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Brook OR, Dadour JR, Robbins JB, Wasnik AP, Akin EA, Borloz MP, Dawkins AA, Feldman MK, Jones LP, Learman LA, Melamud K, Patel-Lippmann KK, Saphier CJ, Shampain K, Uyeda JW, VanBuren W, Kang SK. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group: 2023 Update. J Am Coll Radiol 2024; 21:S3-S20. [PMID: 38823952 DOI: 10.1016/j.jacr.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
This review focuses on the initial imaging in the reproductive age adult population with acute pelvic pain, including patients with positive and negative beta-human chorionic gonadotropin (β-hCG) levels with suspected gynecological and nongynecological etiology. For all patients, a combination of transabdominal and transvaginal pelvic ultrasound with Doppler is usually appropriate as an initial imaging study. If nongynecological etiology in patients with negative β-hCG is suspected, then CT of the abdomen and pelvis with or without contrast is also usually appropriate. In patients with positive β-hCG and suspected nongynecological etiology, CT of the abdomen and pelvis with contrast and MRI of the abdomen and pelvis without contrast may be appropriate. In patients with negative β-hCG and suspected gynecological etiology, CT of the abdomen and pelvis with contrast, MRI of pelvis without contrast, or MRI of pelvis with and without contrast may be appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Joseph R Dadour
- Research Author, Centre Hospitalier de l'Université de Montréal, Montréal, Montreal, Quebec, Canada
| | | | - Ashish P Wasnik
- Panel Vice Chair, University of Michigan, Ann Arbor, Michigan
| | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging
| | - Matthew P Borloz
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Emergency Physicians
| | | | | | - Lisa P Jones
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | - Kira Melamud
- New York University Langone Health, New York, New York
| | | | - Carl J Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Jennifer W Uyeda
- Brigham & Women's Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER
| | | | - Stella K Kang
- Specialty Chair, New York University Medical Center, New York, New York
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Whitworth P, Courtney KG, Oto A, Allen BC, Akin O, Barker SJ, Bartel TB, DuBeau C, Gerena M, Kraft KH, Lew SQ, Mankowski Gettle L, Turkbey B, Uyeda JW, Nikolaidis P. ACR Appropriateness Criteria® Hydronephrosis on Prior Imaging-Unknown Cause. J Am Coll Radiol 2024; 21:S144-S167. [PMID: 38823942 DOI: 10.1016/j.jacr.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Initial imaging evaluation of hydronephrosis of unknown etiology is a complex subject and is dependent on clinical context. In asymptomatic patients, it is often best conducted via CT urography (CTU) without and with contrast, MR urography (MRU) without and with contrast, or scintigraphic evaluation with mercaptoacetyltriglycine (MAG3) imaging. For symptomatic patients, CTU without and with contrast, MRU without and with contrast, MAG3 scintigraphy, or ultrasound of the kidneys and bladder with Doppler imaging are all viable initial imaging studies. In asymptomatic pregnant patients, nonionizing imaging with US of the kidneys and bladder with Doppler imaging is preferred. Similarly, in symptomatic pregnant patients, US of the kidneys and bladder with Doppler imaging or MRU without contrast is the imaging study of choice, as both ionizing radiation and gadolinium contrast are avoided in pregnancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Pat Whitworth
- Thomas F. Frist, Jr. College of Medicine, Belmont University, Nashville, Tennessee.
| | - Kelsey G Courtney
- Research Author, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Twyla B Bartel
- Global Advanced Imaging, PLLC, Little Rock, Arkansas; Commission on Nuclear Medicine and Molecular Imaging
| | - Catherine DuBeau
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire; American Geriatrics Society
| | - Marielia Gerena
- Stony Brook University Medical Center, Stony Brook, New York
| | - Kate H Kraft
- University of Michigan, Ann Arbor, Michigan; American Urological Association
| | - Susie Q Lew
- George Washington University, Washington, District of Columbia; American Society of Nephrology
| | | | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jennifer W Uyeda
- Brigham & Women's Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER
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Nai R, Wang K, Li X, Du S, E T, Xiao H, Quan S, Zhang Y, Yu J, Li J, Zhang X, Wang X. Quantitative measurement of the ureter on three-dimensional magnetic resonance urography images using deep learning. Med Phys 2024. [PMID: 38477634 DOI: 10.1002/mp.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Accurate measurement of ureteral diameters plays a pivotal role in diagnosing and monitoring urinary tract obstruction (UTO). While three-dimensional magnetic resonance urography (3D MRU) represents a significant advancement in imaging, the traditional manual methods for assessing ureteral diameters are characterized by labor-intensive procedures and inherent variability. In the realm of medical image analysis, deep learning has led to a paradigm shift, yet the development of a comprehensive automated tool for the precise segmentation and measurement of ureters in MR images is an unaddressed challenge. PURPOSE The ureter was quantitatively measured on 3D MRU images using a deep learning model. METHODS A retrospective cohort of 445 3D MRU scans (443 patients, 52 ± 18 years; 217 female patients) was collected and split into training, validation, and internal testing cohorts. A 3D V-Net model was trained for urinary tract segmentation, and a post-processing algorithm was developed for ureteral measurements. The accuracy of the segmentation was evaluated using the Dice similarity coefficient (DSC) and volume intraclass correlation coefficient (ICC), with ground truth segmentations provided by experienced radiologists. The external cohort comprised 50 scans (50 patients, 55 ± 21 years; 30 female patients), and the model-predicted ureteral diameter measurements were compared with manual measurements to assess system performance. The various diameter parameters of ureter among the different measurement methods (ground truth, auto-segmentation with automatic diameter extraction, and manual segmentation with automatic diameter extraction) were assessed with Friedman tests and post hoc Dunn test. The effectiveness of the UTO diagnosis was assessed by receiver operating characteristic (ROC) curves and their respective areas under the curve (AUC) between different methods. RESULTS In both the internal test and external cohorts, the mean DSC values for bilateral ureters exceeded 0.70. The ICCs for the bilateral ureter volume obtained by comparing the model and manual segmentation were all greater than 0.96 (p < 0.05), except for the right ureter in the internal test cohort, for which the ICC was 0.773 (p < 0.05). The mean DSCs for interobserver and intraobserver reliability were all above 0.97. The maximum diameter of the ureter exhibited no statistically significant differences either in the dilated (p = 0.08) or in the non-dilated (p = 0.32) ureters across the three measurement methods. The AUCs of ground truth, auto-segmentation with automatic diameter extraction, and manual segmentation with automatic diameter extraction in diagnosing UTO were 0.988 (95% CI: 0.934, 1.000), 0.961 (95% CI: 0.893, 0.991), and 0.979 (95% CI: 0.919, 0.998), respectively. There was no statistical difference between AUCs of the different methods (p > 0.05). CONCLUSION The proposed deep learning model and post-processing algorithm provide an effective means for the quantitative evaluation of urinary diseases using 3D MRU images.
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Affiliation(s)
- Rile Nai
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Kexin Wang
- School of Basic Medical Sciences, Capital Medical University Beijing, Beijing, China
| | - Xiaoqing Li
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Shangsong Du
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Tuya E
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - He Xiao
- Department of Radiology, Beijing Changping Hospital, Beijing, China
| | - Shuo Quan
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yaofeng Zhang
- Beijing Smart Tree Medical Technology Co. Ltd., Beijing, China
| | - Junhua Yu
- Beijing Smart Tree Medical Technology Co. Ltd., Beijing, China
| | - Jialun Li
- Beijing Smart Tree Medical Technology Co. Ltd., Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
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Lee SK, Hyeong S, Kim S, Jeon CY, Lim KS, Bae Jin Y, Choi J. Comparison of static-fluid or excretory magnetic resonance urography with computed tomography urography for visualization of nondilated renal pelvises and ureters in healthy Beagles. Am J Vet Res 2021; 83:229-238. [PMID: 34936574 DOI: 10.2460/ajvr.21.03.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the usefulness of magnetic resonance urography (MRU) for the visualization of nondilated renal pelvises and ureters in dogs and to compare our findings for MRU versus CT urography (CTU). ANIMALS 9 healthy Beagles. PROCEDURES Dogs underwent CTU, static-fluid MRU, and excretory MRU, with ≥ 7 days between procedures. Contrast medium was administered IV during CTU and excretory MRU, whereas urine in the urinary tract was an intrinsic contrast medium for static-fluid MRU. For each procedure, furosemide (1 mg/kg, IV) was administered, and reconstructed dorsal plane images were acquired 3 minutes (n = 2) and 7 minutes (2) later. Images were scored for visualization of those structures and for image quality, diameters of renal pelvises and ureters were measured, and results were compared across imaging techniques. RESULTS Excretory MRU and CTU allowed good visualization of the renal pelvises and ureters, whereas static-fluid MRU provided lower visualization of the ureters. Distention of the renal pelvises and ureters was good in excretory MRU and CTU. Distention of the ureters in static-fluid MRU was insufficient compared with that in CTU and excretory MRU. Distinct artifacts were not observed in CTU and excretory MRU images. Static-fluid MRU images had several mild motion artifacts. CLINICAL RELEVANCE Our findings indicated that excretory MRU with furosemide administration was useful for visualizing nondilated renal pelvises and ureters of dogs in the present study. When performing MRU for the evaluation of dogs without urinary tract dilation, excretory MRU may be more suitable than static-fluid MRU.
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Affiliation(s)
- Sang-Kwon Lee
- College of Veterinary Medicine, Kyungpook National University, Daegu, South Korea
| | - Seongjae Hyeong
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Soyeon Kim
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Chang-Yeop Jeon
- National Primate Research Center (NPRC), Korea Research Institute of Bioscience and Biotechnology (KRIBB), Cheongju, South Korea
| | - Kyung-Seob Lim
- Futuristic Animal Resource & Research Center (FARRC), Korea Research Institute of Bioscience and Biotechnology (KRIBB), Cheongju, South Korea
| | - Yeung Bae Jin
- College of Veterinary Medicine, Gyeongsang National University, Jinju, South Korea
| | - Jihye Choi
- College of Veterinary Medicine, Kyungpook National University, Daegu, South Korea
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Somberg Gunther M, Kanmaniraja D, Kobi M, Chernyak V. MRI of Acute Gynecologic Conditions. J Magn Reson Imaging 2019; 51:1291-1309. [PMID: 31833165 DOI: 10.1002/jmri.27002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/08/2022] Open
Abstract
Although usually not a first-line imaging modality in the setting of acute pelvic pain, magnetic resonance imaging (MRI) is able to depict and characterize a wide range gynecologic diagnoses with high accuracy. Lack of ionizing radiation renders MRI particularly useful for assessment of pregnant women and children. Furthermore, inherent high soft-tissue resolution of MRI allows accurate diagnosis without intravenous contrast use, which is advantageous for patients with renal insufficiency and pregnant patients. Familiarity with the typical MRI appearance of various acute gynecologic conditions helps establish the correct diagnosis. This article reviews the common MRI findings of acute gynecologic processes, in both pregnant and nonpregnant patients. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1291-1309.
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Affiliation(s)
| | | | - Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
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Weitz M, Portz S, Laube GF, Meerpohl JJ, Bassler D. Surgery versus non-surgical management for unilateral ureteric-pelvic junction obstruction in newborns and infants less than two years of age. Cochrane Database Syst Rev 2016; 7:CD010716. [PMID: 27416073 PMCID: PMC6457949 DOI: 10.1002/14651858.cd010716.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Unilateral ureteric-pelvic junction obstruction (UPJO) is the most common cause of obstructive uropathy and may lead to renal impairment and loss of renal function. The current diagnostic approach with renal imaging cannot reliably determine which newborns and infants less than two years of age have a significant obstruction and are at risk for permanent kidney damage. There is therefore no consensus on optimal therapeutic management of unilateral UPJO. OBJECTIVES To assess the effects of surgical versus non-surgical treatment options for newborns and infants less than two years of age with unilateral UPJO. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2016), MEDLINE/Ovid, and EMBASE/Ovid databases from their inception to 13 June 2016. We searched the reference lists of potentially relevant studies without using any language restriction. We also searched the following trial registers for relevant registered studies: www.clinicaltrials.gov/; ISRCTN registry (controlled-trials.com/); www.trialscentral.org/; apps.who.int/trialsearch/; www.drks.de/; and www.anzctr.org.au/trialSearch.aspx. SELECTION CRITERIA We selected randomised and quasi-randomised controlled trials comparing surgical with non-surgical interventions for the treatment of unilateral UPJO. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility and risk of bias of included studies and extracted data. In case of disagreements we consulted a third review author. The data reported in the two included studies did not allow us to perform a meta-analysis. MAIN RESULTS We found only two studies at high risk of bias that were eligible for inclusion in this review. The total sample size, including both trials, was small (n = 107 participants less than six months of age from the UK and USA), and not all prespecified outcome measures were assessed. Reported measures only accounted for the short-term follow-ups. The mean split renal function was not statistically different between the surgical and non-surgical group at the six-month or one-year time point (very low-quality evidence). The surgical group showed a significantly less obstructed drainage pattern and a lower urinary tract dilatation than the non-surgical group (very low-quality evidence). Transfer from the non-surgical group to the surgical group was reported for about one out of five participants. Split renal function after secondary surgical intervention was reported with variable results, but most of the participants reverted to pre-deteriorated values. The studies either provided no or insufficient data on the following outcome measures: postoperative complications, UPJO-associated clinical symptoms, costs of interventions, radiation exposure, quality of life, and adverse effects. AUTHORS' CONCLUSIONS We found limited evidence assessing the benefits and harms of surgical compared to non-surgical treatment options for newborns and infants less than two years of age with unilateral UPJO. The majority of participants in the non-surgical treatment group did not experience any significant deterioration of split renal function, and only about 20% of them underwent secondary surgical intervention, with minor risk of permanent deteriorated split renal function. The study follow-up period was too short to assess the long-term effects on split renal function in both treatment groups. We need further randomised controlled trials with sufficient statistical power and an adequate follow-up period to determine the optimal therapy for newborns and infants less than two years of age with unilateral UPJO.
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Affiliation(s)
- Marcus Weitz
- Children's Hospital TuebingenPediatric NephrologyHoppe‐Seyler‐Strasse 1TuebingenGermany72076
| | - Suniva Portz
- University Hospital TuebingenDepartment of ObstetricsCalwerstraße 7TuebingenGermany72076
| | - Guido F Laube
- University Children's HospitalPediatric NephrologySteinwiesstrasse 75ZurichSwitzerland8032
| | - Joerg J Meerpohl
- Medical Center ‐ University of FreiburgCochrane GermanyBerliner Allee 29FreiburgGermany79110
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes UniversityCochrane France1 place du Parvis Notre‐DameParisFrance75181 Cedex 4
| | - Dirk Bassler
- University Hospital Zurich and University of ZurichDepartment of NeonatologyFrauenklinikstrasse 10ZurichSwitzerland
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Kajbafzadeh AM, Mehdizadeh M, Aryan Z, Ebadi M, Esfahani SA, Montaser-Kouhsari L, Elmi A, Talab SS, Sadeghi Z. Drainage-related ultrasonography (DRUS): a novel technique for discriminating obstructive and nonobstructive hydroureters in children. J Ultrasound 2015; 18:117-25. [PMID: 26191099 DOI: 10.1007/s40477-014-0128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Despite advances in urologic imaging, the paucity of an optimal technique that accurately clarifies obstructive and nonobstructive hydroureter exists. OBJECTIVE This study was conducted to introduce a novel and modified ultrasonographic technique, known as drainage-related ultrasonography (DRUS), discriminating obstructive and nonobstructive, nonrefluxing hydroureter. MATERIALS AND METHODS A total of 358 children (mean age, 3.7 years) with 418 nonrefluxing hydroureter were included. These children were composed of two groups of obstructive nonrefluxing (141 children with 157 dilated ureters) and nonobstructive, nonrefluxing (217 children with 261 hydroureter). The definite diagnosis regarding the subtype of hydroureter was derived from appropriate investigation. The maximum diameter of the dilated ureter, which was observed on ultrasonography, was recorded before and after 3 h of catheterization, as D1 and D2, respectively. To assess the D ratio, a formula was developed, that is, [(|D1 - D2|)/D1] × 100. Values were recorded and cutoff points were set to discriminate between subtypes. RESULTS Obstructive versus nonobstructive subtypes of nonrefluxing hydroureter were clarified with 78.5 % sensitivity and 83.4 % specificity, by setting a cutoff point of 22 % for the D ratio. Regardless of the cutoff point assigned to the reduction in D (D2 compared with D1), DRUS revealed 93.9 % sensitivity, 80.6 % specificity, 63.2 % positive predictive value, and 97.4 % negative predictive value in discriminating upper from lower obstruction. CONCLUSION DRUS affords favorable results in terms of differentiating between obstructive and nonobstructive, nonrefluxing hydroureter, as well as between upper and lower obstruction in obstructive cases. It has the potential to become an efficient imaging modality in the diagnostic algorithm of hydroureter.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street Saadat-Abad Ave, Tehran, 1998714616 Iran
| | - Mehrzad Mehdizadeh
- Pediatric Radiology Department, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Aryan
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street Saadat-Abad Ave, Tehran, 1998714616 Iran
| | - Maryam Ebadi
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street Saadat-Abad Ave, Tehran, 1998714616 Iran
| | - Shadi Abdar Esfahani
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA USA
| | - Laleh Montaser-Kouhsari
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street Saadat-Abad Ave, Tehran, 1998714616 Iran
| | - Azadeh Elmi
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114 USA
| | - Saman Shafaat Talab
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114 USA
| | - Zhina Sadeghi
- Department of Urology, University Hospitals of Case Medical Center, Case Western Reserve University, Cleveland, OH 44106 USA
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Roy C, Ohana M, Host P, Alemann G, Labani A, Wattiez A, Lang H. MR urography (MRU) of non-dilated ureter with diuretic administration: Static fluid 2D FSE T2-weighted versus 3D gadolinium T1-weighted GE excretory MR. Eur J Radiol Open 2014; 1:6-13. [PMID: 26937423 PMCID: PMC4750612 DOI: 10.1016/j.ejro.2014.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/04/2014] [Accepted: 08/06/2014] [Indexed: 12/13/2022] Open
Abstract
T2w-MRU with multiple orientations and diuretic is sufficient to identify non-dilated ureter. T2w-MRU offers information on ureteral contractions and could be proposed to detect initial obstruction before hydronephrosis occurs (for instance in cases of endometriosis). T2w-MRU could also be used to evaluate potential renal donors or in patients unable to receive gadolinium. CE-MRU rapidly produces an overdistended bladder with a risk of false positive diagnosis of mild obstruction. CE-MRU is less convenient for patients.
Objective The goal of this prospective study was to compare the efficiency of two types of MRU after diuretic administration to identify the non-dilated ureter. Methods MR pelvic examinations were performed in 126 patients after receiving furosemide. Each patient underwent in addition to their protocol for context, two types of MRU: 2D T2-weighted FSE (T2w-MRU) and 3D Gd T1-weighted GE (CE-MRU). Four segments were checked for each ureter. For the first part of the analysis, readers evaluated the whole image quality using a four points subjective scale and for the second part, they were asked to score separately each ureteral segment as present or absent. Results 1008 ureteral segments were checked. For the image quality, readers did not find any significant difference (3.8 ± 0.5 vs 3.6 ± 0.7, p value: 0.13) between MRU methods. The interobserver agreement was excellent with a κ correlation coefficient as high as 0.89 for T2w-MRU and 0.92 for CE-MRU, respectively. For the detection of the segments and considering the 9 rotations for the T2W MRU, there were no statistically significant differences between the two groups. Conclusion T2-weighted MRU with multiple orientations and diuretic is sufficient to identify the non-dilated ureter. It offers information on ureteral peristaltism. It can be suggested that this sequence is able to detect an initial obstruction before hydronephrosis occurs.
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Affiliation(s)
- C Roy
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l'hopital BP 426, 67091 Strasbourg Cedex, France
| | - M Ohana
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l'hopital BP 426, 67091 Strasbourg Cedex, France
| | - Ph Host
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l'hopital BP 426, 67091 Strasbourg Cedex, France
| | - G Alemann
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l'hopital BP 426, 67091 Strasbourg Cedex, France
| | - A Labani
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l'hopital BP 426, 67091 Strasbourg Cedex, France
| | - A Wattiez
- Department of Gynecology - University Hospital of Strasbourg - Hospital Hautepierre, 1, place de l'hopital BP 426, 67091 Strasbourg Cedex, France
| | - H Lang
- Department of Urology, University Hospital of Strasbourg - New Civil Hospital, 1, place de l'hôpital BP 426, 67091 Strasbourg Cedex, France
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