Background:Accurate risk stratification of prostate cancer (PCa) is crucial for clinical management. Although diffusion-weighted imaging (DWI) is widely used in PCa evaluation, the value of high and ultrahigh b-values remains under investigation. This study aimed to explore the predictive value of ultrahigh b-value DWI for the Gleason score of PCa patients. Methods:This study gathered a total of 78 patients and acquired T2-weighted imaging (T2WI), conventional DWI (0, 1,000 s/mm2), and ultrahigh b-value DWI (0, 2,000, and 3,000 s/mm2) from each patient. Using reference biopsy as the gold standard, the apparent diffusion coefficient (ADC) of DWI images at different b-values was analyzed. On the basis of regression analysis at various b-values and receiver operating characteristic (ROC) curves, the 3,000 s/mm2 ultrahigh b-value DWI demonstrated greater diagnostic performance in assessing the differentiation of PCa. Results:A total of 154 biopsy-confirmed lesions (102 cancerous lesions and 52 noncancer lesions) were analyzed. Ultrahigh b-value DWI (b=2,000 and 3,000 s/mm2) demonstrated significant differences in ADC values between PCa and noncancerous tissues (P<0.05): at b=2,000 s/mm2, the PCa ADC was 0.740±0.173 ×10-3 mm2/s vs. the non-PCa ADC was 0.949±0.176 ×10-3 mm2/s, whereas at b=3,000 s/mm2, the PCa ADC decreased to 0.581±0.130 vs. the non-PCa ADC was 0.748±0.179 ×10-3 mm2/s, with no overlap between groups. Both b-values showed inverse correlations between the ADC values and Gleason scores (b=2,000: r=-0.401, R2=0.161; b=3,000: r=-0.489, R2=0.240), with stronger linearity at higher b-values. Risk stratification revealed distinct ADC values between the low-risk (0.926±0.125 ×10-3 mm2/s at b=2,000; 0.726±0.097 ×10-3 mm2/s at b=3,000) and intermediate/high-risk groups (P<0.05), although no significant differences existed between the intermediate- and high-risk groups (P>0.05). ROC analysis for differentiating Gleason <7 vs. ≥7 lesions revealed greater diagnostic accuracy at b=3,000 [area under the curve (AUC) =0.908, cutoff =0.615 ×10-3 mm2/s, sensitivity 83.12%, specificity 92%] than at b=2,000 (AUC =0.893, cutoff =0.799 ×10-3 mm2/s, sensitivity 81.82%, specificity 88%). Conclusions:Ultrahigh b-value DWI with quantitative ADC measurements can be an effective indicator for evaluating the differentiation of PCa. It has important value for the clinical prediction of Gleason scores and prognosis assessment.

OBJECTIVE:This article aims to explore the ADC value of ultrahigh b-value DWI and the diagnostic cutoff point in prostate cancer.METHODS:A total of 78 patients were included in this study. T2 weighted imaging (T2WI), conventional diffusion-weighted imaging (DWI) (1000 s/mm2), and DWI with ultrahigh b-values of 2000 s/mm2 and 3000 s/mm2 were performed in each patient. With reference biopsy as the gold standard, the apparent diffusion coefficient (ADC)s of each b-value DWI image were analyzed. According to different b-value receiver operating characteristic (ROC) curves, the ADC diagnostic cutoff point for prostate cancer was determined.RESULTS:A total of 154 lesions were identified as prostate cancer. The ADC values for conventional DWI and ultrahigh b-value DWI with 2000 s/mm2 and 3000 s/mm2 were 1.097×10-3 mm2/s (1.040-1.153), 0.809×10-3 mm2/s (0.766-0.851) and 0.622×10-3 mm2/s (0.591-0.652), respectively, in the peripheral zone and 1.085×10-3 mm2/s (1.022-1.147), 0.815×10-3 mm2/s (0.770-0.861) and 0.651×10-3 mm2/s (0.617-0.685) in the transition zone. The area under the curve (AUC)s of the ADC values from ultrahigh b-value DWI (2000 s/mm2 and 3000 s/mm2) were 0.824 and 0.852 in the peripheral zone and 0.905 for the ADC values from ultrahigh b-value DWI (3000 s/mm2) in the transition zone. In the peripheral zone, the ADC diagnostic cutoff values for prostate cancer were 0.75×10-3 mm2/s and 0.685×10-3 mm2/s in DWI at 2000 s/mm2 and 3000 s/mm2, respectively, and the diagnosis of transition zone cancer was 0.8×10-3 mm2/s and 0.634×10-3 mm2/s, respectively.CONCLUSION:The ADC values from ultrahigh b-value DWI demonstrated better consistency and diagnostic efficacy in the diagnosis of prostate cancer.

Background: To describe the feasibility of anatomy and imaging findings of the prostatic arteries (PAs) on contrast-enhanced MR angiography (ce-MRA). Methods: This prospective study enrolled 7 patients undergoing pelvic 3.0 T ce-MRA and selective pelvic digital subtraction angiography before prostatic artery embolization (PAE). Four patients underwent fluoroscopically triggered ce-MRA and 3 patients underwent time-resolved imaging of contrast kinetics. PAE was performed within one week of MRA. Two radiologists independently analyzed MRA findings. The analyzed parameters included the number of independent PAs and their origin, trajectory, and anastomoses with adjacent arteries. Image quality in terms of signal-to-noise ratio (SNR) and contrast-tonoise ratio (CNR) to visualize common iliac artery and its branches including prostatic arteries was compared between the two groups. Results: A total of 17 PAs were demonstrated in 7 cases. The diagnostic accuracy of MRA in detecting bilateral PAs was 58.82%. Moreover, 71.42% of the patients had only one PA in one side, and 7.14% had independent PAs. The mean diameter of 10 PAs was 1.39 ± 0.46 mm. About 29.41% of PAs originated from the obturator arteries and 29.41% from the pudendal arteries. Bilateral PAs were found to be symmetric in 3 cases and asymmetric in 4 cases. No significance difference was found between the image quality of the two groups, except for the signal intensity of the right common iliac artery and right internal iliac artery and SNR and CNR of the left common iliac artery. Conclusions: This study shows that ce-MRA is able to detect PA, and can provide guidance for PAE.

Purpose: To prospectively assess safety and efficacy of prostatic artery embolization (PAE) with bleomycin-eluting microspheres for benign prostatic hyperplasia (BPH) in a canine model. Materials and Methods: Twelve adult male beagles (mean age, 1.6 y +/- 0.2; range, 1.2-2.0 y) were randomly assigned to group A (n = 6; PAE, with bleomycin-eluting 30-60-mu m HepaSphere microspheres) and group B (n = 6; PAE with bland 30-60-mu m HepaSphere microspheres) between April 2017 and November 2018. Plasma bleomycin concentration in group A was measured within 7 days. Prostate volume (PV) and ischemic volume after PAE were measured by magnetic resonance imaging. Prostates and adjacent organs were harvested after the last magnetic resonance study and histopathologically examined. Results: Plasma bleomycin concentration peaked at 10 minutes at 2,055.0 ng/mL +/- 606.1 and lasted for 1,440 min at low levels after PAE. PV reduction percentage was greater in group A than in group B at 1 month (74.1% +/- 4.3 vs 63.7% +/- 3.5; P =.006) and 3 months (61.5% +/- 6.7 vs 46.1% +/- 3.8; P = .001) after PAE. Proportion of prostate ischemic volume was greater in group A than in group B (75.3% +/- 3.0 vs 62.0% +/- 7.1; P - .006) at 1 month after PAE. Proportion of prostate ischemic volume at I month positively correlated with PV percentage reduction at 3 months in group A (r = 0.840, P = .036) and group 13 (r = 0.844, P = .035). There were no complications or nontarget embolization to surrounding organs after the procedures. Conclusions: In a canine model, PAE with Neomycin-eluting microspheres was feasible and well d and caused ischemic necrosis and reduction in PV.

To assess the usefulness of morphological characteristics of diffusion-weighted imaging (DWI) for differentiating malignant renal tumors from benign renal tumors, and clear cell renal cell carcinoma (RCC) from non-clear cell RCC at 3.0 T.

Background: A major technical challenge of prostatic arterial embolization (PAE) is the identification and catheterization of the prostatic arteries (PAs). Recently, MR angiography has been shown to help visualize PAs, but the clinical utility of MR angiography for this purpose is not known. Purpose: To determine the efficacy of contrast material-enhanced MR angiography in identifying the PA and to evaluate its role in PAE for benign prostatic hyperplasia (BPH). Materials and Methods: In this prospective study, 100 consecutive men who were scheduled to undergo PAE for BPH from January 2015 to May 2017 were assigned by using a randomized block design to either group A (n = 50; mean age, 71.7 years 6 11.9 [standard deviation]) without MR angiography or group B (n = 50; mean age, 72.3 years +/- 12.2) with MR angiography prior to PAE. MR angiography findings of the PA anatomy were compared with those of digital subtraction angiography (DSA). The Student t test and Wilcoxon rank-sum test were used to compare the differences between the parameters indicating the performance of PAE. Results: The mean age of the 100 men in the study was 72.0 years +/- 11.8 (range, 51-88 years). Compared with DSA as the reference standard, MR angiography identified PAs with a sensitivity of 91.5% (97 of 106) and a positive predictive value of 100% (97 of 97). With the knowledge of tube obliquity and anatomy, group B had lower procedure times than group A (82.3 minutes +/- 5.4 vs 123.9 minutes +/- 12.4, P < .001) and shorter fluoroscopy times (13.8 minutes +/- 2.7 vs 28.5 minutes +/- 8.0, P < .001). Additionally, radiation dose was reduced for group A versus group B, from a median of 920 to 339 mGy (P = .004). Conclusion: Contrast-enhanced MR angiography can accurately show anatomy for the prostate arteries, leading to shorter prostatic artery embolization times and lower radiation dose than when preprocedural prostate MR angiography is not performed. Published under a CC BY 4.0 license.

Objective: To assess the values of pelvic contrast enhanced magnetic resonance angiography (MRA) in detection of prostatic artery prior to prostatic arterial embolization(PAE). Methods: This multicenter, prospective study from 5 hospitals in China consisted of 47 patients (mean age (69±16) years, range 56-83 years) who underwent PAE for benign prostatic hyperplasia (BPH) between January 2016 and April 2018, preprocedural prediction of prostatic arteries were determined using contrast enhanced MRA.CE-MRA findings were compared with subsequent intraprocedural digital subtraction angiography (DSA) or DSA combined with cone-beam computed tomography (CT) to assess the sensitivity and specificity with which contrast enhanced MRA predicted the number and origins of prostatic artery, also to assess the optimal oblique projection of PA. Results: In total, 47 patients (94 pelvic sides) with 97 PAs confirmed by DSA or DSA combined with cone-beam CT at the time of embolization, MR angiography successfully identified 88 PAs and their origins , the sensitivity and specificity was 90.7% (88/97) and 93.6% (88/94), respectively.MR angiography correctly determined the bilateral prostatic artery origins in 36 (76.6%) cases.According to the optimal oblique projection of PAs suggested by MR angiography, the origins and trajectory of PAs of all patients underwent PAE with the same oblique projection (20°-45°ipsilateral anterior oblique direction) were clearly displayed when performed the first arteriography. Conclusion: Pelvic contrast enhanced MR angiography with high sensitivity and specificity in detection the origin, trajectory and number of PAs, and it could provide useful information regarding prostatic arteries before PAE.

BACKGROUND:To determine whether MRI feature analysis can differentiate benign retroperitoneal extra-adrenal paragangliomas and schwannomas.METHODS:The MRI features of 50 patients with confirmed benign retroperitoneal extra-adrenal paragangliomas and schwannomas were retrospectively reviewed by two radiologists blinded to the histopathologic diagnosis. These features were compared between two types of tumours by use of the Mann-Whitney test and binary logistic regression. The patients' clinical characteristics were reviewed.RESULTS:Analysis of MRI images from 50 patients revealed no significant differences in the quantitative MRI features of lesion size, ratio of diameter and apparent diffusion coefficient. There were significant differences in the qualitative MRI features of location, necrosis, cysts and degree of tumour enhancement for two readers, with no significant differences in the other qualitative MRI features between these tumours. The combination of necrosis with degree of tumour enhancement during the arterial phase increased the probability that a retroperitoneal mass would represent retroperitoneal extra-adrenal paraganglioma as opposed to schwannoma.CONCLUSION:We have presented the largest series of MRI features of both benign retroperitoneal extra-adrenal paragangliomas and schwannomas. Some MRI features assist in the differentiation between these tumours, with imaging features consisting of necrosis and avid enhancement during the arterial phase, suggestive of retroperitoneal extra-adrenal paragangliomas.

To prospectively estimate measurement and scan reproducibility of parameters of intravoxel incoherent motion (IVIM) in renal tumors, normal renal cortex, and medulla.

目的 探讨扩散加权成像(DWI)诊断前列腺癌的最佳b值.方法 根据纳入和排除标准,收集73例患者,行前列腺T2WI、常规DWI(b=1000 s/mm2)和超高b值DWI(b值分别为2000、3000 s/mm2)检查.在磁共振成像(MRI)图像上,根据评分诊断前列腺病变,并与穿刺活检病理结果对照.以穿刺病理结果为金标准,计算不同影像检查方法诊断前列腺病变的准确度.采用Kappa一致性检验分析观察者间一致性.结果 73例受检者中,穿刺活检证实前列腺癌54例,前列腺增生17例,正常者2例.病灶数141个,其中包括外周带99个,移行区42个.T2WI诊断外周带和移行区前列腺癌的准确度分别为66％(65/99)和69％(29/42),常规DWI诊断的准确度分别为62％(61/99)和52％(22/42),超高b值DWI(b=2000、3000 s/mm2)诊断的准确度分别为77％(76/99)和85％(84/99)以及69％(29/42)和88％(37/42).2000、3000 s/mm2超高b值DWI诊断前列腺外周带癌的敏感度(分别为88％和92％)和特异度(分别为53％和69％),均高于常规DWI(P<0.05).超高b值DWI(b=3000 s/mm2)对于外周带和移行区的一致性分别为0.887和0.842,超高b值DWI(b=2000 s/mm2)对于外周带的一致性为0.821.结论 超高b值DWI诊断前列腺病变的一致性提高,b值3000 s/mm2超高b值DWI对移行区前列腺癌的诊断更有价值.

Objective To explore the value of ultra-high b-value diffusion-weighted imaging(DWI) in diagnosis of prostate cancer. Methods According to inclusion and exclusion criteria, 73 consecutive examinees in Chinese PLA General Hospital from June 2014 to May 2015 were screened. Written informed consent was obtained from all patients. T2WI, conventional DWI with b-value of 1 000 s/mm2and ultra-high b-value DWI with 2 000 s/mm2and 3 000 s/mm2were performed in each examinee. Images were interpreted and were corresponding to histological results conducted by ultrasound guided prostate systematic biopsy. Reference biopsy as the gold standard,the sensitivity,specificity, positive predictive value(PPV) and negative predictive value (NPV) were calculated for each image. Sensitivity and specificity differences between ultra-high b-value DWI and conventional DWI were analyzed. The areas under the curves (AUCs) between ultra-high b-value DWI and other modalities were compared. Results The sensitivity and specificity for ultra-high b-value DWI were 92.5 % and 68.8 % with b-value of 3 000 s/mm2, and they were 88.1 % and 53.1 % for 2 000 s/mm2in peripheral zone. The sensitivity and specificity for ultra-high b-value DWI were 88.0 % and 88.2 % with a b-value of 3 000 s/mm2, and they were 80.0 % and 52.9 % for 2 000 s/mm2in transition zone. The values of sensitivity for ultra-high b-value DWI were significantly higher than those for conventional DWI both in peripheral zone and transition zone (all P <0.000 1). The detection of lesions was comparable with ultra-high b-value DWI at 2 000 s/mm2and 3 000 s/mm2in peripheral zone (P >0.05), whereas the value of specificity for 3 000 s/mm2were significantly higher than that for 2 000 s/mm2in transition zone (P<0.000 1). PPV and NPV for 3 000 s/mm2were significantly higher than those for the other three modalities both in peripheral zone(86.1 % and 81.5 %) and transition zone (91.7 % and 83.3 %). In peripheral zone, the AUCs were 0.591, 0.553, 0.698 and 0.806 in T2WI, conventional DWI and ultra-high b-value DWI at 2 000 s/mm2 and 3 000 s/mm2respectively, for the diagnosis of transition zone cancer were 0.693, 0.506, 0.665 and 0.881 respectively, and the AUCs for the ultra-high b-value with 3 000 s/mm2were the largest. Conclusion Ultra-high b-value DWI is an accurate and reliable method in the diagnosis of prostate cancer.

To assess magnetic resonance imaging (MRI) features after prostatic artery embolization (PAE) for the treatment of medium- and large-volume benign prostatic hyperplasia and to correlate prostate volume with clinical indexes.

The goal of this study was to retrospectively review the magnetic resonance imaging (MRI) features of retroperitoneal extra-adrenal paragangliomas and to evaluate the diagnostic capabilities of MRI. Twenty-four patients with confirmed benign retroperitoneal extra-adrenal paragangliomas who underwent preoperative MRI and surgical resection were enrolled. The patients' clinical characteristics and MRI features were reviewed by two radiologists. There were no significant differences in the qualitative and quantitative MRI features were determined by the reviewers. High signal intensity in T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) was observed in all tumors. In contrast T1-weighted imaging (T1WI) in the arterial phase, 83.33% of the tumors were clearly enhanced. In 87.5% of cases, a persistent enhancement pattern was observed in the venous and delayed phases, and 12.5% of tumors showed a "washout" pattern. The tumor capsule, intratumoral septum and degenerations were visualized in the tumors and may be helpful in the qualitative diagnosis of extra-adrenal paragangliomas in MRI. MRI was useful in locating the position, determining the tumor ranges and visualizing the relationship between the tumors and adjacent structures. The presence of typical clinical symptoms and positivity of biochemical tests are also important factors in making an accurate preoperative diagnosis.

Purpose. To evaluate the incremental value of diffusion-weighted imaging (DWI) in relation to conventional magnetic resonance imaging (MRI) in the differentiation of serous cystadenomas (SCAs) and mucinous cystic neoplasms (MCNs) at 3.0 T. Methods. This retrospective study included 24 patients with SCAs and 39 patients with MCNs which were proved pathologically. All patients underwent conventional MRI and DWI examinations at 3.0 T. Imaging features, apparent diffusion coefficient (ADC) values, and normalized ADC between SCAs and MCNs were compared and placed in multivariate models to predict the differential diagnosis of SCAs and MCNs. The optimal cut-off value was determined using a receiver operating characteristic curve. Results. There are significant differences between SCAs and MCNs with respect to tumor location, shape, and morphology (P = 0.017, P < 0.001, and P < 0.001, respectively). ADC values and normalized ADC of SCAs were significantly lower than those of MCNs (P < 0.001 and P = 0.005, respectively). The addition of the ADC value to imaging features improved the diagnostic performance of DWI MR imaging: the area under the receiver operating characteristic curve increased from 0.907 to 0.972 (P = 0.0314). Conclusions. This indicates that DWI with ADC value assessment may improve the differentiation of SCAs over MCNs beyond the level of characterization achieved with conventional MRI at 3.0 T.

Background Leiomyoma of the prostate is a rare benign tumor arising from smooth muscle fibers. Most cases are incidental findings observed during pathological examinations after resection of the prostate. To the best of our knowledge, only few studies have reported the conventional magnetic resonance imaging (MRI) findings of such tumors; however, no reports have described the ultra-high b-value diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) findings of prostatic leiomyomas. Case presentation We report MR imaging characteristics and surgical pathologic findings of a case of prostatic leiomyoma treated by robot-assisted transperitoneal laparoscopic approach. Typical MR features showed a homogeneous lesion with slightly hypointense signal compared to the skeletal muscle on T2-weighted images, and isointense signal relative to the muscle on T1-weighted images with fat suppression, which collectively demonstrate apparent homogeneous enhancement with a non-enhanced envelope. A slightly hyperintense signal compared to the skeletal muscle was observed on ultra-high b-value DWI, and higher ADC values were observed as compared to the prostate cancer. Conclusions Prostatic leiomyoma is a benign tumor. This case indicates that MRI features of prostatic leiomyoma are helpful for the differential diagnosis of prostate cancer.

Our aim was to study the characteristic MRI findings of renal metastases in assisting differential clinical diagnosis. MRI findings of 35 renal lesions in 13 patients (10 males and 3 females, median age: 54.8 years, age range: 26-77 years) with primary non-renal malignancies were retrospectively reviewed. Only one case was synchronously detected with the primary tumor. The average time interval between renal metastases and primary tumors of the other twelve patients was 36.1 months (range, 1 similar to 132 months). Thirteen metastases proved by pathology in thirteen patients, and the twenty-two lesions in four patients without pathologic proofs were analyzed. MRI features of the lesions were analyzed by two readers. The sample proportions of the two readers and that of lesions with and without pathologic proofs were compared using Chi-square test. SIlesion -to-SIcortex ratio (SILCR) was compared by using paired-sample t-test between lesions with and without pathologic proofs. There was no significant difference in the assessment of these features made by the two reviewers. Between lesions with and without pathologic proofs, there were no significant differences in MRI characteristics as following: an endophytic growth pattern, well-defined boundary, without renal sinus invasion, no microscopic fat component, no pseudocapsule, low signal on T-2-weighted imaging, high signal on DWI, low signal on T-1-weighted imaging, and a hypovascular lesion with homogeneous enhancement pattern. There were no significant differences in SILCR on T-2-weighted imaging, T-1-weighted imaging, corticomedullary phase, and nephrographic phase between lesions with and without pathologic proofs. These findings suggested that some characteristic MRI features can increase confidence in differentiating renal metastases from other primary tumors.

To retrospectively analyze the MR imaging presentation of renal epithelioid angiomyolipoma (EAML).

Prostate cancer is increasing year by year in our country.Diagnosis of early prostate cancer is important.With the development of medical imaging technology, multimodality image-guided biopsy has improved the detection rate of prostate cancer, and reduced the complications.This review focused on the present status of and advances in multimodality imaging technology-guided biopsy for prostate cancer.