Multiparametric Magnetic Resonance Imaging of the Prostate: An Update

Multiparametric magnetic resonance imaging (mp-MRI) has emerged as an important tool for the detection and characterization of prostatic lesions. It now plays a quintessential role in the surveillance, diagnosis, and staging of prostate cancer (PCa), as well as for the detection of local recurrence. As reliance on serum prostate-specific antigen has declined in the recent times, mp-MRI has emerged as the go-to tool for urologists all over the world. Hence, for the clinician, it has become necessary to be well versed with the technique, image interpretation, and fallacies of mp-MRI. Since mp-MRI has the advantage of better contrast resolution, combining PSMA PET (prostate-specific membrane antigen–positron emission tomography) with MRI could provide additional functional information. However, due to the absence of enough evidence supporting its routine use, mp-MRI still has the unsurpassed role in the initial diagnosis and local staging of PCa.

Pelvic mature cystic teratoma with neuroendocrine carcinoma: Report of a rare association and review of literature.

Extra-gonadal malignant transformation of teratoma is rare and there are only a few reports available citing malignancy arising in the non-germ cell components. We hereby report a case of a 35-year-old female, who presented with lower backache with a radiologically identifi able mass lesion in the pre-sacral region. Clinical and radiological fi ndings suggested the possibility of a cystic teratoma. Histopathological examination and relevant immunohistochemical tests detected a mature cystic teratoma with features of a grade 2 neuroendocrine tumor in it. Like the index case, most of the previously reported cases of teratoma with malignant transformation of the somatic components were found in extra-gonadal site. This case is being reported to emphasize that any extra-gonadal mass in reproductive age group, even if it appears radiologically and per-operatively benign, must be subjected to histopathological examination to rule out possibility of malignant transformation of the germ cell or non-germ cell components.

MRI contrast media: What clinicians need to know.

Magnetic resonance imaging (MRI) is an imaging modality that uses the differential spinning of protons (hydrogen) in the body when exposed to an external magnetic field, to produce crosssectional images of the body. The advent of MRI is a boon to mankind as it does not involve ionizing radiation and provides superior soft tissue contrast even without administration of contrast media. The contrast media used in MRI were developed many years after MRI was already in use, the first being gadopentetate dimeglumine—a non-specific extracellular gadolinium chelate. Extracellular agents are the most widely used, although tissue-specific agents have been developed and are used as problem-solving tools in specific conditions. Tolerance to gadolinium-based contrast agents is excellent. The tissue-specific agents do have some adverse effects, though none of them are life-threatening. However, identification of a condition called nephrogenic systemic fibrosis has forced a rethink about the liberal usage of MRI contrast agents.

Nephrogenic systemic fibrosis: A review of the new conundrum.

Nephrogenic systemic fibrosis is an idiopathic, sclerosing condition that occurs only in patients who have impaired renal function. Although its most conspicuous manifestation is in the skin, the condition involves multiple organ systems and is potentially fatal. Its postulated association with gadolinium-based magnetic resonance contrast agents has attracted attention. The distinctive clinical features of this entity include a prodromal systemic inflammatory syndrome followed by a chronic course of fibrosis that has a predilection for the skin and subcutaneous tissues of the extremities. The progressive systemic fibrosing process involves multiple organs and contributes to the morbidity and the increased mortality. Appropriate preventive action, prompt recognition and timely reporting of cases may enable better management of this condition.

Pyle metaphyseal dysplasia.

Pyle type metaphyseal dysplasia is a rare autosomal recessive disease that primarily affects metaphyses. We report a 12 year old boy with Pyles disease. He had mild facial dysmorphism, genu valgum and wasting of legs. Skeletal radiology revealed the characteristic Erlenmeyer flask sign at distal femoral and proximal tibial metaphyses along with platyspondyly.