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PubMed1980

Computed tomography and ultrasound of renal and perirenal diseases in infants and children. Relationship to excretory urography in renal cystic disease, trauma and neoplasm.

Forty-seven infants and children had excretory urography, ultrasound, and computed tomography with the renal and perirenal areas as the primary regions of interest. Ultrasound is an excellent screening procedure and is often diagnostic especially in renal cystic disease. Computed tomography best demonstrated the extent of renal injury and best delineated the geography, character, and extent of solid renal and perirenal neoplasms (screened by ultrasound). Excretory urography in these patients was at times incorrect, often underestimated the extent of the pathologic process, and is often unnecessary.

Adolescent↗

PubMed1981

Excretory urography as a screening method for abnormalities of the upper urinary tract in asymptomatic boys with undescended testicles.

Congenital dystopic testicles frequently occur jointly with abnormalities of the kidneys and the system of draining urinary ducts. A series of 100 asymptomatic boys has been studied by intravenous excretory urography after having undergone orchiopexy for retained testes. All children were clinically non-suspect and there was no history of urinary tract malformation. The investigations brought to light 7 major and 9 minor abnormalities. However, the authors do not recommend the use of intravenous urography as a routine procedure in all children with undescended testicles. The indications of the diagnostic procedure must be limited.

Adolescent↗

PubMed1995

Intravenous excretory urography using Optiray in office urology.

Experiences with the nonionic contrast medium Optiray 300 were analyzed in 120 consecutive patients who underwent intravenous urography. Allergic diathesis was recorded prior to the examination in 12.5% of the patients, pretreatment was given in only 3 cases. The clinical safety of Optiray was outstanding, no adverse reactions were noted. Diagnostic quality of the radiographs was excellent in 78% and good in 22% of the cases. Optiray is considered to be a safe and effective contrast agent for use in intravenous excretory urography.

Adult↗

PubMed1982

Modified excretory urography in prehysterectomy patients.

A retrospective (520 patients) and prospective study (100 patients) of prehysterectomy patients was done to determine the role of preoperative excretory urography. Potentially useful information was provided by the urogram in only a small number of patients (7.4%). It is arguable whether or not preoperative intravenous urography should be done in these patients. However, since most of these patients routinely undergo this study, we suggest that a curtailed urogram consisting of a KUB film, a postinjection 15-minute prone film, and a supine film of the contrast-filled urinary bladder is adequate for preoperative screening, thereby minimizing cost and radiation to the patient.

Female↗

PubMedDate not supplied

Diuresis urography in equivocal pelvi-ureteric obstruction.

In 43 patients with equivocal pelvi-ureteric obstruction, conventional urography was supplemented with diuresis urography. After peroral hydration with 0.5 liters fluid, a large volume of urographic contrast medium was administered and increased diuresis provoked by intravenous injection of furosemide. A relative obstruction of flow was then accentuated by increased dilatation of the renal pelvis. The technique deserves a wider use in the radiologic investigation of patients with equivocal obstruction at the pelvi-ureteric junction.

Adolescent↗

PubMed1997

Computed radiography excretory urography: can the system sensitivity value be used as an image quality indicator?

The purpose of this study is to determine whether the computed radiography system sensitivity value can be used as an image quality indicator for computed radiography excretory urography with radiation dose reduction. One hundred and twenty-four patients with gynecological malignancies were studied prospectively. Five-minute and 10-minute computed radiographic images of excretory urography were obtained in each patient with different radiation doses (ie, a standard dose image required with screen-film method and a reduced dose one). The images were subjectivity scored by three radiologists without knowledge of the exposure factors or the system sensitivity values. The quality scores of the reduced-dose images used in the five steps were compared with those of the standard dose images (the system sensitivity value was 80 to 120). The images with reduced exposures were arbitrarily divided into five steps according to the system sensitivity value (ie, 150 to 250, 260-400, 410-600, 610-1000, and 1010-1500). There was a gradual degradation of the image quality as the system sensitivity value was increased. In terms of visualization of the bones, the images taken with the system sensitivity values of 150-250 (40%-67% of the standard dose system) showed no statistically significant difference from the standard dose images. As for visualization of the renal pelvic margins, the images taken with the system sensitivity values of 260 to 400 (2%-38% of the standard dose system) showed no statistically significant difference. We conclude that system sensitivity value can be used as a practical though approximate indicator of the image quality.

Adult↗

PubMed1996

Clinical evaluation of irreversible data compression for computed radiography in excretory urography.

Efficient data compression is required for practical daily use of digital images in computed radiography (CR). This study investigated the clinical utility of data compression in excretory urography using the FCR 9000 system (Fuji Photo Film, Tokyo, Japan). Type III data compression technique was used, which can achieve a 20:1 to 25:1 compression ratio. To evaluate the degradation of image quality, we compared paired original and compressed CR images. Although a slight deterioration of image quality was noted in the renal calyx including collecting tubules among various anatomical structures, the difference was not significant. Receiver operating characteristics analysis revealed no significant difference among the original and compressed images. We conclude that compressed CR images using Type III data compression technique in excretory urography appear to be clinically applicable and acceptable.

Adolescent↗

PubMed2006

MR urography in children.

MR urography represents the next step in the evolution of uroradiology in children by combining superb anatomic imaging with quantitative functional evaluation in a single examination that does not use ionizing radiation. MR imaging has inherently greater soft-tissue contrast than other imaging techniques. When used in conjunction with dynamic scanning after administration of a contrast agent, it provides non-invasive analysis of the perfusion, concentration and excretion of each kidney. The purpose of this review is to outline our experience with more than 500 MR urograms in children. We outline our technique in detail, showing how we calculate differential renal function and how we assess concentration and excretion in the different regions of the kidney. We show that the dynamic contrast-enhanced data can be processed to yield quantitative measures of individual kidney GFR. In the clinical section we show how MR urography adds unique aspects to the anatomic evaluation of the urinary tract, and by combining the anatomic information with functional information, how we assess hydronephrosis and obstructive uropathy, congenital malformations, pyelonephritis and renal scarring.

Child↗

PubMed1998

Iodixanol in paediatric excretory urography: efficiency and safety compared to iohexol.

BACKGROUND: Iodixanol (Visipaque, Nycomed Imaging AS, Oslo, Norway) is a new non-ionic and isotonic X-ray contrast medium. OBJECTIVE: To assess its safety and efficacy for paediatric excretory urography. MATERIALS AND METHODS: A three-centre trial in which 72 patients were randomised into three parallel groups: iodixanol 270 mgI/ml, iodixanol 320 mgI/ml and iohexol 300 mgI/ml (Omnipaque, Nycomed Imaging, Oslo, Norway). Doses ranging from 1 to 3 ml/kg never exceeded 50 ml. Pulse rate and blood pressure were recorded before, during, and after the examination. Adverse events, including injection associated discomfort, were recorded during and up to 24 h after the examination. The diagnostic quality of the urograms was assessed on a four-level scale. RESULTS: No serious adverse event occurred in any of the three groups. One patient who was given iodixanol 270 mgI/ml, three who received iodixanol 320 mgI/ml, and one who received iohexol 300 mgI/ml experienced transient adverse events. More than 80 % of the urograms in all three groups were rated "good" or "excellent". CONCLUSION: Iodixanol, either 270 mgI/ml or 320 mgI/ml, is well tolerated and efficacious for excretory urography in children.

Adolescent↗

PubMed2005

Improved pelvicalyceal visualization with multidetector computed tomography urography; comparison with helical computed tomography.

Our aim was to compare the quality of pelvicalyceal visualization on computed tomography (CT) urography using a small intravenous contrast material dose, hydration, and high-resolution multidetector CT (MDCT) with that of conventional helical CT. The test (MDCT) group (49 consecutive patients, 98 kidneys) was scanned 5 min following an intravenous bolus of 30 ml of iodinated contrast material. The control (helical CT) group (50 consecutive patients, 95 kidneys) was scanned 5 min following injection of 120-150 ml of intravenous contrast material. Enhancement and quality of calyceal detail were measured using a five-scale grading system (1 for no detail, 5 for cupped calyces). Calyceal attenuation was substantial in both groups (more than 220 Hounsfield units, HU) but less in the test group compared with the control group (mean 475 and 920 HU, respectively), p<0.0001. In the test group, the calyceal attenuation was less than 500 HU in the majority of cases (65/98 kidneys), while the opposite was true for the control group, where calyceal attenuation was more than 750 HU in 50/95 kidneys (p<0.001). The quality of calyceal detail was 3.4/5 in the test group compared with 1.8/5 in the control group (p<0.0001). The combination of hydration, low-contrast dose, and the high image resolution achieved with MDCT significantly improves calyceal visualization in CT urography.

Adult↗

PubMed2006

CT urography: a comparison of strategies for upper urinary tract opacification.

A consensus is yet to be reached regarding the best strategy for ensuring maximum ureteric delineation during CT urography (CTU). In this study we have compared various CTU protocols to try to establish the best method for ureteric delineation. Saline infusion in the supine position, saline infusion in the prone position, furosemide administration (10 mg, iv) and buscopan administration (20 mg iv) with saline infusion in the prone position were tried in four groups, each having 15 patients who were undergoing CTU. The pelvicalyceal system and ureter were divided into six segments, to each of which an opacification score was assigned (0, unopacified segment; 1, less than 50% opacified segment; 2, 50-99% of the segment opacified; or 3, completely opacified segment) and the results compared. Furosemide administration resulted in complete opacification of 93% of the ureters (28 of 30). In the distal (below the sciatic notch) ureter, the mean score with furosemide was 2.9, while that with saline, supine and prone positioning was 1.87 and 1.83, respectively, and this difference was highly significant (P = 0.0002 and P = 0.0001). It was also significantly higher than the buscopan group (score 2.3, P = 0.002). Also in the lower (the iliac crest to the sciatic notch) and upper (above the iliac crest) ureter, furosemide had significantly higher scores than saline infusion in either position. Saline infusion in the supine and prone positions had very similar scores in all segments that were less than the buscopan group, but this difference was not statistically significant. During CT urography, furosemide administration in low doses is the most effective and convenient technique for ureteric opacification.

Adolescent↗

PubMed2005

Dribbling of urine due to ectopic vaginal insertion of an upper pole ureter diagnosed by magnetic resonance urography.

Imaging the urinary tract in children has been mainly based on ultrasound (US) and intravenous pyelography (IVP), but these imaging modalities rarely show ectopic insertion of the ureter and the condition is often under diagnosed due to unusual clinical presentations. Recently newer magnetic resonance urography sequences have been developed that provide better delineation of the urinary tract. We report a 3-year-old girl presenting continuous dribbling of urine in which magnetic resonance urography revealed ectopic vaginal insertion of the ureter.

Child, Preschool↗

PubMed1987

Low-dose digital urography in the pregnant patient.

In the pregnant patient when visualization of the ureters is requested, excretory urography is often ordered. We propose the use of digital radiography using single exposure as an alternative to conventional urography. This technique allows significant dose reduction while visualizing the entire urinary tract. It can be performed on most current-generation computerized tomographic scanners. In addition to dose reduction, the ability to manipulate, magnify, and avoid repeat exposures makes this an attractive alternative to the conventional film-screen technique.

Adult↗

PubMedDate not supplied

Medullary sponge kidney on axial computed tomography: comparison with excretory urography.

To evaluate features of medullary sponge kidney (MSK) on computed tomography (CT), 4-mm-thick axial slices without intravenous contrast material were first made in 13 patients through 24 kidneys which showed images of MSK on excretory urograms. On CT, papillary calcifications were found in eleven kidneys. In five of these kidneys, the calcifications were not detectable on plain films. Some hyperdense papillae (attenuation value 55-70 Hounsfield units) without calcification were found in four other kidneys. Nine kidneys appeared normal. Ten of these 24 kidneys were reexamined by a second series of 4-mm-thick axial slices, 5 min after intravenous injections of 50 ml of Urografin. Images suggesting possible ectasia of precaliceal tubules were found in only four kidneys. These images appear much less obvious and characteristic on CT than on excretory urogram and do nothing more than suggest the possibility of MSK. In conclusion, the sensitivity of CT in the detection of MSK is markedly lower than that of excretory urography. In the most florid cases of the disease, CT can only show images suggesting the possibility of MSK. On the other hand, CT appears much more sensitive than plain films and tomograms of excretory urography in the detection of papillary calcifications, the most frequent complication of MSK.

Female↗

PubMed1994

Iodixanol in intravenous urography: a comparison of iodixanol 270 mgI/ml, iodixanol 320 mgI/ml and iopamidol 300 mgI/ml (NIOPAM).

The first European trial of iodixanol (Nycomed Imaging AS) in adult intravenous urography is reported. Iodixanol is a new non-ionic, dimeric contrast medium of low osmolality. A double-blind, randomized, three group parallel study comparing iodixanol 270 mgI/ml, iodixanol 320 mgI/ml and iopamidol 300 mgI/ml (Niopam) was undertaken. A total of 173 of 180 patients entered completed the trial. Efficacy was evaluated with regard to overall diagnostic information and pyelographic density 5 min after contrast medium administration. Efficacy was found to increase with increasing iodine concentration, with no significant difference between the three contrast media. The incidence of adverse events was low, with no significant difference between the groups. Discomfort occurred less frequently with iodixanol than with iopamidol. We conclude that iodixanol is a safe and efficacious contrast medium for use in intravenous urography.

Adult↗

PubMed1984

Intravenous urography with low-osmolality contrast agents: theoretical considerations and clinical findings.

There are theoretical reasons for expecting some aspects of image quality in intravenous urography to be modified when low-osmolality, rather than conventional, contrast agents are used. The clinical findings in urography using two of these, the non-ionic agents iohexol (Omnipaque 350, Nyegaard) and iopamidol (Niopam 370, Bracco/Merck), are compared with those using sodium iothalamate (Conray 420, May & Baker Ltd), and are discussed against this theoretical background. The best nephrogram obtained with the new agents often occurred later than with the conventional agent, but quantitative differences in its density were explicable on a total iodine dose basis. The pyelographic density obtained with the new agents was significantly greater than with the conventional agent without any evidence, when abdominal compression was used, of the predicted associated poor distension of the collecting system.

Contrast Media↗

PubMed1988

A comparison of real-time ultrasonography with intravenous urography in the follow-up of patients with spinal cord injury.

Patients with spinal cord damage require an expert urological assessment at regular intervals. Seventy-five patients with neurogenic bladder dysfunction associated with spinal paralysis attending for routine assessment of the upper urinary tract had both intravenous urography (IVU) and renal ultrasonography. The combination of a plain radiography of the abdomen and an ultrasound scan of the kidneys was found to be a cheap, safe and reliable alternative to intravenous urography for the regular follow-up of these patients.

Adolescent↗

PubMed1989

Selective use of excretory urography in women with acute pyelonephritis.

The outcome of excretory urography was analyzed in 103 nonpregnant women followed prospectively after community acquired acute pyelonephritis. Radiological abnormality was found in 40 per cent of the patients (17 per cent had major abnormalities, including renal scarring, calculi and obstruction). All 5 women with surgically correctable lesions had rapid bacteriological relapse or recurrent acute pyelonephritis. Neither a history of urinary tract infection, the acute inflammatory response nor infection due to Escherichia coli with or without adhesins specific for Gal alpha 1----4Gal beta-containing receptors was efficient in predicting major radiographic lesions or the outcome of treatment. Bacteremia was detected in 27 per cent of the patients but in the absence of obstruction. These results suggest that excretory urography is dispensable in most women with acute pyelonephritis, and that those needing such investigation may be identified by failure to respond to antibiotic treatment or by the recurrence pattern.

Acute Disease↗