Ultrasound imaging of male urethral stricture disease: a narrative review of the available evidence, focusing on selected prospective studies.

PURPOSE: To synthetize the current scientific knowledge on the use of ultrasound of the male urethra for evaluation of urethral stricture disease. This review aims to provide a detailed description of the technical aspects of ultrasonography, and provides some indications on clinical applications of it, based on the evidence available from the selected prospective studies. Advantages and limitations of the technique are also provided. METHODS: A comprehensive literature search was performed using the Medline and Cochrane databases on October 2022. The articles were searched using the keywords "sonourethrography", "urethral ultrasound", "urethral stricture" and "SUG". Only human studies and articles in English were included. Articles were screened by two reviewers (M.F. and K.M.). RESULTS: Our literature search reporting on the role of sonourethrography in evaluating urethral strictures resulted in selection of 17 studies, all prospective, even if of limited quality due to the small patients' number (varied from 28 to 113). Nine studies included patients with urethral stricture located in anterior urethra and eight studies included patients regardless of the stricture location. Final analysis was based on selected prospective studies, whose power was limited by the small patients' groups. CONCLUSION: Sonourethrography is a cost-effective and safe technique allowing for a dynamic and three-dimensional urethra assessment. Yet, because of its limited value in detecting posterior urethral strictures, the standard urethrography should remain the basic 'road-map' prior to surgery. It is an operator-dependent technique, which can provide detailed information on the length, location, and extent of spongiofibrosis without risks of exposure to ionizing radiation.

Usefulness of core biopsy in diagnosis of pancreatic tumours.

Purpose: The aim of the study was to analyse the usefulness of core biopsy in the diagnosis of malignant neoplasms of the pancreas - sensitivity and accuracy of diagnosis, safety of the procedure, indication of factors that may increase the risk of complications after biopsy. Material and methods: A retrospective analysis of data was performed in a group of 100 patients diagnosed with a focal lesion of the pancreas, qualified for a core biopsy. Results: The results are a sensitivity of 92%, a specificity of 100%, and an accuracy of 93.3%. The incidence of more severe complications according to the Clavien-Dindo classification was 1% (one case in the material studied). The results of the analysis were compared with the results of other authors, showing similar values for the sensitivity and specificity of the method and low rates of serious complications; it also seems that the tissue material obtained by core biopsy has higher diagnostic potential than that obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), currently considered the method of choice. In addition, the costs of transabdominal biopsy and endoscopic biopsy were compared; the lower cost of the former may be an important economic issue when choosing the biopsy method. Conclusions: The results show core biopsy to be a sensitive, accurate, and safe method for obtaining the tissue necessary to plan treatment in patients with pancreatic cancer.

Synchronous bilateral multifocal basal cell adenomas of the parotid gland-a case report.

BACKGROUND: Bilateral parotid gland tumors account for up to 3% of cases. In this group, the vast majority are Warthin's tumors. However, bilateral presentations of other parotid gland tumor entities is also possible, an example of which is a basal cell adenoma (BCA). Bilateral BCA is extremely rare, which could cause misdiagnosing it as a Warthin tumor. CASE PRESENTATION: The current study reports the unique case of a 48-year-old woman who presented with a 6-month history of slowly growing masses located bilaterally in the parotid region, surgically treated with 5-year follow-up (no recurrence, normal facial nerve function). Magnetic resonance imaging (MRI) revealed three lesions: two in the superficial and deep lobes of the right parotid gland, and one in the superficial lobe of the left parotid gland. A total parotidectomy with facial nerve preservation was performed on the right side, and superficial parotidectomy on the left side 6 months later. Histopathological examination confirmed that all three tumors were BCAs. Molecular analysis didn't show any strong, potential of unknown clinical significance in the studied sample. CONCLUSIONS: Multifocal bilateral lesions of the parotid gland are usually Warthin tumors. Detailed preoperative diagnostics including MRI and histopathological examination is essential to avoid misdiagnosing BCA and Warthin tumors. To our best knowledge, no case of synchronous bilateral multifocal basal cell adenomas of the parotid gland has been reported in English literature so far.

Imaging in scrotal trauma: a European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) position statement.

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.Key Points• Greyscale and Colour Doppler ultrasound are the mainstay of imaging in patients with scrotal trauma.• Contrast-enhanced ultrasound and elastography are the advanced techniques useful as a problem-solving modality in equivocal cases.• This paper summarises the position statements of the ESUR-SPIWG on the appropriate utilisation of multiparametric ultrasound and other imaging modalities in the evaluation of scrotal trauma.

Three-dimensional modeling and automatic analysis of the human nasal cavity and paranasal sinuses using the computational fluid dynamics method.

PURPOSE: The goal of this study was to develop a complete workflow allowing for conducting computational fluid dynamics (CFD) simulation of airflow through the upper airways based on computed tomography (CT) and cone-beam computed tomography (CBCT) studies of individual adult patients. METHODS: This study is based on CT images of 16 patients. Image processing and model generation of the human nasal cavity and paranasal sinuses were performed using open-source and freeware software. 3-D Slicer was used primarily for segmentation and new surface model generation. Further processing was done using Autodesk® Meshmixer TM. The governing equations are discretized by means of the finite volume method. Subsequently, the corresponding algebraic equation systems were solved by OpenFOAM software. RESULTS: We described the protocol for the preparation of a 3-D model of the nasal cavity and paranasal sinuses and highlighted several problems that the future researcher may encounter. The CFD results were presented based on examples of 3-D models of the patient 1 (norm) and patient 2 (pathological changes). CONCLUSION: The short training time for new user without a prior experience in image segmentation and 3-D mesh editing is an important advantage of this type of research. Both CBCT and CT are useful for model building. However, CBCT may have limitations. The Q criterion in CFD illustrates the considerable complication of the nasal flow and allows for direct evaluation and quantitative comparison of various flows and can be used for the assessment of nasal airflow.

Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading.

Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.Key Points• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. • Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. • This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.

Efficacy comparison of multi-phase CT and hepatotropic contrast-enhanced MRI in the differential diagnosis of focal nodular hyperplasia: a prospective cohort study.

BACKGROUND: Different clinical behaviour influences the importance of differentiating focal nodular hyperplasia (FNH) from other focal liver lesions (FLLs). The aim of this study was to compare the efficacy of contrast-enhanced CT and MRI in the diagnosis of FNH. METHODS: 157 patients with equivocal FLLs detected in ultrasonography subsequently underwent multi-phase CT and MRI with the use of hepatotropic contrast agent (Gd-BOPTA) in a 1.5 T scanner. Examinations were evaluated by three independent readers. Diagnostic efficacy of different radiological signs of FNH in both CT and MRI was compared and AFROC analysis was performed. RESULTS: 4 hepatocellular adenomas, 95 hepatocellular carcinomas, 98 hemangiomas, 138 metastases and 45 FNHs were diagnosed. In both CT and MRI the radiological sign of the highest accuracy was the presence of the central scar within FNH (0.93 and 0.96 relatively). The sum of two radiological signs in MRI: homogeneous enhancement in hepatic arterial phase (HAP) and enhancing lesion in hepatobiliary phase (HBP) was characterized with high values of sensitivity (0.89), specificity (0.97), PPV (0.82), NPV (0.98) and accuracy (0.96). After inclusion of clinical data into analysis the best discriminating feature in MRI was the presence of enhancing lesion in HBP in patients without cirrhosis. In this regard, efficacy parameters increased to 1.00, 0.99, 0.94, 1.00 and 0.99 accordingly. The area under the curve in AFROC analysis of MRI performance was significantly larger than of CT (p = 0.0145). CONCLUSION: Gd-BOPTA-enhanced MRI is a more effective method in the differential diagnosis of FNH than multi-phase CT.

Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging-An Alternative to Fine Needle Biopsy or Only an Adjunct Test in Preoperative Differential Diagnostics of Malignant and Benign Parotid Tumors?

PURPOSE: The role of dynamic magnetic resonance imaging (MRI) in the preoperative differential diagnostics of parotid tumors is unclear. The aim of this study was to compare the accuracy of dynamic MRI and routinely used fine needle biopsy examination in the preoperative differentiation of malignant and benign parotid tumors. MATERIALS AND METHODS: The study included 100 consecutive patients with parotid tumors treated surgically at the authors' center. Accuracy of dynamic MRI and fine needle biopsy examinations in the differential diagnostics of malignant and benign lesions was verified against the gold standard (ie, final histologic diagnosis). RESULTS: Based on histopathologic examination of surgical specimens, 19 tumors were eventually diagnosed as malignant lesions and 81 were diagnosed as benign. Preoperative fine needle biopsy examination yielded 9 true positive, 70 true negative, 11 false positive, and 10 false negative results, which corresponded to 47.4 and 86.4% sensitivity and specificity, respectively. The most commonly established preoperative diagnosis for 10 tumors that were misdiagnosed as benign based on examination of biopsy specimens was pleomorphic adenoma (n = 10). Dynamic MRI examination yielded 17 true positive, 81 true negative, 2 false negative, and 0 false positive results, which corresponded to 89.5% sensitivity and 100% specificity. CONCLUSIONS: These results suggest that dynamic MRI is highly accurate in the detection of malignant parotid tumors. However, taking into account the high cost and limited availability of this examination, its logical application seems to be verification of preoperative diagnoses in patients whose fine needle biopsy examination turned out to be nondiagnostic or showed pleomorphic adenoma.

Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS).

PURPOSE: Necrotizing enterocolitis (NEC) is associated with high morbidity and mortality. Abdominal radiography is currently an imaging modality of choice in NEC. Recently, a numeric scale of radiological signs in NEC-The Duke Abdominal Assessment (DAAS) was introduced. The aim of this study was to measure the intra- and inter-observer agreement on the radiological signs of NEC according to DAAS to access the feasibility of this scale. MATERIALS AND METHODS: We have retrospectively analyzed 87 radiographs performed in a group of 43 high-risk neonates with suspected NEC. Radiographs were assessed by 6 independent observers: two pediatric radiologists, two radiology residents, and two neonatologists. Data were analyzed using κ statistics as a measure of intra- and inter-observer agreement. RESULTS: Fair-to-good intra-observer agreement was noted for all but one of observers. However, with the wide range in κ values, we found only fair inter-observer agreement detecting signs of NEC according to DAAS. There was a higher intra-group agreement in radiology practitioners, with the highest among experienced pediatric radiologists. CONCLUSION: However, with high observer variability in interpretation of all radiologic signs, we did not confirm that Duke Abdominal Assessment Scale could reliable facilitate reporting of abdominal radiographic findings in neonates with suspected NEC.

Auditory spatial deficits in brainstem disorders.

PURPOSE: Brainstem disorders seem to negatively influence the central auditory system, causing spatial hearing deficits. MATERIAL AND METHODS: We tested 11 patients with brainstem lesions due to ischemic stroke (IS), multiple sclerosis (MS), or cerebellopontine angle tumor (CPAT) together with 50 age- and sex-matched healthy volunteers. We used pure tone audiometry (PTAud), brainstem auditory evoked potentials (BAEPs) and the horizontal minimum audible angle test (HMAAT) for 8 azimuths with binaural stimulation. RESULTS: The chosen patients and the controls had normal or near normal hearing in PTAud. BAEPs interaural wave I-V latency difference was over 7 times longer in the patients group compared to the controls. Additionally, 9 of the 11 patients (81.1%) had abnormal HMAAT results. The biggest quantitative disturbances in HMAAT were present in the CPAT and the MS patients. The sound localization ability in HMAAT was significantly worse in the patients in 0° azimuth in comparison with the controls, and in 45° and 90° azimuth in patients with auditory pathway involvement compared with the ones without the involvement. CONCLUSIONS: Our study confirms the strong relationship between various brainstem pathologies and sound localization disability and sheds some light on the complexity of the relationship.

To assess the quantitative features of focal liver lesions in gadoxetic acid enhanced MRI and to determine whether these features can accurately differentiate benign form malignant lesions.

PURPOSE: The study aims at assessing the quantitative features which distinguish focal liver lesions (FLLs) in gadoxetic acid (GA) enhanced liver MRI and at determining whether these features can accurately differentiate benign from malignant lesions. MATERIAL AND METHODS: 107 patients with 180 unequivocal FLLs in previous examinations were included in a single-center retrospective study. All patients underwent a MRI test of the liver with GA. 99 benign and 74 malignant lesions were included. The group of benign lesions consisted of 60 focal nodular hyperplasias (FNH), 22 hemangiomas (HMG), 6 hepatic adenomas (HA), and 11 other benign lesions (1 angiomyolipioma, 6 lesions histopathology diagnoses as benign without further specification, or ones lacking features of malignancy, and 4 lesions radiologically diagnosed as benign which remained stable in the follow-up studies). The group of malignant lesions consisted of primary 51 hepatocellular carcinomas, 12 metastases, and 11 metastases from melanoma malignum (MM meta). 7 FLLs were excluded (4 cases of uncertain histopathological diagnosis, 2 cholangiocarcinomas, and 1 regenerative nodule). For the included lesions ROI (region of interest) measurements were taken by two observers in the T2-w, ADC (apparent diffusion coefficient) and in the T1-w sequence in the hepatobiliary phase (HBP). The interobserver agreement was evaluated with the Wilcoxon test. The Kruskal - Wallis, Mann - Whitney U and post hoc Dunn's tests were applied to assess if there were any significant differences in the ROI values between individual lesions. The variables with the p values of < 0.05 were considered statistically significant. RESULTS: We found significant differences in the ROI values between lesions with p < 0.0001. Strikingly high ROI values in the T2-w sequence were found for HMG. The lowest ADC values were encountered for metastases and MM metastases. The highest ROI values in the HBP were found for FNH, and the lowest for metastases. We also found statistically significant differences in the ROI values between benign and malignant lesions with benign lesions presenting statistically higher ROI values compared to malignant lesions. CONCLUSIONS: There were significant differences in the ROI values among different types of FLLs. The predominant quantitative feature in the T2-w sequence was a strikingly high ROI value for HMG. Benign lesions presented statistically higher ROI values in the T2-w, ADC, and HBP sequences compared to malignant lesions. This was true for all lesions except for HA.

Predictive value of apparent diffusion coefficient in evaluation of colorectal carcinoma hepatic metastases' response to radiofrequency ablation.

PURPOSE: To establish the apparent diffusion coefficient (ADC) suitability to evaluate the radiofrequency ablation (RFA) outcome in patients with chemotherapy resistant or partially responding colorectal adenocarcinoma liver metastases. MATERIALS AND METHODS: A total of 56 patients with 116 metastatic foci over 10 mm in diameter were examined with 1.5 Tesla MRI scanner 1 day before percutaneous RFA treatment. Lesions were evaluated in echo-planar diffusion-weighted images with b = 0, 15 and 500 s/mm(2) . On basis of computed tomography scan at 6 weeks, 3 and 6 months after RFA and serum CEA (carcinoembryonic antigen) level lesion were recognized as responding or nonresponding lesions. ADC values for b = 0-15 and 0-500 s/mm(2) of responding and nonresponding lesions were compared. RESULTS: Noncomplete ablation concerned 28 lesions. Mean pretreatment ADC values for b = 0-15 and 0-500 s/mm(2) of responding metastases were significantly lower (2.14 and 1.48 × 10(-3) mm(2) /s) than those of nonresponding tumors (2.7 and 1.74 × 10(-3) mm(2) /s). Sensitivity, specificity, and accuracy of ADC values for b = 0-15 s/mm(2) were 79 (95%CI = 59-92), 85 (95%CI = 76-92), 84%; and for b = 0-500 s/mm(2) , the efficacy parameters were, respectively, 78 (95%CI = 56-92), 78 (95%CI = 67-86), and 78%. The P value was under 0.001 for both b parameters. CONCLUSION: The pretreatment ADCs values of chemotherapy resistant or partially responding colorectal adenocarcinoma liver metastatic lesion can be predictive factor of tumors response to RFA therapy.

Numerical analysis of the ostiomeatal complex aeration using the CFD method.

We aimed to analyse ostiomeatal complex (OMC) aeration using the computational fluid dynamics (CFD) method of simulation based on human craniofacial computed tomography (CT) scans. The analysis was based on CT images of 2 patients: one with normal nose anatomy and one with nasal septal deviation (NSD). The Reynolds-Average Simulation approach and turbulence model based on linear eddy viscosity supplemented with the two-equation k-[Formula: see text] SST model were used for the CFD simulation. As a result, we found differences in airflow velocity through the ostiomeatal complex in patients with a normal nose and those with NSD. In a patient with NSD, the flow is turbulent in contrast to the normal nose (laminar flow). A faster (more intensive) airflow through the OMC was observed in the wider nasal cavity of the patient with NSD than on the narrower side. In addition, we want to emphasise the higher speed of airflow through the apex uncinate process area towards the ostiomeatal complex during exhalation, which, in the presence of secretions in the nose, predisposes to its easier penetration into the sinuses of the anterior group.

Maxillary sinus aeration analysis using computational fluid dynamics.

The maxillary sinus aeration using the computational fluid dynamics (CFD) method based on individual adult patients' computed tomography (CT) scans were analyzed. The analysis was based on CT images of 4 patients: one with normal nose anatomy and three with nasal septal deviation (NSD) and concha bullosa (CB). The CFD simulation was performed using the Reynolds-Average Simulation approach and turbulence closure based on linear eddy viscosity supplemented with the two-equation k-[Formula: see text] SST model. As a result, it was found that the lower part of NSD has the most significant impact on the airflow change within the maxillary sinuses compared to CB and the upper part of NSD. In a healthy nose, the airflow in the sinuses is continuous, while NSD and CB change this flow into pulsatile. Multiple changes in the direction of flow during one respiratory phase were observed. The flow intensity within the maxillary sinus opening is lower on the NSD side. The concept of vorticity measure is introduced to evaluate and compare various patients qualitatively. Typically, the lowest values of such measures are obtained for healthy airways and the highest for pathological changes in the nasal cavity.

Feasibility of Intravoxel Incoherent Motion (IVIM) and Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) in Differentiation of Benign Parotid Gland Tumors.

Aim: The aim of this prospective study is to identify quantitative intravoxel incoherent motion and dynamic contrast-enhanced magnetic resonance imaging parameters of the most frequent benign parotid tumors, compare their utility and diagnostic accuracy. Methods: The study group consisted of 52 patients with 64 histopathologically confirmed parotid focal lesions. Parametric maps representing apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (FP) and transfer constant (Ktrans), reflux constant (Kep), extra-vascular extra-cellular volume fraction (Ve), and initial area under curve in 60 s (iAUC) have been obtained from multiparametric MRI. Results: Statistically significant (p < 0.001) inter-group differences were found between pleomorphic adenomas (PA) and Warthin tumors (WT) in all tested parameters but iAUC. Receiver operating characteristic curves were constructed to determine the optimal cut-off levels of the most significant parameters allowing differentiation between WT and PA. The Area Under the Curve (AUC) values and thresholds were for ADC: 0.931 and 1.05, D: 0.896 and 0.9, Kep: 0.964 and 1.1 and Ve: 0.939 and 0.299, respectively. Lesions presenting with a combination of ADC, D, and Ve values superior to the cut-off and Kep values inferior to the cut-off are classified as pleomorphic adenomas. Lesions presenting with combination of ADC, D, and Ve values inferior to the cut-off and Kep values superior to the cut-off are classified as Warthin tumors. Conclusions: DWI, IVIM and quantitative analysis of DCE-MRI derived parameters demonstrated distinctive features of PAs and WT and as such they seem feasible in differentiation of benign parotid gland tumors.

Evaluation of Subcortical Structure Volumes in Patients with Non-Specific Digestive Diseases.

(1) Background: To evaluate volume of subcortical structures such as hippocampus, globus pallidus, putamen, thalamus, nucleus accumbens, amygdala, caudate in patients with non-specific digestive diseases (functional dyspepsia-FD, irritable bowel syndrome-IBS) and non-specific inflammatory bowel diseases-IBD (colitis ulcerosa and Crohn's disease) in comparison to healthy control group (CON). (2) Material: The analysis included data obtained from 57 patients (FD-18, IBS-20, IBD-19) and 19 persons in control group. Both groups underwent examination in a 3T scanner (Achieva TX Philips Healthcare). (3) Results: Significant differences between the IBD group and Control group in volume of left thalamus and IBD group vs Control group in volume of right thalamus. (4) Conclusions: The brain-gut axis hypothesis explains connection between biological behavior, emotions and cognitive functions in patients with gastrointestinal disease. We found that there is a difference between volume of thalamus in IBD patients in comparison to both IBS and control group and it occurred to be smaller. Excess inflammation can be linked with psychological disorders like depressive symptoms, sleep difficulties and/or fatigue. Therefore, there is a need for using treatment both for depressive symptoms and IBD to reduce the causes and effects of inflammation.

Is hepatotropic contrast enhanced MR a more effective method in differential diagnosis of hemangioma than multi-phase CT and unenhanced MR?

BACKGROUND: Cavernous hemangiomas are the most frequent neoplasms of the liver and in routine clinical practice they often need to be differentiated from malignant tumors and other benign focal lesions. The purpose of this study is to evaluate whether diagnostic accuracy of magnetic resonance imaging (MRI) of hepatic hemangiomas, showing atypical pattern on US, improves with the use of Gd-BOPTA in comparison with contrast-enhanced multi-phase computed tomography (CT). METHODS: 178 consecutive patients with ambiguous hepatic masses showing atypical hyperechoic pattern on grey-scale US, underwent unenhanced and contrast-enhanced multi-phase multi-detector CT and MR (1.5T) with the use of liver-specific contrast medium gadobenate dimeglumine (Gd-BOPTA). After intravenous contrast administration arterial (HAP), venous-portal (PVP), equilibrium phases (EP) both in CT and MR and additionally hepatobiliary phase (HBP) in MR were obtained. 398 lesions have been detected including 99 hemangiomas and 299 other lesions. RESULTS: In non-enhanced MDCT examination detection of hemangiomas was characterized by sensitivity of 76%, specificity of 90%, PPV of 71%, NPV of 92% and accuracy of 86%.Non-enhanced MR examination showed sensitivity of 98%, specificity of 99%, PPV of 99%, NPV of 99% and accuracy of 99%.After intravenous administration of contrast medium in MR the mentioned above parameters did not increase significantly. CONCLUSION: Gd-BOPTA-enhanced MR in comparison with unenhanced MRI does not improve diagnostic accuracy in discriminating hemangiomas that show non-specific appearance in ultrasound examination. Unenhanced MR as a method of choice should directly follow US in course of diagnostic algorithm in differentiation of hemangiomas from other liver tumors.

MRI in patients with urethral stricture: a systematic review.

Magnetic resonance imaging (MRI) is gaining acceptance as a diagnostic tool in urethral stricture disease. Numerous publications emphasize on the advantages of MRI including its ability to determine periurethral spongiofibrosis, thus overcoming the main limitation of retrograde urethrography (RUG). It is also becoming an alternative for sonourethrography (SUG), which is a highly subjective examination. Magnetic resonance urethrography (MRU) has become an increasingly appreciated tool for diagnosing patients with urethral stricture disease. Obtained data provides radiologists and urethral reconstructive surgeons with additional information regarding anatomical relationships and periurethral tissue details, facilitating further treatment planning. Considering the great prevalence of urethral stricture disease and necessity of using accurate, and acceptable diagnostic method, this review was designed to provide radiologists and clinicians with a systematic review of the literature on the use of MRI in the urethral stricture disease.

Value of dynamic contrast enhanced MRI in differential diagnostics of Warthin tumors and parotid malignancies.

To define an algorithm for differential diagnostics of parotid malignancies and Warthin tumors (WTs) based on dynamic contrast enhanced MRI (DCE-MRI). 55 patients with parotid tumors treated surgically were analyzed. Of which, 19 had parotid malignancy and 36 had WTs confirmed with postoperative histopathological examination. Accuracy of DCE-MRI parameters (Tpeak and WR) was compared with the histopathological diagnosis. ROC analysis was performed to determine sensitivity and specificity of DCE-MRI with various Tpeak and WR cut-off values. WT showed significantly lower median Tpeak and higher median WR than malignant lesions. The cut-off values for Tpeak and WR providing maximum sensitivity (84.2%) and specificity (86.1%) for malignant tumors were Tpeak > 60 s and WR ≤ 30%. Different diagnostic algorithm, i.e., lower cut-off value for Tpeak (Tpeak = 60 s), increases sensitivity of DCE-MRI in differentiating parotid malignancies from WTs. However, WR > 30% seems to be a key diagnostic criterion for benign lesions. Precise and reliable preoperative diagnostics of parotid tumors aids in careful surgical planning, thereby assisting in achieving sufficient surgical resection margins and facial nerve preservation.

Clinical and demographic data improve diagnostic accuracy of dynamic contrast-enhanced and diffusion-weighted MRI in differential diagnostics of parotid gland tumors.

PURPOSE: To verify if differential diagnostic algorithms based on selected parameters of dynamic and diffusion-weighted MRI, clinical and demographic variables are accurate enough to differentiate between parotid malignancies, pleomorphic adenomas and Warthin tumors. MATERIALS AND METHODS: The study included 84 patients, among them 19 (23%) with postoperative diagnosis of a parotid malignancy, 37 (44%) with Warthin tumors and 28 (33%) with pleomorphic adenomas. Accuracy of dynamic and diffusion-weighted MRI parameters (Tpeak, Tmax, WR and ADC), clinical parameters of the tumor (location in the superficial or deep parotid lobe, single vs. multiple lesion, concomitant lymphadenopathy) and demographic characteristics of the patient (age, sex) was determined on ROC analysis. RESULTS: Compared to Warthin tumors, parotid malignancies showed higher Tpeak, Tmax and ADC, lower WR, were more often located in the deep lobe of the parotid and presented as single lesions with concomitant lymphadenopathy. Consideration of all these variables provided 100% sensitivity and 89.2% specificity of the differential diagnostic algorithm. Compared to pleomorphic adenomas, parotid malignancies presented with lower ADC and Tpeak, higher Tmax, were more often located in the deep lobe of the parotid, associated with concomitant lymphadenopathy, diagnosed in men and individuals older than 66 years. Consideration of all these variables provided 100% sensitivity and 96.4% specificity of the differential diagnostic algorithm. CONCLUSION: Combined analysis of clinical data and results of dynamic and diffusion-weighted MRI may provide nearly ideal accuracy in differential diagnostics of parotid malignancies and the two most common histological types of benign tumors.