RESUMO
PURPOSE: To determine guidelines for biopsy in men with normal prostate-specific antigen (PSA) levels and suspected prostate cancer. MATERIALS AND METHODS: The clinical-sonographic features of 91 lesions of reduced echogenicity in 83 men with normal PSA levels who underwent transrectal ultrasound-guided biopsy were analyzed. RESULTS: Sixteen men (19%) had cancer, two with bilateral foci, and four had prostatic intraepithelial neoplasia (PIN). Fourteen of 47 discrete hypoechoic lesions yielded cancer or PIN versus only five of 44 ill-defined vaguely hypoechoic lesions (P = .03). Fifteen of 18 malignant lesions exceeded 1 cm in longest dimension. In 47 men, sonographic and digital rectal examination (DRE) findings corresponded; 17 (36%) had cancer or PIN. By contrast, of 36 patients with differing sonographic and DRE findings, only three (8%) had malignancy at biopsy (P < .01). CONCLUSION: Predictors of malignancy at sonography of the peripheral prostate gland in men with normal PSA levels include (a) lesion size, (b) degree and focality of hypoechogenicity, and (c) correspondence with the site of DRE abnormality.
Assuntos
Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Exame Físico , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/patologia , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/patologia , Prostatite/diagnóstico por imagem , Prostatite/patologia , Estudos Retrospectivos , Ultrassonografia de IntervençãoRESUMO
To determine whether flow through the subclavian artery might be affected during extracorporeal membrane oxygenation (ECMO), 40 neonates were examined with color Doppler ultrasound during and after ECMO. Retrograde flow in the right vertebral artery, noted in 12 of the 40 neonates (30%), was consistent with vertebral steal. Brachial systolic velocity was significantly less (P less than .01) on the right than on the left side in neonates both with and without vertebral steal. When the arterial cannula was removed after ECMO, vertebral artery flow became antegrade with symmetric velocity. Brachial velocities became symmetric in infants without vertebral steal, but mild asymmetry persisted in neonates who had had vertebral steal. Only one neonate had clinical signs of arm ischemia, which resolved promptly after removal of the cannula. No surviving neonates (n = 11) had neurologic findings related to the vertebrobasilar insufficiency over a 12-22-month period of observation. Vertebral steal appears to be common during ECMO and is resolved after removal of the cannula.