0971 Mother’s Parenting Style As A Moderator In The Relationship Between Temperament And Sleep Problems In Children With Obesity

Introduction

Based on past studies, a child’s temperament and parenting style greatly affect a child’s sleep. However, there are limited studies that have investigated how parenting styles and a child’s temperament interact and affect the child’s sleep in obese children. Thus, this study investigated parenting styles as a moderator in the relationship between temperament and sleep in obese children.

Methods

Seventy-seven obese children (male=66.2%, average BMI = 27.35±2.78) participated in the study. The mean age of the participants was 10.82(± 1.00) years. The primary caregiver (mother) of the participants completed the Junior Temperament and Character Inventory (J-TCI), and Parents as Social Context Questionnaire (K-PSCQ), and Children’s Sleep Habits Questionnaire (CSHQ). Among the different subscales, only Novelty Seeking (NS) and Reward Dependence (RD) were used for analysis among Junior Temperament and Character Inventory (J-TCI) components.

Results

In this sample, 66 children (85.7%) reported significant levels of sleep problems based on the CSHQ. Novelty seeking (NS) and reward dependence (RD) significantly predicted sleep problems (B=-.771, p<.05, B=-.683, p<.01). Additionally, mother’s negative parenting style moderated the relationship between NS and the child’s sleep problem [B=.03, 95% CI=.007, .049] and the relationship between RD and the child’s sleep problem [B=.031, 95% CI=.013, .049]. The more negative mother’s parenting style, the higher the child’s NS or RD scores had a negative effect on sleep.

Conclusion

The results of this study show that obese children experience high levels of sleep disturbance. Additionally, the mother’s negative parenting style moderated the relationship between temperament and sleep problems in obese children. The results suggest that sleep interventions for obese children should include the mother, especially in children with high novelty seeking and reward dependence.

Support

This work was supported by Korea Centers for Disease Control and Prevention & Korea National Research Institute of Health (2019020660E-00)

Diagnostic performance of conventional and advanced imaging modalities for assessing newly diagnosed cervical cancer: systematic review and meta-analysis

OBJECTIVES

To review the diagnostic performance of contemporary imaging modalities for determining local disease extent and nodal metastasis in patients with newly diagnosed cervical cancer.

METHODS

Pubmed and Embase databases were searched for studies published from 2000 to 2019 that used ultrasound (US), CT, MRI, and/or PET for evaluating various aspects of local extent and nodal metastasis in patients with newly diagnosed cervical cancer. Sensitivities and specificities from the studies were meta-analytically pooled using bivariate and hierarchical modeling.

RESULTS

Of 1311 studies identified in the search, 115 studies with 13,999 patients were included. MRI was the most extensively studied modality (MRI, CT, US, and PET were evaluated in 78, 12, 9, and 43 studies, respectively). Pooled sensitivities and specificities of MRI for assessing all aspects of local extent ranged between 0.71-0.88 and 0.86-0.95, respectively. In assessing parametrial invasion (PMI), US demonstrated pooled sensitivity and specificity of 0.67 and 0.94, respectively-performance levels comparable with those found for MRI. MRI, CT, and PET performed comparably for assessing nodal metastasis, with low sensitivity (0.29-0.69) but high specificity (0.88-0.98), even when stratified to anatomical location (pelvic or paraaortic) and level of analysis (per patient vs. per site).

CONCLUSIONS

MRI is the method of choice for assessing any aspect of local extent, but where not available, US could be of value, particularly for assessing PMI. CT, MRI, and PET all have high specificity but poor sensitivity for the detection of lymph node metastases.

KEY POINTS

• Magnetic resonance imaging is the method of choice for assessing local extent. • Ultrasound may be helpful in determining parametrial invasion, especially in lower-resourced countries. • Computed tomography, magnetic resonance imaging, and positron emission tomography perform similarly for assessing lymph node metastasis, with high specificity but low sensitivity.

Quantitative Prostate MRI

Prostate MRI is reported in clinical practice using the Prostate Imaging and Data Reporting System (PI-RADS). PI-RADS aims to standardize, as much as possible, the acquisition, interpretation, reporting, and ultimately the performance of prostate MRI. PI-RADS relies upon mainly subjective analysis of MR imaging findings, with very few incorporated quantitative features. The shortcomings of PI-RADS are mainly: low-to-moderate interobserver agreement and modest accuracy for detection of clinically significant tumors in the transition zone. The use of a more quantitative analysis of prostate MR imaging findings is therefore of interest. Quantitative MR imaging features including: tumor size and volume, tumor length of capsular contact, tumor apparent diffusion coefficient (ADC) metrics, tumor T₁ and T₂ relaxation times, tumor shape, and texture analyses have all shown value for improving characterization of observations detected on prostate MRI and for differentiating between tumors by their pathological grade and stage. Quantitative analysis may therefore improve diagnostic accuracy for detection of cancer and could be a noninvasive means to predict patient prognosis and guide management. Since quantitative analysis of prostate MRI is less dependent on an individual users' assessment, it could also improve interobserver agreement. Semi- and fully automated analysis of quantitative (radiomic) MRI features using artificial neural networks represent the next step in quantitative prostate MRI and are now being actively studied. Validation, through high-quality multicenter studies assessing diagnostic accuracy for clinically significant prostate cancer detection, in the domain of quantitative prostate MRI is needed. This article reviews advances in quantitative prostate MRI, highlighting the strengths and limitations of existing and emerging techniques, as well as discussing opportunities and challenges for evaluation of prostate MRI in clinical practice when using quantitative assessment. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

Can high-risk CT features suggest local recurrence after stereotactic body radiation therapy for lung cancer? A systematic review and meta-analysis

PURPOSE

To perform a systematic review and meta-analysis evaluating usefulness of high-risk CT features (HRFs) on follow-up CT in detecting local recurrence after stereotactic body radiation therapy (SBRT) in lung cancer patients.

METHODS

Pubmed and EMBASE were searched up to January 11th, 2019. We included studies that differentiated local recurrence from post-SBRT changes after SBRT on follow-up CT in lung cancer patients. Methodological quality was assessed using QUADAS-2. The association between HRFs and local recurrence were pooled in the form of odds ratio (OR) using the random effects model. Heterogeneity was examined by the Inconsistency index (I²).

RESULTS

Eight studies were included, consisting of 356 lung cancer patients. The overall prevalence of patients with local recurrence was 18.8 % (67/356). Compared with post-SBRT changes, local recurrence after SBRT more frequently demonstrated air-bronchogram disappearance (OR = 7.15), bulging margin (OR = 24.12), craniocaudal growth (OR = 26.07), enlargement after 12 months (OR = 28.11), enlarging opacity (OR = 7.92), linear margin disappearance (OR = 29.24), and sequential enlargement (OR = 83.23) (p ≤ 0.02). Pleural effusion appearance was not related with local recurrence (p = 0.82). Heterogeneity varied among HRFs (I² = 0-91 %). The quality of the studies was considered moderate.

CONCLUSIONS

Several HRFs on follow-up CT after SBRT were useful in suggesting local recurrence. These HRFs may help raise clinical suspicion of local recurrence, initiate prompt additional test for confirmation and perform subsequent proper personalized salvage treatment.

Diagnostic Performance of Vesical Imaging Reporting and Data System for the Prediction of Muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis

CONTEXT

A noninvasive multiparametric magnetic resonance imaging (MRI)-based scoring system for predicting muscle-invasive bladder cancer (MIBC), the "Vesical Imaging Reporting and Data System" (VI-RADS), was recently developed by an international multidisciplinary panel. Since then, a few studies evaluating the value of VI-RADS for predicting MIBC have been published.

OBJECTIVE

To review the diagnostic performance of VI-RADS for the prediction of MIBC.

EVIDENCE ACQUISITION

PubMed and EMBASE databases were searched up to November 10, 2019. We included diagnostic accuracy studies using VI-RADS to predict MIBC using cystectomy or transurethral resection as the reference standard. Methodological quality was evaluated with Quality Assessment of Diagnostic Accuracy Studies-2. Sensitivity and specificity were pooled and plotted using hierarchical summary receiver operating characteristics (HSROC) modeling. Meta-regression analyses were done to explore heterogeneity.

EVIDENCE SYNTHESIS

Six studies (1770 patients) were included. Pooled sensitivity and specificity were 0.83 (95% confidence interval [CI] 0.70-0.90) and 0.90 (95% CI 0.83-0.95), and the area under the HSROC curve was 0.94 (95% CI 0.91-0.95). Heterogeneity was present among the studies (Q = 29.442, p <  0.01; I² = 87.93%, and 90.99% for sensitivity and specificity). Meta-regression analyses showed that the number of patients (>205 vs ≤205), magnetic field strength (3 vs 1.5 T), T2-weighted image slice thickness (3 vs 4 mm), and VI-RADS cutoff score (≥3 vs ≥4) were significant factors affecting heterogeneity (p ≤  0.03).

CONCLUSIONS

VI-RADS shows good sensitivity and specificity for determining MIBC. Technical factors associated with MRI acquisition and cutoff scores need to be taken into consideration as they may affect performance.

PATIENT SUMMARY

A recently established noninvasive magnetic resonance imaging-based scoring system shows good diagnostic performance in detecting muscle-invasive bladder cancer.

MRI of Bladder Cancer: Local and Nodal Staging

Accurate staging of bladder cancer (BC) is critical, with local tumor staging directly influencing management decisions and affecting prognosis. However, clinical staging based on clinical examination, including cystoscopy and transurethral resection of bladder tumor (TURBT), often understages patients compared to final pathology at radical cystectomy and lymph node (LN) dissection, mainly due to underestimation of the depth of local invasion and the presence of LN metastasis. MRI has now become established as the modality of choice for the local staging of BC and can be additionally utilized for the assessment of regional LN involvement and tumor spread to the pelvic bones and upper urinary tract (UUT). The recent development of the Vesical Imaging-Reporting and Data System (VI-RADS) recommendations has led to further improvements in bladder MRI, enabling standardization of image acquisition and reporting. Multiparametric magnetic resonance imaging (mpMRI) incorporating morphological and functional imaging has been proven to further improve the accuracy of primary and recurrent tumor detection and local staging, and has shown promise in predicting tumor aggressiveness and monitoring response to therapy. These sequences can also be utilized to perform radiomics, which has shown encouraging initial results in predicting BC grade and local stage. In this article, the current state of evidence supporting MRI in local, regional, and distant staging in patients with BC is reviewed. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:649-667.

Phase Instability amid Dimensional Crossover in Artificial Oxide Crystal

Artificial crystals synthesized by atomic-scale epitaxy provide the ability to control the dimensions of the quantum phases and associated phase transitions via precise thickness modulation. In particular, the reduction in dimensionality via quantized control of atomic layers is a powerful approach to revealing hidden electronic and magnetic phases. Here, we demonstrate a dimensionality-controlled and induced metal-insulator transition (MIT) in atomically designed superlattices by synthesizing a genuine two-dimensional (2D) SrRuO_{3} crystal with highly suppressed charge transfer. The tendency to ferromagnetically align the spins in an SrRuO_{3} layer diminishes in 2D as the interlayer exchange interaction vanishes, accompanying the 2D localization of electrons. Furthermore, electronic and magnetic instabilities in the two SrRuO_{3} unit cell layers induce a thermally driven MIT along with a metamagnetic transition.

Diagnostic Performance of MRI for Assessing Parametrial Invasion in Cervical Cancer: A Head-to-Head Comparison between Oblique and True Axial T2-Weighted Images

OBJECTIVE

To directly compare the diagnostic performance of true and oblique axial T2-weighted imaging (T2WI) for assessing parametrial invasion (PMI) in cervical cancer.

MATERIALS AND METHODS

This retrospective study included 71 women with treatment-naive cervical cancer who underwent MRI that included both oblique and true axial T2WI, followed by radical hysterectomy. Two blinded radiologists (Radiologist 1 and Radiologist 2) independently assessed the presence of PMI on both sequences using a 5-point Likert scale. Receiver operating characteristic (ROC) curve analysis was performed, with a subgroup analysis for tumors sized > 2.5 cm and ≤ 2.5 cm in diameter. Inter-reader agreement was assessed with kappa (k) statistics.

RESULTS

At hysterectomy, 15 patients (21.1%) had PMI. For Radiologist 1, the area under the ROC curve (AUC) was greater for oblique axial than for true axial T2WI {0.941 (95% confidence interval [CI] = 0.858-0.983) vs. 0.917 (95% CI = 0.827-0.969), p = 0.027}. The difference was not significant for Radiologist 2 (0.879 [95% CI = 0.779-0.944] vs. 0.827 [95% CI = 0.719-0.906], p = 0.153). For tumors > 2.5 cm, AUC was greater with oblique than with true axial T2WI (0.906 vs. 0.860, p = 0.046 for Radiologist 1 and 0.839 vs. 0.765, p = 0.086 for Radiologist 2). Agreement between the radiologists was almost perfect for oblique axial T2WI (k = 0.810) and was substantial for true axial T2WI (k = 0.704).

CONCLUSION

Oblique axial T2WI potentially provides greater diagnostic performance than true axial T2WI for determining PMI, particularly for tumors > 2.5 cm. The inter-reader agreement was greater with oblique axial T2WI.

Nanoscale heat transport through the hetero-interface of SrRuO3 thin films

A SrRuO₃ thin film has been widely used as a metal electrode in electronic devices based on transition metal oxides, and hence it is important to understand its thermal transport properties to minimize a thermal degradation problem during the device operation. Using the time-domain thermoreflectance measurement technique, we investigate the cross-plane thermal conductivity of the SrRuO₃ thin films with a thickness variation from 1 μm to 8 nm. We find that the thermal conductivity is reduced from about 6 W m^-1 K^-1 for the 1 μm thick film to about 1.2 W m^-1 K^-1 for the 8 nm thick film, and attribute this behavior to the boundary scattering of thermal carriers which originally have the mean free path of about 20 nm in a bulk state. Also, we observe a clear dip behavior of the thermal conductivity in the intermediate thickness around 30 nm which suggests an existence of a strong scattering source other than the film boundary. We explain this result by considering an additional interfacial scattering at the tetragonal-orthorhombic phase boundary which is formed during the strain relaxation with an increase of the film thickness.

Automatic matching of computed tomography and stereolithography data

BACKGROUND AND OBJECTIVE

Computed tomography (CT) is one of the most frequently used medical imaging methods. An important application area of CT is dental implants, which require precise inspection and analysis of oral structures. Since CT provides a precise 3D model of the teeth, bones and nerves, it can be used as a surgical guide for dental implants. Along with CT, optical 3D images called stereolithography (STL) have also been widely used. STL images obtained from optical 3D images can be used to show the 3D surfaces of oral structures. Since CT data and STL data deploy different technologies to obtain dental information, we can obtain more accurate dental implants by combining the two datasets. Since the two datasets are acquired by using different sensors, the datasets need to be registered.

METHODS

An automatic matching algorithm is proposed for CT and STL image registration, which is based on depth maps and maximum intensity projection. Then, fine tuning was performed based on volume matching.

RESULTS

When applied to real-world databases, the proposed method provided an average matching error of 2.7 mm for the upper jaw and 2.3 mm for the lower jaw with an average processing time of about 19 s.

CONCLUSIONS

The proposed method performs accurate registration of CT and STL.

Performance of pre-treatment ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography for detecting metastasis in ovarian cancer: a systematic review and meta-analysis

OBJECTIVE

We describe a systematic review and meta-analysis of the performance of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting metastasis in ovarian cancer.

METHODS

MEDLINE and Embase were searched for diagnostic accuracy studies that used ¹⁸F-FDG PET or PET/CT for pre-treatment staging, using surgical findings as the reference standard. Sensitivities and specificities were pooled and plotted in a hierarchic summary receiver operating characteristic plot. Potential causes of heterogeneity were explored through sensitivity analyses.

RESULTS

Eight studies with 594 patients were included. The overall pooled sensitivity and specificity for metastasis were 0.72 (95% confidence interval [CI]=0.61-0.81) and 0.93 (95% CI=0.85-0.97), respectively. There was considerable heterogeneity in sensitivity (I²=97.57%) and specificity (I²=96.74%). In sensitivity analyses, studies that used laparotomy as the reference standard showed significantly higher sensitivity and specificity (0.77; 95% CI=0.67-0.87 and 0.96; 95% CI=0.92-0.99, respectively) than those including diagnostic laparoscopy (0.62; 95% CI=0.46-0.77 and 0.84; 95% CI=0.69-0.99, respectively). Higher specificity was shown in studies that confirmed surgical findings by pathologic evaluation (0.95; 95% CI=0.90-0.99) than in a study without pathologic confirmation (0.69; 95% CI=0.24-1.00). Studies with a lower prevalence of the FDG-avid subtype showed higher specificity (0.97; 95% CI=0.94-1.00) than those with a greater prevalence (0.89; 95% CI=0.80-0.97).

CONCLUSION

Pre-treatment ¹⁸F-FDG PET/CT shows moderate sensitivity and high specificity for detecting metastasis in ovarian cancer. With its low false-positive rate, it can help select surgical approaches or alternative treatment options.

Comparison of Magnetic Resonance Imaging-stratified Clinical Pathways and Systematic Transrectal Ultrasound-guided Biopsy Pathway for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

Recent studies suggested that magnetic resonance imaging (MRI) followed by targeted biopsy ("MRI-stratified pathway") detects more clinically significant prostate cancers (csPCa) than the systematic transrectal ultrasound-guided prostate biopsy (TRUS-Bx) pathway, but controversy persists. Several randomized clinical trials (RCTs) were recently published, enabling generation of higher-level evidence to evaluate this hypothesis.

OBJECTIVE

To perform a systematic review and meta-analysis of RCTs comparing the detection rates of csPCa in the MRI-stratified pathway and the systematic TRUS-Bx pathway in patients with a suspicion of prostate cancer (PCa).

EVIDENCE ACQUISITION

PubMed, EMBASE, and Cochrane databases were searched up to March 18, 2019. RCTs reporting csPCa detection rates of both pathways in patients with a clinical suspicion of prostate cancer were included. Relative csPCa detection rates of the MRI-stratified pathway were pooled using random-effect model. Study quality was assessed using the Cochrane risk of bias tool for randomized trials. A comparison of detection rates of clinically insignificant PCa (cisPCa) and any PCa was also performed.

EVIDENCE SYNTHESIS

Nine RCTs (2908 patients) were included. The MRI-stratified pathway detected more csPCa than the TRUS-Bx pathway (relative detection rate 1.45 [95% confidence interval {CI} 1.09-1.92] for all patients, and 1.42 [95% CI 1.02-1.97] and 1.60 [95% CI 1.01-2.54] for biopsy-naïve and prior negative biopsy patients, respectively). Detection rates were not significantly different between pathways for cisPCa (0.89 [95% CI 0.49-1.62]), but higher in the MRI-stratified pathway for the detection of any PCa (1.39 [95% CI 1.05-1.84]).

CONCLUSIONS

The MRI-stratified pathway detected more csPCa than the systematic TRUS-guided biopsy pathway in men with a clinical suspicion of PCa, for both biopsy-naïve patients and those with prior negative biopsy. The detection rate of any PCa was higher in the MRI-stratified pathway, but not significantly different from that of cisPCa.

PATIENT SUMMARY

Our meta-analysis of clinical trials shows that the magnetic resonance imaging-stratified pathway detects more clinically significant prostate cancers than the transrectal ultrasound-guided prostate biopsy pathway in men with a suspicion of prostate cancer.

Contribution of Radiology to Staging of Prostate Cancer

Accurate tumor detection and establishment of disease extent are important for optimal management of prostate cancer. Disease stage, beginning with identification of the index prostate lesion, followed by primary tumor, lymph node, and distant metastasis evaluation, provide crucial clinical information that not only have prognostic and predictive value, but guide patient management. A wide array of radiological imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging have been used for the purpose of prostate cancer staging with variable diagnostic performance. Especially, the last years have seen remarkable technological advances in magnetic resonance imaging technology, enabling referring clinicians and radiologists to obtain even more valuable data regarding staging of prostate cancer. Marked improvements have been seen in detection of the index prostate lesion and evaluation of extraprostatic extension while further improvements are still needed in identifying metastatic lymph nodes. Novel approaches such as whole-body MRI are emerging for more accurate and reproducible assessment of bone metastasis. Post-treatment assessment of prostate cancer using radiological imaging is a topic with rapidly changing clinical context and special consideration is needed for the biochemical setting, that is, the relatively high serum prostate-specific antigen levels in studies assessing the value of radiological imaging for post-treatment assessment and emerging therapeutic approaches such as early salvage radiation therapy. The scope of this review is to provide the reader insight into the various ways radiology contribute to staging of prostate cancer in the context of both primary staging and post-treatment assessment. The strengths and limitations of each imaging modality are highlighted as well as topics that warrant future research.

Low-Tube-Voltage CT Urography Using Low-Concentration-Iodine Contrast Media and Iterative Reconstruction: A Multi-Institutional Randomized Controlled Trial for Comparison with Conventional CT Urography

Objective

To compare the image quality of low-tube-voltage and low-iodine-concentration-contrast-medium (LVLC) computed tomography urography (CTU) with iterative reconstruction (IR) with that of conventional CTU.

Materials and Methods

This prospective, multi-institutional, randomized controlled trial was performed at 16 hospitals using CT scanners from various vendors. Patients were randomly assigned to the following groups: 1) the LVLC-CTU (80 kVp and 240 mgI/mL) with IR group and 2) the conventional CTU (120 kVp and 350 mgI/mL) with filtered-back projection group. The overall diagnostic acceptability, sharpness, and noise were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) in the urinary tract were evaluated.

Results

The study included 299 patients (LVLC-CTU group: 150 patients; conventional CTU group: 149 patients). The LVLC-CTU group had a significantly lower effective radiation dose (5.73 ± 4.04 vs. 8.43 ± 4.38 mSv) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ≥ 3), but it was non-inferior when compared to conventional CTU. The mean attenuation value, mean SNR, CNR, and FOM in all pre-defined segments of the urinary tract were significantly higher in the LVLC-CTU group than in the conventional CTU group.

Conclusion

The diagnostic acceptability and quantitative image quality of LVLC-CTU with IR are not inferior to those of conventional CTU. Additionally, LVLC-CTU with IR is beneficial because both radiation exposure and total iodine load are reduced.

Prognostic value of volume-based metabolic parameters of 18F-FDG PET/CT in ovarian cancer: a systematic review and meta-analysis

OBJECTIVE

To perform a systematic review and meta-analysis on the prognostic value of ¹⁸F-FDG PET-derived volume-based parameters regarding metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with ovarian cancer.

METHODS

Pubmed and EMBASE databases were searched up to February 12, 2018 for studies which evaluated MTV or TLG as a prognostic factor in ovarian cancer with progression-free (PFS) and overall survival (OS) as the endpoints. Hazard ratios (HRs) were meta-analytically pooled using the random-effects model. Multiple subgroup analyses based on clinicopathological and PET variables were performed.

RESULTS

Eight studies with 473 patients were included. The pooled HRs of MTV and TLG for PFS were 2.50 (95% CI 1.79-3.48; p < 0.00001) and 2.42 (95% CI 1.61-3.65; p < 0.0001), respectively. Regarding OS, the pooled HRs of MTV and TLG were 8.06 (95% CI 4.32-15.05; p < 0.00001) and 7.23 (95% CI 3.38-15.50; p < 0.00001), respectively. Multiple subgroup analyses consistently showed that MTV and TLG were significant prognostic factors for PFS with pooled HRs ranging from 2.35 to 2.58 and from 1.73 to 3.35, respectively.

CONCLUSIONS

MTV and TLG from ¹⁸F-FDG PET were significant prognostic factors in patients with ovarian cancer. Despite the clinical heterogeneity and difference in methodology between the studies, patients with a high MTV or TLG have a higher risk of disease progression or death.

Differentiation between papillary renal cell carcinoma and fat-poor angiomyolipoma: a preliminary study assessing detection of intratumoral hemorrhage with chemical shift MRI and T2*-weighted gradient echo

Background Recent literature suggests that intratumoral hemorrhage detection may be helpful in differentiating papillary renal cell carcinoma (pRCC) from fat-poor angiomyolipoma (fpAML). Purpose To determine whether intratumoral hemorrhage detected using chemical shift magnetic resonance imaging (MRI) and T2*-weighted (T2*W) gradient echo (GRE) can be used to differentiate pRCC from fpAML. Material and Methods This retrospective study included 42 patients with pRCC (n = 28) and fpAML (n = 14) who underwent MRI followed by surgery. Two blinded radiologists independently assessed the presence of intratumoral hemorrhage using chemical shift MRI (decrease in signal intensity from opposed- to in-phase) and T2*W GRE ("blooming"). Consensus reading was determined for discrepant cases. MRI findings were compared using Chi-square test. Inter-observer agreement was assessed using kappa statistics. Results Inter-observer agreement was substantial for both sequences ( k = 0.622 and 0.793, P < 0.001). For chemical shift MRI, the prevalence of intratumoral hemorrhage was significantly greater in pRCC than in fpAML (71.4% versus 28.6%, P = 0.019 for reader 1; 64.3% versus 14.3%, P = 0.003 for reader 2; and 75% versus 21.4%, P = 0.002 for the consensus). T2*W GRE showed a similar tendency (46.4% versus 14.3%, P = 0.049 for both readers; and 50% versus 14.3%, P = 0.042 for the consensus). Using the consensus reading, sensitivity and specificity of determining pRCC were 75% and 78.6% for chemical shift MRI and 50% and 85.7% for T2*W GRE. Conclusion The prevalence of intratumoral hemorrhage identified from chemical shift MRI or T2*W GRE was significantly different between pRCC and fpAML. These hemorrhage-sensitive MRI sequences may be used as an adjunctive tool for discriminating between the two entities.

Impact of 68Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis

CONTEXT

⁶⁸Gallium prostate-specific membrane antigen positron emission tomography (⁶⁸Ga-PSMA PET) is an emerging imaging modality for assessment of prostate cancer. Recent studies show promising results regarding its ability to detect recurrent or metastatic prostate cancer superior to that of conventional imaging modalities. However, the impact of ⁶⁸Ga-PSMA PET on management of patients with prostate cancer has not been well established.

OBJECTIVE

To perform a systematic review and meta-analysis to evaluate the impact of ⁶⁸Ga-PSMA PET on management of patients with prostate cancer.

EVIDENCE ACQUISITION

Pubmed and EMBASE databases were searched up to January 20, 2018. We included studies that reported proportion of management change after ⁶⁸Ga-PSMA PET in patients with prostate cancer. The quality of the studies was evaluated using the GRADE system. The proportion of management changes were pooled using random-effects model. Subgroup analyses and meta-regression analyses were performed to explore heterogeneity.

EVIDENCE SYNTHESIS

Fifteen studies (1163 patients) were included. The pooled proportion of management changes was 54% (95% confidence interval 47-60%). At meta-regression analyses, PET positivity (%) was a significant factor of heterogeneity (p=0.0486). For patients with biochemical failure, the proportion of radiotherapy (from 56% to 61%), surgery (from 1% to 7%), focal therapy (from 1% to 2%), and multimodal treatment (from 2% to 6%) increased, whereas that of systemic treatment (from 26% to 12%) and no treatment (from 14% to 11%) decreased with ⁶⁸Ga-PSMA PET.

CONCLUSIONS

⁶⁸Ga-PSMA PET had a large impact on the management of patients with prostate cancer. Greater PET positivity was associated with higher proportion of management changes.

PATIENT SUMMARY

We reviewed all previous studies assessing the impact of ⁶⁸Gallium prostate-specific membrane antigen positron emission tomography (⁶⁸Ga-PSMA PET) in patients with prostate cancer. We found that ⁶⁸Ga-PSMA PET altered the management in approximately half of the patients.

Enhanced magnetic and thermoelectric properties in epitaxial polycrystalline SrRuO3 thin films

Transition metal oxide thin films show versatile electric, magnetic, and thermal properties which can be tailored by deliberately introducing macroscopic grain boundaries via polycrystalline solids. In this study, we focus on the modification of magnetic and thermal transport properties by fabricating single- and polycrystalline epitaxial SrRuO₃ thin films using pulsed laser epitaxy. Using the epitaxial stabilization technique with an atomically flat polycrystalline SrTiO₃ substrate, an epitaxial polycrystalline SrRuO₃ thin film with the crystalline quality of each grain comparable to that of its single-crystalline counterpart is realized. In particular, alleviated compressive strain near the grain boundaries due to coalescence is evidenced structurally, which induced the enhancement of ferromagnetic ordering of the polycrystalline epitaxial thin film. The structural variations associated with the grain boundaries further reduce the thermal conductivity without deteriorating the electronic transport, and lead to an enhanced thermoelectric efficiency in the epitaxial polycrystalline thin films, compared with their single-crystalline counterpart.

Apparent diffusion coefficient for prediction of parametrial invasion in cervical cancer: a critical evaluation based on stratification to a Likert scale using T2-weighted imaging

PURPOSE

To evaluate the value of apparent diffusion coefficient (ADC) for determining parametrial invasion (PMI) in cervical cancer, by stratifying them into subgroups based on a Likert scale using T2-weighted imaging (T2WI).

MATERIALS AND METHODS

This retrospective study included 87 patients with FIGO stage IA2-IIB cervical cancer who underwent preoperative MRI followed by radical hysterectomy. Radiological PMI was assessed on T2WI using a six-point Likert scale and ADC values of the tumors were measured. MRI findings were compared between patients with and without PMI. Differences in ADC according to the Likert scale were also assessed.

RESULTS

19 (21.8%) patients had pathological PMI. The prevalence of PMI was significantly associated with Likert scale (P < 0.001). ADC values significantly differed according to Likert scale (P < 0.001). However, only tumors with a Likert score of 0 (MRI-invisible) had significantly greater ADC than others (P < 0.001) while no significant difference was observed among tumors with Likert scores of 1-5 (P = 0.070-0.889). Patients with PMI had significantly lower ADC values than those without PMI (P = 0.034). However, no significant difference was seen between patients with and without PMI within each Likert score group (P = 0.180-0.857).

CONCLUSION

T2WI-based Likert score for radiological PMI and ADC values of the tumor were significantly associated with pathological PMI. However, the apparent association seen between ADC values and PMI may be due to contribution of high ADC values of MRI-invisible tumors rather than reflecting their relationship.

Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: An updated systematic review and meta-analysis of the literature between 2012 and 2016

OBJECTIVE

To review the diagnostic performance of MRI for detection of parametrial invasion (PMI) in cervical cancer patients.

METHODS

MEDLINE and EMBASE databases were searched for studies providing diagnostic performance of MRI for detecting PMI in patients with cervical cancer. Studies published between 2012 and 2016 using surgico-pathological results as reference standard were included. Study quality was evaluated using QUADAS-2. Sensitivity and specificity of all studies were calculated. Results were pooled and plotted in a hierarchical summary receiver operating characteristic plot. Meta-regression and subgroup analyses were performed.

RESULTS

Fourteen studies (1,028 patients) were included. Study quality was generally moderate. Pooled sensitivity was 0.76 (95% CI 0.67-0.84) and specificity was 0.94 (95% CI 0.91-0.95). The possibility of heterogeneity was considered low: Cochran's Q-test (p = 0.471), Tau² (0.240), Higgins I² (0%). With meta-regression analysis, magnet strength, use of DWI, and antispasmodic drugs were significant factors affecting heterogeneity (p < 0.01). Subgroup analysis for studies solely using radical hysterectomy as reference standard yielded pooled sensitivity and specificity of 0.73 (95% CI 0.60-0.83) and 0.93 (95% CI 0.90-0.95), respectively.

CONCLUSIONS

MRI shows good performance for detection of PMI in cervical cancer. Using 3-T scanners and DWI may improve diagnostic performance.

KEY POINTS

• MRI shows good performance for detection of parametrial invasion in cervical cancer. • Subgroup of studies using only radical hysterectomy showed consistent results. • Using 3-Tesla scanners and diffusion-weighted imaging may improve diagnostic performance.

Length of capsular contact on prostate MRI as a predictor of extracapsular extension: which is the most optimal sequence?

Background Length of capsular contact (LCC) is a promising biomarker for predicting extracapsular extension (ECE), but the most optimal magnetic resonance imaging (MRI) sequence for measuring LCC is yet to be determined. Purpose To evaluate LCC using different MRI sequences for determining ECE in prostate cancer. Material and Methods A total of 185 patients underwent prostate MRI followed by radical prostatectomy. LCC was measured separately on T2-weighted (T2W) images, apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced (DCE) MRI. LCCs (LCC_T2, LCC_ADC, LCC_DCE, and LCC_max [greatest value of 3 LCCs]) were compared between sequences using Wilcoxon signed rank test and was tested for determining ECE using the Mann-Whitney U test, ROC curve analysis, and logistic regression analysis. Results There were no significant differences among LCCs ( P = 0.333-0.837). All LCCs were significantly greater in patients with ECE ( P < 0.001). The optimal threshold value for predicting ECE was >14, >13, >12, and >14 mm for LCC_T2, LCC_ADC, LCC_DCE, and LCC_max, respectively. LCC_max yielded the highest area under the curve (0.895) which was significantly greater than that by LCC_ADC (0.858, P = 0.030). Otherwise, there were no significant difference between LCCs ( P = 0.052-0.985). At univariate analysis, age, clinical stage, PSA, Gleason score, and all LCCs were significantly associated with ECE ( P < 0.001-0.040). At multivariate analysis, GS ( P ≤ 0.008) and all LCCs ( P < 0.001) were independently predictive factors. Conclusion LCC measured on any sequence was significantly different in patients with and without ECE and was independently associated with the presence of ECE. Although LCC_max showed the greatest ability to predict ECE, there was relatively equivalent performance among different MRI sequences.

The Kaiser Permanente Northern California research program on genes, environment, and health (RPGEH) pregnancy cohort: study design, methodology and baseline characteristics

Background

Exposures during the prenatal period may have lasting effects on maternal and child health outcomes. To better understand the effects of the in utero environment on children’s short- and long-term health, large representative pregnancy cohorts with comprehensive information on a broad range of environmental influences (including biological and behavioral) and the ability to link to prenatal, child and maternal health outcomes are needed. The Research Program on Genes, Environment and Health (RPGEH) pregnancy cohort at Kaiser Permanente Northern California (KPNC) was established to create a resource for conducting research to better understand factors influencing women’s and children’s health. Recruitment is integrated into routine clinical prenatal care at KPNC, an integrated health care delivery system. We detail the study design, data collection, and methodologies for establishing this cohort. We also describe the baseline characteristics and the cohort’s representativeness of the underlying pregnant population in KPNC.

Methods

While recruitment is ongoing, as of October 2014, the RPGEH pregnancy cohort included 16,977 pregnancies (53 % from racial and ethnic minorities). RPGEH pregnancy cohort participants consented to have blood samples obtained in the first trimester (mean gestational age 9.1 weeks ± 4.2 SD) and second trimester (mean gestational age 18.1 weeks ± 5.5 SD) to be stored for future use. Women were invited to complete a questionnaire on health history and lifestyle. Information on women’s clinical and health assessments before, during and after pregnancy and women and children’s health outcomes are available in the health system’s electronic health records, which also allows long-term follow-up.

Discussion

This large, racially- and ethnically-diverse cohort of pregnancies with prenatal biospecimens and clinical data is a valuable resource for future studies on in utero environmental exposures and maternal and child perinatal and long term health outcomes. The baseline characteristics of RPGEH Pregnancy Cohort demonstrate that it is highly representative of the underlying population living in the broader community in Northern California.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-1150-2) contains supplementary material, which is available to authorized users.

Early stage cervical cancer: role of magnetic resonance imaging after conization in determining residual tumor

BACKGROUND

Although magnetic resonance imaging (MRI) is currently indispensable in the management of cervical cancer, its role in determining residual tumor in patients with cervical cancer after conization is not well known.

PURPOSE

To evaluate the value of MRI after conization in determining residual tumor in patients with FIGO stage IA-IB1 cervical cancer.

MATERIAL AND METHODS

In this retrospective study, 55 patients underwent conization followed by preoperative MRI and definitive surgery. Two radiologists evaluated the presence of residual tumor on MRI. MRI and preoperative clinical variables were compared between patients with and without residual tumor at final pathology using Student's t-test or Chi-square test. Association between variables and the presence of residual tumor was assessed using logistic regression analyses and receiver operating characteristic (ROC) curves.

RESULTS

Residual tumor at final pathology was found in 30 (54.5%) patients. Patients with residual tumor were older, had greater SCC antigen, and more frequently had positive conization margins and identifiable tumor on MRI (P < 0.008). Multivariate analysis showed that age (P = 0.008; odds ratio [OR] = 1.140), positive conization margin (P = 0.016; OR = 11.919), and identifiable tumor on MRI (P = 0.038; OR = 6.926) were independently predictive of residual tumor. Areas under the curve (AUCs) calculated with age (0.693), SCC antigen (0.755), and identifiable tumor on MRI (0.727) were greater than lymphovascular space invasion (0.517) and histological subtype (0.520, P ≤ 0.049). Otherwise, there were no significant differences in the AUCs derived from different variables (P = 0.053-0.970).

CONCLUSION

Identifiable tumor on MRI after conization in patients with early stage cervical cancer was an independent predictor of residual tumor at final pathology.

Angiomyolipoma with minimal fat: differentiation of morphological and enhancement features from renal cell carcinoma at CT imaging

BACKGROUND

Angiomyolipoma (AML) with minimal fat may mimic renal cell carcinoma (RCC) and is difficult to distinguish from RCC with imaging studies alone. Precise diagnostic strategies have been explored to discern AML with minimal fat from RCC.

PURPOSE

To compare the morphological and enhancement features of AML with minimal fat with those of size-matched RCC on computed tomography (CT).

MATERIAL AND METHODS

Our study included 143 pathologically proved renal tumors (29 AML with minimal fat: mean diameter, 2.5 cm; range, 1.2-4 cm; 114 RCC: mean diameter, 2.8 cm; range, 1.3-4 cm). All patients underwent biphasic helical CTs. Two radiologists retrospectively evaluated the morphological (i.e. non-round and round appearances, with or without capsule) and enhancement features (i.e., wash-out, gradual, or prolonged). For the parameters that had statistically significance between the two groups, we calculated the positive and negative predictive values by using the univariate χ(2) test. P < 0.05 indicated a significant difference.

RESULTS

AML with minimal fat showed a non-round appearance without a capsule (n = 24, 83%) and prolonged enhancement (n = 20, 69%). The positive and negative predictive values of the non-round appearance without capsule for differentiating AML with minimal fat from RCC were 82.8% and 95.6%, respectively. The positive and negative predictive values of prolonged enhancement were 62.5% and 90.8%, respectively. These features were valuable predictors for AML with minimal fat from RCC.

CONCLUSION

CT images with non-round shape without capsule and prolonged enhancements may be used to differentiate AML with minimal fat from RCC.

Diagnostic value of integrated PET/MRI for detection and localization of prostate cancer: Comparative study of multiparametric MRI and PET/CT

PURPOSE

To evaluate the diagnostic value of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) compared with conventional multiparametric MRI and PET/computed tomography (CT) for the detailed and accurate segmental detection/localization of prostate cancer.

MATERIALS AND METHODS

Thirty-one patients who underwent integrated PET/MRI using ¹⁸ F-choline and ¹⁸ F-FDG with an integrated PET/MRI scanner followed by radical prostatectomy were included. The prostate was divided into six segments (sextants) according to anatomical landmarks. Three radiologists noted the presence and location of cancer in each sextant on four different image interpretation modalities in consensus (1, multiparametric MRI; 2, integrated ¹⁸ F-FDG PET/MRI; 3, integrated ¹⁸ F-choline PET/MRI; and 4, combined interpretation of 1 and ¹⁸ F-FDG PET/CT). Sensitivity, specificity, accuracy, positive and negative predictive values, likelihood ratios, and diagnostic performance based on the DOR (diagnostic odds ratio) and NNM (number needed to misdiagnose) were evaluated for each interpretation modality, using the pathologic result as the reference standard. Detection rates of seminal vesicle invasion and extracapsular invasion were also evaluated.

RESULTS

Integrated ¹⁸ F-choline PET/MRI showed significantly higher sensitivity than did multiparametric MRI alone in high Gleason score patients (77.0% and 66.2%, P = 0.011), low Gleason score patients (66.7% and 47.4%, P = 0.007), and total patients (72.5% and 58.0%, P = 0.008) groups. Integrated ¹⁸ F-choline PET/MRI and ¹⁸ F-FDG PET/MRI showed similar sensitivity and specificity to combined interpretation of multiparametric MRI and ¹⁸ F-FDG PET/CT (for sensitivity, 58.0%, 63.4%, 72.5%, and 68.7%, respectively, and for specificity, 87.3%, 80.0%, 81.8%, 72.7%, respectively, in total patient group). However, integrated ¹⁸ F-choline PET/MRI showed the best diagnostic performance (as DOR, 11.875 in total patients, 27.941 in high Gleason score patients, 5.714 in low Gleason score groups) among the imaging modalities, regardless of Gleason score. Integrated ¹⁸ F-choline PET/MRI showed higher sensitivity and diagnostic performance than did integrated ¹⁸ F-FDG PET/MRI (as DOR, 6.917 in total patients, 15.143 in high Gleason score patients, 3.175 in low Gleason score groups) in all three patient groups.

CONCLUSION

Integrated PET/MRI carried out using a dedicated integrated PET/MRI scanner provides better sensitivity, accuracy, and diagnostic value for detection/localization of prostate cancer compared to multiparametric MRI. Generally, integrated ¹⁸ F-choline PET/MRI shows better sensitivity, accuracy, and diagnostic performance than does integrated ¹⁸ F-FDG PET/MRI as well as combined interpretation of multiparametric MRI with ¹⁸ F-FDG PET/CT.

LEVEL OF EVIDENCE

2 J. Magn. Reson. Imaging 2017;45:597-609.

Prostate cancer-specific mortality after radical prostatectomy: value of preoperative MRI

BACKGROUND

Although magnetic resonance imaging (MRI) is currently indispensable in the preoperative setting of biopsy-proven prostate cancer, the value of preoperative MRI for predicting prostate cancer-specific mortality (PCSM) is not well known.

PURPOSE

To evaluate the value of MRI for predicting PCSM in patients who underwent radical prostatectomy (RP) for localized prostate cancer.

MATERIAL AND METHODS

A total of 318 patients underwent MRI followed by RP. MRI was assessed for the presence of clinically significant cancer using a five-point Likert scale, where ≥4 was considered positive. Cox proportional hazards regression analyses was used to determine the relationship of preoperative factors with PCSM. PCSM was calculated using the Kaplan-Meier method and compared between factors using the log-rank test.

RESULTS

After a median follow-up of 104 months, 11 (3.5%) patients died of prostate cancer. One hundred and four (32.7%) patients had clinically significant prostate cancer on MRI. Univariate analysis revealed that Gleason grade, greatest percentage of involved core length (GPCL), and clinically significant cancer on MRI were significantly related to PCSM (P = 0.001-0.003). Multivariate analysis showed that GPCL (hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.000-1.057; P = 0.048) and clinically significant cancer on MRI (HR, 10.903; 95% CI, 1.287-92.374; P = 0.028) were independent predictors of PCSM. The 5 - and 10-year PCSM rates were 0.6% and 1.3% in patients with GPCL <50% and 5.1% and 8.6% in those with GPCL ≥50% (P = 0.012). Patients without clinically significant cancer on MRI showed 5 - and 10-year PCSM rates of 0% and 0.5%, respectively, whereas those with clinically significant cancer on MRI showed rates of 8% and 14.2%, respectively (P < 0.001).

CONCLUSION

Preoperative MRI and GPCL may be used to predict PCSM after RP.

Phase transitions via selective elemental vacancy engineering in complex oxide thin films

Defect engineering has brought about a unique level of control for Si-based semiconductors, leading to the optimization of various opto-electronic properties and devices. With regard to perovskite transition metal oxides, O vacancies have been a key ingredient in defect engineering, as they play a central role in determining the crystal field and consequent electronic structure, leading to important electronic and magnetic phase transitions. Therefore, experimental approaches toward understanding the role of defects in complex oxides have been largely limited to controlling O vacancies. In this study, we report on the selective formation of different types of elemental vacancies and their individual roles in determining the atomic and electronic structures of perovskite SrTiO3 (STO) homoepitaxial thin films fabricated by pulsed laser epitaxy. Structural and electronic transitions have been achieved via selective control of the Sr and O vacancy concentrations, respectively, indicating a decoupling between the two phase transitions. In particular, O vacancies were responsible for metal-insulator transitions, but did not influence the Sr vacancy induced cubic-to-tetragonal structural transition in epitaxial STO thin film. The independent control of multiple phase transitions in complex oxides by exploiting selective vacancy engineering opens up an unprecedented opportunity toward understanding and customizing complex oxide thin films.

PI-RADS version 2 for prediction of pathological downgrading after radical prostatectomy: a preliminary study in patients with biopsy-proven Gleason Score 7 (3+4) prostate cancer

OBJECTIVES

To evaluate PI-RADSv2 for predicting pathological downgrading after radical prostatectomy (RP) in patients with biopsy-proven Gleason score (GS) 7(3+4) PC.

METHODS

A total of 105 patients with biopsy-proven GS 7(3+4) PC who underwent multiparametric prostate MRI followed by RP were included. Two radiologists assigned PI-RADSv2 scores for each patient. Preoperative clinicopathological variables and PI-RADSv2 scores were compared between patients with and without downgrading after RP using the Wilcoxon rank sum test or Fisher's exact test. Logistic regression analyses with Firth's bias correction were performed to assess their association with downgrading.

RESULTS

Pathological downgrading was identified in ten (9.5 %) patients. Prostate-specific antigen (PSA), PSA density, percentage of cores with GS 7(3+4), and greatest percentage of core length (GPCL) with GS 7(3+4) were significantly lower in patients with downgrading (p = 0.002-0.037). There was no significant difference in age and clinical stage (p = 0.537-0.755). PI-RADSv2 scores were significantly lower in patients with downgrading (3.8 versus 4.4, p = 0.012). At univariate logistic regression analysis, PSA, PSA density, and PI-RADSv2 scores were significant predictors of downgrading (p = 0.003-0.022). Multivariate analysis revealed only PSA density and PI-RADSv2 scores as independent predictors of downgrading (p = 0.014-0.042).

CONCLUSIONS

The PI-RADSv2 scoring system was an independent predictor of pathological downgrading after RP in patients with biopsy-proven GS 7(3+4) PC.

KEY POINTS

• PI-RADSv2 was an independent predictor of downgrading in biopsy-proven GS 7(3+4) PC • PSA density was also an independent predictor of downgrading • MRI may assist in identifying AS candidates in biopsy-proven GS 7(3+4) PC patients.

Exophytic renal angiomyolipoma and perirenal liposarcoma: revisiting the role of CT for differential diagnosis

BACKGROUND

Exophytic renal angiomyolipoma and liposarcoma are two representative tumors in the retroperitoneum with fatty components that have potential to be misdiagnosed with each other.

PURPOSE

To compare the computed tomography (CT) findings of exophytic renal angiomyolipoma and perirenal liposarcoma.

MATERIAL AND METHODS

Fourteen and 16 cases with histologically-proven exophytic renal angiomyolipoma and perirenal liposarcoma, respectively, with preoperative CT from January 2000 to December 2013 were reviewed by two radiologists blinded to the clinical and pathological findings for an array of CT findings. These findings were compared between exophytic renal angiomyolipoma and perirenal liposarcoma using the Student t-test and Fisher's exact test.

RESULTS

Patients with exophytic renal angiomyolipoma were younger (P = 0.001) without differences in sex (P = 1.000). Exophytic renal angiomyolipomas were smaller (P = 0.004) and more commonly showed the following findings: renal parenchymal defect (P < 0.001), multiple linear vessels (P = 0.026), aneurysmal dilatation of intratumoral vessels (P = 0.024), renal parenchymal vascular pedicle (P < 0.001), hemorrhage (P = 0.037), encapsulated margin (P = 0.001), and other intrarenal fatty lesions (P = 0.037). No significant difference was seen in laterality, renal hilar vascular pedicle, non-fatty soft tissue nodule, calcification, or kidney displacement (P = 0.236-1.000).

CONCLUSION

Several CT findings were significantly different between exophytic renal angiomyolipoma and perirenal liposarcoma and may be helpful for differentiating between the two entities when confronting a fatty mass in the perirenal space.