MR UROGRAPHY WITH DYNAMIC 3D MIP AIDED DETECTION- DIAGNOSTIC SIGNIFICANCE VALUE IN SUSPECTED PELVICALIECTASIS CONFIRMATION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 1
Abstract
BACKGROUND Hydronephrosis is the most common cause of chronic renal failure. Hydronephrosis due to calculus disease is more frequent than without non-calculus aetiology. Mild hydronephrosis or mild pelvicaliectasis is commonly encountered on routine ultrasound screening. Radiologist’s bias in mild pelvicaliectasis as to rule out physiological or early pathology is our purpose of study. Role of MR Urography serve as a problem solving tool for ultrasound in mild pelvicaliectasis by specific protocol with 3D aided and dynamic imaging. The objective of this study is to evaluate efficacy of MR urography for suspecting hydronephrosis in asymptomatic and incidental detected hydronephrosis in other radiological modalities. MATERIALS AND METHODS 34 patients were enrolled in descriptive study with institutional ethical review obtained. Clinically suspected pelvicaliectasis patients screened by Ultrasound were set as inclusion criteria. Pelvicaliectasis positive patients on ultrasound were subjected to MR urography and renal diuretic nuclear study. Remaining patients were set as control group and compared with the results. MR urography non-contrast protocol were deployed. The three dimensional sequence was used to track passage of contrast from kidneys to ureter and bladder. MR urography followed by furosemide scintigraphy was also done to compare the efficacy of MR urography, keeping as reference standard. Nuclear medicine furosemide renal study was done for all MR urography within 1 week duration. Renal functional test parameters like renal transit time and average contrast wash-out time are calculated, and in all the cases these parameters are depicted as characteristics of analysis curve. Bland-Altman plots were used to quantify intra- and interobserver performance. Statistical significance was derived by comparing both modality curves with a mean under the curve of 0.90. Percentage analysis was also done by comparing two modalities, sensitivity and specificity. RESULTS 6 positive cases were noted from MR Urography from sample size (N= 19) with left UPJ obstruction (N= 1), right VUJ obstruction (N= 1), stricture in right mid ureter (n= 3) and left mid ureter (N= 1). Calculus obstruction patients were excluded from the study. All the cases and results were compared with diuretic renal scintigraphy. On the basis of interobserver performance on characteristic curves, results obtained were almost similar. RTT obstructed (RTT > 410 seconds) obtained from both characteristic curves with percentage analysis were with better sensitivity (98.8%) and specificity (100%). CONCLUSION MR Urography proved to be the future gold standard for suspected mild pelvicaliectasis in our study. However, large cohort study needs to be addressed to prove efficacy in large sample volume.
Authors and Affiliations
Ameen M. D, Vetriraj S
Keywords
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- EP ID EP283328
- DOI 10.14260/jemds/2018/8
- Views 112
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