Simone Agostini

Background/Purpose: to assess the inter-reader agreement of the PIFAB (Prostate Imaging after Focal Ablation) score, a new MRI-based standardized system for evaluating post-focal therapy prostate mpMRI, among radiologists in a single large cohort of patients treated with focal therapy (HIFU) in a tertiary care referral University Hospital. Methods: In total, 68 consecutive patients who underwent HIFU were included in this single-center retrospective observational study. A total of 109 post-HIFU follow-up mpMRIs were evaluated by three radiologists with varying levels of experience (12, 8, and 3 years, respectively). All patients underwent their first follow-up mpMRI at 6 months post-treatment, with 30 patients receiving additional evaluations at 18 months and 11 at 30 months. Results: The patients had a mean age of 70.6 ± 8.31 years, a mean pre-treatment PSA (prostate-specific antigen) of 7.85 ± 1.21 ng/mL, and a mean post-treatment PSA of 4.64 ± 4.2 ng/mL. The inter-reader agreement for PI-FAB among the three radiologists showed a Gwet’s AC2 value of 0.941 (95% confidence interval: 0.904–0.978, p < 0.0001). For the most experienced radiologist, at the 6-month follow-up 64 (94.14%) patients were scored as PI-FAB 1, 1 (1.47%) as PI-FAB 2, and 3 (4.41%) as PI-FAB 3. At the 18-month and 30-month follow-ups all patients were scored as PI-FAB 1 (no suspicion of recurrence). Conclusions: Our study demonstrates excellent inter-reader agreement among radiologists with varying levels of experience, confirming that the PI-FAB score is highly reproducible when evaluating post-treatment mpMRI scans. The low rate of PI-FAB 2 and PI-FAB 3 lesions observed at the first follow-up, coupled with the absence of significant recurrence in subsequent evaluations, suggests that HIFU is a reliable technique for prostate cancer treatment in selected patients.

Background: Biparametric MRI (bpMRI) has an important role in the diagnosis of prostate cancer (PCa), by reducing the cost and duration of the procedure and adverse reactions. We assess the additional benefit of the ADC map in detecting prostate cancer (PCa). Additionally, we examine whether the ADC value correlates with the presence of clinically significant tumors (csPCa). Methods: 104 peripheral lesions classified as PI-RADS v2.1 score 3 or 3+1 at the mpMRI underwent transperineal MRI/US fusion-guided targeted biopsy. Results: The lesions were classified as PI-RADS 3 or 3+1; at histopathology, 30 were adenocarcinomas, 21 of which were classified as csPCa. The ADC threshold that maximized the Youden index in order to predict the presence of a tumor was 1103 (95% CI (990, 1243)), with a sensitivity of 0.8 and a specificity of 0.59; both values were greater than those found using the contrast medium, which were 0.5 and 0.54, respectively. Similar results were also found with csPCa, where the optimal ADC threshold was 1096 (95% CI (988, 1096)), with a sensitivity of 0.86 and specificity of 0.59, compared to 0.49 and 0.59 observed in the mpMRI. Conclusions: Our study confirms the possible use of a quantitative parameter (ADC value) in the risk stratification of csPCa, by reducing the number of biopsies and, therefore, the number of unwarranted diagnoses of PCa and the risk of overtreatment.

Clinico-radiological presentation of granulomatous prostatitis (GP) is quite similar to cancer, and differential diagnosis can be very challenging. The study aims to highlight GP features based on clinical findings and multiparametric magnetic resonance imaging (mpMRI) characteristics. We retrospectively reviewed eleven patients from a cohort undergoing targeted biopsy between August 2019 and August 2021. Retrospective data including serum prostate-specific antigen (PSA) levels, PSA density and mpMRI findings were collected. Histopathology revealed seven cases of non-specific GP and four cases of specific GP as a result of intravesical Bacillus Calmette–Guérin (BCG) instillation. All lesions showed low signal intensity in T2w images, restricted diffusivity with hyperintensity in Diffusion-Weighted Imaging (DWI) and low Apparent Diffusion Coefficient (ADC) values. In Dynamic Contrast-Enhanced (DCE) imaging, the enhancement was high-peak and persistent in the majority of cases, especially in BCG-GPs. Moreover, almost all those latter lesions showed avascular core and peripheral rim enhancement. All areas identified on mpMRI were assessed with high to very high suspicion to hold prostate cancer (PIRADS v2.1 scores 4–5). Despite recent advances in imaging modalities and serological investigations, it is currently still a challenge to identify granulomatous prostatitis. Histopathology remains the gold standard in disease diagnosis. However, a differential diagnosis should be considered in patients with prior treatment with BCG.

Urogenital schistosomiasis is a parasitic disease caused by S. haematobium which is endemic in tropical and sub-tropical areas but is increasingly diagnosed in temperate non-endemic countries due to migration and international travels. Early identification and treatment of the disease are fundamental to avoid associated severe sequelae such as bladder carcinoma, hydronephrosis leading to kidney failure and reproductive complications. Radiologic imaging, especially through ultrasound examination, has a fundamental role in the assessment of organ damage and follow-up after treatment. Imaging findings of urinary tract schistosomiasis are observed mainly in the ureters and bladder. The kidneys usually appear normal until a late stage of the disease.

Unfortunately, the first name and family names of all the authors have incorrectly been swapped and published in original article.

In an emergency department, penile traumas are uncommon and a prompt diagnosis is necessary. Penile injury may result from penetrating and non-penetrating trauma. Non-penetrating injuries can produce cavernosal hematomas or fractures: if not treated promptly, these lesions can result in fibrosis or erectile dysfunction. Penile traumatic lesions need a clinical approach first, but a radiological study is often required: ultrasonography with color and spectral Doppler study is usually the first approach. In some cases, magnetic resonance imaging may be performed to better recognize even small discontinuity of the tunica albuginea. Radiologists have to be aware of the various radiological patterns of penile traumatic lesions, in order to establish a prompt and correct diagnosis.

The original version of this article unfortunately contained a mistake. The given name and family name of Filippo Parretti was transposed in the original p