Publications by authors named "Lorenzo E Derchi"

65 Publications

Contrast-enhanced ultrasound after successful cryoablation of benign and malignant renal tumours: how long does tumour enhancement persist?

J Med Imaging Radiat Oncol 2021 Jun 6;65(3):272-278. Epub 2021 Feb 6.

Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.

Introduction: To investigate how long successfully ablated tumours take to become completely avascular at CEUS after cryoablation.

Methods: Ninety-five patients had percutaneous cryoablation of 103 renal tumours investigated at CEUS on post-operative day one. If the lesion was avascular, a contrast-CT/MR was scheduled six months after the procedure, while CEUS was repeated if the lesion still displayed enhancement, until the disappearance of intralesional vascularity. Technical success was defined when the tumour was covered completely by the ablation zone. Technique efficacy was assessed at six months of follow-up.

Results: Technical efficacy was obtained for 101/103 cryoablations, 56% of which (57/101) were avascular on post-operative day one. After one week, two weeks, one month 83%, 91% and 100% of these 101 lesions, respectively, were avascular. Two tumours were unsuccessfully treated. They displayed persistent intralesional vascularity at CEUS one month after the procedure.

Conclusions: After cryoablation, obtaining CEUS before one month may be misleading. When technical efficacy is obtained, disappearance of intralesional enhancement is observed within two weeks in the majority of cases (91%), but can persist until one month. Identification of tumour enhancement after one month may be concerning for residual viable tumour.
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http://dx.doi.org/10.1111/1754-9485.13149DOI Listing
June 2021

Imaging in scrotal trauma: a European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) position statement.

Eur Radiol 2021 Jan 15. Epub 2021 Jan 15.

Department of Radiology, University of Rochester, 601 Elmwood ave, Rochester, NY, 14642, USA.

Imaging plays a crucial role in the evaluation of scrotal trauma. Among the imaging modalities, greyscale ultrasound and Colour Doppler ultrasound (CDUS) are the primary techniques with the selective utilisation of advanced techniques such as contrast-enhanced ultrasound (CEUS) and elastography. Despite ultrasound being the mainstay of imaging scrotal trauma, its diagnostic performance is not fully established. Considering these difficulties and their impact on clinical practice, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) established an expert task force to review the current literature and consolidate their expertise on examination standards and imaging appearances of various entities in scrotal trauma. This paper provides the position statements agreed on by the task force with the aim of providing guidance for the use of imaging especially multiparametric US in scrotal trauma.Key Points• Greyscale and Colour Doppler ultrasound are the mainstay of imaging in patients with scrotal trauma.• Contrast-enhanced ultrasound and elastography are the advanced techniques useful as a problem-solving modality in equivocal cases.• This paper summarises the position statements of the ESUR-SPIWG on the appropriate utilisation of multiparametric ultrasound and other imaging modalities in the evaluation of scrotal trauma.
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http://dx.doi.org/10.1007/s00330-020-07631-wDOI Listing
January 2021

Radiology in the Era of Value-Based Healthcare: A Multi Society Expert Statement From the ACR, CAR, ESR, IS3R, RANZCR, and RSNA.

J Am Coll Radiol 2021 Jun 21;18(6):877-883. Epub 2020 Dec 21.

Harvard Medical School, Boston, Massachusetts; American College of Radiology (ACR), Reston, Virginia; International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria.

Background: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation.

Methods, Findings And Interpretation: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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http://dx.doi.org/10.1016/j.jacr.2020.12.003DOI Listing
June 2021

Radiology in the Era of Value-based Healthcare: A Multi-Society Expert Statement from the ACR, CAR, ESR, IS3R, RANZCR, and RSNA.

Radiology 2021 Mar 21;298(3):486-491. Epub 2020 Dec 21.

From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink).

Background The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. Methods, findings and interpretation This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined. Published under a CC BY 4.0 license.
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http://dx.doi.org/10.1148/radiol.2020209027DOI Listing
March 2021

Radiology in the Era of Value-Based Healthcare: A Multi-Society Expert Statement From the ACR, CAR, ESR, IS3R, RANZCR, and RSNA.

Can Assoc Radiol J 2021 May 20;72(2):208-214. Epub 2020 Dec 20.

American College of Radiology (ACR), Reston, VA, USA.

Background: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation.

Methods, Findings And Interpretation: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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http://dx.doi.org/10.1177/0846537120982567DOI Listing
May 2021

Radiology in the era of value-based healthcare: A multi-society expert statement from the ACR, CAR, ESR, IS3R, RANZCR and RSNA.

J Med Imaging Radiat Oncol 2021 Feb;65(1):60-66

American College of Radiology (ACR), Reston, Virginia, USA.

Background: The value-based healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation.

Methods, Findings And Interpretation: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia and New Zealand, describes the place of radiology in VBH models and the healthcare value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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http://dx.doi.org/10.1111/1754-9485.13125DOI Listing
February 2021

Radiology in the era of value-based healthcare: a multi-society expert statement from the ACR, CAR, ESR, IS3R, RANZCR, and RSNA.

Insights Imaging 2020 Dec 21;11(1):136. Epub 2020 Dec 21.

Harvard Medical School, Boston, USA.

Background: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation.

Methods, Findings And Interpretation: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the healthcare value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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http://dx.doi.org/10.1186/s13244-020-00941-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750384PMC
December 2020

Emergency Ultrasound in Trauma Patients: Beware of Pitfalls and Artifacts!

J Emerg Med 2021 Mar 5;60(3):368-376. Epub 2020 Nov 5.

Department of Radiology, University of Trieste, Trieste, Italy.

Background: Ultrasonography (US) is highly dependent on operators' skills. It is not only a matter of correct scan techniques; there are anatomical structures and variants, as well as artifacts, which can produce images difficult to interpret and which, if not properly understood, can be causes of errors.

Objectives: This paper will review relatively common US pitfalls and artifacts that can be encountered in trauma patients and will offer tips to recognize and avoid them.

Discussion: Normal anatomical structures and anatomical variants can mimic fluid collections or perisplenic lesions. Examination along multiple scan planes, real-time observation of movements or repetition of the study after the patient has drunk some fluid or after placing a finger on her/his body wall can help proper identification. The term artifact in US imaging refers to display phenomena not properly representing the imaged structures. This can result in images suggesting fracture lines within organs or at their borders, lung consolidations, or pleural effusions, and abdominal fluid collections. Their knowledge is the first step to recognize them; then, use of multiple scan planes or repetition of the study after voiding or changes of equipment setting can make them disappear or clarify their nature.

Conclusion: We present possible anatomic pitfalls and artifacts that may affect correct interpretation of US images in patients with abdominal trauma and suggest how to avoid or to clarify them during the examination. Knowing their existence, their appearances, and the reasons why they are produced is important for proper use of this diagnostic technique.
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http://dx.doi.org/10.1016/j.jemermed.2020.10.007DOI Listing
March 2021

Nonscrotal Causes of Acute Scrotum.

J Ultrasound Med 2021 Mar 13;40(3):597-605. Epub 2020 Aug 13.

Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.

Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.
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http://dx.doi.org/10.1002/jum.15431DOI Listing
March 2021

Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations.

J Ultrasound 2020 Dec 27;23(4):487-507. Epub 2020 Jul 27.

Department of Health Sciences (DISSAL), Emergency Radiology, University of Genoa, Policlinico San Martino IST, Via A. Pastore 1, 16132, Genova, Italy.

Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.
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http://dx.doi.org/10.1007/s40477-020-00509-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588576PMC
December 2020

Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading.

Eur Radiol 2020 Jan 22;30(1):11-25. Epub 2019 Jul 22.

Department of Health Sciences (DISSAL), Emergency Radiology, University of Genoa, Policlinico San Martino, Largo R. Benzi, I16122, Genoa, Italy.

Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.Key Points• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. • Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. • This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.
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http://dx.doi.org/10.1007/s00330-019-06280-yDOI Listing
January 2020

Tension hydrocele as an additional cause of acute scrotum: case series and literature review.

Abdom Radiol (NY) 2020 07;45(7):2082-2086

Department of Health Sciences (DISSAL), University of Genoa, Emergency Radiology, Policlinico San Martino Hospital, Largo R. Benzi, 10, 16132, Genoa, Italy.

Purpose: To describe the correlation between acute scrotum pain and tension hydrocele, focusing on US and Doppler features.

Methods And Materials: We evaluated retrospectively a series of five patients with a long history of hydrocele who were referred to our institutions for increasing acute scrotal pain. Patients were approached with gray scale US of both testes, as well as with color-Doppler and spectral analysis, comparing the results with those after aspiration and symptoms relief.

Results: All patients had a "simple" hydrocele with no internal septa; the involved testicles had a "flattened" appearance and parenchymal Doppler signals showed increased intratesticular vascular resistance. One patient had a low diastolic flow, compared to the contralateral testis, with an increased RI value, one had no diastolic flow, two patients had retrograde diastolic flow, and the remaining one had no intratesticular flow visible. After decompression, there were disappearance of pain and improved flow with normalization of testicular vascularity; post-ischemic hyperemia was appreciated in the two patients examined immediately after fluid aspiration, while normal flow was seen in three studies carried out the day after.

Conclusion: To conclude, tension hydrocele is a rare condition that produces alterations of form and circulation of testicles, increase of intraparenchymal vascular resistances and strong and continuous pain, mimicking a testicular torsion. The increase in pressure produces an effect similar to that observed in a compartment syndrome. US findings, together with clinical assessment, indicate when emergency decompression may be appropriate to relieve testicular ischemia.
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http://dx.doi.org/10.1007/s00261-019-01991-8DOI Listing
July 2020

The added value of simultaneous palpation during scrotal ultrasound.

J Clin Ultrasound 2019 May 5;47(4):220-221. Epub 2019 Feb 5.

Department of Health Sciences (DISSAL), University of Genoa; Emergency Radiology, Policlinico San Martino IST, Genoa, Italy.

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http://dx.doi.org/10.1002/jcu.22701DOI Listing
May 2019

There are more anatomical variants in heaven and earth, Horatio, than are dreamt of in our philosophy: the precaval left renal artery.

Radiol Med 2019 Jun 1;124(6):445-449. Epub 2019 Feb 1.

Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Radiologia d'Urgenza, Ospedale Policlinico San Martino IST, Largo R. Benzi, 10, 16132, Genoa, Italy.

Aim: To describe the CT findings in eight patients with left-sided inferior vena cava (IVC) in whom the left renal artery presented a precaval course (pLRA).

Materials And Methods: We searched the teaching files of six radiology departments for patients with pLRAs. Eight patients were found, and the available imaging studies and clinical histories were reviewed. Associated vascular and renal anomalies were noted.

Results: No patient had been examined for problems related to the vascular anomaly found. Four had a double IVC and two a solitary left IVC; in all, the left-sided IVCs had hemiazygos continuation. One patient had situs viscerum inversus. In one case, there was a left kidney in left iliac fossa.

Conclusion: Although rare and probably overlooked, a pLRAs can be encountered in patients with situs viscerum inversus or presenting a left-sided IVC with hemiazygos continuation. These vessels can cause technical problems during surgery at the left renal hilum and should be specifically searched for in patients with vascular anomalies.
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http://dx.doi.org/10.1007/s11547-019-00991-4DOI Listing
June 2019

Multiple, Synchronous Lesions of Differing Histology Within the Same Testis: Ultrasonographic and Pathologic Correlations.

Urology 2018 Nov 10;121:125-131. Epub 2018 Aug 10.

Department of Health Sciences (DISSAL), University of Genoa, Emergency Radiology, Ospedale Policlinico San Martino, Genoa, Italy. Electronic address:

Objective: To describe ultrasound (US) and pathologic findings in 11 patients with multiple, synchronous lesions of different histology within the same testis.

Materials And Methods: We reviewed US and pathologic findings in 11 patients with multiple, synchronous lesions of different histology within the same testis. Lesions were classified as separate or adjacent one to another and attempt was made to predict tumor type on their US textures. Pathologic review assessed presence of normal tissue between adjacent lesions and of Germ Cell Neoplasia In Situ in surrounding parenchyma. Nine cases were from files specifically dedicated to testicular tumors and estimated prevalence was calculated.

Results: Two nodules were seen in nine patients and 3 in remaining two. Nine had tumors of different histology; two had one malignancy and one focal benign lesion. Germ Cell Neoplasia In Situ was seen in 7/11 cases. In dedicated archives, these lesions had 1.83% prevalence.

Conclusion: Multiple focal lesions identified at imaging within the testis are not always of the same histology. This can be suspected in some cases basing on US texture. Recognition that lesions are multiple and an indication of their locations within the testis is the most important role of imaging and may help pathologists correctly sample the specimen to establish nature of each of them. Presence of multiple lesions is regarded as a contraindication to testicular sparing surgery. In two of our patients, one lesion was benign. Then, when the procedure is indicated all lesions have to be sampled and assessed by pathologists before deciding between conservative or radical technique.
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http://dx.doi.org/10.1016/j.urology.2018.07.040DOI Listing
November 2018

Sonographically indeterminate scrotal masses: how MRI helps in characterization.

Diagn Interv Radiol 2018 Jul;24(4):225-236

Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, UK.

Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.
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http://dx.doi.org/10.5152/dir.2018.17400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045519PMC
July 2018

Evaluation of Intratesticular Lesions With Strain Elastography Using Strain Ratio and Color Map Visual Grading: Differentiation of Neoplastic and Nonneoplastic Lesions.

J Ultrasound Med 2019 Jan 19;38(1):223-232. Epub 2018 Jul 19.

Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom.

Objective: To investigate the role of strain elastography using calculated strain ratio and visual elastography score in differentiating nonneoplastic, benign, and malignant neoplastic intratesticular lesions.

Materials And Methods: The study was approved by the hospital review board as a retrospective review of 86 patients examined with gray scale, color Doppler ultrasonography and strain elastography (visual elastography score and strain ratio). Sensitivity, specificity, and positive and negative likelihood ratio of color Doppler and stain elastography were documented. Receiver operator characteristic curves assessed the diagnostic accuracy of strain elastography to discriminate nonneoplastic, benign, and malignant neoplasms. Histology or follow-up ultrasonography determined lesion character.

Results: Thirty-one of 86 (36.0%) intratesticular malignant neoplasms, 17 of 86 (19.8%) benign neoplasms, and 38 of 86 (44.2%) nonneoplastic lesions were confirmed with histology (n = 52) or follow-up sonography (n = 34); 89.5% of intratesticular lesions were heterogeneous or hypoechoic on gray scale, with no difference between benign and malignant. Sensitivity, specificity, positive and negative likelihood ratio for nonneoplasm versus neoplasm were documented: color Doppler: 68.8%, 97.4%, 26.5, 0.32; visual elastography score: 81.3%, 57.9%, 1.93, 0.32; strain ratio: 68.8%, 81.6%, 3.73, 0.38. Neoplastic lesions showed a higher strain ratio than nonneoplastic lesions (P < .001), with strong correlation between median strain ratio and visual elastography score (Spearman's coefficient, 0.693; P < .001). Strain ratio is a significantly better assessment than visual elastography score for malignant lesions (P = .025). Logistic regression analysis revealed significant associations between size (P = .001), hypervascularity (P < .001), and malignancy.

Conclusion: Higher strain ratio and visual elastography score are associated with neoplastic lesions and offer an alternative to assess tissue characteristics but do not improve the diagnostic accuracy when compared with the color Doppler pattern.
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http://dx.doi.org/10.1002/jum.14686DOI Listing
January 2019

Author's Reply.

J Minim Invasive Gynecol 2018 Jul - Aug;25(5):932. Epub 2018 Apr 6.

Genoa, Italy.

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http://dx.doi.org/10.1016/j.jmig.2018.03.028DOI Listing
April 2018

Cyst of Nuck: A Disregarded Pathology.

J Minim Invasive Gynecol 2018 Mar - Apr;25(3):376-377. Epub 2017 Aug 9.

Department of Health Sciences, University of Genoa, Genoa, Italy; Emergency Radiology, Policlinico San Martino IST, Genoa, Italy.

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http://dx.doi.org/10.1016/j.jmig.2017.08.003DOI Listing
August 2017

MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group.

Eur Radiol 2018 Jan 11;28(1):31-43. Epub 2017 Jul 11.

Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, UK.

Objectives: The Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the scrotum.

Methods: The SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were 'magnetic resonance imaging', 'testis or testicle or testicular', 'scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.

Results: The recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary).

Conclusions: The ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented.

Key Points: • This report presents recommendations for magnetic resonance imaging (MRI) of the scrotum. • Imaging acquisition protocols and clinical indications are provided. • MRI is becoming established as a worthwhile second-line diagnostic tool for scrotal pathology.
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http://dx.doi.org/10.1007/s00330-017-4944-3DOI Listing
January 2018

Sonography of Scrotal Wall Lesions and Correlation With Other Modalities.

J Ultrasound Med 2017 Oct 27;36(10):2149-2163. Epub 2017 May 27.

Department of Emergency Radiology, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria, San Martino l'Istituto Scientifico Tumori, Genoa, Italy.

The scrotal wall may be involved in a variety of pathologic processes. Such lesions may rise primarily from the layers of the scrotum or may be due to a process arising from scrotal content. Imaging is not needed in most cases, but it may be useful for making such differentiations and for evaluation of possible involvement of the testes and epididymides in cases of primary wall abnormalities. This pictorial essay will show the imaging findings observed in a variety of pathologic conditions affecting the scrotal wall, both common and unusual ones, with an emphasis on clinically relevant findings and features that lead to a specific diagnosis.
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http://dx.doi.org/10.1002/jum.14257DOI Listing
October 2017

Enlarged seminal vesicles as an initial presentation of polycystic kidney disease.

Kidney Int 2017 05;91(5):1258

Department of Health Sciences (DISSAL), University of Genoa, Emergency Radiology, IRCCS AOU San Martino IST, Genoa, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.kint.2016.11.012DOI Listing
May 2017

Imaging Features of Paratesticular Masses.

J Ultrasound Med 2017 Jul 3;36(7):1487-1509. Epub 2017 Apr 3.

Department of Radiology, Dipartimento di Scienze Della Salute, University of Genoa, Genoa, Italy.

In this pictorial essay, we review the sonographic and other imaging findings of paratesticular masses in correlation with the pathologic findings. The examples include benign and malignant tumors and also non-neoplastic mass lesions of the paratesticular structures. Diagnostic sonographic findings of these mass lesions as well as correlative findings of other imaging methods are presented.
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http://dx.doi.org/10.7863/ultra.16.07015DOI Listing
July 2017

MR imaging in patients with male-to-female sex reassignment surgery: postoperative anatomy and complications.

Br J Radiol 2017 Apr 3;90(1072):20170062. Epub 2017 Mar 3.

3 Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genova, Italy.

Objective: To investigate the role of MRI in the evaluation of both the new female anatomy and complications in male-to-female sex reassignment surgery (MtF-SRS).

Methods: 71 consecutive patients with MtF-SRS had 74 MRI [age range, 21-63 years; mean (±standard deviation) age, 36 ± 10 years; median age, 37 years]. In 47 patients, MRI was performed to rule out early post-operative complications after gender conversion (n = 40), vaginoplasty (n = 6) or remodelling of the labia majora (n = 1). In 27 patients, MRI was performed 1-20 years after MtF-SRS for late post-operative complications, pain or dysuria, inflammatory changes or poor cosmetic outcome. Three patients had MRI both before and after the operation.

Results: MRI allowed investigation of the new female anatomy in all cases. Soon after MtF-SRS, a small amount of blood was identified in all patients around the neoclitoris, urethral plaque and labia. Post-operative complications were clinically significant fluid collections (n = 5), labial abscesses (n = 2), severe cellulitis (n = 3), partial neovaginal prolapse (n = 3), focal necrosis and dehiscence of the vaginal wall (n = 2) and hypovascularization of the neoclitoris (n = 1). After ileal vaginoplasty, three patients developed clinically insignificant haematomas, one a large rectovaginal fistula with dehiscence of the intestinal anastomosis and bowel perforation (n = 1). In the 27 patients investigated 1-20 years after MfF-SRS, MRI demonstrated cavernosal remnants (n = 10), spared testis (n = 1) neovaginal strictures (n = 8), fistulas and abscesses (n = 3) and prolapse (n = 2). Three of these patients also had fibrotic changes. In the remaining three patients, no pathological features were identified.

Conclusion: After genital reconfiguration, MRI allows assessment of the post-operative anatomy and of post-operative complications. Advances in knowledge: Imaging features of the new anatomy and of surgical complications after SRS are discussed and illustrated.
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http://dx.doi.org/10.1259/bjr.20170062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605084PMC
April 2017

Imaging of Bilateral Synchronous Testicular Tumors of Different Histologic Types and Implications for Surgical Management.

J Ultrasound Med 2016 Nov 3;35(11):2511-2516. Epub 2016 Oct 3.

Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy

The clinical history and imaging and pathologic findings in 4 patients with bilateral synchronous testicular tumors of dissimilar histologic types were reviewed. All patients had a large scrotal mass on one side and a smaller nodule on the other one. The appearances of each pair of lesions were different enough to suggest that they could possibly be of different histologic types. The most important role of imaging, however, was its capability to guide the surgical approach to these patients: in 1 case, the smallest lesion was recognized as an epidermoid cyst; in 2 others a conservative approach was deemed possible, given the lesions' small volumes and peripheral locations.
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http://dx.doi.org/10.7863/ultra.15.10048DOI Listing
November 2016

Pitfalls in Imaging for Acute Scrotal Pathology.

Semin Roentgenol 2016 Jan;51(1):60-9

Radiology Section, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

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http://dx.doi.org/10.1053/j.ro.2016.02.012DOI Listing
January 2016

Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee.

Eur Radiol 2016 Jul 24;26(7):2268-78. Epub 2015 Oct 24.

Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, East Sussex, UK.

Objectives: The increasing detection of small testicular lesions by ultrasound (US) in adults can lead to unnecessary orchiectomies. This article describes their nature, reviews the available literature on this subject and illustrates some classical lesions. We also suggest recommendations to help characterization and management.

Methods: The ESUR scrotal imaging subcommittee searched for original and review articles published before May 2015 using the Pubmed and Medline databases. Key words used were 'testicular ultrasound', 'contrast-enhanced sonography', 'sonoelastography', 'magnetic resonance imaging', 'testis-sparing surgery', 'testis imaging', 'Leydig cell tumour', 'testicular cyst'. Consensus was obtained amongst the members of the subcommittee, urologist and medical oncologist.

Results: Simple cysts are frequent and benign, and do not require follow up or surgery. Incidentally discovered small solid testicular lesions detected are benign in up to 80 %, with Leydig cell tumours being the most frequent. However, the presence of microliths, macrocalcifications and hypoechoic areas surrounding the nodule are findings suggestive of malignant disease.

Conclusion: Asymptomatic small testicular lesions found on ultrasound are mainly benign, but findings such as microliths or hypoechoic regions surrounding the nodules may indicate malignancy. Colour Doppler US remains the basic examination for characterization. The role of newer imaging modalities in characterization is evolving.

Key Points: • Characterization of testicular lesions is primarily based on US examination. • The role of MRI, sonoelastography, contrast-enhanced ultrasound is evolving. • Most small non-palpable testicular lesions seen on ultrasound are benign simple cysts. • Leydig cell tumours are the most frequent benign lesions. • Associated findings like microliths or hypoechoic regions may indicate malignancy.
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http://dx.doi.org/10.1007/s00330-015-4059-7DOI Listing
July 2016

Sonographic appearances of the postoperative testis.

J Clin Ultrasound 2016 Jan 24;44(1):12-6. Epub 2015 Sep 24.

Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa, Italy.

Purpose: To describe the sonographic findings observed in the testis in patients who have undergone testicle-sparing surgery and surgical biopsies.

Methods: We reviewed the color Doppler sonographic findings from 14 patients after testicular interventions: 2 open biopsy procedures for infertility and 12 testicle-sparing surgical procedures (1 for spontaneous intratesticular hemorrhage and 11 for small tumors). Ten patients had benign tumors; one had a malignancy. Three patients were symptomatic; all others were studied as follow-up.

Results: Hypoechoic and hypovascular lesions at site of surgery were seen in 10 of the 11 patients after tumorectomy; no changes were observed in one patient. The lesions were either linear or an irregularly triangular shape, located at the surgical site, and interpreted as scars. Retraction of the testicular surface was detected in two cases. In the eight patients who underwent follow-up, lesions disappeared in one case, became smaller in two, and remained stable in five. Of the two patients who underwent biopsy, one developed peritesticular hematoma, and both had late hypoechoic scars in the testis.

Conclusions: Hypoechoic and hypovascular scars are a "normal" postoperative pattern after testicle-sparing surgery. They are either linear or triangular, with rectilinear margins. Such findings need to be correctly interpreted and not misinterpreted as recurrences.
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http://dx.doi.org/10.1002/jcu.22304DOI Listing
January 2016

Imaging of mesothelioma of tunica vaginalis testis.

Eur Radiol 2016 Mar 27;26(3):631-8. Epub 2015 Jun 27.

Department of Health Sciences, University of Genoa, Largo R. Benzi, 10, Genova, Italy.

Objectives: To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis.

Methods: We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis.

Results: A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection.

Conclusions: A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity.

Key Points: Mesotheliomas of the tunica vaginalis are rare, often challenging to diagnose preoperatively. Most common finding is a complex hydrocele with hypervascular parietal vegetations. Septated hydrocele, nodules without hydrocele, a thick-walled paratesticular cyst are less common. Preoperative diagnosis may allow aggressive surgical approach and, possibly, a better prognosis.
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http://dx.doi.org/10.1007/s00330-015-3887-9DOI Listing
March 2016