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Obstruction of the superior vena cava or its major tributaries demonstrated by bolus-injection excretory urography.

Three cases in which venous obstruction in the thorax was demonstrated by visualization of collateral circulation during bolus-injection excretory urography are presented. Visualization of these collateral vessels is highly suggestive of venous obstruction even if this condition is clinically unsuspected. The diagnosis may be confirmed by radionuclide venography, which is easily performed and noninvasive, and allows determination of the level of obstruction, as well as the degree of collateral flow.

Adult↗

Duplication of the müllerian ducts and genitourinary malformations. Part I: the value of excretory urography.

Forty-seven females with duplication of the uterus and cervix were retrospectively studied and their associated urinary tract malformations were analyzed. In 31 of the patients duplication of the müllerian ducts was diagnosed during the work-up for major genitourinary malformations that corresponded to three main complexes of anomalies: cloacal anomalies (16 patients), exstrophic deformities (4 patients), and renal malformation on the same side as an occluded müllerian duct (11 patients). Another five patients with normal kidneys had incomplete müllerian duct fusion discovered incidentally at autopsy, surgery, or during the work-up for urinary tract infections. None of the 11 women examined by excretory urography following the discovery of duplication of müllerian ducts by hysterosalpingography had urinary tract abnormalities. Therefore, although failure of fusion of the müllerian ducts frequently coexists with other genitourinary anomalies, the associated malformations manifest themselves clinically. Women who are found to have duplication of the reproductive tract during the work-up for infertility and who are otherwise asymptomatic and have a normal physical examination do not require urographic investigation.

Abdominal Muscles↗

Excretory urography with glucagon: a randomized trial.

The authors compared the effect of glucagon (1 mg I.V.) and a placebo on visualization of the collecting systems and ureters in 185 adults undergoing routine excretory urography. Either glucagon or the placebo was given 10 minutes after contrast injection in the first 95 patients and 5 minutes after contrast injection in the remaining 90 patients. Ampules were randomized. Objective and subjective analysis showed no improvement in visualization of either the collecting systems or the ureters in either group: in fact, glucagon caused the quality of the urograms to decrease significantly. Possible reasons for this are discussed. No side effects attributable to the glucagon were observed.

Clinical Trials as Topic↗

Systemic response to excretory urography. Work in progress.

Ninety-seven patients who were undergoing excretory urography for suspected genitourinary tract abnormalities were continuously monitored for systemic blood pressure and pulse rates before (control) and after rapid intravenous injections of contrast material (1.5 ml/kg meglumine iothalamate, 60%) using a Bard pressure monitor. We report the systemic responses observed. Clinically obvious reactions to contrast medium were recorded and compared with the blood pressure and pulse rate responses. The most common response to rapid infusion of contrast medium was a transient hypotension. An increase in systemic pressure had a high association with nausea and vomiting. Significant hypotension (mean blood pressure less than 60 mm Hg) was observed in six patients (6%), but no overt clinical manifestations were present.

Adult↗

High-dose clinical urography with the low-osmolality contrast agent Hexabrix: comparison with a conventional contrast agent.

A double-blind clinical trial was performed in 60 patients to compare Hexabrix (ioxaglate meglumine and ioxaglate sodium) and Renografin-60 (diatrizoate meglumine and diatrizoate sodium). Use of Hexabrix produced higher urinary iodine concentrations, lower urine volumes at 30 minutes, and excretory urograms significantly better in diagnostic quality, as rated by four independent observers. There was no difference in nephrogram quality between contrast agents. Patients receiving Hexabrix had less of an increase in heart rate and demonstrated a slight rise in mean arterial blood pressure, rather than the biphasic rise then fall seen with Renografin-60. There was no significant change for up to 96 hours after urography in results of hematology, clinical chemistry, or urinalysis, except for an increase of 0.005 in urine specific gravity with Renografin-60. Patients reported significantly less body heat, heat in the injection arm, and overall discomfort with Hexabrix. There was a similar amount of nausea and vomiting in the two groups. Hexabrix also caused histaminic-type reactions in three patients.

Adult↗

Excretory urography using computed radiography.

A computed radiographic system for generating digital film images was evaluated in the performance of excretory urography. Three experienced radiologists reviewed digital and conventional screen-film urograms for 100 patients in a prospective study to evaluate the clinical utility of the digital system. Results indicate no difference between digital and screen-film urograms in diagnostic sensitivity, specificity, or receiver-operating-characteristic curves for differentiating normal from abnormal studies. Readers' performances in making specific diagnoses were also the same with both techniques.

Humans↗

Tomographic levels for intravenous urography: CT-determined guidelines.

The selection of levels for tomographic sections of the kidneys during intravenous urography has previously been based on empirical observation. Three hundred abdominal computed tomographic scans were analyzed for the anteroposterior (AP) midpoints of the kidneys and their relationship to the patient's AP abdominal diameter. A graph for selection of tomographic levels was generated and compared with existing methods. These guidelines enable a more objective approach to urographic tomography.

Female↗

Assessment of prostatism: role of intravenous urography.

A prospective study of 502 patients referred for assessment of symptoms of bladder outlet obstruction was performed to determine the value of routine intravenous urography (IVU). The purpose was to establish the rate at which significant occult abnormality in the upper urinary tract is detected with IVU alone; to determine to what extent these abnormalities can be predicted from routine clinical and laboratory evaluation, thus allowing better patient selection for IVU; and to recommend alternative imaging modalities. History, physical examination, and routine laboratory studies constituted the preliminary examination. Abnormalities were found in 23% of patients but significant conditions in only 10%. Occult significant abnormalities that would have been missed without IVU occurred in only 1.5% of patients. Most of these could be detected on an abdominal radiograph. Only one malignancy would have been missed without routine IVU. The authors conclude that IVU in the assessment of prostatism should be limited to patients with positive findings in the clinical work-up. An abdominal radiograph is recommended in the others. Significant cost savings can thus be achieved.

Adult↗

Nonionic versus ionic contrast media in intravenous urography: clinical trial in 1,000 consecutive patients.

A double-blind clinical trial was performed in 1,000 consecutive patients to compare the safety and efficacy of intravenously administered nonionic (iohexol) and ionic (metrizoate) urographic contrast media. The patients ranged in age from 10 to 80 years. The incidence of mild to moderate adverse effects was 7.7% with iohexol and 31.2% with metrizoate. No serious reactions were recorded with either of the contrast media. Urography with iohexol was found to give better parenchymal opacification, pelvocalyceal opacification, and overall quality. The sum of examinations with good and excellent overall quality was 97.8% with iohexol and 91.1% with metrizoate. The frequency of poor overall quality urograms was 1.6% with iohexol and 7.5% with metrizoate. The data suggest that iohexol is safer and more frequently produces urograms of better quality.

Adolescent↗

Diagnostic efficacy of excretory urography with low-dose, nonionic contrast media.

A prospective, randomized, physician-blinded study was conducted to determine whether a smaller dose of low-osmolar, nonionic contrast medium can provide diagnostic information on excretory urograms equivalent to that obtained with higher doses of ionic and nonionic contrast agents. One hundred fifty adult patients who underwent excretory urography received a high-dose ionic contrast medium (diatrizoate sodium), high-dose nonionic contrast medium (iohexol), or low-dose nonionic contrast medium (iohexol). All urograms were scored for diagnostic quality. No difference in urographic quality was detected among the different doses of contrast media. The lower dose of low-osmolar nonionic contrast medium provided equivalent diagnostic information. The quality of the nephrotomograms, ureteral image, and overall image was slightly greater with diatrizoate than with a small dose of iohexol, but the difference was not significant. This study suggests that excretory urograms obtained in relatively healthy, well-prepared patients with smaller, less expensive doses of a nonionic contrast agent are at least diagnostically equivalent to those obtained with typical higher doses of ionic and nonionic agents.

Contrast Media↗

Iodixanol in excretory urography: initial clinical experience with a nonionic, dimeric (ratio 6:1) contrast medium. Work in progress.

The authors report the first clinical experience in the United States with the highly water soluble, nonionic dimer (6:1 ratio) contrast medium iodixanol (5,5'-[(2-hydroxyl-1,3-propanediyl)bis(acetylimino)]bis[N,N' - bis(2,3dihydroxypropyl)-2,4,6-triodo1,3-benzenedicarbooxa mide]). Iodixanol has an osmolality less than half that of monomeric, nonionic equivalent contrast media. Sodium, calcium, and magnesium ions were added to iodixanol to make the injected solution isosmotic to blood (290 mosm/kg H2O), with levels of free calcium and magnesium equivalent to levels found in the blood. Forty patients undergoing elective excretory urography were studied after bolus injection of doses of iodixanol with either 27 or 32 g of iodine. No adverse event or idiosyncratic reaction occurred. Seven patients felt coolness at the site of injection. Diagnostically adequate urographic examinations were routinely obtained with both doses. Further clinical investigation with iodixanol is warranted to determine if its beneficial chemical properties minimize both the chemotoxic and osmotoxic side effects and the disruption of physiologic functions that are seen with use of other ionic and nonionic contrast media.

Adult↗

Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography.

PURPOSE: To compare non-contrast-enhanced computed tomography (CT) and intravenous urography (IVU) in the evaluation of patients who present with acute flank pain and in whom ureteric obstruction is suspected. MATERIALS AND METHODS: The findings at non-contrast-enhanced CT and IVU in 20 patients with acute flank pain were compared for the presence or absence of ureteric obstruction and delineation of ureteric stones. RESULTS: Twelve of the 20 patients had non-contrast-enhanced CT and IVU findings consistent with ureteric obstruction. Of these 12 patients, five had a ureteric stone that was demonstrated on both non-contrast-enhanced CT scans and IVU radiographs, six had a stone that was depicted on non-contrast-enhanced CT scans only, and in one patient a stone could not be delineated definitively on either non-contrast-enhanced CT scans or IVU radiographs. Eight patients had findings at non-contrast-enhanced CT and IVU consistent with the absence of obstruction. CONCLUSION: Non-contrast-enhanced CT is more effective than IVU in precisely identifying ureteric stones and is equally effective as IVU in the determination of the presence or absence of ureteric obstruction.

Acute Disease↗

Multi-detector row CT urography in the evaluation of hematuria.

Hematuria can be well evaluated with a comprehensive contrast material-enhanced multi-detector row computed tomography (CT) protocol that combines unenhanced, nephrographic-phase, and excretory-phase imaging. Unenhanced images are obtained from the kidneys to the bladder and allow optimal detection of renal calculi, a common cause of hematuria. Renal parenchymal abnormalities, particularly masses, are best visualized on nephrographic-phase images, which also provide excellent evaluation of the other abdominal organs. Thin-section delayed images obtained from the kidneys to the bladder demonstrate the urinary tract distended with contrast material and are useful in detecting urothelial disease. Intravenous urography, ultrasonography, CT, retrograde ureterography and pyelography, cystoscopy, and ureteroscopy can all be used to evaluate patients with hematuria. In the past, a combination of several of these examinations was necessary to fully evaluate these patients. Now, however, this CT protocol may permit evaluation of hematuria patients with a single comprehensive examination, although more experience and data are needed to determine its efficacy in this setting.

Adult↗

Renal papillary necrosis: review and comparison of findings at multi-detector row CT and intravenous urography.

Renal papillary necrosis is not a pathologic entity but rather a descriptive term for a condition--necrosis of the renal papillae--that has various possible causes. The renal medulla and papillae are vulnerable to ischemic necrosis because of the peculiar arrangement of their blood supply and the hypertonic environment. The etiology of renal papillary necrosis includes diabetes, analgesic abuse or overuse, sickle cell disease, pyelonephritis, renal vein thrombosis, tuberculosis, and obstructive uropathy. Renal papillary necrosis has been diagnosed with the use of intravenous urography and ultrasonography, but contrast material-enhanced computed tomography (CT) may better depict a full range of typical features, including contrast material-filled clefts in the renal medulla, nonenhanced lesions surrounded by rings of excreted contrast material, and hyperattenuated medullary calcifications. In the presence of papillary sloughing, CT may depict hydronephrosis and filling defects in the renal pelvis or ureter, which also may contain calcifications. During healing, the epithelialized papillary tip appears blunted. Shrinkage of the kidney, a common sequela, also may be detected at CT. Multi-detector row CT depicts these and other features more clearly and directly than single-detector row CT, given the advantages of thinner sections and multiplanar reformation, and it may help identify the condition at an earlier stage, when effective treatment can reverse the ischemic process. Familiarity with the CT features of the condition therefore is useful for its successful diagnosis and management.

Contrast Media↗

Tubular nephrotoxicity after intravenous urography with ionic high-osmolal and nonionic low-osmolal contrast media in patients with chronic renal insufficiency.

Nephrotoxicity of intravenous contrast media is more frequent and striking in patients with risk factors, the major one being preexisting chronic renal insufficiency. New nonionic low-osmolal contrast media allegedly have less nephrotoxicity than the traditional ionic high-osmolal ones. This was tested for two contrast media in a group of 18 patients with stable chronic renal insufficiency. The urinary excretion of two brush-border enzymes (alanine aminopeptidase, AAP, and gamma-glutamyl transpeptidase, gamma-GT) and of a lysosomal enzyme (N-acetyl-beta glucosaminidase, NAG), functional markers of tubular injury, were measured before and after intravenous urography with an ionic high-osmolal radiocontrast medium, meglumine sodium diatrizoate, or with a non ionic low-osmolal one, iopamidol. Urinary NAG excretion did not change significantly after administration of either contrast media. Urinary AAP and gamma-GT excretion increased significantly (p less than 0.01) after diatrizoate. After iopamidol, only gamma-GT excretion increased significantly (p less than 0.05). Our data suggest that the nonionic low-osmolal radiocontrast medium iopamidol is less toxic to tubules than the ionic high-osmolal medium diatrizoate and that the brush-border enzymes AAP and gamma-GT are sensitive markers for this toxicity.

Acetylglucosaminidase↗

Gaseous distension of the gut during intravenous urography.

During intravenous urography, the changes in the gastrointestinal tract were assessed in a total of 101 patients within two subgroups: allergic and non-allergic, depending on the patient's reaction or non-reaction to the intravenously injected Conrary 420. The gastrointestinal changes were either nil (that is normal) or abnormal with definite increase in the total volume of gas in the abdomen. Increased gas was commoner (66%) among the non-allergic group as compared with 34% of the allergic group. The aetiological basis being postulated for this observation includes biochemical and chemical changes as well as allergic response within the gut.

Contrast Media↗

Intravenous urography revisited in the age of ultrasound and computerized tomography: diagnostic yield in cases of renal colic, suspected pelvic and abdominal malignancies, suspected renal mass, and acute pyelonephritis.

The aim of our study was to assess the diagnostic yield of intravenous urography (IVU) compared to ultrasound (US) and computerized tomography (CT) in cases of renal colic, suspected pelvic and abdominal malignancies, suspected renal mass, and acute pyelonephritis. We retrospectively analyzed the case charts of 216 consecutive patients. The patients had been referred to the Department of Radiology by different hospital departments and local general practitioners. All had undergone clinical examination, US and IVU, in that order. When deemed necessary, conventional tomography was performed. Patients with renal masses also underwent CT. In cases without renal colic and normal US examination, the subsequent IVU failed to detect any further important pathology. Hydronephrosis was equally well detected using US and IVU, however, the level of obstruction was better determined using delayed X-ray films. In 24% of cases of renal colics the initial US was normal, however, the IVU revealed ureteric obstruction. Repeat US 8-12 h later always showed hydronephrosis. In 6 of 34 solid renal masses, IVU and conventional tomography failed to make the correct diagnosis, but never could the patient be spared a subsequent CT. IVU is only indicated if US shows hydronephrosis. In cases of renal colic, repeat US is necessary to diagnose the possibly developing hydronephrosis. Clinical history, US and a plain abdominal image will suffice to make the diagnosis. Renal masses always require CT. In these cases, IVU is not necessary. There is no indication left for conventional renal tomographies.

Abdominal Neoplasms↗

DMSA renal scanning versus urography for detecting renal scars in vesicoureteral reflux.

32 children admitted to Hacettepe University Hospital for surgical treatment of vesicoureteral reflux (VUR) between 1987 and 1988 were included in this prospective double-blind study. All patients underwent intravenous urography (IVU), voiding cystouretrography and 99mTc DMSA renal scanning. The sensitivity and specificity of the DMSA scan and IVU for detecting renal scarring were investigated. With regard to the presence of renal scarring, the sensitivity and specificity of IVU and DMSA were not found to be statistically different. But when the scars were scored, DMSA was found to have a higher scoring index compared to IVU. In patients who were candidates for surgical management of VUR, renal scars could be detected both by IVU and DMSA scan but, for the follow-up, the DMSA scan was found to be the investigation of choice.

Adolescent↗