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Editor: David A. Turner, MD Department of Diagnostic Radiology Rush-Presbyterian-St Luke’s Medical 1653 West Congress Parkway Chicago, IL 60612

U Imaging From: Richard

Department Hospital, Nottingham,

M.

of Colorectal

We read with and Nuclear Center

which

Medicine

phatically phy (CT)

system

Block,

University

Editor: The editorial by Moss, which issue of Radiology, highlights the identification of recurrent

appeared in the February 1989 some of the options available for colonectal carcinoma and, in particular, discusses the merits of both computed tomography and magnetic resonance imaging in the detection of recurrence of rectal cancer within the pelvis. Both techniques are of value in the detection of recurrence, but I am surprised that no mention of rectal endosonography was made. This is a technique that has been shown to be accurate in the staging of rectal cancers (2-4) and that has also been shown to be useful in the identification of recurrent carcinoma within the pelvis that is undetectable with digital examination or sigmoidoscopy

(5,6).

Volume

It is a technique

174

#{149} Number

that

1

requires

interest

the

in the June

endorse their is the modality

1989

issue

contention of choice

Soulen

little

preparation

and

to the

renal

capsule

with

et al (1),

of Radiology.

that computed for evaluation

renal infection, for both diagnosis and treatment. However, we take issue with their terminology. attenuation, wedge-shaped areas radiating from

Carcinoma

Charnley, FRCS of Surgery, Floor E, West Queen’s Medical Centre England NG7 2UH

great

appeared

relatively

normal

We emtomognaof bacterial

the

Focal, lowcollecting interven-

ing parenchyma are the typical CT findings in acute, uncomplicated, infectious pyelonephritis. The striations within these zones are probably the equivalent of those noted in the urognaphic nephrogram in acute renal inflammation (2). Not to include this pattern in their Table 1 as a finding in acute pyelonephritis we consider to be incorrect. In fact, this could well be the most common and typical CT observation in acute pyelonephritis. In addition, the intense inflammatory response of acute bacterial nephritis is usually not characterized only by these same wedge-shaped zones, as implied. Focal acute bacterial nephritis is almost always represented by a mass with round-

ed contours form material,

with

should

or without

demonstrate

delayed

to absent

areas

very

poor

excretion

of liquefaction.

enhancement of contrast

The

diffuse

by contrast material,

and

global enlargement. Wedge-shaped low-attenuation zones may or may not be present and usually are hard to define. The point to be emphasized is that there is an overlapping spectrum of the parenchymal response to infection-from acute pyelonephritis to renal abscess. The kidney with a mass

Radiology

#{149} 283