One-year Follow-up Results of Transperineal Biopsy For Patients Undergoing Irreversible Electroporation Treatment in Localized Prostate Cancer.

OBJECTIVE: This article reports on the early results of a 1-year follow-up study investigating the efficacy of irreversible electroporation in the treatment of localized prostate cancer. METHODS: The study included 18 out of 40 patients diagnosed with low- and intermediate-risk prostate cancer who underwent irreversible electroporation. Treatment results were evaluated through confirmation biopsies, comparing prostate-specific antigen levels, international prostate symptom scoring, and international index of erectile dysfunction scores before irreversible electroporation and at the 12-month mark. RESULTS: The mean age of the patients was 61.1 years (SD ±6.5). Out of the 18 patients, 16 were tumor free (88.8%), while 2 experienced recurrences, one within the treatment field and the other outside of it (P < .001). Irreversible electroporation significantly reduced mean prostate-specific antigen levels (6.73 ng/mL vs. 2.05 ng/mL, P < .001), indicating a 69.5% reduction within 12 months. Furthermore, there was a significant improvement in mean international prostate symptom scores at the 12-month followup (10.05 vs. 7.52, P=.003). The mean international index of erectile dysfunction scores before treatment was 19.17 (SD ±5.85), and after irreversible electroporation, it was 18.67 (SD ±6.34), with no statistically significant change (P=.065). CONCLUSION: The short-term oncological results of irreversible electroporation treatment are promising, particularly for patients in the low- and intermediate-risk groups. Additionally, irreversible electroporation does not negatively impact the international index of erectile dysfunction; however, it may lead to a decrease in international prostate symptom scores.

Evaluation of clinical and mpMRI findings of irreversible electroporation therapy for the treatment of localized prostate cancer: Preliminary results.

OBJECTIVE: To evaluate early clinical and multiparametric prostate magnetic resonance imaging (mpMRI) results of irreversible electroporation (IRE) efficiency in treatment of localized prostate cancer. MATERIAL AND METHODS: For the patients in whom IRE was performed for local ablation, mpMRI was used for the sixth month follow-up. These images were compared with the mpMRI images obtained before the procedure. We performed transperineal fusion biopsy to patients with diagnosis of localized prostate cancer. We treated the eligible ones with IRE. Six of them have completed their 6-month follow-up period. We compared preoperative prostate specific antigen (PSA), international prostate symptom score, international index of erectile function (IIEF), and mpMRI of these patients with those obtained at the sixth month of follow-up. Side effects experienced by the patients were evaluated as well. RESULTS: We had 10 patients who received IRE treatment. Six patients completed their sixth month-follow-up and came for control visits. At the end of 6 months, the mean decrease in PSA level was 73%. IIEF results were seen not to have changed significantly. On mpMRI, diffusion restriction was seen to have disappeared except for one patient, and Prostate Imaging Reporting Data System scores were decreased. CONCLUSION: We concluded that early clinical and mpMRI results for IRE in the focal ablative treatment of localized prostate cancer were gratifying. As an ambulatory procedure with a low incidence of side effects, we look forward to seeing the long-term results of IRE treatment.

Magnetic resonance tagging for diagnosis of focal hypertrophic cardiomyopathy in a child.

Magnetic resonance imaging has become an important diagnostic tool in the differential diagnosis of lesions for evaluation of cardiovascular disorders. In magnetic resonance tagging (MRt), tissue elements are magnetically labeled so that their positions can be tracked as a function of time. Thus, MRt evaluates heart wall motion both qualitatively and quantitatively. We present herein the case of a 12-year-old boy who had chest pain, dyspnea on effort and murmur. On cardiac computed tomography, there was focal thickening of the left ventricular posterior wall, similar to a mass. MRt indicated active displacement and deformation of the tags at the level of the hypertrophic myocardium during systole, as with normal myocardium. Thus, the tagged images supported the diagnosis of focal hypertrophic cardiomyopathy (HCM). In view of these results, MRt should be considered as a useful technique for differentiating between a mass-like focal lesion such as neoplasm and HCM.

A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer.

OBJECTIVE: To analyze the results of fertility-sparing treatment of early-stage endometrial cancer (EC) in patients treated at Turkish gynecologic oncology centers, and to present a review of the literature. METHODS: Thirteen healthcare centers in Turkey were contacted to determine if they were eligible to participate in the study. Centers that were eligible and agreed to participate were sent a database form to record the demographic characteristics, clinicopathologic findings, and follow-up results for their EC patients. RESULTS: Eleven Turkish healthcare centers provided data on 43 EC patients. Mean duration of treatment was 5 months and mean follow-up was 49 months. In total, 35 (81.4%) patients were tumor free following primary progesterone therapy. Mean time from the end of progesterone therapy to pregnancy was 10.6 ± 4.3 months (range, 3-18 months). Two patients had tumor recurrence during follow-up. The pregnancy rate among the 31 women who actively sought pregnancy was 41.9% (n=13). CONCLUSION: Conservative management of early-stage EC in women of reproductive age using oral progestins was effective and did not compromise oncological outcome. Pregnancy in the study patients was achieved spontaneously and artificially.

Correlation of dynamic multidetector CT findings with pathological grades of hepatocellular carcinoma.

PURPOSE: Our objective was to examine whether different vascularization patterns seen during three phases of dynamic multidetector computed tomography (MDCT) of the liver correlated with the histopathological differentiation findings of hepatocellular carcinoma (HCC) in chronic liver disease patients. MATERIALS AND METHODS: Dynamic MDCT images from 46 patients (38 males and 8 females; ages between 1 and 90 years; mean age, 53) pathologically diagnosed with HCC were retrospectively evaluated. Lesions were divided into three groups according to MDCT enhancement patterns. Pathologically determined differentiation degrees were compared with contrast enhancement patterns in the hepatic arterial, portal venous, and hepatic venous phases. RESULTS: Lesion characterization was as follows: Type 1 (6 patients), hypoattenuating in the hepatic arterial and hepatic venous phases and hyperattenuating in the portal venous phase; Type 2 (10 patients), hypoattenuating in all phases; and Type 3 (30 patients), hyperattenuating in the hepatic arterial and portal venous phases and hypoattenuating in the hepatic venous phase. Patients were pathologically classified as having either well-differentiated (n=32) or poorly differentiated HCC (n=14). All patients with poorly differentiated HCC had a Type 3 enhancement pattern. All patients with Type 1 and 2 enhancement patterns had well-differentiated HCC. There was a significant correlation between pathological differentiation degrees and radiological enhancement (P = 0.003). CONCLUSION: Dynamic MDCT revealed that poorly differentiated HCC patients all had hypervascular enhancement patterns, and hypovascular- type enhancement was present in all patients with well-differentiated HCC. Imaging patterns of dynamic MDCT scanning in HCC patients may be helpful for follow-up examinations and for determining clinical prognosis.

Magnetic resonance imaging in the visualization of benign tumors and tumor-like lesions of hand and wrist.

The differential diagnosis of benign tumors and tumor-like lesions of the hand and wrist region is important with regard to choosing the therapy (medical versus surgical), or to decide to just follow-up the lesion. In most of the cases the proper analysis of MRI findings in correlation with the patient's history is sufficient to meet a specific diagnosis. However, diagnostic confusion is not uncommon as there are numerous lesions affecting the hand and wrist region. This pictorial essay offers a practical radiological approach to benign tumors and tumor-like lesions of the hand and wrist region based on most frequently observed MRI findings.

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears.

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up, 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest follow-up was 28.5 and mean Constant score was 80.3. Constant scores were found to be significantly low for the failed group. Age was found to be significantly related to failed repair. Fatty infiltration stage in the failed repair group was significantly high, and a strong positive correlation for both groups existed pre and postoperatively. When both groups were compared, the failed group was found to have significantly low measurements at extension and internal rotation. Despite high failure rates, functional results were satisfactory. Increased age and fatty infiltration stage decrease success.

Fulminant hepatic failure in children: etiology, histopathology and MDCT findings.

INTRODUCTION: The purpose of this study is to determine the etiologies, histopathology and MDCT findings of children with fulminant hepatic failure admitted to our institution. MATERIALS AND METHODS: Between June 2004 and November 2006, 15 children with fulminant hepatic failure who underwent MDCT were included retrospectively in this study. Twelve patients had liver biopsies. The patients were divided into three groups as hyperacute (Group I), acute (Group II) and subacute (Group III) depending on onset of hepatic encephalopathy. RESULTS: Hepatitis A in 4 patients, non-A, non-E hepatitis in 4; mushroom poisoning in 3; fulminant Wilson's disease in 2; autoimmune hepatitis in 1; and both hepatitis B and toxic hepatitis (with leflunomide treatment) in 1 patient were detected. MDCT of all three groups revealed diffuse reduction in hepatic attenuation in 11 patients; ascites in 9; periportal edema in 6; edema of gallbladder wall in 6; splenomegaly in 6; heterogeneous hepatic parenchyma in 6; hepatomegaly in 3; irregular contours of liver in 2; multiple micronodules in 1 and necrotic areas and regeneration in liver parenchyma in 2 patients. Histopathologic evaluation of liver biopsies showed massive hepatic necrosis, inflammatory cell infiltration and ductular proliferation in 8 patients, periportal edema in 6, edema of gallbladder wall in 5, regenerating nodules and fibrous septa consistent with cirrhotic pattern in 2, and regenerating nodules and necrotic areas in 2 patients. CONCLUSION: The most common MDCT findings in fulminant hepatic failure were diffuse reduction in hepatic attenuation and ascites. Massive hepatic necrosis was the most common histopathologic finding.

MRI findings in renal transplant recipients with hip and knee pain.

PURPOSE: To evaluate and demonstrate the MRI findings of renal transplant recipients with hip and knee pain and to investigate the most common etiology of pain. MATERIALS AND METHODS: 69 hip MRIs of 57 patients with hip pain and 30 knee MRIs of 24 patients with knee pain with no history of trauma were retrospectively evaluated by two radiologists. RESULTS: In the evaluation of hip MRIs, 24 patients had avascular necrosis and effusion, 2 patients had bone marrow edema consistent with early stage of avascular necrosis. 18 patients had only intraarticular effusion, 6 patients had tendinitis, 6 patients had bursitis and 1 patient had soft tissue abscess. Five patients had muscle edema and five patients had muscle atrophy as additional findings to the primary pathologies. Among patients with knee pain, nine patients had degenerative joint disease. Seven patients had chondromalacia, five had bone marrow edema, six had meniscal tear, six had ligament rupture and two had bone infarct. Three of the patients had muscle edema accompanying to other pathologies. CONCLUSION: The most common etiology of hip pain in renal transplant recipients is avascular necrosis as expected, intraarticular effusion is found to be the second reason for pain. However, knee pain is explained by ligament pathology, meniscal tear, chondromalacia or degenerative joint disease rather than osteonecrosis.

Unusual association of tethered cord, filum terminale lipoma, and myxopapillary ependymoma.

STUDY DESIGN: Case report. OBJECTIVE: We report a 67-year old man with a known filum terminale lipoma causing a tethered cord extending to the subcutaneous fat tissue and a newly diagnosed concomitant ependymoma, revealed on lumbar magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA: The coexistence of filum terminale lipoma and ependymoma is very rare. The underlying reason of this coexistence is still unknown. The patients with known filar lipoma causing a tethered cord can be underdiagnosed clinically even though new symptoms develop. METHODS: Case study with lumbar MRI. RESULTS: The patient was operated, and both of the ependymoma and filum terminale lipoma were removed. The pathologic examination was consistent with the MRI findings. Three months after surgery, the patient improved significantly. CONCLUSION: The coexistence of filum terminale lipoma and ependymoma is rare. Patients with relevant symptoms may be referred for an MRI study; however, especially patients with known filar lipomas causing tethered cord may be missed. Therefore, including these patients, a contrast-enhanced lumbar MRI must be performed to exclude any coexistence of filum terminale lipoma and ependymoma in the early course of the disease which can also help the surgeon in guiding the appropriate treatment.

STIR sequence for depiction of degenerative changes in posterior stabilizing elements in patients with lower back pain.

OBJECTIVE: The aims of this study were to investigate whether degenerative posterior paraspinal changes are a cause of lower back pain and to determine the age- and sex-related distribution of these changes on MR images acquired with a STIR sequence. SUBJECTS AND METHODS: The lumbar MRI findings of 372 patients (141 men, 231 women; mean age, 51.2 years) with nonradicular lower back pain and of 249 healthy persons acting as controls (126 men, 123 women; mean age, 49.3 years) were analyzed. The sagittal STIR sequence was used for all MRI examinations. Presence of interspinous ligament edema, facet joint effusion, neocysts, paraspinal muscle edema, subcutaneous edema, disk herniation, and disk degeneration was evaluated, and the incidence of each finding was determined. All findings were grouped according to age and sex. Chi-square, Fisher's exact, and independent-samples Student's t tests and Spearman's rank correlation analysis were used for statistical analysis. RESULTS: The incidences of facet joint effusion, interspinous ligament edema, neocyst formation, and paraspinal muscle edema were found to be statistically significantly higher in patients with lower back pain than in controls. The incidences of intervertebral disk degeneration, disk herniation, and subcutaneous edema in persons with and those without lower back pain were similar. Intervertebral disk degeneration, disk herniation, subcutaneous edema, and muscle edema were found to increase with age in both persons with and those without symptoms. CONCLUSION: Degenerative changes in the posterior paraspinal structures were found in a higher percentage of subjects with lower back pain than in controls. Use of a STIR sequence with homogeneous fat suppression facilitates visualization of these changes.

Various origins of the duplicated middle cerebral artery.

We describe the features of a duplicated middle cerebral artery identified by computed tomographic angiography that originates from a previously undefined origin, ie, from the petrous portion of the internal carotid artery. Recognition of this anomaly is important in patients with a possible aneurysm, which was not present in our patient.

Meniscal tears: role of axial MRI alone and in combination with other imaging planes.

OBJECTIVE: The purpose of this study was to determine the reliability of standard axial MR images alone in the diagnosis of meniscal tears of the knee and in combination with other imaging planes. MATERIALS AND METHODS: Sixty-two patients (55 men, seven women; age range, 23-68 years) with a prior MRI examination who underwent arthroscopic surgery of the knee during a 1-year period were included in the study group. Images were independently reviewed for identification of meniscal tears by two musculoskeletal radiologists blinded to arthroscopic findings. Sequences for meniscal evaluation included axial fat-saturated fast spin-echo proton density, coronal fat-saturated fast spin-echo proton density, and sagittal fast spin-echo proton density with 4- to 5-mm slice thicknesses. Imaging groups for evaluation were axial, coronal, sagittal, axial and sagittal, axial and coronal, and coronal and sagittal. Observers reported a confidence level for the presence or absence of meniscal tear in all imaging groups based on a 5-point scale. Statistical analysis considered medial and lateral menisci separately. RESULTS: Forty patients had medial meniscal tears, and 16 had lateral meniscal tears at arthroscopy. For medial and lateral meniscal tears, the accuracy (79% and 71%, respectively) of imaging in the axial plane was comparable to other imaging groups but the mean confidence levels (2.82 and 3.00, respectively) were low. In one patient, the axial plane alone correctly showed that no tear was present. No statistically significant difference was observed between imaging plane groups of both menisci in the diagnosis of meniscal tears (p > 0.05). The axial plane increased the accuracy of sagittal and coronal planes of lateral meniscus when combined. CONCLUSION: In standard knee MRI examinations, the axial imaging plane may be valuable for the detection and characterization of meniscal tears.