Background: Irreversible electroporation (IRE) is a nonthermal ablative method based on the formation of nanoscale defects in cell membranes leading to cell death. Clinical experience with the technique for treatment of prostate cancer remains limited. Purpose: To evaluate urogenital toxicity and oncologic outcome of MRI-transrectal US fusion-guided IRE of localized prostate cancer. Materials and Methods: In this prospective study, men with biopsy-proven, treatment-naive, low-to intermediate-risk prostate cancer (prostate-specific antigen [PSA], 15 ng/mL; Gleason score, 3 + 4; clinical stage, T2c; lesion size at multiparametric MRI, 20 mm) underwent focal MRI/transrectal US fusion-guided IRE between July 2014 and July 2017. Primary end point was the urogenital toxicity profile of focal IRE by using participant-reported questionnaires. Secondary end points were biochemical, histologic, and imaging measures of oncologic control. Analyses were performed by using nonparametric and x 2 test statistics. Results: Thirty men were included (median age, 65.5 years); mean PSA level was 8.65 ng/mL and mean tumor size was 13.5 mm. One grade III adverse event (urethral stricture) was recorded. The proportion of men with erection sufficient for penetration was 83.3% (25 of 30) at baseline and 79.3% (23 of 29; P. .99) at 12 months. Leak-free and pad-free continence rate was 90% (27 of 30) at baseline and 86.2% (25 of 29; P. .99) at 12 months. Urogenital function remained stable at 12 months according to changes in the modified International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms, or ICIQ-MLUTS, and the International Index of Erectile Function, or IIEF-5, questionnaires (P = .58 and P = .07, respectively). PSA level decreased from a baseline median value of 8.65 ng/mL (interquartile range, 5-11.4 ng/mL) to 2.35 ng/mL (interquartile range, 1-3.4 ng/mL) at 12 months (P , .001). At 6 months, 28 of 30 participants underwent posttreatment biopsy. The rate of infield treatment failure was 17.9% (five of 28) as determined with multiparametric prostate MRI and targeted biopsies at 6 months. Conclusion: After a median follow-up of 20 months, focal irreversible electroporation of localized prostate cancer was associated with low urogenital toxicity and promising oncologic outcomes.

Purpose: To evaluate a fully automatic computer-assisted diagnosis (CAD) method for breast magnetic resonance imaging (MRI), which considered dynamic as well as morphologic parameters and linked those to descriptions laid down in the Breast Imaging Reporting and Data System (BI-RADS) MRI atlas.Materials and Methods: MR images of 108 patients with 141 histologically proven mass-like lesions (88 malignant, 53 benign) were included. The CAD system automatically performed the following processing steps: 3D nonrigid motion correction, detection of lesions by a segmentation algorithm, extraction of multiple dynamic and morphologic parameters, and classification of lesions. As one final result, the lesions were categorized by defining their probability of malignancy; this so-called morpho-dynamic index (MDI) ranged from 0%-100%. The results of the CAD system were correlated with histopathologic findings. Results:The CAD system had a high detection rate of the histologically proven lesions, missing only two malignancies of invasive multifocal carcinomas and four benign lesions (three fibroadenomas, one atypical ductal hyperplasia). The 86 detected malignant lesions showed a mean MDI of 86.1% (615.4%); the mean MDI of the 49 coded benign lesions was 41.8% (622.0%; P < 0.001). Based on receiver-operating characteristic analysis, the diagnostic accuracy of the CAD system was 93.5%. Using an appropriate cutoff value (MDI 50%), sensitivity was 96.5% combined with specificity of 75.5%. Conclusion:The fully automatic CAD technique seems to reliably distinguish between benign and malignant masslike breast tumors. Observer-independent CAD may be a promising additional tool for the interpretation of breast MRI in the clinical routine.

• Computed Tomography guided high-dose-rate brachytherapy offers new therapeutic options for hepatocellular carcinoma • CT-HDRBT can be safely practised in HCCs exceeding 5 cm in diameter • CT-HDRBT offers high rate of local control where thermal ablation is impossible • CT-HDRBT could be a valid alternative to TACE for intermediate stage HCC.