Imaging in Hawaii

Sep 11th, 2017Sep 14th, 2017
Kauai, HI
US
http://diagnosticimagingupdate.com/imaging-in-hawaii/
This course provides the tools for participants to enhance interpretation skills utilizing the latest imaging technologies. It will cover evidence-based practice techniques and protocols for improved diagnostic accuracy in multiple applications.
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Caption: Representative images show emphysema and functional lung maps derived by CT and PREFUL-MRI: (A–C) CT-derived emphysema images, (D–F) perfusion maps, (G–I) regional ventilation maps, (J–L) flow-volume loop correlation metric maps, (M–O) ventilation/perfusion combined parameter maps. (A, D, G, J, M) Images in a 63-year-old male with normal spirometry: FEV1%pred = 89.0%, FEV1/FVC = 0.73; emphysema percentage = 0.2%, QDP = 7%, VDPRVent = 2%, VDPFVL-CM = 1%. (B, E, H, K, N) Images in a 65-year-old female with PRISm + RP: FEV1%pred = 71.2%, FVC %pred = 76.8%, FEV1/FVC = 0.76; emphysema percentage = 4.7%, QDP = 10%, VD-PRVent = 18%, VDPFVL-CM = 6%. (C, F, I, L, O) Images in a 57-year-old male with AO: FEV1%pred = 56.8%, FEV1/FVC = 0.52; emphysema = 11.1%, QDP = 31%, VDPRVent = 33%, VDPFVL-CM = 41%. AO = airflow obstruction, FEV1 = forced expiratory volume in 1 second, FVC = forced vital capacity, FVL-CM = flow-volume loop correlation metric, %pred = percent predicted, PREFUL = phase-resolved function lung, PRISm = preserved ratio impaired spirometry, QDP = perfusion defect percentage, RVent = regional ventilation, VDP = ventilation defect percentage.
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Preablation, postablation, and recurrence multiparametric MRI scans depict a 63-year-old man treated with transperineal focal laser ablation (TPLA) for localized prostate cancer. Clinical parameters included an initial prostate-specific antigen (PSA) level of 7.2 ng/mL, a Prostate Imaging Reporting and Data System (PI-RADS) grade 4 lesion (red circles) in the right apical peripheral zone, and a maximum tumor length of 5 mm. MRI-guided targeted biopsy confirmed a Gleason score 3+4 prostate cancer tumor. (A) Pre-ablation axial T2-weighted MRI scan and apparent diffusion coefficient (ADC) image shows the apical PI-RADS 4 lesion (circles). (B) Six-month post-ablation axial T2-weighted MRI scan and ADC image show cystic necrosis (arrows). There was no evidence of recurrence; the PSA level was 1.5 ng/mL. (C) One-year after ablation, the patient’s PSA level had increased to 4.3 ng/mL. Axial T2-weighted MRI scan and the ADC image shows a recurrent lesion (blue circles) in the right apical peripheral zone adjacent to the ablation scar. Targeted biopsy confirmed Gleason score 3+4 prostate cancer, which was classified as in-field recurrence of clinically significant prostate cancer and subsequently re-treated with TPLA. In summary, serial multiplanar MRI demonstrates treatment response after TPLA with post-ablation necrosis, followed by MRI-detected IFR confirmed with biopsy at 12-month follow-up. Multiparametric MRI was performed with a 3.0-T MRI scanner (Skyra; Siemens Healthineers) using T2-weighted, diffusion-weighted, and ADC sequences, with gadobenate dimeglumine contrast material administration (Bracco Diagnostics).
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