Paradigm Shift in Prostate Cancer Diagnosis: Pre-Biopsy Prostate Magnetic Resonance Imaging and Targeted Biopsy

With regard to the indolent clinical characteristics of prostate cancer (PCa), the more selective detection of clinically significant PCa (CSC) has been emphasized in its diagnosis and management. Magnetic resonance imaging (MRI) has advanced technically, and recent international cooperation has provided a standardized imaging and reporting system for prostate MRI. Accordingly, prostate MRI has recently been investigated and utilized as a triage tool before biopsy to guide tissue sampling to increase the detection rate of CSC beyond the staging tool for patients in whom PCa was already confirmed on conventional systematic biopsy. Radiologists must understand the current paradigm shift for better PCa diagnosis and management. This article reviewed the recent literature, demonstrating the diagnostic value of pre-biopsy prostate MRI with targeted biopsy and discussed unsolved issues regarding the paradigm shift in the diagnosis of PCa.

Circularity Index on Contrast-Enhanced Computed Tomography Helps Distinguish Fat-Poor Angiomyolipoma from Renal Cell Carcinoma: Retrospective Analyses of Histologically Proven 257 Small Renal Tumors Less Than 4 cm

Objective@#To evaluate circularity as a quantitative shape factor of small renal tumor on computed tomography (CT) in differentiating fat-poor angiomyolipoma (AML) from renal cell carcinoma (RCC). @*Materials and Methods@#In 257 consecutive patients, 257 pathologically confirmed renal tumors (either AML or RCC less than 4 cm), which did not include visible fat on unenhanced CT, were retrospectively evaluated. A radiologist drew the tumor margin to measure the perimeter and area in all the contrast-enhanced axial CT images. In each image, a quantitative shape factor, circularity, was calculated using the following equation: 4 x π x (area ÷ perimeter 2 ). The median circularity (circularity index) was adopted as a representative value in each tumor. The circularity index was compared between fat-poor AML and RCC, and the receiver operating characteristic (ROC) curve analysis was performed. Univariable and multivariable binary logistic regression analysis was performed to determine the independent predictor of fat-poor AML. @*Results@#Of the 257 tumors, 26 were AMLs and 231 were RCCs (184 clear cell RCCs, 25 papillary RCCs, and 22 chromophobe RCCs). The mean circularity index of AML was significantly lower than that of RCC (0.86 ± 0.04 vs. 0.93 ± 0.02, p < 0.001).The mean circularity index was not different between the subtypes of RCCs (0.93 ± 0.02, 0.92 ± 0.02, and 0.92 ± 0.02 for clear cell, papillary, and chromophobe RCCs, respectively, p = 0.210). The area under the ROC curve of circularity index was 0.924 for differentiating fat-poor AML from RCC. The sensitivity and specificity were 88.5% and 90.9%, respectively (cut-off, 0.90). Lower circularity index (≤ 0.9) was an independent predictor (odds ratio, 41.0; p < 0.001) for predicting fat-poor AML on multivariable logistic regression analysis. @*Conclusion@#Circularity is a useful quantitative shape factor of small renal tumor for differentiating fat-poor AML from RCC.

Circularity Index on Contrast-Enhanced Computed Tomography Helps Distinguish Fat-Poor Angiomyolipoma from Renal Cell Carcinoma: Retrospective Analyses of Histologically Proven 257 Small Renal Tumors Less Than 4 cm

Objective@#To evaluate circularity as a quantitative shape factor of small renal tumor on computed tomography (CT) in differentiating fat-poor angiomyolipoma (AML) from renal cell carcinoma (RCC). @*Materials and Methods@#In 257 consecutive patients, 257 pathologically confirmed renal tumors (either AML or RCC less than 4 cm), which did not include visible fat on unenhanced CT, were retrospectively evaluated. A radiologist drew the tumor margin to measure the perimeter and area in all the contrast-enhanced axial CT images. In each image, a quantitative shape factor, circularity, was calculated using the following equation: 4 x π x (area ÷ perimeter 2 ). The median circularity (circularity index) was adopted as a representative value in each tumor. The circularity index was compared between fat-poor AML and RCC, and the receiver operating characteristic (ROC) curve analysis was performed. Univariable and multivariable binary logistic regression analysis was performed to determine the independent predictor of fat-poor AML. @*Results@#Of the 257 tumors, 26 were AMLs and 231 were RCCs (184 clear cell RCCs, 25 papillary RCCs, and 22 chromophobe RCCs). The mean circularity index of AML was significantly lower than that of RCC (0.86 ± 0.04 vs. 0.93 ± 0.02, p < 0.001).The mean circularity index was not different between the subtypes of RCCs (0.93 ± 0.02, 0.92 ± 0.02, and 0.92 ± 0.02 for clear cell, papillary, and chromophobe RCCs, respectively, p = 0.210). The area under the ROC curve of circularity index was 0.924 for differentiating fat-poor AML from RCC. The sensitivity and specificity were 88.5% and 90.9%, respectively (cut-off, 0.90). Lower circularity index (≤ 0.9) was an independent predictor (odds ratio, 41.0; p < 0.001) for predicting fat-poor AML on multivariable logistic regression analysis. @*Conclusion@#Circularity is a useful quantitative shape factor of small renal tumor for differentiating fat-poor AML from RCC.

Incidental Ovarian Lesions

Incidental ovarian lesions are diagnostic challenges owing to their wide disease spectrum, ranging from normal findings to malignant ovarian tumors. There are several physiologic ovarian lesions that may not require any follow-up or treatment. While some lesions demonstrate their benign nature on imaging, some significant radiologic features may suggest malignant potential. Therefore, precise interpretation of imaging findings and proper recommendations for clinicians by radiologists are essential for managing incidental ovarian lesions to avoid unnecessary examinations or invasive treatments. The aim of this review is to describe the radiologic findings of commonly encountered incidental ovarian lesions on ultrasonography or computed tomography and to explain the management plan according to the stratified risk for malignancy in each ovarian lesion.

Prognostic Significance for Long-Term Outcomes Following Radical Prostatectomy in Men with Prostate Cancer: Evaluation with Prostate Imaging Reporting and Data System Version 2

OBJECTIVE: To retrospectively determine whether the use of the Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) helps predict long-term outcomes for prostate cancer (PCa) patients following radical prostatectomy (RP). MATERIALS AND METHODS: A total of 166 patients with localized PCa evaluated with multiparametric magnetic resonance imaging (mpMRI) at 3T before RP were enrolled. Three groups were created based on PI-RADS v2 score used to predict clinical outcomes: group A, ≥ 3; group B, ≥ 4; group C, 5. We calculated biochemical recurrence-free survival (RFS) and progression-free survival (PFS). Cox proportion hazards models were used to identify variables predictive of biochemical recurrence and disease progression. RESULTS: During a median follow-up of 9.1 years, biochemical recurrence occurred in 67 patients (40.4%) and disease progression occurred in 55 patients (33.1%). In all groups, 10-year RFS and 10-year PFS were significantly lower for PI-RADS scores ≥ 3, ≥ 4 and 5 than for score < 3, < 4 and < 5 (p <0.05), respectively. In multivariate analysis, PI-RADS score ≥ 3 and score 5 were significant independent risk marker for biochemical recurrence (hazard ratio [HR] = 5.58, p = 0.018; HR = 1.75, p = 0.033) and disease progression (HR = 3.99, p = 0.047; HR = 2.31, p = 0.040). Moderate inter-observer agreement was seen for PI-RADS scoring. CONCLUSION: PI-RADS v2 may be used to predict long-term outcomes following RP in PCa.

CT-Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma in Korea: Mid-Term Outcomes

OBJECTIVE: To evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) treatment in patients with small (< 4 cm) renal cell carcinoma (RCC) in Korea. MATERIALS AND METHODS: Between 2010 and 2015, 51 patients (40 men and 11 women; median age, 57 years) with biopsyproven 51 RCC were treated using CT-guided RFA. All patients were clinically staged T1aN0M0 prior to RFA. The median tumor size and follow-up period were 2.1 cm (range, 1.0-3.9 cm) and 26 months (4-60 months), respectively. Local tumor progression, distant metastasis, primary and secondary effectiveness rates, and major complication rates were recorded. Estimated glomerular filtration rates (GFRs) between pre-RFA and last follow-up were compared using paired t tests. The 2-year recurrence-free survival rate was calculated using Kaplan-Meier survival analysis. RESULTS: Of the 51 patients, 2 (3.9%) experienced local tumor progression, and 1 (2.0%) had lymph node metastasis after the first RFA session. Primary and secondary effectiveness rates were 96.1% (49/51) and 100% (1/1), respectively. Only 1 patient experienced a major complication (uretero-pelvic stricture) after the second RFA session for treating a local tumor progression, and the major complication rate was 1.9% (1/52). The median pre-RFA and last follow-up GFRs were 87.1 mL/ min/1.73 m2 (14.2-142.7 mL/min/1.73 m2) and 72.0 mL/min/1.73 m2 (7.2-112.6 mL/min/1.73 m2), respectively (p < 0.0001). The 2-year recurrence-free survival rate was 96.0%. CONCLUSION: CT-guided RFA is a safe and effective treatment in Korean patients with T1a RCC because of excellent mid-term outcomes.

Long-term outcomes of magnetic resonance imaging-invisible endometrial cancer / 부인종양

OBJECTIVE: Magnetic resonance imaging (MRI) is useful for staging endometrial cancer. The treatment and prognosis of MRI-invisible endometrial cancer remain unclear. The purpose of this study was to retrospectively evaluate the long-term outcomes of patients with MRI-invisible endometrial cancer. METHODS: Between February 1995 and December 2011, we reviewed the medical records of 433 patients with endometrial cancer, which was staged IA on MRI. Of these patients, 89 had MRI-invisible cancer and 344 had MRI-visible cancer. Both cancers were treated with simple hysterectomy with or without lymph node dissection according to the surgeon's decision. Both cancers were compared regarding pathologic findings, recurrence rates, and survival rates. RESULTS: The median sizes of MRI-invisible and MRI-visible cancers were 4 mm (0 to 40 mm) and 20 mm (0 to 89 mm), respectively (p<0.001). Myometrial invasion of these groups were detected in 20.2% (18/89) and 56.7% (195/344), respectively (p<0.001). Lymphadenectomy and follow-up imaging revealed no lymph node metastasis in patients with MRI-invisible cancers, while those revealed in 4.7% (16/344) of patients with MRI-visible cancers (p=0.052). The recurrence rates of MRI-invisible and MRI-visible cancers were 1.1% (1/89) and 7.8% (27/344), respectively (p=0.026). The recurrence-free survival rates of these groups were 98.9% (88/89) and 91.6% (315/344), respectively (p=0.022). CONCLUSION: MRI-invisible endometrial cancer can be treated with less invasive surgery because of its lower tumor burden and better prognosis. This cancer may not require lymphadenectomy because of no metastasis or recurrence in lymph nodes.

Long-term outcomes of magnetic resonance imaging-invisible endometrial cancer / 부인종양

OBJECTIVE: Magnetic resonance imaging (MRI) is useful for staging endometrial cancer. The treatment and prognosis of MRI-invisible endometrial cancer remain unclear. The purpose of this study was to retrospectively evaluate the long-term outcomes of patients with MRI-invisible endometrial cancer. METHODS: Between February 1995 and December 2011, we reviewed the medical records of 433 patients with endometrial cancer, which was staged IA on MRI. Of these patients, 89 had MRI-invisible cancer and 344 had MRI-visible cancer. Both cancers were treated with simple hysterectomy with or without lymph node dissection according to the surgeon's decision. Both cancers were compared regarding pathologic findings, recurrence rates, and survival rates. RESULTS: The median sizes of MRI-invisible and MRI-visible cancers were 4 mm (0 to 40 mm) and 20 mm (0 to 89 mm), respectively (p<0.001). Myometrial invasion of these groups were detected in 20.2% (18/89) and 56.7% (195/344), respectively (p<0.001). Lymphadenectomy and follow-up imaging revealed no lymph node metastasis in patients with MRI-invisible cancers, while those revealed in 4.7% (16/344) of patients with MRI-visible cancers (p=0.052). The recurrence rates of MRI-invisible and MRI-visible cancers were 1.1% (1/89) and 7.8% (27/344), respectively (p=0.026). The recurrence-free survival rates of these groups were 98.9% (88/89) and 91.6% (315/344), respectively (p=0.022). CONCLUSION: MRI-invisible endometrial cancer can be treated with less invasive surgery because of its lower tumor burden and better prognosis. This cancer may not require lymphadenectomy because of no metastasis or recurrence in lymph nodes.

Dynamic Contrast-Enhanced MR Imaging in Detecting Local Tumor Progression after HIFU Ablation of Localized Prostate Cancer

PURPOSE: To retrospectively evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging (DCE-MRI) in detecting recurrent prostate cancer after HIFU of clinically localized cancer, as compared with T2-weighted imaging (T2WI). MATERIALS AND METHODS: Twenty-six patients with increased prostate-specific antigen levels after HIFU were included in this study. All MR examinations were performed using T2WI and DCE-MRI, followed by transrectal ultrasound-guided biopsy. MRI and biopsy results were correlated in six prostate sectors. Residual or recurrent cancer after HIFU was defined as local tumor progression if biopsy results showed any cancer foci. Two independent readers interpreted the MR images. RESULTS: Of 156 prostate sectors, 51 (33%) were positive for cancer in 17 patients. For detecting local tumor progression, the sensitivity of DCE-MRI and T2WI was 80% and 57% for reader 1 (P 0.05). Interobserver agreement of DCE-MRI and T2WI was moderate and fair, respectively. CONCLUSION: For detecting local tumor progression of prostate cancer after HIFU, DCE-MRI was more sensitive than T2WI, with less interobserver variability.

Comprehension of Lung Sounds for Family Medicine Residents in Daegu, Gyeongbuk / 가정의학회지

BACKGROUND: Understanding lung sound is important physical examination of chest. We studied to identify the state of the understanding, the education and the self-learning experience for lung sound's interpretation during the residentship training period. METHODS: Data were collected from 45 family medicine residents who had trained in Daegu and Gyeongbuk from April 1st to May 31th 2008. Residents completed self-administered questionnaire about the education and the self-learning experience for lung sound's interpretation and had been estimated the understanding of lung sound by using the audio file of five lung sounds. RESULTS: The median score (inter-quartile range, IQR) of lung sound's interpretation was 2 (1, 3) between 0 and 5 range. The number of residents who were educated for the interpretation of lung sounds during the training period were 10 (22.2%). Twenty-four (53.3%) had the self-learning experience for lung sounds. CONCLUSION: The understanding for lung sounds of family medicine residents in Daegu, Gyeungbuk was not high and the majority of residents were not educated the interpretation of lung sounds during the training period. Directors of family medicine should consider to make the regular education program for interpretation of lung sound during the training period.

Change of Selection to Antihypertensive Drugs in Hypertensive Patients with Diabetes Mellitus: In Pohang . Gyeongju Primary Care Research Network / 가정의학회지

BACKGROUND: Angiotensin converting enzyme inhibitors (ACEIs) or Angiotensin II type 1 receptor blockers (ARBs) are compelling indication drugs for hypertensive patients with diabetes mellitus. But prescription rate in 2005 year study of Pohang . Gyeongju area was only 30.8%. Therefore, a study on the change of prescription rate in the same area after 3 years was done. METHODS: During three months from January 2008, 152 hypertensive patients with diabetes mellitus on their prescribed antihypertensive medications by 9 family physicians in visiting order were analyzed. After the analysis, the infl uencing factors for such prescriptions were ascertained by directly visiting each physicians who prescribed them. RESULTS: A regimen of 16 antihypertensive agents were prescribed by these family physicians. Prescription count of ACEIs or ARBs was 101 cases (66.4%). ACEIs single therapy was 19 cases (12.5%), ACEIs combination therapy was 7 cases (4.6%), ARBs single therapy was 31 cases (20.4%) and ARBs combination therapy was 44 cases (28.9%). The ACEIs or ARBs which were selected by physicians that followed "compelling indication" was 5 (55.6%), "excellent reduce pressure effect" was 3 (33.3%) and "public relations of new medicine" was 1 (11.1%). CONCLUSION: In prescribing antihypertensive agents for patients with diabetes mellitus, selection of ACEIs or ARBs was increased from 30.8% to 66.4%. Education of recommended standard by participating in such study and developing of excellent new medicines may increase such change.

Influence of Anxiety, Depression and Stress on Adjustment to College in Freshmen of a University / 가정의학회지

BACKGROUND: Freshmen maladaptation to university life has brought a lot of attention recently. Therefore, we intended to investigate about the relationship between anxiety, depression, stress and freshmen adaptation to university life. METHODS: We recruited 861 freshmen of a university located in Gyeongju, Gyeongbuk, and measured their degree of anxiety, depression, and stress by questionnaire from March 10 to 14, 2008. After 8 weeks, we examined their adaptation to university life by questionnaire and finally, analyzed the data of 600 freshmen. RESULTS: Among the freshmen, 285 (47.5%) had anxiety, 95 (15.8%) depression, and 70 (11.7%) stress. Adaptation to university life significantly associated with college-entrance exam experience, the number of close friends in class, willingness to join the club, major satisfaction and distance from the university to hometown, in addition to anxiety, depression, and stress. Risk factors of maladaptation to university life were stress (odds ratio: 2.66, 95% confidence interval: 1.60 to 4.45), depression (2.45; 1.56 to 3.84), one experience of college entrance exam (1.83; 1.24 to 2.69), anxiety (1.73; 1.27 to 2.37) and fewer than 5 close friends (1.60; 1.17 to 2.20). Short distance from the university to hometown (0.72; 0.53 to 0.98), willingness to join the club (0.60; 0.41 to 0.87) and major satisfaction (0.42; 0.29 to 0.61) were identified as lowering the risk of maladaptation to university life. CONCLUSION: Anxiety, depression, and stress closely related to freshmen adaptation to university life. During freshmen's health examination, we need to identify the degree of anxiety, depression and stress in order to predict maladaptation to university life.

A Parkinsonism as a Component of Sylvian Aqueduct Syndrome: Effect of Floating Cranioplasty and Distal Catheter Elongation

The sylvian aqueduct syndrome is a global rostral midbrain dysfunction induced by a transtentorial pressure gradient through the aquaeductus. Several months after ventriculoperitoneal shunt, a patient with hydrocephalus began experiencing a constellation of midbrain dysfunction symptoms, including bradykinesia, medial longitudinal fasciculus syndrome, third nerve palsy, and mutism. These were indicative of cerebral aqueduct syndrome. In addition, the patient showed posture-dependent underdrainage or overdrainage. All symptoms were resolved after distal catheter elongation and floating cranioplasty. We present a case of reversible parkinsonism, which developed in a patient with shunted hydrocephalus and aqueductal stenosis, and discuss the diagnosis and treatment of the sylvian aqueduct syndrome. We also review the literature to address problems of drainage and potential treatment modalities.