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PubMed2007

(Paediatric) magnetic resonance urography: just fancy images or a new important diagnostic tool?

PURPOSE OF REVIEW: Magnetic resonance urography has become an established imaging tool in uroradiology. Its potential to assess anatomy and function makes it an ideal tool for evaluation of urinary tract malformations, renal cysts, genito-urinary tract tumours, infections and renal transplants. This review tries to highlight the potential of magnetic resonance urography in the light of new advances, particularly focusing on paediatric applications. RECENT FINDINGS: Technical innovations such as diaphragmatic tracking, parallel or propeller imaging, faster gradients and higher field strength improve applicability in infants and children. Dynamic studies enable assessment of renal functional parameters such as split renal function, glomerular filtration rate or urinary drainage. Recent advances in magnetic resonance spectroscopy, diffusion imaging and perfusion imaging and new contrast agents promise to widen the potential of magnetic resonance urography as a functional imaging tool, not only in paediatrics but also for other magnetic resonance applications in the genito-urinary tract, such as prostate imaging or in the staging of ovarian and endometrial cancer. SUMMARY: Besides ultrasound being used as the initial imaging method, particularly in children (and as computed tomography in adults), magnetic resonance urography can be envisioned as the major imaging modality for almost all (paediatric) uroradiological queries, consequently creating a growing demand for available equipment and procedural expertise.

Child↗
PubMed1978

The value of provocative and acute urography in patients with intermittent loin pain.

Twenty-two patients with intermittent loin pain thought to be typical of primary pelvic hydronephrosis but with normal appearances at standard excretion urography were subjected to diuretic urography using Frusemide-induced diuresis. If this was normal, acute urography was performed when the patient had pain. Abnormal appearances were shown in only 15 patients. In 4, only the erect films revealed the hydronephrosis. Dilatation occurred in response to a diuretic load in 9 and the abnormality was shown at the time of an attack of pain in 4. The hydronephrosis was shown only during the attack of pain in 2, a diuretic urogram having been normal. In 2 patients the nephrographic signs of acute obstruction were shown to be due to occlusion of the pelvi-ureteric junction at the time of an attack of pain. The importance of sequential examination, the value of erect films and acute urography are stressed.

Diuresis↗
PubMed2002

Urinary tract abnormalities: initial experience with multi-detector row CT urography.

PURPOSE: To evaluate multi-detector row computed tomographic (CT) urography for detection of urinary tract abnormalities. MATERIALS AND METHODS: Sixty-five patients referred from the urology service, in whom urinary tract abnormalities were strongly suspected, underwent multi-detector row CT urography. The technique included unenhanced, nephrographic, compression, and excretory-phase images through the abdomen and pelvis. Transverse images and three-dimensional reformations were reviewed by one of two radiologists. Findings were retrospectively compared with results of urinalysis, cystoscopy and/or ureteroscopy, and/or surgery. RESULTS: Multi-detector row CT urography depicted many clinically diagnosed urinary tract abnormalities, including 15 of 16 uroepithelial malignancies, five congenital anomalies, five urinary tract calculi, and 18 calyceal and/or papillary, 30 renal pelvic and/or ureteral, and 25 bladder abnormalities. All abnormalities were detected on transverse images. These abnormalities included diffuse urothelial wall thickening in four patients (three of whom had transitional cell carcinoma), a renal abscess, a colovesical fistula, and incidentally detected extrarenal disease (a liver mass, hepatic metastases, lymph node metastases, an aortic dissection, and a pheochromocytoma; each of these findings was seen in one patient). CONCLUSION: Multi-detector row CT urography is a useful method for detecting urinary tract abnormalities.

Adult↗
PubMed1981

Screening for urinary tract abnormalities with single-film urography after phlebography and angiography.

Single-film urography was performed after phlebography or angiography in 2,335 patients. Abnormal results were reported in 52 of these patients. Subsequent complete urography verified two significant abnormalities (one renal calculus and one renal cell carcinoma). In addition, there were 28 less significant abnormalities. In 22 patients the single-film urography was incorrectly reported as abnormal. Among the 2,283 normal single-film studies there were three cases of false-negative results (two renal cell carcinoma and one renal calculus with perinephritis). This study does not confirm the value of routine single-film urography after phlebography and angiography.

Adenocarcinoma↗
PubMed1999

Need for intravenous urography in patients with primary transitional carcinoma of the bladder?

OBJECTIVE: To assess the need for and the efficacy of intravenous urography in the detection of a synchronous upper tract urothelial tumor (UTUT) in patients with primary bladder tumor. MATERIALS: Between 1986 and 1996, 793 patients were diagnosed as having primary tumor of the bladder with pathological confirmation of transitional cell carcinoma. All patients underwent intravenous urography prior to transurethral resection. The mean age of the patients was 66.4 years, and 87.7% of them were male. Of these patients, 72% had superficial tumors, while the remaining 28% had infiltrative tumors. Histological classification of the tumors was: grade I, 10%; grade II, 45%, and grade III, 45%. A chi(2) test was used for statistical analysis. RESULTS: The incidence of upper tract urothelial tumors was 1.1% (9 patients), although intravenous urography only diagnosed 6 cases (0.7%). No differences were seen between patients with or without UTUT with regard to histological grade (p = 0.7), multiple bladder tumors (p = 0.7) and tumor infiltration (p = 0.9). In 5.8% of the patients an unsuspected associated pathology was detected which required treatment in 1.4% of the cases. CONCLUSIONS: Due to the low incidence of UTUT (1.1%) in our series and to the fact that intravenous urography was effective in diagnosing synchronous UTUT in only 66.6% of cases, we do not consider that this procedure should be routinely performed in the diagnostic workup of patients with primary transitional cell tumor of the bladder.

Aged↗
PubMedDate not supplied

Role of intravenous urography and transabdominal ultrasonography in the diagnosis of bladder carcinoma.

INTRODUCTION: The present study was carried out to compare the efficacy of transabdominal ultrasonography and intravenous urography in the diagnosis of bladder carcinoma in those patients presenting painless hematuria. MATERIALS AND METHODS: Medical records of 100 patients who had both ultrasonography and intravenous urography were studied. The reported findings of these investigations were correlated with those of cystoscopy. RESULTS: Ultrasonography was significantly more sensitive (96%) in the detection of bladder carcinoma compared to urography (87%). By applying the test of equality of proportions, the value of Z is 2.28, which is statistically significant (p < 0.01). In addition, ultrasonography was more sensitive in clarifying the pathology in upper renal tracts i.e. ureteric obstruction secondary to bladder carcinoma when urography failed due to none or poor excretion of contrast. COMMENTS: We recommend the use of ultrasonography as the initial radiological investigation for detection of bladder carcinomas in patients presenting hematuria. Ultrasonography is safe, easily available, cost effective and provides images of both upper and lower renal tract. Patients diagnosed to be suffering from bladder carcinoma by ultrasonography should be scheduled directly and promptly for cystoscopy and bladder tumor resection.

Adolescent↗
PubMed1978

Furosemide-augmented intravenous urography: results in essential hypertension.

Giving an intravenous diuretic during urography (furosemide-augmented urography, vasodilated urography) causes renal swelling which is easily measured. Several investigators have used this observation as the basis of a screening test for renovascular hypertension. They found that normal kidneys enlarge in area by more than 10%, while kidneys with renal artery stenosis show a blunted size response, usually less than 5%. We used the technique in 46 patients with proven essential hypertension in order to further examine its potential usefulness in the hypertensive population. The 92 kidneys showed an average area increase of only 7.0% +/- 3.6% SD, and only 15% of the kidneys enlarged by more than 10%. Based on these observations we doubt that vasodilated urography will be valuable as a screening test for renovascular hypertension because of the high incidence of false positive and indeterminate results in patients without renal artery stenosis.

Adult↗
PubMed1984

Excretory urography and computed tomography in the initial evaluation of patients with cervical cancer: are both examinations necessary?

One hundred ten patients with carcinoma of the cervix were studied to determine if both excretory urography and computed tomography are needed for routine evaluation. Computed tomography gave more information in 25 patients and the excretory urogram was more informative in 10 patients. Thirty-five hydroureters were detected by computed tomography, whereas excretory urography identified 21. The hydroureter in its entirety was seen more often using computed tomography, and the site of obstruction was identified in 29 of 35 cases. The superiority of computed tomography was particularly evident in patients with stage IIB or more advanced lesions. In stage I-IIA lesions, both techniques yielded the same information about the urinary tract. It was concluded that routine use of both examinations is not indicated. Excretory urography is currently sufficient in evaluation of stage I or IIA lesions, while computed tomography obviates excretory urography in patients with advanced cervical cancer (IIB-IVB).

Female↗
PubMed1987

The evaluation of gross hematuria in anticoagulated patients: efficacy of i.v. urography and cystoscopy.

To determine the efficacy of investigating gross hematuria in anticoagulated patients, records were reviewed of 24 patients who had gross hematuria while being treated with warfarin for various thromboembolic disorders. All had IV urography, and half had cystoscopy. Sources of bleeding were found in seven (29%) of 24 patients by IV urography and in five (42%) of 12 patients by cystoscopy. Abnormalities considered responsible for bleeding included renal stones (four), transitional cell carcinoma (one), calcified renal mass (one), lymphoma (one), bladder tumors (two), hemorrhagic cystitis (two), and a bleeding prostate tumor (one). Additionally, an enlarged prostate was the only abnormal finding in five patients. If an enlarged prostate is considered a source of bleeding, the workup that included both IV urography and cystoscopy identified a cause of bleeding in 17 (71%) of 24 patients. The results suggest that IV urography and cystography are warranted in patients who take anticoagulants and who have gross hematuria.

Adult↗
PubMed1988

ECG abnormalities during excretory urography: the effect of stress.

ECG alterations occurring during IV infusion of contrast agents have been well documented, although the specific causes of these alterations are unknown. Stress and anxiety have been considered important factors, but no prospective evaluation of their impact on ECG alterations has been reported. In order to separate ECG changes resulting from anxiety associated with the procedure itself from those caused by the contrast agent, ECG monitoring was done during IV urography, first when patients were given saline and then again during and after contrast infusion. In both circumstances, the patients were told that they were being given contrast material. One hundred fifty patients undergoing infusion excretory urography with meglumine diatrizoate were studied. Preliminary 12-lead ECGs identified those with initially normal (71) and abnormal (79) tracings. Lead II rhythm strip ECGs were then obtained at 1 and 3 min during a saline infusion and again during contrast infusion; final 12-lead ECGs were done after the contrast infusion. During contrast infusion, PR prolongation (greater than 0.02 sec) occurred in 44% of patients, a change in heart rate (greater than +/- 10 beats/min) occurred in 26%, and benign arrhythmias (premature atrial and ventricular contractions, less than 5/min) occurred in 9%. Saline alone caused no statistically significant ECG alterations (only a single instance of premature atrial contractions). The hypothesis that stress or anxiety may adversely affect ECG reactivity in IV urography is unproved. Although we do not offer proof that it cannot occur, we found no evidence in a study of 150 patients to confirm that stress is an important factor. Only the contrast agent, not saline, produced measurable ECG changes during urography.

Adult↗
PubMed1995

Evaluation of renal masses detected by excretory urography: cost-effectiveness of sonography versus CT.

OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of sonography and CT for the evaluation of renal masses discovered at excretory urography. MATERIALS AND METHODS: The records of 225 patients with a renal mass shown by urography who then had either sonography or CT within 3 months were reviewed retrospectively. The number, location, and size of lesions; initial and subsequent imaging tests; and final diagnoses were determined. Using the current Medicare reimbursements for sonography and CT, we calculated the economic implications of using sonography or CT as the initial examination. Any effect of the location or size of the lesion on the most cost-effective examination was also determined. RESULTS: Twenty-one percent of patients had both initial sonography and follow-up CT because of indeterminate findings or detection of a solid mass that required further staging. When CT was done first, CT findings were equivocal in 12%, necessitating follow-up sonography. At the prevailing charges, CT would have to be needed in 70% of patients initially imaged with sonography to justify the use of CT as the initial examination. The location and size of the lesion did not affect the need for CT at a rate (greater than 70%) that would economically justify use of CT as the first imaging test. Eighty-six percent of patients with a mass detected by urography had either a simple cyst or no evidence of a mass on sonography or CT. CONCLUSION: Sonography is the most cost-effective imaging method for the workup of a renal mass detected at urography. The number of sonographic examinations in which findings are indeterminate or positive (for a solid mass) is not sufficiently high to warrant replacement of sonography by CT, regardless of the size and location of the lesion. CT should be reserved for a limited number of specific indications.

Aged↗
PubMed1995

Preparation of outpatients for excretory urography: is bowel preparation with laxatives and dietary restrictions necessary?

OBJECTIVE: The purpose of this study was to determine whether routine bowel preparation with laxatives and dietary restrictions (liquid supper and fasting after midnight) are necessary for satisfactory visualization of the urinary system during excretory urography in outpatients. SUBJECTS AND METHODS: Two hundred and four consecutive patients who had excretory urography were randomly placed in one of four groups before the examination. Eleven patients were excluded from the study for various reasons. The remaining 193 were divided into four groups. Groups 1 (50 patients) and 2 (45 patients) had bowel cleansing; groups 3 (49 patients) and 4 (49 patients) did not. Groups 1 and 3 were allowed to eat; groups 2 and 4 were given a liquid supper and fasted beginning at midnight the night before the examination. Standard radiographs and tomograms were obtained. Upon completion of excretory urography, the radiographs were reviewed and graded by one radiologist, who did not know to which group each patient belonged. A detailed, anatomically based grading system was developed and used to grade the radiographs. The radiographs of the kidney were divided into upper, middle, and lower margins; images of the calices were divided into upper, middle, and lower segments; images of the renal pelvis were divided into central and medial margins; images of the ureter were divided into upper abdominal, lower abdominal, upper pelvic, and lower pelvic categories; and images of the bladder were divided into full and empty categories. A score of 1 was given to each section visualized. The right and left sides of the urinary system were scored separately but added together for statistical analyses; therefore, the highest total score possible was 28. RESULTS: In the ability to visualize the anatomic structures on excretory urograms, there was no statistically significant difference (p = .06) between images of patients who were allowed to eat (groups 1 and 3, 99 patients, mean score = 27.49 +/- 0.92) and images of patients who were given a liquid supper and then fasted from midnight the night before excretory urography was performed (groups 2 and 4, 94 patients, mean score = 27.16 +/- 1.45). Moreover, there was no statistically significant difference (p = .16) between those patients given laxatives before the examination (groups 1 and 2, 95 patients, mean score = 27.45 +/- 0.93) and those not given laxatives (groups 3 and 4, 98 patients, mean score = 27.20 +/- 1.43). CONCLUSION: Our results show that bowel preparation with laxatives and dietary restrictions do not improve visualization of the urinary tract on excretory urograms obtained in outpatients. We conclude that such preparation in this group of patients was unnecessary and that it need not be performed routinely.

Adolescent↗
PubMed2002

Contrast-enhanced MR urography in the evaluation of renal transplants with urological complications.

AIM: The diagnostic work-up of renal transplants with impaired function due to urological problems can be difficult. This study was performed to assess sensitivity and specificity of non-invasive contrast-enhanced MR urography (MRU). METHODS AND MATERIALS: Thirty-five patients with renal transplants (25 - 71 years, mean: 53.4 years) with sonographically diagnosed hydronephrosis or perirenal fluid collections were assessed by MR urography. MR examinations were carried out at a 1.5 T clinical scanner (Vision, Siemens, Erlangen, Germany) with a 512 matrix contrast-enhanced fat-suppressed T1-weighted FLASH 3D sequence in breath-hold technique. MIP reconstructions were used to produce MR urography. MRU diagnoses were compared to operative results. RESULTS: In all patients, images with sufficient contrast in the renal collecting system were obtained. Hydronephrosis was confirmed in 20 patients, 8 patients showed a different pathology while 7 had normal findings. Compared to operative results, sensitivity of MRU was 100% with a specificity of 78%, respectively. One ureteral stone was misdiagnosed as a stricture, and 2 suspected ureteral stenoses could not be found upon operation. CONCLUSIONS: Contrast-enhanced MR urography is a highly sensitive and specific non-invasive method to evaluate patients suspected of having typical post-transplant urological complications. It may replace invasive procedures such as antegrade pyelography in the pre-operative work-up.

Adult↗
PubMedDate not supplied

[Capacities of examination of renal function at excretory urography].

The study was undertaken to enhance the diagnostic capacities of excretory urography in evaluating renal function, by determining the renal clearance of a contrast medium. The main task of the study was to develop bloodless and rather reliable ways of estimating the volume of the body's distributed contrast medium and its urinary concentration in the patient at urography. Excretory urography was performed in 248 patients aged 12 to 75 years. The specific gravity of excreted urine was determined with a standard laboratory urometer to 0.001 g/cm3. Absoption spectrophotometry was used to determine the serum concentration of contrast medium in 67 patients. The values of concentrations were plotted in the semilogarithmic ordinate system, followed by extrapolation of the initial segment of the plot to the so-called zero point determining the value of the concentration of contrast medium at the moment of its complete distribution in the intercellular space. The derived value was compared with the medium's dose coming into the body, which made it possible to determine the degree of dilution of the substance, i.e. the volume of its distribution in the organism. There was a linear relationship between the concentrations of renally eliminated contrast medium and the specific gravity of excreted urine. The numerical value of the constant reflecting this relationship is equal to 6. There was evidence for that such studies could be made by routine urometry. A high correlation was found between the body mass and the volume of distribution of contrast medium in the intercellular space. The discovery of the above regularities permitted the procedure for measuring the values of two most important physiological renal process (glomerular filtration and trabecular water reabsorption) to be simplified and widely available. The paper outlines the great promises for using excretory urography as a scanning functional test during a primary study and a follow-up of the patient's status.

Adolescent↗
PubMed1990

[Manifestations of dysfunction of the proximal tubules after intravenous urography].

The aim of the work was to investigate functional changes of tubular cells after i.v. urography. As evidence the authors used assessment of urinary levels of membrane-bound enzymes--alkaline phosphatase (AP), gamma-glutamyl-transpeptidase, lysosomally bound enzymes N-acetyl-beta-D-glucosaminidase and its isoenzyme B and the low molecular protein, beta-2-microglobulin. The above substance were assessed in 15 patients with different nephropathies where i.v. urography was indicated. The examinations were made in 24-hour urine samples before i.v. urography and in two 24-hour samples after administration of the contrast substance. In all patients a significant rise of tubular enzyme excretion was observated as well as of beta-2-microglobulin. The greatest rise was recorded in alkaline phosphatase in the second sample after administration of the contrast substance (432% of the initial value). Beta-2-microglobulin and N-acetyl-D-glucoseaminidase rose already during the first collection period (B2M to 357% and NAG to 181% of the initial values). The authors conclude that i.v. urography made by hyperosmolar iodinated preparations (Verografin, Iodamide) significantly affects the function and integrity of the proximal tubule. The applied spectrum of examinations is suitable also for further investigations of the effect of contrast substances on cells of the proximal renal tubule.

Adult↗
PubMed1979

[Diagnostic value of urography in the study of arterial hypertension].

In spite of the widespread use of intravenous urography and its extensive employment in the study of hypertension, there is still no unanimity of views as to its application in such pathology. 147 urographies belonging to 330 hypertense patients admitted to the Bari Medical Pathology Department between 1-1-1975 and 30-9-1977 have therefore been examined so as to assess its diagnostic value. Thereafter, the percentage of abnormalities found with urography were evaluated and compared with those in the population at large. Results stress on the one hand the higher incidence of renal ptosis and poly-cystic kidneys in the hypertense, and also highlight the possibility of revealing clinically silent diseases with this technique; on the other hand, many urographies (more than 50%) were useless and it is not always possible to diagnose certainly the presence of stenosis of the renal artery owing to the presence of false positives and negatives.

Adult↗
PubMed1984

Can ultrasound and computed tomography replace high-dose urography in patients with impaired renal function?

Ninety-one patients with unexplained impaired renal function were investigated by high-dose urography, ultrasound and computed tomography (CT) without contrast. The aim was to evaluate the role of ultrasound and CT in renal failure, in particular their ability to define renal length and to show collecting system dilatation. In the majority of patients, renal length could be measured accurately by ultrasound. Measurements were less that those at urography because of the absence of magnification. Renal measurement by CT was not a sufficiently accurate indicator of renal length to be of clinical use. Both ultrasound and CT were sensitive detectors of collecting system dilatation: neither technique missed any case diagnosed by urography. However, in the presence of staghorn calculi or multiple cysts, neither ultrasound nor CT could exclude collecting system dilatation. CT was the only technique which demonstrated retroperitoneal nodes or fibrosis causing obstruction. It is proposed that the first investigation when renal function is impaired should be ultrasound, with plain films and renal tomograms to show calculi. CT should be reserved for those patients in whom ultrasound is not diagnostic or in whom ultrasound shows collecting system dilatation but does not demonstrate the cause. Using this scheme, ultrasound, plain radiography and CT would have demonstrated collecting system dilatation and, where appropriate, shown the cause of obstruction in 84 per cent of patients in this series. Only 16 per cent of patients would have required either high-dose urography or retrograde ureterograms.

Adolescent↗
PubMed1995

Is routine urography necessary in all patients undergoing suprapubic transvesical prostatectomy?

One hundred and forty consecutive patients were offered transvesical prostatectomy after haematological and urinary investigations but without urography. The results of treatment are comparable to those in similar setting where urography had been performed as a routine procedure. While the renal function was generally poor in the earlier period, improving later in the study period, no urinary abnormality which would have affected outcome was missed by clinical assessment and other investigations. In view of the high cost of urography and possible adverse effects we believe that unless specifically indicated by presence of haematuria or loin pain urography is unnecessary in the diagnostic work of patients for transvesical prostatectomy.

Adult↗