The utility of chemical shift imaging and related fat suppression as standalone technique in cryptorchidism using low field MRI

Cryptorchidism is failure of one or both testes to descend completely into the scrotum. The testis can be located anywhere along its journey of descent, between the lower pole of the kidney and the inguinal canal. Objective: The aim of this study was to assess the effectiveness of chemical shift imaging and Dixon based fat suppression using low field MRI in non-palpable undescended testicle. Patients and methods: From July 2017 through February 2018, Twenty eight boys, presented by either unilateral or bilateral cryptorchidism, with total number of forty testicles, underwent MRI study using low field machine in T1-weighted dual gradient-echo in-phase and opposed-phase sequence with Dixon based fat suppression. Results: Based on the laparoscopic/operative data, twenty one testes were located at the inguinal region, whereas fifteen testes were pelvi-abdominal and four were absent. The whole image sets of CSI and Dixon fat suppression had the highest specificity and positive predictive value (100%) and the highest overall accuracy (95%) for detection of undescended testes. Conclusion: chemical shift imaging combined with Dixon based fat suppression is reliable imaging tool as a standalone technique for evaluating cryptorchidism, providing high specificity and diagnostic accuracy.     

Malignant germ cell tumours of undescended testes: imaging features with pathological correlation

AIM: To illustrate the imaging features of malignant germ cell tumours complicating undescended testes, emphasizing the importance of recognizing this condition and providing a correct diagnosis to facilitate appropriate management. METHODS: The clinical presentation, ultrasonography (US) and computed tomography (CT) features of eight consecutive patients with malignant germ cell tumours of undescended testes were reviewed. RESULTS: CT performed in seven patients showed well-circumscribed soft-tissue masses with inhomogeneous enhancement in all cases. US in four patients showed circumscribed masses with inhomogeneous echogenicity. On pathological examination, there were two cases of embryonal carcinoma and six cases of seminoma. All tumours showed necrosis that correlated to inhomogeneous areas on imaging. CONCLUSION: The radiologist has an important role as he may be the first physician to suggest the diagnosis.     

Ultrasonography of the undescended testis

Sixty prospective sonographic preoperative examinations were performed on 57 boys, 3 to 12 years of age (mean 6 2/3), in order to investigate the accuracy of the method for localizing undescended or non-palpable testes in the anteperitoneal region, i.e. the inguinal canal. Sonographic results agreed with the findings at surgical exploration in 53 (88%) of the 60 examinations performed which was regarded as a satisfactory result. The method is convenient and valuable for the planning of surgery. Sonograms of patients earlier operated upon were difficult to interpret and accounted for some misinterpretations as did examinations in some patients with divergent anatomy.     

Lymphomatous superficial lymph nodes: US detection

Superficial adenopathy is the most frequent clinical manifestation of lymphoma, both at initial workup and later when disease recurs. Data obtained by means of physical examination and ultrasonography (US) of the cervicosupraclavicular, axillary, and inguinal regions were compared for 120 patients, 60 at the time of initial staging and 60 during follow-up for a previously treated lymphoma. Twenty-nine in the second group had recurrent disease, as confirmed with histologic examination. For all 120 patients, US revealed clinically impalpable lesions in an average of 10.8% of cases for the cervicosupraclavicular region, 17.9% for the axillary region, and 4.1% for the inguinal region. Eight of the 29 relapses were not detected at physical examination, and three were demonstrated solely with US. These findings emphasize the value of US exploration of the superficial node-bearing regions in patients with lymphoma, during both initial staging and follow-up.     

隐睾合并精原细胞瘤的CT征象分析

目的:探讨隐睾合并精原细胞瘤的CT特点,以期提高对本病的认识.方法:对7例经手术病理证实的隐睾合并精原细胞瘤的CT图像进行回顾性分析.结果:7例隐睾合并精原细胞瘤中,2例位于后腹膜,3例位于盆腔腹膜外,2例位于腹股沟管.其CT征象有肿块以实质性为主;肿块可有完整包膜,如边缘不清则提示有局部侵犯;肿块长轴多与睾丸下行路径一致;腹股沟管内口附近肿块可见伪足状突起.结论:隐睾合并精原细胞瘤的CT征象有相对特征性,对于本病的诊断具有重要价值.     

Ultrasound features of spermatic cord hydrocele in children

The aim was to evaluate the value of ultrasound diagnosis of spermatic cord hydrocele as a cause of inguinal swelling or mass in children. Clinical and ultrasound (US) findings and surgical procedures of 27 children with spermatic cord hydrocele were reviewed. All children, except one, were referred for US because of suspected inguinal hernia, hydrocele or inguinal mass. In one child, the US examination was performed to confirm the diagnosis of a spermatic cord hydrocele. An encysted hydrocele was diagnosed in 24 out of 27 cases, whereas a funicular type of spermatic cord hydrocele was found in the remaining 3 cases. Internal septa were seen within the fluid mass in four patients. 23 children underwent surgical exploration that confirmed the US diagnosis. Three children with encysted-type hydrocele were only followed clinically and by US, and one was lost from follow-up. US examination is a very sensitive and accurate method for diagnosis of this entity and for exclusion of other lesions in this region.     

腹腔内型隐睾症的CT诊断价值

目的评价CT对腹腔内隐睾的诊断价值.方法对34例年龄在3～31岁,临床未触及且B超未显示的隐睾症病人行CT检查,均经手术证实.结果全部未降睾丸(34枚)均由CT正确显示.34例中6例为两侧性,28例为单侧性.结论CT应成为腹腔内隐睾首选的术前定位方法.     

磁共振在未降睾丸诊断中的临床价值初探

目的评价ＭＲＩ对未降睾丸的诊断价值。方法对１５例年龄在１～２８岁、临床不可触及的未降睾丸病人行ＭＲＩ检查，均经手术证实。结果所有未降睾丸（１８枚）均由ＭＲＩ正确显示，１５例中，３例为双侧，１２例为单侧。结论ＭＲＩ具有无创性、无辐射性，且能多方位成像的特性。本组病例证实其为未降睾丸定位的一种非常有用的影像手段，ＭＲ影像能揭示未降睾丸的解剖及组织学特征，最佳的成像平面为横断位及冠状位，ＧｄＤＴＰＡ增强有助于未降睾丸的显示     

Persistent mullerian duct syndrome with teratoma in an ectopic testis: imaging features

The persistent mullerian duct syndrome represents a rare form of male pseudohermaphroditism, secondary to mullerian inhibiting factor (MIF) deficiency. We describe imaging findings in a 30-year-old male (46 XY karyotype) with bilateral cryptorchidism and mullerian duct anomalies (presence of uterus and fallopian tubes). Grade-III teratoma with yolk sac tumour was detected in one of the undescended testis, lying in the pelvic cavity. The other testis was in the inguinal canal. The rest of the wolffian duct structures (e. g. prostate, seminal vesicles) were nearly normal. Very few reports of imaging findings of this entity have been published thus far, probably because of the rarity of entity, incidental detection of most of the cases at surgery and relatively asymptomatic clinical presentation. Received: 6 March 2000 Revised: 3 August 2000 Accepted: 8 August 2000     

Nonpalpable testes in young boys: evaluation with MR imaging

A prospective evaluation of magnetic resonance (MR) imaging for localization of a nonpalpable testis was performed in 24 boys aged 11 months to 6 years. Definitive surgical follow-up was obtained for 15 nonpalpable testes in 14 patients who form the basis of this study. MR imaging correctly indicated the unilateral absence of a testis in six of seven patients prospectively and all seven patients retrospectively. Surgically localized undescended testes were identified with MR imaging in five of eight cases prospectively and seven of eight cases retrospectively. Like scrotal testes, undescended testes were hypointense to fat on sequences with a short repetition time (TR) and echo time (TE) in all cases, and hyperintense or isointense to fat on long TR/TE sequences in all but two cases. Inguinal testes were located along the course of a linear low-signal-intensity structure that extended to the scrotum, which may represent the remnant of the gubernaculum testis. A low-signal-intensity band through the testis, presumably the mediastinum testis, was seen in five of the undescended testes. Although MR imaging can often be used to localize a nonpalpable testis, currently MR is not sensitive enough to allow complete exclusion of the diagnosis of an undescended testis; thus failure to localize a testis with MR imaging should not defer laparoscopy or surgical exploration when indicated.     

原发性甲旁亢的影像学诊断

目的：对原发性甲旁亢的影像学检查方法及诊断价值进行评估。材料和方法：对手术病理证实的５３例原发性甲旁亢病例的影像学资料进行回顾性分析。其中３５例作ＣＴ检查,Ｂ超检查４６例,核素检查５例。结果：５３例甲旁亢手术确诊甲旁腺腺瘤５１例,占９６．２３％。甲旁腺增生２例。ＣＴ检查有２７例诊断为甲旁腺腺瘤（２７／３５）,病灶８１．４８％位于甲状腺下极（２２／２７）,１８．５２％位于甲状腺上极（５／２７）;各病灶增强后通常有明显强化,比平扫时ＣＴ值上升约３０￣４０Ｈｕ。Ｂ超检查有３８例诊断为甲旁腺腺瘤（３８／４６）。核素检查中３例误诊为甲状腺腺瘤。结论：原发性甲旁亢的定性诊断主要依靠临床及生化检查,定位诊断依靠Ｂ超、ＣＴ及核素等影像学检查,Ｂ超和ＣＴ检查的原发笥甲旁亢的诊断中敏感性及特异性无显著差别,两者可互相补充,根据甲旁     

The echographic picture of the breast following quadrantectomy and radiation therapy]

Our experience moved from the clinical relevance of an eventual positive role of US in the follow-up of breast cancers treated with conservative therapy. This trial was suggested by the more and more frequent use of conservative therapy an by the diagnostic difficulties offered by the breasts treated with surgery and radiation therapy. Aim of the study is to analyze the diagnostic value of US in the identification of local relapse in a group of 60 patients with breast carcinoma (stages I and II) treated with conservative therapy. The patients were studied for at least 2 years following treatment, with clinical, US, and mammographic controls at 6, 12, and 24 months. The following clinical problems were considered: 1) study of the US patterns of the morphological and structural changes induced by conservative treatment; 2) observation of US and mammographic agreement in case of local relapse; 3) role of US in the follow-up of this kind of patients. US patterns and results at 6 months follow: cutaneous scar (60/60 cases), skin thickening (55/60), architectural distortion (asymmetry and amputation of the glandular cone, intramammary scar) (52/60), volumetric changes in the treated breast (50/60), skin asymmetry and retraction (50/60), "parenchymal fibrosis" (48/60), mass (8/60) and calcifications (3/60). As for the very few relapses (4 cases), US failed to reveal a ductal carcinoma which presented as microcalcifications. In our experience, US is a complementary exam to clinical and radiologic investigations, especially in the period immediately following therapy and in case of particular clinical problems, such as increased breast volume, mastitis, and appearance of a nodule.     

Ultrasonographic evaluation of bilateral groins in children with unilateral inguinal hernia

PURPOSE: The presence of hernia was investigated prospectively by US in both groins of children with clinically suspected or apparent unilateral inguinal hernia. MATERIAL AND METHODS: One hundred and twenty-eight (103 boys, 25 girls) were classified into three groups according to age: 0-2, 3-5 and 6-15 years. The widest diameter of the inguinal canal was measured in the longitudinal plane while the children were in the supine position and at rest. The patent processus vaginalis (PPV) values of 4 mm and higher were accepted as hernia. The groins diagnosed clinically and/or ultrasonographically as hernia were explored surgically. The clinical and US findings were compared with surgical results. The relations between hernia diameters and the age groups, sex, right/left and inguinal/scrotal hernias were analyzed statistically. RESULTS: In 128 children, 138 groins were treated with surgery. One hundred and eleven cases were unilateral hernia (73 right, 38 left) and 10 were bilateral. Seven cases were found to be normal. Ten cases with clinically unilateral hernia were bilateral at US and surgery. One hundred and thirty-one of 138 groins were correctly diagnosed by US. The accuracy, specificity and sensitivity of US were 94.9%, 85.7% and 95.4%, respectively. The accuracy of physical examination was 87.7%. There were no significant differences between hernia diameters and the age groups, sex and right/left side except the difference between inguinal and scrotal hernia diameters (p<0.0001). CONCLUSION: US can be used routinely in the pre-operative diagnosis of inguinal hernia in children. PPV values higher than 4 mm, with a high accuracy indicate hernia.     

Ultrasonography in undescended testes

The position of an undescended testicle is of importance for choice of therapy. The aim of this study was to investigate whether the anatomic positions occupied by undescended testicles could be detected by an objective method. Real-time ultrasonography was performed in 83 patients with 123 undescended testicles. Patient compliance was 97 per cent. The testis was demonstrated as an echo-poor, oval structure in 113 of 119 examinations (95%). By determining the relation of the testis to definable anatomic landmarks in the inguinal region, all positions occupied by the testis could be characterized by ultrasound and the testicles classified accordingly. The relationship of the testis to the external ring was established in 112 cases (94%). Twenty-seven per cent of retractile and 11 per cent of truly undescended testicles were demonstrated in more than one ascended position. Estimation of testicular volume by sonography was unsuccessful compared with intraoperative measurements.     

Undescended testis: value of MR imaging

Magnetic resonance (MR) imaging was performed in 32 male patients, 20 with no abnormalities and 12 with clinically suspected undescended testes. The results were compared with ultrasonographic, computed tomographic, clinical, and surgical findings. The undescended testes were unilateral in eight patients (one had testicular duplication) and bilateral in four. Of 16 undescended testes, 15 were correctly identified on MR images. One intraabdominal testis was not seen. Testis-fat contrast at 0.35 T was optimal with a short repetition time (TR) and a short echo time (TE). At 1.5 T, good contrast was achieved with short TR/TE sequences, but the contrast was even more pronounced with even longer TR/TE parameters. In seven patients with unilateral undescended testes, the undescended and contralateral testes showed symmetrical tissue signal intensity on both T1- and T2-weighted images. In three, the undescended testis was of lower signal intensity, suggesting atrophy. MR imaging promises to become an important diagnostic tool in the detection of undescended testes.     

Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings

OBJECTIVE: To determine the diagnostic accuracy of physical examination, ultrasound, and dynamic MRI in patients with inguinal hernia. METHODS: In 41 patients with clinically evident herniations, 82 groins were evaluated using a standard ultrasound and MRI protocol, the latter including T1- and T2-weighted sequences as well as two dynamic sequences. All ultrasound examinations and MRI scans were reviewed without knowledge of clinical findings. In all cases, correlation with findings at laparoscopic surgery was made. RESULTS: At surgery, 55 inguinal herniations were found. Physical examination revealed 42 herniations (one false-positive finding), whereas ultrasound made the diagnosis of a hernia in 56 cases (five false-positive and four false-negative findings). MRI diagnosed 53 herniations (one false-positive and three false-negative findings). Thus, sensitivity and specificity figures were 74.5% and 96.3% for physical examination, 92.7% and 81.5% for ultrasound, and 94.5% and 96.3% for MRI. CONCLUSIONS: In patients with clinically uncertain herniations, MRI is a valid diagnostic tool with a high positive predictive value.     

腹内未降睾丸巨大纯精原细胞瘤六例CT资料分析

目的 探讨螺旋CT对腹内未降睾丸巨大纯精原细胞瘤的诊断价值.方法 回顾性分析经手术病理证实的6例巨大的腹内未降睾丸纯精原细胞瘤的螺旋CT表现.结果 6例肿块长轴与同侧肾下极和腹股沟内环的连线一致.供血动脉均为同侧睾丸动脉,5例显示睾丸静脉引流.同侧睾丸及精索未显示,2例肿块尾端见未退化的睾丸引带.同侧肾脏受压上移.肿块呈囊实混合型,内侧坏死明显,其内可见条状纤维血管分隔,实性部分轻度均匀强化.所有肿块内未见钙化或脂肪.结论 螺旋CT是腹内巨大精原细胞瘤术前定位定性诊断的一种有用的影像手段.     

原发性输尿管癌的影像学特点及诊断价值

目的　探讨原发性输尿管癌的影像学特点及诊断价值。方法　对 2 4例原发性输尿管癌的超声、静脉尿路造影 (IVP)、逆行造影及CT检查资料进行回顾性分析。结果　病变显示率为 :B超 45 .8% ( 11/ 2 4) ,IVP 3 7.5 % ( 9/ 2 4) ,RP 88.8% ( 16/ 18) ,CT 62 .5 % ( 10 / 16)。结论　B超检查利于筛选病例 ;肾盂造影是了解肾功能并显示肿瘤的基本检查方法 ;逆行造影对肿瘤的显示和诊断价值最高 ;病变区CT扫描对于定性诊断、了解周围侵犯程度也具有重要价值。     

Mammography and echography in male breast pathology]

From January 1988 through December 1991, 81 men were examined for breast enlargement or mass in our Institute, by means of clinical examination, mammography, and US. The patients' age ranged 15-71 years (mean: 52 years). Of 81 studied patients, 71 had gynecomastia, 8 had adipomastia, 1 had an infiltrating ductal carcinoma, 1 an angiofibrolipoma and 1 a simple cyst. Both the carcinoma and the cyst were associated with gynecomastia. Three mammographic patterns of gynecomastia were observed: a glandular pattern in 42 cases (32 bilateral and 10 monolateral), a dendritic pattern in 12 (8 bilateral and 4 monolateral), and a nodular pattern in 15 (9 bilateral and 6 monolateral). On US, gynecomastia appeared diffuse in 54 patients and focal in 15. The infiltrating ductal carcinoma was clinically evident; no asymptomatic cancers were detected. Surgical biopsy was performed in 40 cases. A good correlation was observed between mammographic and US signs. The combined use of the two modalities can improve diagnostic accuracy. Biopsy must be performed in all questionable cases.     

未降睾丸并精原细胞瘤的MRI诊断

目的 探讨未降睾丸并精原细胞瘤的ＭＲＩ特点,以期提高对本病的认识。材料与方法 ３例经病理证实的未降睾丸精原细胞瘤,采用Ｓｈｉｍａｄｚｕ５０Ｘ／Ｈ型磁共振仪,０．５Ｔ,超导,术前行ＭＲＩ平扫及增强扫描。结果 ３例均为单侧腹腔内精原细胞瘤,直径分别为８ｃｍ、９ｃｍ及２ｃｍ,其ＭＲＩ特点包括：⑴阴囊内单侧或双侧睾丸缺如并腹内肿块;⑵肿块常较大;⑶信号强度不均,常有出血、钙化及坏死;⑷恶变的未降睾丸可有完