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ObjectivesTo evaluate accuracy and inter-observer variability using Vesical Imaging-Reporting and Data System (VI-RADS) for discrimination between non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC).MethodsBetween September 2017 and July 2018, 78 patients referred for suspected bladder cancer underwent multiparametric MRI of the bladder (mpMRI) prior to transurethral resection of bladder tumor (TURBT). All mpMRI were reviewed by two radiologists, who scored each lesion according to VI-RADS. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each VI-RADS cutoff. Receiver operating characteristics curves were used to evaluate the performance of mpMRI. The Ƙ statistics was used to estimate inter-reader agreement.ResultsSeventy-five patients were included in the final analysis, 53 with NMIBC and 22 with MIBC. Sensitivity and specificity were 91% and 89% for reader 1 and 82% and 85% for reader 2 respectively when the cutoff VI-RADS > 2 was used to define MIBC. At the same cutoff, PPV and NPV were 77% and 96% for reader 1 and 69% and 92% for reader 2. When the cutoff VI-RADS > 3 was used, sensitivity and specificity were 82% and 94% for reader 1 and 77% and 89% for reader 2. Corresponding PPV and NPV were 86% and 93% for reader 1 and 74% and 91% for reader 2. Area under curve was 0.926 and 0.873 for reader 1 and 2 respectively. Inter-reader agreement was good for the overall score (Ƙ = 0.731).ConclusionsVI-RADS is accurate in differentiating MIBC from NMIBC. Inter-reader agreement is overall good.Key Points• Traditionally, the local staging of bladder cancer relies on transurethral resection of bladder tumor.• However, transurethral resection of bladder tumor carries a significant risk of understaging a cancer; therefore, more accurate, faster, and non-invasive staging techniques are needed to improve outcomes.• Multiparametric MRI has proved to be the best imaging modality for local staging; therefore, its use in suitable patients has the potential to expedite radical treatment when necessary and non-invasive diagnosis in patients with poor fitness.

Notably, MRI represents a useful diagnostic tool in supporting the decision to start a more aggressive airway therapy and in monitoring lung disease over time, particularly in patients with AT and airflow obstruction. 2 MRI seems to be a promising tool in patients with AT who can benefit from its diagnostic accuracy in a continuously growing number of situations without the drawbacks of ionising radiation. 3

PurposeTo validate a novel consensus method, called target-in-target, combining human analysis of mpMRI with automated CAD system analysis, with the aim to increasing the prostate cancer detection rate of targeted biopsies.MethodsA cohort of 420 patients was enrolled and 253 patients were rolled out, due to exclusion criteria. 167 patients, underwent diagnostic 3T MpMRI. Two expert radiologists evaluated the exams adopting PI-RADSv2 and CAD system. When a CAD target overlapped with a radiologic one, we performed the biopsy in the overlapping area which we defined as target-in-target. Targeted TRUS-MRI fusion biopsy was performed in 63 patients with a total of 212 targets. The MRI data of all targets were quantitatively analyzed, and diagnostic findings were compared to pathologist’s biopsy reports.ResultsCAD system diagnostic performance exhibited sensitivity and specificity scores of 55.2% and 74.1% [AUC = 0.63 (0.54 ÷ 0.71)] , respectively. Human readers achieved an AUC value, in ROC analysis, of 0.71 (0.63 ÷ 0.79). The target-in-target method provided a detection rate per targeted biopsy core of 81.8 % vs. a detection rate per targeted biopsy core of 68.6 % for pure PI-RADS based on target definitions. The higher per-core detection rate of the target-in-target approach was achieved irrespective of the presence of technical flaws and artifacts.ConclusionsA novel consensus method combining human reader evaluation with automated CAD system analysis of mpMRI to define prostate biopsy targets was shown to improve the detection rate per biopsy core of TRUS-MRI fusion biopsies. Results suggest that the combination of CAD system analysis and human reader evaluation is a winning strategy to improve targeted biopsy efficiency.

IntroductionMyocardial perfusion scintigraphy (MPS) is one of the most commonly performed non-invasive imaging procedures for the diagnosis of Coronary Artery Disease (CAD). Two large trials evaluating over 21,000 patients with a normal SPECT study have demonstrated the safety of stress-only imaging as compared to traditional stress/rest imaging. Comparably low all-cause and cardiac mortality rates were observed with both imaging protocols. This was true irrespective of patient age, gender, cardiac risk factor profile, or stressor employed with SPECT. These results are consistent with earlier studies evaluating patient outcome following normal stress-only imaging. The best use of a stress-only imaging strategy is likely to be in the selected low or intermediate risk population, which forms the referral basis for myocardial perfusion imaging. In this study, we describe the introduction of stress only MPS in comparison to traditional stress/rest MPS.Old PathwayThe traditional stress/rest MPS pathway requires two imaging sessions either the same day or on two separate days according to the patient’s Body Mass Index (BMI). For a 1 day protocol typically the injected activity is split in a 1:3 ratio between the first and second injections. For BMI <30, a total of 1125 MBq is administered. For BMI 30–35, a total of 1475 MBq is administered. For BMI>35, a total of 2000 MBq is administered 1:1. If the BMI is not provided by the requesting clinician then a letter is sent to the patient asking their height and weight.New PathwayFrom September 2014 through December 2014, we introduced selective stress only imaging. A single high dose MIBI stress dose of of 800 MBq, was authorised for all patients, regardless of BMI. After stress imaging, a decision was made regarding the necessity of rest imaging.ResultsPatients were referred from 10 hospitals. 407 patients were scanned. 55% were male and 45% female. Their average age was 66 years (+/-12.9). Their average BMI was 29.4 kg/m2 (+/-6.4).Of the total, 35% percent were normal at stress imaging and did not have rest imaging. Of the 65% who were abnormal, 60% of the combined rest/stress scans were interpreted as abnormal. As a result of this, the average time from request to appointment date for the stress scan reduced from 27 to 14 days.The average time between stress scan and rest scan was 2.5 (range: 1–21 days). The average report turn around time from request to report for MPS was 5 days, but 97% of normal stress only scans were reported the same day. Furthermore, the administered radiation dose was lower for 67% of all patients.In additional to scanning parameters being assessed, patients preferences were also assessed via a questionnaire. 49% expressed a preference for the test to be split across 2 days. 7% said either 1 day or 2 days. 20% of patients had to take a day off work to attend the hospital.ConclusionStress only MPS reduces radiation exposure, increases efficiency and thereby reduces cost.