A pictorial essay of PI-RADS pearls and pitfalls: toward less ambiguity and better practice.

Prostate Imaging Reporting and Data System (PI-RADS) was designed to standardize the interpretation of multiparametric magnetic resonance imaging (MRI) of the prostate, aiding in assessing the probability of clinically significant prostate cancer. By providing a structured scoring system, it enables better risk stratification, guiding decisions regarding the need for biopsy and subsequent treatment options. In this article, we explore both the strengths and weaknesses of PI-RADS, offering insights into its updated diagnostic performance and clinical applications, while also addressing potential pitfalls using diverse, representative MRI cases.

Utility of Prostate Health Index Density for Biopsy Strategy in Biopsy-Naïve Patients With PI-RADS v2.1 Category 3 Lesions.

BACKGROUND: Category 3 lesions in PI-RADSv2.1 pose diagnostic challenges, complicating biopsy decisions. Recent biomarkers like prostate health index (PHI) have shown higher specificity in detecting clinically significant prostate cancer (csPCa) than prostate-specific antigen (PSA). Yet their integration with MRI remains understudied. PURPOSE: To evaluate the utility of PSA and PHI with its derivatives for detecting csPCa in biopsy-naïve patients with category 3 lesion on initial prostate MRI scan. STUDY TYPE: Retrospective. POPULATION: One hundred ninety-three biopsy-naïve patients who underwent MRI, PSA, and PHI testing, followed by both targeted and systematic biopsies. FIELD STRENGTH/SEQUENCE: Turbo spin-echo T2-weighted imaging, diffusion-weighted single-shot echo-planar imaging, and dynamic contrast-enhanced T1-weighted fast field echo sequence imaging in 3 T. ASSESSMENT: PHI density (PHID) and PSA density (PSAD) derived by dividing serum PHI and PSA with prostate volume (MRI based methodology suggested by PI-RADSv2.1). Risk-stratified models to evaluate the utility of markers in triaging patients for biopsy, including low-, intermediate-, and high-risk groups. STATISTICAL TESTS: Independent t-test, Mann-Whitney U test, Mantel-Haenszel test, generalized estimating equation, and receiver operating characteristic (ROC) curve analysis were used. Statistical significance defined as P < 0.05. RESULTS: CsPCa was found in 16.6% (32/193) of patients. PHID had the highest area under the ROC curve (AUROC) of 0.793, followed by PHI of 0.752, PSAD of 0.750, and PSA of 0.654. PHID with two cut-off points (0.88/mL and 1.82/mL) showed the highest potential biopsy avoidance of 47.7% (92/193) with 5% missing csPCa, and the lowest intermediate-risk group (borderline decision group) at 38.9% (75/193), compared to PSA and PHI. DATA CONCLUSION: PHID demonstrated better potential in triaging patients with category 3 lesions, possibly aiding more selective and confident biopsy decisions for csPCa detection, than traditional markers. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 5.

Computed tomography-based prediction model for identifying patients with high probability of non-muscle-invasive bladder cancer.

PURPOSE: To investigate computed tomography (CT)-based prediction model for identifying patients with high probability of non-muscle-invasive bladder cancer (NMIBC). METHODS: This retrospective study evaluated 147 consecutive patients who underwent contrast-enhanced CT and surgery for bladder cancer. Using corticomedullary-to-portal venous phase images, two independent readers analyzed bladder muscle invasion, tumor stalk, and tumor size, respectively. Three-point scale (i.e., from 0 to 2) was applied for assessing the suspicion degree of muscle invasion or tumor stalk. A multivariate prediction model using the CT parameters for achieving high positive predictive value (PPV) for NMIBC was investigated. The PPVs from raw data or 1000 bootstrap resampling and inter-reader agreement using Gwet's AC1 were analyzed, respectively. RESULTS: Proportion of patients with NMIBC was 81.0% (119/147). The CT criteria of the prediction model were as follows: (a) muscle invasion score < 2; (b) tumor stalk score > 0; and (c) tumor size < 3 cm. From the raw data, PPV of the model for NMIBC was 92.7% (51/55; 95% confidence interval [CI] 82.4-98.0) in reader 1 and 93.3% (42/45; 95% CI 81.7-98.6) in reader 2. From the bootstrap data, PPV was 92.8% (95% CI 85.2-98.3) in reader 1 and 93.4% (95% CI 84.9-99.9) in reader 2. The model's AC1 was 0.753 (95% CI 0.647-0.859). CONCLUSION: The current CT-derived prediction model demonstrated high PPV for identifying patients with NMIBC. Depending on CT findings, approximately 30% of patients with bladder cancer may have a low need for additional MRI for interpreting vesical imaging-reporting and data system.

Role of computed tomography in predicting adrenal adenomas with cortisol hypersecretion.

OBJECTIVES: To investigate performance of adrenal CT-derived multivariate prediction models in differentiating adenomas with cortisol hypersecretion from the other subtypes. METHODS: This retrospective study included 127 patients who underwent adrenal CT and had a surgically proven adrenal adenoma. Adenoma subtypes were defined according to biochemical test results: Group A, overt cortisol hypersecretion; Group B, mild cortisol hypersecretion; Group C, aldosterone hypersecretion; and Group D, non-function. Two independent readers analyzed size, attenuation, and washout properties of adenomas, and performed quantitative and qualitative analyses for assessing contralateral adrenal atrophy. Actual and internally validated areas under the curves (AUCs) of adrenal CT-derived multivariate prediction models for differentiating adenomas with cortisol hypersecretion from the other subtypes were assessed. RESULTS: In differentiating Group A from the other groups, the actual and internally validated AUCs of the prediction model were 0.856 (95% confidence interval [CI]: 0.786, 0.926) and 0.847 (95% CI: 0.695, 0.999) for Reader 1, respectively, and 0.901 (95% CI: 0.845, 0.956) and 0.897 (95% CI: 0.783, 1.000) for Reader 2, respectively. In differentiating Group B from groups C and D, the actual and internally validated AUCs of the prediction model were 0.777 (95% CI: 0.687, 0.866) and 0.760 (95% CI: 0.552, 0.969) for Reader 1, respectively, and 0.783 (95% CI: 0.690, 0.875) and 0.765 (95% CI: 0.553, 0.977) for Reader 2, respectively. CONCLUSION: Adrenal CT may be useful in differentiating adenomas with cortisol hypersecretion from the other subtypes. ADVANCES IN KNOWLEDGE: Adrenal CT may benefit in adrenal adenoma subtyping.

An integrated intelligent intersection control system for preventing rear-end and angled crashes: System design and deployment results.

In view of the dynamic all-red extension (DARE) system's effectiveness in preventing angled crashes (Park et al., 2018), this study has further enhanced its function to contend with rear-end collisions with dynamic green extension (DGE). With such a function, the enhanced Integrated Intelligent Intersection control system (III-CS) is capable of dynamically terminating the green at the interval of the lowest rear-end collision risk, so as to prevent undesirable "max-out" under actuated signal control which often traps some vehicles in the dilemma zone during high-volume traffic conditions. To ensure its effectiveness in practice, the proposed III-CS has been designed with the following new features: (i) executing the DGE within a customized time window of the green phase to ensure the signal's effective coordination with its neighboring intersections; (ii) adopting the comparison-based heuristic for the DGE's real-time risk prediction so as to circumvent the computing and communications delays. The results of two after-deployment assessments show that the system's DARE has perfectly detected all red-light runners; 66.7 percent of the decisions by the DGE module were observed to achieve the control objective during the first field assessment. The DGE's performance in making optimal decisions has improved over time and reached the level of 81.3% in the second field evaluation. Other measures of effectiveness, such as the number of vehicles trapped in the dilemma zone and the average deceleration rate of the driving populations approaching the target intersection, have also evolved to the anticipated trend after the deployment.

The utility of two-dimensional shear wave elastography for predicting prostate cancer: a preliminary study.

PURPOSE: This study investigated whether two-dimensional shear wave elastography (2D-SWE), using a newly developed device, is useful for predicting prostate cancer (PCa). METHODS: In this prospective study, 38 patients with suspected PCa underwent 2D-SWE, followed by a standard systematic 12-core biopsy with and without a targeted biopsy. Tissue stiffness on SWE was measured in the target lesion and in 12 regions of the systematic biopsies, and the maximum (Emax), mean (Emean), and minimum (Emin) values of stiffness were generated. The area under the receiver operating characteristic curve (AUROC) for predicting clinically significant cancer (CSC) was calculated. Interobserver reliability and variability were evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman plots, respectively. RESULTS: PCa was found in 78 of 488 regions (16%) in 17 patients. In region-based and patientbased analyses, the Emax, Emean, and Emin values of PCa were significantly higher than those of benign prostate tissue (P<0.001). For the prediction of CSC, the AUROCs of Emax, Emean, and Emin in the patient-based analysis were 0.865, 0.855, and 0.828, while that of prostate-specific antigen density was 0.749. In the region-based analysis, the AUROCs of Emax, Emean, and Emin values were 0.772, 0.776, and 0.727, respectively. The interobserver reliability for the SWE parameters was moderate to good (ICC, 0.542 to 0.769), and the mean percentage differences on Bland-Altman plots were less than 7.0%. CONCLUSION: The 2D-SWE method appears to be a reproducible and useful tool for the prediction of PCa. A larger study is warranted for further validation.

Prostate imaging-reporting and data system version 2 has improved biopsy tumor grade accuracy: a single, tertiary institutional experience.

PURPOSE: To investigate change in prostate biopsy accuracy regarding tumor grade before and after the release of Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) in a single tertiary institution. METHODS: We retrospectively evaluated 1191 patients with biopsy-proven prostate cancer (PCa) who had undergone prostate magnetic resonance imaging (MRI) and surgery before (2013 cohort, n = 394) and 5 years after PI-RADSv2 release (2020 cohort, n = 797). The highest tumor grade of each biopsy and surgical specimen was recorded, respectively. We compared concordant, underestimated, and overestimated biopsy rates regarding tumor grade to surgery between two cohorts, respectively. For patients who underwent both prostate MRI and biopsy at our institution, we investigated proportion of pre-biopsy MRI, age, and prostate-specific antigen of patients, and performed logistic regression to analyze which parameters are associated with concordant biopsy. RESULTS: Concordant and underestimated biopsy rates were significantly different between two cohorts: Concordance and underestimation rates were 47.2% and 46.3% in 2013 and 54.5% and 36.4% in 2020 (p = .019; p = .003), respectively. Overestimated biopsy rates were similar (p = .993). Proportion of pre-biopsy MRI was significantly higher in 2020 than in 2013 (80.9% versus 4.9%; p < .001), and was independently associated with concordant biopsy results in multivariate analysis (odds ratio = 1.486; 95% confidence interval, 1.057-2.089; p = .022). CONCLUSIONS: There was a significant change in proportion of pre-biopsy MRI before and after the release of PI-RADSv2 in patients who underwent surgery for PCa. This change appears to have improved biopsy accuracy regarding tumor grade by reducing underestimation.

Impact of preoperative ultrasonography for predicting the prognosis of deceased donor kidney transplantation.

PURPOSE: This study evaluated the role of donor kidney ultrasonography (US) for predicting functional kidney volume and identifying ideal kidney grafts in deceased donor kidney transplantation. METHODS: In total, 272 patients who underwent deceased donor kidney transplantation from 2000 to 2020 at Samsung Medical Center were enrolled. Donor kidney information (i.e., right or left) was provided to the radiologist who performed US image re-analysis. To binarize each kidney's ultrasound parameters, an optimal cutoff value for estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m2 within 1 year after kidney transplantation was selected using the receiver operating characteristic curve with a specificity >60%. Cox regression analysis was performed for an eGFR less than 30 mL/min/1.73 m2 within 1 year after kidney transplantation and graft failure within 2 years after kidney transplantation. RESULTS: The product of renal length and cortical thickness was a statistically significant predictor of graft function. The odds ratios of an eGFR less than 30 mL/min/1.73 m2 within a year after kidney transplantation and the hazard ratio of graft failure within 2 years after kidney transplantation were 5.91 (P=0.003) and 5.76 (P=0.022), respectively. CONCLUSION: Preoperative US of the donor kidney can be used to evaluate donor kidney function and can predict short-term graft survival. An imaging modality such as US should be included in the donor selection criteria as an additional recommendation. However, the purpose of this study was not to narrow the expanded criteria but to avoid catastrophic consequences by identifying ideal donor kidneys using preoperative US.

Inter-method agreement between wash-in and wash-out computed tomography for characterizing hyperattenuating adrenal lesions as adenomas or non-adenomas.

OBJECTIVES: To investigate inter-method agreement between wash-out and wash-in computed tomography (CT) to determine whether hyperattenuating adrenal lesions are characterized as adenomas or non-adenomas. METHODS: We evaluated 243 patients who underwent wash-out CT for a solid enhancing hyperattenuating (i.e., > 10 Hounsfield unit [HU]) adrenal mass of ≥ 1 to < 4 cm. Wash-out (absolute percentage wash-out [APW]; relative percentage wash-out [RPW]) and wash-in values (enhancement ratio [ER]; relative enhancement ratio [RER]) were analyzed by two independent readers. Diagnostic criteria of wash-out CT for adenoma were APW ≥ 60% or RPW ≥ 40% (conventional method). Three different criteria for wash-in CT were set: ER ≥ 3.0; RER ≥ 200%; and RER ≥ 210%. Concordance rate and inter-method agreement between wash-out and wash-in CT were investigated using Gwet's AC1. RESULTS: For all lesions, concordance rates between wash-out and wash-in CT were > 83%. AC1 between conventional method and ER ≥ 3.0 or between conventional method and RER ≥ 200% were identically 0.843 for reader 1 and 0.776 for reader 2. AC1 between conventional method and RER ≥ 210% were 0.780 for reader 1 and 0.737 for reader 2. For lesions of > 10 to ≤ 30 HU, concordance rates between wash-out and wash-in CT were > 89%. AC1 between conventional method and ER ≥ 3.0 or between conventional method and RER ≥ 200% were identically 0.914 for reader 1 and 0.866 for reader 2. AC1 between conventional method and RER ≥ 210% were 0.888 for reader 1 and 0.874 for reader 2. CONCLUSION: In approximately 90% of patients with a hyperattenuating adrenal lesion of ≥ 1 to < 4 cm and >10 to ≤ 30 HU, wash-out CT with 15-min contrast-enhanced images may be replaced by wash-in CT. KEY POINTS: • An enhancement ratio of ≥ 3.0 or a relative enhancement ratio of ≥ 200% appears to be appropriate as the threshold of wash-in computed tomography (CT) comprising unenhanced and 1-min contrast-enhanced CT. • Measurement of enhancement ratio or relative enhancement ratio was reproducible. • We found good agreement between wash-in and wash-out CT for determining whether hyperattenuating adrenal lesions of ≥ 1 to < 4 cm and >10 to ≤ 30 Hounsfield unit would be characterized as adenomas.

A Retrospective Study of First-Line Therapy Involving Immune Checkpoint Inhibitors in Patients With Poor Risk Metastatic Renal Cell Carcinoma.

Purpose: Patients with International Metastatic RCC Database Consortium (IMDC) poor risk metastatic renal cell carcinoma (mRCC) rarely respond to first-line tyrosine kinase inhibitors (TKIs) including sunitinib, and carries a very poor prognosis. In recent years, combination therapy involving immune checkpoint inhibitors (ICIs) have demonstrated superior efficacy to sunitinib in poor risk disease. Materials and Methods: In a retrospective study using a cancer chemotherapy registry, 206 consecutive patients with mRCC in the first-line setting were identified between Oct 2019 and Dec 2020. Sixty-one patients had a poor risk mRCC, and were treated with TKI monotherapy (n=36), nivolumab plus ipilimumab (n=16), or pembrolizumab plus axitinib (n=9). Endpoints included overall survival (OS), progression-free survival (PFS), response rate (RR), and safety. Results: Patients' median age was 61 years and the median number of risk factors was 3 (range, 3-5). During a median 23.0 months of follow-up, the median OS was 24.3 months with ICI-based combinations and 14.8 months with TKI monotherapy, and the median PFS periods were 9.3 months and 3.4 months, respectively. An objective response occurred in 60% of the patients receiving ICI-based combinations and in 19% of those receiving TKI monotherapy (P=0.001). In the multivariate regression model, number of IMDC risk factors and the ICI-based combination therapy were independent prognostic factors for PFS. All-causality grade 3 or 4 adverse events were 44% for ICI-based combinations and 50% for TKI monotherapy. Conclusions: Among patients with poor risk mRCC, first-line ICI-based therapy showed significantly longer OS and PFS, as well as a higher RR, than TKI monotherapy.

Ovarian Masses in Patients With Breast Cancer.

PURPOSE: The aim of the study was to investigate the characteristic findings of computed tomography (CT) or magnetic resonance imaging (MRI) to discriminate metastasis from primary ovarian tumors in patients with a history of breast cancer. METHODS: This retrospective study enrolled consecutive 72 patients with a history of breast cancer who underwent surgical confirmation of an ovarian mass detected on CT or MRI (primary ovarian tumors, n = 66; metastases, n = 6). Two independent readers analyzed the grade of solid portions of the ovarian mass using a 5-point scale on CT or MRI. A predominantly cystic mass was defined as a solid grade of 1 to 2. Cancer antigen 125 (CA 125) and the initial stage of breast cancer were also investigated. RESULTS: The proportions of predominantly cystic masses were significantly different between metastases (0% for both readers) and primary ovarian tumors (59% for reader 1 and 53% for reader 2, P < 0.05). For masses of solid portion grades 3 to 5, CA 125 was significantly higher for malignant epithelial tumors than for the other tumors ( P < 0.001), and the initial stage of breast cancer was significantly higher for metastases than for the other tumors ( P < 0.001), respectively. CONCLUSIONS: In patients with a history of breast cancer, predominantly cystic masses detected on CT or MRI seem to be primary ovarian tumors. For the other masses, knowledge of CA 125 and initial breast cancer stage may help in the differential diagnosis.

Impact of no residual disease on postoperative computed tomography on survival in patients with optimally debulked advanced high-grade serous ovarian cancer during upfront surgery.

OBJECTIVE: We sought to investigate the impact of size of residual tumors as determined by postoperative computed tomography (CT) on survival of patients with advanced, high-grade serous ovarian carcinoma (HGSC) who achieved residual disease less than 1 cm after primary debulking surgery (PDS). METHODS: We collected data of patients with stage III HGSC who had residual tumor less than 1 cm after PDS between 2013 and 2018. Surgeon-assessed residual disease during surgery was defined as sR0 (no gross residual) or sR1 (gross residual <1 cm), and radiologist-assessed residual disease on postoperative CT was defined as rR0 (no evidence of disease) or rRany (existing residual disease). All patients were classified into the following groups: sR0/rR0, sR1/rR0, sR0/rRany, and sR1/rRany. RESULTS: A total of 436 patients was placed into the sR0/rR0 (n = 187, 42.9%), sR1/rR0 (n = 59, 13.5%), sR0/rRany (n = 79, 18.1%), or sR1/rRany group (n = 111, 25.5%). Discrepancies between surgical and radiological assessments were recorded for 176 patients (40.4%) including 38 cases of sR1/rRany group with discordant residual tumor location indicated between two methods. During multivariate analysis, patients with ascites on preoperative CT, sR0/rRany group inclusion, and sR1/rRany group inclusion showed unfavorable progression-free and overall survival. CONCLUSIONS: The incorporation of surgical and radiological evaluations for determining the size of residual tumors was more accurate than surgical evaluation only for predicting survival among patients with advanced ovarian cancer who underwent PDS to residual disease less than 1 cm.

Clinical significance of a 10-mm cutoff size for adrenal lesions: a retrospective study with 547 non-oncologic patients undergoing adrenal computed tomography.

PURPOSE: To investigate the proportion of clinically significant adrenal lesions in patients with a subcentimeter adrenal lesion, and the sensitivity of a cutoff size of 10 mm on computed tomography (CT). METHODS: This retrospective study included consecutive 547 non-oncologic patients who underwent adrenal CT. Clinically significant adrenal lesions were defined as those that were biochemically abnormal (n = 99) or surgically resected according to the clinician's decision (n = 23). Long-axis diameters (LDs) and short-axis diameters (SDs) of the lesions were measured on CT by two independent readers. Likelihood of the focal lesion was analyzed using a five-point scale (1 = very low; 5 = very high). 66 Sensitivities for clinically significant lesions were analyzed according to cutoff size. Proportions of the clinically significant lesions for subcentimeter lesions were analyzed according to the visual score. RESULTS: Sensitivities for clinically significant lesions for cutoffs of 10, 15, and 20 mm were 93%, 79%, and 63% for LD and 85%, 61%, and 49% for SD for Reader 1 and 89%, 78%, and 65% for LD and 80%, 65%, and 48% for SD for Reader 2, respectively (p < 0.001 for 10 mm versus the other cutoffs). In subcentimeter lesions with visual scores of 1-3, the proportions of clinically significant lesions were 5.4% for LD or SD for Reader 1 and 6.6% for LD and 7.7% for SD for Reader 2, respectively. CONCLUSION: A lesion LD of ≥ 10 mm was a reasonable cutoff for determining adrenal abnormality. Subcentimeter lesions without visually high suspicion had a low risk of clinical significant lesions in our study cohort. Higher cutoffs significantly decreased sensitivity.

Biparametric Magnetic Resonance Imaging-Derived Nomogram to Detect Clinically Significant Prostate Cancer by Targeted Biopsy for Index Lesion.

BACKGROUND: Currently, it is necessary to investigate how to combine biparametric magnetic resonance imaging (bpMRI) with various clinical parameters for the detection of clinically significant prostate cancer (csPCa). PURPOSE: To develop a multivariate prebiopsy nomogram using clinical and bpMRI parameters for estimating the probability of csPCa. STUDY TYPE: Retrospective, single-center study. SUBJECTS: Two hundred and twenty-six patients who underwent targeted biopsy (TBx) for the MRI-suspected index lesion because of clinical suspicions of PCa. FIELD STRENGTH/SEQUENCE: A 3 T MRI including turbo spin-echo T2 -weighted and diffusion-weighted single-shot echo-planar imaging sequences. ASSESSMENT: Prebiopsy clinical and bpMRI parameters were patient age, biopsy history (biopsy-naïve or repeated biopsy status), prostate-specific antigen density (PSAD), Prostate Imaging-Reporting and Data System version 2.1 (PI-RADSv2.1), and apparent diffusion coefficient ratio (ADCR). ADCR was defined as mean ADC of the index lesion divided by mean ADC of the contralateral prostatic region. A multivariate prebiopsy nomogram for csPCa (i.e. Gleason sum ≥7) was developed. Area under the curve (AUC) of each parameter and prebiopsy nomogram was assessed. Five-fold cross-validation was performed for robust estimation of performance of the prebiopsy nomogram. STATISTICAL TESTS: Logistic regression, receiver-operating curve, and 5-fold cross-validation. P-value < 0.05 was considered statistically significant. RESULTS: Proportion of csPCa was 31.9% (72/226). The AUCs of age, biopsy-naïve status, PSAD, PI-RADSv2.1, ADCR, and prebiopsy nomogram were 0.657 (95% confidence interval [CI], 0.580-0.733), 0.593 (95% CI, 0.525-0.660), 0.762 (95% CI, 0.697-0.826), 0.824 (95% CI, 0.770-0.878), 0.829 (95% CI, 0.769-0.888), and 0.906 (95% CI, 0.863-0.948), respectively: AUC of nomogram was significantly different than that of individual parameter. In the 5-fold cross-validation, the mean AUC of the prebiopsy nomogram for csPCa was 0.888 (95% CI, 0.786-0.983). DATA CONCLUSIONS: This multivariate prebiopsy nomogram using clinical and bpMRI parameters may help estimate the probability of csPCa in patients undergoing TBx. ADCR seems to enhance the role of bpMRI in detecting csPCa. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

Risk Factors and Patterns of Locoregional Recurrence after Radical Nephrectomy for Locally Advanced Renal Cell Carcinoma.

PURPOSE: We aimed to investigate the risk factors and patterns of locoregional recurrence (LRR) after radical nephrectomy (RN) in patients with locally advanced renal cell carcinoma (RCC). MATERIALS AND METHODS: We retrospectively analyzed 245 patients who underwent RN for non-metastatic pT3-4 RCC from January 2006 to January 2016. We analyzed the risk factors associated with poor locoregional control using Cox regression. Anatomical mapping was performed on reference computed tomography scans showing intact kidneys. RESULTS: The median follow-up duration was 56 months (range, 1 to 128 months). Tumor extension to renal vessels or the inferior vena cava (IVC) and Fuhrman's nuclear grade IV were identified as independent risk factors of LRR. The 5-year actuarial LRR rates in groups with no risk factor, one risk factor, and two risk factors were 2.3%, 19.8%, and 30.8%, respectively (p < 0.001). The locations of LRR were distributed as follows: aortocaval area (n=2), paraaortic area (n=4), retrocaval area (n=5), and tumor bed (n=11). No LRR was observed above the celiac axis (CA) or under the inferior mesenteric artery (IMA). CONCLUSION: Tumor extension to renal vessels or the IVC and Fuhrman's nuclear grade IV were the independent risk factors associated with LRR after RN for pT3-4 RCC. The locations of LRR after RN for RCC were distributed in the tumor bed and regional lymphatic area from the bifurcation of the CA to that of the IMA.

A Comparison of Non-vascularized Bone Grafting and Internal Fixation in the Treatment of Unstable Scaphoid Waist Nonunion.

Background: When nonunion of scaphoid waist is treated with non-vascularized bone grafting with internal fixation, bony union would be affected not only type of bone graft but also fixation method. Thus, we attempted to investigate whether the bony union depends on how surgeons combine bone grafting and internal fixation. Methods: We treated 38 consecutive patients with unstable nonunion of scaphoid waist. The patients were treated with one of three types of non-vascularized bone grafting and internal fixation by random sampling, regardless of the configuration of the nonunion; cortico-cancellous bone grafting with Kirschner wire (K-wire) fixation group (12 cases), cortico-cancellous bone grafting with headless compression screw fixation group (13 cases) and cancellous bone grafting with K-wire fixation group (13 cases). We compared "union rate" and "time to union" between groups with statistical analysis. We described clinical features of "failure to union" cases. Results: The mean time to union of cancellous bone grafting with K-wire fixation group was significantly shorter than those of other groups. There was also significant difference in mean time to union between cortico-cancellous bone grafting with K-wire fixation group and cancellous bone grafting with K-wire fixation group (when the type of bone grafting was different). All the "failure to union" cases were sclerotic (Herbert type D2) nonunion treated by cortico-cancellous bone grafting. Conclusions: When treating unstable nonunion of scaphoid waist with non-vascularized bone grafting with internal fixation, cancellous bone grafting with K-wire fixation seems to be advantageous in terms of mean time to union. It seems that both bone grafting and fixation method affected "mean time to union" but the type of bone grafting was more influential in achieving union. The failure to union might be frequent in case of Herbert type D2 nonunion combined with cortico-cancellous bone grafting.

Prostate cancer: diagnostic yield of modified transrectal ultrasound-guided twelve-core combined biopsy (targeted plus systematic biopsies) using prebiopsy magnetic resonance imaging.

PURPOSE: This study aimed to analyze the diagnostic yield of modified transrectal ultrasound (TRUS)-guided 12-core combined biopsy (CB) using prebiopsy magnetic resonance imaging (MRI) for detecting clinically significant prostate cancer (csPCa). METHODS: This retrospective study included 130 consecutive patients who underwent modified TRUS-guided 12-core CB using cognitive fusion for lesions of Prostate Imaging-Reporting and Data System (PI-RADS) category ≥ 3. The 12-core CB comprised 3-6-core targeted biopsy (TB) and systematic biopsy (SB). For SB, tissue sampling in TB regions was omitted, and 3-core sampling (i.e., apex, mid, and base) in the contralateral peripheral zone of TB was mandatory. csPCa was defined as International Society of Urological Pathology (ISUP) grade ≥ 2 cancer. The per-patient cancer detection rates (CDRs) according to biopsy type or PI-RADS category were investigated. RESULTS: The CDRs of TB, SB, and CB for csPCa were 47.7% (62/130 patients), 29.2% (38/130), and 52.3% (68/130), respectively. For csPCa, the CDRs of TB and CB according to PI-RADS categories of 3, 4, or 5 were 25.0% (8/32) and 31.3% (10/32), 41.2% (28/68) and 45.6% (31/68), or 86.7% (26/30) and 90.0% (27/30), respectively. In 6 (4.6%) patients, csPCa was detected only by SB. In 18 (13.8%) patients, SB detected PCa of a higher ISUP grade than TB. In 11 (8.5%) patients, SB detected csPCa at contralateral peripheral zone of TB. CONCLUSION: Modified TRUS-guided 12-core CB using prebiopsy MRI seems to be feasible. It may reduce total biopsy cores in patients who are suitable for CB based on prebiopsy MRI findings.

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone.

OBJECTIVE: To compare the diagnostic performance between Prostate Imaging-Reporting and Data System version 2.0 (PI-RADSv2.0) and version 2.1 (PI-RADSv2.1) for clinically significant prostate cancer (csPCa) in the peripheral zone (PZ). MATERIALS AND METHODS: This retrospective study included 317 patients who underwent multiparametric magnetic resonance imaging and targeted biopsy for PZ lesions. Definition of csPCa was International Society of Urologic Pathology grade ≥ 2 cancer. Area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for csPCa were analyzed by two readers. The cancer detection rate (CDR) for csPCa was investigated according to the PI-RADS categories. RESULTS: AUC of PI-RADSv2.1 (0.856 and 0.858 for reader 1 and 2 respectively) was higher than that of PI-RADSv2.0 (0.795 and 0.747 for reader 1 and 2 respectively) (both p < 0.001). Sensitivity, specificity, PPV, NPV, and accuracy for PI-RADSv2.0 vs. PI-RADSv2.1 were 93.2% vs. 88.3% (p = 0.023), 52.8% vs. 76.6% (p < 0.001), 48.7% vs. 64.5% (p < 0.001), 94.2% vs. 93.2% (p = 0.504), and 65.9% vs. 80.4% (p < 0.001) for reader 1, and 96.1% vs. 92.2% (p = 0.046), 34.1% vs. 72.4% (p < 0.001), 41.3% vs. 61.7% (p < 0.001), 94.8% vs. 95.1% (p = 0.869), and 54.3% vs. 78.9% (p < 0.001) for reader 2, respectively. CDRs of PI-RADS categories 1-2, 3, 4, and 5 for PI-RADSv2.0 vs. PI-RADSv2.1 were 5.9% vs. 5.9%, 5.8% vs. 12.5%, 39.8% vs. 56.2%, and 88.9% vs. 88.9% for reader 1; and 4.5% vs. 4.1%, 6.1% vs. 11.1%, 32.5% vs. 53.4%, and 85.0% vs. 86.8% for reader 2, respectively. CONCLUSION: Our data demonstrated improved AUC, specificity, PPV, accuracy, and CDRs of category 3 or 4 of PI-RADSv2.1, but decreased sensitivity, compared with PI-RADSv2.0, for csPCa in PZ.

Eco-Friendly Dye-Sensitized Solar Cells Based on Water-Electrolytes and Chlorophyll.

Organic solvents used for electrolytes of dye-sensitized solar cells (DSSCs) are generally not only toxic and explosive but also prone to leakage due to volatility and low surface tension. The representative dyes of DSSCs are ruthenium-complex molecules, which are expensive and require a complicated synthesis process. In this paper, the eco-friendly DSSCs were presented based on water-based electrolytes and a commercially available organic dye. The effect of aging time after the device fabrication and the electrolyte composition on the photovoltaic performance of the eco-friendly DSSCs were investigated. Plasma treatment of TiO2 was adopted to improve the dye adsorption as well as the wettability of the water-based electrolytes on TiO2. It turned out that the plasma treatment was an effective way of improving the photovoltaic performance of the eco-friendly DSSCs by increasing the efficiency by 3.4 times. For more eco-friendly DSSCs, the organic-synthetic dye was replaced by chlorophyll extracted from spinach. With the plasma treatment, the efficiency of the eco-friendly DSSCs based on water-electrolytes and chlorophyll was comparable to those of the previously reported chlorophyll-based DSSCs with non-aqueous electrolytes.