ABSTRACT
RATIONALE AND OBJECTIVES: To evaluate interobserver agreement of Prostate Imaging Reporting and Data System (PI-RADS) v2 category among radiologists with different levels of experience. The secondary objective was to evaluate the positivity for significant cancer among each category (splitting category 4 into two) and among different lesion sizes. MATERIALS AND METHODS: Institutional review board and ethics comitee approved retrospective study. Eight radiologists with different levels of experienced in prostatic magnetic resonance imaging-two more experienced, four with intermediate experience, and two abdominal radiology fellows-interpreted 160 lesions. Reference standard was fusion-targeted biopsy. Percentage agreement, k coefficients, and analysis concordance were used. RESULTS: Coefficient of concordance according to categories was 0.71 considering both zones, 0.72 for peripheral zone (PZ) and 0.44 for peripheral zone (TZ). Agreement for PI-RADS score of 3 or greater was 0.48 in PZ and 0.57 in TZ. Tumor positivity rates were 54.3% and 66.0% for PI-RADS 3â¯+â¯1 and 4 for PZ, respectively; and 25.0 and 49.2% for PI-RADS 3â¯+â¯1 and 4 for TZ, respectively (p < 0.001 in both analysis). Lesions <10, 10-14, and ≥15 mm had 55.3%, 74.6%, and 93.5% of positivity rates for cancer in PZ (pâ¯=â¯0.002 and <0.001) and 26.7%, 56.5%, and 59.6% in TZ, respectively (pâ¯=â¯0.245 and 0.632). Sensitivities, specificities, and accuracies of magnetic resonance imaging for prostate cancer using PI-RADS v2 were 76%, 72%, and 74% for PZ; and 76%, 69%, and 71% for TZ, respectively. CONCLUSION: This study shows that PI-RADS v2 has overall good interobserver agreement among radiologists with different levels of experience. PI-RADS category 3â¯+â¯1 showed lower positivity rates for significant cancer compared to category 4. Lastly, lesions 10-14 mm has similar positivity rates compared to ≥15 mm for TZ lesions.
Subject(s)
Clinical Competence , Image Interpretation, Computer-Assisted/methods , Image-Guided Biopsy/methods , Magnetic Resonance Imaging/methods , Prostate/pathology , Prostatic Neoplasms/diagnosis , Radiologists/standards , Humans , Male , Reproducibility of Results , Retrospective StudiesABSTRACT
Objectives Discuss neuropsychiatric aspects and differential diagnosis of catatonic syndrome secondary to systemic lupus erythematosus (SLE) in a pediatric patient. Methods Single case report. Result A 13-year-old male, after two months diagnosed with SLE, started to present psychotic symptoms (behavioral changes, hallucinations and delusions) that evolved into intense catatonia. During hospitalization, neuroimaging, biochemical and serological tests for differential diagnosis with metabolic encephalopathy, neurological tumors and neuroinfections, among other tests, were performed. The possibility of neuroleptic malignant syndrome, steroid-induced psychosis and catatonia was also evaluated. A complete reversal of catatonia was achieved after using benzodiazepines in high doses, associated with immunosuppressive therapy for lupus, which speaks in favor of catatonia secondary to autoimmune encephalitis due to lupus. Conclusion Although catatonia rarely is the initial clinical presentation of SLE, the delay in recognizing the syndrome can be risky, having a negative impact on prognosis. Benzodiazepines have an important role in the catatonia resolution, especially when associated with parallel specific organic base cause treatment. The use of neuroleptics should be avoided for the duration of the catatonic syndrome as it may cause clinical deterioration. .
Objetivos Discutir aspectos neuropsiquiátricos e o diagnóstico diferencial da síndrome catatônica secundária a lúpus eritematoso sistêmico (LES) em paciente pediátrico. Métodos Relato de caso individual. Resultado Adolescente do sexo masculino com 13 anos de idade iniciou, após dois meses de diagnosticado com LES, quadro psicótico (alterações comportamentais, alucinações e delírios) que evoluiu para franca catatonia. Durante internação hospitalar foram realizados, entre outros, exames de neuroimagem, bioquímicos e sorologias para diagnóstico diferencial com encefalopatia metabólica, tumores neurológicos e neuroinfecções. Foi avaliada também a possibilidade de síndrome neuroléptica maligna, psicose e catatonia induzida por corticoides. Houve reversão completa da catatonia após o uso de benzodiazepínico em altas doses associado à terapia imunossupressora para o lúpus, o que fala a favor de uma catatonia secundária a uma encefalite autoimune de base lúpica. Conclusão Apesar de a catatonia ser raramente apresentação clínica inicial do LES, o atraso no reconhecimento da síndrome pode ser arriscado, tendo impacto negativo no prognóstico. Os benzodiazepínicos têm papel importante na resolução da catatonia, principalmente quando associada ao tratamento específico em paralelo para a causa orgânica de base. O uso de neurolépticos deve ser evitado durante a vigência da síndrome catatônica, podendo agravar o quadro clínico. .
