Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography?

PURPOSE: To present and evaluate the findings of contrast-enhanced ultrasonography (CEUS) in typical cases of acute painful scrotum. MATERIALS AND METHODS: Nineteen patients aged from 19 to 61 years old were included in the study. All patients underwent grey-scale and color Doppler ultrasonography (US) of the scrotum, followed by imaging after i.v. administration of 2.4 mL of a second generation ultrasound contrast agent (microbubbles of sulphur hexafluoride). ? dedicated, contrast-sensitive technique was used (Contrast Tissue Imaging - CnTI). The diagnosis was confirmed surgically in 6 cases while in the remaining 8 cases it was based on the combination of clinical, imaging and laboratory findings. RESULTS: The final diagnosis was testicular torsion (n = 4), epididymitis (n = 2, one of the cases complicated by abscess), testicular abscess (n = 1), scrotal abscess (n = 1), testicular trauma of varying severity (n = 6). Five out of 19 cases were true negatives: neither clinical examination nor laboratory tests revealed any pathology. CEUS showed complete lack of enhancement in all cases of torsion, permitting a rapid and definitive diagnosis. In the cases of infection complicated by abscesses, CEUS delineated the lesions much better than the combination of B-mode/Color Doppler US. The severely traumatized testicles showed minimal, inhomogeneous or patchy enhancement, while cases of minor trauma showed no significant enhancement defects. Hematomas were presented as non-enhancing lesions. CONCLUSION: Generally, there was no advantage over Doppler US as has been previously shown. However, CEUS can be used supplementary to traditional Doppler US in the investigation of blunt testicular trauma especially when there is uncertainty in diagnosis after appropriate clinical and radiographic evaluations occurs. Further studies are required to clearly define the indications of this method.

Oral magnetic particles as a contrast agent for MR imaging of the abdomen. A phase III clinical trial.

Twenty patients were investigated with MR imaging of the abdomen before and after the administration of oral magnetic particles in the form of a per os solution for opacification of the gastrointestinal lumen. The parameters which were evaluated were a) distribution of the contrast medium in the gastrointestinal tract, b) delineation with the contrast medium of the region of interest c) image quality of general contract effect of the contrast medium d) diagnostic accuracy compared with CT and plain MRI of the same region. At a concentration of 0.5 mg/oral magnetic particles produced a constant negative signal from the gastro- intestinal tract in all spin echo sequences (T1 weighted, T2 weighted, proton density). Its diagnostic accuracy was similar to CT but better than plain MR examination of the same region in 70% of the cases. The diagnostic accuracy was inferior in the lower abdomen because of underdistension of the bowel. Perhaps the solution to the problem would be the combined per os and per rectum administration of the contrast medium.

Differential diagnosis of space-occupying lesions of the liver with MR imaging.

In a retrospective study of 84 patients who underwent MRI examination of the liver the qualitative parameters margin, shape, internal structure, signal intensity and the presence of a capsule were evaluated in 152 lesions comprising 48 hemangiomas, 54 secondary deposits, 23 hepatomas, 8 simple cysts, 17 hydatid cysts, 1 abscess and 1 focal fatty infiltration. Our main objective was to differentiate hemangiomas from secondary deposits and hepatomas. In hemangiomas the combination of smooth margin (98%) round or oval shape (90%) homogeneity (96%) very high signal intensity on T2-weighted sequence (94%), and the complete absence of capsule helped to distinguish them from secondary deposits and hepatomas in the majority of cases. It is concluded that with MR imaging we can establish the diagnosis of focal lesions of the liver in about 95% of cases.