Imaging findings of prostate tuberculosis by transrectal contrast-enhanced ultrasound and comparison with 2D ultrasound and pathology.

OBJECTIVES: This study aimed to investigate the contrast-enhanced ultrasound (CEUS) appearances of prostate tuberculosis (PTB) and its correlation with histopathology. METHODS: Clinical, transrectal ultrasonography (TRUS) and CEUS data of 12 PTB patients confirmed by pathology were retrospectively analyzed, and compared to the pathological findings to identify the pathological structures corresponding to different image enhancement areas. RESULTS: No specific characteristics could be found for the clinical appearances. Enlarged gland, hypoechoic lesions and calcification due to PTB could be found by TRUS, which were also non-specific. CEUS showed hypo- or non-enhanced lesions with varying size, which were related to different pathological stages of PTB. The incidence rate of non-enhanced lesions was 83.3%. The detection rate of suspected lesion by CEUS was significantly higher than that by TRUS (χ2 = 8.000, p = 0.005). Histopathology showed that the hypoenhanced area consisted of tuberculous granulomas, caseous necrosis and incomplete destruction of the glands, while the non-enhanced area consisted of caseous or liquified necrosis. CONCLUSION: CEUS could improve the detection rate of PTB lesions, and the diversity of its manifestations was related to different pathological structures. An enlarged, soft gland with non-enhanced on CEUS may provide valuable information for the diagnosis of PTB, but it is not a substitute for biopsy due to the diversity of CEUS findings. ADVANCES IN KNOWLEDGE: When the lesions of prostate gland are unclear in TRUS examination, CEUS is an ideal option for the detection of lesions, which is conducive to targeted guidance of biopsy areas.

Imaging Manifestations of Genitourinary Tuberculosis.

The genitourinary region is one of the most common sites of extrapulmonary tuberculosis (TB) involvement. The imaging features of genitourinary TB are protean and can mimic other entities, including malignancy, and pose a diagnostic dilemma. Hematogenous seeding and lymphatic spread of mycobacteria from pulmonary, tonsillar, and nodal TB are implicated in the pathogenesis of genitourinary TB. In addition, contiguous extension from the urinary tract and sexual transmission are described as sources of genital TB. Genitourinary TB can be indolent and results in nonspecific signs and symptoms; thus, imaging has a vital role in the working diagnosis for these cases. Classic uroradiologic signs of genitourinary TB are primarily described from the era of intravenous urography and conventional radiography. Now, CT, CT urography, MRI, and US are used in the diagnosis and management. Familiarity with the imaging features of genitourinary TB may help guide the diagnosis and, in turn, lead to timely management. US has a vital role in the evaluation of scrotal and female genital TB. MRI offers superior soft-tissue contrast resolution and excellent depiction of anatomic detail. The various imaging manifestations of genitourinary TB are highlighted. ©RSNA, 2021.

Diagnostic pitfalls of urogenital tuberculosis.

OBJECTIVES: To describe characteristics, details of diagnosis and outcomes of urogenital tuberculosis (UGTB) in a low-prevalence country. METHODS: We conducted a retrospective observational study of 37 consecutive patients diagnosed with UGTB between 1st January 2014 and 31st October 2019 in an East London hospital. RESULTS: 68% (25/37) of patients were male and the median age was 42 years (IQR 34-55). 89% (33/37) of patients were born outside the United Kingdom with 65% (24/37) born in the South Asian region. Renal (32.4%), epididymal (24.3%) and endometrial TB (21.6%) were the most prevalent forms of UGTB. Only 13.5% of UGTB patients had concurrent pulmonary TB. The median length of time from symptom onset to treatment was 163 days, while endometrial TB had an average delay to diagnosis of 564 days. Approximately half of patients with UGTB were culture positive (51.4%). However, 70% of early morning urines (EMUs) sent in urinary TB were culture positive. 11 patients (30.6%) underwent two or more invasive procedures, such as biopsy to obtain specimen samples. The mean treatment length for all UGTB cases was 7.3 months (SD 3.1). Notably, 25% of patients with endometrial TB required surgery despite antituberculous treatment. CONCLUSIONS: UGTB is challenging to diagnose as early disease is often asymptomatic. Clinicians faced with non-specific symptoms, or features suggestive of urogenital malignancy amongst patients from TB-endemic areas, should maintain a high suspicion of UGTB.

Multimodality Imaging of Genitourinary Tuberculosis.

Tuberculosis (TB) prevalence has increased over the past few decades, especially in the developing world. The genitourinary tract is the most common extra-pulmonary location of TB. Symptoms of genitourinary TB are often vague. Diagnosis of genitourinary TB requires a high level of clinical suspicion. Healthcare providers must be familiar with genitourinary TB imaging features on different imaging modalities and how to correlate these findings with urine studies and histologic analysis to definitively diagnose genitourinary TB.

Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings.

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.

Can kidneys be saved in patients with urinary tuberculosis? A study in the era of modern chemotherapy and surgical armamentarium.

OBJECTIVE: To assess renal unit survival and factors affecting renal salvageability in a cohort of patients receiving modern medical and surgical therapy for urinary tuberculosis. METHODS: This was a retrospective single-center study including all patients diagnosed and treated as urinary tuberculosis between 2005 and 2015 at Christian Medical College, Vellore, Tamil Nadu, India. The primary outcome was time to renal unit non-salvageability (estimated glomerular filtration rate of <15 mL/min). RESULTS: A total of 128 patients were included in the study. The mean age was 37.7 ± 11.3 years, 33% had microbiological and 73% had histopathological confirmation in addition to radiological diagnosis. The estimated median survival of the involved renal units (n = 187) on Kaplan-Meier estimate was 75 months (95% CI 39-99). On multivariate analysis, renal units with initial split function >15 mL/min had fivefold the survival estimate as compared with those ≤15 mL/min (P < 0.001); the presence of one, two and three infundibular strictures had a 2.2-, 2.9- and fivefold higher hazard of renal unit loss respectively, and lower ureteric strictures had fivefold longer estimated survival (P = 0.015) after treatment. Renal units in the reconstruction group had 5.44-fold (95% CI 2.71-10.88, P < 0.001) longer survival than the permanent diversion group, with a mean change in split function of +0.76 (±16.11) mL/min, versus -5.61 (±10.87) mL/min respectively. CONCLUSIONS: Loss of renal units is a function of time despite modern treatment. Baseline renal unit function, site of ureteric involvement and extent of infundibular involvement on imaging are helpful in predicting the duration of renal salvageability. When feasible, reconstruction is better at renal function preservation.

Manifestaciones tomográficas extrapulmonares de TBCy algunas de sus complicaciones asociadas / Extrapulmonary TB Tomography and some Associated Complications

La Tuberculosis (TBC) es una patología infecto-contagiosa de alta morbimortalidad en Chile y en el mundo, siendo la segunda causa de muerte por cuestión infecciosa y es considerada una patología de alta relevancia a nivel de salud pública. Es causada por una bacteria de alta virulencia y contagio llamada mycobacterium tuberculosis. En la actualidad contamos con protocolos de detección y tratamiento muy eficaces, que la convierten en una enfermedad prevenible y curable. El diagnóstico se realiza con estudios bacteriológicos específicos frente a una sospecha clínica-epidemiológica sugerente. Sin embargo, el uso de imágenes forma parte casi obligatoria de su estudio y control. Debido a que el órgano diana de la TBC es el pulmón, es habitual utilizar como apoyo diagnóstico una radiografía de tórax, la cual es útil, en caso de TBC pulmonar, al presentar hallazgos característicos y orientadores para su diagnóstico. Es importante destacar que el mycobacterium tuberculosis tiene alto potencial de diseminación por contigüidad, vía linfática y/o hematógena, siendo esa última vía la causante de la mayoría de las TBC extrapulmonares, las cuales se presentan en un 20% de pacientes inmunocompetentes y hasta en un 60% de inmunocomprometidos. La principal localización de una TBC extrapulmonar es a nivel pleural, seguida del compromiso ganglionar, urogenital y osteoarticular, siendo el resto de las localizaciones muy infrecuentes. Para esos casos la tomografía computada (TC) es el estudio por imágenes de elección para el diagnóstico y control, además de ser una herramienta muy útil para la detección de complicaciones.

Tuberculosis (TB) is an infectious disease of high morbility and mortality in Chile and in the world. It is the second cause of death due to infectious causes in the world, and is considered of high relevance to public health. TB is caused by a highly pathogenic and virulent bacterium denominated mycobacterium tuberculosis. Nowadays, there are effective protocols for detection and treatment of this disease, which make it preventable and curable. Diagnosis is reached by specific bacteriological studies in the presence of a clinical epidemiological suspicion. Nevertheless, imagining methods are almost an obligatory part of tuberculosis study and control. Since the lung is the target organ of TB, chest X-ray is commonly used as a support for diagnosis, which is very useful in case of pulmonary TB because it provides characteristic findings to guide diagnosis. It is important to highlight that the mycobacterium tuberculosis has a high potential for dissemination by contiguity, via lymphatic and/or haematogenous, the latter being the cause of the majority of extrapulmonary TB, which are presented in 20% of immunocompetent patients and by up to 60% of immunocompromised. The main site of extrapulmonary TB is into the pleural space, followed by the lymph node, urogenital and osteoarticular involvement, the remainder being infrequent localizations. In these cases, a computed tomography (CT) study based on the selection of images, is the tool used for diagnosis and control, which is also useful for the detection of complications.

Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay.

Urogenital tuberculosis (UGTB) is the most common form of extrapulmonary TB and is responsible for a destructive inflammation of the renal parenchyma and urinary tract often leading to the loss of kidney function. For these reasons, the early diagnosis of this disease, once considered disappeared in developed countries, is very important to establish a prompt and efficient treatment. However, the subtle and non-specific symptoms, often represented by recurrent and persistent lower urinary tract symptoms, can confound and delay the diagnosis. Therefore, an adequate and comprehensive imaging study is necessary in patients with persistent urinary tract infections not responding to the antibiotics and can suggest the hypothesis although bacteriological and/or histologic analysis is required for a definitive diagnosis. In the past years, intravenous urography (IVU) has allowed a comprehensive study of the urinary excretory tract, promoting the knowledge of the radiological findings of this disease. Nowadays, computed tomography urography (CTU), with the implementation of multidetector (MD) technology, has replaced IVU in all its indications; the MDCTU improves the assessment of renal and urinary tract lesions using reformatted images [such as multiplanar reconstruction (MPR) and maximum intensity projection (MIP)]. Therefore, our paper aims to provide a guide for radiologist for searching the classic signs of UGTB on MDCTU, encouraging the use of the MPR and MIP reformatted images.

Imaging Spectrum of Extrathoracic Tuberculosis.

The incidence of extrathoracic tuberculosis (ETB) continues to increase slowly, especially in immunocompromised and multidrug-resistant tuberculosis (TB) patients. ETB manifests with nonspecific clinical symptoms, and being less frequent, is less familiar to most physicians. Imaging modalities of choice are computed tomography (lymphadenopathy and abdominal TB) and MR imaging (central nervous system and musculoskeletal system TB). ETB commonly involves multiple organ systems with characteristic imaging findings that permit accurate diagnosis and timely management.

[The epidemiological situation of urogenital tuberculosis in Siberia and the Far East].

INTRODUCTION: Tuberculosis remains one of the most important problems of our time. Late diagnosis of urogenital tuberculosis (UGT) results from a lack of a clinician awareness, paucity of pathognomonic symptoms and suboptimal therapy for urinary tract infections while UGT often manifests under their disguise. AIM: To determine the incidence of urogenital tuberculosis and its structure in an epidemiologically unfavorable region. MATERIAL AND METHODS: The study compared the temporal changes in the structure of UGT morbidity from 1999 to 2015 in the Siberian and Far Eastern Federal Districts and analyzed outpatient medical records of 456 UGT patients. RESULTS: The highest (46%) proportion of UGT in the structure of extrapulmonary disease was found in 2003, the lowest (22.9%) in 2014. According to outpatient medical records, the proportions of patients with stage 1, stage 2 and cavernous forms of nephrotuberculosis ranged from 21.2 to 37%, 26 to 53.5% and 21.6 to 37%, respectively. The incidence of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013, averaging to 33.9%. CONCLUSIONS: Currently, it is impossible to estimate the true prevalence of UGT, we can only speak about the detection rate. Every fourth UGT patient was under the medical supervision with a wrong diagnosis for 5 or more years. The proportion of UGT in the structure of morbidity from all forms of extrapulmonary TB reached a minimum (22.9%) in 2014 but went up again. Introducing new technologies has led to an improvement of bacteriological verification of UGT and increased prostate tuberculosis detection rate to 35.7%.

18F-flouro-2-deoxyglucose positron emission tomography/computed tomography imaging of solitary prostatic and pulmonary tuberculosis mimicking metastatic prostate cancer.

Genitourinary tuberculosis (TB) is a common type of extrathoracic TB and can be found in isolation or associated with pulmonary TB. It contributes to 10-14% of extrapulmonary TB. Prostate TB is rare and usually found incidentally following transurethral resection of the prostate for treatment of benign prostatic obstruction as an isolated lesion in immunocompetant patient. The authors report a case of prostatic and pulmonary TB in animmunocompetant patient investigating for the positive positron emission tomography in lung and prostate. To our knowledge, this is the first case reported in the literature presenting with simultaneous hypermetabolic lesions in the prostate and lung.

Nationwide survey of urogenital tuberculosis in Japan.

OBJECTIVES: To determine current epidemiology and treatment patterns of urogenital tuberculosis in Japan. METHODS: A questionnaire was sent to the urological departments of 1203 Japanese hospitals. Clinical data was reviewed retrospectively; no time range was specified. RESULTS: Of the 1203 hospitals, 399 returned questionnaires with information about 355 urogenital tuberculosis patients. Of the 399, 153 institutions reported at least one patient, and 201 patients were identified between 2000 and 2007. Infections were located in the kidneys (n = 242), ureter (n = 96), bladder (n = 100), epididymis or testes (n = 81) and prostate (n = 9). CONCLUSIONS: Urogenital tuberculosis is rare in Japan, but patients do exist, and we should not ignore them.

Imaging findings of urinary tuberculosis on computerized tomography versus excretory urography: through 46 confirmed cases.

BACKGROUND: Imaging findings of urinary tuberculosis (TB) on excretory urography (IVP) and CT have been reported to be nonspecific although CT may provide detailed informations. We performed a retrospective study of patients with proven urinary TB to compare imaging findings on IVP and CT and to make a systemic approach to imaging analysis of urinary TB. METHODS: Urinary TB was diagnosed in 46 patients who had IVP and CT examinations prior to definitive diagnosis and treatment. They were 30 females and 16 males with a mean age of 43.6 ys. We assessed the presence and frequency of urinary tract calcifications, autonephrectomy, renal parenchymal masses, renal parenchymal scarring, moth-eaten calices, amputated infundibulum, renal parenchymal cavities, hydrocalycosis, hydronephrosis, hydroureter and thick urinary tract walls. RESULTS: CT was most sensitive in detecting any renal parenchyma cavities (p=0.01), hydronephrois (p=0.0005), ureteral stricture (p=0.03) and walls thickening of the renal pelvis / ureter (p< 0.0001). Four imaging patterns were noted in 20 IVPs (43%) and 34 CTs (74%) with multiple findings. They were hydrocalycosis, hydronephrosis or hydroureter du to multiple stricture sites, ureteral stricture with thick wall, autonephrectomy combined with at least 1 other type of imaging finding and thick wall of renal pelvis or ureters and bladder with at least 1 other type of imaging finding. CONCLUSIONS: Renal parenchymal cavities, hydronephrosis, ureteral stricture and thickened urinary tract walls were significantly more common on CT than on IVP. Multiple findings on CT were more common and very useful for TB diagnosis. Thus, we recommend CT as the standard exam in patients with suspicion of urinary TB.