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1.
Urology ; 108: 171-174, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28705578

RESUMO

Cloacal duplication is an exceedingly rare group of anomalies with a limited number of cases reported so far. The anomaly may be confined to partial bladder duplication or it may involve complete duplication of the urogenital tract, hindgut, spine, lower limbs, and vascular structures. Every case is unique and ought to be approached individually. By means of imaging studies and endoscopy, anatomic details should be carefully defined before endorsing surgical correction. A satisfactory outcome can be achieved in the majority of cases. In this report, we describe 3 girls with cloacal duplication, and review pertinent imaging and surgical management.


Assuntos
Cloaca/anormalidades , Gerenciamento Clínico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Criança , Pré-Escolar , Cloaca/diagnóstico por imagem , Cloaca/cirurgia , Cistoscopia , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Doenças Raras , Ultrassonografia , Anormalidades Urogenitais/diagnóstico
2.
J Urol ; 192(1): 194-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24518781

RESUMO

PURPOSE: Staging of childhood renal tumors is crucial for treatment planning and outcome prediction. We sought to identify whether computerized tomography could accurately predict the local stage of childhood renal tumors. MATERIALS AND METHODS: We retrospectively reviewed our database for patients diagnosed with childhood renal tumors and treated surgically between 1990 and 2013. Inability to retrieve preoperative computerized tomography, intraoperative tumor spillage and nonWilms childhood renal tumors were exclusion criteria. Local computerized tomography stage was assigned by a single experienced pediatric radiologist blinded to the pathological stage, using a consensus similar to the Children's Oncology Group Wilms tumor staging system. Tumors were stratified into up-front surgery and preoperative chemotherapy groups. The radiological stage of each tumor was compared to the pathological stage. RESULTS: A total of 189 tumors in 179 patients met inclusion criteria. Computerized tomography staging matched pathological staging in 68% of up-front surgery (70 of 103), 31.8% of pre-chemotherapy (21 of 66) and 48.8% of post-chemotherapy scans (42 of 86). Computerized tomography over staged 21.4%, 65.2% and 46.5% of tumors in the up-front surgery, pre-chemotherapy and post-chemotherapy scans, respectively, and under staged 10.7%, 3% and 4.7%. Computerized tomography staging was more accurate in tumors managed by up-front surgery (p <0.001) and those without extracapsular extension (p <0.001). CONCLUSIONS: The validity of computerized tomography staging of childhood renal tumors remains doubtful. This staging is more accurate for tumors treated with up-front surgery and those without extracapsular extension. Preoperative computerized tomography can help to exclude capsular breach. Treatment strategy should be based on surgical and pathological staging to avoid the hazards of inaccurate staging.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Tomografia Computadorizada por Raios X , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estadiamento de Neoplasias/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
5.
Urology ; 81(4): 880-4, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23395121

RESUMO

OBJECTIVE: To define the preoperative kidney and stones characteristics on noncontrast-enhanced computed tomography that affect the success of extracorporeal shockwave lithotripsy (SWL) for treatment of renal calculi in pediatric patients. MATERIALS AND METHODS: From 2005 to 2011, 57 children (age <16 years) with documented preoperative noncontrast-enhanced computed tomography scans underwent SWL for treatment of renal stones and were included in the present study. Stone size, site, multiplicity, average skin-to-stone distance, stone attenuation value, and kidney morphology were determined from the preoperative noncontrast-enhanced computed tomography scans. Success was defined as radiographically stone-free status at the 3-month follow-up examination after a single lithotripsy session without the need for additional sessions or ancillary procedures. RESULTS: After a single session of SWL, 24 children (42.1%) were stone free on the 3-month follow-up imaging study without the need for additional SWL sessions. Treatment failed in 33 patients (57.9), with residual fragments in 30 children, of whom 29 required repeat SWL, and 3 with stones that were considered unchanged and were finally treated with percutaneous nephrolithotomy. Logistic regression analysis revealed that stone attenuation in Hounsfield units (HU) and stone length were the only significant predictors of success. When the HU were stratified into 2 groups of ≤600 and >600 HU, the SWL success rate was 82.1% and 20%, respectively (P = .023). When length was stratified as ≤12 mm and >12 mm, the stone-free rate was 58.6% and 25.1%, respectively (P = .016). CONCLUSION: Stone attenuation ≤600 HU and stone length ≤12 mm were significant independent predictors of SWL success in children.


Assuntos
Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Cálculos Renais/patologia , Litotripsia , Masculino , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
6.
BJU Int ; 111(4): 666-71, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22924860

RESUMO

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Extracorporeal shockwave lithotripsy is effective for the treatment of paediatric renal stones with favourable short-term safety. Extracorporeal shockwave lithotripsy for treatment of paediatric renal stones is also safe for the kidney and the child on long-term follow-up. OBJECTIVE: To evaluate the long-term effects of extracoporeal shockwave lithotripsy (SWL) for treatment of renal stones in paediatric patients. PATIENTS AND METHODS: A database of paediatric patients who underwent SWL monotherapy for treatment of renal stones from September 1990 through to January 2009 was compiled. This study included only patients with follow-up for more than 2 years. The long-term effects of SWL were evaluated at the last follow-up with measurement of patients' arterial blood pressure, estimation of random blood sugar and urine analysis. The results of diastolic blood pressure were plotted against a standardized age reference curve. The treated kidney was examined by ultrasonography for measurement of renal length and detection of stones. The measured renal lengths were plotted against age-calculated normal renal lengths in healthy individuals. RESULTS: The study included 70 patients (44 boys (63%) and 26 girls) with mean age at the time of SWL 6.5 ± 3.6 years (range 1-14). The mean follow-up period was 5.2 ± 3.6 years (range 2.1-17.5). The mean age at last follow-up was 11.7 ± 5.3 years (range 4.4-27.5). No patients developed hypertension or diabetes. Only one treated kidney was smaller than one standard deviation of the calculated length. The cause of this was obstruction by a stone in the pelvic ureter 3 years after SWL. CONCLUSION: The long-term follow-up after SWL for treatment of renal stones in paediatric patients showed no effect on renal growth and no development of hypertension or diabetes.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Segurança do Paciente , Adolescente , Fatores Etários , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Cálculos Renais/diagnóstico por imagem , Litotripsia/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Tempo , Resultado do Tratamento , Ultrassonografia
7.
Int Urol Nephrol ; 44(6): 1623-30, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22833254

RESUMO

OBJECTIVES: To evaluate the outcome of transurethral resection of the ejaculatory duct (TURED) in the treatment for ejaculatory duct obstruction (EDO) and define predictors of success. MATERIALS AND METHODS: We retrospectively evaluated 23 infertile men between 2006 and 20011, who were diagnosed as having EDO. Inclusion criteria were azoospermia or oligozoospermia, low ejaculate volume, low ejaculate PH, little or no fructose in seminal plasma with normal serum levels of gonadotropins and testosterone and evidence of obstruction on transrectal ultrasonography (TRUS) or magnetic resonance images (MRI). Seventeen patients were diagnosed as complete EDO, and the remaining 6 were considered as having partial EDO. All patients were treated by TURED. RESULTS: Midline cysts were diagnosed in seven cases, and the remaining 16 patients had postinflammatory obstruction of ejaculatory ducts (ED). Overall, a significant improvement of semen quality was achieved after surgery. All patients with partial EDO showed improvements in semen parameters after TURED compared to 23.5% (4/17) in those with complete EDO. Improvement in sperm count was 71.5% and 31% for patients with midline cysts and patients with non-cystic causes of EDO, respectively. Six (26%) patients developed complications including epididymo-orchitis in 2, watery ejaculate in 3 and conversion to azoospermia in 1. Spontaneous pregnancies were achieved in 3 (13%) cases: 2 (33.3%) men with partial and 1 (5.9%) with complete obstruction. CONCLUSION: Partial EDO, whatever the etiology, has an excellent outcome after TURED. Complete EDO due to cysts appears to respond better than postinflammatory obstruction to TURED.


Assuntos
Ductos Ejaculatórios/cirurgia , Infertilidade Masculina/cirurgia , Adulto , Humanos , Infertilidade Masculina/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Uretra , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto Jovem
8.
BJU Int ; 110(11 Pt B): E622-7, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22757606

RESUMO

UNLABELLED: What's known on the subject? and What does the study add? Diffusion-weighted (DW) MRI is a non-invasive technique measuring the microscopic mobility of water molecules in the tissues without contrast administration. It provides information on perfusion and diffusion simultaneously in any organ, so it can be used to differentiate normal and abnormal tissue structure, and it might help in the characterization of various abnormalities. In recent years, DW-MRI has been applied in the evaluation of urinary tract lesions, such as malignant renal, prostatic and bladder tumours; however, it has not previously been tested on its ability to distinguish residual cancer from fibrotic and inflammatory changes secondary to transurethral resection (TUR) and intravesical chemotherapy, both of which manifest as bladder-wall thickening on T2-weighted MRI. This is the first study to show the feasibility of DW-MRI in follow-up of patients with superficial bladder tumours after TUR. DW-MRI was highly reliable in differentiating post-TUR inflammatory changes from bladder tumours, with results similar to those of conventional cystoscopy. This non-invasive method could be used efficiently in future for follow-up of this patient group and may obviate the need for routine cystoscopy. OBJECTIVE: • To study the feasibility of using diffusion-weighted (DW) magnetic resonance imaging (MRI) in bladder cancer follow-up after transurethral resection (TUR). PATIENTS AND METHODS: • Included in the study were 47 patients with a history of TUR of superficial bladder carcinoma, who were admitted to our centre between January and December 2011 for follow-up cystoscopy. • Before cystoscopy, DW-MRI was performed and the apparent diffusion coefficient (ADC) value was measured in a circular region of interest within the carcinoma and normal bladder wall. • Two radiologists, blinded to the results of cystoscopy, independently interpreted the DW images. • A comparison of imaging findings with those of cystoscopy was performed using the McNemar test. RESULTS: • In our 47 patients, cystoscopy identified 34 bladder lesions in 24 patients and in the remaining 23 the bladder looked normal. • In the 24 patients with malignant bladders, DW-MRI detected 32/34 tumours with two false-negative findings of lesions in two patients. • In 23 patients with non-malignant bladders, the DW-MRI data were accurate for 21 patients, as two patients were misdiagnosed as malignant. • The sensitivity, specificity, accuracy, positive and negative predictive values of DW-MRI for identifying bladder tumours were 91.6% (22/24), 91.3% (21/23), 91.5% (43/47), 91.6 (22/24) and 91.3 (21/23), respectively. • Using the McNemar test there was no significant difference between DW-MRI and cystoscopy. CONCLUSIONS: • DW-MRI has a high reliability in differentiating post-TUR inflammatory changes from bladder tumours, which is similar to that of cystoscopy. • DW-MRI could be a first-line diagnostic test in follow-up of patients after TUR.


Assuntos
Carcinoma de Células de Transição/diagnóstico , Cistectomia/métodos , Cistoscopia/métodos , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Uretra , Neoplasias da Bexiga Urinária/cirurgia
9.
J Magn Reson Imaging ; 36(2): 438-42, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22535687

RESUMO

PURPOSE: To retrospectively assess the value of magnetic resonance imaging (MRI) in the diagnosis of vesicouterine fistula (VUF). MATERIALS AND METHODS: Between January 2003 and January 2011, 12 patients with a diagnosis of VUF were surgically managed at our center; among them, eight patients had MRI among their preoperative radiological investigations and those were included in our study. The clinical presentation, radiological investigations, and surgical findings of the patients were reviewed. RESULTS: The mean age of the patients was 31 years. Seven of the eight patients had complaints of cyclic hematuria and the remaining patient complained of urinary leakage through the vagina. The etiology of VUF was cesarean section in all patients. The preoperative radiological investigations included conventional cystography in five patients, intravenous urography in two, computed tomography (CT) urography in two, and MRI in eight. The sensitivities of diagnosis for these investigations were 40%, 0%, 50%, and 100%, respectively. CONCLUSION: In our small retrospective series, pelvic MRI was reliable and sensitive for diagnosis of VUF. It should be considered in the work-up of patients with suspected VUF.


Assuntos
Imagem por Ressonância Magnética/métodos , Fístula Vesicovaginal/patologia , Adulto , Feminino , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
10.
Urology ; 79(2): e17-8, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21762968

RESUMO

Seminal vesicles cyst (SVC) associated with ipsilateral renal agenesis is a rare condition. Until now, contralateral renal agenesis has been found together with SVC in only 3 cases. We report the first case in the literature where contralateral renal agenesis was seen together with giant SVC, causing ipsilateral ureteral obstruction with rising of serum creatinine.


Assuntos
Cistos/complicações , Doenças dos Genitais Masculinos/complicações , Hidronefrose/etiologia , Rim/anormalidades , Imagem por Ressonância Magnética , Glândulas Seminais/patologia , Adulto , Creatinina/sangue , Cistos/patologia , Cistos/cirurgia , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Hidronefrose/patologia , Hidronefrose/cirurgia , Masculino , Noctúria/etiologia
11.
Arab J Urol ; 10(3): 279-83, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26558037

RESUMO

OBJECTIVE: To evaluate the detectability, size, location and density of urinary stones with unenhanced computed tomography (CT), using the half-radiation (low) dose (LDCT) technique, compared with the standard-dose CT (SDCT), in obese patients. PATIENTS AND METHODS: The study included 50 patients with a body mass index of >30 kg/m(2) and bilateral renal stones diagnosed with SDCT, and managed on one side. All the patients had LDCT during the follow-up and SDCT was used as a reference for comparison. RESULTS: Of the 50 patients, the right side was affected in 27 and the left side in 23. In all, 35 patients had a single stone while the remaining 15 had multiple stones. With SDCT, 95 stones were detected; there were 45 of ⩽5 mm, 46 of 6-15 mm and only four of >15 mm. LDCT barely detected three stones of <3 mm, compared with SDCT, while larger stones had the same appearance at both scans. The site of stone in the kidney or the ureter did not affect its detection on LDCT vs. SDCT. The mean stone diameter was identical in both techniques. At LDCT, all stones were detected with no difference in their number, location or density vs. SDCT. However, the tube current and radiation dose were significantly lower with LDCT. CONCLUSIONS: In obese patients with stone disease, LDCT is as accurate as SDCT, while avoiding exposure of the patient to high-dose radiation.

12.
Urology ; 77(2): 286-90, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20719366

RESUMO

OBJECTIVES: To evaluate the ability of noncontrast computed tomography (NCCT) to predict stone composition and fragility for treatment with extracorporeal shock wave lithotripsy (SWL). METHODS: A total of 103 stones from patients who had undergone different open surgical procedures were scanned with a 64 detector row helical computed tomography (CT) scanner using 1-mm collimation at 2 energy levels of 80 and 120 kV. The chemical compositions of the urinary stones were assessed on the basis of the differences in the densities measured in Hounsfield units (HU). Stones were then broken in an electromagnetic lithotripter until complete fragmentation, and number of shock waves was counted. RESULTS: After exclusion of the groups with few calculi, 46 pure stones (18 uric acid, 22 calcium oxalate monohydrate, 6 struvite) and 48 mixed stones were included in the statistical analysis. For measurements at 120-kV, 80-kV, and dual-energy CT values, the overall difference between the densities of the stones was statistically significant; however there was a cross-over in densities between all stone groups. There were significant positive correlations at 120-kV, 80-kV, and dual-energy CT values between stone density and number of shock waves required for complete fragmentation. Stones with HU >1000 required statistically significant higher number of shock waves. CONCLUSIONS: Multidetector CT is not an accurate method for detection of human stone compositions; however a high stone CT attenuation value is s significant predictor of failure to fragment renal stones by SWL.


Assuntos
Litotripsia , Tomografia Computadorizada por Raios X , Cálculos Urinários/química , Cálculos Urinários/diagnóstico por imagem , Humanos , Técnicas In Vitro , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X/métodos , Cálculos Urinários/terapia
13.
Urology ; 75(6): 1353-6, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20350760

RESUMO

OBJECTIVES: We determined the value of clinical and radiological findings in diagnosis of false penile fracture. Also, the long-term outcome of conservative and surgical treatment of such patients was evaluated. METHODS: Seventeen patients with false penile fracture were treated conservatively (3 patients) and surgically (14 patients) at our center. Medical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function and penile sequelae were obtained during follow-up using the Sexual Health Inventory for Men (SHIM) questionnaire and local examination. RESULTS: The most common cause of false penile fracture is sexual intercourse (76.5%). False fracture was suspected in 3 patients who presented with small hematoma and slow post-trauma detumescence; intact tunicas were diagnosed by magnetic resonance imaging (MRI) in all of them and were managed conservatively. Surgical penile exploration was performed in 14 cases, in whom preoperative ultrasound was done in 6, and it was false positive for presence of tunical tear in 50%. Exploration revealed nonspecific dartos bleeding in 9 cases and avulsed superficial dorsal vein in 5. Long-term follow-up (mean=93 months) was available for 16 patients, among whom there was no complications. CONCLUSIONS: In most cases, false penile fracture is indistinguishable from true penile fracture either clinically or radiologically. In atypical cases, MRI seems to be a promising modality for diagnosis of such patients. The long-term outcome of conservative and surgical treatment is excellent.


Assuntos
Imagem por Ressonância Magnética/métodos , Doenças do Pênis/diagnóstico , Doenças do Pênis/terapia , Pênis/lesões , Pênis/patologia , Adulto , Analgésicos/uso terapêutico , Bandagens , Estudos de Coortes , Crioterapia , Diagnóstico Diferencial , Drenagem/métodos , Disfunção Erétil/prevenção & controle , Reações Falso-Positivas , Seguimentos , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto Jovem
14.
ScientificWorldJournal ; 9: 441-8, 2009 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-19526183

RESUMO

The purpose of our study was to assess the role of a 64-slice multidetector CT (MDCT) scanner in the characterization of different solid renal masses, using a simplified approach to correct the postenhancement attenuation values. The study included 96 consecutive adults (58 men, 38 women) with renal masses; 93 with unilateral and three with bilateral masses. All of our patients underwent multiphasic CT study including pre- and postcontrast corticomedullary (CM) and nephrographic phases. We analyzed the images and corrected the postcontrast attenuation values at the CM phase. The postbiopsy or -surgical data were used as reference standard. There were 53 masses at the right kidney, 40 at the left kidney, and three bilateral. The final diagnosis of the 96 solid parenchymal masses were 28 clear-type renal cell carcinoma (RCC), 22 papillary-type RCC, 21 chromophobe-type RCC, six XP 11.2 chromosomal translocation-type RCC, 15 angiomyolipoma (AML), and seven oncocytoma. All the AML had fat, with attenuation values less than -40 HU at the nonenhanced scan. There is no difference in the precontrast attenuation values for the different types other than AML. At the postcontrast CM phase after the correction of the attenuation values, the clear cell type could be separated easily, with attenuation values >20 with specificity, sensitivity, and overall accuracy of 92, 84, and 93%, respectively. The 64-slice MDCT scanner with application of enhancement values correction allows diagnosis of clear cell carcinoma. Also, AML could be identified easily with fat inside at the precontrast scan.


Assuntos
Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Rim/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
15.
Rheumatol Int ; 30(1): 75-9, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19360409

RESUMO

In a previous study, the musculoskeletal affections among kidney recipients (KR) were reported, with 63 KR suffering from joint affections. We sought to determine the prevalence of osteonecrosis (ON) among those KR with joint affections, its distribution among the affected joints, and possible risk predictors. KR were subjected to biochemical, haematological, and hepatitis serology estimations. Radiographic and magnetic resonance imaging were performed. Relevant data were retrieved from Patient Information System. Fourteen KR were suffering from ON, with an incidence of 22.2% in KR with joint affections and 12.0% in the target population of KR. The femoral head was affected in 57.1% and the femoral condyles in 28.6%. Hypocalcaemia was observed in KR with ON. Whether hypocalcaemia is a causative or associative of ON yet remains to be decided in forthcoming studies.


Assuntos
Hipocalcemia/epidemiologia , Transplante de Rim/efeitos adversos , Osteonecrose/epidemiologia , Adulto , Artrografia , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Estudos Transversais , Egito/epidemiologia , Feminino , Humanos , Hipocalcemia/diagnóstico , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Prevalência , Medição de Risco , Fatores de Risco
16.
Radiology ; 251(2): 415-21, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19304915

RESUMO

PURPOSE: To prospectively evaluate the usefulness of diffusion-weighted (DW) magnetic resonance (MR) imaging for the detection of bladder neoplasms in patients with gross hematuria of lower urinary tract origin. MATERIALS AND METHODS: The study protocol received institutional ethical committee approval, and informed consent was obtained. Between April 2007 and March 2008, 130 consecutive patients with gross hematuria whose upper urinary tract had a normal appearance at ultrasonographic examination were prospectively enrolled. Mean age was 59.4 years (range, 45-75 years). All patients were evaluated by using T2-weighted high-spatial-resolution MR imaging of the urinary bladder, followed by DW MR imaging. Two radiologists independently interpreted the T2-weighted and DW images, and discrepancies were resolved by consensus. Agreement was evaluated by using the kappa statistic. All patients underwent conventional cystoscopy. With cystoscopy and the final histopathologic findings as the reference standards, a comparison with imaging findings was performed by using the McNemar test. RESULTS: The consensus diagnostic performance of DW MR imaging for identification of bladder tumors was: sensitivity, 98.1% (104 of 106); specificity, 92.3% (24 of 26); PPV, 100% (104 of 104); negative predictive value, 92.3% (24 of 26); and accuracy, 97.0% (128 of 132). Two cases were falsely negative on T2-weighted MR images but were correctly diagnosed by using DW MR images. The agreement between DW MR imaging results and cystoscopic findings was excellent (kappa = 0.94) for identification of bladder neoplasm. DW MR imaging had a sensitivity and PPV of 98.5% (128 of 130) and 100% (128 of 128), respectively, for determining the cause of hematuria. CONCLUSION: DW MR imaging is a highly reliable imaging approach for identification of bladder tumors in patients with gross hematuria.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Hematúria/diagnóstico , Hematúria/etiologia , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
17.
Eur Radiol ; 19(7): 1575-81, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19247665

RESUMO

The aim of this work was to evaluate the clinical feasibility of diffusion-weighted (DW) MRI in detection and staging of urinary bladder tumour and to compare DW MRI with the T(2)-weighted technique. One hundred and six patients with bladder tumour were prospectively included in our study. All patients were evaluated with MR imaging. We started with axial T(2)-weighted high resolution MR of the urinary bladder, then DW MRI. Two radiologists independently interpreted the MR images, and discrepancies were resolved by consensus. The accuracy of DW MRI in staging of bladder tumour was evaluated using the final histopathological findings. In DW imaging (DWI) staging accuracy was 63.6% and 69.6% in differentiating superficial from invasive tumours and organ-confined from non-organ-confined tumours, respectively. On a stage by a stage basis, DWI accuracy was 63.6% (21/33), 75.7% (25/33), 93.7% (30/32) and 87.5% (7/8) for stages T1, T2, T3 and T4, respectively. In the T(2)-weighted technique, the overall staging accuracy was only 39.6% and accuracy for differentiating superficial from invasive tumours and organ-confined from non-organ-confined tumours was 6.1% and 15.1%, respectively. DW is superior to T(2)-weighted MRI in staging of organ-confined tumours (< or =T2) and both techniques are comparable in the evaluation of higher-stage tumours.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
18.
ScientificWorldJournal ; 8: 364-70, 2008 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-18454244

RESUMO

We conducted a prospective study to demonstrate the feasibility of using diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of urinary bladder carcinomas. Between January to June 2007, 43 patients with single bladder tumor were included in our study. Before taking a biopsy, DW MRI was obtained in the axial plane under free breathing scanning with a multisection, spin-echo type, single-shot echo planar sequence with a body coil. Moreover, the apparent diffusion coefficient (ADC) value was measured in a circular region of interest within the carcinoma, urine, normal bladder wall, prostate, and seminal vesicle. All carcinomas in the 43 patients were clearly shown as high signal intensity relative to the surrounding structure. The sensitivity and positive predictive values of DW MRI were 100% in terms of correctly detecting the carcinomas. The ADC value in the carcinoma (1.40 +/- 0.51) was significantly lower compared with that of urine (3.50 +/- 0.43) (p < 0.001), normal bladder wall (2.29 +/- 0.78) (p < 0.001), peripheral zone of prostate (1.77 +/- 0.44) (p < 0.05), transition zone of prostate (1.88 +/- 0.54) (p < 0.05), and the seminal vesicle (2.12 +/- 0.43) (p < 0.001). There was no statistical difference in ADC values between different histological subtypes. There was no overlap between the ADC values of the tumors and the urine, but there was no clear cutoff between the tumor and bladder wall, prostate, or seminal vesicles. Bladder carcinomas have significantly lower ADC when compared to surroundings. Clinical experience with this method is still preliminary and further studies are required.


Assuntos
Carcinoma/diagnóstico , Imagem por Ressonância Magnética/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Humanos , Invasividade Neoplásica , Projetos Piloto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
ScientificWorldJournal ; 8: 176-81, 2008 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-18301819

RESUMO

The ideal imaging modality should demonstrate the presence or absence of a clinically significant causative vascular lesion which, in high-flow arterial priapism, may need intervention. We report a 22-year-old male with post-traumatic arterial priapism. Doppler US could not reliably identify a significant vascular lesion. Magnetic resonance angiography (MRA) demonstrated the presence of cavernous artery pseudoaneurysm. Based on this finding, embolization was decided with a successful outcome. Contrast enhanced The ideal imaging modality should demonstrate the presence or absence of a clinically significant, causative vascular lesion that, in high-flow arterial priapism, may need intervention. We report a 22-year-old male with post-traumatic arterial priapism. Color Doppler ultrasound could not reliably identify a significant vascular lesion. Magnetic resonance angiography (MRA) demonstrated the presence of a cavernous artery pseudoaneurysm. Based on this finding, embolization was decided, with a successful outcome. Contrast-enhanced MRA appears to be a useful, noninvasive diagnostic tool for decision making in cases of high-flow priapism.


Assuntos
Angiografia por Ressonância Magnética , Pênis/patologia , Priapismo/diagnóstico , Adulto , Falso Aneurisma/diagnóstico por imagem , Embolização Terapêutica , Humanos , Masculino , Pênis/irrigação sanguínea , Priapismo/fisiopatologia , Priapismo/terapia , Resultado do Tratamento , Ultrassonografia Doppler em Cores
20.
BJU Int ; 99(3): 641-5, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17407519

RESUMO

OBJECTIVE: To study the ability of comprehensive magnetic resonance imaging (MRI) to replace multiple imaging methods in the evaluation of patients with pelvi-ureteric junction obstruction (PUJO). PATIENTS AND METHODS: Between May 2003 and November 2005, 46 consecutive patients (22 male and 24 females; mean age 31.6 years) with symptomatic primary PUJO were included. All had comprehensive MRI, including MR urography (MRU), dynamic MRI and MR angiography (MRA). Morphological results of MRU were compared with that of renal ultrasonography or intravenous urography, while the anatomical results of MRA were compared with the operative findings. A correlation between MR clearance and radioisotope clearance was done using linear regression analysis. RESULTS: MRU showed the morphology of the collecting system in all patients, and the ureter below the PUJ in 31 of 46 (67%), but renal stones were missed in three of 10 patients. MRA showed crossing vessels in 22 patients (48%). There was a strong correlation between MR clearance and radioisotope clearance (r = 0.823, P < 0.001). From the MRI results, 35 patients (19 with crossing vessels and 16 with marked hydronephrosis) had pyeloplasty and 11 had an endopyelotomy. Findings during pyeloplasty showed one false-negative and one false-positive result of the preoperative MRI. Therefore, the sensitivity, specificity and accuracy of MRA were 95%, 94% and 94%, respectively. The outcome was successful in 44 (96%) patients. One failure after pyeloplasty was managed with endopyelotomy and the other was treated with pyeloplasty after endopyelotomy. CONCLUSION: Comprehensive MRI is a valuable and accurate single-imaging method for evaluating patients with PUJO.


Assuntos
Cálculos Renais/diagnóstico , Pelve Renal/patologia , Imagem por Ressonância Magnética/normas , Obstrução Ureteral/diagnóstico , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos
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