OBJECTIVE:The aim of this study was to reveal the histopathological results of Prostate Imaging Reporting and Data System 3 lesions and to investigate whether targeted biopsy is essential in these lesions. METHODS:One hundred and twenty-seven patients with 176 lesions, being categorized as Prostate Imaging Reporting and Data System 3 according to Prostate Imaging Reporting and Data System version 2.1, who underwent transrectal ultrasound-magnetic resonance imaging fusion biopsy were included in the study. RESULTS:The mean age of the patients was 62.4 years. The median of prostate-specific antigen, prostate-specific antigen density, free prostate-specific antigen, and free/total prostate-specific antigen were 6.64 ng/mL, 0.10 ng/mL2, 1.24 ng/mL, and 0.18 ng/mL, respectively. In patient- and lesion-based analysis, the prevalence of adenocarcinoma was 12.7 and 9%, and clinically significant prostate cancer was 2.3 and 1.7%, respectively. The rate of prostate cancer detected by systematic biopsy alone was 7.8%, and 1.5% of these were clinically significant. There was no significant difference in prostate-specific antigen or prostate-specific antigen density between patients with histopathologically malignant and benign Prostate Imaging Reporting and Data System 3 lesions (p≥0.233). prostate-specific antigen density was higher in malignant patients, considering only 89 patients with index lesion P3 (p=0.046). Family history was significantly higher in malignant patients (p=0.028). CONCLUSION:Since clinically significant prostate cancer is very low in Prostate Imaging Reporting and Data System 3 lesions, clinical findings and risk factors should be considered in the biopsy decision in patients with index lesion Prostate Imaging Reporting and Data System 3. However, in patients with index lesions Prostate Imaging Reporting and Data System 4 and 5, targeting these Prostate Imaging Reporting and Data System 3 areas might be important with regard to the extent of the disease.

Objective: Prostate-specific antigen density (PSAd) has gained traction as a superior diagnostic marker, compared with PSA alone, for predicting clinically significant prostate cancer (csPCa). However, prostate gland volume may affect the diagnostic accuracy of PSAd. To evaluate how prostate volume influences the diagnostic performance of PSAd for detecting csPCa in patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. Materials and Methods: We retrospectively analyzed 576 patients with PI-RADS 3 lesions who underwent PSA testing, multiparametric magnetic resonance imaging (MRI), and cognitive-and fusion-guided transrectal prostate biopsies between 2017 and 2025. PSAd was calculated as serum PSA divided by MRI-measured prostate volume. Patients were stratified into three groups according to prostate volume: <= 30 mL, 31-50 mL, and >= 51 mL. csPCa was defined as International Society of Urological Pathology grade >= 2. Diagnostic performance of PSAd was assessed using receiver operating characteristic (ROC) curve analysis with volume-specific cut-offs. Results: The overall csPCa detection rate was significantly higher in patients with prostates <= 30 mL (p<0.001). Across all volume groups, csPCa detection remained <5% when PSAd <0.10 ng/mL/mL. For glands <= 30 mL, csPCa rates rose sharply above this threshold. ROC analysis revealed that small prostates had a slightly higher diagnostic accuracy [area under the curve (AUC) 0.668] compared with intermediate (AUC 0.599) and large (AUC 0.633) glands. Optimal PSAd cut-offs were narrowly distributed (0.1058-0.1531), but diagnostic sensitivity varied with volume. Conclusion: The findings indicate that the diagnostic performance of PSAd in predicting csPCa is influenced by prostate volume. Instead of proposing definitive universal cut-off values, our results suggest that lower PSAd thresholds may be considered in patients with larger prostate volumes, particularly in borderline cases such as PI-RADS 3 lesions. Incorporating prostate volume into PSAd interpretation may improve risk stratification and contribute to more individualized biopsy decision-making.

To evaluate renal parenchymal stiffness using 2D shear wave elastography (SWE) in patients with chronic kidney disease (CKD) and to investigate the correlation between SWE results and demographic as well as laboratory findings. We evaluated 41 CKD patients and 40 controls who underwent abdominal ultrasound (US) between December 2020 and November 2022. SWE measurements were performed by a single radiologist, assessing renal stiffness in the lower pole, middle section, and upper pole of each kidney. The mean stiffness values were calculated from at least six measurements per kidney. Laboratory data, including glomerular filtration rate (GFR), serum urea, and creatinine levels, were obtained. Mann-Whitney U and Spearman correlation tests were used for statistical analysis. CKD patients (mean age: 66 years) showed significantly higher cortical stiffness compared with controls (15.6 kPa vs. 5.5 kPa, p < 0.001). A positive correlation was found between stiffness and serum urea/creatinine levels, while an inverse correlation was observed with GFR (p < 0.001). A negative correlation was observed between kidney size and SWE (r = -0.215, p = 0.054), while parenchymal thickness showed a stronger and statistically significant inverse relationship with SWE (r = -0.301, p = 0.006). No significant correlation was found with age or gender (p > 0.05). SWE is a reliable, noninvasive method for assessing renal fibrosis in CKD. With standardization, it could become a valuable tool in routine CKD evaluation.

OBJECTIVE:To evaluate whether fusion biopsy provides an advantage in detecting clinically significant prostate cancer(csPCa) in elusive small-diameter lesions, especially in high volume prostates. MATERIAL AND METHODS:Data of 762 patients who underwent multiparametric magnetic resonance imaging(mpMRI) before prostate biopsy at single center between January 2017 and January 2024 were retrospectively assessed. All of these patients underwent combined cognitive and fusion targeted biopsy and systematic biopsy of suspicious lesions and transrectal ultrasonography guided systematic biopsy by 2 separate experienced radiologists(with histopathological evaluation completed for all specimens). Lesions were categorized by diameter (≤5 mm, 6-10 mm, >10 mm) and prostate volumes (≤30 mL, 31-70 mL, >70 mL). (All patients underwent 3T mpMRI, and lesions were scored using PI-RADS v2.1. The largest lesion with the highest PI-RADS score was considered the index lesion.) RESULTS: Patient characteristics, including clinical and radiological features, were balanced between cognitive and fusion biopsy groups. PI-RADS stratification showed similar detection rates for PI-RADS 3, 4 and 5 lesions between methods. For lesions ≤5 mm, fusion biopsy showed a significantly higher csPCa detection rate than cognitive biopsy (16.4% vs. 3%, P = 0.033). No clinical significant prostate cancer was detected in lesions ≤5 mm with prostate volumes >30 ml in cognitive biopsy group. For lesions 6-10 mm and >10 mm, detection rates were comparable between procedures. CONCLUSION:MRI Fusion-targeted biopsy is particularly advantageous for smaller lesions and in settings where precise lesion targeting is critical. However, for larger lesions or institutions with skilled operators, cognitive-targeted biopsy remains a viable and effective alternative.

OBJECTIVES:The study aims to evaluate Prostate Imaging-Reporting and Data System 4 (PI-RADS 4) lesions, including those with primary diffusion restriction (diffusion-weighted imaging score 4) and those upgraded from PI-RADS 3 due to positive dynamic contrast-enhanced findings, and to compare outcomes between these groups while also assessing cancer detection rates and prostatitis between upgraded cases and PI-RADS 3 lesions. METHODS:In this single-center cohort study, peripheral zone lesions classified as PI-RADS 3 and 4 by multiparametric MRI and biopsied via MRI/transrectal ultrasound-guided targeted biopsy were analyzed. RESULTS:Of 420 peripheral zone lesions from 272 patients, 202 were PI-RADS 3, 81 PI-RADS 3 + 1, and 137 PI-RADS 4. Cancer detection rates significantly differed between PI-RADS 3 + 1 and PI-RADS 4 (38.3% vs 73% for overall cancer; 6.2% vs 30.7% for clinically significant cancer, P < .001). PI-RADS 3 + 1 lesions had significantly higher cancer detection rates than PI-RADS 3 lesions (38.3% vs 19.8%, P  = .001). Prostatitis was significantly more prevalent in PI-RADS 3 (34.7%) and PI-RADS 3 + 1 (29.6%) than in PI-RADS 4 (10.9%) lesions (P < .001). CONCLUSIONS:PI-RADS 3 + 1 lesions show significantly different cancer detection rates from both PI-RADS 3 and 4, suggesting they should be managed as a distinct entity. Higher prevalence of prostatitis in PI-RADS 3 + 1 lesions indicates that clinical evaluation for inflammatory conditions may help reduce unnecessary biopsies in this subgroup. ADVANCES IN KNOWLEDGE:PI-RADS 3 + 1 lesions show higher cancer detection than PI-RADS 3 but lower than PI-RADS 4, and are more frequently associated with prostatitis than PI-RADS 4. These findings support individualized management to avoid unnecessary biopsies.

IntroductionRecent guidelines suggest that biopsy may be omitted in some groups of patients with PI-RADS 3 lesions on mpMRI. In this study, we aimed to evaluate biopsy strategies involving prostate-specific antigen density (PSAd) to avoid unnecessary biopsy versus the risk of missing clinically significant prostate cancer (csPCa) in patients with PI-RADS 3 lesions.Material and MethodsData of 616 consecutive patients who underwent PSAd and mpMRI before prostate biopsy between January 2017 and January 2022 at a single center were retrospectively assessed. All of these patients underwent combined cognitive or fusion targeted biopsy of suspicious lesions and transrectal ultrasonography guided systematic biopsy. PI-RADS 3 based strategies with PSAd and mpMRI combination were created. For each strategy, avoided unnecessary biopsy, reduced ISUP Grade 1, and missed ISUP Grade ≥ 2 ratios were determined. Decision curve analysis (DCA) was used to statistically compare the net benefit of each strategy.ResultsDCA revealed that patients who had PI-RADS 3 lesions with PSAd ≥0.2, and/or patients who had PI-RADS 4 and 5 lesions had the most benefit, under the threshold probability level between 10% and 50%, which avoided 48.2% unnecessary prostate biopsies and reduced 51% of ISUP grade 1 cases, while missed 17.5% of ISUP Grade ≥2 cases. (22.1% for ISUP grade 2 and 8.8% for ISUP grade ≥ 3). Strategy 1 (PI-RADS 4–5 and/or PSAd ≥0.2), 3 (PI-RADS 4–5 and/or PI-RADS 3 if PSAd ≥0.15), and 7 (PI-RADS 4–5 and/or PI-RADS 3 if PSAd ≥0.15 and/or PI-RADS 2 if PSAd ≥0.2) were the next three best strategies.ConclusionmpMRI combined with PSAd strategies reduced biopsy attempts in PI-RADS 3 lesions. Using these strategies, the advantage of avoiding biopsy and the risk of missing the diagnosis of csPCa can be discussed with the patient, and the biopsy decision can be made afterwards.MICROABSTRACTAlthough most studies focus on preventing unnecessary prostate biopsy, patients may not accept the rates of missing clinically significant prostate cancer and the associated clinical risks. Therefore, our risk-adapted strategies allow each patient and clinician to choose the most appropriate strategy for themselves.

Background: Multiparametric magnetic resonance imaging (mpMRI) is used as a current marker in preoperative staging and surgical decision-making, but current evidence on predicting post-surgical oncological outcomes based on preoperative mpMRI findings is limited. In this study We aimed to develop a risk classification based on mpMRI and mpMRI-derived biopsy findings to predict early biochemical recurrence (BCR) after radical prostatectomy. Methods: Between January 2017 and January 2023, the data of 289 patients who underwent mpMRI, transrectal ultrasound-guided cognitive and fusion targeted biopsies, and subsequent radical prostatectomy (RP) with or without pelvic lymph node dissection in a single center were retrospectively re-evaluated. BCR was defined as a prostate specific-antigen (PSA) >= 0.2 ng/mL at least twice after RP. Multivariate logistic regression models tested the predictors of BCR. The regression tree analysis stratified patients into risk groups based on preoperative mpMRI characteristics. Receiver operating characteristic (ROC)-derived area under the curve (AUC) estimates were used to test the accuracy of the regression tree-derived risk stratification tool. Results: BCR was detected in 47 patients (16.2 %) at a median follow-up of 24 months. In mpMRI based multivariate analyses, the maximum diameter of the index lesion (HR 1.081, 95%Cl 1.015-1.151, p = 0.015) the presence of PI-RADS 5 lesions (HR 2.604, 95%Cl 1.043-6.493, p = 0.04), >= iT3a stage (HR 2.403, 95%Cl 1.013-5.714, p = 0.046) and ISUP grade >= 4 on biopsy (HR 2.440, 95%Cl 1.123-5.301, p = 0.024) were independent predictors of BCR. In regression tree analysis, patients were stratified into three risk groups: maximum diameter of index lesion, biopsy ISUP grade, and clinical stage on mpMRI. The regression tree-derived risk stratification model had moderate-good accuracy in predicting early BCR (AUC 77 %) Conclusion: Straightforward mpMRI and mpMRI-derived biopsy-based risk stratification for BCR prediction provide an additional clinical predictive model to the currently available pathological risk tools.

Introduction: The aim of this study is to reveal MR defecography findings of pelvic floor failure and to highlight the significant points regarding acquiring and interpreting images. Materials and Methods: The patients who underwent MR defecography imaging in our department between 2013 and 2016 were retrospectively evaluated. Abnormalities of pelvic compartments were both investigated and graded. Axial diameter of the levator hiatus and iliococcygeus angle were measured at rest and during straining and the measurements were compared. H line, M line and ARA were measured at rest, during straining and defecation and the measurements were compared. Results: There was a statistically significant difference between rest and straining, rest and defecation, straining and defecation phases in terms of the length of M and H lines. Changes in the transverse diameter of levator hiatus and iliococcygeus angle between rest and straining phases were statistically significant. In the patients without spastic pelvic floor syndrome, there was a statistically significant difference between rest and straining, rest and defecation, straining and defecation phases in terms of ARA. In the patients with spastic pelvic floor syndrome, changes in ARA between rest and straining, rest and defecation phases were statistically significant. There was no statistically significant difference between straining and defecation phases in terms of ARA. Conclusion: MR defecography gives detailed information about pelvic compartment abnormalities in the patients with pelvic floor failure. While early images of defecation are more useful for the assessment of the posterior compartment, late phase images would allow more accurate definition of anterior and middle compartment abnormalities. Keywords: MR defecography, pelvic floor dysfunction, spastic pelvic floor syndrome

Objectives:We aimed to describe the MR defecography findings of anismus, and to compare them with those seen in other pelvic floor disorders.Materials and Methods: MR defecography findings suggesting anismus (Group 1) were compared with findings of other pelvic floor abnormalities (Group 2).Anorectal angle (ARA) was measured both at rest and during defecation.Anal canal diameter was measured as the width of ultrasound gel column passing through the anal canal during defecation on CINE images.Percentage of rectal emptying was calculated by measuring the maximum dimension of contrast-filled rectum at rest and of retained contrast material at the end of the examination after defecatory attempts.MR images were retrospectively evaluated by two radiologists in consensus.Results: There were 60 patients in Group 1 (39 female, mean age 45 years), and 41 patients in Group 2 (39 female, mean age 54 years).The mean ARA at rest was 97.7° in Group 1, 106.8° in Group 2, and ARA during defecation was 98.8° in Group 1, and 134.9° in Group 2. The mean value of rectal emptying was 35%, and 83% in Group 1 and 2, respectively.Anal canal did not open in 5 patients, the width of the anal canal was less than 10 mm in 48 patients, and was between 10 and 14 mm in 7 patients in Group 1.It was less than 10 mm in 9 patients, between 10 and 15° in 12 patients and more than 15 mm in 20 patients in Group 2. There was a statistically significant difference between two groups in all parameters (p<0.05).Accompanying pelvic floor pathologies were present in 28 patients in Group 1 (47%), and rectocele was the most frequent associated abnormality. Conclusion:MR defecography findings in patients with anismus are significantly different from other pelvic floor pathologies.

Aim: Both anismus and perineal descent may cause symptoms of obstructed defecation, and impaired rectal evacuation may be a major finding of anismus, or due to insufficient patient co-operation.The aim was to compare static magnetic resonance defecography (MRD) measurements in patients with anismus and perineal descent, and to identify findings which may rule out anismus in patients who can not defecate.Method: Patients with symptoms of obstructed defecation who underwent MRD between July 2016 and March 2018 were retrospectively evaluated.Thickness of anal sphincter was measured on T2W axial images.Anorectal angle (ARA) and M-line were measured on static MRD images with distended rectum.After all measurements were completed, patients were divided into two groups depending on the diagnosis indicated by MRD.Group 1 consisted of patients with findings suggesting anismus and group 2 consisted of patients with perineal descent.The measurements of ARA, M line and thicknesses of anal sphincter were compared.Results: In total 90 patients (68 female; 75.6%) were included.Group 1 consisted of 37 (20 female) patients with a mean age of 46 years.Group 2 consisted of 53 (48 female) patients with a mean age of 52 years.Both the age (p=0.039) and the gender distribution (p<0.01)differed significantly between the groups, while the thickness of the internal and external anal sphincter was not significantly different.Both the ARA measurements (p=0.025) and difference in the length of M-line (p=0.047) were significantly different between the groups on images with distended rectum.Conclusion: Patients with anismus were younger but there was no gender predilection.When the rectum was filled with contrast media, the ARA was wider and M-line was longer in patients with perineal descent.

Dyssynergic defecation (DD) is defined as paradoxical contraction or inadequate relaxation of the pelvic floor muscles during defecation, which causes functional constipation. Along with the anal manometry and balloon expulsion tests, magnetic resonance (MR) defecography is widely used to diagnose or rule out pelvic dyssynergia. Besides the functional abnormality, structural pathologies like rectocele, rectal intussusception, or rectal prolapse accompanying DD can also be well demonstrated by MR defecography. This examination can be an uncomfortable experience for the patient, so the imaging method and the importance of patient cooperation must be explained in detail. The defecatory phase of the examination is indispensable for evaluation, and inadequate effort should be ruled out before diagnosing DD. MR defecography provides important data for the diagnosis of DD, but optimal imaging criteria should be applied. Further tests can be suggested if patient co-operation is not sufficient or MR defecography findings are irrelevant.

Amaç: Günlük pratikte karşılaştığımız, yüzeysel yerleşimli, palpabl yumuşak doku kitlelerinin ultrasonografi (

To assess and compare the multiphasic computed tomography (CT) features of neuroendocrine tumor (NET) liver metastases and to investigate the possibility to predict the histologic subtype of the primary tumor. Between January 2013 and December 2017 patients with biopsy proven NET with at least one liver metastasis who underwent multiphasic CT were enrolled in this study. All cases were acquired using a standardized multiphasic liver CT protocol, arterial, portal, and hepatic venous phases were obtained. Images were retrospectively analyzed in consensus by two abdominal radiologists blinded to clinical data and histologic subtype. The size, number, and location of lesions were noted. Enhancement patterns of each lesion on arterial, portal, and hepatic venous phases were assessed. For quantitative analysis, CT attenuation of tumors, liver parenchyma, and aorta were measured using a circular region of interest (ROI) on arterial, portal, and hepatic venous phases for reflecting the blood supply of the tumor. Tumor-to-aorta and tumor-to-liver ratio were calculated in all three phases. Differences between subtypes of NET liver metastases were studied using ROC analysis of clustered data. A total of 255 neuroendocrine tumor liver metastases divided into 101 (39.6%) pancreatic, 60 (23.5%) gastroenteric and 94 (36.8%) lung NET liver metastases were analyzed. Contrast enhancement of lesions was homogeneous in 78% of patients (n = 199), which was significantly more frequent in patients with pancreatic group than in those with gastroenteric origin (n = 90, 89.1% vs. n = 28, 46.7%; p < 0.001). Gastroenteric NET metastases frequently showed heterogeneous enhancement, which was significantly higher than in the other two groups (50% vs. 3% and 2%). With respect to the location of the primary tumor, the difference in enhancement patterns of the liver lesions was statistically significant (p < 0.001). Pancreatic NET metastases were mostly hyperdense on arterial images and isodense on portal and hepatic venous phase images (79.2%, n = 80). Gastroenteric NET metastases were mostly hyperdense on arterial phase images and hypodense on portal and hepatic venous phase images (n = 28, 46.7%). The most frequent pattern for lung NET metastases was hypoattenuation on all three phase images (n = 44, 46.8%). ROC analysis of clustered data revealed statistically significant differences between pancreatic NET liver metastases, gastroenteric NET liver metastases, and lung NET liver metastases in terms of tumor-to-aorta (T–A) ratio and tumor-to-liver (T–L) ratio (p < 0.001). We observed statistically significant differences in multiphasic CT features (enhancement pattern, T–A ratio, and T–L ratio) between histologic subtypes of NET liver metastases. As the difference in histological subtypes of NET liver metastases results in a different prognosis and different management strategy, these CT features might help to identify the primary tumor when it is not known to ensure accurate tumor staging and to provide optimal treatment.

Congenital aneurysms and diverticula of the heart are rare anomalies and their prenatal diagnosis is challenging.Fetuses with suspected cardiac aneurysms on ultrasound (US) screening should undergo targeted fetal echocardiography, postnatal imaging, and follow-ups.Herein, we describe the second trimester US scan and postnatal cardiac magnetic resonance imaging (MRI) findings of a baby girl with concurrent septal and right ventricular cardiac aneurysms.Other cardiac and extra-cardiac structures were normal.Upon consultation about the prognostic uncertainty of the situation, the family chose to continue the pregnancy.The rest of the pregnancy and birth was without any complications.Follow-up postnatal echocardiograms showed no progression regarding the size of the aneurysms.The baby is still on follow-up without any medication and is thriving.To the best of our knowledge, this case report is the first to show the prenatal diagnosis of two concurrent rare cardiac aneurysms.

Background/aim: We aimed to present the magnetic resonance cholangiopancreatography (MRCP) findings of biliary tract complications after liver transplantation. Materials and methods: Seventy-five patients who underwent MRCP in our department between July 2011 and July 2015 after liver transplantation were retrospectively evaluated. The MRCP images were reevaluated by three radiologists in consensus. Diagnostic confirmation of MRCP findings was obtained with direct cholangiographic examinations or with clinical, radiological, and laboratory findings and concordance between MRCP findings and the final diagnosis was investigated. Results:Twenty-seven of the 75 patients had normal MRCP findings and at least one type of biliary tract complication was detected on the MR images of 48 patients. These complications included anastomotic stricture, dilatation of the biliary tract, nonanastomotic stricture, biliary leakage, cholangitis, biloma, abscess due to cholangitis, biliary stone-sludge, and donor-to-recipient bile duct disproportion. Thirty of the 75 patients were followed only by clinical and laboratory findings without further imaging. Forty-five patients underwent direct cholangiographic examinations. At the end of the follow-up period, 28 of the 75 patients were considered free of biliary tract complications, and at least one bile duct complication was diagnosed in 47 patients. Conclusion: With its high sensitivity and specificity, MRCP should be the first choice of method in the diagnosis and follow-up of biliary complications after liver transplantation.

BACKGROUND:Structural changes during lactation make breast physical examination difficult. When breast problems occur, patients are often referred for an ultrasound (US) scan. Most breast lesions diagnosed in these patients are benign, but the diagnosis of breast cancer is a challenge. We aim to demonstrate the spectrum of US imaging findings in lactating women.METHODS:77 breastfeeding patients who underwent breast US in our department between February 2012 and March 2017 were evaluated. Patients' electronic medical records were reviewed for the presenting complaint, US reports, pathology results if available, and clinical/radiologic follow-up. All examinations were performed by 2 radiologists.RESULTS:28 of the 77 patients had normal US findings. Cysts were seen in 16 patients. 4 patients had stable fibroadenomas. 6 patients had US imaging findings suggestive of mastitis, 5 patients had galactoceles, 1 patient had an abscess, and 1 patient had unilateral hypertrophy without any accompanying lesion. In 13 patients, BI-RADS 3 solid masses were diagnosed. Invasive breast cancer was diagnosed in 3 patients.CONCLUSION:US can demonstrate or exclude a true mass against the background of a nodular breast parenchyma. Radiologists must be aware of malignant US features to avoid delays in the diagnosis of pregnancy-associated breast cancer.

Objective: We aimed to investigate the MR imaging findings of patients with hematologic malignancies who have symptoms suggesting perianal infection and to demonstrate the importance of imaging.Subjects and methods: The study included 36 patients with hematologic malignancies who underwent anorectal MR imaging in our department between September 2011-May 2016. Two radiologists experienced in abdominal radiology viewed the MR images in consensus. Abscesses, fistulous or sinus tracts, signal alterations and contrast enhancement in keeping with an inflammation and edema in the perianal region were recorded.Results: Perianal abscess was found in 16 of the 36 patients. In 10 of these 16 patients there was also extensive inflammatory signal alterations in perianal and/or perineal soft tissues.In six of the 36 patients perianal fistula was detected. A sinus tract was seen at the level of subcutaneous external anal sphincter in one patient. Inflammatory signal alterations in the surrounding soft tissues were present in three of these seven patients.There were abscesses in labium majus in two patients and in one patient there were perineal abscesses with accompanying inflammatory signal alterations.In six of the 36 patients no abscess or fistula/sinus tract was seen. There were only inflammatory signal alterations with contrast enhancement in perianal or subcutaneous tissues.In two patients presenting with perianal pain and hemorrhoids, minimal inflammatory changes were detected on MR images.There were two patients with normal MR imaging findings.Conclusion: As digital examination of the anorectum and rectoscopy are avoided in neutropenic patients, MR imaging, which clearly demonstrates the perianal pathology should be preferential.