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Background Urinary bladder cancer is the second most common neoplasm of the urinary tract. Tumor staging and regional disease spread are the strongest predictors of treatment outcome. Our study aims to compare the diagnostic performance of conventional and diffusion-weighted magnetic resonance imaging (DW-MRI), using a 3T MR scanner, in grading and staging of urinary bladder cancer with histopathologic correlation. Results The sensitivity, specificity, and accuracy of combined use of HR T2WI and DWI were better than using HR T2WI only to differentiate T1 stage from further stages (95%, 100%, and 98%, respectively). Differentiating organ confined bladder cancer (T1 and T2 stages) from tumors with extravesical extension was better when using both HR T2WI and DWI than using HR T2WI (accuracy 100% and 93%, respectively). Kappa agreement was better when using both HR T2WI and DWI than HR T2WI only (0.963 and 0.496 respectively). Grade III lesions showed statistically significant lower ADC values than grades I and II with ADC cut off value ≤ 0.95 × 10−3 mm2/s. No statistically significant difference was found in ADC values between transitional cell carcinoma (TSC) and other cell types. Conclusion Combined use of DWI and HR T2WI provides more accurate urinary bladder cancer staging and prediction of aggressiveness of certain histologic grade (GIII lesions) using ADC values. 3 T scanners have the potential to achieve higher diagnostic capability in evaluation of urinary bladder cancer.

To determine the diagnostic sensitivity and interobserver agreement of Gallium 68-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) imaging for diagnosis and staging of patients with newly diagnosed prostate cancer (PC). One hundred and seventy-three men (mean age, 68 ± 7.7 years; range 46–84 years) with newly diagnosed, untreated PC were enrolled in this prospective study between January 2017 and August 2018. All patients underwent a 68Ga-PSMA-11 PET/CT examination. For each patient, we determined the disease stage, the Gleason score, and the maximum standardized uptake value (SUVmax) for primary prostatic tumor and extraprostatic metastases. The diagnostic sensitivity and interobserver agreement of 68Ga-PSMA-11 PET/CT for diagnosis and staging of PC were established by histopathology as the reference standard. 68Ga-PSMA-11 PET/CT examinations were interpreted as positive for PC in 166 of 173 patients (101 patients had primary prostatic tumor only, two patients had extraprostatic metastases only and 63 patients had combined lesions). The sensitivity of 68Ga-PSMA-11 PET/CT examination in the diagnosis of PC was 96%. 68Ga-PSMA-11 PET/CT produced a significant change of stage in 28.6% patients with an upstage in 17.9% patients and a downstage in 10.7% patients. The interobserver agreements were almost good to perfect (k = 0.63–0.89) for visual image interpretation, SUVmax measurement, and tumor staging. 68Ga-PSMA-11 PET/CT is a valuable tool with high diagnostic sensitivity (96%) and high reproducibility for diagnosis and staging of patients with newly diagnosed PC.

Background Some COVID-19 patients with similar quantitative CT measurements had variable clinical presentation and outcome. The absence of reasonable clinical explanations, such as pre-existing comorbidities or vascular complications, adds to the confusion. The authors believed that neglecting the impact of certain severe morphologic features could be an alternative radiological explanation. This study aims to optimize the initial CT staging of COVID-19 and propose a new combined morphologic/volumetric CT severity index (CTSI) to solve this clinico-radiological mismatch. Results This multi-center study included two major steps. The first step of the study entailed a standardized combined morphologic/volumetric CT severity analyses to propose a new optimized CTSI. This was conducted retrospectively during the period from June till September 2020. It included 379 acutely symptomatic COVID-19 patients. They were clinically classified according to their oxygen saturation and respiratory therapeutic requirements into three groups: group A (mild 298/79%), group B (borderline severity 57/15%), and group C (severe/critical 24/6%). The morphologic and volumetric assessment of their HRCT was analyzed according to severity, by two consultant radiologists in consensus. A new 25 point-CTSI has been created, combining eight morphological CT patterns [M1:M8; 8 points] and four grades of volumetric scores [S1:S4; 17 points]. The addition of the M5 pattern (air bubble sign), M6 pattern (early fibrosis and architectural distortion), or M7 pattern (crazy-paving) proved to increase the clinical severity. The second step of the study entailed a standardized blinded/independent validation analysis for the proposed CTSI. This was prospectively conducted on other 132 patients during October 2020 and independently performed by other two consultant radiologists. Validation results reached 80.2% sensitivity, 91.8% specificity, AUROC-curve = 0.8356, and 90.9% accuracy. Conclusion A new optimized CTSI with accepted validation is proposed for initial staging of COVID-19 patients, using combined morphologic/volumetric assessment instead of the quantitative assessment alone. It could solve the clinico-radiological mismatch among patients with similar quantitative CT results and variable clinical presentation during the absence of pre-existing comorbidities or vascular complications.

The evolution in imaging has had an increasing role in the diagnosis, staging and follow up of bladder cancer. Conventional cystoscopy is crucial in the diagnosis of bladder cancer. However, a cystoscopic procedure cannot always depict carcinoma in situ (CIS) or differentiate benign from malignant tumors prior to biopsy. This review will discuss the standard application, novel imaging modalities and their additive role in patients with bladder cancer. Staging can be performed with CT, but distinguishing between T1 and T2 BCa (bladder cancer) cannot be assessed. MRI can distinguish muscle-invasive from non-muscle-invasive tumors with accurate local staging. Vesical Imaging-Reporting and Data System (VI-RADS) score is a new diagnostic modality used for the prediction of tumor aggressiveness and therapeutic response. Bone scintigraphy is recommended in patients with muscle-invasive BCa with suspected bony metastases. CT shows low sensitivity for nodal staging; however, PET (Positron Emission Tomography)/CT is superior and highly recommended for restaging and determining therapeutic effect. PET/MRI is a new imaging technique in bladder cancer imaging and its role is promising. Texture analysis has shown significant steps in discriminating low-grade from high-grade bladder cancer. Radiomics could be a reliable method for quantitative assessment of the muscle invasion of bladder cancer.

Background: Urinary bladder cancer (BC) is reported as the 2nd most common genitourinary cancer in males and the 9th most common in females. Accurate pre-surgical evaluation of the local stage of the bladder cancer is crucial in the treatment strategy. So it is very important to evaluate and no invasive imaging modality to help accurate staging of the disease. Purpose:To evaluate role of diffusion weighted MR imaging (DW-MRI) in detection, T-staging of urinary bladder carcinoma.Patients and methods: During the period between November 2018 and November 2019, 44 patients (36 males and 8 females) presenting with haematuria, lower urinary symptoms and urinary bladder mass detected by ultrasound, were enrolled prospectively. All patients underwent standard MRI protocol and diffusion weighted MR imaging of urinary followed by transurethral cystoscopy. Then transurethral resection of the bladder tumor (TURBT) or radical cystectomy according to the tumor staging with histological examination of resected specimens. Results:Correlation between MR and cystoscopy showing 100% sensitivity in detection of the lesions and as regard to MRI staging of bladder carcinoma and histopathological results the study revealed that 38 patients (86.3%) had the same T stage while 6 patients (13.6%) were overstaged. Conclusion:DWI have very high sensitivity in detection of the bladder lesions with accurate predictions of the T staging of bladder carcinoma can be made by means of DWI.

There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in many different patterns with variable degrees of severity varying from asymptomatic and uncomplicated forms to life threatening complicated infections. Cross-sectional imaging techniques—including both computed tomography (CT) and magnetic resonance imaging (MRI)—have become very important tools not only for evaluation of UTIs, but also for detection of associated complications. Selection of either CT or MRI in the UTI evaluation depends on several factors such as the presence of contraindication, experience, cost and availability. CT and MRI help in early detection and management of UTIs that reduce the prevalence and severity of complications. In this article we will present the radiologic findings at CT and MRI in different types of upper and lower UTIs including acute pyelonephritis, intrarenal and perinephric abscesses, pyonephrosis, chronic pyelonephritis, emphysematous UTIs, xanthogranulomatous pyelonephritis, tuberculosis (TB), bilharziasis, fungal infection, corynebacterium infection, ureteritis, cystitis, prostatitis, prostatic abscess and urethritis.

We aim to review the new modifications in MR imaging technique, image interpretation, lexicon, and scoring system of the last version of Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) in a simple and practical way. This last version of PI-RADS v2.1 describes the new technical modifications in the protocol of Multiparametric MRI (MpMRI) including T2, diffusion-weighted imaging (DWI), and dynamic contrast enhancement (DCE) parameters. It includes also; new guidelines in the image interpretation specifications in new locations (lesions located in the central zone and anterior fibromuscular stroma), clarification of T2 scoring of lesions of the transition zone, the distinction between DWI score 2 and 3 lesions in the transition zone and peripheral zone, as well as between positive and negative enhancement in DCE. Biparametric MRI (BpMRI) along with simplified PI-RADS is gaining more acceptances in the assessment of clinically significant prostatic cancer.

Objectives To assess feasibility of automatically calculated CT perfusion parameters using two different methods of drawing regions of interest (ROIs) to reflect split renal function in comparison with MAG3 renography. Methods and materials 51 potential kidney donors (24 males, 27 females) were prospectively evaluated by preoperative CT perfusion. Post processing was done twice; one with ROI around renal cortex only and the other around cortex and medulla. Perfusion parameters (perfusion, peak enhancement intensity PEI and blood volume BV) were compared between the two methods. Split values for each of these parameters were calculated and compared to split renal function measured by MAG3 renography using paired samples t test. Results Perfusion was significantly lower in method 2 than in method 1 while PEI and BV showed no significant difference between the two methods. Split values of CT parameters showed no significant difference from corresponding renography split function (p value > 0.1) except BV by method 1 and perfusion by method 2 which showed significant difference ( p value Conclusion Certain CT perfusion parameters can reflect split renal function. Perfusion was more accurate in reflecting split renal function with ROI around the cortex while BV was more accurate with ROI around the whole parenchyma.

Background Renal transplantation could be considered for patients with end-stage renal disease. Ultrasonography is the imaging method chosen for renal allograft evaluation early in the postoperative period. Sono-elastography is used to estimate tissue stiffness. This study aimed to assess the correlation between sono-elastography and renal allograft histopathology in patients who had transplanted kidney and determine the efficacy of grayscale ultrasound, sono-elastography, and color duplex in evaluation renal allograft complications and correlation with renal function. Results Forty patients (26 males and 14 females) who underwent renal transplantation were included. Their ages ranging from 10:52 years; they all subjected to ultrasound, color Doppler, sono-elastography, and histopathology. The studded patients were divided into 3 groups according to histopathology: patient with normal results, patients with ATI, and patients with CAI. The difference between the mean elasticity values between the three groups was statistically highly significant (p value < 0.001) with high specificity, sensitivity, and accuracy in differentiating ATI and normal groups and also CAI and normal groups, while the lowest sensitivity noticed in differentiating between ATI and CAI groups that is mean elasticity was good to differentiating between ATI and normal groups and also between CAI and normal groups while it was less in differentiating between ATI and CAI groups. As regards the RI, the highest sensitivity of the RI was in differentiating ATI and normal with high sensitivity, specificity, and accuracy, and the lowest sensitivity, specificity, and accuracy of RI were in differentiating CAI and normal groups. Conclusion Transplanted renal allograft could be assessed by combined US, color duplex Doppler, and sono-elastography examination; also we can detect posttransplant complications early. Sono-elastography could be an efficient noninvasive method to diagnose and monitor kidney allograft rejection and follow-up of the renal allograft, which may give a further and possibly earlier prognostic index for chronic dysfunction in addition to serum creatinine.

Objective: To survey computed tomography (CT) radiation dose associated with non-contrast spiral Multislice CT examination in our institute. Methods: Detailed parameters for 362 consecutive examinations, including the patient weight, height, volume CT dose index (CTDIvol), scan length, and dose length product (DLP) were recorded from the dose report. Effective dose (E) was estimated for each patient. The differences between E doses were statistically analyzed using SSPS. Results: Patients body mass index (BMI) was 13.4 to 51.42 (average BMI 29.5 kg/m). Patients dose data (1 scan phase for each patient) from dose information: the median value of DLP was 586.45 mGy cm (83.30â1179.70 mGy cm), median value of CTDIvol was 12.07 (2.20â23.9 mGy), median value of mAs used was 186.50 (34â334 mAs). Effective dose range was (1.1â16.5 mSv) according to international commission of radiological protection (ICRP) 103 and according to ICRP60 the range was (1.3â18.93 mSv). Median value of frequent CT examinations for the same patient was 2 (min 1 scan/year & max 11 scan/year). CT dose variation was highly significant (p value

Objective To study image quality of MRI scanner using the American College of Radiology (ACR) phantom. Material and methods Image quality of 1.5 T MRI scanner was tested using ACR phantom. A standard head coil with standard restraints was used to fix the phantom head position. The phantom included seven modules for measuring MRI scanner image quality. MRI images for each module were analyzed. Results For the Geometric accuracy test the inside length of the phantom was 146 mm and the inside diameter was 189.4 mm. For the High-contrast spatial resolution, individual small bright spots on the image were three pairs of hole arrays and were distinguishable. For the slice thickness test, the top signal ramp length was 54.4 mm and bottom signal ramp length was 54.8 mm so the slice thickness was 5.46 mm. For the slice position accuracy, the bar length differences of intensity uniformity a value, called percent integral uniformity (PIU), was 96.15%. For the percent-signal ghosting, ghosting ratio was 0.0002. For the low contrast object detectability, the sum of numbers of complete spokes scored was 30 spokes. Conclusions Image quality tests were very important in acceptance of any MRI scanner after installation and during maintenance. Using ACR phantom, these tests approve that the image parameters are acceptable.

INTRODUCTION AND OBJECTIVES:With increasing use of minimally-invasive surgery to the kidney, hematuria and renal injury have become frequent urologic complications, and the use of renal angioemboli...

Introduction: Because the reports in the literature of radiologic investigations for upper tract urothelial cancer (UTUC) are limited by the number of patients, and included patients with different pathologies, we aimed to study the overall accuracy of computed tomography (CT) in the diagnosis of UTUC and their accuracy on predicting tumor location. Methods: A retrospective review from 1990 to 2017 included patients who were treated for UTUC. Unenhanced CT scan was obtained first using Multi-Detector Computed Tomography (MDCT, Philips Medical Systems), then nonionic contrast medium, containing 350 mg iodine /ml was injected at 4 mL/s. Analysis was performed using SPSS®. Results: Of 275 patients, complete data on CT was available on 270 (98%) patients. CT reported only two false positive and six false negative results and the overall accuracy was 96-97%. In comparison to the final pathological reports, CT /CTU detected 85% of the tumor location of in the renal pelvic and 50% of the calyceal tumors. In ureteric tumors, they detected distal (66/71= 93%) more than proximal ureteric tumors (60%). Conclusion: In our cohort, CT/ CTU has a high overall accuracy (97%) in diagnosing UTUC, capability to well visualize tumors of distal ureter and renal pelvis, but could miss calyceal tumors. The matter to rely only on CT without ureteroscopic biopsy in the diagnosis of UTUC especially if radical surgery is planned needs further prospective studies.

Diffusion-weighted magnetic resonance imaging (DW-MRI) is a promising noninvasive technique that provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. DWI has a large number of potential clinical applications in the evaluation of urinary tract especially in the field of oncology. Addition of DWI to conventional MRI sequences can address many of the diagnostic problems, like detection of small lesions and differentiating recurrent lesions from postoperative inflammatory changes. DWI improves tumor staging by MRI that has a great impact on patient’s management. DWI can be used in monitoring of tumor response to chemoradiotherapy; it can detect early changes in tumor metabolism and microstructural changes that can be detected by changes in the apparent diffusion coefficient (ADC) of the lesions.

Magnetic Resonance Imaging (MRI) has been widely applied to various medical procedures. The daily growth of medical data leads to human mistakes in manual analysis; and increases the need for automatic analysis. Therefore, applying tools to collect, classify, and analyse medical data automatically is essential. Medical imaging issues are extremely complex, due to the high importance of correct diagnosis and treatment of diseases in healthcare systems. For these reasons, automatic medical image analysis algorithms are used to help increase the reliability and accurate understanding of medical images. The objective of this paper is to investigate the use of Artificial Neural Network (ANN) algorithms, such as multilayer perceptron (MLP), Jordan/Eleman network, Self-Organizing Feature Map (SOFM) and Support Vector Machine (SVM), to early detect bladder cancer (diagnosis), to determine tumour staging (for the sake of prognosis), and to assess the accuracy of MRI in T staging bladder cancer. A set of functional images, taken by Magnetic Resonance (MR), was used. It was found that multilayer perceptron (MLP) neural network gave better results than all other algorithms. We developed a model that defines cancer level in order to enhance its treatment. Experimental results show that the devised approach increases the accuracy of bladder cancer diagnosis to 81.8% using Generalized Feed Forward (GFF) after processing for more than 40 hours.

Background: Emergence agitation (EA) is a common distressing problem in children after sevoflurane general anesthesia. The aim of the present study was to test the efficacy of ketamine in prevention of EA after sevoflurane general anesthesia in children undergoing magnetic resonance imaging (MRI) scan. Also, we evaluated the safety and efficacy of the face mask for administration of sevoflurane anesthesia in children. Methods: In this randomized study, 120 children aged 2–7 years (ASA I or II) of either sex scheduled for elective MRI scan under sevoflurane anesthesia were enrolled in the study protocol. Patients were randomly allocated to one of 3 groups: saline group receiving normal saline (n = 40), ketamine 0.25 group receiving 0.25 mg/kg of ketamine intravenously 10 min prior the end of the procedure (n = 40), and ketamine 1.0 group receiving 1.0 mg/kg of ketamine intravenously before sevoflurane induction, (n = 40). Anesthesia was provided with sevoflurane in 100% oxygen. EA score, pausing of the scan, scan time, discharge time and any reported adverse events were recorded. Results: No significant differences as regards age, weight, sex, or ASA score were found among the studied groups. Children in ketamine 1.0 group reported significant lower EA score in comparison with ketamine 0.25 and saline groups (P

The main goal of this study is to determine which parameters [e.g. clinical biomarkers, demographics and image-markers using 4D (3D + b-value) diffusion-weighted MRI (DW-MRI)] are more correlated with transplanted kidney status in patients who have undergone kidney transplantation, and can be used for early assessment of acute renal rejection.The study included 16 patients with stable graft function and 37 patients with acute rejection (AR), determined by renal biopsy post-transplantation. 3D DW-MRI of each allograft had been acquired using a series of b-values 50 and 100-1000 in steps of 100 smmANOVA of the saturated model found that odds of AR depended significantly on SPCr, CrCl and ADC at b = 500, 600, 700 and 900 smmPreliminary findings suggest that ADC provides improved detection of AR than lab values alone. At least two non-zero gradient strengths should be used for optimal results. Advances in knowledge: This paper investigated possible correlations between image-based and clinical biomarkers, and the fusion of both with respect to biopsy diagnosis of AR.

In recent years, magnetic resonance imaging (MRI) has been explored for non-invasive assessment of renal transplant function. This paper proposes a computer-aided diagnostic (CAD) system for the assessment of renal transplant status, which integrates both clinical and MRI-derived biomarkers. The latter are derived from either 3D (2D + time) dynamic contrast-enhanced MRI or 4D (3D + b-value) diffusion-weighted (DW) MRI. In order to extract the MRI-based biomarkers, our framework performs multiple image processing steps, including MRI data alignment to handle the motion effects, kidney segmentation using a geometric deformable model, local motion correction, and estimation of image-based biomarkers. These biomarkers are fused with clinical biomarkers (creatinine clearance and serum plasma creatinine) for the classification of transplant status using a machine learning classifier. Our CAD system has been tested on a cohort of 100 subjects (50 DCE-MRI and 50 DW-MRI) using a “leave-one-subject-out” approach and distinguished rejection from non-rejection transplants with an overall accuracy of 98% for both DCE-MRI and DW-MRI data sets. These preliminary results demonstrate the promise of the proposed CAD system as a reliable non-invasive diagnostic tool for renal transplant assessment.

This paper overviews one of the most important, interesting, and challenging problems in oncology, early diagnosis of prostate cancer. Developing effective diagnostic techniques for prostate cancer is of great clinical importance and can improve the effectiveness of treatment and increase the patient's chance of survival. The main focus of this study is to overview the different in-vitro and in-vivo technologies for diagnosing prostate cancer. This review discusses the current clinically used in-vitro cancer diagnostic tools, such as biomarker tests and needle biopsies and including their applications, advantages, and limitations. Moreover, the current in-vitro research tools that focus on the role of nanotechnology in prostate cancer diagnosis have been detailed. In addition to the in-vitro techniques, the current study discusses in detail developed in-vivo non-invasive state-of-the-art Computer-Aided Diagnosis (CAD) systems for prostate cancer based on analyzing Transrectal Ultrasound (TRUS) and different types of magnetic resonance imaging (MRI), e.g., T2-MRI, Diffusion Weighted Imaging (DWI), Dynamic Contrast Enhanced (DCE)-MRI, and multi-parametric MRI, focusing on their implementation, experimental procedures, and reported outcomes. Furthermore, the paper addresses the limitations of the current prostate cancer diagnostic techniques, outlines the challenges that these techniques face, and introduces the recent trends to solve these challenges, which include biomarkers used in in-vitro lab-on-a-chip nanotechnology-based methods.

The aim of this study was to determine the feasibility, accuracy and diagnostic potential of combined static-excretory MR Urography in children with sonographically detected hydronephrosis. We prospectively evaluated 28 children (11 girls and 17 boys), mean age 8.3 years (range 2 months–16 years). Static-excretory MR Urography was performed in all cases. The results of MR Urography were compared with the results of other imaging modalities, cystoscopy and surgery. In 28 children, 61 renal units were evaluated by MR Urography (the renal unit is the kidney and its draining ureter). The final diagnoses included: normal renal units (n = 23); uretropelvic junction obstruction (n = 14); megaureter (n = 8); midureteric stricture (n = 1), complicated duplicated systems (n = 5), post ESWL non-obstructive dilation (n = 2), extrarenal pelvis (n = 4), dysplastic kidney (n = 4). Complex pathology and more than one disease entity in were found in 7 children. The MRI diagnosis correlated with the final diagnosis in 57 units, with diagnostic accuracy 93.4%. In conclusions static and excretory MRU give both morphological and functional information in a single examination without exposure to ionizing radiation and iodinated contrast agent. It is a valuable imaging technique for children with upper urinary tract dilatation; especially in cases of complex congenital pathologies and severely hydronephrotic kidney.

analysis of Magnetic Resonance Imaging (MRI) images using Artificial Neural Network (ANN)-based system is implemented in this paper to achieve a rapid and accurate diagnosis tool for bladder cancer. The proposed approach comprises image enhancement, removal of border, feature extraction and bladder cancer recognition using multilayer perception (MLP) with sequential weight/bias training function. We develop a model that defines the cancer level in order to enhance its treatment. Experimental results show that the devised approach increases the accuracy of diagnosis of bladder cancer up to 95%.

A novel framework for the classification of acute rejection versus nonrejection status of renal transplants from 2-D dynamic contrast-enhanced magnetic resonance imaging is proposed. The framework consists of four steps. First, kidney objects are segmented from adjacent structures with a level set deformable boundary guided by a stochastic speed function that accounts for a fourth-order Markov-Gibbs random field model of the kidney/background shape and appearance. Second, a Laplace-based nonrigid registration approach is used to account for local deformations caused by physiological effects. Namely, the target kidney object is deformed over closed, equispaced contours (iso-contours) to closely match the reference object. Next, the cortex is segmented as it is the functional kidney unit that is most affected by rejection. To characterize rejection, perfusion is estimated from contrast agent kinetics using empirical indexes, namely, the transient phase indexes (peak signal intensity, time-to-peak, and initial up-slope), and a steady-phase index defined as the average signal change during the slowly varying tissue phase of agent transit. We used a kn-nearest neighbor classifier to distinguish between acute rejection and nonrejection. Performance of our method was evaluated using the receiver operating characteristics (ROC). Experimental results in 50 subjects, using a combinatoric kn-classifier, correctly classified 92% of training subjects, 100% of the test subjects, and yielded an area under the ROC curve that approached the ideal value. Our proposed framework thus holds promise as a reliable noninvasive diagnostic tool.

Many complications of percutaneous nephrolithotomy (PNL) were reported. In this report, we present a rare complication, which has never been reported. It is the migration of stone fragments into the venous system causing pulmonary emboli. We reviewed the literatures reporting complications following PNL, and there was no available previous report about such complication. It was suspected intraoperative and confirmed radiologically postoperative. In this case, pulmonary emboli have had no clinical consequences and were managed conservatively.

The objective was to develop a novel and automated comprehensive framework for the non-invasive identification and classification of kidney non-rejection and acute rejection transplants using 2D dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The proposed approach consists of four steps. First, kidney objects are segmented from the surrounding structures with a geometric deformable model. Second, a non-rigid registration approach is employed to account for any local kidney deformation. In the third step, the cortex of the kidney is extracted in order to determine dynamic agent delivery, since it is the cortex that is primarily affected by the perfusion deficits that underlie the pathophysiology of acute rejection. Finally, we use an analytical function-based model to fit the dynamic contrast agent kinetic curves in order to determine possible rejection candidates. Five features that map the data from the original data space to the feature space are chosen with a k-nearest-neighbor (KNN) classifier to distinguish between acute rejection and non-rejection transplants. Our study includes 50 transplant patients divided into two groups: 27 patients with stable kidney function and the remainder with impaired kidney function. All of the patients underwent DCE-MRI, while the patients in the impaired group also underwent ultrasound-guided fine needle biopsy. We extracted the kidney objects and the renal cortex from DCE-MRI for accurate medical evaluation with an accuracy of 0.97 ± 0.02 and 0.90 ± 0.03, respectively, using the Dice similarity metric. In a cohort of 50 participants, our framework classified all cases correctly (100%) as rejection or non-rejection transplant candidates, which is comparable to the gold standard of biopsy but without the associated deleterious side-effects. Both the 95% confidence interval (CI) statistic and the receiver operating characteristic (ROC) analysis document the ability to separate rejection and non-rejection groups. The average plateau (AP) signal magnitude and the gamma-variate model functional parameter α have the best individual discriminating characteristics. Copyright © 2013 John Wiley & Sons, Ltd.

Malignant hypertension in young female with disparity in kidney size raise the attention toward non-essential renovascular hypertension. In this case we describe a young female suffered severe hypertension associated with deterioration of kidney function and disparity in kidney size by ultrasound. Hemodialysis was started because of electrolytes imbalance and fluid overload which is unusual with unilateral renal artery stenosis. Management by traditional antihypertensive medication was with limited benefit and patient condition required intensive care monitoring. Balloon dilatation angioplasty with stent insertion in the left renal artery was performed, blood pressure started to respond to anti-hypertensive medications but she became anuric. Daily hemodialysis session was done, after few days her condition started to improve and serum creatinine returned to normal base 1.1 mg/dl without dialysis support. The patient presentation was not classic toward either unilateral renal artery stenosis or reno-parenchymal disease.

Study Type – Diagnostic (exploratory cohort) Level of Evidence 3a What's known on the subject? and What does the study add? Diffusion-weighted (DW) MRI is a non-invasive technique measuring the microscopic mobility of water molecules in the tissues without contrast administration. It provides information on perfusion and diffusion simultaneously in any organ, so it can be used to differentiate normal and abnormal tissue structure, and it might help in the characterization of various abnormalities. In recent years, DW-MRI has been applied in the evaluation of urinary tract lesions, such as malignant renal, prostatic and bladder tumours; however, it has not previously been tested on its ability to distinguish residual cancer from fibrotic and inflammatory changes secondary to transurethral resection (TUR) and intravesical chemotherapy, both of which manifest as bladder-wall thickening on T2-weighted MRI. This is the first study to show the feasibility of DW-MRI in follow-up of patients with superficial bladder tumours after TUR. DW-MRI was highly reliable in differentiating post-TUR inflammatory changes from bladder tumours, with results similar to those of conventional cystoscopy. This non-invasive method could be used efficiently in future for follow-up of this patient group and may obviate the need for routine cystoscopy. OBJECTIVE • To study the feasibility of using diffusion-weighted (DW) magnetic resonance imaging (MRI) in bladder cancer follow-up after transurethral resection (TUR). PATIENTS AND METHODS • Included in the study were 47 patients with a history of TUR of superficial bladder carcinoma, who were admitted to our centre between January and December 2011 for follow-up cystoscopy. • Before cystoscopy, DW-MRI was performed and the apparent diffusion coefficient (ADC) value was measured in a circular region of interest within the carcinoma and normal bladder wall. • Two radiologists, blinded to the results of cystoscopy, independently interpreted the DW images. • A comparison of imaging findings with those of cystoscopy was performed using the McNemar test. RESULTS • In our 47 patients, cystoscopy identified 34 bladder lesions in 24 patients and in the remaining 23 the bladder looked normal. • In the 24 patients with malignant bladders, DW-MRI detected 32/34 tumours with two false-negative findings of lesions in two patients. • In 23 patients with non-malignant bladders, the DW-MRI data were accurate for 21 patients, as two patients were misdiagnosed as malignant. • The sensitivity, specificity, accuracy, positive and negative predictive values of DW-MRI for identifying bladder tumours were 91.6% (22/24), 91.3% (21/23), 91.5% (43/47), 91.6 (22/24) and 91.3 (21/23), respectively. • Using the McNemar test there was no significant difference between DW-MRI and cystoscopy. CONCLUSIONS • DW-MRI has a high reliability in differentiating post-TUR inflammatory changes from bladder tumours, which is similar to that of cystoscopy. • DW-MRI could be a first-line diagnostic test in follow-up of patients after TUR.

Genitourinary schistosomiasis is produced by Schistosoma haematobium, a species of fluke that is endemic to Africa and the Middle East, and causes substantial morbidity and mortality in those regions. It also may be seen elsewhere, as a result of travel or immigration. S haematobium, one of the five fluke species that account for most human cases of schistosomiasis, is the only species that infects the genitourinary system, where it may lead to a wide spectrum of clinical symptoms and signs. In the early stages, it primarily involves the bladder and ureters; later, the kidneys and genital organs are involved. It rarely infects the colon or lungs. A definitive diagnosis of genitourinary schistosomiasis is based on findings of parasite ova at microscopic urinalysis. Clinical manifestations and radiologic imaging features also may be suggestive of the disease, even at an early stage: Hematuria, dysuria, and hemospermia, early clinical signs of an established S haematobium infection, appear within 3 months after infection. At imaging, fine ureteral calcifications that appear as a line or parallel lines on abdominopelvic radiographs and as a circular pattern on axial images from computed tomography (CT) are considered pathognomonic of early-stage schistosomiasis. Ureteritis, pyelitis, and cystitis cystica, conditions that are characterized by air bubble-like filling defects representing ova deposited in the ureter, kidney, and bladder, respectively, may be seen at intravenous urography, intravenous ureteropyelography, and CT urography. Coarse calcification, fibrosis, and strictures are signs of chronic or late-stage schistosomiasis. Such changes may be especially severe in the bladder, creating a predisposition to squamous cell carcinoma. Genital involvement, which occurs more often in men than in women, predominantly affects the prostate and seminal vesicles.

Purpose: To retrospectively assess the value of magnetic resonance imaging (MRI) in the diagnosis of vesicouterine fistula (VUF). Materials and Methods: Between January 2003 and January 2011, 12 patients with a diagnosis of VUF were surgically managed at our center; among them, eight patients had MRI among their preoperative radiological investigations and those were included in our study. The clinical presentation, radiological investigations, and surgical findings of the patients were reviewed. Results: The mean age of the patients was 31 years. Seven of the eight patients had complaints of cyclic hematuria and the remaining patient complained of urinary leakage through the vagina. The etiology of VUF was cesarean section in all patients. The preoperative radiological investigations included conventional cystography in five patients, intravenous urography in two, computed tomography (CT) urography in two, and MRI in eight. The sensitivities of diagnosis for these investigations were 40%, 0%, 50%, and 100%, respectively. Conclusion: In our small retrospective series, pelvic MRI was reliable and sensitive for diagnosis of VUF. It should be considered in the work-up of patients with suspected VUF. J. Magn. Reson. Imaging 2012;36:438–442. © 2012 Wiley Periodicals, Inc.

To assess the accuracy of multi-detector computed tomography (MDCT) in preoperative staging of renal cell carcinoma (RCC) and to detect the possible risk factors for mis-staging. In addition, the impact of radiological mis-staging on surgical decision and operative procedures was evaluated.Data files of 693 patients, who underwent either radical or partial nephrectomy after preoperative staging by MDCT between January 2003 and December 2010, were retrospectively reviewed. Radiological data were compared to surgical and histopathological findings. Patients were classified according to 2009 TNM staging classification. Diagnostic accuracy per stage and its impact on surgical intervention were evaluated.The overall accuracy was 64.5%, and over-stage was detected in 29.5% and under-stage in 6%. Sensitivity and specificity were highest in stage T3b (85 and 99.5%, respectively), while T4 showed the lowest sensitivity and PPV (57 and 45%). Degree of agreement with pathological staging was substantial in T1 (κ = 0.7), fair in T2 (κ = 0. 4), perfect in T3b (κ = 0.81), and slight for the other stages (κ =0.1). On multivariate analysis, conventional RCC and tumor size7 cm represent the significant risk factors (RR: 1.6, 95% CI: 1.1-2.3, P0.004 and RR: 2.4, 95% CI: 1.7-3.5, P0.001, respectively). Mis-staging was seen to have no negative impact on surgical decision.MDCT is an accepted tool for renal tumor staging. Tumor mis-staging after MDCT is of little clinical importance. Large tumor size7 cm and conventional RCC are risk factors for tumor mis-staging.

Aim of the work To evaluate the feasibility of dynamic contrast enhanced (DCE) MR Renography (MRR) in evaluation of renal allograft dysfunction using the computer based technique for motion correction and creation of renographic curves. Materials and methods Between April 2007 and March 2008, 55 consecutive patients underwent kidney transplantation at our center from live related donors. There were 42 men and 13 women. The patients were divided into two main groups; first group (23 patients) included patients with stable graft function as indicated by normal serum creatinine (⩽1.3 mg/dl). The second group (32 patients) included patients with acute kidney dysfunction as indicated by elevated serum creatinine. All were examined by DCE-MRI, ultrasound-guided needle biopsy was done for all the patients in the second group after MRI study. Results There were 23 patients with normal graft function (group 1) and 32 patients with acute graft impairment (group 2); 24 with acute cellular rejection and eight with acute tubular necrosis (ATN). Morphological evaluation revealed preserved corticomedullary differentiation (CMD) in group 1 while in group 2 there were poor CMD in 16 cases and lost CMD in nine cases. Functional evaluation using the mean intensity of the medullary region, to create MR Renographic curves, was used with sensitivity, specificity and accuracy of 75%, 96% and 84%, respectively. Conclusion Computer aided analysis of renographic MR curves and the mean intensity of the medulla region have more important features than maximum intensity, it allows separation of normal kidney from impaired one but it cannot differentiate the underlying causes of the graft dysfunction.

Objectives To assess the predictive importance of ultrasonic grade 1 hyperechogenicity in potential live related kidney donors in the absence of urinary abnormalities and with perfect renal function.