Usefulness of balanced SSFP sequence in robot-assisted MRI-guided prostate biopsy: Beyond scouting

OBJECTIVES

To determine whether bSSFP images are useful for visualizing prostatic lesionsin MRI-guided in-bore transrectal biopsy.

METHODS

This retrospective studyincluded 67 men witha single suspected cancer on MRI (PI-RADS 2.1 category ≥ 3) who underwent in-bore transrectal MRI-guided biopsy. Two uroradiologists independently rated lesion conspicuity on a 3-point scale (1:non-visible, 2:slightly visible, 3:clearly visible) on T2WI, DWI, and balanced SSFP.We used measures of frequency to compare lesion conspicuity in 3 sequences. We used Cohen's kappa to assess inter-rater reliability.

RESULTS

Lesions were rated (1) non-visible in 18 % (12/67) of T2WI, 5 % (3/67) of DWI, and 10 % (7/67) of balanced SSFP images, (2) slightly visible in 56 % (37/67) on T2WI, 13 % (9/67) on DWI, and 48 % (32/67) on bSSFP, and (3) clearly visible in 27 %(18/67) on T2WI, 82 % (55/67) on DWI, and 42 % (28/67) on bSSFP. Lesions classified as prostate cancer at histology were slightly-clearly visible in 85 % (41/48) on T2WI, 100 % (48/48) on DWI, and 94 % (45/48) on bSSFP. Lesions classified as PI-RADS ≥ 4 were visible in 87 % (47/54) of T2WI, 100 % (54/54) of DWI, and 93 % (50/54) of bSSFP. Gleason ≥ 3 + 4 lesions were visible in 85 % (37/43) of T2WI, 100 % (43/43) of DWI, and 95 % (41/43) of bSSFP. Inter-rater agreement was excellent for T2WI (k = 0.97) and bSSFP (k = 0.94), and good for DWI (k = 0.75).

CONCLUSION

Balanced SSFP is useful for visualizing prostatic lesions. Replacing T2WI with balanced SSFP can reduce the duration of in-bore transrectal MRI-guided biopsy.

Pituitary Abscess: Two Case Reports and Review of the Literature

Pituitary abscesses are infrequent entities, often forgotten and hence rarely included in the differential diagnosis of sellar lesions. However, given that they share the clinical manifestations of other more common pathologies in this region, the treatment of pituitary abscesses is usually performed correctly without demonstrating a relevant delay in therapeutic decisions when surgical options are considered as the alternative of choice. Two patients with intrasellar expansive processes and endocrinological alterations who were diagnosed intraoperatively as having pituitary abscesses are presented. In both cases, transsphenoidal surgery was performed; adjuvant antibiotic treatment was established for just one of them. Both patients are currently without symptoms due to mass-effect; one of the patients continues exhibiting residual endocrinological alteration and no signs of relapse in imaging studies.