Proposal for standardized ultrasound analysis of the salivary glands: Part 1 submandibular gland.

Objectives: The Salivary Gland Committee of the American Academy of Otolaryngology-Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. Methods: Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. Results: A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. Conclusion: Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.

Suspected Autosomal Recessive Polycystic Kidney Disease but Cerebellar Vermis Hypoplasia, Oligophrenia Ataxia, Coloboma, and Hepatic Fibrosis (COACH) Syndrome in Retrospect, A Delayed Diagnosis Aided by Genotyping and Reverse Phenotyping: A Case Report and A Review of the Literature.

The clinical features of cerebellar vermis hypoplasia, oligophrenia, ataxia, coloboma, and hepatic fibrosis (COACH) characterize the rare autosomal recessive multisystem disorder called COACH syndrome. COACH syndrome belongs to the spectrum of Joubert syndrome and related disorders (JSRDs) and liver involvement distinguishes COACH syndrome from the rest of the JSRD spectrum. Developmental delay and oculomotor apraxia occur early but with time, these can improve and may not be readily apparent or no longer need active medical management. Congenital hepatic fibrosis and renal disease, on the other hand, may develop late, and the temporal incongruity in organ system involvement may delay the recognition of COACH syndrome. We present a case of a young adult presenting late to a Renal Genetics Clinic for evaluation of renal cystic disease with congenital hepatic fibrosis, clinically suspected to have autosomal recessive polycystic kidney disease. Following genetic testing, a reevaluation of his medical records from infancy, together with reverse phenotyping and genetic phasing, led to a diagnosis of COACH syndrome.

MR Imaging-Transrectal US Fusion for Targeted Prostate Biopsies: Implications for Diagnosis and Clinical Management.

Cancer of the prostate gland is a common but heterogeneous disease requiring individualized risk stratification for optimal clinical management. However, transrectal ultrasonography (US)-guided biopsy-the standard of care for diagnosis of prostate cancer-frequently fails to detect aggressive tumors or provide reliable parameters for pretreatment risk stratification. Multiparametric magnetic resonance (MR) imaging is the most accurate imaging technique for prostate cancer detection and local staging. Recently, different approaches have been developed to allow targeted biopsies of areas that are suspicious for cancer at MR imaging, including direct MR imaging guidance and MR imaging-transrectal US fusion, which can be achieved with cognitive fusion or software assistance. Regardless of the technique used, targeted prostate biopsies have the potential to increase detection of clinically relevant prostate cancer and provide more reliable risk stratification in patients with known cancer. The authors discuss the shortcomings of traditional diagnostic workup for prostate cancer, the rationale for targeted prostate biopsies, the different techniques available for targeting suspicious areas seen at MR imaging, and the clinical contexts in which targeted prostate biopsies might be useful. In addition, they discuss opportunities and challenges associated with MR imaging-transrectal US fusion biopsy, as well as questions that need to be addressed before formal incorporation of this technique into practice guidelines.

Geometric distortion in diffusion-weighted MR imaging of the prostate-contributing factors and strategies for improvement.

RATIONALE AND OBJECTIVES: Image distortion on diffusion-weighted imaging (DWI) of the prostate in 3T endorectal magnetic resonance imaging (MRI) examinations is common. The aim of this study was to determine the degree of distortion on DWI using a state-of-the-art clinical protocol and to explore the main contributors to geometric distortion. MATERIALS AND METHODS: Forty consecutive patients underwent 3T MRI of the prostate with an endorectal coil filled with air (n = 20) or barium sulfate (n = 20). Distortion was measured as the maximum displacement of the outer boundary of the prostate on DWI relative to T2-weighted imaging. The effects of phase-encoding direction, receiver bandwidth, and parallel imaging were then assessed in a prostate phantom on two MRI scanners from different manufacturers. RESULTS: There was no statistical difference in the mean displacement of the prostate on DWI between the air cohort (1.8 ± 1.2 mm, range 0-4.2 mm) and barium cohort (1.8 ± 2.2 mm, range 0-9 mm). Displacement of the prostate was observed in the phase-encoding direction. Phantom experiments demonstrated a horizontal displacement of 6.0 mm in the phase-encoding direction, which decreased with the use of parallel imaging and higher bandwidth. Geometric distortion was similar for all b values and across manufacturers. CONCLUSIONS: Geometric distortion on DWI of the prostate is common in the phase-encoding direction and does not improve with inflating the coil with barium sulfate. Strategies to reduce this artifact include the use of higher bandwidth and accelerated imaging. Correction of this phenomenon should improve localization of prostate cancer, particularly important for targeted prostate biopsies or focal therapies.