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ABSTRACT |
Monday, May 1, 1:30 PM–3:30 PM
Abstracts 078–089
Moderators: Vikram Dogra, MD and Melvyn T. Korobkin, MD
1:30 PM
078. Comparison of MRI with Fluoroscopic Defecography for the Diagnosis of Pelvic Organ Prolapse
Pannu H.K.*; Scatarige J.C.; Eng J.; Jones B.; Gayler B.W.; Radiology, Johns Hopkins Medical Institutions, Baltimore, MD.
Address correspondence to H.K. Pannu (hpannu1{at}jhmi.edu)
Objective: To compare magnetic resonance imaging (MRI) with fluoroscopic defecography (FD) for diagnosing pelvic organ prolapse.
Materials and Methods: From 3/97 to 8/04, 115 patients had MRI and FD within 6 months and 82 were available for review. All patients were women with average age 58.8 years (range 34–84 years). MRI was performed with rectal contrast (n = 35), without rectal contrast (n = 47), with SSFSE (n = 57) or T2FSE (n = 25) sequences. FD was performed with rectal (n = 82), vaginal (n = 82), small bowel (n = 81) and bladder (n = 78) contrast. Each study was independently reviewed by 2 readers and outcome variables were presence/absence of cystocele, vaginal prolapse, enterocele, and rectocele and their size relative to the pubococcygeal line. The relationship between these outcome variables and effect of modality, reader, and rectal contrast on MR were analyzed with logistic and linear multivariate regression and analysis was adjusted for repeated measurements (clustering) within each patient.
Results: All patients–There were cystoceles in 88% patients on FD and 80% patients on MRI, vaginal prolapse in 80% on FD and 56% on MRI, enteroceles in 37% on FD and 23% on MRI, rectoceles in 60% on FD and 36% patients on MRI. There were significantly more cystoceles (OR 1.88, p = 0.04), vaginal prolapses (OR 3.22, p < 0.0005), enteroceles (OR 1.97, p = 0.007) and rectoceles (OR 2.64, p < 0.0005) on FD than on MRI (OR = odds ratio). Correlation coefficients between readers for prolapse-size cystocele 0.75 for FD, 0.94 for MRI; vaginal prolapse 0.39 for FD, 0.73 for MRI; enterocele 0.74 for FD, 0.95 for MRI; rectocele 0.87 for FD, 0.86 for MRI. There was no significant difference between readers for diagnosis and mean size of prolapse.
MRI with rectal contrast vs noncontrast MRI–there were significantly more cystoceles (OR 4.08, p = 0.028), vaginal prolapses (OR 2.73, p = 0.018), and rectoceles (OR 5.83, p < 0.0005) on rectal contrast MRI than noncontrast. MRI with rectal contrast vs FD–there was statistical significance only for enteroceles more of which were found on FD (OR 2.52, p = 0.02).
Conclusion: More pelvic organ prolapse is seen on FD than on MRI with/without rectal contrast. More prolapse is seen on MRI with rectal contrast than on noncontrast MRI. There is statistically no significant difference in the diagnosis of pelvic organ prolapse between MRI with rectal contrast and FD except for enteroceles. There is less interobserver variability in measurement of prolapse with MRI than with FD.
079. Clinical Impact of MRI of the Female Pelvis when Recommended by Sonologist Following Initial Sonogram
Bergin D.*; Chopra S.; Mitchell D.; Parker L.; Lev-Toaff A.; Radiology, Thomas Jefferson University Hospital, Philadelphia, PA.
Address correspondence to D. Bergin (diane.bergin{at}jefferson.edu)
Objective: To evaluate pattern of recommendation for MRI of female pelvis made by experienced sonologist when reading an initial pelvic ultrasound in a busy academic institution with a high clinical volume and extensive ultrasound expertise
Materials and Methods: A twelve month database search was performed to identify women who had undergone a pelvic MRI recommended by the sonologist after an initial pelvic ultrasound. We evaluated the indications for the ultrasound, and the reason for recommendation to MRI. We documented MRI diagnosis and compared this with results of pathology when available and/or results of follow-up imaging where possible.
Results: Of 2200 pelvic US and 450 pelvic MRI performed in our department in 12-month period, 93 women (age range; 16-88, mean; 48) were referred to MRI by the sonologist following initial sonogram. Indications for US were: pelvic pain (19%), menorrhagia (14%), adnexal mass (13%), postmenopausal bleeding (12%), uterine enlargement/mass (12%) and miscellaneous conditions (17%). Most common reason for MRI referral was complex adnexal cystic mass (41%). Other reasons were mass of unknown origin (14%), endometrial thickening /mass (11%), simple adnexal cystic structure (11%), adenomyosis (7%), solid adnexal mass and myometrial mass (6.06%) and non visualization of ovary (4.%). MR diagnosis included myoma (22%), benign ovarian cyst (18%), benign solid adnexal lesion (15%), hydrosalpinx/peritoneal inclusion cyst (8%), malignant mass (adnexal/uterine), (11%), adenomyosis (8%). 3% of cases remained indeterminate on MR whereas no abnormality was seen in 16% of cases as questioned by US. On comparing US and MRI diagnosis, 29% cases had same diagnosis on both the modalities, different but benign in 45% and different but malignant in 9%. Pathological proof was obtained confirming diagnosis made by MR in 29%, pathology was different than MR but benign: 8% and different but malignant in 2 cases. 8% had follow up imaging (10–24 months) had stable findings. No pathology or follow-up imaging was obtained in 50%.
Conclusion: The majority of recommendation to MRI from are made for evaluation of adnexal mass indeterminate on US. MRI in this setting provides definitive characterization of the adnexal mass, differentiating benign from malignant and facilitates appropriate therapeutic management.
080. Imaging Characteristics to Increase Detection of Adenomyosis by Transvaginal Ultrasound using MRI as Gold Standard
Bergin D.*; Lev-Toaff A.; Orrs F.; Chopra S.; Mitchell D.; Radiology, Thomas Jefferson University Hospital, Philadelphia, PA.
Address correspondence to D. Bergin (diane.bergin{at}jefferson.edu)
Objective: To identify imaging features of adenomyosis on transvaginal ultrasound using MRI as gold standard.
Materials and Methods: Database search identified patients who had transvaginal ultrasound and MRI of the pelvis within 6 months of each other in a 3 year period. MR images were reviewed by an experienced MR radiologist to evaluate for adenomyosis (focal or diffuse junctional zone thickness 12mm with or without myometrial cysts). Ultrasounds were reviewed by an experienced sonoradiologist blinded to MR findings, specifically to look for characteristics of adenomyosis. Sonographic features of adenomyosis were noted: indistinct endometrial-myometrial junction, myometrial cysts, asymmetric thickening of myometrium, mass effect, striated shadowing (alternating bands of increased and decreased echogenicity in myometrium) and thickened inner hypoechoic myometrium. Findings at ultrasound and MRI were compared to original ultrasound reading. Statistical analysis was performed using Fisher Exact test and logistic regression ROC analysis.
Results: Ultrasound and MRI of 80 patients, 34 to 68 years (mean 48) were reviewed. 22/80 were excluded because of presence of large central fibroids (n = 17) and nondiagnostic image quality (n = 5). 47/58 patients were premenopausal and 11/58 were post-menopausal. 45/58 had adenomyosis on MRI. 33/58 had adenomyosis diagnosed on ultrasound: sensitivity 73%, specificity 46% compared to original ultrasound reading: sensitivity 40%, specificity 69%. The sensitivity and specificity of individual sonographic characteristics were: indistinct endometrial-myometrial junction 38%, 77%, striated shadowing 44%, 100%, thickened hypoechoic inner myometrium 40%, 77%, mass effect 18%, 100% and asymmetric myometrial thickness: 33%, 85% respectively. Using ROC analysis with full loaded formula combining all imaging characteristics the area under the ROC curve was 0.89. There was mild positive correlation between detection of adenomyosis on ultrasound and junctional zone thickness at MR (r 0.56, p < 0.01).
Conclusion: Detection of adenomyosis by transvaginal ultrasound may be improved by increased awareness of the entity and recognition of its specific sonographic imaging characteristics.
081. Correlation of Metabolic Activity in Histologic Subtypes of Cervical Cancer on FDG-PET/CT
Viswanathan C.*; Iyer R.B.*; Balachandran A.; Macapinlac H.A.; Diagnostic Imaging, UT MD Anderson Cancer Center, Houston, TX.
Address correspondence to C. Viswanathan (cviswanathan{at}gmail.com)
Objective: To determine if histologic subtype correlates with the degree of metabolic activity and glucose uptake as measured by standard uptake value (SUV) on FDG-PET/CT in patients with cervical cancer.
Materials and Methods: A retrospective review of patients with a known diagnosis of cervical cancer and who received PET/CT studies was performed. Over a nine month period at our institution, sixty patients with a history of cervical cancer presented for evaluation with PET/CT. Some patients presented for PET/CT at initial diagnosis, while others presented with recurrent disease. Histologic subtype of the primary tumor was obtained by review of the medical record. Pathology was provided at our institution either from biopsy, surgical resection or evaluation of outside slides. Full body 2D PET study was performed approximately one hour after the administration of 15–20 mCi of 18F-FDG. A non-contrast CT was then performed for attenuation correction and diagnostic purposes. Patients were scanned using a Discovery ST 16 (GE Healthcare, Milwaukee, WI) system and images were reviewed on a GE Advantage Windows workstation. Review of the PET/CT studies was performed by radiologists/nuclear medicine physicians with experience in PET/CT. The maximum SUV for a tumor was obtained by applying a 3D region of interest cursor around the lesion and obtaining the maximum SUV.
Results: A total of 39 patients had positive PET/CT findings. These findings included FDG uptake in the primary cervical tumor, as well as regional and distal lymph nodes, and in other metastatic sites, such as lung. Twenty-nine patients had squamous cell carcinoma, 9 had adenocarcinoma/adenosquamous carcinoma, and 1 patient had aneuroendocrine tumor. The 29 cases of squamous cell carcinoma had maximum SUV ranging from 4.4 to 31, with an average of 17. The 9 cases of adenocarcinoma/adenosquamous carcinoma had maximum SUV of 6 to 45, with an average of 17. The one case of neuroendocrine tumor of the cervix was a metastatic lesion to the liver, which had a maximum SUV of 22.
Conclusion: While PET/CT is used in the staging and surveillance of patients with cervical cancer, based on the experience at our institution, the degree of metabolic activity as measured by maximum SUV is variable in patients with cervical cancer and does not appear to correlate directly with any specific histologic subtype.
082. To Determine FDG Uptake by Uterine Fibroids in Patients Undergoing Combined PET/CT
Saksena M.A.*; Blake M.; Brachtel E.F.; Harisinghani M.G.1; Mueller P.R.; Radiology, Massachusetts General Hospital, Boston, MA.
Address correspondence to M.A. Saksena (msaksena{at}partners.org)
Objective: The purpose of the study was to determine FDG uptake by uterine fibroids in patients undergoing combined PET/CT.
Materials and Methods: 34 women who had undergone a PET/CT study for staging of a known malignancy were included in the study. All patients had known uterine fibroids diagnosed either by MRI studies (n = 30) or established on histological exam post hysterectomy (n = 4). 48 fibroids were evaluated in the 34 patients who had a mean age of 60 years (35–85). 9 women were pre-menopausal (12 lesions) and 25 were post-menopausal (36 lesions). 14 women contributed more than one fibroid. Qualitative and quantitative evaluation of FDG uptake by uterine fibroids was made on the PET/CT studies. Fibroids were localized by the co-registered CT component of the PET/CT. Standardized uptake value based on the patient's weight were calculated for each fibroid and the normal myometrium in each case.
Results: The mean fibroid size was 2.8 cm (1.2–6). On qualitative examination 39 fibroids (81.2%) showed no significant FDG uptake,5 (10.4 %) showed mild uptake, 1 (2%) demonstrated moderate uptake and 3 (6.2 %) demonstrated intense uptake on the PET/CT study. 9 (75%) fibroids in pre-menopausal women demonstrated mild to intense FDG uptake. None of the post-menopausal patients demonstrated any uptake in their fibroids. The average mean SUV values of the fibroids were 1.6 (0.9–7.3). Pathological correlation was made for 9 fibroids. Of these 1 showed intense uptake on the PET and was completely cellular on histology. 6 fibroids showed no FDG uptake and were mostly collagenous. 2 fibroids showed no uptake and were partially hyalinized on pathology. On correlation with MRI, one fibroid which showed intense uptake demonstrated arterial enhancement on dynamic MR imaging.
Conclusion: Benign fibroids do not demonstrate increased FDG uptake in postmenopausal women. Most premenopausal women demonstrate mild to moderate FDG uptake in fibroids. However, extremes of no uptake and intense uptake were also seen in pre-menopausal fibroids. Hence, in premenopausal women with a known malignancy FDG avid fibroids should not diagnosed as metastatic disease. Additionally, any activity in a fibroid like lesion in a postmenopausal patient should be evaluated further to rule out malignant involvement. Although we were able to perform pathological correlation in a small number of lesions FDG avidity of fibroids appears to correlate with cellularity on histological examination with more avid fibroids demonstrating increased FDG uptake.
083. Vesico-ureteral Reflux: Detection with MR Cystography Using Dynamic Gadolinium Detection Pulse Sequence Technique. Initial Experience
Teh H.S.1*; Yeh B.M.2; Gan S.J.1; Ng F.C.1; 1. Radiology, Changi General Hospital, Singapore, Singapore; 2. Radiology, University of California, San Francisco, San Francisco, CA.
Address correspondence to H.S. Teh (cyber_xray{at}yahoo.com)
Objective: To evaluate the feasibility of using MR as an imaging technique for detection of vesico-ureteric reflux (VUR).
Materials and Methods: Study received institutional review board approval, and written informed consent was obtained from all patients. A total of 6 patients (age range, 24–35 years, 5 female and 1 male) had VUR detected on fluoroscopic voiding cystourethrography (VCUG) and were recruited into the study. One patient was excluded when MR imaging revealed an intra-uterine pregnancy. These yielded 10 kidney-ureter units (Five were normal, and 5 had VUR detected on VCUG. MR cystography was performed using a 1.5-T MR scanner. Patients were catheterized and gadolinium-enhanced saline was infused into the bladder. A gadolinium detection pulse sequence technique was used. This allowed real-time visualization of images in fluoroscopy window on the console as they were being obtained, was used to detect VUR. When the contrast was seen refluxing into the urinary tract, a three-dimensional (3D) MR gradient echoes sequence was triggered. The result was compared to VCUG.
Results: Findings at MR cystography and VCUG were concordant in 8 (Four normal; 4 with VUR) of the 10 kidney-ureter units (80%). There was discordance between the two techniques in the remaining 2 kidney ureter units; one had VUR detected on MR cystography only, and the other on VCUG alone. There was also good concordance for the extent of hydronephrosis.
Conclusion: MR cystography does not involve ionizing radiation and give excellent anatomical depiction of the urinary system. This novel technique holds potential as a screening examination for diagnosing VUR.
084. Endorectal MR and MR Spectroscopic Imaging of Prostate Cancer: Distinction of True Positive Results from Chance Detections
Hom J.J.1*; Coakley F.V.1; Simko J.P.2; Lu Y.1; Qayyum A.1; Carroll P.R.3; Kurhanewicz J.1; 1. Radiology, University of California, San Francisco, San Francisco, CA; 2. Anatomic Pathology, University of California, San Francisco, San Francisco, CA; 3. Urology, University of California, San Francisco, San Francisco, CA.
Address correspondence to J.J. Hom (jeffhom1{at}yahoo.com)
Objective: To investigate size criteria for the distinction of true positive results from chance detections at endorectal MR and MR spectroscopic imaging of prostate cancer, since a large imaging lesion may coincidentally encompass a small focus of cancer and be inappropriately considered a true positive result.
Materials and Methods: Endorectal MR and MR spectroscopic imaging were performed in 48 men prior to radical prostatectomy. Two independent readers, unaware of clinical data, recorded maximum axial diameter and location of all suspected peripheral zone tumor nodules on a standardized diagram of the prostate based on MR images alone and then on combined MR and MR spectroscopic images. Detected nodules were classified as matched lesions if tumor was present in the same location at step-section histopathological review. For all matched lesions, kappa values were calculated to examine agreement between measured and actual tumor size. Over-measurements at imaging with kappa values less than 0.2 were considered chance detections.
Results: One hundred thirteen peripheral zone tumor nodules were found at histopathological review, with a mean size of 8 mm (range, 1 to 32). At MR imaging, 2 of 27 and 4 of 35 matched lesions for readers 1 and 2 were chance detections, respectively. The corresponding numbers at MR and MR spectroscopic imaging were 1 of 21 and 1 of 31, respectively. In all but one case, the measured diameter of chance-detected lesions was over twice that of the histopathological diameter, and none of the matched lesions with a kappa value greater than 0.2 had a measured diameter that was over twice the actual diameter. Using this diameter threshold to distinguish true positive results, the mean histopathological diameter of detected tumors was 15 mm, compared to 4 mm for all undetected and for chance-detected tumors (p < 0.05).
Conclusion: A match by size as well as by location is required for a true positive reading on endorectal MR and MR spectroscopic imaging of prostate cancer, since overestimates of tumor size at imaging may represent chance detections. To ensure uniformity in the comparison of scientific and clinical studies, peripheral zone tumors detected at MR and MR spectroscopic imaging of the prostate that are in the same location as tumors at histopathological review should be considered chance detections if the MR axial diameter is more than twice the histopathological axial diameter.
085. Accuracy of Staging Bladder Cancer: Have We Improved?
Anderson A.K.*; Fielding J.R.; Lee K.H.; Wallen E.; Pruthi R.; Radiology and Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Address correspondence to A.K. Anderson (akanderson4{at}hotmail.com)
Objective: To determine whether MRI and 16 detector MDCT have improved staging accuracy of bladder cancer.
Materials and Methods: During a 3 year period, 30 patients with biopsy proven transitional cell bladder cancer underwent staging using CT or MR imaging followed by surgical resection. All axial images were reviewed retrospectively by 3 radiologists masked to clinical outcome and evaluated for T and N stage. Specifically, tumor was defined as organ confined, with local extension when perivesical stranding or contourdeformity was seen, and unresectable when tumor involved the pelvic sidewall or adjacent organs. Lymph nodes were considered positive when a single node measured > 1 cm in maximal diameter or when a group of 3 nodes of any size was identified along the pelvic sidewall. Comparison was made with surgical outcome and pathology review. Overall sensitivity, specificity, positive and negative predictive value for each reader's interpretation of all 30 cases was assessed and then determined for the single slice (n = 11) and 16 detector MDCT (n = 11).
Results: Surgical exploration and pathologic analysis revealed 4 stage T1, 11 stage T2, 6 stage T3 and 9 stage T4 tumors. Five tumors had adjacent positive lymph nodes. Overall, organ confined disease PPV ranged from 62%–75% and NPV from 53% to 75%. For local extension, PPV ranged from 30%–56% and NPV 80 to 93%. For unresectable disease, PPV ranged from 57% to 75% and NPV from 76% to 81%. For N stage the PPV ranged from 38% to 41% and the NPV from 61% to 69% respectively. When the 16 detector MDCT data was separated from that obtained using single slice CT and MRI, only the NPV for local extension improved (85–100%) while the remaining parameters were stable or slightly worse.
Conclusion: Despite the use of contrast enhanced MR and thin collimation CT, T and N staging of bladder cancer using CT or MRI remains poor, particularly for local extension of disease and lymph node involvement.
086. MDCT Urography of Bladder Cancers
Willatt J.M.*; Caoili E.M.; Cohan R.H.; Ellis J.H.; Francis I.R.; Montie J.E.; Department of Urology, University of Michigan Health System, Ann Arbor, MI. Address correspondence to J.M. Willatt (jwillatt{at}med.umich.edu)
Objective: To review the multidetector CT urographic (MDCTU) appearance of pathologically proven bladder cancers and to compare imaging with pathologic findings.
Materials and Methods: 92 patients diagnosed with histologically or cytologically proven bladder cancers (90 primary bladder neoplasms and 2 metastatic to the bladder from other primaries) were evaluated with MDCTU. Two radiologists retrospectively reviewed the exams, characterizing the CT appearance of the bladder neoplasms. Comparison was made with medical records and pathologic reports.
Results: 84 of the 92 bladder neoplasms were easily identified. 3 were identified but felt to be subtle (two of which were not identified when prospectively interpreted). 5 neoplasms could not be identified, even retrospectively. Three of the 87 patients with detectable bladder neoplasms had concurrent negative cystoscopies but subsequently had positive biopsies within 6 months of the exam. The 87 retrospectively detected neoplasms had three distinct MDCT appearances: diffuse wall thickening (n = 45), focal wall thickening (n = 60), and filling defects (1). 19 patients demonstrated both diffuse wall thickening and focal wall thickening. Neoplastic bladder wall thickening was between 3 and 23 mm. Focal filling defects and mass-like neoplasms ranged in size from 3 to 94 cm. in maximal dimension. Tumors could be identified in all areas of the bladder whether the surrounding/adjacent bladder lumen was opacified with excreted contrast material (n = 35), partially opacified (n = 26), or unopacified (n = 26).
Conclusion: MDCT urography is a promising technique for detecting bladder neoplasms. Neoplasms can be visualized in unopacified and opacified portions of the bladder.
087. MR Versus CT in Detecting Metastatic Pelvic Lymph Nodes in Patients with Primary Bladder and Prostate Cancer
Saokar A.1*; Braschi M.1,2; Jantsch M.K.1,2; Hahn P.1; Mueller P.R.1; Harisinghani M.G.1,2; 1. Radiology, Massachusetts General Hospital, Boston, MA; 2. Radiology, Center for Molecular Imaging Research, Boston, MA.
Address correspondence to A. Saokar (asaokar{at}partners.org)
Objective: Since the advent of cross-sectional imaging nodal staging in oncology patients has improved significantly. As MR has better soft tissue resolution than CT we hypothesized that contrast enhanced MRI detects more lymph nodes. The purpose of this study was to compare conventional contrast enhanced MR to contrast enhanced CT in detection of lymph nodes within the pelvis of patients with known primary bladder and prostate malignancies.
Materials and Methods: Thirty patients (M:F = 27:3, age 50–80; mean 64,7yrs) with prostate (n = 18) or bladder cancer (n = 12) who had undergone both CT and MR within a period of 30 days (range 0–30 d; mean 16d) were included in this retrospective study. Two radiologists independently reviewed the CT and MR images in 2 different sessions. The location, number and size of the lymph nodes was recorder. The nodes were grouped based on location as external iliac, obturator, internal iliac, common iliac, presacral and perirectal. Based on size, the nodes were classified as: < 5 mm, 6–10 mm, and > 10 mm. The number of lymph nodes seen on CT and MR were compared based on size and location: Signed Rank test was used for statistical analysis.
Results: A total of 189 nodes were detected on CT and 266 nodes were seen on MR (p < 0.0001). Based on nodal location the number of nodes detected by CT and MR were: common iliac: CT/MR = 32/34; external iliac: CT/MR = 73/87; obturator: CT/MR = 48/74; internal iliac: CT/MR = 24/45; presacral: CT/MR = 6/11; perirectal: CT/MR = 6/13. MR detected more lymph nodes compared to CT I all nodal regions. This difference was statistically significant in the external iliac (p < 0.046), obturator (p < 0.0003) and internal iliac nodes chains (p < 0.0029). Although MR detected more nodes in the common iliac, presacral and perirectal areas, the difference was not statistically significant. Based on size the number of nodes detected by CT and MR were as follows: 1–5 mm: CT/MR = 91/166; 6–10 mm: CT/MR = 91/93; > 10 mm: CT/MR = 7/7. MR detected significantly more nodes than CT in the size range of 1–5 mm.
Conclusion: MR detects more pelvic nodes compared to CT and should be considered in nodal staging of pelvic malignancies. The sensitivity of MR is higher for the detection of £5 mm nodes.
088. Sonographic Appearance of Leydig Cell Tumor of the Testis
Maizlin Z.V.1*; Cooperberg P.1; Tiwari P.1; Belenky A.4; Kunichezky M.5; Sandbank J.3; Strauss S.2; 1. Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada; 2. Radiology, Assaf Harofeh Medical Center, Zerifin, Israel; 3. Pathology, Assaf Harofeh Medical Center, Zerifin, Israel; 4. Radiology, Rabin Medical Center, Petach Tikva, Israel; 5. Pathology, Rabin Medical Center, Petach Tikva, Israel.
Address correspondence to Z.V. Maizlin (zeev25{at}yahoo.com)
Objective: To determine the gray-scale and color Doppler sonographic features of Leydig cell tumors of the testis in a series of patients.
Materials and Methods: We analyzed the sonographic appearance of 11 proven Leydig cell tumors in 10 patients aged 26–47 years. Sonographic features that were reviewed included size and echogenicity of the tumors, the presence of cystic areas or calcifications, and distribution pattern of detectable blood flow on color or power Doppler imaging.
Results: The tumors ranged from 0.4 to 3.0 cm in diameter, but most were less than 1.0 cm in diameter. In one testis, two discrete Leydig cell tumors were found. Ten (91%) of the 11 tumors were homogeneously hypoechoic. Only one tumor was isoechoic with the testis. None of the tumors contained calcifications. Of 9 tumors with color Doppler imaging, eight (89%) showed a characteristic pattern of increased peripheral blood flow, which was either circumferential or punctate. Only one tumor was found with internal hypervascularity.
Conclusion: Peripheral hypervascularity, in a hypoechoic testicular tumor which has little or no internal color Doppler flow, should suggest the possibility of a Leydig cell tumor, and consideration given to testicular sparing surgery.
089. Correlation between Gleason Score and Sonographic Appearance of Prostate Cancer
Muglia V.F.*; Elias J.; Silva H.; Tucci S.; Pastorello M.; Reis R.B.; Martins A.P.; Trad C.S.; Imaging and Medical Physics Center, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
Address correspondence to V.F. Muglia (muglia{at}convex.com.br)
Objective: To verify if there is a relationship between Gleason Score and sonographic appearance of Prostate Cancer on Trans-Rectal Ultrasound (TRUS).
Materials and Methods: We prospectively evaluated 153 patients submitted to US-guided prostate biopsy from July 2003 to July 2004. Before the biopsy, a careful examination with a 6.0 to 8.0 MHz convex endorectal transducer was performed. We looked for hypoechoic and indirect signs of isoechoic lesions. At least twelve samples were collected from each patient, using an 18G needle and biopsy gun. Additional samples were taken when suspected lesions were found. The Gleason Score was determined by an experienced pathologist in this field.
Results: The mean age of our sample was 54.6 years, varying from 45 to 86 years. Histologic results in 52 cases (33.98%) were positive for prostate cancer. Thirty-three (63.46%) patients had hypoechoic lesions and nineteen (36.54%) had isoechoic can-cers. The Gleason Score for hypoechoic lesions varied from 5 to 10 and for isoechoic lesions from 4 to 7. By using 95% Confidence Intervals we found statistically significant difference between the two groups.
Conclusion: Our results suggested that hypoechoic prostate cancer tend to be a higher Gleason Score than isoechoic ones. Well-differentiated neoplasms have a tendency to reproduce the histological pattern of normal tissue, which could be the explanation for isoechoic lesions exhibit a lower Gleason Score.
* Will present paper
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