Study Design Retrospective cohort study.
Objective Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly, and they can be accurately identified on anteroposterior (AP) radiographs of the lumbosacral spine. This study attempts to determine the prevalence of this congenital anomaly and to increase awareness among all clinicians to reduce the risk of surgical and procedural errors in patients with LSTV.
Methods A retrospective review of 5,941 AP and lateral lumbar radiographs was performed. Transitional vertebrae were identified and categorized under the Castellvi classification.
Results The prevalence of LSTV in the study population was 9.9%. Lumbarized S1 and sacralized L5 were seen in 5.8 and 4.1% of patients, respectively.
Conclusion LSTV are a common normal variant and can be a factor in spinal surgery at incorrect levels. It is essential that all clinicians are aware of this common congenital anomaly.
Introduction: Nerve-sparing prostatectomy is recommended in cases of organconfined prostate cancer but is generally contraindicated in patients with suspected extra-prostatic extension (EPE). PSMA ligand imaging has been shown to be valuable in predicting EPE when performed on a hybrid PET/MRI scanner; however, the majority of PSMA-PET imaging is performed using PET/CT. To our knowledge, there are no established PET/CT criteria for assessing EPE. In this study, we aim to provide a reproducible method for evaluating EPE on PSMA-PET/CT imaging and assess its utility compared with MRI. Methods: Imaging findings and histopathology were reviewed for 100 consecutive patients who underwent a radical prostatectomy after imaging with MRI and 18F-DCFPyL PSMA-PET/CT. Results: A broad tumour-capsule interface measured using a standardised technique on fused PSMA-PET/CT imaging is associated with a higher risk for established EPE (P < 0.001). In our cohort, applying the criteria of tumourcapsule contact ≥ 10 mm measured on PET/CT was as sensitive as applying PI-RADS version 2 criteria to mpMRI imaging for predicting EPE (74% and 79%, respectively, P = 0.11) and had superior specificity (86% and 61%, respectively, P = 0.035). 93% of MRI-occult lesions were visualised on PSMA-PET/CT. Applying the proposed PET/CT criteria for EPE to this subgroup of 14 patients yielded a sensitivity of 67% and specificity of 92%. Conclusion: Our results suggest that tumour-capsule interface measured on fused F18-DCFPyL PSMA-PET/CT imaging is comparable to MRI criteria for predicting the presence of EPE. Applying PET/CT criteria may be of particular benefit in predicting EPE in patients with MRI-occult prostate cancer.
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