Материал: Advanced Imaging of the Abdomen - Jovitas Skucas

PANCREAS

and spinal cord. J Formos Med Assoc 1997;96:754– 757.

55.Setiawan MW, Samsi TK, Wulur H, Sugianto D, Pool TN. Epigastric pain and sonographic assessment of the pancreas in dengue hemorrhagic fever. J Clin Ultrasound 1998;26:257–259.

56.Kim YH. Pancreatitis in association with Clonorchis sinensis infestation: CT evaluation. AJR 1999;172: 1293–1296.

57.Midiri M, Lo Casto A, Sparacia G, et al. Magnetic resonance imaging of pancreatic changes in patients with transfusion-dependent beta-thalassemia major. AJR 1999;173:187–192.

58.Kim T, Murakami T, Takamura M, et al. Pancreatic mass due to chronic pancreatitis: correlation of CT and MR imaging features with pathologic findings. AJR 2001;177:367–371.

59.Fukukura Y, Inoue H, Miyazono N, et al. Lymphoepithelial cysts of the pancreas: demonstration of lipid component using CT and MRI. [Review] J Comput Assist Tomogr 1998;22:311–313.

60.Paal E, Thompson LD, Heffess CS. A clinicopathologic and immunohistochemical study of ten pancreatic lymphangiomas and a review of the literature. Cancer 1998;82:2150–2158.

61.Ferrozzi F, Cusmano F, Zuccoli G, Tognini G, Bassi S, Gabrielli M. [Mesenchymal tumors of the pancreas: computed tomography patterns.] [Italian] Radiol Med 1999;98:295–299.

62.Voss SD, Kruskal JB, Kane RA. Chronic inflammatory pseudotumor arising in the hepatobiliary-pancreatic system: progressive multisystemic organ involvement in four patients. AJR 1999;173:1049–1054.

63.Sorensen HT, Mellemkjaer L, Steffensen FH, Olsen JH, Nielsen GL. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med 1998;338:1169–1173.

64.Michaud DS, Giovannucci E, Willett WC, Colditz GA, Fuchs CS. Coffee and alcohol consumption and the risk of pancreatic cancer in two prospective United States cohorts. Cancer Epidemiol Biomarkers Prev 2001;10: 429–437.

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66.Safi F, Schlosser W, Falkenreck S, Beger HG. Prognostic value of CA 19–9 serum course in pancreatic cancer. Hepatogastroenterology 1998;45:253–259.

67.Kondoh S, Kaino M, Okita S, Ryozawa S, Akiyama T, Okita K. Detection of Ki-ras and p53 gene mutations in tissue and pancreatic juice from pancreatic adenocarcinomas. J Gastroenterol 1998;33:390–396.

68.Ariyama J, Suyama M, Satoh K, Sai J. Imaging of small pancreatic ductal adenocarcinoma. [Review] Pancreas 1998;16:396–401.

69.Tsunoda T, Yamamoto Y, Kimoto M, et al. Staging and treatment for patients with pancreatic cancer. How small is an early pancreatic cancer? J Hepato Biliary Pancreatic Surg 1998;5:128–132.

70.Yokohata K, Shirahane K, Yonemasu H, et al. Focal ductal branch dilatation on magnetic resonance cholangiopancreatography: a hint for early diagnosis of pancreatic carcinoma. Scand J Gastroenterol 2000; 35:1229–1232.

71.Romijn MG, Stoker J, van Eijck CH, van Muiswinkel JM, Torres CG, Lameris JS. MRI with mangafodipir trisodium in the detection and staging of pancreatic cancer. J Magn Reson Imaging 2000;12:261–268.

72.Fink C, Grenacher L, Hansmann HJ, et al. [Prospective study to compare high-resolution computed tomography and magnetic resonance imaging in the detection of pancreatic neoplasms: use of intravenous and oral MR contrast media.] [German] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2001;173:724–730.

73.Boland GW, O’Malley ME, Saez M, Fernandez- del-Castillo C, Warshaw AL, Mueller PR. Pancreaticphase versus portal vein-phase helical CT of the pancreas: optimal temporal window for evaluation of pancreatic adenocarcinoma. AJR 1999;172:605–608.

74.McNulty NJ, Francis IR, Platt JF, Cohan RH, Korobkin M, Gebremariam A. Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 2001;220:97–102.

75.Yamada Y, Mori H, Kiyosue H, Matsumoto S, Hori Y, Maeda T. Computed tomography assessment of the inferior peripancreatic veins: clinical significance. AJR 2000;174:677–684.

76.Furukawa H, Iwata R, Moriyama N, Kosuge T. Selective intraarterial contrast-enhanced CT of pancreaticoduodenal tumors: early clinical experience in evaluating blood supply and detectability. AJR 2000;75:91–97.

77.Karlson BM,Ekbom A,Lindgren PG,Kallskog V,Rastad J. Abdominal US for diagnosis of pancreatic tumor: prospective cohort analysis. Radiology 1999;213:107– 111.

78.Diehl SJ, Lehmann KJ, Gaa J, Meier-Willersen HJ, Wendl K, Georgi M. [The value of magnetic resonance tomography (MRT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic tumors.] [German] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1999; 170:463–469.

79.Ichikawa T, Sou H,Araki T, et al. Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 2001;221:107–116.

80.Raderer M, Kurtaran A, Yang Q, et al. Iodine- 123–vasoactive intestinal peptide receptor scanning in patients with pancreatic cancer. J Nucl Med 1998;39:1570–1575.

81.Gabata T, Kadoya M, Terayama N, Sanada J, Kobayashi S, Matsui O. Groove pancreatic carcinomas: radiological and pathological findings. Eur Radiol 2003;13: 1679–1684.

82.Hosch SB, Knoefel WT, Metz S, et al. Early lymphatic tumor cell dissemination in pancreatic cancer: frequency and prognostic significance. Pancreas 1997; 15:154–159.

83.Sheridan MB, Ward J, Guthrie JA, et al. Dynamic contrast-enhanced MR imaging and dual-phase helical CT in the preoperative assessment of suspected pancreatic cancer: a comparative study with receiver operating characteristic analysis. AJR 1999;173:583–590.

84.Schima W, Fugger R, Schober E, et al. Diagnosis and staging of pancreatic cancer: comparison of man-

gafodipir trisodium-enhanced MR imaging and contrast-enhanced helical hydro-CT. AJR 2002;179: 717–724.

85.Catalano C, Laghi A, Fraioli F, et al. Pancreatic carcinoma: the role of high-resolution multislice spiral CT in the diagnosis and assessment of resectability. Eur Radiol 2003;13:149–156.

86.Nishiharu T, Yamashita Y, Abe Y, et al. Local extension of pancreatic carcinoma: assessment with thin-section helical CT versus with breath-hold fast MR imaging— ROC analysis. Radiology 1999;212:445–452.

87.Vargas R, Nino-Murcia M, Trueblood W, Jeffrey RB Jr. MDCT in Pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations. AJR 2004;182:419–425.

88.O’Malley ME, Boland GW, Wood BJ, Fernandez-del Castillo C, Warshaw AL, Mueller PR. Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT. AJR 1999;173:1513–1518.

89.Hough TJ, Raptopoulos V, Siewert B, Matthews JB. Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas. AJR 1999;173: 1509–1512.

90.Baek SY, Sheafor DH, Keogan MT, DeLong DM, Nelson RC. Two-dimensional multiplanar and threedimensional volume-rendered vascular CT in pancreatic carcinoma: interobserver agreement and comparison with standard helical techniques. AJR 2001;176: 1467–1473.

91.Diehl SJ, Lehmann KJ, Sadick M, Lachmann R, Georgi M. Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 1998; 206:373–378.

92.Kaneko T, Nakao A, Inoue S, et al. Extrapancreatic nerve plexus invasion by carcinoma of the head of the pancreas. Diagnosis with intraportal endovascular ultrasonography. Int J Pancreatol 1996;19:1–7.

93.Hannesson PH, Lundstedt C, Dawiskiba S, Stridbeck H, Ihse I. Transhepatic intravascular ultrasound for evaluation of portal venous involvement in patients with cancer of the pancreatic head region. Eur Radiol 2002;12:1150–1154.

94.Cohen L, Hendrickson FR, Lennox AJ, Kroc TK, Hatcher MA, Bennett BR. Pancreatic cancer: treatment with neutron irradiation alone and with chemotherapy. Radiology 1996;200:627–630.

95.Yamakado K, Nakatsuka A, Tanaka N, et al. Portal venous stent placement in patients with pancreatic and biliary neoplasms invading portal veins and causing portal hypertension: initial experience. Radiology 2001;220:150–156.

96.Hishinuma S, Ogata Y, Matsui J, Ozawa I. Results of surgery and adjuvant radiotherapy for pancreatic cancer. J Hepato Biliary Pancreatic Surg 1998;5: 143–150.

97.Watanabe M, Miura H, Inoue H. Et al. Mixed osteo- clastic/pleomorphic-type giant cell tumor of the pancreas with ductal adenocarcinoma: histochemical and immunohistochemical study with review of the literature. [Review] Pancreas 1997;15:201–208.

98.Paner GP, Thompson KS, Reyes CV. Hepatoid carcinoma of the pancreas. Cancer 2000;88:1582–1589.

99.Gupta AK, Mitra DK, Berry M, Dinda AK, Bhatnagar V. Sonography and CT of pancreatoblastoma in children. AJR 2000;174:1639–1641.

100.Montemarano H, Lonergan GJ, Bulas DI, Selby DM. Pancreatoblastoma: imaging findings in 10 patients and review of the literature. [Review] Radiology 2000;214:476–482.

101.Merkle EM, Bender GN, Brambs HJ. Imaging findings in pancreatic lymphoma: differential aspects. AJR 2000;174:671–675.

102.Mizumoto K, Suehara N, Ohuchida J, et al. Pancreatic tumor formed by infiltration of adult T-cell leukemia cells. Int J Pancreatol 1997;21:253–257.

103.Bastian D, Ramaswamy A, Barth PJ, Gerdes B, Ernst M, Bartsch D. Malignant fibrous histiocytoma of the pancreas: a case report with genetic analysis. [Review] Cancer 1999;85:2352–2358.

104.Luttges J, Pierre E, Zamboni G, et al. [Malignant non-epithelial tumors of the pancreas.] [German] Pathologe 1997;18:233–237.

105.Motoo Y, Kawashima A, Watanabe H, Su SB, Okai T, Sawabu N. Undifferentiated (anaplastic) carcinoma of the pancreas showing sarcomatous change and neoplastic cyst formation. Int J Pancreatol 1997;21: 243–248.

106.Ng CS, Loyer EM, Iyer RB, David CL, DuBrow RA, Charnsangavej C. Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrastenhanced helical CT. AJR 1999;172:1555–1559.

107.Niv Y, Turani C, Kahan E, Fraser GM. Association between pancreatic cystadenocarcinoma, malignant liver cysts, and polycystic disease of the kidney. Gastroenterology 1997;112:2104–2107.

108.Sand JA, Hyoty MK, Mattila J, Dagorn JC, Nordback IH. Clinical assessment compared with cyst fluid analysis in the differential diagnosis of cystic lesions in the pancreas. Surgery 1996;119:275–280.

109.Curry CA, Eng J, Horton KM, et al. Computed tomography of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? AJR 2000; 175:99–103.

110.Koito K, Namieno T, Nagakawa T, Shyonai T, Hirokawa N, Morita K. Solitary cystic tumor of the pancreas: EUS-pathologic correlation. Gastrointest Endosc 1997;45:268–276.

111.Sperti C, Pasquali C, Perasole A, Liessi G, Pedrazzoli S. Macrocystic serous cystadenoma of the pancreas: clinicopathologic features in seven cases. Int J Pancreatol 2000;28:1–7.

112.Khurana B, Mortele KJ, Glickman J, Silverman SG, Ros PR. Macrocystic serous adenoma of the pancreas: radiologic-pathologic correlation. AJR 2003;181:119– 123.

113.Fukushima N, Mukai K. Pancreatic neoplasms with abundant mucus production: emphasis on intraductal papillary-mucinous tumors and mucinous cystic tumors. [Review] Adv Anat Pathol 1999;6:65– 77.

114.Kimura W, Kuroda A, Makuuchi M. Problems in the diagnosis and treatment of a so-called mucinproducing tumor of the pancreas. [Review] Pancreas 1998;16:363–369.

115.Torresan F, Casadei R, Solmi L, Marrano D, Gandolfi L. The role of ultrasound in the differential diagnosis of

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serous and mucinous cystic tumours of the pancreas. Eur J Gastroenterol Hepatol 1997;9:169–172.

116.Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. AJR 2000;174:1005–1008.

117.Paal E, Thompson LD, Przygodzki RM, Bratthauer GL, Heffess CS. A clinicopathologic and immunohistochemical study of 22 intraductal papillary mucinous neoplasms of the pancreas, with a review of the literature. [Review] Mod Pathol 1999;12:518–528.

118.Zanelli M, Casadei R, Santini D, et al. Pseudomyxoma peritonei associated with intraductal papillarymucinous neoplasm of the pancreas. Pancreas 1998; 17:100–102.

119.Irie H, Honda H, Aibe H, et al. Magnetic resonance cholangiopancreatographic differentiation of benign and malignant intraductal mucin-producing tumors of the pancreas. AJR 2000;174:1403–1408.

120.Taouli B, Vilgrain V, Vullierme MP, et al. Intraductal papillary mucinous tumors of the pancreas: helical CT with histopathologic correlation. Radiology 2000; 217:757–764.

121.Fukukura Y, Fujiyoshi F, Sasaki M, Inoue H, Yonezawa S, Nakajo M. Intraductal papillary mucinous tumors of the pancreas: thin-section helical CT findings. AJR 2000;174:441–447.

122.Onaya H, Itai Y, Niitsu M, Chiba T, Michishita N, Saida Y. Ductectatic mucinous cystic neoplasms of the pancreas: evaluation with MR cholangiopancreatography. AJR 1998;171:171–177.

123.Koito K, Namieno T, Ichimura T, et al. Mucinproducing pancreatic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. Radiology 1998;208: 231–237.

124.Levy P, Bougaran J, Gayet B. [Diffuse peritoneal carcinosis of pseudo-papillary and solid tumor of the pancreas. Role of abdominal injury.] [Review] [French] Gastroenterol Clin Biol 1997;21:789–793.

125.Buetow PC, Buck JL, Pantongrag-Brown L, Beck KG, Ros PR, Adair CF. Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases. Radiology 1996;199:707–711.

126.Kaassis M, Duquenne M, Croue A, Ronceray J, Rohmer V, Bigorgne JC. [Calcitonin-secreting neuroendocrine carcinoma of the pancreas with splenic invasion and paraneoplastic hypercalcemia.] [French] Presse Med 2001;30:24.

127.Ichikawa T, Peterson MS, Federle MP, et al. Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection. Radiology 2000;216:163– 171.

128.Thoeni RF, Mueller-Lisse UG, Chan R, Do NK, Shyn PB. Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal sensitivity. Radiology 2000;214:483–490.

129.Semelka RC, Custodio CM, Cem Balci N, Woosley JT. Neuroendocrine tumors of the pancreas: spectrum of appearances on MRI. J Magn Reson Imaging 2000; 11:141–148.

130.Seelig MH, Schonleben K. Intra-abdominal ectopic thyroid presenting as a pancreatic tumour. [Review] Eur J Surg 1997;163:549–551.

131.Soga J, Yakuwa Y, Osaka M. Insulinoma/hypoglycemic syndrome: a statistical evaluation of 1085 reported cases of a Japanese series. J Exp Clin Cancer Res 1998;17:379–388.

132.Gouya H, Vignaux O, Augui J, et al. CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR 2003;181: 987–992.

133.Fidler JL, Fletcher JG, Reading CC, et al. Preoperative detection of pancreatic insulinomas on multiphasic helical CT. AJR 2003;181:775–780.

134.Service FJ, Natt N, Thompson GB, et al. Noninsulinoma pancreatogenous hypoglycemia: a novel syndrome of hyperinsulinemic hypoglycemia in adults independent of mutations in Kir6.2 and SUR1 genes. J Clin Endocrinol Metab 1999;84:1582–1589.

135.Soga J, Yakuwa Y. The gastrinoma/Zollinger-Ellison syndrome: statistical evaluation of a Japanese series of 359 cases. J Hepato Biliary Pancreatic Surg 1009;5: 77–85.

136.Tang C, Biemond I, Verspaget HW, Offerhaus GJ, Lamers CB. Expression of somatostatin receptors in human pancreatic tumor. Pancreas 1998;17:80–84.

137.Ruszniewski P, Amouyal P, Amouyal G, et al. Localization of gastrinomas by endoscopic ultrasonography in patients with Zollinger-Ellison syndrome. Surgery 1995;117:629–635.

138.Lebtahi R, Cadiot G, Marmuse JP, et al. False-positive somatostatin receptor scintigraphy due to an accessory spleen. J Nucl Med 1997;38:1979–1981.

139.Soga J, Yakuwa Y. Vipoma/diarrheogenic syndrome: a statistical evaluation of 241 reported cases. J Exp Clin Cancer Res 1998;17:389–400.

140.Virgolini I, Kurtaran A, Leimer M, et al. Location of a VIPoma by iodine-123–vasoactive intestinal peptide scintigraphy. J Nucl Med 1998;39:1575–1579.

141.Furukawa H, Mukai K, Kosuge T, et al. Nonfunctioning islet cell tumors of the pancreas: clinical, imaging and pathological aspects in 16 patients. Jpn J Clin Oncol 1998;28:255–261.

142.Stafford-Johnson DB, Francis IR, Eckhauser FE, Knol JA, Chang AE. Dual-phase helical CT of nonfunctioning islet cell tumors. J Comput Assist Tomogr 1998; 22:335–339.

143.Kauppila LI, Hekali P, Penttila A. Postmortem pancreatic angiography in 45 subjects with non-insulin- dependent diabetes mellitus and 51 controls. Pancreas 1998;16:60–65.

144.Barone R, Procaccini E, Chianelli M, et al. Prognostic relevance of pancreatic uptake of technetium-99m labelled human polyclonal immunoglobulins in patients with type 1 diabetes. Eur J Nucl Med 1998; 25:503–508.

145.Altobelli E, Blasetti A, Verrotti A, Di Giandomenico V, Bonomo L, Chiarelli F. Size of pancreas in children and adolescents with type I (insulin-dependent) diabetes. J Clin Ultrasound 1998;26:391–395.

146.Tano S, Ueno N, Ueno T, Wada S, Aizawa T, Kimura K. Pancreatic arteriovenous malformation with duodenal ulcer. Demonstration by color Doppler ultrasonography. Dig Dis Sci 1996;41:1232–1237.

147.Sato M, Kishi K, Shirai S, et al. Radiation therapy for a massive arteriovenous malformation of the pancreas. AJR 2003;181:1627–1628.

148.Molina M, Ortega G, Redondo C, Galera C, Perez Lujan YR. [Tuberculous abscess of the pancreas as initial manifestation of AIDS.] [Spanish] Gastroenterol Hepatol 1997;20:165–166.

149.Hancock MR, Smith NA, Hawkins DA, Gazzard B, Ball SG. Biochemical assessment of pancreatic disease in human immunodeficiency virus infected men. J Clin Pathol 1997;50:674–676.

150.Sollinger HW, Odorico JS, Knechtle SJ, D’Alessandro AM, Kalayoglu M, Pirsch JD. Experience with 500 simultaneous pancreas-kidney transplants. Ann Surg 1998;228:284–296.

151.Heverhagen JT, Wagner HJ, Ebel H, Levine AL, Klose KJ, Hellinger A. Pancreatic transplants: noninvasive evaluation with secretin-augmented MR pancreatography and MR perfusion measurements—preliminary results. Radiology 2004;233:273–280.

152.Krebs TL, Daly B, Wong-You-Cheong JJ, Carroll K, Bartlett ST. Acute pancreatic transplant rejection: evaluation with dynamic contrast-enhanced MR imaging compared with histopathologic analysis. Radiology 1999;210:437–442.

153.Eubank WB, Schmiedl UP, Levy AE, Marsh CL. Venous thrombosis and occlusion after pancreas transplantation: evaluation with breath-hold gadolinium-en-

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154.Fiorina P, La Rocca E, Venturini M, et al. Effects of kidney-pancreas transplantation on atherosclerotic risk factors and endothelial function in patients with uremia and type 1 diabetes. Diabetes 2001;50:496–501.

155.Meador TL, Krebs TL, Cheong JJ, Daly B, Keay S, Bartlett S. Imaging features of posttransplantation lymphoproliferative disorder in pancreas transplant recipients. AJR 2000;174:121–124.

156.Lupo LG, Pannarale OC, Altomare DF, et al. Is pyloric function preserved in pylorus-preserving pancreaticoduodenectomy? Eur J Surg 1998;164:127–132.

157.Aldrighetti L, Ferla G. Portal vein graft rectal evacuation after Whipple procedure. The Fabrizio’s disease. Hepatogastroenterology 1996;43:1638–1639.

158.Dickinson RJ, Davies S. Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors. Eur J Gastroenterol Hepatol 1998;10:423–428.

159.Hans de Vries J, Duijm LE, Dekker W, Guit GL, Ferwerda J, Scholten ET. Computed tomography before and after ERCP: detection of pancreatic pseudotumor, asymptomatic retroperitoneal perforation, and duodenal diverticulum. Gastrointest Endosc 1997;45: 231–235.

Technique

Conventional Radiography

and Urography

Indications for intravenous (IV) pyelography (the term IV urography is used by some) have decreased considerably, but this examination is still indicated if pyelocalyceal visualization is needed. Small transitional cell carcinomas, pyeloureteritis cystica, medullary sponge kidney, and papillary necrosis continue to be best identified with IV urography. A current major indication for IV urography is in investigating hematuria in adults, although here computed tomographic urography combined with cystoscopy are making inroads, and magnetic resonance (MR) is not far behind.

Intravenous urography is insensitive in detecting small renal parenchymal tumors. Thus about one third of tumors <3cm in diameter are not detected. Even with larger tumors urography is generally insensitive in differentiating benign from malignant tumors. This test, however, does provide information on renal function and gross anatomy, and it aids in evaluating disorders of the collective systems. It tends to be somewhat inferior in infants compared to older children.

Retrograde ureteropyelography has a role if insufficient contrast is excreted during an IV urogram. For suspected obstruction, however, currently noncontrast computed tomography (CT) is considered to be superior.

Computed Tomography

The introduction of multislice helical CT has had a major impact on uroradiology. Multislice CT allows imaging during specific contrast opacification phases. Depending on the study indication, the CT protocol used can be modified accordingly. Thus suspected acute urinary obstruction by a stone is studied without contrast, in the workup of hypertension and suspected renal artery stenosis emphasis is on arterial phase images, while some infections are detected only during later phases; small renal tumors are readily imaged in a breathhold; potential living renal donor evaluation

is simplified and therapy aided by threedimensional (3D) imaging. Using a two-bolus technique both a nephrogenic and excretory phases can be obtained with one scan, although such a protocol tends not to visualize all of the ureters completely.

Are screening serum creatinine levels necessary prior to contrast CT studies? Only 3% of over 2000 consecutive outpatients undergoing contrast-enhanced CT had elevated serum creatinine levels, and risk factors were identified in a majority of these (1); screening for risk factors appears adequate in this patient population.

Renal opacification can be divided into three phases: first is an early vascular or bolus phase, then a nephrogram phase (consisting of a nephrogram), followed by a pyelogram or equilibrium (delayed) phase. A corticomedullary phase, providing maximum differen-