Precise Prostate Cancer Assessment Using IVIM-Based Parametric Estimation of Blood Diffusion from DW-MRI.

Prostate cancer is a significant health concern with high mortality rates and substantial economic impact. Early detection plays a crucial role in improving patient outcomes. This study introduces a non-invasive computer-aided diagnosis (CAD) system that leverages intravoxel incoherent motion (IVIM) parameters for the detection and diagnosis of prostate cancer (PCa). IVIM imaging enables the differentiation of water molecule diffusion within capillaries and outside vessels, offering valuable insights into tumor characteristics. The proposed approach utilizes a two-step segmentation approach through the use of three U-Net architectures for extracting tumor-containing regions of interest (ROIs) from the segmented images. The performance of the CAD system is thoroughly evaluated, considering the optimal classifier and IVIM parameters for differentiation and comparing the diagnostic value of IVIM parameters with the commonly used apparent diffusion coefficient (ADC). The results demonstrate that the combination of central zone (CZ) and peripheral zone (PZ) features with the Random Forest Classifier (RFC) yields the best performance. The CAD system achieves an accuracy of 84.08% and a balanced accuracy of 82.60%. This combination showcases high sensitivity (93.24%) and reasonable specificity (71.96%), along with good precision (81.48%) and F1 score (86.96%). These findings highlight the effectiveness of the proposed CAD system in accurately segmenting and diagnosing PCa. This study represents a significant advancement in non-invasive methods for early detection and diagnosis of PCa, showcasing the potential of IVIM parameters in combination with machine learning techniques. This developed solution has the potential to revolutionize PCa diagnosis, leading to improved patient outcomes and reduced healthcare costs.

Renal arterial embolization: Indications, angiographic findings, and outcomes in a series of 170 patients.

Background: The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization (RAE) compelled us to report our overall experience on a series of patients. Materials and methods: A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019. History, physical examination, and laboratory data were reviewed for all patients. Abdominal ultrasound was the initial imaging study, and all patients underwent subsequent computed tomography or magnetic resonance imaging. The outcome of RAE was determined based on radiographic and clinical findings. Results: Data from 202 patients were analyzed, with a mean age of 45 ± 15 years, and 71.3% of patients were male. Iatrogenic injury was the most common indication for RAE (54%), followed by renal tumors, trauma, and spontaneous, in 27.7%, 10.4%, and 8.4% of patients, respectively. Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding (40.6%), whereas no lesions were identified on angiography in 32 patients (15.8%), after which RAE was subsequently aborted. Renal arterial embolization was successful in 158 of 170 patients (92.9%) after 1 or more trials (maximum of 4). Microcoil alone or with other embolic materials was the most commonly used material for embolization (85%). Conclusions: Iatrogenic injury was the most common indication for RAE. Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography; however, angiography showed a negative result in 16% of patients, even those with symptoms. When lesions are present on angiography, the overall success of repeated trials of RAE reached 92.9%.

Predictors of renal angioembolization outcome: A retrospective analysis with 148 patients at a tertiary urology institute.

Objective: The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization (RAE). Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side effects, while helping to prepare for an alternate procedure and improving patient's overall satisfaction. Methods: A retrospective analysis between January 2006 and December 2018 was performed, and the indications for RAE were classified into post-traumatic, iatrogenic, renal tumors, and spontaneous. Patients who underwent RAE prior to nephrectomy were eliminated. Computed tomography angiography was performed in patients with normal renal function and those who had no contrast allergy, otherwise magnetic resonance angiography was performed. For the purpose of statistical analysis, we stratified patients into two main categories based on the final outcome-successful or failed. Results: Of 180 patients, 32 with negative angiography were eliminated, leaving 148 patients; 136 (91%) had successful outcomes after one or more trials and 12 had unsuccessful outcomes. The mean age was 45±15 years, and 105 (71%) were male. Neither gender, side of the lesion, presence of hematuria, indication for RAE, nor the type of lesion affected the outcome. On the other hand, renal anatomy with presence of accessory artery was the only predictor to failed RAE (p=0.001). Failed RAE trial was a predictor for nephrectomy as a secondary procedure (p=0.03). Conclusion: No pre-procedural predictors could anticipate the RAE outcome, and different indications can be scheduled to RAE, which is equally effective. The presence of accessory renal artery on diagnostic angiography is the only factor that may predict the failure of the procedure.