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The purpose of this paper is to review the indications for transrectal ultrasound; to briefly describe the sonographic technique; to describe the sonographic findings of prostatic carcinoma; to review the indications for transrectal sonographic-guided biopsy; and to discuss the controversles of routine screening and staging.

The purpose of this study was to review the embryology, classification, imaging features and treatment options of Mullerian duct anomalies. The three embryological phases will be described and the appearance of the seven classes of Mullerian duct anomalies will be illustrated using hysterosalpingography, ultrasound and MRI. This exhibit will also review the treatment options, including interventional therapy. The role of imaging is to help detect, classify and guide surgical management. At this time, MRI is the modality of choice because of its high accuracy in detecting and accurately characterising Mullerian duct anomalies. In conclusion, radiologists should be familiar with the imaging features of the seven classes of Mullerian duct anomalies, as the appropriate course of treatment relies upon the correct diagnosis and categorisation of each anomaly.

Eleven cases of bilateral diffuse microlithiasis of the testes were evaluated sonographically. The presence of testicular microlithiasis was coincidental to the presence of testicular neoplasms (n = 2), nontesticular malignant lesion in the abdomen or chest (n = 2), subfertility (n = 2), varicocele (n = 1), epididymitis (n = 1), testicular maldescent (n = 1), scrotal trauma (n = 1), and transient scrotal pain (n = 1). Clinical follow-up suggested that testicular microlithiasis is an asymptomatic nonprogressive condition. Sonographic examination of testicular microlithiasis shows diffuse hyperechoic nonshadowing foci measuring 1-2 mm in diameter throughout both testes. The diagnosis of testicular microlithiasis was pathologically proved in five cases. In six cases, the diagnosis was made on the basis of the sonographic appearance (n = 6), clinical information and follow-up (n = 6), and radiologic demonstration of testicular microcalcifications (n = 3). The sonographic appearance of testicular microlithiasis is specific, and we believe that biopsy or orchiectomy in these cases is unnecessary.

In order to determine if serial, noninvasive evaluation of polytetrafluoroethylene (PTFE) vascular access grafts could identify a subgroup of patients at risk for thrombosis, the authors studied flow characteristics, using duplex ultrasonic scanning, in 18 hemodialysis patients with forearm loop grafts. On average, five examinations were performed per patient over the 10-month study period. Seven episodes of thrombosis occurred in six patients. The mean Doppler flow in grafts that subsequently thrombosed was significantly lower than in those that did not (544 +/- 218 ml/min versus 843 +/- 391 ml/min, p less than 0.001). The interval from last examination to thrombosis ranged from 13 to 58 days. At a defined cut-off flow of 450 ml/min, this test yielded a sensitivity of 83% and a specificity of 75% for episodes of thrombosis occurring within 2 to 6 weeks. The authors conclude that episodes of thrombosis in PTFE arm loop grafts are usually preceded by significantly lower Doppler-measured flow than grafts that do not thrombose and that it may be possible, by this means, to identify grafts at risk.

With the introduction of grey-scale imaging, the diagnostic capability of ultrasound has been greatly increased. Previously, ultrasound images were limited to a bistable presentation that did not distinguish between high- and low-level echoes. As a result the images could be interpreted by only a few experienced ultrasonographers. Grey-scale imaging with the use of a television scan converter allows both the strong and the weaker echoes to be displayed, so that both the outline and the internal texture of normal abdominal organs and lesions can be visualized on a single scan. Abnormalities are now more readily identified and their relation to normal organs is more easily appreciated so that the scans can be interpreted not only by the ultrasonographer but also by the clinician. Several cases are presented in which grey-scale ultrasound was used.

In a 12-month period 100 patients with clinical evidence of acute disease of the gallbladder were studied in hospital by grey-scale ultrasonography. During the same hospital admission it was possible to correlate results of ultrasonography with operative findings in 66 patients. In 52 patients the ultrasonographic diagnosis of gallstones was proved to be correct. There were no false-positive results. In seven patients the ultrasonographic report of a normal gallbladder without stones was also confirmed. In two patients, the report of a normal gallbladder without stones was erroneous. In two more patients the scan was indeterminate and stones were found at operation. In the remaining three patients echogenic material was reported and at operation minute stones and "sludge" were found. No complications resulted from the ultrasonography. The study showed that grey-scale ultrasonography is a reliable, rapid and safe technique for detecting gallstones in patients with a clinical diagnosis of acute cholecystitis.