Incremental value of MRI for preoperative penile cancer staging.

PURPOSE: To evaluate the incremental value of magnetic resonance imaging (MRI), compared to clinical examination, for penile cancer (PC) local staging. MATERIALS AND METHODS: Twenty-five consecutive patients with histologically proven PC were evaluated prospectively. MRI staging was performed on 1.5 and 3.0T scanners using high-resolution T2 -weighted and postcontrast T1 -weighted images. Two blinded observers interpreted MR images. Clinical local staging was performed by experienced urologists. The pathology report was used as the standard of reference. RESULTS: The interobserver agreement for MRI staging, using a kappa test for T-staging was moderate, 0.52 (95% confidence interval [CI] = 0.24-0.78), P = 0.001, although a high correlation for N-staging, 0.72 (95% CI = 0.42-1.00), P = 0.001, was detected. Clinical staging was correct in 52.0% (13/25) of patients. After pathological staging, five (20.0%) lesions were upstaged and seven (28.0%) lesions were downstaged compared to clinical examination. MRI accurately defined T-staging in 18/25 lesions (72.0%). After pathologic staging, five (20.0%) were upstaged and two downstaged (8.0%), compared to MRI. Fifteen patients were submitted to inguinal and pelvic lymphadenectomy and considered for comparison of accuracy of nodal staging by physical examination and MRI. Clinical staging accurately staged 7/15 patients (46.7%). After histopathologic analysis, six cases had nodal staging upgraded and two cases were downgraded. MRI correctly staged 13/15 (86.7%). Using a chi-square for comparison, differences in proportion of corrected staging between clinical examination and MRI were not significant for T-staging (P = 0.14), but were significant for nodal staging (P = 0.02). CONCLUSION: According to our results, MRI improves local staging of PC patients, particularly for those with limited physical examination. LEVEL OF EVIDENCE: 1 J. Magn. Reson. Imaging 2017;45:118-124.

Pre-treatment MRI minimum apparent diffusion coefficient value is a potential prognostic imaging biomarker in cervical cancer patients treated with definitive chemoradiation.

BACKGROUND: Diffusion Weighted (DW) Magnetic Resonance Imaging (MRI) has been studed in several cancers including cervical cancer. This study was designed to investigate the association of DW-MRI parameters with baseline clinical features and clinical outcomes (local regional control (LRC), disease free survival (DFS) and disease specific survival (DSS)) in cervical cancer patients treated with definitive chemoradiation. METHODS: This was a retrospective study approved by an institutional review board that included 66 women with cervical cancer treated with definitive chemoradiation who underwent pre-treatment MRI at our institution between 2012 and 2013. A region of interest (ROI) was manually drawn by one of three radiologists with experience in pelvic imaging on a single axial CT slice encompassing the widest diameter of the cervical tumor while excluding areas of necrosis. The following apparent diffusion coefficient (ADC) values (×10(-3) mm(2)/s) were extracted for each ROI: Minimum - ADCmin, Maximum - ADCmax, Mean - ADCmean, and Standard Deviation of the ADC - ADCdev. Receiver operating characteristic (ROC) curves were built to choose the most accurate cut off value for each ADC value. Correlation between imaging metrics and baseline clinical features were evaluated using the Mann Whitney test. Confirmatory multi-variate Cox modeling was used to test associations with LRC (adjusted by gross tumor volume - GTV), DFS and DSS (both adjusted by FIGO stage). Kaplan Meyer curves were built for DFS and DSS. A p-value < 0.05 was considered significant. Women median age was 52 years (range 23-90). 67 % had FIGO stage I-II disease while 33 % had FIGO stage III-IV disease. Eighty-two percent had squamous cell cancer. Eighty-eight percent received concurrent cisplatin chemotherapy with radiation. Median EQD2 of external beam and brachytherapy was 82.2 Gy (range 74-84). RESULTS: Women with disease staged III-IV (FIGO) had significantly higher mean ADCmax values compared with those with stage I-II (1.806 (0.4) vs 1.485 (0.4), p = 0.01). Patients with imaging defined positive nodes also had significantly higher mean (±SD) ADCmax values compared with lymph node negative patients (1.995 (0.3) vs 1.551 (0.5), p = 0.03). With a median follow-up of 32 months (range 5-43) 11 patients (17 %) have developed recurrent disease and 8 (12 %) have died because of cervical cancer. ROC curves based on DSS showed optimal cutoffs for ADCmin (0.488 × 10(-3)), ADCmean (0.827 × 10(-3)), ADCmax (1.838 × 10(-3)) and ADCdev (0.148 × 10(-3)). ADCmin higher than the cutoff was significantly associated with worse DFS (HR = 3.632-95 % CI: 1.094-12.054; p = 0.035) and DSS (HR = 4.401-95 % CI: 1.048-18.483; p = 0.043). CONCLUSION: Pre-treatment ADCmax measured in the primary tumor may be associated with FIGO stage and lymph node status. Pre-treatment ADCmin may be a prognostic factor associated with disease-free survival and disease-specific survival in cervical cancer patients treated with definitive chemoradiation. Prospective validation of these findings is currently ongoing.

Sinais de hipervascularização em imagens de ressonância magnética em metástases ósseas de carcinoma de células renais / Signs of hypervascularization at magnetic resonance imaging in bone metastases from renal cell carcinoma

OBJETIVO: Avaliar a frequência de hipervascularização pela visualização de vasos no interior ou ao redor de metástases ósseas de carcinoma de células renais. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, exames de ressonância magnética de 13 pacientes com diagnóstico de carcinoma de células renais, com 15 lesões ósseas metastáticas, que não haviam sido submetidos a nenhum tratamento. RESULTADOS: Foram encontrados sinais de hipervascularização em 12 das 15 lesões (80%), sendo 6 na coluna lombar, 3 na bacia, 1 na coluna torácica, 1 na ulna e 1 na tíbia. CONCLUSÃO: A alta frequência de hipervascularização em metástases ósseas de carcinoma de células renais encontrada neste trabalho pode sugerir a etiologia renal, tornando-se muito útil na apresentação clínica usual de lesão óssea única com neoplasia primária desconhecida.

OBJECTIVE: To evaluate the frequency of hypervascularization by visualizing vascular structures inside or around bone metastases from renal cell carcinoma. MATERIALS AND METHODS: Magnetic resonance imaging studies of 13 untreated patients with diagnosis of renal cell carcinoma and 15 metastatic bone lesions were retrospectively evaluated. RESULTS: Signs of hypervascularization were found in 12 of the 15 bone lesions (80%), 6 of them localized in the lumbar spine, 3 in the hip, 3 in the thoracic spine, 1 in the ulna and 1 in the tibia. CONCLUSION: The high frequency of hypervascularization of bone metastases from renal cell carcinoma found in the present study may suggest that the renal etiology is a useful parameter in the evaluation of a usual clinical presentation of a single bone lesion with unknown primary neoplasm.

Evaluation of urogenital fistulas by magnetic resonance urography / Avaliação das fístulas urogenitais por urorressonância magnética

OBJETIVO: As fístulas vesicovaginais e ureterovaginais são complicações incomuns, secundárias a doenças ou a cirurgias pélvicas. O sucesso terapêutico dessas fístulas depende de adequada avaliação pré-operatória para o diagnóstico e visualização do seu trajeto. Este trabalho tem o objetivo de demonstrar o potencial da urorressonância no diagnóstico das fístulas urogenitais e na visualização dos seus trajetos. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os prontuários médicos e as imagens radiológicas e de urorressonância magnética de sete pacientes do sexo feminino com diagnóstico de fístula urogenital. Para a urorressonância foram realizadas seqüências 3D-HASTE com saturação de gordura. RESULTADOS: Seis pacientes apresentavam fístula vesicovaginal e uma paciente tinha diagnóstico de fístula ureterovaginal à direita. Com a utilização da urorressonância magnética, foi possível demonstrar o trajeto da fístula em seis das sete pacientes (85,7 por cento), sem a necessidade de cateterização vesical ou da injeção de contraste. CONCLUSÃO: Este estudo demonstra o potencial e a aplicabilidade da urorressonância na avaliação dessas fístulas.

OBJECTIVE: Vesicovaginal and ureterovaginal fistulas are unusual complications secondary to pelvic surgery or pelvic diseases. The therapeutic success in these cases depends on an appropriate preoperative evaluation for diagnosis and visualization of the fistulous tract. The present study is aimed at demonstrating the potential of magnetic resonance urography for the diagnosis of vesicovaginal and ureterovaginal fistulas as well as for defining the fistulous tracts. MATERIALS AND METHODS: Seven female patients clinically diagnosed with vesicovaginal or ureterovaginal fistulas had their medical records, radiological and magnetic resonance images retrospectively reviewed. Magnetic resonance urography included 3D-HASTE sequences with fat saturation. RESULTS: Six patients presented vesicovaginal fistulas and, in one patient, a right-sided ureterovaginal fistula was diagnosed. Magnetic resonance urography allowed the demonstration of the fistulous tract in six (85.7 percent) of the seven patients evaluated in the present study, without the need of bladder catheterization or contrast injection. CONCLUSION: This study demonstrates both the potential and applicability of magnetic resonance urography in the evaluation of these types of fistulas.