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Ultrasound Elastography Patterns of the Prostate
Abstracts followed by greyscale, colour Doppler ultrasonography and elastography of the scrotum (General Electric, Voluson E8 scanner, linear probe). Corresponding images obtained at different angles with and without elastographic option were correlated. Video clips representing compression and decompression were analysed frame by frame. Patterns of testicular, epididymal and spermatic cord anatomy in transverse, longitudinal and oblique planes as well as common elastography artefacts were found. Conclusion: Differences in colour coding of stiffness of the same region may be huge depending on the magnitude and way (speed of probe movement) the pressure is delivered to the organ. Therefore, ultrasound elastography examinations should be archived and compared as video clips instead of single images to minimise inter-observer and intraobserver variation. Elastography reveals dynamic tissue behaviour under compression and decompression and must be recorded and analysed as a process to make possible any valuable interpretation. Differences in organ response in various planes depend on its internal structure.
P 161 ee Ultrasound Elastography Patterns of the Prostate W. Białek,1 M. Jaskiewicz,1 P. Wieczorek,2 K. Bar1 1 Department of Urology and Urological Oncology, SPSK4, Lublin/PL, 2 Department of Radiology, DSK, Lublin/PL Learning Objectives: The work was aimed at defining sonoelastographic colour patterns of normal anatomy of the prostatic gland and adjacent structures. We tried to specify the scheme of proper examination and determine artifacts of the method. Background: The elastogram is a map of tissue stiffness derived from changes in the sonographic radiofrequency specle image during the application of external pressure and subsequent relaxation. Tissue response to the ultrasound probe direct compression is coded with a wide range of colours, from red for soft tissue to blue for hard structures. Imaging Findings or Procedure Details: Examinations were performed in 110 patients (22-53 years old). Digital transrectal examination of the prostate was followed by greyscale, colour Doppler ultrasonography and elastography assessment (General Electric, Voluson E8 scanner, endorectal end-fire probe). Scans were obtained in five parallel transverse planes from prostatic apex to the level of the seminal vesicles, in at least three sagittal planes and oblique aspects. Corresponding images obtained at different angles with and without elastographic option were correlated. Video clips representing compression and decompression were analysed frame by frame. Elastographic patterns of the prostate and surrounding tissue were found. We identified also common artifacts of the technology. Conclusion: Differences in colour coding of stiffness of the same region may be huge depending on the magnitude and way (speed of probe movement) the pressure is delivered to the organ. Therefore, ultrasound elastography examinations should be archived and compared as video clips instead of single images to minimise interobserver and intra-observer variation. Elastography reveals dynamic tissue behaviour under compression and decompression and must be recorded and analysed as a process to make possible any valuable interpretation. Differences in organ response in various planes depend on its internal structure. There are certain limitations of elastography due to size, shape, depth of tissue penetration and angle of imaging of convex endorectal endfire probe one must be aware of. Therefore it is essential to perform examination symmetrically on both lobes of the gland in the same manner. Taking under consideration signifi-
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cant diversity in size and morphology of the prostatic gland depending on patient age and presence of benign prostatic hyperplasia, the study will be continued.
Genitourinary / Kidney and Adrenal Glands P 162 se Castleman’s Disease of the Kidney: Report of a Case with US, CT and Histological Findings C. C. Ooi, F. K. Cheah, S. K. Wong Department Diagnostic Radiology, Singapore General Hospital, Singapore/SG Purpose: Castleman disease is a relatively rare benign lymphoproliferative disorder. We report a case of Castleman’s disease of the kidney that mimicked a renal neoplasm. Material & Methods: A 47-year-old male presented with dyspeptic symptoms. Ultrasound revealed a vascularized, heterogeneous mass in the left kidney with similar findings demonstrated on triphasic CT scan. Provisional diagnosis of renal cell carcinoma was made. Results: Percutaneous biopsy confirmed the diagnosis of hyalinevascular type of Castleman’s disease. The patient was managed conservatively. A 6-monthly CT follow-up revealed no disease progression. Conclusion: We suggest that Castleman’s disease should be included in the differential diagnosis of vascular renal tumors.
P 163 ee Post Renal Transplant Complications: Spectrum of Sonographic Findings K. J. Ong,1 S. M. D. Lau,2 N. A. Gazali,2 C. C. Ooi,2 R. Abu Bakar,2 R. H. G. Lo2 1 Department of Diagnostic Radiology, Singapore General Hospital, Singapore/SG, 2Singapore General Hospital, Singapore/SG Learning Objectives: This didactic exhibit aims to: 1. Review the role of ultrasound in the diagnosis and management of various recognized postrenal transplant complications. 2. Describe the characteristic sonographic features of renal transplantation complications. 3. Increase the awareness of urologic, vascular and non-vascular postrenal transplant complications on ultrasound and hence allow early detection and timely intervention to prevent graft failure. Background: Renal transplantation is the preferred treatment for endstage renal disease patients. With the increase of renal transplantation performed each year, it is essential for sonographers and radiologists to be aware of the potential complications that can occur in the postoperative period which may threaten graft viability. Ultrasound is often the primary imaging modality for evaluation of renal transplants since it is reliable, cost effective, non-nephrotoxic and can be performed at the bedside. Imaging Findings or Procedure Details: We discuss the spectrum of sonographic findings of renal transplant complications, both vascular and nonvascular, including but not limited to renal arterial stenosis and venous thrombosis, arteriovenous fistula, peritransplant collections (lymphocele, hematoma), and post-transplant lymphoproliferative disorder. Where available, correlation with other imaging modalities (such as angiography, CT, MRI) and histopathology will be presented. Conclusion: The ability to recognize the sonographic appearances of these complications allow early and rapid diagnosis to be made, thus enabling timely management and intervention, which prolong graft survival.
P 161 ee Ultrasound Elastography Patterns of the Prostate W. Białek,1 M. Jaskiewicz,1 P. Wieczorek,2 K. Bar1 1 Department of Urology and Urological Oncology, SPSK4, Lublin/PL, 2 Department of Radiology, DSK, Lublin/PL Learning Objectives: The work was aimed at defining sonoelastographic colour patterns of normal anatomy of the prostatic gland and adjacent structures. We tried to specify the scheme of proper examination and determine artifacts of the method. Background: The elastogram is a map of tissue stiffness derived from changes in the sonographic radiofrequency specle image during the application of external pressure and subsequent relaxation. Tissue response to the ultrasound probe direct compression is coded with a wide range of colours, from red for soft tissue to blue for hard structures. Imaging Findings or Procedure Details: Examinations were performed in 110 patients (22-53 years old). Digital transrectal examination of the prostate was followed by greyscale, colour Doppler ultrasonography and elastography assessment (General Electric, Voluson E8 scanner, endorectal end-fire probe). Scans were obtained in five parallel transverse planes from prostatic apex to the level of the seminal vesicles, in at least three sagittal planes and oblique aspects. Corresponding images obtained at different angles with and without elastographic option were correlated. Video clips representing compression and decompression were analysed frame by frame. Elastographic patterns of the prostate and surrounding tissue were found. We identified also common artifacts of the technology. Conclusion: Differences in colour coding of stiffness of the same region may be huge depending on the magnitude and way (speed of probe movement) the pressure is delivered to the organ. Therefore, ultrasound elastography examinations should be archived and compared as video clips instead of single images to minimise interobserver and intra-observer variation. Elastography reveals dynamic tissue behaviour under compression and decompression and must be recorded and analysed as a process to make possible any valuable interpretation. Differences in organ response in various planes depend on its internal structure. There are certain limitations of elastography due to size, shape, depth of tissue penetration and angle of imaging of convex endorectal endfire probe one must be aware of. Therefore it is essential to perform examination symmetrically on both lobes of the gland in the same manner. Taking under consideration signifi-
S117
cant diversity in size and morphology of the prostatic gland depending on patient age and presence of benign prostatic hyperplasia, the study will be continued.
Genitourinary / Kidney and Adrenal Glands P 162 se Castleman’s Disease of the Kidney: Report of a Case with US, CT and Histological Findings C. C. Ooi, F. K. Cheah, S. K. Wong Department Diagnostic Radiology, Singapore General Hospital, Singapore/SG Purpose: Castleman disease is a relatively rare benign lymphoproliferative disorder. We report a case of Castleman’s disease of the kidney that mimicked a renal neoplasm. Material & Methods: A 47-year-old male presented with dyspeptic symptoms. Ultrasound revealed a vascularized, heterogeneous mass in the left kidney with similar findings demonstrated on triphasic CT scan. Provisional diagnosis of renal cell carcinoma was made. Results: Percutaneous biopsy confirmed the diagnosis of hyalinevascular type of Castleman’s disease. The patient was managed conservatively. A 6-monthly CT follow-up revealed no disease progression. Conclusion: We suggest that Castleman’s disease should be included in the differential diagnosis of vascular renal tumors.
P 163 ee Post Renal Transplant Complications: Spectrum of Sonographic Findings K. J. Ong,1 S. M. D. Lau,2 N. A. Gazali,2 C. C. Ooi,2 R. Abu Bakar,2 R. H. G. Lo2 1 Department of Diagnostic Radiology, Singapore General Hospital, Singapore/SG, 2Singapore General Hospital, Singapore/SG Learning Objectives: This didactic exhibit aims to: 1. Review the role of ultrasound in the diagnosis and management of various recognized postrenal transplant complications. 2. Describe the characteristic sonographic features of renal transplantation complications. 3. Increase the awareness of urologic, vascular and non-vascular postrenal transplant complications on ultrasound and hence allow early detection and timely intervention to prevent graft failure. Background: Renal transplantation is the preferred treatment for endstage renal disease patients. With the increase of renal transplantation performed each year, it is essential for sonographers and radiologists to be aware of the potential complications that can occur in the postoperative period which may threaten graft viability. Ultrasound is often the primary imaging modality for evaluation of renal transplants since it is reliable, cost effective, non-nephrotoxic and can be performed at the bedside. Imaging Findings or Procedure Details: We discuss the spectrum of sonographic findings of renal transplant complications, both vascular and nonvascular, including but not limited to renal arterial stenosis and venous thrombosis, arteriovenous fistula, peritransplant collections (lymphocele, hematoma), and post-transplant lymphoproliferative disorder. Where available, correlation with other imaging modalities (such as angiography, CT, MRI) and histopathology will be presented. Conclusion: The ability to recognize the sonographic appearances of these complications allow early and rapid diagnosis to be made, thus enabling timely management and intervention, which prolong graft survival.