Genitourinary tract imaging - part 9 doc

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The ‘‘stipple sign’’—urographic harbinger of transi- tional cell neoplasms. Urol Radiol 1979;1(2): 77–9. [59] Brennan RE, Pollack HM. Nonvisualized (‘‘phantom’’) renal calyx: causes and radiologi- cal approach to diagnosis. Urol Radiol 1979; 1(1):17–23. [60] Batata MA, Whitmore WF, Hilaris BS, et al. Primary carcinoma of the ureter: a prognostic study. Cancer 1975;35(6):1626–32. O’Connor et al 130 Imaging the Male Repr oductive Tract: Current Trends and Future Dir ections Jurgen J. Fu ¨ tterer, MD, PhD a, * , Stijn W.T.P.J. Heijmink, MD a , J. Roan Spermon, MD, PhD b The male reproductive system encompasses sev- eral organs: the testes, ejaculatory ducts, seminal ves- icles, prostate, and penis. The function of this system is to accomplish reproduction. The testes are outside the abdominal cavity within the scrotal sac. This keeps the testes from the regular body temperature and at an optimal temperature for sperm. The main role of the prostate gland is to produce and secrete an alkaline fluid. This helps to energize and protect the sperm during intercourse in the vaginal canal. The male reproductive tract is a common site for diseases. Diagnostic imaging modalities, such as ultrasound (US), CT, MR imaging, and positron emission tomography (PET), increasingly are used to evaluate these diseases. The purpose of this review is to provide an overview of the use of imag- ing techniques in the male reproductive tract and to discuss current trends and future directions in pros- tate and testicular imaging. This review focuses on the prostate and scrotum. Prostate The prostate changes and commonly enlarges with age. The most frequent types of prostate disease are prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer. Prostate cancer is the most com- mon malignancy in men [1]. Imaging of the pros- tate remains a challenging endeavor. Anatomy of the prostate The prostate is a small gland and situated directly caudal to the bladder. The prostate gland envelops the prostatic urethra and the ejaculatory ducts. The seminal vesicles are paired grapelike pouches filled with fluid that are located caudolateral to the corresponding deferent duct, between the blad- der and rectum. The prostate is divided into apex and base (directed upward to the inferior border of the bladder). On the basis of its embryologic origins, the prostate is divided anatomically into RADIOLOGIC CLINICS OF NORTH AMERICA Radiol Clin N Am 46 (2008) 133–147 a Department of Radiology (667), University Medical Centre Nijmegen, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands b Department of Urology, University Medical Centre Nijmegen, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands * Corresponding author. E-mail address: j.futterer@rad.umcn.nl (J.J. Fu ¨ tterer). - Prostate Anatomy of the prostate Acute and chronic prostatitis Benign prostate hyperplasia Prostate cancer - Scrotum Anatomy of the scrotum Cryptorchidism Acute scrotal pain Scrotal masses - Summary Prostate Scrotum - References 133 0033-8389/08/$ – see front matter ª 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.rcl.2008.01.005 radiologic.theclinics.com Fig. 3. US imaging (Aplio, Toshiba Medical Systems, Tokyo, Japan) of the prostate in a 55-year-old man who had a PSA level of 6.89 ng/mL. (A) No abnormality was observed on gray-scale imaging. (B–H) Contrast harmonic imaging was performed. (B) Until 28 seconds after bolus injection of 2.4 mLSonoVue (Bracco, Milan, Italy), no enhancement was observed in the prostate. (C) Subsequently, within 1 second, the first contrast enhancement is seen in the left peripheral zone (yellow circle). (D–F) The area (circle) continues to enhance more compared with the rest of the prostate until 40 seconds post injection. (G) At 40 seconds post injection, the entire prostate shows a homogeneous enhancement. (H) Step-section histopathology after radical prostatectomy confirmed the cancer focus (yellow outline, T) with Gleason score 3 1 5. Imaging the Male Reproductive Tract 137 . experience with multi-detector row CT urography. Radiol- ogy 2002;222:353–60. [36] Fielding JR, Silverman SG, Rubin GD. Helical CT of the urinary tract. AJR Am J Roentgenol 199 9;172:1 199 –206. [37] Smith. 2003;41(5) :97 9 99 . [55] Browne RF, Meehan CP, Colville J, et al. Transi- tional cell carcinoma of the upper urinary tract: spectrum of imaging findings. Radiographics 2005;25(6):16 09 27. [56]. transi- tional cell neoplasms. Urol Radiol 197 9;1(2): 77 9. [ 59] Brennan RE, Pollack HM. Nonvisualized (‘‘phantom’’) renal calyx: causes and radiologi- cal approach to diagnosis. Urol Radiol 197 9; 1(1):17–23. [60]