The role of the radiologist in the evaluation of male infertility: recommendations of the European Society of Urogenital Radiology-Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for scrotal imaging.

OBJECTIVES: The Scrotal and Penile Imaging Working Group (SPIWG) of the European Society of Urogenital Radiology (ESUR) aimed to produce recommendations on the role of the radiologist in the evaluation of male infertility focused on scrotal imaging. METHODS: The authors independently performed an extensive literature Medline search and a review of the clinical practice and consensus opinion of experts in the field. RESULTS: Scrotal ultrasound (US) is useful in investigating male infertility. US abnormalities related to abnormal sperm parameters (sperm concentration, total count, motility, and morphology) are low testicular volume (TV), testicular inhomogeneity (TI), cryptorchidism, testicular microlithiasis (TML), high-grade varicocele, bilateral absence of vas deferens, bilateral dilation and echotexture abnormalities of the epididymis. The proposed ESUR-SPIWG recommendations for imaging in the evaluation of male infertility are therefore: to measure TV; investigate TI; perform annual (US) follow-ups up to age 55 in men with a history of cryptorchidism/orchidopexy and/or in men with TML plus "additional risk factors" or with "starry sky" TML; perform scrotal/inguinal US in men with nonpalpable testis; perform scrotal US in men with abnormal sperm parameters to investigate lesions suggestive of tumors; evaluate varicocele in a standardized way; evaluate the presence or absence of vas deferens; investigate the epididymis to detect indirect signs suggesting obstruction and/or inflammation. CONCLUSIONS: The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on TV, inhomogeneity, localization, varicocele, vas deferens, and epididymal abnormalities. Cryptorchidism, TML, and lesions should be detected in relation to the risk of testicular tumors. CLINICAL RELEVANCE STATEMENT: The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal semen parameters in an evidence-based manner, and provide a standardized report to patients. KEY POINTS: So far, ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility were not available. The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on testicular volume, inhomogeneity, localization, varicocele, vas deferens and epididymal abnormalities, and assessing cryptorchidism, testicular microlithiasis and lesions in relation to the risk of testicular tumors. The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal sperm parameters in an evidence-based manner, and provide a standardized report to patients.

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.

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.

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.

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.

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.

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.

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-weighted MRI in the differential diagnosis of parotid malignancies and pleomorphic adenomas: can the accuracy of dynamic MRI be enhanced?

OBJECTIVES: (1) To verify whether appropriate selection of cutoff values for dynamic and diffusion-weighted magnetic resonance imaging (MRI) parameters optimizes the accuracy of preoperative differential diagnosis of parotid malignancies and pleomorphic adenomas. (2) To define the role of preoperative MRI in the differential diagnosis of parotid tumors. STUDY DESIGN: The retrospective analysis included 221 surgical patients with parotid tumors. Aside from ultrasonography-guided fine-needle biopsy, the preoperative protocol included dynamic and diffusion-weighted MRI. Final diagnoses were based on histopathologic examination of surgical specimens. Receiver operating characteristic analysis was conducted to determine the sensitivity and specificity of preoperative MRI with various combinations of cutoff values. RESULTS: Twenty-four patients with parotid malignancies (10.8%) and 57 with pleomorphic adenomas (25.8%) were identified. Parotid malignancies had significantly lower values of apparent diffusion coefficient and Tpeak, as well as significantly higher values of Tmax and washout rate. An apparent diffusion coefficient ≤1.267 × 103 mm/s2 yielded optimum accuracy in identification of parotid malignancies (95.8% sensitivity and 93% specificity). CONCLUSION: Diffusion-weighted MRI is effective in differential diagnosis of parotid malignancies. Optimization of preoperative diagnosis of parotid tumors should include preselection identification of Warthin tumors on the basis of dynamic MRI, followed by identification of pleomorphic adenomas based on diffusion-weighted MRI and cytologic examination of the remaining lesions.

Diagnostic Imaging of Hepatocellular Carcinoma - A Pictorial Essay.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, which develops mostly in the setting of chronic liver disease. European Association for the Study of the Liver (EASL) and European Organization for Research and Treatment of Cancer (EORTC) prepared guidelines for screening, follow-up and diagnosis of HCC to facilitate decision making and optimize both diagnostic and therapeutic protocols. The review briefly describes etiology, epidemiology and histopathology of HCC and presents EASL-EORTC guidelines for surveillance and diagnosis of HCC. Target population and screening algorithm is presented in the surveillance section. Ultrasound imaging of HCC and the role of contrast enhanced ultrasound are described as well as the value of laboratory tests in screening. Further, radiological features of HCC in multiphase CT and dynamic contrast enhanced MRI and diagnostic criteria are presented. Additionally, the advantages of advanced techniques in MRI such as diffusion weighed imaging and the use of hepatocyte-specific contrast agents are discussed. Lastly, the EASL-EORTC guidelines are compared with the guidelines of the American Association for the Study of Liver Diseases and the Japan Society of Hepatology. Also LI-RADS and the Barcelona Clinic Liver Cancer classification are mentioned. In the near future, due to the ongoing advances in imaging a revision of the guidelines may be expected.

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.

Parotid malignancies are not homogenous in terms of their presentation on dynamic MRI - a preliminary report.

CONCLUSION: At least two groups of parotid malignancies exist, including one whose parameters of dynamic MRI closely resemble those of pleomorphic adenomas. Also tumors with long time to peak enhancement after administration of a contrast agent (Tpeak) and low washout rate (WR) should be considered malignant, especially single masses with concomitant lymphadenopathy located within the deep parotid lobe. OBJECTIVE: To verify if malignant tumors of the parotid are homogeneous in terms of parameters of preoperative dynamic MRI: Tpeak and WR. METHODS: The retrospective analysis included 221 surgical patients with parotid tumors. Aside from fine needle biopsy, pre-operative examination included dynamic and diffusion-weighted MRI. Final diagnosis was based on histopathological examination of the surgical specimen. RESULTS: Twenty-four of 221 (10.8%) malignant lesions were identified. Using k-means clustering based on Tpeak and WR values, two distinct clusters of parotid malignancies were identified. The cut-off value for Tpeak optimally differentiating between the clusters was 140 s; the cut-off value for WR could not be identified. The two clusters did not differ in terms of dynamic and diffusion-weighted MRI parameters, patient age, sex and prevalence of lymphadenopathy. Significant inter-cluster differences were found in the prevalence of deep parotid lobe involvement and presence of a single mass.

Uncharacteristic metastasis of a renal clear-cell carcinoma to the muscles of the forearm-case report.

Clear-cell renal carcinoma constitutes over 90% of all cases of renal cancers. One of the least common locations of metastases of this type of cancer are skeletal muscles. We believe that this is the first case ever presented of renal clear-cell cancer metastasis to the extensor digitorum muscle. Our case should sensitize clinicians and radiologists dealing with this type of carcinoma to the abundance of metastases, their uncommon locations and frequently asymptomatic nature, which all makes them easy to overlook on physical and imaging examinations.

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.

Auditory deficits in neurological disorders.

Neurological diseases present with diverse and often complex symptomatology. Focal neurological signs such as paresis, aphasia or visual field deficits together with often serious general state of a neurological patient usually push auditory symptoms into the background. Here, we present a review of literature on central and peripheral auditory disturbances that can appear in the course of most common neurological diseases. We present: cerebral stroke, cochleovestibular nerve compression syndrome, cerebral palsy, multiple sclerosis, epilepsy, myasthenia gravis and brain tumors. We focus on the neuroanatomical basis of auditory dysfunctions, their character and prevalence typical for the abovementioned diseases. Theoretical considerations are supported by broad audiological and neuroimaging studies of our patients. Auditory symptoms in neurological diseases seem to be rare. However, knowledge of these symptoms and their origin can be helpful in proper diagnosis and comprehensive patient management.

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.