- Email: [email protected]
Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary?
374
Abstracts / Clinical Imaging 30 (2006) 372 – 375
( P =.005). MnDPDP-enhanced MRI appeared to be more accurate than unenhanced MRI, but this was not significant ( P =.059). The sensitivity of CT was 48.4% versus 58.1% for unenhanced MRI ( P = .083) and 66.1% for MnDPDP-enhanced MRI ( P =.004). The difference in specificity between procedures was not significant. The per-lesion sensitivity was 71.7%, 74.9%, and 82.7% for CT, unenhanced MRI, and MnDPDP-enhanced MRI, respectively; the positive predictive value of the procedures was 84.0%, 96.0%, and 95.8%, respectively. MnDPDP-enhanced MRI provided a highlevel diagnostic confidence in 92.5% of the cases versus 82.5% for both unenhanced MRI and CT. The kappa value for interobserver variability was N.75 for all procedures. Conclusions: The diagnostic accuracy and sensitivity of MnDPDPenhanced MRI are significantly higher than single section spiral CT in the detection of colorectal cancer liver metastases; no significant difference in diagnostic accuracy was observed between unenhanced MRI and MnDPDP-enhanced MRI. n 2006 The Royal College of Radiologists. Reprinted with permission.
The incidence of hepatic pseudolesions caused by focal rib compression as seen on multidetector row CT in patients of different hepatic function Nishie A, Yoshimitsu K, Hiroyuki I, Aibe H, Tajima T, Asayama Y, Matake K, Ishicami K, Nakayama T, Kakihara D, Honda H (Department of Clinical Radiology, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582, Japan). Eur J Radiol 2006;57: 108 – 114. Objective: This study aimed to determine whether the incidence of pseudolesions of the liver caused by rib compression is correlated with liver function. Materials and methods: Multidetector row CT images of 150 consecutive cases were evaluated for the presence of pseudolesions caused by rib compression. Liver function was categorized into two groups, mainly using the Child–Pugh classification: Group I—normal liver function and Grade A; Group II—Grades B and C. The number of focal deformities of the liver caused by rib compression was also counted. The incidence of pseudolesions based on number of patients or focal deformities of liver parenchyma by rib compression were compared between the two groups. Results: There were 108 and 42 patients in Groups I and II, respectively; 169 and 41 focal deformities of the liver caused by rib compression were found in Groups I and II, respectively. Patient-based and deformity-based incidences of pseudolesions were 10.7% (16/150) and 7.6% (16/210), respectively. All pseudolesions were seen in patients of Group I. Both patient-based and deformity-based incidences of pseudolesions were significantly higher in Group I as compared with those in Group II. Conclusion: Pseudolesions of the liver caused by focal rib compression may be seen more frequently in patients with preserved liver function than in those with impaired function.
Multidetector-row CT of renal arteries: review of the performances in normo- and hypertensive patients Coulier B (Department of Diagnostic Imaging, Clinique St Luc, Rue St Luc 8, B-5004 Bouge (Namur), Belgium). J Belge Radiol 2006;88:311– 321. Objective: This study aimed to justify and illustrate the advantages of multidetector-row CT (MDCT) as probably the most effective method for imaging renal arteries and to debate the question of multiple renal arteries. Methods and materials: The renal arteries of 158 hypertensive patients were investigated with 8-row and 16-row MDCT using a highly standardized protocol; the results were compared with those obtained in a group of 112 normotensive patients. Results: MDCT of the renal arteries was found technically safely interpretable in 97.4% of cases. Fibromuscular dysplasia was found in 7/156 hypertensive patients (4.66%) concerning 9 arteries (2.18%),
and N50% atherosclerotic stenosis (in terms of reduction of the crosssectional area) was found in 11/156 patients (7%) concerning 14 arteries (3.4%). Accessory renal arteries were found in 66/156 hypertensive patients (42.3%), implicating 84 kidneys (27%), and in 50/112 patients (44.6%) of the normotensive group, implicating 67 kidneys (29.9%). Conclusion: With a good protocol, MDCT of the renal arteries is technically interpretable in most patients and can safely rule out atherosclerotic stenosis and/or fibromuscular dysplasia. The systematic cine-review of the native millimetric reconstructions and volume rendering images are the most recommended methods. Direct axial MPR views of the arterial lumen are also possible, permitting a precise calculation of the percentage of stenosis from the cross-sectional area of the artery, an advantage on DSA in cases of asymmetrical stenosis. Finally, a very high prevalence of multiple renal arteries — the highest ever reported to our knowledge — is found, and the prevalence appears similar in both hypertensive and normotensive groups; this high prevalence not only confirms and emphasizes the very high sensibility and resolution of MDCT but also definitively disproves the hypothesis that multiple renal arteries could predispose to hypertension.
A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer Heijmink SWTPJ, van Moerkerk H, Kiemeney LALM, Witjes JA, Frauscher F, Barentsz JO (Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein zui 10, NL-6500 HB Nijmegen, The Netherlands). Eur Radiol 2006;16:927 – 938. Transrectal ultrasound (TRUS) is an important tool for urologists and radiologists in the detection of prostate cancer. Various TRUS-guided biopsy techniques are applied in clinical practice. Frequently, only the detection rates achieved with these methods are compared. Other diagnostic performance parameters, particularly the specificity and negative predictive value, are seldom compared. After extensive assessment of the available literature, this review describes the methods of TRUS-guided biopsy for prostate cancer detection. A distinction was made between systematic biopsies and biopsies that target a perceived (hypoechoic or Dopplerenhancing) lesion on imaging. Subsequently, the diagnostic performance (sensitivity, specificity, positive and negative predictive values, and accuracies) was compared between these techniques. Imaging-guided biopsy showed better diagnostic performance than systematic biopsy with higher sensitivity. The combinations of sensitivity and specificity were highest for color Doppler and contrast-enhanced targeted biopsy. Studies targeting hypoechoic lesions had relatively high sensitivity, but specificity was low. Presently, however, with widespread prostate-specific antigen screening, fewer prostate cancers are hypoechoic, and the value of targeting hypoechoic lesions has diminished. Performing color or contrast-enhanced Doppler biopsy or adding these techniques to systematic biopsies improves diagnostic performance, particularly by increasing sensitivity.
Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary? Puig J, Darnell A, Bermu´dez P, Malet A, Serrate G, Bare´ M, Prats J (Diagnostic Imaging Department, UDIAT CD, Institut Universitari, Fundacio´ Parc Tauli, Corporacio´ Sanita´ria Parc Tauli, Parc Tauli s/n E08208 Barcelona, Spain). Eur Radiol 2006;16:939 – 943. The aim of this study was to assess infectious complications in transrectal ultrasound-guided prostate biopsy (TRUSPB), comparing two groups of patients: one group with antibiotic prophylaxis and the other without prophylaxis. A total of 1018 TRUSPBs were performed from April 1996 to July 2003. No antibiotic prophylaxis was given in the first 614; the remaining 404 procedures were performed under antibiotic prophylaxis. Biopsy complications were assessed at outpatient urologist visits after the procedure in the 212 first biopsies and by telephone interview in the remaining 806. A total of 78 infectious complications were found. Major
Abstracts / Clinical Imaging 30 (2006) 372 – 375 infectious complications (n = 41) were septic shock (n = 3), sepsis (n = 3), Fournier gangrene (n = 1), urinary tract infection (n = 2), and fever requiring hospital admission (n = 32). Minor infectious complications were fever that did not require admission (n = 29), prostatitis (n = 6), and epididymitis (n = 2). Infectious complications occurred in 63 of 614 (10.3%) procedures without antibiotic prophylaxis and in 15 of 404 (3.7%) of those with antibiotic prophylaxis ( P =.0001). Of the 41 major infectious complications, 31 (75.6%) occurred in procedures without antibiotic prophylaxis (n = 583) versus 10 (24.4%) in those with prophylaxis (n = 394; P =.0410). In conclusion, transrectal ultrasound-guided biopsy of the prostate has a statistically significant higher risk of infectious complications when performed without antibiotic prophylaxis.
CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures Vogl TJ, Proschek D, Mack M, Hochmuth K (Department of Diagnostic and Interventional Radiology, University of Frankfurt, Theodor-Stern-Kai 7, D-60596 Frankfurt am Main, Germany). Eur Radiol 2006;16:797–803. The purpose of this study was to determine the efficacy and safety of CT-guided percutaneous vertebroplasty in the treatment of vertebral compression fractures. The primary objectives were pain reduction and bone-cement leakage during a long-term follow-up in patients with osteoporotic vertebral compression fractures. CT-guided percutaneous vertebroplasty was carried out in 61 patients (mean age, 71.4 years; range, 42–83; female ratio, 73.8%) with vertebral compression fractures. Treatment was carried out on an outpatient basis. Pain, bone-cement leakage, and complications were monitored and recorded. The mean follow-up time was 19.8 months (range, 3–52). Paired comparison procedures were used for the analysis of the results, which showed that all patients had a significant reduction of pain. The mean visual analogue scale (VAS) score before treatment was 8.8 points (range, 6.5–9.8 points). The mean VAS score after treatment was significantly reduced to 2.6 points (range, 1.5 – 4.1 points; Pb.01). No clinical or neurological complications were documented. Minor and asymptomatic bone-cement leakage was observed in 54% of the cases. Percutaneous vertebroplasty is an efficient and safe interventional procedure that rapidly improves the mobility and quality of life of patients with vertebral compression fractures. CT guidance is a reasonable upgrade in the treatment procedure, which reduces the amount of bone-cement leakage.
Diffusion-weighted MRI of the spine tumors [in French] Lasbleiz J, Askri A, Le Duff F, Decaux O, Marin F, Duvauferrier R (De´partment de Radiologie et d’Imagerie Me´dicale, Ho´pital Sud, BP 90347, F-35203 Rennes cedex 2, France). J Radiol 2006;87:480. Purpose: This study aimed to evaluate the contribution of diffusionweighted MR imaging in malignant spine pathology. Materials and methods: Between February 2004 and January 2005, 49 patients (43 to 86 years old) were included. Three groups were made: osteoporotic collapses (n = 13), malignant collapses (n = 15), and malignant spine lesions (n = 21). The MRI (Symphony 1.5 T) allowed SENSE imaging. After conventional MRI examination (T1, T2 fat sat, T1 with Gadolinium), all patients underwent diffusion-weighted imaging (Spin Echo) with variable b values: 0, 250, 500, 750, and 1000. The diffusion sequence lasted 2 min 29 s. The Apparent Diffusion Coefficient (ADC) was calculated automatically. The analysis was qualitative (signal study b =1000 mm2/s) and quantitative (ADC measurement). Results: The image quality was good except for some cervical examinations. Qualitative analysis did not show a difference between benign and malignant lesions. Quantitative results are malignant spine lesion (mean ADC= 0.82610 3 s/mm2), malignant spinal collapses (mean ADC=0.91210 3 s/mm2), and benign spinal collapses (mean ADC=1.49710 3 s/mm2).
375
There were overlapping results between benign and malignant lesion. The statistical study showed a significant difference (t test with Pb1/10,000). For an ADC threshold value of 1.089 (malignant lesion ADCb1.089), ROC curve showed a specificity of 80% and a sensitivity of 83.3%. Conclusion: Performing diffusion-weighted imaging of the spine is easy with new MR technology. The ADC measurement of spine lesion provides important additional information but does not serve as a substitute for the routine MRI sequences. In the future, it could become an important point in this difficult diagnosis.
Radiofrequency ablation of chondroblastoma using a multi-tined expandable electrode system: initial results Tins B, Cassar-Pullicino V, McCall I, Cool P, Williams D, Mangham D (Department of Radiology, RJAH Orthopaedic and District Hospital, Oswestry, SY10 7AG, UK). Eur Radiol 2006;16:804–810. The standard treatment for chondroblastoma is surgery, which can be difficult and disabling due to its apo- or epiphyseal location. Radiofrequency (RF) ablation potentially offers a minimally invasive alternative. The often large size of chondroblastomas can make treatment with plain electrode systems difficult or impossible. This article describes the preliminary experience of RF treatment of chondroblastomas with a multi-tined expandable RF electrode system. Four cases of CT-guided RF treatment are described. The tumor was successfully treated in all but two cases, wherein complications occurred: infraction of a subarticular chondroblastoma in one case and cartilage and bone damage in the unaffected compartment of a knee joint in the other. RF treatment near a joint surface threatens the integrity of cartilage and, therefore, long-term joint function. In weight-bearing areas, the lack of bone replacement in successfully treated lesions contributes to the risk of mechanical failure. Multi-tined expandable electrode systems allow the treatment of large chondroblastomas. In weightbearing joints and lesions near the articular cartilage, there is a risk of cartilage damage and mechanical weakening of the bone. In lesions without these caveats, RF ablation appears promising. The potential risks and benefits need to be evaluated for each case individually.
Radiological assessment of bone segments for transplantation: experience at Rizzoli Orthopedic Institute Tetta C *, Taddia N, Poli T, Quinto C, Fornasari PM, Albisinni U. Eur J Radiol 2006;57:115–118. Aim: This study aimed to analyze results obtained from radiological assessment of skeletal segments stored in the musculoskeletal tissue bank at Rizzoli Orthopedic Institute. Materials and methods: Between January 1997 and June 2003, 891 bone segments underwent radiographic examination in two views. Two hundred thirteen of these segments were examined by a radiologist between July 2002 and June 2003. Diagnostic evaluation was aimed at recognizing relevant degenerative, traumatic, and focal lesions. Focal lesions underwent histological tests. Results: Twenty-two lytic lesions were found in 12 segments. Ten of these were studied between July 2002 and June 2003 and two in the period before specialist radiological assessment. In the latter cases, the lesions were identified by the orthopedic specialist who had examined the X-rays before planning surgery. Histological tests showed that the bone tissue was normal or involved in degenerative phenomena. Conclusions: We think that donor screening should include radiological assessment of bone segments, performed according to standard parameters by a radiologist to identify bone lesions that may jeopardize the successful outcome of surgery.
* E-mail address: [email protected].
Abstracts / Clinical Imaging 30 (2006) 372 – 375
( P =.005). MnDPDP-enhanced MRI appeared to be more accurate than unenhanced MRI, but this was not significant ( P =.059). The sensitivity of CT was 48.4% versus 58.1% for unenhanced MRI ( P = .083) and 66.1% for MnDPDP-enhanced MRI ( P =.004). The difference in specificity between procedures was not significant. The per-lesion sensitivity was 71.7%, 74.9%, and 82.7% for CT, unenhanced MRI, and MnDPDP-enhanced MRI, respectively; the positive predictive value of the procedures was 84.0%, 96.0%, and 95.8%, respectively. MnDPDP-enhanced MRI provided a highlevel diagnostic confidence in 92.5% of the cases versus 82.5% for both unenhanced MRI and CT. The kappa value for interobserver variability was N.75 for all procedures. Conclusions: The diagnostic accuracy and sensitivity of MnDPDPenhanced MRI are significantly higher than single section spiral CT in the detection of colorectal cancer liver metastases; no significant difference in diagnostic accuracy was observed between unenhanced MRI and MnDPDP-enhanced MRI. n 2006 The Royal College of Radiologists. Reprinted with permission.
The incidence of hepatic pseudolesions caused by focal rib compression as seen on multidetector row CT in patients of different hepatic function Nishie A, Yoshimitsu K, Hiroyuki I, Aibe H, Tajima T, Asayama Y, Matake K, Ishicami K, Nakayama T, Kakihara D, Honda H (Department of Clinical Radiology, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582, Japan). Eur J Radiol 2006;57: 108 – 114. Objective: This study aimed to determine whether the incidence of pseudolesions of the liver caused by rib compression is correlated with liver function. Materials and methods: Multidetector row CT images of 150 consecutive cases were evaluated for the presence of pseudolesions caused by rib compression. Liver function was categorized into two groups, mainly using the Child–Pugh classification: Group I—normal liver function and Grade A; Group II—Grades B and C. The number of focal deformities of the liver caused by rib compression was also counted. The incidence of pseudolesions based on number of patients or focal deformities of liver parenchyma by rib compression were compared between the two groups. Results: There were 108 and 42 patients in Groups I and II, respectively; 169 and 41 focal deformities of the liver caused by rib compression were found in Groups I and II, respectively. Patient-based and deformity-based incidences of pseudolesions were 10.7% (16/150) and 7.6% (16/210), respectively. All pseudolesions were seen in patients of Group I. Both patient-based and deformity-based incidences of pseudolesions were significantly higher in Group I as compared with those in Group II. Conclusion: Pseudolesions of the liver caused by focal rib compression may be seen more frequently in patients with preserved liver function than in those with impaired function.
Multidetector-row CT of renal arteries: review of the performances in normo- and hypertensive patients Coulier B (Department of Diagnostic Imaging, Clinique St Luc, Rue St Luc 8, B-5004 Bouge (Namur), Belgium). J Belge Radiol 2006;88:311– 321. Objective: This study aimed to justify and illustrate the advantages of multidetector-row CT (MDCT) as probably the most effective method for imaging renal arteries and to debate the question of multiple renal arteries. Methods and materials: The renal arteries of 158 hypertensive patients were investigated with 8-row and 16-row MDCT using a highly standardized protocol; the results were compared with those obtained in a group of 112 normotensive patients. Results: MDCT of the renal arteries was found technically safely interpretable in 97.4% of cases. Fibromuscular dysplasia was found in 7/156 hypertensive patients (4.66%) concerning 9 arteries (2.18%),
and N50% atherosclerotic stenosis (in terms of reduction of the crosssectional area) was found in 11/156 patients (7%) concerning 14 arteries (3.4%). Accessory renal arteries were found in 66/156 hypertensive patients (42.3%), implicating 84 kidneys (27%), and in 50/112 patients (44.6%) of the normotensive group, implicating 67 kidneys (29.9%). Conclusion: With a good protocol, MDCT of the renal arteries is technically interpretable in most patients and can safely rule out atherosclerotic stenosis and/or fibromuscular dysplasia. The systematic cine-review of the native millimetric reconstructions and volume rendering images are the most recommended methods. Direct axial MPR views of the arterial lumen are also possible, permitting a precise calculation of the percentage of stenosis from the cross-sectional area of the artery, an advantage on DSA in cases of asymmetrical stenosis. Finally, a very high prevalence of multiple renal arteries — the highest ever reported to our knowledge — is found, and the prevalence appears similar in both hypertensive and normotensive groups; this high prevalence not only confirms and emphasizes the very high sensibility and resolution of MDCT but also definitively disproves the hypothesis that multiple renal arteries could predispose to hypertension.
A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer Heijmink SWTPJ, van Moerkerk H, Kiemeney LALM, Witjes JA, Frauscher F, Barentsz JO (Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein zui 10, NL-6500 HB Nijmegen, The Netherlands). Eur Radiol 2006;16:927 – 938. Transrectal ultrasound (TRUS) is an important tool for urologists and radiologists in the detection of prostate cancer. Various TRUS-guided biopsy techniques are applied in clinical practice. Frequently, only the detection rates achieved with these methods are compared. Other diagnostic performance parameters, particularly the specificity and negative predictive value, are seldom compared. After extensive assessment of the available literature, this review describes the methods of TRUS-guided biopsy for prostate cancer detection. A distinction was made between systematic biopsies and biopsies that target a perceived (hypoechoic or Dopplerenhancing) lesion on imaging. Subsequently, the diagnostic performance (sensitivity, specificity, positive and negative predictive values, and accuracies) was compared between these techniques. Imaging-guided biopsy showed better diagnostic performance than systematic biopsy with higher sensitivity. The combinations of sensitivity and specificity were highest for color Doppler and contrast-enhanced targeted biopsy. Studies targeting hypoechoic lesions had relatively high sensitivity, but specificity was low. Presently, however, with widespread prostate-specific antigen screening, fewer prostate cancers are hypoechoic, and the value of targeting hypoechoic lesions has diminished. Performing color or contrast-enhanced Doppler biopsy or adding these techniques to systematic biopsies improves diagnostic performance, particularly by increasing sensitivity.
Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary? Puig J, Darnell A, Bermu´dez P, Malet A, Serrate G, Bare´ M, Prats J (Diagnostic Imaging Department, UDIAT CD, Institut Universitari, Fundacio´ Parc Tauli, Corporacio´ Sanita´ria Parc Tauli, Parc Tauli s/n E08208 Barcelona, Spain). Eur Radiol 2006;16:939 – 943. The aim of this study was to assess infectious complications in transrectal ultrasound-guided prostate biopsy (TRUSPB), comparing two groups of patients: one group with antibiotic prophylaxis and the other without prophylaxis. A total of 1018 TRUSPBs were performed from April 1996 to July 2003. No antibiotic prophylaxis was given in the first 614; the remaining 404 procedures were performed under antibiotic prophylaxis. Biopsy complications were assessed at outpatient urologist visits after the procedure in the 212 first biopsies and by telephone interview in the remaining 806. A total of 78 infectious complications were found. Major
Abstracts / Clinical Imaging 30 (2006) 372 – 375 infectious complications (n = 41) were septic shock (n = 3), sepsis (n = 3), Fournier gangrene (n = 1), urinary tract infection (n = 2), and fever requiring hospital admission (n = 32). Minor infectious complications were fever that did not require admission (n = 29), prostatitis (n = 6), and epididymitis (n = 2). Infectious complications occurred in 63 of 614 (10.3%) procedures without antibiotic prophylaxis and in 15 of 404 (3.7%) of those with antibiotic prophylaxis ( P =.0001). Of the 41 major infectious complications, 31 (75.6%) occurred in procedures without antibiotic prophylaxis (n = 583) versus 10 (24.4%) in those with prophylaxis (n = 394; P =.0410). In conclusion, transrectal ultrasound-guided biopsy of the prostate has a statistically significant higher risk of infectious complications when performed without antibiotic prophylaxis.
CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures Vogl TJ, Proschek D, Mack M, Hochmuth K (Department of Diagnostic and Interventional Radiology, University of Frankfurt, Theodor-Stern-Kai 7, D-60596 Frankfurt am Main, Germany). Eur Radiol 2006;16:797–803. The purpose of this study was to determine the efficacy and safety of CT-guided percutaneous vertebroplasty in the treatment of vertebral compression fractures. The primary objectives were pain reduction and bone-cement leakage during a long-term follow-up in patients with osteoporotic vertebral compression fractures. CT-guided percutaneous vertebroplasty was carried out in 61 patients (mean age, 71.4 years; range, 42–83; female ratio, 73.8%) with vertebral compression fractures. Treatment was carried out on an outpatient basis. Pain, bone-cement leakage, and complications were monitored and recorded. The mean follow-up time was 19.8 months (range, 3–52). Paired comparison procedures were used for the analysis of the results, which showed that all patients had a significant reduction of pain. The mean visual analogue scale (VAS) score before treatment was 8.8 points (range, 6.5–9.8 points). The mean VAS score after treatment was significantly reduced to 2.6 points (range, 1.5 – 4.1 points; Pb.01). No clinical or neurological complications were documented. Minor and asymptomatic bone-cement leakage was observed in 54% of the cases. Percutaneous vertebroplasty is an efficient and safe interventional procedure that rapidly improves the mobility and quality of life of patients with vertebral compression fractures. CT guidance is a reasonable upgrade in the treatment procedure, which reduces the amount of bone-cement leakage.
Diffusion-weighted MRI of the spine tumors [in French] Lasbleiz J, Askri A, Le Duff F, Decaux O, Marin F, Duvauferrier R (De´partment de Radiologie et d’Imagerie Me´dicale, Ho´pital Sud, BP 90347, F-35203 Rennes cedex 2, France). J Radiol 2006;87:480. Purpose: This study aimed to evaluate the contribution of diffusionweighted MR imaging in malignant spine pathology. Materials and methods: Between February 2004 and January 2005, 49 patients (43 to 86 years old) were included. Three groups were made: osteoporotic collapses (n = 13), malignant collapses (n = 15), and malignant spine lesions (n = 21). The MRI (Symphony 1.5 T) allowed SENSE imaging. After conventional MRI examination (T1, T2 fat sat, T1 with Gadolinium), all patients underwent diffusion-weighted imaging (Spin Echo) with variable b values: 0, 250, 500, 750, and 1000. The diffusion sequence lasted 2 min 29 s. The Apparent Diffusion Coefficient (ADC) was calculated automatically. The analysis was qualitative (signal study b =1000 mm2/s) and quantitative (ADC measurement). Results: The image quality was good except for some cervical examinations. Qualitative analysis did not show a difference between benign and malignant lesions. Quantitative results are malignant spine lesion (mean ADC= 0.82610 3 s/mm2), malignant spinal collapses (mean ADC=0.91210 3 s/mm2), and benign spinal collapses (mean ADC=1.49710 3 s/mm2).
375
There were overlapping results between benign and malignant lesion. The statistical study showed a significant difference (t test with Pb1/10,000). For an ADC threshold value of 1.089 (malignant lesion ADCb1.089), ROC curve showed a specificity of 80% and a sensitivity of 83.3%. Conclusion: Performing diffusion-weighted imaging of the spine is easy with new MR technology. The ADC measurement of spine lesion provides important additional information but does not serve as a substitute for the routine MRI sequences. In the future, it could become an important point in this difficult diagnosis.
Radiofrequency ablation of chondroblastoma using a multi-tined expandable electrode system: initial results Tins B, Cassar-Pullicino V, McCall I, Cool P, Williams D, Mangham D (Department of Radiology, RJAH Orthopaedic and District Hospital, Oswestry, SY10 7AG, UK). Eur Radiol 2006;16:804–810. The standard treatment for chondroblastoma is surgery, which can be difficult and disabling due to its apo- or epiphyseal location. Radiofrequency (RF) ablation potentially offers a minimally invasive alternative. The often large size of chondroblastomas can make treatment with plain electrode systems difficult or impossible. This article describes the preliminary experience of RF treatment of chondroblastomas with a multi-tined expandable RF electrode system. Four cases of CT-guided RF treatment are described. The tumor was successfully treated in all but two cases, wherein complications occurred: infraction of a subarticular chondroblastoma in one case and cartilage and bone damage in the unaffected compartment of a knee joint in the other. RF treatment near a joint surface threatens the integrity of cartilage and, therefore, long-term joint function. In weight-bearing areas, the lack of bone replacement in successfully treated lesions contributes to the risk of mechanical failure. Multi-tined expandable electrode systems allow the treatment of large chondroblastomas. In weightbearing joints and lesions near the articular cartilage, there is a risk of cartilage damage and mechanical weakening of the bone. In lesions without these caveats, RF ablation appears promising. The potential risks and benefits need to be evaluated for each case individually.
Radiological assessment of bone segments for transplantation: experience at Rizzoli Orthopedic Institute Tetta C *, Taddia N, Poli T, Quinto C, Fornasari PM, Albisinni U. Eur J Radiol 2006;57:115–118. Aim: This study aimed to analyze results obtained from radiological assessment of skeletal segments stored in the musculoskeletal tissue bank at Rizzoli Orthopedic Institute. Materials and methods: Between January 1997 and June 2003, 891 bone segments underwent radiographic examination in two views. Two hundred thirteen of these segments were examined by a radiologist between July 2002 and June 2003. Diagnostic evaluation was aimed at recognizing relevant degenerative, traumatic, and focal lesions. Focal lesions underwent histological tests. Results: Twenty-two lytic lesions were found in 12 segments. Ten of these were studied between July 2002 and June 2003 and two in the period before specialist radiological assessment. In the latter cases, the lesions were identified by the orthopedic specialist who had examined the X-rays before planning surgery. Histological tests showed that the bone tissue was normal or involved in degenerative phenomena. Conclusions: We think that donor screening should include radiological assessment of bone segments, performed according to standard parameters by a radiologist to identify bone lesions that may jeopardize the successful outcome of surgery.
* E-mail address: [email protected].