Resistive indices in the evaluation of infants with obstructive and nonobstructive pyelocaliectasis.

Diagnosing obstructive uropathy by renal resistive indices calculated from duplex Doppler sonographic waveforms has been supported as well as challenged in the radiology literature relating to adults. Despite reports of normally higher resistive indices in children as compared to adults, two studies have documented high sensitivity and specificity of renal Doppler sonography in the diagnosis of obstructive uropathy in children, using the same discriminatory criterion of a resistive index of 0.7 or greater as used in adults. We evaluated 43 infants with significant or bilateral pyelocaliectasis secondary to both obstructive and unobstructive uropathy and found no significant difference in the mean resistive indices or the mean difference in resistive indices of two kidneys in one patient. We conclude that Doppler sonography in infants has no value in differentiating obstructive from nonobstructive pyelocaliectasis.

Complications of prostate cryosurgery: CT findings in three patients.

We present the computed tomographic (CT) findings of complications of prostate cryosurgery in three patients. One patient had injury to the bladder base and rectum, which resulted in ureteral obstruction and vesicorectal fistula. The other two patients had urethral injuries. All three patients had CT evidence of prostate necrosis. If utilization of prostate cryosurgery increases, complications will be encountered more frequently on imaging studies.

Prostate carcinoma: transrectal US after cryosurgical ablation.

PURPOSE: To characterize the transrectal ultrasound (US) morphology of the prostate after cryosurgical ablation and correlate these findings with the detection of residual tumor at transrectal US-directed biopsy. MATERIALS AND METHODS: Findings from 24 transrectal US examinations in 15 patients (age range, 63-75 years) who had undergone cryosurgical ablation of the prostate were reviewed. Prospective identification of focal lesions with transrectal US and retrospective review of US prostate morphology were correlated with clinical data and transrectal US-directed biopsy results. RESULTS: Identification of a focal lesion with transrectal US yielded a sensitivity of 13%, specificity of 69%, positive predictive value of 17%, and negative predictive value of 61% for the detection of residual carcinoma. US prostate morphology was variable and distorted in the majority of cases. CONCLUSION: Identification of focal lesions with transrectal US is not a reliable criterion for the detection of residual tumor in the prostate after cryosurgical ablation. Systematic biopsy should not be deferred owing to lack of transrectal US identification of focal abnormalities in patients with appropriate clinical indications.

Transrectal ultrasound of the prostate bed after collagen injection.

OBJECTIVE: Transurethral injection of collagen (TCI) may be used to treat urinary incontinence following radical prostatectomy for prostate cancer. The transrectal ultrasound (TRUS) findings after TCI are described in this report. MATERIALS AND METHODS: TRUS exams of four postprostatectomy patients who had undergone TCI were reviewed. Findings were correlated with pathologic specimens obtained at TRUS-guided core biopsy. These histologic specimens were compared with others from postprostatectomy patients who had not undergone TCI. RESULTS: Well defined bladder apex masses of uniform echogenicity, hypoechoic to adjacent fat and muscle, were identified sonographically in all TCI patients. Masses from which positive biopsies were obtained were similar in appearance to those with no malignancy. Hypocellular fibrous tissue and foci of acellular loose connective tissue were identified in the biopsies of those patients who had undergone TCI. No acellular areas were identified in specimens from patients who had not had TCI. CONCLUSION: Sequelae of TCI should be included in the differential diagnosis of perianastomotic masses in postprostatectomy patients. However, the need for biopsy is not obviated as residual or recurrent prostate carcinoma may coexist.

Sonography of the umbilical cord.

Knowledge of the development, normal sonographic appearance, and potential abnormalities of the umbilical cord is important in fetal assessment. The umbilical cord can be visualized throughout most of gestation and is detectable sonographically soon after visualization of the fetal pole. The normal umbilical cord is 50-60 cm long and may coil as many as 40 times, usually to the left. Abnormalities in umbilical cord size, degree of coiling, attachment, and position can have important implications for the outcome of the pregnancy. Structural abnormalities of the umbilical cord such as single umbilical artery, knots, cysts, and tumors may be associated with fetal distress or malformations. Color Doppler ultrasound (US) is useful in the identification and evaluation of structural abnormalities of the cord. By allowing measurement of blood flow velocity in the umbilical artery, duplex Doppler US may provide additional information in the evaluation of intrauterine growth retardation and twin-twin transfusion syndrome.

Sonographic evaluation of the breast.

Knowledge of appropriate ultrasonographic (US) techniques and the US appearance of the normal breast and specific lesions is essential for successful application of breast US. The highest quality breast sonograms are achieved with 5-10-MHz linear transducers, imaging the lesion within the transducer focal zone, and relatively steep time-gain compensation curves. On sonograms, the fat in normal breast parenchyma is hypoechoic, fibrous tissue is echogenic, and glandular tissue is intermediate in echogenicity. Some normal structures can simulate masses, including the anterior costochondral junction when imaged in cross section and fat lobules outlined by Cooper ligaments when imaged in a perpendicular plane. Cysts have an anechoic interior, sharp margins, and posterior acoustic enhancement. Benign solid lesions are usually hypoechoic but variable in US appearance, which can overlap with that of complicated cysts. The classic US appearance of breast carcinoma is a hypoechoic mass with inhomogeneous internal echoes, irregular margins, and variable acoustic shadowing, although carcinoma can appear well circumscribed or have posterior acoustic shadowing in some cases. The most important function of breast US is differentiating a cyst from a solid lesion. US is also useful for evaluating a palpable mass in either young patients (< 30 years old) or those with dense breasts and negative mammographic results.

Radical prostatectomy: transrectal sonographic evaluation to assess for local recurrence.

PURPOSE: To determine sonographic features associated with locally recurrent or residual tumor. MATERIALS AND METHODS: Twenty-three transcretal ultrasound (TRUS) studies were performed in 21 patients with suspected recurrent prostatic carcinoma after prostatectomy. The original prospective TRUS reports were reviewed, followed by blinded review, and the findings were compared with biopsy results. RESULTS: A discrete perianastomotic mass was identified prospectively in eight (73%) of 11 patients with positive biopsy results and in two (17%) of 12 with negative results; no mass was identified in the remaining patients. At preliminary retrospective review, the echogenic retroanastomotic fat plane was not intact in 10 (91%) of 11 patients with positive biopsy results and in two (17%) of 12 with negative results; it was intact in the remaining patients. CONCLUSION: Sonographic visualization of a mass in the prostate bed or loss of integrity of the retroanastomotic fat plane is strongly correlated with finding recurrent or residual tumor in this location. TRUS in evaluation of the source of postoperative evaluation of prostate-specific antigen levels warrants further investigation.

Computed tomography diagnosis of partial anomalous pulmonary venous drainage.

A case of the rarely occurring partial anomalous pulmonary venous drainage of the right upper lobe into the azygos arch is presented. Computed tomography (CT) clearly demonstrated the abnormal vessel coursing through the right upper lobe and draining into the azygos arch.

MR imaging of the brachial plexus.

The brachial plexus is difficult to evaluate with conventional radiologic techniques, including CT. However, it is well shown by MR imaging, which has direct multiplanar imaging capability and superior soft-tissue resolution [1-4]. We present our technique for evaluating the brachial plexus, discuss the anatomy, and illustrate normal and abnormal findings.

MR imaging of the female pelvic region.

Magnetic resonance (MR) imaging is a valuable technique for noninvasive evaluation of the female pelvic region. This article presents the normal anatomy and abnormalities of the female pelvis. MR imaging may be more useful than clinical evaluation or other imaging modalities in diagnosing or staging developmental anomalies, leiomyomas, adenomyosis, endometrial or cervical carcinoma, vaginal neoplasms, ovarian cysts, endometriosis, teratomas, polycystic ovaries, or other ovarian masses. It could potentially replace laparoscopy as a more useful tool in the diagnosis of uterine anomalies. MR imaging is generally capable of helping determine whether a pelvic mass is uterine or adnexal in origin and may be used to characterize some adnexal masses. In some cases, MR imaging is used to differentiate recurrent disease from posttreatment fibrosis, which aids in treatment planning.

Ultrasound of the scrotum.

High-resolution real time ultrasound of the scrotum, including gray-scale and color Doppler sonography is presented. The normal anatomy of the scrotum with sonographic correlation is reviewed. The sonographic features of scrotal pathology, including congenital, neoplastic, inflammatory, and traumatic conditions are presented.

CT evaluation of congenital and acquired abnormalities of the azygos system.

Congenital and acquired abnormalities may alter the anatomy, size, or position of the azygos system. Computed tomography is often able to depict these abnormalities and in many cases indicate the cause. In this article, the normal anatomy of the azygos system is discussed and examples of congenital and acquired abnormalities are presented.

MR imaging of uterine carcinoma: correlation with clinical and pathologic findings.

Thirteen patients with clinical stages I and II endometrial carcinoma were examined with magnetic resonance (MR) imaging before surgery. Depth of invasion and stage of disease were assessed, and the results were compared with those from MR images of the surgical specimens and pathologic findings. Staging with MR imaging was accurate in 11 of 13 patients (85%). Our results agree with previous reports that MR imaging is an accurate, noninvasive method of assessing depth of myometrial invasion and cervical involvement. We anticipate that MR imaging will have an increasing role in treatment of patients with endometrial carcinoma.

Uterine leiomyomas in the infertile patient: preoperative localization with MR imaging versus US and hysterosalpingography.

Eleven women with a history of infertility and uterine leiomyomas underwent magnetic resonance (MR) imaging of the pelvis prior to myomectomy. Nine also underwent preoperative pelvic ultrasonography (US), and ten underwent hysterosalpingography. All studies were interpreted prospectively by independent observers. With each imaging modality, the location (one of 11 anatomic segments), size, and appearance of detected uterine leiomyomas were determined and compared with surgical and histologic findings. Among the nine patients who underwent both MR and US, the sensitivity (85%) and accuracy (94%) of MR imaging for abnormal segments was significantly better than that of US (sensitivity = 69%, P = .015; accuracy = 87%, P = .043). For the ten patients who underwent both MR and hysterosalpingography, the sensitivity (91%) and accuracy (96%) of MR imaging was better than that of hysterosalpingography (sensitivity = 18%, P = .0005; accuracy = 72%, P = .0005). The specificities of the three modalities did not significantly differ (100%, 97%, and 98% for MR, US, and hysterosalpingography, respectively). These data suggest that MR imaging is superior to US or hysterosalpingography for preoperatively locating uterine leiomyomas.

Acute tentorial subdural hematoma as a false-positive in indium-111 leukocyte scintigraphy.

A case of acute tentorial subdural hematoma detected by In-111 leukocyte scintigraphy and confirmed by CT brain scan is herein described. White blood cells are an integral part of the blood pool and labeled white cells freely leave the intravascular space in case of active bleeding. Acute hemorrhage and hematoma can thus be a cause of a false-positive study.