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Image Fusion of the Kidney
S208
Ultrasound in Medicine and Biology
level of sleep. This is the first report which exhibits water absorption from urine within the human urinary bladder in the fully physiological situation without any invasive techniques. Possible physiological mechanism for bladder absorption will be discussed. T16-14-IN06 Ultrasound of the Acute Scrotum Harvey L. Nisenbaum Department of Medical Imaging, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania The presentation will discuss ultrasound (US) evaluation of Torsion/ Infarction; Infection; and Trauma in the Acute Scrotum Testicular Torsion - incidence in males younger than 25 years approx 1:4000 - more often involves left testicle - salvage rate: - 90% if detorsion within 6 hours of pain - 50% if detorsion occurs at 12 hours - 10% if detorsion occurs at 24 hours - approaching 0% if detorsion is delayed greater than 24 hours Epididymitis - 5th most common urologic diagnosis ages 18-50 - approx 600,000 medical visits/yr in USA - retrograde passage of infected urine from prostatic urethra to epididymis via ejaculatory ducts and vas deferens - orchitis in 20-40% of cases - complications of acute epididymitis and epididymo-orchitis include following: - scrotal abscess and pyocele - testicular infarction - chronic epididymitis and orchalgia - infertility secondary to inflammation or epididymal duct obstruction - testicular atrophy with resulting hypogonadotropic hypogonadism - cutaneous fistula Testicular Trauma - blunt trauma- majority - penetrating trauma - testicular rupture- urologic emergency; more than 80% of ruptured testes can be saved if surgery is performed within 72 hours - blunt testicular injuries can be managed either medically or surgically, depending on the clinical presentation - 2 factors allow protection from minor external trauma - physiologic hydrocele- testis slides freely scrotal sac - suspended by spermatic cord allows free movement - US/CDU valuable for diagnosis and staging testicular injuries - tunica albuginea disruption diagnostic of testicular rupture - direct visualization of testicular fracture line rare- in approx 17% pts - other findings- scrotal wall thickening, hematocele, testicular hematoma Conclusions - US should be the first imaging modality to evaluate the acute scrotum - Use highest frequency transducer possible - Include CDU (Power Doppler as needed; include spectral Doppler especially infection) T16-14-IN07 Image Fusion of the Kidney Michel Claudon Radiologist, University of Lorraine, Nancy, France Image fusion of kidney is now currently used by increasing teams to facilitate the realization of second-row ultrasound (US) examination in
Volume 43, Number S1, 2017 complex cases, when contrast-enhanced ultrasound (CEUS), guided biopsy or interventional procedure is required. Fusion is usually obtained using CT series of images, generally after contrast-injection, but T2 -weighted sequences or post-Gd T1-weighted series are more commonly considered. Fusion can be made using various fusion protocols, which require some training phase. Transfer of significant images from PACS to the Ultrasound equipment is a point of attention. Examples of various pathological cases of complex cystic lesions, tumors, vascular pathologies will be presented to illustrate the interest of the technique. T16-14-IN08 New Role of Transrectal Ultrasound Guided Prostate Biopsy Osamu Ukimura Department of Urology, Kyoto Prefectural University of Medicine Recent efforts towards the earlier detection of prostate cancer (PCa) have resulted in the discovery of earlier, smaller-volume, lower-grade PCa that are often described as clinically insignificant, with a 10-yr relative survival rate comparable to the general population. However, there is still underdiagnosis of high-risk PCa. In contrast, overdetection occurs in patients found to have PCa, and the possibly consequent overtreatment is one of the main concerns in prostate oncology. The role of prostate biopsies has changed. Their importance has evolved from pure cancer detection to assisting clinical patient management. Biopsy as a critical part of active surveillance protocols emphasises the necessity of reproducible and standardised staging and grading strategies. The historical likelihood of missing clinically significant cancers because of sampling error during random prostate biopsy. Nowadays, the imageguided targeted biopsy has been essential in prostate biopsy. T16-14-IN09 Multiparametric Ultrasound Performs as well as Multiparametric MRI for Prostate Cancer on Initial Biopsy Pat Fulgham Department of Urology, Texas Health Presbyterian Dallas, Dallas, Texas The current enthusiasm for multiparametric MRI (mpMRI) in the management of prostate disease is based on excellent anatomic detail and the ability to characterize tissue based on water diffusion and blood flow. Systems of mpMRI/ultrasound fusion of images have been developed to attempt to improve the diagnostic accuracy of biopsy for prostate cancer. For the initial biopsy of a patient thought to be at risk for prostate cancer, multiparametric ultrasound (mpUS) performs as well as mpMRI in terms of the positive biopsy rate (66.5%) and clinically significant disease detection (12.7%). Careful selection of patients, meticulous attention to ultrasound technique and biopsies targeted to ultrasound abnormalities (not exclusively changes in echogenicity) are critical to achieving optimal results. Systematic biopsy, without attention to sonographic abnormalities, is not an optimal technique. The results of such biopsies are not valid for comparison to mpMRI-targeted biopsies. T16-14-IN10 Erectile Dysfunction: Ultrasound Assessment and 1600 Patients Results Leandro Fernandez, MD Laboratorio de Ecografıa Avanzada. Instituto Medico La Floresta, Caracas, Venezuela Erectile Dysfunction (ED) is the impossibility to achieve and/ maintain sufficient erection to have satisfactory and fulfilling sex intercourse for both partners. ED affects a high number of men around the World, with significant impact on sexual function and quality of life. The erection is the phenomenon of penile erectile tissue vasodilation, mediated by complex
Ultrasound in Medicine and Biology
level of sleep. This is the first report which exhibits water absorption from urine within the human urinary bladder in the fully physiological situation without any invasive techniques. Possible physiological mechanism for bladder absorption will be discussed. T16-14-IN06 Ultrasound of the Acute Scrotum Harvey L. Nisenbaum Department of Medical Imaging, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania The presentation will discuss ultrasound (US) evaluation of Torsion/ Infarction; Infection; and Trauma in the Acute Scrotum Testicular Torsion - incidence in males younger than 25 years approx 1:4000 - more often involves left testicle - salvage rate: - 90% if detorsion within 6 hours of pain - 50% if detorsion occurs at 12 hours - 10% if detorsion occurs at 24 hours - approaching 0% if detorsion is delayed greater than 24 hours Epididymitis - 5th most common urologic diagnosis ages 18-50 - approx 600,000 medical visits/yr in USA - retrograde passage of infected urine from prostatic urethra to epididymis via ejaculatory ducts and vas deferens - orchitis in 20-40% of cases - complications of acute epididymitis and epididymo-orchitis include following: - scrotal abscess and pyocele - testicular infarction - chronic epididymitis and orchalgia - infertility secondary to inflammation or epididymal duct obstruction - testicular atrophy with resulting hypogonadotropic hypogonadism - cutaneous fistula Testicular Trauma - blunt trauma- majority - penetrating trauma - testicular rupture- urologic emergency; more than 80% of ruptured testes can be saved if surgery is performed within 72 hours - blunt testicular injuries can be managed either medically or surgically, depending on the clinical presentation - 2 factors allow protection from minor external trauma - physiologic hydrocele- testis slides freely scrotal sac - suspended by spermatic cord allows free movement - US/CDU valuable for diagnosis and staging testicular injuries - tunica albuginea disruption diagnostic of testicular rupture - direct visualization of testicular fracture line rare- in approx 17% pts - other findings- scrotal wall thickening, hematocele, testicular hematoma Conclusions - US should be the first imaging modality to evaluate the acute scrotum - Use highest frequency transducer possible - Include CDU (Power Doppler as needed; include spectral Doppler especially infection) T16-14-IN07 Image Fusion of the Kidney Michel Claudon Radiologist, University of Lorraine, Nancy, France Image fusion of kidney is now currently used by increasing teams to facilitate the realization of second-row ultrasound (US) examination in
Volume 43, Number S1, 2017 complex cases, when contrast-enhanced ultrasound (CEUS), guided biopsy or interventional procedure is required. Fusion is usually obtained using CT series of images, generally after contrast-injection, but T2 -weighted sequences or post-Gd T1-weighted series are more commonly considered. Fusion can be made using various fusion protocols, which require some training phase. Transfer of significant images from PACS to the Ultrasound equipment is a point of attention. Examples of various pathological cases of complex cystic lesions, tumors, vascular pathologies will be presented to illustrate the interest of the technique. T16-14-IN08 New Role of Transrectal Ultrasound Guided Prostate Biopsy Osamu Ukimura Department of Urology, Kyoto Prefectural University of Medicine Recent efforts towards the earlier detection of prostate cancer (PCa) have resulted in the discovery of earlier, smaller-volume, lower-grade PCa that are often described as clinically insignificant, with a 10-yr relative survival rate comparable to the general population. However, there is still underdiagnosis of high-risk PCa. In contrast, overdetection occurs in patients found to have PCa, and the possibly consequent overtreatment is one of the main concerns in prostate oncology. The role of prostate biopsies has changed. Their importance has evolved from pure cancer detection to assisting clinical patient management. Biopsy as a critical part of active surveillance protocols emphasises the necessity of reproducible and standardised staging and grading strategies. The historical likelihood of missing clinically significant cancers because of sampling error during random prostate biopsy. Nowadays, the imageguided targeted biopsy has been essential in prostate biopsy. T16-14-IN09 Multiparametric Ultrasound Performs as well as Multiparametric MRI for Prostate Cancer on Initial Biopsy Pat Fulgham Department of Urology, Texas Health Presbyterian Dallas, Dallas, Texas The current enthusiasm for multiparametric MRI (mpMRI) in the management of prostate disease is based on excellent anatomic detail and the ability to characterize tissue based on water diffusion and blood flow. Systems of mpMRI/ultrasound fusion of images have been developed to attempt to improve the diagnostic accuracy of biopsy for prostate cancer. For the initial biopsy of a patient thought to be at risk for prostate cancer, multiparametric ultrasound (mpUS) performs as well as mpMRI in terms of the positive biopsy rate (66.5%) and clinically significant disease detection (12.7%). Careful selection of patients, meticulous attention to ultrasound technique and biopsies targeted to ultrasound abnormalities (not exclusively changes in echogenicity) are critical to achieving optimal results. Systematic biopsy, without attention to sonographic abnormalities, is not an optimal technique. The results of such biopsies are not valid for comparison to mpMRI-targeted biopsies. T16-14-IN10 Erectile Dysfunction: Ultrasound Assessment and 1600 Patients Results Leandro Fernandez, MD Laboratorio de Ecografıa Avanzada. Instituto Medico La Floresta, Caracas, Venezuela Erectile Dysfunction (ED) is the impossibility to achieve and/ maintain sufficient erection to have satisfactory and fulfilling sex intercourse for both partners. ED affects a high number of men around the World, with significant impact on sexual function and quality of life. The erection is the phenomenon of penile erectile tissue vasodilation, mediated by complex