Magnetic resonance imaging and ultrasound evaluation of penile and testicular masses.

The purpose of this study is to present the role of ultrasonography and MRI in the investigation of testicular and penile masses, as well as to review the literature. This article is based on our experience with 230 patients who presented with acute or subacute scrotal pain or painless enlargement of the scrotum or penis. Gray scale and color Doppler ultrasonography (CDU) were applied in all cases. In 73 cases, the final diagnosis was established by surgery and in 157 cases by follow-up. MRI was performed in 48 cases. Ultrasonography was the initial imaging modality in all cases. It provided detailed anatomic information with high sensitivity and accuracy in cases of torsion, inflammation, varicocele and trauma. In cases of tumor, US showed the presence of the mass in all cases, while it additionally revealed certain characteristic features of tissue constitution and blood supply. In most cases, differentiation between various types of tumors or differentiation between malignant and benign lesions was impossible. MRI, besides the detailed anatomic imaging, also provided a certain degree of tissue specificity. MRI could help in the detection and staging of penile cancer and in the evaluation of testicular and scrotal masses, especially when a diagnostic dilemma occurred on ultrasonographic examination. Ultrasonography, combining gray scale and color techniques, is irreplaceable in the diagnostic work-up of scrotal and penile masses, while MRI can serve as a problem solving diagnostic modality.

Ossifying pituitary gonadotroph adenoma: A case report.

BACKGROUND: Bone formation in pituitary adenomas is a rare finding. Only two previous cases were published, occurring in a prolactin- producing and a growth hormone- producing pituitary adenoma respectively, both in pre-menopausal women. CLINICAL MATERIAL: This is the third report of an ossified pituitary adenoma and the first report of a pituitary gonadotroph adenoma with bone formation occurring in an elderly man. MRI imaging revealed an unusual eggshell cap-like calcified structure surrounding the tumor. Histologically, the adenoma contained irregularly anastomosing trabecules with well formed lacunae and osteoblasts along the margins. CONCLUSIONS: Insufficient tumor blood supply may trigger proliferation of connective tissue that subsequently undergoes osteoid metaplasia. Pituitary adenoma with osteoid metaplasia should be included in the differential diagnosis of calcifying tumors in the sella region.

MR urography in the diagnosis of urinary tract obstruction.

OBJECTIVE: To evaluate the efficiency of MR urography in depicting the urinary tract. METHODS: 33 patients with urinary tract abnormalities were additionally evaluated with MR urography. 25 had dilated upper urinary tracts because of urinary obstruction and 8 had normal tracts. MR urography was performed with a 1,5T magnet using a heavy T2w sequence (3D-IR-TSE) in the coronal plane. Images were post-processed using the MIP algorithm. Both reconstructed and source images were evaluated. The results of MR urography were compared with the final diagnosis, which was established surgically in 23 cases, and with multimodality imaging workup in 10 cases. RESULTS: MR urography correctly depicted the level of obstruction and the degree of dilatation of the urinary tract in all 25 patients with hydronephrotic kidneys (sensitivity 100%). Additionally, it succeeded in suggesting the underlying pathology in 25 cases (48%). Concerning the 8 patients without dilatation of the urinary tract, there was either no depiction or depiction was bad. CONCLUSION: MR urography, a new noninvasive technique, demonstrates 100% sensitivity in diagnosing urinary tract obstruction and also suggests the underlying pathology in many cases. In nondilated systems it is not possible to get good images because MR urography only depicts fluid in the urinary tract. Thus we believe that MR urography can provide a reliable alternative in selected cases as opposed to other more invasive modalities, such as retrograde or antegrade urography, and is without the risk of contrast media and radiation exposure.

Comparative study of magnetic resonance angiography, digital subtraction angiography, duplex ultrasound examination with surgical and histological findings of atherosclerotic carotid bifurcation disease.

This study was designed in order to determine the diagnostic accuracy in imaging of the extracranial arteries by using magnetic resonance angiography (MRA), digital subtraction angiography (DSA), B-mode duplex ultrasonic examination (DUE) in comparison with the surgical and histological findings of the specimen removed after endarterectomy. The degree of stenosis of the arterial lumen of the surgical specimen was compared with the imaging findings of MRA, DSA and DUE: a) the degree of agreement of stenosis with histologic findings was found in 89% of cases for MRA, in 93% for DSA and 88% for DUE; b) the correlation of morphology of the plaque showed agreement in 91% of the cases with MRA, in 94% with DSA and 87% with DUE; c) the constitution of the plaque was in agreement with DUE findings in 96% of cases. There is no significant difference between the three methods, as far as the estimation of degree of carotid stenosis and morphology of the atheromatous plaque in the carotid arteries. MRA findings are similar with those of DSA and DUE with a high sensitivity and specificity concerning the constitution of the plaque. The combination of MRA and DUE provides all the necessary information concerning the extracranial segments of the cerebral arteries for the preoperative evaluation of patients with carotid disease.

Three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography in carotid artery dissections.

A retrospective analysis comparing the three-dimensional time-of-flight MR angiography, MR imaging and transfemoral digital substraction angiography (DSA) in cases of carotid artery dissection was made. During a 2-year period, 12 cases (11 males and 1 female), aged between 16 and 60 years, were submitted to our Hospital with the symptoms of TIA, stroke or cranial nerve palsies and the suspicion of carotid dissection. Transfemoral angiograms were done in other Institutions, while the MRI and MRA were performed in our diagnostic center. Blind interpretation of MR and angiography images was made by two independent radiologists. MR angiography in combination with MR imaging was more accurate than conventional angiography in the diagnosis of carotid artery dissection. Respective sensitivity and specificity were 100% and 100% for MRI with MRA and 91.6% and 100% for conventional angiography. From the analysis of this small series, we can conclude that MR angiography in combination with MR imaging is a reliable noninvasive method for use in diagnosis of extracranial internal carotid artery dissection.

Liver lesion on computed tomography and ultrasonography in adult Niemann Pick disease related to sea blue histiocyte syndrome--a case report.

The case of a 42-year-old man with Niemann Pick disease and a liver lesion is presented. The lesion was hypodense on CT and had mixed echogenicity on US. Hepatosplenomegaly, interstitial infiltration of the lungs, an absence of neurological signs, family history, laboratory data, sea blue histiocytes in the bone marrow and Niemann Pick's cells in the liver suggested a subtype of Niemann Pick disease (Type B), with a focal lesion in the liver due to thus condition. We believe that this is the first case in the literature. Niemann Pick disease and its subtypes, as also the sea blue histiocyte syndrome are briefly discussed.