Diagnostyka obrazowa jąder

Pathological lesions within the scrotum are relatively rare in imaging except for ultrasonography. The diseases presented in the paper are usually found in men at the age of 15–45, i.e. men of reproductive age, and therefore they are worth attention. Scrotal ultrasound in infertile individuals should be conducted on a routine basis owing to the fact that pathological scrotal lesions are frequently detected in this population. Malignant testicular cancers are the most common neoplasms in men at the age of 20–40. Ultrasound imaging is the method of choice characterized by the sensitivity of nearly 100% in the differentiation between intratesticular and extratesticular lesions. In the case of doubtful lesions that are not classifi ed for intra-operative verifi cation, nuclear magnetic resonance is applied. Computed tomography, however, is performed to monitor the progression of a neoplastic disease, in pelvic trauma with scrotal injury as well as in rare cases of scrotal hernias involving the ureters or a fragment of the urinary bladde

Chronic phimosis as a cause of obstructive uropathy in an adult patient

Background: Phimosis is a rare cause of obstructive uropathy and renal failure. This report presents a case of a 22-year-old man with phimosis, resulting in such complications. Case report: The patient with incidentally revealed elevated serum creatinine level was subjected to ultrasonography, voiding cystourethrography and static fluid MR urography (sMRU), combined with conventional T1- and T2-weighted images. The urinary tract dilatation and the bladder diverticula were diagnosed with the use of imaging modalities. Two months after circumcision the degree of hydroureteronephrosis as well as creatinine level decreased. Conclusions: The obstructive uropathy involving the upper urinary tract and resulting in renal failure may develop on the basis of chronic phimosis. Completing of standard imaging techniques with MR urography significantly improved the possibility of the urinary tract evaluation in the presented case

Imaging methods in hepatocellular carcinoma

Hepatocellular cancer (HCC) is the third most common cause of cancer-related death. Ultrasonography reveals 75–90% of HCC lesions in cirrhotic patients. Ambiguous and non-characteristic appearance of HCC lesions in this examination results in low efficacy of early detection. Multiphase computer tomography (CT) is a recommended method of assessment of HCC. Arterial and venous-portal phases allow to visualize most of HCC and equilibrium phase provides prognostic information. Dynamic contrast- enhanced magnetic resonance imaging (MR) after contrast medium administration is conducted similarly to computer tomography examination. Arterial phase allows to detect hipervascular lesions, as most of HCC, and venous-portal phase permits to assess lesions with poor arterial supply. The sensitivity of MR examination is slightly higher than CT’s and rises after hepatotropic contrast medium infusion. Enhancement in hepatocyte-specific phase is possible only within normal hepatocytes, thus no enhancement expose pathological liver cells. Moreover, 20% of HCC lesions smaller than 2 cm has non typical arterial phase enhancement and their identification is possible only in hepatocyte-specific phase. Barcelona Clinic Liver Cancer Group guidelines allow to diagnose HCC in cirrhotic patients, without the need for biopsy, on basis of typical radiological features in dynamic CT-scan or MR study: intensive enhancement in arterial phase and persistent ‘washout’ of contrast medium from HCC lesion in venous-portal and equilibrium phases. Onkol. Prak. Klin. 2011; 7, 2: 73–83Rak wątrobowokomórkowy (HCC) jest trzecią pod względem częstości przyczyną zgonów z powodu choroby nowotworowej. Czułość rozpoznawania HCC w ultrasonografii u chorych z marskością wątroby ocenia się na poziomie 75–90%. Trudności wczesnego rozpoznania HCC w tym badaniu wynikają z braku jednoznacznych różnicujących cech tego nowotworu, zwłaszcza gdy rozwija się on w przebiegu marskości. Polecanym badaniem w wykrywaniu HCC jest tomografia komputerowa (CT) z obrazowaniem w fazach tętniczej, żylnej wrotnej i równowagi. Fazy tętnicza i żylna wykrywają większość HCC, a faza równowagi służy ocenie dodatkowych czynników prognostycznych. Badanie dynamiczne rezonansu magnetycznego (MR) po dożylnym podaniu środka kontrastującego przeprowadza się analogicznie do badania CT: faza tętnicza służy do uwidocznienia zmian dobrze unaczynionych, do których należy większość HCC, zaś żylna wrotna do oceny ognisk ubogo unaczynionych. Czułość badania MR jest nieznacznie większa od czułości CT i wzrasta po zastosowaniu hepatotropowych środków kontrastowych. Wzmocnienie w fazie hepatocytarnej dotyczy prawidłowych hepatocytów, a jego brak jest objawem występowania patologicznych komórek wątrobowych. Dwadzieścia procent HCC o wymiarze mniejszym niż 2 cm nie ulega wzmocnieniu w sposób typowy w fazie tętniczej, ale dzięki niskiemu sygnałowi w fazie hepatocytarnej możliwe jest ich rozpoznanie. Kryteria barcelońskie pozwalają na rozpoznanie HCC u chorych z marskością wątroby bez konieczności wykonywania biopsji, jedynie na podstawie cech radiologicznych w badaniu dynamicznym CT albo MR (intensywne wzmocnienie w fazie tętniczej i wypłukiwania środka kontrastującego z ogniska HCC w fazie żylnej wrotnej lub równowagi). Onkol. Prak. Klin. 2011; 7, 2: 73–8

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The aim of the study was to evaluate the usefulness of 18F-FLT PET/CT in the detection and differentiation of gastric cancers (GC). 104 consecutive patients (57 cases of adenocarcinoma tubulare (G2 and G3), 17 cases of mucinous adenocarcinoma, 6 cases of undifferentiated carcinoma, 14 cases of adenocarcinoma partim mucocellulare, and 10 cases of end stage gastric cancer) with newly diagnosed advanced gastric cancer were examined with FLT PET/CT. For quantitative and comparative analyses, the maximal standardized uptake value (SUVmax) was calculated for both the tumors and noninvaded gastric wall. Results. There were found, in the group of adenocarcinoma tubulare, SUVmax 1.5–23.1 (7.46±4.57), in mucinous adenocarcinoma, SUVmax 2.3–10.3 (5.5±2.4), in undifferentiated carcinoma, SUVmax 3.1–13.6 (7.28±3.25), in adenocarcinoma partim mucocellulare, SUVmax 2–25.3 (7.7±6.99), and, in normal gastric wall, SUVmax 1.01–2.55 (1.84±0.35). For the level of 2.6 cut-off value between the normal wall and neoplasm FLT uptake from ROC analysis, all but five gastric cancers showed higher accumulation of FLT than noninfiltrated mucosa. Conclusion. Gastric cancer presents higher accumulation of 18F-FLT than normal, distended gastric mucosa. Significantly higher accumulation was shown in cancers better differentiated and with higher cellular density

MRI in the evaluation of the azoospermic male

PURPOSEWe aimed to show the usefulness of magnetic resonance imaging (MRI) in the evaluation of infertile men and its ability to distinguish obstructive from nonobstructive azoospermia. METHODSBetween April 2015 and February 2018, 45 azoospermic men underwent scrotal MRI. We evaluated the images with an emphasis on signal characteristics of the testis and morphologic changes typical for obstruction. Testicular volume (TV), apparent diffusion coefficient (ADC) value, T1 and T2 signal ratios (testis/muscle) were measured for every testis. On the basis of histologic results, patients were divided into two groups: obstructive azoospermia (OA) and nonobstructive azoospermia (NOA).RESULTSTestes of patients in the OA group had significantly lower ADC values (mean 0.876±101 ×10-3 mm2/s) than in the NOA group (mean, 1.114±147 ×10-3 mm2/s). TV was significantly higher in patients with OA (median, 17.61 mL; range, 11.1–38.4 mL) than in those with NOA (median, 10.5 mL; range, 5.2–22.2 mL). ROC analysis showed that both TV and ADC values were highly predictive for distinguishing between OA and NOA patients, with an area under the ROC curve of 0.82 and 0.92 respectively. A cutoff value of ≥12.4 mL could distinguish obstructive from nonobstructive azoospermia with a sensitivity of 92% and specificity of 63%, whereas for ADC measurements a cutoff value of ≥0.952 ×10-3 mm2/s exhibited a sensitivity of 81% and specificity of 90% There was no statistically significant difference in T1 and T2 signal ratios between both groups. Abnormalities typical for obstruction of the male reproductive tract (e.g., dilatation of ejaculatory ducts, prostatic or seminal vesicle cysts) were found in 78% of patients (14/18) in the obstructive group.CONCLUSIONScrotal MRI is a very effective tool for the evaluation of azoospermic men and may provide important information facilitating interventional treatment of infertility

Percutaneous lung needle biopsies : utility and complications in various chest lesions : a single-institution experience

Purpose: It is crucial to obtain a specific diagnosis before treatment of chest pathology is initiated. The purpose of the study is to present the utility of percutaneous biopsies, core and fine-needle aspiration, in various thoracic lesions, and related complications. Material and methods: A total of 593 transthoracic biopsies were performed in the Department of Radiology between 2013 and 2016. Fine-needle aspiration biopsy (FNAB) and core biopsy (CB) were implemented. The procedures were divided into four groups according to the location of the pathology: lung lesions (LL - 540), mediastinal masses (MM - 25), chest wall tumours (CWT - 13), and pleural lesions (PL - 15). The lung lesion group was divided into two subgroups: lung nodules and lung infiltrations. All groups were analysed in respect of diagnostic accuracy, pathological findings, and complication rate. Results: Pathological diagnosis was confirmed in 447 cases after all 593 procedures. The sensitivity of malignancy diagnosis in the group of lung tumours was 75% for FNAB and 89% for CB. The sensitivity in other groups, where CB was a preferable technique, was counted for lung infiltration, mediastinal masses, chest wall tumours, and pleural lesions and amounted to 83.3%, 90.9%, 100%, and 85.7%, respectively. In the group of lung tumours malignancy was confirmed most commonly (79%), while in the lung infiltration group benign processes dominated (83%). There was no statistical difference between the pneumothorax rate after CB and FNAB. Haemoptysis appeared more often after CB. Conclusions: FNAB and CB are useful, safe, and sensitive tools in the diagnostic work-up. They can both be used to diagnose almost all chest pathologies

Skuteczność mykofenolanu mofetilu w opornym na konwencjonalne leczenie zespole Goodpasture’a — opis przypadku i przegląd literatury

Zespół Goodpasture’a jest rzadką chorobą autoimmunologicznącharakteryzującą się występowaniemgwałtownie postępującego kłębuszkowego zapalenianerek, krwotokami śródpęcherzykowymi i obecnościąprzeciwciał przeciwko błonie podstawnejkłębuszków (GBM). Mimo intensywnego leczeniaimmunosupresyjnego wspartego zabiegami plazmaferez,schorzenie to często prowadzi do schyłkowejniewydolności nerek.U większości pacjentów poziom przeciwciał anty--GBM zmniejsza się do nieoznaczalnego w ciągukilku miesięcy od początku choroby. Są oni zwykledobrymi kandydatami do przeszczepienia nerki, podwarunkiem że miano przeciwciał pozostaje ujemneprzez przynajmniej 12 miesięcy.W artykule przedstawiono przypadek 31-letniegopacjenta ze schyłkową niewydolnością nerekw przebiegu zespołu Goodpasture’a, u którego mianoprzeciwciał anty-GBM utrzymywało się na wysokimpoziomie, mimo powtarzanych plazmaferez i immunosupresjiz użyciem cyklofosfamidu i steroidów.Pacjent nie mógł być umieszczony na liście oczekującychna przeszczep nerki, ponieważ obecnośćprzeciwciał przeciwko błonie podstawnej kłębuszkówznacząco zwiększa ryzyko nawrotu chorobyi wczesnej utraty przeszczepu. Z tego względu rozpoczętoterapię mykofenolanem mofetilu, co spowodowałonatychmiastowe zmniejszenie poziomuprzeciwciał do wartości niewykrywalnych.Obecnie w surowicy pacjenta nadal nie stwierdzasię obecności przeciwciał, a sam chory jest zgłoszonydo zabiegu przeszczepienia nerki. Jest to jedenz pierwszych przypadków opisania skutecznościmykofenolanu mofetilu w hamowaniu produkcjiprzeciwciał anty-GBM