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Compared to systematic, transperineal biopsy as a reference test, magnetic resonance imaging targeted biopsy alone detected as many Gleason score 7 or greater tumors while simultaneously mitigating the detection of lower grade disease. The gold standard for cancer detection in primary biopsy is a combination of systematic and targeted cores.

ObjectiveTo develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD).MethodsThe technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding.ResultsConsensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the “Rule of three” for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system.ConclusionThis literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD.Key points • These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.

Standard TRUS-biopsies lead to significant underestimation of PC under AS. MRI/TRUS-fusion biopsies, and especially the TB component allow more reliable risk classification, leading to a significantly decreased chance of subsequent AS-disqualification. Cancer detection with mpMRI alone is not yet sensitive enough to omit SB on follow-up after initial 12-core TRUS-biopsy. After MRI/TRUS-fusion biopsy confirmed AS, it may be appropriate to biopsy only those men with suspected progression on MRI.

MRI-targeted biopsies detected significantly more anteriorly located sPC compared with SBs in the repeat-biopsy setting. The more cost-efficient bpMRI was statistically not inferior to mpMRI in sPC detection in TZ/AFMS.

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Introduction and hypothesis To demonstrate mesh magnetic resonance (MR) visibility in living women, the feasibility of reconstructing the full mesh course in 3D and document its spatial relationship to pelvic anatomical structures. Methods This is a proof of concept study of three patients from a prospective multi-center trial evaluating women with anterior vaginal mesh repair using a MR-visible Fe3O4-polypropylene implant for pelvic floor reconstruction. High resolution sagittal T2-weighted sequences, transverse T1-weighted (T1w) FLASH 2D and transverse T1w FLASH 3D sequences were performed to evaluate Fe3O4-polypropylene mesh MR-visibility and overall postsurgical pelvic anatomy three months after reconstructive surgery. Full mesh course as well as important pelvic structures were reconstructed using the 3D Slicer® software program based on T1 and T2 MR-images. Results Three women with POP-Q grade III cystoceles were successfully treated with a partially absorbable MR-visible anterior vaginal mesh with 6 fixation arms showing no recurrent cystocele in the 3 months follow-up examination. The course of mesh in the pelvis was visible on MR-images in all three women. The mesh body and arms could be reconstructed allowing visualization of the full course of the mesh in relationship to important pelvic structures such as the obturator or pudendal vessel-nerve bundles in 3D. Conclusions The use of MR-visible Fe3O4-polypropylene meshes in combination with post-surgical 3D reconstruction of the mesh and adjacent structures is feasible suggesting it might be a useful tool to more precisely evaluate mesh complications and might be a valuable interactive feedback tool for surgeons and mesh design engineers.