Introduction: To examine the use of prostate magnetic resonance imaging (MRI) for staging after a new diagnosis of prostate cancer in our hospital system. There are no universally accepted recommendations to guide the use of MRI for staging purposes. In practice, prostate MRI is used to help distinguish T2 and T3 cancer. Prostate MRI is a modality that could aid in the triage of patients to radical prostatectomy or non-surgical treatments via accurate identification of organ-confined disease.Materials and Methods: We performed a retrospective review of prostate cancer patients who underwent staging MRI with 1.5T MRI with endorectal (ER) coil. We compared patient characteristics in patients who underwent surgery and those who did not, and used pathology reports from prostatectomy samples to calculate the negative predictive value (NPV) for extra-capsular extension (ECE) and seminal vesicle invasion (SVI).Results: We found that patients who underwent radical prostatectomy were younger, had lower Gleason scores, and had lower PSA values at diagnosis than patients who were not treated surgically. We calculated a NPV of 93.7% for SVI and 69.5% for ECE. We found variation in rates of accurate identification of T3 prostate cancer across the seven radiologists who interpreted MRI images in our study.Conclusions: 1.5T MRI with ER coil has a high NPV for SVI and a lower NPV for ECE. The utilization of 3TMRI may enable practitioners to more confidently rule out ECE. Future studies will be necessary to generate guidelines for use of MRI in prostate cancer staging.
Introduction: The management of lymphoid malignancies has greatly evolved in the last decade with the advent of targeted therapies, which have improved response and survival in patients with Hodgkin's lymphoma (HL), non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL) and plasma cell myeloma (PCM). The PI3K pathway seems to play a seminal role in the development of lymphoid malignancies. CAL-101 is a highly selective PI3K p110δ inhibitor currently undergoing clinical development. Areas covered: The aims of this review are to summarize our understanding of the PI3K pathway, its role in lymphoid malignancies, the preclinical and clinical experience accumulated with CAL-101, a PI3Kδ inhibitor, and potential areas of future development. Expert opinion: CAL-101 is a novel drug that has shown preclinical activity against CLL, NHL, HL and PCM cells. There is early evidence of clinical efficacy in CLL and indolent NHL. Studies using CAL-101 alone or in combination are also ongoing in PCM, HL and aggressive NHL. However, additional studies are needed to prove CAL-101 is effective and safe as the goals of therapy for patients with lymphoid neoplasms are not only directed towards improving response and cure rates but also prolonging survival without affecting quality of life.
Abstract Infants and children often present with a wide range of musculoskeletal (MSK) infections in daily clinical practice. This can vary from relatively benign superficial infections such as cellulitis to destructive osseous and articular infections and life-threatening deep soft tissue processes such as necrotizing fasciitis. Imaging evaluation plays an essential role for initial detection and follow-up evaluation of pediatric MSK infections. Therefore, a clear and up-to-date knowledge of imaging manifestations in MSK infections in infants and children is imperative for timely and accurate diagnosis that, in turn, can result in optimal patient management. This article reviews an up-to-date practical imaging techniques, the differences between pediatric and adult MSK infections, the spectrum of pediatric MSK infections, and mimics of pediatric MSK infections encountered in daily clinical practice by radiologists and clinicians.
Objectives: The aim of this retrospective study was to investigate the relationship between lung lesion lobar distribution, lesion size, and lung biopsy diagnostic yield. Material and Methods: This retrospective study was performed between January 1, 2013, and April 30, 2019, on CT-guided percutaneous transthoracic needle biopsies of 1522 lung lesions, median size 3.65 cm (range: 0.5– 15.5 cm). Lung lesions were localized as follows: upper lobes, right middle lobe and lingual, lower lobes superior segments, and lower lobes basal segments. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and/or pathology reports. Results were considered diagnostic if malignancy or a specific benign diagnosis was established, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. Results: The positive predictive value (PPV) of a diagnostic yield was 85%, regardless of lobar distribution. Because all PPVs were relatively high across locations (84–87%), we failed to find statistically significant difference in PPV between locations ( P = 0.79). Furthermore, for every 1 cm increase in target size, the odds of a diagnostic yield increased by 1.42-fold or 42% above 85%. Although target size increased the diagnostic yield differently by location (between 1.4- and 1.8-fold across locations), these differences failed to be statistically significant, P = 0.55. Conclusion: Percutaneous transthoracic needle biopsy of lung lesions achieved high diagnostic yield (PPV: 84– 87%) across all lobes. A 42% odds increase in yield was achieved for every 1 cm increase in target size. However, this increase in size failed to be statistically significant between lobes.
The x-ray examinations usually do not reveal morbid changes after lung expansion in the treatment of spontaneous pneumothorax. In our observation computed tomography (CT) and scintigraphy enable not only the exact determination of the extent of changes but also they disclose bullae invisible in conventional chest radiographs. 15 patients with cured spontaneous pneumothorax and 10 patients with radiographic evidence of a bulla or bullae were examined. CT scans showed bullae from 3 to 18 cm in diameter involving predominantly the upper lobes. 4 patients had additionally subpleural or intraparenchymal bullae of various degrees. In all patients with cured spontaneous pneumothorax, CT scans revealed intraparenchymal bullae, and in 6 cases bilateral intraparenchymal bullae were revealed. Only in sites of large bullae, no isotopic marker or its low elimination was shown in perfusion and inhalation scintigraphy. 10 patients with giant bullous emphysema were operated; in 6 patients enucleation of bullae, in 3 lobectomy and in one patient bullectomy were performed.CT is a method of choice in the diagnosis of lung emphysematous bullae and it enables the detection of the changes undetectable in chest radiographs. Perfusion and inhalation scintigraphy is helpful in the diagnosis of large emphysematous bullae and postoperative follow-up examination.
