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PubMed1980

Visualization of the renal arteries during excretory urography.

1. Intravenous excretory urography was modified and expanded in order to visualize the aorta and the renal arteries. 2. The new procedure consists of the rapid intravenous injection of contrast medium, determination of the circulation time between the injection site and abdominal aorta, tomography with a multileaf cassette with five films (angiotomography) and continuation of the investigation as with routine excretory urography. 3. In 343 patients a total of 739 single or multiple renal arteries were identified at least partially. Of these, 83% could be clearly outlined between the aorta and the first division. 4. In 71 hypertensive patients angiography and angiotomography were separately evaluated. With angiotomography all 165 single or multiple renal arteries seen with angiography were visualized at least partially, whereas a total of 149 (90%) of renal arteries could be completely outlined between the aorta and the first division of the renal arteries. 5. A sensitivity for the presence of renal artery stenosis of 92% and a specificity for the absence of artery stenosis of 99% can be calculated for angiotomography in the diagnosis of renal artery stenosis. 6. Thus this method permits the detection or exclusion of renal artery stenosis in almost three-quarters of patients with hypertension, without angiography.

Adult↗
PubMed1978

Urography in children: when should it be done? 1. Infection.

Radiologic evaluation of urinary tract infection in children should include both excretory urography and voiding cystourethrography. Excretory urography is done to search for anomalies predisposing to infection and for signs of previous episodes of pyelonephritis or reflux and to serve as a baseline for future studies. Voiding cystourethrography is done to search for abnormalities in the natural barriers that protect the renal medulla from infection. If reflux is found to be present and sequential reflux studies are done, they should be performed by the radionuclide method to observe changes in degree or cessation.

Child↗
PubMed1997

Contrast-enhanced magnetic resonance urography. First experimental results with a polymeric gadolinium bloodpool agent.

RATIONALE AND OBJECTIVES: The authors investigated the feasibility of contrast-enhanced excretory magnetic resonance urography to visualize the nonobstructed urinary tract with a macromolecular gadolinium-based bloodpool agent. METHODS: Excretory magnetic resonance imaging was performed in seven pigs using a T1-weighted three dimensional fast-field-echo sequence before and up to 120 minutes after administration of a gadolinium bloodpool prototype agent. RESULTS: During the first 15 minutes after injection, the urographic effect was predominantly poor. Visualization of the entire urinary tract was excellent in four pigs and incomplete but satisfactory in three 105 minutes after injection. Furosemide application was tested in one case, which improved image quality effectively. Corresponding to the physiological excretion rate, signal measurements in the renal parenchyma revealed a gradual decrease of the initially distinct contrast enhancement. CONCLUSIONS: T1-weighted contrast-enhanced magnetic resonance urography using a polymeric gadolinium bloodpool allows detailed visualization of the normal urinary tract, while information about the excretory function is obtained simultaneously. However, application of a diuretic seems to be essential to prevent lengthy examination duration.

Animals↗
PubMed2005

Multislice computed tomography-urography: intraindividual comparison of different preparation techniques for optimized depiction of the upper urinary tract in an animal model.

OBJECTIVES: We sought to evaluate intraindividually 3 different preparation protocols for achieving improved opacification and anatomic depiction of the upper urinary tract in multisclice computed tomography urography (MSCTU) using a porcine model. MATERIAL AND METHODS: MSCTU was performed in 8 healthy pigs. Each animal underwent 3 MSCT urographies using 3 different preparations before the injection of contrast material: A, intravenous (iv) saline (250 mL); B, iv low-dose furosemide (0.1 mg/kg); and C, iv saline (250 mL) plus iv low-dose furosemide (0.1 mg/kg). Image analysis was performed blinded to the applied protocols and included the evaluation of the opacification and anatomic depiction of the upper urinary tract by means of graded scales. Ureteral distension was determined and density was measured within the collecting system. RESULTS: Furosemide significantly improved both mean opacification scores and mean scores of anatomic depiction compared with the exclusive infusion of saline for MSCTU. There was no significant difference between the application of furosemide and the combination of furosemide plus saline. A significant increase of 25-26% for ureteral distension was found when furosemide was applied. Significant lower mean attenuation values (Hounsfield units) and standard deviation were found within the opacified urine for diuretic-enhanced MSCTU. CONCLUSIONS: Low-dose furosemide injection is superior to saline infusion for achieving optimal enhancement in MSCTU. It is not necessary to combine furosemide and saline infusion. In MSCTU, low-dose furosemide is a simple add-on simplifying image acquisition timing and removing the need for abdominal compression devices.

Animals↗
PubMed1984

Pre-cystoscopic diagnosis of bladder tumour by modified intravenous urography.

Intravenous urography is the primary radiographic procedure used to evaluate patients with haematuria. During the last 15 years a modification of intravenous urography, using delayed films of the bladder, has aided the correct pre-cystoscopic diagnosis of bladder tumor in 82 of the 95 patients seen with this condition at our medical centre. After injection of contrast medium, anteroposterior and oblique views of the abdomen are obtained up to 15 min. Our modification consists of taking delayed films of the full bladder 1/2 h and 1 h later, followed by a post-voiding film. A bladder tumour appears as a filling defect or space-occupying lesion and can be distinguished from other lesions. Such delayed films increase the yield in the radiographic diagnosis of bladder tumours.

Aged↗
PubMed2004

Renal transit time with MR urography in children.

PURPOSE: To prospectively evaluate use of dynamic contrast material-enhanced magnetic resonance (MR) urography for measurement of renal transit time (RTT) of a contrast agent through the kidney and collecting system so as to identify obstructive uropathy in children. MATERIALS AND METHODS: One hundred twenty-six children suspected of having hydronephrosis were hydrated prior to undergoing both conventional and dynamic contrast-enhanced MR urography of the kidneys and urinary tract. A three-dimensional sequence was used to track passage of contrast agent through the kidneys. Time between the appearance of contrast material in the kidney and its appearance in the ureter at or below the level of the lower pole of the kidney was defined as RTT. Bland-Altman plots were used to quantify intra- and interobserver performance. In 30 children, a nuclear medicine renogram was also obtained, and the half-life of renal signal decay after furosemide administration was derived and compared with the MR imaging RTT by using receiver operating characteristic curves. RESULTS: On the basis of RTT, kidneys were classified as normal (RTT </= 245 seconds), equivocal (245 seconds > RTT </= 490 seconds), or obstructed (RTT > 490 seconds). Inter- and intraobserver agreement indicated that the technique is both robust and reproducible. Receiver operating characteristic analysis for comparison of results of MR imaging and diuretic renal scintigraphy showed good agreement between the modalities, with a mean area under the curve of 0.90. CONCLUSION: When used in conjunction with morphologic images obtained in the same examination, RTT generally allowed normal kidneys to be differentiated from obstructed and partially obstructed kidneys.

Adolescent↗
PubMed1998

Potential renal transplant donors: evaluation with gadolinium-enhanced MR angiography and MR urography.

PURPOSE: To determine prospectively the feasibility and accuracy of combined gadolinium-enhanced magnetic resonance (MR) angiography, MR urography, and MR nephrography in the presurgical evaluation of potential renal transplant donors. MATERIALS AND METHODS: Twenty-two potential donors for renal transplantation were evaluated with 1.5-T MR imaging. MR angiograms were evaluated for the number of renal arteries, presence of early arterial branches, and renal artery stenoses. The renal collecting system and ureters were evaluated on the MR urograms. Renal parenchyma was assessed on the MR nephrogram. Prospective interpretation of MR images was compared with that of conventional angiograms and excretory urograms and with surgical findings. RESULTS: Gadolinium-enhanced MR angiography enabled correct identification of the arterial supply to all 44 native kidneys (44 single or dominant renal arteries and nine accessory renal arteries), four of five early arterial branches arising in the proximal 2 cm of the renal artery, a mild truncal stenosis in one renal artery, and two anomalies of the draining renal veins. The MR urogram accurately depicted a duplicated collecting system and mild unilateral pelvicalicectasis. The MR nephrogram showed renal size and a solitary cyst in one kidney, confirmed with sonography. CONCLUSION: Combined gadolinium-enhanced MR angiography, MR urography, and MR nephrography can accurately depict the arterial supply, collecting system, and renal parenchyma of donor kidneys.

Adult↗
PubMed1981

The effect of DDAVP on intravenous urography.

The possible role of an antidiuretic hormone analogue, DDAVP (1 deamino-8-D-arginine vasopressin), in intravenous urography has been studied. The minimum effective dose of intravenous DDAVP in normal hydrated subjects was shown to be 2 ng/kg. During intravenous urography in fluid restricted subjects, a dose of 1 microgram DDAVP was necessary to reduce significantly the urine flow rate after contrast medium injection. Although the mean pyelographic score after DDAVP was increased, the differences observed were not statistically significant. The possible reasons for this finding are discussed.

Arginine Vasopressin↗
PubMed2005

Dynamic contrast-enhanced MR urography in the evaluation of pediatric hydronephrosis: Part 1, functional assessment.

OBJECTIVE: The purpose of our study was to derive time-intensity curves for the renal cortex and medulla from 3D dynamic MR urography and to assess whether these curves are predictive of obstruction. MATERIALS AND METHODS: Fifty-nine examinations were performed in 53 pediatric patients and the degree of obstruction assessed using the renal transit time. The cortex and medulla were segmented using a semiautomatic method, and mean time-intensity curves were derived for the segmented volumes. The basic parameters of the curves (amplitude, washout) were assessed, as was the presence of certain characteristic features of the curves. RESULTS: The images allowed clear visualization of three phases of the uptake of contrast material in the cortex, the medulla, and the collecting system. Both the amplitude of the curves and the washout of the contrast material were predictive of obstruction. The distal tubular peak was reliably detected in the cortex of nonobstructed kidneys. CONCLUSION: Combining signal-intensity-versus-time-curve analysis with the other parameters that can be derived from the same MR urography data set provides a powerful tool for the diagnosis of obstruction.

Child↗
PubMed1987

The relationship between pressure flow studies and furosemide urography in hydronephrosis.

Patients with hydronephrosis were assessed by furosemide intravenous urography, pressure flow studies and renography. The area increase during furosemide urography was compared to the pressure increase during perfusion and the renographically assessed functional share. We found no correlation between the area increase and the pressure changes during perfusion. Neither was any correlation found between the functional share and the area index. It is concluded that cases of idiopathic hydronephrosis cannot be categorized by the methods currently available.

Adolescent↗
PubMed1975

The findings reported in patients undergoing excretory urography for recurrent urinary tract infection.

There was little difference between the proportion of lesions found by excretion urography in patients with recurrent urinary tract infections referred by general practitioners or hospital staff, or between Horton General Hospital which is a district general hospital, and the United Oxford Hospitals, which is a teaching group. Many patients with urinary tract infections may be saved an unnecessary visit to the hospital consultant if this is first investigated by the general practitioner.About one fifth of all patients had significant lesions shown by excretory urography which suggests that the investigation is worthwhile in patients with recurrent urinary tract infections.

Adolescent↗
PubMed1985

[Ultrasonic evaluation of the urinary tract in patients with spinal cord injuries. Systematic comparison with intravenous urography in 50 cases].

Intravenous urography and ultrasonography were performed routinely, and at the same time, in 50 patients with spinal cord injuries, to compare diagnostic efficacy. Ultrasound was found to be as reliable as intravenous urography in 92% of renal and bladder explorations and to supply additional data on these regions in 6% of cases. It was also found to be equally effective for ureteral dilatation cases, although the site and nature of the obstacle could not be established except in 66% of patients. Ultrasound imaging should therefore play an important role in the urologic surveillance of these patients.

Adolescent↗
PubMed1998

[Breath-hold 3D MR urography with 2 ml Gd-DTPA injection].

Breath-hold gadolinium-enhanced 3D MR urography was performed in five healthy volunteers. Enhanced 3D fast gradient-echo with a spectral IR pulse sequence was used for depicting MR urography, which was obtained 5-10 minutes after the injection of 2 ml of gadopentate dimeglumine (0.013-0.02 mmol/kg). The urinary tract was depicted as a high-signal intensity area, and detectability of the non-dilated urinary tracts was superior to that of heavy T2-weighted images. At the same time, comparison between the urinary tract and vascular structure could be made using breath-hold contrast-enhanced 3D MR angiography with an additional Gd-DTPA injection.

Adult↗
PubMed1984

Predictive value of excretory urography, ultrasonography, computerized tomography, and liver and bone scan in the staging of bilharzial bladder cancer in Saudi Arabia.

The role of ultrasonography, computed tomography (CT), and radioisotopic scanning in the staging of bilharzial bladder cancer has not been reported previously. Forty patients with invasive bladder cancer seen at the King Faisal Specialist Hospital and Research Centre between January 1978 and June 1981 underwent complete preoperative workup for staging of their tumors prior to radical cystectomy. The preoperative radiologic investigations included excretory urography (IVP), ultrasonography (US), CT of the pelvis, and liver and bone scans. The results of these investigations were compared with the operative and pathologic staging. Ninety-three percent of the patients with bilharzial cancer had evidence of ureteric obstruction on IVP compared with 22% of the nonbilharzial cancer patients. The presence of ureteric obstruction in these patients did not correlate with the stage of the disease with 83% of the patients with superficial tumors (T1 and T2) having hydroureteronephrosis. Ultrasonography and CT had an 83% accuracy in the staging of superficial tumors. Stage T3 tumors were understaged in 14% of the cases. Ultrasonography did not differentiate Stages T3 and T4 tumors while CT scan differentiated these two stages in 57% of the cases. Bone scan failed to reveal evidence of metastatic disease in any of the bilharzial cancer patients. Liver scan was suspicious for liver metastases in two patients with bilharzial cancers in whom open liver biopsy revealed only hepatic bilharziasis. Of all the radiographic studies, US or preferably CT scan seem to be of some value in the staging of bilharzial tumors localized to the bladder. Bone and liver scans are probably of no cost effective benefit.

Adolescent↗
PubMed2004

Combined magnetic resonance urography and targeted helical CT in patients with renal colic: a new approach to reduce delivered dose.

PURPOSE: To determine whether magnetic resonance urography (MRU), obtained before helical computed tomography (CT) in patients with acute renal colic, can help delimit the obstructed area to be subsequently examined by a targeted CT scan, thus reducing the dose of radiation. MATERIALS AND METHODS: Patients (51) with symptoms of acute renal colic underwent MRU and a total urinary tract helical CT. CT images from the 5 cm below the level of ureteral obstruction as demonstrated by MRU were selected out. Combined interpretation of MRU and selected CT images constituted protocol A. Protocol B consisted of the entire unenhanced helical CT of the urinary tract. The two protocols were compared regarding the following points: 1) sensitivity in diagnosing the presence of obstructing urinary stones, and 2) the delivered radiation dose. RESULTS: Protocol A and protocol B had, respectively, 98% and 100% sensitivity in demonstrating ureteral stone as a cause of renal colic. Estimated average dose calculated from phantom study was 0.52 mSv for protocol A and 2.83 mSv for protocol B. Therefore, the effective radiation dose was 5.4 times lower in protocol A compared to protocol B. CONCLUSION: Combined MRU and short helical CT has a high sensitivity in detecting ureteral calculi with a reduced radiation dose.

Adolescent↗
PubMed1985

Tomographic renal cortical scintigraphy: correlation with intravenous urography, computed tomography, ultrasonography, angiography, and nuclear magnetic resonance imaging.

This study evaluates single-photon renal tomoscintigraphy (SPECT) in the evaluation of renal masses and correlates this modality, where indicated, with computed tomography (CT), ultrasonography (US), angiography (ANGIO) and nuclear magnetic resonance imaging (NMR). Eight patients with renal cortical lesions detected on intravenous urography (IVP) were evaluated by SPECT and planar nuclear imaging using Tc-99m glucoheptonate (GH). Three of these patients were felt particularly likely to have renal tumors and were additionally evaluated with US, CT, ANGIO and NMR. The five patients with nodules on IVP that were not particularly suggestive of malignancy had functioning, benign, renal tissue accounting for their IVP lesions. Four of five were found by planar-GH nuclear imaging, five/five by SPECT-GH. In addition, SPECT-GH allowed better "confidence" in the normal renal tissue diagnosis in three/five cases. Of the three renal lesions that were highly suggestive of malignancy, two were hypernephromas and one was hypertrophied functioning cortical tissue. All three were correctly identified prospectively on SPECT-GH; however, one hypernephroma was missed on planar-GH. NMR, CT, and ANGIO detected only one of two hypernephromas prospectively (US detected both); all four modalities incorrectly diagnosed the hypertrophied tissue suggestive of malignancy.

Angiography↗
PubMed1986

Is there need for both intravenous urography and voiding cystography in the evaluation of children with recurrent urinary tract infections?

In a prospective study 33 children (aged 6-14 years) consecutively referred for recurrent urinary tract infections (RUTI), underwent intravenous urography (IVU) as well as voiding cystography (VC). Seven children had unilateral and two children had bilateral renal scarring, while ten children had unilateral and six children had bilateral vesico-ureteral reflux (VUR). Following normal IVU VUR was demonstrated in 22% of the ureters, but in all cases of low grade. In abnormal IVU, i.e. renal scarring or dilatation of the ureters, VC showed high grade VUR in 54% of the ureters. Based on these results and the current theories on the significance of patient age and grade of VUR, we conclude that in case of a normal IVU in children with RUTI and age of at least 6 years, there is no reason to supplement the pre-treatment evaluation with VC.

Adolescent↗