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The findings on sonographic examination of intestinal disorders in the right iliac fossa are often nonspecific. We have found the classification system just described useful because it leads to a meaningful differential diagnosis, which may be narrowed on the basis of various distinguishing features. The use of other imaging techniques, imaging-guided aspiration or biopsy, or surgical intervention may be necessary to make the exact diagnosis.

The purpose of our study was to determine whether physicians prefer radiology reports with no description, a brief description, or a detailed description of the radiologic findings. We also examined the effects of various clinical circumstances and physician characteristics (e.g., specialty and number of years in practice) on these preferences. This study, which is limited to commonly encountered scenarios, is concerned solely with the description of imaging findings and not with other aspects of the reports, such as the diagnosis and technique.A questionnaire was sent to the 100 physicians who most frequently refer patients to our practice for chest radiographs and abdominal sonograms. The questionnaire outlined six clinical scenarios. For each scenario the physician was asked to indicate the preferred radiology report from a set of three reports varying in descriptive detail.Seventy-seven physicians replied. For a normal chest radiograph in a patient without specific chest symptoms, the most popular report format indicated simply that the examination was normal. When there were clinical findings involving the chest or abnormal radiologic findings, the majority of referring physicians desired a description of the findings and the radiologic diagnosis. For abdominal sonograms the majority of physicians favored reports detailing the findings, even when the findings were normal. In all instances the preferences expressed were independent of the academic status, number of years in practice, number of reports read per day, and specialty of the referring physician.Our results show that preferences of referring physicians for the extent of description of imaging findings included in radiology reports depend on the clinical circumstances. In the specific clinical scenarios examined, physicians preferred that the report include a brief description of the findings, except for screening chest radiographs, for which "normal examination" was an acceptable report. The referring physicians' preferences regarding the amount of descriptive detail included in the report were independent of their specialty, academic status, and experience.

Adrenal gland imaging has improved drastically since the advent of CT and MR imaging. The purpose of this essay is to illustrate findings on cross-sectional imaging of adrenal gland tumors. Emphasis is given to imaging features that help to characterize specific lesions.

Cryotherapy is the in situ destruction of abnormal tissue using subzero temperatures (Fig. 1). Recent studies have demonstrated the technical feasibility, safety, and effectiveness of hepatic cryotherapy in the treatment of liver tumors [1, 2]. Such treatment can be precisely focused on the tumor, thereby preserving surrounding normal tissue. In addition, because major vessels with flowing blood are protected from cryoablation, tumors adjacent to these vessels can be treated without sacrificing vasculature. Hepatic cryoablation is therefore particularly suitable for patients who do not qualify for surgical resection because of multiple metastases involving both lobes of the liver, or because of lesions close to major blood vessels. After the procedure, CT during arterioportography is of little value in distinguishing cryolesion from malignant tumor (Fig. 2), and CT with IV contrast enhancement is recommended for follow-up. It is important to distinguish CT findings of successful and unsuccessful treatment, treatment complications such as abscess and cholestasis, and recurrent tumor. The purpose of this essay is to illustrate the findings on CT with IV contrast enhancement in various situations, emphasizing features that are useful in making accurate differential diagnosis.

CT and conventional MR imaging are helpful in characterizing adrenal tumors, but a specific diagnosis is not achieved for a substantial number of lesions. Chemical-shift imaging relies on the different resonance frequencies of protons in water and triglyceride molecules and therefore may permit a more specific diagnosis of adrenal adenomas, which are known to contain abundant lipid. The purpose of this study was to evaluate the usefulness of chemical-shift MR imaging in the differentiation of adrenal adenomas from other adrenal masses.Forty-one adrenal masses (17 nonhyperfunctioning adenomas, two aldosteronomas, six pheochromocytomas, one ganglioneuroma, five adrenal carcinomas, one lymphoma, seven metastases, one case of extramedullary hematopoiesis, and one leiomyosarcoma) suspected clinically or identified by sonography or CT in 38 patients were prospectively evaluated with MR imaging. Pathologic proof of diagnosis was obtained for 28 lesions, and stability on imaging follow-up (mean, 19 months) was accepted as proof of diagnosis of benign adenoma for 13 lesions. In-phase T1-weighted spin-echo sequences (500/20 [TR/TE]) and opposed-phase gradient-echo sequences (142/6.3, flip angle = 90 degrees) of the adrenal regions were applied. Quantitative analysis of signal intensity loss in the adrenal lesions relative to reference tissues (liver, muscle, and spleen) on in-phase and opposed-phase sequences was done to differentiate adenomas from nonadenomas. Region-of-interest signal intensity measurements were obtained in a standard fashion by selection of the largest possible representative sample.Using liver as the reference standard, we found that mean signal intensity ratios were 0.47 (range, 0.23-0.97) for adrenal adenomas and 0.88 (range, 0.65-1.32) for nonadenomas; signal intensity ratios for two adenomas overlapped those of the nonadenomas. Using muscle as the reference standard, we found that mean signal intensity ratios were 0.44 (range, 0.22-0.66) for adrenal adenomas and 0.85 (range, 0.59-1.39) for nonadenomas; signal intensity ratios for two adenomas overlapped those of the nonadenomas. Using spleen as the reference standard, we found that mean signal intensity ratios were 0.45 (range, 0.27-0.73) for adrenal adenomas and 0.97 (range, 0.8-1.18) for nonadenomas, with no overlap. The mean signal intensity ratios were significantly different between adenomas and nonadenomas for all three reference tissues (p.001).Our results show that chemical-shift MR imaging is an important new technique that enables the differentiation of adrenal adenomas from other adrenal masses, reducing the need for biopsy and prolonged imaging follow-up in patients with adrenal tumors.

The feasibility of fluoroscopically guided percutaneous gastrostomy in patients with cystic fibrosis is presented, highlighting differences between these and other patients undergoing the procedure.