Letters U

Plantar

to the

Fasciitis:

US

Editor graphic

Imaging

From: Wayne

W. Gibbon,

Department Wales

FRCS,

FRCR

of Diagnostic

Cardiff,

(CT)

terial these

Radiology,

University

Hospital

study

shows

patients are important step in the evaluation

of

Wales

a renal

mass

and

use of contrast

ma-

is not advised because of an elevated creatinine level. days when cost containment and expeditious workup

(US)

examination.

safer

procedure,

considerations, of renal masses Surely

since

US

it seems that the next should be an ultrasound

is a less

intravenous

In of

expensive,

faster,

administration

and

of contrast

Editor: In the June 1991 issue of Radiology, Berkowitz et al (1) discussed the use of magnetic resonance (MR) imaging in the diagnosis of plantan fasciitis. We have recently been using a 7.5-MHz binear-array transducer to obtain high-resolution real-time ultrasound (US) images of the same condition. The numbers in our study, as in the study by Berkowitz et ab, are small (13 patients), but initial results are remarkably similar to those recently demonstrated with MR imaging. The thickness of the plantar fascia on US images at the point of crossing the anterior bonder of the calcancus was 1.5-4.1 mm

material is not required and US can effectively help distinguish solid from cystic renal masses. Therefore, I would welcome learning why the authors chose MR imaging instead of US in

(mean,

3.04

mm)

for

asymptomatic

heels

Dr Rofsky

(mean,

4.68

mm)

for symptomatic

heels.

of 1.0-3.2

mm

(mean,

1.66

mm)

was

and

2.9-6.7

A thickness

mm

difference

demonstrated

when

insertion

and

of the

plantan

pen-insertion

features US more

and

fascia,

edema

corresponded

appearances

was not achieved. hypoechogenicity

were well

of tendinitis

corn-

readily

accessible of plantan

tudinal

parametric

and

may

fasciitis,

studies

than

be of more

particularly

sign

and

in the sports

value

in as-

regard

to longi-

medicine

setting.

2.

diology 1991; 179:665-667. Harke HT, Gnissom LE, Finkelstein loskeletal system with sonography.

3.

Brandt

cuff

TD,

Cardone

sonography:

BW,

S.

Grant

Plantan

fasciitis:

MR

imaging.

MS. Evaluation of the AJR 1988; 150:1253-1261. TH,

a reassessment.

Post

M, Weiss

Radiology

1989;

CA.

Renal

Lesion

Ra-

Leon

Department

ciably

Rotator

portant

DeSoto

and

O’Hana

Streets,

of Pittsburgh

School

accepted

probais a

concepts.

We

provided

the

requisite

exposing

intravenous

informa-

the patient

administration

to the

of iodinatcd

habitus,

of the kidneys the ability

can be limited

of the operator,

and

by the the

pnes-

is calcium

in the

wall

or if the cyst

contains

any-

The

details

insight patient

PA 15261

was

bilateral

well as multiple, Editor: I read with interest the article by Rofsky et al in the July issue of Radiology (1) in which the authors recommend performing gadolinium-enhanced magnetic resonance (MR) examination when a non-contrast material-enhanced computed tomo-

of case

pertinent noted

renal

5 in our

to these

issues.

to have

a 5-cm

study

(1) provide

left renal

cysts at US evaluation

mass

imand

for nonspecific

abdominal pain. Because of the patient’s baseline renal insufficiency, CT was performed without intravenous administration of contrast material. A slightly heterogeneous left renal mass as

of

Hospital

Pittsburgh,

universally

without

US evaluation

if there

multiple, University

of a high

of enhancement

of

thing but clean fluid. Furthermore, tumors can be missed at sonography when they arc confused with normal renal tissue between cysts in patients with multiple renal masses. The accurate characterization of each lesion is crucial, especially when there is an option for performing a renal-sparing partial ne-

173:323-327.

MD

Presbyterian-University

is suggestive

pant

ence of multiple renal lesions. It is also clear that renal cysts cannot always be diagnosed accurately with sonography, espe-

muscu-

Characterization

of Radiology,

Medicine,

with

body

This Skolnick,

of all or

material.

patient’s

From: M.

is enhancement

MR imaging

associated

phrectomy.

U

a mass does not renal cyst, an-

CT, is indicated. The a neoplasm is suspected

the absence are

enhancement

Accurate R, Rudicel

while These

instances,

tion about contrast

JF, Kier

there

of enhancement

of benignity.

these

References Berkowitz

of our article (1), when criteria for a simple

whether

of malignancy,

risks

1.

respond:

were simply reporting on our experience with five patients who had renal masses that were not cysts at sonography and who were not considered to be good candidates for contrastenhanced CT because of histories of renal insufficiency. In

and is quick,

clinical with

colleagues

in the Discussion all of the sonographic

bility

sonographic

MR imaging it is inexpensive,

and

the lesion (2). The presence

(2,3). of view however,

Rofsky NM, Weinreb JC, Bosniak MA, Libes RB, Birnbaum BA. Renal lesion characterization with gadolinium-enhanced MR imaging: efficacy and safety in patients with renal insufficiency. Radiology 1991; 180:85-89.

is to determine

at the calcancal interface definition, demonstrated. These

recognized

1.

other study, usually contrast-enhanced primary goal of performing CT when

of fascia the

patients.

Reference

stated meet

Qualitative

variably

with

has a narrower field operator dependent;

sessment

loss

of their

We agree with Dr Skolnick that US should be used to characterize renal masses whenever possible. However, as clearly

paring symptomatic and asymptomatic sides of the same mdividual, with a relative percentage difference of 31.8%-100.7% (mean, 57.7%). These results provide a presumptive sensitivity and specificity of 100% when the study is performed “blind” and compared with symptoms, although a diagnosis by means of histologic examination changes of local or diffuse

the workup

attenuation a

values

bilateral (5-30

well-circumscribed HU)

with gadolinium-enhanced hancement in the left renal smaller US nor

(2.5-cm) renal nonenhanced

were

demonstrated.

lesions

of varied Evaluation

MR imaging demonstrated mass, as well as enhancement

lesion within the right CT enabled determination

enin a

kidney. Neither of the pncs-

285