When whole-lesion histograms were used to derive ADC parameters, 10th percentile ADC correlated with Gleason score better than did other ADC parameters, suggesting that 10th percentile ADC may prove to be optimal for differentiating low-grade from intermediate- or high-grade prostate cancer with diffusion-weighted MR imaging.

Purpose A barrier to acceptance of active surveillance (AS) for men with prostate cancer (PCa) is the risk of underestimating the cancer burden upon initial biopsy. We assessed the value of endorectal magnetic resonance imaging (eMRI) in predicting upgrading on confirmatory biopsy in men with low-risk PCa. Methods 388 consecutive men (mean age,60.6, range 33–89 years) with clinically low-risk PCa (initial biopsy Gleason score≤6, PSA<10 ng/mL, clinical stage≤T2a) underwent eMRI before confirmatory biopsy. Three radiologists independently, retrospectively scored tumor visibility on eMRI using a five-point scale (1-definitely no tumor—5-definitely tumor). Inter-reader agreement was assessed with weighted kappa statistics. Associations between MRI scores and confirmatory biopsy findings were evaluated using measures of diagnostic performance and multivariate logistic regression. Results On confirmatory biopsy, Gleason score was upgraded in 79/388 (20%) of patients. MRI scores ≤2 had high negative predictive value (0.96–1.0) and specificity (0.95–1.0) for upgrading on confirmatory biopsy. An MRI score of 5 was highly sensitive for upgrading on confirmatory biopsy (0.87–0.98). At multivariate analysis, patients with higher MRI scores were more likely to be upgraded on confirmatory biopsy (odds-ratios=2.16–3.97). Inter-reader agreement and diagnostic performance were higher for the more experienced readers (kappa=0.41–0.61; area under the curve [AUC]=0.76–0.79) than for the least experienced reader (kappa=0.15–0.39; AUC=0.61–0.69). MRI performed similarly in predicting low-risk and very low-risk (Gleason score 6, <3 positive cores, <50% involvement in all cores) PCa. Conclusion Adding eMRI to the initial clinical evaluation in men with clinically low-risk PCa helps predict findings on confirmatory biopsy and assess eligibility for AS.

PurposePatients with idiopathic pulmonary fibrosis (IPF) show increased PET signal at sites of morphological abnormality on high-resolution computed tomography (HRCT). The purpose of this investigation was to investigate the PET signal at sites of normal-appearing lung on HRCT in IPF.MethodsConsecutive IPF patients (22 men, 3 women) were prospectively recruited. The patients underwent 18F-FDG PET/HRCT. The pulmonary imaging findings in the IPF patients were compared to the findings in a control population. Pulmonary uptake of 18F-FDG (mean SUV) was quantified at sites of morphologically normal parenchyma on HRCT. SUVs were also corrected for tissue fraction (TF). The mean SUV in IPF patients was compared with that in 25 controls (patients with lymphoma in remission or suspected paraneoplastic syndrome with normal PET/CT appearances).ResultsThe pulmonary SUV (mean ± SD) uncorrected for TF in the controls was 0.48 ± 0.14 and 0.78 ± 0.24 taken from normal lung regions in IPF patients (p < 0.001). The TF-corrected mean SUV in the controls was 2.24 ± 0.29 and 3.24 ± 0.84 in IPF patients (p < 0.001).ConclusionIPF patients have increased pulmonary uptake of 18F-FDG on PET in areas of lung with a normal morphological appearance on HRCT. This may have implications for determining disease mechanisms and treatment monitoring.

(i) HDV infection is present in 16.6% of hepatitis B infected patients in Pakistan, most commonly in younger males living in rural areas; and (ii) delta virus infected patients have less severe clinical liver disease compared to delta negative, hepatitis B patients.