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Purpose: In several of the initial patients undergoing brachytherapy at our institution radioactive implants were visible in the thorax on chest radiography. The clinical ramifications of this unanticipated finding were unclear. Thus, we investigated the incidence of brachytherapy seed migration to the chest and whether these seeds were associated with any clinical significance., Materials and Methods: We retrospectively reviewed the records of all patients who underwent ultrasound or computerized tomography guided brachytherapy of 103palladium seeds from March 1997 to March 1999. This list of patients on brachytherapy was then matched against the radiology computer system to determine those who had undergone chest X-ray after brachytherapy. When the radiology report was unclear regarding brachytherapy seeds, chest x-rays were reviewed by one of us (R. O.) to determine the presence and position of the seeds., Results: Post-brachytherapy chest x-rays were available in 110 of the 183 patients. In 78 cases no brachytherapy seeds were identified. Radioactive implants were identified on chest radiography in 32 patients (29%), including 1 to 5 seeds in 20, 8, 1, 2 and 1, respectively. No patients complained of any change in pulmonary symptoms after brachytherapy., Conclusions: Radioactive implants migrated after brachytherapy for localized prostate cancer in 29% of the patients who underwent post-procedure radiography. There did not appear to be a pattern to the seed distribution. However, while the incidence was not negligible, no patient appeared to have any acute pulmonary symptoms. Therefore, while the migration of radioactive implants to the chest is a real phenomenon, it appears to have no adverse clinical consequences in the early post-procedure period.

Imaging studies used for the detection and characterization of urinary tract calculi are presented in this article. Comparisons of traditional imaging studies are made with noncontrast helical CT scanning, the most recent addition to stone imaging. Imaging findings for noncontrast helical CT and an approach to dealing with various combinations of CT studies are also presented.

Purpose: To evaluate color Doppler ultrasound (US) in detection of subclinical stenosis of hemodialysis access grafts and fistulas., Materials and Methods: Doppler US was performed in 40 consecutive patients with no clinical or laboratory findings of hemodialysis access dysfunction. To assess the presence and percentage of stenosis, the maximum systolic blood velocity and velocity ratios were measured and the US images were assessed visually. Fistulography was recommended in patients who demonstrated stenosis greater than 50% at US., Results: At US, 32 of the 40 patients had evidence of stenosis greater than 50%. In 23 of the 32 patients, a follow-up fistulogram was obtained. Hemodynamically significant stenosis was confirmed in 19 of the 23 patients at fistulography. Percutaneous transluminal angioplasty was then performed in 18 of the 19 patients and was successful., Conclusion: Color Doppler US is more sensitive than clinical or laboratory methods for detection of hemodialysis access stenosis. Screening with US appears to enable earlier detection and therapy.

Purpose: We assessed the impact of ultrasound on the referring urologist diagnosis of scrotal disorders., Materials and Methods: University urologists (6 attending and 3 resident physicians) in a clinic setting completed questionnaires before and after on 35 patients with scrotal symptoms. The physicians were requested to estimate the probability (0 to 100%) of their most likely diagnosis before and after receiving the sonographic information. We calculated the mean change in diagnostic percentage confidence and also the proportion of patients whose pre-sonographic diagnosis was changed., Results: Scrotal ultrasound changed the initial diagnosis in 11 of 35 patients (32%, 95% confidence interval 19 to 49). The mean percentage gain in diagnostic certainty from ultrasound was 29% (95% confidence interval 20 to 39, p < 0.001)., Conclusions: Scrotal ultrasound has considerable impact on referring urologist diagnosis of scrotal abnormalities.

Purpose: We evaluated the clinical use of the renal resistive index in identifying patients with acute urinary tract obstruction., Materials and Methods: Of 54 patients with suspected acute urinary tract obstruction who underwent measurements of renal resistive index 19 had unilateral obstruction documented with excretory urography and comprise our study sample. The contralateral nonobstructed kidneys served as controls. Criteria for obstruction were a resistive index of 0.70 or greater or a side to side difference of 0.10 or greater. We calculated sensitivity, specificity, and positive and negative predictive values., Results: Sensitivity for obstruction was 42% with 11 false-positive cases, specificity was 79%, and positive and negative predictive values were 67 and 57%, respectively., Conclusions: Renal resistive index measurements are not valuable in detecting acute urinary tract obstruction.

Interactive educational programs provide an excellent adjunct to traditional lectures. Unfortunately, interactive programs often require more computer resources and financial support than are available to most educators. Photo CD technology provides individual radiologists a way to create relatively inexpensive interactive teaching programs on PCs.

Ultrasound is being used with increasing frequency in the evaluation of the male reproductive tract. To detect abnormalities, it is important to have a comprehensive understanding of the normal anatomy and normal variations. In this article, the ultrasound anatomy of the scrotum, penis, prostate, and seminal vesicles is presented. Because ultrasound is a very visual process, the anatomy is presented not only with text, but also through the liberal use of ultrasound images and associated diagrams. Ultrasound is both an operator- and equipment-dependent procedure and, where appropriate, we have included technical discussions regarding ultrasound equipment and settings.

Photo CD technology has expanded significantly since its introduction a few years ago. Because it is not strictly considered interactive multimedia, it has been largely overlooked in the medical field, but it has tremendous capabilities for image storage, retrieval, and transfer. Images can be used for both educator-assisted conferences and self teaching. Adding audio technology to the photo CD expands the self-teaching concept. The equipment needed is simple and relatively inexpensive. The time required to learn how to create photo CDs is short, and they can be produced at almost any institution.

Rationale and Objectives: We assessed the value of postsurgical computed tomography (CT) in detecting locally recurrent prostatic carcinoma and determined the most effective CT findings., Methods: We studied 13 patients with recurrent disease (prostate specific antigen [PSA] > 0.4 ng/ml) and 11 patients with no evidence of recurrence (PSA < 0.3 ng/ml). Pelvic CT scans were independently interpreted by four readers who were unaware of patient status. Readers measured tissue volume in the prostatic fossa and evaluated each scan for the presence of six potentially discriminating criteria. We determined sensitivity and specificity and developed mean and pooled receiver operating characteristic (ROC) curves for each criterion and for overall rating., Results: The respective mean ROC curves, sensitivity, and specificity for each criterion were as follows: irregular tissue margins = .50, .67, and .32; inhomogeneous tissue density = .35, .76, and .11; asymmetric residual seminal vesicles = .68, .86, and .16; fat infiltration around seminal vesicles = .67, .69, and .43; infiltration of perirectal fat = .60, .71, and .40; and margins of the levator ani = .50, .78, and .09. The overall rating of whether a scan was normal or reflected recurrent cancer was .56, .75, and .32. Mean tissue volume in the prostatic fossa was 15.01 cm3 for the positive cases and 11.06 cm3 for the negative cases (p < .05), but because of a large overlap, this difference was not practically significant., Conclusion: CT scanning is not an effective technique for detecting recurrent prostate malignancy. Normally, there is a moderate amount of soft tissue in the prostatic fossa postoperatively that should not be confused for malignancy.

We present two cases showing bilateral segmental delayed nephrograms secondary to radiation injury which occurred during radiation therapy for retroperitoneal adenopathy. The abnormal areas in the affected kidneys were not devoid of a nephrogram, but rather showed a persistent corticomedullary separation indicative of slowed perfusion. Linear margins not conforming to the normal renal lobular configuration were a confirmatory feature. Radiation injury should be included in the differential of both the asymmetric prolonged nephrogram and the "segmental" nephrogram.

Tubular ectasia of the rete testis is a recently recognized entity whose sonographic appearance has been described principally in the radiological literature. The sonographic features of this benign process must be appreciated by urologists as well so that is not mistaken for malignancy. We report 3 cases showing the spectrum of this process and review the literature.

Pulmonary angiography is sensitive and specific in the diagnosis of pulmonary thromboembolism, but it remains an invasive procedure. Experience with 1,350 pulmonary angiograms was reviewed to ascertain the incidence, etiologies, and avoidance of complications. There were three deaths, all of which were secondary to cor pulmonale in patients with pulmonary hypertension and right ventricular end diastolic pressure (RVEDP) equal to or greater than 20 mmHg. Other complications consisted of cardiac perforation in 14 patients and endocardial or myocardial injury in six without sequelae, 11 significant arrhythmias and five cardiac arrests successfully treated, minor contrast material reactions in 11 patients, and a few insignificant complications. Carefully performed pulmonary angiography is safe if one avoids injecting contrast material into a patient with an elevated RVEDP.

During a 5-year period from 1969 to 1974, 53 (8.5%) of 631 patients developed late complications following abdominal aortic reconstructive surgery. Occlusion was the most frequent complication and occurred in 4%. Others included stenosis, false aneurysm, enteric fistula and infection. Late complications were demonstrated by roentgenographic methods. Angiography was the most valuable roentgen study. It is indicated in all patients suspected of having delayed complications except those with unstable life-threatening hemorrhage. Additional roentgenographic studies including the barium enema and barium meal may help make the diagnosis and exclude other entities. In any patient with an abdominal aortic graft and gastrointestinal bleeding, the diagnosis of an aorto-enteric fistula should be considered until otherwise proven.

A case of massive hydronephrosis of the upper portion of a duplicated collecting system in a middle-aged male is presented. Computerized tomographic examination of the abdomen provided the most precise information and led to a correct preoperative diagnosis, whereas both urography and ultrasound did not.

A case is presented for the routine determination of detrusor pressure in the performance of urodynamic studies. Its particular value in the investigation of the patient with subtle bladder instability, urinary incontinence, and voiding dysfunction is described.

Video urodynamics is a technique utilizing synchronously recorded urodynamic studies and custourethrography for the evaluation of complex lower urinary tract problems. The technique and equipment used in approximately 900 consecutive studies is reported. The value of this method in the investigation of urinary incontinence, complex bladder outlet obstructive states, and neurogenic bladder in particular is presented.

Clinical experience with 99mTc-polyphosphate scintigraphy in more than 200 patients with suspected stress fractures is presented. Stress fractures occur in bone which has been weakened as a result of accelerated physiological change induced by excessive muscular and mechanical activity. Unlike traumatic fractures, they are not accompanied by radiographic abnormality early in their course. Bone scintigraphy is sensitive enough to detect the physiological alterations found in stress fractures and was responsible for decreased morbidity in this series of patients due to early diagnosis.

The ultrasonic echo pattern of renal masses is retrospectively correlated with the angiographic vascular pattern in 36 cases where a noncystic-appearing mass was identified by either study. Pathologic or cytologic correlation was available in 31 of these masses. In carcinomas the echogenicity was usually found to correlate well with the degree of neovascularity.

Turner syndrome is commonly associated with urinary tract anomalies. A second case is reported of its unusual association with retrocaval ureter and massive hydronephrosis.

This article considers the various imaging modalities that can be used in the diagnosis of adrenal disorders and their relative role in the evaluation of specific adrenal disorders. Modalities discussed include abdominal radiography, nephrotomography, ultrasound, computed tomography, arteriography, venography, adrenal venous sampling, radioisotope scanning, and nuclear magnetic resonance. Disorders dealt with include Cushing's disease, pheochromocytoma, primary aldosteronism, neuroblastoma, ganglioneuroma, sympathogonioma, and nonfunctioning adrenal tumors.

Bladder neck dysfunction has been evaluated in 16 male patients. The efficacy of the traditional investigative methods for this entity is questionable and the value of video-urodynamics for definitive diagnosis is presented. The ability of the condition to masquerade as prostatis is apparent and treatment by unilateral bladder neck incision is proposed.

Radiologic evaluation of a renal mass involves two phases. Initial detection of the mass depends on high-quality excretory urography. Once detected, a number of diagnostic modalities are available to further evaluate the mass. The studies needed for any given mass can be kept limited, and, with careful use of the scheme presented, a diagnosis can be made with minimal invasiveness and expense.

Percutaneous needle puncture and aspiration of suspected cystic renal masses may provide accurate diagnosis in selected cases. However, renal cyst puncture is not a totally innocuous procedure and certain complications may be encountered. Report is made of 2 cases of renal cyst puncture followed by abscess formation, necessitating surgical intervention. An improved technique involving surgical preparation of the operative area and utilization of double-needle method of cyst puncture is advocated.

Renal failure from urographic contrast media is a serious potential hazard of excretory urography and is usually recognized by the clinician 24--48 hr after the procedure. The association of an abnormally increasing nephrogram with development of oliguric renal failure in children was described in 1969, but in 112 subsequent reported cases of contrast-induced renal failure, a persistent nephrographic pattern was described only once. With special attention to the abnormally persistent nephrogram, we were able to detect nine cases of contrast-induced renal failure after excretory urography. Two of these cases are discussed in detail and pertinent data on the other seven are presented.

Many investigators have focused on the female urethral syndrome and its causes. The origin remains enigmatic, but the benign course of this condition is well established. We evaluated 105 patients with urethral syndrome and analyzed the necessity for a complex urologic workup. The lack of significant findings on these studies suggests that the cost effectiveness of radiographic and invasive studies cannot justify their continued use.

Multiple faceted stones can develop in any sacular structure. Five cases of renal stones are described, four cases with calculi in calyceal diverticuli and one case with calculi in a hydronephrotic sac. Emphasis is on the remarkably similar radiographic appearance these cases of renal stones have with gallstones.

Decreased renal function following arteriography is much more common than is currently realized. Steps to detect this failure are necessary, especially in high risk patients, so that stressful situations such as surgery can be avoided. A recently performed prospective random study of 100 patients undergoing angiography demonstrated a 10% incidence of renal failure. Those patients most at risk had preexisting renal disease as indicated by an elevated serum creatinine and/or cardiovascular disease severe enough to require digoxin, diuretics, or nitroglycerin. No cases of renal failure occurred in the absence of one or both of these processes. The likelihood of postangiographic renal failure was unrelated to the quantity of contrast as measured either by total volume or per kilogram body weight.

To determine the accuracy of scintigraphy in distinguishing true renal masses from normal variants, 40 patients with excretory urographic findings indicating a possible, but not definite, mass lesion were studied. Scintigraphy correctly identified 17 true masses and 17 normal variants. Four false positive and two false negative results were obtained.

The rapid intravenous injection of a large bolus of contrast medium produces a vascular as well as a tubular nephrogram. They are additive but the vascular phase is early, intense, and brief whereas the tubular phase is less intense but more prolonged. The addition of tomography during either phase improves visualization of the renal parenchyma and its outline. A comparison study of tomography during the vascular phase (vascular nephrotomography) with that at five minutes demonstrated the superiority of the former. Our technique, data, and illustrative case abstracts are presented.