Tuberculosis of male genitourinary tract

Abstracts Doppler Ultrasound is clinically important for evaluation of various hepatic vascular disease as well as hepatic vessel evaluation after liver transplantation. However, there are some limitations in conventional Doppler methods as follows: 1) time consuming and labor intensive and 2) limited slow flow sensitivity. There are two recently advanced Doppler signal-processing methods (i.e., UltraFast and superb microvascular imaging), which overcome those limitations. UltraFast Doppler ultrasound, which emerged with the advent of massive parallel computing (or processing) capabilities, transmits several tilted plane waves into the medium and coherently sums the backscattered echoes to reconstruct US images, leading to a marked increase in the frame rate, while conventional ultrasound imaging involves sequential medium insonification via focused beams and successive image reconstruction. A stored UltraFast Doppler clip contains information on both spectral analysis and color-coded flow imaging and could be retrospectively evaluated quantitative analysis, because UltraFast ultrasound has high spatio-temporal resolution. Superb microvascular imaging (SMI, Cannon Medical Systems Corporation, Tochigi, Japan) uses a different kind of adaptive wall filter, which could minimize the flash artifact and increased sensitivity to slow flow and improve the signal detection of flow from small vessels. Therefore, in clinical practice, UltraFast Doppler can be performed by anyone. If the exam protocol such as acquisition of clip by less experienced sonographer and evaluation by retrospective wave reconstruction by specialist can be established, efficient work force management can be possible. Superb Microvascular imaging can distinguish very slow portal flow by portal hyper tension and so forth from thrombus. Thrombus can be evaluated with almost the same resolution as CT. The weak flow of a small hepatic artery hiding by vigorous flow of portal vein after liver transplantation can be also distinguished. In conclusion, smart application of recent advanced Doppler technique will help comprehensive assessment of hepatic vascular abnormalities.

The application of gel pad for the examination of axilla with automated breast sonography JooHyun Kim Seoul National University Bundang Hospital, Seongnam-si, GyeongiDo, South Korea Background: Automated Breast Ultrasonography (ABUS) is mechanically designed to only examine the breast, so there exists a technical limitation on examining the axilla. For this reason, further examination with Hand Held Ultrasonography (HHUS) is currently required to supplement the limitation of ABUS. Objective: This study aims to demonstrate technical aspects of making and applying gel pads for the assessment of axilla with ABUS, and to evaluate the usefulness of the gel pad application. Methods: For the experiment 1, four gel pads that could be applied to its shape for each individual patients’ axilla were produced by infusing each one of four materials (water, water & 1% super absorbent polymer mixture, ultrasonic gel, ABUS lotion) on every sterilized probe covers, where air bubbles were removed as much as possible. ABUS phantom test was carried out in each gel pads, and the acquired images were qualitatively evaluated to select the best source material. For the experiment 2, 20 patients who visited our institution for breast sonography underwent the axilla examination using HHUS and ABUS with the selected gel pad. The acquired images were qualitatively evaluated for the clarity of anatomical structures and the presence of the artifact to ABUS based on HHUS. Result: As a result of experiment 1, gel pads made of each four materials showed total score of 24, 34, 43, and 40, respectively. The gel pad made of ultrasonic gel was found to be the best material among all. Experiment 2 resulted that the image quality of ABUS showed 80%

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“Equal” and 20% “Insufficient” in the definition of the anatomical structures compared to HHUS, whereas artifacts presented in all cases. Conclusion: The application of gel pad during the examination of axilla with ABUS was highly effective. This application can overcome the technical limitation and expand the role of ABUS as a reliable diagnostic tool.

Clinical Usefulness of contrast-enhanced ultrasound for percutaneous biopsies of focal liver lesions Jung Hoon Kim,1 Hyo Won Eun,2 Hyo-Jin Kang,1 Sang Min Lee,1 Joon Koo Han1 1 Seoul National University College of Medicine, Seoul, South Korea, 2 Department of Radiology, Samsung Medical Center, Seoul, South Korea Purpose: To determine the value of contrast-enhanced ultrasound (CEUS) for fusion guided, percutaneous biopsies of focal liver lesions. Materials and Methods: Eighty patients with focal liver lesions identified on CT/MRI were enrolled. For percutaneous US guided biopsy planning, real-time fusion of CT/MRI with USG was performed, and subsequently CEUS was performed using sulphur hexafluoride microbubble (SonoVue, n = 40) and perfluorobutane-containing microbubble (Sonazoid, n = 40). We evaluated visibility and technical feasibility confidence level. Technical failure and occurrence of change of the target were also assessed. Results: Among the 80 patients, four were technical failure for image fusion and one were technical failure for CEUS. Confirmative histologic diagnostic results were reported in 72 patients (90%) and the remaining patients were also helpful for making the final diagnosis using pathology results. Targeted lesion was changed in 22 patients (27.5%) on CEUS. As the lesion is necrotic, presumed target was more frequently changed after CEUS. Confidence level of technical success of procedure was significantly increased on CEUS comparison with BUS (p < 0.001). Conspicuity of the targeted lesion was improved on CEUS and significantly more visualized than B-US (p < 0.001). Conclusion: CEUS would be helpful for planning of hepatic biopsy in terms of tumor visibility and viable portion assessment, and consequently higher operator confidence, compared with B-US.

Tuberculosis of male genitourinary tract Yongsoo Kim, Young Seo Cho, On Koo Cho Hanyang University Guri Hospital, Gurisi, Gyounggido, South Korea Background Information: In the past decade, there has been a significant rise in the prevalence of tuberculosis as well as an increase in the extrapulmonary manifestations worldwide. Genitourinary tuberculosis is the most common manifestation of extrapulmonary tuberculosis. Diagnosis is often difficult and delayed because tuberculosis has a variety of clinical and radiological presentations, and it can mimic numerous other disease entities. A high level of suspicion is required and positive results on culture or histologic examination of biopsy or surgical specimens is still required in many patients for definite diagnosis. Educational Goals:  To review the ultrasonographic features of tuberculosis affecting the kidney, adrenal gland, and male genital tracts.  To know the routes of Tuberculous spread. Imaging Findings: Tuberculous infection occur all genitourinary organs, kidney, adrenal gland, ureter, urinary bladder, prostate, epididymis and testes. We reviewed pathophysiology of Tuberculous infection affecting male genitourinary tracts. We also reviewed the characteristic ultrasonographic and CT findings of Tuberculous

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infection. We compared other differential diagnostic diseases (inflammatory bowel diseases, peritoneal diseases) to these ultrasonographic and CT manifestations. Conclusion: Tuberculous infection can mimic numerous other disease entities. Although a positive culture of histologic analysis of biopsy specimens is still required in many patients to yield the definite diagnosis, recognition and understanding of the spectrum of imaging features of extrapulmonary tuberculosis can aid in diagnosis.

Sonographic and CT findings of intraperitoneal focal fat infarction and its mimics Hyun Cheol Kim, Sang Won Kim, Dal Mo Yang, Wook Jin Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, South Korea Objectives: The term of intraperitoneal focal fat infarction (IFFI) is a group of self-limiting and relatively rare acute abdominal condition essentially characterized by infarction and/or torsion of the omentum and epiploic appendages. The purpose of this exhibit is to demonstrate the sonographic and CT findings of IFFI and its mimics. Methods: IFFI represents the grouping of various acute abdominal conditions with the common denominator of spontaneous fatty tissue necrosis. We retrospectively reviewed the sonographic results in patients with acute abdominal pain, and selected uncommon entities such as greater omental infarction, lesser omental infarction, epiploic appendagitis or encapsulated fat necrosis. We also selected its mimics such as diverticulitis, appendicitis, inflammatory bowel disease, colon cancer or other miscellaneous conditions. Results: Regardless of differences of its anatomical location, the sonographic appearances of IFFI show similar as a hyperechoic, solid, noncompressible, ovoid, or cake-like mass with a location that corresponds to the region of maximum tenderness. The integrities of adjacent organs differentiate IFFI from the hyperechoic fat in cases of its mimics. We demonstrate sonographic findings of IFFI using diverse cases, highlighting the differential diagnosis at each location. Most of the cases were also correlated with CT imaging. Conclusion: Familiarity and recognition of the sonographic appearances of IFFI can provide guidance for appropriate conservative managements that are essential for preventing an unnecessary surgery. References: 1. van Breda Vriesmann AC, et al. Eur Radiol 1999; 9:1186 1192. 2. ter Meulen PH, et al. Dig Surg 2001; 18:328-331. 3. Puylaert JB. Right-sided segmental infarction of the omentum: clinical, US, and CT findings. Radiology 1992; 185:169-172. 4. Coulier B, et al. Intraperitoneal fat focal infarction of the lesser omentum: case report. Abdom Imaging 2004; 29:498-501. 5. Kamaya A, et al. Imaging manifestations of abdominal fat necrosis and its mimics. Radiographics 2011;31:2021-2034.

Volume 45, Number S1, 2019 endometriosis staging. Magnetic Resonance imaging provides complementary information and its always necessary in cases with ureteral involvement, extensions adhesions, heterogeneous ovarian cysts and large uterus. The aim of this study is to describe and illustrate radiologic signs, surgery and pathologic correlations of deep endometriosis, from a reference Center, presenting a pre surgical protocol study using ultrasound technique and magnetic resonance imaging. This presentation is dedicated to the evaluation of: uterus, retrocervical and retrouterine regions, uterosacral ligaments, uterine insertion of the round ligaments, Douglas pouch, ovaries and adnexal regions, vagina, rectovaginal septum, bladder, urinary system, intestinal lesions (rectosigmoid colon, sigmoid descending, colon transition, vermiform appendix, ileum and ceccum). References: 1. Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Chamie LP, Blasbalg R, Pereira RM, Warmbrand G, Serafini PC. Radiographics. 2011 Jul-Aug;31(4):E77-100. doi: 10.1148/rg.314105193. 2. Transvaginal US after bowel preparation for deeply infiltrating endometriosis: protocol, imaging appearances, and laparoscopic correlation. Chamie LP, Pereira RM, Zanatta A, Serafini PC. Radiographics. 2010 Sep;30(5):1235-49. doi: 10.1148/rg.305095221.

Ovaries: what you should know to differentiate benign to malignant and avoid unnecessary follow-up or surgeries? Maria Cristina Chammas, Ana Paula Klautau Leite, Sandra Monica Tochetto, Julia Diva Zavariz Hospital das Clinicas - School of Medicine - S~ ao Paulo - Brazil, Sao Paulo, SP, Brazil

Deep pelvic endometriosis: “Tips and Tricks” by transvaginal ultrasound (USTV). Correlating finding of USTV, MR imaging and laparoscopy Maria Cristina Chammas, Ana Paula Klautau Leite, Sandra Monica Tochetto, Julia Diva Zavariz Hospital das Clinicas - School of Medicine - S~ ao Paulo - Brazil, Sao Paulo, SP, Brazil

Transvaginal ultrasound (TVUS) is the method of choice to detect adnexal masses achieving high sensitivity in ovarian cancer diagnoses. Subjective assessment by an experienced ultrasound examiner is the optimal approach to discriminate between benign and malignant masses. In the other hand, a large multicenter study reported that the false positive rate could be as high as 24%. Besides operator experiences, another reason could be problems in the transmission of information about findings to the clinician who makes the final decision. Several strategies have been proposed to differentiate the two entities, especially using pelvic ultrasound based on their morphological scoring. There is a considerable variability in reporting regarding management and or follow-up recommendations related to the patient’s findings. The goal of this study was to list the most important aspect of guidelines, to differentiate between benign and malignant masses. References: 1. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. Timmerman D1, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I; International Ovarian Tumor Analysis (IOTA) Group. BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6839. 2. Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings. Amor F1, Vaccaro H, Alcazar JL, Leon M, Craig JM, Martinez J. J Ultrasound Med. 2009 Mar;28(3):285-91. 3. Management of Asymptomatic Ovarian and Other Adnexal Cysts Imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Levine D, et al. Radiology Volume 256, Issue 3Sep 1 2010.

Endometriosis is characterized by the growth of endometrial tissue outside the uterine cavity. The standard gold diagnosis for endometriosis is the surgery. For surgical planning, the imaging diagnosis is fundamental to obtain complete excision and patient’s treatment. The transvaginal ultrasounds after bowel preparation should be the first line in the diagnosis and

Transvaginal ultrasound (USTV) for Deep Pelvic Endometriosis: How “To Do” do it Maria Cristina Chammas, Ana Paula Klautau Leite, Sandra Monica Tochetto, Julia Diva Zavariz