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Objective: A retrospective analysis of the clinical utility of (99m)Tc-dimercaptosuccinic acid (DMSA) single photon emission CT (SPECT) for characterization of suspected renal masses., Methods: 15 patients who had undergone (99m)Tc-DMSA SPECT were identified, and 13 patients also had SPECT/CT. (99m)Tc-DMSA uptake in the renal lesion was characterized semiquantitatively. Other imaging tests, histology and clinical data were available for correlation., Results: (99m)Tc-DMSA was not taken up in all five renal masses with histological confirmation of malignancy (uptake 7-19% of normal renal tissue); in two further masses, which were clinically likely to be malignant; and in one indeterminate mass (lack of sufficiently long follow-up). No renal malignancy was identified in any of the seven patients whose renal masses had normal (99m)Tc-DMSA uptake (41-130%)., Conclusion: Although caution with regard to applying those results in clinical practice must be advised, owing to the retrospective nature of this report and the small number of patients included, it seems that (99m)Tc-DMSA SPECT shows a clinically useful diagnostic accuracy for distinguishing true renal masses (which in many cases require surgery) from pseudomasses., Advances in Knowledge: (99m)Tc-DMSA SPECT is a clinically useful adjunct test for characterization of suspected renal masses.

Objective: To establish whether there is a consensus regarding the significance of testicular microlithiasis and a strategy for managing patients with this condition, amongst ultrasound practitioners in the UK., Methods: An electronic questionnaire was distributed to 1482 members of the British Medical Ultrasound Society (BMUS), requesting information from ultrasound practitioners involved in scrotal ultrasound about their interpretation of the risk associated with testicular microlithiasis and their departmental or personal recommendations for managing patients with this condition., Results: Responses were obtained from 221 BMUS members. Analysis demonstrated a wide variation in the significance attributed to the discovery of testicular microlithiasis and the risk of subsequent development of testicular germ cell tumours. There was also great variation in strategies for management of patients with testicular microlithiasis, including the need for surveillance ultrasound, amongst ultrasound practitioners regardless of their job description., Conclusion: Lack of consensus shown by this study highlights significant differences across the UK in managing patients with testicular microlithiasis and validates the importance of guidance currently being formulated by the European Society of Urogenital Radiology., Advances in Knowledge: We believe that this is the first survey to be conducted amongst imaging specialists in the UK regarding testicular microlithiasis and demonstrates that there is currently no uniform practice in managing patients with this condition.

Objectives: Digital tomosynthesis is a new digital technique based on conventional X-ray tomography. It acquires multiple low-dose projections during a single sweep of the X-ray tube, which are reassembled to provide high-resolution slices at different depths. Suggested uses include visualisation of pulmonary nodules, mammography, angiography, dental imaging and delineation of fractures. This study aims to evaluate its potential role as part of an intravenous urogram (IVU) by assessing the diagnostic quality in imaging the kidneys in clinical practice., Methods: 100 renal units from consecutive traditional IVU studies were retrospectively compared with 101 renal units imaged using digital tomosynthesis. These were scored for visualisation of the renal outline and collecting system, presence of a renal cyst or mass and overall diagnostic quality. Radiation doses were calculated., Results: 46.5% of traditional IVUs were found to be of diagnostic quality. The IVUs with digital tomosynthesis were of diagnostic quality in 95.5%. This represents a highly statistically significant difference (p<0.0001). There was also a statistically significant dose reduction, with a mean reduction of 56%, for the samples studied., Conclusion: Digital tomosynthesis offers a significant increase in the percentage of diagnostic quality tests for assessing renal pathology, compared with traditional IVU, and significantly reduces radiation. It also offers considerable advantages in ease and speed of imaging. For these reasons, in any situation where IVU is still being used to assess the kidneys, digital tomosynthesis is likely to be of considerable benefit in improving diagnostic quality.

Quasistatic strain imaging is a form of elastography that can produce qualitative images of tissue stiffness with only software modifications to conventional ultrasound hardware. Unlike current commercial offerings, the novel strain-imaging system that is the subject of this paper displays regions of signal decorrelation using an overlaid colour mask and can also produce three-dimensional (3D) strain images. In illustrative studies of the breast, testis and thyroid, the colour mask is seen to reduce the potential to misinterpret noise as meaningful stiffness information, and also helps to differentiate cystic and solid lesions. High-quality imaging of the testis in vivo demonstrates that 3D strain imaging is feasible.

Increasing trainee numbers and changes to working patterns have resulted in a scarcity of training opportunities for training-grade doctors wishing to learn nephrostomy tube insertion techniques. A method of introducing trainees to the skills required to perform percutaneous nephrostomy in a safe, non-threatening environment, without risk to patients, is desirable. Commercial and biological nephrostomy phantoms are available, but they are expensive and not widely available, and a cheap, safe, valid alternative is desirable. We describe a simple technique for producing a gelatin-based phantom, which we suggest has face and content simulator validity. The use of this nephrostomy phantom could optimise existing clinical training opportunities through familiarisation with nephrostomy technique and equipment, and development of the psychomotor skills required for successful nephrostomy insertion prior to undertaking supervised procedures on patients.

We describe the imaging appearances of a patient with bilateral, synchronous, multiloculated renal cell carcinoma with a predominantly cystic nature. The patient had progressive chronic renal failure. He was initially erroneously diagnosed as having autosomal dominant polycystic kidney disease (ADPKD) on the basis of the imaging findings. We believe this to be the first report describing bilateral synchronous renal carcinomas replacing the renal parenchyma imitating ADPKD.