Splenogonadal fusion evaluation using Contrast Enhanced Ultrasound and Elastography. A case report

We present the case of splenogonadal fusion in a 53-year-old male patient assessed by ultrasound and MRI, confirmed by pathologic examination. In addition to B-mode and colour-coded Doppler ultrasound, shear wave elastography and CEUS were performed and are presented in detail. Splenogonadal fusion is a rare congenital anomaly presumably caused by an abnormal attachment of splenic tissue to the gonad during gestation. Diagnosis is challenging for clinicians and in unclear cases splenogonadal fusion might cause unnecessary orchiectomies with benign pathologic results. Ultrasound is the first-line imaging modality in the diagnosis of testicular pathologies. This case report summarizes all available modern ultrasound imagingtechnologies and highlights the possibilities for the diagnosis of splenogonadal fusion.

Intravascular Ultrasound for Evaluation of Left Gonadal Vein Anatomic Variations During Coil Embolization

We illustrate the intravascular ultrasound (US) findings in the evaluation of left gonadal vein anatomic variations. During a 2-year period, 4 consecutive patients (mean age, 37 years; range, 28-45 years) with left-sided varicocele underwent embolization. Intravascular US examinations and retrograde venography were performed to assess varicocele anatomy. Anatomic variants were recorded and categorized. A comparison between intravascular US and fluoroscopic findings was performed. The Fisher exact test was used for statistical analysis (P < .05). Technical success was achieved in all cases. There was a statistically significant difference in the maximum gonadal vein diameter between venography and intravascular US (P = .0087). Intravascular US showed left gonadal vein anatomic variations and better ability in the evaluation of the vein diameter.

Ultrasound measurement of reproductive organs in juvenile European sea bass Dicentrarchus labrax

In this study, ultrasonographic examination was performed thrice, 15 days apart, on juvenile European sea bass Dicentrarchus labrax, from 330 to 360 days of age, to assess the size and the morphology of male and female. Results have proved this method as a suitable and non-invasive procedure to assess sexual differentiation.

Creation of a voxel phantom of the ICRP reference crab

The International Commission on Radiological Protection (ICRP) has modeled twelve reference animal and plant (RAP) species using simple geometric shapes in Monte-Carlo (MCNP) based simulations. The focus has now shifted to creating voxel phantoms of each RAP in order to estimate doses to biota with a higher degree of confidence. This paper describes the creation of a voxel model of a Dungeness crab from CT images with shell, gills, gonads, hepatopancreas, and heart identified and segmented. Absorbed fractions were tabulated for each organ as a source and target at twelve photon and nine electron energies: 0.01, 0.015, 0.02, 0.03, 0.05, 0.1, 0.2, 0.5, 1.0, 1.5, 2.0, and 4.0 MeV for photons and 0.1, 0.2, 0.4, 0.5, 0.7, 1.0, 1.5, 2.0 and 4.0 MeV for electrons. AFs whose error exceeded 5% are marked with an underline in the data tables; AFs whose error was higher than 10% were excluded, and are shown in the tabulated data as a dashed line. A representative sample of the data is shown in Figs. 3-8; the entire data set is available as an electronic appendix. The results are consistent with previous small organism studies (Kinase, 2008; Stabin et al., 2006), and suggest that AF values are highly dependent on source organ location and mass.

[The nature of the germinal mass (gonad) in trematode parthenites (Trematoda)]

Dynamics of reproduction of the Notocotylus imbricatus (Notocotylidae), Echinostom caproni (Echinostomatidae), Sphaeridiotrema globulus and Psilotrema tuberculata (Psilostomatidae) rediae was examined. Forming of germinal mass in trematodes is considered and discussed on the base of literary and original data.

Computed tomography shielding methods: a literature review

OBJECTIVE

To investigate available shielding methods in an effort to further awareness and understanding of existing preventive measures related to patient exposure in computed tomography (CT) scanning.

METHODS

Searches were conducted to locate literature discussing the effectiveness of commercially available shields. Literature containing information regarding breast, gonad, eye and thyroid shielding was identified. Because of rapidly advancing technology, the selection of articles was limited to those published within the past 5 years. The selected studies were examined using the following topics as guidelines: the effectiveness of the shield (percentage of dose reduction), the shield's effect on image quality, arguments for or against its use (including practicality) and overall recommendation for its use in clinical practice.

RESULTS

Only a limited number of studies have been performed on the use of shields for the eyes, thyroid and gonads, but the evidence shows an overall benefit to their use. Breast shielding has been the most studied shielding method, with consistent agreement throughout the literature on its effectiveness at reducing radiation dose. The effect of shielding on image quality was not remarkable in a majority of studies. Although it is noted that more studies need to be conducted regarding the impact on image quality, the currently published literature stresses the importance of shielding in reducing dose.

CONCLUSION

Commercially available shields for the breast, thyroid, eyes and gonads should be implemented in clinical practice. Further research is needed to ascertain the prevalence of shielding in the clinical setting.

Hypoplastic uterus and clitoris enlargement in Swyer syndrome

BACKGROUND

Swyer syndrome is associated with absent testicular differentiation in a 46XY phenotypic female.

CASE

A 17-year-old female presented with primary amenorrhea and 46XY karyotype. Breast and pubic hair development were Tanner 2, and clitoral enlargement was noted. Magnetic resonance imaging revealed a hypoplastic uterus and 2 "normal ovaries." Serum follicle-stimulating hormone and luteinizing hormone were elevated. Testosterone and androstenedione were in the female range. Dehydroepiandrosterone sulfate was slightly elevated. Laparoscopic bilateral gonadectomy was performed. Pathology reports showed bilateral microscopic benign hilar cell tumors.

SUMMARY AND CONCLUSION

The diagnosis was a real puzzle for the clinicians because of the association of clitoral hypertrophy without hirsutism, female internal genitalia, and a 46XY karyotype. Clitoral enlargement can be explained by transient androgen secretion by the hilar cells found in the resected gonads.

Use of multiplanar 3-dimensional ultrasonography for prenatal sex identification

OBJECTIVE

Determination of fetal sex is an important part of detailed second-trimester ultrasonography. This task can be hindered by the fetal position, a low amniotic fluid volume, and advanced gestational age. Identification of fetal sex is further important in multiple gestations and prior histories of indeterminate-sex pregnancies. The goal of the study was to compare the effectiveness of 2-dimensional ultrasonography (2DUS) versus 3-dimensional ultrasonography (3DUS) at sex identification and to determine how genitalia measurements taken with 3DUS technology compare with measurements taken with 2DUS.

METHODS

A total of 111 patients at or beyond 16 weeks' gestation were recruited. Assignments of fetal sex using 2DUS and 3DUS were compared by the test of proportions. The actual neonatal sex was obtained after delivery. Given such small number of misdiagnoses by either 2DUS or 3DUS, the accuracies of the two modalities were not found to be statistically distinguishable from one another (P = .5585). The penile length, scrotal width, and bilabial diameter according to gestational age were measured and compared with previously published 2DUS data by t tests.

RESULTS

Sexes were assigned and interpreted in 65 cases. Ranges of genitalia measurements were plotted against gestational age and were found to be comparable with published data. There was a dramatic difference between the bilabial diameter and scrotal width with advancing gestational age that made sex determination much easier in the third trimester.

CONCLUSIONS

Although 3DUS did not have better prediction of fetal sex when compared with 2DUS, it may be a useful tool in conjunction with traditional imaging techniques in assigning fetal sex.

Prenatal sonographic findings in a fetus with splenogonadal fusion limb defect syndrome

Splenogonadal fusion limb defect syndrome (SGFLD) is a very rare abnormality. We report on a case with prenatal sonographic findings of a fetus with postnatally diagnosed SGFLD syndrome. This is also the second case of prenatal ultrasonographic diagnosis of gastrointestinal malrotation associated with SGFLD. A 26-year-old primigravid woman was referred to our clinic because of nonvisualization of both fetal femoral bones at 20 weeks of gestation. A detailed sonographic examination showed complete bilateral absence of lower limbs, micrognathia, single umbilical artery and a right-sided stomach. Autopsy confirmed prenatal sonographic findings and additionally showed that the spleen was abnormally connected to the left gonad by a fibrous band. In conclusion, although all limbs and both sides were equally affected in most of the reported cases, SGFLD syndrome should be considered in cases with terminal limb defects of lower limbs.

Overnight resident preliminary interpretations on CT Examinations: should the process continue?

We report our experience with resident preliminary interpretations given at night on both abdominal and neurological CT scans to quantify the discrepancy rate when compared to the final report. An attempt was also made to document any adverse clinical outcomes as a result of the preliminary interpretation. From January 1, 2004 to December 31, 2004, adult CT examinations were prospectively interpreted by residents at night at a level I trauma center. Both the neurological and body CT scans were reviewed beginning at 7:00 a.m. the following morning by the respective subspecialty staff and discrepancies were noted. Adult CT examinations (6,858) were prospectively interpreted by residents: 5,206 cranial spinal CT examinations and 1,652 body CT examinations. Among the neurological studies, there were six cases identified as major discrepancies (0.1%) and 185 minor discrepancies (3.5%). Among the body CT cases, there were seven cases identified as major discrepancies (0.4%) and 23 cases of minor discrepancies (1.4%). There is a low discrepancy rate (0.2% major and 3.1% minor) in the preliminary resident interpretations from the final report. The process of overnight preliminary CT interpretations should continue as it is not substandard care.

Determination of dose-area product from panoramic radiography using a pencil ionization chamber: Normalized data for the estimation of patient effective and organ doses

The aims of the present study were (a) to investigate the potential of pencil ionization chamber to be used for the determination of dose-width product (DWP) and dose-area product (DAP) from panoramic radiographic exposures and (b) to provide data normalized to DAP for the determination of patient effective and gonadal dose from panoramic radiography performed in any laboratory. A pencil ionization chamber commonly used to measure CT dose index (CTDI) in CT scanners was employed to determine DWP for various combinations of panoramic exposure settings at the beam exit slit of a Cranex Tome panoramic x-ray unit (Soredex, Helsinki, Finland). DWP values were also measured using an array of thermoluminescence dosimeters. Reproducibility of the DWP measurement was tested. The effect of milliamperage and kilovoltage of panoramic exposures on DWP was investigated. DAP was estimated using the value of DWP measured using the pencil ionization chamber and the beam exit slit length measured using dosimetric film attached on the beam exit slit. A Rando anthropomorphic phantom appropriately loaded with thermoluminescent dosimeters (TLDs) was used to obtain organ dose and effective dose values from panoramic radiography. Reproducibility of DWP determination using the proposed method was better than 1.5%. DWP was found to be linearly related to milliamperage (r>0.999, p<0.001) and to kilovoltage raised in a power ranging from 2.18 to 2.55. DWP measured using the pencil chamber was found to be up to 11% higher than the corresponding values determined using TLD array. The panoramic exposure obtained with settings appropriate for the typical adult patient was found to result in 0.008 mSv patient effective dose, 0.0002 mGy gonadal dose, and 11.3 cGy cm2 DAP. The use of a pencil ionization chamber is proposed for the determination of DWP and DAP from panoramic radiographic exposures. Normalized data over DAP were provided for the determination of patient effective and gonadal dose from panoramic radiography.

Patient surface radiation doses at two PET imaging facilities

To develop a practical means of auditing the procedures and to optimize the administered radionuclide activity, patient surface radiation doses following the administration of 18FDG for PET imaging have been measured at breast and gonad locations at two PET facilities. Patient dosimetry was performed using LiF TLD-100 chips placed near the breasts and gonads for 2 h following tracer injection. Standard uptake values from the image-reconstruction algorithms of one PET camera were investigated in regions of interest in tomograms of the myocardium and liver with the aim of validating dosimetry at breasts. Mean doses measured on the patient's skin ranged between 3.3 and 6.1 microGy MBq(-1) at the gonads and between 3.9 and 6.4 microGy MBq(-1) at the breasts, noticeably lower than the calculations reported in the literature. These values show good concordance with the injected activities, although they are not proportional. The proportion of injected activity actually contributing to image production seems to decrease gradually as the injected activity increases. Conversely, for a given injected activity, breast and gonadal doses were found to be lower than the values expected from the numerical calculations reported in the literature, showing increasing discrepancies when the injected activity increased. Doses measured at the right breast were consistently higher than for the left, which is indicative of greater radiotracer absorption by the liver compared to the average absorption in the body.

Evaluation of equine fetal growth from day 100 of gestation to parturition by ultrasonography

Transrectal and transabdominal ultrasonography were performed on normal pregnant mares (n=10) at 2 week intervals from day 100 of gestation to parturition to evaluate fetal growth. Several fetal anatomical regions (head, eye, aorta, abdomen, rib, gonad, kidney and femur) were imaged and measured using standardized scan plans. The results of these analyses indicate that all of the biometric parameters correlate strongly with the day of gestation. Growth charts were developed, which demonstrate that the following variables have linear relationships with the day of gestation on which they were measured: aortic systolic diameter, biparietal diameter, approximate eye volume, femur length and kidney cross-sectional area. The linear regression equation across days was developed for aortic, systolic and biparietal diameter, approximate eye volume, femur length and kidney cross-sectional area, thus allowing assessment of normal equine fetal development after day 100 of gestation. This non-invasive method can be used to estimate fetal age if mating or ovulation dates are unknown, provided the fetus is developing normally. The use of transrectal and transabdominal ultrasonography, as well as different probe frequencies (5.0 or 3.5 MHz), to measure different biometric parameters during gestation is reported.

Mixed gonadal dysgenesis associated with unilateral cavernosal fibrosis and presenting as a cystic lower abdominal mass

We report the first case of a patient suffering from mixed gonadal dysgenesis and fibrosis of the left cavernous body. The patient who complained about erectile dysfunction had received a penile prosthesis and was diagnosed 3 years after surgery when internal rudimentary gonads presented as a lower abdominal mass.

Reducing radiation doses to the breast, thyroid and gonads during diagnostic radiography

The skin entry and exit doses on patients undergoing routine radiographic examinations of areas in which the breast, thyroid and gonads are included in the primary beam were measured using thermoluminescent dosimeters. To obtain further information about patient doses, measurements were also made on a phantom at similar skin positions and at the positions of these organs. Comparisons of the doses to these radiosensitive organs were made for the antero-posterior and postero-anterior projections. In cases where it was found that the doses were reduced by the use of non-conventional relationship between the relative positions of the patient and the film, suggestions are made for the adaptations which would have to be made to X-ray equipment to enable these projections to be taken routinely. Other techniques, such as air gap techniques and thyroid shielding, whereby patient doses can be reduced during routine radiography are also examined. Finally the implications of these results for radiation protection of patients are considered.