Jane Belfield

Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee

AbstractObjectivesThe subcommittee on scrotal imaging, appointed by the board of the European Society of Urogenital Radiology (ESUR), have produced guidelines on imaging and follow-up in testicular microlithiasis (TML).MethodsThe authors and a superintendent university librarian independently performed a computer-assisted literature search of medical databases: MEDLINE and EMBASE. A further parallel literature search was made for the genetic conditions Klinefelter’s syndrome and McCune-Albright syndrome.ResultsProposed guidelines are: follow-up is not advised in patients with isolated TML in the absence of risk factors (see Key Points below); annual ultrasound (US) is advised for patients with risk factors, up to the age of 55; if TML is found with a testicular mass, urgent referral to a specialist centre is advised.ConclusionConsensus opinion of the scrotal subcommittee of the ESUR is that the presence of TML alone in the absence of other risk factors is not an indication for regular scrotal US, further US screening or biopsy. US is recommended in the follow-up of patients at risk, where risk factors other than microlithiasis are present. Risk factors are discussed and the literature and recommended guidelines are presented in this article.Key Points• Follow up advised only in patients with TML and additional risk factors. • Annual US advised for patients with risk factors up to age 55. • If TML is found with testicular mass, urgent specialist referral advised. • Risk factors – personal/ family history of GCT, maldescent, orchidopexy, testicular atrophy.

Testicular, Epididymal and Adnexal Ultrasound: A Pictorial Review. Part 1: Testicular Ultrasound

Diagnostic ultrasound is considered to be the gold standard imaging modality for testicular assessment. As a result, it is frequently encountered by general radiologists and sonographers on daily ultrasound lists as well as by radiology residents out of hours. The main strength of diagnostic ultrasound in testicular assessment is that the high-frequency linear transducers utilized reproduce high-resolution images allowing accurate assessment of the testicular parenchyma. The fact that no ionizing radiation is utilized is particularly important as many patients on whom a testicular scan is requested are young or middle aged and the testis as an organ is very radiosensitive. This pictorial review comprises a range of illustrated images of congenital, benign, malignant, infection, polyorchidism and prosthesis-related pathologies collated over a two-year period at our institution.

Renal transplant ultrasound: a pictorial review

Renal transplantation is considered the optimal treatment in patients with end-stage renal disease. Ultrasound is usually the first choice imaging modality for evaluating renal transplant anatomy and perfusion. It is important to be aware of how to image a renal transplant, the normal sonographic appearances and relevant pathological processes. Renal transplant ultrasound imaging includes duplex vascular evaluation and the operator must have a sound knowledge of both normal and abnormal Doppler waveforms. Complications following renal transplantation are usually assessed with ultrasound. The time frame in which complications can occur stretches from the immediate postoperative period to months or years following transplantation. A knowledge of the anticipated complications relative to that timescale helps to focus the examination. This pictorial review aims to demonstrate the appearances of the normal renal transplant as well as potential complications. These include vascular (renal vein thrombosis, renal artery stenosis, pseudoaneurysm and arteriovenous fistulae), parenchymal (acute rejection, acute tubular necrosis and malignancy) and urological (ureteric stricture and renal calculi) complications.

Sonographically indeterminate scrotal masses: how MRI helps in characterization

Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.

Pitfalls in Stone Imaging.

and subsequent urinoma in severe obstruction. The CTKUB is also useful to exclude extrarenal causes of acute abdominal pain, including acute appendicitis, ruptured aortic aneurysm, and diverticulitis. Scanning protocols would vary from center to center, but a standard protocol should include images of the entire urinary tract, from the upper pole of the kidneys to the base of the urinary bladder. 5 Scanning patients in the prone position can beadvantageousasithelpstodistendthedistaluretersand can also help ascertain if a calculus has passed into the urinary bladder or is in the intravesical portion of the ureter. On evaluating CTKUB, the axial images should be carefully examined and then reconstructed for the radiologist to examine the coronal and sagittal views.

Testicular, epididymal and adnexal ultrasound: a pictorial review. Part 2: Epididymal and Adnexal ultrasound

Ultrasound is the primary imaging modality for testicular and scrotal assessment, with no risk of ionising radiation to radiosensitive tissue. Scrotal ultrasound is reliable in distinguishing between intratesticular and extratesticular lesions and characterising them as cystic or solid. High-resolution images are reproducible with the added advantage of further characterisation by using colour Doppler assessment or Valsalva manoeuvres. This pictorial review covers the anatomy of the epididymis and adnexa, and describes the ultrasound appearances of a range of extratesticular pathologies including congenital, benign, post-surgical, infective and vascular conditions collated over a two-year period at our institution.

Chapter 10: Normal Anatomical Variants

Retroaortic renal vein occurs as part of the complex developmental of the inferior vena cava. The exact incidence is unknown (estimated 3%), but it is increasingly being reported with high-resolution images on CT and MRI. Patients are usually asymptomatic, but compression of the renal vein may cause haematuria, flank pain and varicoceles. It is important to report a retroaortic left renal vein if a patient is going to have a nephrectomy, either for malignancy, or as a living kidney donor.