Phillip F. C. Lung

Contrast-Enhanced Ultrasound in the Evaluation of Focal Testicular Complications Secondary to Epididymitis

OBJECTIVE The purpose of this study is to determine the effectiveness of contrast-enhanced ultrasound in evaluating incidental focal testicular lesions in epididymitis. MATERIALS AND METHODS Intratesticular lesions ipsilateral to epididymitis were subject to B-mode color Doppler ultrasound and contrast-enhanced ultrasound, with their appearances reviewed in consensus. Final interpretation was by histologic analysis or follow-up ultrasound. RESULTS Over 28 months, 16 focal testicular lesions (median lesion size, 24 mm; range, 14-48 mm) in 14 patients (median age, 49 years; range, 18-81 years) were examined. Lesions were oval (n = 14), wedge shaped (n = 1), or involved the entire testis (n = 1). Lesions were isoechoic (n = 1), hypoechoic (n = 4), or of mixed echogenicity (n = 11). Color Doppler ultrasound flow was not clearly depicted in 13 lesions but was present in three lesions, with contrast-enhanced ultrasound concordant with color Doppler ultrasound, showing unequivocal absence of vascularity and increased flow, respectively. In the avascular lesions, rim enhancement (n = 6), vascular projections (n = 4), and irregular (n = 10) and smooth (n = 2) borders were documented. The observers identified infarction (n = 9), abscess (n = 4), orchitis (n = 1), and tumor (n = 2). Histologic examination (seven lesions in five patients) confirmed infarction, abscess formation, and seminoma; follow-up ultrasound confirmed resolution for eight patients. CONCLUSION Contrast-enhanced ultrasound is a useful adjuvant to color Doppler ultrasound examination of a focal lesion in the testis ipsilateral to epididymitis to improve the characterization of nonvascularized tissue.

Re: New ultrasound techniques for imaging of the indeterminate testicular lesion may avoid surgery completely

SirdWe read with interest the article by Kirkham et al.1 The authors recommend targeted testicular excision biopsy with histological analysis of frozen samples as the investigation of choice for “indeterminate” intra-testicular lesions. In our experience, with recent advances in ultrasound technology, there are a number of investigations in the radiologists armamentarium that need to be exhausted before a lesion is deemed “indeterminate” and the patient is subjected to an excision biopsy. The most important ultrasound technique for the interrogation of a focal indeterminate testicular lesion is colour Doppler ultrasound, with all types of primary testicular tumours (both germ cell and non-germ cell tumours)

Is ultrasound elastography of the liver ready to replace biopsy? A critical review of the current techniques

Accurate assessment of liver fibrosis in patients with chronic liver disease is necessary to determine prognosis, monitor disease progression and formulate treatment decisions. Currently, histological staging of liver biopsy is the most widely used reference standard for this purpose. Liver biopsy, however, has recognized risks, as well as sampling and observer error. These limitations have stimulated the search for new non-invasive approaches. Numerous methodologies, including serum markers, magnetic resonance elastography and ultrasound elastography, have evolved in the last decade to predict fibrosis in those with chronic liver disease. Ultrasound elastography methods assess liver fibrosis by determining liver stiffness and translate this into a quantifiable measurement for analysis. As these tests are non-invasive, without side-effect or discomfort, it is possible to conduct repeat examinations at much closer intervals than biopsy. The three most investigated ultrasound elastography methods are transient elastography, realtime elastography and acoustic radiation force impulse. Although significant strides have been made in the development of the technology, an unequivocal advocacy of elastography as a surrogate for biopsy is still not established. The aim of this review is to evaluate the advantages, limitations and clinical relevance of the three ultrasound-based modalities. Also, the review shall assess the current and possible future clinical application the modalities may serve both separate and in conjunction with liver biopsy.

Anterior Mediastinal Mass

A 50-year-old man developed a bronchogenic cyst complicated by hemorrhage. A complete radiographic chest work-up provided a reliable diagnostic approach. Bronchogenic cysts are usually asymptomatic incidental discoveries. Chest ultrasonography confirms the cystic nature of the mediastinal mass. Computed tomography scan and especially magnetic resonance imaging further support the diagnosis and are helpful for guiding surgery. Surgery is required because of the unpredictable risk of hemorrhage, infection or enlargement.