Assessment of ureteral obstruction in patients with compromised renal function: Value of Curved Planar Reformations in MDCT

Abstract

ObjectiveTo evaluate the usefulness of MDCT using a curved planar reformation technique for the noninvasive assessment of the causes and level of ureteral obstruction in patients with compromised renal function. Patients and methodsBetween January 2012 and February 2013, 50 patients with clinical and sonographic manifestations of ureteral obstruction underwent non-contrast multidetector CT (MDCT) using a 16-slice machine. A total of 65 ureters were examined. Curved planar reformation images were performed to display the entire course of ureters in the same image. All patients had renal impairment with serum creatinine greater than 2.0mg/dl. The gold standard for diagnosis of the cause of obstruction was ureteroscopy and/or open surgery. The sensitivity, specificity and overall accuracy of MDCT using curved planar reformation in the diagnosis of ureteral obstruction were calculated in comparison with the gold standard. ResultsA total of 65 ureters were examined (35 unilateral, 15 bilateral). The most common cause of ureteric obstruction was ureteric stone representing 27/65 (41.5%), followed by ureteric stricture representing 23/65 (35.4%). The lower third was the most affected in our study, it was encountered in 38/65 ureters (58.46%). The total sensitivity, specificity and accuracy of CPR for the cause of the ureteric obstruction were 98.5%, 98.5% and 97.8%, respectively (P value >0.05). CPR also was more sensitive and accurate for the level of ureteral obstruction with a total sensitivity of 100% and accuracy of 100% (P value >0.001). ConclusionCurved planar reformation MDCT is a useful noninvasive technique which is accurate in diagnosing the cause and level of ureteral obstruction in patients with compromised renal functions and is helpful for planning the therapeutic management of such patients.