MR staging of prostate cancer. How we can improve our accuracy with decisions aids and optimal techniques.

This article reviews the MR staging of prostate cancer. There has been considerable variability in the MR results to date. The reasons are complex and include reader experience, the learning curve, and a lack of clear definition of the diagnostic features of advanced disease.

CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II.

Purpose: To prospectively evaluate the relative accuracy of computed tomography (CT) and magnetic resonance (MR) imaging in the staging of colorectal carcinoma.

Materials And Methods: CT and MR studies were independently interpreted in a group of 478 patients with colorectal carcinoma in a study conducted from 1989 to 1993. The accuracy of each modality was assessed in a subset of 365 patients with primary tumors with respect to staging of local extent of tumor, status of local-regional lymph nodes, and the presence of liver metastases.

An analysis of the time course of postoperative prostate-specific antigen failure in patients with positive surgical margins: implications on the use of adjuvant therapy.

Objectives: The role of adjuvant therapy in the postprostatectomy setting for positive margin patients is an unresolved issue. The purpose of this study is to provide the rationale for patient selection in Phase III trials that test the impact of adjuvant therapy on survival in positive margin prostate cancer patients.

Methods: Early (12 months or less) and delayed (more than 12 months) postoperative prostate-specific antigen (PSA) failure have been correlated with distant and local failure, respectively, as the site of first failure.

Effect of slice acquisition direction on image quality in thoracic MRI.

Objective: We tested the basic observation that imaging the heart and pericardium in systole improves image quality compared with that in diastole.

Materials And Methods: Twenty consecutive patients and two volunteers underwent sequential ECG-gated short TE transaxial prospective multislice SE MRI with both caudocranially and craniocaudally directed slice prescriptions, keeping other imaging parameters constant. Images of the heart and pericardium were obtained in systole and diastole and examined by three independent reviewers for image quality.

Second trimester uterine atony imitating ectopic pregnancy: magnetic resonance diagnosis.

When an obstetrical patient was referred for inability to auscultate fetal heart tones at 18 weeks' gestation, ultrasound identified a single living fetus in the maternal right upper quadrant. Magnetic resonance imaging (MRI) ruled out a suspected uterine ectopic pregnancy and avoided laparotomy. The patient experienced an uncomplicated term delivery.

Superparamagnetic iron oxide hepatic MR imaging: efficacy and safety using conventional and fast spin-echo pulse sequences.

The purpose of this study was to evaluate the technical efficacy and safety of iv ferumoxides (Feridex), a superparamagnetic iron oxide contrast agent for detection of hepatic lesions using conventional spin-echo and fast spin-echo MR images. Precontrast and postcontrast MR studies were performed on 25 patients with suspected focal hepatic lesions. Conventional T1- and T2-weighted MR images, as well as fast spin-echo and fat suppressed fast spin-echo MR images, were evaluated.

Thrombophlebitic retroperitoneal collateral veins mimicking lymphadenopathy: MR and CT appearance.

The authors report the magnetic resonance (MR) and computed tomography (CT) features of what is believed to be thrombophlebitis of the left cava of a duplicated IVC, which mimicked lymphadenopathy, and prompted both a CT-guided needle aspiration biopsy and surgical exploration. Knowledge that retroperitoneal vascular anomalies can mimick lymphadenopathy, both clinically and radiographically, may help obviate further testing and intervention.

The use of dynamic magnetic resonance imaging to evaluate orthotopic continent urinary diversion.

Objectives: The purpose of this study was to evaluate a dynamic magnetic resonance (MR) examination in patients after radical cystoprostatectomy with a neobladder.

Methods: All 12 subjects were studied with the injection of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) and showed normal renal enhancement patterns and upper urinary tracts, except 1 patient who had mild right hydronephrosis. All neobladders were also visualized with gadolinium and 9 of 11 patients were able to void on command.

Evaluation of erectile function in men with sickle cell disease.

Objectives: To evaluate and characterize erectile manifestations associated with sickle cell disease using nocturnal penile tumescence testing with polysomnography (NPT/PSG) and magnetic resonance imaging (MRI) of the penis.

Methods: Six variably potent men with sickle cell disease, of whom 5 reported a history of priapism, underwent comprehensive evaluations of erectile function. Evaluations involved a medical history and physical examination with completion of priapism and sexual function questionnaires, followed by NPT/PSG and MRI of the penis.

Staging of prostate cancer: results of Radiology Diagnostic Oncology Group project comparison of three MR imaging techniques.

Purpose: To assess accuracy of three different magnetic resonance (MR) imaging techniques, including the endorectal coil, in staging prostate cancer.

Materials And Methods: MR imaging was performed in 213 patients with prostate cancer with a conventional body coil, with fat suppression and a body coil, and with an endorectal coil. Radiologists identified tumor invasion into periprostatic tissues, neurovascular bundles, and seminal vesicles.

MR imaging and sonography of early prostatic cancer: pathologic and imaging features that influence identification and diagnosis.

Objective: The purpose of this study was to correlate findings at MR imaging and transrectal sonography with histopathologic findings after surgery in patients with prostatic cancer, to identify the pathologic characteristics of prostatic cancer that improved detection with MR imaging and transrectal sonography, and to identify the imaging characteristics that correlated with detection of true cancers.

Materials And Methods: Data from MR imaging in 320 patients and from transrectal sonography in 343 patients who were enrolled in the Radiological Diagnostic Oncology Group multiinstitutional study of imaging in prostatic cancer were correlated with results of radical prostatectomy. Only cancers 5 mm or greater in at least one dimension were evaluated pathologically.

Prospective comparison of T2-weighted fast spin-echo, with and without fat suppression, and conventional spin-echo pulse sequences in the upper abdomen.

Purpose: To evaluate use of fast spin-echo (FSE) magnetic resonance imaging with and without fat suppression in the liver and upper abdomen.

Materials And Methods: Conventional spin-echo (SE) T2-weighted, FSE T2-weighted, and fat-suppressed FSE T2-weighted images from 37 patients strongly suspected to have focal hepatic lesions were evaluated.

Results: Quantitative analysis demonstrated that fat-suppressed FSE imaging had the highest lesion-liver contrast-to-noise ratio; conventional SE imaging, the lowest.

Lymphoma: monitoring tumor size and signal intensity with MR imaging.

To assess the potential value of magnetic resonance (MR) imaging in monitoring disease status, 34 patients with residual masses underwent MR imaging at sequential intervals. Patterns of signal intensity suggestive of active and inactive residual disease were compared to changes in tumor size. The signal intensity pattern was suggestive of persistent disease in 18 patients, even though tumor size was stable or decreased.

The influence of finasteride on the volume of the peripheral and periurethral zones of the prostate in men with benign prostatic hyperplasia.

To determine the influence of androgen deprivation induced by the potent 5 alpha-reductase inhibitor finasteride on the volume of the zones of the prostate, 20 symptomatic men with established BPH were randomized to one of three groups: placebo, finasteride 1 mg, and finasteride 5 mg/day. The volume of the entire prostate gland, periurethral zone, and peripheral zone and the seminal vesicles were determined by three dimensional reconstructions of magnetic resonance contoured images of the prostate. There was no significant difference between the results achieved with 1 and 5 mg of finasteride per day; thus the results in these two groups were combined.

MRI of the renal veins: assessment of nonneoplastic venous thrombosis.

Nonneoplastic renal vein thrombosis (RVT) is a clinical dilemma that poses a problem both from a clinical and diagnostic imaging perspective. An accurate noninvasive study to diagnose nonneoplastic RVT would be desirable. Magnetic resonance flow imaging is a noninvasive method of assessing vascular patency and depiction of thrombus.

Needle-tip localization during CT-guided abdominal biopsy: comparison of conventional and spiral CT.

Objective: This study was performed to determine whether the time required for needle-tip localization during biopsy of the abdomen would be reduced if continuous-volume data acquisition, also known as spiral CT, were used for guidance instead of conventional CT.

Subjects And Methods: Forty patients had biopsies of an abdominal mass; half underwent needle-tip localizations with conventional CT and half with spiral CT. The times required to localize the needle for 104 needle passes were calculated; scanning and reconstruction times were included, and the radiologist's technique and procedural difficulties were deliberately excluded.

Accuracy of in-vivo assessment of prostatic volume by MRI and transrectal ultrasonography.

More accurate noninvasive estimation of prostate size is important in therapeutic trials for benign prostatic hyperplasia. The accuracy of MRI and transrectal ultrasound (TRUS) in assessing prostate weight was evaluated in 48 patients who underwent radical prostatectomy for stage A or B cancer. The volume derived from the wet weight of the freshly excised specimen was used as a reference.

Efficacy of prostate-specific antigen and magnetic resonance imaging in staging stage C adenocarcinoma of the prostate.

Objectives: The authors compared the two most common presurgical tests now used for the preoperative staging of adenocarcinoma of the prostate, prostate-specific antigen (PSA) and magnetic resonance imaging (MRI).

Methods: One hundred consecutive radical retropubic prostatectomy patients were imaged at 1.5 Tesla before surgery with routine T1-weighted and T2-weighted transaxial images.

MR imaging of the female pelvic region.

Magnetic resonance (MR) imaging is a valuable technique for noninvasive evaluation of the female pelvic region. This article presents the normal anatomy and abnormalities of the female pelvis. MR imaging may be more useful than clinical evaluation or other imaging modalities in diagnosing or staging developmental anomalies, leiomyomas, adenomyosis, endometrial or cervical carcinoma, vaginal neoplasms, ovarian cysts, endometriosis, teratomas, polycystic ovaries, or other ovarian masses.

MR imaging in adenocarcinoma of the prostate: interobserver variation and efficacy for determining stage C disease.

Patients with adenocarcinoma of the prostate confined to the gland (stage B) are candidates for a potentially curative surgical procedure (radical retropubic prostatectomy). However, patients with adenocarcinoma that penetrates the capsule or invades the seminal vesicles (stage C) are no longer considered good candidates for surgical cure of their disease. The purpose of this study was to compare the ability of four radiologists to detect stage C disease on MR images and to evaluate interobserver variability.

MR detection of breast implant rupture.

Breast implant rupture can be difficult to diagnosis. Various modalities including direct clinical palpation, ultrasound, CT, and mammography have been used to evaluate for the presence of prosthesis rupture. We report a case in which the presence of breast implant rupture was determined using MR with characterization of the inflammatory reaction in the soft tissues around the implant.

Mass-like hepatic hypertrophy: MRI findings with histologic correlation.

Hepatic parenchyma may hypertrophy following asymmetrical injury. The histologic characteristics of hypertrophic hepatic parenchyma are more similar to normal hepatic parenchyma than is the more severely damaged liver. We present four cases where large hypertrophic masses resembled neoplasm on other imaging modalities or at surgery, but had MRI signal characteristics similar to those of normal liver.

Biliary cystadenoma with intratumoral bleeding: radiologic-pathologic correlation.

We report a case of a 35-year-old woman with a mucinous biliary cystadenoma of the liver. The patient presented with the acute onset of upper abdominal pain and jaundice, symptoms caused by bleeding into the cystadenoma. Findings of a variety of imaging modalities including ultrasound, CT angiography, MR imaging, and endoscopic retrograde cholangiopancreatography are correlated and verified by pathological studies performed on the material obtained surgically.