HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Goldman, S. M. Articles by Sandler, C. M. Search for Related Content PubMed PubMed Citation Articles by Goldman, S. M. Articles by Sandler, C. M.

Genitourinary Imaging: The Past 40 Years¹

¹ From the Department of Radiology, University of Texas–Houston Medical School, 6431 Fannin St, MSB 2.132, Houston, TX 77030. Received October 6, 1999; revision requested November 1; revision received December 14; accepted December 20. Address correspondence to S.M.G. (e-mail: chairman@msrad3.med.uth.tmc.edu).

View larger version (95K): [in a new window]   Figure 1. Anteroposterior retrograde air pyelogram demonstrates upper pole stones (arrowhead). This technique was still used by some urologists into the 1970s to demonstrate stones. Air introduced into the collecting system is still used by many interventional uroradiologists to identify posterior calices prior to percutaneous nephrostomy.

View larger version (97K): [in a new window]   Figure 2a. Renal cysts in a 49-year-old woman with vague abdominal pain. (a) Oblique IVU image shows a medial lower pole mass (arrow) displacing and distorting the renal pelvis and lower calices. (b) High-dose bolus nephrotomogram obtained in a steeply oblique position demonstrates the same mass (arrowheads) to be lucent and largely well defined. However, a thin, smooth rim could not unequivocally be demonstrated overlying the contrast material-filled calices (arrows). (c, d) Anteroposterior selective arteriograms, therefore, were obtained that showed the mass to be avascular except for a few tumor vessels (arrowhead in c) suspected medially. (e) Anteroposterior selective arteriogram with epinephrine reveals marked decrease in blood flow to the kidney and no tumor vascularity, which indicates that the lesion is a simple cyst.

View larger version (77K): [in a new window]   Figure 2b. Renal cysts in a 49-year-old woman with vague abdominal pain. (a) Oblique IVU image shows a medial lower pole mass (arrow) displacing and distorting the renal pelvis and lower calices. (b) High-dose bolus nephrotomogram obtained in a steeply oblique position demonstrates the same mass (arrowheads) to be lucent and largely well defined. However, a thin, smooth rim could not unequivocally be demonstrated overlying the contrast material-filled calices (arrows). (c, d) Anteroposterior selective arteriograms, therefore, were obtained that showed the mass to be avascular except for a few tumor vessels (arrowhead in c) suspected medially. (e) Anteroposterior selective arteriogram with epinephrine reveals marked decrease in blood flow to the kidney and no tumor vascularity, which indicates that the lesion is a simple cyst.

View larger version (94K): [in a new window]   Figure 2c. Renal cysts in a 49-year-old woman with vague abdominal pain. (a) Oblique IVU image shows a medial lower pole mass (arrow) displacing and distorting the renal pelvis and lower calices. (b) High-dose bolus nephrotomogram obtained in a steeply oblique position demonstrates the same mass (arrowheads) to be lucent and largely well defined. However, a thin, smooth rim could not unequivocally be demonstrated overlying the contrast material-filled calices (arrows). (c, d) Anteroposterior selective arteriograms, therefore, were obtained that showed the mass to be avascular except for a few tumor vessels (arrowhead in c) suspected medially. (e) Anteroposterior selective arteriogram with epinephrine reveals marked decrease in blood flow to the kidney and no tumor vascularity, which indicates that the lesion is a simple cyst.

View larger version (106K): [in a new window]   Figure 2d. Renal cysts in a 49-year-old woman with vague abdominal pain. (a) Oblique IVU image shows a medial lower pole mass (arrow) displacing and distorting the renal pelvis and lower calices. (b) High-dose bolus nephrotomogram obtained in a steeply oblique position demonstrates the same mass (arrowheads) to be lucent and largely well defined. However, a thin, smooth rim could not unequivocally be demonstrated overlying the contrast material-filled calices (arrows). (c, d) Anteroposterior selective arteriograms, therefore, were obtained that showed the mass to be avascular except for a few tumor vessels (arrowhead in c) suspected medially. (e) Anteroposterior selective arteriogram with epinephrine reveals marked decrease in blood flow to the kidney and no tumor vascularity, which indicates that the lesion is a simple cyst.

View larger version (106K): [in a new window]   Figure 2e. Renal cysts in a 49-year-old woman with vague abdominal pain. (a) Oblique IVU image shows a medial lower pole mass (arrow) displacing and distorting the renal pelvis and lower calices. (b) High-dose bolus nephrotomogram obtained in a steeply oblique position demonstrates the same mass (arrowheads) to be lucent and largely well defined. However, a thin, smooth rim could not unequivocally be demonstrated overlying the contrast material-filled calices (arrows). (c, d) Anteroposterior selective arteriograms, therefore, were obtained that showed the mass to be avascular except for a few tumor vessels (arrowhead in c) suspected medially. (e) Anteroposterior selective arteriogram with epinephrine reveals marked decrease in blood flow to the kidney and no tumor vascularity, which indicates that the lesion is a simple cyst.

View larger version (116K): [in a new window]   Figure 3a. (a) Anteroposterior retrograde pyelogram demonstrates autosomal dominant polycystic renal disease. The kidneys are enlarged with distorted calices (arrows) that are compressed by multiple intrarenal cysts. An IVU image could not be obtained because the patient had renal failure. (b) Contemporary US image obtained from the extended longitudinal view of the right kidney shows autosomal dominant polycystic renal disease. The cursors denote the length and width of the kidney: 210.4 x 68.6 mm. C = cyst. (c) Transverse computed tomographic (CT) and (d) coronal T1-weighted magnetic resonance (MR) (16/800 [repetition time msec/echo time msec]) images show the cysts (C).

View larger version (107K): [in a new window]   Figure 3b. (a) Anteroposterior retrograde pyelogram demonstrates autosomal dominant polycystic renal disease. The kidneys are enlarged with distorted calices (arrows) that are compressed by multiple intrarenal cysts. An IVU image could not be obtained because the patient had renal failure. (b) Contemporary US image obtained from the extended longitudinal view of the right kidney shows autosomal dominant polycystic renal disease. The cursors denote the length and width of the kidney: 210.4 x 68.6 mm. C = cyst. (c) Transverse computed tomographic (CT) and (d) coronal T1-weighted magnetic resonance (MR) (16/800 [repetition time msec/echo time msec]) images show the cysts (C).

View larger version (110K): [in a new window]   Figure 3c. (a) Anteroposterior retrograde pyelogram demonstrates autosomal dominant polycystic renal disease. The kidneys are enlarged with distorted calices (arrows) that are compressed by multiple intrarenal cysts. An IVU image could not be obtained because the patient had renal failure. (b) Contemporary US image obtained from the extended longitudinal view of the right kidney shows autosomal dominant polycystic renal disease. The cursors denote the length and width of the kidney: 210.4 x 68.6 mm. C = cyst. (c) Transverse computed tomographic (CT) and (d) coronal T1-weighted magnetic resonance (MR) (16/800 [repetition time msec/echo time msec]) images show the cysts (C).

View larger version (110K): [in a new window]   Figure 3d. (a) Anteroposterior retrograde pyelogram demonstrates autosomal dominant polycystic renal disease. The kidneys are enlarged with distorted calices (arrows) that are compressed by multiple intrarenal cysts. An IVU image could not be obtained because the patient had renal failure. (b) Contemporary US image obtained from the extended longitudinal view of the right kidney shows autosomal dominant polycystic renal disease. The cursors denote the length and width of the kidney: 210.4 x 68.6 mm. C = cyst. (c) Transverse computed tomographic (CT) and (d) coronal T1-weighted magnetic resonance (MR) (16/800 [repetition time msec/echo time msec]) images show the cysts (C).

View larger version (117K): [in a new window]   Figure 4. Normal seminal vesiculogram. The anteroposterior antegrade image was obtained by means of cutdown on the vas deferens in the scrotum and demonstrates a moderate amount of extravasation of contrast material at the injection site.

View larger version (120K): [in a new window]   Figure 5. Anteroposterior retroperitoneal pneumogram following injection of intravenous contrast material demonstrates a normal adrenal gland (A).

View larger version (146K): [in a new window]   Figure 6. Anteroposterior abdominal aortogram shows a large adrenal tumor in a 51-year-old man. The tumor is demonstrated by bowing of the inferior adrenal artery (arrowheads). The arrow points to abnormally enlarged tumor vessels within the mass.

View larger version (116K): [in a new window]   Figure 7a. Large right upper pole renal cyst in a 57-year-old man not appreciated on (a) a routine anteroposterior IVU image but readily seen on (b) an anteroposterior tomogram. (c) Double-contrast cyst puncture radiograph obtained cross-table with the patient in the lateral prone position shows the walls to be smooth (arrows in b and c). The layer between the contrast material and the air (A) is normal cyst fluid.

View larger version (108K): [in a new window]   Figure 7b. Large right upper pole renal cyst in a 57-year-old man not appreciated on (a) a routine anteroposterior IVU image but readily seen on (b) an anteroposterior tomogram. (c) Double-contrast cyst puncture radiograph obtained cross-table with the patient in the lateral prone position shows the walls to be smooth (arrows in b and c). The layer between the contrast material and the air (A) is normal cyst fluid.

View larger version (106K): [in a new window]   Figure 7c. Large right upper pole renal cyst in a 57-year-old man not appreciated on (a) a routine anteroposterior IVU image but readily seen on (b) an anteroposterior tomogram. (c) Double-contrast cyst puncture radiograph obtained cross-table with the patient in the lateral prone position shows the walls to be smooth (arrows in b and c). The layer between the contrast material and the air (A) is normal cyst fluid.

View larger version (175K): [in a new window]   Figure 8. Coronal B-mode longitudinal US scan of the left kidney obtained by using black on a white background shows a renal cyst (C). Note the anechoic nature of the lesion and its enhanced back wall.

View larger version (169K): [in a new window]   Figure 9a. Early generation transverse CT scans of renal cell carcinoma. (a) Transverse image shows a large tumor mass (M) is present in the right kidney with extension into the right renal vein and inferior vena cava (arrow). (b) Transverse CT scan in a different patient shows a left renal cell carcinoma with extension (arrow) through the renal capsule and Gerota fascia.

View larger version (143K): [in a new window]   Figure 9b. Early generation transverse CT scans of renal cell carcinoma. (a) Transverse image shows a large tumor mass (M) is present in the right kidney with extension into the right renal vein and inferior vena cava (arrow). (b) Transverse CT scan in a different patient shows a left renal cell carcinoma with extension (arrow) through the renal capsule and Gerota fascia.

View larger version (174K): [in a new window]   Figure 10. Early generation transverse CT image demonstrates angiomyolipoma. The lesion (T) arising from the ventral aspect of the right kidney has virtually the same attenuation as that of the retroperitoneal fat, which indicates its true nature.

View larger version (133K): [in a new window]   Figure 11a. Transverse CT scans of a right adrenal adenoma (arrowhead in a and b) in a 63-year-old man with weight loss and asbestos exposure. (a) The CT attenuation during the dynamic phase of contrast enhancement was 29 HU. (b) Fifteen minutes after the injection of contrast material, the attenuation was 8 HU.

View larger version (142K): [in a new window]   Figure 11b. Transverse CT scans of a right adrenal adenoma (arrowhead in a and b) in a 63-year-old man with weight loss and asbestos exposure. (a) The CT attenuation during the dynamic phase of contrast enhancement was 29 HU. (b) Fifteen minutes after the injection of contrast material, the attenuation was 8 HU.

View larger version (134K): [in a new window]   Figure 12a. Transverse fast multiplanar spoiled gradient-echo MR image of bilateral adrenal adenomas (arrowheads in a and b). Note the loss of signal intensity in the adrenal adenomas compared with the liver on (a) the out-of-phase image (150/1.9) in contrast to (b) the in-phase image (150/4.2).

View larger version (122K): [in a new window]   Figure 12b. Transverse fast multiplanar spoiled gradient-echo MR image of bilateral adrenal adenomas (arrowheads in a and b). Note the loss of signal intensity in the adrenal adenomas compared with the liver on (a) the out-of-phase image (150/1.9) in contrast to (b) the in-phase image (150/4.2).

View larger version (154K): [in a new window]   Figure 13a. Renal cell carcinoma in a 46-year-old man with acquired immunodeficiency syndrome. Transverse dynamic spiral CT scans obtained in (a) the nephrographic phase and (b) the excretory phase both show the tumor (T). The nephrographic phase shows a normal renal vein (v in a) and more of the inhomogeneous nature of the tumor.

View larger version (150K): [in a new window]   Figure 13b. Renal cell carcinoma in a 46-year-old man with acquired immunodeficiency syndrome. Transverse dynamic spiral CT scans obtained in (a) the nephrographic phase and (b) the excretory phase both show the tumor (T). The nephrographic phase shows a normal renal vein (v in a) and more of the inhomogeneous nature of the tumor.

View larger version (133K): [in a new window]   Figure 14a. (a) Coronal three-dimensional fast gradient-echo dynamic contrast-enhanced MR angiogram (6/1.3, 45° flip angle) and (b) coronal single-shot fast spin-echo MR urogram (2,047/620, 10-cm section thickness) in a healthy renal donor. Note the excellent demonstration of the main renal arteries bilaterally. The renal veins and inferior vena cava (arrow in a) are also well shown. On the urogram, the collecting systems and ureters, as well as a distended urinary bladder, are well shown.

View larger version (83K): [in a new window]   Figure 14b. (a) Coronal three-dimensional fast gradient-echo dynamic contrast-enhanced MR angiogram (6/1.3, 45° flip angle) and (b) coronal single-shot fast spin-echo MR urogram (2,047/620, 10-cm section thickness) in a healthy renal donor. Note the excellent demonstration of the main renal arteries bilaterally. The renal veins and inferior vena cava (arrow in a) are also well shown. On the urogram, the collecting systems and ureters, as well as a distended urinary bladder, are well shown.

View larger version (127K): [in a new window]   Figure 15a. Transverse nonenhanced helical CT scans demonstrate acute right ureteral obstruction secondary to a distal ureteral calculus. (a) Image obtained through the middle portion of the kidneys shows dilatation of the right renal pelvis (p) and moderate perinephric stranding (arrow) and edema. (b) The obstructing calculus (arrow) is seen in the right ureterovesical junction.

View larger version (130K): [in a new window]   Figure 15b. Transverse nonenhanced helical CT scans demonstrate acute right ureteral obstruction secondary to a distal ureteral calculus. (a) Image obtained through the middle portion of the kidneys shows dilatation of the right renal pelvis (p) and moderate perinephric stranding (arrow) and edema. (b) The obstructing calculus (arrow) is seen in the right ureterovesical junction.

View larger version (126K): [in a new window]   Figure 16a. Fistula to the bladder secondary to Crohn disease in a 19-year-old man with hematuria and particulate matter in the urine. (a) Transverse CT scan of the bladder shows a small pocket of air (arrowhead) trapped just beneath the bladder mucosa. (b) Transverse CT scan obtained at a higher level shows the inflamed thickened small bowel (arrowhead).

View larger version (145K): [in a new window]   Figure 16b. Fistula to the bladder secondary to Crohn disease in a 19-year-old man with hematuria and particulate matter in the urine. (a) Transverse CT scan of the bladder shows a small pocket of air (arrowhead) trapped just beneath the bladder mucosa. (b) Transverse CT scan obtained at a higher level shows the inflamed thickened small bowel (arrowhead).

View larger version (109K): [in a new window]   Figure 17a. Acute testicular torsion. (a) Transverse color Doppler US image of both the right (R) and left (L) hemiscrotums show absence of perfusion in the left testicle as a result of acute testicular torsion. (b) Coronal color Doppler US image of the left testicle also shows no arterial flow. (c) Coronal color Doppler US image of the right testicle (T) is normal.

View larger version (106K): [in a new window]   Figure 17b. Acute testicular torsion. (a) Transverse color Doppler US image of both the right (R) and left (L) hemiscrotums show absence of perfusion in the left testicle as a result of acute testicular torsion. (b) Coronal color Doppler US image of the left testicle also shows no arterial flow. (c) Coronal color Doppler US image of the right testicle (T) is normal.

View larger version (109K): [in a new window]   Figure 17c. Acute testicular torsion. (a) Transverse color Doppler US image of both the right (R) and left (L) hemiscrotums show absence of perfusion in the left testicle as a result of acute testicular torsion. (b) Coronal color Doppler US image of the left testicle also shows no arterial flow. (c) Coronal color Doppler US image of the right testicle (T) is normal.

View larger version (162K): [in a new window]   Figure 18a. Chronic testicular torsion in a 29-year-old man with 2-3 days of testicular pain. (a) Anteroposterior delayed nuclear medicine scan obtained with the use of technetium 99m diethylenetriamine pentaacetic acid shows absence of uptake in the testicle with increased flow to the scrotal skin (arrow). (b) Transverse power Doppler US image also demonstrates absence of perfusion in the testicle itself, with a rim (arrows) of peripheral hyperemia. (c) Transverse gray-scale US image shows inhomogeneity in the testis (T), which is indicative of infarction. Cursors denote the overall size of the testis to be 20.5 x 32.3 mm.

View larger version (162K): [in a new window]   Figure 18b. Chronic testicular torsion in a 29-year-old man with 2-3 days of testicular pain. (a) Anteroposterior delayed nuclear medicine scan obtained with the use of technetium 99m diethylenetriamine pentaacetic acid shows absence of uptake in the testicle with increased flow to the scrotal skin (arrow). (b) Transverse power Doppler US image also demonstrates absence of perfusion in the testicle itself, with a rim (arrows) of peripheral hyperemia. (c) Transverse gray-scale US image shows inhomogeneity in the testis (T), which is indicative of infarction. Cursors denote the overall size of the testis to be 20.5 x 32.3 mm.

View larger version (172K): [in a new window]   Figure 18c. Chronic testicular torsion in a 29-year-old man with 2-3 days of testicular pain. (a) Anteroposterior delayed nuclear medicine scan obtained with the use of technetium 99m diethylenetriamine pentaacetic acid shows absence of uptake in the testicle with increased flow to the scrotal skin (arrow). (b) Transverse power Doppler US image also demonstrates absence of perfusion in the testicle itself, with a rim (arrows) of peripheral hyperemia. (c) Transverse gray-scale US image shows inhomogeneity in the testis (T), which is indicative of infarction. Cursors denote the overall size of the testis to be 20.5 x 32.3 mm.

View larger version (149K): [in a new window]   Figure 19. Anteroposterior upright radiograph from an IVU shows a dermoid cyst of the ovary. Note the characteristic teethlike calcification (arrowhead) in the dermoid cyst. Pelvic floor relaxation is present as an incidental finding.

View larger version (101K): [in a new window]   Figure 20. Posteroanterior pelvic pneumogram shows polycystic ovaries. This image was obtained by injecting air or carbon dioxide intraperitoneally. The patient was then tilted with the head down in the prone position. In so doing, the rising air or carbon dioxide outlined the enlarged ovaries (O) and the normal-sized uterus (U). The bladder (B) is seen, as is the bowel.

View larger version (138K): [in a new window]   Figure 21a. Bilateral invasive ovarian cancer in a 74-year-old woman. (a) Anteroposterior IVU image shows a large mass (M) of soft-tissue arising from the pelvis and partially obstructing the right ureter. R = right. (b) Anteroposterior image obtained during barium enema examination performed the same day shows elevation of a redundant sigmoid colon on the left side (arrowhead). On the right side, the mass separates and lifts the cecum and distal ileum (solid arrow) and compresses the sigmoid colon (open arrow). (c) Transverse CT scan shows an extensive invasive mass (M).

View larger version (131K): [in a new window]   Figure 21b. Bilateral invasive ovarian cancer in a 74-year-old woman. (a) Anteroposterior IVU image shows a large mass (M) of soft-tissue arising from the pelvis and partially obstructing the right ureter. R = right. (b) Anteroposterior image obtained during barium enema examination performed the same day shows elevation of a redundant sigmoid colon on the left side (arrowhead). On the right side, the mass separates and lifts the cecum and distal ileum (solid arrow) and compresses the sigmoid colon (open arrow). (c) Transverse CT scan shows an extensive invasive mass (M).

View larger version (134K): [in a new window]   Figure 21c. Bilateral invasive ovarian cancer in a 74-year-old woman. (a) Anteroposterior IVU image shows a large mass (M) of soft-tissue arising from the pelvis and partially obstructing the right ureter. R = right. (b) Anteroposterior image obtained during barium enema examination performed the same day shows elevation of a redundant sigmoid colon on the left side (arrowhead). On the right side, the mass separates and lifts the cecum and distal ileum (solid arrow) and compresses the sigmoid colon (open arrow). (c) Transverse CT scan shows an extensive invasive mass (M).

View larger version (116K): [in a new window]   Figure 22. Chain cystourethrogram for evaluation of stress urinary incontinence. Sagittal image of the bladder from the lateral view was obtained after insertion of a copper chain into the urethra and bladder. The chain allows demonstration of the urethrovesical angles when the patient strains, the measurement of which constitutes the major criterion for classifying stress incontinence according to Green (71).

View larger version (160K): [in a new window]   Figure 23. Coronal endovaginal hysterosonogram demonstrates a large endometrial polyp (arrow).