New Prostate MRI Scoring Systems (PI-QUAL, PRECISE, PI-RR, and PI-FAB): AJR Expert Panel Narrative Review.

Multiparametric MRI (mpMRI), interpreted using PI-RADS, improves the initial detection of clinically significant prostate cancer (PCa). Prostate MR image quality has increasingly recognized relevance to the use of mpMRI for PCa diagnosis. Additionally, mpMRI is increasingly used in scenarios beyond initial detection, including active surveillance and assessment for local recurrence after prostatectomy, radiation therapy, or focal therapy. Acknowledging these evolving demands, specialized prostate MRI scoring systems beyond PI-RADS have emerged, to address distinct scenarios and unmet needs. Examples include Prostate Imaging Quality (PI-QUAL) for assessment of image quality of mpMRI, Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation (PRECISE) recommendations for evaluation of serial mpMRI examinations during active surveillance, Prostate Imaging for Recurrence Reporting System (PI-RR) for assessment for local recurrence after prostatectomy or radiation therapy, and Prostate Imaging after Focal Ablation (PI-FAB) for assessment for local recurrence after focal therapy. These systems' development and early uptake signal a compelling shift towards prostate MRI standardization in different scenarios, and ongoing research will help refine their roles in practice. This AJR Expert Panel Narrative Review critically examines these new prostate MRI scoring systems (PI-QUAL, PRECISE, PI-RR, and PI-FAB), analyzing the available evidence, delineating current limitations, and proposing solutions for improvement.

The relationship of kinesiophobia in patients with lymphedema: a case-control investigation.

Introduction: Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia. Methods: A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13). Results: Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild. Conclusions: Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.

Psychological distress among Brazilian workers during the initial stage of the COVID-19 pandemic: a descriptive study.

Background: COVID-19 pandemic imposed drastic and abrupt changes to working environment and organization and that might have caused additional negative effects on mental health. Thus, this study aimed to quantify and assess the severity of psychological distress experienced by Brazilian essential and nonessential workers during the first months of the COVID-19 pandemic. Methods: This descriptive study included 2,903 participants who answered an online questionnaire between April and May 2020. The research questionnaire was translated and culturally adapted to the Brazilian population from a questionnaire developed and validated for the Spanish population. Variables were analyzed using simple and cumulative percentage distributions and measures of central tendency and dispersion. The Wilson score interval was used to calculate confidence interval (CI) for the main outcome, psychological distress. Results: It was observed a high prevalence (72.6%) of psychological distress among the study's participants. They also presented a median risk perception score of 60 (out of a maximum of 90), and their greatest concern was transmitting the virus to family members, close contacts or patients. Furthermore, it was found a lower sense of coherence and work engagement among the participants than those observed in previous studies conducted in other countries. Conclusion: Almost three quarters of the study's participants were classified as presenting psychological distress. Thus, it is imperative to provide mental health remotely delivered interventions to workers during public health events that require prolonged social distancing measures.

Assessment and indicators of kinematic behavior and perceived fatigability.

OBJECTIVE: The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task. METHODS: A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale. RESULTS: Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger. CONCLUSION: The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.

Risk perception of healthcare workers in the first wave of the COVID-19 pandemic in Brazil.

Objectives: To validate the items of the Emotional Impact Questionnaire coronavirus disease-2019 (COVID-19) related to risk perception, estimating its degree, among healthcare workers in the first wave of COVID-19 pandemic, identifying possible associated factors.Methods: cross-sectional study in 1872 healthcare workers of Brazil. The population was characterized by sociodemographic and occupational information, knowledge about COVID-19, quality of information received, risk perception and preventive measures about the disease, and sense of coherence. Results: Being divorced, having a chronic disease, spending more than 1 h per day getting informed about COVID-19, and always or almost always wearing a mask regardless of symptoms, as well as self-perception of health were associated with high-risk perception. An inverse association was found between risk perception, sense of coherence and not knowing if one has had occasional contact with confirmed COVID-19 cases. Conclusion: Risk perception is influenced by emotions, experiences, and knowledge. Sense of coherence and resilience have a role in reducing risk perception. Understanding risk perception is crucial for developing effective strategies to mitigate the impact of the COVID-19 pandemic and other similar scenarios.

Cystic Fibrosis in an Adolescent: A "Miranda Warning" Against Blaming TB-A Case-Based Scholarly Update.

Cystic fibrosis (CF) is a multisystem disorder that occurs as a result of autosomal recessive congenital transmission of CF transmembrane conductance regulator (CFTR) gene mutation on chromosome 7. Because it is considered a disease of the Caucasian pediatric population or due to lack of awareness, it is rarely considered in developing countries like ours. This case report presents the first case of cystic fibrosis ever reported in Ethiopia and possibly East Africa, that of a 17-year-old female diagnosed with the disease following a CT scan of her abdomen and chest. She was initially misdiagnosed and treated for tuberculosis (TB) as she was a chronic cougher. Perhaps due to epidemiological evidence, there is an obstinate tendency of blaming tuberculosis (TB) for almost every case of chronic cough with fibro-bronchiectatic lung parenchymal changes in Ethiopia. Once a diagnosis of TB is posted on such patients, their diagnosis remains in the circle of TB reinfection, relapse or resistance, followed by multiple phases of anti-mycobacterial drugs. This could lead to hazardous implications, including unnecessary prolonged anti-mycobacterial treatments, possibility of developing drug resistance, and mismanagement-related patient morbidity. This patient's chest and abdominal CT findings, including bronchiectasis, hepatic steatosis, pancreatic lipomatosis, micro-gallbladder and proximal colonic wall thickening, led to the diagnosis of CF. This article, presenting the first documented case of CF in the region, is meant to be a helpful reminder for clinicians and radiologists to also consider presumably "rare" illnesses like CF rather than blaming TB for every chronic cough and highlights the importance of abdominal CT features in the diagnosis of CF.

Assessment and indicators of kinematic behavior and perceived fatigability

SUMMARY OBJECTIVE: The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task. METHODS: A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale. RESULTS: Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger. CONCLUSION: The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.

Split scar sign to predict complete response in rectal cancer after neoadjuvant chemoradiotherapy: systematic review and meta-analysis.

OBJECTIVES: Magnetic resonance imaging (MRI) is the modality of choice for rectal cancer initial staging and restaging after neoadjuvant chemoradiation. Our objective was to perform a meta-analysis of the diagnostic performance of the split scar sign (SSS) on rectal MRI in predicting complete response after neoadjuvant therapy. METHODS: MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through June 2023. Primary studies met eligibility criteria if they evaluated the diagnostic performance of the SSS to predict complete response on pathology or clinical follow-up in patients undergoing neoadjuvant chemoradiation. A meta-analysis with a random-effects model was used to estimate pooled sensitivity and specificity, area under the curve (AUC), and diagnostic odds ratio (DOR) of the SSS. RESULTS: A total of 4 studies comprising 377 patients met the inclusion criteria. The prevalence of complete response in the studies was 21.7-52.5%. The pooled sensitivity and specificity of the SSS to predict complete response were 62.0% (95% CI, 43.5-78.5%) and 91.9% (95% CI, 78.9-97.2%), respectively. The estimated AUC for SSS was 0.83 (95% CI, 0.56-0.94) with a DOR of 18.8 (95% CI, 3.65-96.5). CONCLUSION: The presence of SSS on rectal MRI demonstrated high specificity for complete response in patients with rectal cancer after neoadjuvant chemoradiation. This imaging pattern can be a valuable tool to identify potential candidates for organ-sparing treatment and surveillance. CLINICAL RELEVANCE STATEMENT: SSS presents high specificity for complete response post-neoadjuvant. This MRI finding enhances rectal cancer treatment assessment and aids clinicians and patients in choosing watch-and-wait over immediate surgery, which can potentially reduce costs and associated morbidity. KEY POINTS: •Fifteen to 50% of rectal cancer patients achieve complete response after neoadjuvant chemoradiation and may be eligible for a watch-and-wait strategy. •The split scar sign has high specificity for a complete response. •This imaging finding is valuable to select candidates for organ-sparing management.

Congenital syphilis: performance of primary care services in São Paulo, 2017.

OBJECTIVE: To evaluate congenital syphilis prevention actions in primary health care services in the state of São Paulo. METHODS: Cross-sectional evaluative research that used indicators extracted from the Survey of Evaluation and Monitoring of Primary Care Services ( Avaliação e Monitoramento de Serviços da Atenção Básica - QualiAB) in the state of São Paulo in 2017. An evaluative matrix composed of 31 indicators of prevention of congenital syphilis, categorized into four domains of analysis: diagnosis and treatment of acquired syphilis (10); basic infrastructure and resources (7); prevention of congenital syphilis during prenatal care (7); and educational actions and prevention of sexually transmitted infections (7). The frequency of services with positive responses for each indicator and the percentage of service performance were calculated based on the proportion of indicators reported per service and the overall average observed. Subsequently, services were classified into four quality groups, and associations between groups and each indicator, type of organizational arrangement and location were estimated. RESULTS: 2,565 services participated, located in 503 municipalities, with an overall average performance of 74.9%. The domain "diagnosis and treatment of acquired syphilis" had the highest performance (89.8%), followed by "infrastructure and basic resources" (79.5%), "prevention of congenital syphilis in prenatal care" (73.3%) and "educational actions and prevention of sexually transmitted infections" (56.8%). There was a significant difference between quality groups and all indicators and types of organizational arrangements. CONCLUSIONS: The evaluated services have limitations in the development of actions to prevent congenital syphilis, mainly related to health education and actions included in prenatal care, such as screening and adequate treatment of pregnant women and their partners. Changes are needed in the work process, with the expansion of educational and surveillance actions, as well as the qualification of the teams to effectively comply with the protocols.

Spontaneous Suburothelial Hemorrhage: The Crucial Role of Radiology in Preventing Unnecessary Interventions.

Spontaneous suburothelial hemorrhage (SSH), also known as Antopol Goldman lesion, is a rare condition characterized by spontaneous bleeding into the renal sinus and proximal ureter wall. This case report describes the clinical presentation, imaging findings, and management of SSH in a 20-year-old female initially suspected to have urothelial malignancy. Imaging features of SSH include pre-contrast hyperdensity and non-enhancing thickening of the pelviureteric wall, which can mimic transitional cell carcinoma (TCC) and lead to unnecessary interventions. Radiologists should maintain a high level of suspicion for SSH and be aware of its imaging characteristics to avoid misdiagnosis. Additionally, clinical data, such as bleeding dyscrasia, can aid in the imaging diagnosis. This report provides insights into the diagnosis and management of SSH while offering a comprehensive literature review on its clinical presentation and imaging features. Increased awareness of SSH will facilitate accurate diagnosis and appropriate management, avoiding unnecessary interventions for patients with this benign condition.

Impact of 18F-DCFPyL PET/MRI in Selecting Men With Low-/Intermediate-Risk Prostate Cancer for Focal Ablative Therapies.

PURPOSE: To compare the diagnostic performance of multiparametric (mp) MRI to 18F-DCFPyL PET/MRI for detecting clinically significant (cs) prostate cancer (PCa) in men with low-/intermediate-risk PCa being considered for focal ablative therapy (FT), using 2 interpretation schemes, and to assess the rate of exclusion from FT for each modality. METHODS: This prospective study evaluated men with low- or intermediate-risk PCa, potential candidates for FT based on initial biopsy as per institutional protocol, who underwent 18F-DCFPyL PET/MRI. Each modality (mpMRI, PET/MRI using PROMISE classification [PET/MRI PROMISE], and PET/MRI considering any focal lesion on PET as positive [PETFL/MRI]) was assessed independently. All suspicious lesions underwent PET/MRI-ultrasound fusion biopsies. Diagnostic performances were calculated and compared using the exact binomial test on paired proportions. RESULTS: Thirty-four men (median age, 64 years; interquartile range, 60-70 years) were included. Overall, 40 of 67 lesions (60%) identified on mpMRI and/or PET/MRI were malignant, and 34 of 40 lesions (85%) were csPCa (≥6 mm ISUP [International Society of Urological Pathology Grade Group] GG1 or ISUP-GG ≥2). On lesion-level analysis, for detecting csPCa, sensitivity appeared higher for PETFL/MRI than mpMRI and PET/MRI PROMISE (97% vs 76% and 79%, respectively [P = 0.02 and 0.03]), whereas specificity was lower (30% vs 85% and 88%, respectively [P < 0.001]). The calculated overall accuracy rates for PETFL/MRI, mpMRI, and PET/MRI PROMISE were 64%, 81%, and 84%, respectively. PETFL/MRI, mpMRI, and PET/MRI PROMISE excluded 10 of 34 (29%), 7 of 34 (21%), and 6 of 34 (18%) men from FT, respectively. CONCLUSIONS: 18F-DCFPyL PET/MRI excluded nearly 30% of patients with low-/intermediate-risk PCa from FT, with a potential role in decreasing selection failure. Compared with mpMRI, PET/MRI had a higher sensitivity for detecting csPCa in men who were candidates for FT.ClinicalTrials.gov identifier NCT03149861.

Inter-reader variability and reproducibility of the PI-QUAL score in a multicentre setting.

PURPOSE: To assess the inter-reader reproducibility of the Prostate Imaging Quality (PI-QUAL) score between readers with varying clinical experience and its reproducibility at assessing imaging quality between different institutions. METHODS: Following IRB approval, we assessed 60 consecutive prostate MRI scans performed at different academic teaching and non-academic hospitals uploaded to our institutes' PACS for second opinion or discussion in case conferences. Anonymized scans were independently reviewed using the PI-QUAL scoring sheet by three readers - two radiologists (with 1 and 12 years Prostate MRI reporting experience), and an experienced MRI technician with interest in image acquisition and quality. All readers were blinded to the site where scans were acquired. RESULTS: Agreement coefficients between the 3 readers in paired comparison for each individual PI-QUAL score was moderate. When the scans were clustered into 2 groups according to their ability to rule in or rule out clinically significant prostate cancer [i.e., PI-QUAL score 1-3 vs PI-QUAL score 4-5], the Gwet AC1 coefficients between the three readers in paired comparison was good to very good [Gwet AC 1:0.77, 0.67, 0.836 respectively] with agreement percentage of 88.3%, 83.3% and 91.7% respectively. Agreement coefficient was higher between the experienced radiologist and the experienced MRI technician than between the less experienced trainee radiologist and the other two readers. The mean PI-QUAL score provided by each reader for the scans was significantly higher in the academic hospitals (n = 32) compared to the community hospital (n = 28) [experienced radiologist 4.6 vs 2.9; trainee radiologist 4.5 vs 2.4; experienced technologist 4.4 vs 2.4; p value < 0.001]. CONCLUSION: We observed good to very good reproducibility in the assessment of each MRI sequence and when scans were clustered into two groups [PI-QUAL 1-3 vs PI-QUAL 4-5] between readers with varying clinical experience. However, the reproducibility for each single PI-QUAL score between readers was moderate. Better definitions for each PI-QUAL score criteria may further improve reproducibility between readers. Additionally, the mean PI-QUAL score provided by all three readers was significantly higher for scans performed at academic teaching hospitals compared to community hospital.

Evaluation of MR anatomically-guided PET reconstruction using a convolutional neural network in PSMA patients.

Background. Recently, approaches have utilized the superior anatomical information provided by magnetic resonance imaging (MRI) to guide the reconstruction of positron emission tomography (PET). One of those approaches is the Bowsher's prior, which has been accelerated lately with a convolutional neural network (CNN) to reconstruct MR-guided PET in the imaging domain in routine clinical imaging. Two differently trained Bowsher-CNN methods (B-CNN0 and B-CNN) have been trained and tested on brain PET/MR images with non-PSMA tracers, but so far, have not been evaluated in other anatomical regions yet.Methods. A NEMA phantom with five of its six spheres filled with the same, calibrated concentration of 18F-DCFPyL-PSMA, and thirty-two patients (mean age 64 ± 7 years) with biopsy-confirmed PCa were used in this study. Reconstruction with either of the two available Bowsher-CNN methods were performed on the conventional MR-based attenuation correction (MRAC) and T1-MR images in the imaging domain. Detectable volume of the spheres and tumors, relative contrast recovery (CR), and background variation (BV) were measured for the MRAC and the Bowsher-CNN images, and qualitative assessment was conducted by ranking the image sharpness and quality by two experienced readers.Results. For the phantom study, the B-CNN produced 12.7% better CR compared to conventional reconstruction. The small sphere volume (<1.8 ml) detectability improved from MRAC to B-CNN by nearly 13%, while measured activity was higher than the ground-truth by 8%. The signal-to-noise ratio, CR, and BV were significantly improved (p< 0.05) in B-CNN images of the tumor. The qualitative analysis determined that tumor sharpness was excellent in 76% of the PET images reconstructed with the B-CNN method, compared to conventional reconstruction.Conclusions. Applying the MR-guided B-CNN in clinical prostate PET/MR imaging improves some quantitative, as well as qualitative imaging measures. The measured improvements in the phantom are also clearly translated into clinical application.

Depressive symptoms and their severity in a sample with lymphedema: a case-control investigation.

Objectives: Depression is a condition that can be associated with other illnesses, especially chronic illnesses. Lower limb lymphedema is a chronic, disabling condition that can affect the quality of life and be related to psychological and psychosocial factors that interfere with people's lives. This study aims to characterize and analyze the depressive symptoms and their severity reported by people with lower limb lymphedema and compare them with a matched group without lymphedema. Methods: A case-control study was carried out (n = 80) with participants divided into a case group (40 people with lower limb lymphedema) and a control group (40 people without lower limb lymphedema). Both groups were anthropometrically, sociodemographically, and clinically characterized. In the case group, a characterization of lymphedema was performed. Participants completed the Beck Depression Inventory-II. Results: Individuals with lower limb lymphedema have higher BDI-II scores than the matched group without lymphedema. Somatic depressive symptoms were, in general, the most reported and the ones with the highest scores. The depressive symptoms most reported by the case group were tiredness or fatigue, loss of energy, and changes in sleeping. Tiredness or fatigue, loss of energy, and loss of interest in sex were the most severe depressive symptoms reported by individuals with lower limb lymphedema. Conclusion: Considering the apparent tendency to depression, greater attention should be given to the mental health of people with lower limb lymphedema.

Upper-Limb Kinematic Behavior and Performance Fatigability of Elderly Participants Performing an Isometric Task: A Quasi-Experimental Study.

Upper-limb position-sustained tasks (ULPSIT) are involved in several activities of daily living and are associated with high metabolic and ventilatory demand and fatigue. In older people, this can be critical to the performance of daily living activities, even in the absence of a disability. OBJECTIVES: To understand the ULPSIT effects on upper-limb (UL) kinetics and performance fatigability in the elderly. METHODS: Thirty-one (31) elderly participants (72.61 ± 5.23 years) performed an ULPSIT. The UL average acceleration (AA) and performance fatigability were measured using an inertial measurement unit (IMU) and time-to-task failure (TTF). RESULTS: The findings showed significant changes in AA in the X- and Z-axes (p < 0.05). AA differences in women started earlier in the baseline cutoff in the X-axis, and in men, started earlier between cutoffs in the Z-axis. TTF was positively related to AA in men until 60% TTF. CONCLUSIONS: ULPSIT produced changes in AA behavior, indicative of movement of the UL in the sagittal plane. AA behavior is sex related and suggests higher performance fatigability in women. Performance fatigability was positively related to AA only in men, where movement adjustments occurred in an early phase, though with increased activity time.

The Impact of Low Back Pain on the Quality of Life of Children between 6 and 12 Years of Age.

This study aimed to evaluate the impact of low back pain on the perceived health-related quality of life of children between 6 and 12 years of age. This is a cross-sectional study of three hundred seventy-seven students from three schools (two private and one public) located in the city of Botucatu, São Paulo. Data were collected using the Pediatric Quality of Life Inventory (PedsQL, version 4.0), a questionnaire comprising questions on personal background, sociodemographic and socioeconomic information, and a questionnaire about quality of life. Comparisons were made between groups with and without low back pain. The chi-squared test was used for analyzing categorical variables, and the non-parametric Mann-Whitney test was used for continuous variables. According to the findings obtained in this study, it was observed that low back pain in the last month was reported by 27.3% of the total participants. The perceived health-related quality of life was lower among individuals who had low back pain, and the scores of physical and emotional functioning domains were also lower in the presence of low back pain. The prevalence of low back pain among children and adolescents is relatively high. Furthermore, the repercussions of low back pain may lead to a lower overall perception of the health-related quality of life in this population and affect aspects of physical and emotional functioning.

PI-RR: The Prostate Imaging for Recurrence Reporting System for MRI Assessment of Local Prostate Cancer Recurrence After Radiation Therapy or Radical Prostatectomy-A Review.

The purpose of this article is to review clinical application of the Prostate Imaging for Recurrence Reporting (PI-RR) system. This system, released in 2021, represents international consensus-based guidelines for the acquisition, interpretation, and reporting of multiparametric MRI performed to detect locally recurrent prostate cancer after radiation therapy or radical prostatectomy. The system reduces variability through use of a standardized and structured reporting approach whereby the overall level of suspicion of recurrence is classified on a 5-point scale. The overall suspicion score is derived from 5-point scales for assessing DWI and dynamic contrast-enhanced (DCE) imaging. Separate scales for both DWI and DCE imaging are provided for evaluation after radiation therapy and after radical prostatectomy. These scales account for the relation between detected abnormalities and the location of the primary tumor on pretreatment imaging. T2-weighted imaging is also assessed on a 5-point scale and is useful for anatomic imaging but does not influence the overall score. Initial retrospective studies have shown promising results with respect to the reproducibility and accuracy of PI-RR in detecting locally recurrent tumor.

Micro-Ultrasound: Current Role in Prostate Cancer Diagnosis and Future Possibilities.

Prostate Cancer (PCa) is the second most common cancer in men. Population screening using prostate specific antigen (PSA) blood test and digital rectal exam (DRE) is recommended by the NCCN, EAU and other prominent clinical guidelines. While MRI is the recommended initial test in men at risk for PCa, micro-Ultrasound (MicroUS) is a novel high resolution ultrasound technology that has shown promise in PCa detection. This article provides a narrative review of the studies to date which have been conducted to evaluate the functionality and efficacy of MicroUS within the patient care pathway for prostate cancer. A total of 13 relevant publications comparing detection of csPCa between MicroUS and mpMRI were selected. An amount of 4 publications referring to use of MicroUS for other indications were found. Each publication was evaluated for risk of bias and applicability using the Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool. The studies reviewed conclude that MicroUS detection rates for clinically significant prostate cancer diagnosis are comparable to the detection rates of mpMRI guided biopsy procedures. While the existing literature indicates that MicroUS should replace conventional TRUS for prostate imaging and biopsy, it is not yet clear whether MicroUS should be used on its own or in conjunction with mpMRI for augmenting prostate cancer detection. The ongoing OPTIMUM trial will provide evidence on how best to utilize this new technology. Early data also suggest this flexible new imaging modality has a place in local staging and active surveillance of prostate cancer as well as in bladder cancer staging.

The role of [18F]-DCFPyL PET/MRI radiomics for pathological grade group prediction in prostate cancer.

PURPOSE: To evaluate the diagnostic accuracy of [18F]-DCFPyL PET/MRI radiomics for the prediction of pathological grade group in prostate cancer (PCa) in therapy-naïve patients. METHODS: Patients with confirmed or suspected PCa, who underwent [18F]-DCFPyL PET/MRI (n = 105), were included in this retrospective analysis of two prospective clinical trials. Radiomic features were extracted from the segmented volumes following the image biomarker standardization initiative (IBSI) guidelines. Histopathology obtained from systematic and targeted biopsies of the PET/MRI-detected lesions was the reference standard. Histopathology patterns were dichotomized as ISUP GG 1-2 vs. ISUP GG ≥ 3 categories. Different single-modality models were defined for feature extraction, including PET- and MRI-derived radiomic features. The clinical model included age, PSA, and lesions' PROMISE classification. Single models, as well as different combinations of them, were generated to calculate their performances. A cross-validation approach was used to evaluate the internal validity of the models. RESULTS: All radiomic models outperformed the clinical models. The best model for grade group prediction was the combination of PET + ADC + T2w radiomic features, showing sensitivity, specificity, accuracy, and AUC of 0.85, 0.83, 0.84, and 0.85, respectively. The MRI-derived (ADC + T2w) features showed sensitivity, specificity, accuracy, and AUC of 0.88, 0.78, 0.83, and 0.84, respectively. PET-derived features showed 0.83, 0.68, 0.76, and 0.79, respectively. The baseline clinical model showed 0.73, 0.44, 0.60, and 0.58, respectively. The addition of the clinical model to the best radiomic model did not improve the diagnostic performance. The performances of MRI and PET/MRI radiomic models as per the cross-validation scheme yielded an accuracy of 0.80 (AUC = 0.79), whereas clinical models presented an accuracy of 0.60 (AUC = 0.60). CONCLUSION: The combined [18F]-DCFPyL PET/MRI radiomic model was the best-performing model and outperformed the clinical model for pathological grade group prediction, indicating a complementary value of the hybrid PET/MRI model for non-invasive risk stratification of PCa. Further prospective studies are required to confirm the reproducibility and clinical utility of this approach.