Faculty Bibliography

PURPOSE/OBJECTIVE:To assess the incremental value of diffusion-weighted (DW) magnetic resonance (MR) imaging over T2-weighted MR imaging at 3 T for prostate cancer detection and to investigate the use of the apparent diffusion coefficient (ADC) to characterize tumor aggressiveness, with whole-mount step-section pathologic analysis as the reference standard. MATERIALS AND METHODS/METHODS:The Internal Review Board approved this HIPAA-compliant retrospective study and waived informed consent. Fifty-one patients with prostate cancer (median age, 58 years; range, 46-74 years) underwent T2-weighted MR imaging and DW MR imaging (b values: 0 and 700 sec/mm(2) [n = 20] or 0 and 1000 sec/mm(2) [n = 31]) followed by prostatectomy. The prostate was divided into 12 regions; two readers provided a score for each region according to their level of suspicion for the presence of cancer on a five-point scale, first using T2-weighted MR imaging alone and then using T2-weighted MR imaging and the ADC map in conjunction. Areas under the receiver operating characteristic curve (AUCs) were estimated to evaluate performance. Generalized estimating equations were used to test the ADC difference between benign and malignant prostate regions and the association between ADCs and tumor Gleason scores. RESULTS:For tumor detection, the AUCs for readers 1 and 2 were 0.79 and 0.76, respectively, for T2-weighted MR imaging and 0.79 and 0.78, respectively, for T2-weighted MR imaging plus the ADC map. Mean ADCs for both cancerous and healthy prostatic regions were lower when DW MR imaging was performed with a b value of 1000 sec/mm(2) rather than 700 sec/mm(2). Regardless of the b value used, there was a significant difference in the mean ADC between malignant and benign prostate regions. A lower mean ADC was significantly associated with a higher tumor Gleason score (mean ADCs of [1.21, 1.10, 0.87, and 0.69] × 10(-3) mm(2)/sec were associated with Gleason score of 3 + 3, 3 + 4, 4 + 3, and 8 or higher, respectively; P = .017). CONCLUSION/CONCLUSIONS:Combined DW and T2-weighted MR imaging had similar performance to T2-weighted MR imaging alone for tumor detection; however, DW MR imaging provided additional quantitative information that significantly correlated with prostate cancer aggressiveness.

PURPOSE/OBJECTIVE:To determine the prognostic importance of pleural effusions on preoperative computed tomographic (CT) images in patients with advanced epithelial ovarian cancer. MATERIALS AND METHODS/METHODS:The institutional review board waived informed consent for this HIPAA-compliant study of 203 patients with International Federation of Obstetrics and Gynecology stage III (n = 172) or IV (n = 31) epithelial ovarian cancer who underwent CT before primary cytoreductive surgery between 1997 and 2004 (mean age, 61 years; range, 37-96 years). Two radiologists retrospectively evaluated chest and/or abdominal CT images for pleural malignancy and the presence, size, and laterality of pleural effusions. To evaluate survival, Kaplan-Meier methods were used, with log-rank P values for comparisons. Multivariate analyses were conducted by using Cox proportional hazards regression. κ Statistics were calculated for interreader agreement. RESULTS:Median survival was 50 months (95% confidence interval [CI]: 45, 55 months) for patients with stage III disease and 41 months (95% CI: 27, 58 months) for patients with stage IV disease. Readers 1 and 2 found pleural effusions in 40 and 41 stage III and 20 and 21 stage IV patients, respectively. At multivariate analysis, after controlling for stage, age at surgery, preoperative serum CA-125 level, debulking status, and ascites, moderate-to-large pleural effusion on CT images was significantly associated with worse overall survival (reader 1: hazard ratio = 2.27 [95% CI: 1.31, 3.92], P < .01; reader 2: hazard ratio = 2.25 [95% CI: 1.26, 4.01], P = .02). Preoperative CA-125 level, debulking status, and ascites were also significant survival predictors (P ≤ .03 for all for both readers). Readers agreed substantially in distinguishing small from moderate-to-large effusions (κ = 0.764). CONCLUSION/CONCLUSIONS:Moderate-to-large pleural effusion on preoperative CT images in patients with stage III or IV epithelial ovarian cancer was independently associated with poorer overall survival after controlling for age, preoperative CA-125 level, surgical stage, ascites, and cytoreductive status.

PURPOSE/OBJECTIVE:To assess the value of magnetic resonance (MR) imaging in determining the site of origin of newly diagnosed uterine cancer (corpus vs cervix) when clinical and/or histologic evaluation is indeterminate. MATERIALS AND METHODS/METHODS:The Institutional Review Board approved and waived informed consent for this HIPAA-compliant study of 59 women (median age, 59 years; range, 28-84 years) who underwent pelvic MR imaging to determine the anatomic origin of uterine cancer. Two radiologists independently retrospectively assessed all MR imaging studies. In 48 patients who underwent hysterectomy, surgical pathologic findings were the reference standard, and overall test yields and diagnostic likelihood ratios were measured. Accuracy in detecting invasion of adjacent structures was also calculated. For the remaining patients, imaging and biopsy findings are presented descriptively. RESULTS:At hysterectomy, 32 patients had uterine corpus cancer and 16 had cervical cancer. Overall test yields for reader 1 and reader 2 were 0.85 and 0.88, respectively. When a reader attributed a tumor's origin to either the uterine corpus or cervix, the odds of the tumor originating from that site were 4.80-6.35 times greater than they would have been if no other information were available. Accuracy levels in detecting invasion of the myometrium, cervical stroma, parametria and/or adnexae, and vagina, respectively, were 72%, 69%, 74%, and 85% for reader 1 and 78%, 77%, 76%, and 85% for reader 2. CONCLUSION/CONCLUSIONS:MR imaging is useful for determining the anatomic origin of uterine cancer and provides helpful information regarding invasion of adjacent structures.

We describe the case of a 48-year-old male with primary seminal vesicle carcinoma. Although most malignant lesions involving the seminal vesicles are the result of secondary spread from other tumors, primary seminal vesicle carcinoma must be considered in the differential diagnosis, as the prognosis for this condition is dismal. Magnetic resonance imaging plays a crucial role in assessment, as it can exquisitely depict the anatomy of this region and define the extent of a seminal vesicle lesion.

Positive surgical margins after radical prostatectomy are associated with an increased risk of cancer recurrence. Depending on the patient's clinical presentation and the amount of residual prostatic tissue, this could be described as a surgical complication or as treatment failure. Endorectal magnetic resonance (MR) imaging provides useful information regarding the presence and extent of benign and/or malignant residual prostate tissue. The clinical features and MR images from a 55-year-old man who underwent prostatectomy for prostate cancer and was found to have a considerable amount of residual prostatic tissue postoperatively on MR imaging are presented in the article.

Gynecologic malignancies account for 10%-15% of all malignancies in females. A variety of oncologic options are available depending on organ of origin, histologic diagnosis, and disease grade and stage. Gynecologic malignancies are usually treated with surgery, chemotherapy, or radiation therapy. Posttreatment imaging plays a crucial role in the assessment of treatment response and tumor recurrence. Imaging of the female pelvis following chemotherapy and radiation therapy is particularly challenging due to alteration of the normal anatomy and loss of tissue planes. Expected changes in appearance occur following chemotherapy-radiation therapy, as do complications such as fistulas, proctitis, enteritis, typhlitis, cystitis, and insufficiency fractures. Radiologists should be familiar with both the expected posttreatment imaging findings and the imaging features of common complications to help make the correct interpretation and avoid possible pitfalls.

The lymphomas are a heterogeneous group of malignancies, which exhibit a range of different molecular features, genetics, and clinical presentations. Consequently, therapeutic approaches and clinical outcomes differ greatly. Following therapy, the thorax may be a site of disease recurrence, but infection, drug reactions, and radiation pneumonitis are commonly encountered. We present a comprehensive review of these conditions, focussing on their radiological appearances, in order that radiologists may better engage their colleagues in haemato-oncology.

Little is known regarding public awareness of the roles and responsibilities of a consultant radiologist. Between 1 April and 20 May 2008, 916 outpatients attending our radiology department completed a questionnaire addressing this issue. We found public perception variable. Thirty-six percent of respondents thought we were responsible for choosing appropriate imaging; only 65% perceived that we reported studies. Another 38% felt that we did not play an important role in their treatment, and 38% considered that we were not part of their medical team. Thirty-two percent of respondents preferred their hospital consultant to give them their imaging results, with 17% preferring this to come from the radiologist. There is significant under-appreciation of the roles and responsibilities of a consultant radiologist. It is important that we educate the public to ensure that future health policy reflects the increasingly central role imaging plays in health-care delivery.

The aortic root links the left ventricle and ascending aorta and functions as a support structure for the aortic valve. It can be affected by a variety of congenital and acquired conditions, some of which are potentially life threatening. Echocardiography and cardiac magnetic resonance imaging are established non-invasive imaging techniques for assessing the aortic root. Recent technological advances have allowed multidetector computed tomography to emerge as an alternative means of assessing this aortic segment. This pictorial essay reviews the anatomy of the aortic root and illustrates the salient computed tomography imaging features of a range of congenital and acquired conditions that may affect it.