Role of 68Ga and 18F PSMA PET/CT and PET/MRI in biochemical recurrence of prostate cancer: a systematic review of prospective studies.

OBJECTIVE: To systematically review the prospective literature on the role of 68Ga and 18F PSMA PET/CT and PET/MRI as a tool for functional imaging in prostate cancer biochemical recurrence (BCR), particularly with respect to detection efficacy and impact on management. METHODS: We performed a systematic literature search using PubMed in July 2021, focusing on original prospective studies looking at PSMA PET/CT and PET/MRI in BCR. RESULTS: We included 20 prospective studies reporting on 68Ga and 18F PSMA PET/CT and PET/MRI. Pooled PSMA PET positivity was 66.6% out of 2110 patients. The only factor consistently reported as associated with PSMA PET positivity was PSA level at the time of the study. Analysis of PSMA PET positivity rates in differing PSA ranges confirmed increasing positivity with increasing PSA levels. No significant adverse reactions were reported in the 20 studies, but only 6 studies mentioned safety or adverse reactions. A major change of management occurred in 42.7% of all patients scanned with PSMA PET/CT and more specifically 63.2% of those patients positive on PSMA PET/CT. There are no long-term studies that prove a survival benefit from these changes in management. CONCLUSION: There is prospective evidence for efficacy of PSMA PET/CT and PET/MRI in localizing disease recurrence in BCR, which increases with increasing PSA level at the time of scanning. There are no reported significant adverse effects related to the PSMA PET ligands. There is evidence of major change in management but no evidence for whether this achieves any improvement in outcome.

The spectrum of sclerosing cholangitis and the relevance of IgG4 elevations in routine practice.

OBJECTIVES: American Association for the Study of Liver Diseases (AASLD) guidance recommends measurement of IgG4 in patients with sclerosing cholangitis (SC). The objective of this study was to evaluate this by analyzing our SC practice. METHODS: Characteristics were collected on 168 patients with radiological or biopsy proven SC; IgG4 was measured and magnetic resonance cholangiopancreatography studies were reviewed. RESULTS: In all, 49% of patients were females and 55% had inflammatory bowel disease. Large duct disease was present in 63%, small duct disease in 8%, overlap with AIH in 11%, and secondary SC in 18%. Secondary etiologies included autoimmune pancreatitis (AIP) (8%), intra-hepatic cholelithiasis (3%), portal vein thrombosis (2%), and neonatal Kasai (2%). In all, 101 patients had sufficient radiology and serology for re-evaluation. IgG4 was elevated (>104 mg/dl) in 22% of patients. This was associated with male gender (73%; P=0.016), a past history of pancreatitis (27% vs. 5%; P=0.007), a higher alkaline phosphatase (ALP) value, median 338.5 U/l vs. 160 (P=0.005), and a higher primary sclerosing cholangitis (PSC) Mayo risk score, mean 0.6 vs. -0.2 (P=0.0008). Prior biliary intervention was more likely (36 vs. 13%; P=0.023), while abnormal pancreatic imaging was noted in 15%, more frequently if IgG4 was elevated (40 vs. 8%; P=0.0007). After excluding those with pancreatic disease on magnetic resonance imaging, 14 patients had elevated IgG4. This group had higher ALP 379 U/l vs. 155.5 (P=0.0006), aspartate aminotransferase (AST) 72.5 U/l vs. 34 (P=0.0005), alanine aminotransferase (ALT) 90.5 U/l vs. 36 (P=0.004), and PSC Mayo risk score values 0.4 vs. -0.2 (P=0.017). CONCLUSIONS: SC is a heterogeneous liver injury. IgG4 testing may be clinically important in all patients, since it appears to identify a distinct patient population, more so than just those with AIP.

The role of cross-sectional imaging in male infertility: a pictorial review.

Infertility is a common problem. The role of imaging in assisting clinical evaluation is discussed. Ultrasound and magnetic resonance imaging are first-line, noninvasive imaging techniques that provide accurate definition of anatomical causes of infertility. This affords an opportunity to deliver timely and appropriate treatment. This pictorial review illustrates normal imaging anatomy and various causes of male infertility, and focuses on congenital and acquired testicular abnormalities and post-testicular obstruction, such as congenital absence of the vasa deferentia, seminal vesicle cysts, prostatic utricle cysts, Mullerian cysts, ejaculatory duct cysts (Wolffian cysts), and epididymal obstruction.

Upper abdominal teratomas in infants: radiological findings and importance of the vascular anatomy.

BACKGROUND: Primary upper abdominal teratomas are extremely rare tumours, most commonly arising in infants. The radiological literature relating to them is sparse. Surgical resection is difficult due to distortion of the vascular anatomy. OBJECTIVE: To reassess the value of preoperative imaging with specific reference to the presence/absence of typical features of teratoma, anatomical location and adjacent vascular anatomy. MATERIALS AND METHODS: The histopathology database was used to identify infants with upper abdominal teratoma. Pathological, surgical and radiological data were reviewed. RESULTS: The search of the database identified 12 infants (10 girls, 2 boys) with an abdominal/retroperitoneal teratoma during the period 1993 to 2006. All teratomas were benign. In the majority of infants, typical radiological features of teratoma were demonstrated (fat, calcium). Identification of the major abdominal vessels on CT scan (most commonly the inferior vena cava) was not possible in all infants. Distortion (and commonly encasement) of the adjacent major abdominal vessels was usually evident. CONCLUSION: Upper abdominal teratomas in infants have typical radiological features. Preoperative delineation of the major vascular anatomy is often imprecise. Significant distortion of vascular anatomy was present in all infants and awareness of this feature impacts on surgical planning.

Follow-up imaging after laparoscopic heminephrectomy in children.

BACKGROUND: The radiological findings after laparoscopic heminephrectomy in children are not widely reported. OBJECTIVE: To document the range of imaging appearances following laparoscopic heminephrectomy in children. MATERIALS AND METHODS: We reviewed all imaging and all radiology reports performed on children in our institution who had undergone laparoscopic heminephrectomy over a 6-year period. RESULTS: Between 2001 and 2007, 35 patients (24 girls, 11 boys) had laparoscopic heminephrectomy. The mean age at surgery was 3.5 years. The sites of surgery comprised 12 right upper, 5 right lower, 18 left upper and 3 left lower heminephrectomies. These numbers included three patients who had bilateral procedures. The most consistent postoperative finding was an avascular cyst related to the site of surgery, seen after 23 of 38 procedures. Of these 23 cysts, 13 were simple and 10 were septated and/or contained echogenic debris. CONCLUSION: A cyst related to the site of laparoscopic heminephrectomy is a frequent postoperative occurrence but is not widely recognized for being simply this. Simple, anechoic, and septated appearances are possible. This cyst may be confusing to the radiologist and the clinician if they are not aware of the history of laparoscopic heminephrectomy and the technique that has been used. Whilst the exact aetiology of this cystic lesion is uncertain, all the patients in our series had a heminephrectomy performed with the use of an Endoloop (Ethicon, Somerville, NJ). No patients have required intervention to date.

Can the use of the radial artery be expanded to all patients with different surgical grafting techniques? Early clinical and angiographic results in 600 patients.

OBJECTIVE: The use of the radial artery (RA) as a conduit for coronary artery bypass grafting (CABG) is gaining in popularity worldwide and is being increasingly adopted by many cardiac surgeons. Encouraged by our satisfactory early experience with the use of the RA conduit, we have expanded its use to more than 90% of all coronary surgery patients. The aim of the present study was to review our clinical and angiographic results when the use of the RA conduit was expanded to all patients including those aged 65 years and older and diabetics with different surgical grafting techniques. METHODS: The records of 600 consecutive patients who underwent isolated CABG using the RA graft at Harefield Hospital between January 1999 and August 2002 were reviewed retrospectively. Ninety-three (15.5%) patients consented and underwent angiography before discharge at the earliest on the fourth postoperative day, aiming to look at the quality of anastomoses and the patency of the RA grafts. RESULTS: The 600 patients had 613 RA grafts to perform 652 distal RA anastomoses. The proximal ends of 515 (84%) RA grafts were anastomosed to the aorta, 98 (16%) RA grafts were constructed as Y-grafts with 49 (8%) RA off a vein graft hood, and 49 (8%) RA grafts were constructed as T- or Y-grafts off an internal thoracic artery (ITA) graft. The proximal ends of 19 (19/294 or 6.5%) vein grafts were constructed as Y-grafts off the RA grafts. Two hundred and sixty-one (43.5%) patients were above the age of 65 years and 111 (18.5%) patients were diabetics. There were four in-hospital deaths (0.6%) among the study patients. Six (1%) patients developed forearm hematoma/seroma postoperatively. The operation time, the hospital stay, and the incidence of conduit harvest site infection for the patients who had vein grafts in addition to the RA grafts were significantly higher than those of patients who had RA grafts only. On postoperative angiography, 86 out of 93 (92.5%) RA grafts were found to be patent with good quality distal anastomoses. The maximum stenosis of the coronary arteries bypassed by the patent 86 RA grafts was 82.6 +/- 6.2%, while it was 56.3 +/- 15.4% for the coronary arteries bypassed by the occluded seven RA grafts, p < 0.001. CONCLUSION: The use of the RA can be expanded to all patients with different surgical grafting techniques and provides satisfactory clinical and angiographic outcomes.

The clinical outcome and quality of life following minimally invasive direct coronary artery bypass surgery.

BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) through a limited anterior small thoracotomy has been shown to be a promising technique of surgical treatment for single or double vessel disease. Little is known about the Health-Related Quality Of Life (HRQOL) in this group of patients. METHODS: The records of 75 consecutive patients who underwent MIDCAB procedure at Harefield Hospital between April 2000 and January 2002 were reviewed retrospectively. HRQOL assessment was planned in a cross-sectional design. Patients were contacted by telephone to conduct a semi-structured interview and were sent two questionnaires: the Short Form health survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: There was no in-hospital death. Patients stayed in the Intensive Therapy Unit (ITU) for 11.56 +/- 4.55 hours and stayed in hospital for 3 +/- 2.34 days. None of the study patients had perioperative myocardial infarction (MI) or neurological complications including permanent and transient strokes. We were able to contact all the 75 patients by telephone and they also completed the SF-36 and HADS. The SF-36 scores were compared to an age-matched group of normal British people. The MIDCAB group had an excellent general health perception compared to the normal group (p < 0.001), but similar scores otherwise. The HADS scores showed that only 1 patient (1.3%) had mild depression, 5 patients (6.7%) had mild anxiety, and 2 patients (2.6%) had moderate anxiety. CONCLUSION: MIDCAB is a safe surgical treatment and provides excellent clinical and HRQOL outcomes.

Use of radial artery graft reduces the morbidity of coronary artery bypass graft surgery in patients aged 65 years and older.

BACKGROUND: The use of the radial artery graft in patients aged 65 years and older could prevent the occurrence of leg wound infection, which is known to increase the morbidity of coronary artery bypass grafting surgery. METHODS: We reviewed, retrospectively, 261 patients aged 65 years and older (age range 65 to 93 years), who underwent coronary artery bypass grafting surgery between February 1998 and August 2001. All the patients received at least one radial artery graft in addition to either a left internal thoracic artery, right internal thoracic artery, or saphenous vein graft as required. Saphenous vein grafts were used in 141 (54.1%) patients (group 1), and these were compared to 120 (45.9%) patients (group 2) who received only arterial conduits. Angiography was performed on 26 consecutive patients. The aim of the study was to review the clinical and angiographic outcomes in this population. RESULTS: The mean number of distal anastomoses performed was 2.98. Mean global operating time was 204 minutes. This time dropped to 201 minutes in group 1 versus 231 minutes in group 2; p = 0.009. Sixteen (11.3%) patients receiving saphenous vein grafts had leg wound infection whereas only 1 (0.3%) patient of the global population had a forearm infection. The mean global hospital stay was 9.81 days; this duration increased to 13 days when leg wound infection occurred versus 9.1 days when infection did not occur; p = 0.008. Twenty-six (10%) patients underwent an early angiographic study. Twenty-four (92.3%) radial artery grafts were patent. CONCLUSIONS: The routine use of radial artery grafts in patients aged 65 years and older is feasible, safe, and does not increase mortality, morbidity, or the complexity of coronary artery bypass grafting surgery.