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CT TO SOFT TISSUE HISTOPATHOLOGY IN PROSTATE CANCER
Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011
THE JOURNAL OF UROLOGY姞
patient with symptoms but a normal preoperative T1/2, P40 provided valuable functional information both before and after surgical correction. Source of Funding: None
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2308 INVESTIGATION OF THE MORPHOLOGICAL CHANGES IN PENILE ERECTION AND PENILE ARTERIAL INFLOW USING TURBO-FLASH MRI Jintetsu Soh*, Yoshio Naya, Atsushi Ochiai, Yasuyuki Naitoh, Noriyuki Kanemitsu, Kazumi Kamoi, kawauchi Akihiro, tsuneharu Miki, Kyoto, Japan
2307 CORRELATION OF INDIUM-111 CAPROMAB PENDETIDE SPECT/CT TO SOFT TISSUE HISTOPATHOLOGY IN PROSTATE CANCER William Rieter*, Samuel Deem, Leonie Gordon, Thomas Keane, Charleston, SC INTRODUCTION AND OBJECTIVES: Indium-111 capromab pendetide SPECT/CT has become an increasingly important tool in the management of prostate cancer on account of its ability to accurately detect soft tissue metastases. Yet, only a few studies have been published regarding its diagnostic role in localized disease. In order to gain a more comprehensive understanding of its absolute utility, we have determined the diagnostic performance of In-111 capromab pendetide in associated soft tissues via correlation to a gold standard of histopathology. METHODS: In this retrospective study, all In-111 capromab pendetide SPECT/CT scans acquired at our institution were reviewed for dedicated histopathology within a four-month period. Statistical measures of performance were calculated in terms of glandular, seminal vesicle and lymph node activity. The accuracies of glandular and seminal vesicle activity were then correlated to the indices of risk and treatment history. RESULTS: A total of 200 scans met the criteria of our study. Of them, 197 had prostate gland histopathology and 94 had bilateral seminal vesicle histopathology for comparison. An additional five scans had a total of 43 lymph nodes for comparison. The statistical measures of performance are summarized in Table 1. For glandular activity alone, scan accuracy was found to significantly improve with increasing Gleason score (p⬍0.0001). The scans demonstrating discordant results were broadly associated with low to intermediate grade tumors. Furthermore, the glandular scan accuracy was significantly increased in setting prior to treatment (91%, p⫽0.0005). After treatment the accuracies ranged from 54.5-66.7%. No statistically significant differences were found between the groups with regards to seminal vesicle activity. CONCLUSIONS: The results of this study further validate the role of In-111 capromab pendetide in diagnosing lymph node metastases from primary cancers of the prostate, but also demonstrate the test may have limited utility in diagnosing tumors within the seminal vesicles. In terms of glandular activity, further studies are needed regarding its utility for noninvasive grading of primary tumors, and as a component in clinical management algorithms. TABLE 1. Statistical measures of performance for capromab when compared against histopathology. Seminal Prostate Gland Vesicles Lymph Nodes Sensitivity 89.6 (85-94.3) 17.5 (7.3-32.8) 60.0 (14.7-94.7) Specificity
18.2 (5.0-31.3)
80.4 (74.0-86.8)
97.4 (92.3-100)
Accuracy
77.7 (71.9-83.5)
67.0 (60.3-73.7)
93.0 (85.4-100)
PPV
84.5 (79.1-89.9)
19.4 (6.5-32.4)
75.0 (19.4-99.4)
NPV
26.1 (8.1-44.0)
78.3 (71.7-84.8)
94.9 (88.0-100)
PLR
1.10
0.89
22.80
NLR
0.57
1.03
0.41
PPV ⫽ positive predictive value; NPV ⫽ negative predictive value; PLR ⫽ positive likelihood ratio ⫽ sensitivity / (1-specificity); NLR ⫽ negative likelihood ratio ⫽ (1-sensitivity) / specificity; Confidence intervals are denoted by parentheses.
Source of Funding: None
INTRODUCTION AND OBJECTIVES: To date, there are no reports concerning real-time imaging analysis of penile erection from the beginning to complete erection, and from sustained erection till the end of erection. The objectives of this study were to observe the morphological changes in normal penile erection chronologically from the beginning to complete erection, and till the end of erection, and to evaluate the required penile arterial inflow for normal erection, using Turbo-FLASH magnetic resonance imaging (MRI) by taking continuous high resolution images without stopping movement for real-time imaging analysis. METHODS: The study subjects were 10 volunteers aged 22 to 47 years (median: 31 years) who gave written informed consents. Erection was induced by visual arousal stimulation using videos. Imaging devices and their conditions: (1) MRI: MAGNETOM Sonata 1.5T, Siemens AG; (2) Coil: Body Array Coil and Spine Coil; (3) Imaging sequence: True FISP sequence; and (4) Imaging conditions: Repetition Time (TR): 4.38 milliseconds, Echo Time (TE): 2.19 milliseconds, Scan Time: 0.85 seconds/slice. Morphological analysis: Using static images and dynamic images, the extensions of caverns of the corpora cavernosa and tunica albuginea were analyzed to evaluate the morphological changes of normal penile erection chronologically under MRI observation (Figure 1). Evaluation of arterial blood inflow into corpora cavernosa: The area and volume change ratios of the corpora cavernosa, such as volume change in 1 second, were evaluated. RESULTS: The duration from the beginning to complete erection ranged from 110 to 120 seconds (median: 116 seconds) in 5 volunteers who achieved complete erection. The volume changes in the corpora cavernosa from baseline and the maximum change ratio in 1 second ranged from 28 to 35 mL (median: 32 mL), and from 0.5 to 0.8 mL/sec (median: 0.6 mL/sec), respectively (Figure 2). On the other hand, in the other 5 volunteers with incomplete erection, the volume changes in the corpora cavernosa from baseline and the maximum change ratio in 1 second ranged from 5 to 17 mL (median: 12 mL), and from 0.1 to 0.3 mL/sec (median: 0.2 mL/sec), respectively. CONCLUSIONS: Using Turbo-FLASH MRI, real-time imaging analysis of the erectile function was performed, which enabled to evaluate the duration from the beginning to complete erection, the required arterial blood inflow into the corpora cavernosa for complete erection and the volume change ratio in 1 second.
THE JOURNAL OF UROLOGY姞
patient with symptoms but a normal preoperative T1/2, P40 provided valuable functional information both before and after surgical correction. Source of Funding: None
e925
2308 INVESTIGATION OF THE MORPHOLOGICAL CHANGES IN PENILE ERECTION AND PENILE ARTERIAL INFLOW USING TURBO-FLASH MRI Jintetsu Soh*, Yoshio Naya, Atsushi Ochiai, Yasuyuki Naitoh, Noriyuki Kanemitsu, Kazumi Kamoi, kawauchi Akihiro, tsuneharu Miki, Kyoto, Japan
2307 CORRELATION OF INDIUM-111 CAPROMAB PENDETIDE SPECT/CT TO SOFT TISSUE HISTOPATHOLOGY IN PROSTATE CANCER William Rieter*, Samuel Deem, Leonie Gordon, Thomas Keane, Charleston, SC INTRODUCTION AND OBJECTIVES: Indium-111 capromab pendetide SPECT/CT has become an increasingly important tool in the management of prostate cancer on account of its ability to accurately detect soft tissue metastases. Yet, only a few studies have been published regarding its diagnostic role in localized disease. In order to gain a more comprehensive understanding of its absolute utility, we have determined the diagnostic performance of In-111 capromab pendetide in associated soft tissues via correlation to a gold standard of histopathology. METHODS: In this retrospective study, all In-111 capromab pendetide SPECT/CT scans acquired at our institution were reviewed for dedicated histopathology within a four-month period. Statistical measures of performance were calculated in terms of glandular, seminal vesicle and lymph node activity. The accuracies of glandular and seminal vesicle activity were then correlated to the indices of risk and treatment history. RESULTS: A total of 200 scans met the criteria of our study. Of them, 197 had prostate gland histopathology and 94 had bilateral seminal vesicle histopathology for comparison. An additional five scans had a total of 43 lymph nodes for comparison. The statistical measures of performance are summarized in Table 1. For glandular activity alone, scan accuracy was found to significantly improve with increasing Gleason score (p⬍0.0001). The scans demonstrating discordant results were broadly associated with low to intermediate grade tumors. Furthermore, the glandular scan accuracy was significantly increased in setting prior to treatment (91%, p⫽0.0005). After treatment the accuracies ranged from 54.5-66.7%. No statistically significant differences were found between the groups with regards to seminal vesicle activity. CONCLUSIONS: The results of this study further validate the role of In-111 capromab pendetide in diagnosing lymph node metastases from primary cancers of the prostate, but also demonstrate the test may have limited utility in diagnosing tumors within the seminal vesicles. In terms of glandular activity, further studies are needed regarding its utility for noninvasive grading of primary tumors, and as a component in clinical management algorithms. TABLE 1. Statistical measures of performance for capromab when compared against histopathology. Seminal Prostate Gland Vesicles Lymph Nodes Sensitivity 89.6 (85-94.3) 17.5 (7.3-32.8) 60.0 (14.7-94.7) Specificity
18.2 (5.0-31.3)
80.4 (74.0-86.8)
97.4 (92.3-100)
Accuracy
77.7 (71.9-83.5)
67.0 (60.3-73.7)
93.0 (85.4-100)
PPV
84.5 (79.1-89.9)
19.4 (6.5-32.4)
75.0 (19.4-99.4)
NPV
26.1 (8.1-44.0)
78.3 (71.7-84.8)
94.9 (88.0-100)
PLR
1.10
0.89
22.80
NLR
0.57
1.03
0.41
PPV ⫽ positive predictive value; NPV ⫽ negative predictive value; PLR ⫽ positive likelihood ratio ⫽ sensitivity / (1-specificity); NLR ⫽ negative likelihood ratio ⫽ (1-sensitivity) / specificity; Confidence intervals are denoted by parentheses.
Source of Funding: None
INTRODUCTION AND OBJECTIVES: To date, there are no reports concerning real-time imaging analysis of penile erection from the beginning to complete erection, and from sustained erection till the end of erection. The objectives of this study were to observe the morphological changes in normal penile erection chronologically from the beginning to complete erection, and till the end of erection, and to evaluate the required penile arterial inflow for normal erection, using Turbo-FLASH magnetic resonance imaging (MRI) by taking continuous high resolution images without stopping movement for real-time imaging analysis. METHODS: The study subjects were 10 volunteers aged 22 to 47 years (median: 31 years) who gave written informed consents. Erection was induced by visual arousal stimulation using videos. Imaging devices and their conditions: (1) MRI: MAGNETOM Sonata 1.5T, Siemens AG; (2) Coil: Body Array Coil and Spine Coil; (3) Imaging sequence: True FISP sequence; and (4) Imaging conditions: Repetition Time (TR): 4.38 milliseconds, Echo Time (TE): 2.19 milliseconds, Scan Time: 0.85 seconds/slice. Morphological analysis: Using static images and dynamic images, the extensions of caverns of the corpora cavernosa and tunica albuginea were analyzed to evaluate the morphological changes of normal penile erection chronologically under MRI observation (Figure 1). Evaluation of arterial blood inflow into corpora cavernosa: The area and volume change ratios of the corpora cavernosa, such as volume change in 1 second, were evaluated. RESULTS: The duration from the beginning to complete erection ranged from 110 to 120 seconds (median: 116 seconds) in 5 volunteers who achieved complete erection. The volume changes in the corpora cavernosa from baseline and the maximum change ratio in 1 second ranged from 28 to 35 mL (median: 32 mL), and from 0.5 to 0.8 mL/sec (median: 0.6 mL/sec), respectively (Figure 2). On the other hand, in the other 5 volunteers with incomplete erection, the volume changes in the corpora cavernosa from baseline and the maximum change ratio in 1 second ranged from 5 to 17 mL (median: 12 mL), and from 0.1 to 0.3 mL/sec (median: 0.2 mL/sec), respectively. CONCLUSIONS: Using Turbo-FLASH MRI, real-time imaging analysis of the erectile function was performed, which enabled to evaluate the duration from the beginning to complete erection, the required arterial blood inflow into the corpora cavernosa for complete erection and the volume change ratio in 1 second.