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Usefulness of evaluating testicular heterogeneity in cases of testicular torsion
Abstracts 2. Belay RE, Huang GO, Shen JK, Ko EY. Diagnosis of clinical and subclinical varicocele: how has it evolved? Asian J Androl 2016;18:182-5
Usefulness of evaluating testicular heterogeneity in cases of testicular torsion Phua Hwee Tang,1,2 Dorinda Chew,2 Narasimhan Laksmi2 1 Duke NUS Medical School, Singapore, 2 KK Women’s and Children’s Hospital, Singapore Introduction: Testicular heterogeneity on preoperative ultrasound has been reported to be able to determine testicular viability in patients with testicular torsion. Aim: Determine if testicular heterogeneity in the context of testicular torsion can distinguish between testes which atrophy and those that recover. Materials and Methods: Patients investigated for testicular torsion with preoperative ultrasound available from 2007 to 2017 were reviewed in this IRB approved retrospective study. Testicular torsion was diagnosed as having reduced/absent testicular vascularity or whirlpool sign on ultrasound. Those presenting with possible testicular torsion who had normal testes on ultrasound served as controls. Testicular texture was quantified with TexRad software. The ratios of the texture of right to left testes were compared in those with normal testes to identify the best texture parameters to use. Based on surgical and follow up ultrasound findings, torted testes were sorted into 3 groups (resected, atrophied, recovered) and their preoperative textures compared against normal testes. Results: There were 60 patients who had unilateral testicular torsion of which 19 underwent orchidectomy, 22 had orchidopexy but the torted testes atrophied, 19 had orchidopexy and the torted testes recovered. Control group comprised of 42 patients investigated for testicular torsion with normal testes. Entropy was the least variable texture parameter with right to left ratio of 1.00 +/-0.02 in controls. Preoperative ultrasound average entropy ratio was statistically significantly elevated (p<0.01) at 1.03 +/-0.04 in torsion cases (1.05 +/-0.04 for resected testes, 1.03 +/- 0.03 for testes which atrophied and 1.00 +/-0.03 for testes which recovered). There is much overlap of values between testes which recovered and those that atrophied. Conclusion: Heterogeneity of the torted testes as measured by TexRad entropy values can be higher than normal controls on preoperative ultrasound. However there is much overlap of the entropy values between torted testes that recover and those that atrophy. References: 1. Parenchymal Echo Texture Predicts Testicular Salvage After Torsion: Potential Impact on the Need for Emergent Exploration. Jonathan D. Kaye, Edan Y. Shapiro, Selwyn B. Levitt, Steven C. Friedman, Jordan Gitlin, Jaime Freyle, Lane S. Palmer. The Journal of Urology. 2008;180:1733-1736. 2. Ultrasounographic Assessment of Testicular Viability Using Heterogeneity Levels in Torsed Testicles. Patrick Samson, Christopher Hartman, Ricardo Palmerola, Zara Rahman, Michael Siev, Lane S. Palmer, Sleiman R. Ghorayeb.The Journal of Urology. 2017;197:925-930.
SESSION 14F: WORKSHOP - MSK LIVE SCANNING MSK Live Scanning: Foot and Rheumatology Colin Chun Wai Chong Radiologist, Chong MSK Radiology, Newmarket, QLD, Australia
S71
Ultrasound has a distinct advantage over other imaging modality of musculoskeletal conditions that are only detected with patient movement. Dynamic ultrasound allows the sonologist to visualise nerves, muscles, tendons, ligaments and their interactions in real time. A directed and relevant clinical history and understanding of biomechanics allow the sonologist to characterise pathologies that involve sensations of snapping, popping, clicking, clunking, triggering or crackling, replicated by reproducing the patient’s symptoms.
SESSION 14G: GENERAL HEAD & NECK Radiofrequency ablation of thyroid nodules Woojin Cho Department of Otolaryngology and Head and Neck Surgery, Withsim Clinic, Bundang-gu, Seongnam-si, South Korea The treatment goals of Image-guided intervention for thyroid nodule are the relief of symptoms by reducing the nodule volume and the maintaining of symptom free status without regrowth of treated lesion. Thus, it is basically not indicated for the nodules which are not related to the patient’s discomfort even they are large. And up to now, except for few limited cases impossible to get surgery, the applications for the malignant disease and follicular neoplasm have not been established firmly. For this reason, preoperative cytopathologic and ultrasonographic evaluations are important to confirm that the target lesion is benign. Thermal ablation is one category of it and consists of radiofrequency ablation (RFA), laser ablation, microwave ablation and high-intensityfocus-ultrasound. RFA for benign thyroid nodules have been reported to have a high efficacy with a low complication rate. Its efficacy is generally evaluated by volume reduction rate. Reported short-term results are 50-80% volume reduction at 6 months, 79-90% at 2 years, and 93% at 4 years. Recurrence rates after the procedure have been reported 5.6%. All recurrent cases showed regrowth of the incompletely treated nodule margin. For this reason, it is recommended to ablate the nodule completely to minimize recurrence. The multiple sessions are needed to get the wellablated nodule without damaging the adjacent tissues. In this presentation, we can discuss how to make a plan before and after thyroid RFA to reach more successful treatment goal, minimizing the recurrence and the complications.
Ultrasonography and ultrasound-guided intervention of salivary gland masses Yung-Liang Wan Professor of Radiology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan The presence of a mass in parotid gland is a diagnostic and therapeutic challenge clinically. A patient with sialadenitis, benign neoplasm or lymphoid hyperplasia may be treated conservatively. Patients with lymphoma should undergo chemotherapy or radiation therapy after systemic staging, while those with primary malignancy may require extensive surgery. It is reported that there is significant difference between the benign and malignant lesions with respect to the shape (p = 0.037, oval or round versus irregular). The benign neoplasms and lymphoid hyperplasia are more likely to have homogeneous texture, well-defined margin and round or oval shape; while the malignancies and inflammatory lesions tend to be heterogeneous with indistinct margin and irregular shape (p = 0.002, 0.001 and 0.009 for texture, margin and shape,
Usefulness of evaluating testicular heterogeneity in cases of testicular torsion Phua Hwee Tang,1,2 Dorinda Chew,2 Narasimhan Laksmi2 1 Duke NUS Medical School, Singapore, 2 KK Women’s and Children’s Hospital, Singapore Introduction: Testicular heterogeneity on preoperative ultrasound has been reported to be able to determine testicular viability in patients with testicular torsion. Aim: Determine if testicular heterogeneity in the context of testicular torsion can distinguish between testes which atrophy and those that recover. Materials and Methods: Patients investigated for testicular torsion with preoperative ultrasound available from 2007 to 2017 were reviewed in this IRB approved retrospective study. Testicular torsion was diagnosed as having reduced/absent testicular vascularity or whirlpool sign on ultrasound. Those presenting with possible testicular torsion who had normal testes on ultrasound served as controls. Testicular texture was quantified with TexRad software. The ratios of the texture of right to left testes were compared in those with normal testes to identify the best texture parameters to use. Based on surgical and follow up ultrasound findings, torted testes were sorted into 3 groups (resected, atrophied, recovered) and their preoperative textures compared against normal testes. Results: There were 60 patients who had unilateral testicular torsion of which 19 underwent orchidectomy, 22 had orchidopexy but the torted testes atrophied, 19 had orchidopexy and the torted testes recovered. Control group comprised of 42 patients investigated for testicular torsion with normal testes. Entropy was the least variable texture parameter with right to left ratio of 1.00 +/-0.02 in controls. Preoperative ultrasound average entropy ratio was statistically significantly elevated (p<0.01) at 1.03 +/-0.04 in torsion cases (1.05 +/-0.04 for resected testes, 1.03 +/- 0.03 for testes which atrophied and 1.00 +/-0.03 for testes which recovered). There is much overlap of values between testes which recovered and those that atrophied. Conclusion: Heterogeneity of the torted testes as measured by TexRad entropy values can be higher than normal controls on preoperative ultrasound. However there is much overlap of the entropy values between torted testes that recover and those that atrophy. References: 1. Parenchymal Echo Texture Predicts Testicular Salvage After Torsion: Potential Impact on the Need for Emergent Exploration. Jonathan D. Kaye, Edan Y. Shapiro, Selwyn B. Levitt, Steven C. Friedman, Jordan Gitlin, Jaime Freyle, Lane S. Palmer. The Journal of Urology. 2008;180:1733-1736. 2. Ultrasounographic Assessment of Testicular Viability Using Heterogeneity Levels in Torsed Testicles. Patrick Samson, Christopher Hartman, Ricardo Palmerola, Zara Rahman, Michael Siev, Lane S. Palmer, Sleiman R. Ghorayeb.The Journal of Urology. 2017;197:925-930.
SESSION 14F: WORKSHOP - MSK LIVE SCANNING MSK Live Scanning: Foot and Rheumatology Colin Chun Wai Chong Radiologist, Chong MSK Radiology, Newmarket, QLD, Australia
S71
Ultrasound has a distinct advantage over other imaging modality of musculoskeletal conditions that are only detected with patient movement. Dynamic ultrasound allows the sonologist to visualise nerves, muscles, tendons, ligaments and their interactions in real time. A directed and relevant clinical history and understanding of biomechanics allow the sonologist to characterise pathologies that involve sensations of snapping, popping, clicking, clunking, triggering or crackling, replicated by reproducing the patient’s symptoms.
SESSION 14G: GENERAL HEAD & NECK Radiofrequency ablation of thyroid nodules Woojin Cho Department of Otolaryngology and Head and Neck Surgery, Withsim Clinic, Bundang-gu, Seongnam-si, South Korea The treatment goals of Image-guided intervention for thyroid nodule are the relief of symptoms by reducing the nodule volume and the maintaining of symptom free status without regrowth of treated lesion. Thus, it is basically not indicated for the nodules which are not related to the patient’s discomfort even they are large. And up to now, except for few limited cases impossible to get surgery, the applications for the malignant disease and follicular neoplasm have not been established firmly. For this reason, preoperative cytopathologic and ultrasonographic evaluations are important to confirm that the target lesion is benign. Thermal ablation is one category of it and consists of radiofrequency ablation (RFA), laser ablation, microwave ablation and high-intensityfocus-ultrasound. RFA for benign thyroid nodules have been reported to have a high efficacy with a low complication rate. Its efficacy is generally evaluated by volume reduction rate. Reported short-term results are 50-80% volume reduction at 6 months, 79-90% at 2 years, and 93% at 4 years. Recurrence rates after the procedure have been reported 5.6%. All recurrent cases showed regrowth of the incompletely treated nodule margin. For this reason, it is recommended to ablate the nodule completely to minimize recurrence. The multiple sessions are needed to get the wellablated nodule without damaging the adjacent tissues. In this presentation, we can discuss how to make a plan before and after thyroid RFA to reach more successful treatment goal, minimizing the recurrence and the complications.
Ultrasonography and ultrasound-guided intervention of salivary gland masses Yung-Liang Wan Professor of Radiology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan The presence of a mass in parotid gland is a diagnostic and therapeutic challenge clinically. A patient with sialadenitis, benign neoplasm or lymphoid hyperplasia may be treated conservatively. Patients with lymphoma should undergo chemotherapy or radiation therapy after systemic staging, while those with primary malignancy may require extensive surgery. It is reported that there is significant difference between the benign and malignant lesions with respect to the shape (p = 0.037, oval or round versus irregular). The benign neoplasms and lymphoid hyperplasia are more likely to have homogeneous texture, well-defined margin and round or oval shape; while the malignancies and inflammatory lesions tend to be heterogeneous with indistinct margin and irregular shape (p = 0.002, 0.001 and 0.009 for texture, margin and shape,