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PubMed1981

["Arterial time" in intravenous urography: a critical study (author's transl)].

A prospective study was conducted, in order to establish the precise "arterial time" during intravenous urography, by employing a very precise technique in three groups of patients. The first group had a standard film taken, centered on the kidneys during "arterial time", after the intravenous injection of a contrast medium bolus, followed by a second film with the same centering as rapidly as possible after the previous film. Zonography during "arterial time" in the plane of the arteries was conducted in the second group, and this was followed by three successive tomographic sections in the parenchymatous planes as rapidly as possible. A third group, acting as controls, had a simple film taken, centered on the kidneys during ideal "nephrographic time" (arterial time + 10 seconds). A double-blind technique was used to analyse the results. The arterial film of intravenous urography, whatever the technique employed, has several inconveniences and, above all, certain limitations. Though it is of undoubted value in some cases, it should be employed with caution in certain precise cases, and should not be given an absolute definitive value without due reflection. The interest of a urography examination, which may not have detected a lesion, should not be underestimated, as it can still supply very explicit information suggesting the presence of a renal artery disorder.

Adolescent↗
PubMed1993

Comparison of excretory urography and ultrasonography for detection of experimentally induced pyelonephritis in dogs.

Pyelonephritis was experimentally induced in 10 clinically normal dogs by nephropyelocentesis and introduction of Proteus mirabilis into the randomly chosen right or left renal pelvis. Dogs were examined by nephrosonography and excretory urography before and 2 weeks after infection. The major nephrosonographic findings of pyelonephritis were renal pelvic dilatation, usually with proximal ureteral dilatation, and a hyperechoic mucosal margin line within the renal pelvis, proximal portion of the ureter, or both. In addition, at least one or more of the following were observed: generalized hyperechoic renal cortex, focal hyperechoic areas within the medulla, and focal hyperechoic or hypoechoic cortical lesions. Interpretation of excretory urograms resulted in 3 false-negative and 1 false-positive conclusions, compared with the histologic findings. Interpretation of nephrosonograms resulted in 2 false-negative and no false-positive conclusions. Of the kidneys with histologic evidence of pyelonephritis, 73% were detected by excretory urography, whereas 82% were detected by nephrosonography. Nephrosonography appeared to be useful for detection of mild to moderate cases of acute pyelonephritis that may be be interpreted as such by excretory urography.

Animals↗
PubMed1996

Clinical safety and efficacy of iobitridol in urography.

PURPOSE: Evaluation of imaging quality and safety of iobitridol 300 compared to iohexol 300 in urography. MATERIALS AND METHODS: 180 patients were included in an urography multicenter study (3 centers, 60 patients in each). RESULTS: There was no significant difference in either the imaging quality or the clinical safety between the 2 contrast media groups. CONCLUSION: Iobitridol is a safe and efficient contrast agent in urography.

Contrast Media↗
PubMed1977

Renal function after high-dose urography in patients with chronic renal insufficiency.

Renal function was assessed by frequent recordings of Ccr and serum creatinine in 22 patients with chronic renal failure before and after high-dose urography. Urography was followed by a significant, moderate and transient decrease in Ccr which was maximal on the second day; at the same time a significant increase in serum creatinine was observed which was maximal on the fourth day after urography. In all but two patients, Ccr and serum creatinine returned to pre-urographic levels within the next two weeks. Possible causes of the deleterious effects of the contrast media on the kidneys are discussed.

Creatinine↗
PubMed1996

Assessment of painful ureterohydronephrosis during pregnancy by MR urography.

The purpose of this study was to assess the value of the fast imaging sequence called RARE (rapid acquisition with relaxation enhancement) MR urography (or RMU) in pregnant women with painful ureterohydronephrosis. A total of 17 pregnant women with an acute flank pain were examined with RMU. Results were compared with those of US, X-rays and the evolution of symptoms. The gold standard techniques used to evaluate the results of MR urography were US when it showed the entire dilated urinary tract and the nature of the obstruction (9 cases), limited intravenous urography (IVU) when performed (3 cases) or endoscopic procedure (5 cases). The accuracy of RMU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (sensitivity 100% in our series). The determination of the type of obstruction, intrinsic vs extrinsic, was always exact. The RMU technique alone could not specify the exact nature of the obstruction. The RMU technique is able to differentiate a physiological from a pathological ureterohydronephrosis during pregnancy. It could be considered as the procedure of choice when US failed to establish the differential diagnosis.

Adult↗
PubMed1982

Yield of screening urography in young women with urinary tract infection.

In order to determine the diagnostic yield and therapeutic outcome of screening urography in young women with urinary tract infection, 1000 urographic examinations were reviewed. Of these 96.4% were normal; 1.4% revealed abnormalities that subsequently required therapy. Each treated abnormality was expensive to diagnose; protocols other than universal urography could have made most of these diagnoses. The incidence of treated abnormalities may be no greater in this group than in the general population. Universal screening urography in these patients cannot be definitely recommended.

Adolescent↗
PubMedDate not supplied

MR urography today.

Magnetic resonance (MR) urography is performed by pursuing two different imaging strategies. On the one hand, heavily T2-weighted turbo spin-echo sequences are employed for obtaining unenhanced static-water images of the urinary tract. On the other, the T(1)-weighted MR urographic technique imitates conventional intravenous pyelography and is, therefore, referred to as excretory MR urography. For this reason, a gadolinium contrast agent is injected intravenously and, after its renal excretion, the gadolinium-enhanced urine is imaged with fast T1-weighted gradient-echo sequences. Both MR urographic techniques can be combined for a comprehensive examination of the upper urinary tract. This article reviews the current technical principles, imaging capabilities, and clinical applications of T2- and T1-weighted MR urography in adult and pediatric patients.

Adult↗
PubMed1978

Volume changes in the rat renal cortex during urography.

At different periods of urography rat kidney were instantly frozen at -165 degrees C. Using appropriate histological techniques and planimetry of different cortical compartments and fractions the structural background of renal cortical volume variations during urography was elucidated. The renal cortex reacted to intravenous injection of hypertonic contrast medium with an immediate increase of volume, followed by a decrease from 30 to 60 seconds. Measuring the volume shares of different cortical compartments, the complex nature of cortical volume variations during the first minutes of urography could be demonstrated. Subdivision of the tubular compartments into cellular and luminal fractions showed even greater complexity of volume variations. All the major cortical volume changes came to an end approximately three minutes after the injections.

Animals↗
PubMed1979

Kidney distension during IV urography in normal rats and in rats with artificial unilateral renal artery stenosis.

Acute changes in kidney size during IV urography were studied in normal rats and in rats with artificial unilateral renal artery stenosis. In normal rats, IV bolus injection of sodium iothalamate (400 mg I/ml), 1.5 ml/kg body weight, produced an increase in area of the renal silhouette by an average maximum of 12.7% after 60 seconds. In nine out of ten rats which developed hypertension after left sided renal artery clamping, renal distension was either small or absent on the stenosed side, while the contralateral right kidney showed normal distension during IV urography. Two out of three rats, which remained normotensive after renal arterial clamping, showed normal distension of both kidneys. These results confirm earlier observations in man that the acute changes in size of the kidney during IV urography can be used as an aid in the urographic screening of hypertensive patients for significant renal arterial stenosis. In all rats with arterial clamp and hypertension, the stenosed kidney was smaller than its contralateral mate. An index between the size of the non-stenosed and the stenosed kidneys greater than 1.15 was only seen in these particular rats.

Animals↗
PubMed1998

Comparison between the efficacy of dimeric and monomeric non-ionic contrast media (iodixanol vs iopromide) in urography in patients with mild to moderate renal insufficiency.

Non-ionic dimers induce less diuresis than non-ionic monomers, resulting in increased opacification of the urinary tract in intravenous (i.v.) urography. This double blind, comparative, randomized, parallel trial compared the efficacy of iodixanol (non-ionic dimer) and iopromide (non-ionic monomer) in 100 patients with mild to moderate renal insufficiency (serum creatinine of 135 to 265 mumol l-1) who underwent i.v. urography. A total dose of 600 mgI kg-1 bw of iodixanol (320 mgI ml-1) or iopromide (300 mgI ml-1) was injected. Radiographs were blindly evaluated by three radiologists who analysed different parameters (renal border visualization, nephrogram density, calyceal filling and density, papillary blush detection, delineation of collecting ducts, renal pelvis opacification, visualization of ureters, bladder density, bladder distention). Densitometric evaluation on the renal pelvis and bladder was also performed. Iodixanol showed better filling and density of the calyces (p = 0.004), more frequent detection of papillary blush (p = 0.003) and better opacification of the renal pelvis (p = 0.006). No significant differences between the two contrast media were found in regard to other parameters. In conclusion, the results confirmed theoretical expectations. The non-ionic dimer iodixanol is to be preferred to a non-ionic monomer such as iopromide in i.v. urography on patients with impaired renal function.

Adult↗
PubMed2005

Dynamic contrast-enhanced MR urography in the evaluation of pediatric hydronephrosis: Part 2, anatomic and functional assessment of ureteropelvic junction obstruction [corrected].

OBJECTIVE: The purpose of our study was to retrospectively review our experience using MR urography in the diagnosis of ureteropelvic junction (UPJ) obstruction in children. MATERIALS AND METHODS: Sixty-one studies were performed in 50 children with hydronephrosis but without hydroureter. Anatomic criteria assessed included degree of hydronephrosis, morphology of the renal pelvis, atrophy of medulla, swirling contrast material, fluid levels, and the presence of fetal folds and crossing vessels. Functional criteria included renal transit time, differential renal function, and time-intensity curves when available. RESULTS: Thirty-one kidneys were classified as obstructed, 15 as equivocal, and 15 as nonobstructed. Obstructed systems had more marked hydronephrosis, more extensive medullary atrophy, more fluid levels, and more swirling contrast material. Fetal folds were seen in only the equivocal and nonobstructed groups. Crossing vessels were seen in all groups. Obstructed systems also showed greater functional derangement, decreased split renal function, and abnormal time-intensity curves. CONCLUSION: MR urography provides both excellent anatomic and functional information in children with UPJ obstruction in a single test that does not use ionizing radiation. MR urography may lead to greater understanding of the pathophysiology of UPJ obstruction.

Adolescent↗
PubMed2000

Transrectal ultrasonography of distal ureteral calculi: comparison with intravenous urography.

In a prospective fashion, transrectal ultrasonography and intravenous urography were performed in 48 patients with distal ureteral calculi. We compared the ability of the two modalities to detect calculus and to determine the size of the calculus, the degree of obstruction, and the degree of hydroureter. In 11 cases (23%), the calculus was not seen at intravenous urography, while transrectal ultrasonography detected calculus in each patient. In 37 cases in which calculi were detected by both modalities, the average diameter of the calculus determined by ultrasonography was significantly larger (P < 0.05) than that obtained by plain radiography. Positive correlations were obtained in the assessment of degree of obstruction (correlation coefficient = 0.587, P < 0.05) and hydroureter (correlation coefficient = 0.794, P < 0.05) between the two techniques. Transrectal ultrasonography appears to be a useful adjunctive method to evaluate distal ureteral calculus, particularly if the results of intravenous urography are inconclusive.

Adult↗
PubMed1998

[Diagnostic evaluation of magnetic resonance urography in urinary tract dilatation and obstruction].

OBJECTIVE: To evaluate the diagnostic value of magnetic resonance urography (MRU). METHODS: Two hundred and one patients were examined, 92 patients with urinary tract dilatation using a modified, heavily T2-weighted fast spin-echo pulse sequence and fat-suppression pulse aid. Postprocedure processing was performed with a maximum-intensity-projection (MIP) algorithm. RESULTS: In the 92 patients with urinary tract dilatation, 86 had obstructive urinary tract dilatation 6 non-obstructive urinary tract dilatation. In the 86 patients, 14 had ureteral carcinoma, 19 calculus, and 13 benign stricture, 23 congenital ureteral stricture/or with anomalies, 7 ureteral obstructive caused by extrinsic pelvis disease, and 10 bladder carcinoma involved ureter. In the 6 patients, 5 had nervous bladder. MR urography provided the high-resolution image of the urinary tract and determined the presence of obstruction. CONCLUSION: MR urography is a reliable noninvasive method for depicting the urinary tract.

Adolescent↗
PubMedDate not supplied

[The advisability of performing excretory urography in renal colic].

Basing on their experience with 1115 cases of prehospitalization excretory urography, the authors think it misleading to reject excretory urography at the height of renal colic because normal kidney completely excretes contrast medium. It is shown that a part of the latter is deposited by the affected kidney and fills the upper urinary tracts up to the level of the obstacle causing acute urostasis. Excretory urography at the height of renal colic is valid in hospitals with 24-hour x-ray service and in cases of urgent surgery.

Adolescent↗
PubMed1996

[Urography with magnetic resonance: a new method for the study of the renal collecting system in patients without obstructive uropathy].

A new MR technique is proposed to study the renal collecting system and the proximal ureteral portion in patients without obstructive uropathy, using fat-suppressed Turbo Spin Echo sequences, after drug-induced distension of the urinary tract. Nine normal volunteers and 16 patients (11 with renal stones, 1 with bilateral pyeloureteral junction stenosis, 1 with renal ptosis, 1 with ureteral hyperkinesia, 1 with renal tumor and 1 with a symptomatic renal cyst) were submitted to MR-Urography, performed with a 3D non-breath-hold fat-suppressed Turbo SE sequence (TR = 3000 ms, TE = 800 ms, 6 acquisitions, Turbo Factor = 128, Matrix = 128 x 256 or 256 x 256, acquisition time = 5 min 15 sec or 10 min 36 sec) on the coronal plane. With these acquisition parameters, parenchymal signal can be completely suppressed while enhancing fluid signal. These acquisitions were post-processed with the MIP algorithm to obtain very similar images to those of conventional urography. The maximum filling of the renal collecting system was obtained with the i.v. administration of 250 ml saline solution within 2-3 minutes and then the i.v. injection of 20 mg furosemide. The renal collecting system was optimally depicted in all the volunteers and the patients, except for 2 cases because of malfunctioning respiratory gating. Anatomical detailing was really improved after the diuretic administration, especially in the study of the major caliceal systems. To conclude, MR-Urography permits accurate morphological detailing of the renal collecting system also in patients without obstructive uropathy.

Adult↗
PubMed1983

Preoperative urography in large bowel cancer: a useless investigation?

The utility of intravenous urography (IVU) in the preoperative assessment of patients with adenocarcinoma of the large bowel has been investigated in 4226 patients derived from a prospective multicentre study entitled the Large Bowel Cancer Project. An IVU was carried out in 956 of these patients (22.6 per cent), subsequent surgery revealed unsuspected direct urinary tract involvement in 75. However, 42 (56 per cent) had shown no IVU abnormality. Twenty patients having a clinical colovesical fistula had had a preoperative IVU. Only half showed an abnormality. In the entire study group, 10 nephrectomies and 40 other concomitant urinary tract resections were performed. Four of these nephrectomies were associated with right-sided tumours. A significantly higher number of patients with a rectal primary had a preoperative IVU. The value of routine preoperative urography before large bowel cancer surgery is questioned, and other methods of determining function in the other kidney before nephrectomy should be sought.

Adenocarcinoma↗
PubMedDate not supplied

Magnetic resonance urography by breath-hold contrast-enhanced three-dimensional FISP.

The purpose of this study was to present our initial experience with contrast-enhanced MR urography with a breath-hold three-dimensional imaging technique. We performed MR urographic studies in two pigs (four studies) and five human subjects using gadopentetate dimeglumine. The FISP sequence we used was the same as the one used for contrast-enhanced three-dimensional breath-hold angiography. MR three-dimensional urograms were obtained 7-24 minutes after the contrast injection with a dose as low as .03 mmol/kg. The calyces, renal pelves, and ureters were very well visualized. Three-dimensional MR urography can be acquired within a single breath-hold after administration of gadolinium chelates. This technique could become part of a protocol that could potentially lead to a single comprehensive diagnostic workup for suspected ureteral obstruction and gross hematuria.

Adult↗
PubMed1978

Excretory urography in evaluation of the surgical cancer patient.

Excretory urography was performed routinely in 504 patients with sarcoma, melanoma, pelvic, head and neck, or other localized tumors over a 5-year period. There were benign abnormalities in 14.4% of the patients examined, tumor associated abnormalities in 10.7%, and 1.4% false positives. The diagnosis of a benign lesion did not change cancer therapy in any patient. Findings on excretory urography were valuable in the management of patients with pelvic and intra-abdominal tumors. In these patients ureteral obstruction was always caused by tumor. There was a high rate of false positively in non-abdominal tumors. No second primary tumors were found.

Abdominal Neoplasms↗