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OBJECTIVE: To determine whether small, incidentally detected testicular lesions can be safely followed up, by assessing growth rate and volume threshold for benign vs. malignant lesions. METHODS: This retrospective observational study includes a consecutive series of 130 testicular incidentalomas < 1 cm and with negative tumour markers identified from October 2001 to November 2022, which were initially followed up with ultrasound. A total of 39 cases proceeded to surgery during the study period, either due to lesion growth (n = 28) or patient preference/recommendation by the referring urologist (n = 11). For the lesions that were growing, specific growth rate (SGR) and doubling time (DT) were calculated assuming an exponential growth pattern. In addition, the velocity of increase of the average diameter (∆Dav) and of the maximum diameter (∆Dmax) were calculated. RESULTS: Of the 130 nodules that were initially followed up, six disappeared, eight were reduced in size, eighty-eight were stable, and twenty-eight increased in size. For operated nodules all 18 malignant tumours, 8/9 benign tumours, and 2/12 surgically proved non-neoplastic lesions were growing. The best cut-off values of the growth indicators to differentiate between malignant and non-malignant histology were 3.47 × 10-3%volume/day, ≤ 179 days, > 10 × 10-3 mm/day, and > 5 × 10-3 mm/day for SGR, DT, ∆Dmax, ∆Dav, respectively. CONCLUSIONS: Malignant and non-malignant small incidentalomas can be effectively differentiated based on growing parameters, even though overlap exists. An increase of the maximum diameter of about 1 mm and 2 mm in three months and in six months, respectively, suggests malignancy. CLINICAL RELEVANCE STATEMENT: Growing parameters allow an educated assessment of benign and malignant small testicular incidentalomas. Non-aggressive management is justified and safe when follow-up includes self-examination and tumour marker assessment to reduce the risk of interval tumour growth. KEY POINTS: Small, non-palpable and asymptomatic testicular nodules < 1 cm are unexpectedly discovered during scrotal ultrasound. Growth indicators estimate the potential malignancy, even though overlap with non-malignant lesions exists. Non-growing incidentalomas can be safely followed up.
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Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.
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Ultrasonografía , Varicocele/diagnóstico por imagen , Humanos , Infertilidad Masculina/etiología , Masculino , Pene/diagnóstico por imagen , Guías de Práctica Clínica como Asunto , Escroto/diagnóstico por imagen , Espermatogénesis , Varicocele/clasificación , Varicocele/complicaciones , Varicocele/patologíaRESUMEN
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.
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Infertilidad Masculina/diagnóstico por imagen , Escroto/diagnóstico por imagen , Varicocele/diagnóstico por imagen , Consenso , Medicina Basada en la Evidencia , Humanos , Infertilidad Masculina/etiología , Masculino , Pene/diagnóstico por imagen , Espermatogénesis/fisiología , Ultrasonografía , Varicocele/complicacionesAsunto(s)
Códigos de Ética/historia , Ética Médica/historia , Juramento Hipocrático , Antigua Grecia , Historia Antigua , Humanos , ItaliaRESUMEN
Pooled data from 16 radiology centers were retrospectively analyzed to seek patients with pathologically proven testicular lymphoma and grayscale and color Doppler images available for review. Forty-three cases were found: 36 (84%) primary and 7 (16%) secondary testicular lymphoma. With unilateral primary lymphoma, involvement was unifocal (n = 10), multifocal (n = 11), or diffuse (n = 11). Synchronous bilateral involvement occurred in 6 patients. Color Doppler sonography showed normal testicular vessels within the tumor in 31 of 43 lymphomas (72%). Testicular lymphoma infiltrates through the tubules, preserving the normal vascular architecture of the testis. Depiction of normal testicular vessels crossing the lesion is a useful adjunctive diagnostic criterion.
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Linfoma/diagnóstico por imagen , Neoplasias Testiculares/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Grey-scale ultrasound has an important diagnostic role in nephrology. The absence of ionizing radiations and nephrotoxicity, rapidity of execution, excellent repeatability, the possibility to perform the test at the patient's bed and the low cost represent important advantages of this technique. Paired with real-time sonography and colour-power-Doppler contrast-enhanced ultrasound (CEUS) reduces the diagnostic gap with computed tomography (CT) and magnetic resonance (MR) and represents a major step in the evolution of clinical ultrasound. Although there are several situations in which contrast-enhanced CT and MR are indicated (i.e. evaluation of cystic or ischemic lesions, traumatisms and ablative therapies of the native and transplanted kidney), the use of CT contrast media presents a high risk of contrast-induced nephropathy (i.e. in elderly people, subjects with comorbidities and those with renal dysfunction), while gadolinium-based RM contrast agents are contraindicated for the risk of nephrogenic systemic fibrosis (i.e. in patients with severe renal dysfunction). In these situations, CEUS may be a viable alternative, however, as any technique associated with the infusion of pharmacological substances, the potential advantages and risks of CEUS should be critically evaluated. In this regard, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has published the guidelines for the use of CEUS for the kidney imaging and the International Contrast Ultrasound Society (ICUS) has been recently founded. The aim of this review is to offer an updated overview of the potential applications of CEUS in nephrology, reporting some indications and possible risks associated to its use.
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Medios de Contraste , Enfermedades Renales/diagnóstico por imagen , Nefrología/métodos , Humanos , UltrasonografíaRESUMEN
Varicocele is defined as abnormally dilated scrotal veins. It is present in 15 % of normal males and in 40 % of males with infertility. This disorder is a challenge for the physicians involved in the diagnosis and treatment, as the pathophysiology of varicocele is not yet completely understood. For this reason, accurate diagnostic criteria and clear indications for treatment in asymptomatic adolescents or adults with clinical or subclinical varicocele are still not defined. Ultrasonography (US) is considered the best method for calculating the volume of the testicles, measuring vein diameter and monitoring the growth of the testis in adolescent patients. Color-Doppler US is the method of choice for detecting spermatic vein reflux and for classifying the grade of varicocele. Various classification systems have been published with recommendations on how to perform US imaging of the scrotum. Currently, color-Doppler US and spectral analysis are the most effective, non-invasive diagnostic procedures as they allow detection of subclinical varicocele associated with infertility. Various techniques are used in the treatment of varicocele including open surgery, laparoscopic procedures and interventional radiology. However, there is no consensus among physicians on which technique is the most effective in terms of outcome and complication rates. This review shows that color-Doppler US is currently the most widely employed diagnostic method for detection and classification of varicocele caused by venous reflux, as it is reliable and easily performed. The review also highlights the role of varicocelectomy in the management of adult male infertility.
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The increased use of ultrasound in patients with urological and andrological symptoms has given an higher detection of intra-testicular nodules. Most of these lesions are hypoechoic and their interpretation is often equivocal. Recently, new ultrasound techniques have been developed alongside of B-mode and color-Doppler ultrasound. Although not completely standardized, contrast-enhanced ultrasound (CEUS) and tissue elastography (TE), added to traditional ultrasonography, can provide useful information about the correct interpretation of incidentally detected non-palpable testicular nodules. The purpose of this review article is to illustrate these new techniques in the patient management.
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Escroto/diagnóstico por imagen , Enfermedades Testiculares/diagnóstico por imagen , Humanos , Hallazgos Incidentales , Masculino , UltrasonografíaRESUMEN
We present the case of an 80-year-old man with two renal solid masses found at sonography, which were imaged by contrast-enhanced ultrasound, CT, and MRI and confirmed histologically. Contrast-enhanced ultrasound findings suggested a benign mass and a CT-guided biopsy yielded a diagnosis of extramedullary hematopoiesis.
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Hematopoyesis Extramedular , Riñón/diagnóstico por imagen , Anciano de 80 o más Años , Humanos , Riñón/fisiología , Masculino , UltrasonografíaRESUMEN
OBJECTIVE: To evaluate the efficacy of contrast-enhanced ultrasound (CEUS) in patients with acute scrotal pain not defined at ultrasound (US) with colour Doppler . METHODS: CEUS was carried out in 50 patients with acute scrotal pain or scrotal trauma showing testicular lesion of undefined nature at US. The accuracy of US and CEUS findings versus definitive diagnosis (surgery or follow-up) was calculated. RESULTS: Twenty-three patients had a final diagnosis of testicular tumour, three abscess, eight focal infarction, seven trauma, three testicular torsion, one haematoma. Five patients were negative. Thirty-five patients were operated (23 testicular tumours, six trauma, three testicular torsion, one abscess, one focal infarction, and one haematoma) and 15 underwent medical treatment or were discharged. US provided a definitive diagnosis in 34/50 as compared to the 48/50 patients diagnosed at CEUS. Sensitivity and specificity were 76% and 45% for US and 96% and 100% for CEUS respectively. CONCLUSIONS: CEUS was more accurate in the final diagnosis compared to US, potentially reducing the need for further imaging. In particular CEUS can be proposed in emergency in cases where US diagnosis remains inconclusive, namely in infarction, and trauma, when testicular torsion cannot be ruled out, and in identifying testicular mass.
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Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Aumento de la Imagen/métodos , Escroto/diagnóstico por imagen , Escroto/patología , Ultrasonografía Doppler en Color/métodos , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Medios de Contraste , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Epididimitis/diagnóstico , Epididimitis/diagnóstico por imagen , Estudios de Seguimiento , Enfermedades de los Genitales Masculinos/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Orquitis/diagnóstico , Orquitis/diagnóstico por imagen , Dolor/diagnóstico , Dolor/etiología , Estudios Prospectivos , Medición de Riesgo , Torsión del Cordón Espermático/diagnóstico , Torsión del Cordón Espermático/diagnóstico por imagen , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/diagnóstico por imagen , Adulto JovenRESUMEN
With the advent of microbubble contrast agents and contrast-specific techniques, contrast enhanced ultrasonography (CEUS) has become a powerful additional tool for radiological imaging. When microbubbles are administered intravenously, the sensitivity and specificity of ultrasound (US) can approach those of computed tomography (CT) and magnetice resonance (MR) with the advantages of no radiation, lower cost and the possibility of their use in patients with renal failure or in intensive care units. Functional (perfusional) information can be obtained in addition to morphologic information, often making further imaging unnecessary. Nevertheless, CEUS requires expertise and adequate US equipment. In addition, subjects and organs unsuitable for US are also unsuitable for CEUS, which is not a panoramic imaging modality and consequently not a substitute for comprehensive whole-body imaging.
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Enfermedades Renales/diagnóstico por imagen , Medios de Contraste , Humanos , UltrasonografíaRESUMEN
Acute colonic diverticulitis is a common cause of acute abdominal symptoms, especially in elderly patients. Sonography is frequently used as the initial imaging modality because of its ready availability. This pictorial essay aims to provide an overview of the sonographic features of acute colonic diverticulitis and of the more common differential diagnosis.
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Diverticulitis del Colon/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Enfermedad Aguda , Diagnóstico Diferencial , Humanos , Reproducibilidad de los ResultadosRESUMEN
A number of benign and malignant diseases with different causes, clinical features, management, and outcome can manifest as painful penile induration. The most common such conditions are active Peyronie disease, inflammation, trauma, venous or corporal thrombosis, acute ischemic disorders, and primary or secondary tumors. In patients with painful penile induration, a preliminary differential diagnosis is based on the patient's history and results of laboratory studies, penile inspection, and palpation. Imaging is often required to confirm the clinical diagnosis, assess the extent of disease, and determine patient treatment. A basic clinical investigation comprising penile inspection and palpation should be performed by the radiologist before imaging; such an evaluation is a great help in selecting the best imaging modality and examination technique. Moreover, acquisition of preliminary clinical information eases interpretation of the imaging features and facilitates identification of clinically relevant information that may result in a change in patient treatment. In standard clinical practice, color Doppler ultrasonography is often the first imaging modality used to evaluate patients with painful penile induration. This technique clearly demonstrates normal penile anatomy and its corresponding changes in most of the clinically relevant situations. Magnetic resonance imaging is the optimal imaging modality for tumor staging. Other imaging modalities are required less frequently.
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Imagen por Resonancia Magnética/métodos , Dolor/etiología , Induración Peniana/complicaciones , Induración Peniana/diagnóstico , Pene/diagnóstico por imagen , Pene/patología , Ultrasonografía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Dolor/diagnósticoRESUMEN
The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy, sensitivity, and specificity to correctly classify focal lesions of the kidney. To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading. The average diagnostic accuracy across the three blinded readers ('average reader') was 83.7% for gadobutrol and 87.3% for gadopentate dimeglumine. The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0% for gadobutrol and 6.9% for gadopentate dimeglumine. Sensitivity of the average reader was 85.2% for gadobutrol and 88.7% for gadopentate dimeglumine. Specificity of the average reader was 82.1% for gadobutrol and 86.1% for gadopentate dimeglumine. In conclusion, this study documents evidence for the noninferiority of a single i.v. bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI.
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Gadolinio DTPA , Aumento de la Imagen/métodos , Neoplasias Renales/diagnóstico , Neoplasias Renales/epidemiología , Imagen por Resonancia Magnética/métodos , Compuestos Organometálicos , Medios de Contraste , Europa (Continente)/epidemiología , Femenino , Gadolinio DTPA/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Método Simple CiegoRESUMEN
PURPOSE: To prospectively compare the sensitivity and specificity of ultrasonography (US) with those of contrast material-enhanced US in the depiction of solid organ injuries in children with blunt abdominal trauma, with contrast-enhanced computed tomography (CT) as the reference standard. MATERIALS AND METHODS: The study protocol was approved by the ethics board, and written informed consent was obtained from parents. US, contrast-enhanced US, and contrast-enhanced CT were performed in 27 consecutive children (19 boys, eight girls; mean age, 8.9 years +/- 2.8 [standard deviation]) with blunt abdominal trauma to determine if solid abdominal organ injuries were present. Sensitivity, specificity, agreement, accuracy, number of lesions correctly identified, and positive and negative predictive values were determined for US and contrast-enhanced US, as compared with contrast-enhanced CT. RESULTS: In 15 patients, contrast-enhanced CT findings were negative. Contrast-enhanced CT depicted 14 solid organ injuries in 12 patients. Lesions were in the spleen (n = 7), liver (n = 4), right kidney (n = 1), right adrenal gland (n = 1), and pancreas (n = 1). Contrast-enhanced US depicted 13 of the 14 lesions in 12 patients with positive contrast-enhanced CT findings and no lesions in the patients with negative contrast-enhanced CT findings. Unenhanced US depicted free fluid in two of 15 patients with negative contrast-enhanced CT findings and free fluid, parenchymal lesions, or both in eight of 12 patients with positive contrast-enhanced CT findings. Overall, the diagnostic performance of contrast-enhanced US was better than that of US, as sensitivity, specificity, and positive and negative predictive values were 92.2%, 100%, 100%, and 93.8%, respectively. CONCLUSION: Contrast-enhanced US was almost as accurate as contrast-enhanced CT in depicting solid organ injuries in children.
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Traumatismos Abdominales/diagnóstico por imagen , Heridas no Penetrantes/diagnóstico por imagen , Niño , Medios de Contraste , Femenino , Humanos , Masculino , Fosfolípidos , Valor Predictivo de las Pruebas , Curva ROC , Sensibilidad y Especificidad , Hexafluoruro de Azufre , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Sonography is widely used in the initial diagnostic assessment of blunt abdominal trauma in adults and children. It has been formally incorporated worldwide into the routine armamentarium available for emergency diagnosis and treatment as a means of rapid detection of free abdominal fluid, normally referred to as FAST (Focused Assessment with Sonography in Trauma). However, there is some controversy regarding its value because free abdominal fluid may be lacking in patients with abdominal organ injuries from blunt trauma. More recently, a new ultrasound technique has been developed using contrast agents. Contrast-enhanced ultrasound performs better than the non-contrast-enhanced technique for the detection of abdominal solid organ injuries and can play an important role in the prompt evaluation of patients with blunt trauma. Furthermore, contrast-enhanced ultrasound can be used in the follow-up of patients who have solid organ lesions and are managed with nonoperative treatment, avoiding radiation and iodinated contrast medium exposure.
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Traumatismos Abdominales/diagnóstico por imagen , Medios de Contraste , Ultrasonografía Intervencional , Heridas no Penetrantes/diagnóstico por imagen , Humanos , Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador/métodos , Riñón/diagnóstico por imagen , Riñón/lesiones , Hígado/diagnóstico por imagen , Hígado/lesiones , Páncreas/diagnóstico por imagen , Páncreas/lesiones , Bazo/diagnóstico por imagen , Bazo/lesiones , Ultrasonografía Intervencional/métodosRESUMEN
Acute renal failure is a sudden and sustained decrease in the glomerular filtration rate associated with a loss of excretory function and the accumulation of metabolic waste products and water. It leads to an increase in serum urea and creatinine, usually with a decrease in urine output. Although routine surveillance of patients by means of laboratory examinations has been well defined, very little is known about renal imaging. Modern technology has provided a large number of sophisticated monitoring systems. Ultrasonography with color-Doppler study of the kidneys may be indicated as a possible monitor of renal perfusion. Ultrasonography is often used as the initial imaging procedure in the examination of patients with renal failure. Aside from excluding hydronephrosis, it is well recognized in characterizing the type of renal disease, especially in an acute setting. This article describes the use of ultrasound to achieve the proper diagnosis of acute renal diseases and to enable the appropriate and early assessment of these patients in intensive care units.
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Lesión Renal Aguda/diagnóstico por imagen , Ultrasonografía Doppler en Color , Lesión Renal Aguda/etiología , Cuidados Críticos , Humanos , Ultrasonografía Doppler en Color/métodosRESUMEN
A 58 years man was submitted to a sextant echo-guided transrectal prostate biopsy. Three weeks later he started complaining of lower abdominal and urinary tract symptoms. Abdominal ultrasound and 3D contrast enhanced CT detected an ovular shaped and capsulated 140 cc volume mass into the peritoneum compressing the bladder. Cytology evaluation showed only haemorrhagic content. After the mass evacuation all the symptoms referred, disappeared. Anyway a hematoma into the peritoneum following a transrectal echo-guided prostate biopsy should represent a unique entity. In fact, this is considered a safe procedure in which generally mild complications occur and they stop spontaneously.
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Hematoma/etiología , Enfermedades Peritoneales/etiología , Próstata/diagnóstico por imagen , Próstata/patología , Anciano , Biopsia/efectos adversos , Biopsia/métodos , Hematoma/complicaciones , Humanos , Masculino , Enfermedades Peritoneales/complicaciones , Ultrasonografía , Trastornos Urinarios/etiologíaRESUMEN
OBJECTIVE: The objective of our study was to prospectively compare the diagnostic value of sonography and contrast-enhanced sonography with CT for the detection of solid organ injuries in blunt abdominal trauma patients. SUBJECTS AND METHODS: Sonography, contrast-enhanced sonography, and CT were performed to assess possible abdominal organ injuries in 69 nonconsecutive hemodynamically stable patients with blunt abdominal trauma and a strong clinical suspicion of abdominal lesions. Sonography and contrast-enhanced sonography findings were compared with CT findings, the reference standard technique. RESULTS: Thirty-two patients had 35 abdominal injuries on CT (10 kidney or adrenal lesions, seven liver lesions, 17 spleen lesions, and one retroperitoneal hematoma). Sixteen lesions were detected on sonography, and 32 were seen on contrast-enhanced sonography. The sensitivity and specificity of sonography were 45.7% and 91.8%, respectively, and the positive and negative predictive values were 84.2% and 64.1%, respectively. Contrast-enhanced sonography had a sensitivity of 91.4%, a specificity of 100%, and positive and negative predictive values of 100% and 92.5%, respectively. CONCLUSION: Contrast-enhanced sonography was found to be more sensitive than sonography and almost as sensitive as CT in the detection of traumatic abdominal solid organ injuries. It can therefore be proposed as a useful tool in the assessment of blunt abdominal trauma.