ABSTRACT
OBJECTIVES: To compare T2-weighted MRI and functional MRI techniques in guiding repeat prostate biopsies. METHODS: Sixty-eight patients with a history of negative biopsies, negative digital rectal examination and elevated PSA were imaged before repeat biopsies. Dichotomous criteria were used with visual validation of T2-weighted MRI, dynamic contrast-enhanced MRI and literature-derived cut-offs for 3D-spectroscopy MRI (choline-creatine-to-citrate ratio >0.86) and diffusion-weighted imaging (ADC × 10(3) mm(2)/s < 1.24). For each segment and MRI technique, results were rendered as being suspicious/non-suspicious for malignancy. Sextant biopsies, transition zone biopsies and at least two additional biopsies of suspicious areas were taken. RESULTS: In the peripheral zones, 105/408 segments and in the transition zones 19/136 segments were suspicious according to at least one MRI technique. A total of 28/68 (41.2%) patients were found to have cancer. Diffusion-weighted imaging exhibited the highest positive predictive value (0.52) compared with T2-weighted MRI (0.29), dynamic contrast-enhanced MRI (0.33) and 3D-spectroscopy MRI (0.25). Logistic regression showed the probability of cancer in a segment increasing 12-fold when T2-weighted and diffusion-weighted imaging MRI were both suspicious (63.4%) compared with both being non-suspicious (5.2%). CONCLUSION: The proposed system of analysis and reporting could prove clinically relevant in the decision whether to repeat targeted biopsies.
Subject(s)
Biomarkers, Tumor/analysis , Biopsy, Needle/methods , Diffusion Magnetic Resonance Imaging/methods , Imaging, Three-Dimensional/methods , Magnetic Resonance Spectroscopy/methods , Meglumine , Organometallic Compounds , Prostatic Neoplasms/diagnosis , Ultrasonography, Interventional/methods , Aged , Humans , Male , Middle Aged , Prostatic Neoplasms/metabolism , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
OBJECTIVES: To evaluate the efficacy and safety of a porcine biomaterial (Pelvicol) in the transvaginal surgical treatment of urogenital prolapse. MATERIAL AND METHOD: Prospective study from June 2001 to February 2004 based on 132 patients with a mean age of 67.6 +/- 9.89 years presenting major urogenital prolapse: 132 cystoceles and 84 rectoceles with 100% and 63.4% of grade 2 or 3, respectively. Patients were evaluated by questionnaire and clinical examination at 1 month, 6 months, 12 months and 24 months after the operation. Two hundred and sixteen Pelvicol implants were inserted via a vaginal approach: 132 anterior implants and 84 posterior implants. RESULTS: The mean follow-up was 21 months [range: 6-24]. No intraoperative complication was observed. The postoperative complication rate was 11.3% (15/132) including 1 prosthetic exposure with a favourable outcome. After 6 months, 1 recurrence of cystoceles and 1 recurrence of rectoceles were found in 132 patients. Out of the 117 patients followed up for 12 months, 6 presented with grade 2 cystoceles and 1 grade 2 rectoceles. After 24 months, out of the 107 patients evaluated, 18 cystoceles and 9 rectoceles of grade 2 or 3 were found. Globally, 83.1% of patients did not present with grade 2 or 3 recurrences after 24 months. Safety was considered to be good with 10% of moderate pelvic pain and 6% of de novo dyspareunia at 12 months. The overall satisfaction rate was 94%. CONCLUSION: These preliminary results demonstrate an efficacy of 83.1% at 24 months and the good safety of Pelvicol in the transvaginal surgical treatment of urogenital prolapse.
