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Echogenic Patterns of Local Pelvic Recurrences Following Radical Pelvic Surgery as Evaluated by Transrectal Ultrasonography
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ECHOGENIC PATTERNS OF LOCAL PELVIC RECURRENCES FOLLOWING RADICAL PELVIC SURGERY AS EVALUATED BY TRANSRECTAL ULTRASONOGRAPHY. Raul 0, Parra*, St. Louis, MO, Richard M. Wolf and Robert P. Huben, Buffalo, NY (Presentation to be made by Dr. Parra)
IN-OFFICE ULTRASONOGRAPHY (IOUS) 'ID IMAGE THE KIDNEYS AND BLADDERS OF CHIWREN. Max 1-',aizels, Mark R. Zaontz*, Daniel L. Houlihan*, and Casimir F. Firlit. Chicago, IL (Presentation to be made by Dr. Maizels). The availability of portable ultrasound scanners prompte:J. us to evaluate the usefulness of personally scanning the urinary tract of children in an office setting. Herein, we present the first experience with in-office ultrasonography (IOUS) for children with urological problems. Since February, 1986 we prospectively :inBged the kidneys and bladders of 172 children who presented for office evaluation using a pcrtable 5 MHz real tine linear array scanner. Initially, we gained familiarity with IOUS by examining 38 children with problems not recognized to be associated with renal malfornations(i.e., undescended testis); IOUS showed hydronephrosis in one boy with buried penis which was later found to be due to a ureteropelvic junction obstruction. Then, we used the IOUS to supplement the office evaluation of children with a history of urine infection, voiding problems, or known renal malfonnations. The IOUS showed 12 (50%) of 24 children with a history of urine infection had: thickened detrusor, large bladder capacity with/without residual urme, or reduced sensation to void. The IOUS showed 24 (32%) of 74 children with voiding problems had: thickened detrusor, SITall/large bladder capacity with/without residual urine, fecal inpaction, or suspected bladder neck obstruction (which was later found to require internal urethrotomy) . In 35 children with known renal rralfonnations, the IOUS was useful to assess the progress or to clarify the etiology of hydronephrosis. The C:iaqnostic value of the IOUS was able to be assessed in 98 c.hiicre.n ¼here enough data was available to compare the results of the IOUS vs. the results of subsequent urography or clinical outcorre; the IOUS had a 98% sensitivity and an 82% specificity. We conclude the IOUS is reliable to identify: incomplete bladder emptying in children with urine infection related to dysfunctional voiding, detrusor thickening related to the "unstable" bladder, and the likely etiol0c,,y of hydronephrosis.
We have used transrectal ultrasonography as a means of objectively assessing local pelvic recurrences following radical cystectomy and prostatectomy in a total of 18 patients. Of these, 10 were post radical cystectomy and 8 post radical prostatectomy. The echogenicity of the lesions were studied for each group. Of those patients with prostatic recurrences, 7 of 8, or 87.5%, had hypoechoich echo patterns, and in l, or 12.5%, the pattern was isoechoiche In the group with recurrences after cystectomy, 6 of 10, or 60%, the echo pattern was hypoechoich vs 4, or 40%, in which the pattern was found to be isoechoich. In none of the studies was a hyperechoich pattern identified. We conclude that transrectal ultrasonography represents a valuable and re.liable method of evaluating and following local pelvic recurrences after radical pelvic surgery, and that the echogenic pattern is predominantly hypoechoich.
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560
MAGNETIC RESONANCE IMAGING OF KIDNEYS FOLLOWING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY, *Bruce R. Baumgartner,
CXMPARISON OF MAGNETIC RESONANCE IMAGING AND CCMPUTED 'IDMJ-GRAPHY IN THE DIAGNOSIS AND STAGING OF RENAL MASSES *Bradley L. Willoughby, ''William T. Yuh, *1'bnzer M. AbuYousef, Icwa City, IA (Presentation to be made by Dr. Willoughby) Preliminary studies have shawn that renal masses are nure accurately staged by magnetic resonance (MR) than computed tomography (CT) imaging but ccmparative prospective studies with pathologic staging are few. MR and CT images were obtained on 27 patients with renal neoplasms, Lesions included renal cell carcinomas (22), oncocytomas (3), oomplex cysts (1) and vascular anolffilies (1). Pathologic diagnosis and staging was obtained in 26 of 27 cases. MR was !1Dre accurate than CT in discriminating benign from malignant lesions (correct di.agnosis 89% vs. 81%); however, no oncocytorna feature allcwed differentiation from renal cell carcinoo,a. MR was superior in dem:mstrating extracapsular extension, renal vein or vena cav-a protrusion and separation from surrowoding organs, MR correctly staged 91% of renal cell carcinomas vs. 77% by CT. '.Ihe ability to image in three orthogonal planes and enhance:'! definition of tissues allows precise diagnosis and staging of renal 1!13.SSes.
*Kevin W. Dickey, *Rendon C. Nelson, Samuel S. Ambrose, Kenneth N. Walton, and *Michael E. Bernardino, Atlanta,
GA,
(Presentation to be made by Dr. Baumgartner). MRI scans were obtained the day following extracorpor-
eal shock wave lithotripsy (ESWL) therapy in 34 patients to evaluate for possible renal damage or other complication. The untreated kidneys, with or without calculi, acted as controls. Five patients had ESWL to both kidneys prior to MRI. The kidneys were studied with spin echo, rnultislice images using Tl-weighted pulse sequences" Ultrasonography was also performed the same day as the
MRI in 21 patients. MRI studies of the 39 kidneys following ESWL showed one or more abnormality in 29 (7 5%) cases" Small subcapsular or perinephric fluid collections were noted in ten (25%) patients. Ultrasonography in 6 of these 10 patients demonstrated no fluid; ultrasound studies were not available in the other four patients. Generalized loss of
corticomedullary junction (CMJ) was noted in 8 (21%) cases and focal loss in 16 (42%). One patient with adult polycystic kidney disease (APKD) had MRI before and after ESWL and had no CMJ on either. The more pronounced alterations in the Ct-U correlate with increased numbers of shock waves received by the kidney. Hydronephrosis was detected by MRI in eight treated patients, six of whom had some CMJ alteration. In addition) focal areas
of increased signal intensity (7) or decreased signal (3) were noted in the kidney after shock treatment, including the patient with APKD. Abnormalities commonly occur in the kidneys after ESWL treatment and subtle changes
detected by MRI may not be apparent with other imaging techniques, The resultant clinical significance of these findings is not yet determined.
243A
.. :-.-
557
558
ECHOGENIC PATTERNS OF LOCAL PELVIC RECURRENCES FOLLOWING RADICAL PELVIC SURGERY AS EVALUATED BY TRANSRECTAL ULTRASONOGRAPHY. Raul 0, Parra*, St. Louis, MO, Richard M. Wolf and Robert P. Huben, Buffalo, NY (Presentation to be made by Dr. Parra)
IN-OFFICE ULTRASONOGRAPHY (IOUS) 'ID IMAGE THE KIDNEYS AND BLADDERS OF CHIWREN. Max 1-',aizels, Mark R. Zaontz*, Daniel L. Houlihan*, and Casimir F. Firlit. Chicago, IL (Presentation to be made by Dr. Maizels). The availability of portable ultrasound scanners prompte:J. us to evaluate the usefulness of personally scanning the urinary tract of children in an office setting. Herein, we present the first experience with in-office ultrasonography (IOUS) for children with urological problems. Since February, 1986 we prospectively :inBged the kidneys and bladders of 172 children who presented for office evaluation using a pcrtable 5 MHz real tine linear array scanner. Initially, we gained familiarity with IOUS by examining 38 children with problems not recognized to be associated with renal malfornations(i.e., undescended testis); IOUS showed hydronephrosis in one boy with buried penis which was later found to be due to a ureteropelvic junction obstruction. Then, we used the IOUS to supplement the office evaluation of children with a history of urine infection, voiding problems, or known renal malfonnations. The IOUS showed 12 (50%) of 24 children with a history of urine infection had: thickened detrusor, large bladder capacity with/without residual urme, or reduced sensation to void. The IOUS showed 24 (32%) of 74 children with voiding problems had: thickened detrusor, SITall/large bladder capacity with/without residual urine, fecal inpaction, or suspected bladder neck obstruction (which was later found to require internal urethrotomy) . In 35 children with known renal rralfonnations, the IOUS was useful to assess the progress or to clarify the etiology of hydronephrosis. The C:iaqnostic value of the IOUS was able to be assessed in 98 c.hiicre.n ¼here enough data was available to compare the results of the IOUS vs. the results of subsequent urography or clinical outcorre; the IOUS had a 98% sensitivity and an 82% specificity. We conclude the IOUS is reliable to identify: incomplete bladder emptying in children with urine infection related to dysfunctional voiding, detrusor thickening related to the "unstable" bladder, and the likely etiol0c,,y of hydronephrosis.
We have used transrectal ultrasonography as a means of objectively assessing local pelvic recurrences following radical cystectomy and prostatectomy in a total of 18 patients. Of these, 10 were post radical cystectomy and 8 post radical prostatectomy. The echogenicity of the lesions were studied for each group. Of those patients with prostatic recurrences, 7 of 8, or 87.5%, had hypoechoich echo patterns, and in l, or 12.5%, the pattern was isoechoiche In the group with recurrences after cystectomy, 6 of 10, or 60%, the echo pattern was hypoechoich vs 4, or 40%, in which the pattern was found to be isoechoich. In none of the studies was a hyperechoich pattern identified. We conclude that transrectal ultrasonography represents a valuable and re.liable method of evaluating and following local pelvic recurrences after radical pelvic surgery, and that the echogenic pattern is predominantly hypoechoich.
559
560
MAGNETIC RESONANCE IMAGING OF KIDNEYS FOLLOWING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY, *Bruce R. Baumgartner,
CXMPARISON OF MAGNETIC RESONANCE IMAGING AND CCMPUTED 'IDMJ-GRAPHY IN THE DIAGNOSIS AND STAGING OF RENAL MASSES *Bradley L. Willoughby, ''William T. Yuh, *1'bnzer M. AbuYousef, Icwa City, IA (Presentation to be made by Dr. Willoughby) Preliminary studies have shawn that renal masses are nure accurately staged by magnetic resonance (MR) than computed tomography (CT) imaging but ccmparative prospective studies with pathologic staging are few. MR and CT images were obtained on 27 patients with renal neoplasms, Lesions included renal cell carcinomas (22), oncocytomas (3), oomplex cysts (1) and vascular anolffilies (1). Pathologic diagnosis and staging was obtained in 26 of 27 cases. MR was !1Dre accurate than CT in discriminating benign from malignant lesions (correct di.agnosis 89% vs. 81%); however, no oncocytorna feature allcwed differentiation from renal cell carcinoo,a. MR was superior in dem:mstrating extracapsular extension, renal vein or vena cav-a protrusion and separation from surrowoding organs, MR correctly staged 91% of renal cell carcinomas vs. 77% by CT. '.Ihe ability to image in three orthogonal planes and enhance:'! definition of tissues allows precise diagnosis and staging of renal 1!13.SSes.
*Kevin W. Dickey, *Rendon C. Nelson, Samuel S. Ambrose, Kenneth N. Walton, and *Michael E. Bernardino, Atlanta,
GA,
(Presentation to be made by Dr. Baumgartner). MRI scans were obtained the day following extracorpor-
eal shock wave lithotripsy (ESWL) therapy in 34 patients to evaluate for possible renal damage or other complication. The untreated kidneys, with or without calculi, acted as controls. Five patients had ESWL to both kidneys prior to MRI. The kidneys were studied with spin echo, rnultislice images using Tl-weighted pulse sequences" Ultrasonography was also performed the same day as the
MRI in 21 patients. MRI studies of the 39 kidneys following ESWL showed one or more abnormality in 29 (7 5%) cases" Small subcapsular or perinephric fluid collections were noted in ten (25%) patients. Ultrasonography in 6 of these 10 patients demonstrated no fluid; ultrasound studies were not available in the other four patients. Generalized loss of
corticomedullary junction (CMJ) was noted in 8 (21%) cases and focal loss in 16 (42%). One patient with adult polycystic kidney disease (APKD) had MRI before and after ESWL and had no CMJ on either. The more pronounced alterations in the Ct-U correlate with increased numbers of shock waves received by the kidney. Hydronephrosis was detected by MRI in eight treated patients, six of whom had some CMJ alteration. In addition) focal areas
of increased signal intensity (7) or decreased signal (3) were noted in the kidney after shock treatment, including the patient with APKD. Abnormalities commonly occur in the kidneys after ESWL treatment and subtle changes
detected by MRI may not be apparent with other imaging techniques, The resultant clinical significance of these findings is not yet determined.
243A