RESUMEN
A range of conditions involving the kidneys and urinary bladder can cause organ-threatening complications that are preventable if diagnosed promptly with diagnostic imaging. Common imaging modalities include either computed tomography or diagnostic ultrasound. Traditionally, ultrasound of the kidney-genitourinary system has required consultative teams consisting of a sonographer performing image acquisition and a radiologist performing image interpretation. However, diagnostic point-of-care ultrasound (POCUS) has recently emerged as a useful tool to troubleshoot acute kidney injury at the bedside. Studies have shown that non-radiologists can be trained to perform diagnostic POCUS of the kidneys and bladder with high accuracy for a set number of important conditions. Currently, diagnostic POCUS of the kidney-genitourinary system remains underused in actual clinical practice. This is likely because image acquisition for this organ system is unfamiliar to most clinicians in specialties that encounter acute kidney injury, including primary care, emergency medicine, intensive care, anesthesiology, nephrology, and urology. To address this multi-specialty educational gap, this narrative review was developed by a multi-disciplinary group to provide a specialty-agnostic framework for kidney-genitourinary POCUS image acquisition: indications/contraindications, patient positioning, transducer selection, acquisition sequence, and exam limitations. Finally, we describe foundational concepts in kidney-genitourinary ultrasound image interpretation, including key abnormal findings that every bedside clinician performing this modality should know.
Asunto(s)
Riñón , Sistemas de Atención de Punto , Ultrasonografía , Humanos , Ultrasonografía/métodos , Riñón/diagnóstico por imagen , Adulto , Masculino , Femenino , Sistema Urogenital/diagnóstico por imagen , Sistema Urogenital/lesiones , Enfermedades Renales/diagnóstico por imagenRESUMEN
Fibrosis is a pathological process involving the abnormal deposition of connective tissue, resulting from improper tissue repair in response to sustained injury caused by hypoxia, infection, or physical damage. It can impact any organ, leading to their dysfunction and eventual failure. Additionally, tissue fibrosis plays an important role in carcinogenesis and the progression of cancer.Early and accurate diagnosis of organ fibrosis, coupled with regular surveillance, is essential for timely disease-modifying interventions, ultimately reducing mortality and enhancing quality of life. While extensive research has already been carried out on the topics of aberrant wound healing and fibrogenesis, we lack a thorough understanding of how their relationship reveals itself through modern imaging techniques.This paper focuses on fibrosis of the genito-urinary system, detailing relevant imaging technologies used for its detection and exploring future directions.
Asunto(s)
Fibrosis , Humanos , Sistema Urogenital/diagnóstico por imagen , Sistema Urogenital/patología , RadiologíaRESUMEN
Fetal MR imaging overcomes many of the technical barriers of ultrasound and is an important diagnostic tool for fetal genitourinary (GU) anomalies. It is suited for evaluation of GU anomalies because of the fluid-sensitive sequences and superior soft tissue contrast. Often GU malformations are part of a multisystem genetic or congenital condition, and imaging the entire fetus with MR adds additional clarity about the extent of disease. It adds confidence to diagnoses of renal agenesis, urinary tract dilation, cystic disease, and tumors. It is particularly useful to delineate anatomy in complex GU malformations. This additional information guides counseling.
Asunto(s)
Imagen por Resonancia Magnética , Diagnóstico Prenatal , Anomalías Urogenitales , Sistema Urogenital , Humanos , Imagen por Resonancia Magnética/métodos , Anomalías Urogenitales/diagnóstico por imagen , Diagnóstico Prenatal/métodos , Femenino , Embarazo , Sistema Urogenital/diagnóstico por imagen , Sistema Urogenital/embriologíaRESUMEN
AIM: To analyse the diagnostic yield of computed tomography (CT) in septic patients from a medical intensive care unit (ICU). MATERIALS AND METHODS: A full-text search of the department's radiological information system (RIS) retrieved 227 body CT examinations undertaken to search for a septic focus in 2018 from medical ICU patients. CT reports were categorised according to the identified foci. Clinical and laboratory information was gathered. Data were analysed statistically using descriptive statistics, diagnostic test quality criteria, binomial tests and chi-square test. RESULTS: A total of 227 CT examinations from 165 septic patients detected 264 foci, which were distributed as follows: 58.3% (n=154/264) chest, 26.5% (n=70/264) abdomen, 5.3% (n=14/264) genitourinary system, and 9.8% (n=26/264) other body regions. In 15.9% (n=36/227) no focus was identified on CT. Based on CT reports, 37.5% (n=99/264) of foci were graded as certain, 18.9% (n=50/264) as likely, and 15.9% (n=42/264) as possible infectious sources. Septic foci were detected using CT with 75.8% sensitivity (95% confidence interval [CI] 69.6-81.9%) and 59.46% specificity (95% CI 42.9-76.1%). The positive predictive value was 90.6% (95% CI 86-95.2%), with a negative predictive value of 32.4% (95% CI 21-43.8%). CONCLUSION: The present results confirm that body CT is a suitable rule-in test for septic patients in medical intensive care, although it cannot reliably rule out a septic focus. Follow-up CT examinations may reveal a septic source in the further course of a patient's hospital stay.
Asunto(s)
Sepsis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Abdomen/diagnóstico por imagen , Anciano , Distribución de Chi-Cuadrado , Intervalos de Confianza , Cuidados Críticos , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Sepsis/clasificación , Sepsis/epidemiología , Tórax/diagnóstico por imagen , Sistema Urogenital/diagnóstico por imagenRESUMEN
Congenital genitourinary anomalies are among the most frequent types of birth defects in neonates. Some anomalies can be a significant cause of morbidity in infancy, while others remain asymptomatic even until adulthood and can be at times the only manifestation of a complex systemic disease. The spectrum of these anomalies results from the developmental insults that can occur at various embryologic stages, and an understanding of the formation of the genitourinary system is helpful in the evaluation and treatment of a child with a congenital genitourinary anomaly. Imaging plays an essential role in the diagnosis of congenital genitourinary anomalies and treatment planning. In this article, we highlight the embryologic and characteristic imaging features of various congenital genitourinary anomalies, demonstrate the utility of different imaging modalities in management, and review specific imaging modalities and protocols for image optimization.
Asunto(s)
Anomalías Urogenitales , Adulto , Niño , Diagnóstico por Imagen , Femenino , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Anomalías Urogenitales/diagnóstico por imagen , Sistema Urogenital/diagnóstico por imagenRESUMEN
The acute abdomen is a potentially life-threatening condition and requires a rapid diagnosis. After clinical inspection and in cases with unclear ultrasound findings or unclear serious symptoms computed tomography (CT) and in pregnant women and children magnetic resonance imaging (MRI) is usually necessary. This second part of "Imaging in the acute abdomen" focuses on frequent organ specific causes of the gastrointestinal tract and the urogenital system.
Asunto(s)
Abdomen Agudo , Abdomen Agudo/diagnóstico por imagen , Abdomen Agudo/etiología , Niño , Femenino , Tracto Gastrointestinal/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Embarazo , Tomografía Computarizada por Rayos X , Sistema Urogenital/diagnóstico por imagenRESUMEN
In this review, we will discuss the imaging findings of common as well as uncommon lower genitourinary tract infections. For both clinicians and radiologists, it is imperative to understand etiopathogenesis, epidemiological information, clinical presentation, imaging findings and management options of such conditions. Knowledge of salient imaging features of these infections is of utmost importance because prompt recognition enables appropriate management.
Asunto(s)
Infecciones Urinarias , Sistema Urogenital , Diagnóstico por Imagen , Humanos , Radiólogos , Infecciones Urinarias/diagnóstico por imagen , Sistema Urogenital/diagnóstico por imagenRESUMEN
Tuberculosis (TB) is a multi-systemic disease instigated by Mycobacterium tuberculosis that can involve any organ. In any child presenting with clinical features involving multiple organ systems, TB forms an important differential. This holds particularly for endemic countries like India. Genitourinary TB (GUTB) comprises up to 27% of all extrapulmonary TB cases. We present an unusual presentation of disseminated TB involving kidneys and presenting as gross hematuria. 12-year-old girl, presented with recurrent episodes of gross hematuria of one-month duration. She received multiple packed cell transfusions for the same. She had chronic malnutrition. USG KUB with renal doppler was normal. Given persistent hematuria, CT urography was done which showed features suggestive of papillary necrosis with cystitis. Tubercular workup showed multiple opacities predominantly involving perihilar regions bilaterally on chest x-ray along with positive Mantoux test. Sputum for AFB was positive for tubercular bacilli. Urine samples were also sent for CBNAAT which showed TB bacilli sensitive to rifampicin. With a diagnosis of disseminated TB, antitubercular therapy (ATT) was started followed by cystoscopic resection of inflamed bladder wall tissue. Bladder mucosal biopsy confirmed caseating granulomas suggestive of tuberculous cystitis. The patient is doing well and symptom-free after completion of ATT.
Asunto(s)
Transfusión Sanguínea/métodos , Cistitis , Hematuria , Mycobacterium tuberculosis/aislamiento & purificación , Rifampin/administración & dosificación , Tuberculosis Urogenital , Sistema Urogenital/diagnóstico por imagen , Antibióticos Antituberculosos/administración & dosificación , Niño , Cistitis/diagnóstico por imagen , Cistitis/patología , Cistitis/cirugía , Femenino , Hematuria/diagnóstico , Hematuria/etiología , Humanos , Riñón/diagnóstico por imagen , Riñón/patología , Necrosis , Recurrencia , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Tuberculosis Urogenital/diagnóstico , Tuberculosis Urogenital/fisiopatología , Sistema Urogenital/microbiologíaRESUMEN
BACKGROUND: Klippel-Trenaunay Syndrome (KTS) is a genetic vascular malformation disorder which induces a variety of phenotypic expression in patients which differ in terms of severity/location. While previous studies have documented genitourinary (GU) complications in adult KTS patients, documentation of the scope and incidence of GU involvement in the pediatric population with imaging findings is currently limited. This study represents the largest KTS genitourinary review to date. OBJECTIVE: To assess the incidence, scope, clinical findings and imaging characteristics of GU pathology in pediatric KTS patients. MATERIALS/METHODS: Using a retrospective data analysis design, the charts and imaging studies of pediatric KTS patients were reviewed. All patients received care at a specialized vascular clinic within a multicenter tertiary care system. Variables studied included age, age at KTS diagnosis, gender, urologic involvement, and age of urologic complication. RESULTS: 58 patients were identified. 33 were male and 25 were female. 10 patients had GU findings. Three of these patients had multifocal GU involvement (greater than 1 finding). Urologic manifestations were diverse with 9 distinct diagnoses involving 6 unique organs. Renal, vesical and scrotal pathologies were most common. Hematuria was the most common presenting symptom in 30% (3/10). Previously unreported findings (labial swelling, renal lymphatic cysts) were identified. The average age of KTS diagnosis was 4.9 years. The average age of documented GU complication and involvement was 7.6 years. CONCLUSION: Significant GU complications due to KTS can occur in the pediatric population. Early clinical and imaging characterization of these conditions is important for management, family education and early intervention strategies.
Asunto(s)
Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagen , Sistema Urogenital/diagnóstico por imagen , Adolescente , Adulto , Niño , Preescolar , Edema/complicaciones , Femenino , Humanos , Incidencia , Síndrome de Klippel-Trenaunay-Weber/complicaciones , Síndrome de Klippel-Trenaunay-Weber/patología , Masculino , Estudios Retrospectivos , Malformaciones Vasculares/complicacionesRESUMEN
Radiographs of the abdomen and pelvis are routinely obtained as a standard part of clinical care for the abdomen and pelvis. Brisk advances in technology over the last few decades have resulted in a multitude of medical devices and materials. Recognizing and evaluating these devices on abdominal and pelvic radiographs are critical, yet increasingly a difficult endeavor. In addition, multiple devices serving different purposes may have a similar radiographic appearance and position causing confusion for the interpreting radiologist. The role of the radiologist is to not only identify accurately these medical objects, but also to confirm for their accurate placement and to recognize any complications that could affect patient care, management or even be potentially life threatening. An extensive online search of literature showed our review article to be the most comprehensive work on medical devices and materials of the abdomen and pelvis, and in this second part of our two-part series, we discuss in depth about the neurologic and genitourinary devices seen on abdominal and pelvic radiographs.
Asunto(s)
Abdomen/diagnóstico por imagen , Equipos y Suministros/estadística & datos numéricos , Pelvis/diagnóstico por imagen , Radiografía/métodos , Radiólogos/estadística & datos numéricos , Catéteres/estadística & datos numéricos , Equipos y Suministros/efectos adversos , Femenino , Cuerpos Extraños/diagnóstico por imagen , Humanos , Neuroestimuladores Implantables/estadística & datos numéricos , Masculino , Radiografía/estadística & datos numéricos , Radiografía Abdominal/métodos , Radiografía Abdominal/estadística & datos numéricos , Stents/estadística & datos numéricos , Sistema Urogenital/diagnóstico por imagenRESUMEN
OBJECTIVE. Blunt pelvic trauma is associated with injuries to the musculoskeletal, lower genitourinary, and vascular systems, leading to significant morbidity and mortality. This article provides a comprehensive review of these injuries, reviews classification systems that are helpful in predicting prognosis, describes the most appropriate imaging tests for injury detection, and emphasizes the role that interventional radiology plays in the setting of pelvic trauma. CONCLUSION. Blunt pelvic injuries can involve the musculoskeletal, genitourinary, and vascular systems, often concomitantly, making it imperative for radiologists to recognize injury patterns and understand implications for management. Injury classifications can be helpful in determining management and predicting prognosis. Contrast-enhanced CT is the imaging modality test of choice in evaluating pelvic trauma, and protocols should be optimized for best detection of injuries. Transcatheter arterial embolization plays a critical role in stopping acute hemorrhage and improving clinical outcomes.
Asunto(s)
Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Huesos Pélvicos/lesiones , Sistema Urogenital/diagnóstico por imagen , Sistema Urogenital/lesiones , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Heridas no Penetrantes/diagnóstico por imagen , HumanosRESUMEN
Extrapulmonary tuberculosis in children tends to be more severe than the adults. It can affect almost any organ system of the body. The clinical manifestations are often non-specific. Imaging findings are also not always very specific. This article describes the imaging spectrum of pediatric extrapulmonary tuberculosis.
Asunto(s)
Diagnóstico por Imagen/métodos , Pruebas Diagnósticas de Rutina/métodos , Tuberculosis Pulmonar/diagnóstico por imagen , Cavidad Abdominal/diagnóstico por imagen , Cavidad Abdominal/fisiología , Adulto , Artritis/diagnóstico por imagen , Artritis/patología , Niño , Humanos , Linfadenopatía/diagnóstico por imagen , Linfadenopatía/patología , Sistema Musculoesquelético/diagnóstico por imagen , Osteomielitis/diagnóstico por imagen , Osteomielitis/patología , Pericardio/diagnóstico por imagen , Pericardio/patología , Tuberculosis Meníngea/diagnóstico por imagen , Tuberculosis Meníngea/patología , Tuberculosis Pleural/diagnóstico por imagen , Tuberculosis Pleural/patología , Tuberculosis Pulmonar/patología , Sistema Urogenital/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: To evaluate the effect of changes in bladder volume during high-dose intensity-modulated-radiotherapy (IMRT) of prostate cancer on acute genitourinary (GU) toxicity and prospectively evaluate a simple biofeedback technique for reproducible bladder filling with the aim of reducing acute GU toxicity. METHODS: One hundred ninety-three patients were trained via a biofeedback mechanism to maintain a partially filled bladder with a reproducible volume of 200-300â¯cc at planning CT and subsequently at each fraction of radiotherapy. We prospectively analyzed whether and to what extent the patients' ability to maintain a certain bladder filling influenced the degree of acute GU toxicity and whether cut-off values could be differentiated. RESULTS: We demonstrated that the ability to reach a reproducible bladder volume above a threshold volume of 180â¯cc and maintain that volume via biofeedback throughout treatment predicts for a decrease in acute GU toxicity during curative high-dose IMRT of the prostate. Patients who were not able to reach a partial bladder filling to that cut-off value and were not able to maintain a partially filled bladder throughout treatment had a significantly higher risk of developing ≥grade 2 GU acute toxicity. CONCLUSION: Our results support the hypothesis that a biofeedback training for the patient is an easy-to-apply, useful, and cost-effective tool for reducing acute GU toxicity in high-dose IMRT of the prostate. Patients who are not able to reach and maintain a certain bladder volume during planning and treatment-two independent risk factors-might need special consideration.
Asunto(s)
Neoplasias de la Próstata/radioterapia , Radioterapia de Intensidad Modulada/efectos adversos , Vejiga Urinaria/efectos de la radiación , Sistema Urogenital/efectos de la radiación , Anciano , Anciano de 80 o más Años , Biorretroalimentación Psicológica , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Tamaño de los Órganos/efectos de la radiación , Estudios Prospectivos , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Traumatismos por Radiación/diagnóstico por imagen , Traumatismos por Radiación/prevención & control , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Tomografía Computarizada por Rayos X , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/patología , Sistema Urogenital/diagnóstico por imagen , Sistema Urogenital/patologíaRESUMEN
OBJECTIVES: To measure the length, width and area of the urogenital hiatus (UH), and the length and mean echogenicity (MEP) of the puborectalis muscle (PRM), automatically and observer-independently, in the plane of minimal hiatal dimensions on transperineal ultrasound (TPUS) images, by automatic segmentation of the UH and the PRM using deep learning. METHODS: In 1318 three- and four-dimensional (3D/4D) TPUS volume datasets from 253 nulliparae at 12 and 36 weeks' gestation, two-dimensional (2D) images in the plane of minimal hiatal dimensions with the PRM at rest, on maximum contraction and on maximum Valsalva maneuver, were obtained manually and the UH and PRM were segmented manually. In total, 713 of the images were used to train a convolutional neural network (CNN) to segment automatically the UH and PRM in the plane of minimal hiatal dimensions. In the remainder of the dataset (test set 1 (TS1); 601 images, four having been excluded), the performance of the CNN was evaluated by comparing automatic and manual segmentations. The performance of the CNN was also tested on 117 images from an independent dataset (test set 2 (TS2); two images having been excluded) from 40 nulliparae at 12 weeks' gestation, which were acquired and segmented manually by a different observer. The success of automatic segmentation was assessed visually. Based on the CNN segmentations, the following clinically relevant parameters were measured: the length, width and area of the UH, the length of the PRM and MEP. The overlap (Dice similarity index (DSI)) and surface distance (mean absolute distance (MAD) and Hausdorff distance (HDD)) between manual and CNN segmentations were measured to investigate their similarity. For the measured clinically relevant parameters, the intraclass correlation coefficients (ICCs) between manual and CNN results were determined. RESULTS: Fully automatic CNN segmentation was successful in 99.0% and 93.2% of images in TS1 and TS2, respectively. DSI, MAD and HDD showed good overlap and distance between manual and CNN segmentations in both test sets. This was reflected in the respective ICC values in TS1 and TS2 for the length (0.96 and 0.95), width (0.77 and 0.87) and area (0.96 and 0.91) of the UH, the length of the PRM (0.87 and 0.73) and MEP (0.95 and 0.97), which showed good to very good agreement. CONCLUSION: Deep learning can be used to segment automatically and reliably the PRM and UH on 2D ultrasound images of the nulliparous pelvic floor in the plane of minimal hiatal dimensions. These segmentations can be used to measure reliably UH dimensions as well as PRM length and MEP. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Asunto(s)
Músculos Abdominales/diagnóstico por imagen , Diafragma Pélvico/diagnóstico por imagen , Ultrasonografía/métodos , Sistema Urogenital/diagnóstico por imagen , Músculos Abdominales/anatomía & histología , Músculos Abdominales/fisiología , Aprendizaje Profundo , Estudios de Evaluación como Asunto , Femenino , Edad Gestacional , Humanos , Imagenología Tridimensional/métodos , Contracción Muscular/fisiología , Red Nerviosa , Embarazo , Sistema Urogenital/anatomía & histología , Sistema Urogenital/fisiología , Maniobra de Valsalva/fisiologíaRESUMEN
Advances in the management of genitourinary neoplasms have resulted in a trend towards providing patients with personalized care. Texture analysis of medical images, is one of the tools that is being explored to provide information such as detection and characterization of tumors, determining their aggressiveness including grade and metastatic potential and for prediction of survival rates and risk of recurrence. In this article we review the basic principles of texture analysis and then detail its current role in imaging of individual neoplasms of the genitourinary system.
Asunto(s)
Diagnóstico por Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Neoplasias Urogenitales/diagnóstico por imagen , Humanos , Sistema Urogenital/diagnóstico por imagenRESUMEN
Contrast-enhanced ultrasound (CEUS) is a versatile imaging modality that improves the diagnostic potential of conventional ultrasound. It allows for portable imaging at the bedside. In this paper, we illustrate how CEUS can be used in evaluating several focal lesions in the pediatric population, including liver hemangioma, telangiectasias, splenic hamartomas, and bladder lesions. We describe the ultrasound findings and contrast enhancement patterns associated with these lesions. Findings are correlated with MRI, CT, and/or pathology when available. This paper demonstrates the value of CEUS in improving characterization of many focal lesions in the pediatric population. CONCLUSION: CEUS is a valuable bedside technique for use in the pediatric population to evaluate focal lesions in various organs, and will allow for safe, more efficient diagnostic imaging. What is Known: ⢠CEUS offers many advantages over CT and MRI and is underutilized in the United States. ⢠It is only FDA approved for vesicoureteral reflux and liver in the pediatric population. However, off label uses are well described. What is New: ⢠This pictorial essay describes ultrasound findings and contrast enhancement patterns associated with liver hemangioma, liver telangiectasia, splenic hamartoma, hemorrhagic ovarian cyst, urachal remnant, spinning top urethras, and kaposiform hemangioendothelioma. ⢠We demonstrate the utility of CEUS in expanding the diagnostic potential of conventional ultrasound.