Risk Biomarkers for Biochemical Recurrence after Radical Prostatectomy for Prostate Cancer Using Clinical and MRI-Derived Semantic Features.

OBJECTIVES: This study aimed to assess the impact of the covariates derived from a predictive model for detecting extracapsular extension on pathology (pECE+) on biochemical recurrence-free survival (BCRFS) within 4 years after robotic-assisted radical prostatectomy (RARP). METHODS: Retrospective data analysis was conducted from a single center between 2015 and 2022. Variables under consideration included prostate-specific antigen (PSA) levels, patient age, prostate volume, MRI semantic features, and Grade Group (GG). We also assessed the influence of pECE+ and positive surgical margins on BCRFS. To attain these goals, we used the Kaplan-Meier survival function and the multivariable Cox regression model. Additionally, we analyzed the MRI features on BCR (biochemical recurrence) in low/intermediate risk patients. RESULTS: A total of 177 participants with a follow-up exceeding 6 months post-RARP were included. The 1-year, 2-year, and 4-year risks of BCR after radical prostatectomy were 5%, 13%, and 21%, respectively. The non-parametric approach for the survival analysis showed that adverse MRI features such as macroscopic ECE on MRI (mECE+), capsular disruption, high tumor capsular contact length (TCCL), GG ≥ 4, positive surgical margins (PSM), and pECE+ on pathology were risk factors for BCR. In low/intermediate-risk patients (pECE- and GG < 4), the presence of adverse MRI features has been shown to increase the risk of BCR. CONCLUSIONS: The study highlights the importance of incorporating predictive MRI features for detecting extracapsular extension pre-surgery in influencing early outcomes and clinical decision making; mECE+, TCCL, capsular disruption, and GG ≥ 4 based on pre-surgical biopsy were independent prognostic factors for early BCR. The presence of adverse features on MRI can assist in identifying low/intermediate-risk patients who will benefit from closer monitoring.

Hepatic Vascular Disorders: From Diagnosis to Interventional Radiology.

Hepatic vascular pathology comprises a spectrum of diseases with specific imaging features that have portal hypertension as a common denominator. The imaging features of the main pathologies are described, such as portal thrombosis, Budd-Chiari syndrome, hereditary hemorrhagic telangiectasia, portosystemic shunts and congenital vascular malformations. Endovascular intervention techniques are listed according to the indication for each hepatic vascular pathology and emphasis is placed on the ability to shape disease progression in order to prevent related morbidity and mortality.

Early biomarkers of extracapsular extension of prostate cancer using MRI-derived semantic features.

BACKGROUND: To construct a model based on magnetic resonance imaging (MRI) features and histological and clinical variables for the prediction of pathology-detected extracapsular extension (pECE) in patients with prostate cancer (PCa). METHODS: We performed a prospective 3 T MRI study comparing the clinical and MRI data on pECE obtained from patients treated using robotic-assisted radical prostatectomy (RARP) at our institution. The covariates under consideration were prostate-specific antigen (PSA) levels, the patient's age, prostate volume, and MRI interpretative features for predicting pECE based on the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.0 (v2), as well as tumor capsular contact length (TCCL), length of the index lesion, and prostate biopsy Gleason score (GS). Univariable and multivariable logistic regression models were applied to explore the statistical associations and construct the model. We also recruited an additional set of participants-which included 59 patients from external institutions-to validate the model. RESULTS: The study participants included 184 patients who had undergone RARP at our institution, 26% of whom were pECE+ (i.e., pECE positive). Significant predictors of pECE+ were TCCL, capsular disruption, measurable ECE on MRI, and a GS of ≥7(4 + 3) on a prostate biopsy. The strongest predictor of pECE+ is measurable ECE on MRI, and in its absence, a combination of TCCL and prostate biopsy GS was significantly effective for detecting the patient's risk of being pECE+. Our predictive model showed a satisfactory performance at distinguishing between patients with pECE+ and patients with pECE-, with an area under the ROC curve (AUC) of 0.90 (86.0-95.8%), high sensitivity (86%), and moderate specificity (70%). CONCLUSIONS: Our predictive model, based on consistent MRI features (i.e., measurable ECE and TCCL) and a prostate biopsy GS, has satisfactory performance and sufficiently high sensitivity for predicting pECE+. Hence, the model could be a valuable tool for surgeons planning preoperative nerve sparing, as it would reduce positive surgical margins.

Predicting liver metastases growth patterns: Current status and future possibilities.

Colorectal cancer is highly incident worldwide and presents a health burden with elevated mortality rate despite prevention, detection, and treatment, mainly due to metastatic liver disease. Histological growth patterns of colorectal cancer liver metastases have emerged as a reproducible prognostic factor, with biological implications and therapeutic windows. Nonetheless, the histological growth patterns of colorectal cancer liver metastases are only known after pathological examination of a liver resection specimen, thus limiting the possibilities of pre-surgical decision. Predicting the histological growth pattern of colorectal cancer liver metastases would provide valuable information for patient-tailored medicine. In this article, we perform a review of the histological growth patterns and their implications, with a focus on the possibilities for their prediction.

New boundaries of liver imaging: from morphology to function.

From an invisible organ to one of the most explored non-invasively, the liver is, today, one of the cornerstones for current cross-sectional imaging techniques and minimally invasive procedures. After the achievements of US, CT and, most recently, MRI in providing highly accurate morphological and structural information about the organ, a significant scientific development has gained momentum for the last decades, coupling morphology to liver function and contributing far most to what we know today as precision medicine. In fact, dedicated tailor-made investigations are now possible in order to detect and, most of all, quantify physiopathological processes with unprecedented certitude. It is the intention of this review to provide a better insight to the reader of several functional imaging techniques applied to liver imaging. Contrast enhanced imaging, diffusion weighted imaging, elastography, spectral computed tomography and fat and iron assessment techniques are commonly performed clinically. Diffusion kurtosis imaging, magnetic resonance spectroscopy, T1 relaxometry and radiomics remain largely limited to advanced clinical research. Each of them has its own value and place on the diagnostic armamentarium and provide unique qualitative and quantitative information regarding the pathophysiology of diseases, contributing at a large scale to model therapeutic decisions and patient follow-up. Therefore, state-of-the-art liver imaging acts today as a non-invasive surrogate biomarker of many focal and diffuse liver diseases.

Imaging biomarkers of diffuse liver disease: current status.

We are happy to introduce this special issue of Abdominal Radiology on "diffuse liver disease". We have invited imaging experts to discuss various topics pertaining to diffuse liver disease, covering a vast array of imaging techniques including ultrasound (US), CT, MRI and new molecular imaging agents. Below, we briefly discussed the current status, limitations, and future directions of imaging biomarkers of diffuse liver disease.

Metabolic tumor burden quantified on [18F]FDG PET/CT improves TNM staging of lung cancer patients.

PURPOSE: The purpose of our study was to test a new staging algorithm, combining clinical TNM staging (cTNM) with whole-body metabolic active tumor volume (MATV-WB), with the goal of improving prognostic ability and stratification power. METHODS: Initial staging [18F]FDG PET/CT of 278 non-small cell lung cancer (NSCLC) patients, performed between January/2011 and April/2016, 74(26.6%) women, 204(73.4%) men; aged 34-88 years (mean ± SD:66 ± 10), was retrospectively evaluated, and MATV-WB was quantified. Each patient's follow-up time was recorded: 0.7-83.6 months (mean ± SD:25.1 ± 20.3). RESULTS: MATV-WB was an independent and statistically-significant predictor of overall survival (p < 0.001). The overall survival predictive ability of MATV-WB (C index: mean ± SD = 0.7071 ± 0.0009) was not worse than cTNM (C index: mean ± SD = 0.7031 ± 0.007) (Z = -0.143, p = 0.773). Estimated mean survival times of 56.3 ± 3.0 (95%CI:50.40-62.23) and 21.7 ± 2.2 months (95%CI:17.34-25.98) (Log-Rank = 77.48, p < 0.001), one-year survival rate of 86.8% and of 52.8%, and five-year survival rate of 53.6% and no survivors, were determined, respectively, for patients with MATV-WB < 49.5 and MATV-WB ≥ 49.5. Patients with MATV-WB ≥ 49.5 had a mortality risk 2.9-5.8 times higher than those with MATV-WB < 49.5 (HR = 4.12, p < 0.001). MATV-WB cutoff points were also determined for each cTNM stage: 23.7(I), 49.5(II), 52(III), 48.8(IV) (p = 0.029, p = 0.227, p = 0.025 and p = 0.001, respectively). At stages I, III and IV there was a statistically-significant difference in the estimated mean overall survival time between groups of patients defined by the cutoff points (p = 0.007, p = 0.004 and p < 0.001, respectively). At stage II (p = 0.365), there was a clinically-significant difference of about 12 months between the groups. In all cTNM stages, patients with MATV-WB ≥ cutoff points had lower survival rates. Combined clinical TNM-PET staging (cTNM-P) was then tested: Stage I < 23.7; Stage I ≥ 23.7; Stage II < 49.5; Stage II ≥ 49.5; Stage III < 52; Stage III ≥ 52; Stage IV < 48.8; Stage IV ≥ 48.8. cTNM-P staging presented a superior overall survival predictive ability (C index = 0.730) compared with conventional cTNM staging (C index = 0.699) (Z = -4.49, p < 0.001). CONCLUSION: cTNM-P staging has superior prognostic value compared with conventional cTNM staging, and allows better stratification of NSCLC patients.

Schwannoma of the tongue-A common tumour in a rare location: A case report.

Schwannoma is a benign tumour that arises from Schwann cells of the peripheral nerve sheath, and is a common tumour of the head and neck. However, intraoral location is very uncommon (only 1% of all head and neck schwannomas). We report a rare case of lingual schwannoma in a 20-year-old male patient who presented with a small, slow-growing mass over the right lateral border of the tongue with 1 year of evolution and that became recently ulcerated. The patient underwent MRI examination and complete surgical excision. Histopathological and immunohistochemical examination confirmed the diagnosis.

Diffuse pulmonary ossification: A case report.

Diffuse pulmonary ossification (DPO) is a rarely diagnosed entity that may present with characteristic imaging features. It is listed in the differential diagnosis of lung parenchymal calcifications and should be considered by the radiologist if the appropriate findings are identified. We report a case of DPO secondary to mitral stenosis in a patient whose severe cardiac pathology lead to death few weeks after a chest CT was done. To date, there are no specific treatments with proved benefit in this pathology.

25 Years of Contrast-Enhanced MRI: Developments, Current Challenges and Future Perspectives.

UNLABELLED: In 1988, the first contrast agent specifically designed for magnetic resonance imaging (MRI), gadopentetate dimeglumine (Magnevist(®)), became available for clinical use. Since then, a plethora of studies have investigated the potential of MRI contrast agents for diagnostic imaging across the body, including the central nervous system, heart and circulation, breast, lungs, the gastrointestinal, genitourinary, musculoskeletal and lymphatic systems, and even the skin. Today, after 25 years of contrast-enhanced (CE-) MRI in clinical practice, the utility of this diagnostic imaging modality has expanded beyond initial expectations to become an essential tool for disease diagnosis and management worldwide. CE-MRI continues to evolve, with new techniques, advanced technologies, and novel contrast agents bringing exciting opportunities for more sensitive, targeted imaging and improved patient management, along with associated clinical challenges. This review aims to provide an overview on the history of MRI and contrast media development, to highlight certain key advances in the clinical development of CE-MRI, to outline current technical trends and clinical challenges, and to suggest some important future perspectives. FUNDING: Bayer HealthCare.

[The role of percutaneous renal fenestration in the management of acute aortic dissection. Case report]. / Papel da Fenestração Renal Percutânea no Tratamento da Dissecção Aórtica Aguda. Caso Clínico.

Aortic dissection is one of the most feared vascular disease, coursing with high rate of complications. Depending on the location of the intimal tear, aortic dissection could implicate the ascending aorta, the heart and descending aorta, or only the descending aorta. The first case (type A) has absolute surgical indication. Independently of a good surgical result, vascular complications may occur, such as arterial renal compression, associated with flow disturbances to these organs. Percutaneous fenestration has been proven as a good solution in selected patients, in experienced hands. We present a case in which the percutaneous technique was successfully used.

Comparative study of Greulich and Pyle Atlas and Maturos 4.0 program for age estimation in a Portuguese sample.

Age estimation of living individuals has become one of the big issues of forensic anthropology. The increase of children and adolescents with no valid proof of their chronological age is a legal concern to many countries, especially in situations of illegal immigration, sub adult delinquency and juvenile work. For this purpose, the use of radiological methods for evaluation of skeletal maturation is particularly useful. In this study we compare the two of the most common methods applied in age estimation by hand/wrist radiographs: the Radiographic Atlas of Skeletal Development of the Hand and Wrist made by Greulich and Pyle (GP), 1959,and the Sempé method developed for computer--Maturos 4.0 (MT) program. These methods were applied to a sample of 230 radiographs of the hand and wrist from Portuguese children and adolescents of known sex age and age, aged between 12 and 20 years, who performed medical examination at the University of Coimbra Hospitals during 2005. The methods achieved different performances, depending on the age group. Between 12 and 15 years the bone age with the MT program is closer to the chronological age, whereas in older ages the GP Atlas method is more trustworthy. At the ages with legal consequences in Portugal (16 and 18 years) the GP Atlas method is most accurate, namely to decide whether an individual is younger or older than 18 years. Around 16 years old, although there are doubts in relation to the accuracy of both methods, GP Atlas seems to perform better.

[Gd-EOB-DTPA-enhanced magnetic resonance imaging: differentiation between focal nodular hyperplasia and hepatocellular adenoma]. / Ressonância magnética hepática com Gd-EOB-DTPA: diferenciação entre hiperplasia nodular focal e adenoma hepatocelular.

UNLABELLED: Gadoxetic acid (Gd-EOB-DTPA) is a contrast media used in magnetic resonance imaging (MRI) for the detection and characterization of hepatic lesions. It shows combined properties of extracellular and biliary excretion, with 50% of the administered dose eliminated by the hepatobiliary pathway. One of its applications, therefore, is the characterization of focal hepatic lesions, including those of hepatocellular nature, such as focal nodular hyperplasia and hepatocellular adenoma. Patients with focal nodular hyperplasia (FNH) are usually asymptomatic and rarely reveal complications. In other hand, hepatocellular adenoma may suffer complications, such as intraperitoneal or intratumoral (sometimes massive) bleeding and the possible progression to malignancy. OBJECTIVES: To determine the value of MRI with Gd-EOB-DTPA in characterizing hepatic lesions, particularly in the differentiation between HNF and AHC. MATERIAL AND METHODS: A retrospective study was carried out by investigating cases of FNH and HCA referred for MR evaluation with Gd-EOB-DTPA in the Department of Radiology of the University Hospitals of Coimbra (HUC) between August 2009 and December 2010. We evaluated 32 patients, 24 with FNH and 8 AHC. The diagnosis was established by histology, follow-up or agreement between imaging methods. In order to evaluate the enhancement after contrast administration in the hepatobiliary phase, we calculated the values of Signal-to-noise ratio (SNR), Contrast-to-noise ratio (CNS) and percentage of enhancement. Statistical analysis was performed with SPSS, version 18, and the tests were evaluated at a significance level of 5%. RESULTS: The SNR and CNR after contrast is significantly different for the two types of lesion (p <0.001 and p = 0.03, respectively), with higher values for both parameters in the group of focal nodular hyperplasia. As for the % of enhancement, there is a statistically significant difference between groups (p = 0.006), again with the FNH group presenting higher values. There are significant differences in both groups among the studies pre-and post-contrast for the CNR (FNH: p <0.001; adenoma: p = 0.017), but for the SNR of the lesion the difference manifests in the HNF group (p <0,001); the CNR values increase in FNH and decrease in hepatocellular adenoma, while for the SNR of the lesion post-contrast values are higher than pre-contrast, in both groups. CONCLUSIONS: Magnetic resonance imaging with hepatospecific contrast is a valuable method for characterization of benign hepatic lesions, helping to differentiate FNH from HCA, based on the different patterns of uptake and retention of Gd-EOB-DTPA.

Imaging of pancreas transplantation and its complications.

Pancreas transplantation is an effective treatment for type 1 diabetes mellitus and is being increasingly performed worldwide. Early recognition of graft-related complications is fundamental for graft survival; thus, radiologists must be aware of the transplantation technique, pancreas-graft imaging and postoperative complications. We present normal pancreas-graft imaging appearances and the imaging features of postoperative complications.