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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.

Iatrogenic ureteral injury associated with lumbar spine surgery is an uncommon but devastating complication with associated medicolegal implications.We performed a systematic review of the English language literature published between 1954 and 2019, accessed through 4 popular databases. We found 44 articles (28 case reports, 9 case-based reviews, 4 case series, 1 original article, 1 case illustration, and 1 pictorial) containing 46 cases of ureteral injuries after posterior or lateral lumbar spine surgery.Except for 5 cases with insufficient data, 24 of the remaining 41 patients were female and 17 were male, with ages ranging from 16 years to 83 years. Excluding 4 cases without enough information, initial diagnoses of lumbar disc herniation (n = 33) or lumbar spinal stenosis (n = 4), spondylolisthesis (n = 3), degenerative disc disease (n = 1), and failed back surgery syndrome (n = 1) were reported from 18 countries; 54% of patients were from the United States, Japan, or Turkey. The interval from spinal surgery to restorative surgery ranged from24 hours to 1 month to 1 year; in 48% of patients, it was1 week, and 90% of patients recovered completely. Initial surgery was combined with vascular injury in 15% of patients.Ureteral injury associated with lumbar spine surgery is overreported in developed or developing countries. It should be considered in the differential diagnosis of any patient who presents with symptoms of acute abdomen after lumbar spine surgery, and patients who underwent restorative surgery had a good prognosis.

Objective Calcified or ossified chronic subdural hematoma (CSDH), characterized by slowly progressing neurologic symptoms, is a rarely seen entity that may remain asymptomatic for many years. Management of CSDH has improved dramatically in recent years as a result of advances in diagnostic tools, but there is still some controversy regarding the optimal treatment strategy. Methods In this systematic review, PRISMA guidelines were followed to query existing online databases between January 1930 and December 2018. We found a total of 88 articles containing 114 cases of calcified or ossified CSDH, comprising 83 patients operated on and 31 not operated on. Results In this study, there were 78 males and 29 females (7 with unreported gender) from 25 countries, ages ranging from 4 months to 86 years (mean, 33.7 years), with CSDH caused by head trauma in 33.3%, shunting for hydrocephalus in 27.2%, or after cranial surgery in 4.4%. The duration of symptoms ranged from acute onset to 20 years, with a mean of 24.1 months. Imaging techniques such as radiography, computed tomography, and magnetic resonance imaging were used, with pathologic confirmation of CSDH and complete recovery in 56.4% of patients. Conclusions Incidence of calcified or ossified CSDH is high in certain countries, including the United States, Japan, and Turkey, with a steady increase in recent years. The therapy of choice is surgery in these patients and it should be considered in the differential diagnosis at presentation because of its infrequency and variable clinical manifestation, after shunting in children or head trauma in adults.

Background/Aim: Although normal Color Doppler US (CDU) findings of the carotid system were described by many studies, normal findings of the vertebral system have not been studied extensively. This study aimed to evaluate vertebral artery CDU hemodynamic and morphologic findings in patients with normal vertebral arteries (VAs) on 64-slice Computed Tomography Angiography (CTA) and investigate the correlation between RDUS and CTA in evaluating the VA anatomy.Methods: In this retrospective cohort analysis, the patients referred to our radiology department for CTA who had normal VA anatomy underwent a CDU for visualization of the orifice and segments (V1-V2) of the VA. Peak systolic velocity (PSV), and end-diastolic velocity (EDV) were measured in V1 while PSV, EDV were measured and resistive index and FV were calculated in V2. The presence of hypoplasia and dominance were noted.Results: A total of 77 patients who had normal vertebral arteries on CTA were included in this study. CDU findings were highly consistent with multislice CTA findings regarding the measurement of VA diameter (ICC=0.856, ICC=0.830), hypoplasia (kappa=0.488), and dominance (kappa=0.752). No consistency was found between the two modalities in the visualization of the orifice and V1 segment of the VAs on both sides. CTA was able to show the orifice and the V1 segment in all cases, while the success rate was lower in CDU, especially in terms of visualizing the orifice of VA. VA FV was not significantly different between the patients with and without vertebrobasilar insufficiency (P=0.300). Conclusion: CDU findings were consistent with 64-slice CTA findings in VA diameter measurement and the diagnosis of hypoplasia and dominance. However, CTA is more successful than RDUS in evaluating the vertebral artery orifice and V1 segment, the most common sites of atherosclerotic involvement. There was no significant difference between the patients with and without VBI symptoms in evaluating FV.

Chronic subdural hematoma (CSDH) is a disease characterized by abnormal accumulation of blood products in the subdural space. Head trauma plays an important role in its etiology. The incidence of CSDH is increasing in advanced age, male gender, and in those with coagulopathies. CSDH has a clinical presentation ranging from being asymptomatic to causing coma. While surgical options are used in symptomatic patients, observation with medical treatment is an option in asymptomatic cases. The first imaging study in a simple radiologically uncomplicated CSDH evaluation is a non-contrast computed tomography (CT) scan. Contrast-enhanced CT or magnetic resonance imaging is very useful in evaluating complicated cases. Since the transformation from an acute hematoma is paramount in its pathophysiology, it is important to review previous imaging, if available, to obtain a detailed clinical history, to develop a differential diagnosis, and to avoid radiological pitfalls. Radiological imaging provides useful information for guiding treatment, posttreatment follow-up and to determine prognosis as well as to confirm the diagnosis of CSDH.

Ultrasound (US) is the most commonly used imaging tool in clinical practice. The innovation including contrast enhanced ultrasound (CEUS) and elastography has transformed US into a multiparametric imaging tool which allows the evaluation of different characteristics of the pathological conditions in the same session. Urology is among the cardinal fields of medicine where US has been used for both diagnostic and therapeutic purposes. 3D imaging, as a valuable complement to 2D US is a widely available feature in many of the currently available US machines. The development of novel technologies such as US-enhanced CL, endoluminal US, micro-ultrasound, PAI and SR-UMI might potentially revolutionize modern medical diagnostics by enlarging the field of its clinical applications including urology.

Other than physical examination, radiological imaging is the most important modality involved in diagnosing patients with craniosynostosis. This chapter reviews the pros and cons of the most used radiological imaging modalities used to investigate premature suture fusion.

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

Infectious diseases of the central nervous system (CNS) are still important causes of morbidity and mortality in spite of the presence of significant progress in the prevention and treatment in recent years. Fungal pathogens rarely affect the CNS. Development of fungal infections depends on host’s immune status and fungal virulence factors. Immunocompetent individuals are usually resistant to fungal infections. These infections are particularly seen in immunocompromised persons. Microbiologically, fungal infections are caused by yeasts, molds, and dimorphic fungi in immunocompromised hosts. The most common fungal infection is cryptococcal meningitis, although the most common nosocomial infection is candidiasis. In immunocompromised patients, invasive aspergillosis and mucormycosis are associated with high morbidity and mortality. Infections due to fungal pathogens frequently present with a variety of neuroimaging features in neuroradiological techniques such as magnetic resonance imaging. In this chapter, we will review radiological characteristics of fungal diseases involving the CNS, according to morphologic features of fungal pathogens.

Background In cranial surgery, different foreign body (FB) materials are used and may be left intentionally or unintentionally in the surgical field after closure, inducing a foreign body granuloma (FBG). This is a rare complication in neurosurgery, but it may be a diagnostic dilemma, with sometimes medicolegal implications. Methods We performed a systematic review of the English literature between 1965 and 2018 and found a total of 77 articles concerning 100 cases of FBG caused by retained material located within the cranium or surrounding soft tissues. Results There were 60 females and 40 males, with ages ranging from 1 to 77 years. Most initial diagnoses were cranial/intracranial tumors, trigeminal neuralgia, hemifacial spasm, intracranial aneurysm, hydrocephalus, head injury, infectious disease, and nontraumatic intracerebral hematoma. The interval from the causative surgical operation to presentation of the FBG ranged from 2 weeks to 20 years. Various radiologic modalities were used and histologic study confirmed the presence of FBG in all patients. Intentional FB was used and left in 77 patients, and unintentional FB was found postoperatively in 23 patients. Associated infection was found in 13 patients. Complete recovery was seen in 47.6% of patients with sufficient data. Conclusions Despite being unusual, a retained FBG should be considered in the differential diagnosis of any patient after cranial surgery. A history of surgery, clinical symptoms, physical examination findings, laboratory results, and the use of appropriate neuroimaging explorations may provide a correct preoperative diagnosis. In addition, unintentionally retained FBs are preventable errors in the operating room.

Objective Retention of nonabsorbable hemostatic materials (RNHMs), that is, retained surgical sponge, gauzoma, gossypiboma, muslinoma, or textiloma, is a rarely seen surgical complication after spinal surgery that may remain asymptomatic for many years and may represent a diagnostic difficulty with associated medicolegal implications. Methods We performed a systematic review of the English-language literature published between 1965 and 2017, accessed through 4 popular databases. We found a total of 37 articles (24 case reports; 7 image presentations; 5 clinical series, and 1 letter to editor) containing 58 cases of RNHMs located within the spinal canal or around the spinal column after surgery. Results In this study, there were 29 female and 29 male patients from 13 countries, ages ranging from 17 years to 87 years, with initial diagnoses of lumbar or cervical disc herniation, spinal stenosis, or spondylolisthesis (n = 54), or spinal tumor (n = 4). The interval from the initial surgery to the presentation of RNHMs ranged from 13 days to 40 years, with a mean of 75.9 months. Various imaging techniques such as computed tomography and magnetic resonance imaging were used with histologic study, confirming the presence of RNHMs in the majority of patients with a complete recovery resulting in 93% of patients. Conclusions RNHMs is an overreported entity in underdeveloped or developing countries, including Turkey and Morocco, with progression occurring over years. RNHMs should be considered in the differential diagnosis of any patient who presents with back pain, spinal cord, or nerve roots symptomatology after spinal surgery.

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.

Tuberculosis (TB) of the central nervous system (CNS) can cause meningitis, epidural abscess, subdural empyema, brain abscess, and intraspinal abscess. Underlying predisposing conditions that lead to the development of TB of the CNS are often associated with some form of immunosuppression. The prognosis for these infections is often related to the extent of the disease and the neurological state of the patient at the time of diagnosis. Cranial and spinal involvement due to TB can be suspected on laboratory and imaging studies, but biopsy may be required to establish a definitive diagnosis. Once the diagnosis is established, prolonged treatment with anti-TB therapy is necessary to eradicate the cranial or spinal infection with inflammatory markers being followed to monitor the response to therapy. Failure to respond to medical management may lead to repeat drainage or resection of intracranial suppuration. Spinal TB is usually treated medically although surgery is indicated for confirmed instability, pronounced deformity, and neurological deficit.

Central nervous system (CNS) tuberculosis (TB) is a dreadful form of TB which may be potentially lethal in the setting of delayed diagnosis. Clinical and paraclinical manifestations of CNS TB may simulate other neurological diseases such as tumors and other infectious and noninfectious conditions. Whoever, the advantage of TB over of the tumors is that this life-threatening disease can be cured with timely diagnosis. Imaging features of various types of CNS TB, including tuberculous meningitis, tuberculoma, abscess, cerebritis, miliary TB, ventriculitis, and encephalopathy, were presented in this chapter.

Tuberculosis (TB) which has still an ongoing importance in today is one of the infections that affect many systems. In case of a delay in diagnosis and treatment, central nervous system (CNS) TB may go on with sequelae, and it can even be fatal. Therefore, it is important to make an early and accurate diagnosis. For this reason, many new methods as well as traditional ones have been developed. Culture and staining methods, molecular analysis, and serological and biochemical monitoring can be used to determine the agent within the capacity of medical institution. However, some of these methods are time-consuming, and some others have sensitivity, false negativity, and false positivity problems in cases with TB of CNS. In suspected cases results should be interpreted cautiously after most appropriate test or test combinations are chosen.

Spinal canal infections may include the epidural space (epidural abscesses), the meninges (meningitis), the subdural space (subdural abscesses), and the spinal cord (intramedullary abscesses). Arachnoiditis involves the arachnoid lining along the spinal cord and accounts for approximately 20% of spinal tuberculosis (TB) cases. Extradural tuberculomas are the most common spinal tuberculomas (approximately 65%), while intramedullary tuberculomas are very rare. Helpful but nondiagnostic laboratory studies include an elevated leukocyte count and estimated sedimentation rate. In most patients, cerebrospinal fluid analysis reveals an active inflammatory response with lymphocytosis, hypoglycorrhachia, and increased protein values. Magnetic resonance imaging is the imaging modality of choice for the diagnosis of the disease. Differentiating from tumors and inflammatory and demyelinating diseases, vascular and granulomatous lesions may be extremely difficult to establish if the patient does not have systemic TB. Based on the location of the spinal infection and the neurological symptoms of the patients, surgical treatment may be indicated, and long-term anti-TB chemotherapy is recommended.

Central nervous system (CNS) tuberculosis (TB) is a serious and deadly form of TB which affects young children and human immunodeficiency virus-infected individuals predominantly. It is the most critical extrapulmonary manifestation of TB, with a high mortality rate and residual neurologic sequelae. It constitutes approximately 1% of all tuberculosis cases. Although various suggestions have been reported related to the occurrence mechanism of the disease, the mechanism is not entirely understood yet. It is considered that Mycobacterium tuberculosis should pass through the blood-brain barrier (BBB) for the occurrence of TB of CNS. The exact entry mechanism of M. tuberculosis to the CNS by passing through the BBB has not been fully elucidated to date. While some authors have suggested that free bacilli directly pass through the endothelial barrier, others have considered that bacilli enter via the macrophages. Various studies in in vitro and animal models have been used for understanding the pathogenesis of TB of CNS.

Spinal subdural tuberculosis (TB) rarely presents as spinal subdural abscess, spinal subdural empyema, intramedullary and extramedullary tuberculoma, infected spinal subdural cyst, infectious spinal subdural cyst, or arachnoiditis. The most commonly used laboratory parameters for the assessment of spinal infection are erythrocyte sedimentation rate, C-reactive protein, and white blood cell count. Percutaneous computed tomography (CT)-guided needle biopsy can be used for revealing the etiology of spinal infection including TB. Cross-sectional imaging tools such as CT, magnetic resonance imaging (MRI), and myelo-CT can be used for the assessment of the spinal subdural abscess. Sometimes, correct diagnosis using with radiologic tools may be challenging, and these atypical involvements can lead to misdiagnosis and neurological problems such as paraplegia.

Most tuberculosis (TB) of the spine is found at a single vertebral level with several adjacent vertebral bodies also involved. Multifocal, noncontiguous presentation is unusual, and surgery for such a condition is still not considered the best practice by all surgeons. Nonetheless, in the presence of spinal instability, extensive abscess, progressive acute neurological impairment, and/or medical treatment failure, consideration of surgical intervention is warranted.In these cases surgery should follow a protocol for solving the neurological deficits from proximal to distal, preferably at the mechanically unstable levels first. A less aggressive approach can also be planned staged or not to minimize the surgical impact. Because of the risk inherent in each approach complications may be higher by addressing more than one lesion surgically at a time. In respect to outcome this will be dictated mainly by the remaining neurological deficit or any symptomatic kyphotic deformity. This is not significantly different from what is published in the literature for the treatment of contiguous spinal TB lesions.

Tuberculosis (TB) of the sellar/suprasellar region is extremely uncommon even in regions where neuro-TB is common. Tuberculoma is the commonest manifestation of neuro-TB of the sellar-suprasellar region. Patients with these lesions usually suffer from headache, vomiting, visual compromise, and hypofunction of the pituitary gland. On MRI tuberculomas are usually hypointense on T1-weighted images and iso- to hyperintense on T2-weighted images with perilesional edema. Magnetic resonance spectroscopy, on the other hand, may reveal elevated lipid-lactate peaks. The enhancement in intracranial tuberculomas is also varied. There are other lesions involving this region which need to be differentiated from tuberculomas. Most patients end up with surgery as preoperative diagnosis is not always possible due to the lack of any single specific imaging sign for sellar/suprasellar tuberculomas. The histopathological feature of a central area of caseating necrosis surrounded by mononuclear cells is pathognomic of tuberculoma. The duration of treatment is usually 1 year which sometimes may extend further depending upon other variables of the patient.

Cerebrovascular manifestations are uncommon features of brucellosis especially as the presenting feature. The major mechanisms of stroke in neurobrucellosis are mycotic aneurysm, embolism from cardiac vegetations, and Brucella-associated vasculitis. Spread of inflammation from adjacent meninges may lead to cerebral venous sinus thrombosis. Common clinical presentation includes stroke, transient ischemic attack, seizures, and symptoms of increased intracranial pressure along with features of meningeal irritation and systemic features. Neurotuberculosis, primary central nervous system lymphoma, demyelination, neurosyphilis, and vasculitis are the common differential diagnoses. There are no evidence-based guidelines for the management of cerebrovascular complications of neurobrucellosis. The usual clinical practice is medical management followed by surgical/endovascular treatment if required.

Brucellosis is a zoonotic disease, with sheep, goat, camel, livestock animals, etc., as the primary hosts and human beings as the secondary host. It is a member of the specie brucella with melitensis, abortus, suis, and canis subgroups being a Gram-negative short rodlike bacteria which are intracellular. This infection is endemic in some parts of the world, in particular in the Mediterranean basin. Involvement of the nervous system by the organism is seen in about 5–10 % of cases which may involve the central nervous system or may involve the spinal system, the latter being the subject of this chapter. The diagnosis is done by clinical and laboratory findings such as blood agglutinin levels, isolation of the species from blood flow, or other specimens. Along with the laboratory findings, plain X-rays, CT, MRI, and radionuclide studies are of importance. The treatment options are antibiotics as the first step in case of lack of neurologic deterioration. If neurologic deterioration occurs, surgical procedures can be carried by an anterior, posterior, or combined approach. Brucellosis is an infection which causes socioeconomic problems, so its diagnoses and treatment should be done carefully. Recent investigations and developments in medications and invasive techniques provide the chance to treat it thoroughly.

Brucellosis, being a systemic disease, may affect many organ systems. The involvement of the musculoskeletal involvement is associated with 10–85 % of the focal complications. Spinal involvement is one of the most commonly encountered localized forms of human brucellosis. It is a destructive disease process requiring a correct and early diagnosis and an immediate treatment. Spinal brucellosis is more prevalent in older patients or in subjects with prolonged illness prior to treatment. The lumbar vertebrae are involved more frequently than the thoracic and cervical ones. Paravertebral, epidural, and psoas abscess can occur in the setting of brucellar spondylitis. Medical treatment for brucellar spondylitis should consist of two antibiotic agents for at least 12 weeks.

Brucellosis is a worldwide zoonotic disease of domestic and wild animals. The infection is transmitted to humans by direct contact with the tissues of infected animals, ingestion of food and drinks with risk, and inhalation of infectious aerosols. Brucellosis can involve any organ or system in the body. Osteoarticular brucellosis is the most frequent complication of brucellosis. Sacroiliitis, spondylitis, peripheral arthritis, and osteomyelitis of the long bones are the most frequent sites of skeletal brucellosis. Cranial bone involvement in brucellosis is considered to be extremely rare and cutaneous manifestations of brucellosis are also uncommon. Scalp involvement is also extremely rare in brucellosis. The findings of both skeletal and cutaneous brucellosis are nonspecific. For differential diagnosis, a thorough history including job, journey to endemic areas, and ingestion of contaminated food or water, clinical evaluation, laboratory tests including serology or polymerase chain reaction assay combined with culture, and radiologic tests should be evaluated.

Neurobrucellosis is a rare but important complication of brucellosis with a rate of about 3–5 %. Intracranial epidural and subdural empyemas are less common and present with nonspecific signs and symptoms including several days of fever, headache, altered mental status and confusion, seizures, and focal neurological deficits. Neuroimaging is very crucial in the diagnosis. Surgical and medical treatments are the cornerstone of therapy. The purposes of this chapter are to emphasize the brucellar epidural and subdural empyemas to keep these neurobrucellosis forms in mind and to review the diagnostic and treatment modalities.

The presentation of the role of surgery in the treatment of neurobrucellosis is the scope of this chapter. As laboratory and imaging diagnostic methods and antibacterial drug regimens continuously evolve, the same occurs to operative equipment and methods. Surgical involvement in life-threatening conditions such as brain and spinal abscess is thoroughly presented. In this chapter, special issues such as cerebrovascular involvement or intraparenchymal lesions are addressed. Intervention in structures with high morbidity like the cervical spine is exposed. Minimal invasive techniques, stenting, grafts, and instrumentation are presented in a friendly way for anyone who is involved in the treatment of neurobrucellosis.

The present paper discusses the characteristics, diagnosis, and treatment of epidural and subdural spinal abscesses, which are the rare complications of brucellosis. Epidural and subdural spinal abscesses have high mortality and their prognosis is quite good with early diagnosis and treatment. There is no standard practice concerning treatment; long-term combined antibiotic therapy, with additional surgical therapy in those having neurological deficit, is required. Attention should be paid particularly for epidural and subdural spinal involvement in the places where brucellosis is endemic.

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.

The goal of this cross-sectional observational study was to determine the incidence of pineal gland calcification (PGC), to investigate the interaction of PGC and aging, and to compare the incidence of PGC among the populations living in Turkey. In a prospective study the rate of PGC on CT scans of 1376 individuals in six referral centers from different regions of Turkey was investigated, with emphasis on effects of climatological parameters and aging on PGC. It was found that the incidence of PGC increased rapidly after first decade and the increase remains gradual thereafter, higher in males than in females for all age groups. There was a significant difference for incidence and degree of PGC between different clinics and between both sexes (p

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