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PURPOSE: To evaluate the clinical utility of dynamic gadolinium-enhanced magnetic resonance (MR) imaging of the breast with commercially available techniques in patients scheduled for excisional biopsy. MATERIALS AND METHODS: A total of 91 breast abnormalities, 70 benign and 21 malignant, were evaluated. Thin-section three-dimensional gradient-echo images were obtained before and 2, 4, and 7 minutes after injection of contrast material. Three radiologists prospectively evaluated the mammograms and MR images. RESULTS: The areas under the receiver operating characteristic curves were 0.820 for mammography and 0.893 for MR imaging (P = .67). Sensitivity of MR imaging was 82.5%, compared with 74.6% for mammography. Specificity of MR imaging was 82.5%, compared with 79.1% for mammography. Enhancement profiles showed early intense enhancement in malignancies but considerable overlap with enhancement of benign disease. CONCLUSION: Breast MR imaging is a slightly more sensitive modality than mammography but not a highly specific technique for evaluating breast lesions. It has utility in several clinical situations but should not be used as a substitute for biopsy or general screening.

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Does a normal leg phlebogram exclude deep venous thrombosis (DVT)? Is it safe not to anticoagulate patients with suspected DVT and a normal phlebogram? To answer these questions a retrospective study was undertaken of 71 outpatients with clinically suspected DVT and a normal phlebogram. Patients were followed for 5 months on the average; data were obtained from conversations with referring physicians and interviews with patients. Nine patients were excluded from the study because of incomplete follow-up data; four others were excluded because they were treated with coumadin "on clinical grounds". Five patients continued having symptoms subsequently attributed to arthritis, cellulitis and/or venous stasis. Fifty-three patients had no venous thromboembolic problems during the follow-up period and their symptoms subsided without therapy. We conclude that a properly performed normal leg phlebogram excludes a diagnosis of clinically significant DVT. No patient in this study developed problems because anticoagulant therapy was withheld based on a negative phlebogram.

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Technical factors and diagnostic criteria that permit discrimination among diseases of the renal sinus are described. Because the size of the collecting system changes with the state of hydration, a standard approach permits optimal comparison of examinations performed on different occasions. A fluid challenge is indicated if relative or partial obstruction is suspected. Ureteric compression permits optimal delineation of the collecting system but is indicated only in selected situations. Both tumor and blood clot within the renal sinus appear as echogenic masses without a significant acoustic shadow. Serial ultrasound studies demonstrate the resolution of the blood clot. Both in vivo and in vitro studies of renal stones demonstrate that the acoustic shadow of nephrolithiasis is best seen with low gain and with the stone within the focal zone of the transducer.

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Computed body tomography has become useful in the diagnosis of pancreatic disease. Pancreatitis frequently results in lateral and posterior extension of inflammatory tissue into the pararenal fat planes, which can be visualized by CT. In our series it was associated with clinically diagnosed pancreatitis. Of 100 cases studied for abdominal pathology where pancreatic visualization was optimum, 10 had enlargement of the pancreas with destruction of soft tissue planes extending into the left pararenal space and clinical findings of pancreatitis. Carcinoma of the pancreas was identified in 12; no abnormality was identified in 49; the remaining cases were mixed intraabdominal and retroperitoneal pathology. The value of this sign lies in separating inflammatory processes from neoplastic disease; the sign was not found in normals.

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A prospective evaluation of computed tomography and ultrasound was performed on 24 consecutive patients with suspected pelvic masses. Of the 24 patients, 22 had subsequent surgical identification of abnormalities; two were considered normal on clinical follow-up. Ultrasound provided important clinical information in 17 of 24 patients; CT in 15 of 24 patients. There were three false negative examinations with each method and no false positives. Differentiation between benign and malignant disease could not be made in four of 24 patients by ultrasound and five of 24 patients by CT. Because both imaging techniques depict similar pathology and use similar diagnostic criteria, the two methods tend not to be complementary.

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A pulse Doppler device linked to a commercially available B-mode ultrasound scanner permits the origin of the Doppler signals to be located accurately on the B-scan by a bright-up cursor. Case histories illustrate the clinical application of this device in differentiating between vascular and nonvascular structures, or patent and thrombosed vessels. This is especially valuable when there is pathological distortion of the anatomy.

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Although oral cholecystography is a highly accurate investigation for the diagnosis of gallbladder disease, false normal examinations do occur. In other patients, the presence of jaundice, nausea, or vomiting may preclude oral cholecystography. When there is clinical suspicion of gallbladder disease with a normal or equivocal oral cholecystogram, ultrasound examination is a highly accurate alternative imaging procedure. We describe in this article three patients with apparently normal oral cholecystography who were found to have obvious gallstones on ultrasound examination and at surgery. The relative accuracy of these diagnostic procedures is reviewed and their place in the diagnosis of biliary tract disease is discussed.

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Most fungal infections of the urinary tract involve the drainage structures rather than the kidney parenchyma. They usually occur in patients with diabetes or other chronic debilitating diseases and in the presence of urinary stasis. Conglomeration of fibrillar hyphae results in fungal balls which produce nonopaque filling defects in the renal pelvis, ureter, or bladder. Such fungal ball colonies were demonstrated by percutaneous (antegrade) pyelography in the upper urinary tract in two cases. A percutaneous nephrostomy was performed in one patient to provide drainage of pus in the renal pelvis.

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