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This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.
BACKGROUND: MR urography (MRU) is an image diagnostic method which provides us with the image of urinary retention under non-invasive procedures. This time, MRU was conducted in the patients who were suspected to have urinary passage disorder, and its clinical usefulness was compared with that of drip infusion pyelography (DIP) or retrograde pyelography (RP). METHODS: The study was conducted in 65 patients who were suspected to have obstructive uropathy based on the ultrasonographic findings. MRU was conducted by means of fast SE method to obtain heavy T2-weighted image. The urogram was reconstructed by means of MIP (maximum intensity projection) method. As imaging examinations, MRU, DIP and RP were conducted respectively in 65, 47 and 27 patients. Evaluation of clinical usefulness of MRU and its indications were conducted with respect to (1) the degree of urinary retention which is identifiable by MRU by (2) comparing performance of MRU and that of other image diagnostic methods based on the scores given to MRU and other methods according to the following scale: Urinary tract is not identifiable 0 point Urinary tract is slightly identifiable 1 point The obstructive region is almost clearly identifiable 2 points The lesion causative for obstruction is identifiable 3 points. RESULTS: 1) Mild urinary retention for which overall image of urinary tract was barely identifiable by DIP was identifiable by MRU. 2) In the comparison between DIP and MRU, 24 patients whose urinary tracts were totally unidentifiable by DIP was given was 2.4 points in the average for the identifiability of urinary retention by MRU. Conversely, only poor images were attainable by MRU in the patients whose urinary flow was clearly seen in DIP. The patients whose urinary flow was clearly seen in RP was give 1.9 points in the average for the identifiability of urinary retention by MRU, indicating that relatively poor images were attainable by MRU in those patients. CONCLUSION: Mild urinary retention for which overall image of urinary tract was barely identifiable by DIP was identifiable by MRU. Therefore, it is suggested that MRU is more useful in the case that only poor images were attainable by DIP. MRU is not the one which can replace RP including urinary cytodiagnosis but is useful to identify the location of the urinary tract tumor which is unidentifiable by RP or to monitor the progress of the urinary obstruction caused by benign diseases.
OBJECTIVE: To determine whether same-day sonographic evaluation of the gallbladder is possible after the use of oral or intravenous iodinated contrast agents during intravenous urography or computed tomography. METHODS: One hundred fifty-three patients involved in this prospective study received low-osmolar or conventional contrast material. Each preparation contained 300 mg/mL iodine. Sixty-six patients received contrast agents intravenously, and 87 received them orally. Gallbladder volume was estimated sonographically, and the precontrast volume was used to calculate the volume after contraction at 30-minute intervals up to 2 hours after contrast agent administration. RESULTS: Gallbladder volume returned to precontrast values at 2 hours irrespective of the type of contrast agent or route of administration. The mean volume after contraction at 0.5 hour was 71% after intravenous contrast agent administration and 76% after oral contrast agent administration. Both changes were statistically significantly different from precontrast values (P < .01, null hypothesis) and were unaffected by the osmolarity of the contrast agent. CONCLUSIONS: Gallbladder volume was restored to precontrast values 2 hours after contrast agent administration. Thus any strategy involving simultaneous same-day sonographic or computed tomographic assessment of the gallbladder after contrast agent administration can be confidently undertaken after this period. This finding may have cost-saving implications.
Urographic diagnosis has been significantly improved by the routine addition of tomography. This simple, effortless and time saving technique has resulted in the salvage of urographic studies that would otherwise have been considered indeterminate. Repeated-examinations are avoided. Tomography has also demonstrated lesions where conventional urograms have been considered normal. Finally renal lesions already demonstrable by conventional urography, can be better interpreted and analyzed.
PURPOSE: We reviewed the quality and usefulness of single shot intraoperative excretory urography (IVP) for evaluating suspected upper urinary tract trauma at our trauma center. MATERIALS AND METHODS: Between 1990 and 1997 single shot intraoperative IVP for staging renal injuries was performed in 50 patients in whom clinical instability and/or major associated injuries mandated an intraoperative study. Contrast material (2 ml/kg) was injected intravenously and images were obtained after 10 minutes. The quality and usefulness of each study were scored by a single attending urologist on a scale of 1-worst to 5-best. RESULTS: Intraoperative study quality was generally good (average score 3.84). The information obtained was generally considered useful for determining urological treatment (average score 3.96). In 16 patients (32%) intraoperative IVP findings safely obviated renal exploration. No contrast medium reactions were noted and no complications developed that were attributable to intraoperative IVP. CONCLUSIONS: Intraoperative single shot, high dose IVP is safe, efficient and of high quality in the majority of cases when performed as recommended. This study often provides important information that facilitates rapid and accurate decision-making. Intraoperative IVP is a useful tool for guiding the exploration of penetrating renal injuries and confirming blunt renal injuries that may be safely observed.
In a prospective study conducted between June 1992 and July 1993, we examined eighty adult Ethiopian individuals for kidney size, in order to provide a standard renal size during routine examination. The size of the kidney was assessed by measurement of the length, cortical thickness and width from intravenous urography (IVU). We found that the left kidney was longer than the right and the mean kidney length was greater in men than in women. Furthermore, we found that there is a positive correlation of the kidney length with body height and body weight. However, there was no correlation between kidney size and the age and sex of the subjects investigated. Data from the present study are similar to findings reported from elsewhere and suggest that renal size standard set for patients elsewhere could also be applicable to our patients in a routine examination.
We report our clinical experience with magnetic resonance urography in 13 patients. This noninvasive relatively new application of magnetic resonance to initial radiologic evaluation of patients with acute flank pain offers valuable diagnostic information and may provide additional support in defining the need for possible further therapeutic intervention in selected cases.
Intravenous urography and isotope renography studies were made in 54 patients with hydronephrosis. Thirty six of these patients underwent reconstructive surgery and were also studied postoperatively. Both studies gave more or less consistent results - that is to say evaluations of renal function and drainage from each individual study were similar - but no individual parameter was of any specific significance in the selection of patients for therapy. Points were allocated to each parameter, and after summing these points for each individual patient, 3 groupings became apparent: a low count group - patients with pelvectasia but normal renal function:a middle count group - patients with certain hydronephrosis; and a high count group with severe hydronephrosis, and markedly impaired renal function. Post-operatively, renal function was unaltered or mildly reduced in group 1, and improved in groups 2 and 3, though the differences were not statistically significant. It was hoped that the studied would allow differentiation between patients of the low count group, but the conundrum remains - which of them can be categorized as normal variants, and which were in fact displaying early pathological signs of essentially progressive disease.
BACKGROUND: The present investigation is an extension of our earlier work on oxidative stress in a number of clinical situations and awareness of potential toxicity of contrast media. It was of interest to understand the relative safety (in terms of balance between oxidants/antioxidants) of the usage of iodinated contrast media in urography. METHODS: Alterations in serum levels of oxidant lipid peroxidation and product malondialdehyde (MDA) and components of anti-oxidant have been studied in 125 patients (with renal calculus disease) to undergo intravenous urographic procedure before and 3 hours following intravenous administration of Trivideo-400 (Iothalmate Sodium 40 ml: 18 gm Iodine) and results of serum levels of MDA (nmol/ml), SOD (mu/ml), Vit-C and Vit-E (mg/dl) were also compared with 135 appropriately age matched controls. RESULTS: The salient features of present investigation indicated definite pattern viz. Significant rise in serum levels of oxidant MDA (4.35 +/- 2.05) and fall in SOD (3.04 +/- 1.04), Vit-C (0.55 +/- 0.17), Vit-E (0.67 +/- 0.20) in patients at pre-IVU stage in comparison with those of controls viz MDA (4.35 +/- 2.05), SOD (3.77 +/- 1.55), Vit-C (0.71 +/- 0.25) and Vit-E (0.80 +/- 0.30). There occurred further elevation in serum levels of MDA (5.28 +/- 2.48) and fall in SOD (3.07 +/- 0.97), Vit-C (0.52 +/- 0.16), Vit-E (0.66 +/- 0.19) showing no significant alterations 3 hours following intravenous IVU procedure. CONCLUSIONS: It is concluded that contrast media induced changes did remain within tolerable physiological limits and no significant changes in anti-oxidant components Vit-E and SOD were suggestive of relative safety of iodinated contrast media usage.
Physiologically, two complementary mechanisms regulate plasma osmolality: antduretic hormone ADH) and thirst. ADH release s supressed, thirst s inhbted and renal water loss occurs when plasma osmolality below a threshold level. The rise in plasma osmolalty causes ADH release, stimulation of thirst and water intake. Acute water intoxication is exceptional in patients without a chronic psychiatric disease. Herein, we describe a case of acute water intoxication in a previously healthy patient, after making an intravenous urography. The excessive water intake and the impossibility of renal water loss because of streee-induced ADH release originated t. Only nine cases have been previously described; almost they all were women preparing for diagnostic procedures.
OBJECTIVE: The objective of this study was to compare the efficacy of plain spiral computed tomographic (CT) scan with intravenous urography (IVU) in the evaluation of patients with suspected urinary calculi/obstruction. MATERIALS AND METHODS: Twenty consecutive patients with acute signs of renal colic were prospectively examined with unenhanced spiral CT followed by an IVU within the same day. The CT scans were reviewed jointly by 2 radiologists blinded to the IVU and a consensus was reached for each finding. The IVU was similarly reviewed by another 2 separate radiologists. RESULTS: Eleven of the 20 patients had signs of urinary obstruction on CT and IVU. Of these 11 patients, 7 had a ureteric calculus that was demonstrated on CT and IVU and 4 had a calculus that was demonstrated on CT only. Two patients had a urinary calculus seen on CT and IVU with no signs of urinary obstruction. One patient had a calculus seen on CT alone with no urinary obstruction. Two patients only had signs of urinary obstruction on CT. The remaining 4 cases had normal findings on CT and IVU. CONCLUSION: Unenhanced CT is more effective than IVU in identifying ureteric calculi and is equally effective in detecting urinary obstruction. CT is also useful in detecting secondary signs of obstruction even in the absence of any calculus.
OBJECTIVE: To evaluate the role of magnetic resonance urography (MRU) in the diagnosis of upper urinary tract obstruction. METHODS: MRU was performed for 35 patients suspicious of upper urinary tract obstruction. RESULTS: MRU provided high resolution images of the urinary tract. The site of upper urinary tract obstruction and hydronephrosis could be clearly shown. CONCLUSIONS: MRU, a nontraumatic technique, needs no iodinated contrast medium. It might be widely adopted in the diagnosis of upper urinary diseases.
OBJECTIVE: To evaluate magnetic resonance urography (MRU) in the diagnosis of urinary tract obstruction after renal transplantation. METHODS: A total of 31 patients with suspected urinary tract obstruction after renal transplantation were examined, and the results were compared with those from surgery and B-ultrasound examination. RESULTS: The urinary tract after renal transplantation was clearly shown using MRU, and all patients were clearly diagnosed by MRU. Imaging results were consistent with those from surgery. CONCLUSIONS: MRU is suitable for detecting urinary tract obstruction after renal transplantation. It is a alternative method for IVP and CT in patients with renal function impairment and uremia.
High-dose bolus urography was evaluated in 38 patients with severe renal failure. Iothalamate meglumine (Conray 60) (2 ml/kg of body weight) was injected within one minute and nephrotomograms were taken for 30 minutes, with delayed films until 24 hours. Immediate nephrograms were obtained in all cases. The collecting systems, seen in 29 cases, were dilated in three. In the rest, obstruction could be ruled out by a combination of roentgenographic criteria. No untoward reactions occurred, and all the required information was obtained within 30 minutes. The results were superior to plain nephrotomography or infusion pyelography. We conclude that bolus nephrotomography is the procedure of choice in the investigation of severe renal failure.
In 200 adult patients, urography with Urovist S (50 ml sodium diatrizoate 50%) achieved good or satisfactory visualisation of the urinary tract in 80-90%. The medium was generally well tolerated. Reactions, which were mostly mild, occurred in 13% of patients.
The non-ionic contrast medium metrizamide was compared to the sodium salt of diatrizoate to investigate the potential usefulness of metrizamide in clinical urography when ureteric stasis is applied. After intravenous injection of the contrast media to rabbits at dose level 175 mg I/kg, the kidneys were subjected to temporary bilateral ureteric stasis. Urine was collected through ureteric catheters and analyzed for its concentration of iodine, sodium and potassium. After metrizamide injection the urine iodine concentration was twice as high as after sodium diatrizoate injection. This difference between one non-ionic and one ionic contrast medium was larger than what has been reported earlier during free flow of urine at the same dose. Furthermore, during the periods of ureteric stasis metrizamide was excreted faster than diatrizoate. When diatrizoate was given as its sodium salt, the sodium given was excreted at about the same rate as the diatrizoate given.
A case of recurrent intraperitoneal bladder rupture is reported. Tearing occurred after minor trauma in a woman who had suffered a fracture of the pelvic rim 6 years earlier. Spontaneous rupture of the bladder is rare. The symptoms of an intraperitoneal bladder rupture may suggest intestinal disease and intravenous urography may be misleading. A retrograde cystogram is required to obtain the diagnosis.
The efficacy and safety of Optiray (Ioversol), a new low osmolar non ionic contrast agent, were evaluated in an open trial for pediatric intravenous urography. At a concentration of 30% iodine, Optiray had a good diagnostic efficacy and was found to be well tolerated.