Contemporary Review of Multimodality Imaging of the Prostate Gland.

Tissue changes and the enlargement of the prostate, whether benign or malignant, are among the most common groups of diseases that affect men and can have significant impacts on length and quality of life. The prevalence of benign prostatic hyperplasia (BPH) increases significantly with age and affects nearly all men as they grow older. Other than skin cancers, prostate cancer is the most common cancer among men in the United States. Imaging is an essential component in the diagnosis and management of these conditions. Multiple modalities are available for prostate imaging, including several novel imaging modalities that have changed the landscape of prostate imaging in recent years. This review will cover the data relating to commonly used standard-of-care prostate imaging modalities, advances in newer technologies, and newer standards that impact prostate gland imaging.

Applications of PET/MRI in Abdominopelvic Oncology.

With PET/MRI, the strengths of PET and MRI are combined to allow simultaneous image acquisition and near-perfect image coregistration. MRI is increasingly being used for staging and restaging of abdominopelvic oncologic lesions, including prostate, hepatobiliary, pancreatic, neuroendocrine, cervical, and rectal cancers. Fluorine 18-fluorodeoxyglucose PET/CT has long been considered a cornerstone of oncologic imaging, and the development of multiple targeted radiotracers has led to increased research on and use of these agents in clinical practice. Thus, simultaneously performed PET/MRI enables the acquisition of complementary imaging information, with distinct advantages over PET/CT and MR image acquisitions. The authors provide an overview of PET/MRI, including descriptions of the major differences between PET/MRI and PET/CT, as well as case examples and treatment protocols for patients with commonly encountered malignancies in the abdomen and pelvis. Online supplemental material is available for this article. ©RSNA, 2021.

Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection.

Magnetic resonance imaging (MRI)/ultrasound fusion-targeted biopsy (TB) has been shown to more accurately identify higher-grade prostate cancers compared with standard-of-care systematic sextant prostate biopsy (SB). However, occasional false-positive imaging findings occur. We investigated the histologic findings associated with false-positive prostate MRI findings. A retrospective review was performed on our surgical pathology database from 2014 to 2017 selecting patients with no cancer detected on TB with concurrent SB after at least 1 prior benign SB session. Histologic features evaluated included percentage of core involvement by chronic inflammation, percentage of core composed of stroma, percentage of glands involved by atrophy, and presence of the following features: acute or granulomatous inflammation, stromal nodular hyperplasia, adenosis, squamous metaplasia, basal cell hyperplasia, and presence of skeletal muscle. Histologic findings were compared between TB and concurrent SB. We identified 544 patients who underwent TB. Of these, 41 patients, including 62 targeted lesions, met criteria. Compared with SB tissue, the mean percentage of stroma was increased in TB (P = .02). Basal cell hyperplasia was also found to be more common on TB (P = .02). Both high percentage of stroma (P = .046) and presence of basal cell hyperplasia (P = .038) were independent predictors on multivariate analysis. The combination of high chronic inflammation, high stroma, acute inflammation, and basal cell hyperplasia was associated with TB (P = .001). Atrophic glands and chronic inflammation showed a positive correlation (r = 0.67, P = .003), which was especially seen in high prostate imaging reporting and data system lesions. Specific benign histologic entities are associated with false-positive findings on prostate MRI.

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus.

We reviewed the role of transesophageal echocardiography (TEE) in the management of renal cell carcinoma (RCC) with associated tumor thrombus. Many consider intraoperative TEE as imperative in cases of Level 4 thrombi with atrial involvement, as well as in cases that require the use of cardiopulmonary bypass (CPB). However, the role of TEE in the surgical management of RCC with associated inferior vena cava (IVC) thrombus may expand beyond this subset. When performed after induction, TEE provides updated information regarding tumor thrombus staging, which is essential for optimal surgical planning. Furthermore, TEE provides feedback regarding properties of the thrombus, such as fragility and adherence, which may alter surgical technique. TEE can also be used intraoperatively for central venous line placement, to monitor cardiovascular and fluid status, to guide vascular clamp placement, and to ensure complete removal of the tumor thrombus. In some cases, the use of TEE allows for less morbid procedures and safe avoidance of CPB. We therefore recommend the use of preoperative TEE in all cases with a known tumor thrombus with discretion as to what extent TEE is used throughout the remainder of the case. Further investigation is necessary to elucidate the effect of TEE on patient outcomes, including surgical complication rates, morbidity and mortality of procedures, and cancer control.

The case for salvage cystectomy after pelvic radiation.

Radical cystectomy is considered the standard of care for muscle invasive bladder cancer (MIBC), as well as some high-grade or recurrent non-muscle invasive bladder cancers. There are a number of reasons that urologic surgeons may find themselves considering a salvage cystectomy (SC) for a patient. Understanding the risks associated with performing SC is important for patient counseling when considering primary management of MIBC. Awareness of the unique complications that can occur can alter surgical technique and approach and can equip clinical staff with knowledge to properly monitor the patient during post-operative surveillance to identify and treat these situations. In this review, we characterize the outcomes of patients who underwent SC, elucidate the special considerations that must be made when performing this surgery, and discuss these outcomes in comparison to primary surgery in the absence of radiation.

Elevated lipase without pancreatitis in infectious colitis.

BACKGROUND: An elevated lipase typically confirms the diagnosis of pancreatitis. Elevated lipase may be associated with other disorders, typically with some influence on the pancreas. The differential is more limited than elevated amylase secondary to the mostly unique production of lipase in pancreatic acinar cells. Elevated lipase has been reported in patients with inflammatory bowel disease, but not previously reported in infectious colitis. CASE REPORT: A 65-year-old woman presented to the emergency department with left lower quadrant abdominal pain radiating to her left flank worsening over 2 days. She denied epigastric pain. She had occasional nausea and occasional nonbilious and nonbloody emesis, and also reported diarrhea and weight loss over the preceding months. Laboratory values were largely unremarkable except for a grossly elevated lipase level. Computed tomography scan of her abdomen was performed and revealed findings consistent with infectious colitis, without signs of pancreatic inflammation or other findings associated with pancreatitis. She was admitted to the hospital and treated for infectious colitis with antibiotics and improved over 2 days, and was subsequently discharged for follow-up with her gastroenterologist. This is the first reported case of elevated lipase without pancreatitis associated with infectious colitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of other potential causes of elevated lipase and not assume that all cases of elevated lipase are associated with pancreatitis. This may possibly avoid unnecessary admission in situations that are not clearly pancreatitis.