Comparison of Multiparametric Magnetic Resonance Imaging-Targeted Biopsy With Systematic Transrectal Ultrasonography Biopsy for Biopsy-Naive Men at Risk for Prostate Cancer: A Phase 3 Randomized Clinical Trial.

Importance: Magnetic resonance imaging (MRI) with targeted biopsy is an appealing alternative to systematic 12-core transrectal ultrasonography (TRUS) biopsy for prostate cancer diagnosis, but has yet to be widely adopted. Objective: To determine whether MRI with only targeted biopsy was noninferior to systematic TRUS biopsies in the detection of International Society of Urological Pathology grade group (GG) 2 or greater prostate cancer. Design, Setting, and Participants: This multicenter, prospective randomized clinical trial was conducted in 5 Canadian academic health sciences centers between January 2017 and November 2019, and data were analyzed between January and March 2020. Participants included biopsy-naive men with a clinical suspicion of prostate cancer who were advised to undergo a prostate biopsy. Clinical suspicion was defined as a 5% or greater chance of GG2 or greater prostate cancer using the Prostate Cancer Prevention Trial Risk Calculator, version 2. Additional criteria were serum prostate-specific antigen levels of 20 ng/mL or less (to convert to micrograms per liter, multiply by 1) and no contraindication to MRI. Interventions: Magnetic resonance imaging-targeted biopsy (MRI-TB) only if a lesion with a Prostate Imaging Reporting and Data System (PI-RADS), v 2.0, score of 3 or greater was identified vs 12-core systematic TRUS biopsy. Main Outcome and Measures: The proportion of men with a diagnosis of GG2 or greater cancer. Secondary outcomes included the proportion who received a diagnosis of GG1 prostate cancer; GG3 or greater cancer; no significant cancer but subsequent positive MRI results and/or GG2 or greater cancer detected on a repeated biopsy by 2 years; and adverse events. Results: The intention-to-treat population comprised 453 patients (367 [81.0%] White, 19 [4.2%] African Canadian, 32 [7.1%] Asian, and 10 [2.2%] Hispanic) who were randomized to undergo TRUS biopsy (226 [49.9%]) or MRI-TB (227 [51.1%]), of which 421 (93.0%) were evaluable per protocol. A lesion with a PI-RADS score of 3 or greater was detected in 138 of 221 men (62.4%) who underwent MRI, with 26 (12.1%), 82 (38.1%), and 30 (14.0%) having maximum PI-RADS scores of 3, 4, and 5, respectively. Eighty-three of 221 men who underwent MRI-TB (37%) had a negative MRI result and avoided biopsy. Cancers GG2 and greater were identified in 67 of 225 men (30%) who underwent TRUS biopsy vs 79 of 227 (35%) allocated to MRI-TB (absolute difference, 5%, 97.5% 1-sided CI, -3.4% to ∞; noninferiority margin, -5%). Adverse events were less common in the MRI-TB arm. Grade group 1 cancer detection was reduced by more than half in the MRI arm (from 22% to 10%; risk difference, -11.6%; 95% CI, -18.2% to -4.9%). Conclusions and Relevance: Magnetic resonance imaging followed by selected targeted biopsy is noninferior to initial systematic biopsy in men at risk for prostate cancer in detecting GG2 or greater cancers. Trial Registration: ClinicalTrials.gov Identifier: NCT02936258.

Spine-GAN: Semantic segmentation of multiple spinal structures.

Spinal clinicians still rely on laborious workloads to conduct comprehensive assessments of multiple spinal structures in MRIs, in order to detect abnormalities and discover possible pathological factors. The objective of this work is to perform automated segmentation and classification (i.e., normal and abnormal) of intervertebral discs, vertebrae, and neural foramen in MRIs in one shot, which is called semantic segmentation that is extremely urgent to assist spinal clinicians in diagnosing neural foraminal stenosis, disc degeneration, and vertebral deformity as well as discovering possible pathological factors. However, no work has simultaneously achieved the semantic segmentation of intervertebral discs, vertebrae, and neural foramen due to three-fold unusual challenges: 1) Multiple tasks, i.e., simultaneous semantic segmentation of multiple spinal structures, are more difficult than individual tasks; 2) Multiple targets: average 21 spinal structures per MRI require automated analysis yet have high variety and variability; 3) Weak spatial correlations and subtle differences between normal and abnormal structures generate dynamic complexity and indeterminacy. In this paper, we propose a Recurrent Generative Adversarial Network called Spine-GAN for resolving above-aforementioned challenges. Firstly, Spine-GAN explicitly solves the high variety and variability of complex spinal structures through an atrous convolution (i.e., convolution with holes) autoencoder module that is capable of obtaining semantic task-aware representation and preserving fine-grained structural information. Secondly, Spine-GAN dynamically models the spatial pathological correlations between both normal and abnormal structures thanks to a specially designed long short-term memory module. Thirdly, Spine-GAN obtains reliable performance and efficient generalization by leveraging a discriminative network that is capable of correcting predicted errors and global-level contiguity. Extensive experiments on MRIs of 253 patients have demonstrated that Spine-GAN achieves high pixel accuracy of 96.2%, Dice coefficient of 87.1%, Sensitivity of 89.1% and Specificity of 86.0%, which reveals its effectiveness and potential as a clinical tool.

Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation.

INTRODUCTION: This study evaluates the clinical benefit of magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy over systematic biopsy between first-time and repeat prostate biopsy patients with prior atypical small acinar proliferation (ASAP). MATERIALS: 100 patients were enrolled in a single-centre prospective cohort study: 50 for first biopsy, 50 for repeat biopsy with prior ASAP. Multiparameteric magnetic resonance imaging (MP-MRI) and standard 12-core ultrasound biopsy (Std-Bx) were performed on all patients. Targeted biopsy using MRI-TRUS fusion (Fn-Bx) was performed f suspicious lesions were identified on the pre-biopsy MP-MRI. Classification of clinically significant disease was assessed independently for the Std-Bx vs. Fn-Bx cores to compare the two approaches. RESULTS: Adenocarcinoma was detected in 49/100 patients (26 first biopsy, 23 ASAP biopsy), with 25 having significant disease (17 first, 8 ASAP). Fn-Bx demonstrated significantly higher per-core cancer detection rates, cancer involvement, and Gleason scores for first-time and ASAP patients. However, Fn-Bx was significantly more likely to detect significant cancer missed on Std-Bx for ASAP patients than first-time biopsy patients. The addition of Fn-Bx to Std-Bx for ASAP patients had a 166.7% relative risk reduction for missing Gleason ≥ 3 + 4 disease (number needed to image with MP-MRI=10 patients) compared to 6.3% for first biopsy (number to image=50 patients). Negative predictive value of MP-MRI for negative biopsy was 79% for first-time and 100% for ASAP patients, with median followup of 32.1 ± 15.5 months. CONCLUSIONS: MR-TRUS Fn-Bx has a greater clinical impact for repeat biopsy patients with prior ASAP than biopsy-naïve patients by detecting more significant cancers that are missed on Std-Bx.

Biliary cystadenoma: an unusual cause of acute pancreatitis and indication for mesohepatectomy.

The classic presentation of cystic hepatobiliary lesions is usually nonspecific and often identified incidentally. Here we describe the case of a patient presenting with acute pancreatitis resulting from a large centrally located biliary cystadenoma compressing the pancreas. Determination of the origin of the cystic lesion was difficult on imaging studies. Due to the difficult location of the lesion, a complete surgical resection was achieved with mesohepatectomy and the suspected diagnosis confirmed by pathology. The patient continues to do well 2 years post-op with no signs of recurrence.

Substrate utilization during graded aerobic exercise in rainbow trout.

A biochemical approach was employed to examine the oxidative utilization of carbohydrate and lipid in red muscle of rainbow trout (Oncorhynchus mykiss) during sustained swimming at 30 and 60% of their critical swimming speed (U(crit); for 2, 15 and 240 min) and during non-sustainable swimming at 90% U(crit) (for 2, 15 and 45 min). Measurements included pyruvate dehydrogenase (PDH) activity, creatine phosphate, ATP, glycogen, glycolytic intermediates, acetyl-CoA, acetyl-, total-, free-, short-chain fatty acyl- and long-chain fatty acyl- carnitine, intramuscular triacylglycerol and malonyl-CoA concentrations, and whole body oxygen consumption ((O)(2)). During the first 2 min at 30 and 60% U(crit), oxidation of endogenous glycogen by PDH activation increased 4- and 8-fold, respectively, yielding 1.5- to 2.5-fold increases in acetyl-CoA and 2- to 6-fold increases in acetyl-carnitine concentrations. Within 15 min, PDH activity returned to control values (153.9+/-30.1 nmol g(-1) wet tissue min(-1)); after 240 min there were small 1.7- to 2.6-fold increases in long-chain fatty acyl-carnitine and approx. 50% decreases in malonyl-CoA concentrations, indicating an overall enhancement of lipid oxidation. Sustainable swimming at 30 and 60% U(crit) was further characterized by 1.5- and 2.2-fold increases in M(O(2)), respectively. Non-sustainable swimming at 90% U(crit) was characterized by a sustained tenfold (approx.) elevation of red muscle PDH activity (approx. 1600 nmol g(-1) wet tissue min(-1)). Significant 67% decreases in white muscle creatine phosphate and 73% decreases in glycogen levels, without matching increases in lactate levels, point to significant recruitment of white muscle during high-speed swimming for power production, and the potential export of white muscle lactate to red muscle for oxidation. Overall, sustainable exercise at 30 and 60% U(crit) is supported by approximately equal contributions of carbohydrate (approx. 45%) and lipid (approx. 35%) oxidation, whereas non-sustainable swimming is supported primarily by carbohydrate oxidation with only moderate contributions from lipid oxidation.