Influences of the Social Media Continuum Model in Radiology: Theory and Reality.

Social media utilization has been growing exponentially worldwide and has created a thriving venue for radiologists and the profession of radiology to engage in on both the academic and social levels. The aim of this article is to conduct updated literature review and address a gap in the literature by introducing a simple classification for social media utilization and a new theoretical model to outline the role and potential value of social media in the realm of radiology. We propose classifying social media through usage-driven and access-driven indices. Furthermore, we discuss the interdependency of radiologists, other physicians and non-physician stakeholders, scientific journals, conferences/meetings and the general public in an integrated social media continuum model. With the ongoing sub-specialization of radiology, social media helps mitigate the physical barriers of making connections with peers and audiences which would have otherwise been unfeasible. The constant evolution and diversification of social media platforms necessitates a novel approach to better understand its role through a radiological lens. With the looming fear of 'ancillary service' labelling, social media could be the golden plate to halt the path towards commoditization of radiology.

Radiological diagnosis of vesicouterine fistula: role of magnetic resonance imaging.

PURPOSE: To retrospectively assess the value of magnetic resonance imaging (MRI) in the diagnosis of vesicouterine fistula (VUF). MATERIALS AND METHODS: Between January 2003 and January 2011, 12 patients with a diagnosis of VUF were surgically managed at our center; among them, eight patients had MRI among their preoperative radiological investigations and those were included in our study. The clinical presentation, radiological investigations, and surgical findings of the patients were reviewed. RESULTS: The mean age of the patients was 31 years. Seven of the eight patients had complaints of cyclic hematuria and the remaining patient complained of urinary leakage through the vagina. The etiology of VUF was cesarean section in all patients. The preoperative radiological investigations included conventional cystography in five patients, intravenous urography in two, computed tomography (CT) urography in two, and MRI in eight. The sensitivities of diagnosis for these investigations were 40%, 0%, 50%, and 100%, respectively. CONCLUSION: In our small retrospective series, pelvic MRI was reliable and sensitive for diagnosis of VUF. It should be considered in the work-up of patients with suspected VUF.

Genitourinary schistosomiasis: life cycle and radiologic-pathologic findings.

Genitourinary schistosomiasis is produced by Schistosoma haematobium, a species of fluke that is endemic to Africa and the Middle East, and causes substantial morbidity and mortality in those regions. It also may be seen elsewhere, as a result of travel or immigration. S haematobium, one of the five fluke species that account for most human cases of schistosomiasis, is the only species that infects the genitourinary system, where it may lead to a wide spectrum of clinical symptoms and signs. In the early stages, it primarily involves the bladder and ureters; later, the kidneys and genital organs are involved. It rarely infects the colon or lungs. A definitive diagnosis of genitourinary schistosomiasis is based on findings of parasite ova at microscopic urinalysis. Clinical manifestations and radiologic imaging features also may be suggestive of the disease, even at an early stage: Hematuria, dysuria, and hemospermia, early clinical signs of an established S haematobium infection, appear within 3 months after infection. At imaging, fine ureteral calcifications that appear as a line or parallel lines on abdominopelvic radiographs and as a circular pattern on axial images from computed tomography (CT) are considered pathognomonic of early-stage schistosomiasis. Ureteritis, pyelitis, and cystitis cystica, conditions that are characterized by air bubble-like filling defects representing ova deposited in the ureter, kidney, and bladder, respectively, may be seen at intravenous urography, intravenous ureteropyelography, and CT urography. Coarse calcification, fibrosis, and strictures are signs of chronic or late-stage schistosomiasis. Such changes may be especially severe in the bladder, creating a predisposition to squamous cell carcinoma. Genital involvement, which occurs more often in men than in women, predominantly affects the prostate and seminal vesicles.

Quantitative enhancement washout analysis of solid cortical renal masses using multidetector computed tomography.

PURPOSE: The aim of the study was to prospectively assess the utility of quantitative enhancement washout method in the differentiation of benign solid renal masses from various subtypes of malignant masses using multidetector computed tomography. METHODS: In a prospective investigation from January 2009 to May 2010, 97 patients with solid renal masses underwent CT scan examination with unenhanced, arterial, parenchymal, and delayed phases. The following features were analyzed: the maximum attenuation value in each phase, attenuation difference (enhancement) of the mass in each phase from the unenhanced phase (ΔH), and parenchymal and delayed phases' washout. Of these patients, 82 (85%) underwent unilateral radical nephrectomy, 15 (15%) underwent partial nephrectomy. Group comparison was performed with the Kruskal-Wallis test and Mann-Whitney U test. RESULTS: The masses included in our study were 45 clear cell renal cell carcinomas (CCRCCs); 18 chromophobe renal cell carcinomas, 16 papillary (PRCC), 14 oncocytomas, and 4 minimal fat containing angiomyolipomas. In the arterial phase, the CCRCC was the most enhancing type and could be differentiated from other renal masses (benign or malignant) with high sensitivity and specificity. In the parenchymal phase, the CCRCCs demonstrated the highest washout. Chromophobe renal cell carcinomas showed the second highest washout in this phase. Benign lesions and PRCCs did not exhibit significant washout in this phase. In the delayed phase, the malignant lesions (with the exception of PRCCs) showed the highest washout. Benign lesions showed significant washout but less than malignant lesions. CONCLUSIONS: Multiphasic multidetector CT utilizing arterial-phase attenuation and quantitative enhancement washout method could help in the preoperative differentiation of various types of solid renal masses.

Evaluation of a synchronous twin-pulse technique for shock wave lithotripsy: a prospective randomized study of effectiveness and safety in comparison to standard single-pulse technique.

OBJECTIVE: To asses the efficacy and safety of bidirectional synchronous twin-pulse extracorporeal shock wave lithotripsy (ESWL) compared with standard ESWL. PATIENTS AND METHODS: Between March 2003 and December 2006, 240 patients with a radio-opaque single renal stone of 10 mm the rate for the failure of disintegration was 13.3% for the DLS vs 1.4% for the TH (P = 0.009). For stones of 10 mm it was 78.1% and 66.7%, respectively (P = 0.14). The median (range) number of sessions in both groups was 2 (1-5). After ESWL urinary NAG levels were increased significantly in both groups; in the TH group it declined below the level before ESWL after 2 days, while in the DLS group it remained high after 7 days. In the DLS group four patients developed subcapsular or parenchymal haematoma after ESWL, vs none in the TH group. There was loss of corticomedullary differentiation after ESWL in three patients in the DLS group and only one in the TH group. In the DLS group there was a statistically significantly decrease in bilateral renal perfusion after ESWL, but no changes in the TH group. CONCLUSIONS: Synchronous twin-pulse ESWL has clinical advantages over standard ESWL in terms of safety and efficacy.

Diagnostic value of combined static-excretory MR Urography in children with hydronephrosis.

The aim of this study was to determine the feasibility, accuracy and diagnostic potential of combined static-excretory MR Urography in children with sonographically detected hydronephrosis. We prospectively evaluated 28 children (11 girls and 17 boys), mean age 8.3 years (range 2 months-16 years). Static-excretory MR Urography was performed in all cases. The results of MR Urography were compared with the results of other imaging modalities, cystoscopy and surgery. In 28 children, 61 renal units were evaluated by MR Urography (the renal unit is the kidney and its draining ureter). The final diagnoses included: normal renal units (n = 23); uretropelvic junction obstruction (n = 14); megaureter (n = 8); midureteric stricture (n = 1), complicated duplicated systems (n = 5), post ESWL non-obstructive dilation (n = 2), extrarenal pelvis (n = 4), dysplastic kidney (n = 4). Complex pathology and more than one disease entity in were found in 7 children. The MRI diagnosis correlated with the final diagnosis in 57 units, with diagnostic accuracy 93.4%. In conclusions static and excretory MRU give both morphological and functional information in a single examination without exposure to ionizing radiation and iodinated contrast agent. It is a valuable imaging technique for children with upper urinary tract dilatation; especially in cases of complex congenital pathologies and severely hydronephrotic kidney.

Power doppler sonography in early renal transplantation: does it differentiate acute graft rejection from acute tubular necrosis?

To evaluate the role of power Doppler in the identification and differentiation between acute renal transplant rejection and acute tubular necrosis (ATN), we studied 67 live donor renal transplant recipients. All patients were examined by spectral and power Doppler sonography. Assessment of cortical perfusion (CP) by power Doppler was subjective, using our grading score system: P0 (normal CP); homogenous cortical blush extending to the capsule, P1 (reduced CP); cortical vascular cut-off at interlobular level, P2 (markedly reduced CP); scattered cortical color flow at the interlobar level. Renal biopsies were performed during acute graft dysfunction. Pathological diagnoses were based on Banff classification 1997. The Mann- Whitney test was used to test the difference between CP grades with respect to serum creatinine (SCr), and resistive index (RI). For 38 episodes of acute graft rejection grade I, power Doppler showed that CP was P1 and RI ranging from 0.78 to 0.89. For 21 episodes of acute graft rejection grade II, power Doppler showed that CP was P1, with RI ranging from 0.88 to >1. Only one case of grade III rejection had a CP of P2. Twelve biopsies of ATN had CP of P0 and RI ranging from 0.80 to 0.89 There was a statistically significant correlation between CP grading and SCr (P <0.01) as well as between CP grading and RI (P <0.05). CP grading had a higher sensitivity in the detection of early acute rejection compared with RI and cross-sectional area measurements. We conclude that power Doppler is a non-invasive sensitive technique that may help in the detection and differentiation between acute renal transplant rejection and ATN, particularly in the early post-transplantation period.

Evaluation of coronary calcium score by multidetector computed tomography in relation to endothelial function and inflammatory markers in asymptomatic individuals.

BACKGROUND: Coronary calcification has been correlated with the presence and extent of coronary artery disease (CAD), so in the present study the associations between coronary artery calcification score (CACS) and endothelial dysfunction, as well as the important inflammatory markers C-reactive protein (CRP), interleukin (IL)-6, and oxidized low-density lipoprotein (OxLDL), were studied in asymptomatic individuals at intermediate risk for CAD. METHODS AND RESULTS: The study group comprised 177 subjects (103 males) aged 50.6+/-5.9 years. CACS was measured by multidetector computed tomography using the Agatston method. Endothelium-dependent flow-mediated dilatation (FMD) and endothelium-independent nitroglycerin-mediated dilatation (NMD) were measured by high-resolution external brachial ultrasound. Coronary artery calcification (CAC) was detected in 82 subjects (52 males), and the median CACS was 143 [31-311.25] units. After adjusting for gender and body mass index, log (CACS +1) correlated positively with age (r=0.401, p<0.001) and IL-6 levels (r=0.442, p<0.001), and negatively with FMD (r=-0.511, p<0.001). The correlations of log (CACS +1) with CRP and OxLDL levels, and with NMD, were non-significant. In a multivariate-adjusted logistic regression model, age (odds ratio (OR) =1.083 [1.014-1.156]), serum IL-6 level (OR=3.837 [2.166-6.798]) and FMD (OR=0.851 [0.793-0.913]) were significantly and independently associated with CAC. CONCLUSIONS: Peripheral endothelial function inversely correlated with CACS, whereas IL-6 level was associated with CACS. Testing for endothelial function and IL-6 level may improve cardiovascular risk assessment and help target the therapeutic strategies in asymptomatic patients at intermediate CAD risk.

Magnetic resonance imaging in the evaluation of pelvi-ureteric junction obstruction: an all-in-one approach.

OBJECTIVE: To study the ability of comprehensive magnetic resonance imaging (MRI) to replace multiple imaging methods in the evaluation of patients with pelvi-ureteric junction obstruction (PUJO). PATIENTS AND METHODS: Between May 2003 and November 2005, 46 consecutive patients (22 male and 24 females; mean age 31.6 years) with symptomatic primary PUJO were included. All had comprehensive MRI, including MR urography (MRU), dynamic MRI and MR angiography (MRA). Morphological results of MRU were compared with that of renal ultrasonography or intravenous urography, while the anatomical results of MRA were compared with the operative findings. A correlation between MR clearance and radioisotope clearance was done using linear regression analysis. RESULTS: MRU showed the morphology of the collecting system in all patients, and the ureter below the PUJ in 31 of 46 (67%), but renal stones were missed in three of 10 patients. MRA showed crossing vessels in 22 patients (48%). There was a strong correlation between MR clearance and radioisotope clearance (r = 0.823, P < 0.001). From the MRI results, 35 patients (19 with crossing vessels and 16 with marked hydronephrosis) had pyeloplasty and 11 had an endopyelotomy. Findings during pyeloplasty showed one false-negative and one false-positive result of the preoperative MRI. Therefore, the sensitivity, specificity and accuracy of MRA were 95%, 94% and 94%, respectively. The outcome was successful in 44 (96%) patients. One failure after pyeloplasty was managed with endopyelotomy and the other was treated with pyeloplasty after endopyelotomy. CONCLUSION: Comprehensive MRI is a valuable and accurate single-imaging method for evaluating patients with PUJO.

Evaluation of a synchronous twin-pulse technique for shock wave lithotripsy: the first prospective clinical study.

OBJECTIVE: To present the results of the first clinical study of a synchronous twin-pulse technique for extracorporeal shock-wave lithotripsy (ESWL), which is effective for in vitro stone fragmentation and safe when assessed in vivo on animal tissue. PATIENTS AND METHODS: Fifty patients with urinary stones (35 men and 15 women) were enrolled and treated with the TWINHEADS lithotripter. The entry criteria were: age > or = 18 years, with a radio-opaque single stone in the kidney or upper ureter, a normal laboratory profile (serum creatinine, liver function, blood, bleeding and clotting times, and prothrombin concentration). The exclusion criteria included lower ureteric stones, patients with urinary tract infection, obstructed urinary tract distal to the stones, or congenital abnormalities. All patients received one session and were evaluated by ultrasonography (US), urinary tract plain X-ray, and complete laboratory investigations before and immediately after treatment, and after 2, 14 and 30 days. Patients requiring re-treatment at the 14-day visit received a second session and were re-evaluated after 7 and 14 days. RESULTS: The mean (sd, range) stone size (longest diameter) was 12.3 (2.6, 9-18) mm. Intravenous sedation was used in 30 patients. There was mild haematuria in 25 patients on the day of treatment. During the follow-up there was no evidence of haematoma, gross renal injury, upper urinary tract obstruction or significant changes in the laboratory investigations. After 14 days, 17 patients (34%) were free of stones, with residual stones of < or = 5 mm in 20 (40%); they were free of stones at the 1-month follow-up. Thirteen patients (26%) had residual stones of 6-9 mm, but the stones were half or less of the original size. Patients with residual stones of > 5 mm had another ESWL session and were free of stones within 14 days. Thus all patients were rendered stone-free within 1 month. CONCLUSIONS: Synchronous twin-pulse ESWL is promising, seems safe and effective for treating patients with renal and upper ureteric lithiasis.

Magnetic resonance imaging as a sole method for the morphological and functional evaluation of live kidney donors.

OBJECTIVE: To evaluate gadolinium-enhanced dynamic magnetic resonance imaging (MRI) as the sole method for the anatomical and functional assessment of potential live-kidney donors. SUBJECTS AND METHODS: The study included 50 consecutive kidney donors; in addition to routine donor evaluation, the kidney was imaged with Gd-enhanced dynamic MRI, which was also used for selectively determining the glomerular filtration rate (GFR) of each kidney. All donors had a m99Tc-mercaptoacetyltriglycine (MAG3) renal scan as the reference standard to measure GFR. The anatomical results of MRI were compared with the findings at donor nephrectomy, and the GFR estimated from MRI compared with that from MAG3 scintigraphy. RESULTS: MR angiography had 100% sensitivity, 94% specificity and 96% overall accuracy for detecting the number of renal arteries, and 100% sensitivity, 98% specificity and 98% overall accuracy for the number of renal veins. There was a close correlation (r = 0.54, P < 0.01) between the GFR of each kidney estimated by MRI or MAG3. For the right and left kidneys the mean isotope clearance was not significantly different from that of mean MRI clearance. MR urography allowed visualization of the urinary tract and the detection of any abnormality. CONCLUSION: Gd-enhanced dynamic MRI can provide accurate information about the anatomy of the urinary tract and vasculature of the kidney, and can be used to accurately estimate the selective GFR of each kidney. Therefore, we recommend MRI as a single imaging diagnostic method for assessing potential live kidney donors.

Contrast enhanced spiral computerized tomography in live kidney donors: a single session for anatomical and functional assessment.

PURPOSE: We evaluated contrast enhanced spiral computerized tomography (CT) as a single session for anatomical and functional assessment of potential live kidney donors. MATERIALS AND METHODS: The study included 80 consecutive kidney donors. In addition to routine donor evaluation, radiological imaging of the kidneys was performed with spiral CT, which was also used for selective determination of the glomerular filtration rate (GFR) of each kidney. All donors underwent 99mTc-mercaptoacetyltriglycine renal scan as a gold standard for GFR determination. Anatomical results of spiral CT were compared to operative findings at donor nephrectomy. Moreover, the results of CT GFR were compared with those of standard 99mTc-mercaptoacetyltriglycine GFR. RESULTS: Spiral CT detected major renal abnormalities that might be potentially significant for safe renal donation in 4 of the 80 donors (5%). Spiral CT had 100% sensitivity, 85.7% specificity and 97.2% overall accuracy for detecting the number of renal arteries. To identify the number of renal veins spiral CT had 100% sensitivity, 92.3% specificity and 98.6% overall accuracy. A comparison between the isotope GFR of each kidney with the corresponding CT GFR showed a perfect correlation (r = 0.54, p <0.001). For the right and left kidneys mean isotope clearance was not significantly different from that of mean CT clearance. CONCLUSIONS: Multidetector row spiral CT with contrast medium can provide accurate information regarding the anatomy of the urinary tract and vasculature of the kidney. Moreover, it can detect renal and vascular abnormalities that might be potentially significant for safe renal donation. In addition, it can accurately demonstrate selective GFR of each kidney. Therefore, we recommend spiral CT with contrast material as a single radiological diagnostic modality for the assessment of potential live kidney donors.

Contrast enhanced spiral computerized tomography in patients with chronic obstructive uropathy and normal serum creatinine: a single session for anatomical and functional assessment.

PURPOSE: We evaluated contrast enhanced spiral computerized tomography (CT) as a single session for the anatomical and functional assessment of patients with chronic obstructive uropathy and normal serum creatinine. MATERIALS AND METHODS: The study included 65 patients with unilateral or bilateral chronic renal obstruction and normal serum creatinine. Five patients had bilateral obstruction and the remaining 60 had unilateral obstruction and a normal contralateral kidney. Therefore, the total number of renal units was 130, that is 70 obstructed and 60 normal. All patients underwent contrast enhanced spiral CT together with excretory urography (IVP) and Tc-mercaptoacetyltriglycine renal scan. CT was used to identify the cause of obstruction and selectively determine the glomerular filtration rate (GFR) of the 2 kidneys. The diagnostic accuracy of CT for identifying the cause of hydronephrosis was compared with that of IVP. Moreover, a correlation was made between CT GFR and isotope GFR. RESULTS: Obstruction was caused by ureteropelvic junction narrowing in 25 cases, ureteral stones in 21, ureteral stricture in 20 and extrinsic ureteral obstruction in 4. Contrast enhanced spiral CT identified the cause of hydronephrosis in all obstructed kidneys (100% sensitivity), while IVP identified the cause in 52 (74% sensitivity), which was a significant difference (p <0.05). CT and IVP excluded obstruction in all normal kidneys (100% specificity). A comparison between the isotope GFR of obstructed kidneys with the corresponding CT GFR showed a perfect correlation (r = 0.78, p <0.0001). Moreover, a similar comparison between isotope GFR and CT GFR of normal kidneys showed an excellent correlation (r = 0.73, p <0.0001). In obstructed and normal kidneys mean isotope clearance was not significantly different from that of mean CT clearance. CONCLUSIONS: Contrast enhanced spiral CT is more sensitive than IVP for identifying the cause of chronic obstructive uropathy. Moreover, it is as accurate as radioisotope renal scan for calculating the total and separate kidney function. We recommend spiral CT with contrast medium as a single radiological diagnostic modality for the assessment of patients with chronic renal obstruction and normal serum creatinine.