Severity of aortic arch calcification is associated with age, diabetes duration, diabetic complications (retinopath), microalbuminuria), coronary artery disease, insulin dependence, and presence of hypertension and dyslipidaemia.
Aortic arch calcification has a high specificity for detection of severe coronary atherosclerosis in patients with CAD. Sensitivity is higher in patients with type 2 diabetes, while specificity is slightly higher in non-diabetic patients.
INTRODUCTION AND OBJECTIVES: With the increasing use of PUL for BPH management and MRI for evaluation for prostate cancer, invariably there will be patients where these 2 technologies meet. PUL comprises of a stainless steel Urethral Anchor (UA) and a Nitinol Capsular Tab (NCT). We sought to define the amount of artefact caused by PUL on MRI, map the location of the artefact and relate these findings to a database of MR guided biopsies.METHODS: With Ethics approval, 10 men scheduled for a PUL procedure were enrolled. Standard mpMRI protocol using a 3T scanner was performed pre-PUL insertion and repeated 1-3 months post-PUL. Pre and Post PUL images were compared to measure maximum artefact diameter around each implant in T2, DWI and DCE protocols. An Artefact Reduction Protocol (ARP) attempted to reduce the size of the artefact. The location of each artefact was recorded and compared to a separate database of 225 patients with MR guided biopsies.The locations of biopsy proven prostate cancer were mapped to either Peripheral Zone (PZ) or Transitional Zone (TZ). TZ cancer was further categorised to the Anterior Transitional Zone (ATZ) or Posterior Transitional Zone (PTZ).RESULTS: Artefact occurred around the UA only. The NCT showed negligible artefact in all protocols. Mean T2 artefact was 7.7mm (Median 7.7mm, SD[1.71mm). ARP reduced the mean T2 artefact to 5.4mm (Median 5mm, SD[1.43, 30% reduction). Mean DCE artefact was 10mm (Median 9.4mm, SD[2.5mm). Mean DWI artefact was 28.2mm (Median 26.5mm, SD[7.8mm). Artefact caused by PUL was confined to the PTZ, and did not affect imaging of the ATZ or PZ in any protocol. In a group of 225 consecutive MR guided biopsies, there were 55 positive biopsies (TZ[13, PZ[32). Prostate cancer was found in the TZ in 13 cases (G6 [7, G7[4, G8[2). The TZ cancer was further mapped to ATZ only (n[10), ATZþPZ (n[2), PTZ only (n[0) and PTZþPZ (n[1) to analyse the risk of PUL artefact obscuring cancer confined to PTZ only.CONCLUSIONS: This is the first study to define the size and location of artefact caused by PUL on MRI. The Nitinol CT causes NO artefact on MRI. The stainless steel UA causes the least MRI artefact in T2 (7.7mm) and largest artefact on DWI (28.2mm) confined to the PTZ. The ATZ and PZ of the prostate are not affected by PUL artefact. ARP was able to reduce artefact size by 30% in T2 with some degradation of image quality. No patient in 225 MR guided biopsies had a cancer solely confined to the PTZ (one-side 95% upper confidence limit:[0,1.3%]). PUL artefact is confined to the PTZ and in our series, is unlikely to obscure a prostate cancer on MRI. Further studies are warranted.
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