Objective  To assess the ability of power Doppler ultrasonography (PDU) to detect acute pyelonephritis and to compare the findings from PDU with those from enhanced computed tomography (CT). Patients and methods  Eleven patients (mean age 18.5 years, range 5–37) admitted to hospital with a clinical diagnosis of pyelonephritis were assessed with PDU and enhanced CT, the latter providing the reference method. Results  The imaging studies showed normal findings in three patients; a single focus of pyelonephritis was detected by CT in six, whereas a matching defect was detected on PDU in five, with PDU failing to detect an infective focus in one. Multifocal diffuse pyelonephritis was diagnosed correctly by enhanced CT and PDU in two patients. Conclusion  Power Doppler ultrasonography had an overall sensitivity of 88% and complete specificity in the evaluation of patients with acute pyelonephritis.

Objective  To determine the role of transrectal power Doppler ultrasonography (PDU) in the diagnosis of prostate cancer. Patients and methods  Thirty‐six patients (mean age 66.4 years, sd 7.7, range 59–82) with possible prostate cancer, suspected from an abnormal digital rectal examination or elevated prostate specific antigen level, underwent transrectal ultrasonography, transrectal PDU and biopsy. The vascularity on PDU was graded on a scale of 0–2, where grade 1–2 was considered positive and grade 0 negative. Results  The vascularity was grade 2 in 11 patients, grade 1 in 11 and grade 0 in 14; 20 of the 36 (56%) patients had prostate cancer. Of the 22 patients positive on PDU, 18 had malignant disease and four benign; two of 20 patients with histopathologically confirmed malignancy had a normal PDU. The sensitivity of PDU was 90%, the specificity 75% and the positive predictive value 82%. Conclusion  Focal hypervascularity on PDU was associated with an increased likelihood of prostate cancer. Although ultrasonography alone cannot detect all cancers, even using PDU, the technique appears to increase the sensitivity and to help identify appropriate sites for biopsy.