OBJECTIVE. The purpose of this study was to retrospectively evaluate the impact of multiparametric prostate MRI, including diffusion-weighted imaging (DWI) performed using different b values as well as dynamic contrast-enhanced MRI (DCE-MRI) on the accuracy, sensitivity, and specificity for transition zone (TZ) tumor detection and localization. MATERIALS AND METHODS. We included 106 prostate cancer patients (mean age [± SD], 62 ± 7 years) who underwent 3-T MRI with a pelvic phased-array coil before radical prostatectomy. Three radiologists independently reviewed cases to record the likelihood of tumor in each of six TZ regions. Scores were initially assigned using T2-weighted imaging alone, reassigned after integration of DWI at b = 1000 s/mm(2) and corresponding apparent diffusion coefficient (ADC) maps, reassigned again after integration of DWI at b = 2000 s/mm(2), and reassigned a final time after integration of DCE-MRI. Generalized estimating equations based on binary logistic regression were used to compare sessions for TZ tumor detection, using prostatectomy findings as reference standard. RESULTS. Of the TZ sextants, 9.7% (62/636) contained tumor. All readers had higher sensitivity for T2-weighted imaging integrated with DWI at b = 1000 s/mm(2) and ADC compared with T2-weighted imaging alone (reader 1, 54.8% vs 33.9%; reader 2, 53.2% vs 22.6%; and reader 3, 50.0% vs 19.4% [p ≤ 0.002]); two readers had further increased sensitivity also incorporating b = 2000 s/mm(2) (reader 1, 74.2% and reader 2, 62.9%; p ≤ 0.011), and one reader had further increased sensitivity also incorporating both b = 2000 s/mm(2) and DCE-MRI (reader 3, 61.3%, p = 0.013). DCE-MRI otherwise did not improve sensitivity (p ≥ 0.054). Other measures were similar across the four sessions (reader 1, specificity 97.4-98.3% and accuracy 91.2-95.9%; reader 2, specificity 95.8-98.4% and accuracy 91.0-92.6%; reader 3, specificity 90.9-96.7% and accuracy 88.1-89.2%). CONCLUSION. DWI assists TZ tumor detection through higher sensitivity, particularly when using a very high b value; DCE-MRI lacks further additional benefit.

Intravoxel incoherent motion imaging parameters with inclusion of histogram measures of heterogeneity can help differentiate malignant from benign lesions as well as various subtypes of renal cancers.

OBJECTIVE. The purpose of this article is to perform an intraindividual comparison between 1.5 T and 3 T chemical-shift MRI in differentiating adrenal adenomas and nonadenomas, including comparison of quantitative thresholds. MATERIALS AND METHODS. In this retrospective study, 37 adrenal lesions in 36 patients (20 men and 16 women; mean [± SD] age, 66.7 ± 12.9 years; 27 benign adenomas in 27 patients; 10 nonadenomas in nine patients) imaged at 1.5 T and 3 T were identified. Two readers qualitatively assessed intralesional signal loss between in- and opposed-phase images. One reader placed ROIs on adrenal lesions, spleen, liver, and muscle. Quantitative measures of signal loss, such as signal intensity (SI) index, adrenal-to-spleen ratio, adrenal-to-liver ratio, and adrenal-to-muscle ratio, were calculated. Qualitative and quantitative measures between field strengths were assessed with McNemar test and ROC analysis, respectively. RESULTS. Accuracy in qualitative adenoma identification (86.5% [32/37] at 1.5 T and 81.1% [30/37] at 3 T for reader 1; 81.1% [30/37] at 1.5 T and 83.8% [31/37] at 3 T for reader 2; both p ≥ 0.180) was equivalent at both field strengths. AUCs were not statistically significantly different between field strengths for quantitative measures: AUCs at 1.5 T versus 3 T were 0.956 versus 0.915 for SI index, 0.963 versus 0.870 for adrenal-to-spleen ratio, 0.935 versus 0.852 for adrenal-to-liver ratio, and 0.948 versus 0.948 for adrenal-to-muscle ratio (all p > 0.11). The optimal threshold for SI index was lower at 3 T (> 7.4%) than at 1.5 T (> 21.6%) but had similar sensitivity (1.5 T, 92.6% [25/27]; 3 T, 88.9% [24/27]) and specificity (1.5 T, 90.0% [9/10]; 3 T, 90.0% [9/10]). CONCLUSION. Chemical-shift imaging has similar diagnostic efficacy for differentiating adrenal adenomas and nonadenomas at 1.5 T and 3 T. However, quantitative measures have different thresholds for this differentiation at 3 T; in particular, the commonly applied SI index is much lower at 3 T.

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Admission CT findings serve as independent predictors of hospital resource utilization in suspected acute appendicitis.

RESULTS: Upstaging was identified at radical prostatectomy in 39/95 (41%) patients. Patients with upstaging at radical prostatectomy had elevated prostate-specific antigen (median 9 vs. 6.3, P¼0.007), higher proportion of positive targeted biopsy cores (0.8 vs. 0.6, P¼0.01) and maximum percent targeted biopsy core involvement (85% vs. 75%, P¼0.01), and higher rate of perineural invasion (PNI) on systematic biopsy (28% vs. 9%, P¼0.02). Moreover, compared with organ-confined disease, upstaging was more detected in greater biopsy grade groups on targeted (P¼0.01) and systematic biopsies (P¼0.02), and among patients with prostate imaging reporting and data system (PI-RADS) score 5 on MRI (P¼0.007). On multivariable analysis including targeted biopsy tumor involvement, PI-RADS score, total biopsy grade groups, PNI on systematic biopsy (OR 5.27, P¼0.02) and clinical T1c (OR 4.16, 95%CI 1.21-13.51, P¼0.02) remained significantly associated with an increased risk of upstaging at radical prostatectomy.CONCLUSIONS: PNI on systematic biopsy is a significant predictor of upstaging to T3a at radical prostatectomy, whereas no targeted biopsy pathological features yielded a significant association. Systematic biopsy maintains an important role in the prediction of nonorgan confined disease in patients with prostate cancer.

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