Imaging of the acute female pelvis

University of Genoa, Genoa, Italy, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Female patients with acute abdomino/pelvic symptoms are a relatively common problem in the Emergency Department. The diagnostic approach to them is based first on clinical ground (which symptoms, which age), then on lab tests (especially a serum beta-hCG assessment) and imaging. Content: Ultrasound (US) is the preferred imaging technique when clinical findings suggest an acute pelvic condition; however, symptoms are not always specific and also computed tomography (CT) and magnetic resonance imaging (MRI) are frequently employed. Although, ideally, imaging examinations should be performed with full knowledge of both clinical and laboratory situation, this is not always the case, since some lab tests are time-consuming and emergency studies have to be performed before knowing their results. Conclusion: A large variety of conditions may cause acute pelvic symptoms but the most common and ”dangerous” ones are adnexal torsion, pelvic inflammatory disease (PID) and ectopic pregnancy. This presentation will describe the imaging findings observed in them and will underline the need for integration of clinical information with imaging findings to reach the correct diagnosis

Multiple, Synchronous Lesions of Differing Histology Within the Same Testis: Ultrasonographic and Pathologic Correlations

Objective: To describe ultrasound (US) and pathologic findings in 11 patients with multiple, synchronous lesions of different histology within the same testis. Materials and methods: We reviewed US and pathologic findings in 11 patients with multiple, synchronous lesions of different histology within the same testis. Lesions were classified as separate or adjacent one to another and attempt was made to predict tumor type on their US textures. Pathologic review assessed presence of normal tissue between adjacent lesions and of Germ Cell Neoplasia In Situ in surrounding parenchyma. Nine cases were from files specifically dedicated to testicular tumors and estimated prevalence was calculated. Results: Two nodules were seen in nine patients and 3 in remaining two. Nine had tumors of different histology; two had one malignancy and one focal benign lesion. Germ Cell Neoplasia In Situ was seen in 7/11 cases. In dedicated archives, these lesions had 1.83% prevalence. Conclusion: Multiple focal lesions identified at imaging within the testis are not always of the same histology. This can be suspected in some cases basing on US texture. Recognition that lesions are multiple and an indication of their locations within the testis is the most important role of imaging and may help pathologists correctly sample the specimen to establish nature of each of them. Presence of multiple lesions is regarded as a contraindication to testicular sparing surgery. In two of our patients, one lesion was benign. Then, when the procedure is indicated all lesions have to be sampled and assessed by pathologists before deciding between conservative or radical technique

Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee

The subcommittee on scrotal imaging, appointed by the board of the European Society of Urogenital Radiology (ESUR), have produced guidelines on imaging and follow-up in testicular microlithiasis (TML)

MR imaging in patients with male-to-female sex reassignment surgery: Postoperative anatomy and complications

OBJECTIVE: To investigate the role of MRI in the evaluation of both the new female anatomy and complications in male-to-female sex reassignment surgery (MtF-SRS). METHODS: 71 consecutive patients with MtF-SRS had 74 MRI [age range, 21-63 years; mean (\ub1standard deviation) age, 36\u2009\ub1\u200910 years; median age, 37 years]. In 47 patients, MRI was performed to rule out early post-operative complications after gender conversion (n\u2009=\u200940), vaginoplasty (n\u2009=\u20096) or remodelling of the labia majora (n\u2009=\u20091). In 27 patients, MRI was performed 1-20 years after MtF-SRS for late post-operative complications, pain or dysuria, inflammatory changes or poor cosmetic outcome. Three patients had MRI both before and after the operation. RESULTS: MRI allowed investigation of the new female anatomy in all cases. Soon after MtF-SRS, a small amount of blood was identified in all patients around the neoclitoris, urethral plaque and labia. Post-operative complications were clinically significant fluid collections (n\u2009=\u20095), labial abscesses (n\u2009=\u20092), severe cellulitis (n\u2009=\u20093), partial neovaginal prolapse (n\u2009=\u20093), focal necrosis and dehiscence of the vaginal wall (n\u2009=\u20092) and hypovascularization of the neoclitoris (n\u2009=\u20091). After ileal vaginoplasty, three patients developed clinically insignificant haematomas, one a large rectovaginal fistula with dehiscence of the intestinal anastomosis and bowel perforation (n\u2009=\u20091). In the 27 patients investigated 1-20 years after MfF-SRS, MRI demonstrated cavernosal remnants (n\u2009=\u200910), spared testis (n\u2009=\u20091) neovaginal strictures (n\u2009=\u20098), fistulas and abscesses (n\u2009=\u20093) and prolapse (n\u2009=\u20092). Three of these patients also had fibrotic changes. In the remaining three patients, no pathological features were identified. CONCLUSION: After genital reconfiguration, MRI allows assessment of the post-operative anatomy and of post-operative complications. Advances in knowledge: Imaging features of the new anatomy and of surgical complications after SRS are discussed and illustrated

Sonography of Scrotal Wall Lesions and Correlation With Other Modalities

The scrotal wall may be involved in a variety of pathologic processes. Such lesions may rise primarily from the layers of the scrotum or may be due to a process arising from scrotal content. Imaging is not needed in most cases, but it may be useful for making such differentiations and for evaluation of possible involvement of the testes and epididymides in cases of primary wall abnormalities. This pictorial essay will show the imaging findings observed in a variety of pathologic conditions affecting the scrotal wall, both common and unusual ones, with an emphasis on clinically relevant findings and features that lead to a specific diagnosis

European ADPKD Forum multidisciplinary position statement on autosomal dominant polycystic kidney disease care

Autosomal dominant polycystic kidney disease (ADPKD) is a chronic, progressive condition characterised by the development and growth of cysts in the kidneys and other organs and by additional systemic manifestations. Individuals with ADPKD should have access to life-long, multidisciplinary, specialist and patient-centred care involving: 1) A holistic and comprehensive assessment of the manifestations, complications, prognosis and impact of the disease (in physical, psychological and social terms) on the patient and their family; 2) Access to treatment to relieve symptoms, manage complications, preserve kidney function, lower the risk of cardiovascular disease, and maintain quality of life; 3) Information and support to help patients and their families act as fully informed and active partners in care, i.e. to maintain self-management approaches, deal with the impact of the condition, and participate in decision-making regarding healthcare policies, services and research. Building on discussions at an international Roundtable of specialists and patient advocates involved in ADPKD care, this paper sets out 1) The principles for a patient-centred, holistic approach to the organisation and delivery of ADPKD care in practice, with a focus on multi-specialist collaboration and shared-decision making, 2) The rationale and knowledge base for a Route Map for ADPKD care intended to help patients navigate the services available to them and to help stakeholders and decision-makers take practical steps to ensure that all patients with ADPKD can access the comprehensive multi-specialist care to which they are entitled. Further multispecialty collaboration is encouraged to design and implement these services, and to work with patient organisations to promote awareness building, education, and research

Radiology in the Era of Value-Based Healthcare: A Multi-Society Expert Statement From the ACR, CAR, ESR, IS3R, RANZCR, and RSNA

Background: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology’s central role; this may have future negative consequences for resource allocation. Methods, findings and interpretation: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined

Scrotal Masses

The role of radiology in the study of patients with scrotal masses is very important. Imaging, in fact, is used to confirm presence of the disease process, to evaluate its location and extent, and to assess its nature. These goals can be reached in many cases through careful analysis of imaging findings and correlation with clinical and laboratory test

Imaging Techniques and Normal Anatomy: Scrotum

The scrotum is a fibromuscular sac divided into two compartments by a median raphe. Its wall is composed (from superficial to deep) by skin, superficial fascia, dartos muscle, external spermatic fascia, cremasteric fascia, and internal spermatic fascia. The raphe is continuous with the dartos muscle. Beneath the internal spermatic fascia, there is the tunica vaginalis, a mesothelial layer which outlines a sac containing a testis, epididymis, and spermatic cord, usually together with a small amount of fluid. The layer of the tunica vaginalis lining the scrotal wall is defined as the parietal layer; the one extending over the testis and epididymis is called the visceral one. The two layers join at the posterolateral aspect of the testis, where the tunica attaches to the scrotal wall. Beneath the visceral layer of the tunica vaginalis is the tunica albuginea, an inelastic structure which covers the testis and, at its posterior surface, projects into the inner part to form an incomplete septum, the mediastinum; from there, multiple thin fibrous septa extend into the testicular parenchyma, dividing it into 200\u2013400 lobules. Each lobule contains one to three seminiferous tubules which, at the mediastinum, open via the tubuli recti into dilated spaces called the rete testis and then drain into the epididymis through 10\u201315 efferent ductules. The epididymis, a tubular structure consisting of a head, body, and tail, is located superior to and contiguous with the posterior aspect of the testis. After entering the epididymal head, the ductules from the rete testis form a single duct, the ductus epididymis, which has very tortuous course from the head to the tail (up to 6 m). The ductus finally becomes the vas deferens and continues in the spermatic cor