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PubMed1964

THE EFFECT OF UROGRAPHY ON RENAL FUNCTON IN PATIENTS WITH MULTIPLE MYELOMA.

Reports in the medical literature of seven patients with multiple myeloma who died of acute renal failure following intravenous urography prompted a study of 39 patients with multiple myeloma who were subjected to intravenous urography at the Cleveland Clinic from 1940 to 1959. Four developed acute renal failure and two died within three weeks. All four revealed evidence of renal damage, or insufficiency, or both prior to urography. Thirty-five patients, 15 of whom had renal damage, had no untoward reaction to intravenous urography. These observations suggest that urography is associated with a small but definite risk in patients who have multiple myeloma and renal involvement.

Acute Kidney Injury↗
PubMed1988

Relative merits of ultrasound and intravenous urography in the investigation of the urinary tract.

Three hundred and fifty adult patients referred for intravenous urography were entered into a prospective double blind trial comparing intravenous urography with real time ultrasound. The study was performed to clarify the relative merits of the two techniques. Our results show that ultrasound and a plain abdominal radiograph should be the examination of first choice in most circumstances. This is particularly so in vague abdominal pain and in recurrent urinary tract infections where intravenous urography can usually be omitted or used only as a secondary investigation for further evaluation of abnormal ultrasound findings. In acute renal colic, intravenous urography should be the primary investigation. In macroscopic haematuria, initial examination by ultrasound would reliably diagnose mass lesions, show whether the lesion is cystic or solid and assess possible spread. Normal ultrasound does not exclude haematuria due to ureteric lesions or bladder lesions and intravenous urography is recommended.

Clinical Trials as Topic↗
PubMed2000

Appearance of autosomal recessive polycystic kidney disease in magnetic resonance imaging and RARE-MR-urography.

PURPOSE: To describe the appearance of autosomal recessive polycystic kidney disease (ARPKD) on MRI and RARE-MR urography. MATERIALS AND METHODS: Seven boys and one girl (aged 3 months to 14 years, median 2.5 years) were evaluated. Images were obtained with 0.23-T and 1.5-T MR systems using T1-weighted (T1-W) spin-echo, T2-weighted (T2-W) turbo-spin-echo and RARE-MR-urography sequences. Signal intensities, morphological appearance of the affected kidneys and, specifically, the picture of the urinary tract on RARE-MR-urography were evaluated. RESULTS: All children showed kidney enlargement, reniform but humpy kidney shape, homogeneously grainy renal parenchyma, normal renal pelvis and normal calyces. Signal intensity was hyperintense in T2-W images in all cases. In six cases (n = 7), T1-W images were hypointense. On RARE-MR urography a hyperintense, linear radial pattern was seen in the cortex and medulla which represents the characteristic microcystic dilatation of collecting ducts in ARPKD. Three boys and the girl presented with a few circumscribed small subcapsular cysts. CONCLUSIONS: In order to confirm the diagnosis of ARPKD, RARE-MR urography seems to be a non-invasive imaging tool that shows directly the microcystic dilated water-filled collecting ducts.

Adolescent↗
PubMed2004

Diagnosis of noncalcareous hydronephrosis: role of magnetic resonance urography and noncontrast computed tomography.

OBJECTIVES: To evaluate the role of magnetic resonance urography (MRU) and noncontrast computed tomography (NCCT) in the diagnosis of noncalcareous hydronephrosis when excretory urography (intravenous urography) is either contraindicated or inconclusive. METHODS: A total 108 consecutive patients with noncalcareous hydronephrosis were included in this study. In all patients, intravenous urography was either contraindicated or could not determine the diagnosis. In all patients, calculus obstruction was excluded by NCCT and all underwent heavily T2-weighted MRU. The final definitive diagnosis was established by retrograde or antegrade ureterography, endoscopy, or open surgery and was considered the reference standard for the diagnosis of obstruction. Normal kidneys in patients with unilateral obstruction were considered the reference standard for the absence of obstruction. The results of MRU were compared with those of NCCT regarding sensitivity, specificity, and overall accuracy. RESULTS: Of the 108 patients, 5 had bilateral obstruction and the remaining 103 had unilateral obstruction. Of the latter group, 5 had a solitary kidney; therefore, the total number of renal units was 211 (113 obstructed and 98 normal units). Ureteral strictures were identified by NCCT in 15 (28%) of 54 and by MRU in 45 (83%) of 54 patients. Bladder, ureter, or prostate tumors causing ureteral obstruction could be diagnosed in one half of the 54 patients with such tumors by NCCT (27 of 54) and in all but 2 patients by MRU (52 of 54). Both NCCT and MRU could identify all extraurinary causes of obstruction. Overall, of the 113 kidneys with noncalculus obstruction, the cause could be identified by MRU in 102 (sensitivity of 90%) and by NCCT in 47 (sensitivity of 42%), a difference of statistically significant value in favor of MRU (P <0.001). The specificity of T2-weighted MRU and NCCT was 100% and 99%, respectively (not a statistically significant difference). The overall accuracy of T2-weighted MRU and NCCT was 95% and 68%, respectively (P <0.001). CONCLUSIONS: In patients with ureteral obstruction in whom intravenous urography is not helpful and after NCCT has excluded stone disease, heavily T2-weighted MRU is a sensitive and specific method in the identification of the cause of obstruction.

Adult↗
PubMed1979

Prediction of vesico-ureteral reflux in children from intravenous urography films.

Intravenous urography and voiding urethrocystography were performed on 255 children with urinary tract infection. Eighty-six (34%) of these children had some kind of abnormality of the urinary tract. Vesico-ureteral reflux was observed to 96 ureters (19%) in 69 children (27%). The prediction of vesico-ureteral reflux by two radiologists from urography films only gave 46 (48%) and 51 (53%) false negative results respectively. In cases of clinically important reflux (III--V degrees), however, the rate of false negative predictions was 0/18 and 1/18 (6%) respectively. The rate for false positive predictions were 45/413 (11%) for both radiologists. In view of the number of pathological findings in this series i.v. urography is recommended as a routine in children undergoing urological work-up after their first urinary tract infection. As the clinically important vesico-ureteral reflux seems to be predictable from urography films alone, voiding urethrocystography seems not to be justified in children with negative i.v. urography, and can be postponed and carried out later if the urinary tract infection recurs.

Adolescent↗
PubMed1987

Transabdominal ultrasound versus excretory urography in preoperative evaluation of patients with prostatism.

Transabdominal ultrasound is superior to excretory urography when radiographic imaging of the urinary tract is indicated in patients with prostatism. We studied 53 patients with excretory urography and ultrasonography before prostatectomy. Patients with a history of microscopic or macroscopic hematuria, urolithiasis, renal failure or upper urinary tract anomalies were excluded from our study. Ultrasonography proved to be more accurate in defining prostatic size and configuration. Bladder wall thickness also was quantified more clearly with ultrasonography. We found 17 renal masses incidentally with excretory urography, although ultrasound was essential and superior to excretory urography in defining these masses in each case. We recommend that ultrasonography be used in lieu of excretory urography when imaging of the urinary tract is indicated before prostatectomy.

Humans↗
PubMed2000

Feasibility and utility of respiratory-gated, gadolinium-enhanced T1-weighted magnetic resonance urography in children.

RATIONALE AND OBJECTIVES: To evaluate the feasibility and utility of respiratory-gated, gadolinium-enhanced T1-weighted magnetic resonance (MR) urography in children. METHODS: In a prospective study, 30 consecutive children, aged 3 weeks to 13.8 years, underwent MR urography. After intravenous injection of low-dose furosemide and gadopentetate dimeglumine, respiratory-gated, coronal, T1-weighted 3D-gradient-echo sequences were obtained at 1.5 T 5 to 30 minutes after contrast administration. Postprocessing of the data was performed using a maximum-intensity projection algorithm. In addition, precontrast half-Fourier rapid acquisition with relaxation enhancement MR urograms were obtained in 29 children. RESULTS: Respiratory-gated, T1-weighted MR urography was successfully performed in all children without the need for sedation. Compared with the final diagnosis, prospective analysis of MR urography images revealed the correct diagnosis in 56 of 58 pelvicaliceal systems (96%). The ureteral morphology was correctly evaluated in 59 of 64 ureters (92%). The method showed limited efficiency for evaluating nonfunctioning renal units. CONCLUSIONS: Respiratory-gated, gadolinium-enhanced T1-weighted MR urography is a feasible and effective diagnostic tool in the assessment of upper urinary tract morphology in children. It is especially useful in depicting nondilated collecting systems and ureters.

Adolescent↗
PubMed2004

CT urography.

With the recent introduction of multi-detector row helical computed tomography (CT), the radiologic evaluation of patients with urologic disease has changed rapidly. Two major approaches to CT urography have been developed. The first approach combines axial CT with timed excretory urography (EU) performed by using conventional radiography, digital radiography, or CT scanned projection radiography (SPR). This approach produces traditional projection urograms, and the timed imaging technique is familiar to radiologists and clinicians. Additional excretory phase CT can be performed when the EU findings are positive or indeterminate. Improved CT SPR processing technology produces radiographlike images, thus eliminating patient transportation between the CT and urography suites or the necessity for a CT suite with a ceiling-mounted x-ray tube and a modified CT tabletop for performance of EU. The second approach to CT urography combines axial CT with thin-section excretory phase CT. The near-isotropic volume data set enables creation of high-resolution two- and three-dimensional reformatted images. However, the increased amount of radiation and the time required for data manipulation are concerns. Further studies evaluating large numbers of patients with various urothelial abnormalities will be necessary to determine the optimal CT urography technique for clinical practice.

Equipment Design↗
PubMed2004

Multislice CT urography: state of the art.

Recent improvements in helical CT hardware and software have provided imagers with the tools to obtain an increasingly large number of very thin axial images. As a result, a number of new applications for multislice CT have recently been developed, one of which is CT urography. The motivation for performing CT urography is the desire to create a single imaging test that can completely assess the kidneys and urinary tract for urolithiasis, renal masses and mucosal abnormalities of the renal collecting system, ureters and bladder. Although the preferred technique for performing multislice CT urography has not yet been determined and results are preliminary, early indications suggest that this examination can detect even subtle benign and malignant urothelial abnormalities and that it has the potential to completely replace excretory urography within the next several years. An important limitation of multislice CT urography is increased patient radiation exposure encountered when some of the more thorough recommended techniques are utilized.

Contrast Media↗
PubMed1985

Sonography as a substitute for excretory urography in children with urinary tract infection.

The possibility was explored of substituting renal sonography for excretory urography in children with urinary tract infection. Seventy-one patients were studied prospectively with voiding cystourethrography, sonography, and excretory urography; each examination was reviewed independently and without knowledge of the results of the others. Compared with urography the sensitivity and specificity of sonography was 100% and 51%, respectively, provided sonograms were of good technical quality. In a few instances, however, focal renal parenchymal scars were clearly seen only on urography. The findings suggest that in the absence of vesicoureteral reflux children with urinary tract infection should be studied with sonography. No further study is needed if a good-quality sonogram is within normal limits. In the presence of vesicoureteral reflux, however, or a suspicious or abnormal sonogram, excretory urography appears to be still necessary, at least at the present level of knowledge and technical expertise.

Adolescent↗
PubMed1985

Sonography vs. excretory urography in acute flank pain.

A prospective study compared the diagnostic accuracy of sonography and excretory urography in determining the cause of acute flank pain in 61 patients. Forty-one patients had urinary tract stone disease. Of these, five had nonobstructing renal stones and 36 had obstructing stones. A correct diagnosis was made by urography in 85% and by sonography in 66%. Small stones at the ureterovesical junction were more accurately diagnosed by sonography (79%) than by urography (68%). In all the patients where sonography failed to detect the offending stone, the stone was calcified and evident on the plain radiographs. There were no false-positive diagnoses in the patients clinically judged to have passed a renal stone (nine patients) or whose pain was arising outside of the urinary tract (five patients). Neither sonography (17%) nor urography (50%) was accurate in diagnosing acute pyelonephritis in the six patients with this diagnosis. Although sonography is not as accurate overall as urography in acute flank pain, it is a viable alternative in those with recurrent renal colic due to stone disease and in the pregnant patient.

Abdomen↗
PubMed1997

MR urography: evaluation of a three-dimensional fast spin-echo technique in patients with hydronephrosis.

OBJECTIVE: The purpose of this study was to evaluate a respiratory-triggered three-dimensional (3D) fast spin-echo technique for MR urography in patients with urinary tract dilatation. SUBJECTS AND METHODS: Using a respiratory-triggered 3D fast spin-echo technique for MR urography, we obtained MR urograms in 24 patients with hydronephrosis. Images were separately reviewed by two radiologists who evaluated the images for quality, presence of, degree of, level of, and cause of urinary tract dilatation. Findings were compared with all available clinical, imaging, surgical, and pathologic data, which served as the standard of reference. Sensitivity, specificity, positive predictive value, and negative predictive value of MR urograms were calculated for each reviewer to reveal urinary tract dilatation. For each reviewer, we calculated agreement between MR urography and the standard of reference using kappa analysis. We also calculated interobserver agreement for the presence of degree of, level of, and cause of urinary tract dilatation. RESULTS: Technically adequate MR urograms were obtained in all patients. For detection of urinary tract dilatation by MR urography, the sensitivity was 100%; specificity was 96%; positive predictive value was 96%; and negative predictive value was 100%. The kappa values for the degree of dilatation seen on the MR urograms were 0.57 (moderate) and 0.43 (moderate); for the level of obstruction, 0.74 (substantial) and 0.55 (moderate); and for the cause of obstruction, 0.66 (moderate) and 0.66 (moderate). Interobserver agreement for seeing dilatation on MR urograms was 1.0 (perfect agreement); degree of dilatation, 0.48 (moderate); level of dilatation, 0.60 (moderate); and cause of dilatation, 0.74 (substantial). CONCLUSION: MR urography using a respiratory-triggered 3D fast spin-echo technique can produce high-resolution images of the urinary tract by which reviewers can achieve a high sensitivity (100%) and specificity (96%) for the detection of urinary tract dilatation. On MR urograms, reviewers also identified the cause of obstruction in most patients: 92% (reviewer 1) and 88% (reviewer 2).

Adult↗
PubMed1999

Rare-MR-urography--a new diagnostic method in autosomal recessive polycystic kidney disease.

PURPOSE: To describe the appearance of autosomal recessive polycystic kidney disease (ARPKD) by using a new diagnostic method: RARE-MR-urography. MATERIAL AND METHODS: Eight children were evaluated using MR images from 0.23 T and 1.5 T MR units, using T1-weighted spin-echo and T2-weighted turbo spin-echo sequences and RARE-MR-urography. Signal intensities, morphological appearance of the affected kidneys and, specifically, the picture of the urinary tract in RARE-MR-urography, were evaluated. RESULTS: All children showed enlargement, reniform but humpy kidney shape, homogeneous-grainy renal parenchyma, normal renal pelvis and calyces. Although ARPKD is always associated with some degree of congenital hepatic fibrosis, there was no bile duct dilatation or liver fibrosis at the time of examination. Signal intensity was hyperintense in T2-weighted images in all cases. In 5 cases, T1-weighted images were hypointense. In RARE-MR-urography, hyperintense, linear, radial patterns in cortex and medulla were seen, which represent microcystic dilatation of collecting ducts and are therefore characteristic of ARPKD. Four patients presented with a few circumscribed small subcapsular cysts. CONCLUSION: RARE-MR-urography is a noninvasive method which demonstrates the pathognomonic water-filled cystic structures throughout the kindeys in ARPKD.

Adolescent↗
PubMed1992

[Comparison of urography and ultrasonography findings in patients prior to prostatectomy].

In order to evaluate the assess of ultrasonographic examinations in patients before prostatectomy the authors correlated preoperative findings obtained by urography with ultrasonographic findings. Urography of the upper urinary pathways revealed 12 (18.8%) pathological findings, ultrasonographic examination 26 findings (40.6%) in a group of 64 patients. While in 14 patients a pathological finding on ultrasonography was not revealed by urography, only in one patient with a positive urographic finding ultrasonography was negative. Ultrasonographic examination proved to be more valuable in assessing the post-miction residue, as compared with urography. Moreover, ultrasonography is useful for assessing the volume of tissue of benign prostatic hyperplasia. Correlation of the calculated volume of prostatic tissue by means of ultrasonography with the weight of removed tissue revealed a close linear correlation. Ultrasonographic examination of patients before prostatectomy replaced urography which proved to be unnecessary diagnostic procedure.

Aged↗
PubMed2003

[Magnetic resonance urogram as alternative to i.v. urography. Report of 3 cases. Review of the literature].

OBJECTIVES: Intravenous urography (IVU) has been classically considered as an essential examination in the great majority of urologic diseases due to the great amount of information that supplies both functional and morphological, mainly for ureteral abnormalities where other exams do not reach enough definition. Nevertheless, there are cases in which it is not possible to perform an intravenous urography due to allergy to iodine contrasts or renal failure with impossibility of contrast excretion. METHODS: We report three cases which represent the example of the indications of MRI urography as an alternative to IVU in cases in which this latter cannot or should not be performed. RESULTS: MRI urography is completely accepted as a diagnostic technique for urologic diseases as an alternative to IVU. It has advantages, such as obtaining images in multiple planes, avoiding the use of ionizing radiation, that there is no evidence of it causing cell damage, that it does not require glomerular elimination of any substance so it can be used in patients with renal failure and allergy to iodine contrasts. CONCLUSIONS: The use of MRI urography results in an advantage for patients with renal failure, iodine contrasts allergy, or greater risk of contrast nephrotoxicity as it is the case of renal transplant patients.

Adult↗
PubMed2005

CT-Urography.

In this paper we present an overview of CT-Urography. With the advent of multislice CT scanners and the evolution of image processing methods this technique now affords optimal urographic images comparable to those obtained with conventional techniques. We describe the acquisition techniques and protocols used by the various authors. Effective radiation dose has conditioned the use of CT-Urography so that the tendency today is to reduce the number of scans by performing, after the nonenhanced scan, a single contrast-enhanced scan comprising both the nephrographic and urographic phase. With the use of multislice CT the quality of the urogram improves with the number of slices. We illustrate a variety of processing techniques, multiplanar reconstruction (MPR), maximum (MIP) and average intensity projection (AIP) and volume rendering (VR) and present a series of upper urinary tract tumours testifying to the superiority of the AIP technique over MIP. We then review the results of comparative studies of CT-Urography with conventional urography in upper urinary tract diagnostics. Finally, we describe the advantages and limitations of CT-Urography.

Contrast Media↗
PubMed2005

MR urography in pediatric uropathies with dilated urinary tracts.

PURPOSE: To determine the diagnostic value of magnetic resonance (MR) urography in children with urinary tract dilatation. MATERIALS AND METHODS: Twenty-five children between the ages of 4 months and 13 years (19 males and 6 females, mean age 6.5 years) were evaluated with T2 weighted and contrast-enhanced T1 weighted MR sequences. Results were compared with findings obtained with ultrasonography (n=25), intravenous urography (n=18), Tc99m- DTPA scintigraphy (n=16), and/or micturating cystouretrography (n=13). RESULTS: MR urography provided a superior imaging of urinary system dilatation, the site and the etiology of obstruction, and both regular and complicated kidney duplication than did conventional imaging methods. MR urography that used T2 weighted sequences was able to demonstrate 29 of 32 (90.6%) abnormal renal collecting systems. Fourteen of 21 (66.7%) normal systems were revealed by heavily T2 weighted images. Forty-six of 51 (90.2%) renal collecting systems could be shown by T1 weighted sequences. With this sequence, however, five collecting systems (9.8%) could not be shown secondary to poor renal function and/or dilution of contrast agent within the dilated urinary tract. CONCLUSION: In children, MR urography may replace conventional uroradiological methods.

Adolescent↗
PubMed1989

[The optimum dose of iohexol 399 in excretory urography].

A randomized clinical trial was conducted to determine the optimum does of iohexol (iodine concentration 300 mgI/ml) as a contrast agent for excretory urography in screening outpatients. Cases were divided into two groups, 30 cases in Group A receiving 0.4 ml/kg of iohexol and 29 cases in group B receiving 0.8 ml/kg. Urography was performed at intervals of 5 minutes and 10 minutes following the injection. The diagnostic effectiveness of various X-ray images including nephrograms, the pyelocaliceal system, ureter and bladder were assessed. There was a significant disparity between the two groups during pyelocaliceal urography after 5 minutes, with a fair diagnosis attainable for 73.3% of group A versus 89.6% for group B (P less than 0.05), but after 10 minutes the rates for the two groups had evened out to 93.4% for group A and 96.6% for group B. During urography of the ureter after 5 minutes, only 16.6% of the cases in group A could be easily diagnosed against 51.7% of the cases in group B (P less than 0.05). However, after 10 minutes the rate for group A was up to 56.7% while the rate for group B was 82.8% (P less than 0.1). In the ureter after 5 minutes, non-diagnosable images constituted 26.7% of group A and 10.4% of group B, while after 10 minutes this had dropped to 16.6% for group A and 0% for group B. A comprehensive study of these results suggests that for diagnostic screenings which use iohexol as a contrast agent in excretory urography, optimal results may be obtained using iohexol in amounts of between 0.4 ml/kg and 0.8 ml/kg.

Ambulatory Care↗