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ABSTRACT |
Tuesday, May 8, 11:20 AM–12:30 PM
Abstracts 098-104
Moderator(s): Erick Remer and Harpreet K. Pannu
11:20 AM
098. Monitoring Bladder Tumor Growth in a Mouse Model by Flat Panel Detector, Cone Beam Computed Tomography
Dogra V.*; Conover D. L.; Golijanin D.; Johnson A. M.; Ning R.; Messing E. M.; Wood R. W.; Reeder J. E. University of Rochester Medical Center, Rochester, NY
Address correspondence to V. Dogra (Vikram_Dogra{at}urmc.rochester.edu)
Objective: To reliably and noninvasively detect, measure, and monitor experimentally induced bladder cancers in the laboratory mouse.
Materials and Methods: UPII-SV40T transgenic mice have tissue-specific expression of the simian virus large T antigen in the bladder, reliably develop organ-confined tumors, and thus are excellent models of human bladder cancer. Mice were anesthetized and imaged at monthly intervals throughout their lifetime using a unique flat panel detector-based cone beam computed tomography (FPDCT) system designed and constructed at the University of Rochester (Ning et al, IEEE Trans. Med. Imaging 19:949–963, 2000). Mice were injected with a soluble iodinated, nonionic contrast agent, Omnipaque, which is excreted in urine and allows visualization of bladder filling defects. The FPDCT system acquired 290 two-dimensional images in ten seconds, which were used to produce three-dimensional reconstructions of true isotropic resolution (180 µm3) by a filtered back projection-based modified Feldkamp's reconstruction algorithm. Data were analyzed and three-dimensional images visualized using Amira 3.1.1-1 for MacOSX. Filling defects were measured using ImageJ particle analysis algorithms.
Results: Histologically confirmed bladder tumors were detected and measured in UPII-SV40T mice following injection of the contrast agent. Ten male mice were analyzed monthly from four to eight months of age. Bladder tumor volumes were less then 1 mm3 through 5 months of age. Mean tumor volumes were 8.8, 23.9, and 44.0 mm3 at 6, 7, and 8 months, respectively. Tumor growth was logarithmic, p < 0.0001. In addition, ureterohydronephrosis was observed in several animals with partial or complete obstruction of the urinary tract at late timepoints.
Conclusion: Urogenital tumors of the mouse can be reliably detected and measured using FPDCT scanning. Use of repeated (longitudinal) FPDCT scanning of small animals reduces or eliminates the need for serial sacrifice study designs by permitting accurate in vivo monitoring of tumors in individual animals.
099. Detection of the Bladder Tumor With 3D Ultrasound and Virtual Sonographic Cystoscopy
Kocakoc E.*; Kiris A.; Orhan I.; Poyraz A.; Artas H.; Firdolas F. Firat University, Elazig, Turkey
Address correspondence to E. Kocakoc (ercankocakoc{at}yahoo.com)
Objective: Bladder tumor is one of the most common types of malignant neoplasm of the urinary tract. The purpose of this study was to evaluate the role of three-dimensional (3D) ultrasound (US) and sonographic cystoscopy in the detection of the bladder tumors. To our knowledge this is the first report on 3D US and sonographic cystoscopy of the bladder tumors.
Materials and Methods: Thirty-one patients with suspected or known bladder tumors were included this study. All patients underwent 3D US and conventional cystoscopy within 15 days. The number, size, location, and morphologic features of the lesions were evaluated on gray scale, 3D virtual, and multiplanar reconstruction (MPR) images. The lesions were recorded as polypoid, sessile, or wall thickening. The results of 3D sonographic cystoscopy were compared with the findings conventional cystoscopy, which is considered as a gold standard.
Results: Twenty-eight (90.3 %) of 31 3D virtual sonographic cystoscopy were good or excellent image quality. Images in three examinations were suboptimal due to inadequate bladder distention. Conventional cystoscopy revealed 47 lesions in 22 of remained 28 patients, 3D ultrasonographic virtual cystoscopy detected 41 (87.2 %) of these 47 lesions. 3D virtual US alone has 96.2% sensitivity, 70.6% specificity, 93.9% positive predictive value (PPV), and 80% negative predictive value (NPV) for tumor detection. Combination of gray-scale US, MPR, and 3D virtual US revealed a 96.4% sensitivity, 88.8% specificity, 97.6% PPV, and 84.2% NPV for tumor detection.
Conclusion: 3D US is a promising, alternative noninvasive technique for use in the detection of bladder tumors and its localization and perivesical spreads. The location, size, and morphology of the tumors shown on 3D US images were in good agreement with the findings of conventional cystoscopy.
100. Characterization of Bladder Hernias Identified on CT
Choi A. Y.2*; Perlmutter S.1; Katz D. S.1 1. Stony Brook University Hospital, Stony Brook, NY; 2. Winthrop-University Hospital, Mineola, NY
Address correspondence to A. Choi (dsk2928{at}pol.net)
Objective: Bladder hernias are relatively commonly observed incidentally on CT scans, particularly anteroinferiorly on the right in older men with concurrent right inguinal hernia and enlargement of the prostate, yet there is little in the imaging or clinical literature on this observation to our knowledge. Recently, we encountered a patient who had inadvertent partial cystectomy due to inguinal hernia repair with an associated unrecognized bladder hernia. The purpose of this study was therefore to determine the frequency and location of incidental bladder hernias retrospectively identified on a series of CT examinations of the abdomen and pelvis.
Materials and Methods: 451 consecutive CT examinations of the abdomen and pelvis from two hospital-based scanners were retrospectively reviewed by a senior radiology resident and a radiology attending. On each CT scan, a bladder hernia was characterized as definitely present, equivocally present, absent, or nondiagnostic. Hernia location and associated findings including extension into an inguinal or other hernia was recorded. Demographic information was collected, as well as prostate maximal AP and transverse dimensions in men if a hernia was definitively present.
Results: Thirty-five (7.8%) of cases had a definite bladder hernia, 39 had equivocal findings (8.6%), 302 were negative (67%; mean age 49), and 75 cases were excluded (16.6%; 41 with Foley catheter and collapsed bladder, 27 with an empty/mostly empty bladder, and 7 with miscellaneous reasons for exclusion). Of the 35 definitive hernias, 19 were present in men (mean age 59 years, range 5–87), and 16 were present in women (mean age 61 years, range 22 to 91). Of the 16 women, 11 had obturator hernias, 3 had left anterior and/or lateral hernias, and 2 had right anterior and/or lateral hernias (1 of which extended into an inguinal hernia). Of the 19 men, 10 had right hernias, 5 had left hernias, and 4 had bilateral hernias; the hernias were typically some combination of anterior, inferior, and lateral, and 9 of these extended into an inguinal hernia (2 bilaterally). The mean transverse and AP dimensions of the prostate in the 19 men were 4.5 and 3.4 cm.
Conclusion: Incidental bladder hernias are relatively common, representing 7.8% of a series of consecutive CT examinations. Although many such hernias were "classical," occurring in older men on the right side, obturator hernias in women as well as left-sided hernias and hernias in relatively younger individuals were also identified.
101. Normal Prostate Size on CT with Age Correlation
Kobi M.*; Chia F.; Freeman K.; Rozenblit A. Montefi ore Medical Center, Bronx, NY
Address correspondence to M. Kobi (mkobi{at}nyc.rr.com)
Objective: To determine the normal range of prostate sizes on CT in men of various age groups.
Materials and Methods: We retrospectively analyzed medical records and CT scans of 1487 men between 20 to 90 years of age who presented to the emergency department with abdominal or flank pain between May 2005 and December 2005. Patients with known prostate disease, elevated PSA levels, and hepatic cirrhosis were excluded. The remaining 1082 subjects were subsequently subdivided into seven age strata by decades (20–29, 30–39, 40–49, 50–59, 60–69, and greater than 70). Measurements of the anterior-posterior and transverse diameters of the prostate were obtained on a PACS workstation using the largest axial cross-section of the gland. Data was analyzed using linear regression model with data sets of the transverse, anterior-posterior, and average diameter; the latter was calculated as an average of the transverse and anterior-posterior diameters. Mean values and standard deviations were then calculated.
Results: We found a linear correlation between age and the evaluated dimensions of the prostate. The correlation coefficients for transverse, anterior-posterior and average diameter were 0.63 (p < 0.0001), 0.48 (p < 0.0001), and 0.64 (p < 0.0001), respectively. The mean values and standard deviations for each age strata from youngest to oldest were as follows: 3.7 ± 0.4 cm, 3.8 ± 0.4 cm, 4.0 ± 0.5 cm, 4.3 ± 0.5 cm, 4.6 ± 0.5 cm, 4.8 ± 0.6 cm for the transverse diameter; 3.2 ± 0.4 cm, 3.3 ± 0.4 cm, 3.6 ± 0.4 cm, 3.7 ± 0.5 cm, 3.8 ± 0.6 cm, 4.1 ± 0.6 cm for the anterior-posterior diameter; 3.4 ± 0.3 cm, 3.6 ± 0.3 cm, 3.8 ± 0.4 cm, 4.0 ± 0.4 cm, 4.2 ± 0.4 cm, 4.5 ± 0.6 cm for the average diameter. Using two standard deviations as the range of normal, the transverse diameter of normal prostate did not exceed 5 cm in men under the age of 50, and the average diameter did not exceed 5 cm in men under the age of 70.
Conclusion: The range of normal for cross-sectional prostate size on CT is linearly related to patient age, with mean average diameter enlarging by 2 mm/decade between the third and seventh decade not exceeding 5 cm under the age of 70. The normal transverse diameter can reach 5 cm in men younger than 50, but greater values are normal for older men.
102. Longitudinal Serum Prostate Specific Antigen Levels in Patients with Untreated Prostate Cancer: Correlation with Findings at Serial Endorectal MR and MR Spectroscopic Imaging
Chen I.; Coakley F. V.; Westphalen A. C.*; Qayyum A.; Carroll P. R.; Kurhanewicz J. University of California, San Francisco, San Francisco, CA
Address correspondence to A. Westphalen (antonio.westphalen{at}radiology.ucsf.edu)
Objective: To determine if longitudinal serum prostate specific antigen (PSA) levels in patients with untreated prostate cancer are correlated with findings of malignancy or hyperplasia at serial endorectal MR and MR spectroscopic imaging, since it has been demonstrated that contemporary cross-sectional PSA measurements in North American men are more closely correlated with hyperplasia than cancer.
Materials and Methods: We retrospectively identified 69 men with biopsyproven prostate cancer being managed by watchful waiting who underwent serial endorectal MR and MR spectroscopic imaging and who had contemporaneous serial PSA measurements performed. The mean follow-up period was 392 days (range, 294 to 571). A panel of three experienced readers reviewed the initial and follow-up MR and MR spectroscopic imaging studies and classified findings of prostate cancer as stable or progressive. Another reader assessed benign prostatic hyperplasia by calculating total gland and central gland volumes on all studies.
Results: At follow-up MR and MR spectroscopic imaging, 51, 17, and 1 patients had stable, progressive, or nonevaluable prostate cancer, respectively. The mean PSA velocity was significantly greater in patients with radiologically progressive disease (1.42 versus 0.42 ng/ml/year, p = 0.04). A PSA velocity of over 0.75 ng/mL/year identified those with radiologically progressive disease with a true-positive fraction of 0.71 and a false-positive fraction of 0.39. PSA levels were not correlated with changes in total or central gland volumes (p > 0.05).
Conclusion: Longitudinal PSA measurements in patients with untreated prostate cancer correlate with findings of malignancy but not hyperplasia at serial endorectal MR and MR spectroscopic imaging. Serum PSA is a useful tumor marker in patients with prostate cancer being managed conservatively, and a PSA velocity over 0.75 ng/mL/year is reasonably well correlated with radiological progression.
103. Pre-treatment Magnetic Resonance Imaging Features of Prostate Cancer as a Predictor of Response to External Beam Radiotherapy
McKenna A. D.; Westphalen A. C.*; Qayyum A.; Roach M.; Kurhanewicz J.; Coakley F. V. University of California, San Francisco, San Francisco, CA
Address correspondence to A. Westphalen (antonio.westphalen{at}radiology.ucsf.edu)
Objective: To determine if pre-treatment endorectal MR imaging findings are predictive of outcome in patients who undergo external beam radiotherapy for prostate cancer, since the identification of prognostic variables on imaging might contribute to improved patient-specific management.
Materials and Methods: We retrospectively identified 74 men with biopsy-proven prostate cancer who underwent endorectal MR imaging of the prostate at our institution between January 1998 and April 2002 and who subsequently underwent external beam radiotherapy. A single experienced reader independently reviewed all MR studies and recorded tumor size, stage, and the radial diameter of extracapsular extension (if present). Fisher's exact and Student's t tests were used to investigate the relationship between MR findings and the development of confirmed metastatic disease.
Results: Prior to treatment, the mean prostate specific serum antigen level were 7.5 ng/mL and the median biopsy Gleason score was 7. Based on MR imaging, 24, 22, and 28 patients had stage T1, T2, and T3 disease, respectively. After a mean follow-up of 42 months (range, 2 to 92), 4 patients developed metastases. Fisher's exact test demonstrated that patients with T3 disease on MR imaging were significantly more likely to develop metastases than those with T1 or T2 disease (4 of 28 versus 0 of 46, p < 0.02). Student's t test showed the mean radial diameter of extracapsular extension was significantly greater in the patients who developed metastases than those who did not (7.5 versus 1.0 mm, p < 0.0001); in particular, 3 of 5 patients with more than 5 mm of extracapsular extension at MR imaging before radiation developed metastases at 24, 43, and 63 months after therapy, respectively.
Conclusion: The presence and degree of extracapsular extension seen on endorectal MR imaging prior to external beam radiotherapy for prostate cancer are associated with the development of posttreatment metastatic recurrence. Patients with more than 5 mm of extracapsular extension on endorectal MR imaging prior to external beam radiotherapy for prostate cancer are at high risk for recurrence, and may be candidates for more aggressive adjuvant systemic therapy.
104. CT Intravenous Urography: A Retrospective Evaluation of Three Different CT Protocols for Opacification of the Urinary Collecting System
Mottola J.1,2*; Kirkpatrick I.2; Henderson B.1 1. University of Manitoba Health Science Centre, Winnipeg, Canada; 2. University of Manitoba St. Boniface Hospital, Winnipeg, Canada
Address correspondence to J. Mottola (jmottola{at}hotmail.com)
Objective: To retrospectively evaluate three different CT intravenous urography protocols for opacification of the urinary collecting system.
Materials and Methods: Ninety patients were evaluated for hematuria with 16-row MDCT, first with a noncontrast exam. Excretory phases were then all acquired with 1.25-mm slice thickness and 50% overlap with protocols as follows: (A) 30 patients received 30 cc IV contrast, followed by 250 cc IVNS over 10 minutes. 120 cc IV contrast was then administered and following a 100-second delay, combined nephrographic and excretory phase imaging was obtained. (B) 30 patients received 120 cc IV contrast, and following a 90-second delay an infused examination was obtained. This was followed by a 250 cc IVNS bolus, and at 11 minutes by excretory phase imaging. (C) Protocol same as (A) but using 60 cc IV contrast for the first bolus and 100 cc for the second. Thus, protocols (A) and (C) required one less scan and less radiation exposure than protocol (B). The urinary tract was divided into 12 segments for evaluation, 6 on either side (upper calyces, lower calyces, renal pelvis, proximal ureter, middle ureter, and distal ureter). A single reader blinded to all scan information scored opacification of the collecting system on a scale of 0–5 (0 = 0% opacified, 1 = 1–24%, 2 = 25–49%, 3 = 50–74%, 4 = 75–99%, and 5 = 100%). Obstructed collecting systems (11), nonfunctioning kidneys (2), and nephrectomies (2) were excluded. Opacification scores were compared by using Wilcoxon scores (rank sums) for each segment, and ANOVA for sums and averages.
Results: Mean opacification scores for protocols A, B, and C were as follows: upper pole (3.81, 4.27, 4.44), lower pole (3.58, 4.29, 4.42) renal pelvis (4.54, 4.58, 4.67), proximal ureter (3.86, 3.71, 3.89), middle ureter (3.11, 2.90, 3.36), and distal ureter (3.12, 2.86, 3.38). B and C significantly improved (p < 0.03 for B and p < 0.01 for C) upper and lower pole calyceal opacification when compared to A. No significant differences (p > 0.05) involving the remaining segments were seen using any technique. No significant differences (p > 0.05) in the average opacification scores (3.67, 3.76, and 4.03 for A, B, and C) or the summative opacification scores (22.02, 22.61, and 24.16 for A, B, and C) were seen using any technique.
Conclusion: The 60 cc initial/100 cc at 10-minute protocol with combined nephrographic and excretory imaging significantly improves or equals calyceal opacification, while limiting radiation exposure.
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