signal suppression at 3 T.

PURPOSE: To retrospectively investigate the value of fused T2-weighted and high-b-value diffusion-weighted imaging with background body signal suppression (DWIBS) at 3 T to evaluate parametrial invasion in cervical cancer. MATERIALS AND METHODS: In this institutional review board-approved study, 152 consecutive patients with biopsy-proven cervical cancer who underwent radical hysterectomies also underwent pretreatment magnetic resonance imaging (T2-weighted imaging and DWIBS) at 3 T. Two radiologists independently evaluated the presence of parametrial invasion at T2-weighted imaging, fused T2-weighted imaging and high-b-value DWIBS (ie, fused T2-weighted DWIBS), and combined T2-weighted imaging and fused T2-weighted DWIBS, and the results were compared with histopathologic findings. RESULTS: Parametrial invasion was identified by pathologic analysis in 37 of 152 patients (24.3%). For association with parametrial invasion, the specificity and accuracy of fused T2-weighted DWIBS (97.4% and 90.1%, respectively, for reader 1; 95.7% and 89.5%, respectively, for reader 2) and combined T2-weighted imaging and fused T2-weighted DWIBS (99.1% and 93.4%, respectively, for reader 1; 96.5% and 92.8%, respectively, for reader 2) were significantly better than those of T2-weighted imaging alone (88.7% and 85.5%, respectively, for reader 1; 85.2% and 83.6%, respectively, for reader 2) (all P < .05). The respective sensitivity of T2-weighted imaging, fused T2-weighted DWIBS, and combined T2-weighted imaging and fused T2-weighted DWIBS was 75.7%, 67.6%, and 75.7% for reader 1 and 78.4%, 70.3%, and 81.1% for reader 2, and did not show significant differences (P value, ≤.375 to >.999). The respective area under the curve for association with parametrial invasion of T2-weighted imaging, fused T2-weighted DWIBS, and combined T2-weighted imaging and fused T2-weighted DWIBS was 0.912, 0.951, and 0.976 for reader 1 and 0.890, 0.932, and 0.968 for reader 2 (P < .05). Interreader agreements were excellent (κ = 0.89, 0.9, and 0.86 for T2-weighted imaging, fused T2-weighted DWIBS, and combined T2-weighted imaging and fused T2-weighted DWIBS, respectively). CONCLUSION: Fusion of high-b-value DWIBS with T2-weighted imaging can improve the diagnostic performance in association with parametrial invasion in cervical cancer compared with T2-weighted imaging alone.

Percutaneous radiofrequency ablation of sporadic Bosniak III or IV lesions: treatment techniques and short-term outcomes.

PURPOSE: To evaluate retrospectively the techniques and outcomes of percutaneous radiofrequency (RF) ablation for treatment of Bosniak III or IV lesions. MATERIALS AND METHODS: Between August 2006 and August 2013, 30 patients (25 men and 5 women; mean age, 57 y; range, 22-77 y) with 35 nonhereditary Bosniak III (n = 15) or IV (n = 20) lesions underwent computed tomography-guided RF ablation. The mean size of the lesions was 2.8 cm ± 0.9 (range, 1.1-4.3 cm). The mean follow-up period was 24 months ± 16 (range, 6-70 mo). Duration of ablation, number of sessions and electrode repositions, primary and secondary effectiveness rates, major complication rate, reduction rate of lesion size, estimated glomerular filtration rate (GFR), and local tumor progression were recorded. Wilcoxon signed rank test was used for statistical analysis. RESULTS: Mean duration of ablation was 18 minutes ± 14 (range, 2-65 min), and median number of sessions was one. Median number of electrode repositions was 1.0 ± 1.6 (range, 0-6). Primary and secondary effectiveness rates were 97.1% (34 of 35) and 100% (1 of 1), respectively. Mean reduction rate of lesion size was significantly greater from before RF ablation to 1 month after RF ablation (7.1 mm/mo ± 4.5) compared with from 1 month after RF ablation to the last month of follow-up (0.2 mm/mo ± 0.2; P < .0001). Mean GFR after RF ablation (65.4 mL/min/1.73 m(2) ± 26.1) was minimally reduced but significantly different from mean GFR before RF ablation (76.0 mL/min/1.73 m(2) ± 28.4; P < .0001). Major complications occurred in 2 of 35 RF ablation sessions for a rate of 5.7%, resulting from pneumothorax. Of 30 patients, 29 (96.7%) did not have local tumor progression or metastasis for 2 years. CONCLUSIONS: Percutaneous RF ablation is technically feasible and yields excellent short-term outcomes in treating sporadic Bosniak III or IV lesions.