[Amebic abscess in the liver; early suspicion, late detection].
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Humans↗
Biomedical subjects
G J Jager
Publications and source records attributed to G J Jager.
[High-flow priapism: a rare, easily treatable disorder with excellent prognosis].
Four patients, men aged 33, 37, 37 and 12 years, were examined because of priapism following trauma. In all four high-flow priapism was diagnosed, based on intracavernous blood gas analysis and selective angiography. One of the men aged 37 was subsequently found to be suffering from low-flow priapism caused by chronic myeloid leukaemia (the blood gas analysis had been performed after decompression of the cavernous body). Two other patients were treated by selective internal pudendal artery embolisation. In the fourth, who developed a vascular spasm at angiography, embolisation was not performed: he recovered spontaneously. In contrast to high-flow priapism, low-flow priapism is an urological emergency for diagnosis and treatment to prevent permanent impotence.
Adult↗
Proton MR spectroscopy of the normal human prostate with an endorectal coil and a double spin-echo pulse sequence.
This report describes the use of an endorectal coil and a double spin-echo pulse sequence for localized 1H MR spectroscopy of the normal prostate in volunteers. The spectra showed well-resolved signals for citrate, (phospho)choline, and creatine protons. Additional signals were assigned to taurine and myoinositol protons. J modulation of the main and outer peaks of citrate could be monitored in vivo. Apparent relaxation times T1 and T2 have been estimated for the methyl protons of cholines and creatine. An effective T1 relaxation time was estimated for the main peaks of the citrate multiplet. Ratios of the integrals of these resonances have been evaluated, and tissue contents of choline and creatine were estimated using the H2O signal as an internal reference. Spectroscopic imaging experiments revealed a lower relative citrate signal in central parts of the prostate than in peripheral parts.
Adult↗
Removal of the outer lines of the citrate multiplet in proton magnetic resonance spectra of the prostatic gland by accurate timing of a point-resolved spectroscopy pulse sequence.
Proton MR spectra of a healthy human prostatic gland show a major signal for citrate appearing as an AB-type multiplet. After application of multipulse localization sequences, the outer lines of this multiplet often appear with dispersion line shapes disturbing the baseline and interfering with proper quantification of citrate itself and other nearby resonances. Based upon analytical descriptions of the time evaluation of an AB spin system during a point resolved spectroscopy (PRESS) pulse sequence (90x-tau 1-180y-tau 2-180y-t), equations were derived representing the intensity of the absorption and dispersion line shape of the outer lines of the citrate multiplet at the top of echo t = tau 2-tau 1. From these equations, it was calculated that the outer lines of citrate can be removed almost completely using a PRESS pulse sequence with tau 1 = 11 ms and tau 2 = 60 ms. The theoretical description was confirmed by the almost complete disappearance of the two outer citrate resonances in in vitro and in vivo proton MR spectra acquired with this pulse sequence timing.
Citric Acid↗
Amyloidosis of the seminal vesicles simulating tumor invasion of prostatic carcinoma on endorectal MR images.
Amyloid deposits within the seminal vesicles are a common finding at autopsy. The incidence increases with age. Amyloid deposits can mimic tumor extension into the seminal vesicles due to prostate or bladder cancer on T2-weighted MR images. We describe a case of seminal vesicle amyloidosis demonstrating the MR appearance and the characteristic pathologic findings. Recognizing seminal vesicle amyloidosis may prevent overstaging prostate cancer on MR images.
Adenocarcinoma↗
Dynamic TurboFLASH subtraction technique for contrast-enhanced MR imaging of the prostate: correlation with histopathologic results.
PURPOSE: To assess whether a TurboFLASH (fast low-angle shot) magnetic resonance (MR) sequence can improve the accuracy of fast spin-echo (SE) endorectal coil MR imaging in the staging and localization of prostate cancer. MATERIALS AND METHODS: In 57 patients with prostate cancer, MR imaging was performed with the following sequences: T1-weighted SE, T2-weighted fast SE, single-section gadolinium-enhanced dynamic subtracted TurboFLASH (one image every 1.25 or 2.5 seconds), and late-phase gadolinium-enhanced T1-weighted SE. Retrospectively, two blinded independent readers graded onset and steepest slope of enhancement and assessed tumor involvement and capsular penetration. MR findings were correlated with histopathologic results. RESULTS: On TurboFLASH images, prostate cancer was characterized by early and rapidly accelerating enhancement compared with that of surrounding tissues. Average sensitivity, specificity, and accuracy for detection of tumor involvement for the two readers with TurboFLASH images were 73.5%, 81.0%, and 77.5%. These values with fast SE images were 57.5%, 80.5%, and 72.0%. Depiction of capsular penetration and delineation and staging of tumor were better when TurboFLASH images were included with fast SE images. Differences between the two sequences, however, were not statistically significant. CONCLUSION: Because the TurboFLASH sequence did not statistically significantly improve tumor localization and staging results, routine use is not recommended. The technique may be useful for selected patients with equivocal evidence of capsular penetration.
Aged↗
[Changed diagnosis and treatment in hepatocellular carcinoma].
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Carcinoma, Hepatocellular↗
Sensitivity of frozen section examination of pelvic lymph nodes for metastatic prostate carcinoma.
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Frozen Sections↗
Primary staging of urinary bladder carcinoma: the role of MRI and a comparison with CT.
Since the introduction, pelvic MRI has been considered the best non-invasive technique for primary staging of urinary bladder cancer. Before using MRI an understanding of normal and pathological MR images of the urinary bladder is essential. This review therefore describes the MR anatomy of the urinary bladder as well as the appearances of carcinoma. MRI plays an important clinical role in staging the primary tumour. In superficial tumours, clinical staging, which includes transurethral biopsy, is the best technique. For invasive tumours, MRI is superior to other techniques such as CT scanning, transvesical ultrasonography and clinical staging. A limitation of both MRI and CT scanning is their inability to recognize minimal tumour growth in the muscle layer of the bladder wall, or to differentiate between post-transurethral resection oedema and tumour. Therefore, in all patients with urinary bladder cancer staging should preferably start with MRI followed by clinical staging. Unfortunately, however, because of the high cost of this strategy, MRI has to be reserved for staging deeply invasive and superficial poorly differentiated tumours.
Biopsy↗
Primary staging of prostate cancer.
Staging prostate cancer is a systematic classification of the extent of disease based on clinical and pathological criteria. Despite general acceptance of the TNM staging system, a lot of controversy and uncertainty with respect to staging still exists. This paper gives an overview of different staging modalities and emphasizes the need for incorporation of prognostic factors, such as tumour grade and volume, in the staging system.
Diagnostic Imaging↗
Epiploic appendicitis: ultrasound and CT characteristics.
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Abdominal Pain↗
Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging.
PURPOSE: To evaluate contrast enhancement patterns of urinary bladder cancer and surrounding structures and to evaluate a fast dynamic first-pass magnetic resonance (MR) imaging technique in tumor and node staging and in differentiation of urinary bladder cancer from postbiopsy effects. MATERIALS AND METHODS: Sixty-one consecutive patients with histologically proved urinary bladder cancer were referred to undergo unenhanced and dynamic MR imaging 1-4 weeks after transurethral resection or biopsy. Subtraction and time (to beginning of enhancement) images were acquired. RESULTS: Results with unenhanced T1- and T2-weighted images were compared with those obtained with the unenhanced images plus dynamic contrast material-enhanced single-section turbo fast low-angle shot (FLASH) images. Urinary bladder cancer started to enhance 6.5 seconds +/- 3.5 (standard deviation) after the beginning of arterial enhancement, which was 4 seconds earlier than most other structures (postbiopsy tissue, 13.6 seconds +/- 4.2). In differentiation of postbiopsy tissue from malignancy on the basis of the beginning of enhancement depicted on time and subtracted images, accuracy improved from 79% to 90% (P < .02) and specificity improved from 33% to 92% (not significant). Overall, tumor staging accuracy improved significantly from 67% to 84% (P < .01) by adding the turbo FLASH images. CONCLUSION: Fast dynamic first-pass MR imaging, with at least one image acquired every 2 seconds, improved delineation of urinary bladder cancer, tumor staging, and detection of metastases.
Biopsy↗
Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology.
OBJECTIVE: To evaluate the accuracy of MR imaging of the prostate with an endorectal surface coil in determining presence, localization, volume, and local stage of prostate carcinoma. SUBJECTS AND METHODS: MR images of 34 patients with biopsy-proven cancer were correlated retrospectively with the histologic mappings of radical prostatectomy specimens. The volume and number of tumor lesions of MR images were calculated and compared with the surgical specimens used as the gold standard. Tumor stage based on MR imaging was compared with the pathologic stage according to the TNM classification. Predictive values were calculated separately for all lesions and for the lesions correctly localized with MR imaging. RESULTS: MR imaging correctly depicted the location of 67% of the tumors. Twenty percent of the lesions depicted by MR imaging appeared to be false-positive errors. The tumors that were missed were located centrally and ventrally in the prostate. Tumor volume as shown by MR imaging was within a 25% range of the actual tumor volume in 10 cases, overestimated in 16 cases, and underestimated in eight cases. Histopathology showed capsular penetration in 12 of 34 patients (35%) and in 14 of 52 lesions (27%). Sensitivity, specificity, and positive predictive values were 43%, 84%, and 55%, respectively. Histologically, capsular penetration extended less than 1 mm into the periprostatic adipose tissue in seven patients. Sensitivity for capsular penetration less than 1 mm was 14%. Sensitivity for capsular penetration more than 1 mm was 71%. Accuracy for differentiating a pT2 from a pT3 tumor was 68%. CONCLUSION: Results from this study indicate that the accuracy of the technique was not satisfactory for predicting actual tumor volume. Tumor detection and localization was more accurate in the peripheral zone than in the central zone. Accuracy was poor for detecting capsular penetration of less than 1 mm, but accuracy was much better for penetration of more than 1 mm. Because recent reports suggest that capsular penetration of less than 1 mm does not adversely affect surgical cure, MR imaging still may be practical in the selection of patients for radical prostatectomy.
Adenocarcinoma↗
Pelvic adenopathy in prostatic and urinary bladder carcinoma: MR imaging with a three-dimensional TI-weighted magnetization-prepared-rapid gradient-echo sequence.
OBJECTIVE: The purpose of this study was to evaluate a magnetization-prepared-rapid gradient-echo (MP-RAGE) sequence as a three-dimensional (3D) T1-weighted MR imaging technique to reveal lymph node metastases from carcinoma of the bladder and the prostate. SUBJECTS AND METHODS: Using a 3D T1-weighted MP-RAGE sequence, MR images of 134 consecutive patients with prostatic carcinoma (n = 63) or urinary bladder carcinoma (n = 71) who were scheduled for radical prostatectomy or radical cystectomy were correlated with histopathologic findings after fine-needle aspiration biopsy (FNAB) (n = 6), open or laparoscopic pelvic lymph node dissection (n = 127), or autopsy (n = 1). MR imaging was used 10 times to guide FNAB in nine patients. RESULTS: The sensitivity, specificity, accuracy, and positive predictive valve of the technique were 75%, 98%, 90%, and 94%, respectively. Thin-slice (1.2-mm) multiplanar reconstructed images correctly revealed diseased nodes in 33 patients. However, MR imaging failed to reveal microscopic metastatic deposits in normally sized nodes in 11 patients. Two other patients had enlarged nodes without metastasis. Furthermore, FNAB guided by MR imaging revealed metastases in six of nine patients. CONCLUSION: MR imaging with a 3D MP-RAGE sequence was accurate in revealing nodal metastases from carcinoma of the prostate and bladder. This imaging technique can be used to select patients for biopsy or laparoscopic pelvic lymph node dissection.
Aged↗
Preliminary results of endorectal surface coil magnetic resonance imaging for local staging of prostate cancer.
OBJECTIVE: To evaluate the effectiveness of endorectal surface coil (ERC) magnetic resonance imaging (MRI) in the local staging of adenocarcinoma of the prostate (ACP). MATERIALS AND METHODS: A total of 23 patients who were considered candidates for radical prostatectomy because of clinically localized ACP were examined by ERC-MRI. All patients underwent laparoscopic or open lymph-node dissection prior to surgery. Four patients had positive lymph nodes at operation. A total of 19 underwent radical prostatectomy, allowing comparison of the MRI data with the surgical pathologic findings. RESULTS: Twelve patients had extraglandular spread of ACP (T3) and 7 had locally confined ACP (T2). ERC-MRI predicted correctly a T3 tumor in 10 of 12 cases and a T2 tumor in 4 of 7 cases. ERC-MRI was 74% accurate in differentiating T2 from T3 tumor. Three cases of overestimation were in studies with poor image quality because of bowel movement motion artifacts. CONCLUSION: ERC-MRI was found to be a sensitive modality in staging clinically localized ACP.
Adenocarcinoma↗
Subcutaneous emphysema of the lower extremity of abdominal origin.
Three cases of subcutaneous emphysema of the lower extremity due to abdominal disease are reported. These were due to (a) perforation of the sigmoid, (b) perirectal abscess, and (c) non-traumatic metastatic gas gangrene due to emphysematous cholecystitis. The mechanisms and anatomical pathways are discussed.
Abscess↗