Objectives To investigate Haralick texture analysis of prostate MRI for cancer detection and differentiating Gleason Scores (GS). Methods One hundred and forty-seven patients underwent T2- weighted (T2WI) and diffusion-weighted prostate MRI. Cancers ≥0.5ml and non-cancerous peripheral (PZ) and transition zone (TZ) tissue were identified on T2WI and apparent diffusion coefficient (ADC) maps, using whole-mount pathology as reference. Texture features (Energy, Entropy, Correlation, Homogeneity, Inertia) were extracted and analyzed using generalized estimating equations. Results PZ cancers (n=143) showed higher Entropy and Inertia and lower Energy, Correlation and Homogeneity compared to non-cancerous tissue on T2WI and ADC maps (p-values: <.0001–0.008). In TZ cancers (n=43), we observed significant differences for all five texture features on the ADC map (all p-values: <.0001) and for Correlation (p=0.041) and Inertia (p=0.001) on T2WI. On ADC maps, GS was associated with higher Entropy (GS 6 vs 7: p=0.0225; 6 vs >7: p=0.0069) and lower Energy (GS 6 vs 7: p=0.0116, 6 vs >7: p=0.0039). ADC map Energy (p=0.0102) and Entropy (p=0.0019) were significantly different in GS ≤3+4 vs. ≥4+3 cancers; ADC map Entropy remained significant after controlling for the median ADC (p=0.0291). Conclusion Several Haralick based texture features appear useful for prostate cancer detection and GS assessment.

Objectives To evaluate the recommendations for multiparametric prostate MRI (mp-MRI) interpretation introduced in the recently updated Prostate Imaging Reporting and Data System version 2 (PI-RADSv2), and investigate the impact of pathologic tumour volume on prostate cancer (PCa) detectability on mpMRI. Methods This was an institutional review board (IRB)-approved, retrospective study of 150 PCa patients who underwent mp-MRI before prostatectomy; 169 tumours ≥0.5-mL (any Gleason Score [GS]) and 37 tumours <0.5-mL (GS ≥4+3) identified on whole-mount pathology maps were located on mp-MRI consisting of T2-weighted imaging (T2WI), diffusion-weighted (DW)-MRI, and dynamic contrast-enhanced (DCE)-MRI. Corresponding PI-RADSv2 scores were assigned on each sequence and combined as recommended by PI-RADSv2. We calculated the proportion of PCa foci on whole-mount pathology correctly identified with PI-RADSv2 (dichotomized scores 1–3 vs. 4–5), stratified by pathologic tumour volume. Results PI-RADSv2 allowed correct identification of 118/125 (94 %; 95 %CI: 90–99 %) peripheral zone (PZ) and 42/44 (95 %; 95 %CI: 89–100 %) transition zone (TZ) tumours ≥0.5 mL, but only 7/27 (26 %; 95 %CI: 10–42 %) PZ and 2/10 (20 %; 95 %CI: 0–52 %) TZ tumours with a GS ≥4+3, but <0.5 mL. DCE-MRI aided detection of 4/125 PZ tumours ≥0.5 mL and 0/27 PZ tumours <0.5 mL. Conclusions PI-RADSv2 correctly identified 94–95 % of PCa foci ≥0.5 mL, but was limited for the assessment of GS ≥4+3 tumours ≤0.5 mL. DCE-MRI offered limited added value to T2WI+DW-MRI.

Debra Goldman owns stock in Johnson and Johnson Jaclyn F. Hechtman has received honoraria from Cor2Ed, WebMD, and Axiom Healthcare Strategies as well as research funding from Bayer, Loxo Oncology, and Boehringer Ingelheim.

Objectives To analyze patterns of critical care medicine (CCM) beds, use, and costs in acute care hospitals in the United States (US), and relate CCM beds and use to population shifts, age groups, and Medicare and Medicaid beneficiaries from 2000 to 2010. Design Retrospective study of data from the federal Healthcare Cost Report Information System, American Hospital Association and US Census Bureau. Setting Acute care US hospitals with intensive care beds. Measurements and Main Results From 2000 to 2010, US hospitals with CCM beds decreased by 17% (3,586 to 2,977), while the US population increased by 9.6% (282.2M to 309.3M). Although hospital beds decreased by 2.2% (655,785 to 641,395), CCM beds increased by 17.8% (88,235 to 103,900), a 20.4% increase in the CCM/hospital bed ratio (13.5% to 16.2%). There was a greater percentage increase in premature/neonatal (29%, 14,391 to 18,567) than in adult (15.9%, 71,978 to 83,417) or pediatric (2.7%, 1,866 to 1,916) CCM beds. Hospital occupancy rates increased by 10% (59% to 65%), while CCM occupancy rates were stable (range 65%–68%). CCM beds per 100,000 total population increased by 7.4% (31.3 to 33.6). The proportional use of CCM services by Medicare beneficiaries decreased by 17% (37.9% to 31.4%) whereas that by Medicaid rose by 18% (14.5% to 17.2%). Between 2000 and 2010, annual CCM costs nearly doubled (92.9%, $56 to $108 billion). In the same period, the proportion of CCM cost to the Gross Domestic Product (GDP) increased by 32.1% (0.54% to 0.72%, $10,285 to $14,964 trillion). Conclusions Critical care medicine use and costs in the US continue to rise. The increasing use of CCM by the premature/neonatal and Medicaid populations should be considered by healthcare policy makers, state agencies, and hospitals as they wrestle with critical care bed growth and the associated costs.

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.