IMPORTANCE Magnetic resonance imaging (MRI) with targeted biopsy is an appealing alternative to systematic 12-core transrectal ultrasonography (TRUS) biopsy for prostate cancer diagnosis, but has yet to be widely adopted.OBJECTIVE To determine whether MRI with only targeted biopsy was noninferior to systematic TRUS biopsies in the detection of International Society of Urological Pathology grade group (GG) 2 or greater prostate cancer. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, prospective randomized clinical trial was conducted in 5 Canadian academic health sciences centers between January 2017 and November 2019, and data were analyzed between January and March 2020. Participants included biopsy-naive men with a clinical suspicion of prostate cancer who were advised to undergo a prostate biopsy. Clinical suspicion was defined as a 5% or greater chance of GG2 or greater prostate cancer using the Prostate Cancer Prevention Trial Risk Calculator, version 2. Additional criteria were serum prostate-specific antigen levels of 20 ng/mL or less (to convert to micrograms per liter, multiply by 1) and no contraindication to MRI. INTERVENTIONS Magnetic resonance imaging-targeted biopsy (MRI-TB) only if a lesion with aProstate Imaging Reporting and Data System (PI-RADS), v 2.0, score of 3 or greater was identified vs 12-core systematic TRUS biopsy. MAIN OUTCOME AND MEASURESThe proportion of men with a diagnosis of GG2 or greater cancer. Secondary outcomes included the proportion who received a diagnosis of GG1 prostate cancer; GG3 or greater cancer; no significant cancer but subsequent positive MRI results and/or GG2 or greater cancer detected on a repeated biopsy by 2 years; and adverse events. RESULTSThe intention-to-treat population comprised 453 patients (367 [81.0%] White, 19 [4.2%] African Canadian, 32 [7.1%] Asian, and 10 [2.2%] Hispanic) who were randomized to undergo TRUS biopsy (226 [49.9%]) or ), of which 421 (93.0%) were evaluable per protocol. A lesion with a PI-RADS score of 3 or greater was detected in 138 of 221 men (62.4%) who underwent MRI, with 26 (12.1%), 82 (38.1%), and 30 (14.0%) having maximum PI-RADS scores of 3, 4, and 5, respectively. Eighty-three of 221 men who underwent MRI-TB (37%) had a negative MRI result and avoided biopsy. Cancers GG2 and greater were identified in 67 of 225 men (30%) who underwent TRUS biopsy vs 79 of 227 (35%) allocated to MRI-TB (absolute difference, 5%, 97.5% 1-sided CI, −3.4% to ϱ; noninferiority margin, −5%). Adverse events were less common in the MRI-TB arm. Grade group 1 cancer detection was reduced by more than half in the MRI arm (from 22% to 10%; risk difference, −11.6%; 95% CI, −18.2% to −4.9%).CONCLUSIONS AND RELEVANCE Magnetic resonance imaging followed by selected targeted biopsy is noninferior to initial systematic biopsy in men at risk for prostate cancer in detecting GG2 or greater cancers.

Low PMA is a marker of physical frailty associated with increased LOS in older adults undergoing cardiac surgical procedures. Further research is necessary to validate PMA as a prognostic marker and therapeutic target in this vulnerable population.

Thirty‐one high‐risk patients (16 to 35 weeks' gestation) underwent two‐dimensional and three‐dimensional ultrasonography to compare two‐dimensional and non‐cardiac‐gated three‐dimensional ultrasonography of the normal fetal heart. After normal two‐dimensional studies, three‐dimensional sonographic volumes were acquired without cardiac gating in transverse and longitudinal planes. Standard cardiac views were derived from three‐dimensional data, analyzed, and rated as follows: (1) not identifiable, (2) identifiable but inadequate for diagnosis, (3) adequate, and (4) excellent. Two‐dimensional ultrasonography demonstrated better yields of diagnostically acceptable images of basic echocardiographic views (four‐chamber view, 100% for two‐dimensional sonography versus 10 to 71% for three‐dimensional sonography; right ventricular outflow tract, 42% for two‐dimensional versus 6 to 26% for three‐dimensional ultrasonography; left ventricular outflow tract, 71% for two‐dimensional versus 13 to 45% for three‐dimensional sonography). In one subject three‐dimensional ultrasonography was superior to two‐dimensional sonography in demonstrating an outflow tract. Aortic and ductal arches were not imaged with the two‐dimensional technique but were available from the acquired three‐dimensional volumes in 3 to 32% and 23%, respectively. False‐positive and false‐negative findings were observed on three‐dimensional ultrasonograms. Overall, compared to two‐dimensional ultrasonography, non‐cardiac‐gated three‐dimensional sonography yielded inadequate reconstructed image quality of basic echocardiographic views (four‐chamber view, right ventricular outflow tract, left ventricular outflow tract). Three‐dimensional ultrasonography, however, shows potential for allowing nonechocardiographers to acquire some diagnostically acceptable views of the aortic and ductal arches.

BACKGROUND AND PURPOSE: Dual-energy CT is not used routinely for evaluation of the head and neck, and there is no consensus on the optimal virtual monochromatic image energies for evaluating normal tissues or head and neck cancer. We performed a quantitative evaluation to determine the optimal virtual monochromatic images for visualization of normal tissues, head and neck squamous cell carcinoma, and lymphadenopathy.

This study has shown that PMA is a marker of frailty associated with midterm survival in women who undergo TAVR. Further research is warranted to pursue PMA as a prognostic marker and therapeutic target in this vulnerable population.

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BACKGROUND AND PURPOSE:The attenuation of normal nonossified thyroid cartilage can be similar to that of head and neck squamous cell carcinoma on CT. We compared dual-energy CT spectral Hounsfield unit attenuation characteristics of nonossified thyroid cartilage with that of squamous cell carcinoma to determine the optimal virtual monochromatic image reconstruction energy levels for distinguishing tumor from normal nonossified thyroid cartilage.

The 40-keV VMIs improve tumor visibility objectively and subjectively both by head and neck specialists and general radiologists.