[Medullar thoracic compression by tophaceous gout: presentation of a case and review of the literature]. / Compresion medular dorsal por tofos gotosos: presentacion de un caso y revision de la bibliografia.

INTRODUCTION: Spine involvement in gout is an extremely uncommon complication. Dorsalgia and quadriplegia are some manifestations that may occur, although these symptoms are seen more frequently in other more prevalent pathologies, such as spinal tumors. CASE REPORT: We present an unusual case of thoracic spinal cord compression at T10-T11 level caused by the extradural deposit of tophaceous material in a 52-year-old woman with uncontrolled chronic tophaceous gout. In addition to intensive medical treatment, the patient required surgery (hemilaminectomy and spinal decompression) and subsequent rehabilitation. Overall and neurological evolution were satisfactory.

TITLE: Compresion medular dorsal por tofos gotosos: presentacion de un caso y revision de la bibliografia.Introduccion. La afectacion de la columna vertebral en la gota es una complicacion extremadamente infrecuente. La dorsalgia y la cuadriplejia son algunas manifestaciones que se pueden presentar, aunque estos sintomas se ven con mas frecuencia en otras patologias mas prevalentes, como los tumores medulares. Caso clinico. Se presenta un caso inusual de compresion medular dorsal en D10-D11 causado por el deposito extradural de material tofaceo en una paciente de 52 años con gota tofacea cronica incontrolada. Ademas de un tratamiento medico intensivo, la paciente requirio cirugia (hemilaminectomia y descompresion medular) y rehabilitacion posterior. La evolucion general y neurologica fue satisfactoria.

Diagnostic value of CT, PET and combined PET/CT performed with low-dose unenhanced CT and full-dose enhanced CT in the initial staging of lymphoma.

AIM: The aim of this paper was to compare the accuracy of contrast-enhanced computed tomography (CT), positron emission tomography (PET), unenhanced low-dose PET/CT (LD-PET/CT) and full-dose enhanced PET/CT (FD-PET/CT) for the initial staging of lymphoma. METHODS: One hundred and one lymphoma patients were examined by [18F]FDG-PET/CT including unenhanced low-dose CT and enhanced full-dose CT. Each modality of PET/CT was evaluated by a nuclear medicine physician and a radiologist unaware of the other modality, while the CT and PET images were interpreted separately by another independent radiologist and nuclear medicine physician respectively. The nodal and extranodal lesions detected by each technique were compared with a reference standard. RESULTS: For nodal assessment, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative LR (LR-) of LD-PET/CT were 97%, 96%, 98%, 95%, 26 and 0.02 respectively, and those of FD-PET/CT were 97%, 97%, 98%, 95%, 36 and 0.02. These results were significantly better than those of PET (sensitivity 82%, specificity 81%, PPV 88%, NPV 72%, LR+ 4.3, LR- 0.21). Likewise, both PET/CT displayed a higher sensitivity, NPV and LR- than CT (91%, 84%, 0.1 respectively). For organ evaluation, both modalities of PET/CT also had significantly better sensitivity and NPV than that of PET (LD-PET/CT: sensitivity 92%, NPV 90%; FD-PET/CT sensitivity 94%, NPV 92%; PET: sensitivity 70%, NPV 69%). The sensitivity, specificity, PPV and NPV for bone marrow involvement were 29%, 84%, 45% and 72% respectively for PET, and 29%, 90%, 56%, and 74% for both, LD-PET/CT, and FD-PET/CT. No significant differences were found between LD-PET/CT and FD-PET/CT, but FD-PET/CT detected important incidental findings in 5.9% of patients. CONCLUSION: PET/CT is an accurate technique for the initial staging of lymphomas without significant differences between LD-PET/CT and FD-PET/CT. FD-PET/CT detects relevant incidental findings that are missed on LD-PET/CT.

Comisión Nacional de la especialidad de Radiodiagnóstico. ¿Qué es y para qué sirve? / What is the National Commission for the Specialty of Diagnostic Imaging and what is its purpose?

La Comisión Nacional de Radiodiagnóstico es un órgano asesor del Ministerio de Sanidad y Consumo y del Ministerio de Educación en temas de formación sanitaria especializada. Dentro del capítulo de Formación de Residentes en Radiología se explican las competencias y funciones de la Comisión Nacional de la especialidad de Radiodiagnóstico, como son: elaboración del programa formativo, elaboración del libro del residente, establecimiento de criterios de evaluación, propuesta de áreas de capacitación específica, establecimiento de criterios de evaluación de unidades docentes y formativas y participación en el diseño de planes integrales dentro de la especialidad. También se detallan otras funciones meramente administrativas, pero que repercuten en toda la comunidad radiológica (AU)

The National Commission for the Specialty of Diagnostic Imaging is an organ of the Ministry of Health and Consumer Affairs and of the Ministry of Education that is responsible for the evaluation of thet raining of specialists in diagnostic imaging. With in the chapter on the training of radiology residents, the jurisdiction and function of the Nation Commission for the Specialty of Diagnostic Imaging are described as including the elaboration of a training program, the elaboration of the resident’s log book, the establishment of criteria for evaluation, the proposal of areas of specific competence, the establishment of criteria for the evaluation of teaching and training units, and the participation in the design of integrated plans with in the specialty. Other, merely administrative, functions that have repercussions in the radiological community are also detailed (AU)

[What is the National Commission for the Specialty of Diagnostic Imaging and what is its purpose?]. / Comisión Nacional de la especialidad de Radiodiagnóstico. ¿Qué es y para qué sirve?

The National Commission for the Specialty of Diagnostic Imaging is an organ of the Ministry of Health and Consumer Affairs and of the Ministry of Education that is responsible for the evaluation of the training of specialists in diagnostic imaging. Within the chapter on the training of radiology residents, the jurisdiction and function of the Nation Commission for the Specialty of Diagnostic Imaging are described as including the elaboration of a training program, the elaboration of the resident's logbook, the establishment of criteria for evaluation, the proposal of areas of specific competence, the establishment of criteria for the evaluation of teaching and training units, and the participation in the design of integrated plans within the specialty. Other, merely administrative, functions that have repercussions in the radiological community are also detailed.

[The usefulness of PET/CT in lung cancer]. / Utilidad de la PET/TC en el cáncer de pulmón.

Lung cancer is the leading cause of cancer-related death. Accurate staging is essential for the optimal management and treatment of these patients. Positron emission tomography (PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms for oncologic patients because they provide valuable functional information. The hybrid PET/CT technique acquires both anatomic (CT) and metabolic (PET) images in a single session, combining the benefits of each modality and minimizing their limitations. This article reviews the role of PET/CT in lung cancer staging, with emphasis on non-small cell carcinoma, evaluating the advantages and limitations of the technique. Other applications of the technique, such as planning radiotherapy, are also discussed.

Utilidad de la PET/TC en el cáncer de pulmón / The usefulness of PET/CT in lung cancer

El cáncer de pulmón es la causa más frecuente de mortalidad por cáncer. Para un manejo adecuado de estos pacientes es esencial realizar una estadificación precisa de la enfermedad. La tomografía por emisión de positrones (PET) y, más recientemente, la PET/tomografía computarizada (TC) se han introducido en los algoritmos diagnósticos de los pacientes oncológicos, debido a la valiosa información funcional que proporcionan. La técnica híbrida PET/TC adquiere en una sola sesión las imágenes anatómicas (TC) y metabólicas (PET), combinando los beneficios de cada modalidad y minimizando sus limitaciones.En este artículo se revisa el papel de la PET/TC en la estadificación del cáncer de pulmón, con énfasis en el carcinoma no microcítico, evaluando sus ventajas y limitaciones, así como otras aplicaciones como la planificación de la radioterapia (AU)

Lung cancer is the leading cause of cancer-related death. Accurate staging is essential forthe optimal management and treatment of these patients. Positron emission tomography(PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms foroncologic patients because they provide valuable functional information. The hybrid PET/CT technique acquires both anatomic (CT) and metabolic (PET)images in a sing lesession,combining the benefits of each modality and minimizing their limitations.This article reviews the role of PET/CT in lung cancer staging, with emphasison non-smallcell carcinoma, evaluating the advantages and limitations of the technique. Otherapplications of the technique, such as planning radiotherapy, are also discussed (AU)

Nuevo programa de radiodiagnóstico / No disponible

No disponible

[Integrated PET/CT scanner in oncology applications: a radiologic perspective]. / Uso del sistema híbrido PET/TC en oncología: perspectiva radiológica.

OBJECTIVE: To describe our experience with an integrated PET/CT system in the clinical applications in Oncology. MATERIAL AND METHODS: An integrated PET/CT scanner is an in-line system combining a full-ring detector PET and a multidetector row helical CT in one machine. This is a multidisciplinary technique involving a nuclear medicine physician, a radiologist, a radiopharmacologist, and a physicist, with distinct tasks and working together. The clinical indications for PET scans are determined by the National Health System, which in Madrid is coordinated by Agencia Laín Entralgo, and are performed by a nuclear medicine physician with the help of a radiologist for CT interpretation. The combined PET/CT scans are supervised and interpreted by both a nuclear medicine physician and a radiologist. RESULTS: Between September 2003 and August 2005, a total of 2459 examinations were performed at our institution: 2200 were PET scans with low-dose noncontrast-CT for attenuation correction (clinical indications approved by NHS), and 259 were combined PET/CT scans with full-diagnostic enhanced-CT (in the setting of research programmes). The overall distribution of clinical indications for the 2459 examinations were: lung cancer 14.7%, solitary lung nodule characterization 7%, lymphoma 23.5%, colon cancer 18.5%, gastric cancer 1.9%, brain tumors 2.6%, head-neck tumors 5.5%, thyroid cancer 5%, breast cancer 4%, unknown origin cancer 4.3%, epilepsy 1.4%, others 11.6%. CONCLUSION: In our experience, the integrated PET/CT system has advantages over the stand-alone PET and/or CT. However, more studies, as the ongoing research programmes at our facility are needed for the diagnostic validation of this technique.

Uso del sistema híbrido PET/TC en oncología: perspectiva radiológica / Integrated PET/CT scanner in oncology applications: a radiologic perspective

Objetivo. Describir nuestra experiencia con la técnica combinada tomografía por emisión de positrones-tomografía computarizada (PET/TC) en el manejo de la patología oncológica. Material y métodos. El equipo PET/TC combina en un sistema híbrido un escáner helicoidal multicorte y un escáner PET. La técnica es multidisciplinar interviniendo un médico nuclear, un radiólogo, un físico y un radiofarmacéutico, con funciones diferenciadas. Las indicaciones de la PET se determinan bajo uso tutelado en el Sistema Nacional de Salud (SNS), coordinado por la Unidad de Evaluación de Tecnologías Sanitarias de la Agencia Laín Entralgo, bajo la supervisión y realización de un médico nuclear ayudado si se requiere para interpretar la TC por un radiólogo. Cuando se usa como estudio combinado, los estudios son supervisados por un médico nuclear y un radiólogo. Resultados. Entre septiembre de 2003 y agosto de 2005 hemos efectuado 2.459 estudios: 2.200 como PET, con TC de baja dosis (indicaciones clínicas bajo uso tutelado en el SNS) y 259 como estudios realizados en el marco de proyectos de investigación utilizándose, en estos casos, como sistema híbrido en una única sesión. Los resultados globales muestran los siguientes porcentajes: cáncer de pulmón 14,7%, nódulo pulmonar solitario 7%, neoplasias linfoides 23,5%, cáncer colorrectal 18,5%, cáncer gástrico 1,9%, tumores cerebrales 2,6%, tumores de cabeza-cuello 5,5%, tiroides 5%, mama 4%, tumores de origen desconocido 4,3%, epilepsia 1,4% y otros 11,6%. Conclusión. En nuestra experiencia el sistema híbrido PET/TC aporta ventajas en comparación con la PET y/o TC aisladamente, pero son necesarios estudios de validación diagnóstica, que estamos realizando en indicaciones clínicas concretas

Objective. To describe our experience with an integrated PET/CT system in the clinical applications in Oncology. Material and methods. An integrated PET/CT scanner is an in-line system combining a full-ring detector PET and a multidetector row helical CT in one machine. This is a multidisciplinary technique involving a nuclear medicine physician, a radiologist, a radiopharmacologist, and a physicist, with distinct tasks and working together. The clinical indications for PET scans are determined by the National Health System, which in Madrid is coordinated by Agencia Laín Entralgo, and are performed by a nuclear medicine physician with the help of a radiologist for CT interpretation. The combined PET/CT scans are supervised and interpreted by both a nuclear medicine physician and a radiologist. Results. Between September 2003 and August 2005, a total of 2459 examinations were performed at our institution: 2200 were PET scans with low-dose noncontrast-CT for attenuation correction (clinical indications approved by NHS), and 259 were combined PET/CT scans with full-diagnostic enhanced-CT (in the setting of research programmes). The overall distribution of clinical indications for the 2459 examinations were: lung cancer 14.7%, solitary lung nodule characterization 7%, lymphoma 23.5%, colon cancer 18.5%, gastric cancer 1.9%, brain tumors 2.6%, head-neck tumors 5.5%, thyroid cancer 5%, breast cancer 4%, unknown origin cancer 4.3%, epilepsy 1.4%, others 11.6%. Conclusion. In our experience, the integrated PET/CT system has advantages over the stand-alone PET and/or CT. However, more studies, as the ongoing research programmes at our facility are needed for the diagnostic validation of this technique

[Quality assessment in single-slice spiral brain CT examinations of patients with cerebrovascular accident]. / Evaluación de la calidad de los exámenes de tomografía computarizada de cerebro en la indicación de accidente cerebro-vascular agudo.

OBJECTIVES: Our objective was to apply quality criteria proposed by the European Commission (EC) Guidelines to the brain CT examinations for cerebrovascular accident (CVA) diagnosis at single-slice spiral CT scanners from five different hospitals in the Madrid area. MATERIAL AND METHODS: A sample of 100 brain CT examinations was collected and independently reviewed by five radiologists, to determine the degree of fulfilment of image quality criteria. Dose measurements were performed to estimate the values of the CT dose indexes (CTDIw, CTDIair), the dose length product (DLP), and the effective dose (E). RESULTS: Once the McNemar test was applied to the sample, the number of observers' readings was reduced to three. The quality criteria were, in general, fulfilled, since mean values of image quality score between 80% and 92% were deduced, with variation coefficients per centre in the range of 0.07-0.1. However, both visualization criteria 1.1.2 and 1.1.3 exhibited similar ranges of fulfilment (38% - 94%). The good compliance with critical reproduction criteria in the study reflected the capability of these CT scanners to create images of adequate quality, although optimisation should be achieved in some of the centres. Concerning radiation exposure, the mean values per centre of the dose quantities were in the range of 42-64 mGy for the weighted CTDI (CTDIw), 423-744 mGy x cm for DLP, and 1.1-1.9 mSv for E. CONCLUSIONS: The mean values at three centres were close to but above the reference value proposed by the EC Guidelines for CTDIw (60 mGy), and lower than the corresponding reference level for DLP (1050 mGy x cm). Dose optimisation techniques focused on the adjustment of the CTDIw-related examination parameters were proposed.

Evaluación de la calidad de los exámenes de tomografía computarizada de cerebro en la indicación de accidente cerebro vascular agudo / Quality assessment in single-slice spiral brain ct examinations of patients with cerebrovascular accident

Objetivos. El objetivo del trabajo ha sido aplicar los criterios de calidad propuestos en la Guía de la Comisión Europea sobre criterios de calidad en tomografía computarizada (TC) para exámenes de cerebro en la indicación de accidente cerebro-vascular (ACV) en cinco centros de la Comunidad de Madrid dotados de equipos de TC helicoidal de corte único. Material y métodos. Se ha recogido una muestra de 100 exámenes de cerebro que ha sido analizada independientemente por cinco radiólogos para establecer el grado de cumplimiento de los criterios de imagen propuestos. Se han efectuado medidas de dosis en los centros para estimar los valores de los índices de dosis de TC (CTDIw, CTDIair), el producto dosis-longitud (DLP) y la dosis efectiva (E). Resultados. Después de aplicar las pruebas de McNemar y de Friedman a las evaluaciones, se seleccionaron las correspondientes a tres observadores. En general se cumplieron los criterios de calidad en una proporción alta, con promedios del índice de calidad de imagen por centros entre el 80% y el 92%, y coeficientes de variación entre 0,07 y 0,1. Sin embargo, dos criterios de visualización (el 1.1.2 y el 1.1.3) se cumplieron en una proporción variable según los centros con un rango similar de cumplimiento medio (38%-94%). Los criterios de reproducción crítica se cumplieron en una mayor proporción que los de visualización, reflejando así la capacidad técnica de estos equipos para generar imágenes de calidad adecuada, aunque en algunos centros hay que optimizar los procedimientos. En cuanto a las dosis de radiación, los valores medios del CTDIw por centros estuvieron en el intervalo 42-64 mGy, los del DLP entre 423 y 744 mGy·cm y la dosis efectiva media entre 1,1 y 1,9 mSv. Conclusiones. Los valores medios del CTDIw en tres de los centros estuvieron ligeramente por encima del valor de referencia propuesto en la Guía Europea (60 mGy) y en todos por debajo del correspondiente para el DLP (1050 mGy·cm). Se han analizado y propuesto vías de optimización de la calidad de imagen y la dosis en cada centro

Objectives. Our objective was to apply quality criteria proposed by the European Commission (EC) Guidelines to the brain CT examinations for cerebrovascular accident (CVA) diagnosis at single-slice spiral CT scanners from five different hospitals in the Madrid area. Material and methods. A sample of 100 brain CT examinations was collected and independently reviewed by five radiologists, to determine the degree of fulfilment of image quality criteria. Dose measurements were performed to estimate the values of the CT dose indexes (CTDIw, CTDIair), the dose length product (DLP), and the effective dose (E). Results. Once the McNemar test was applied to the sample, the number of observers' readings was reduced to three. The quality criteria were, in general, fulfilled, since mean values of image quality score between 80% and 92% were deduced, with variation coefficients per centre in the range of 0.07-0.1. However, both visualization criteria 1.1.2 and 1.1.3 exhibited similar ranges of fulfilment (38% -- 94%). The good compliance with critical reproduction criteria in the study reflected the capability of these CT scanners to create images of adequate quality, although optimisation should be achieved in some of the centres. Concerning radiation exposure, the mean values per centre of the dose quantities were in the range of 42-64 mGy for the weighted CTDI (CTDIw), 423-744 mGy·cm for DLP, and 1.1-1.9 mSv for E. Conclusions. The mean values at three centres were close to but above the reference value proposed by the EC Guidelines for CTDIw (60 mGy), and lower than the corresponding reference level for DLP (1050 mGy·cm). Dose optimisation techniques focused on the adjustment of the CTDIw-related examination parameters were proposed

Role of computed tomography and magnetic resonance imaging in aortobronchial fistula diagnosis following aortic coarctation reparative surgery. Report of two cases.

Aortobronchial fistula (ABF) is an uncommon complication of aortic coarctation repair which may occur years after successful coarctation correction. It is invariably fatal if not diagnosed and treated. ABF diagnosis poses a challenge for clinicians and radiologists because of the difficulty in detecting the fistula and the risks associated with some of the diagnostic procedures. Two cases of ABF occurring 1 and 20 years after reparative surgery of aortic coarctation are reported. The advantages and disadvantages of different imaging procedures for the evaluation of patients with suspected ABF are reviewed and the role of computed tomography angiography and magnetic resonance imaging is underlined.

[Contrast-enhanced sonourethrography versus conventional miction cystourethrography in the assessment of the urethra: preliminary study]. / Uretrocistosonografía contrastada versus cistouretrografía miccional convencional para el estudio de la uretra: estudio preliminar.

BACKGROUND AND AIMS: Voiding cystourethrography (VCUG) is the first choice imaging modality for assessing the urethra, but this technique exposes patients to ionizing radiation. Cystosonography with echocontrast (CS) has proved to be a reliable technique to detect and grade vesicoureteral reflux (VUR) without exposing patients to ionizing radiation, but its capacity to adequately study the urethra has yet to be demonstrate in large series of patients. The aim of this study is to demonstrate the reliability of contrast-enhanced CS for assessing the urethra by comparing the results with those of the VCUG. MATERIAL AND METHODS: 108 patients were studied with ultrasound (US) using a galactose-based contrast agent. This exam was always followed by VCUG. Basal and voiding urethral US studies were performed with. Patients were studied in supine decubitus position. Girls were examined by longitudinal translabial approach, with the probe (a 7.5 MHz liner array transducer) positioned longitudinally at the introitus, to evaluate the bladder neck and urethra. In boys the transducer was initially placed longitudinally in the escrotum at ventral root of the penis to assess the bladder neck and proximal bulbar urethra, and then displaced distally toward the penile urethra. On basal study the echogenic urethral mucosa and the collapsed sonolucent urethral lumen were indentified and measured when distended. The patients were asked to void with the probe in place. During voiding attention was focused on elasticity and distention of urethral walls, as well as in the caliber of the entire urethra. Patients unable to void during either CS or VCUG were excluded. RESULTS: The bladder neck and the entire urethra were well demonstrate with CS. All females and 43 males showed a normal urethra both in CS and VCUG. Four patients were dignoses of posterior urethral valves (PUV) with CS and confirmed at VCUG, one patient had anterior urethral valves and 5 showed urethral stenosis at both techniques. Three patients with a vesicosphincteric dysinergia, 14 with resected PUV and one with a resected syringocele were adequately evaluated. Twelve girls showed vaginal reflux. The information provided by CS was equivalent to the VCUG in all patients but two with a syringocele (only seen on VCUG). CONCLUSIONS: CS is a reliable imaging modality sufficiently sensitive and specific to study the urethra, adding dynamic information to VCUG and can be used as a complement to VCUG.

Ecocistografía con contraste: una nueva modalidad de imagen para diagnosticar el reflujo vesicoureteral / Cystosonography with echoenhancer. A new imaging technique for the diagnosis of vesicoureteral refluxobjective

OBJETIVO: Analizar la utilidad de la ecografía realzada con un medio de contraste ecopotenciador (ecocistografía) para diagnosticar el reflujo vesicoureteral, comparando los resultados de esta nueva modalidad de imagen con los de la cistouretrografía miccional convencional (CUMS). PACIENTES Y MÉTODOS: Se incluyeron 169 pacientes (293 unidades renales) con edades comprendidas entre 3 días y 18 años y se estudiaron con ultrasonidos para valorar la existencia de reflujo vesicoureteral, después de rellenar la vejiga con suero salino mezclado con una suspensión de galactosa y ácido palmítico (Levograf(r)) que actúa como agente ecopotenciador. Se obtuvieron imágenes ecográficas tanto durante el llenado vesical como durante la micción. Esta exploración fue siempre seguida de una CUMS durante la misma sesión diagnóstica. RESULTADOS: En 50 unidades renales se detectó reflujo vesicoureteral pasivo tanto en ecocistografía como en la CUMS. En 22 unidades se detectó reflujo pasivo únicamente en la ecocistografía y en tres se detectó reflujo pasivo en la CUMS y la ecocistografía fue negativa. En 56 unidades renales se detectó reflujo activo por ambos procedimientos. En 17 unidades se objetivó reflujo activo en la ecocistografía y la CUMS fue normal y en cinco se observó reflujo activo en la CUMS y la ecocistografía no consiguió demostrarlo. Considerando el reflujo globalmente, de las 293 unidades renales totales, en 204 (69,6 por ciento) no se encontró reflujo vesicoureteral por ninguno de los dos procedimientos y en 63 (21,5 por ciento) unidades se detectó reflujo en ambos, independientemente de si éste era activo o pasivo. En 19 unidades se observó reflujo vesicoureteral (activo o pasivo) sólo en la ecocistografía y en siete unidades se encontró únicamente en la CUMS. La sensibilidad de la ecocistografía para detectar reflujo frente a la CUMS fue del 90,5 por ciento y la especificidad del 91,4 por ciento. CONCLUSIÓN: La ecocistografía es una modalidad de imagen útil para diagnosticar el reflujo vesicoureteral, suficientemente sensible y específica, y presenta la ventaja sobre la CUMS de que no es necesario utilizar radiaciones ionizantes (AU)

[Cystosonography with echoenhancer. A new imaging technique for the diagnosis of vesicoureteral reflux]. / Ecocistografía con contraste: una nueva modalidad de imagen para diagnosticar elreflujo vesicoureteral.

AIM: To analyze the utility of contrast enhanced ultrasonography of the bladder and kidneys (cystosonography) for the diagnosis of vesicoureteral reflux (VUR) by comparing the results of this new imaging modality with those of micturating cystourethrography (MCU). PATIENTS AND METHODS: A total of 169 patients (293 kidney units) aged between 3 days and 18 years were sonographically evaluated for the presence of VUR after filling the bladder with saline and a galactose and palmitic acid suspension (Levograf) as an echoenhancing agent. Ultrasonographic images were obtained during bladder filling and micturation. This procedure was always followed by MCU during the same diagnostic session. RESULTS: In 50 kidney units both cystosonography and MUR detected VUR during bladder filling. In 22 units, only cystosonography detected passive reflux during bladder filling and in 3 only MCU did so. In 56 units, both methods detected active VUR during micturation. In 17 units, only cystosonography detected active reflux during micturation, the results of MCU being normal, and in 5, only MCU detected active reflux. Overall, of the 293 kidney units, VUR was not detected by either of the imaging modalities in 204(69.6%) and was detected by both methods, irrespective of whether it was active or passive, in 63(21.5%). In 19 units, VUR (active or passive) was observed only by cystosonography and in 7 only by MCU. When MCU was used as the reference method, cystosonography had a sensitivity of 90.5% and a specificity of 91.4%. CONCLUSIONS: Contrastenhanced cystosonography is a reliable modality, with sufficient sensitivity and specificity in the diagnosis of VUR and does not expose patients to ionizing radiation.

Computed tomography in abdominal Castleman's disease.

Three patients with abdominal Castleman disease studied by CT are presented. Two cases corresponded to localized mesenteric disease and the third to a systemic form of the process. The CT findings are nonspecific, although a dense enhancement of the lesions can be demonstrated sometimes on dynamic CT.