Comparative effectiveness of [(18) F]-fluorocholine PET-CT and pelvic MRI with diffusion-weighted imaging for staging in patients with high-risk prostate cancer.

BACKGROUND: Accurate staging is important before surgical decision in patients with high-risk prostate cancer (PCa). The purpose of this study was to prospectively compare the diagnostic performance of (18) F-FCholine and MRI with diffusion weighted imaging (DWIMRI) for local and regional lymph node (LN) staging before radical prostatectomy (RP) with extended pelvic lymphadenectomy (PLND). METHODS: We identified 47 patients who underwent (18) F-FCholine and DWIMRI followed by surgical treatment (either prostatectomy or LN dissection or an association of prostatectomy and LN dissection) between May 2010 and December 2012 at Bordeaux University Hospital. These patients were part of a prospective study (EudraCT number 2009-014839-21) evaluating the interest of (18) F-FCholine in staging of high-risk PCa. Diagnostic performances were retrospectively determined for each of (18) F-FCholine and DWIMRI considering LN invasion, each of prostate sextants, capsular invasion and extension to seminal vesicles. (18) F-FCholine and MR findings were correlated with histological findings. RESULTS: In a region-based LN analysis, the sensitivity and positive predictive value specificity were respectively, 56% and 98% for (18) F-Choline, and 17% and 97% for DWIMRI. In a patient-based analysis the sensitivity and positive predictive value were respectively 78% and 94% for (18) F-Choline and 33% and 84% for DWIMRI (P = 0.015). For tumor staging, DWIMRI showed better performances with a better specificity (69%) for sextants analysis and sensitivity to detect seminal vesicle invasion (73% vs. 36%). CONCLUSIONS: (18) F-FCholine imaging appears to provide helpful additional information in the staging of high-risk PCa. It appears essential for predicting LN status due to its higher sensitivity and specificity for LN involvement. However, despite excellent performance, it cannot replace MRI that remains better for tumoral localization and local evaluation, especially for seminal vesicle invasion. PATIENT SUMMARY: This study highlights the interest of (18) F-Choline in the staging of high risk prostate cancer in addition with DWI MRI, especially so in the evaluation of lymph node involvement due to its high sensitivity and excellent specificity.

Real-time contrast-enhanced transrectal US-guided prostate biopsy: diagnostic accuracy in men with previously negative biopsy results and positive MR imaging findings.

PURPOSE: To retrospectively evaluate diagnostic accuracy of real-time contrast material-enhanced (CE) ultrasonography (US) transrectal US-guided biopsies in patients with persistently elevated prostate-specific antigen (PSA) levels, previous negative systematic transrectal US-guided biopsy results, and positive prostate multiparametric magnetic resonance (MR) findings. MATERIALS AND METHODS: Institutional review board approval was obtained for this retrospective study. Informed consent was waived. From 2007 to 2011, 178 patients with increased PSA levels (mean, 10.7 ng/mL [10.7 µg/L]), previous negative findings of random biopsies, and targets depicted at multiparametric MR imaging underwent transrectal US-guided prostate biopsies after injection of sulfur hexafluoride microbubbles. CE US-targeted biopsies were performed systematically in cancer-suggestive regions, followed by random acquisition of 12 nontargeted cores in all other regions. Diagnostic accuracy of CE US-targeted biopsies was measured with sensitivity, specificity, and positive and negative predictive values. Fisher exact and Mann-Whitney U tests were used to compare subgroups of patients. Potential predictive variables were examined with a logistic regression model. RESULTS: CE US findings were positive in a first group of 158 patients and negative in a second group of 20 patients. Prostate carcinoma (PCa) was detected in 75 patients in the first group (47.5%) and in eight of the second group (40.0%). Overall cancer detection rate was 46.6% (83 of 178). In the first group, PCa was detected with targeted biopsies alone in 18 patients (24%), with nontargeted biopsies alone in 23 (30.7%), and with both in 34 (45.3%). Mean number of CE US-targeted cores per cancer-suggestive region was 2.2. CE US-targeted biopsies had a positive overall detection rate of 30.9%, while it was 6.9% for 12-core nontargeted biopsies (P < .001). PSA level and Gleason score were associated with positivity of CE US-targeted biopsies (P = .031 and P = .015, respectively). CONCLUSION: Real-time CE US-targeted transrectal US biopsy offers excellent sensitivity for PCa detection in men with previous negative biopsy results and positive findings at multiparametric MR imaging. It may be combined with conventional random biopsies to increase specificity.

Neurologic manifestations of pediatric chikungunya infection.

Chikungunya virus, a mosquito-borne arbovirus, was responsible for a massive epidemic in La Réunion Island during 2005 to 2006. The disease is usually benign, but neurologic involvement, with sometimes fatal outcome, has been described. We report a retrospective hospital-based pediatric series of 30 children (23 boys and 7 girls) who presented neurologic manifestations of chikungunya such as encephalitis (n = 12), febrile seizures (n = 10), meningeal syndrome (n = 4), and acute encephalopathy (n = 4). Cerebrospinal fluid biological and cytological analyses (n = 23) were unremarkable except for 1 case of acute disseminated encephalomyelitis. The presence of viral genome in cerebrospinal fluid was inconstantly positive. Brain magnetic resonance imaging (MRI) scans (n = 14) were abnormal in 5 cases. Electroencephalography was nonspecific. Two patients died. At discharge and 6 months later, 5 children had neurologic sequelae. Patients with initial severe neurologic presentation and having pathological brain MRI had more sequelae or fatal disease.