Value of Endorectal MRI in Romanian Men for High Risk of Prostate Cancer: MRI Findings Compared with Saturation Biopsy.

PURPOSE: To evaluate the potentials of T2 weighted (T2W)MRI and diffusion weighted (DW) MRI for prostate cancer(PCa) detection, local staging and treatment planning in high-risk group. MATERIAL AND METHODS: Endorectal MRI was performed in 17 Romanian men (median age: 66 years; range: 58 75 years), prostate specific antigen (PSA) serum levels (median: 20 ng mL; range: 8.6 100 ng mL) with positive findings for PCa(median Gleason score: 8; range: 7 - 9). Imaging findings were compared to standarised 20-core transperineal saturation biopsy. The prostate was divided into 16 standart sectors(10 posterior and 6 anterior). RESULTS: Overall, prostate cancer was detected in 16 patients(94%) on DW-MRI alone and in all 17 patients (100%) on T2W-MRI alone, and on combined imaging. On T2W-MRI165 sectors out of 272 were suspicious for PCa and 124 (75%)were cancer positive. On DW-MRI 126 sectors out of 272 were suspicious for PCa and 118 (95%) were cancer positive. On the combined imaging approach 134 sectors out of 272 were suspicious for PCa and 126 (94%) were cancer positive. This resulted in diagnostic accuracies per sector of 76% for T2WMRI, 86% for DW-MRI and 89% for combined imaging. Multifocal PCa was confirmed both on MR imaging and by biopsy in 8 of the 17 men (47%) Extra capsular extension(ECE) or seminal vesicles invasion (SVI) was highly suspected in 8 (47%) respectively 7 (41%) of the 17 patients. 6 patients(35%) presented both ECE and SVI. MRI findings were taken into account for treatment planning and none of these patients underwent radical prostatectomy and instead was treated with palliative cryotherapy, radiotherapy and hormone therapy. CONCLUSIONS: Endorectal MRI is highly accurate in PCa detection in the high-risk group and seems to have an important role in local staging and treatment planning for Romanian population.

Role of mastoid pneumatization in temporal bone fractures.

BACKGROUND AND PURPOSE: The mastoid portion of the temporal bone has multiple functional roles in the organism, including regulation of pressure in the middle ear and protection of the inner ear. We investigated whether mastoid pneumatization plays a role in the protection of vital structures in the temporal bone during direct lateral trauma. MATERIAL AND METHODS: The study was performed on 20 human temporal bones isolated from cadavers. In the study group formed by 10 temporal bone samples, mastoid cells were removed and the resulting neocavities were filled. The mastoids were maintained intact in the control group. All samples were impacted at the same speed and kinetic energy. The resultant temporal bone fractures were evaluated by CT. RESULTS: Temporal squama fractures were 2.88 times more frequent, and mastoid fractures were 2.76 times more frequent in the study group. Facial nerve canal fractures were 6 times more frequent in the study group and involved all the segments of the facial nerve. Carotid canal fractures and jugular foramen fractures were 2.33 and 2.5 times, respectively, more frequent in the study group. CONCLUSIONS: The mastoid portion of the temporal bone plays a role in the absorption and dispersion of kinetic energy during direct lateral trauma to the temporal bone, reducing the incidence of fracture in the setting of direct trauma.

Typical and unusual sonoelastographic patterns of breast cystic lesions: impact on BI-RADS classification.

PURPOSE: To describe the sonoelastographic appearance of breast cysts (simple, complicated-cysts with sedimentation and complex-cysts with internal solid parts). To assess the influence of sonoelastography on the BI-RADS classification of complicated cysts. MATERIALS AND METHODS: A prospective study was conducted and all cysts diagnosed by the same radiologist between May 2007 and July 2008 in our breast unit were included. Each lesion was assessed according to BI-RADS and the Tsukuba elasticity score using a Hitachi 8500 US device. Cytology or histopathology was obtained for complicated and complex cysts. RESULTS: 49 simple, 43 complicated and 14 complex cysts were detected. The elasticity patterns were divided into 4 categories: typical BGR (blue-green-red) pattern, appearance similar to that described for solid. lesions, variants of BGR, an inverse score of 3. The BGR pattern was predominant in breast cysts. Atypical elasticity patterns were mostly associated with complicated and complex cysts. BI-RADS classification of complicated cysts before and after elastography showed a statistically significant difference in terms of final category assessment (most of the complicated cysts were downgraded to BI-RADS 2 after elastography). CONCLUSION: Being aware of the wide spectrum of elastographic patterns of breast cysts and considering elastography when assessing the BI-RADS category of complicated cysts may lead radiologists to better patient management.