Fergus V. Coakley

Association of renal agenesis and mullerian duct anomalies.

Purpose The purpose of this work was to determine the association of renal agenesis with the different types of mullerian duct anomalies (MDAs). Method A 5 year retrospective review of MR records identified 57 patients with MDAs. Associated renal anomalies were correlated with the various types of MDAs. Results Renal agenesis was found in 17 (29.8%) of 57 patients. No other renal anomalies were identified. Renal agenesis was more frequent in patients with uterus didelphys (13/16 cases). Renal agenesis was also seen in patients with uterine agenesis (2/5 cases) and unicornuate uterus (2/7 cases). All 11 cases of obstructed uterus didelphys were associated with renal agenesis ipsilateral to the side of the obstructing transverse hemivaginal septum. Conclusion Renal agenesis is more commonly seen in uterus didelphys than in other types of MDAs. Renal agenesis in patients with uterus didelphys is often ipsilateral to an obstructing, transverse, hemivaginal septum.

Role of magnetic resonance imaging in fetal surgery

Prenatal magnetic resonance imaging (MRI) has several advantages over obstetric ultrasound, including a larger field of view, superior soft-tissue contrast, more precise volumetric measurements, and greater accuracy in the demonstration of intracranial abnormalities. Prenatal MRI has been shown to positively and incrementally influence management in a substantial proportion of patients being considered for fetal intervention. Despite these findings, precise indications for prenatal MRI in the setting of fetal surgery are not yet established, because both prenatal MRI and fetal surgery are relatively new techniques that remain in evolution. Conditions in which prenatal MRI appears to contribute to fetal surgical planning and postoperative evaluation are described in this review. These conditions include congenital diaphragmatic hernia, cystic adenomatoid malformation, sacrococcygeal teratoma, complicated twin pregnancies, upper airway obstruction, and myelomeningocele.

Blood loss during radical retropubic prostatectomy: relationship to morphologic features on preoperative endorectal magnetic resonance imaging

OBJECTIVES To determine whether morphologic features at preoperative magnetic resonance imaging (MRI) are related to intraoperative blood loss during radical retropubic prostatectomy. METHODS Endorectal MRI was performed in 143 patients with newly diagnosed prostate cancer before radical retropubic prostatectomy. Two independent readers rated the prominence of the periprostatic veins (on the basis of number and size) at four anatomic sites on a 3-point scale. Other features analyzed were prostate volume and interspinous diameter. RESULTS A prominence of the anterior and posterior apical periprostatic veins was positively associated with blood loss (correlation coefficient = 0.22 and 0.17 and P <0.01 and <0.05, respectively). Blood loss was not related to prostate volume (correlation coefficient = 0.02, P = 0.8) or interspinous diameter (correlation coefficient = 0.01, P = 0.9). The site-specific scores of both readers demonstrated positive agreement, with Pearsons correlation coefficients of 0.51 to 0.65 (P <0.01). CONCLUSIONS A marked prominence of the apical periprostatic veins on preoperative MRI is associated with greater intraoperative blood loss during radical retropubic prostatectomy. Other morphologic factors appear unrelated to the amount of intraoperative blood loss.

Imaging of hepatocellular carcinoma: A practical approach

Imaging of hepatocellular carcinoma (HCC) is complicated because the tumor has a varied radiologic appearance and frequently coexists with cirrhotic regenerative and dysplastic nodules. In cirrhotic patients, any dominant solid nodule that is not clearly a hemangioma should be considered a HCC until proven otherwise, especially if the lesion is hypervascular, of high T2 signal intensity, or demonstrates venous invasion. Biopsy of HCC in cirrhosis is risky and surveillance is often preferable. The doubling time of HCC is 1 to 12 months, and a nodule that is stable over 4 months is very unlikely to be a HCC. However, stable nodules cannot be dismissed, since livers containing dysplastic nodules are at high risk to develop HCC. In noncirrhotic patients, any solid mass that is not clearly a hemangioma or focal nodular hyperplasia is potentially a HCC, and biopsy may be required. Venous invasion by tumor should be distinguished from bland thrombus. Imaging detection of nodal metastases is limited by the frequent finding of benign reactive lymphadenopathy in cirrhosis. Resection is the preferred treatment for HCC, but is contraindicated in the presence of tumors in both lobes, major venous invasion, invasion of adjacent organs other than the gallbladder, tumor rupture, nodal metastases, or distant metastases.

MRI of vaginal leiomyomas

The MR appearances of two cases of vaginal leiomyoma are described. Both patients presented with a periurethral mass; one patient presented during pregnancy. MRI allowed precise anatomic localization of the masses and confident preoperative characterization in both cases.

Routine editing of trainee-generated radiology reports: effect on style quality.

RATIONALE AND OBJECTIVES The authors performed this study to determine the effect of routine editing on the style quality of trainee-generated radiology reports. MATERIALS AND METHODS Trainee-generated reports of 50 body computed tomographic scans obtained at a tertiary care cancer center were edited in a routine fashion by one of two attending radiologists. Three physicians and four radiologists each independently evaluated the randomized unedited and edited reports (n = 100) and rated each report for clarity, brevity, readability, and quality of the impression by using a five-point scale. RESULTS Editing significantly improved mean ratings for clarity (4.6 after editing vs 4.2 before editing, P < .007), brevity (4.6 vs 4.2, P < .007), readability (4.4 vs 4.1, P < .007), and quality of the impression (4.5 vs 4.3, P < .007). CONCLUSION Routine editing of trainee-generated reports significantly improves the perceived report quality. This finding suggests that greater emphasis should be placed on stylistic aspects of reporting during training to improve report style quality at dictation.

Renal involvement by Rosai–Dorfman disease: CT findings

Rosai–Dorfman disease is a rare disease characterized histologically by proliferation of histiocytes and has clinical features suggestive of a lymphomalike disease. Lymph nodes and extranodal sites might be involved, but renal involvement is rare. We present computed tomographic findings in three cases of renal involvement by Rosai–Dorfman disease. Two cases showed renal hilar masses and one case showed subcapsular hypodense infiltration. Renal involvement by Rosai–Dorfman disease has a characteristic appearance and should be included in the differential diagnosis of renal hilar masses or subcapsular hypodense infiltration.

Non-Hodgkin lymphoma as a cause of intrahepatic periportal low attenuation on CT.

Two cases of non-Hodgkin lymphoma (NHL), one AIDS related, with hepatic involvement manifesting as infiltrating mass-like periportal intrahepatic low attenuation on CT are described. One case demonstrated mass effect with compression of adjacent bile ducts causing jaundice. NHL should be included in the differential diagnosis of mass-like periportal intrahepatic low attenuation lesions.

Bilateral renal masses after local Bacillus Calmette-Guerin therapy for postcystectomy ureteral cancer

Bacillus Calmette-Guerin was administered through the ileal conduit of a 63-year-old man with upper tract recurrence of transitional cell carcinoma. Subsequent computed tomography showed bilateral renal masses, which were granulomatous at pathologic examination. The bacilli likely reached the kidneys via proven ileoureteral reflux. Patients with reflux may benefit from antituberculous prophylaxis.