Androgen deprivation therapy (ADT), used in selected patients with prostate cancer (PCa), is associated with accelerated bone loss and increased fragility fracture risk. Radiofrequency Echographic Multi-Spectrometry (REMS) is a non-ionizing ultrasound-based technique for axial bone mineral density (BMD) assessment.
To evaluate REMS-derived BMD at the lumbar spine and femoral neck in men with PCa receiving ADT and in age- and body mass index-matched healthy controls.
In this cross-sectional study, 143 Caucasian men were enrolled between October 2023 and October 2024: 83 patients with histologically confirmed PCa receiving ADT for at least 6 months and 60 healthy controls. REMS scans were performed at the lumbar spine and femoral neck. Between-group differences in BMD, T-score, and Z-score were assessed using an unpaired
t
-test.
Compared with controls, patients receiving ADT showed lower REMS-derived BMD at the lumbar spine (0.885 ± 0.08 vs. 0.945 ± 0.11 g/cm²;
p
= 0.007), corresponding to a 6.3% difference. Femoral neck BMD was also lower in the PCa group (0.691 ± 0.08 vs. 0.715 ± 0.10 g/cm²;
p
= 0.01), corresponding to a 3.4% difference.
These findings are consistent with the known skeletal effects of ADT and support the potential role of REMS as a radiation-free tool for identifying reduced axial BMD in men with PCa undergoing ADT. Longitudinal monitoring assessments are ongoing to clarify the temporal relationship between ADT exposure and progressive bone loss.
M. Montatore, Riccardo Guglielmi, Amanda Isaac et al.· Aging Clinical and Experimen...· 0 citations
Endovascular aneurysm repair (EVAR) has become a widely adopted treatment for abdominal aortic aneurysms, offering lower perioperative morbidity and mortality than open surgical repair. Nevertheless, long-term imaging surveillance remains essential because procedure-related complications may occur years after treatment. Among these, endoleaks represent the most frequent and clinically relevant finding, particularly Type II endoleaks, which are sustained by retrograde collateral perfusion and may be associated with persistent aneurysm sac filling and sac enlargement. Computed tomography angiography (CTA) remains the reference standard for anatomical assessment after EVAR, providing detailed evaluation of endograft integrity, aneurysm sac morphology, and vascular anatomy. However, repeated CTA examinations involve cumulative radiation exposure and iodinated contrast administration and may be limited in the detection of low-flow or intermittent endoleaks. Contrast-enhanced ultrasound (CEUS) provides real-time hemodynamic assessment, improves detection of slow-flow endoleaks, and avoids both ionizing radiation and nephrotoxic contrast agents. Nevertheless, CEUS may be affected by operator dependency and limited anatomical overview. CT–ultrasound fusion imaging combines pre-acquired CTA datasets with real-time ultrasound through spatial co-registration and probe tracking, enabling simultaneous evaluation of vascular anatomy and flow dynamics. This narrative review critically synthesizes current evidence regarding CTA, CEUS, and CT–ultrasound fusion imaging in post-EVAR surveillance, with particular emphasis on the incremental clinical value of fusion imaging beyond standalone CTA and CEUS. Particular attention is devoted to diagnostic performance, technical implementation, clinical applicability, current limitations, and future perspectives of CT–CEUS fusion imaging.
M. Montatore, Gianmichele Muscatella, R. Tupputi et al.· Radiation· 0 citations
POURPOSE
To provide an update on the role of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) of prostate cancer, with particular focus on standardizing image acquisition and reporting through PI-RADS v2.1, PI-QUAL v2, and PRECISE v2, as well as their clinical implications in risk stratification and follow-up.
MATERIALS AND METHODS
Narrative review of the literature and the most recent international guidelines on the use of mpMRI in patients undergoing AS. Selection criteria, follow-up protocols (12-24 months), imaging quality parameters (PI-QUAL v2), the longitudinal assessment system PRECISE v2, and the main radiological triggers for re-biopsy and multidisciplinary discussion were analyzed.
RESULTS
Baseline mpMRI improves candidate selection and reduces the risk of underestimating clinically significant disease. During follow-up, radiological progression shows a sensitivity of approximately 59% and specificity of approximately 75%, with a high negative predictive value (81-88%) but moderate positive predictive value. PRECISE v2 introduces updated categories, mandatory integration of image quality assessment, and systematic comparison with prior examinations, thereby improving reproducibility and comparability.
CONCLUSIONS
The standardized integration of mpMRI, PI-QUAL v2, and PRECISE v2 enables more structured patient monitoring and supports multidisciplinary decision-making. However, mpMRI does not replace scheduled biopsies. The implementation of radiomics and artificial intelligence may further enhance the objectivity and effectiveness of active surveillance.
V. Testini, L. Eusebi, Giuseppe Sortino et al.· Abdominal Radiology· 1 citation
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