Dynamic magnetic resonance imaging in acute pyelonephritis

Martina, Maria Cristina; Campanino, Pier Paolo; Caraffo, F.; Marcuccio, Cristina; Gunetti, F.; Colla, Loredana; Cassinis, Maria Carla; Gandini, Giovanni

doi:10.1007/s11547-009-0468-5

Cited by 22 publications

(5 citation statements)

References 23 publications

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“…Computed tomography (CT) or magnetic resonance imaging (MRI) examination allows precise definition of the inflammatory areas and evidence of abscesses [11][12][13]. As patients with non-complicated APN are mostly women of childbearing age, MR might be chosen as the preferred imaging technique and CT should be performed only in the case of contraindications or logistical problems (long wait before the availability of an MRI) [14].…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis

et al. 2013

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Objectives The diagnosis of acute pyelonephritis (APN) requires demonstration of parenchymal involvement. When no predisposing conditions are found, non-complicated APN is suspected and CT or MRI should be performed. Diffusion-weighted (DW) MRI might be useful, quicker and cheaper than the standard gadolinium-enhanced (GE) MRI. The aim of this study is to compare DW-MRI with GE-MRI to test its diagnostic accuracy in APN. Methods Of 318 consecutive patients hospitalised for APN, 279 underwent MRI. Four hundred and fourteen MR studies (first test and follow-up examinations) were gathered and data were processed using Diffusion Analysis software. DW-MRI has been compared with GE-MRI for evaluating diagnostic agreement. Results Two hundred and forty-four patients were diagnosed as having APN; 35 were negative. One hundred and sixty-three APN cases were considered non-complicated and selected for the study. Among the 414 MR examinations, comparing DW-MRI with GE-MRI, positive correlation was found in 258 cases, negative in 133. There were 14 falsenegatives and 9 false-positives. DW-MRI achieved sensitivity 95.2 %, specificity 94.9 %, positive predictive value 96.9 %, negative predictive value 92.3 % and accuracy 94.6 %. Conclusions DW-MRI is reliable for diagnosing noncomplicated APN. The high diagnostic agreement between DW-MRI and GE-MRI offers new perspectives in diagnostic management, enabling diagnosis of non-complicated APN without using ionising radiation or contrast media. Key Points • The diagnosis of acute pyelonephritis (APN) requires demonstration of renal involvement.• Hitherto magnetic resonance imaging required gadolinium enhancement (GE-MRI) to establish this diagnosis.• But diagnostic agreement between diffusion-weighted and GE-MRI offers new diagnostic opportunities.• Quantification of ADC values can help diagnose and monitor APN.• DW-MRI avoids ionising radiation and paramagnetic contrast medium administration.

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Section: Introductionmentioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis

et al. 2013

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“…MRI Abdomen and Pelvis. Both MRI of the abdomen and pelvis and MRU can be used to evaluate the urinary tract and have the advantage to provide more functional information than CT. MRI has been shown to be useful in the diagnosis and follow-up of UTI and acute pyelonephritis [27,35,36]. MRI is effective at diagnosing pelvic-organ prolapse.…”

Section: Us Kidneys and Bladder Retroperitonealmentioning

confidence: 99%

ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females

Imaging¹,

Venkatesan

Oto

et al. 2020

Journal of the American College of Radiology

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Urinary tract infections (UTIs) in women are common, with an overall lifetime risk over >50%. UTIs are considered recurrent when they follow complete clinical resolution of a previous UTI and are usually defined as at least three episodes of infection within the preceding 12 months. An uncomplicated UTI is classified as a UTI without structural or functional abnormalities of the urinary tract and without relevant comorbidities. Complicated UTIs are those occurring in patients with underlying structural or medical problems. In women with recurrent uncomplicated UTIs, cystoscopy and imaging are not routinely used. In women suspected of having a recurrent complicated UTI, cystoscopy and imaging should be considered. CT urography or MR urography are usually appropriate for the evaluation of recurrent complicated lower urinary tract infections or for women who are nonresponders to conventional therapy, develop frequent reinfections or relapses, or have known underlying risk factors.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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness

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“…After contrast administration, abscesses often show peripheral rim enhancement with progressive enhancement [18]. Delayed phase post-contrast scanning is particularly important for the differentiation of abscesses from non-abscessed infectious foci and infarctions or scars, with the latter having viable tissue that enhances on delayed imaging [19]. Restricted diffusion on DWI is a typical feature of organized abscesses due the accumulation of white blood cells with intact cell membranes, which leads to high cellularity and viscosity [17].…”

Section: Renal Abscessmentioning

confidence: 99%

Imaging Manifestations of Acute and Chronic Renal Infection That Mimics Malignancy: How to Make the Diagnosis Using Computed Tomography and Magnetic Resonance Imaging

et al. 2019

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Purpose To review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis. Conclusion Acute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Infection may be suspected when patients are young and otherwise healthy when there is marked associated perinephric changes and in the absence of metastatic adenopathy or disease elsewhere in the abdomen and pelvis. Renal abscesses, from bacterial or atypical microbial agents, can appear as complex cystic renal masses mimicking cystic renal cell carcinoma. Associated inflammatory changes in and around the kidney and local invasion favour infection. Emphysematous pyelonephritis can mimic necrotic or fistulizing tumour; however, infection is more likely and should always be considered first. Xanthogranulomatous pyelonephritis can mimic malignancy when focal or multifocal and in cases without associated renal calculi. Malacoplakia is an inflammatory process that may mimic malignancy and should be considered in patients with chronic infection. Bacillus Calmette-Guerin (BCG)-induced pyelonephritis is rare but can mimic renal malignancy and should be considered in patients presenting with a renal mass when being treated with BCG for urinary bladder UCC.

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Dynamic magnetic resonance imaging in acute pyelonephritis

Abstract: Renal MRI is an effective tool for the diagnosis and follow-up of APN both in patients not at risk and those at higher risk, such as those with a transplanted kidney. The high costs of the examination are offset by better treatment planning and early complication detection.

Cited by 22 publications

References 23 publications

Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis

Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis

ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females

Imaging Manifestations of Acute and Chronic Renal Infection That Mimics Malignancy: How to Make the Diagnosis Using Computed Tomography and Magnetic Resonance Imaging

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