Accuracy of the Vesical Imaging-Reporting and Data System (VIRADS) for pre-treatment staging of bladder cancer in an Australian cohort.

INTRODUCTION: To evaluate the performance of the Vesical Imaging-Reporting and Data System (VIRADS) in differentiating muscle-invasive and non-muscle-invasive bladder cancer and whether this reporting system improves inter-reader agreement. METHODS: Sixty-four cases of multiparametric 3 tesla bladder MRI from January 2014 to May 2020 were reviewed retrospectively. T2-weighted, diffusion and post-contrast images were reviewed. All magnetic resonance images were reported by a radiologist with 15 years' experience (Reader 1) and a final year radiology trainee with a special interest in urogenital imaging with 3 years of experience (Reader 2). Both readers were blinded to clinical history and histopathology results when scoring each lesion. RESULTS: The sensitivity and specificity for differentiating MIBC and NMIBC were 91% and 68%, respectively, for Reader 1 and 91% and 63%, respectively, for Reader 2. The inter-reader agreement for assigning VIRADS scores was 0.79. The area under the receiver operator curve for Reader 1 and 2 were not significantly different (Reader 1 = 0.79, Reader 2 = 0.77, P = 0.83). CONCLUSIONS: Staging of bladder cancer prior to treatment can be accurately and reliably diagnosed using VIRADS, a novel, standardised reporting system for bladder MRI.

The expanding role of imaging in the diagnosis and management of sports injuries.

BACKGROUND: Medical imaging has an increasing role in the early diagnosis and management of sports injuries. Post-injury management decisions are becoming more heavily dependent on imaging findings. Timely use of appropriate imaging for sports injuries is required for optimal outcomes. OBJECTIVE: The aims of this article are to discuss a range of imaging options that are available in the clinical setting of sports injury, and to provide an insight into the role of each imaging modality and image-guided procedures in enabling early return to activity for the athlete. DISCUSSION: Although imaging is playing an increasing part in the diagnosis and management of sports injuries, the role of each modality is not usually clear because of a considerable overlap of roles of these modalities. A succinct summary of imaging modalities commonly used in the clinical setting of sporting injuries is presented in this article, including the relative merits for choosing the correct imaging modality.

Comparison of cranial ultrasound and MRI for detecting BRAIN injury in extremely preterm infants and correlation with neurological outcomes at 1 and 3 years.

This study aimed to investigate the accuracy of different grades of brain injuries on serial and term equivalent age (TEA)-cranial ultrasound imaging (cUS) as compared to TEA magnetic resonance imaging (MRI) in extremely preterm infants < 28 weeks, and determine the predictive value of imaging abnormalities on neurodevelopmental outcome at 1 and 3 years. Seventy-five infants were included in the study. Severe TEA-cUS injury had high positive predictive value-PPV (100%) for predicting severe MRI injury compared to mild to moderate TEA-cUS injury or severe injury on worst cranial ultrasound scan. Absence of moderate to severe injury on TEA cUS or worst serial cUS was a good predictor of a normal MRI (negative predictive values > 93%). Severe grade 3 injuries on TEA-US had high predictive values in predicting abnormal neurodevelopment at both 1 and 3 years of age (PPV 100%). All grades of MRI and worst serial cUS injuries poorly predicted abnormal neurodevelopment at 1 and 3 years. Absence of an injury either on a cranial ultrasound or an MRI did not predict a normal outcome. Multiple logistic regression did not show a significant correlation between imaging injury and neurodevelopmental outcomes.Conclusion: This study demonstrates that TEA cUS can reliably identify severe brain abnormalities that would be seen on MRI imaging and positively predict abnormal neurodevelopment at both 1 and 3 years. Although MRI can pick up more subtle abnormalities that may be missed on cUS, their predictive value on neurodevelopmental impairment is poor. Normal cUS and MRI scan may not exclude abnormal neurodevelopment. Routine TEA-MRI scan provides limited benefit in predicting abnormal neurodevelopment in extremely preterm infants. What is Known: • Preterm neonates are at increased risk of white matter and other brain injuries, which may be associated with adverse neurodevelopmental outcome. • MRI is the most accurate method in detecting white matter injuries. What is New: • TEA-cUS can reliably detect severe brain injuries on MRI, but not mild/moderate lesions as well as abnormal neurodevelopment at 1 and 3 years. • TEA-MRI brain injury is poor in predicting abnormal neurodevelopment at 1 and 3 years and normal cUS or MRI brain injury may not guarantee normal neurodevelopment.

Correlation of apparent diffusion coefficient ratio on 3.0 T MRI with prostate cancer Gleason score.

INTRODUCTION: The purpose was to investigate the usefulness of ADCratio on Diffusion MRI to discriminate between benign and malignant lesions of Prostate. METHODS: Images of patients who underwent in-gantry MRI guided prostate lesion biopsy were retrospectively analyzed. Prostate Cancers with 20% or more Gleason score (GS) pattern 3 + 3 = 6 in each core or any volume of higher Gleason score pattern were included. ADCratio was calculated by two reviewers for each lesion. The ADCratio was calculated for each lesion by dividing the lowest ADC value in a lesion and highest ADC value in normal prostate in peripheral zone (PZ). ADCratio values were compared with the biopsy result. Data was analysed using independent samples T-test, Spearman correlation, intra-class correlation coefficient (ICC) and Receiver operating characteristic (ROC) curve. RESULTS: 45 lesions in 33 patients were analyzed. 12 lesions were in transitional zone (TZ) and 33 in perpheral zone PZ. All lesions demonstrated an ADCratio of 0.45 or lower. GS demonstrated a negative correlation with both the ADC value and ADCratio. However, ADCratio (p < 0.001) demonstrated a stronger correlation compared to ADC value alone (p = 0.014). There was no significant statistical difference between GS 3 + 4 and GS 4 + 3 mean ADCtumour value (p = 0.167). However when using ADCratio, there was a significant difference (p = 0.032). ROC curve analysis demonstrated an area under the curve of 0.83 using ADCratio and 0.76 when using ADCtumour value when discriminating Gleason 6 from Gleason ≥7 tumours. Inter-observer reliability in the calculation of ADC ratios was excellent, with ICC of 0.964. CONCLUSION: ADCratio is a reliable and reproducible tool in quantification of diffusion restriction for clinically significant prostate cancer foci.

In-gantry MRI guided prostate biopsy diagnosis of prostatitis and its relationship with PIRADS V.2 based score.

INTRODUCTION: The recent literature has focussed predominantly on prostate cancer detection which has been revolutionized by multiparametric magnetic resonance imaging (mpMRI). Due to an overlap of features, prostatitis may mimic prostate cancer on MRI, especially in patients with chronic prostatitis. We retrospectively analysed our in-gantry MRI-guided biopsy (MRGB) results to determine incidental detection rate of prostatitis in Prostate Imaging Reporting and Data System (PIRADS) 3, 4 and 5 foci reported on diagnostic MRI of the prostate. METHODS: About 137 patients underwent in-gantry MRGB for lesions with PIRADS score of 3 or above. All the biopsies were performed utilizing the dynaTRIM™ system (Invio Inc, Germany) on a three-tesla MRI scanner (Ingenia 3.0T, Philips, Netherlands) by a Radiologist and a Urologist. RESULTS: We biopsied 228 lesions in 137 patients. There were 55 lesions that returned positive for prostate cancer with a Gleason Score of 3 + 3 = 6 or above. There were 62 lesions that showed inflammation. The distribution of these lesions was 3 (5%) in the central zone, 32 (52%) in the transitional zone and 27 (43%) in the peripheral zone. Inflammation was found in 36 (58%) PIRADS 3 lesions, 24 (39%) PIRADS 4 lesions and 2 (3%) PIRADS 5 lesions on pre biopsy MRI evaluation. CONCLUSION: In our series, biopsies which showed inflammation had a radiological appearance on mpMRI more likely of a PIRADS 3 or 4 lesions with only 3% of PIRADS 5 biopsies showing inflammation. This would suggest that a higher PIRADS score can more reliably differentiate between prostate cancer and prostatitis.

mp-MRI Prostate Characterised PIRADS 3 Lesions are Associated with a Low Risk of Clinically Significant Prostate Cancer - A Retrospective Review of 92 Biopsied PIRADS 3 Lesions.

OBJECTIVE: To determine whether prostate image reporting and data system (PIRADS) 3 lesions as assessed by a 3T multiparametric magnetic resonance imaging (MRI) represent clinically significant prostate cancer. METHOD: A retrospective review was performed on a series of consecutive patients who underwent MRI guided biopsy of the prostate for clinical suspicion of prostate cancer between January 2013 and March 2014. Demographic, clinical, MRI and biopsy data were reviewed and compared. The same 3T MRI without the use of an endo-rectal coil was employed to assess each patient, obtaining high resolution T2 weighted images, diffusion weighted imaging and dynamic contrast enhancement. The MRI data was sent to Dynacad software for analysis. A single experienced radiologist reported all the studies from this series using a modified PIRADS scoring system. Subsequently, all the lesions marked PIRADS 3 or above were targeted with 18G core biopsy using DynaTrim in-gantry MRI guidance system. Needle position targeting the lesion was recorded prior to each biopsy. All core biopsy samples were sent to one of two pathology laboratories where they were processed and reported as per the International Society of Urological Pathology protocols. RESULTS: One hundred and eighteen patients comprising a total of 215 lesions were reviewed. Amongst this cohort, 92 PIRADS 3 lesions were identified and biopsied. The mean age of patients in this cohort was 62.6 years. Median prostate specific antigen (PSA) was 6.5 ng/ml and median prostate size was 78.4 ml. Eightysix (93.5%) of biopsied PIRADS 3 lesions were benign and 6 (6.5%) lesions were found to be malignant. Of these 6 malignant lesions, 4 (66%) were Gleason score 6 (3 + 3) and 2 (33%) were Gleason score 7 (3 + 4). Of the 86 non-malignant lesions, 1 (1.2%) represented high-grade prostate intraepithelial neoplasia and 2 (2.4%) represented atypical small acinar proliferation. PIRADS 3 lesions within the peripheral zone were more likely to be associated with malignant disease compared with lesions identified within the transition zone (10.8 vs. 3.8%). Those with malignant disease had a higher median PSA (8.1 vs. 6.4 ng/ml) and higher median PSA density (0.12 vs. 0.08) than those without malignant disease. Those with benign pathology had a higher prevalence of inflammation (31.4 vs. 16.7%). As per Epstein's criteria, 4 (4.3%) of the biopsied lesions represented clinically significant disease. CONCLUSION: We have demonstrated in our series, that prostate lesions characterized on a 3T multiparametric MRI examination of the prostate as PIRADS 3, according to the current prevalent scoring systems, are associated with a low likelihood of the presence of clinically significant prostate cancer.

Are renal volumes measured by magnetic resonance imaging and three-dimensional ultrasound in the term neonate comparable?

Renal volume, but not renal length, has been shown to be positively correlated with renal function. Three-dimensional (3D) ultrasound and magnetic resonance imaging (MRI) are two modalities used to assess renal volume. The aim of our study was to determine whether 3D ultrasound measurements of renal volume in the neonate are comparable to those of MRI measurements. Preterm and term neonates had an MRI and 3D ultrasound to determine renal volume at the same time as they had an MRI brain scan for other clinical conditions. The preterm neonates were all term corrected age, and the term neonates were 1-4 weeks of age. None of the kidneys examined were abnormal. There were no significant differences in the weight or length of the preterm and term infants at the time of their MRI scan. The left renal length was significantly longer according to MRI measurements than according to 3D ultrasound measurements (p=0.02). Renal volumes of both the left and right kidney were greater when measured by MRI than by 3D ultrasound (p<0.0001, respectively). Total volumes of the kidneys were greater when measured by MRI than by 3D ultrasound (p=0.008). Renal volume in neonates was significantly less when evaluated by 3D ultrasound than by MRI. These results demonstrate that MRI and 3D ultrasound renal volumes are not comparable in the neonatal population and, therefore, the same radiological modality should be used if repeat volume measurements are to be performed.

Does extreme prematurity affect kidney volume at term corrected age?

OBJECTIVE: Extreme prematurity exposes the neonate to a number of potential renal insults that may result in a reduced number of glomeruli and/or renal size. This may predispose these individuals to cardiovascular disease later in life. The objective was to determine using magnetic resonance imaging (MRI) whether extreme prematurity results in decreased renal volume. METHODS: Neonates <29 weeks' gestation and term infants undergoing MRI of the brain were enrolled in the study. An MRI was performed at term corrected age in the premature neonate and within the first 4 weeks of life in the term neonate. RESULTS: Seventeen preterm infants and 13 term infants had MRIs performed. There was no significant difference in weight and length at the time of MRI (p = 0.76 and 0.11, respectively). There was no significant difference in total renal volume or total kidney volume to weight ratio between the preterm and term neonates (p = 0.83 and 0.6, respectively). CONCLUSIONS: At term corrected age, extremely premature neonates have the same renal volume as term infants. It is unclear whether renal volume is a good indicator of glomerular number.

Early diffusion-weighted magnetic resonance imaging findings in neonatal herpes encephalitis.

Neonatal herpes encephalitis is usually caused by herpes simplex virus type 2 and results in significant morbidity and mortality. Imaging diagnosis with ultrasound, computed tomography scan and conventional magnetic resonance imaging may be normal in the early course of the disease. In this case diffusion-weighted magnetic resonance imaging detected the disease process earlier and better than the conventional T2-weighted or fluid-attenuated inversion recovery imaging sequences. The use of diffusion-weighted magnetic resonance imaging in neonatal herpes encephalitis proved to be a useful tool in the early stage of the disease.

Predicting outcome in term neonates with hypoxic-ischaemic encephalopathy using simplified MR criteria.

BACKGROUND: MRI is an established investigation in the evaluation of neonates with suspected hypoxic-ischaemic encephalopathy (HIE). However, its role as a predictor of neurodevelopmental outcome remains complex. OBJECTIVE: To establish reproducible simplified MR criteria and evaluate their role in predicting neurodevelopmental outcome in term neonates with HIE. MATERIALS AND METHODS: Term neonates with suspected HIE had MRI at 7-10 days of age. MR scans were interpreted according to new simplified criteria by two radiologists blinded to the clinical course and outcome. The new simplified criteria allocated grade 1 to cases with no central and less than 10% peripheral change, grade 2 to those with less than 30% central and/or 10-30% peripheral area change, and grade 3 to those with more than 30% central or peripheral change. MRI changes were compared with clinical neurodevelopmental outcome evaluated prospectively at 1 year of age. Neurodevelopmental outcome was based upon the DQ score (revised Griffith's) and cerebral palsy on neurological assessment. RESULTS: Of 20 subjects, all those showing severe (grade 3) MR changes (35%) died or had poor neurodevelopmental outcome. Subjects with a normal MR scan or with scans showing only mild (grade 1) MR changes (55%) had normal outcomes. One subject showing moderate (grade 2) changes on MRI had a moderate outcome (5%), while another had an atypical pattern of MR changes with a normal outcome (5%). CONCLUSIONS: Assessment of full-term neonates with suspected HIE using the simplified MR criteria is highly predictive of neurodevelopmental outcome.