In Vivo Quantification of Water Diffusion, Stiffness, and Tissue Fluidity in Benign Prostatic Hyperplasia and Prostate Cancer.

OBJECTIVES: Water diffusion, tissue stiffness, and viscosity characterize the biophysical behavior of tumors. However, little is known about how these parameters correlate in prostate cancer (PCa). Therefore, we paired tomoelastography of the prostate with diffusion-sensitive magnetic resonance imaging for the quantitative mapping of biophysical parameters in benign prostatic hyperplasia (BPH) and PCa. MATERIALS AND METHODS: Multifrequency magnetic resonance imaging elastography with tomoelastography processing was performed at 60, 70, and 80 Hz using externally placed compressed-air drivers. Shear-wave speed (SWS) and loss angle (φ) were analyzed as surrogate markers of stiffness and viscosity-related fluidity in the normal peripheral zone (PZ), hyperplastic transition zone (TZ), which is consistent with BPH, and PCa lesions. The SWS and φ were correlated with the normalized apparent diffusion coefficient (nADC). RESULTS: Thirty-nine men (median age/range, 67/49-88 years), 25 with BPH and 14 with biopsy-proven PCa, were prospectively enrolled in this institutional review board-approved study. The SWS in PCa (3.1 ± 0.6 m/s) was higher than in TZ (2.8 ± 0.3 m/s, P = 0.004) or tended to be higher than in PZ (2.8 ± 0.4 m/s, P = 0.025). Similarly, φ in PCa (1.1 ± 0.1 rad) was higher than in TZ (0.9 ± 0.2 m/s, P < 0.001) and PZ (0.9 ± 0.1 rad, P < 0.001), whereas nADC in PCa (1.3 ± 0.3) was lower than in TZ (2.2 ± 0.4, P < 0.001) and PZ (3.1 ± 0.7, P < 0.001). Pooled nADC was inversely correlated with φ (R = -0.6, P < 0.001) but not with SWS. TZ and PZ only differed in nADC (P < 0.001) but not in viscoelastic properties. Diagnostic differentiation of PCa from normal prostate tissues, as assessed by area under the curve greater than 0.9, was feasible using nADC and φ but not SWS. CONCLUSIONS: Tomoelastography provides quantitative maps of tissue mechanical parameters of the prostate. Prostate cancer is characterized by stiff tissue properties and reduced water diffusion, whereas, at the same time, tissue fluidity is increased, suggesting greater mechanical friction inside the lesion. This biophysical signature correlates with known histopathological features including increased cell density and fibrous protein accumulation.

LOW-DOSE COMPUTED TOMOGRAPHY OF THE PARANASAL SINUSES: PERFORMANCE OF TWO DIFFERENT ITERATIVE RECONSTRUCTION ALGORITHMS.

To evaluate the performance of two iterative reconstruction algorithms in low-dose paranasal sinus computed tomography (CT). Sinus CT scans were reconstructed using Adaptive Iterative Dose Reduction 3D (AIDR 3D, n = 36 patients) or Sinogram Affirmed Iterative Reconstruction (SAFIRE, n = 32 patients). Reconstructed images were evaluated regarding subjective image quality, depiction of anatomic landmarks and noise (HU). Dose-length product (DLP), calculated effective dose (ED) and CT dose index (CTDIvol) were documented for each scan. Images were not significantly different in subjective image quality (p = 0.09) and conspicuity of anatomic landmarks (p = 0.28). Noise was significantly lower in images reconstructed with AIDR 3D (p = 0.012). DLP, ED and CTDIvol were significantly lower in the SAFIRE datasets (each p < 0.001). The results indicate that iterative reconstruction, independent of the manufacturer, enables for imaging the paranasal sinuses with an ED below 0.1 mSv while ensuring diagnostic image quality.

Assessment of fatty degeneration of the gluteal muscles in patients with THA using MRI: reliability and accuracy of the Goutallier and quartile classification systems.

The purpose of this study was to quantify the performance of the Goutallier classification for assessing fatty degeneration of the gluteus muscles from magnetic resonance (MR) images and to compare its performance to a newly proposed system. Eighty-four hips with clinical signs of gluteal insufficiency and 50 hips from asymptomatic controls were analyzed using a standard classification system (Goutallier) and a new scoring system (Quartile). Interobserver reliability and intraobserver repeatability were determined, and accuracy was assessed by comparing readers' scores with quantitative estimates of the proportion of intramuscular fat based on MR signal intensities (gold standard). The existing Goutallier classification system and the new Quartile system performed equally well in assessing fatty degeneration of the gluteus muscles, both showing excellent levels of interrater and intrarater agreement. While the Goutallier classification system has the advantage of being widely known, the benefit of the Quartile system is that it is based on more clearly defined grades of fatty degeneration.

Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI.

OBJECTIVE: To assess anatomical risk factors in patients after lateral patellar dislocation (LPD) and controls using MRI. METHODS: MR images of 186 knees after LPD and of 186 age- and gender-matched controls were analysed. The presence of trochlear dysplasia was assessed by evaluation of trochlear inclination, facet asymmetry, and trochlear depth; patella alta was evaluated by the Insall-Salvati index and Caton-Deschamps index; the lateralised force vector was measured by the tibial tuberosity-trochlear groove (TT-TG) distance. RESULTS: Compared with controls, dislocators had significantly lower values for all three parameters of trochlear dysplasia (-32 %, -32 %, -44 %) and significantly higher values for patella alta (+14 %,+13 %) and TT-TG (+49 %) (all P < 0.001). Trochlear dysplasia was observed in 112 dislocators (66 %), of whom 61 (36 %) additionally had patella alta and 15 (9 %) an abnormal TT-TG. As isolated risk factors, patella alta (15 %) and abnormal TT-TG (1 %) were rare. Only 25 dislocators (15 %) had no anatomical risk factors. Trochlear dysplasia in conjunction with abnormal TT-TG or patella alta is associated with a 37- and 41-fold higher risk. CONCLUSION: Most dislocators have anatomical risk factors, varying in severity and constellation.

Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations.

BACKGROUND: The role of anatomic risk factors in patellofemoral instability is not yet fully understood, as they have been observed in patients either alone or in combination and in different degrees of severity. PURPOSE: To prospectively analyze rotational limb alignment in patients with patellofemoral instability and in controls using magnetic resonance imaging (MRI). STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Thirty patients (mean age, 22.9 y; range, 12-41 y) with a history of patellar dislocation and 30 age- and sex-matched controls (mean age, 25.2 y; range, 16-37 y) were investigated. The patients underwent MRI of the leg at 1.5 T using a peripheral angiography coil and a T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence for measuring femoral antetorsion, tibial torsion, knee rotation, and mechanical axis deviation (MAD). The mean values of these parameters were compared between patients and controls. In addition, the patients underwent an assessment to determine the influence of rotational limb alignment on lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, Insall-Salvati index, and tibial tuberosity-trochlear groove distance. RESULTS: Patients had 1.56-fold higher mean femoral antetorsion (20.3° ± 10.4° vs 13.0° ± 8.4°; P < .01) and 1.6-fold higher knee rotation (9.4° ± 5.0° vs 5.7° ± 4.3°; P < .01) compared with controls. Moreover, patients had 2.9 times higher MAD (0.81 ± 0.75 mm vs -0.28 ± 0.87 mm; P < .01). Differences in tibial torsion were not significant. Also, there were no significant correlations between parameters of rotational alignment and standard anatomic risk factors. CONCLUSION: Our results suggest that some patients with nontraumatic patellar instability have greater internal femoral rotation, greater knee rotation, and a tendency for genu valgum compared with healthy controls. Rotational malalignment may be a primary risk factor in patellar dislocation that has so far been underestimated.