[en] Purpose: To determine the association of asymmetric spermatic cord vessel enhancement and enlargement on contrast-enhanced CT with ipsilateral scrotal pathology. Methods: This case series included 30 men with contrast-enhanced CT: 10 cases had asymmetric enhancement and enlargement of spermatic cord vessels with confirmed ipsilateral scrotal pathology determined by additional imaging and/or clinical records; 20 negative reference cases had no such findings with normal corresponding scrotal ultrasound. Maximum spermatic vessel diameters and attenuation values were determined bilaterally. Two blinded radiologists independently assessed all exams for interobserver agreement. Results: For cases, maximum spermatic cord vessel diameters were greater ipsilaterally (5.9 ± 1.7 mm) than contralaterally (4.0 ± 1.1 mm), p < 0.001. Maximum HU values were greater ipsilaterally (139.5 ± 29.5) than contralaterally (70.6 ± 17.5), p < 0.0003. Maximum spermatic vessel diameters and attenuation values were significantly greater for positive than negative reference cases (p < 3.9 x 10^-8 and p < 4.9 x 10^-7 respectively). There was substantial interobserver agreement for asymmetric spermatic vessel enlargement (κ = 0.79) and enhancement (κ = 0.73). In 3 cases, the CT findings lead to a scrotal ultrasound that confirmed the diagnosis and altered patient management. Conclusion: MDCT findings of asymmetric spermatic vessel enlargement and enhancement are indicators of ipsilateral scrotal pathology. The detection of such finings may have implications for patient care and should prompt further evaluation of the scrotum in the proper clinical setting.

[en] Radiation nephropathy was first recognized in 1906. The kidney is a radiosensitive organ with a tolerance dose (5% complications in 5 years) of 20 Gray. The imaging findings of acute and chronic radiation induced renal injury are previously described. Radiation-induced adrenal injury, to our knowledge, has not been described in the literature. Unlike the kidneys and other upper abdominal organs, the adrenal glands are traditionally thought to be radio-resistant, protected from radiation-induced injury by proximity to adjacent organs and by the adrenal medulla which reportedly has increased radio-resistance. We present the computed tomographic imaging findings of a patient with acute radiation induced adrenal injury which resulted in adrenal insufficiency following radiotherapy of an adjacent thecal metastasis

[en] 

Purpose

To compare frequency of new and recurrent urothelial cell carcinoma (UCC) among patients with and without pseudodiverticulosis on imaging.

Methods

This retrospective case–control study compared all 113 sequential patients with ureteral pseudodiverticulosis on radiographic urography between 1/1/2002 and 12/31/2012. Six patients were lost to follow-up. 107 patients without pseudodiverticulosis were matched by imaging modality, clinical indication, and tumor grade. Known UCC and primary outcome of new or recurrent UCC were determined through pathology on cystoscopy or clinical follow-up.

Results

Nearly half of patients with pseudodiverticulosis had known UCC at the time of imaging (49/107, 46%). Mean cystoscopy follow-up was 7.0 and 4.6 years for pseudodiverticulosis cases with and without known UCC, respectively, and 7.5 and 7.3 years for controls, respectively. Mean clinic follow-up was 7.5 and 6.0 years for pseudodiverticulosis cases with and without known UCC, respectively, and 6.4 and 7.6 years for controls, respectively. Among patients with known UCC at the time of imaging, similar rates of recurrent UCC were demonstrated on follow-up among patients with pseudodiverticulosis (6/49, 12%) and without (7/49, 14%). Among patients with no known history of UCC at the time of imaging, no patients with pseudodiverticulosis developed UCC on follow-up and 5% (3/58) of patients without pseudodiverticulosis developed UCC.

Conclusion

Although half of patients with ureteral pseudodiverticulosis have a known diagnosis of UCC, the presence of pseudodiverticulosis did not signify an increased likelihood of developing new or recurrent UCC over the follow-up period.

[en] The Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the scrotum. The SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were 'magnetic resonance imaging', 'testis or testicle or testicular', 'scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary). The ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented. (orig.)

[en] The increasing detection of small testicular lesions by ultrasound (US) in adults can lead to unnecessary orchiectomies. This article describes their nature, reviews the available literature on this subject and illustrates some classical lesions. We also suggest recommendations to help characterization and management. The ESUR scrotal imaging subcommittee searched for original and review articles published before May 2015 using the Pubmed and Medline databases. Key words used were 'testicular ultrasound', 'contrast-enhanced sonography', 'sonoelastography', 'magnetic resonance imaging', 'testis-sparing surgery', 'testis imaging', 'Leydig cell tumour', 'testicular cyst'. Consensus was obtained amongst the members of the subcommittee, urologist and medical oncologist. Simple cysts are frequent and benign, and do not require follow up or surgery. Incidentally discovered small solid testicular lesions detected are benign in up to 80 %, with Leydig cell tumours being the most frequent. However, the presence of microliths, macrocalcifications and hypoechoic areas surrounding the nodule are findings suggestive of malignant disease. Asymptomatic small testicular lesions found on ultrasound are mainly benign, but findings such as microliths or hypoechoic regions surrounding the nodules may indicate malignancy. Colour Doppler US remains the basic examination for characterization. The role of newer imaging modalities in characterization is evolving. (orig.)

[en] Imaging plays a crucial role in the evaluation of scrotal trauma. Among the imaging modalities, greyscale ultrasound and Colour Doppler ultrasound (CDUS) are the primary techniques with the selective utilisation of advanced techniques such as contrast-enhanced ultrasound (CEUS) and elastography. Despite ultrasound being the mainstay of imaging scrotal trauma, its diagnostic performance is not fully established. Considering these difficulties and their impact on clinical practice, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) established an expert task force to review the current literature and consolidate their expertise on examination standards and imaging appearances of various entities in scrotal trauma. This paper provides the position statements agreed on by the task force with the aim of providing guidance for the use of imaging especially multiparametric US in scrotal trauma.