Robert F. Spataro

Diagnosis of Nonopaque Calculi by Computed Tomography

Computed tomography can aid in the distinction of calculi from both tumors and clots in the urinary tract. Its availability, simplicity of interpretation, and noninvasiveness establish it as an important diagnostic modality in selected cases when calculus is in the differential diagnosis of upper urinary tract filling defects.

Urography with Low-Osmolality Contrast Media: Comparative Urinary Excretion of Iopamidol, Hexabrix, and Diatrizoate

The pharmacokinetics and urinary excretion characteristics of sodium diatrizoate, the new low-osmolality contrast medium iopamidol, a nonionic monomer, and ioxaglate, a monoacidic dimer, were compared. Using rabbits, experimental urography was performed at a dose of 450 mg I/kg. The lowosmolality co

The use of percutaneous nephrostomy and urinary alkalinization in the dissolution of obstructing uric acid stones.

Two patients are described who presented with complete urinary obstruction secondary to nonopaque uric acid stones. They were treated with percutaneous nephrostomy for urinary diversion and urinary alkalinization by local irrigation and oral sodium bicarbonate therapy with complete dissolution of the stone after 16 and 21 days of therapy. Percutaneous nephrostomy with urinary alkalinization is a reasonable, relatively safe alternative to surgical stone removal for patients with obstructing uric acid stones.

Computed tomography of adult polycystic disease.

Twenty-three cases of polycystic disease were reviewed. All were easily detected by computed tomography. All manifested diffuse, bilateral renal cystic disease, and 74% had demonstrable hepatic cystic disease. Computed tomography is more accurate than other conventional modalities in diagnosing renal cysts, and its simplicity of operation and ease of interpretation are unmatched.

Characteristics of calcification in tumors of the pineal gland.

Thirty-two cases of proved pineal tumor were analyzed. Calcification was seen in 75%. The size, character, and position of the calcification were useful indicators of abnormality on plain-film evaluation. Frays cranioangle method was more sensitive than Oons method in determining abnormal position of the calcified pineal tumor on the lateral skull film. Most calcifications were displaced postero-inferiorly or inferiorly, which can be explained by obstructive hydrocephalus or direct tumor expansion.

Epinephrine enhanced knee arthrography.

The effect of .3 cc of 1:1000 epinephrine on iodine concentration, total iodine content, fluid volume and radiographic quality was evaluated in knee arthrograms in dogs. With the addition of epinephrine the iodine concentration and total iodine content were significantly higher initially and remained significantly higher than in controls over a one hour period. The fluid volume in the knee was significantly lower with epinephrine. Initially both contrast absorption and dilution have major effects in decreasing iodine concentration. With increasing time the effect of contrast absorption becomes the major factor, having a two of three times greater effect on decreasing iodine concentration. With epinephrine radiographs were judged significantly better early and while the quality deteriorated rapidly in the controls the enhanced quality with epinephrine persisted up to one hour. Epinephrine is a very useful adjunct in enhancing the quality of knee arthrography.

New and old contrast agents: pharmacology, tissue opacification, and excretory urography.

In equivalent doses for intravenous urograms conventional ionic contrast agents give iodine concentrations in the urine of approximately 30 mg iodine/ml, nonionic contrast media provide approximately 50 mg iodine/ml, and the ionic dimer Hexabrix approximately 70 mg iodine/mL. These new low osmolality, contrast media provide significantly higher urinary iodine concentrations than conventional ionic contrast media, provide better diagnostic quality excretory urograms, better patient tolerance, and fewer adverse side-effects and serious reactions. These new low osmolality, contrast media have significant advantages in intravenous urography in both safety and efficacy when compared to conventional higher osmolality contrast media.

Use of low-osmolality contrast media in patients with previous reactions.

Fischer HW, Spataro RF. Use of low‐osmolality contrast media in patients with previous reactions. Invest Radiol 1988;23(Suppl 1):S186‐S188.

Urinary Tract Obstruction in Polycystic Renal Disease

The incidence and cause of urinary tract obstruction in 100 consecutive patients with polycystic renal disease are reported. Because of nonspecific symptoms, poor renal function, and calyceal distortion, obstruction may be difficult to detect. A number of patients had infundibular obstruction caused by a calculus, clot, or inflammation and edema of the pelvocalyceal wall.

Clinical comparison of Hexabrix, iopamidol, and Urografin-60 in whole body computed tomography.

Urografin 60, iopamidol and Hexabrix were studied in patients undergoing body CT scans to examine the pharmacodynamics of these contrast agents. Immediately following rapid injection, the lower osmolality media, Hexabrix and iopamidol, gave greater aortic concentration of iodine in addition to higher concentrations in the liver and spleen. These two agents also provided significantly better renal enhancement than Urografin 60, with Hexabrix giving higher levels than iopamidol. The higher early vascular concentrations of Hexabrix and iopamidol and the relative absence of side effects due to hyperosmolality and decreased toxicity may have advantages in dynamic CT scanning.