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Aim: The aim of our study was to evaluate the sensitivity of contrast-enhanced magnetic resonance (CE-MR) with phased array coil in the diagnosis of local recurrence in patients with prostate cancer after radical prostatectomy and referred for salvage radiotherapy (SRT)., Materials and Methods: This retrospective study included 73 patients treated with SRT after radical prostatectomy in the period between September 2006 and November 2017. All patients performed a CE-MRI with phased array coil before the start of SRT. A total of 213 patients treated at the ASST Grande Ospedale Metropolitano Niguarda in the period between September 2006 and November 2017 with SRT after radical prostatectomy were reviewed. Seventy-three patients with a CE-MRI with phased array coil of the pelvis before the start of SRT were included in the present study., Results: At imaging review, recurrence local recurrent disease was diagnosed in 48 of 73 patients. By considering as reference standard the decrease in prostate-specific antigen (PSA) value after radiotherapy, we defined: 41 true positive (patients with MRI evidence of local recurrence and PSA value decreasing after SRT), 7 false positive (patients with MRI evidence of local recurrence without biochemical response after SRT), 3 true negative (patients without MRI evidence of local recurrence and stable or increased PSA value after SRT) and 22 false negative (patients without MRI evidence of local recurrence and PSA value decreasing after SRT) cases. The sensitivity values were calculated in relation to the PSA value before the start of treatment, obtaining a value of 74% for PSA above 0.2 ng/mL., Conclusion: The sensitivity of CE-MRI in local recurrence detection after radical prostatectomy increases with increasing PSA values. CE-MRI with phased array coil can detect local recurrences after radical prostatectomy with a good sensitivity in patients with pre-RT PSA value above 0.2 ng/mL.

ExAblate 2000 MRgFUS system (InSightec) installed in Ospedale Maggiore Niguarda Ca' Granda (Milano, Italy) is currently used to treat uterine fibroids. Through the magnetic resonance thermometry (PRF method), it is possible to monitor the temperature in the target in real-time and compute the treated region calculating the thermal dose. The purpose of this work is to investigate the errors in the temperature measurements and their effect on thermal dose. A low pass filtering of temperature maps is proposed to reduce the errors and therefore to improve the reliability of the treated regions calculated. The PRF method was studied through a calibration experiment on ex vivo pig muscle. The outcome resulted to be a very good linearity (p value 0.03) between phase and temperature in the range of interest, and an α value of -0.0109 ± 0.0002 ppm/°C. Temperature statistical uncertainty was evaluated by analyzing the temperature readout variability in specific gel provided by InSightec for daily quality assurance control. It resulted to be 1.89 ± 0.32 °C. A Monte Carlo simulation of the MRI temperature measurement and thermal dose calculations in our specific conditions of geometry and statistical uncertainty revealed that a low-pass filtering process on each temperature map can strongly reduce systematic errors in thermal dose evaluations (1.11 overestimation factor instead of 2.62 without filter); consequently the systematic errors on the size of the predicted ablated area are reduced as well., (Copyright © 2013 Associazione Italiana di Fisica Medica. All rights reserved.)

We report a case of a large perinephric pseudoaneurysm due to spontaneous rupture of renal angiomyolipoma, occluded by percutaneous thrombin injection under ultrasound guidance in a young woman affected by tuberous sclerosis.

Non tuberculous Mycobacterial (NTM) Infections mainly affect immunocompromised patients, appearing as disseminated or pulmonary disease. In immunocompetent children the most common form of infection with NTM is cervical adenitis. Ear infection seems to be a rare disease. We present a case of otomastoiditis caused by Mycobacterium avium in a 15 months old child, immunologically normal. Patient was referred for persistent right otitis unresponsive to routine medical therapy. TC scan of the ear and temporal bones revealed: soft tissue in external auditory canal, Eustachian canal, and middle ear overlying ossicles with erosion of tegmen tympani. Tuberculin skin test was positive with 5 units PPD and culture yielded M. avium. The patient undergo timpanomastoidectomy and medical therapy with antituberculous drugs and Steroids, subsequently he was given Clarithromycin and Rifabutin. M. avium is an ubiquitous low grade pathogen found in soil, water, dust and food. There is no evidence of direct transmission. Only a few cases of otomastoiditis due to M. avium have previously been reported. The case presented underlines the importance of microbiological investigations. When a NTM infection is suspected surgeons and infectious diseases specialists should cooperate to find an optimal treatment regimen of this unusual disease.