Urography In Diagnosis Research Articles

Comparative study of ultrasound abdomen and pelvis with CT urography in diagnosis of benign causes of Hematuria

Comparative study of ultrasound abdomen and pelvis with CT urography in diagnosis of benign causes of Hematuria

Comparative evaluation of the role of CT urography in diagnosis of urinary tract in patients with hematuria

Background and Aim: CT urography is a single comprehensive modality for the diagnosis of patients suspected with hematuria. Hence, the present study was designed to evaluate the efficacy of the diagnostic role of CTU in comparison with other diagnostic modalities. Material and Methods: A total of 83 patients suspected with hematuria between 18-75 years of age presented at the Department of Radio-diagnosis, Kasturba Medical College (KMC), Manipal University, and Mangalore were selected. The patients were subjected to 3 phase CT examination after obtaining informed consent—first was an initial non-contrast phase followed by a nephrographic phase and then pyelographic phase. Patients' demographic details viz. age, gender, and clinical manifestations were recorded. Assessment parameters like sensitivity, specificity, positive predictive value, and negative predictive value were analyzed. Results: The majority of study subjects with hematuria i.e. 28.92% belonged to the age group of 60-70 years followed by 25.30% in 50-60 years and 20.48% fallen in the age group of 40-50 years with male predominance. Ureteroscopy was done for 17 cases, nephroscopy for 4 cases. 6 were radiodense calculi and 2 were radiolucent calculi. USG showed renal, PUJ and one VUJ calculus and hydronephrosis but it was only after CTU ureteric calculi were detected. 9 patients had both renal and ureteric calculi. Cystoscopy was done for 25 cases, out of which 17 cases showed bladder transitional cell carcinoma (TCC). In 14 cases, 11 out of 14 cases showed masses confined to the kidney (

Role of Magnetic Resonance Urography in Diagnosis of Pediatric Obstructive Uropathy: A Surgeon Perspective

Role of Magnetic Resonance Urography in Diagnosis of Pediatric Obstructive Uropathy: A Surgeon Perspective

Role of Magnetic Resonance Urography in Diagnosis of Pediatric Obstructive Uropathy: A Surgeon Perspective

Background: Obstructive uropathy is a group of different pathologies. Congenital obstructive uropathy represents a major cause of renal failure in infants and children. Urinary tract obstruction is defined as any condition that impairs urinary drainage from the pelvicalyceal system and leads to increased pressure and reduced urine flow rate. Objective: The aim of this study was to assess the role of combined static and dynamic Magnetic Resonance Urography in the management of pediatric obstructive uropathy and to compare it with our basic investigations. Patients and Methods: This study was conducted on the pediatric patients presented to Pediatric Surgery Department in cooperation with Radiology Department, Ain Shams University Hospitals, presented with upper urinary tract dilatation detected by ultrasonograghy. Results: There was a high agreement between MRU and our standard imaging data as regard detection of urinary tract obstruction giving the MRU no superiority to the basic imaging in this field. Combined MRU showed the highest accuracy among other investigations in identification of the level of obstruction. Dynamic MRU and renal scintigraphy in our study yielded similar results for identification of split renal function. Conclusion: This study provides evidence that combined static and dynamic MRU is a promising technique that allows anatomical and functional evaluation of obstructed kidneys to be used as a single modality for the comprehensive evaluation of urinary tract obstruction.

590 Precision of CT urography in diagnosis of transitional cell carcinoma

590 Precision of CT urography in diagnosis of transitional cell carcinoma

Contemporary evaluation of urography in diagnosis in patients with urothelial cell carcinoma.

312 Background: Upper urinary tract tumors (UUTT) can occur synchronous or metachronous (0.7 – 6%) with bladder tumors. The optimal imaging technique of the upper urinary tract is unclear. Studies on the accuracy of retrograde pyelography (RUP) and comparative studies on detection level are sparse. In this study we evaluated the effectiveness of a first RUP in patients with a first manifestation of urothelial cell carcinoma (UCC) in the urinary tract. Methods: In this retrospective study we evaluated all consecutive patients with pathologic proven UCC who underwent their first RUP between March 1998 and April 2008 in the University Medical Center Groningen, Netherlands. Data regarding patient and tumor characteristics, results from RUPs, use of alternative imaging techniques, treatment and outcome were collected from the electronically patient’s records. Follow up was calculated from the first RUP to the last registrated visit. Descriptive statistics have been used to evaluate the performance of the RUP. Results: A total of 156 patients underwent a first RUP because of a first manifestation of UCC of the bladder or upper urinary tract. A mean follow up of 5.09 years was achieved (range 0-13 years). On 17 RUPs (11%) abnormalities were detected. In 16 patients a malignancy was diagnosed. Except one renal cell carcinoma all tumors were UCC of the renal pelvis, ureters or both. Muscle invasive tumors were diagnosed in 7 of these 17 patients. In 30 patients (19%) no conclusive results were obtained because of failure of the RUP due to technical difficulties. In 19 of 30 patients alternative imaging was performed, with intravenous pyelography in 11 patients, computer tomography urography in 7 patients and with both in 1 patient. No UUTTs were diagnosed in this group. In 109 (70%) patients whit a negative RUP three patients developed a tumor after 8, 52, and 65 months. The latter two we consider as newly developed lesions. Conclusions: RUP in patients with a first manifestation of UCC is a very sensitive and accurate diagnostic tool in detecting UUTT.

Predictive Value of Current Imaging Modalities for the Detection of Urolithiasis During Pregnancy: a Multicenter, Longitudinal Study

We determined the optimal imaging study by which to diagnose and treat pregnant patients with suspected urolithiasis. A retrospective, multicenter study was performed to determine the comparative accuracy of imaging modalities used before the surgical management of suspected urolithiasis in pregnant patients. Patients with a clinical suspicion of urolithiasis were evaluated with directed imaging including renal ultrasound alone, renal ultrasound and low dose computerized tomography, or renal ultrasound and magnetic resonance urography. When indicated, patients underwent therapeutic ureteroscopy. The rate of negative ureteroscopy was determined and the positive predictive values of the imaging modalities were calculated. A total of 51 pregnant patients underwent ureteroscopy. The mean age of the cohort was 27 years. Mean gestational age was 24.4 weeks. Of the women 24 (47%) underwent renal ultrasound and low dose computerized tomography, 22 (43%) underwent ultrasound alone, and 5 (10%) underwent renal ultrasound and magnetic resonance urography. Negative ureteroscopy occurred in 7 of the 51 patients (14%). The rate of negative ureteroscopy among patients who underwent renal ultrasound alone, renal ultrasound and low dose computerized tomography, and renal ultrasound and magnetic resonance urography was 23%, 4.2% and 20%, respectively. The positive predictive value of computerized tomography, magnetic resonance and ultrasound was 95.8%, 80% and 77%, respectively. The rate of negative ureteroscopy was 14% among pregnant women undergoing intervention in our series. Of the group treated surgically after imaging with ultrasound alone, 23% had no ureteral stone, resulting in the lowest positive predictive value of the modalities used. Alternative imaging techniques, particularly low dose computerized tomography, offer improved diagnostic information that can optimize management and obviate unnecessary intervention.

Role of the MDCT urography in diagnosis of renovascular diseases

PurposeThe current study aimed to evaluate the efficiency of the MDCT urography in the diagnosis of renovascular diseases. Material and methodsTen consecutive patients were recruited from the Urology out patients’ clinics of Assuit University. Their ages ranged from 22 to 60years. Prior to Multidetector Computed Tomography (MDCT) examination, relevant clinical data and renal function tests were obtained in every patient. ResultIn the current study MDCT easily diagnosed during the arterial phase, six patients with renal aneurysms, two patients with nutcracker syndrome, one patient with arteriovenous malformation (AVM) and one patient of renal artery stenosis. ConclusionMDCT plays an important role in the evaluation and management of both primary renovascular disease and the secondary manifestations of each disease. MDCT angiography with multiplanar reconstruction and three-dimensional display is valuable in studying patients with renovascular lesions involving the proximal renal vessels.

Tumor Characteristics of Urothelial Carcinoma on Multidetector Computerized Tomography Urography

We investigated the relationship between tumor characteristics of urothelial carcinoma and detectability on multidetector computerized tomography urography. We retrospectively reviewed all adult consecutive patients with hematuria who underwent multidetector computerized tomography urography during a 23-month period at our hospital. Patients with a final diagnosis of urothelial carcinoma verified by histological examination of surgical specimens were included in the study. The presence and location of urothelial carcinomas on multidetector computerized tomography urography without knowledge of final diagnosis were recorded. Tumor characteristics (location, size, histological classification and stage) were recorded based mainly on histological findings. The association between tumor characteristics and urothelial carcinoma detectability on multidetector computerized tomography urography was analyzed. A total of 70 patients who underwent multidetector computerized tomography urography had 87 verified urothelial carcinomas. Of these carcinomas 6 (6.9%) were undetectable by multidetector computerized tomography urography, including 5 ureteral and 1 bladder urothelial carcinoma. Size of detectable and nondetectable tumors on multidetector computerized tomography urography differed significantly (3.05 +/- 1.79 vs 0.65 +/- 0.99 cm, respectively, p = 0.001). Tumor location (p = 0.009), tumor size 1 cm or larger (p = 0.003) and noncarcinoma in situ tumors (p = 0.001) were significantly associated with multidetector computerized tomography urography detectability. Conversely organ confined disease had no association with multidetector computerized tomography urography detectability. Multivariate analyses showed that noncarcinoma in situ tumor was a significant predictor of multidetector computerized tomography urography detectability (p = 0.001). Multidetector computerized tomography urography is useful for detecting nearly all urothelial carcinomas in adults with hematuria. Careful assessment by multidetector computerized tomography urography is needed to detect small (less than 1 cm) or ureteral urothelial carcinomas. It remains a challenge to detect carcinoma in situ tumors by multidetector computerized tomography urography. Thus, negative results of urothelial carcinomas on multidetector computerized tomography urography do not exclude the presence of carcinoma in situ tumors.

Role of magnetic resonance urography in diagnosis of duplex renal system: Our initial experience at a tertiary care institute

Aim:To determine diagnostic value of magnetic resonance urography in cases of duplex renal system.Method:Twenty cases between five month to nine years with suspected or known duplex renal system were evaluated by ultrasound (USG), micturating cystourethrography (MCU), intravenous urography (IVU) and magnetic resonance urography (MRU). The findings of these diagnostic imaging studies were then compared with each other and against the results of final diagnosis established at surgery.Results:Duplex renal system could be identified in two of these cases on USG, was diagnosed in four in IVU and could be diagnosed in all cases with MRU.Conclusion:MRU is superior and far accurate than IVU, MCU and USG in diagnosing duplex renal system.

Application of magnetic resonance urography in diagnosis of congenital urogenital anomalies in children

Magnetic resonance urography (MRU) has become a useful adjuvant in evaluating urogenital anomalies. In present study, we evaluated the ability of MRU in diagnosis of different congenital urogenital anomalies when the results of conventional imaging modalities were inconclusive. A total of 90 children were included in this series. The children were evaluated with T2-weighted and contrast-enhanced T1-weighted MRU sequences. The results were compared with findings obtained with ultrasonography, intravenous urography, renal nuclide scan, and voiding cystourethrography. MRU was requested in these children because conventional imaging modalities were equivocal or a co-existing urogenital anomaly was suspected. Only those cases that underwent surgery were included in this study and the surgical findings were set as the reference standard in statistical evaluation. The records of 61 boys with mean (range) age of 2.3 years (2 months-12 years) and 29 girls with mean (range) age of 3.3 years (3 months-12 years) were reviewed. The final diagnosis was ureteropelvic junction obstruction (n = 25), vesicoureteral junction obstruction (n = 16), ureterocele (n = 19), ectopic kidney (n = 11), posterior urethral valve (n = 17), and polycystic kidney (n = 2). The overall sensitivity of MRU, intravenous urography, renal nuclide scan, ultrasonography, and voiding cystourethrography in diagnosis of the aforementioned anomalies were 86, 63, 50, 44, and 41%, respectively. MRU was much more sensitive than other imaging modalities in diagnosis of end-ureteral dilation (100%) and ureterocele (89%). MRU provides a reliable noninvasive technique for imaging of the congenital anomalies in the urinary tract of children with T2-weighted MRU sequences providing unenhanced static-water images of the urinary tract as well as depicting adjacent soft-tissue lesions, and T1-weighted MRU technique imitating conventional intravenous urography. Both MRU sequences can be combined for a comprehensive examination of the urinary tract.

99mTechnetium-Dimercapto-Succinic Acid Renal Scanning and Excretory Urography in Diagnosis of Renal Scars in Children

We compared the ability of excretory urography (without tomography) and 99mtechnetium-dimercapto-succinic acid renal scanning to detect renal scars in 32 children with primary vesicoureteral reflux. These children did not have hydronephrosis, renal failure or urinary tract obstruction. In all cases both studies were conducted within a 10-month period. The findings from both modalities were in agreement for 51 of the 64 renal units evaluated (80 per cent). Evaluation of the excretory urogram indicated 6 cases of diffuse and 2 of focal scarring that were not detected by evaluation of the renal scan. The sensitivity of excretory urography to detect renal scars was 84 per cent and the specificity was 83 per cent. The 99mtechnetium-dimercapto-succinic acid renal scan showed 5 cases of focal renal scarring not detected by excretory urography. The sensitivity of the renal scan to detect renal scars was 77 per cent and the specificity was 75 per cent. We conclude that neither study alone could effectively replace the other for the detection of renal scars, and recommend that both be included in the initial evaluation and followup of patients with renal scars.

Comparison of Methods of Intravenous Urography in Diagnosis of Blunt Renal Trauma

Comparison of Methods of Intravenous Urography in Diagnosis of Blunt Renal Trauma

Supine and prone positions in intravenous urography for diagnosis of bladder lesions.

excerpt Aprevious report (3) has indicated the value of the prone view during intravenous urography for the diagnosis of lesions of the upper urinary tract. Inasmuch as the specific gravity of urinecontaining contrast medium is greater than that of ordinary urine, it has been possible to demonstrate layering, with the opacified urine dependent to the nonopacified (4, 5). Baumrucker (1) determined urine specific gravities in 22 patients just before and again at fifteen minutes after the intravenous administration of Diodrast; the opacified urine showed an increase in specific gravity ranging from 0.007 to 0.042. Figure 1 shows similar results in 30 consecutive intravenous urographic examinations with 30 c.c. of 50 per cent Hypaque, in which the specific gravity was determined just before and again thirty minutes after the administration of the medium. In this group the usual increase is 0.020 to 0.040. Fifty per cent Hypaque solution has a specific gravity of 1.32. During urography dependent areas of the u...