Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer Before Robot-Assisted Radical Prostatectomy

The accuracy of multi-parametric MRI (mpMRI) in pre-operative staging of prostate cancer (PCa) remains controversial. Objective: To evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1-5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents poorest and 5 represents best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for binary classification of EPE including 95% confidence intervals and area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. 39 men (32.2%), or 43 lobes (18.6%) had EPE. Likert score ≥3 had sensitivity (SE), specificity (SP), NPV, PPV of 90.4%, 52.3%, 96%, 29.9%, respectively, and AUC was 0.82 (95% CI: 0.77-0.86). AUC was 0.63 (95% CI: 0.37-0.9), 0.77 (0.71-0.84) and 0.92 (0.88-0.96) for biparametric scans, PI-QUAL 1-3 and PI-QUAL 4-5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was a) multi-parametric and b) of a higher image quality according to the PI-QUAL scoring system.

Immune Checkpoint Inhibitor-Induced Cerebral Pseudoprogression: Patterns and Categorization

BackgroundThe inclusion of immune checkpoint inhibitors (ICIs) in therapeutic algorithms has led to significant survival benefits in patients with various metastatic cancers. Concurrently, an increasing number of neurological immune related adverse events (IRAE) has been observed. In this retrospective analysis, we examine the ICI-induced incidence of cerebral pseudoprogression and propose a classification system.MethodsWe screened our hospital information system to identify patients with any in-house ICI treatment for any tumor disease during the years 2007-2019. All patients with cerebral MR imaging (cMRI) of sufficient diagnostic quality were included. cMRIs were retrospectively analyzed according to immunotherapy response assessment for neuro-oncology (iRANO) criteria.ResultsWe identified 12 cases of cerebral pseudoprogression in 123 patients treated with ICIs and sufficient MRI. These patients were receiving ICI therapy for lung cancer (n=5), malignant melanoma (n=4), glioblastoma (n=1), hepatocellular carcinoma (n=1) or lymphoma (n=1) when cerebral pseudoprogression was detected. Median time from the start of ICI treatment to pseudoprogression was 5 months. All but one patient developed neurological symptoms. Three different patterns of cerebral pseudoprogression could be distinguished: new or increasing contrast-enhancing lesions, new or increasing T2 predominant lesions and cerebral vasculitis type pattern.ConclusionCerebral pseudoprogression followed three distinct patterns and was detectable in 3.2% of all patients during ICI treatment and in 9.75% of the patients with sufficient brain imaging follow up. The fact that all but one of the affected patients developed neurological symptoms, which would be classified as progressive disease according to iRANO criteria, mandates vigilance in the diagnosis and treatment of ICI-induced cerebral lesions.

Chest CT Usage in Covid-19 Pneumonia: Multicenter Study on Radiation Doses and Diagnostic Quality in Brazil

We assessed variations in chest CT usage, radiation dose and image quality in COVID-19 pneumonia. Our study included all chest CT exams performed in 533 patients from 6 healthcare sites from Brazil. We recorded patients’ age, gender and body weight and the information number of CT exams per patient, scan parameters and radiation doses (volume CT dose index—CTDIvol and dose length product—DLP). Six radiologists assessed all chest CT exams for the type of pulmonary findings and classified CT appearance of COVID-19 pneumonia as typical, indeterminate, atypical or negative. In addition, each CT was assessed for diagnostic quality (optimal or suboptimal) and presence of artefacts. Artefacts were frequent (367/841), often related to respiratory motion (344/367 chest CT exams with artefacts) and resulted in suboptimal evaluation in mid-to-lower lungs (176/344) or the entire lung (31/344). There were substantial differences in CT usage, patient weight, CTDIvol and DLP across the participating sites.

Sonography-Based Determination of Hip Joint Anterior Alpha-Angle: A Reliable and Reproducible Method

Purpose Femoroacetabular impingement (FAI) is a known risk factor for hip osteoarthritis. The gold standard for diagnostics is X-ray and MRI. The accuracy of hip joint alpha angle measurements obtained using sonography is equal to measurements in MRI for patients with cam impingement of the hip joint. Materials and Methods Patients with hip pain and MRI and sonography were evaluated between January 2015 and December 2019 in a single center. Musculoskeletal sonography was performed according to the DEGUM guidelines by ultrasound-certified specialists. Measurements were repeated three times by two independent investigators. Results 285 patients were screened, and 110 patients (49 females, 61 males) met the inclusion criteria. The mean age at time of investigation of 54 left and 56 right hip joints was 54.2 years. 1320 measurements were performed. The mean alpha angle was 50.7° in MRI and 50.4° in sonography with a mean difference of 0.28° (p>0.05). Conclusion Determining hip alpha angle using sonography is a safe and reproducible method. No statistically significant differences between results in MRI and sonography could be seen. Although this is a retrospective, single-center study including only Caucasian mid-Europeans and with the known limitations of ultrasound imaging, it nevertheless shows that sonography can be used as a simple, cheap, and fast technique to assess the hip alpha angle without losing diagnostic quality.

P-OGC75 Use of a single visit combined contrast enhanced CT with PET (PET/CeCT) in the staging of oesophageal and gastric cancers during the COVID-19 pandemic – is it adequate, timely and cost effective?

Background COVID-19 has had a massive effect on service provision within the NHS. At our regional oesophagogastric centre the usual protocol for workup of new cancers involves endoscopy, with separate imaging in the form of a contrast enhanced CT, and standard PET/CT (PET with non-contrast CT). To reduce exposure to the hospital environment and potential infection, a group of patients underwent combined PET/CeCT imaging in a single hospital visit. The aim of this project was to assess whether the combined scans were of adequate diagnostic quality, cost efficient, and if they reduced time to treatment. Methods We retrospectively identified all patients who had been discussed in the Upper GI cancer MDT in 2020 at our trust. To be included in the study, the diagnosis must have been made during 2020. Using our MDT records, clinical letters, endoscopy and radiology systems, we obtained dates of investigations along with types and dates of treatment. Data was tabulated in Microsoft Excel. Upper GI consultant radiologists advised on diagnostic quality and technicality of scans, and trust finance directors were able to advise on costs of imaging. Results 211 new oesophageal or gastric cancers were discussed in our MDT in 2020. 33 patients had PET/CeCT, these took place between March and October. 178 patients had separate imaging. Median time from diagnostic OGD to PET/CeCT was 8 days vs 16 days to final imaging in the separate group. Median time from diagnostic OGD to treatment start date was 36 days for PET/CeCT vs 41 days in the separate group. No PET/CeCT’s required repeating due to poor diagnostic quality. At our trust PET/CeCT had a cost saving of £88.58 compared to separate scans. Conclusions Our experience is that PET/CeCT allows accurate radiological staging of oesophagogastric cancers with a single patient visit, at more convenience to the patient and with reduced potential exposure to COVID-19. Patients were able to complete their cancer staging and start their treatment pathway sooner than with separate scans. This comes with a significant cost saving to the NHS per patient, which at our trust scaled up to a potential £18,000 in one year. Our MDT is now planning to perform radiotherapy planning CT images in the same episode.

Free-breathing contrast-enhanced multiphase MRI of the liver in patients with a high risk of breath-holding failure: comparison of compressed sensing-accelerated radial and Cartesian acquisition techniques

Background Knowing the advantages and disadvantages of each magnetic resonance (MR) technique, would allow us to choose a sequence better suited in patients with a high risk of breath-holding failure. Purpose To compare the image quality of free-breathing contrast-enhanced multiphase MR imaging (MRI) using incoherent Cartesian k-space sampling combined with a motion-resolved compressed sensing reconstruction (XD-VIBE) and Golden-Angle Radial Sparse Parallel MRI (GRASP). Material and Methods A total of 67 patients were included. Overall image quality, motion artifacts, and liver edge sharpness on arterial and portal-venous phase were evaluated by two radiologists. We evaluated the signal intensity ratio between liver in the late arterial phase to aorta at peak enhancement and the detection rate of hypervascular lesions. Results Overall image quality, artifact, and liver edge sharpness scores of XD-VIBE and GRASP were not significantly different ( P = 0.070–0.397). Four (reviewer 1, 12.1%) and seven patients (reviewer 2, 21.2%) received non-diagnostic quality in the XD-VIBE group whereas one patient (reviewer 2, 2.9%) received non-diagnostic quality in the GRASP group. The ratio between the aorta and liver signal for GRASP was significantly higher than that of XD-VIBE (0.32 ± 0.10 vs. 0.47 ± 0.13; P < 0.001). The hypervascular lesion detection rate of XD-VIBE (86.7%) was higher than that of GRASP (57.1%) in the arterial phase without a statistically significant difference ( P = 0.081). Conclusion Overall image quality of XD-VIBE and GRASP were not significantly different. More XD-VIBE examinations were rated non-diagnostic. On the other hand, the relative liver parenchymal enhancement to the aorta in the late arterial phase of GRASP was higher than that of XD-VIBE, which potentially leads to lower detectability of hypervascular lesions on arterial phase images.

Cosmetic “Gold Thread Therapy”: A Nuisance That Decreases the Diagnostic Quality of a Dental Panoramic Image

During routine imaging of the craniofacial region, it is recognised that some “cosmetic” procedures with metallic insertions can be revealed radiographically. These objects however make it difficult to obtain a good interpretation of anatomical structures for management of diseases. A 58-year-old female patient visited a private dental facility in Kuala Lumpur for prosthodontic replacement of missing teeth. The dental panoramic image revealed generalized bone loss and numerous unusual multiple thread-like radioopacities. These gold threads made radiographic evaluation difficult and complicated the process of treatment planning for dental implant placement advocated for this patient.

Initial Clinical Experience With a Simple, Home System for Early Detection and Monitoring of Diabetic Foot Ulcers: The Foot Selfie

Background: Diabetic foot ulcers (DFUs) are a leading cause of disability and morbidity. There is an unmet need for a simple, practical, home method to detect DFUs early and remotely monitor their healing. Method: We developed a simple, inexpensive, smartphone-based, “ Foot Selfie” system that enables patients to photograph the plantar surface of their feet without assistance and transmit images to a remote server. In a pilot study, patients from a limb-salvage clinic were asked to image their feet daily for six months and to evaluate the system by questionnaire at five time points. Transmitted results were reviewed weekly. Results: Fifteen patients (10 male) used the system after approximately 5 minutes of instruction. Participants uploaded images on a median of 76% of eligible study days. The system captured and transmitted diagnostic quality images of the entire plantar surface of both feet, permitting clinical-management decisions on a remote basis. We monitored 12 active wounds and 39 pre-ulcerative lesions (five wounds and 13 pre-ulcerative lesions at study outset); we observed healing of seven wounds and reversal of 20 pre-ulcerative lesions. Participants rated the system as useful, empowering, and preferable to their previous methods of foot screening. Conclusions: With minimal training, patients transmitted diagnostic-quality images from home on most days, allowing clinicians to review serial images. This system permits inexpensive home foot screening and monitoring of DFUs. Further studies are needed to determine whether it can reduce morbidity of DFUs and/or the associated cost of care. Artificial intelligence integration could improve scalability.

Fine Needle Aspiration: who must perform this Procedure?

In this historical moment, when FNA seems to have lost its paramount importance, it’s necessary to publish the data of the case study carried out from 2007 to 2014 in the pathologic anatomy unit at Carlo Poma Hospital in Mantua. This work includes 5,586 FNAs performed in various parts of the body. In particular, we examined 583 breast FNAs performed by a pathologist without help from a radiologist. The data confirm that it is very important for a pathologist to be present when a sample is being taken as this results in a decrease in the number of inadequate preparations as well as in improved diagnostic quality.

Cancer Cell Profiling Using Image Moments and Neural Networks with Model Agnostic Explainability: A Case Study of Breast Cancer Histopathological (BreakHis) Database

With the evolution of modern digital pathology, examining cancer cell tissues has paved the way to quantify subtle symptoms, for example, by means of image staining procedures using Eosin and Hematoxylin. Cancer tissues in the case of breast and lung cancer are quite challenging to examine by manual expert analysis of patients suffering from cancer. Merely relying on the observable characteristics by histopathologists for cell profiling may under-constrain the scale and diagnostic quality due to tedious repetition with constant concentration. Thus, automatic analysis of cancer cells has been proposed with algorithmic and soft-computing techniques to leverage speed and reliability. The paper’s novelty lies in the utility of Zernike image moments to extract complex features from cancer cell images and using simple neural networks for classification, followed by explainability on the test results using the Local Interpretable Model-Agnostic Explanations (LIME) technique and Explainable Artificial Intelligence (XAI). The general workflow of the proposed high throughput strategy involves acquiring the BreakHis public dataset, which consists of microscopic images, followed by the application of image processing and machine learning techniques. The recommended technique has been mathematically substantiated and compared with the state-of-the-art to justify the empirical basis in the pursuit of our algorithmic discovery. The proposed system is able to classify malignant and benign cancer cell images of 40× resolution with 100% recognition rate. XAI interprets and reasons the test results obtained from the machine learning model, making it reliable and transparent for analysis and parameter tuning.