CT urography

With the advent of multi-detector row CT scanners, evaluation of the urothelium of the entire urinary tract with high-resolution thin sections during a single breath-hold has become a reality. Multidetector CT urography (MDCTU) is a single examination that allows evaluation of potential urinary tract calculi, renal parenchymal masses, and both benign and malignant urothelial lesions. Initial results with this new technique are encouraging. Current investigations of MDCTU focus on methods to improve opacification and distension of the upper urinary tract-the collecting systems, pelvis, and ureters. The role of abdominal compression, infusion of saline and/or furosemide, and optimal time delay of excretory phase imaging is being explored. Upper tract urothelial malignancies, including small lesions less the 5 mm in diameter, can be detected with high sensitivity. Methods to reduce radiation exposure are being explored, including split-bolus contrast injection techniques that combine nephrographic and excretory phases into a single phase. It is likely that in the near future, radiological evaluation of significant unexplained hematuria or of known or prior urothelial malignancy will consist of a single examination—MDCTU.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47976/1/10406_2005_Article_114.pd

Milk of calcium renal cyst: CT findings

Milk of calcium in the kidney is usually found in association with hydronephrosis or caliceal diverticula. A case of milk of calcium in a renal cyst is presented. Contiguity with an adjacent rib can make it difficult to detect the dependent layered milk of calcium.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29915/1/0000272.pd

Diagnostic Dilemma of Small Incidentally Discovered Adrenal Masses: Role for 131 I-6β-Iodomethyl-norcholesterol Scintigraphy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42408/1/268-21-1-36_21n1p36.pd

3D excretory MR urography: Improved image quality with intravenous saline and diuretic administration

Purpose To assess the effect of diuretic administration on the image quality of excretory magnetic resonance urography (MRU) obtained following intravenous hydration, and to determine whether intravenous hydration alone is sufficient to produce diagnostic quality studies of nondilated upper tracts. Materials and Methods A total of 22 patients with nondilated upper tracts were evaluated with contrast-enhanced MRU. All patients received 250 mL of saline intravenously immediately prior to the examination. A total of 11 patients received 10–20 mg furosemide in addition to saline. Imaging was performed with a three-dimensional (3D) and two-dimensional (2D) breathhold spoiled gradient-echo sequences. Excretory MRU images were acquired five minutes after the administration of 0.1 mmol/kg gadolinium and were independently reviewed by two radiologists, who were blinded to the MRU technique. Readers evaluated the calyces, renal pelvis, and ureters qualitatively for degree of opacification, distention, and artifacts on a four-point scale. Statistical analysis was performed using a permutation test. Results There was no significant disagreement between the two readers ( P = 0.14). Furosemide resulted in significant improvement in calyceal and renal pelvis distention ( P < 0.005), and significant artifact reduction in all upper tract segments ( P < 0.001) compared to the effect of saline alone. Conclusion Intravenous furosemide significantly improves the image quality of excretory MRU studies obtained following intravenous hydration. Intravenous saline alone is insufficient to produce diagnostic quality studies of the non-dilated upper tracts. J. Magn. Reson. Imaging 2007. © 2007 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56023/1/20875_ftp.pd

Scintigraphy of incidentally discovered bilateral adrenal masses

The purpose of this study was to determine the patterns of iodine-131 6β-iodomethylnorcholesterol (NP-59) imaging and the correlation with computed tomography (CT)-guided adrenal biopsy and follow-up in patients with bilateral adrenal masses. To this end we investigated a consecutive sample of 29 euadrenal patients with bilateral adrenal masses discovered on CT for reasons other than suspected adrenal disease. Adrenal scintigraphy was performed using 1 mCi of NP-59 injected intravenously, with gamma camera imaging 5–7 days later. In 13 of the 29 patients bilateral adrenal masses were the result of metastatic involvement from lung carcinoma (5), lymphoma (3), adrenocarcinoma of the colon (3), squamous cell carcinoma of the larynx (1), and anaplastic carcinoma of unknown primary (1). Among these cases the NP-59 scan demonstrated either bilaterally absent tracer accumulation (in eight, all with bilateral metastases proven by CT guided biopsy or progression on follow-up CT) or marked asymmetry of adrenocortical NP-59 uptake (in five). Biopsy of the adrenal demonstrating the least NP-59 uptake documented malignant involvement of that gland in five of five patients. In two patients an adenoma was found simultaneously in one adrenal with a contralateral malignant adrenal mass. In each of these cases, the adenoma demonstrated the greatest NP-59 uptake. In 16 patients diagnosis of adenoma was made on the basis of (a) CT guided adrenal biopsy of the gland with the greatest NP-59 uptake of the pair ( n =4), or (b) adrenalectomy ( n =2), or (c) absence of change in the size of the adrenal mass on follow-up CT scanning performed 6 months to 3 years later ( n =10). It is concluded that differential in vivo functional information provided by NP-59 scintigraphy complements that derived from anatomic imaging and can be used in patients with bilateral adrenal masses to select which gland would be the best choice for further diagnostic invasive evaluation (e.g., adrenal biopsy) or may suggest the presence of bilateral adrenal metastases in patients with incidentally discovered, bilateral adrenal masses.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46838/1/259_2004_Article_BF00941847.pd