Journal highlights

The following are highlights from the current issues of RSNA’s peer-reviewed journals.


Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: 10 Years’ Experience

Benign prostatic hyperplasia is one of the most common diseases of middle-aged and older men. Benign prostatic hyperplasia–associated morbidities affect as many as 75% of men in the United States by age 70. Medications are the first-line noninvasive treatment to control lower urinary tract symptoms (LUTS).

Prostatic artery embolization (PAE) has been widely used by interventional radiologists during the last decades to treat urological bleeding from different prostatic causes. A decade after PAE was introduced in clinical practice, there have been multiple reports of symptom reduction, quality of life improvement and reduction of prostate size. The use of intraprocedural cone-beam CT has improved the accuracy as well as the efficacy of the procedure.

In a new study in Radiology, Francisco Cesar Carnevale, MD, PhD, University of São Paulo Medical School in Brazil, evaluated the efficacy, safety, and long-term results of PAE for benign prostatic hypertrophy.

Dr. Carnevale and colleagues performed a retrospective single-center study from 2008 to 2018 in patients with moderate to severe benign prostatic hyperplasia– related symptoms. International Prostate Symptom Score (IPSS), quality-of-life score, maximum urinary flow rate, postvoid residual volume, prostate-specific antigen (PSA), and prostate volume were assessed.

“PAE resulted in an average reduction of prostate volume of 39%, and improved IPSS and quality-of-life score by a mean of 16 points and 4 points, respectively. Although long-term results for PAE are promising, further investigations regarding optimal technical aspects of the procedure and patient selection are still required. Our data indicate that PAE is a safe and effective procedure with the potential to become an alternative treatment in the management of benign prostatic enlargement due to benign prostatic hyperplasia,” the authors conclude.

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A, Three-dimensional rotational angiography reconstruction using cone-beam CT software shows right prostatic posterolateral (arrowhead) and anteromedial branches (arrows), as well as other right-sided pelvic arteries. B, Reconstruction, including soft tissues, confirms right-lobe prostatic vascular anatomy. C, Arterial segmentation reconstruction shows best oblique angulation to be used as road-map guide, avoiding use of additional digital subtraction arteriogram (DSA). D, Selective ipsilateral oblique DSA shows right posterolateral (arrowhead) and anteromedial (white arrows) prostatic branches, right seminal vesical artery (black arrow), and right-lobe intraprostatic branches. E, DSA after embolization with tip of microcatheter at main trunk of prostatic artery (arrow) shows occlusion of distal intraprostatic branches, and reflux to origin of right prostatic artery. F, After distal navigation of microcatheter (arrowhead) for Proximal Embolization First, Then Embolize Distal technique, DSA shows intraprostatic branches still patent (white arrows) and opened collateral shunt (black arrow).

Carnevale et, al; Radiology 2020 ©RSNA 2020

Cardiothoracic Imaging

Feasibility of Cardiovascular Four-dimensional Flow MRI During Exercise in Healthy Participants

Exercise cardiovascular MRI is an emerging technique with great clinical potential. Previous studies have used exercise either adjacent to or inside the bore of the MRI scanner to measure ventricular volumes, myocardial perfusion and cardiac output immediately after or during exercise.

Four-dimensional (4D) flow MRI allows for simultaneous measurement of flow in several vessels and hemodynamic derivatives of the velocity field, including ventricular kinetic energy (KE).

A new study in Radiology: Cardiothoracic Imaging, investigated the feasibility of performing free-breathing 4D flow MRI during continuous high-intensity exercise to quantify blood flow and ventricular KE in healthy adult participants.

Jacob A. Macdonald, PhD, University of Wisconsin, Madison, and colleagues performed cardiac 4D flow MRI in 11 healthy young adult participants at rest and during exercise with an MRI-compatible exercise stepper.

Flow was measured in the ascending aorta (AAo) and main pulmonary artery (MPA). KE was quantified in the left and right ventricle. Significant changes in flow and KE during exercise were identified by using tests. Repeatability was assessed with inter- and intra-observer comparisons and an analysis of internal flow consistency.

“Four-dimensional flow MRI can quantify increases in flow in the AAo and MPA during strenuous exercise and is highly repeatable. KE had reduced repeatability because of suboptimal segmentation methods and requires further development before clinical implementation. With further development, biventricular 4D flow exercise cardiac MRI can fulfill a valuable clinical role in evaluating patients with right-sided heart dysfunction, a group not well-addressed by stress echocardiography,” the authors conclude.


Mechanisms and Origins of Spinal Pain: From Molecules to Anatomy with Diagnostic Clues

Spinal pain, especially low back pain (LBP), is a widespread clinical and diagnostic problem for both patients and physicians, because back pain has a wide variety of causes and provocations. Because of its variable nature and manifestations, back pain is challenging to diagnose and treat correctly. In addition, the pain is induced not only by direct mechanical pressure such as a herniated disk or degenerated bone, but also by inflammation and associated proinflammatory cytokines.

Diagnostic clues provided by MRI can help radiologist understand potential underlying mechanisms and help guide clinicians in the management of LBP.

In a new article in RadioGraphics, Yoshiaki Ota, MD, University of Michigan, Ann Arbor, and colleagues reviewed the microscopic and macroscopic mechanisms for each category of LBP and the relationship between imaging findings and pain mechanisms.

Researchers focused on detailed anatomy and the role of microscopic mechanisms for each category of pain. To help further guide diagnostic workup or the next step in management, radiologists should be familiar with the mechanisms of pain and the diagnostic and management clues they provide at imaging, including information about the sinuvertebral nerves, pro-inflammatory cytokines, peripheral disk herniation and the dorsal root ganglion.

“Familiarity with the pain mechanisms and anatomy related to pain signal pathways can help radiologists further guide diagnostic workup and/or the next step in management of LBP,” the authors write.

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Ota 1

Annular fissure of the L5-S1 intervertebral disk in a 20-year-old man who presented with acute LBP. (a) Axial T2- weighted MR image shows an annular fissure as a focal zone of hyperintensity in the anulus (arrow).

Ota et al, RadioGraphics 2020:40;4 ©RSNA 2020

Ota 2

Annular fissure of the L5-S1 intervertebral disk in a 20-year-old man who presented with acute LBP. (b) Illustration shows that macro- or microscopic disruption of disk integrity can cause disk material to diffuse to adjacent nerve endings or nerve roots, allowing phospholipase A2 (PL-A2), IL-1 (IL 1beta), and nitric oxide (NO) to stimulate nerve inflammation, neuroexcitation, and pain responses (discogenic pain).

Ota et al, RadioGraphics 2020:40;4 ©RSNA 2020