Focal laser ablation as clinical treatment of prostate cancer: report from a Delphi consensus project.

PURPOSE: To define the role of focal laser ablation (FLA) as clinical treatment of prostate cancer (PCa) using the Delphi consensus method. METHODS: A panel of international experts in the field of focal therapy (FT) in PCa conducted a collaborative consensus project using the Delphi method. Experts were invited to online questionnaires focusing on patient selection and treatment of PCa with FLA during four subsequent rounds. After each round, outcomes were displayed, and questionnaires were modified based on the comments provided by panelists. Results were finalized and discussed during face-to-face meetings. RESULTS: Thirty-seven experts agreed to participate, and consensus was achieved on 39/43 topics. Clinically significant PCa (csPCa) was defined as any volume Grade Group 2 [Gleason score (GS) 3+4]. Focal therapy was specified as treatment of all csPCa and can be considered primary treatment as an alternative to radical treatment in carefully selected patients. In patients with intermediate-risk PCa (GS 3+4) as well as patients with MRI-visible and biopsy-confirmed local recurrence, FLA is optimal for targeted ablation of a specific magnetic resonance imaging (MRI)-visible focus. However, FLA should not be applied to candidates for active surveillance and close follow-up is required. Suitability for FLA is based on tumor volume, location to vital structures, GS, MRI-visibility, and biopsy confirmation. CONCLUSION: Focal laser ablation is a promising technique for treatment of clinically localized PCa and should ideally be performed within approved clinical trials. So far, only few studies have reported on FLA and further validation with longer follow-up is mandatory before widespread clinical implementation is justified.

An e-nose made of carbon nanotube based quantum resistive sensors for the detection of eighteen polar/nonpolar VOC biomarkers of lung cancer.

A room temperature operating electronic nose (e-nose) has been developed by the assembly of conductive polymer nanocomposite (CPC) quantum resistive sensors (QRS). The fabrication of QRS by spray layer by layer (sLbL) of CPC solutions allowed us to obtain transducers with reproducible initial properties that could be easily tailored by adjusting either the number of sprayed layers and/or the solution composition. The selectivity of QRS was varied by changing the chemical nature of the polymer matrix in which carbon nanotubes (CNTs) were dispersed in solution, i.e., poly(carbonate) (PC), poly(caprolactone) (PCL), poly(lactic acid) (PLA), poly(styrene) (PS), and poly(methyl methacrylate) (PMMA). The e-nose was then successfully used to detect several volatile organic compounds (VOCs) selected among lung cancer biomarkers: a first set of seven polar vapours (water, ethanol, methanol, acetone, propanol, isopropanol, and 2-butanone), and another set of eleven less and nonpolar vapours (chloroform, toluene, benzene, styrene, cyclohexane, o-xylene, n-propane, n-decane, 1,2,4-trimethyl benzene, isoprene, and 1-hexene). The discrimination ability of the e-nose evaluated after a 3D principal component analysis (PCA) pattern recognition treatment was proved to be very good. Moreover, the quantitativity of the transducers' chemo-resistive responses was well fitted with the Langmuir-Henry-Clustering (LHC) model for both acetone and toluene vapours in a wide range of concentrations. The QRS developed in this study appear to be very good candidates to design low cost e-noses for the anticipated diagnosis of lung cancer by VOC analysis in breath, with ppm level sensitivity (tested down to 2.5 parts per million), short response time (a couple of seconds), low consumption, and a large signal to noise ratio (SNR ≥ 10).

Fine control of carbon nanotubes-polyelectrolyte sensors sensitivity by electrostatic layer by layer assembly (eLbL) for the detection of volatile organic compounds (VOC).

Volatile organic compounds (VOC) sensors have recently extended their field of application to medical area as they are considered as biomarkers in anticipated diagnosis of diseases such as lung cancer by breath analysis. Conductive polymer nanocomposites (CPC) have already proved their interest to fabricate sensors for the design of electronic noses (e-noses) but, for the first time to our knowledge, the present study is showing that electrostatic layer by layer assembly (eLbL) is bringing an interesting input to tailor the sensitivity of carbon nanotubes (CNT)-polyelectrolyte sensors. By this technique transducers are progressively built in 3D alternating dipping into sodium deoxycholate (DOC)-stabilized SWNT and poly(diallyldimethyl-ammonium chloride) [PDDA] solutions, respectively anionic and cationic. The precise control of transducers thicknesses (between 5 and 40nm) resulting from this process allows a fine tuning of multilayer films resistance (between 50 and 2kΩ) and thus of their sensitivity to VOC. Interestingly the surfactant used to disperse CNT into water, DOC is also found to enhance CNT sensitivity to vapors so is it for the polyelectrolyte PDDA. Finally it is found that transducers with 16 bilayers of PDDA/DOC-CNT provide optimum chemo-resistive properties for the detection and discrimination of the eight vapors studied (chloroform, acetone, ethanol, water, toluene, dichloromethane, tetrahydrofuran and methanol).

Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury.

Bone marrow contusions are frequently identified at magnetic resonance imaging after an injury to the musculoskeletal system. These osseous injuries may result from a direct blow to the bone, from compressive forces of adjacent bones impacting one another, or from traction forces that occur during an avulsion injury. The distribution of bone marrow edema is like a footprint left behind at injury, providing valuable clues to the associated soft-tissue injuries. Five contusion patterns with associated soft-tissue injuries occur in the knee: pivot shift injury, dashboard injury, hyperextension injury, clip injury, and lateral patellar dislocation. The classic bone marrow edema pattern seen following the pivot shift injury involves the posterolateral tibial plateau and the midportion of the lateral femoral condyle. Edema occurs in the anterior aspect of the proximal tibia following the dashboard injury. Hyperextension results in the "kissing" contusion pattern involving the anterior aspect of the proximal tibia and distal femur. The clip injury results in a prominent area of edema involving the lateral femoral condyle and a smaller area of edema involving the medial femoral condyle. Finally, lateral patellar dislocation results in edema involving the inferomedial patella and anterior aspect of the lateral femoral condyle. In many instances, the mechanism of injury can be determined by studying the distribution of bone marrow edema, which then enables one to predict with accuracy the specific soft-tissue abnormalities that are likely to be present.

Association of intramuscular cysts of the rotator cuff with tears of the rotator cuff: magnetic resonance imaging findings and clinical significance.

Cystic lesions that arise adjacent to the shoulder have been reported in association with labral tears or as an unusual manifestation of massive rotator cuff tears. The purpose of this study was to define the relationship between intramuscular cysts of the rotator cuff and tears of the rotator cuff. Thirteen cases of intramuscular cysts of the rotator cuff were identified on magnetic resonance imaging of the shoulder and analyzed retrospectively along with the clinical data. Surgical findings were retrospectively reviewed in 5 patients who underwent follow-up arthroscopy. This series shows that intramuscular cysts of the rotator cuff are associated with small, full-thickness tears or partial undersurface tears of the rotator cuff. These cysts are easily identified on T2-weighted sequences and, when present, should always prompt a thorough search for associated rotator cuff pathology.

Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients.

OBJECTIVE: The purpose of this study was to assess the accuracy of routine T2-weighted MR imaging in detecting and grading articular cartilage lesions in the knee compared with arthroscopy. SUBJECTS AND METHODS: We examined 130 consecutive patients who underwent MR imaging and arthroscopy of the knee for suspected internal derangement. MR imaging consisted of axial and coronal T2-weighted fast spin-echo sequences with fat saturation and sagittal T2-weighted spin-echo sequences. Each single plane was evaluated and graded for the presence and appearance of articular cartilage defects using a standard arthroscopic grading scheme adapted to MR imaging. RESULTS: Of the 86 arthroscopically proven abnormalities, 81 were detected on MR imaging. Sensitivity of the T2-weighted fast spin-echo sequence with fat saturation was 61% for the coronal plane alone and 59% for the axial plane alone. Specificity for each plane was 99%. Sensitivity for the sagittal T2-weighted spin-echo sequence was 40%, and specificity was 100%. Sensitivity of the combination of axial and coronal T2-weighted fast spin-echo sequences with fat saturation and sagittal T2-weighted spin-echo sequence compared with arthroscopy for revealing cartilage lesions was 94%, specificity was 99%, and accuracy was 98%. Sensitivity of coronal and axial T2-weighted fast spin-echo sequences with fat saturation was 93%, and specificity was 99%. Fifty-five lesions (64%) were identically graded on MR imaging and arthroscopy. Seventy-eight lesions (90%) were within one grade using MR imaging and arthroscopy, and 84 lesions (97%) were within two grades using MR imaging and arthroscopy. CONCLUSION: T2-weighted fast spin-echo MR imaging with fat saturation is an accurate and fast technique for detecting and grading articular cartilage defects in the knee. The combination of the axial and coronal planes offers sufficient coverage of articular surfaces to provide a high sensitivity and specificity for chondral defects.

MR imaging findings of lateral ulnar collateral ligament abnormalities in patients with lateral epicondylitis.

OBJECTIVE: The purpose of this paper was to use MR imaging to determine whether a relationship exists between lateral epicondylitis and abnormalities of the lateral ulnar collateral ligament. SUBJECTS AND METHODS: The study group comprised 35 consecutive patients who were referred for MR imaging to rule out lateral epicondylitis. On MR imaging, "lateral epicondylitis" was defined as increased signal intensity of the extensor tendons close to their insertion on the lateral epicondyle. The severity of the lateral epicondylitis was graded as mild, moderate, or severe. The origin of the lateral collateral ligamentous complex was characterized, and the lateral ulnar collateral ligament was graded as normal, thickened, partially torn, or torn. Eleven patients underwent elbow surgery after the initial MR examination. RESULTS: In 15 patients, MR imaging revealed characteristics of mild lateral epicondylitis. In 13 of these patients, the lateral ulnar collateral ligament was normal; one patient showed a thickened ligament; and one patient had a thinned ligament. In 11 patients, MR imaging showed features of moderate lateral epicondylitis. In eight of these patients, the lateral ulnar collateral ligament was thickened, and in the remaining three patients the ligament was normal. All nine patients with severe lateral epicondylitis showed abnormalities of the lateral ulnar collateral ligament on MR imaging. In one of these patients the lateral ulnar collateral ligament was thickened, in three patients we saw a partial tear, and in the remaining five patients we saw a complete tear of the ligament. CONCLUSION: In our study, MR imaging features of lateral epicondylitis were often associated with thickening and tears of the lateral ulnar collateral ligament.

The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation.

OBJECTIVE: The purpose of this study was to describe the MR arthrography appearance of the glenolabral articular disruption (GLAD) lesion. Proper diagnosis of this lesion is important because it can be a source of persistent shoulder pain that requires surgical repair and because it is often difficult to diagnose clinically. MATERIALS AND METHODS: Findings on MR arthrography were retrospectively correlated with the clinical histories and physical examination findings of six patients in whom we saw the typical appearance of the GLAD lesion. Four of these patients underwent follow-up arthroscopy that included surgical proof of GLAD lesions. RESULTS: Five of the six patients had a documented glenohumeral impaction injury associated with an abducted externally rotated shoulder. All six patients had persistent shoulder pain, but their shoulders were stable during routine examination. In all patients, MR arthrography showed a superficial tear of the anteroinferior labrum with an adjacent articular cartilage injury. The torn labrum remained firmly attached to the anterior scapular periosteum, and contrast material was seen to extend into the labral tear and cartilaginous defect. CONCLUSION: The MR arthrography findings of GLAD lesions include a nondisplaced tear of the anteroinferior labrum with an adjacent chondral injury. The pattern of chondral injury can range from a cartilaginous flap tear to a depressed osteochondral injury of the articular cartilage and underlying bone.

MR arthrography of the shoulder.

Although conventional MR imaging allows direct visualization of major anatomic structures, smaller intraarticular structures, including the glenoid labrum, glenohumeral ligaments, and articular surface of the rotator cuff tendon can be difficult to evaluate in the absence of a joint effusion. The authors review the techniques employed in performing MR arthrography, imaging characteristics of MR arthrography, and diagnostic utilization of the technique. Suggested indications are provided.

Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum.

OBJECTIVE: The purpose of this study was to compare oblique axial MR arthrograms obtained with the patient's shoulder in abduction and external rotation (ABER) position with conventional axial MR arthrograms obtained with the patient's arm in neutral position and the shoulder not rotated in revealing tears of the anterior glenoid labrum (AGL). SUBJECTS AND METHODS: MR arthrography of the shoulder that included an additional oblique axial imaging sequence with the patient in the ABER position was performed in 256 patients. Assessment of AGL integrity with patients in both conventional axial and ABER positions was made before surgery. These assessments were compared with the surgical findings. RESULTS: Of the 92 patients who underwent surgery, AGL tears were found in 27. Conventional axial MR arthrograms revealed 13 tears (sensitivity, 48%; specificity, 91%). A separate review of MR arthrograms obtained with patients in the ABER position revealed 24 tears (sensitivity, 89%; specificity, 95%). Reviewed together, axial MR arthrograms and MR arthrograms obtained with patients in the ABER position revealed 26 tears (sensitivity, 96%; specificity, 97%). CONCLUSION: Oblique axial MR arthrograms obtained with the patient's shoulder in the ABER position were significantly more sensitive in revealing AGL tears (p = .005) than were conventional axial MR arthrograms obtained with the patient's aim in a neutral position and the shoulder not rotated.

Pyomyositis of the anterior tibial compartment.

Five oncology patients developed bacterial pyomyositis involving the anterior tibial compartment and resulting in compartment syndrome with ischemia and abnormalities of neuromuscular function. All patients were neutropenic and thrombocytopenic, and four were receiving or had recently received cancer chemotherapy. Three infections were due to gram-negative bacilli and two to Staphylococcus aureus. Appropriate antimicrobial therapy and surgical drainage in four patients resulted in the resolution of these infections with good residual muscle function. To our knowledge, primary pyomyositis has never previously been known to cause compartment syndrome.

Useful internal standards for distinguishing infiltrative marrow pathology from hematopoietic marrow at MRI.

The objective of this study was to establish internal standards on MRI differentiating infiltrative marrow pathology from hematopoietic marrow. The T1-weighted images of 74 patients (51 biopsy-proven; 23 clinical follow-up) were reviewed retrospectively. The relative signal intensity of bone marrow was compared to adjacent skeletal muscle (n = 65) and/or nondegenerated intervertebral disk (n = 53). Twenty foci were hyperintense compared to muscle, of which 17 (85%) cases represented normal red marrow (P < .0001); 45 were isointense or hypointense compared to muscle, of which 44 (98%) represented infiltrative marrow processes (P < .0001). Twelve were hyperintense compared to disk, of which 12 (100%) represented normal red marrow (P < .0001); 41 were isointense or hypointense compared to disk, of which 40 (98%) represented infiltrative marrow processes (P < .0001). On T1-weighted spin-echo MRI, skeletal muscle and intervertebral disk may serve as internal standards for differentiating infiltrative pathology from normal hematopoietic marrow. Marrow lesions that are relatively isointense or hypointense to muscle and/or disk should not be considered normal hematopoietic marrow.

Humeral avulsion of the anterior shoulder stabilizing structures after anterior shoulder dislocation: demonstration by MRI and MR arthrography.

OBJECTIVE: To demonstrate the MRI findings of an anterior shoulder capsular avulsion from the humerus, with or without subscapularis rupture, after anterior dislocation or severe abduction external rotation injury. DESIGN AND PATIENTS: We retrospectively reviewed the MRI and MR arthrographic examinations of seven patients who were identified at surgery with avulsion of the anterior shoulder stabilizers from the humerus. MRI was correlated with clinical history and surgical results. RESULTS: MRI findings included: inhomogeneity or frank disruption of the anterior capsule at the humeral insertion (all), fluid intensity anterior to the shoulder (six patients), tear of the subscapularis tendon (six patients), dislocation of the biceps tendon (four patients), and a Hill-Sachs deformity (four patients). MR arthrography additionally found extravasation of contrast through the capsular defect (two patients). CONCLUSIONS: Our findings suggest that MRI is helpful for diagnosing humeral avulsion of the anterior glenohumeral capsule, especially when a tear of the subscapularis tendon insertion is present. MR arthrography may be of benefit for diagnosing capsular avulsion without associated subscapularis tendon abnormality.

Perspective volume rendering of CT and MR images: applications for endoscopic imaging.

PURPOSE: To use perspective volume rendering (PVR) of computed tomographic (CT) and magnetic resonance (MR) imaging data sets to simulate endoscopic views of human organ systems. MATERIALS AND METHODS: Perspective views of helical CT and MR images were reconstructed from the data, and tissues were classified by assigning color and opacity based on their CT attenuation or MR signal intensity. "Flight paths" were constructed through anatomic regions by defining key views along a spline path. Twelve movies of the thoracic aorta (n=3), tracheobronchial tree (n=4), colon (n=3), paranasal sinuses (n=1), and shoulder joint (n=1) were generated to display images along the flight path. All abnormal results were confirmed at surgery. RESULTS: PVR fly-through enabled evaluation of the full range of tissue densities, signal intensities, and their three-dimensional spatial relationships. CONCLUSION: PVR is a novel way to present volumetric data and may enable noninvasive diagnostic endoscopy and provide an alternate method to analyze volumetric imaging data for primary diagnosis.

The Buford complex--a variation of normal shoulder anatomy: MR arthrographic imaging features.

OBJECTIVE: The purpose of this study was to show the MR arthrographic imaging features of a normal anatomic variation of the shoulder: the absence of the anterior superior labrum and the presence of a "cordlike" middle glenohumeral ligament,which together are known as the Buford complex. MATERIALS AND METHODS: We retrospectively analyzed the MR arthrographic examinations of 10 patients with arthroscopically proven Buford complexes. RESULTS: MR arthrographic examinations showed an absent anterior superior labrum and an associated cordlike middle glenohumeral ligament in all patients. No contiguous tear of the superior labrum or anterior inferior labrum was evident. Originally, this variation was mistakenly diagnosed as a labral avulsion in two of the 10 patients. Also, a differential diagnosis of a superior labral tear was mistakenly offered for four patients. CONCLUSION: An absent anterior superior labrum and an associated cordlike middle glenohumeral ligament represent the normal variation that is known as the Buford complex rather than an avulsed labrum. This normal variation may be mistaken for a detached labrum.

Posterosuperior glenoid impingement of the shoulder: findings at MR imaging and MR arthrography with arthroscopic correlation.

PURPOSE: To determine the utility of magnetic resonance (MR) imaging and MR arthrography in the evaluation of arthroscopic findings of posterosuperior glenoid impingement. MATERIALS AND METHODS: The findings at MR imaging, MR arthrography, and physical examination with the patient under anesthesia were retrospectively reviewed in eight patients with arthroscopic evidence of posterosuperior glenoid impingement. RESULTS: All patients had shoulder pain; anterior instability was found in six patients. Other than bone marrow abnormalities, findings at MR imaging were not reliable for the detection of posterosuperior glenoid impingement. MR arthrography was superior to routine MR imaging in all four cases in which it was done; positioning the shoulder in abduction and external rotation was beneficial in three of four patients. CONCLUSION: Impingement of the rotator cuff on the posterior superior glenoid labrum is a cause of posterior shoulder pain in athletes who throw. MR arthrography may allow detection of abnormalities associated with this clinical entity.