Publications

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    ABSTRACT: Objectives To evaluate the automated two-point Dixon screening sequence for the detection and estimated quantification of hepatic iron and fat compared with standard sequences as a reference. Methods One hundred and two patients with suspected diffuse liver disease were included in this prospective study. The following MRI protocol was used: 3D-T1-weighted opposed- and in-phase gradient echo with two-point Dixon reconstruction and dual-ratio signal discrimination algorithm (“screening” sequence); fat-saturated, multi-gradient-echo sequence with 12 echoes; gradient-echo T1 FLASH opposed- and in-phase. Bland–Altman plots were generated and correlation coefficients were calculated to compare the sequences. Results The screening sequence diagnosed fat in 33, iron in 35 and a combination of both in 4 patients. Correlation between R2* values of the screening sequence and the standard relaxometry was excellent (r = 0.988). A slightly lower correlation (r = 0.978) was found between the fat fraction of the screening sequence and the standard sequence. Bland–Altman revealed systematically lower R2* values obtained from the screening sequence and higher fat fraction values obtained with the standard sequence with a rather high variability in agreement. Conclusions The screening sequence is a promising method with fast diagnosis of the predominant liver disease. It is capable of estimating the amount of hepatic fat and iron comparable to standard methods. Key points • MRI plays a major role in the clarification of diffuse liver disease. • The screening sequence was introduced for the assessment of diffuse liver disease. • It is a fast and automated algorithm for the evaluation of hepatic iron and fat. • It is capable of estimating the amount of hepatic fat and iron.
    European Radiology 12/2014; · 4.34 Impact Factor
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    ABSTRACT: All participants for image samplings provided written informed consent. Conventional B-mode ultrasonography (US) has been widely utilized for musculoskeletal problems as a first-line approach because of the advantages of real-time access and the relatively low cost. The biomechanical properties of soft tissues reflect to some degree the pathophysiology of the musculoskeletal disorder. Sonoelastography is an in situ method that can be used to assess the mechanical properties of soft tissue qualitatively and quantitatively through US imaging techniques. Sonoelastography has demonstrated feasibility in the diagnosis of cancers of the breast and liver, and in some preliminary work, in several musculoskeletal disorders. The main types of sonoelastography are compression elastography, shear-wave elastography, and transient elastography. In this article, the current knowledge of sonoelastographic techniques and their use in musculoskeletal imaging will be reviewed. © RSNA, 2014.
    Radiology 09/2014; 272(3):622-633. · 6.34 Impact Factor
  • Radiology 09/2014; 272(3):622-633. · 6.34 Impact Factor
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    ABSTRACT: To prospectively assess the value of coronary CT angiography (CTA) in asymptomatic patients with high 'a priori' risk of coronary artery disease (CAD).
    Open heart. 08/2014; 1(1):e000096.
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    ABSTRACT: Evaluation of the Prostate Imaging Reporting and Data System (PI-RADS) scoring system for classifying multi-parametric magnetic resonance imaging findings of the prostate using whole-mount step-section slides as reference standard.
    World Journal of Urology 08/2014; · 2.89 Impact Factor
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    ABSTRACT: The objective of this study was to report on the incidence of left arm ischemia, left arm function, and quality of life after thoracic endovascular aortic repair (TEVAR) by stent grafting with and without coverage of the left subclavian artery (LSA). All patients who underwent TEVAR since 1996 in our institution were included. Basic demographic parameters, underlying disease, details of TEVAR, long-term left arm function (Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire), and quality of life (12-Item Short Form Health Survey) were analyzed. End points were left arm ischemia, need for LSA revascularization (before or after TEVAR), long-term functional impairment, and quality of life. A total of 138 patients underwent TEVAR for degenerative aneurysm (n = 64), traumatic aortic injury (TAI; n = 38), or Stanford type B dissection (n = 36). Seventy-three patients (52.9%) had LSA coverage, which led to partial or complete LSA occlusion in 49 (35.5%). Selectively, nine patients (6.5%) had primary LSA revascularization. After TEVAR, left arm ischemia was observed in only one patient, who consecutively needed a left carotid to subclavian bypass. During a mean follow-up period of 4.1 ± 3.7 years, no additional patient needed secondary LSA revascularization. In comparing patients with occluded vs patent LSA, the Physical Component Summary (PCS) and Mental Component Summary (MCS) health scores (12-Item Short Form Health Survey) as well as DASH scores were similar. However, subgroup analysis showed better PCS scores for TAI patients with patent LSA, whereas MCS and DASH scores were similar in TAI patients, and scores were indifferent within thoracic aortic aneurysm and Stanford type B dissection subgroups. In comparing different subgroups, TAI patients had significantly better PCS, MCS, and DASH scores. TEVAR is associated with a low risk of peri-interventional left arm ischemia. During long-term follow-up, secondary LSA revascularization is uncommon. Coverage of the LSA has no impact on left arm function and quality of life, probably with the exception of physical health scores in patients with TAI.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 03/2014; · 3.52 Impact Factor
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    ABSTRACT: OBJECTIVE. The purpose of this study was to compare prostate cancer detection rate of real-time elastography (RTE) with that of multiparametric MRI to evaluate the advantages and disadvantages of the two methods. SUBJECTS AND METHODS. Thirty-nine patients with biopsy-proven prostate cancer underwent both RTE and multiparametric MRI to localize prostate cancer before radical prostatectomy. RTE was performed to assess prostate tissue elasticity, and hard lesions were considered suspicious for prostate cancer. Multiparametric MRI included T2-weighted MRI, diffusion-weighted MRI (DWI), and contrast-enhanced MRI (CE-MRI) with an endorectal coil at 1.5 T. After radical prostatectomy, whole-mount step sections of the prostate were generated, and the prostate cancer detection rates with both modalities were analyzed for cancer lesions measuring 0.2 cm(3) or larger. RESULTS. Histopathologic examination revealed 61 cancer lesions. RTE depicted 39 of 50 cancer lesions (78.0%) in the peripheral zone and 2 of 11 (18.2%) in the transitional zone. Multiparametric MRI depicted 45 of 50 cancer lesions (90.0%) in the peripheral zone and 8 of 11 (72.7%) in the transitional zone. Significant differences between the two modalities were found for the transitional zone and anterior part in prostates with volumes greater than 40 cm(3) (p < 0.05). Detection rates for high-risk prostate cancer (Gleason score ≥ 4 and 3) and cancer lesions with volumes greater than 0.5 cm(3) were high for both methods (93.8% and 80.5% for RTE, 87.5% and 92.7% for multiparametric MRI). Volumetric measurements of prostate cancer were more reliable with T2-weighted MRI than with RTE (Spearman rank correlation, 0.72 and 0.46). CONCLUSION. RTE and multiparametric MRI depicted high-risk prostate cancer with high sensitivity. However, multiparametric MRI seems to have advantages in tumor volume assessment and for the detection of prostate cancer in the transitional zone and anterior part within prostates larger than 40 cm(3).
    American Journal of Roentgenology 03/2014; 202(3):W263-9. · 2.90 Impact Factor
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    ABSTRACT: Purpose To compare the elasticity of the median nerve (MN) between healthy volunteers and patients with carpal tunnel syndrome (CTS) and to evaluate the diagnostic utility of sonoelastographic measurements of the elasticity of the MN. Materials and Methods This study was performed with institutional review board approval and written informed consent from all participants. Hands in 22 healthy volunteers and in 31 patients with symptomatic CTS were studied. The cross-sectional area (CSA) and the elasticity of the MN, which was measured as the acoustic coupler (AC)/MN strain ratio, were evaluated. Results Both hands in 22 healthy volunteers (three men [mean age, 52.7 years; age range, 41-65 years]; 19 women [mean age, 62.2 years; age range, 40-88 years]) and 43 hands in 31 patients with symptomatic CTS (three men [mean age, 69.0 years; age range, 46-88 years]; 28 women [mean age, 61.2 years; age range, 39-92 years]) were studied. Both the AC/MN strain ratio and the CSA in the patients with CTS were significantly higher than those in the healthy volunteers (P < .001). The presence of CTS was predicted by means of AC/MN strain ratio and CSA cutoff values, respectively, of 4.3 and 11 mm(2), with areas under the receiver operating characteristic curves (AUCs) of 0.78 (95% confidence interval [CI]: 0.69, 0.88) and 0.85 (95% CI: 0.78, 0.93). A logistic model that combined the AC/MN strain ratio and the CSA improved diagnostic accuracy for CTS, with an AUC of 0.91 (95% CI: 0.85, 0.97; P < .001). Conclusion Sonoelastography provides significant improvement in the diagnostic accuracy of the ultrasonographic assessment of CTS. © RSNA, 2013.
    Radiology 02/2014; 270(2):481-6. · 6.34 Impact Factor
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    ABSTRACT: Palpation of organs is one of the oldest clinical examination techniques, for instance, if you think of the palpation of the breast or the digital rectal examination of the prostate, where hard palpable regions are suspicious for cancer. This is the basic principle of real-time elastography, an ultrasound technique, which is able to visualise tissue elasticity. Since prostate cancer features an increased stiffness due to the higher cell and vessel density than the normal surrounding tissue, real-time elastography has been used for several years for prostate cancer detection. This review introduces the different techniques of ultrasound elastography and furthermore summarises its limitations and potentials.
    BioMed Research International 01/2014; 2014:180804. · 2.71 Impact Factor
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    ABSTRACT: PURPOSE To prospectively compare non-calcified plaque delineation and image quality of coronary artery computed tomography angiograms (CCTA) obtained with sonogram-affirmed iterative reconstruction (SAIR) with different strengths and filtered back projection (FBP). METHOD AND MATERIALS A total of 53 patients (body weight 90.4±21.6 kg, BMI 29.5±6.6) were investigated. CCTA was performed using 128-slice dual-source CT. Images were reconstructed with standard FBP and sonogram-affirmed iterative reconstruction using different strength (I2f, I3f, I4f). Image quality score (IQS) of overall CCTA exam and a non-calcified plaque outer border delineation scores (PDS) were evaluated respectively by using a 5-scale score: from 1= non-diagnostic to 5=excellent. Image noise, contrast-to-noise ratio (CNR) of aorta root, left main and right coronary artery proximal part, and the non-calcified plaques were quantified and compared among the 4 image reconstructions. IQS and PDS were compared between different BMI groups (BMI<28 and ≥28). RESULTS There were 69.8% patients in FBP, 98.0% in I2f, 98.1% in I3f and 100% in I4f who had good overall CCTA IQS. There were statistical differences in CCTA exam IQS among the 4 image reconstructions (P<0.01). There were 60 non-calcified plaques by I2f-I4f, out of those 11 (18.3%) plaques were missed by FBP. PDS increased constantly from FBP (2.7±0.4) to I2f (3.2±0.3), to I3f (3.5±0.3) up to I4f (4.0±0.4), while CNRs of the non-calcifying plaque increased and image noise decreased, respectively. Similarly, CNR of aortic root, left main and right coronary artery improved and image noise declined from FBP to I2f, I3f and I4f. IQS improvements were consistent in low and high BMI groups, however, PDS improvement were greater in high BMI group>28 (P<0.05). The improvements in IQS were more obviously between FBP and SAIR other than comparison among SAIR with different strength. I4f revealed the highest IQS and PDS. CONCLUSION SAIR offers improved image quality and non-calcifying plaque delineation as compared with FBP, especially if BMI is increasing. Importantly, 18.3% of non-calcifying plaques were missed with FBP but detected by SAIR. I4f shows the best IQS and PDS among the different SAIR strength. CLINICAL RELEVANCE/APPLICATION SAIR improves non-calcifying plaque delineation and detection, and image quality in CCTA. In high BMI patients, highest SAIR strength I4f is most beneficial.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: Purpose To define the stiffness of the intracarpal tunnel contents and to evaluate the effect of corticosteroid injection on the intracarpal tunnel contents by using sonoelastography. Materials and Methods This study was conducted with the approval of the institutional review boards, and all participants provided written, informed consent. Both hands were studied in 20 healthy volunteers, including eight men (mean age, 59.6 years; range, 50-76 years) and 12 women (mean age, 61.0 years; range, 39-79 years) and 22 hands were studied in 20 patients with carpal tunnel syndrome (CTS) (five men [mean age, 49.0 years] and 15 women [mean age, 61.1 years]; range, 39-89 years) between April 2012 and August 2012. The stiffness of the intracarpal tunnel contents was estimated as the standardized acoustic coupler (AC)-to-intracarpal tunnel contents surrounding the nerve (AC/C) strain ratio, analyzed with the Mann-Whitney U test. The patients were treated with corticosteroid injections, and the strain ratio was reexamined 6 weeks later, analyzed with the Wilcoxon t test. Results The mean AC/C strain ratio in the CTS patients was 12.6 ± 4.7 (standard deviation), which was higher (stiffer) than that in the healthy volunteers with a mean strain ratio of 8.2 ± 3.5 (P = .0013). Six weeks after the injection, the mean AC/C strain ratio had decreased to 8.5 ± 4.1 (P = .00069, compared with the preinjection value) in the CTS patients. Conclusion The stiffness of the intracarpal tunnel contents in untreated CTS patients is higher than that of healthy volunteers but decreases 6 weeks after corticosteroid injection. ©RSNA, 2013.
    Radiology 11/2013; · 6.34 Impact Factor
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    ABSTRACT: Purpose : To report a retrospective review of all patients who were admitted to the interventional radiology unit at our hospital for transcatheter arterial embolization (TAE) of an acute active hemorrhage of the inferior epigastric artery. Methods : From 1996 to 2012, 52 consecutive patients (26 men; mean age 63±15 years) with hemodynamically relevant active abdominal wall hematoma were admitted for TAE of the inferior epigastric artery. Of these, 19 patients had spontaneous hemorrhage due to use of anticoagulants, 18 due to abdominal trauma, and 15 due to an iatrogenic complication. All superselective embolizations were performed using a coaxial catheter technique with a 0.018-inch microcatheter introduced through the diagnostic macrocatheter. Various embolization methods, alone or in combination, were applied, including primarily microcoils and polyvinyl alcohol particles. Results : Primary technical success was achieved in 47/52 (90%) patients; the remainder needed a second embolization session (secondary success 100%). The mean puncture-to-hemostasis time was 65.4±35 minutes. No patient developed a large hematoma or pseudoaneurysm at the puncture site. The 30-day mortality was 19% (n=10) and the total cumulative mortality rate was 23% (n=12). Over a mean 67-month follow-up of 39/40 survivors (1 lost to follow-up), no complications from the embolization procedure, such as abdominal wall ischemia, were observed. There were no differences in outcomes based on etiology of the hemorrhage. Conclusion : In selected patients with acute active hemorrhage of the IEA in the anterior abdominal wall, TAE is a fast, safe, minimally invasive, and reliable method with a high technical success rate and no long-term complications.
    Journal of Endovascular Therapy 08/2013; 20(4):561-7. · 2.70 Impact Factor
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    ABSTRACT: The differentiation between stable and vulnerable plaques in the internal carotid artery (ICA) remains a matter of interest. With the implementation of contrast agent in magnetic resonance imaging (MRI) a more detailed plaque characterization is possible. The study at hand focuses on enhancement patterns of fibro cellular tissue in different kinds of plaques in the ICA. Between May 2011 and December 2012, 49 patients (39 male) with >50% stenosis of the ICA were consecutively enrolled. In 10 patients with bilateral ICA stenosis, both plaques were included for analysis. We performed a classification of plaques according to Cai and observed 11 type 4-5 plaques, 15 type 6 plaques and 33 type 8 plaques. MRI was performed on a 3T whole body MR system. The standard 12 channel head coil was combined with the neck extension coil and two bilateral 7cm loop coils. Post-contrast T1w images were subtracted from pre contrast images to identify late enhancement in fibro cellular tissue. Enhancement patterns were allocated as intraluminal, intraplaque and vasa vasorum enhancement in different types of plaques. Fibro cellular tissue always exhibited a higher contrast enhancement compared to the sternocleidomastoid muscle. This reflects a higher grade of vascularization of the fibrocellular tissue. Contrast enhancement was present irrespective of the plaque type. In detail, intraluminal, intraplaque and vasa vasorum enhancement were observed in all types of plaques. Even type 8 plaques, according to the classification of Cai, had a significant contrast enhancement, though supposed to be with low inflammatory activity. Type 8 plaques might not be as stable as postulated. Whether the relevant uptake of contrast agent is due to the fibrous tissue or reflects the inflammatory activity of the plaque should be matter of further investigations.
    European journal of radiology 08/2013; · 2.65 Impact Factor
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    ABSTRACT: Subclavian artery aneurysm is a rare but serious disease due to the risk of thrombosis, embolization, rupture and compression of adjacent structures. Treatment consists of surgical and endovascular techniques. Up to now few long-term follow-up results have been reported. In our study the results from 15 patients treated for subclavian artery aneurysms were evaluated. Eleven patients underwent open surgical reconstruction, four patients were treated endovascularly. After a mean follow-up period of 77 months (83 months for the open surgical group, 38 months for the endovascular group), 10 of 11 open surgical reconstructions and all primarily implanted stent grafts were patent. Secondary intervention was necessary in two patients. Thirty-day mortality for both treatment groups was 0%. Subclavian artery aneurysm-related symptoms disappeared in six out of 10 patients after the treatment. Long-term outcomes with good technical results, patency rates and low periprocedural morbidity could be shown in both treatment groups.
    Vascular 03/2013; · 0.86 Impact Factor
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    ABSTRACT: Pain around the greater trochanter is still a common clinical problem that may be secondary to a variety of either intra-articular or periarticular pathologies. Gluteal tendon pathologies are one of the primary causes of greater trochanteric pain, with attrition of the fasciae latae against the gluteus medius and minimus tendons, and the trochanteric bursa being possible causes. Key sonographic findings of gluteal tendinopathy, bursitis, and differential diagnosis are described in this overview. Clinical diagnosis and treatment of greater trochanteric pain syndrome is still challenging; therefore ultrasound is helpful to localize the origin of pain, determine underlying pathology, and, based on these findings, to guide local aspiration and/or injection in cases of tendinopathy and/or bursitis.
    Seminars in Musculoskeletal Radiology 03/2013; 17(1):43-8. · 1.40 Impact Factor
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    ABSTRACT: Purpose:To compare and determine the level of agreement of findings at conventional B-mode ultrasonography (US) and sonoelastography of the Achilles tendon with findings at histologic assessment.Materials and Methods:This study was conducted with the approval of the institutional review boards, and all cadavers were in legal custody of the study institution. Thirteen Achilles tendons in 10 cadavers (four male, six female; age range, 70-90 years) were examined with B-mode US and sonoelastography. B-mode US grading was as follows: Grade 1 indicated a normal-appearing tendon with homogeneous fibrillar echotexture; grade 2, a focal fusiform or diffuse enlarged tendon; and grade 3, a hypoechoic area with or without tendon enlargement. Sonoelastography grading was as follows: Grade 1 indicated blue (hardest) to green (hard); grade 2, yellow (soft); and grade 3, red (softest). Twenty-five biopsy specimens from representative lesions of the middle and distal thirds of the Achilles tendons were evaluated histologically. The concordance of B-mode US grading compared with sonoelastographic grading was assessed by using κ analysis.Results:With B-mode US and sonoelastography, all 11 tendon thirds of histologically normal tendons were verified as normal (grade 1). Sonoelastography depicted 14 of 14 (100%) tendon thirds with histologic degeneration (grade 2 or 3), whereas B-mode US could depict only 12 of 14 (86%) lesions (grade 2 or 3). Only moderate agreement between B-mode US and sonoelastography was seen (κ = 0.52, P < .001).Conclusion:Sonoelastography might help predict signs of histopathologic degeneration of Achilles tendinosis, potentially more sensitively than B-mode US.© RSNA, 2013.
    Radiology 02/2013; · 6.34 Impact Factor
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    ABSTRACT: Hepatocellular carcinoma is one of the most common cause of cancer related death. The present review gives an overview on the loco-regional therapy performed by transarterial chemoembolization (TACE).TACE combines two different therapeutic approaches. First, application of chemotherapeutic agents into tumor's feeding vessels and second, selectively de-arterialization by different particle embolization applicated during angiography. Different chemoembolization agents and techniques are described. The methode is save and less invasive. Side effects range from the postembolization syndrom with nausea, vomiting, fever and abdominal pain up to hepatic insufficiency, which is very rare.The aim of the therapy is control clinical symptoms, prolonge progression free survival, stabilize quality of life and survival. Further indications are bridging therapy prior liver transplantation and TACE is used as a neoadjuvant therapy.Thus, TACE plays a role in the therapy of HCC and indication should be tailored to the individual patient's condition by an interdisciplinary tumor board.
    Wiener Medizinische Wochenschrift 02/2013;
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    ABSTRACT: Modern radiology offers countless opportunities both in the detection but also in the characterization of primary liver malignancies. Ultrasound remains usually the first exploratory overview study whereat using ultrasound contrast agent for a further characterization of liver lesions improves this technique considerably. Advanced cross-sectional imaging methods can, in most cases, already provide an exact diagnosis. Thus, the CT is already considered a standard technique for liver imaging and magnetic resonance imaging has gained in recent years due to liver-specific contrast agents and faster sequences a central role in liver imaging. The following article provides an overview of these various radiological procedures and describes the different primary liver malignancies and their imaging characteristics.
    Wiener Medizinische Wochenschrift 02/2013;
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    ABSTRACT: Ultrasonography is the standard modality to image the scrotum because it can provide information about volume, echo texture, tissue stiffness and functional information that includes macrovascularization and microvascularization. Indeed, ultrasound imaging is indicated in the presentation of acute scrotal pain and swelling to differentiate between testicular torsion, infarction and inflammation, as well as being the modality of choice when an intrascrotal mass is suspected. Advances in ultrasonography technology have produced new innovative techniques for imaging the scrotum, including grey-scale ultrasound, Doppler ultrasonography, contrast-enhanced ultrasonography and real-time sonoelastography. Each of these techniques provides information that can be useful when diagnosing diseases and disorders of the testicles. Consequently, the standard approach to accurate diagnosis should rely on multiparametric ultrasonography techniques, rather than just one or two techniques in isolation.
    Nature Reviews Urology 01/2013; · 4.79 Impact Factor
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    ABSTRACT: Purpose. To evaluate the ESUR scoring system (PI-RADS) for multiparametric MRI of the prostate in clinical routine and to define a reliable way to generate an overall PI-RADS score. Methods. Retrospective analysis of all patients with a history of negative prebiopsies, who underwent 3 Tesla multiparametric MRI from October 2011 to April 2013 (n = 143): PI-RADS scores for each single modality were defined. To generate the overall PI-RADS score, an algorithm based approach summing up each single-modality score to a sum-score was compared to a more subjective approach, weighting the single modalities dependent on the radiologist's impression. Because of ongoing cancer suspicion 73 patients underwent targeted mpMRI-ultrasound image fusion rebiopsy. For this group thresholds for tumor incidences and malignancy were calculated. Results. 39 (53%) out of 73 targeted rebiopsies were cancer positive. The PI-RADS score correlated well with tumor incidence (AUC of 0.86, 95% CI 0.78 to 0.94) and malignancy (AUC 0.84, 95% CI 0.68 to 0.99). Regarding the sum-score a threshold of ≥10 turned out to be reliable for cancer detection (sensitivity 90%, specificity 62%) and for ≥13 for indicating higher malignancy (Gleason ≥4 + 3) (sensitivity 80%, specificity 86%). To generate the overall PI-RADS score, the use of an algorithm based approach was more reliable than that of the approach based on the radiologist's impression. Conclusion. The presented scoring system correlates well with tumor incidence and malignancy. To generate the overall PI-RADS score, it seems to be advisable to use an algorithm based instead of a subjective approach.
    BioMed research international. 01/2013; 2013:252939.

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