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1.
Radiologie (Heidelb) ; 62(6): 523-534, 2022 Jun.
Article in German | MEDLINE | ID: mdl-35925057

ABSTRACT

Due to the complexity of pelvic floor dysfunctions and the frequent interdisciplinary findings, dynamic magnetic resonance imaging (MRI) can provide valuable (additional) information for the clinical examination in other disciplines through a comprehensive morphological and functional representation of the pelvic floor. It has therefore largely replaced conventional defecography under fluoroscopy in clinical practice. In order to increase the effectiveness and communication between radiology and the other specialist disciplines, recommendations for the standardized implementation and results of dynamic MRI were published by the European Society for Urogenital radiology (ESUR) in 2016 and based on these the Society for Abdominal Radiology (SAR) published simplified recommendations in 2019 for routine clinical use.


Subject(s)
Defecography , Pelvic Floor Disorders , Defecography/methods , Female , Humans , Magnetic Resonance Imaging/methods , Pelvic Floor/diagnostic imaging , Pelvic Floor Disorders/diagnostic imaging , Radiography, Abdominal/methods
2.
Eur Radiol ; 30(8): 4272-4283, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32221681

ABSTRACT

OBJECTIVE: To develop imaging guidelines for the MR work-up of female genital tract congenital anomalies (FGTCA). METHODS: These guidelines were prepared based on a questionnaire sent to all members of the European Society of Urogenital Radiology (ESUR) Female Pelvic Imaging Working Group (FPI-WG), critical review of the literature and expert consensus decision. RESULTS: The returned questionnaires from 17 different institutions have shown reasonable homogeneity of practice. Recommendations with focus on patient preparation and MR protocol are proposed, as these are key to optimised examinations. Details on MR sequences and planning of uterus-orientated sequences are provided. CONCLUSIONS: The multiplanar capabilities and soft tissue resolution of MRI provide superb characterisation of the wide spectrum of findings in FGTCA. A standardised imaging protocol and method of reporting ensures that the salient features are recognised, contributing to a correct diagnosis and classification of FGTCA, associated anomalies and complications. These imaging guidelines are based on current practice among expert radiologists in the field and incorporate up to date information regarding MR protocols and essentials of recently published classification systems. KEY POINTS: • MRI allows comprehensive evaluation of female genital tract congenital anomalies, in a single examination. • A dedicated MRI protocol comprises uterus-orientated sequences and vaginal and renal evaluation. • Integration of classification systems and structured reporting helps in successful communication of the imaging findings.


Subject(s)
Magnetic Resonance Imaging/methods , Urogenital Abnormalities/diagnostic imaging , Contrast Media , Endometriosis/diagnostic imaging , Europe , Fasting , Female , Humans , Hysterosalpingography , Imaging, Three-Dimensional , Kidney/abnormalities , Kidney/diagnostic imaging , Ovary/abnormalities , Ovary/diagnostic imaging , Parasympatholytics , Radiography , Radiology , Spine/abnormalities , Spine/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography , Ureter/abnormalities , Ureter/diagnostic imaging , Uterus/abnormalities , Uterus/diagnostic imaging , Vagina/abnormalities , Vagina/diagnostic imaging , Vaginal Creams, Foams, and Jellies
3.
Spinal Cord ; 58(2): 203-210, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31506586

ABSTRACT

STUDY DESIGN: A prospective single arm study. OBJECTIVES: Previously we have demonstrated that magnetic resonance (MR) defecography is feasible in participants with complete spinal cord injury (SCI). The main aim of this study is to evaluate whether MR defecography can provide objective parameters correlating with the clinical manifestations of neurogenic bowel dysfunction (NBD) in participants with SCI. SETTING: A monocentric study in a comprehensive care university hospital Spinal Cord Injury Center. METHODS: Previously published MR defecography parameters (anorectal angle (ARA), hiatal descent (M-line) and hiatal width (H-line)) of twenty participants with SCI were now compared to a standardized clinical assessment of NBD. Descriptive statistics, correlations and t-tests for independent samples were calculated. RESULTS: The significantly higher values for the ARA at rest and M-line at rest in participants with SCI correlated with the clinical assessment of bowel incontinence. Furthermore, in nearly half of the investigated SCI cohort the normally positive difference between ARA, M-line and H-line at rest and during defecation became negative suggesting pelvic floor dyssynergia as a potential mechanism underlying constipation in people with complete SCI. In fact, these participants showed a more severe clinical presentation of NBD according to the total NBD score. CONCLUSIONS: MR defecography provides objective parameters correlating with clinical signs of NBD, such as constipation and bowel incontinence. Therefore, MR defecography can support pathophysiology-based decision-making with respect to specific therapeutic interventions, which should help to improve the management of NBD.


Subject(s)
Constipation/diagnostic imaging , Defecography/standards , Fecal Incontinence/diagnostic imaging , Neurogenic Bowel/diagnostic imaging , Pelvic Floor/diagnostic imaging , Spinal Cord Injuries/complications , Adult , Aged , Constipation/etiology , Feasibility Studies , Fecal Incontinence/etiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurogenic Bowel/etiology , Pelvic Floor/physiopathology , Prospective Studies , Young Adult
4.
Arch Gynecol Obstet ; 299(5): 1391-1398, 2019 05.
Article in English | MEDLINE | ID: mdl-30719553

ABSTRACT

PURPOSE: The aim of this study is to analyze the correct staging of primary endometrial cancer (EC) using clinical examination and 3 Tesla (T) magnetic resonance imaging (MRI) results compared to histopathology. METHODS: In this prospective, non-randomized, single-center study, 26 women with biopsy-proven EC were evaluated. All women underwent clinical examination including transvaginal ultrasound (CE/US) and 3T MRI (T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences) prior to surgery. Spearman's correlation coefficient was employed to analyze the correlation between both staging methods and histopathology and generalized estimation equation analysis to compare their staging results. Main outcome measures are determinations of local tumor extent for EC on CE/US and 3T MRI compared to histopathology (gold standard). RESULTS: Sixteen women had an early-stage pT1a tumor, 10 a locally advanced ≥ pT1b tumor. The early stage was correctly diagnosed at CE/US in 100%, by MRI in 81%. Spearman's correlation coefficient was r = 1.0 (p < 0.001) for correlation of CE/US and histopathology, r = 0.93 (p < 0.001) for correlation of MRI and pathology. A locally advanced tumor stage was exactly diagnosed by MRI in 70% and at CE/US in 50%. CONCLUSIONS: CE/US is sufficient for staging T1a endometrial cancer, while MRI provides higher sensitivity in detecting locally advanced tumors. Based on our results, combining CE/US and 3T MRI in patients with at least suspected deep myometrial invasion offers a more reliable workflow for individual treatment planning.


Subject(s)
Endometrial Neoplasms/diagnostic imaging , Endometrial Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Aged , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Prospective Studies
5.
Neurourol Urodyn ; 38(1): 369-378, 2019 01.
Article in English | MEDLINE | ID: mdl-30387537

ABSTRACT

AIMS: To develop MR-based measurement technique to evaluate the postoperative dimension and location of implanted magnetic resonance (MR)-visible meshes. METHODS: This technique development study reports findings of six patients (A-F) with cystoceles treated with anterior vaginal MR-visible Fe3 O4 -polypropylene implants. Implanted meshes were reconstructed from 3 months and/or 1 year postsurgical MR-images using 3D Slicer®. Measurements including mesh length, distance to the ischial spines, pudendal, and obturator neurovascular bundles and urethra were obtained using software Rhino® and a custom Matlab® program. The range of implanted mesh length and their placements were reported and compared with mesh design and implantation recommendations. With the anterior/posterior-mesh-segment-ratio mesh shrinkage localization was evaluated. RESULTS: Examinations were possible for patients A-D 3 months and for A, C, E, and F 1 year postsurgical. The mesh was at least 40% shorter in all patients 3 months and/or 1 year postoperatively. A, B showed shrinkage in the anterior segment, D, E in the posterior segment (Patients C, F not applicable due to intraoperative mesh trimming). Patient E presented pain in the area of mesh shrinkage. In Patient C posterior mesh fixations were placed in the iliococcygeal muscle rather than sacrospinous ligaments. Arm placement less than 20 mm from the pudendal neurovascular bundles was seen in all cases. The portion of the urethra having mesh underneath it ranged from 19% to 55%. CONCLUSIONS: MRI-based measurement techniques have been developed to quantify implanted mesh location and dimension. Mesh placement variations possibly correlating with postoperative complications can be illustrated.


Subject(s)
Cystocele/surgery , Imaging, Three-Dimensional , Pelvic Floor/surgery , Pelvic Organ Prolapse/surgery , Surgical Mesh , Aged , Cystocele/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Pelvic Floor/diagnostic imaging , Pelvic Organ Prolapse/diagnostic imaging
6.
Acta Radiol ; 59(10): 1264-1273, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29409326

ABSTRACT

Background Dynamic magnetic resonance imaging (dMRI) captures the entire pelvis during Valsalva maneuver and helps diagnosing pelvic floor changes after reconstructive surgery. Purpose To evaluate therapeutic outcome five years after reconstructive surgery using clinical examination, dMRI, and quality-of-life (QOL) questionnaire. Material and Methods Clinical examination, dMRI, and QOL questionnaire were conducted before surgery and in the follow-ups at 12 weeks, one year, and five years in women with pelvic organ prolapse (POP) stage ≥2. dMRI was performed at 1.5-T using a predefined protocol including sagittal T2-weighted (T2W) sequence at rest and sagittal T2W true-FISP sequence at maximum strain for metric POP measurements (reference points = bladder, cervix, pouch, rectum). Pelvic organ mobility (POM) was defined as the difference of the metric measurement at maximum strain and at rest. Results Twenty-six women with 104 MRI examinations were available for analysis. dMRI results mostly differ to clinical examination regarding the overall five-year outcome and the posterior compartment in particular. dMRI diagnosed substantially more patients with recurrent or de novo POP in the posterior compartment (n = 17) compared to clinical examination (n = 4). POM after five years aligns to preoperative status except for the bladder. POM reflects best the QOL results regarding defecation disorders. Conclusion A tendency for recurrent and de novo POP was seen in all diagnostic modalities applied. dMRI objectively visualizes the interaction of the pelvic organs and the pelvic floor after reconstructive surgery and POM correlated best with the women's personal impression on pelvic floor complaints.


Subject(s)
Magnetic Resonance Imaging/methods , Pelvic Floor/diagnostic imaging , Pelvic Floor/surgery , Pelvic Organ Prolapse/diagnostic imaging , Pelvic Organ Prolapse/surgery , Plastic Surgery Procedures , Quality of Life , Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Prospective Studies , Surgical Mesh , Surveys and Questionnaires , Treatment Outcome , Valsalva Maneuver
7.
Eur J Radiol ; 91: 15-21, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28629562

ABSTRACT

INTRODUCTION: To investigate whether MR-defecography can be employed in sensorimotor complete spinal cord injury (SCI) subjects as a potential diagnostic tool to detect defecational disorders associated with neurogenic bowel dysfunction (NBD) using standard parameters for obstructed defecation. MATERIAL AND METHODS: In a prospective single centre clinical trial, we developed MR-defecography in traumatic sensorimotor complete paraplegic SCI patients with upper motoneuron type injury (neurological level of injury T1 to T10) using a conventional 3T scanner. Defecation was successfully induced by eliciting the defecational reflex after rectal filling with ultrasonic gel, application of two lecicarbon suppositories and digital rectal stimulation. Examination was performed with patients in left lateral decubitus position using T2-weighted turbo spin echo sequence in the sagittal plane at rest (TE 89ms, TR 3220ms, FOV 300mm, matrix 512×512, ST 4mm) and ultrafast-T2-weighted-sequence in the sagittal plane with repeating measurements (TE 1.54ms, TR 3.51ms, FOV 400mm, matrix 256×256, ST 6mm). Changes of anorectal angle (ARA), anorectal descent (ARJ) and pelvic floor weakness were documented and measured data was compared to reference values of asymptomatic non-SCI subjects in the literature to assess feasibility. RESULTS: MR-defecography provides evaluable imaging sequences of the induced evacuation phase in SCI patients. Measurement results for ARA, ARJ, hiatal width (H-line) and hiatal descent (M-line) deviate significantly from reference values in the literature in asymptomatic subjects without SCI. The overall mean values in our study for SCI patients were: ARA (rest) 127.3°, ARA (evacuation) 137.6°, ARJ (rest) 2.4cm, ARJ (evacuation) 4.0cm, H-line (rest) 7.6cm, H-line (evacuation) 8.1cm, M-line (rest) 2.6cm, M-line (evacuation) 4.2cm. CONCLUSIONS: MR-defecography is feasible in sensorimotor complete SCI patients. Individual MR-defecography findings may help to determine specific therapeutical options for respective patients suffering from severe NBD.


Subject(s)
Defecography/methods , Magnetic Resonance Imaging/methods , Neurogenic Bowel/complications , Neurogenic Bowel/diagnostic imaging , Paraplegia/complications , Spinal Cord Injuries/complications , Adult , Aged , Constipation/physiopathology , Feasibility Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Young Adult
8.
Eur Urol ; 72(6): 888-896, 2017 12.
Article in English | MEDLINE | ID: mdl-28400169

ABSTRACT

BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC; Gleason score≥3+4) detection. Decision making based on European Randomised Study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome prostate-specific antigen (PSA) limitations. OBJECTIVE: We added pre-biopsy mpMRI to ERSPC-RC parameters and developed risk models (RMs) to predict individual sPC risk for biopsy-naïve men and men after previous biopsy. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively analyzed clinical parameters of 1159 men who underwent mpMRI prior to MRI/transrectal ultrasound fusion biopsy between 2012 and 2015. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariate regression analyses were used to determine significant sPC predictors for RM development. The prediction performance was compared with ERSPC-RCs, RCs refitted on our cohort, Prostate Imaging Reporting and Data System (PI-RADS) v1.0, and ERSPC-RC plus PI-RADSv1.0 using receiver-operating characteristics (ROCs). Discrimination and calibration of the RM, as well as net decision and reduction curve analyses were evaluated based on resampling methods. RESULTS AND LIMITATIONS: PSA, prostate volume, digital-rectal examination, and PI-RADS were significant sPC predictors and included in the RMs together with age. The ROC area under the curve of the RM for biopsy-naïve men was comparable with ERSPC-RC3 plus PI-RADSv1.0 (0.83 vs 0.84) but larger compared with ERSPC-RC3 (0.81), refitted RC3 (0.80), and PI-RADS (0.76). For postbiopsy men, the novel RM's discrimination (0.81) was higher, compared with PI-RADS (0.78), ERSPC-RC4 (0.66), refitted RC4 (0.76), and ERSPC-RC4 plus PI-RADSv1.0 (0.78). Both RM benefits exceeded those of ERSPC-RCs and PI-RADS in the decision regarding which patient to receive biopsy and enabled the highest reduction rate of unnecessary biopsies. Limitations include a monocentric design and a lack of PI-RADSv2.0. CONCLUSIONS: The novel RMs, incorporating clinical parameters and PI-RADS, performed significantly better compared with RMs without PI-RADS and provided measurable benefit in making the decision to biopsy men at a suspicion of PC. For biopsy-naïve patients, both our RM and ERSPC-RC3 plus PI-RADSv1.0 exceeded the prediction performance compared with clinical parameters alone. PATIENT SUMMARY: Combined risk models including clinical and imaging parameters predict clinically relevant prostate cancer significantly better than clinical risk calculators and multiparametric magnetic resonance imaging alone. The risk models demonstrate a benefit in making a decision about which patient needs a biopsy and concurrently help avoid unnecessary biopsies.


Subject(s)
Magnetic Resonance Imaging/methods , Prostate/pathology , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Age Factors , Aged , Biopsy , Digital Rectal Examination , Humans , Male , Middle Aged , Models, Theoretical , Neoplasm Grading , Organ Size , Prostate-Specific Antigen/blood , ROC Curve , Retrospective Studies , Risk Assessment/methods , Unnecessary Procedures
9.
Langenbecks Arch Surg ; 402(8): 1271-1278, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28093632

ABSTRACT

PURPOSE: The study aims to describe the technique and analyze the outcome of an arcuated bladder incision with building of a triangular flap, first described by Uebelhoer (UBBF), as a modification of the classical rectangular Boari bladder flap (BBF), that is often viable, but can present difficulties, such as reduced flap vascularization and mobility in pretreated patients. METHODS: Twelve consecutive patients with distal or mid ureteral leakage or stenosis, that underwent UBBF, were retrospectively analyzed. We assessed postoperative morbidity using Clavien-Dindo classification. Short- and long-term functional outcomes were assessed using glomerular filtration rate (GFR), ultrasound, and renal scintigraphy. RESULTS: Patients underwent UBBF during initial oncological surgery in five cases and due to ureteral defects following oncological surgery or radiotherapy in seven cases. Median patient age was 57 (interquartile range (IQR) 46-72), defect length was 7.5 cm (IQR 5-8 cm), and median follow-up period was 41 (IQR 36-48) months. In short-term follow-up, 11/13 postoperative morbidities were Clavien-Dindo level I-II complications, mostly infections. Two level IIIa complications occurred. One anastomotic leakage was treated sufficiently with temporarily ureteral stenting and one voiding disorder needed intervention. In the long-term follow-up, 84% of patients had improved or constant GFR. In the one-year renal scintigraphy, no urodynamically relevant voiding disorder occurred. CONCLUSIONS: The UBBF is a reliable procedure to reconstruct ureteral trauma even in complex oncological, pretreated patients suffering from distal or mid ureteral defects. It can be performed easily by a modified arcuate incision and provides good long-term functional outcomes.


Subject(s)
Laparoscopy/methods , Plastic Surgery Procedures/methods , Surgical Flaps , Ureter/surgery , Urinary Bladder/surgery , Urologic Neoplasms/surgery , Aged , Female , Glomerular Filtration Rate , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Urologic Neoplasms/pathology
10.
Int Urogynecol J ; 28(8): 1131-1138, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28124074

ABSTRACT

INTRODUCTION AND HYPOTHESIS: To demonstrate mesh magnetic resonance imaging (MRI) visibility in living women, the feasibility of reconstructing the full mesh course in 3D, and to document its spatial relationship to pelvic anatomical structures. METHODS: This is a proof of concept study of three patients from a prospective multi-center trial evaluating women with anterior vaginal mesh repair using a MRI-visible Fe3O4 polypropylene implant for pelvic floor reconstruction. High-resolution sagittal T2-weighted (T2w) sequences, transverse T1-weighted (T1w) FLASH 2D, and transverse T1w FLASH 3D sequences were performed to evaluate Fe3O4 polypropylene mesh MRI visibility and overall post-surgical pelvic anatomy 3 months after reconstructive surgery. Full mesh course in addition to important pelvic structures were reconstructed using the 3D Slicer® software program based on T1w and T2w MRI. RESULTS: Three women with POP-Q grade III cystoceles were successfully treated with a partially absorbable MRI-visible anterior vaginal mesh with six fixation arms and showed no recurrent cystocele at the 3-month follow-up examination. The course of mesh in the pelvis was visible on MRI in all three women. The mesh body and arms could be reconstructed allowing visualization of the full course of the mesh in relationship to important pelvic structures such as the obturator or pudendal vessel nerve bundles in 3D. CONCLUSIONS: The use of MRI-visible Fe3O4 polypropylene meshes in combination with post-surgical 3D reconstruction of the mesh and adjacent structures is feasible suggesting that it might be a useful tool for evaluating mesh complications more precisely and a valuable interactive feedback tool for surgeons and mesh design engineers.


Subject(s)
Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Pelvic Bones/diagnostic imaging , Pelvic Floor/diagnostic imaging , Surgical Mesh , Aged , Cystocele/surgery , Feasibility Studies , Female , Ferrosoferric Oxide , Humans , Pelvic Floor/blood supply , Pelvic Floor/innervation , Polypropylenes , Postoperative Period , Proof of Concept Study , Prospective Studies , Vagina/diagnostic imaging , Vagina/surgery
11.
Eur Radiol ; 27(5): 2067-2085, 2017 May.
Article in English | MEDLINE | ID: mdl-27488850

ABSTRACT

OBJECTIVE: To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD). METHODS: The technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding. RESULTS: Consensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the "Rule of three" for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system. CONCLUSION: This literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD. KEY POINTS: • These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.


Subject(s)
Pelvic Floor/diagnostic imaging , Pelvic Floor/physiopathology , Pelvic Organ Prolapse/diagnostic imaging , Defecography/methods , Female , Humans , Magnetic Resonance Imaging/methods , Pelvic Organ Prolapse/physiopathology , Radiography, Abdominal/methods , Rectocele/diagnostic imaging , Rectocele/physiopathology
12.
Eur Urol ; 70(5): 846-853, 2016 11.
Article in English | MEDLINE | ID: mdl-26810346

ABSTRACT

BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) and MRI fusion targeted biopsy (FTB) detect significant prostate cancer (sPCa) more accurately than conventional biopsies alone. OBJECTIVE: To evaluate the detection accuracy of mpMRI and FTB on radical prostatectomy (RP) specimen. DESIGN, SETTING AND PARTICIPANTS: From a cohort of 755 men who underwent transperineal MRI and transrectal ultrasound fusion biopsy under general anesthesia between 2012 and 2014, we retrospectively analyzed 120 consecutive patients who had subsequent RP. All received saturation biopsy (SB) in addition to FTB of lesions with Prostate Imaging Reporting and Data System (PI-RADS) score ≥2. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The index lesion was defined as the lesion with extraprostatic extension, the highest Gleason score (GS), or the largest tumor volume (TV) if GS were the same, in order of priority. GS 3+3 and TV ≥1.3ml or GS ≥3+4 and TV ≥0.55ml were considered sPCa. We assessed the detection accuracy by mpMRI and different biopsy approaches and analyzed lesion agreement between mpMRI and RP specimen. RESULTS AND LIMITATIONS: Overall, 120 index and 71 nonindex lesions were detected. Overall, 107 (89%) index and 51 (72%) nonindex lesions harbored sPCa. MpMRI detected 110 of 120 (92%) index lesions, FTB (two cores per lesion) alone diagnosed 96 of 120 (80%) index lesions, and SB alone diagnosed 110 of 120 (92%) index lesions. Combined SB and FTB detected 115 of 120 (96%) index foci. FTB performed significantly less accurately compared with mpMRI (p=0.02) and the combination for index lesion detection (p=0.002). Combined FTB and SB detected 97% of all sPCa lesions and was superior to mpMRI (85%), FTB (79%), and SB (88%) alone (p<0.001 each). Spearman's rank correlation coefficient for index lesion agreement between mpMRI and RP was 0.87 (p<0.001). Limitations included the retrospective design, multiple operators, and nonblinding of radiologists. CONCLUSIONS: MpMRI identified 92% of index lesions compared with RP histopathology. The combination of FTB and SB was superior to both approaches alone, reliably detecting 97% of sPCa lesions. PATIENT SUMMARY: Multiparametric magnetic resonance imaging detects the index lesion accurately in 9 of 10 patients; however, the combined biopsy approach, while missing less significant cancer, comes at the cost of detecting more insignificant cancer.


Subject(s)
Image-Guided Biopsy/methods , Magnetic Resonance Imaging/methods , Prostate , Prostatic Neoplasms , Ultrasonography, Interventional/methods , Aged , Anesthesia, General/methods , Dimensional Measurement Accuracy , Germany , Humans , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Predictive Value of Tests , Prostate/diagnostic imaging , Prostate/pathology , Prostate/surgery , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Retrospective Studies , Tumor Burden
13.
Neurourol Urodyn ; 35(2): 218-23, 2016 Feb.
Article in English | MEDLINE | ID: mdl-25393071

ABSTRACT

AIMS: Measurements indicating a loss of integrity of the levator ani muscle, which is an integral part of the pelvic floor, have been subject of recent studies using translabial ultrasound and 3D-MRI-models. We transferred these measurements into 2D-3 T-MR-images for clinical routine, as it is objective and does not need exhaustive post-processing. METHODS: The trial was accepted by the local ethics committee. 25 healthy volunteers fulfilled the inclusion criteria and gave written informed consent. Using high-resolution T2-weighted images (TE 5030-7810 ms, TR 88-112 ms, matrix 512, FOV 280-300 mm, ST 2-3 mm), measurements of anteroposterior hiatus (APH), laterolateral hiatus (LLH), hiatal area (HA), hiatal circumference (HC), levator area (LA), maximum muscle thickness (MMT) and levator urethra gap (LUG) were transferred from ultrasound, iliococcygeus width (IW), puborectalis attachment width (PAW), and levator symphysis gap (LSG) were transferred from 3D-MRI-models. We compared our results to previous studies in the literature. RESULTS: Mean value was 52.22 ± 6.97 mm for APH, 33.15 ± 4 mm for LLH, 13.22 ± 3.05 cm(2) for HA, 14.19 ± 1.61 cm for HC, 7.14 ± 1.85 cm(2) for LA, 6.45 ± 2.07 mm for MMT, 19.47 ± 2.38 mm for LUG, 45 ± 3.97 mm for IW, 33.94 ± 3.34 mm for PAW, 20.54 ± 5.29 mm for LSG. Our results for APH, HA, LUG, and with limitations LA, were comparable to the literature, while HC, LLH, and MMT showed anatomical variances. Results for IW and LSG were comparable, but challenging to measure. We newly proposed a cutoff value for PAW. CONCLUSIONS: 2D-3 T-MRI combines high-resolution images with objective measurements of parameters regarding pelvic floor integrity, without resorting to exhaustive post-processing methods. Our results may provide a good foundation for further 2D-MR-studies.


Subject(s)
Magnetic Resonance Imaging , Parity , Pelvic Floor/diagnostic imaging , Adult , Anatomic Landmarks , Cross-Sectional Studies , Female , Healthy Volunteers , Humans , Image Interpretation, Computer-Assisted , Predictive Value of Tests , Young Adult
14.
J Endourol ; 29(12): 1396-405, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26154571

ABSTRACT

PURPOSE: To investigate the value of multiparametric magnetic resonance imaging (mpMRI) and to predict extracapsular extension (ECE), seminal vesicle (SV) infiltration, and a negative surgical margin (SM) status at radical prostatectomy (RP) for different prostate cancer (PC) risk groups. PATIENTS AND METHODS: In the study, 805 men underwent 3 tesla mpMRI without endorectal coil before MRI/transrectal ultrasonography-fusion guided prostate biopsy. MRIs were analyzed using the prostate imaging reporting and data system. The cohort was classified into risk groups according to National Comprehensive Cancer Network (NCCN) criteria. Of 132 men who subsequently underwent RP, pathologic stage and SM status at RP were used as reference. Retrospectively, we investigated a European Society of Urogenital Radiology (ESUR) score for ECE and SV-infiltration. Statistical analyses included regression analyses, receiver operating characteristics (ROC), and Youden Index to assess an ESUR-score cutoff. RESULTS: Area under the curve in ROC curve analyses was 0.82 for ESUR-ECE score to detect pT(3a)-disease and 0.77 for ESUR-SV score for pT(3b). Using a cutoff of 4 for ECE and of 2 for SV, the positive predictive value of the ECE-score for harboring pT(3) was 50.0%, 90.0%, and 88.8% for the low-, intermediate- and high-risk cohort. Retrospectively, the use of the ESUR-ECE score preoperatively would have changed the initial surgical plan, according to NCCN criteria, in 31.1% of patients. In the high-risk subgroup, 9/35 (25.7%) patients were correctly assessed as not harboring pT(3) by imaging (ECE score <4), and would have allowed secure robot-assisted radical prostatectomy and nerve-sparing surgery (NSS). When T3 suspicion on preoperative MRI would be taken into account, intraoperative frozen-sections (IFS) might avoid positive SM in 12/18 high-risk patients and an oncologic secure NSS in 8/20 intermediate-risk patients. CONCLUSION: Prediction of pT(3) disease is crucial to plan NSS and to achieve negative SM in RP. Standardized ECE scoring on mpMRI is an independent predictor of pT(3) and may help to plan RP with oncologic security, even in high-risk patients. In addition, it allows more accurate selection of a subgroup of patients for systematic and MRI-guided IFS.


Subject(s)
Magnetic Resonance Imaging , Prostatectomy/methods , Prostatic Neoplasms/diagnosis , Seminal Vesicles/pathology , Aged , Biopsy , Cohort Studies , Frozen Sections , Humans , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Neoplasm, Residual , Organ Size , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , ROC Curve , Regression Analysis , Retrospective Studies , Risk Assessment , Treatment Outcome
15.
J Urol ; 193(1): 87-94, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25079939

ABSTRACT

PURPOSE: Multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsy may improve the detection of clinically significant prostate cancer. However, standardized prospective evaluation is limited. MATERIALS AND METHODS: A total of 294 consecutive men with suspicion of prostate cancer (186 primary, 108 repeat biopsies) enrolled in 2013 underwent 3T multiparametric magnetic resonance imaging (T2-weighted, diffusion weighted, dynamic contrast enhanced) without endorectal coil and systematic transperineal cores (median 24) independently of magnetic resonance imaging suspicion and magnetic resonance imaging targeted cores with software registration (median 4). The highest Gleason score from each biopsy method was compared. McNemar's tests were used to evaluate detection rates. Predictors of Gleason score 7 or greater disease were assessed using logistic regression. RESULTS: Overall 150 cancers and 86 Gleason score 7 or greater cancers were diagnosed. Systematic, transperineal biopsy missed 18 Gleason score 7 or greater tumors (20.9%) while targeted biopsy did not detect 11 (12.8%). Targeted biopsy of PI-RADS 2-5 alone overlooked 43.8% of Gleason score 6 tumors. McNemar's tests for detection of Gleason score 7 or greater cancers in both modalities were not statistically significant but showed a trend of superiority for targeted primary biopsies (p=0.08). Sampling efficiency was in favor of magnetic resonance imaging targeted prostate biopsy with 46.0% of targeted biopsy vs 7.5% of systematic, transperineal biopsy cores detecting Gleason score 7 or greater cancers. To diagnose 1 Gleason score 7 or greater cancer, 3.4 targeted and 7.4 systematic biopsies were needed. Limiting biopsy to men with PI-RADS 3-5 would have missed 17 Gleason score 7 or greater tumors (19.8%), demonstrating limited magnetic resonance imaging sensitivity. PI-RADS scores, digital rectal examination findings and prostate specific antigen greater than 20 ng/ml were predictors of Gleason score 7 or greater disease. CONCLUSIONS: Compared to systematic, transperineal biopsy as a reference test, magnetic resonance imaging targeted biopsy alone detected as many Gleason score 7 or greater tumors while simultaneously mitigating the detection of lower grade disease. The gold standard for cancer detection in primary biopsy is a combination of systematic and targeted cores.


Subject(s)
Image-Guided Biopsy/methods , Magnetic Resonance Imaging, Interventional , Multimodal Imaging , Prostate/pathology , Prostatic Neoplasms/pathology , Ultrasonography, Interventional , Aged , Humans , Male , Middle Aged , Neoplasm Grading , Perineum , Prospective Studies , Prostate/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging
16.
Acta Radiol ; 56(8): 1002-8, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25136056

ABSTRACT

BACKGROUND: Pelvic organ prolapse (POP) is a common disorder in elderly women often surgically repaired with alloplastic meshes; yet knowledge of the pelvic floor behavior and multi-compartment defects postoperatively is scarce. PURPOSE: To evaluate the 1-year outcome after mesh repair in patients with POP using clinical examination (CE), dynamic magnetic resonance imaging (dMRI), and the prolapse quality-of-life (P-QOL) questionnaire. MATERIAL AND METHODS: A prospective observational study was conducted of 69 women undergoing pelvic mesh surgery. Clinical examination, dMRI, and the P-QOL questionnaire were applied before and after surgery to evaluate POP. Mean outcome measures were POP outcome as determined on clinical and dMRI examinations and its impact on quality of life. Statistical results were obtained with SPSS version 15.0. ANOVA was used to compare pre-/postsurgical quality of life data. RESULTS: Sixty-nine women (mean age, 64.75 years; BMI, 26.75 kg/m(2); postmenopausal, 89.2%) were recruited and treated with Seratom® or Perigee™ mesh implants. A significant improvement in the position of bladder neck, vaginal vault/uterus, pouch of Douglas, and rectum was found 12 weeks and 1 year after surgery using POP-Q scale and dMRI. Advanced cystoceles and enteroceles seem underestimated by CE using the POP-Q system compared to dMRI results (P = 0.003 and P < 0.001), vice versa dMRI overestimated POP compared to CE. Sixty-four women completed the P-QOL questionnaire, presenting reduced quality of life before surgery which improves postsurgically. Prolapse impact and physical, social, and role limitations correlated strongest with a low quality of life (P < 0.001). CONCLUSION: The 1-year follow-up after mesh repair showed statistical and clinical improvement for all tools employed. dMRI seems a reliable tool for simultaneous assessment of defects in all three compartments, but tends to overestimate POP compared to clinical examination.


Subject(s)
Magnetic Resonance Imaging , Patient Satisfaction , Pelvic Organ Prolapse/diagnosis , Pelvic Organ Prolapse/surgery , Quality of Life/psychology , Surgical Mesh , Aged , Aged, 80 and over , Female , Follow-Up Studies , Germany , Humans , Longitudinal Studies , Middle Aged , Pelvic Organ Prolapse/psychology , Treatment Outcome
17.
Gynecol Obstet Invest ; 79(2): 101-6, 2015.
Article in English | MEDLINE | ID: mdl-25531860

ABSTRACT

AIM: To develop a magnetic resonance (MR)-visible mesh using iron oxides and prove visibility. METHODS: In a phantom study, a suitable iron oxide, Fe3O4 [iron(II,III) oxide] and FeOOH [iron(III) oxide-hydroxide], concentration was determined using relaxometric MR measurements of the transverse relaxation rates R2 and R2*. Next, a nonabsorbable mesh was designed from the MR-visible threads woven into a polypropylene mesh. The mesh was implanted into a fresh female cadaver via the transobturator route, and MR visibility was assessed with various MR pulse sequences in a clinical 3-tesla system. RESULTS: Optimal contrast was achieved with Fe3O4 at 0.2 weight-% in all imaging sequences, and the optimal contrast was achieved in a 3D spoiled gradient-echo (fast low-angle shot) acquisition. In this concentration range the apparent transverse relaxation rate R2* is below 10 ms. The mesh was visible in the cadaver on T1-weighted 3D spoiled gradient-echo images and T1-weighted fast spin-echo images. CONCLUSION: Mesh materials can be manufactured to be visible on MR with a negative contrast. Fe3O4 meshes could simplify follow-up examinations and help diagnose origins of postsurgical lesions after urogynecological procedures with mesh material.


Subject(s)
Ferrosoferric Oxide , Magnetic Resonance Imaging/methods , Pelvic Organ Prolapse/surgery , Polypropylenes , Surgical Mesh , Cadaver , Female , Ferric Compounds , Humans
18.
Eur J Radiol ; 83(7): 1030-1035, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24794864

ABSTRACT

INTRODUCTION: The objective of this trial is to investigate the diagnostic value of magnetic resonance imaging (MRI) with an endorectal surface coil for precise local staging of patients with histologically proven cervical cancer by comparing the radiological, clinical, and histological results. MATERIALS AND METHODS: Women with cervical cancer were recruited for this trial between February 2007, and September 2010. All the patients were clinically staged according to the FIGO classification and underwent radiological staging by MRI that employed an endorectal surface coil. The staging results after surgery were compared to histopathology in all the operable patients. RESULTS: A total of 74 consecutive patients were included in the trial. Forty-four (59.5%) patients underwent primary surgery, whereas 30 (40.5%) patients were inoperable according to FIGO and underwent primary radiochemotherapy. The mean age of the patients was 50.6 years. In 11 out of the 44 patients concordant staging results were obtained by all three staging modalities. Thirty-two of the 44 patients were concordantly staged by FIGO and histopathological examination, while only 16 were concordantly staged by eMRI and histopathological examination. eMRI overstaged tumors in 14 cases and understaged them in 7 cases. CONCLUSIONS: eMRI is applicable in patients with cervical cancer, yet of no benefit than staging with FIGO or standard pelvic MRI. The most precise preoperative staging procedure still appears to be the clinical examination.


Subject(s)
Image Enhancement/instrumentation , Magnetic Resonance Imaging/instrumentation , Rectum , Transducers , Uterine Cervical Neoplasms/pathology , Adult , Aged , Equipment Design , Equipment Failure Analysis , Female , Humans , Middle Aged , Neoplasm Staging , Reproducibility of Results , Sensitivity and Specificity
19.
Arch Gynecol Obstet ; 289(4): 851-8, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24173171

ABSTRACT

PURPOSE: The aim of this study was to evaluate the staging accuracy of magnetic resonance imaging (MRI) with an endorectal surface coil on patients with endometrial cancer compared to results obtained using the International Federation of Gynecology and Obstetrics (FIGO) classification and histopathology. METHODS: In this prospective study, patients with biopsy-proven endometrial cancer were staged clinically using the FIGO classification before undergoing 1.5 T MRI with an endorectal surface coil (eMRI). The staging results from the FIGO classification and from eMRI were compared with the histopathological results after surgery. Furthermore, each patient was given a questionnaire designed by the authors to evaluate the patients' opinions on eMRI. The responses were examined using the methods of descriptive analysis. RESULTS: A total of 33 consecutive patients were recruited and clinically staged before undergoing eMRI. Subsequently, 21 patients underwent primary surgery and 12 patients primary radiochemotherapy. The FIGO stages were identical to the histopathological results in 17 (81 %) cases, and those of eMRI were identical in 15 (71 %). In 13 (62 %) cases, FIGO and eMRI staged identically. In 12 (57 %) of the 21 cases, all three staging modalities diagnosed the same tumor stage. eMRI overstaged the tumor in four patients and understaged it in two. All T1a tumors were staged correctly by eMRI. Eighteen patients answered the questionnaire, of whom 11 (61 %) patients stated that their experience with eMRI was overall positive. CONCLUSIONS: It seems feasible in principle to employ eMRI for diagnosing patients with endometrial cancer stage T1a. Yet, the results of eMRI for our study population were not better than the results obtained using the FIGO classification or than those from using MRI without an endorectal surface coil. eMRI thus does not meet the expectations based on its use in other pelvic tumor entities.


Subject(s)
Endometrial Neoplasms/pathology , Magnetic Resonance Imaging/instrumentation , Aged , Aged, 80 and over , Biopsy , Female , Humans , Lymphatic Metastasis , Middle Aged , Neoplasm Staging , Prospective Studies , Rectum , Surveys and Questionnaires
20.
Acta Radiol ; 55(4): 495-504, 2014 May.
Article in English | MEDLINE | ID: mdl-23939382

ABSTRACT

BACKGROUND: Therapeutical outcome after prolapse surgery is evaluated using a standardized grading system based on maximum prolapse extent, which might not provide the full picture of the patient's subjective outcome. We therefore applied an evaluation method, which is detached from a grading system. PURPOSE: To evaluate the impact of pelvic organ mobility in dynamic magnetic resonance imaging (MRI) before and after mesh-repair surgery in patients with symptomatic pelvic organ prolapse. MATERIAL AND METHODS: To obtain measurements, we performed parasagittal T2-weighted turbo spin echo sequence at rest (TR, 3460 ms; TE, 85 ms; matrix, 512; slice thickness [ST], 5 mm), parasagittal T2-weighted true fast imaging with steady-state precession (TrueFISP) single-shot sequence during straining (TR, 397.4 ms; TE, 1.5 ms; matrix, 256; ST, 8 mm), and parasagittal T2-weighted TrueFISP sequence at maximum strain (TR, 4.3 ms; TE, 2.15 ms; matrix, 256; ST, 5 mm) at 1.5 T MRI. Pelvic organ prolapse (anatomical landmarks: bladder, cervix, pouch, rectum) was measured perpendicularly with reference to the pubococcygeal and the midpubic line. Pelvic organ mobility was defined as the difference between the measured distance at rest and at maximum strain for each anatomical landmark. All patients underwent mesh-repair procedure. Eighty patients could be included in this short-term follow-up study. Due to the physical diagnosis of pelvic organ prolapse, 51 underwent anterior mesh repair, 16 underwent posterior mesh repair, and 13 underwent total mesh repair. Surgery was performed by one surgeon, using mesh implants from several manufacturers. RESULTS: Median values of maximum organ prolapse for bladder, cervix, pouch, and rectum preoperatively were 2.54 cm, 0.33 cm, 2.47 cm, and 0.32 cm, respectively, and 12 weeks postoperatively 0.87 cm, -1.79 cm, 1.49 cm, and 0.49 cm, respectively. Highly significant improvement (P < 0.001) of pelvic organ mobility was observed in the treated compartment at 4- and 12-week follow-up. Physical evaluation 12 weeks after mesh-repair showed an asymptomatic POP-Q stage I, if any. CONCLUSION: Dynamic MRI is useful in visualizing the maximum extent of pelvic organ prolapse, as the evaluation of pelvic organ mobility documents the intraindividual therapeutic outcome detached from a grading system based on maximal prolapse values.


Subject(s)
Magnetic Resonance Imaging/methods , Pelvic Organ Prolapse/diagnosis , Pelvic Organ Prolapse/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Postoperative Complications/diagnosis , Surgical Mesh , Treatment Outcome
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