The edition · Radiology
The PI-RADS ellipsoid is good enough for prostate volume and PSA density
A prospective study finds manual segmentation adds little outside very large glands, bilateral distal femoral sclerosis in older women looks like a benign fat-necrosis pattern, and follow-up recommendations for incarcerated patients were completed less than one time in ten.
The edition in brief
In 328 men having 3 T prostate MRI, volume from the PI-RADS ellipsoid formula agreed closely with manual segmentation (ICC 0.985; mean difference 5.5 cc) and classified PSA density at the usual cut-offs with sensitivity 0.86 to 0.95 and specificity 0.88 to 0.97; it underestimated glands over 80 cc, and tuning the coefficient did not help. A European Radiology series of 30 women with a mean age of 77 describes bilateral distal femoral sclerotic lesions, mostly lateral, linear or mixed, with fat-signal marrow on MRI and fat necrosis with dystrophic calcification on the one histological sample, suggesting a benign pattern that may not need biopsy. In NELSON screen-detected lung cancers, adenocarcinomas were smaller, slower-growing, more often in the right upper lobe and pleural-based than other subtypes. A US single-centre review found only 8.6% of radiology follow-up recommendations for incarcerated patients were completed as outpatients within the recommended window. The pearl: Fleischner guidance is for incidental nodules, not screening.
Bilateral distal femoral sclerosis in older women: a likely benign pattern
Symmetrical, mainly lateral distal femoral sclerosis with fat-signal marrow in an older woman may be a benign fat-necrosis pattern; reserve workup for aggressive features or cancer history.
Screen-detected adenocarcinomas: smaller, slower, upper-lobe and pleural-based
In lung screening, slow-growing, upper-lobe or pleural-based nodules can still be adenocarcinoma; manage by protocol and confirm subtype with tissue.
Follow-up imaging for incarcerated patients completed less than one time in ten
Track actionable imaging recommendations actively; for patients likely to be lost to follow-up, consider completing the study before discharge.
Fleischner is for incidental nodules, not screening
Use Fleischner for incidental nodules in adults 35 and over, Lung-RADS for screening, and clinical context for patients with cancer or immunosuppression.
Ellipsoid prostate volume matches segmentation closely enough for PSA density
The PI-RADS ellipsoid formula is accurate enough for routine prostate volume and PSA density; check large glands near a threshold.
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