Imaging and intervention of retroperitoneal fibrosis

Abstract

Retroperitoneal fibrosis is a rare condition characterized by the development of fibrous plaques in the retroperitoneal space. The fibrous plaques characteristically arise distal to the bifurcation of the abdominal aorta and progress to encase the iliac vessels distally and are defined by the associated encasement of one or both ureters. Imaging plays an important role in not only establishing the diagnosis, but also in monitoring disease progression. Historically, the radiological diagnosis was made predominantly by intravenous urography and retrograde pyelography. More recently, advances in cross-sectional imaging with ultrasound and contrast-enhanced CT have allowed for a more precise diagnosis as well as helping to accurately define the extent of the disease. At our institution, we have found ultra-fast MRI to also play a useful role in establishing the diagnosis. In particular, magnetic resonance urography using HASTE (half Fourier-acquired single shot turbo spin-echo) sequences allow a safe alternative to intravenous urography, particularly in patients with poor renal function. The purpose of this article is to describe the role of the various imaging methods available to the radiologist and to emphasize the important role that the interventional radiologist now plays, not only in obtaining tissue for diagnosis, but also in providing treatment of the disease by percutaneous nephrostomy drainage and subsequent stent placement in select cases.

Post traumatic retroperitoneal fibrosis as a cause of low-back pain

“…However, in some instances, when the results of the currently available imaging tests are highly characteristic, biopsy may not be needed. This is mainly the case when clinical data, test results and other examinations all point to an exclusively idiopathic aetiology, or when it is believed that the condition is secondary to a disease that has already been determined 22 . Some degree of consensus exists as to the initial treatment of idiopathic cases with corticosteroids 23 , although these have shown no clear evidence of potential benefits 24 .…”

Ormond’s Disease or Secondary Retroperitoneal Fibrosis? An Overview of Retroperitoneal Fibrosis

“…MR urography (MRU) using half Fourier acquired single shot turbo (fast) spin echo sequences (HASTE, SSFSE) can be used to scan the renal tract of patients with retroperitoneal fibrosis and offers a safe alternative to IVU without the need for contrast medium application. According to IVU, it shows bilateral hydronephrosis combined with hydroureter and medial deviation of the ureters [35]. CT and MRI are the modalities of choice for evaluating the extent of the disease [18].…”

“…In ultrasound, retroperitoneal fibrosis appears as a smooth-bordered, hypoechoic, or isoechoic mass. By involving the ureter, fibrosis can cause unilateral hydronephrosis in one third of patients or bilateral hydronephrosis in two thirds of patients [18,35]. The scout films of excretory urograms typically show normal psoas outlines bilaterally, because the mass usually does not extend to the lateral borders of the muscle [1].…”

Retroperitoneal Fibrosis as a Rare Cause of Lower Limb Claudication

“…Due to unspecific clinical symptoms RF diagnosis is based on imaging examinations, such as CT and MRI. The characteristic feature of RF is the creation of a so-called "blanket" covering the aorta and inferior caval vein by a fibrous mass (6).…”