Metastasectomy of a solitary liver tumor from prostate cancer after radical prostatectomy.

Introduction: Metastasectomy of oligometastatic prostate cancer has the potential to contribute to improving prognosis. We report on a case of metastasectomy of solitary liver tumor after radical prostatectomy. Case presentation: An 80-year-old man underwent radical prostatectomy for prostate cancer, followed by radiotherapy after the operation because of increased serum prostate-specific antigen levels of 0.529 ng/mL. Levels increased further to 0.997 ng/mL even after salvage therapy. The patient then received androgen deprivation therapy. Levels remained stable for 3 years, but rapidly increased to 19.781 ng/mL in the following 6 months. Abdominal computed tomography revealed a solitary liver tumor, and no metastasis to other sites was identified. The patient underwent liver segmentectomy. Microscopic examination of excised specimens revealed prostate cancer cells. Five years after surgery, serum prostate-specific antigen maintained to the lowest level so far. Conclusion: Metastasectomy might be a beneficial therapeutic option to improve the prognosis for solitary metastasis from prostate cancer.

[A Case of Ileal Carcinoma Diagnosed under the Examination for Intestinal Obstruction after Gastric Surgery and Performed Laparoscopic Resection].

A 69-year-old man presented to our hospital with chief complaints of epigastral pain and nausea, was diagnosed with intestinal obstruction after gastric surgery. Abdominal CT performed on the admission showed the tumor located on the terminal ileum. On colonoscopy, type 1 cancer was found near the Bauhin valve in the ileum, and suspected primary ileal carcinoma. Laparoscopic ileocecal resection was performed. The pathological diagnosis was moderately differentiated adenocarcinoma, and the pathological stage was T3(SS), N1(3/16), M0, Stage ⅢA. Although superficial surgical site infection was occurred, the patient was discharged 11 days after surgery. He hoped to adopt without adjuvant chemotherapy, so he has been followed as outpatient. Twenty one months since the surgery, there has been no evidence of cancer recurrence.

Anterior Prostate Cancer: Diagnostic Performance of T2-Weighted MRI and an Apparent Diffusion Coefficient Map.

OBJECTIVE: Diagnosis of anterior prostate cancer is challenging. The purpose of this study was to evaluate the diagnostic performance of T2-weighted imaging and an apparent diffusion coefficient (ADC) map in the detection of anterior prostate cancer and to compare that with the diagnostic performance in the detection of posterior prostate cancer. MATERIALS AND METHODS: We retrospectively reviewed the records of 87 patients who underwent 3-T MRI that included T2-weighted imaging and diffusion-weighted imaging before radical prostatectomy. The prostate gland was divided into anterior and posterior segments, and the radiologists interpreted two protocols (T2-weighted imaging alone vs T2-weighted imaging and an ADC map) and sorted the confidence levels for the presence of prostate cancer into five grades. ROC analysis was performed to evaluate the diagnostic performance of each protocol for the detection of anterior and posterior prostate cancers. We also assessed the relative fractions of sensitivity and specificity between anterior and posterior prostate cancers. Additionally, the ADCs of noncancerous anterior fibromuscular stroma were measured and compared with the ADCs of anterior prostate cancers. RESULTS: The AUCs with T2-weighted imaging alone and with T2-weighted imaging and an ADC map were 0.75 and 0.88 for anterior prostate cancer, respectively, and were 0.70 and 0.81 for posterior prostate cancer. The sensitivity for detecting anterior prostate cancer was 90% and was significantly higher than that for detecting posterior prostate cancer in the protocol using T2-weighted imaging and an ADC map (p = 0.003) when scores of 3-5 were considered as positive for prostate cancer. The ADC was significantly lower in anterior prostate cancer (mean, 0.80 × 10(-3) mm(2)/s) than in noncancerous anterior fibromuscular stroma (1.13 × 10(-3) mm(2)/s) (p < 0.001). CONCLUSION: The protocol using T2-weighted imaging and an ADC map showed higher accuracy for the detection of anterior prostate cancer than for the detection of posterior prostate cancer.

Magnetic resonance enterocolonography in detecting erosion and redness in intestinal mucosa of patients with Crohn's disease.

BACKGROUND AND AIM: In Crohn's disease (CD), assessment of disease activity and extension is important for clinical management. Endoscopy is the most reliable tool for evaluating disease activity in these patients and it distinguishes between lesions based on ulcer, erosion, and redness. Magnetic resonance imaging (MRI) is less invasive than endoscopy; however, the sensitivity of MRI in detecting lesions is believed to be lower, and whether MRI can detect milder lesions has not been studied. The aim of this study was to compare the detection ability of magnetic resonance enterocolonography (MREC) with ileocolonic endoscopy in patients with CD. METHODS: A total of 27 patients with CD underwent both MREC and ileocolonoscopy. There were 55 lesions (18 ileum and 37 colon) endoscopically detected, and the findings of MREC were compared with each ileocolonoscopic finding to determine sensitivity and specificity. RESULTS: For a positive lesion defined as having at least one of the following: wall thickness, edema, diffusion-weighted imaging (DWI) high intensity and relative contrast enhancement (RCE) on MREC, the sensitivities were 100% for ulcer, 84.6% for erosion, and 52.9% for redness, suggesting an ability to detect milder lesions such as erosion or redness. Moreover, RCE values were well correlated with the severity of endoscopically identified active lesions. CONCLUSION: MREC findings may be useful not only for evaluation of ulcers, but also for detection of endoscopically identified milder lesions in CD, suggesting a clinical usefulness of MREC for disease detection and monitoring.

Diffusion-weighted imaging of prostate cancer using a statistical model based on the gamma distribution.

PURPOSE: To assess the adequacy of a statistical model based on the gamma distribution for diffusion signal decays of prostate cancer (PCa) using b-values ranging up to 2000 sec/mm(2) , and to evaluate the differences in gamma model parameters for PCa, benign prostatic hyperplasia (BPH), and peripheral zone (PZ). MATERIALS AND METHODS: Twenty-six patients with histologically proven PCa underwent diffusion-weighted magnetic resonance imaging using five b-values (0, 500, 1000, 1500, 2000 sec/mm(2) ). The acquired signal decay curves were fit with both gamma and truncated Gaussian models and a statistical comparison between the two fits was performed. The acquired parameters using the gamma model (mean, standard deviation, the area fraction for D < 1.0 mm(2) /s [Frac<1.0], the area fraction of D > 3.0 mm(2) /s [Frac>3.0]) were compared between PCa, BPH, and PZ. RESULTS: The gamma model provided a statistically improved fit over the truncated Gaussian model in PCa. The mean and the standard deviation were significantly lower in PCa than in BPH and PZ (P < 0.01). Frac<1.0 was significantly higher in PCa than in BPH and PZ, and Frac>3.0 was significantly lower in PCa than in BPH and PZ (P < 0.01). CONCLUSION: A statistical model based on the gamma distribution proved suitable for describing diffusion signal decay curves of PCa. This approach may provide better correlation between diffusion signal decay and histological information in the prostate gland.

Diffusion kurtosis imaging study of prostate cancer: preliminary findings.

PURPOSE: To evaluate the differences in parameters of diffusion kurtosis imaging (DKI) between prostate cancer, benign prostatic hyperplasia (BPH), and benign peripheral zone (PZ). MATERIALS AND METHODS: Twenty-four foci of prostate cancer, 41 BPH nodules (14 stromal and 27 nonstromal hyperplasia), and 20 benign PZ from 20 patients who underwent radical prostatectomy were investigated. Diffusion-weighted imaging (DWI) was performed using 11 b-values (0-1500 s/mm(2) ). DKI model relates DWI signal decay to parameters that reflect non-Gaussian diffusion coefficient (D) and deviations from normal distribution (K). A mixed model analysis of variance and receiver operating characteristic (ROC) analyses were performed to assess the statistical significance of the metrics of DKI and apparent diffusion coefficient (ADC). RESULTS: K was significantly higher in prostate cancer and stromal BPH than in benign PZ (1.19 ± 0.24 and 0.99 ± 0.28 versus 0.63 ± 0.23, P < 0.001 and P < 0.001, respectively). K showed a trend toward higher levels in prostate cancer than in stromal BPH (1.19 ± 0.24 versus 0.99 ± 0.28, P = 0.051). On the ROC analyses, a significant difference in area under the curve was not observed between K and ADC, however, K showed the highest sensitivity among three parameters. CONCLUSION: DKI may contribute to the imaging diagnosis of prostate cancer, especially in the differential diagnosis of prostate cancer and BPH.

[The diagnostic value of pre-biopsy magnetic resonance imaging for precise detection of clinically localized prostate cancer compared to post-biopsy setting].

A total of 136 patients who underwent radical prostatectomy following histological diagnosis of prostate cancer by transrectal biopsy and 3-Tesla magnetic resonance imaging (MRI) were evaluated. MRI was performed on 26 patients before prostate biopsy (pre-biopsy group) and on 110 patients after prostate biopsy (post-biopsy group). We defined the largest tumor focus in a radical prostatectomy specimen as the index cancer. We compared the accuracy of MRI in detecting and localizing the index cancer in the groups. The sensitivity of detecting the index cancer by MRI was significantly (p = 0.012) higher in the pre-biopsy group (96.2%) than in the post-biopsy group (77. 3%). The negative predictive value of extracapsular invasion was 84.6% in the pre-biopsy group and 80.7% in the post-biopsy group. The average interval between biopsy and MRI was 42.8 days. Artifacts due to post-biopsy hemorrhage were observed in 32 (29.1%) of the patients in the post-biopsy group. The sensitivity of detecting the index cancer by MRI was significantly (p = 0.022) higher in 78 patients without artifacts due to hemorrhage (83.3%) than in the 32 patients with artifacts due to hemorrhage (62.5%). Even if MRI is delayed until after prostate biopsy,the artifact due to hemorrhage markedly interferes with the accuracy of MRI. Although pre-biopsy MRI is more accurate than post-biopsy MRI,there are some problems to be solved,such as cost effectiveness and the detectability of low-malignant and small cancers.

An intravoxel incoherent motion diffusion-weighted imaging study of prostate cancer.

OBJECTIVE: The purpose of this study is to investigate whether the intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters are different between prostate cancer, benign prostatic hyperplasia (BPH), and healthy peripheral zone (PZ). MATERIALS AND METHODS: Detailed diffusion measurements of 26 patients with histologically proven prostate cancer have been made in this retrospective study. Trace IVIM DWI was performed using 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, and 1000 s/mm2). Biexponential fits were applied to diffusion decay curves to calculate molecular diffusion coefficient, perfusion-related diffusion coefficient, and perfusion fraction on the basis of the IVIM model. Decay curves were also fit with monoexponential decay functions, and a statistical comparison between mono- and biexponential fits was performed. Paired t tests were performed to evaluate the statistical significance of the parameters of IVIM DWI and apparent diffusion coefficient (ADC) between prostate cancer, BPH, and PZ. RESULTS: The chi-square values of biexponential fits were smaller than those from monoexponential fits in all cases. Biexponential functions provided statistically improved fits over monoexponential functions in 81% of cases. The ADC, molecular diffusion coefficient, and perfusion fraction in prostate cancer were significantly lower than those found in the PZ; however, perfusion fractions in prostate cancer and BPH were not significantly different. There were no significant differences in the prostate cancer, BPH, and PZ for the perfusion-related diffusion coefficient, which had large SDs. CONCLUSION: IVIM DWI parameters are significantly different between prostate cancer and PZ. IVIM DWI may offer additional information for tissue characterization in the prostate gland.

Simultaneous bicompartmental bucket handle meniscal tears with a clinically competent Anterior Cruciate Ligament.

Bucket handle meniscal tears (BHMT) of the knee occur infrequently (approximately 10% of meniscal injuries). Simultaneous, bicompartmental BHMT are extremely rare. Previously, these have only been reported in association with a ruptured anterior cruciate ligament (ACL). The pathomechanism of this injury was thought to be due to the lack of knee stability following the ACL injury. We present a case of a 38 year old male patient with bicompartmental BHMT with a clinically competent ACL. This highlights the need for clinical and radiological suspicion of simultaneous BHMTs even in the presence of an intact ACL.