Urogenital Imaging

Professor SK Morcos, FRCS, FFRRCSI, FRCR, Consultant Radiologist, Sheffield Teaching Hospitals, NHS Foundation Trust, Department of Diagnostic Imaging, Northern General Hospital, Sheffield, UK (President, European Society of Urological Radiology). Henrik S. Thomsen, Professor of Radiology, University of Copenhagen, Chairman, Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev, DENMARK.

Foreword xiii

Preface xv

Contributors xvii

1 Adrenal Imaging 1
Khaled M. Elsayes, Isaac R. Francis, Melvyn Korobkin and Gerard M. Doherty

1.1 Introduction 1

1.2 Cushing’s syndrome 2

1.3 Primary hyperaldosteronism 5

1.4 Pheochromocytoma 8

1.5 Adrenal cortical carcinoma 12

1.6 Adrenal incidentaloma 15

2 Retroperitoneal Masses 21
Pietro Pavlica, Massimo Valentino and Libero Barozzi

2.1 Introduction 21

2.2 Retroperitoneal anatomy 21

2.3 Pathological conditions 22

2.4 Primary solid retroperitoneal tumors 22

2.5 Retroperitoneal lymphoma 27

2.6 Cystic retroperitoneal masses 30

2.7 Retroperitoneal metastases 32

2.8 Retroperitoneal fibrosis (Ormond’s disease) 33

2.9 Retroperitoneal fluid collections (traumatic and non-traumatic) 35

References 41

3 Imaging of Renal Artery Stenosis 43
Robert Hartman

3.1 Introduction 43

3.2 Clinical features 43

3.3 Pathology 45

3.4 Imaging of suspected renal artery stenosis 45

References 51

4 Renal Masses 53
Philip J. Kenney

4.1 Introduction 53

4.2 Symptomatic renal carcinoma 53

4.3 Incidental renal masses 55

4.4 Patients with a known cancer (other than RCC) 62

4.5 Renal mass in patients with symptoms 63

4.6 Vascular lesions presenting as a renal mass 68

4.7 Renal mass in patients with cystic disease 72

4.8 Treatment 73

References 73

5 Non-neoplastic Renal Cystic Lesions 75
Sameh K. Morcos

5.1 Introduction 75

5.2 Classification 75

5.3 Cystic lesions affecting renal cortex 76

5.4 Cystic lesions of renal medulla 80

5.5 Cystic diseases affecting both the cortex and medulla 86

References 97

6 Urological and Vascular Complications Post-renal Transplantation 99
Tarek El-Diasty and Yasser Osman

6.1 Introduction 99

6.2 Vascular complications 99

6.3 Urological complications 107

6.4 Ureteric strictures 110

6.5 Post-transplant lymphocele 113

6.6 Delayed graft function (DGF) 116

6.7 Post-transplant bladder malignancy 119

References 120

7 Urinary Tract Injuries 121
Elliott R. Friedman, Stanford M. Goldman and Tung Shu

7.1 Introduction 121

7.2 Renal trauma 121

7.3 Adrenal trauma 130

7.4 Ureteral trauma 131

7.5 Bladder trauma 133

7.6 Urethral trauma 136

7.7 Penile and scrotal trauma 142

References 147

8 Urinary Tract Infections 149
Mikael Hellström, Ulf Jodal, Rune Sixt and Eira Stokland

8.1 Symptomatic urinary tract infection in children 149

8.2 Symptomatic upper urinary tract infection in adults 167

8.3 Emphysematous pyelonephritis 173

8.4 Xanthogranulomatous pyelonephritis 174

8.5 Urinary tract infection in the immunocompromised patient 177

8.6 Tuberculosis 179

8.7 Schistosomiasis 183

8.8 Hydatid disease (echinococcosis) 188

8.9 Urethritis 191

References 193

9 Imaging of the Genitourinary System – Urolithiasis 195
Sami A Moussa and Paramananthan Mariappan

9.1 Introduction 195

9.2 Pathology 195

9.3 Clinical features 197

9.4 Evaluation of patients with suspected urinary stones 198

9.5 Treatment 198

9.6 Imaging 199

References 218

10 Hematuria 219
Thomas Bretlau, Kirstine L. Hermann, Jørgen Nordling and Henrik S. Thomsen

10.1 Definition 219

10.2 Clinical considerations 219

10.3 Diagnosis of hematuria 220

10.4 Epidemiology 220

10.5 Distribution of malignancy in patients with hematuria 223

10.6 Imaging 223

10.7 Summary 230

References 234

11 Bladder Cancer 235
G. Heinz-Peer and C. Kratzik

11.1 Introduction 235

11.2 Clinical features 237

11.3 Pathology 239

11.4 Imaging findings 243

11.5 Treatment planning 253

11.6 Post-treatment Imaging 254

11.7 Summary 254

References 255

12 Imaging of Urinary Diversion 257
Sameh Hanna and Hesham Badawy

12.1 Introduction 257

12.2 Indications for urinary diversion 257

12.3 Types of urinary diversion 257

12.4 Non-continent cutaneous form of diversion 258

12.5 Continent cutaneous urinary diversion (Continent Catheterizing Pouches) 258

12.6 Non-orthotopic continent diversion, relying on the anal sphincter for continence 260

12.7 Orthotopic form of diversion to the native, intact urethra (neobladder) 261

12.8 Contraindications to urinary diversion 264

12.9 Complications of urinary diversions 264

12.10 The role of radiologist in urinary diversion includes 267

12.11 Imaging studies 268

12.12 Imaging of complications 269

12.13 Summary 271

References 271

13 Imaging of the Prostate Gland 273
François Cornud

13.1 Introduction 273

13.2 Zonal anatomy and benign prostatic hypertrophy 273

13.3 Diagnosis of prostate cancer: TRUS features 276

13.4 Diagnostic of prostate cancer: MRI 284

13.5 Contrast-enhanced (dynamic) MRI 285

13.6 Magnetic Resonance Spectroscopic Imaging (MRSI) 290

13.7 Diffusion-weighted imaging 292

13.8 Indications of functional MRI 295

13.9 Extension of prostate cancer 297

13.10 Local extension by TRUS and TRUS-guided biopsy 297

13.11 MRI and staging of prostate cancer 298

13.12 Local staging 299

13.13 Lymph node metastases: lympho-MRI 304

13.14 Bone metastases: whole marrow MRI 304

13.15 Benign disorders of the prostate (BPH excluded) 305

References 321

14 Haemospermia 323
Drew A. Torigian, Keith N. Van Arsdalen and Parvati Ramchandani

14.1 Introduction 323

14.2 Clinical features 323

14.3 Pathology 325

14.4 Imaging findings 325

14.5 Summary 337

References 337

15 Scrotal Masses 339
Lorenzo E. Derchi and Alchiede Simonato

15.1 Introduction 339

15.2 Clinical features 339

15.3 Pathology 340

15.4 Imaging 340

15.5 Important principles in assessment of scrotal masses 341

15.6 Important problems in differentiating benign from malignant lesions 345

References 350

16 Gynaecological Adnexal Masses 351
John A. Spencer and Michael J. Weston

16.1 Introduction 351

16.2 Clinical features 351

16.3 Pathology 352

16.4 Imaging 354

16.5 Standard radiographic techniques 355

16.6 Ultrasound (US) 355

16.7 MR Imaging (MRI) 366

16.8 Computed Tomography 373

References 379

17 Imaging of Abnormal Uterine Bleeding 381
Patricia Noël, Evis Sala and Caroline Reinhold

17.1 Abnormal uterine bleeding 381

17.2 Adenomyosis 382

17.3 Leiomyomas 385

17.4 Endometrial polyp 389

17.5 Endometrial hyperplasia 391

17.6 Endometrial carcinoma 394

17.7 Summary 396

References 397

18 Female Pelvic Floor Dysfunction 399
Rania Farouk El Sayed

18.1 Introduction 399

18.2 Anatomical considerations 399

18.3 Pathophysiology of pelvic floor dysfunction 401

18.4 Clinical features 401

18.5 Imaging of pelvic floor dysfunction 404

18.6 Magnetic resonance imaging (MRI) 407

References 413

19 Imaging of female infertility 415
Ahmed-Emad Mahfouz and Hanan Sherif

19.1 Introduction 415

19.2 Polycystic ovary syndrome 415

19.3 Abnormalities of the fallopian tubes (Hydrosalpinx/Hematosalpinx, tubal block) 418

19.4 Fibroids 421

19.5 Adenomyosis 423

19.6 Developmental anomalies of the uterus 424

19.7 Endometriosis 429

19.8 Imaging 430

Index 431