Imaging: MRI/fusion Bx improves risk stratification

Rose Khavari, MDA prospective evaluation of cancer detection rates with PI-RADS and the finding that use of micro-computed tomography enabled rapid phenotyping of GU anomalies in adult and embryonic mice were among other key imaging studies from the AUA annual meeting. The take-home messages were presented by Rose Khavari, MD, of Houston Methodist Hospital, Houston.

A multi-institutional evaluation of magnetic resonance imaging and confirmatory fusion biopsy in men considering active surveillance for prostate cancer demonstrated improved risk stratification to inform decision-making.

Presence of PI-RADS (Prostate Imaging Reporting and Data System version 2) 4 or 5 (versus 1-3) proved to be a significant predictor of upgrading prostate cancer from Gleason score 6 to 7 or higher.

A prospective evaluation of cancer detection rates with PI-RADS showed an “unexpectedly low” detection rate and a high false-positive rate for detection of clinically significant prostate cancer with PI-RADS 4 lesions.

Evaluation of radiologist interpretation of prostate MRI results showed relatively low interobserver agreement at an academic medical center.

Prostate MRI may lack the sensitivity needed to calculate accurately the treatment area for local treatment modalities such as high-intensity focused ultrasound (HIFU).

Contrast-enhanced ultrasound (CEUS) may have a role in intraoperative assessment during HIFU procedures and postoperative evaluation of treated and untreated areas afterward.

Comparison of 2D and 3D ultrasound imaging with urodynamic measurements in women with overactive bladder showed that an ellipsoid bladder shape cannot be assumed and that tracing the perimeter with 3D imaging better accounts for non-uniform geometry and provides more accurate volume measurement.

A study of patients undergoing prostate artery embolization showed that a majority of prostatic arteries had origin in the internal pudendal artery and obturator artery but rarely (3%) in the inferior vesical artery, contradicting information in many genitourinary anatomy textbooks.

Use of micro-computed tomography enabled rapid phenotyping of GU anomalies in adult and embryonic mice, a possible prelude to clinical use of the imaging technology.

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