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130
Trang 2Imaging the Male Reproductive
Tract: Current Trends and Future
Directions
Jurgen J Fu¨tterer, MD, PhDa,*, Stijn W.T.P.J Heijmink, MDa,
J Roan Spermon, MD, PhDb
The male reproductive system encompasses
sev-eral organs: the testes, ejaculatory ducts, seminal
ves-icles, prostate, and penis The function of this system
is to accomplish reproduction The testes are outside
the abdominal cavity within the scrotal sac This
keeps the testes from the regular body temperature
and at an optimal temperature for sperm The main
role of the prostate gland is to produce and secrete
an alkaline fluid This helps to energize and protect
the sperm during intercourse in the vaginal canal
The male reproductive tract is a common site for
diseases Diagnostic imaging modalities, such as
ultrasound (US), CT, MR imaging, and positron
emission tomography (PET), increasingly are used
to evaluate these diseases The purpose of this
review is to provide an overview of the use of
imag-ing techniques in the male reproductive tract and to
discuss current trends and future directions in
pros-tate and testicular imaging This review focuses on
the prostate and scrotum
Prostate The prostate changes and commonly enlarges with age The most frequent types of prostate disease are prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer Prostate cancer is the most com-mon malignancy in men[1] Imaging of the pros-tate remains a challenging endeavor
Anatomy of the prostate The prostate is a small gland and situated directly caudal to the bladder The prostate gland envelops the prostatic urethra and the ejaculatory ducts The seminal vesicles are paired grapelike pouches filled with fluid that are located caudolateral to the corresponding deferent duct, between the blad-der and rectum The prostate is divided into apex and base (directed upward to the inferior border
of the bladder) On the basis of its embryologic origins, the prostate is divided anatomically into
R A D I O L O G I C
C L I N I C S
O F N O R T H A M E R I C A
Radiol Clin N Am 46 (2008) 133–147
a Department of Radiology (667), University Medical Centre Nijmegen, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands
bDepartment of Urology, University Medical Centre Nijmegen, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands
* Corresponding author
E-mail address: j.futterer@rad.umcn.nl (J.J Fu¨tterer)
- Prostate
Anatomy of the prostate
Acute and chronic prostatitis
Benign prostate hyperplasia
Prostate cancer
- Scrotum
Anatomy of the scrotum
Cryptorchidism Acute scrotal pain Scrotal masses
- Summary Prostate Scrotum
- References
133
0033-8389/08/$ – see front matter ª 2008 Elsevier Inc All rights reserved doi:10.1016/j.rcl.2008.01.005
radiologic.theclinics.com
Trang 3Fig 3.US imaging (Aplio, Toshiba Medical Systems, Tokyo, Japan) of the prostate in a 55-year-old man who had
a PSA level of 6.89 ng/mL (A) No abnormality was observed on gray-scale imaging (B–H) Contrast harmonic imaging was performed (B) Until 28 seconds after bolus injection of 2.4 mLSonoVue (Bracco, Milan, Italy), no enhancement was observed in the prostate (C) Subsequently, within 1 second, the first contrast enhancement
is seen in the left peripheral zone (yellow circle) (D–F) The area (circle) continues to enhance more compared with the rest of the prostate until 40 seconds post injection (G) At 40 seconds post injection, the entire prostate shows a homogeneous enhancement (H) Step-section histopathology after radical prostatectomy confirmed the cancer focus (yellow outline, T) with Gleason score 3 1 5
Imaging the Male Reproductive Tract 137