ABSTRACT
Magnetic resonance imaging (MRI) has shown a great potential in the evaluation and management of prostate cancer. In this study, we would like to evaluate the benefit of multiparametric MRI in the detection and localization of prostate cancer by comparing it with the gold standard of histopathology from radical prostatectomy. In this single-centre prospective study, 90 consecutive patients underwent radical prostatectomy from November 2016 to May 2018. All patients first underwent multiparametric (mp)-MRI, and all suspicious regions of interest were delineated and recorded on a 5-point scale as defined in prostate imaging reporting and data system version 2 (PI-RADS V2) score. All radical prostatectomy specimens, acquired after robotic radical prostatectomy with extended pelvic lymphadenectomy, were sent for histopathological examination (HPE). The mean age of the 90 patients was 65.3 years, and the mean serum prostate-specific antigen (PSA) was 16.9 ng/ml. The sensitivity and specificity of mp-MRI in the detection of the corresponding region of interest (ROI) on HPE were 67.4% and 89.3% respectively. Positive predictive value (PPV), negative predictive value (NPV), and accuracy of mp-MRI in the detection of corresponding ROI on HPE were 86.3%, 73.3%, and 78.3% respectively. The mp-MRI detected 96.8% solitary lesions and 61.7% multifocal lesions on the corresponding ROI on HPE. Multiparametric MRI has an excellent specificity and reasonable sensitivity for the diagnosis of prostate cancer. It is a good modality for the detection of solitary tumours, higher-grade tumours, detection of seminal vesicle invasion and extracapsular extension and helps in the decision-making process before radical prostatectomy, focal therapy or selecting an appropriate candidate for active surveillance.
ABSTRACT
Encephalocele is a mesodermal defect in the skull bones and duramater. Parietal encephalocele is a rare congenital anomaly of newborn with variable prognostic value. The authors report a case of a very large inter parietal encephalocele with no associated other system malformations. A midline inter parietal encephalocele is much rare, earlier reported cases were posterior parietal in location. Such cases can be successfully operated upon with a very good outcome. A unique case of a 18 day neonate, with swelling over scalp was evaluated by the neurosurgical team and the patient underwent neurosurgery. In planning the strategy for management of encephalocele, one needs to take into consideration the site, size, contents, patency of CSF pathway, neurological status and other associated anomalies. Inspite of such a big encephalocele in an atypical location, excision and repair gave excellent results.
