Urologic radiology最新文献

Although the prevalence of renovascular hypertension is low, clinical criteria can select a population in which renovascular hypertension is significantly more common (prevalence of 15%). In these selected patients, it is appropriate to proceed to a screening modality to look for a significant renal artery stenosis. Choices of the noninvasive methods include captopril-enhanced renal scintigraphy, magnetic resonance (MR) angiography, and intravenous digital subtraction renal angiography (DSRA). Intraarterial DSRA or conventional arteriography may also be used to reliably detect renal artery stenosis, with the advantage that both the diagnostic and the interventional procedure can be performed at the same setting. A high percentage of a group of patients who are selected by means of clinical and arteriographic studies will benefit from revascularization. Thus, the renal artery angioplasty may be performed during the arteriogram in which the stenosis is confirmed.

Abdominal neuroblastoma is reviewed in terms of its diagnosis, including in utero, at birth, and through infancy into childhood. Age at diagnosis remains the best predictor of survival, with infants under 1 year of age having almost 100% cure. Ultrasonography and magnetic resonance imaging (MRI) are the recommended diagnostic modalities to stage the abdominal primary, although computed tomography (CT) (including myelography) is still widely and efficiently used. Examples are given of each stage.

Eighty-three patients with radiographically opaque renal stones were evaluated prospectively with ultrasound and compared to KUB (kidneys, ureters, bladder) with tomograms (KUB/T) to further define the use of ultrasound in the evaluation of renal calculi. The presence or absence and the size, number, and location of stones were analyzed and correlated for each modality. Ultrasound detected the presence of renal stones in 77 of 83 (93%) patients. However, all of the stones were detected on ultrasound in only 60% of these patients. Thirty percent (80 of 269) of the papillary-calyceal stones seen on KUB/T were missed on US; 66% of the stones missed measured 2 mm or less. Although ultrasound can be used for detection of intrarenal stones, KUB/T is a more accurate imaging examination for determination of size and number of small stones.

Renal lymphangioma is a very rare lesion. A case of lymphangioma that presented as a small, hyperechoic renal mass on sonography in a child is reported. On CT, the lesion appeared as a low-density, enhancing renal mass. Despite its rarity, lymphangioma should be considered in the differential diagnosis of such a lesion. A suspected lymphangioma may be evaluated by percutaneous biopsy.

This review describes and illustrates the radiologic techniques, normal anatomy, and common congenital and acquired lesions of the urethra in men and women. Voiding cystourethrography and retrograde urethrography are the most common imaging modalities employed in the diagnosis of anatomic lesions of the urethra. The appearance of the urethra may then dictate the need for further functional evaluation with urodynamic studies. Congenital lesions in men include posterior and anterior urethral valves and duplicated urethra. In women, ectopic insertion of the ureter into the urethra is the usual congenital lesion. Acquired urethral lesions include benign prostatic hypertrophy in men and strictures and diverticula in both men and women.

Dilatation of the urinary tract is detected in a number of settings throughout childhood. Children may be asymptomatic or present with urinary tract infection, hematuria, or voiding symptoms. Evaluation of the affected urinary tract may require standard radiographic techniques (VCUG, EU) complemented by ultrasound and nuclear medicine studies. The goal of imaging is to differentiate hydronephrosis (HN) from hydroureteronephrosis (HUN) and to provide the correct diagnosis so that appropriate treatment can be given. This article reviews and demonstrates the findings in some common and uncommon causes of HN and HUN.

Sixty-one cases of diverticulum of the male urethra were reviewed. This group included 10 patients with congenital and 51 with acquired diverticula. The etiology of the acquired variety, the radiological findings, and the frequency of appearance in both congenital and acquired diverticula of the urethra during a 30-year period are described.

This paper demonstrates the findings of various radiologic imaging modalities in a case of shotgun injury to the kidney. This case is unusual because buckshot entered the renal collecting system, and subsequently passed through the urinary tract in the urine, causing "bullet colic." References to such injury in the literature are discussed, along with role of each imaging modality in the initial and subsequent radiologic workup, with particular emphasis on the usefulness of ultrasonography in evaluation of this patient.

All physicians who had billed Pennsylvania Blue Shield for at least three intravenous contrast studies during 1989 were surveyed on their use of nonionic versus ionic contrast. This surveyed group represents a diversity of hospital sizes, practice types, and group sizes. Of the 383 physician groups surveyed, responses were obtained from 285. The majority of the responding groups were radiologists (94.0%). Nonionic contrast is utilized in 41.3% of all intravenous studies. Radiologists use nonionic contrast in a much greater proportion than nonradiologists (P < 0.0001), with 17.6% of radiologists utilizing nonionic contrast in all of their patients. Conversely, 75% of nonradiologists utilize ionic contrast in all of their patients. For all physician groups surveyed, 40.3% utilize nonionic for at least 50%, while 27.6% use nonionics for more than 75% of their patients. The routine use of steroid premedication prior to the injection of ionic contrast is not a common practice. The increased utilization of nonionic contrast found in this survey may reflect the cross-section of physicians and practice types surveyed or may represent changing practice patterns among physicians utilizing contrast material.