Assessment of prostate cancer with dynamic contrast-enhanced computed tomography using an en bloc approach.

OBJECTIVES: The aim of this study was to assess the performance of dynamic contrast-enhanced computed tomography of the prostate in patients with biopsy-proven prostate cancer. MATERIAL AND METHODS: A total of 46 male patients (median age, 65 years; range, 49-73 years) with biopsy-proven prostate cancer underwent an en bloc computed tomography perfusion (CTP) scan of the prostate before surgery. The perfusion parameters mean transit time (MTT), blood flow (BF), and blood volume (BV), as well as the microvessel density (MVD) of surgical specimens were determined. Differences in CTP parameters and MVD among postsurgical Gleason score (sGS) and postsurgical combined Gleason grade (sGG) groups were analyzed. Spearman correlation coefficients were determined between CTP parameters and presurgical biopsy-derived Gleason score (bGS), presurgical biopsy-derived combined Gleason grade (bGG), sGS, sGG, MVD, and pathological tumor stage. A linear regression analysis was carried out for exogenous variables BF, BV, MTT, bGS, and presurgical biopsy-derived combined Gleason grade and endogenous variables sGS, sGG, MVD, and T stage. A receiver operating characteristics analysis was performed to analyze the discriminating performance of CTP parameters and bGS between intermediate- and high-grade tumors. RESULTS: The mean perfusion parameters within the prostate tissue were as follows: BF, 39.1 ± 13.4 mL/100 mL min; BV, 4.9 ± 2.4 mL/100 mL; and MTT, 8.9 ± 3.7 seconds. The mean MVD of the tumor tissue was 144.3 ± 55.6/mm. Computed tomography perfusion parameters and MVD were significantly higher in patients with high-grade tumors compared with those with intermediate-grade tumors (P < 0.01 for BF, BV, and MVD). Only BV and MVD were significantly different among sGS and sGG groups. Moderate correlations were found between BF and sGS (0.38) and between BV and sGS (0.43). Linear relations of BV to sGS and to sGG were found. Blood volume (area under the curve, 0.86) was superior to bGS (area under the curve, 0.75) in discriminating high-grade from intermediate-grade tumors. CONCLUSION: Computed tomography perfusion parameters derived by en bloc perfusion of the prostate are higher in high-grade tumors compared with intermediate-grade tumors. Blood flow and BV correlate with the definitive Gleason score. Blood volume predicts high-grade tumors better than does the Gleason score of biopsy specimens. Further studies are needed to determine a potential role for CTP in prostate cancer patients.

Assessing ischemic heart disease in patients with left bundle branch block--an emerging role for multislice computed tomography.

Diagnosis of left bundle branch block (LBBB) with concomitant coronary artery disease (CAD) alters the prognosis and the therapeutic management. All common non-invasive stress tests have a limited performance to identify CAD in patients with LBBB. Thus invasive coronary angiography is often needed to confirm or defer obstructive CAD. We propose a new diagnostic algorithm in evaluation of symptomatic and asymptomatic patients with LBBB.

Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging.

OBJECTIVE: The objective of this study was to correlate chronic medial knee pain at rest and during exercise with bone scintigraphic uptake, bone marrow edema pattern (BMEP), cartilage lesions, meniscal tears, and collateral ligament pathologies on magnetic resonance MR imaging (MRI). MATERIALS AND METHODS: Fifty consecutive patients with chronic medial knee pain seen at our institute were included in our study. Pain level at rest and during exercise was assessed using a visual analog scale (VAS). On MR images, BMEP volume was measured, and the integrity of femoro-tibial cartilage, medial meniscus, and medial collateral ligament (MCL) were assessed. Semiquantitative scintigraphic tracer uptake was measured. Multivariate linear regression analysis was performed. RESULTS: At the day of examination, 40 patients reported medial knee pain at rest, 49 when climbing stairs (at rest mean VAS 33 mm, range 0-80 mm; climbing stairs mean VAS, 60 mm, range 20-100 mm). Bone scintigraphy showed increased tracer uptake in 36 patients (uptake factor, average 3.7, range 2.4-18.0). MRI showed BMEP in 31 studies (mean volume, 4,070 mm(3); range, 1,200-39,200 mm(3)). All patients with BMEP had abnormal bone scintigraphy. Ten percent of patients with pain at rest and 8% of patients with pain during exercise showed no BMEP but tracer uptake in scintigraphy. Tracer uptake and signal change around MCL predicted pain at rest significantly (tracer uptake p = 0.004; MCL signal changes p = 0.002). Only MCL signal changes predicted pain during exercise significantly (p = 0.001). CONCLUSION: In chronic medial knee pain, increased tracer uptake in bone scintigraphy is more sensitive for medial knee pain than BMEP on MRI. Pain levels at rest and during exercise correlate with signal changes in and around the MCL.

Esophagus imaging for radiofrequency ablation of atrial fibrillation using a dual-source computed tomography system: preliminary observations.

OBJECTIVE: The very recent introduction of dual-source computed tomography (DSCT) has significantly improved the temporal resolution of ECG-gated multidetector-row cardiac computed tomography (CT). The aim of the present study was to evaluate whether with a DSCT visualization of the esophagus is feasible without any use of contrast in the esophagus. MATERIALS AND METHODS: A total of 20 patients were evaluated. Ten patients underwent examination with a DSCT scanner without a gastric tube. In another ten patients, which served as control group, a CT scan was performed with a radio-opaque gastric tube prior to circumferential pulmonary vein isolation (in seven patients with a 16-slice CT and in three patients with a DSCT). RESULTS: In the control group the gastric tube and the left atrium were reconstructed and were well visualized in all ten patients in the electro-anatomic mapping system, independently whether 16-row CT or DSCT scan was used. In the study group integration of the esophagus into the electro-anatomic mapping system was not feasible, due to the lacking contrast counterpart the surrounding tissue. CONCLUSIONS: Even with the newest generation of DSCT scanner it is not possible to integrate the esophagus image into the 3-D electroanatomic mapping system without contrast by whatever means. However placing a conventional gastric tube before performing the CT scan allowed visualization and integration of the esophagus into the 3-D electro-anatomical map in all patients.