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Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.

Turgut, Ahmet Tuncay (isu author) Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations. Key Points center dot Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. center dot Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. center dot This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting. WOS:000501139000002 31332561 Q1

Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.

The Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the scrotum. The SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were ‘magnetic resonance imaging’, 'testis or testicle or testicular', 'scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary). The ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented. • This report presents recommendations for magnetic resonance imaging (MRI) of the scrotum. • Imaging acquisition protocols and clinical indications are provided. • MRI is becoming established as a worthwhile second-line diagnostic tool for scrotal pathology.

Vaginal bleeding is the most common cause of emergency care in the first trimester of pregnancy and accounts for the majority of premenopausal bleeding cases. Ultrasound evaluation combined with a quantitative beta human chorionic gonadotropin test is an established diagnostic tool to assess these patients. Spontaneous abortion because of genetic abnormalities is the most common cause of vaginal bleeding; ectopic pregnancy and gestational trophoblastic disease are other important causes and in all patients presenting with first trimester bleeding, ectopic pregnancy should be suspected and excluded, as it is associated with significant maternal morbidity and mortality. A thorough knowledge of the normal sonographic appearance of intrauterine gestation is essential to understand the manifestations of an abnormal gestation. Arteriovenous malformation of the uterus is a rare but important cause of vaginal bleeding in the first trimester, as it has to be differentiated from the more common retained products of conception, with which it is often mistaken.

Hydatid disease, a worldwide zoonosis, is caused by the larval stage of the Echinococcus tapeworm. Although it can involve almost every organ of the body, lung involvement follows in frequency the hepatic infestation in adults and is the predominating site in children. Radiologically, hydatidosis usually demonstrates typical findings, but many patients are at risk of developing various complications of hydatid disease with atypical imaging findings and these are rarely described in the literature. In this pictorial review, the imaging features of local complications of hydatid disease involving the thorax including intrapulmonary or pleural rupture, infection of the ruptured cysts, reactions of the adjacent tissues, thoracic wall invasion and iatrogenic involvement of pleura are described. Additionally, imaging characteristics of transdiaphragmatic thoracic involvement of hepatic hydatid disease are presented. To prevent the development of subsequent catastrophic results, all radiologists need to be aware of the atypical imaging appearances of complications of pulmonary hydatid disease.

Background: Color Doppler ultrasonography (CDUS) has been used for the diagnosis of diffuse and nodular thyroid diseases as a noninvasive assessment method for the evaluation of blood flow for nearly two decades. The study was undertaken to determine vascularity of the thyroid gland using CDUS and the inferior thyroidal artery (ITA) in the hypothyroid patients and evaluate their relationship with the efficacy of the medical treatment for hypothyroidism. Patients and Methods: A total of 42 patients with hypothyroidism were evaluated clinically by laboratory tests regarding the thyroid function and by CDUS for estimation of the parenchymal color flow pattern (PCFP) of the thyroid gland and the measurement of the maximum systolic velocity (MSV) in the ITA both before and after medical treatment for 6 months. Results: The mean thyroid stimulating hormone (TSH) and MSV values of the ITA which were noted before and after therapy as 25.7±26.7 μIU/mL, 35.5±10.1 cm/sec and 1.6±0.8 μIU/mL, 31.0±10.2 cm/sec respectively were significantly different (p ＜ 0.001, p=0.02, respectively). The PCFP did not change in 29 patients, whereas in 10 patients it changed to a lower grade and in three patients to a higher grade. By comparison of the patients without any change in PCFP and those with a change to lower grade, significant differences for the decrease of TSH and MSV of the ITA were noted (p = 0.035 and p = 0.027, respectively). Conclusion: MSV of the ITA, as well as PCFP, can be used to assess the vascularity of the thyroid gland in the hypothyroidism. The vascular change of PCFP and decreased MSV of the ITA after thyroid hormone replacement may have a adjuvant role for determining the effects of medical treatment in the hypothyroidism in addition to hormonal evaluation.

Significant intra- and interobserver variation has been reported for estimating the dimensions and the volume of the thyroid gland by conventional sonography in adults. This study aimed to assess the role of extended field-of-view (EFOV) sonography for evaluating the size of the thyroid gland. The mediolateral, anteroposterior, and craniocaudal diameters of both thyroid lobes as well as total thyroid volumes of 30 female patients with the clinical diagnosis of goiter were measured three times by three radiologists with the EFOV sonography technique. Based on these findings, the correlation between the measurements of different operators and different measurements of the same operator was investigated. The interobserver variations for craniocaudal diameters of the right and left thyroid lobes were 3.3% ± 1.9% (mean ± SD) and 2.8% ± 1.3% (mean ± SD), respectively ( P = .012), which were lower than the variations calculated for transverse and mediolateral diameters. The interobserver variation for the calculation of the total glandular volume was 6.3% ± 3.8% (mean ± SD). The intraobserver variations for the three radiologists assessing the total thyroid volume were 4.9% ± 3.0%, 4.2% ± 2.4%, and 4.5% ± 1.7% (all mean ± SD), respectively ( P = .521). EFOV sonography should be considered as an alternative technique for the dimension measurements of the thyroid gland, particularly in cases with goiter.

Purpose To assess the frequency of complications specifically related to local anesthetic infiltration prior to transrectal ultrasound (TRUS)-guided prostate biopsy. Methods A total of 200 patients receiving 10 cm3 (5 cm3 on each side) of 2% lidocaine injected around the periprostatic nerve plexus under TRUS guidance before prostate biopsy were included. Various complications presumed to be associated with local anesthesia were noted during and after the biopsy procedure. Two weeks later, periprostatic tissue integrity and vascularization were re-examined with TRUS Doppler examination to assess for fibrosis or infection. Results The most common finding was pain due to puncture with the needle used for local anesthesia (27%). Also recorded were the need for repeated injections during the biopsy procedure (4.5%), symptoms associated with systemic lidocaine toxicity (2%), urinary incontinence (1.5%), and degradation of the image resolution due to anesthetic injection (1%). Increased vascularization within the periprostatic region was uncommon (2%) on the 2-week follow-up examination. No TRUS finding consistent with rectal wall hematoma or other periprostatic change and no erectile dysfunction associated with the procedure occurred. There was a significant difference in overall pain scores between the subgroups of patients (p < 0.001). Conclusion TRUS-guided periprostatic nerve blockade is an effective method for relieving discomfort from prostate biopsy with very few complications. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008

Objective To determine the limits for the amount of tunical fluid enough to be termed as hydrocele by using extended-field of view US technology and to define hydrocele for the first time with standard numerical criteria. Methods A total of 60 patients were evaluated in this prospective study. Group 1 consisted of 20 patients with unilateral clinical hydrocele. Group 2 included 20 patients referred for scrotal US for reasons other than hydrocele. Group 3 comprised 20 male controls with no scrotal complaints. Testis volume ( V t ), scrotum volume ( V s ) and V t / V s ratio were calculated for each subject by dimensions measured in longitudinal and tranverse planes. Results Mean V t / V s ratio was 0.28 ± 0.17 (range, 0.07–0.57), 0.69 ± 0.08 (range, 0.53–0.80) and 0.71 ± 0.07 (range, 0.61–0.85) for groups 1, 2 and 3, respectively. Mean V t / V s for group 1 was significantly lower than those for groups 2 and 3, respectively ( p V t / V s ratio was determined as the optimal cut-off point below which the US diagnosis of hydrocele could be made (sensitivity 95.0% and specificity 97.5%). Conclusions We propose a novel US parameter of V t / V s ratio below 0.55 for a standard distinction between hydrocele and physiological amount of scrotal fluid.

OBJECTIVE The purpose of this study was to assess the role of spectral Doppler ultrasonographic parameters of the feeding arteries of the prostate for the detection of prostate cancer. METHODS A total of 55 patients referred for prostate biopsy with a mean age of 66.4 years (range, 46-82 years) were included. In each patient, Doppler indices from bilateral capsular and urethral arteries were obtained. The indices were compared with regard to malignant (group A) and benign (group B) subgroups of histopathologic outcomes of transrectal ultrasonographically guided prostate biopsy for each side (n = 19 and n = 91 for groups A and B, respectively) and to assess whether the indices were significantly altered on the side with cancer compared with the contralateral side. RESULTS The mean pulsatility index value for the capsular artery of group A (1.49 +/- 0.57) was significantly lower than that of group B (1.71 +/- 0.52; P = .048). The mean resistive index and systolic/diastolic ratio for the capsular artery of group A (0.78 +/- 0.10 and 5.40 +/- 2.74, respectively) were lower than those of group B (0.82 +/- 0.08 and 7.40 +/- 4.91) despite being statistically insignificant (P = .075 and .119, respectively). CONCLUSIONS Spectral waveform measurements by power Doppler transrectal ultrasonography may be useful in differentiating prostate cancer from benign hypertrophy. Further research is needed to elucidate the potential of spectral Doppler indices of the capsular and urethral arteries.

Purpose. To evaluate the effect of clinical varicocele on testicular microcirculation using spectral Doppler analysis. Methods. Forty-nine young and healthy volunteers were enrolled in this prospective study. Varicocele grades were determined according to sonographic parameters. Patients with left-sided clinical varicocele were classified as the patient group (n = 15), while the remaining patients served as controls (n = 34). Spectral Doppler measurements of testicular arteries (peak systolic/end diastolic velocity, resistance index, pulsatility index) were measured from capsular and intratesticular branches. Results. No statistically significant difference was found between the Doppler parameters obtained from the intratesticular branches of both testes and the capsular branches of the right testis. On the other hand, in left-sided clinical varicocele cases, the average resistance index (RI) and pulsatility index (PI) of capsular branches of the left testes (RI, 0.68 ± 0.04; PI, 1.22 ± 0.15) were significantly greater than in the control group (RI, 0.64 ± 0.06; PI, 1.07 ± 0.18) (p < 0.05 and p < 0.01, respectively). Conclusions. Increased RI and PI of capsular branches of testicular arteries on spectral Doppler examination may be an indicator of impaired testicular microcirculation in patients with clinical varicocele. Further studies addressing the correlations with sperm counts are needed to determine the cut-off values for these indices. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007

The increasing detection of small testicular lesions by ultrasound (US) in adults can lead to unnecessary orchiectomies. This article describes their nature, reviews the available literature on this subject and illustrates some classical lesions. We also suggest recommendations to help characterization and management. The ESUR scrotal imaging subcommittee searched for original and review articles published before May 2015 using the Pubmed and Medline databases. Key words used were ‘testicular ultrasound’, ‘contrast-enhanced sonography’, ‘sonoelastography’, ‘magnetic resonance imaging’, ‘testis-sparing surgery’, ‘testis imaging’, ‘Leydig cell tumour’, ‘testicular cyst’. Consensus was obtained amongst the members of the subcommittee, urologist and medical oncologist. Simple cysts are frequent and benign, and do not require follow up or surgery. Incidentally discovered small solid testicular lesions detected are benign in up to 80 %, with Leydig cell tumours being the most frequent. However, the presence of microliths, macrocalcifications and hypoechoic areas surrounding the nodule are findings suggestive of malignant disease. Asymptomatic small testicular lesions found on ultrasound are mainly benign, but findings such as microliths or hypoechoic regions surrounding the nodules may indicate malignancy. Colour Doppler US remains the basic examination for characterization. The role of newer imaging modalities in characterization is evolving. • Characterization of testicular lesions is primarily based on US examination. • The role of MRI, sonoelastography, contrast-enhanced ultrasound is evolving. • Most small non-palpable testicular lesions seen on ultrasound are benign simple cysts. • Leydig cell tumours are the most frequent benign lesions. • Associated findings like microliths or hypoechoic regions may indicate malignancy.

Objective. The purpose of this study was to evaluate the effect of premicturitional bladder volume (V 1 ) on postvoid residual urine volume (V 2 ) measurements and to assess the ideal V 1 for an accurate V 2 determination. Methods. Twenty-five healthy men without any urinary symptoms constituted the study group. Measurements by transabdominal ultrasonography for V 1 and V 2 were performed for each subject at 3 different phases, each of which was preceded by oral intake of 1000 mL of water and accompanied by "mild," "moderate," and "severe" sensations of micturition, respectively. Results. Mean ± SD V 1 and V 2 during the first, second, and third phases were 117.7 ± 70.3 and 1 ± 1, 356.2 ± 112.3 and 11.5 ± 12 and 639.6 ± 171.8 and 58.8 ± 35.2 mL, respectively. With 50 mL as the cutoff value for a pathologic V 2 , 15 (60%) men had V 2 in the third phase exceeding this value, whereas the same rate was calculated as 0% for either of the first 2 phases. No patient with V 1 of less than 540 mL had V 2 of greater than 50 mL. Conclusions. Postvoid residual urine volume measurements with an uncomfortably full bladder result in high false-positive postmicturitional residue values even in healthy young men. We strongly advise that V 1 measurements of the bladder be performed before V 2 measurements and that V 2 not be measured if V 1 is greater than 540 mL.

Objective. The purpose of this study was to evaluate the transrectal ultrasonographic features of the prostate after biopsy and to find out whether any ultrasonographically detectable lesion forms secondary to biopsy. Methods. Prebiopsy transrectal ultrasonographic findings in 60 consecutive patients who underwent repeated biopsies were evaluated. Detected lesions that were not defined before the first biopsy were considered postbiopsy-formed lesions and were sampled during the second biopsy. All transrectal ultrasonographically detected lesions were correlated with histopathologic results in the same locations. Results. There were 7 (11.6%) patients with new hypoechoic lesions formed after the first biopsy. Histopathologic analysis of postbiopsy-detected lesions showed that 38.5% were cancer; 62.5% of the detected benign lesions were prostatitis foci. Conclusions. Prostate biopsy does not give rise to formation of fibrotic scar tissue in the peripheral zone. Most postbiopsy-detected lesions are prostatitis foci, but all hypoechoic lesions must be sampled during repeated prostate biopsies because of the 38.5% cancer detection rate. Key words: biopsy; prostate; transrectal ultrasonography.

The subcommittee on scrotal imaging, appointed by the board of the European Society of Urogenital Radiology (ESUR), have produced guidelines on imaging and follow-up in testicular microlithiasis (TML). The authors and a superintendent university librarian independently performed a computer-assisted literature search of medical databases: MEDLINE and EMBASE. A further parallel literature search was made for the genetic conditions Klinefelter’s syndrome and McCune-Albright syndrome. Proposed guidelines are: follow-up is not advised in patients with isolated TML in the absence of risk factors (see Key Points below); annual ultrasound (US) is advised for patients with risk factors, up to the age of 55; if TML is found with a testicular mass, urgent referral to a specialist centre is advised. Consensus opinion of the scrotal subcommittee of the ESUR is that the presence of TML alone in the absence of other risk factors is not an indication for regular scrotal US, further US screening or biopsy. US is recommended in the follow-up of patients at risk, where risk factors other than microlithiasis are present. Risk factors are discussed and the literature and recommended guidelines are presented in this article. • Follow up advised only in patients with TML and additional risk factors. • Annual US advised for patients with risk factors up to age 55. • If TML is found with testicular mass, urgent specialist referral advised. • Risk factors – personal/ family history of GCT, maldescent, orchidopexy, testicular atrophy.

Diffusion-weighted magnetic resonance imaging (MRI), which involves the acquisition of a magnetic resonance signal related to the Brownian motion of water protons in tissue, has become a useful technique for assessing tumors. In this article, we review the basic concepts, imaging strategies, and body applications of diffusion-weighted MRI in detecting and monitoring cancer.

Objectives The purpose of the study was to evaluate the association of sonographic worsening in type 2a hips with risk factors of developmental dysplasia of the hip, stability of the hip, and initial sonographic findings. Methods Among infants who were referred for hip sonography between 2007 and 2009, 3450 were included in this study. Sonographic examinations were performed by combining the static Graf technique and the dynamic Harcke technique. The rate of sonographic worsening in type 2a hips and the relationship between sonographic worsening and risk factors for developmental dysplasia, instability of the hip, lateralization (right or left) of immaturity, and the presence of unilateral and bilateral immature hips were evaluated. Results Type 2a hips were observed in 529 infants (15.3%; 780 hips [11.3%]). Of these, in 36 cases (6.8%; 44 hips [5.6%]), the sonographic results worsened. Twenty-five of these 36 cases (32 of 44 hips) were diagnosed as type 2 b; in others, the dysplasia worsened, and 6 cases (7 hips) were classified as type 2 c, 3 cases (3 hips) as type D, and 2 cases (2 hips) as type 3. Instability, unilateral type 2a hips, and associated central nervous system anomalies were found to be independent predictors of sonographic worsening in type 2a hips. Conclusions Type 2a hips may worsen sonographically at a rate of 5.6%; hence, sonographic follow-up is needed. Instability, central nervous system anomalies, and unilateral type 2a hips were found to be independent predictors of sonographic worsening. Our study shows that cases with these risk factors should be followed more carefully.

PURPOSE To investigate in otherwise healthy children the association between the caries index, the stimulated salivary flow rate (SFR), and the spectral Doppler findings of the changes in blood perfusion in the salivary glands during the secretion of saliva. MATERIALS AND METHODS The study group consisted of 38 children with a mean age of 9.47 ± 1.89 years. The caries index was calculated by determining the number of decayed, missing, and filled teeth. Groups A, B, and C represented subjects with low, moderate, and normal SFRs, respectively, calculated by obtaining chewing-stimulated whole saliva. All subjects were examined by color Doppler ultrasonography (CDUS) before and during secretory stimulation with lemon, by which maximum systolic velocity (MSV), pulsatility index (PI), resistive index (RI), and flow volume (FV) were calculated at the external carotid and facial arteries. RESULTS The differences for spectral indices obtained before and after stimulation were significantly different among Groups A, B, and C at the external carotid artery (P = 0.006 for delta MSV, P = 0.014 for delta PI, P < 0.001 for delta RI, and P = 0.022 for delta FV) and at the facial artery (P = 0.001 for delta MSV, P = 0.004 for delta PI, P < 0.001 for delta RI, and P < 0.001 for delta FV). In addition, significant correlations were calculated between the SFR and the aforementioned delta values. CONCLUSION CDUS enabled the evaluation of changes in blood perfusion in the salivary glands during salivary stimulation and may be a promising tool for the assessment of caries risk in children.

OBJECTIVE. Hydatid involvement of the kidney accounts for only 2–4% of all cases of hydatid disease. The purpose of this article is to review the imaging features of hydatid disease of the kidney and thus show the role of radiography, excretory urography, sonography, CT, and MRI in the diagnosis of hydatidosis.CONCLUSION. The radiologist should be familiar with the imaging findings of hydatid disease because early diagnosis is important for more appropriate treatment.

Hydatid disease, caused by Echinococcus granulosus, is a parasitic disease that is endemic in many parts of the world. Hydatid cyst demonstrates a variety of imaging features, varying according to growth stage, associated complications, and affected tissue. The radiologic findings range from purely cystic lesions to a completely solid appearance. Ultrasound is the most important imaging modality for liver hydatid disease and clearly demonstrates the floating membranes, daughter cysts, and hydatid sand characteristically seen in purely cystic lesions. The radiologist's familiarity with the imaging findings of the disease is very important for earlier diagnosis and an appropriate treatment. There are several classification schemes for liver hydatid cysts based on their ultrasound appearances; the initial classification by Gharbi et al and the World Health Organization classification are the most commonly preferred. Computed tomography and magnetic resonance imaging play a key role in recognizing the complications such as rupture and infection of cysts associated with hydatid disease. Today, percutaneous treatment of liver hydatid cysts, a safe, easily applicable, and well-tolerated method, has become the most effective and reliable treatment procedure in most cases if the hydatid cyst is viable. In patients treated with the percutaneous treatment technique, a decrease in the dimensions of the cyst, solidification of the cyst contents, and irregularity in the walls of cysts are signs suggestive of cure. The radiologist should also be familiar with the postoperative follow-up ultrasound findings of hydatid cyst to prevent misinterpretation of the hypoechoic, anechoic, or hyperechoic appearance of posttreatment hydatid disease appearance as recurrence.

Background Extended field of view (EFOV) ultrasound (US) provides images with a large anatomic field of view and is a technical modification of conventional US. In this study, we aimed to assess the role of EFOV US in the accurate measurement of the longitudinal dimension of hyperplastic thyroid glands which were too big to be documented in a single image. In addition, the accuracy and reliability of EFOV US were compared with those of dual image US. Patients and Methods The actual longitudinal dimensions of 22 surgical specimens of thyroid glandular lobes excised by thyroidectomy were measured manually in the postoperative period. The longitudinal dimensions were also measured by two radiologists using EFOV US and dual image US after the surgical specimens were being placed in containers filled with gel. Results The accuracy and the reliability of EFOV US ( r = 0.997–0.999; reproducibility, 99.88%; repeatability, 99.88–99.92) were found to be higher than the dual imaging technique ( r = 0.970–0.986; reproducibility, 99.51%; repeatability, 99.56–99.59) in measuring the longitudinal dimension of enlarged thyroid glands. However, our results revealed that both US techniques can be considered in the evaluation of hyperplastic thyroid gland size. Dual image US should be regarded as the second choice for longitudinal dimension measurement of hyperplastic thyroid glands. Conclusion Based on our findings, we propose the use of EFOV US for accurate and reliable measurements in patients with an enlarged thyroid gland. EFOV US has a crucial role in the diagnosis and follow-up of patients undergoing medical therapy for diffuse or nodular goiter.

Objective. The purpose of this study was to investigate whether an inguinal hernia would have an impact on the testicular volume and blood flow by scrotal ultrasonography. Methods. Twenty-six male patients with unilateral inguinal hernias with a mean age of 48.1 years were included in the study. Testicular volumes were calculated, and spectral parameters such as the pulsatility index and resistive index of the testicular artery at supratesticular, subcapsular, and intratesticular levels on both the side with the inguinal hernia and the contralateral side were measured by a preoperative ultrasonographic examination. Comparisons between the dependent groups were performed by a Wilcoxon or paired samples t test where appropriate. Results. The mean ± SD testicular volume on the side with the inguinal hernia was significantly higher than that on the contralateral testis (15.46 ±4.49 versus 14.54 ± 3.65 mL, respectively; P

Objectives The purpose of this study was to investigate the value of tumor-bladder wall contact length (CL), tumor height (H), and height-to-length ratio (H/CL) for preoperative staging of bladder carcinoma. Methods Fifty-seven patients with bladder tumors underwent suprapubic ultrasonography preoperatively, and the CL of the tumor with the bladder wall and H in the bladder lumen were measured. The CL, H, and H/CL values were correlated with the wall invasion determined by histopathologic analysis of the cystectomy material. Invasion was staged according to the TNM classification system. Results Statistically significant differences were found for CL (P < .001) and H/CL (P = .001) between the superficial and invasive tumor groups. These parameters were also effective for differentiating superficial or deep muscle invasion. A CL of greater than 41.5 mm and an H/CL of less than 0.605 were calculated as cutoff values for differentiating superficial and invasive tumors. Height had no value for determining invasion. Conclusions The ultrasonographic measurements of CL of the tumor with the bladder wall and H/CL may be useful for staging bladder carcinoma by verification of these findings in larger groups of patients.

Objective. The purpose of this study was to determine the role of chronic constipation in the etiopathogenesis of varicocele in men. Methods. In this prospective study, group 1 included 25 male patients who had symptoms of chronic constipation for a mean duration ± SD of 17.0 ± 20.3 months (range, 3-96 months), and group 2 included 26 male subjects without any symptoms associated with constipation. All subjects were evaluated by both physical examination and scrotal ultrasonography. For the plexus pampiniformis (PP) veins, a mean diameter exceeding 2 mm and reflux for more than 1 second were accepted as suggestive findings for varicocele, as described previously. Results. Left varicocele was detected in 13 (52%) of the 25 patients in group 1 and in 5 (19%) of the 26 subjects in group 2 (P = .02). The mean diameters of the left PP veins were 2.58 ± 0.97 mm (range, 1.2-4.3 mm) in group 1 and 1.71 ± 0.53 mm (range, 1.0-3.0 mm) in group 2 (P

Hydatid disease, a worldwide zoonosis, is caused by the larval stage of the Echinococcus tapeworm. Although the liver and the lungs are the most frequently involved organs in the body, hydatid cysts of other organs are unusual. Radiologically, they usually demonstrate typical imaging findings, but unusual imaging characteristics of complicated cyst of hydatid disease, associated with high morbidity and mortality, are rarely described in the literature. The purpose of this study is to review the general features of hydatidosis and to discuss atypical imaging characteristics of the complicated hydatid disease in the human, with an emphasis on structure and rupture of the cystic lesion as well as ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) features of the disease. In our study, the available literature and images of the cases with complicated hydatidosis involving liver, lung, brain, spine and orbit were reviewed retrospectively. In hydatid disease, there are many potential local and systemic complications due to secondary involvement in almost any anatomic location in humans. Radiologically, in addition to the presence of atypical findings such as perifocal edema, non-homogenous contrast enhancement, multiplicity or septations and calcification, various unusual manifestations due to rupture or infection of the cyst have been observed in our cases with complicated hydatid disease. To prevent subsequent acute catastrophic results and the development of recurrences in various organs, it should be kept in mind that complicated hydatid cysts can cause unusual USG, CT, and MRI findings, in addition to typical ones, in endemic areas. Therefore, familiarity with atypical radiological appearances of complicated hydatid disease may be valuable in making a correct diagnosis and treatment.

Objective The purpose of this study was to determine whether hydrocele has any effect on the volume and shape of the ipsilateral testis and can be implicated as a cause of testicular ischemia. Methods Group 1 consisted of 23 patients with unilateral idiopathic hydrocele, whereas 30 healthy men constituted group 2. All patients underwent scrotal ultrasonography by which testicular dimensions in craniocaudal (D(cc)), anteroposterior (D(ap)), and mediolateral axes were measured, followed by calculation of the D(cc)/D(ap) ratio and testicular volume. By color Doppler analysis, the resistivity index of the subcapsular artery (RI(sc)) and the resistivity index of the intratesticular artery were determined. Results The mean D(cc)/D(ap) ratio +/- SD for group 1 was 1.7 +/- 0.3 (range, 1.1-2.3), significantly lower than that of group 2, which was 1.9 +/- 0.3 (range, 1.3-2.2) (P = .028). Mean testicular volume values of subjects having hydrocele for more than and less than 6 months were 13.4 +/- 7.3 and 22.5 +/- 5.1 cm3, respectively; the difference between the subgroups was significant (P = .003). For the ipsilateral testis, mean RI(sc) values were 0.70 +/- 0.06 (range, 0.60-0.80) in group 1 and 0.65 +/- 0.06 (range, 0.59-0.83) in group 2. The mean RI(sc) was significantly higher in group 1 (P = .006). Conclusions Unilateral idiopathic hydrocele has a tendency for rounding rather than flattening the ipsilateral testis as well as elevating the RI(sc) on the affected side. To the best of our knowledge, no strict spectral Doppler analysis criteria have been proposed for testicular ischemia yet. Therefore, the impact of the difference of the RI(sc) should raise the suspicion for ischemia, and further research is needed to elucidate any effect on spermatogenesis.

Purpose: To determine whether idiopathic hydrocele effects the shape of ipsilateral testis and can be implicated as a cause of testicular ischemia. Methods and Materials: Group 1 consisted of 23 patients with unilateral idiopathic hydrocele whereas 30 healthy males constituted group 2. All patients underwent scrotal US by which testicular dimensions in craniocaudal (Dcc) and anteroposterior (Dap) axis were measured and Dcc/Dap ratio was calculated. By spectral Doppler analysis, resistivity indices of subcapsular and intratesticular arteries (RIsk, RIit) and RIsk/RIit ratio were determined. Results: Mean Dcc/Dap ratio for group 1 was 1.7±0.3(range,1.1–2.3), significantly lower than that for group 2 which was 1.9±0.3(range,1.3–2.2)(p=0.028). For ipsilateral testis in group1 and group 2, mean RIsk was 0.70±0.06(range,0.60–0.80) and 0.65±0.06(range,0.61–0.83) whereas mean RIit was 0.62±0.04 (range,0.56–0.72) and 0.59±0.06(range,0.51–0.74), respectively. Mean RIsk and RIit were significantly higher in group 1(p=0.006 and 0.021, respectively). Conclusions: Unilateral idiopathic hydrocele has a tendency for rounding rather than flattening the ipsilateral testis and elevating RIsk and RIit on the effected side. Since no spectral Doppler analysis criteria has been proposed for testicular ischemia yet, the impact of the difference for RIsk and RIit should arise the suspicion for ischemia. Further research is needed to elucidate any effect on spermatogenesis.

Purpose To evaluate the varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography. Materials and methods Sixty patients {48 patients with upper motor neuron injury (U-MNI) and 12 patients with lower-MNI} with traumatic spinal cord injury and age matched 48 healthy volunteers were enrolled in this prospective study. Testis volumes and varicocele grades were determined. Presence of varicocele was also classified according to clinical significance. Results Testis volumes of U-MNI sub-group (14.81 ± 4.74 ml) were significantly smaller than the control group (18.20 ± 4.52 ml, p = 0.000) and L-MNI sub-group (17.88 ± 3.23 ml, p = 0.008). No left-sided clinical varicocele was found in L-MNI sub-group (0/12, 0%), whereas there were 14 patients in control group (14/48, 29%) and 7 patients in U-MNI sub-group (7/47, 15%), and the difference was statistically significant ( p = 0.000, 0.007, respectively). Conclusion Clinical varicocele frequency of U-MNI patients, who have spastic paralysis of abdominal and lower extremity muscles, is similar to the control group. This finding inspires that increased intra-abdominal pressure via normal to increased abdominal muscle tonus may have a role in the varicocele etiology, beside the classical factors. Absence of clinical varicocele in L-MNI patients, who have flaccid paralysis of the same muscle groups, supports this observation.

Objective. Sports-related injuries are among the major causes of testicular trauma. In this study, we aimed to determine sonographically whether chronic urogenital trauma during horse riding increases the prevalence of scrotal sonographic abnormalities. To our knowledge, there are no studies in the literature that have focused on this topic. Methods. Group 1 included 26 male riders with a mean age ± SD of 31 ± 2.9 (range, 26‐38) years and with a mean riding experience of 5 ± 2.6 (range, 1‐10) years, whereas group 2 included 26 healthy nonriding men with a mean age of 31 ± 3.2 (range, 26‐41) years. After the clinical evaluation, all patients underwent scrotal sonographic examination. Results. The prevalence of overall scrotal sonographic abnormalities in group 1 was significantly higher than that in group 2 (77% versus 38%; P < .05). The detected sonographic findings in group 1 were varicocele (46%), hydrocele (19%), testicular cyst (4%), epididymal cyst (35%), testicular calcification (19%), epididymal calcification (8%), scrotal calculus (8%), and inhomogeneity of parenchymal echo texture (4%). However, only varicocele (19%), epididymal cyst (19%), testicular calcification (12%), and scrotal calculus (4%) were detected in group 2. Between the 2 groups, the difference was significant for varicocele prevalence (P < .05) and marginally significant for hydrocele prevalence (P = .051). Conclusions. We recommend scrotal sonographic examination of equestrians when they have a palpable mass or related symptoms, the etiology of which was found in our study to be closely related

Despite being highly efficient for the relief of patient discomfort due to transrectal ultrasound (TRUS) guided prostate biopsy, periprostatic anesthesia is occasionally reported to be of limited use. We aimed to evaluate the efficacy of conscious sedation, an accepted method for lessening patient discomfort due to interventional radiological procedures and compare it with periprostatic anesthesia.93 candidates for biopsy were randomised to three groups: group 1 (n = 31) received intravenous midazolam, group 2 (n = 31) received periprostatic lidocaine injection, whereas group 3 (n = 31) received no anesthetic before the procedure. After the biopsy patients were asked to express discomfort by visual anologue scale (VAS).The mean scores for groups 1 and 2 were significantly lower than that of group 3 (1.4 +/- 1.1 and 2.0 +/- 1.5 versus 4.7 +/- 1.6, respectively; p0.05 for both). For patients with VAS scores exceeding 4 (moderate to severe discomfort), a significant difference was calculated between groups 1 and 2 (3% versus 29%, p0.05) and between each and group 3 (3% and 29% versus 80%, respectively; p0.05 for each).Sedation is an alternative for increasing patient comfort during TRUS-guided prostate biopsy, especially in clinical situations like patient anxiety, young age, repeat biopsies or inflammatory anal diseases.