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This article reviews the diagnosis, pathology and imaging of testicular tumours, predominantly germ cell tumours. It will discuss the imaging techniques used in their diagnosis, staging and surveillance.

Background The advantages of preoperative localization in the management of primary hyperparathyroidism have not been clearly demonstrated. The aim of this study was to investigate prospectively the accuracy of three localization techniques in patients with this condition.
Methods Forty-nine consecutive patients with primary hyperparathyroidism underwent ultrasonography, magnetic resonance imaging (MRI) and technetium-thallium (Tc-Tl) subtraction scanning before surgery, during which an attempt was made to identify all parathyroid glands. A scan was regarded as correct if it identified an enlarged parathyroid gland on the correct side of the neck as subsequently demonstrated at surgery.
Results Ultrasonography had a sensitivity of 38 per cent (18 correct scans in 47 patients) with a positive predictive value of 78 per cent. The sensitivity of MRI was 72 per cent (34 of 47) with a predictive value of 92 per cent. Tc-Tl scanning was 60 per cent sensitive (28 of 47) with a predictive value of 85 per cent. Two patients with negative neck explorations were subsequently found to have mediastinal adenomas.
Conclusion Ultrasonography, MRI and Tc-Tl scanning have limited value as localization techniques and the relatively low sensitivity of these investigations means they are of no value before first-time surgery.

A prospective study has been carried out to examine the role of magnetic resonance imaging (MRI) in the investigation of renal cell carcinoma in 24 patients. In all cases the inferior vena cava (IVC) was well demonstrated with MRI. In 14 out of 15 patients where surgical correlation was available, the MRI and operative staging were in agreement. Magnetic resonance imaging and computed tomographic (CT) staging were in agreement in 16 out of the 17 patients where both were performed. In one case, CT suggested hepatic invasion but this was found not to be present on MRI and at operation. Magnetic resonance imaging also provided substantial additional information in three patients, including two cases where MRI demonstrated a patent IVC that appeared occluded on CT (one of which also had vertebral metastases seen on MRI but missed on CT) and one case where CT failed to demonstrate minimal involvement of the IVC. Magnetic resonance imaging is an accurate means of staging renal cell carcinoma with clear advantages over CT. In no case in this series was inferior vena cavography found to be necessary.

The role of magnetic resonance imaging (MRI) in the investigation of head and neck tumours (excluding those primarily arising from the central nervous system or orbits) has been investigated. Follow-up data were obtained on 45 scans on 42 patients. MRI provided significant additional information compared with computed tomography (CT) in nine out of 17 (53%) scans performed for staging purposes. In the assessment of 19 patients with suspected tumour recurrence, MRI demonstrated a sensitivity of 100%, a specificity of 80% and an accuracy of 89%.

A computed tomography model was used in eight patients to show how the heart diameter and cardiothoracic ratio might change between antero-posterior and postero-anterior positions. Results were compared with measurements made on erect antero-posterior chest radiographs taken on 103 patients without cardiac failure (controls) and 106 with cardiac failure. An upper limit of cardiothoracic ratio of 55% and of heart diameter of 165 mm in males and 150 mm in females was shown to provide useful discrimination between normal and abnormal heart size.

22 patients with thyroid eye disease were examined with magnetic resonance imaging (MRI) and the results compared with 10 controls. Imaging was performed on a 1.0 T scanner using a head coil. All patients were examined using both T1W and short tau inversion recovery (STIR) sequences. The relative signal intensity (SI) of individual extraocular muscles were quantified by comparison with SI from the adjacent temporalis muscle to give a signal intensity ratio (SIR). The results were compared with clinical disease activity assessed by the Werner grading system. Visual evaluation of muscle size and calculated SIRs showed an increase when compared to normals in 15 of the 22 patients. This difference was significant in patients with high grade (4–6) clinical disease. The known histological changes in this disease suggest that this increase in signal is caused by oedema secondary to acute inflammation. STIR sequences suppress the retro-orbital fat and thus enhance these changes both in the muscles and in the fat itself. The MR findings suggest that the STIR sequence can be used to predict those patients that will respond to anti-antiflammatory treatment.

The level of error in radiology has been tabulated from articles on error and on "double reporting" or "double reading". The level of error varies depending on the radiological investigation, but the range is 2-20% for clinically significant or major error. The greatest reduction in error rates will come from changes in systems.

Objective:To determine whether patients with proven ureteric calculi on IVU require repeat IVU after resolution of symptoms and passage of calculus on plain X–ray. Methodology:IVU reports for a 12–month period were obtained and notes and X–rays of those patients with ureteric calculi were reviewed. Presentation, management and subsequent imaging after resolution of symptoms were determined for each patient. All X–rays were reviewed by a uroradiologist. Results:Fifty–eight patients were investigated for the study. All initial IVUs showed upper tract dilation or obstruction. Forty–three eventually passed their calculi spontaneously and of these, 18 had KUB, all of which showed passage of the calculus and 25 had repeat IVU, 22 of which were normal. The 3 abnormal IVUs showed persisting calculi which were visible on the plain film. Fifteen patients required surgical intervention and all had repeat IVU, of which 5 were abnormal. Conclusion:This study suggests that following resolution of symptoms due to ureteric colic, patients who pass their calculi spontaneously can be followed up by KUB. Only those with persistent calculi on KUB or those who have had surgical intervention require repeat IVU.

Although up to 90% of ureteric calculi are radio-opaque, the accuracy of plain films for their detection is surprisingly poor (Bloom et al, 1988). A case is presented where a vesico-ureteric calculus was visible only when the patient was radiographed with a full bladder. A radiograph taken with an empty bladder allowed bowel loops to fall down into the pelvis and obscure the calculus. Performing the abdominal radiograph with a full bladder rather than post-micturition potentially avoids this problem and may be useful when following up patients with ureteric calculi.

100 consecutive magnetic resonance imaging (MRI) examinations were reviewed independently by two radiologists. Patients were selected so that the anatomical areas of clinical interest coincided with the special interests of the reviewers. The reviewers were both consultant radiologists, one with 3 years' and the other with 6 years' experience of MRI. Hard copy images from the MRI examinations were reported independently by both reviewers. Of the 100 MRI examinations, there was full concordance of opinion in 61/100. Of the remaining 39 cases, four (10%) were considered “minor unrelated” differences, 12 (31%) “minor related” differences and 23 (59%) “major related” differences resulting in a significant change in patient management.

SummaryIntractable haemorrhage from the bladder wall during transurethral resection of bladder tumour is uncommon but potentially catastrophic. Internal iliac artery embolisation is a minimally invasive technique, which is now widely practised to stop bleeding from branches of these arteries in situations including pelvic malignancy, obstetric and gynaecological emergencies and trauma. We report its successful use peri-operatively, in an unfit, elderly patient with uncontrolled bleeding.

An 80-year-old man was admitted for repair of a right inguinal hernia. While on the ward, he complained of back pain in the lower thoracic and upper lumbar region, present for around 3 months, with some pain in the right groin. He was found to have reduced pin-prick sensation in the T12 to L2 dermatomes and a numb area on the lateral aspect of the right thigh.He had a previous history of a thoraco-abdominal repair of a hiatus hernia 2 years earlier. Postoperatively, he had developed an oesophageal leak into the left hemithorax but this had settled with an intercostal drain without further surgery.

This book is intended to be “a companion to and an extension of volume 3 (of contemporary issues in computed tomography (CT); of the kidneys and adrenals) and has been expanded to encompass the entire urinary tract” and to include magnetic resonance imaging (MRI).The book is in two sections.