The AUA 2016 imaging take-home messages included abstracts about texture analysis, an imaging algorithm using CT and MRI in the evaluation of fat-poor angiomyolipomas, and contrast-enhanced ultrasound. The take-home messages were presented by Gary J. Faerber, MD, of the University of Utah Health Sciences, Salt Lake City.
Gary J. Faerber, MDThe AUA 2016 imaging take-home messages included abstracts about texture analysis, an imaging algorithm using CT and MRI in the evaluation of fat-poor angiomyolipomas, and contrast-enhanced ultrasound. The take-home messages were presented by Gary J. Faerber, MD, of the University of Utah Health Sciences, Salt Lake City.
The utility of the Prostate Imaging Reporting and Data System (PI-RADS) has been demonstrated for peripheral lesions, but two studies reported varying results using PI-RADS and MRI in diagnosing central lesions. Of 252 lesions identified in one study, 128 had prostate cancer detected. Midline lesions also had higher rates of being intermediate- or high-risk cancers. In the second study, 27 central zone lesions were identified and biopsied despite the fact the central zone lesions were more likely to have higher PI-RADS scores than the peripheral zone or transitional zone lesions. Only two of 27 had significant prostate cancer, and both of these lesions had PI-RADS scores <3.
Texture analysis, which uses mathematical methods to evaluate the intensity and relationship of pixels on CT with one another, appears to differentiate oncocytomas from clear cell carcinomas. This suggests a noninvasive method of differentiating benign from malignant renal lesions is possible.
A study examining what to do with patients with a negative fusion-guided biopsy identified 45 patients who had an initial negative fusion biopsy but who underwent repeat fusion biopsy due to a rising PSA or atypical small acinar proliferation (ASAP) found on initial fusion biopsy. Ten of the 45 had a positive repeat fusion biopsy; of those, three of 10 had intermediate-risk prostate cancer and only one had high-risk disease. Risk factors associated with a positive repeat biopsy were PSA >10 ng/mL and a mean PSA rise of 3. Higher PI-RADS scores, history of ASAP, or change in PSA density were not associated with a positive re-biopsy.
Pulsed laser and ultrasound multispectral photoacoustic imaging (MPI) was used to identify six of seven oncocytomas and 19 of 22 renal cell carcinomas (RCC), suggesting MPI could be used intraoperatively to assist surgeons in enucleation in the case of oncocytoma versus wider resection in the case of RCC.
An imaging algorithm using CT and MRI in the evaluation of fat-poor angiomyolipomas (AMLs) seems to be very predictive. MRI+CT scores of 0 to 1 demonstrated no AMLs, whereas MRI+CT scores of 4 to 6 captured 93% of all fat-poor AMLs.
Continue to the next page for more take-home messages.
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