MRI has several applications in urology, including evaluating the prostate, penis, scrotum, kidneys, and adrenal glands. For the prostate, MRI is useful for detecting and localizing cancer, assessing tumor staging and extent, and guiding biopsies. It provides better soft tissue contrast than other modalities like CT or ultrasound. On T2-weighted MRI sequences, prostate cancer appears as an area of low signal intensity in the peripheral zone compared to the normally high signal prostate tissue. Functional sequences like diffusion-weighted imaging can also identify cancers. MRI is particularly helpful for detecting multifocal tumors and assessing extracapsular extension and seminal vesicle invasion.
CT and MRI urography are radiological techniques used to evaluate the kidneys, ureters, and bladder. CT urography involves acquiring images in three phases after intravenous contrast administration, while MRI urography uses heavily T2-weighted sequences without contrast or excretory T1-weighted sequences after gadolinium contrast. Both techniques provide anatomical details and can detect conditions like renal calculi, tumors, and congenital anomalies. CT urography has advantages of better spatial resolution and ability to depict calcifications but exposes patients to radiation, while MRI urography avoids radiation but has longer scan times and lower spatial resolution.
This document discusses various imaging modalities used to evaluate renal masses, including plain radiography, intravenous urography, ultrasound, computed tomography, magnetic resonance imaging, and renal arteriography. For each modality, it describes their utility in detecting and characterizing renal masses and differentiating renal cell carcinoma from other lesions. It also provides examples of imaging findings for various renal pathologies such as abscesses, cysts, angiomyolipomas, and others.
Multiparametric (mp) mri of prostate cancerElsayed Salih
Multiparametric (mp) MRI combines anatomical T2-weighted imaging with functional techniques such as diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) imaging, and magnetic resonance spectroscopy (MRS) to improve prostate cancer detection and localization. T2-weighted imaging provides detail on zonal anatomy but has limited specificity for cancer. DWI and DCE help identify cancers as regions with restricted diffusion and early contrast enhancement respectively. The PI-RADS scoring system grades lesions on a scale of 1 to 5 based on findings from mpMRI. MpMRI can help guide biopsy or focal therapy of index lesions and select patients for active surveillance.
This document provides an overview of MRI in urology, with a focus on MRI of the prostate. It discusses the moderators and professors of the department of urology. It then covers the basic principles of MRI, including magnetic field strength, radiofrequency pulses, T1/T2 weighting, and contrast agents. Applications of MRI for prostate imaging and prostate cancer detection are described, including T2-weighted imaging, diffusion-weighted imaging, and magnetic resonance spectroscopy. The PIRADS scoring system and assessment of extracapsular extension on MRI are also summarized.
An overview of Renography - the medical imaging of kidneys using Nuclear Medicine - including its advantages and disadvantages over other Radiographic imaging modalities.
CT urography provides a comprehensive non-invasive evaluation of the urinary tract. It is performed as a multiphase exam, including an unenhanced phase followed by corticomedullary, nephrographic and excretory phases after intravenous contrast administration. The nephrographic phase provides the highest sensitivity for detecting renal masses and abnormalities. Various dose reduction techniques can be used, including lower dose protocols, split-bolus contrast injection, dual-energy CT, and iterative reconstruction. These allow radiation doses to be reduced by up to 80% compared to traditional triple-phase CT urography exams.
This document provides an overview of renal isotope studies used to assess renal function and anatomy. It describes the radiopharmaceuticals, patient preparation, indications, and findings for renal scans, renograms, and nuclear cystograms. Key points include that renal scans evaluate renal blood flow, structure, and drainage using agents retained in tubules, filtered by glomeruli, or secreted by tubules. Renograms generate time-activity curves to assess obstruction, transplantation, renovascular hypertension, and hydronephrosis. Nuclear cystograms evaluate vesicoureteral reflux.
CT and MRI urography are radiological techniques used to evaluate the kidneys, ureters, and bladder. CT urography involves acquiring images in three phases after intravenous contrast administration, while MRI urography uses heavily T2-weighted sequences without contrast or excretory T1-weighted sequences after gadolinium contrast. Both techniques provide anatomical details and can detect conditions like renal calculi, tumors, and congenital anomalies. CT urography has advantages of better spatial resolution and ability to depict calcifications but exposes patients to radiation, while MRI urography avoids radiation but has longer scan times and lower spatial resolution.
This document discusses various imaging modalities used to evaluate renal masses, including plain radiography, intravenous urography, ultrasound, computed tomography, magnetic resonance imaging, and renal arteriography. For each modality, it describes their utility in detecting and characterizing renal masses and differentiating renal cell carcinoma from other lesions. It also provides examples of imaging findings for various renal pathologies such as abscesses, cysts, angiomyolipomas, and others.
Multiparametric (mp) mri of prostate cancerElsayed Salih
Multiparametric (mp) MRI combines anatomical T2-weighted imaging with functional techniques such as diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) imaging, and magnetic resonance spectroscopy (MRS) to improve prostate cancer detection and localization. T2-weighted imaging provides detail on zonal anatomy but has limited specificity for cancer. DWI and DCE help identify cancers as regions with restricted diffusion and early contrast enhancement respectively. The PI-RADS scoring system grades lesions on a scale of 1 to 5 based on findings from mpMRI. MpMRI can help guide biopsy or focal therapy of index lesions and select patients for active surveillance.
This document provides an overview of MRI in urology, with a focus on MRI of the prostate. It discusses the moderators and professors of the department of urology. It then covers the basic principles of MRI, including magnetic field strength, radiofrequency pulses, T1/T2 weighting, and contrast agents. Applications of MRI for prostate imaging and prostate cancer detection are described, including T2-weighted imaging, diffusion-weighted imaging, and magnetic resonance spectroscopy. The PIRADS scoring system and assessment of extracapsular extension on MRI are also summarized.
An overview of Renography - the medical imaging of kidneys using Nuclear Medicine - including its advantages and disadvantages over other Radiographic imaging modalities.
CT urography provides a comprehensive non-invasive evaluation of the urinary tract. It is performed as a multiphase exam, including an unenhanced phase followed by corticomedullary, nephrographic and excretory phases after intravenous contrast administration. The nephrographic phase provides the highest sensitivity for detecting renal masses and abnormalities. Various dose reduction techniques can be used, including lower dose protocols, split-bolus contrast injection, dual-energy CT, and iterative reconstruction. These allow radiation doses to be reduced by up to 80% compared to traditional triple-phase CT urography exams.
This document provides an overview of renal isotope studies used to assess renal function and anatomy. It describes the radiopharmaceuticals, patient preparation, indications, and findings for renal scans, renograms, and nuclear cystograms. Key points include that renal scans evaluate renal blood flow, structure, and drainage using agents retained in tubules, filtered by glomeruli, or secreted by tubules. Renograms generate time-activity curves to assess obstruction, transplantation, renovascular hypertension, and hydronephrosis. Nuclear cystograms evaluate vesicoureteral reflux.
This document discusses imaging techniques for prostate cancer, including CT, MR imaging, ultrasound, and bone scanning. It provides details on the anatomy of the prostate and origins of prostate cancer within its zones. MR imaging techniques like T2-weighted imaging, diffusion-weighted imaging, MR spectroscopy, and dynamic contrast-enhanced imaging are described for evaluating prostate cancer diagnosis, staging, detection of recurrence, and assessment of treatment response. The roles of ultrasound and CT are also summarized.
CT urography is an imaging technique used to examine the urinary tract. It involves non-contrast CT imaging followed by CT imaging after intravenous contrast administration, including excretory phase images 8-10 minutes later. CT urography can detect abnormalities of the kidneys, ureters and bladder such as tumors, stones, infections and congenital anomalies. It provides both anatomical and functional information about the urinary tract.
1. Renal radionuclide imaging uses various radiotracers like DMSA, MAG3, and DTPA with technetium-99m or iodine-131 to evaluate renal perfusion and function, obstruction, renovascular hypertension, infection, and transplant and congenital kidney anomalies.
2. DMSA scintigraphy with technetium-99m is commonly used to assess renal morphology and detect infections, masses, and post-infection scarring by visualizing renal contours and detecting "cold" defects.
3. Diuretic renal scans with MAG3 or DTPA and Lasix are used to evaluate obstruction by assessing tracer washout from the renal pelvises,
A presentation about Intravenous Urography (Also known as Intravenous Pyeography).
The presentation contains 41 slides, and is divided into 4 parts :
1 - Introduction.
2 - The procedure.
3 - Examples for abnormal findings.
4 - Studies comparing IVU accuracy with KUB & USG with CT Scan.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
Urinary tract disorders can cause calculi (stones), nephrocalcinosis (calcification of the renal parenchyma), and obstruction. Calculi can be seen on CT and ultrasound and come in various shapes and sizes. Nephrocalcinosis causes focal or diffuse renal calcification and can be caused by hypercalcemia, hyperparathyroidism, or renal tubular acidosis. Urinary tract obstruction leads to dilation of the renal pelvis and ureters and can be identified and localized with ultrasound or IVU. CT is also useful for evaluating acute obstruction. Common causes include stones, tumors, strictures, congenital issues, and retroperitoneal fibrosis.
This document discusses the normal anatomy of the male and female urethra and various pathologies that can affect the urethra, as seen on medical imaging. For the male urethra, it describes the anatomy in detail and covers acquired inflammatory diseases like gonorrhea and nonspecific urethritis. It also discusses strictures, calculi, condyloma, and other conditions. For the female urethra, it briefly outlines the anatomy and mentions acquired urethral diverticula. Various imaging techniques for evaluating the urethra are also reviewed, including retrograde urethrography, ultrasonography, and others.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
Urethral strictures are more commonly seen in the anterior urethra. They are commonly seen secondary to gonococcal urethritis or trauma. The normal urethral lumen is 4mm or less in diameter and has small thin walls. A stricture appears as a segment of narrowed lumen with irregularity and thickening of the wall due to fibrosis and scarring.
Retroperitoneal fibrosis is a rare condition where a fibro-inflammatory mass envelops and potentially obstructs retroperitoneal structures like the ureters. It is idiopathic in most cases. Imaging shows a soft tissue mass surrounding the aorta and ureters, often causing hydronephrosis. Treatment involves stenting of the ureters to relieve obstruction and use of corticosteroids or immunosuppressants to reduce inflammation and fibrosis in active cases. Biopsy is needed to confirm diagnosis and rule out malignancy. The goal of management is to preserve renal function and prevent involvement of other organs.
This document provides information about computed tomography (CT) scanning of the abdomen and pelvis. It describes how CT scanning works, its common uses, and the procedure. CT scanning uses x-rays to create cross-sectional images of the body and is often used to help diagnose abdominal or pelvic pain and diseases of the internal organs. The procedure involves positioning the patient on a table that slides through the CT machine, which rotates around the patient to obtain images from different angles. Contrast material may be used to enhance visibility of certain structures.
This document provides an overview of magnetic resonance cholangiopancreatography (MRCP). It discusses patient preparation, techniques, advantages, limitations, and clinical applications of MRCP. Key points include: MRCP uses heavily T2-weighted sequences to noninvasively visualize the biliary and pancreatic ducts. Patient preparation involves fasting and administering oral contrast. Thin-slab MRCP images provide high resolution of the ductal systems. MRCP is useful for evaluating biliary diseases, pancreatic diseases, and postoperative complications without radiation exposure. Limitations include inability to detect small stones and artifacts from gas or metal.
The document provides an overview of the anatomy and imaging techniques of the urinary tract. It describes the pelvicalyceal system including the minor and major calyces that drain into the renal pelvis. It notes the locations of the renal hilum and discusses the ureters, bladder, and urethra. Common congenital anomalies are described such as duplex collecting systems, ureteropelvic junction obstruction, megacalyces, and calyceal diverticula. Imaging modalities for evaluating the urinary tract include KUB, IVP, ultrasound, MRI, and urethrograms. Characteristic signs of conditions like papillary necrosis are also outlined.
The voiding cystourethrogram is an x-ray exam used to evaluate the lower urinary tract. It involves inserting a catheter into the bladder and filling it with contrast dye before taking x-rays during urination. It can detect conditions like vesicoureteral reflux, bladder abnormalities, and issues with the bladder outlet. The document provides detailed information on how the exam is performed, what is evaluated, common findings, and examples of various normal and abnormal results.
This document discusses the use of MRI in evaluating pelvic and scrotal pathology. It describes how T1-weighted and T2-weighted imaging are used to detect tumors and stage disease in organs like the prostate, bladder, and kidneys. Diffusion-weighted imaging and dynamic contrast-enhanced MRI help identify cancers by their restricted diffusion and microvascular properties. MR spectroscopy provides metabolic information on tissue composition and can improve cancer detection compared to MRI alone. The document also notes scenarios where MRI may be helpful in evaluating indeterminate scrotal masses identified on ultrasound.
This document provides a summary of kidney anatomy and ultrasound appearance in 3 paragraphs:
The kidneys have a complex internal architecture visible on ultrasound, including echogenic renal sinuses containing vessels and collecting systems. Each kidney contains lobes with a medullary pyramid, cortex, and vessels. In adults there are typically 11 pyramids and 9 calices. The kidneys have a slightly ovoid shape viewed longitudinally from the front or back. Normal kidney size varies by individual but is around 10.5-11cm on average.
Ultrasound is used to image the kidneys using curvilinear probes from various approaches. The native kidneys are best seen from the back using adjacent organs as an acoustic window.
1. Renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for 80-90% of primary malignant renal tumors in adults. RCC is typically diagnosed in patients between 50-70 years of age.
2. The main subtypes of RCC include clear cell RCC (70-80% of cases), papillary RCC (13-20% of cases), and chromophobe RCC (5% of cases). These subtypes have distinct histological features and imaging appearances.
3. Imaging plays an important role in the diagnosis and staging of RCC. On CT, clear cell RCC usually appears as a heterogeneous enhancing renal mass. Papillary R
This document summarizes the use of ultrasound and CT scans in evaluating the kidneys, bladder, and urinary tract. It describes how ultrasound and CT work, the different phases of a CT urography exam, and what each modality can be used to diagnose, including kidney abnormalities, urinary tract obstructions, masses, and gallstones. It provides an overview of the diagnostic value of these imaging techniques for the urinary system.
Magnetic Resonance Imaging is a technique that uses the magnetic field and radio waves to create detail images of the organs and tissues of the human body
Magnetic resonance imaging (MRI) of the prostate has advanced from using only morphological T1- and T2-weighted sequences to identify cancer to using multiparametric MRI (mpMRI) combining anatomical T2-weighted imaging with functional techniques. MpMRI provides improved ability to distinguish benign from malignant tissue by adding diffusion-weighted imaging, dynamic contrast-enhanced imaging, and sometimes magnetic resonance spectroscopy. Recent advances at 3T MRI fields with endorectal coils or without further improve diagnostic capability compared to 1.5T, though 1.5T remains acceptable. Computer-assisted evaluation may enhance interpretation but is not required.
Prostate carcinoma is the most common malignancy in males, typically affecting men over 50 years old. On transrectal ultrasound (TRUS), prostate carcinoma usually appears as a hypoechoic lesion in the peripheral zone. Multiparametric MRI with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences is the most sensitive imaging method for detecting prostate carcinoma, as it can identify restricted diffusion and abnormal enhancement patterns not seen on ultrasound. While imaging is useful for detection and staging of prostate carcinoma, biopsy remains the standard for diagnosis.
This document discusses imaging techniques for prostate cancer, including CT, MR imaging, ultrasound, and bone scanning. It provides details on the anatomy of the prostate and origins of prostate cancer within its zones. MR imaging techniques like T2-weighted imaging, diffusion-weighted imaging, MR spectroscopy, and dynamic contrast-enhanced imaging are described for evaluating prostate cancer diagnosis, staging, detection of recurrence, and assessment of treatment response. The roles of ultrasound and CT are also summarized.
CT urography is an imaging technique used to examine the urinary tract. It involves non-contrast CT imaging followed by CT imaging after intravenous contrast administration, including excretory phase images 8-10 minutes later. CT urography can detect abnormalities of the kidneys, ureters and bladder such as tumors, stones, infections and congenital anomalies. It provides both anatomical and functional information about the urinary tract.
1. Renal radionuclide imaging uses various radiotracers like DMSA, MAG3, and DTPA with technetium-99m or iodine-131 to evaluate renal perfusion and function, obstruction, renovascular hypertension, infection, and transplant and congenital kidney anomalies.
2. DMSA scintigraphy with technetium-99m is commonly used to assess renal morphology and detect infections, masses, and post-infection scarring by visualizing renal contours and detecting "cold" defects.
3. Diuretic renal scans with MAG3 or DTPA and Lasix are used to evaluate obstruction by assessing tracer washout from the renal pelvises,
A presentation about Intravenous Urography (Also known as Intravenous Pyeography).
The presentation contains 41 slides, and is divided into 4 parts :
1 - Introduction.
2 - The procedure.
3 - Examples for abnormal findings.
4 - Studies comparing IVU accuracy with KUB & USG with CT Scan.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
Urinary tract disorders can cause calculi (stones), nephrocalcinosis (calcification of the renal parenchyma), and obstruction. Calculi can be seen on CT and ultrasound and come in various shapes and sizes. Nephrocalcinosis causes focal or diffuse renal calcification and can be caused by hypercalcemia, hyperparathyroidism, or renal tubular acidosis. Urinary tract obstruction leads to dilation of the renal pelvis and ureters and can be identified and localized with ultrasound or IVU. CT is also useful for evaluating acute obstruction. Common causes include stones, tumors, strictures, congenital issues, and retroperitoneal fibrosis.
This document discusses the normal anatomy of the male and female urethra and various pathologies that can affect the urethra, as seen on medical imaging. For the male urethra, it describes the anatomy in detail and covers acquired inflammatory diseases like gonorrhea and nonspecific urethritis. It also discusses strictures, calculi, condyloma, and other conditions. For the female urethra, it briefly outlines the anatomy and mentions acquired urethral diverticula. Various imaging techniques for evaluating the urethra are also reviewed, including retrograde urethrography, ultrasonography, and others.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
Urethral strictures are more commonly seen in the anterior urethra. They are commonly seen secondary to gonococcal urethritis or trauma. The normal urethral lumen is 4mm or less in diameter and has small thin walls. A stricture appears as a segment of narrowed lumen with irregularity and thickening of the wall due to fibrosis and scarring.
Retroperitoneal fibrosis is a rare condition where a fibro-inflammatory mass envelops and potentially obstructs retroperitoneal structures like the ureters. It is idiopathic in most cases. Imaging shows a soft tissue mass surrounding the aorta and ureters, often causing hydronephrosis. Treatment involves stenting of the ureters to relieve obstruction and use of corticosteroids or immunosuppressants to reduce inflammation and fibrosis in active cases. Biopsy is needed to confirm diagnosis and rule out malignancy. The goal of management is to preserve renal function and prevent involvement of other organs.
This document provides information about computed tomography (CT) scanning of the abdomen and pelvis. It describes how CT scanning works, its common uses, and the procedure. CT scanning uses x-rays to create cross-sectional images of the body and is often used to help diagnose abdominal or pelvic pain and diseases of the internal organs. The procedure involves positioning the patient on a table that slides through the CT machine, which rotates around the patient to obtain images from different angles. Contrast material may be used to enhance visibility of certain structures.
This document provides an overview of magnetic resonance cholangiopancreatography (MRCP). It discusses patient preparation, techniques, advantages, limitations, and clinical applications of MRCP. Key points include: MRCP uses heavily T2-weighted sequences to noninvasively visualize the biliary and pancreatic ducts. Patient preparation involves fasting and administering oral contrast. Thin-slab MRCP images provide high resolution of the ductal systems. MRCP is useful for evaluating biliary diseases, pancreatic diseases, and postoperative complications without radiation exposure. Limitations include inability to detect small stones and artifacts from gas or metal.
The document provides an overview of the anatomy and imaging techniques of the urinary tract. It describes the pelvicalyceal system including the minor and major calyces that drain into the renal pelvis. It notes the locations of the renal hilum and discusses the ureters, bladder, and urethra. Common congenital anomalies are described such as duplex collecting systems, ureteropelvic junction obstruction, megacalyces, and calyceal diverticula. Imaging modalities for evaluating the urinary tract include KUB, IVP, ultrasound, MRI, and urethrograms. Characteristic signs of conditions like papillary necrosis are also outlined.
The voiding cystourethrogram is an x-ray exam used to evaluate the lower urinary tract. It involves inserting a catheter into the bladder and filling it with contrast dye before taking x-rays during urination. It can detect conditions like vesicoureteral reflux, bladder abnormalities, and issues with the bladder outlet. The document provides detailed information on how the exam is performed, what is evaluated, common findings, and examples of various normal and abnormal results.
This document discusses the use of MRI in evaluating pelvic and scrotal pathology. It describes how T1-weighted and T2-weighted imaging are used to detect tumors and stage disease in organs like the prostate, bladder, and kidneys. Diffusion-weighted imaging and dynamic contrast-enhanced MRI help identify cancers by their restricted diffusion and microvascular properties. MR spectroscopy provides metabolic information on tissue composition and can improve cancer detection compared to MRI alone. The document also notes scenarios where MRI may be helpful in evaluating indeterminate scrotal masses identified on ultrasound.
This document provides a summary of kidney anatomy and ultrasound appearance in 3 paragraphs:
The kidneys have a complex internal architecture visible on ultrasound, including echogenic renal sinuses containing vessels and collecting systems. Each kidney contains lobes with a medullary pyramid, cortex, and vessels. In adults there are typically 11 pyramids and 9 calices. The kidneys have a slightly ovoid shape viewed longitudinally from the front or back. Normal kidney size varies by individual but is around 10.5-11cm on average.
Ultrasound is used to image the kidneys using curvilinear probes from various approaches. The native kidneys are best seen from the back using adjacent organs as an acoustic window.
1. Renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for 80-90% of primary malignant renal tumors in adults. RCC is typically diagnosed in patients between 50-70 years of age.
2. The main subtypes of RCC include clear cell RCC (70-80% of cases), papillary RCC (13-20% of cases), and chromophobe RCC (5% of cases). These subtypes have distinct histological features and imaging appearances.
3. Imaging plays an important role in the diagnosis and staging of RCC. On CT, clear cell RCC usually appears as a heterogeneous enhancing renal mass. Papillary R
This document summarizes the use of ultrasound and CT scans in evaluating the kidneys, bladder, and urinary tract. It describes how ultrasound and CT work, the different phases of a CT urography exam, and what each modality can be used to diagnose, including kidney abnormalities, urinary tract obstructions, masses, and gallstones. It provides an overview of the diagnostic value of these imaging techniques for the urinary system.
Magnetic Resonance Imaging is a technique that uses the magnetic field and radio waves to create detail images of the organs and tissues of the human body
Magnetic resonance imaging (MRI) of the prostate has advanced from using only morphological T1- and T2-weighted sequences to identify cancer to using multiparametric MRI (mpMRI) combining anatomical T2-weighted imaging with functional techniques. MpMRI provides improved ability to distinguish benign from malignant tissue by adding diffusion-weighted imaging, dynamic contrast-enhanced imaging, and sometimes magnetic resonance spectroscopy. Recent advances at 3T MRI fields with endorectal coils or without further improve diagnostic capability compared to 1.5T, though 1.5T remains acceptable. Computer-assisted evaluation may enhance interpretation but is not required.
Prostate carcinoma is the most common malignancy in males, typically affecting men over 50 years old. On transrectal ultrasound (TRUS), prostate carcinoma usually appears as a hypoechoic lesion in the peripheral zone. Multiparametric MRI with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences is the most sensitive imaging method for detecting prostate carcinoma, as it can identify restricted diffusion and abnormal enhancement patterns not seen on ultrasound. While imaging is useful for detection and staging of prostate carcinoma, biopsy remains the standard for diagnosis.
The document discusses the normal anatomy of the prostate gland, which is divided into four zones - peripheral, central, transitional and anterior fibromuscular stroma. It describes multiparametric MRI for prostate imaging, which includes T2-weighted imaging, diffusion-weighted imaging, dynamic contrast enhanced imaging, and magnetic resonance spectroscopy. Multiparametric MRI is useful for detecting and characterizing prostate cancers, differentiating them from benign conditions, and staging disease. PIRADS scoring is used to standardize MRI findings for reporting and management decisions.
Presentation1, radiological imaging of anal carcinoma.Abdellah Nazeer
1) MRI is the preferred imaging modality for staging anal carcinoma due to its ability to accurately assess the size and extent of primary tumors as well as lymph node involvement.
2) Anal carcinoma is typically staged according to tumor size (T-stage), lymph node involvement (N-stage), and presence of distant metastases (M-stage). MRI allows for evaluation of these factors.
3) Additional imaging with PET/CT may be used to detect distant metastases and better define lymph node involvement, potentially changing staging in 20% of cases and treatment planning in 3-5% of cases.
Imaging HNF(head neck and face) -canceramol lahoti
1. Imaging plays an important role in head and neck cancer for tumor detection, characterization, staging, treatment planning, and monitoring treatment response and recurrence. MRI is often the preferred initial imaging modality, while CT and PET are also used.
2. Ultrasound is useful for imaging neck lymph nodes and salivary glands. CT is better for evaluating bone involvement. PET is used for detecting distant metastases.
3. Imaging also guides biopsies and interventions such as embolization prior to surgery. Advances include functional MRI, PET/CT, and intra-arterial chemotherapy.
Dr. Basant Regmi's presentation discusses imaging in prostatic cancer. It begins with an overview of prostate anatomy, noting that 70% of cancers arise in the peripheral zone. Imaging modalities are then reviewed, including USG, TRUS, MRI, and MRS. TRUS is preferred for screening and biopsy guidance but only detects 50-70% of cancers. PSA levels, density, and velocity provide additional information. Multiparametric MRI with PIRADS scoring is now widely used for detection and characterization. Contrast-enhanced ultrasound and 3D scans are also investigated but provide limited benefits.
1. MRI of the prostate uses different sequences including T1-weighted, T2-weighted, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced (DCE) imaging to evaluate prostate anatomy and identify lesions.
2. The Prostate Imaging Reporting and Data System (PIRADS) assigns scores to lesions seen on multi-parametric MRI to assess clinical significance and guide biopsy and treatment. It divides the prostate into sectors for systematic evaluation.
3. Multi-parametric MRI of the prostate has high negative predictive value and positive predictive value for clinically significant prostate cancer compared to systematic biopsy alone, and can help reduce unnecessary biopsies and biopsy cores when
rectal cancer staging;Imaging for rectal cancer staging -Endoscopic ultrasoun...jim kuok
1. Rectal MRI is used to stage rectal cancer by identifying the tumor and assessing invasion depth (T stage), lymph node involvement (N stage), and distance to nearby structures.
2. EUS is also used but is inferior to MRI for early lesions and has limitations including inability to detect microscopic invasion and overstaging inflammation.
3. CT is limited for local staging but used to assess for distant metastases, most common sites being liver, lungs, and lymph nodes.
This study investigated the use of diffusion-weighted MRI in differentiating between borderline epithelial ovarian tumours (BEOTs) and malignant epithelial ovarian tumours (MEOTs). The study found that BEOTs typically demonstrated low or moderate signal intensity in solid components on DW imaging, while MEOTs showed high signal intensity. The mean ADC value of solid components was also higher in BEOTs than MEOTs. An optimal ADC threshold of 1.039x10-3 mm2/s differentiated the two with high sensitivity and specificity. DW imaging and ADC values were thus useful for distinguishing BEOTs and MEOTs, which has implications for determining appropriate surgical approaches. Limitations included potential effects of free-bre
MR imaging is useful for staging prostate cancer once diagnosis is established through biopsy. It allows for identification of extracapsular extension, seminal vesicle invasion, and lymph node involvement. The departmental cases demonstrated various MRI findings of prostate cancer, including low T2 signal in the peripheral zone, restricted diffusion, and increased choline on MR spectroscopy. MRI is more sensitive and specific than other imaging modalities for local staging of prostate cancer when combined with MR spectroscopy.
This document discusses multiparametric MRI for prostate cancer detection and characterization. It describes how MRI utilizes the magnetic properties of hydrogen protons to generate images. Multiparametric MRI combines anatomical T2-weighted imaging with functional techniques like diffusion-weighted imaging, dynamic contrast-enhanced imaging, and magnetic resonance spectroscopy. These functional sequences provide additional information on tissue vascularity and cellularity that can help distinguish prostate cancer from normal tissue and other mimics.
Presentation1.pptx, perfusiona and specroscopy imaging in brain tumour.Abdellah Nazeer
The document discusses the use of perfusion MRI and MR spectroscopy in evaluating brain tumors. It states that perfusion MRI can help estimate tumor grade, guide biopsy to aggressive portions, and better delineate tumor margins compared to conventional MRI. MR spectroscopy can detect metabolic alterations to help characterize tumors and differentiate them from other conditions like abscesses. Together, perfusion MRI and MR spectroscopy provide physiological and metabolic information complementary to anatomical MRI for diagnosing and monitoring brain tumors.
1) Prostate cancer is one of the most common cancers in elderly men and early detection can lead to complete cure. Accurate localization and staging is important for treatment planning.
2) While prostate biopsy is the standard diagnostic technique, ultrasound has low sensitivity and the biopsy is essentially blind. Multi-parametric MRI can improve biopsy results by localizing suspicious areas for targeted biopsy and assessing extra-prostatic extension and clinical staging.
3) The study evaluated 50 patients undergoing multi-parametric MRI and biopsy to diagnose prostate cancer. MRI showed high specificity and sensitivity over clinical assessment alone in diagnosing and staging prostate cancer.
MR spectroscopy by Dr. Nida Kanwal, Neurosurgery, Liaquat National Hospitalnoorulainiqbal
MR spectroscopy provides a non-invasive way to measure brain chemistry by detecting metabolic biomarkers. It can help characterize tumors, infections, strokes and neurodegenerative diseases. Placement of the voxel for spectroscopy is important to include the area of interest while avoiding areas like necrosis. Various metabolites are measured including NAA, creatine and choline to determine the nature of the lesion. MR spectroscopy is an advanced technique that is added on to conventional MRI scans.
This document discusses imaging modalities used for head and neck cancers including radiography, ultrasound, CT, MRI, nuclear scans and PET CT/PET MR. It describes the anatomy visualized by each modality and indications for their use. Key points covered include ultrasound criteria for evaluating lymph nodes, advantages and disadvantages of CT and MRI, and basics of interpreting various tissue types on imaging studies. The neck is divided into spaces and triangles and relevant anatomy of each area is outlined.
This document discusses imaging of prostate cancer. It begins with an introduction to prostate cancer epidemiology and symptoms. Transrectal ultrasound is described as the primary imaging method for diagnosis and staging, allowing visualization of the prostate zones and measurement of volume. Appearances of normal variants, benign conditions like BPH and prostatitis, and prostate cancer on ultrasound are presented. The role of MRI in accurate staging of extracapsular extension and seminal vesicle invasion is also summarized.
PI-RADS v2 is a standardized reporting system for multiparametric MRI of the prostate to improve detection and characterization of prostate cancer. It assesses T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast enhanced imaging on a 1-5 scale. A score of 1 indicates cancer is highly unlikely while 5 indicates cancer is highly likely. PI-RADS v2 aims to improve outcomes for patients by facilitating targeted biopsies and treatment decisions. While it has good performance, limitations include not addressing recurrent cancer or other body parts. Further studies are still needed to validate its accuracy and reduce interpreter variability.
This document provides contouring and treatment planning guidelines for stereotactic body radiation therapy (SBRT). It discusses indications, contraindications, simulation, target volume delineation, organ at risk contouring, dose prescription, and plan evaluation for SBRT treatment of lung, spine, liver, and other cancers. Key considerations include ensuring accurate tumor targeting given organ motion, minimizing dose to nearby organs at risk, and prescribing ablative doses in a small number of fractions to achieve tumor control.
Management of carcinoma nasopharynx presents many challenges:
1) Detection is difficult due to its deep, silent location and treatment is challenging due to proximity to critical structures.
2) Radiotherapy alone was historically used but results in 5-year OS of only 35-50%.
3) The current standard of care is chemoradiotherapy which provides excellent tumor control and improves outcomes over radiotherapy alone, with 5-year OS of 70-80% for early stages and 50% for advanced stages.
This document discusses varicoceles, including their definition, etiology, pathophysiology, clinical features, investigations, treatment options, and complications. Varicoceles involve dilated and tortuous veins in the spermatic cord and are a common cause of male infertility. While often asymptomatic, varicoceles can cause pain and negatively impact testicular function and sperm quality. Treatment involves surgical repair of the affected veins to prevent further damage to the testes.
Resistive index and its applications in UrologyPrateek Laddha
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- Orthotopic diversion was pioneered in the 1950s as an alternative to ureterosigmoidostomy and ileal conduit diversion due to complications of those procedures.
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
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Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
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Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
4. ▪ Because of the limitations of DRE, transrectal US, and transrectal
US–guided biopsy, there is a need for further imaging, with MR
imaging being an attractive modality owing to its high resolution and
soft-tissue contrast.
▪ As cases in which MR imaging will be the only modality to
demonstrate a suspicious focus are unavoidable, biopsy guidance
with MR imaging continues is well established at many centers.
▪ Localization of prostate cancer,
– PSA screening provides no spatial information and
– DRE essentially involves a surface assessment of the prostate.
– DRE and transrectal US are also operator dependent.
Role of MR Imaging in Screening,
Localization, and Biopsy
5. ▪ Prostate cancer is multifocal in 85% of cases, and this property can
be assessed only with imaging or biopsy not with PSA screening;
DRE has only very limited capability for this purpose.
▪ MR imaging is currently best suited for detection of multiple foci and
for localization of prostate cancer, which is becoming increasingly
important.
6. ▪ Results of clinical staging with DRE, serum PSA levels, and biopsy-derived
Gleason score are of limited use in guiding treatment decisions.
▪ MR imaging and other imaging modalities have been evaluated for their
ability to improve staging accuracy. The most important aspect of local
staging is differentiation between
– organ-confined disease (stageT1 orT2) and
– early advanced disease in the form of extracapsular extension or seminal vesicle
invasion (stageT3).
Staging of Prostate Cancer
7. ▪ MR imaging is most suited for evaluation of the prostate, as it has
unparalleled ability to depict exquisite soft-tissue contrast.
▪ Computed tomography (CT) does not provide sufficient soft-tissue
contrast beyond size assessment of the prostate. Although CT is
valuable in the evaluation of pelvic lymphadenopathy and bone
metastases, MR imaging and bone scanning have been found
superior in their assessment.
8. Anatomy
Figure 1 Distribution and proportions of the tissue layers
composing the prostate. Diagram of the prostate shows its
zonal anatomy in the sagittal plane and corresponding axial
sections from the base (1), midgland (2), and apex (3). Note the
anterior fibromuscular stroma (red), peripheral zone (pink),
central zone (yellow), and transition zone (blue).
11. Anatomy of the prostate
on endorectal MR
images obtained at 1.5
T. (a) Sagittal T2-
weighted image shows
division of the prostate
into three sections in the
craniocaudal direction
The superior one-
third of the prostate
below the bladder is
the base
The middle one-
third is the
midgland
The distal one-third is
the apex.
12. (b) Axial T2-weighted image (6000/92)
shows the base of the prostate. The
anterior fibromuscular stroma (arrow)
consists of nonglandular tissue and
appears dark. Note the symmetric
homogeneous muscular stroma layer
(arrowheads) in the posterior prostate
base.
13. (c) Axial T2-weighted image of the
midprostate shows the homogeneously
bright peripheral zone (arrowheads)
surrounding the central gland (white
arrows). The central gland is composed of
the transition zone and central zone, which
cannot be resolved at imaging. Therefore,
they are referred to jointly as the central
gland. Note the neurovascular bundles at the
5-o'clock and 7-o'clock positions (black
arrows).
14. (d) Axial T2-weighted image of the prostatic
apex shows the homogeneous peripheral
zone (arrowheads) surrounding the
urethra (U). Note that the volume of the
peripheral zone increases from the base to
the apex.
15. Morphologic Imaging with T2-weighted and
T1-weighted Sequences
On T2-weighted images, the normal peripheral
zone has homogeneous high signal intensity
and the central gland has variable amounts of
intermediate signal intensity, which is often
replaced by well-circumscribed hyperplastic
nodules of BPH
▪ BPH on endorectal MR images obtained at
1.5T.
▪ (a) Axial T2-weighted image (6000/92) shows
well-defined heterogeneously bright
hyperplastic nodules in the central prostate.
Note the discrete dark margins of the
junction of the central gland and the
peripheral zone pseudo capsule (arrows).
16. (b) Color map from computer-assisted
diagnosis analysis of DCE MR imaging
data shows a region of interest (ROI)
marking the left hyperplastic nodule
of BPH.
17. ▪ Prostate cancer in a 43-year-old
man with a Gleason score of 4 + 3
and a PSA level of 90.5 ng/mL.
Endorectal MR imaging was
performed at 3.0T.
▪ (a) T2-weighted image shows a
voxel of interest (square) in the
left peripheral zone. Although the
left peripheral zone is enlarged
compared with the right
peripheral zone, it has no focal
dark areas. There are patchy dark
abnormalities in the right
peripheral zone.
18. ▪ Prostate cancer arising in the transition zone poses additional imaging
difficulties because of the heterogeneity of signal intensity in the central
gland.
▪ Although there are several findings supporting the diagnosis of a transition
zone tumor , such as a region of homogeneous low T2 signal intensity in the
transition zone and lack of the low-signal-intensity rim commonly seen in
association with BPH, low signal intensity is also normally seen in the
anterior fibromuscular stroma as well as in the stromal type of BPH.
▪ Several studies that investigated the accuracy of MR imaging in detection
of prostate cancer reported low sensitivity, low specificity, and high inter
observer variability, even when high-resolution endorectal MR imaging was
used.
19. ▪ Prostate cancer of the transition zone in a 52-year-old man with a Gleason score of 3 + 4
and a PSA level of 19 ng/mL. Endorectal MR imaging was performed at 1.5 T. (a) Axial T2-
weighted image shows ill-defined homogeneous dark infiltration of the central gland
(arrows).
20. ▪ (b) Sagittal T2-weighted image shows homogeneous dark tissue
replacing the central gland (arrows).
21. Multiparametric-magnetic resonance
imaging (mp-MRI)
▪ Multiparametric-magnetic resonance imaging (mp-MRI) has shown promising results in
diagnosis, localization, risk stratification and staging of clinically significant prostate cancer.
▪ It has also opened up opportunities for focal treatment of prostate cancer.
▪ Combinations of
– T2-weighted imaging,
– diffusion imaging,
– perfusion (dynamic contrast-enhanced imaging) and
– spectroscopic imaging have been used in mp-MRI assessment of prostate cancer, butT2 morphologic
assessment and functional assessment by diffusion imaging remains the mainstay for prostate cancer
diagnosis on mp-MRI.
▪ Because assessment on mp-MRI can be subjective, use of the newly developed standardized
reporting Prostate Imaging and Reporting Archiving Data System scoring system and
education of specialist radiologists are essential for accurate interpretation.
22.
23. T2-WI
▪ T2-WI ISTHEWORKHORSE OF PROSTATE MRI.
– high spatial resolution
– defines the zonal anatomy differentiating the peripheral zone from the
transition zone, the central zone, ejaculatory ducts, anterior fibromuscular
stroma, seminal vesicles and the urethra.
– The neurovascular bundles are also outlined onT2WI.
– The peripheral zone has high signal intensity on T2WI, reflecting its higher water
content, and cancer in the peripheral zone appears as an area of lower signal .
▪ However, low T2 signal in the peripheral zone may also be seen in
benign abnormalities, including prostatitis, fibrosis, scar tissue, post-
biopsy hemorrhage or post-irradiation.
24. ▪ A 55-year-old man with Gleason 7
(4 + 3) prostate cancer. (a) Axial
T2-weighted image (T2WI) shows
the normal hyperintense T2 signal
in the peripheral zone (white
arrow) from the high water
content with cancer (black arrow)
appearing as an area of low signal
on T2WI. (b) Apparent diffusion
coefficient map at the same level
showing low signal from the
restricted diffusion at the site of
cancer (arrow)
25. ▪ The heterogenous appearance with multiple BPH (benign prostate
hyperplasia or benign enlargement of the prostate) nodules makes
assessment for cancer more difficult in the transition zone, especially for
the less-experienced reader.
▪ Functional imaging is not always helpful in the assessment of transition
zone tumor as areas of benign stromal or proliferating hyperplasia may
show heterogenous enhancement on DCE and restricted diffusion on DWI.
▪ Morphological features onT2WI, such as an
– “erased charcoal” appearance ,
– indistinct margins of the nodule,
– extension of low signal into peripheral zone,
– lenticular shape, extension to fibromuscular stroma and local invasion,
26. ▪ help to differentiate tumor from benign tissue, but again some BPH
nodules may also not be clearly demarcated or encapsulated and
therefore this remains a well-identified limitation of mp-MRI.
▪ T2WI is considered the dominant of all the mp-MRI sequences for
detection of cancer in the transition zone.
27. ▪ Transition zone tumor. A 54-
year-old male with biopsy-
confirmed Gleason 8 prostate
carcinoma. The T2-weighted
image showing a typical
“erased charcoal” (arrow)
appearance in the transition
zone
28. ▪ The degree of intensity decrease on T2WI in the peripheral zone has
been correlated with Gleason grade of tumor, with higher Gleason
score components showing lower signal intensities, thereby playing a
role in risk stratification of tumor.
▪ The high spatial resolution of T2WI makes the sequence also the
mainstay for local staging of disease.
▪ Low signal intensity extension to seminal vesicles, obliteration of the
recto–prostatic angle and extension to neurovascular bundles are
signs of extracapsular extension (ECE) of tumor onT2WI.
29. ▪ Extracapsular extension of
tumor. A 64-year-old male with
biopsy-confirmed Gleason 7 (3
+ 4) prostate carcinoma. Axial
T2-weighted image obtained
with the endorectal coil shows
the low signal tumor in the left
peripheral zone with minimal
extension along the left
neurovascular bundle (arrow)
30. Diffusion-weighted MRI
▪ Diffusion-weighted MRI is a functional imaging tool that
measures the random Brownian motion of water molecules in
tissue.
▪ The apparent diffusion coefficient (ADC) on MRI or the net
displacement of molecules quantifies the restriction of water
diffusion.
▪ Interpretation with high b values >1000 s/mm2 is advocated for
DWI in combination with ADC, with the hallmark of cancer
being low ADC and iso to high signal on high b value DWI
images (≥ 1400 s/mm2).
▪ Limitations of DWI include increased noise and anatomic
distortion of the image
31. ▪ Studies have also shown an inverse correlation between quantitative ADC values and
Gleason score, and may therefore help in assigning accurate risk stratification for
selection of therapeutic options.
▪ DWI is a widely available technique and is considered to be the most important
functional imaging sequence in mp-MRI.
▪ Functional imaging (DWI, DCE and magnetic resonance spectroscopic imaging [MRSI]),
and in particular DWI, may help to differentiate cancer from benign abnormalities such
as prostatitis, fibrosis, scar tissue, post-biopsy hemorrhage or post-irradiation in the
peripheral zone
32. ▪ Therefore, DWI is considered as the dominant sequence for
identifying tumors in the peripheral zone
▪ It is also the most useful of all the functional imaging sequences for
tumor detection in the transition zone.
▪ Multiple studies have shown DWI to be the most effective of the mp-
MRI sequences for detecting prostate cancer, thereby improving the
diagnostic performance of mp-MRI
33. DYNAMIC CONTRAST IMAGING
▪ DCE MRI relies on fast T1-weighted sequences before, during and after rapid
intravenous (IV) administration (2–4 mL/s) of a bolus of a gadolinium-based
contrast agent to assess tumor angiogenesis.
▪ During DCE MRI, tumors demonstrate early and high-amplitude enhancement
followed by rapid washout in some cases compared with normal tissue.
▪ DCE MRI images can be evaluated by simple visual analysis in a qualitative
manner on the raw data via scrolling through serial obtained images or on
subtraction images, to look for early nodular and focal enhancement.
34. ▪ Alternatively, semi-quantitative parameters such as upslope
gradient, peak enhancement and washout gradient can be calculated
to generate a slope curve (types A, B and C) for assessment.
▪ Quantitative metric assessment may also be performed using
pharmacokinetic (Tofts) models to estimate contrast concentration
within the tissue.
35. ▪ It provides the transfer constant Ktrans, which describes microvascular
permeability and blood flow, andVe, the extracellular–extravascular
compartment volume fraction or leakage space.
▪ For routine clinical assessment, visual analysis of images or semi-
quantitative assessment of enhancement curve type are considered
adequate for image interpretation.
▪ Quantitative assessment is valuable for assessing response to therapy
when there are no changes to morphologic appearances.
▪ DCE MRI is the dominant sequence for detecting residual/recurrent tumor
following therapy. Early nodular enhancement on DCE MRI following focal
therapy (post-treatment, the area becomes fibrotic and DWI is generally
not useful in assessment) and in the prostate bed following prostatectomy
helps identify the site of local recurrence.
36. ▪ Residual tumor following focal
therapy. Dynamic contrast-
enhanced axial subtraction
image 6 months following focal
therapy shows a nodular area
of enhancement at the margin
of the treatment. Magnetic
resonance-directed fusion
biopsy of the area was
performed, which revealed
Gleason 6 disease
37. Spectroscopic Imaging
• MR spectroscopy provides metabolic information about prostate tissue by
demonstrating the relative concentration of chemical compounds.
• Normal prostate tissue contains a high level of citrate.
▪ On MRSI of the prostate, the dominant peaks in the spectra are from protons in
citrate (resonates at 2.6 ppm), creatine (resonates at 3.0 ppm) and choline
compounds (resonates at 3.2 ppm). Polyamine signals may also be identified.
▪ In cancer,
– choline signals are elevated while citrate signals decrease, in comparison with benign
tissue.
▪ For image interpretation, the choline plus creatine-to-citrate ratio is often used as
a metabolic biomarker, although it is more reliable in the peripheral zone, which
has high citrate levels.
38. ▪ the ability of MRSI to improve the cancer detection rate in patients
with an elevated PSA
▪ for detecting recurrence and monitoring therapy response.
▪ three-dimensional spectroscopic acquisition usually takes about 10–
15 min.
▪ Considerable magnetic field distortions may occur from hemorrhage
and therefore the exam has to be performed after sufficient delay
following biopsy.
▪ MRSI needs more time and expertise than other MR functional
techniques; therefore, its clinical application is limited.
39.
40. Treatment selection
▪ Men classified as having high risk PCa are known to be a highly
heterogenous group in terms of surgical resectability and outcomes , some
of whom are curable by radical prostatectomy and others of whom are not
curable by surgery and would benefit more from combined androgen
deprivation and radiotherapy.
▪ routine MRI in higher-risk men may identify those with evidence of
extensiveT3 disease, whom are inappropriate for radical prostatectomy.
▪ MRI could be added to existing nomograms for prediction of organ-
confined disease in high-risk men.
▪ Likewise in intermediate risk PCA, men with evidence of higher volume/
grade disease on MRI may be at higher risk of failure with low dose rate
brachytherapy, and those with or extensive EPE or SVI on MRI may be
inappropriate for radical prostatectomy .
41. Surgical planning
▪ Two studies have prospectively trialled the incorporation of MRI into
pre-operative plans for nerve-sparing prostatectomy.
▪ STUDY: 135 men had T2WI with an ERC at 1.5T then the urologist
judged need for NVB resection on a scale from 1 (definite
preservation) to 5 (definite resection), before and after reviewing the
MRI. Histopathology determined that neurovascular bundle (NVB)
resection was warranted in 16% of NVBs due to posterolateral ECE or
PSMs. ROC-AUCs were significantly better for the post-MRI versus
pre-MRI surgical plan (0.83 vs 0.74, p < 0.01).
42. ▪ Studies support the use of MRI in nerve-sparing decisions.
▪ MRI may also be of value in guiding the width of resection for the
apical, anterior, posterior and bladder neck dissection: MRI evidence
of high grade/ volume tumour or of ECE may prompt a wider
dissection in that region.
43. Radiotherapy planning
▪ MRI may help define the location, grade, volume and extent of prostate tumours
more accurately if used in combination with biopsy, than biopsy alone.
▪ This has created great interest in the concept of using MRI for treatment planning
in external beam therapy, especially Intensity-Modulated Radio-Therapy (IMRT);
an MRI-based boost-dose up to 80 Gy to the dominant tumour appears to be
associated with low toxicity, however cancer control outcomes are not yet
available.
▪ EPE on MRI was shown to be the strongest predictor of biochemical recurrence in
one study of men undergoing combined brachytherapy + IMRT, which suggests it
could be useful in guiding prognosis and treatment planning.
▪ MRI has been used to plan low dose brachytherapy, although using an endorectal
coil can distort the prostate and lead to errors in dosimetry planning
44. Focal therapy planning
▪ minimally invasive therapy for prostate cancer
▪ involves the localization and ablation of an area/s of significant
cancer
▪ spares the remainder of the prostate
▪ Minimizes treatment related side effects
▪ major impact on quality of life.
▪ The key to a successful outcome with focal therapy lies in the
accurate localisation and risk stratification of all foci of clinically
significant cancer.
45. ▪ MRI appears to be of value at all stages of focal therapy, including:
– localisation and categorisation of risk in all foci,
– monitoring during treatment to guide the treatment field and monitor for
toxicity and efficacy,
– initial post-treatment imaging to determine success and exclude residual viable
disease, and
– finally follow up imaging for recurrence &/or monitoring of low risk foci.
▪ The role of MRI in focal therapy, although promising, remains
experimental
46. MR Imaging–guided Biopsy
▪ image-guided interventions are needed to
increase the accuracy and repeatability with
which needles are placed in the prostate.
▪ MR imaging provides more detailed anatomic
images of the prostate than does transrectal
US
▪ most accurate imaging modality for
localization of prostate cancer,
▪ MR imaging–based guidance offers the
possibility of more precise targeting, which
may be crucial to the success of modern
diagnostic and local therapeutic interventions
in the prostate.
47. ▪ Real-time virtual sonography is a technique in
which the MR imaging dataset is coregistered to
landmarks during the US examination, so that a
needle can be placed sonographically.
49. MR Imaging of the Penis and Scrotum
▪ Traditionally, owing to its low cost, ready availability, and proved
diagnostic accuracy, ultrasonography (US) has been the primary
modality for imaging of the penis and scrotum.
▪ US is limited by its relatively
– small useful field of view (FOV),
– operator dependence, and
– inability to provide much information on tissue characterization.
▪ Magnetic resonance (MR) imaging has become problem-solving
adjunct.
50. ▪ US has proved inconclusive in up to 5% of cases of suspected scrotal disease, with MR imaging
providing additional value in many of these instances.
▪ The performance of MR imaging following inconclusive US is cost effective.
▪ Specifically, MR imaging can help differentiate between benign and malignant lesions seen at US.
▪ The larger FOV of MR imaging can also allow delineation of tumor extent in cases of large masses
and better visualization of locoregional metastatic disease. In addition, MR imaging has proved
superior to physical examination in the staging of penile cancer .
▪ MR imaging to helpS characterize blood products of varying ages and depict the T1- and T2-
hypointense tunica albuginea is a powerful advantage in cases of penile or scrotal trauma.
▪ Defining the extent of inflammatory or infectious diseases and potentially identifying unexpected
sources of infection represent advantages of MR imaging over US in patients with suspected
abscess or Fournier gangrene.
▪ Pathologic processes into three general categories: (a) traumatic, including penile fracture and
contusion; (b) infectious or inflammatory, including Fournier gangrene and scrotal abscess;
and (c) neoplastic, including both benign and malignant penile and scrotal tumors
51. PENIS: NORMAL ANATOMY
▪ The corpus spongiosum and the corpora cavernosa
– hyperintense onT2-weighted images
– intermediate signal intensity onT1-weighted images.
▪ The musculature of the urethra appears hypointense relative to the surrounding
corpus spongiosum.
▪ Both the corpus spongiosum and the corpora cavernosa are enveloped by a strong
fascial sheath known as the tunica albuginea.
▪ The tunica albuginea appears hypointense on bothT1- andT2-weighted images.
▪ The intravenous administration of gadolinium-based contrast agents, both the
corpus spongiosum and corpora cavernosa enhance.
▪ The cavernosal bodies demonstrate gradual enhancement with a centrifugal
pattern, whereas the corpus spongiosum enhances early
52. ▪ Normal penile anatomy.
Sagittal (a) and coronal (b)T2-
weighted MR images show the
corpora cavernosa and corpus
spongiosum with high signal
intensity (black arrow) and the
surrounding tunica albuginea
with low signal intensity (white
arrow).
53. ▪ (b)T2-weighted MR images
show the corpora cavernosa
and corpus spongiosum with
high signal intensity (black
arrow) and the surrounding
tunica albuginea with low
signal intensity (white arrow).
54. ▪ Normal scrotal anatomy.
CoronalT2-weighted MR
image shows homogeneously
hyperintense testes (black
arrow) beneath the more
hypointense epididymis
(arrowhead).The scrotal sac
(white arrow) is hypointense, a
normal finding on bothT1- and
T2-weighted images.
55. Penile trauma. (a) SagittalT2-weighted MR image in a 43-year-old man shows a focal region of low signal intensity in the
left corpus cavernosum (black arrow) without disruption of theT1- andT2-hypointense tunica albuginea fibrous band
(white arrow), findings that are consistent with penile contusion. (b) SagittalT2-weighted MR image in a 17-year-old boy
demonstrates focal disruption of the hypointense tunica albuginea of the left corpus cavernosum (black arrow) associated
with a large hematocele (white arrow)
56. Scrotal hematoma. (a) CoronalT2-weighted MR image in a 24-year-old man demonstrates a hematoma with a
markedly hypointense hemosiderin rind in the left side of the scrotum (arrow). (b) CoronalT2-weighted MR image in a
22-year-old man shows a large, complex fluid collection with classic hypointense signal in the scrotum (arrow), a
finding that is consistent with blood products.
57. ▪ Undescended testis. Sagittal
T2-weighted MR image in a 44-
year-old man demonstrates an
undescended testis in the left
inguinal canal (arrow
58. Scrotal abscess in a 40-year-old man. Axial postcontrastT1-weighted MR image (a), DW image (b), and apparent
diffusion coefficient (ADC) map (c) show a deep, peripherally enhancing fluid collection at the base of the scrotum with
associated diffusion restriction (arrow).
59. Penile-scrotal abscess with cutaneous fistula in a 21-year-old man. (a) Axial postcontrast T1-weighted MR image
shows extensive inflammation of the scrotum (white arrow) with a fistula to the skin surface (black arrow). (b) Axial
postcontrast T1-weighted MR image shows a large, peripherally enhancing abscess at the base of the penis.
60. Infected penile implant in a 67-year-old man. Axial T2-
weighted (a) and axial fat-saturated T-weighted (b) MR images
show peri-implant edema and fluid (arrow).
61. Fournier gangrene in a 47-year-old man. (a) Coronal fat-saturated T2-weighted MR image demonstrates
diffuse edema of the perineum and scrotum (black arrow), with pockets of air and an air-fluid level seen
in the right side of the scrotum (white arrow). (b, c) Axial in-phase (b) and opposed-phase (c) T1-
weighted MR images demonstrate characteristic blooming (arrow) that is more pronounced in b due to
progressive dephasing associated with the longer echo time used for in-phase imaging.
62. Peyronie disease in a 29-year-old man. Sagittal fat-saturated
T2-weighted MR image demonstrates focal thickening and plaque of
the tunica albuginea along the dorsum of the penis (arrow).
63. Lipoma of the spermatic cord in a 22-year-old man. Axial
postcontrast fat-saturated T1-weighted MR image demonstrates
complete fat saturation of a scrotal mass (arrow), in contrast
to the higher-signal-intensity testicles.
64. Liposarcoma of the spermatic cord in a 63-year-old man. (a) Axial
postcontrast T1-weighted MR image demonstrates an enhancing scrotal
mass (arrow), which was surgically confirmed to be a dedifferentiated
liposarcoma. (b) Coronal postcontrast fat-saturated T1-weighted MR
image in a different patient demonstrates an irregular, enhancing soft-
tissue mass with internal lipid in the left side of the scrotum
(arrow), a finding that was also confirmed to be a scrotal liposarcoma.
65. Lymphangioma in a 19-year-old man. Axial T2-weighted
MR image demonstrates a cystic scrotal mass with
multiple septa and fluid-fluid levels (arrow).
66. Scrotal hemangioma in a 27-year-old man. Sagittal T2-weighted MR
image (a) and axial postcontrast T1-weighted MR
image (b) demonstrate a lobulated, T2-hyperintense mass with
nodular areas of enhancement (arrow).
67. Scrotal arteriovenous malformation in a 41-year-old man. Axial fat-saturated T2-weighted
MR image shows a large tangle of dilated tubular vessels involving the scrotum (arrow). MR
imaging is performed prior to surgery or embolization to evaluate lesion extent.
68. Varicocele in a 44-year-old man. Sagittal T2-weighted
MR image shows dilated paratesticular veins (white
arrow) with extension into the testes (black arrow).
69. Adenomatoid tumor of the epididymis in a 24-year-old man.
Coronal T2-weighted MR image show a well-defined paratesticular
mass (arrow) with homogeneous signal intensity lower than that
of the normal testes.
70. Scrotal plexiform neurofibroma in a 35-year-old man with
neurofibromatosis type 1. Axial T2-weighted MR image shows a
large plexiform neurofibroma (arrow) causing marked enlargement
of the scrotum.
71. Testicular germ cell tumor in a 23-year-old man. Axial T2-weighted (a) and coronal
postcontrast T1-weighted (b) MR images demonstrate a large enhancing mass infiltrating the
right testis (black arrow) and a necrotic tumor in the left testis (white arrow). Results
of bilateral orchiectomy confirmed seminoma of both testes
Note the asymmetric enlargement of the right
thigh (a) related to Klippel-Trénaunay-Weber syndrome.
72. Testicular lymphoma in a 30-year-old man. Coronal fat-saturated
T2-weighted MR image shows a round, hypointense mass in the
testis (arrow), a finding that proved to be large cell non-
Hodgkin lymphoma.
73. Squamous cell carcinoma of the penis. (a) Sagittal T2-weighted MR image
demonstrates a large, heterogeneously hypointense mass (arrow) involving the
penile shaft, with invasion of the corpus cavernosum. (b) Axial postcontrast
fat-saturated T1-weighted MR image in a different patient demonstrates a
heterogeneously enhancing penile mass (arrow).
74. Urethral squamous cell carcinoma in a 78-year-old man. Axial T2-
weighted (a) and postcontrast T1-weighted (b) MR images
and ADC map (c) demonstrate an enhancing mass (arrow) at the base of the penis
in the expected location of the bulbomembranous junction of the urethra, with
associated diffusion restriction.
75. Epithelioid sarcoma. Sagittal T2-weighted (a) and axial
postcontrast T1-weighted (b) MR images demonstrate a large,
heterogeneously enhancing mass (arrow) engulfing the scrotum and
penis.
76. Metastasis to the penis from a primary transitional cell carcinoma of the
bladder in a 65-year-old man. Axial postcontrast T1-weighted MR
image (a) and ADC map (b) demonstrate two enhancing masses at the base of the
penis (arrow), with associated diffusion restriction.
81. ▪ The MR imaging appearance of clear cell RCC varies depending on the presence of
hemorrhage and necrosis.
▪ Clear cell RCC most frequently demonstrates a signal intensity similar to that of the
renal parenchyma on T1-weighted images and increased signal intensity on T2-
weighted images. Loss of signal intensity within the solid portions of clear cell
RCCs on opposed-phase images compared with in-phase images is due to
cytoplasmic fat and has been observed in up to 60% of these tumors
▪ Central necrosis is common and is typically seen as a homogeneous hypointense
area in the center of the mass onT1-weighted images.
▪ On T2-weighted images, necrosis tends to have moderate to high signal intensity
(Fig 2), although occasionally it may appear hypointense.
▪ In the presence of central necrosis, a solid rim of tumor is frequently seen at the
periphery of the mass. Postcontrast images demonstrate lack of enhancement in
areas of necrosis and marked enhancement in the viable components of the tumor.
82. ▪ Clear cell RCC in a 52-year-old
man. (a) Axial in-phase T1-
weighted MR image shows a
right renal mass with a thick
rim of tumor (arrows). The
signal intensity of the rim is
similar to that of the renal
cortex. A central low-signal-
intensity area (arrowhead) is
also present.
83. ▪ (b) On an axial opposed-phase
T1-weighted MR image, the
mass appears homogeneous
and is hypointense relative to
the renal cortex.
84. ▪ (c) Photomicrograph (original
magnification, ×10;
hematoxylin-eosin [H-E] stain)
helps confirm the presence of
conventional (clear cell) RCC
(Fuhrman grade 1–2). Clear cell
cytoplasm may contain lipid
that is responsible for the loss
of signal intensity on opposed-
phase MR images. Many tumor
cells contain finely granular
eosinophilic cytoplasm.
85. ▪ Predominantly cystic
RCC. (a) Coronal single-shot
fast spin-echo T2-weighted MR
image shows a mass in the
upper pole of the right kidney,
with predominantly high signal
intensity that is suggestive of
fluid contents. A small nodule
with intermediate signal
intensity (arrow) is noted
centrally at the confluence of
thin septa.
86. ▪ (b) Coronal subtraction image
(postcontrast nephrographic
phase data – precontrast data)
shows enhancement of the
small central nodule (arrow)
within the mass.
87. Papillary RCC accounts for approximately
10%–15% of all RCCs and may be multifocal.
Type I (basophilic)
Type I (basophilic) papillary tumors
are composed of small cuboidal cells
with uniform nuclei covering thin
papillae.
they demonstrate homogeneous low
signal intensity on T2-weighted
images, with homogeneous low-level
enhancement after intravenous
contrast material administration.
Necrosis and hemorrhage may be
present in low-grade type I tumors
and, when present, result in a more
heterogeneous appearance.
Type II (eosinophilic)
▪ eosinophilic. Type II (eosinophilic) papillary
RCCs consist of large eosinophilic cells with
pleomorphic nuclei.
▪ they usually have a more complex
appearance than do low-grade papillary
tumors, with hemorrhage and necrosis.
Enhancing papillary projections at the
periphery of a cystic hemorrhagic mass are
common and can be better depicted on
subtraction images. A fibrous capsule is
typically present in papillary RCCs. Type I
tumors tend to be of lower nuclear grade
than type II tumors. However, the histologic
subtype is an independent predictor of
prognosis regardless of the nuclear grade
(17)
88. ▪ Low-grade papillary RCC in a
70-year-old woman. (a) Coronal
fat-saturated steady-state fast
spin-echo T2-weighted MR
image shows a small mass
(arrow) in the upper pole of the
right kidney. The mass is
homogeneously hypointense
relative to the adjacent renal
parenchyma.
89. ▪ (b) On a sagittal oblique
subtraction image, the mass
(arrow) enhances
homogeneously and less than
the normal right kidney.
90. ▪ High-grade papillary RCC in a
70-year-old man. (a) Sagittal
unenhanced 3D fat-saturated
GRE T1-weighted MR image
shows a large, heterogeneous
mass. The hyperintense
component is consistent with
blood products. The peripheral
anterior area of the mass
(arrowheads) is clearly
hypointense relative to the
hemorrhagic component.
91. ▪ (b) On a sagittal delayed
venous phase image obtained
after the administration of
gadolinium-based contrast
material, the peripheral area
(arrowheads) is slightly less
hypointense relative to the
larger central portion, a finding
that suggests the presence of
an enhancing solid component.
Determination of tumor
enhancement is challenging on
the basis of these findings
alone.
92. ▪ (c) On a postcontrast
subtraction image (data in b –
data in a), the enhancement of
the peripheral component of
the mass (arrowheads) is
readily visible.
93. ▪ Chromophobe renal tumors account for approximately 4%–11% of
RCCs
▪ Central necrosis may be absent even in very large chromophobe
carcinomas. Although the imaging features of chromophobe RCC can
be identical to those of clear cell RCC, the chromophobe subtype
tends to have a better prognosis
94. tcc
▪ TCC is much less common in the upper tract than in the bladder. However, it accounts for 90% of
all tumors that arise from the renal pelvic urothelium
▪ TCCs are typically isointense relative to the renal medulla onT1-weighted images, making the
detection of small tumors in the collecting system virtually impossible.
▪ Larger infiltrative tumors may obliterate the fat in the renal sinus, which may be appreciated on
T1-weighted images without the use of fat-saturation techniques.
▪ This appearance may mimic the so-called faceless kidney, described in the presence of a
duplicated collecting system.
▪ Coronal contrast-enhancedT1-weighted images are helpful in distinguishing between these two
conditions.
▪ Bright signal intensity due to urine in the collecting system onT2-weighted images provides
excellent soft-tissue contrast for the detection of these tumors, which are characteristically seen
as hypointense filling defects. InfiltrativeTCC can be seen on single-shotT2-weighted images as a
hypointense soft-tissue mass infiltrating the renal parenchyma, which has intermediate signal
intensitY.
95. ▪ (a) Coronal contrast-enhanced
MIP image obtained after the
administration of 10 mg of
furosemide clearly depicts the
lower calices (straight arrow)
and the lower pole (dotted line)
of the left kidney. Note the
normal enhancement of the
lower pole of the right kidney
(arrowheads) and the excreted
contrast material in the lower
pole calix (curved arrow).
96. ▪ (b) Coronal contrast-enhanced
3D arterial phase image shows
an infiltrating mass that
involves the renal sinus (arrow)
and the lower pole
(arrowheads) of the left
kidney.
97. ▪ (c) Photomicrograph (original
magnification, ×4; H-E stain)
shows the tumor composed of
fibrovascular cores lined by
low-grade cytologically
malignant cells, findings that
are consistent with a low-grade
papillary urothelial carcinoma.
A focus of invasive carcinoma
in the renal sinus was also
present.
98. ▪ Renal involvement by lymphoma may be due to hematogenous
dissemination or contiguous extension of retroperitoneal disease; primary
renal lymphoma is rare. Non-Hodgkin lymphoma is much more common in
the kidney than is Hodgkin disease. The most common pattern of
lymphomatous involvement of the kidney (60% of cases) consists of one or
more homogeneous masses with low-level enhancement .
▪ A bulky retroperitoneal mass, which may extend directly to and encase one
or both kidneys, is the second most common pattern (25%–30% of cases).
▪ Less commonly seen is an infiltrative pattern, characterized by
nephromegaly without disruption of the renal contour. Involvement of the
perinephric space by lymphoma is uncommon but strongly suggests the
diagnosis (Fig 10). There may be peripelvic and periureteral disease that
manifests as wall thickening and enhancement (Fig 11). Following
treatment, imaging findings may resolve with minimal residual scarring.
99. ▪ Renal lymphoma in a 31-year-
old man with recurrent
mediastinal lymphoma and an
enlarging renal mass. Sagittal
contrast-enhanced fat-
saturated subtraction
(excretory phase data –
precontrast data) T1-weighted
MR image reveals a well-
defined, homogeneous,
hypoenhancing mass (arrows).
Lymphoma was confirmed with
percutaneous biopsy.
100. ▪ Xanthogranulomatous pyelonephritis is an uncommon entity that
results from severe chronic infection causing diffuse renal destruction
and may be misdiagnosed as a tumor.
▪ The inflammatory process extends outside the kidney to the
perinephric fat and may extend further in the retroperitoneum and to
the abdominal wall.
▪ Proteus species and Escherichia coli are commonly associated
organisms. Risk factors include female gender and diabetes.
▪ Most patients have nephrolithiasis, and staghorn calculi are found in
approximately one-half of patients.
101. ▪ Diffuse and focal (“tumefactive”) forms of the disease have been reported. The diffuse
form is characterized by extensive involvement of the renal parenchyma and is the
more common form (58). Gross examination reveals massive renal enlargement,
lithiasis, peripelvic fibrosis, hydronephrosis, and lobulated yellow masses replacing
renal parenchyma .
▪ The focal (tumefactive) form manifests as a focal renal mass of yellow tissue with
regional necrosis and hemorrhage mimicking RCC .
▪ At MR imaging, the renal parenchyma is compressed by dilated calices and replaced by
abscess cavities with intermediate signal intensity on T1-weighted images and high
signal intensity onT2-weighted images.
▪ Cavity walls may show marked enhancement after contrast material administration.
▪ Calculi are better depicted with CT but may be seen at MR imaging as areas of signal
void within the collecting system. Although the focal form of the disease may be
misinterpreted as a renal neoplasm, the presence of a staghorn calculus, appropriate
clinical presentation (eg, chronic pyelonephritis in diabetic patients), and the
characteristic imaging findings strongly suggest the diagnosis
102. ▪ Xanthogranulomatous
pyelonephritis in a 32-year-old
woman with diabetes
and Proteus infection of the
urinary tract. (a) Coronal
steady-state fast spin-echo T2-
weighted MR image shows a
poorly defined mass
(arrowheads) in the lower pole
of the right kidney and
hydronephrosis (arrows) in the
upper pole.
103. ▪ (b) Axial contrast-enhanced 3D
nephrographic phase fat-saturated
GRE T1-weighted MR image shows
irregular areas of enhancement
extending into the perinephric space
(arrowheads). The hypointense areas
in the central region of the kidney
(arrows) correspond to portions of a
large staghorn calculus, which was
better visualized at unenhanced CT.
The appropriate clinical history and
characteristic imaging findings
strongly suggest the diagnosis of
xanthogranulomatous pyelonephritis,
which was confirmed at nephrectomy
in this case.
109. Axial in-phase (a) and out-of-phase (b) MR images show an adrenal adenoma
(arrow), which exhibits the typical decrease in signal intensity on the out-of-
phase image.