What abdominal radiologists should know about extragenital endometriosis-associated neuropathy.

PURPOSE: The aim of this study is to provide an overview of endometriosis-associated neuropathy and to review main anatomical concepts of intrapelvic peripheral nerves. METHODS: In this pictorial essay, we review the anatomy of pelvic nerves and imaging features of endometriosis-associated neuropathy. We also evaluate clinical findings, imaging features, and outcome of seven patients with endometriosis-associated neuropathy. RESULTS: Nerve involvement by endometriosis is rare and may manifest with neurological symptoms, including pain, muscle weakness, bowel and bladder incontinence, and paraplegia. The neural involvement may be isolated or caused by a direct extension of a deep infiltrating endometriosis of the pelvic structure. Magnetic resonance imaging (MRI) is a reliable imaging modality for detecting neural involvement of endometriosis. On MRI, the main imaging features are retractile fibrous tissue and endometriomas. The signal intensity of the endometriotic tissue may vary depending on the age of the hemorrhage and the proportion of endometrial cells and stroma. Early diagnosis and treatment may avoid permanent neural damage. CONCLUSION: Considering that patients with endometriosis usually undergo pelvic MRI, which is generally reported by a non-musculoskeletal-trained radiologist, abdominal radiologists need to be familiar with the pelvic nerve anatomy and the possible patterns of presentation of neural endometriosis. Early diagnosis may obviate permanent nerve damage and MRI is a reliable tool for the diagnosis.

Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

ABSTRACT Objectives To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. Materials and Methods In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). Results Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. Conclusions Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

OBJECTIVES: To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. MATERIALS AND METHODS: In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). RESULTS: Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. CONCLUSIONS: Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Evaluation of adrenal tumors by magnetic resonance imaging with histological correlation / Avaliação por ressonância magnética dos tumores de adrenal com correlação histológica

A ressonância magnética é ferramenta importante para a detecção e caracterização dos tumores adrenais. O conhecimento das diferentes apresentações dos tumores primários e secundários à ressonância magnética e sua correlação com dados da histologia são essenciais para o correto raciocínio diagnóstico. Este artigo revisa os aspectos que podem estreitar o diagnóstico diferencial dos tumores adrenais, dando ênfase à correlação histológica daqueles mais comuns.

Magnetic resonance imaging is an important tool for the detection and characterization of adrenal tumors. The knowledge about the different presentations of primary and secondary adrenal tumors at magnetic resonance imaging and their correlation with histological data are essential for the establishment of a correct diagnosis. The present study reviews magnetic resonance imaging aspects which may narrow the differential diagnosis of adrenal tumors, emphasizing the histological correlation of the most frequent ones.