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PubMed1985

Prolonged half-life following diuretic radionuclide urography as evidence of ureteral obstruction.

Diuretic radionuclide urography is an accurate technique for detecting obstruction as a possible cause of nephroureteral dilatation. This technique was used to evaluate radioisotope retention in the renal pelvis noted on the bone scan of a patient with prostate carcinoma. There was some washout of the pelvic radioactivity following intravenous furosemide, but the half-life was markedly prolonged, allowing the correct diagnosis of partial obstruction to be made.

Aged↗
PubMedDate not supplied

Diagnostic pitfalls of breath-hold MR urography in obstructive uropathy.

Breath-hold MR urography (MRU) is being used with increasing frequency to evaluate urinary tract pathology. Although multiple studies have documented the accuracy of breath-hold MRU in the evaluation of obstructive uropathy, pitfalls associated with this technique may result in diagnostic errors. This essay illustrates both technical and interpretive pitfalls of MRU and suggests strategies for their recognition and avoidance.

Adult↗
PubMed2004

Magnetic resonance urography: a new gold standard for the evaluation of solitary kidneys and renal buds?

PURPOSE: We evaluated the diagnostic potential of magnetic resonance urography (MRU) in pediatric patients with a solitary kidney and/or dysplastic orthotopic or ectopic renal buds. We present our evolving experience with this imaging procedure. MATERIALS AND METHODS: A total of 30 patients with a mean age of 43.8 months with a known or suspected solitary kidney with or without clinical symptoms underwent ultrasound of the urinary tract as well as voiding cystourethrogram, renal static dimercapto-succinic acid (DMSA) scintigraphy and MRU. The results of these diagnostic imaging studies were then compared with each other and set against the results of the final diagnosis established at surgery and by histology, if available. RESULTS: Dysplastic orthotopic or dystopic renal buds suspected on ultrasound in 11 of the 30 patients were confirmed in all 11 by MRU. While accompanying ectopic ureteral insertions were shown in only 3 patients by ultrasound, they were visualized in all 4 by MRU. The other 7 patients with dysplastic renal buds had orthotopic ureteral orifices. DMSA scintigraphy failed to detect 10 renal buds. CONCLUSIONS: The diagnostic value of MRU appears to be superior to that of other imaging tests, even to that of DMSA scintigraphy, which with voiding cystourethrography is currently considered the gold standard for evaluating sonographically suspected solitary kidneys with contralateral orthotopic or ectopic renal buds and ectopic ureteral insertion.

Adolescent↗
PubMed1981

Intravenous urography in the follow-up of carcinoma of the bladder.

A urographic survey of 250 patients being followed for bladder cancer revealed 3 unsuspected ureteric tumours and 18 cases of ureteric obstruction. The tumours occurred in patients always affected by bladder recurrence and the obstructions were largely due to treatment of paraureteric bladder tumours by cystodiathermy or radiotherapy. Regular follow-up intravenous urography is therefore unnecessary except in patients with frequent recurrences, but we advocate radionuclide renography as an essential, inexpensive screening test to rule out ureteric obstruction following the treatment of paraureteric tumours.

Adult↗
PubMed1984

Urography and cystoscopy in bladder mucosal abnormality.

A prospective study was carried out on 60 patients. The diagnostic usefulness of intravenous urography (IVU) compared with that of cystoscopy in assessing the state of the bladder mucosa was evaluated. Collectively, radiology was as good as cystoscopy in suggesting the final diagnosis of the location and severity of a mucosal lesion. The after-micturition film (AMF) from IVU was the single most informative film which produced correct results in 59 of 60 patients. The full bladder film was the least useful examination and in 45 cases suggested an incorrect or misleading diagnosis.

Adolescent↗
PubMed1987

99mTc DTPA scintigraphy compared with intravenous urography in the follow-up of posterior urethral valves.

Twenty-seven patients with posterior urethral valves with varying degrees of renal function underwent both intravenous urography (IVU) and DTPA scan during their follow-up. Although the IVU was successful in excluding obstruction in 31 kidneys, the DTPA scan was successful in 43 kidneys. In addition, the DTPA scan provides quantifiable renal function, exposes the child to a lower radiation dose and has no morbidity compared with an IVU. It is recommended that the DTPA scan should replace the IVU for long-term follow-up and that the latter should be reserved for certain problems.

Child↗
PubMed1989

Renal carcinomas missed by urography.

It is well accepted that renal masses are missed on intravenous urography. We present 3 patients with renal carcinoma; their tumours, measuring between 3 and 5 cm, were not detected on good quality IVU but were demonstrated on ultrasound. We wish to emphasise the importance of performing an ultrasound or computed tomography examination in cases where a renal tumour is suspected when the IVU is normal.

Aged↗
PubMed1992

Comparison of DMSA scintigraphy with intravenous urography for the detection of renal scarring and its correlation with vesicoureteric reflux.

A series of 208 patients was prospectively assessed for reflux nephropathy by intravenous urography (IVU) and 99mTc-dimercaptosuccinate (DMSA) scintigraphy. All patients were studied at least 3 months after their most recent urinary tract infection and micturating cystourethrography (MCU) was performed prior to the scintigraphic studies. DMSA scintigraphy detected significantly more cortical abnormalities than did IVU. There was also a correlation between cortical abnormalities in the DMSA studies and the degree of reflux on MCU. The validity of DMSA as a cortical imaging agent is evaluated and the histological evidence for its efficacy derived from the animal model is reviewed, lending weight to its establishment as the "gold standard" for renal cortical scarring.

Child↗
PubMed2004

Dynamic gadolinium-enhanced magnetic resonance urography for assessing drainage in dilated pelvicalyceal systems with moderate renal function: preliminary results and comparison with diuresis renography.

OBJECTIVE: To evaluate the use of dynamic gadolinium diethylenetriaminepenta-acetic acid (DTPA)-enhanced magnetic resonance urography (Gd-MRU) for assessing kidneys with markedly dilated pelvicalyceal systems and impaired function. PATIENTS AND METHODS: Eight children (mean age 30 months, sd 25) were assessed, diagnosed as having gross unilateral hydronephrosis with a mean (sd) anteroposterior renal pelvic diameter of 36 (7) mm and reduced (30-40%) renal function. Dynamic Gd-MRU was performed after the patients were pre-loaded with intravenous fluid and diuretics, and comprised a dynamic T1-weighted sequence after Gd-DTPA (0.1 mmol/kg body weight) was administered, with a time-intensity curve of each kidney produced. Drainage was diagnosed by a clearly declining time-intensity curve and direct visualization of contrast medium within the ureter in several frames. High-grade or complete obstruction was diagnosed when drainage of contrast medium could not be detected. Gd-MRU results were compared with diuresis radionuclide (mercapto-acetyltriglycine, MAG3) renography within the same week. Unobstructive units detected by Gd-MRU were treated conservatively with a close follow-up by ultrasonography and radionuclide studies. RESULTS: Diuresis MAG3 renography showed drainage in three dilated units and poor washout in five; in contrast, Gd-MRU showed drainage in seven dilated systems (three showed poor washout by MAG3), and obstruction in the remaining case. The unobstructed units detected by MRU under conservative treatment thus showed no further deterioration of renal function or progressive hydronephrosis in the subsequent follow-up (mean 18 months, range 15-23). CONCLUSION: These preliminary results suggest that dynamic Gd-MRU is a useful noninvasive imaging method in distinguishing obstructive from unobstructive dilated systems, particularly in patients with hydronephrosis and reduced renal function.

Child↗
PubMed2005

Planning percutaneous nephrolithotomy using multidetector computed tomography urography, multiplanar reconstruction and three-dimensional reformatting.

OBJECTIVE: To assess a modified technique of multidetector computed tomographic urography (CTU) which can reproducibly and accurately map the pelvicalyceal system (PCS) and complex renal calculi, as such information is essential in choosing the optimal percutaneous approach into the PCS for safe and successful percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Ten consecutive patients with renal calculi underwent a modified four-detector multislice CTU with frusemide, abdominal compression and subsequent injection with contrast medium. After unenhanced CT of the abdomen, a high-resolution contrast-enhanced scan was taken through the kidneys in the pyelographic phase. Data were analysed using multiplanar reconstruction and three-dimensional (3D) reformatting. RESULTS: In 10 CTUs there were three staghorn, two diverticular, 25 calyceal, two infundibular and two renal pelvic calculi; nine showed posterior calyces and good infundibular anatomy, and provided a good map of the PCS. Seven patients had PCNL, with the remaining three having either primary extracorporeal shock wave lithotripsy or conservative management. CTU detected stones in all patients and accurately located their relation to the PCS. With reconstructed images, subjectively the 3D imaging provided an advantage over conventional imaging in optimizing nephrostomy placement. CONCLUSION: CTU with this protocol and post-processing techniques enables an accurate and confident, reproducible prediction of the site, number and size of stones in complex pelvicalyceal anatomy, optimal site(s) for placing the percutaneous track, and potential hazards when placing the track, with no significant increase in the patient's radiation burden. 3D CTU should become the standard imaging method for planning PCNL in selected patients.

Diuretics↗
PubMed2006

Limited significance of routine excretory urography in the follow-up of patients with superficial bladder cancer after transurethral resection.

OBJECTIVES: To evaluate the utility of routine excretory intravenous urography (IVU) for detecting subsequent upper urinary tract cancer (UUTC) during the follow-up of patients with superficial bladder cancer. PATIENTS AND METHODS: The study included 413 patients who had transurethral resection (TUR) of superficial bladder cancer between January 1986 and December 2003, and were followed for at least 1 year. After TUR, patients were followed by periodic cystoscopy, urinary cytology and IVU. The risk factors for UUT recurrence after TUR were analysed, and based on this outcome, we then determined whether routine IVU should be used for patients with superficial bladder cancer. RESULTS: During the observation period, UUTCs developed in 20 of the 413 patients (4.8%) within a median of 33 months from the initial TUR to the detection of UUTCs. Among several factors examined, only multiplicity was significantly associated with UUT recurrence after TUR. Of the 20 patients with secondary UUTCs, only two, who had multiple superficial bladder cancers at initial presentation, were diagnosed as having UUTCs by routine IVU, while the remaining 18 presented with symptoms suggesting possible UUT recurrence before IVU, including macrohaematuria (10 patients), intravesical recurrence (five), positive urinary cytology (five), abdominal pain (three) and high fever (two). CONCLUSIONS: Most patients with recurrent UUTCs presented with some subjective and/or objective symptoms, and routine IVU failed to detect recurrent diseases in such patients. Therefore, routine IVU may not be required for all patients who have TUR of superficial bladder cancer.

Aged↗
PubMed2006

Computed tomography urography for diagnosing bladder cancer.

OBJECTIVE: To evaluate the use of computed tomography urography (CTU) for diagnosing bladder tumours in patients with macroscopic haematuria and aged >40 years. PATIENTS AND METHODS: In all, 200 consecutive patients attending a fast-track haematuria clinic were assessed using 'same-day' CTU and flexible cystoscopy. Patients were aged >40 years and had macroscopic haematuria with no urine infection. CTU studies were reported by one uroradiologist and scored on a 3-point scale to quantify the probability of bladder cancer. All flexible cystoscopies were performed by the same cystoscopist with no knowledge of the findings of CTU, and scored using a 3-point scale. Cystoscopy, pathological findings and CTU were then compared. RESULTS: The prevalence of bladder tumours was 24%; when CTU was compared with the histopathological findings, there was one false-positive and three false-negative diagnoses, indicating a sensitivity of 0.93 and a specificity of 0.99, with a 0.98 positive and 0.97 negative predictive value for detecting bladder cancer. A review of the three false-negative cases showed that one was missed on original CTU reporting, the second had the appearance of prostate cancer on CTU and the third was a squamous metaplasia. CONCLUSION: CTU is an accurate method of detecting bladder tumours in the present patients, and is reliable and accurate for assessing the bladder. Our results support the use of CTU as a first-line screening tool for this high-risk group, the use of which will obviate the need for flexible cystoscopy in patients with a negative CTU and allow those with an obvious tumour to be referred directly for rigid cystoscopy and resection. The remaining patients should be referred for flexible cystoscopy. Such a pathway would accelerate patient assessment by using fewer tests and provide a true 'one-stop' clinic, allowing a comprehensive evaluation with a single test for the upper and lower urinary tract.

Adult↗
PubMed1997

MR cholangiopancreatography and MR urography: improved enhancement with a negative oral contrast agent.

At magnetic resonance (MR) cholangiopancreatography and MR urography with an oral negative contrast agent, low signal intensity was produced in phantoms. In 20 patients suspected of having biliary tract and pancreatic diseases and in 20 healthy volunteers, the signal intensity in the gastrointestinal tract was almost completely eliminated with the negative contrast agent. Differences in image quality between pre- and postcontrast images were statistically significant.

Administration, Oral↗
PubMed2006

Magnetic resonance urography: a pictorial overview.

Magnetic resonance urography (MRU) can be performed on the basis of two different imaging strategies: static-fluid MRU, based on heavily T2 weighted turbo spin echo (TSE) sequences, and gadolinium-enhanced excretory MRU. Both MR urographic techniques in combination with standard MRI permit a comprehensive examination of the entire urinary tract. This pictorial review illustrates the MRU features of the a wide spectrum of pathological conditions affecting the urinary tract.

Humans↗
PubMed2005

Acute ureteric calculus obstruction: unenhanced spiral CT versus HASTE MR urography and abdominal radiograph.

The aim of this study is to compare the performance of unenhanced spiral CT to the combination of HASTE MR urography (MRU) and plain abdominal radiography (KUB) in patients suspected of having acute calculus ureteric obstruction. 64 patients with suspected acute calculus ureteric obstruction were evaluated. The presence of perirenal fluid, presence and level of ureteric obstruction and calculi were assessed on both techniques. 44 of 64 (69%) patients had acute calculus ureteric obstruction based on clinical, radiographic or surgical findings. MRU showed perirenal fluid in acute ureteric obstruction (77%) with a greater sensitivity than CT showed stranding (45%). The combination of fluid and ureteric dilation on MRU showed a sensitivity of 93% (CT 80%), specificity of 95% (CT 85%), and accuracy of 94% (CT 81%). There were 61 findings of either fluid or ureteric dilatation on MRU in 44 acutely obstructed kidneys compared with 37 similar findings on CT (p<0.005). Although there was excellent reproducibility (Kappa=/>0.75) in the finding of perirenal fluid on MRU, there was only fair interobserver agreement (Kappa<0.4) regarding perirenal stranding on CT. MRU/KUB showed ureteric calculi in 21/29 (72%) of patients with calculi seen by CT. Overall, MRU/KUB revealed 2.4 abnormalities per acutely obstructed ureter compared with 1.8 abnormalities detected by CT. MRU/KUB using HASTE sequences can diagnose the presence of acute calculus ureteric obstruction with similar accuracy to spiral CT. The technique has less observer variability and is more accurate than CT in detecting evidence of obstruction such as perirenal fluid.

Acute Disease↗
PubMedDate not supplied

Comparative study between intravenous urography and renal scintigraphy with DMSA for the diagnosis of renal scars in children with vesicoureteral reflux.

PURPOSE: To assess the value of intravenous urography (IVU) in detecting and grading the renal scar, comparing its results with those of scintigraphy with dimercaptosuccinic acid (DMSA). MATERIALS AND METHODS: The study included 43 children investigated by DMSA and IVU, who had vesicoureteral reflux diagnosed and classified through voiding cystourethrography. RESULTS: Among the kidneys with reflux, there was agreement between the results of DMSA and IVU concerning the presence and the absence of scars in 82.4% of the cases. Based on the results obtained, IVU would have a sensitivity of 66.6%, specificity of 94.4%; accuracy of 82.5%; positive predictive value (PPV) of 90% and negative predictive value (NPV) of 79%, when compared with DMSA results. Our data also confirm the close relation between the reflux grade and the presence of renal scar, since 75% of the kidneys with grade IV and V reflux presented scars. In relation to the grading of nephropathy, in 78% of patients the classification of the scar by both methods was identical. The highest disagreement was verified in the group with segmental scar on DMSA, where 41.6% of the kidneys were classified as normal on IVU. CONCLUSION: The data obtained confirm that the scintigraphy with DMSA is essential in the investigation of patients with renal scar, and cannot be replaced by IVU, due to its low sensitivity and lower ability of satisfactory grading.

Journal Article↗
PubMed2000

[MR urography: technique and clinical application in patients with kidney transplantation].

OBJECTIVE: To assess the value of magnetic resonance urography (MRU) for the noninvasive postoperative evaluation of renal transplants. METHODS: 28 cases of renal transplantation were examined with a modified, heavily T2-weighted fast apin-echo pulse sequence and fat-suppression pulse aid. Post-procedure processing was performed with a maximal-projection (MIP) algorithm. RESULTS: 28 patients were studied. MRU revealed abnormal finding in 9 patients: mild dilatation of the renal pelvis without any urodynamic relevant obstruction (2), moderate dilatation of the renal pelvis (3), acute rejection (3), and ATN (1). Ureteral stenosis was diagnosed in 1 patients and treated surgically. CONCLUSIONS: MRU is an alternative to conventional urinary tract images techniques. It requires no radiation or iodinated contrast material. It is reliable and noninvasive in depicting the urinary tract. MRU can be used as a noninvasive technique for assessment of renal transplantation in cases suspicious of complication in the excretory system.

Adult↗
PubMed2003

Magnetic resonance urography by virtual reality modelling.

PURPOSE: The purpose of this study was to create a 3D visualization of the urinary tract by a novel virtual reality approach, and to evaluate the usefulness of this method for papillary classification as compared with 2D urogram obtained by maximum intensity projection (MIP). MATERIALS AND METHODS: In one healthy pig, magnetic resonance urography was performed using a T1-weighted 3D gradient echo pulse sequence. Post-processing was performed by means of an MIP algorithm and by using 3D virtual reality modelling, followed by manual classification of papillae as being either simple or compound. RESULTS: The 2D MIP urogram demonstrated 6 simple and 6 compound papillae, whereas the 3D urogram demonstrated 5 simple and 7 compound papillae. In both urograms, some papillae were unsuccessfully classified. CONCLUSION: The possibility of using virtual reality devices allowed 3D rotation and offered additional diagnostic information. However, further studies should reveal its feasibility in diseased kidneys.

Animals↗