The new correction method is a simple tool for excluding intrinsic influences on the enhancement of lesions. Quantitative enhancement evaluation with this method of the influence of intrinsic factors enables accurate differentiation between renal clear cell carcinoma and renal papillary carcinoma.
Mucofalk CT is a simple, rapid, noninvasive, and accurate method of evaluating extramucosal manifestations of Crohn disease. The tubeless procedure improved patients' comfort and decreased time, cost, and radiation exposure.
Despite of the diagnostic potential of conventional CT (CCT), limitations being inherent in this technology reduce its diagnostic confidence and limit clinical CT applications as 3D imaging. Helical CT (HCT) has far overcome the limitations of CCT and has become the standard CT technology. After a short overview on the technique of HCT and its advantages over CCT, the impact of HCT on the detection of disorders of the urinary organs is discussed. Due to the high quality of 3D reconstructions, vessels are visualized free of artefacts resulting in a dramatic improvement and acceptance of CT angiography, which has become a clinically important examination in the evaluation of obstructive renal artery disease. Fast HCT provides a precise assessment of the three phases of the nephrogram and it is a prerequisite for an improved depiction of abnormal vascular perfusion and impaired tubule transit of contrast material. Helical CT enables an improved characterization of cystic mass lesions reducing the diagnosis of indeterminate masses and thus facilitating a better therapeutic management. The diagnosis of renal cell carcinomas (RCC) has improved due to an increased sensitivity in detecting small RCCs, and an increased specificity in the diagnosis of neoplastic lesions. Improved staging of RCCs is the result of accurate assessment of venous tumour extension. When planning nephron-sparing surgery 3D display of the renal tumour helps to determine the resectability of the mass depicting its relation to major renal vessels and the renal collecting system. In the evaluation of renal trauma HCT provides shorter scanning time and thus fewer artefacts in the examination of traumatized patients who cannot cooperate adequately. Three-dimensional postprocessing modalities allow the assessment of the renal vascular pedicel by CT angiography and improve the demonstration of complex lacerations of the renal parenchyma. In the evaluation of the upper urinary tract unenhanced HCT has become the imaging method of choice in the diagnosis and differential diagnosis of acute flank pain since it is highly sensitive and specific in detecting calculus disease. Unenhanced HCT may furthermore demonstrate causes of flank pain unrelated to urolithiasis. Gapless volume scanning and improved resolution in the z-axis during the excretory phase enables improved visualization of the renal collecting systems and ureters, resulting in a better demonstration of intraluminal and extraluminal pathology.
The aim of this study was to evaluate the feasibility and diagnostic potential of dynamic MR urography (MRU) in neonates and infants with sonographically detected abnormalities of the upper urinary tract. Thirty infants (age range 5 days to 3 years, mean age 7.9 months; male:female: 22:8) underwent MRU using T2 and contrast-enhanced dynamic T1-weighted sequences. The results were compared with the findings of ultrasound ( n=30), intravenous urography (IVU, n=19) and/or scintigraphy ( n=25) based on the criteria suggestive of obstructive uropathy. Oral sedation was sufficient to perform MRU with diagnostic quality in 20 of 21 patients younger than 1 year; 9 older patients needed intravenous sedation. Diagnosis of the 66 renal units (58 kidneys, 29 successful examinations) included normal systems (contralateral units), duplex systems, vesico-ureteral reflux, obstructive megaureter, ureteropelvic junction obstruction and accompanying renal parenchymal disease, with complex pathology in 10 patients. Magnetic resonance urography demonstrated anatomy better than IVU, particularly the renal parenchyma, (ectopic) ureters, and poorly functioning dilated systems. Magnetic resonance urography was superior to US in showing ureteral pathology. Tiny cysts in dysplastic kidneys were better seen by US. Gadolinium-enhanced dynamic MRU allowed accurate assessment of obstruction applying IVU criteria. Here MRU matched IVU results, and most of the scintigraphic findings. Magnetic resonance urography can be performed in young infants with diagnostic quality using oral sedation. Magnetic resonance urography correctly depicts anatomy and allows assessment of the urinary tract better than US and IVU, with additional functional information. Magnetic resonance urography thus has the potential to replace IVU for many indications.
The incidence of post-traumatic sequels seems to be associated with higher speed at impact, lack of braking attempts, and higher numbers of vehicle parts deformed.
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