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Biomedical subjects

C M Tempany

Publications and source records attributed to C M Tempany.

At least 37 records · Page 2Linked to original sources
PubMed2000

Staging of advanced ovarian cancer: comparison of imaging modalities--report from the Radiological Diagnostic Oncology Group.

PURPOSE: To compare ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT) for diagnosing and staging advanced ovarian cancer. MATERIALS AND METHODS: US, CT, and MR imaging were performed in 280 patients. Images were read by three radiologists from each of the five hospitals. Image analysis included determination of malignancy within the peritoneum (11 sites), lymph nodes (10 sites), and hepatic parenchyma. The standard of reference was based on surgical and histopathologic findings. Statistical methods used were receiver operating characteristic (ROC) curve analysis, pairwise comparison of areas under the ROC curves (A(z)), analysis of sensitivity and specificity pairs, and assessment of agreement between the degree of suspicion and standard of reference. RESULTS: There were 118 patients with malignant tumors; 73 (62%) had stage III or IV disease. Metastases were found in the peritoneum in 70 (59%), nodes in 20 (17%), and liver in seven (6%) cases. In the peritoneum, MR imaging and CT (A(z) = 0.96 for both) were more accurate than US (A(z) = 0.86), especially in the subdiaphragmatic spaces and hepatic surfaces. MR imaging and CT were more sensitive than US (95%, 92%, and 69%, respectively) for peritoneal metastases. MR imaging was more accurate than CT for detection of lymph node metastases (A(z) = 0.76 vs 0.57, P =.04). In the liver, the A(z) values for the three modalities were 0.77-0.94. CONCLUSION: CT and MR imaging are equally accurate, and either modality can be used to stage advanced ovarian cancer.

Adult↗
PubMed2000

Three-dimensional real-time magnetic resonance-guided interstitial prostate brachytherapy optimizes radiation dose distribution resulting in a favorable acute side effect profile in patients with clinically localized prostate cancer.

PURPOSE: A large number of men are diagnosed with early-stage prostate cancer as a result of prostate-specific antigen (PSA) screening. For many of these men, prostatectomy results in long-term freedom from biochemical and clinical failure. Despite limited follow-up data, ultrasound-guided prostate brachytherapy has gained acceptance as a treatment for early-stage prostate cancer, in part due to its favorable side effect profile and brief recovery period. We report on the use of three-dimensional real-time magnetic resonance (MR) guidance, which has several advantages compared with biplanar ultrasound guidance for prostate brachytherapy, including enhanced geometric and dosimetric feedback during the procedure. MATERIALS AND METHODS: Median clinical target volume coverage of 96% was achieved using MR guidance. The ability to define more precisely the clinical target volume with MR and the use of real-time assessment of dose distribution resulted in an excellent acute side effect profile. Only 19% of patients required oral alpha1 blockers for postimplant urethritis and 9% required temporary reinsertion of the Foley catheter due to acute urinary obstruction. CONCLUSIONS: These results compare favorably to those of ultrasound-guided brachytherapy. Further follow-up is needed to ascertain the impact this technique will have on cancer control and long-term quality of life.

Aged↗
PubMed2000

Transperineal magnetic resonance image guided prostate biopsy.

PURPOSE: We report the findings of a transperineal magnetic resonance image (MRI) guided biopsy of the prostate in a man with increasing prostate specific antigen who was not a candidate for a transrectal ultrasound guided biopsy. MATERIALS AND METHODS: Using an open configuration 0.5 Tesla MRI scanner and pelvic coil, a random sextant sample was obtained under real time MRI guidance from the peripheral zone of the prostate gland as well as a single core from each MRI defined lesion. The patient had previously undergone proctocolectomy for ulcerative colitis and, therefore, was not a candidate for transrectal ultrasound guided biopsy. Prior attempts to make the diagnosis of prostate cancer using a transurethral approach were unsuccessful. RESULTS: The random sextant samples contained benign prostatic hyperplasia, whereas Gleason grade 3 + 3 = 6 adenocarcinoma was confirmed in 15% and 25% of the 2 cores obtained from the MRI targeted specimens of 2 defined lesions. The procedure was well tolerated by the patient. CONCLUSIONS: Transperineal MRI guided biopsy is a new technique that may be useful in detecting prostate cancer in men with increasing prostate specific antigen who are not candidates for transrectal ultrasound guided biopsy.

Adenocarcinoma↗
PubMed1999

Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis--report of the Radiology Diagnostic Oncology Group.

PURPOSE: To determine the optimal imaging modality for diagnosis and staging of ovarian cancer. MATERIALS AND METHODS: Two hundred eighty women suspected to have ovarian cancer were enrolled in a prospective study before surgery. Doppler ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging were used to evaluate the mass; conventional US, CT, and MR imaging were used to stage spread. RESULTS: All three modalities had high accuracy (0.91) for the overall diagnosis of malignancy. In the ovaries, the accuracy of MR imaging (0.91) was higher than that of CT and significantly higher than that of Doppler US (0.78). In the extraovarian pelvis and in the abdomen, conventional US, CT, and MR imaging had similar accuracies (0.87-0.95). In differentiation of disease confined to the pelvis from abdominal spread, the specificity of conventional US (96%) was higher than that of CT and significantly higher than that of MR imaging (88%), whereas the sensitivities of MR imaging (98%) and CT (92%) were significantly higher than that of conventional US (75%). CONCLUSION: MR imaging is superior to Doppler US and CT in diagnosis of malignant ovarian masses. There is little variation among conventional US, CT, and MR imaging as regards staging.

Adult↗
PubMed1998

Real-time magnetic resonance image-guided interstitial brachytherapy in the treatment of select patients with clinically localized prostate cancer.

PURPOSE: This study was performed to establish the dose-localization capability and acute toxicity of a real-time intraoperative magnetic resonance (MR) image-guided approach to prostate brachytherapy in select patients with clinically localized prostate cancer. METHODS AND MATERIALS: Nine patients with 1997 American Joint Commission on Cancer (AJCC) clinical stage T1cNxM0 prostate cancer, prostate-specific antigen (PSA) < 10 ng/ml, biopsy Gleason score not exceeding 3 + 4, and endorectal coil MR stage T2 disease were enrolled into this study. The prescribed minimum peripheral dose was 160 Gy to the clinical target volume (CTV), which was the MR-defined peripheral zone (PZ) of the prostate gland. Using a real-time 0.5 Tesla intraoperative MR imaging unit, 5-mm image planes were obtained throughout the prostate gland. The PZ of the prostate gland, anterior rectal wall, and prostatic urethra were identified on the T2 weighted axial images by an MR radiologist. An optimized treatment plan for catheter insertion was generated intraoperatively. Each catheter containing the 125Iodine sources was placed under real-time MR guidance to ensure that its position in the coronal, sagittal, and axial planes was in agreement with the planned trajectory. Real-time dose- volume histogram analyses were used intraoperatively to optimize the dosimetry. RESULTS: For the 9 study patients, 89-99% (median 94%) of the CTV received a minimum peripheral dose of 160 Gy and > or = 95% of the volume of the prostatic urethra and 42-89% (median 70%) of the volume of the anterior rectal wall received doses that were below the reported tolerance. All patients voided spontaneously within 3 h after discontinuation of the Foley catheter and no patient required more than a limited course (< or = 3 weeks) of oral alpha-1 blockers for postimplant urethritis. CONCLUSIONS: Real-time MR-guided interstitial radiation therapy provided the ability to achieve the planned optimized dose-volume histogram profiles to the CTV and healthy juxtaposed structures intraoperatively, with minimal acute morbidity.

Aged↗
PubMed1998

Assessment of prostate cancer volume using endorectal coil magnetic resonance imaging: a new predictor of tumor response to neoadjuvant androgen suppression therapy.

OBJECTIVES: A clinical tool that can reliably assess prostate cancer response to androgen suppression is lacking. This pilot study was designed to identify the potential clinical factor(s) that correlate with tumor response after neoadjuvant therapy. METHODS: Twenty-one patients managed with definitive local therapy and neoadjuvant androgen suppression (median 3 months [range 2 to 7]) between 1995 and 1997 comprise the study population. Fisher's exact test was used to test the significance of the proportion of patients with a given clinical factor and the outcome of pathologic organ-confined disease. The clinical factors tested included preoperative prostate-specific antigen, biopsy Gleason score, clinical stage, months of total androgen suppression, the change in the endorectal magnetic resonance imaging (erMRI)-defined stage, the change in erMRI-defined tumor, and the change in the erMRI-defined prostate volume during neoadjuvant androgen suppression. RESULTS: All 21 patients had a decrease in the erMRI-determined prostate volume and prostate-specific antigen during androgen suppression, whereas only 10 of 21 (48%) had a reduction in the erMRI-determined tumor volume. There was a statistically significant increased proportion of patients with a decrease in the erMRI-determined tumor volume (P = 0.008) who had pathologic organ-confined disease. CONCLUSIONS: The results of this pilot study suggest that the changes in the erMRI-determined tumor volume occurring during androgen suppression may be predictive of the tumor response. Validation in a larger prospective study is currently underway.

Androgen Antagonists↗
PubMed1998

Open-configuration MR imaging, intervention, and surgery of the urinary tract.

The open-configuration MR imaging system provides new applications both in diagnosis and in therapy of conditions in the urinary tract. In addition to conventional imaging, the open configuration permits MR imaging of patients in many positions. This has already been shown to be useful in imaging the pelvis during voiding, where a sitting position allows urodynamic evaluation. The lithotomy position can be used for imaging the prostate, which also permits procedural access. The ultimate purpose of the interventional MR imaging suite is to integrate therapeutic tools and techniques with MR imaging. From surgical planning through specialized imaging systems with minimally invasive surgical applications, new methods are being developed and implemented. This new field of image-guided therapy will require extensive clinical development and evaluation for applications in the urinary tract. This will require a large concentrated interdisciplinary effort of surgeons, radiologists, computer scientists, engineers, and physicists. Successful integration of basic research and clinical work will result in a number of cutting-edge technologies with direct clinical application in the urinary tract. Initial projects have included biopsies, endoscopies, and real-time procedural control of high-temperature and cryogenic ablations. It is anticipated that the current surge in image-guided interventions will motivate even more research activity in this field, and will ultimately define the role of MR imaging guidance in urologic intervention and surgery.

Animals↗
PubMed1998

MR imaging of the prostate and bladder.

Magnetic resonance imaging has become an important imaging modality for the male pelvis. Its unparalleled ability to depict soft tissue structures and highlight pathology have made it the best method for determining the extent of many disease processes. This article reviews the use of MR to evaluate diseases of the prostate gland and bladder. In both, the major indication for imaging is the local staging of cancer, and MR is currently the best imaging modality. This article will discuss the critical clinical issues concerning prostate cancer and neoplasms of the bladder, and the contribution of MR imaging.

Humans↗
PubMed1998

Original smooth receiver operating characteristic curve estimation from continuous data: statistical methods for analyzing the predictive value of spiral CT of ureteral stones.

RATIONALE AND OBJECTIVES: Diagnostic studies such as spiral computed tomography (CT) in patients with obstructing ureteral calculi often necessitate the analysis of continuous test data (e.g., stone sizes). The accuracy of a test can be summarized by using a receiver operating characteristic (ROC) curve. The authors developed and compared three methods for constructing a smooth ROC curve from continuous diagnostic data. MATERIALS AND METHODS: Nonparametric, semiparametric, and parametric smooth ROC curve analyses were applied to data from 100 unenhanced spiral CT scans of patients with proved obstructing ureteral stones. Accuracy in using stone size to predict the need for intervention was evaluated by means of these methods. Characteristics and summary measures of the resulting ROC curves were estimated. RESULTS: All methods fit the data well. The nonparametric method followed the details of the empiric data. The semiparametric and parametric methods yielded similar estimates of the ROC curve parameters. Areas under the ROC curves were 0.807, 0.821, and 0.814 for nonparametric, semiparametric, and parametric methods, respectively, in comparison with 0.811 for the empiric method. CONCLUSION: The parametric method is preferred for constructing a smooth ROC curve with available stone-size data derived from spiral CT. The analyses confirm the predictive value of stone size in determining the need for intervention.

Humans↗
PubMed1997

Staging prostate cancer with MR imaging: a combined radiologist-computer system.

PURPOSE: To test the accuracy of a combined radiologist-computer system in the diagnosis with magnetic resonance (MR) imaging of cancer of the prostate gland. MATERIALS AND METHODS: The combined system was developed and tested by four specialists in prostate MR imaging and five radiologists expert in body MR imaging. Each group read MR images obtained in 100 proved cases of prostate cancer. The images were obtained from two sources, and all were obtained with an endorectal surface coil. Prostate MR specialists ranked imaging features of cases to develop a checklist for image interpretation. Features with greatest diagnostic value were incorporated in the combined system. Accuracy measures were derived from the area index of the receiver operating characteristic curve for the combined system and compared with those of radiologists working alone. RESULTS: Body MR radiologists had a mean baseline accuracy of 0.67; mean accuracy of their combined system was 0.80. The prostate MR specialists, when they rated the features in each case, had a mean accuracy of 0.81; the accuracy of their combined system was 0.87. CONCLUSIONS: A combined radiologist-computer system substantially improved accuracy of body MR radiologists in the diagnosis of prostate cancer. High levels of accuracy were also achieved by the system with prostate MR specialists.

Diagnosis, Computer-Assisted↗
PubMed1997

Prostate cancer: relative effects of demographic, clinical, histologic, and MR imaging variables on the accuracy of staging.

PURPOSE: To determine the effects on the accuracy of staging prostate gland cancer of diagnostic prediction rules based on demographic, clinical, histologic, and magnetic resonance (MR) image variables. MATERIALS AND METHODS: A total of 200 cases from four medical centers were evaluated by nine radiologists experienced in MR imaging. The accuracies of the four diagnostic variables (age, prostate specific antigen level, Gleason tumor grade, and MR imaging findings) were measured, both singly and combined in a particular sequence, by calculating the area index of the receiver operating characteristic curve. RESULTS: The accuracy of staging with single variables (age, 0.58; prostate specific antigen level, 0.74; Gleason grade 0.73, MR image findings, 0.74) increased as the variables were optimally merged. The first two variables combined to yield an accuracy of 0.74; the first three combined to yield an accuracy of 0.81; and all four variables resulted in an accuracy of 0.86. In a clinically important subset of 69 cases for which antigen level and Gleason grade together were inconclusive for the purposes of staging, the addition of MR imaging findings resulted in an increase in accuracy from 0.55 to 0.73. CONCLUSION: Optimal merging of diagnostic test results yields an improvement in the accuracy of prostate cancer staging.

Age Factors↗
PubMed1996

An analysis of the time course of postoperative prostate-specific antigen failure in patients with positive surgical margins: implications on the use of adjuvant therapy.

OBJECTIVES: The role of adjuvant therapy in the postprostatectomy setting for positive margin patients is an unresolved issue. The purpose of this study is to provide the rationale for patient selection in Phase III trials that test the impact of adjuvant therapy on survival in positive margin prostate cancer patients. METHODS: Early (12 months or less) and delayed (more than 12 months) postoperative prostate-specific antigen (PSA) failure have been correlated with distant and local failure, respectively, as the site of first failure. In this study, a Cox regression multivariate analysis was used to determine the significant independent clinical and pathologic predictors of early and delayed postoperative PSA failure in 143 margin-positive prostate cancer patients. RESULTS: Margin-positive patients with positive pelvic lymph nodes, seminal vesicle invasion, or prostatectomy Gleason sum 8 or higher were excluded. For the remaining patients, a prostatectomy Gleason sum of 7, preoperative PSA more than 20 ng/mL, and an endorectal coil magnetic resonance imaging (erMRI) scan showing extensive disease were significant independent predictors of early postoperative PSA failure. Conversely, a prostatectomy Gleason sum of 6 or less, preoperative PSA 20 ng/mL or less, and an erMRI showing limited disease predicted delayed PSA failure. CONCLUSIONS: Preliminary data suggest that the pattern of first failure can be predicted by the time course of rise in the postoperative PSA. The preliminary results of this study suggest that patient selection for clinical trials examining the efficacy of postoperative adjuvant therapy in the positive margin patient may be determined on the basis of the clinical and pathologic characteristics that predict early versus delayed postoperative PSA failure.

Clinical Trials, Phase III as Topic↗
PubMed1996

CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II.

PURPOSE: To prospectively evaluate the relative accuracy of computed tomography (CT) and magnetic resonance (MR) imaging in the staging of colorectal carcinoma. MATERIALS AND METHODS: CT and MR studies were independently interpreted in a group of 478 patients with colorectal carcinoma in a study conducted from 1989 to 1993. The accuracy of each modality was assessed in a subset of 365 patients with primary tumors with respect to staging of local extent of tumor, status of local-regional lymph nodes, and the presence of liver metastases. RESULTS: In the staging of local extent of tumor, CT is more accurate than MR imaging, particularly in the definition of penetration of the muscularis propria by rectal cancer (74% vs 58%). Accuracies of CT and MR imaging were equivalent in depiction of transmural extent in colon cancers. CT and MR imaging exhibited accuracies of 62% and 64% in assessment of lymph node involvement with sensitivities of 48% and 22%, respectively. The accuracy of MR imaging and of CT (85% for each) are better for evaluation of liver metastases; lower sensitivities (62% and 70%, respectively) than specificities (97% and 94%, respectively) were demonstrated for both modalities. CONCLUSION: CT was more accurate than MR imaging in detection and characterization of transmural penetration of rectal tumors. Recent technologic advances in MR imaging may affect these results.

Aged↗
PubMed1996

Small (< or = 3 cm) hyperechoic renal masses: comparison of helical and convention CT for diagnosing angiomyolipoma.

OBJECTIVE: Because hyperechoic renal masses may represent angiomyolipomas or small renal cancers, CT is often used to reveal the fatty component, which allows diagnosis of angiomyolipoma in most cases. Because conventional CT can fail to reveal fat in angiomyolipomas 3 cm or smaller, we conducted a study to determine whether helical CT would improve our detection of fat and allow more of these masses to be diagnosed as angiomyolipomas. SUBJECTS AND METHODS: We used helical and conventional CT to examine 20 masses (5-29 mm in diameter) in 17 patients who had a small hyperechoic mass detected sonographically. Densitometry was performed by three readers and the mean attenuation values were compared. RESULTS: Of the 20 masses, we diagnosed angiomyolipoma in 16 masses using helical CT and in 14 masses using conventional CT. In 11 masses, we found the measured attenuation values to be more negative on helical CT scans than on conventional CT scans. In five masses, we found the opposite to be true. In the remaining four masses, we were unable to diagnose angiomyolipoma. Of the masses that we diagnosed as angiomyolipoma, the mean attenuation value when examined with helical CT (-44 H) was more negative than with conventional CT (-35 H) but not significantly so (p = .058). However, in the subset of patients with masses that were 2 cm or less in diameter (n = 14), the mean attenuation values on helical CT were significantly lower than on conventional CT (-40 H versus -30 H, p < .05). Likewise, for masses with attenuation values that differed by more than 6 H (n = 8), when imaged by the two techniques we again found that mean attenuation values on helical CT were significantly lower (-43 H versus -24 H, p < .05). CONCLUSION: Helical CT revealed angiomyolipoma across all cases as well as conventional CT did. Also, helical CT was more sensitive in revealing fat in masses less than 2 cm in diameter and in masses in which the attenuations of the two CT techniques differed by a significant amount. We preferred helical CT over conventional CT when examining hyperechoic masses for the purpose of diagnosing angiomyolipoma.

Adult↗
PubMed1996

MR staging of prostate cancer. How we can improve our accuracy with decisions aids and optimal techniques.

This article reviews the MR staging of prostate cancer. There has been considerable variability in the MR results to date. The reasons are complex and include reader experience, the learning curve, and a lack of clear definition of the diagnostic features of advanced disease. The problems associated with achieving a consistently high degree of accuracy are discussed. The author describes a new study aimed at improving radiologists accuracy and illustrates some of the findings and specific features of advanced disease that are useful.

Clinical Competence↗
PubMed1995

Evaluation of erectile function in men with sickle cell disease.

OBJECTIVES: To evaluate and characterize erectile manifestations associated with sickle cell disease using nocturnal penile tumescence testing with polysomnography (NPT/PSG) and magnetic resonance imaging (MRI) of the penis. METHODS: Six variably potent men with sickle cell disease, of whom 5 reported a history of priapism, underwent comprehensive evaluations of erectile function. Evaluations involved a medical history and physical examination with completion of priapism and sexual function questionnaires, followed by NPT/PSG and MRI of the penis. RESULTS: Many different erectile abnormalities were identified in this group using NPT/PSG, although nocturnal erection durations as well as detumescence times were uniformly prolonged. Various axial rigidity measurements were obtained, which correlated fairly well with individual reports of erectile function. MRI findings ranged from normal corporeal anatomy to corporeal destruction with intracorporeal fibrosis and hemosiderin deposition. CONCLUSIONS: In sickle cell disease, the erectile dysfunction that commonly occurs may be markedly different among men with this disease and may not always be predicted on the basis of clinical history of priapism. Generally, clinical assessments of erectile function may be derived from clinical histories and physical examinations. NPT/PSG and MRI of the penis are in accord with these assessments, obviating their routine use, although they may be valuable management adjuncts in certain situations.

Adolescent↗
PubMed1995

The use of dynamic magnetic resonance imaging to evaluate orthotopic continent urinary diversion.

OBJECTIVES: The purpose of this study was to evaluate a dynamic magnetic resonance (MR) examination in patients after radical cystoprostatectomy with a neobladder. METHODS: All 12 subjects were studied with the injection of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) and showed normal renal enhancement patterns and upper urinary tracts, except 1 patient who had mild right hydronephrosis. All neobladders were also visualized with gadolinium and 9 of 11 patients were able to void on command. There was close agreement in all cases with the MR findings and other imaging studies. RESULTS: A static and dynamic Gd-DTPA contrast medium MR did image the entire urinary system, similar to a computed tomographic scan or intravenous urogram. Renal function data, similar to a renal radioisotope scan, was obtained from the Gd-DTPA scans. A dynamic voiding study provided visualization of the lower genitourinary tract similar to a conventional voiding cystourethrogram. CONCLUSIONS: We conclude that this single MR technique may provide information similar to that obtained from multiple standard imaging studies in the postoperative assessment of the radical cystectomy patient with a neobladder. It may be especially helpful in the presence of azotemia or contrast allergy.

Adult↗