Objectives
To develop technical guidelines for computed tomography urography.
Methods
The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi ...survey followed by a face-to-face meeting. Consensus was strictly defined using a priori criteria.
Results
Forty-two expert uro-radiologists completed both survey rounds with no attrition between the rounds. Ninety-six (70%) of the initial 138 statements of the questionnaire achieved final consensus. An intravenous injection of 20 mg of furosemide before iodinated contrast medium injection was judged mandatory. Improving the quality of excretory phase imaging through oral or intravenous hydration of the patient or through the use of an abdominal compression device was not deemed necessary. The patient should be imaged in the supine position and placed in the prone position only at the radiologist’s request. The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. Repeated single-slice test acquisitions should not be performed to decide of the timing of excretory phase imaging; instead, excretory phase imaging should be performed 7 min after the injection of the contrast medium. The optimal combination of unenhanced, corticomedullary phase and nephrographic phase imaging depends on the context; suggestions of protocols are provided for eight different clinical situations.
Conclusion
This expert-based consensus conference provides recommendations to standardise the imaging protocol for computed tomography urography.
Key Points
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To improve excretory phase imaging, an intravenous injection of furosemide should be performed before the injection of iodinated contrast medium.
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Systematic oral or intravenous hydration is not necessary to improve excretory phase imaging.
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The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation.
Micro-Abstract Patients with metastatic renal cell carcinoma with a skeletal muscle index (SMI) in the highest tercile have better overall survival with everolimus therapy versus those with an SMI in ...the lowest tercile. Low SMI did not influence the toxicity of everolimus. Whether SMI provides additional prognostic value to the International Metastatic Database Consortium prognostic group criteria remains to be determined.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Rapid prototyping is a technique used for creating computer images in three dimensions more efficiently than classic techniques. Percutaneous nephrolithotomy (PCNL) is a popular method to remove ...kidney stones; however, broader use by the urologic community has been hampered by the morbidity associated with needle puncture to gain access to the renal calix (bleeding, pneumothorax, hydrothorax, inadvertent colon injury). A training model to improve technique and understanding of renal anatomy could improve complications related to renal puncture; however, no model currently exists for resident training.
We created a training model using the rapid prototyping technique based on abdominal CT images of a patient scheduled to undergo PCNL. This allowed our staff and residents to train on the model before performing the operation. This model allowed anticipation of particular difficulties inherent to the patient's anatomy.
After training, the procedure proceeded without complication, and the patient was discharged at postoperative day 1 without problems.
We hypothesize that rapid prototyping could be useful for resident education, allowing the creation of numerous models for research and surgical training. In addition, we anticipate that experienced urologists could find this technique helpful in preparation for difficult PCNL operations.
The GreenLight laser is one of the main alternative treatments for benign prostatic hyperplasia (BPH). Ultrasonography with contrast (ECUS) is one of the main innovations in radiology that has led to ...the examination of tissue vascularity. The objective of the study was to measure the impact of photovaporization of the prostate (PVP) on the prostate gland with ECUS.
We conducted a pilot study to assess the impact of PVP on the prostate by using ECUS intraoperatively (ethical committee approval No. 2012-001451-39). Twelve patients undergoing PVP for symptomatic BPH were enrolled in this study after providing their informed consent. ECUS was performed just before and after PVP in the operating room and at 1 month postoperatively.
Comparative analysis showed that after PVP, a nonvascularized area with an average thickness of 11.1 mm was observed beyond the operative cavity. The nonvascularized area was thinner at 1 month postoperatively and disappeared at 6 months for the six patients evaluated. This is the first study using contrast-enhanced ultrasonography to measure the impact of PVP on the prostate. Our study has the limitations of a pilot study with a small population and a short follow-up. Based on these results, we would advise beginners to take into account the necrosis thickness and to limit the depth of vaporization.
Through the use of ECUS, our study demonstrated that a large area of necrosis is induced around the surgical cavity from the action of the GreenLight laser. Being aware of this phenomenon will certainly reduce the risk of complications induced by surgery.
To define magnetic resonance (MR) imaging criteria for the diagnosis of cavernous sinus invasion by pituitary adenoma.
The MR images obtained in 106 patients (86 female, 20 male; age range, 16-71 ...years) were reviewed retrospectively by two physicians. The standard-of-reference criteria for invasion were the surgical findings. A chi(2) analysis was performed, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for nine groups of MR imaging signs were computed.
Invasion of the cavernous sinus was certain (PPV, 100%) if the percentage of encasement of the internal carotid artery (ICA) by tumor was 67% or greater. It was highly probable if the carotid sulcus venous compartment was not depicted (PPV, 95%) or the line joining the lateral wall of the intracavernous and supracavernous ICAs was passed by the tumor (PPV, 85%). It was definitely not invaded (NPV, 100%) if the percentage of encasement of the intracavernous ICA was lower than 25% or the line joining the medial wall of the intracavernous and supracavernous ICAs was not passed by the tumor.
The radiologic diagnosis of cavernous sinus invasion by pituitary adenoma remains difficult, but the above-mentioned criteria may be of assistance.
Recently, we described three components of a normal pharyngeal swallowing sound. The aim of the present study was to identify variations of these components using synchronized acoustic-radiological ...data in partially laryngectomized (PL) and totally laryngectomized (TL) patients before and after surgery. In this prospective study, from January 2003 to December 2006 we enrolled 14 patients in a PL group and 9 patients in a TL group. A fluoroscopy camera and a microphone were connected to a computer to obtain acoustic-radiological data (25 images/s). The subjects were asked to perform six deglutitions of 10 ml of barium suspension. The average durations of the sound variables were measured before and after surgery. The duration of the preoperative pharyngeal sound was 602 ms in the PL group and 562 ms in the TL group. It was significantly decreased after the TL (296 ms) and was increased after the PL (740 ms). A typical profile of the swallowing sound for each group was obtained. This study allowed us to describe the main variations of the pharyngeal swallowing sound induced by PL and TL. This noninvasive tool could be useful to assess postoperative swallowing function.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Cavernomas are vascular malformations mostly observed in the central nervous system. They occur in sporadic and familial forms. Familial forms are characterized by the presence of multiple lesions, ...an autosomal dominant pattern of inheritance and possible de novo lesions. We report two sporadic cases whose follow-up showed the appearance of new lesions.
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