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Background Ultrasound measurements of renal dimensions are conventionally limited to renal length, shape and cortical thickness. These are regarded as adequate for normal therapeutic decision-making and volume measurements are reserved for a few clinical trials. However, there is no evidence concerning the degree to which renal length or volume is independently susceptible to heritable and environmental influences. Aim We aimed to determine whether renal length or width (as a surrogate of volume) was more influenced by heritability. Methods A single operator measured renal length and width in 114 adult monozygotic and same-sex dizygotic Hungarian twin pairs (mean age 43.6 ± 16.3 years), using an Esaote MyLab 70X ultrasound machine with curved array transducer (1–8 MHz, CA431). Results Analysis of within-pair co-twin correlations adjusted for age and gender showed that the age- and sex-adjusted heritability of average renal length was 51% (95% confidence interval, 29–72%). Renal width showed negligible genetic influence. Common environmental effects had no influence, and unshared environments were responsible for 49–80% of the variance, mainly renal width. Conclusions This study is the first to demonstrate the moderate heritability and limited environmental influence on renal length, and the contrasting lack of heritability of renal width, which is mainly influenced by unshared environmental components, that is lifestyle habits. Renal width therefore better represents the influence of modifiable environmental factors than renal length. The results suggest that renal width not length should be reported to facilitate early detection and monitoring of renal disease.

Background Non-alcoholic fatty liver disease (NAFLD) has been linked to increased cardiovascular morbidity. However, genetic factors have an unclear role in this condition. Aims To analyse heritability of NAFLD and its association with abnormal vascular parameters in a large twin cohort. Methods Anthropometric and lipid metabolic parameters were obtained from 208 adult Hungarian twins (63 monozygotic and 41 dizygotic pairs; 58 men and 150 women; age 43.7 ± 16.7 years). B-mode ultrasonography was performed to detect steatosis and categorize severity. Brachial and aortic augmentation indices and aortic pulse wave velocity were assessed using oscillometry (TensioMed Arteriograph). Carotid intima media thickness (IMT) was measured using ultrasonography on the proximal common, distal common and internal carotid arteries. Results NAFLD was identified in 47 subjects (22.6%), of which 44 (93.6%) had mild and 3 (6.4%) had moderate steatosis. These subjects were older (age: 50.9 ± 14.3 vs. 41.5 ± 16.7 years, P

Objectives Decreased thyroid volume has been related to increased prevalence of thyroid cancer. Subjects and methods One hundred and fourteen Hungarian adult twin pairs (69 monozygotic, 45 dizygotic) with or without known thyroid disorders underwent thyroid ultrasound. Thickness of the thyroid isthmus was measured at the thickest portion of the gland in the midline using electronic calipers at the time of scanning. Volume of the thyroid lobe was computed according to the following formula: thyroid height*width*depth*correction factor (0.63). Results Age-, sex-, body mass index- and smoking-adjusted heritability of the thickness of thyroid isthmus was 50% (95% confidence interval [CI], 35 to 66%). Neither left nor right thyroid volume showed additive genetic effects, but shared environments were 68% (95% CI, 48 to 80%) and 79% (95% CI, 72 to 87%), respectively. Magnitudes of monozygotic and dizygotic co-twin correlations were not substantially impacted by the correction of covariates of body mass index and smoking. Unshared environmental effects showed a moderate influence on dependent parameters (24-50%). Conclusions Our analysis support that familial factors are important for thyroid measures in a general twin population. A larger sample size is needed to show whether this is because of common environmental (e.g. intrauterine effects, regional nutrition habits, iodine supply) or genetic effects.

Gorlin-Goltz syndrome (GGS) consists of ectodermal and mesodermal abnormalities. In this case report we will investigate lower extremity lesions of GGS. A 52-year-old man with GGS underwent skull and lower extremity computer tomography. Radiographic findings included cervical spondylosis, transparent areas with slurred margins, and cerebral falx calcification. Tibial and fibular specific cortical lesions (thin cortical and subcortical cystic lesions) were seen on the radiography, which was confirmed by computer tomography. To our knowledge, this is the first report of such a long lesion of the tibia and fibula. Specific lower extremity cortical lesions (thin cortical and subcortical cystic lesions) may occur and these abnormalities can be found on radiography or CT, which are most probably attributed to retinoid treatment.

A 62-year-old female patient, symptomfree hematuria was found. Ultrasonography and computed tomography (CT) scan showed an endophytic mass on the medial pelvic wall on the solitary, right kidney. Nephrectomy was offered to the patient. Due to the solitary kidney, this would have meant lifelong hemodialysis for her. She refused nephroureterectomy but was ready to consider kidney-sparing operative solution. Therefore, percutaneous resection of the tumor, rather than nephroureterectomy was discussed. In order to decide such an operation, we had to prove with full certainty that there were no other small lesions in the pelvis. Noninvasive virtual pyeloscopy, rather than semirigid or flexible ureterorenoscopy, served this purpose.

Background Transitional cell carcinoma (TCC) may mimic renal cell carcinoma (RCC) when it develops in a similar location, therefore, differentiation with imaging techniques might be challenging. Preoperative differentiation may have a significant role indicating the type of surgical treatment (nephrectomy vs. ureteronephrectomy). Purpose To retrospectively analyze the differences in the contrast enhancement of TCC and RCC. Material and Methods Images of 20 RCC and 12 TCC (mean ages, 62.3 ± 14.1 and 67.4 ± 12.0 years, respectively) were analyzed from patients who underwent multiphase computed tomography (CT) examinations following 1.5 mL/kg non-ionic contrast agent administration. Unenhanced corticomedullary (30–45 s), nephrographic (70–90 s), and excretory (300–480 s) phases were imaged. The attenuation characteristics of RCC and TCC were compared to the attenuation of the normal renal cortex. Results Significant differences were found in the attenuation ratios between RCC or TCC in the corticomedullary ( P = 0.040) and nephrographic ( P = 0.004) phases using three regions of interest (ROIs) of 10 mm2 size. If measuring ROIs comprising the complete tumor lesion instead of three small ROIs, no significant difference was observed in the attenuation ratios between RCC in TCC in any phases. Conclusion Our study reports significant attenuation differences between RCC and TCC in the corticomedullary and nephrographic phases by multiphase CT. The findings underscore the importance of multiphase CT in the differentiation of these two different entities. Using multiple small (three) ROIs is more accurate than measuring the whole tumor attenuation.

PURPOSE Conventional clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) have different behavioral characteristics and clinical management strategies (nephrectomy vs. nephron-sparing surgery). Our aim was to retrospectively evaluate the contrast enhancement pattern of ccRCC and pRCC and evaluate its possible diagnostic role for preoperative differentiation using a standardized protocol. MATERIALS AND METHODS Quadriphasic multidetector computed tomography (CT) images (unenhanced, corticomedullary, nephrographic, and excretory phases) of 19 patients with 20 ccRCC and 14 patients with 15 pRCC lesions (mean ages, 62.3±14.1 and 61.4±13.7 years, respectively) were reviewed retrospectively. The attenuation characteristics were compared with the attenuation of the normal renal cortex using either multiple 10 mm2 regions of interest or whole tumor attenuation measurements. The degree of contrast enhancement was also compared. RESULTS Univariate analysis revealed that ccRCC lesions showed higher mean attenuation values on the corticomedullary and nephrographic phases compared with pRCC masses (P < 0.05) using both measurement techniques. CONCLUSION The findings underscore the importance of multiphase CT in the differentiation of these two subtypes of RCC using standard assessment techniques. The measurement of the degree of enhancement on contrast-enhanced multidetector CT may be a simple and useful method to radiologically differentiate between the two histological types of RCC.

Absence of the superior vena cava (SVC) is a rare variety of vascular anomaly. The purpose of this report is to describe the computed tomography (CT) findings of the partial absence of the SVC without persistent left SVC in a patient with no evidence of congenital cardiovascular disease and no prior history of central venous instrumentation. A 77-year-old woman with a history of colon cancer underwent thoracoabdominal CT imaging because of abdominal pain of uncertain cause. No tumor recurrence was observed. A complicated“investigation” confirmed a thymoid cancer surgery back in 1976, which was accompanied by resection of the SVC and the left brachiocephalic vein because of their invasion. Owing to the absence of the SVC and bilateral brachiocephalic veins, caval hypertension developed in the patient, resulting in the dilation of cavo-caval anastomoses. In addition, new anastomoses were opened. The clinical significance and possible embryogenesis of this anomaly are discussed. The extremely rare condition of the partial absence of the SVC appeared with subcutaneous dilated, tortuous collaterals in an asymptomatic adult patient. This anomaly is becoming clinically more relevant with the increasing use of minimally invasive vascular surgery.

Decrease in renal parenchymal thickness (RPT) is an important sign of renal disease, which is accompanied by decreased renal cortical thickness (RCT). Several renal conditions are associated with a decrease in RPT and RCT, such as chronic kidney disease, renal transplantation, or nephropathia epidemica (1-3). Parenchymal thickness indicates chronic nature of renal failure and is regarded as a more exact sonographic parameter in end-stage renal failure than renal size (4,5). There is increasing evidence that RPT is a sensible marker of acute kidney damage (6). Ultrasound assessment of RPT can reliably differentiate between patients with acute or chronic renal failure (7). RCT and RPT are regarded as early and sensitive morphological markers for the early diagnosis of atherosclerotic kidney disease and correlate with the coronal diameter, renal volume, intraparenchymal resistance indices, glomerular filtration rate, and proteinuria (8). Although the change in RPT has been comprehensively studied in acute and chronic renal diseases, it has not been studied extensively in healthy people. There is little knowledge on whether the normal RPT, an index for studying the health status of the kidney, is only influenced by environmental factors or if it is also influenced by genetic factors. We hypothesized that the previously described normal age-related change in RPT can be also genetically influenced (9).

Virtual pyeloscopy (VP) plays an important role in the organ-sparing nephroscopic tumour resection and traditional pole resection, especially when a fibreoptic ureteroscopic examination cannot be performed. A 67-year-old man developed macroscopic hematuria. Abdominal computed tomography (CT) and cystoscopy revealed a lower calix renal stone and a 20-mm lower pyelon mass suggesting transitional cell cancer. An additional small satellite lesion in the pelvico-ureteral junction was supposedly present. Three-phase MultiDetector CT with VP showed a solitary 3 to 4-mm renal pelvic lesion beyond the known calix stone and lower pole mass. In our case, VP played an important role in the organ-sparing nephroscopic tumour resection and traditional pole resection.

Background and Purpose— Few family studies reported moderate genetic impact on the presence and scores of carotid plaques. However, the heritability of carotid plaque characteristics remains still unclear. Twin studies more reliably estimate the relative contribution of genes to these traits in contrast to family study design. Methods— One hundred ninety-two monozygotic and 83 dizygotic adult twin pairs (age 49±15 years) from Italy, Hungary, and the United States underwent B-mode and color Doppler ultrasound of bilateral common, internal, and external carotid arteries. Results— Age-, sex-, and country-adjusted heritability was 78% for the presence of carotid plaque (95% CI, 55%–90%), 74% for plaque echogenicity (hypoechoic, hyperechoic, or mixed; 95% CI, 38%–87%), 69% for plaque size (area in mm 2 in longitudinal plane; < or >50 percentile; 95% CI, 16%–86%), 74% for plaque sidedness (unilateral or bilateral; 95% CI, 25%–90%), 74% for plaque numerosity (95% CI, 26%–86%), 68% (95% CI, 40%–84%), and 66% (95% CI, 32%–90%) for the presence of plaque in carotid bulbs and proximal internal carotid arteries. No role of shared environmental factors was found. Unique environmental factors were responsible for the remaining variance (22%–34%). Controlling for relevant covariates did not change the results significantly. Conclusions— The heritability of ultrasound characteristics of carotid plaque is high. Unshared environmental effects account for a modest portion of the variance. Our findings should stimulate the search for genes responsible for these traits.

Intravenous contrast medium (ICM) rarely induces anaphylactic reactions, including urticaria, hypotension and respiratory failure. Even the most modern ICM may cause such adverse events. Thrombocytopenia has been reported as an extreme rare consequence of ICM. Here we report on a case of a 72-year-old male patient with a self-limiting severe acute thrombocytopenia following administration of intravenous non-ionic low-osmolarity contrast medium. No such low platelet count has ever been reported. We also present a review of the literature.

We report the first European case of cerebral iodized lipid embolism post transcatheter arterial embolization for hepatocellular carcinoma. Lipiodol emboli and corresponding multifocal brain ischemia were documented with computed tomography (CT) and magnetic resonance (MR) in the acutely symptomatic patient. Transcranial Doppler sonography with contrast indicated a right-to-left shunt, while on a follow-up CT scan lipiodol embolization was detected in both lungs. Dilated pulmonary vessels and thick vascular channels were seen in the vicinity of the right diaphragm suggestive of pulmonary arteriovenous shunt. The patient symptoms regressed with supportive care alone, but he died 5 months later due to hepatic failure unrelated to the procedure.