Background
To evaluate FCH‐PET/CT and parathyroid 4D‐CT so as to guide surgery in patients with primary hyperparathyroidism (pHPT) and prior neck surgery.
Methods
Medical records of all patients referred for a FCH‐PET/CT in our institution were systematically reviewed. Only patients with pHPT, a history of neck surgery (for pHPT or another reason) and an indication of reoperation were included. All patients had parathyroid ultrasound (US) and Tc‐99m‐sestaMIBI scintigraphy, and furthermore, some patients had 4D‐CT. Gold standard was defined by pathological findings and/or US‐guided fine‐needle aspiration with PTH level measurement in the washing liquid.
Results
Twenty‐nine patients were included in this retrospective study. FCH‐PET/CT identified 34 abnormal foci including 19 ectopic localizations. 4D‐CT, performed in 20 patients, detected 11 abnormal glands at first reading and 6 more under FCH‐PET/CT guidance. US and Tc‐99m‐sestaMIBI found concordant foci in 8/29 patients. Gold standard was obtained for 32 abnormal FCH‐PET/CT foci in 27 patients. On a per‐lesion analysis, sensitivity, specificity, positive and negative predictive values were, respectively, 96%, 13%, 77% and 50% for FCH‐PET/CT, 75%, 40%, 80% and 33% for 4D‐CT. On a per‐patient analysis, sensitivity was 85% for FCH‐PET/CT and 63% for 4D‐CT. FCH‐PET/CT results made it possible to successfully remove an abnormal gland in 21 patients, including 12 with a negative or discordant US/Tc‐99m‐sestaMIBI scintigraphy result, with a global cure rate of 73%.
Conclusion
FCH‐PET/CT is a promising tool in the challenging population of reoperative patients with pHPT. Parathyroid 4D‐CT appears as a confirmatory imaging modality.
Background
Accurate prostate zonal segmentation on magnetic resonance images (MRI) is a critical prerequisite for automated prostate cancer detection. We aimed to assess the variability of manual prostate zonal segmentation by radiologists on T2-weighted (T2W) images, and to study factors that may influence it.
Methods
Seven radiologists of varying levels of experience segmented the whole prostate gland (WG) and the transition zone (TZ) on 40 axial T2W prostate MRI images (3D T2W images for all patients, and both 3D and 2D images for a subgroup of 12 patients). Segmentation variabilities were evaluated based on: anatomical and morphological variation of the prostate (volume, retro-urethral lobe, intensity contrast between zones, presence of a PI-RADS ≥ 3 lesion), variation in image acquisition (3D vs 2D T2W images), and reader’s experience. Several metrics including Dice Score (DSC) and Hausdorff Distance were used to evaluate differences, with both a pairwise and a consensus (STAPLE reference) comparison.
Results
DSC was 0.92 (± 0.02) and 0.94 (± 0.03) for WG, 0.88 (± 0.05) and 0.91 (± 0.05) for TZ respectively with pairwise comparison and consensus reference. Variability was significantly (p < 0.05) lower for the mid-gland (DSC 0.95 (± 0.02)), higher for the apex (0.90 (± 0.06)) and the base (0.87 (± 0.06)), and higher for smaller prostates (p < 0.001) and when contrast between zones was low (p < 0.05). Impact of the other studied factors was non-significant.
Conclusions
Variability is higher in the extreme parts of the gland, is influenced by changes in prostate morphology (volume, zone intensity ratio), and is relatively unaffected by the radiologist’s level of expertise.
• MpMRI has the capability to detect PCa recurrence in post-HIFU monitoring. • The sensitivity of T2w and DWI for detecting PCa recurrence was not improved by DCE. • Readers with different degrees of experience did not improve their performance with DCE.
Prostate cancer histologic volume can be assessed using MREV or MROV with a good accuracy and low inter-observer variability. MTD has the lowest inter-observer variability and provides best degrees of correlation with MHD. MTD should be used on MRI for selecting and following patients for active surveillance and staging before focal treatment of prostate cancer.
The diagnostic contribution of 2D-Shear Wave Elastography (SWE) in superficial lymph nodes (LN) management of any origin was evaluated on 222 patients referred for needle core biopsy. Conventional B-mode/Doppler ultrasound examinations (Conv-US) and SWE were performed for each patient.Quantitative SWE parameters and qualitative SWE map features were extracted. Carcinomas were found significantly stiffer than benign LN (29.5±32.3 kPa versus 6.7±12.3 kPa). Lymphomas exhibited intermediate stiffness (11.4±5.2 kPa). Qualitative SWE analysis provided color patterns specific to histopathology (stiff rim, nodular and undetermined patterns related to malignancy and blue pattern to benignity). Adding SWE to Conv-US improved the sensitivity of LN diagnosis (from 81.1% to 92.0%) but decreased its specificity (from 73.2% to 67.6%) due to the high prevalence of lymphomas over carcinomas. Inter-observer agreement of quantitative SWE was good (ICC of 0.82). LN location and histology type were shown to influence the reported diagnostic performance of SWE.
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