Topic: Imaging

Updates on the Imaging for Urothelial Carcinoma

Updates on the Imaging for Urothelial Carcinoma

by | Nov 2024

Desencia E. Thomas, MD, presents an update on imaging techniques for urothelial carcinoma (UC), emphasizing advancements in diagnosis and staging.

In this 18-minute presentation, Dr. Thomas highlights the diagnostic accuracy of CT urography. MR urography provides an alternative for patients unable to tolerate iodine-based contrast or when CT findings are inconclusive. PET imaging, including 18-F FDG PET, excels in detecting distant metastases, but tracers like 11-C acetate and choline help minimize false positives in the urinary tract due to reduced excretion.

Dr. Thomas discusses the role of MRI in bladder cancer staging, where VI-RADS scoring helps distinguish between muscle-invasive and non-invasive cancers. This system, using T2-weighted, diffusion-weighted, and contrast-enhanced sequences, enables precise preoperative staging. Dual-energy CT (DECT) is also emerging, allowing reduced radiation exposure while retaining diagnostic value.

Key challenges include limited imaging sensitivity for early-stage UC and difficulty assessing tumor invasion depth. Dr. Thomas emphasizes that contrast-enhanced ultrasound may assist patients with contraindications to CT or MRI, although it remains less sensitive for upper tract tumors. She stresses that imaging advancements hold promise for improving UC management and minimizing invasive procedures like TURBT.

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HoLEP

HoLEP

by | Sep 2024

Lori B. Lerner, MD, delves into the complexities of enucleation techniques for treating benign prostatic hyperplasia (BPH), emphasizing the importance of understanding prostate anatomy. In this 11-minute presentation, she highlights how individual anatomical variations influence surgical decisions and outcomes, particularly in laser enucleation.

Dr. Lerner outlines different approaches to enucleation, involving strategic incisions to address each patient’s specific anatomy. She discusses complex cases, such as patients with a significant portion of their prostate extending into the bladder, nodular prostates, or elevated bladder necks, which necessitate tailored approaches.

Dr. Lerner’s presentation underscores the necessity of careful preoperative imaging, using tools like MRI or CAT scans, to map the prostate’s structure and guide the surgical approach. She advocates against routine excessive testing, emphasizing responsible and targeted use of diagnostic tools to inform clinical decisions without unnecessary expenditure. Lerner also addresses potential complications such as postoperative stress urinary incontinence.

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Imaging and Biomarkers in Patient Selection for Focal Ablation

Imaging and Biomarkers in Patient Selection for Focal Ablation

by | Aug 2024

Ezequiel Becher, MD, discusses the critical role of imaging and biomarkers in selecting patients for focal ablation in prostate cancer treatment.

He highlights the advancements in imaging technologies that have revolutionized prostate cancer diagnostics, particularly multiparametric MRI (mpMRI). In addition to imaging, Dr. Becher underscores the significance of biomarkers in patient selection. While prostate-specific antigen (PSA) levels are traditionally used, they are complemented by more specific biomarkers such as PCA3, TMPRSS2-ERG, and genomic tests that provide a deeper understanding of tumor biology and aggressiveness.

Dr. Becher also addresses the challenges and limitations of current imaging and biomarker techniques. He advocates for continuous refinement of these technologies and the development of standardized protocols to enhance diagnostic accuracy. Looking forward, he points to the potential of artificial intelligence and machine learning in improving diagnostic precision and patient selection processes.

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UPJO Management: Cut, Construct, or Check

UPJO Management: Cut, Construct, or Check

by | Aug 2024

Benjamin K. Canales, MD, MPH, discusses the pathophysiology and clinical presentation of UPJO, emphasizing its impact on renal function and patient quality of life. He outlines the diagnostic approach, including imaging techniques such as ultrasound, CT, and diuretic renography, which are essential for assessing the obstruction and guiding treatment decisions.

The presentation delves into the three primary management strategies for UPJO: surgical intervention, reconstructive techniques, and conservative monitoring. Dr. Canales provides a detailed analysis of each approach and discusses the indications, success rates, and potential complications of open, laparoscopic, and robotic-assisted pyeloplasty, offering insights into selecting the most appropriate surgical technique based on patient-specific factors.

Dr. Canales reviews the evidence supporting reconstructive techniques, including endopyelotomy and balloon dilation, as minimally invasive alternatives, highlighting their benefits and limitations. Conservative management and active surveillance are presented as viable options for patients with mild or asymptomatic UPJO.

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