Noninvasive Assessment of Acute Ureteral Obstruction with Diffusion-weighted MR Imaging: A Prospective Study

Thoeny, Harriet C.; Binser, Tobias; Roth, Beat; Kessler, Thomas M.; Vermathen, Peter

doi:10.1148/radiol.2523082090

Cited by 78 publications

(62 citation statements)

References 30 publications

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“…Although DW-MRI is already routinely used and is valuable for the detection of acute vascular lesions in patients with stroke symptoms, its application in abdominal organs is challenging due to respiration, peristalsis and magnetic susceptibility artifacts (15,16). Only in recent years it reveals an appreciable progress in DW-MRI of the kidneys (13,17,18), but to the best of our knowledge, little work has been done to evaluate the renal function sequentially under the insult produced by radiographic contrast agents using a noninvasive DW-MR technique.…”

Section: Discussionmentioning

confidence: 99%

Time course study on the effects of iodinated contrast medium on intrarenal water transport function using diffusion‐weighted MRI

Wang

Zhang

Yang

et al. 2012

Magnetic Resonance Imaging

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Purpose: To assess the effects of intravenous-injected iodinated contrast medium (CM) on intrarenal water diffusion using noninvasive diffusion-weighted MRI (DW-MRI). Materials and Methods:Ten New Zealand White rabbits were randomized to receive a 6 mL/kg body weight intravenous injection of clinically used iopamidol-370 (n ¼ 7) or an equivalent amount of 0.9% physiological saline (n ¼ 3). A sequential DW-MRI was performed to estimate the intrarenal apparent diffusion coefficient (ADC) at 24 h before and 1 h, 24 h, 48 h, and 72 h after administration.Results: Iopamidol produced a progressive ADC reduction in inner stripes of the renal outer medulla (IS) by 13.92% (P ¼ 0.05) at 1 h, 17.52% (P ¼ 0.02) at 24 h, 20.23% (P ¼ 0.01) at 48 h and 16.31% (P ¼ 0.04) at 72 h after injection. Cortical ADC was decreased by 14.14% (P ¼ 0.01) at 48 h and 14.12% (P ¼ 0.01) at 72 h after injection. Iopamidol produced slight decrease of ADCs in outer stripes of the outer medulla (OS) and inner medulla (IM) of kidney but without statistical difference. In control group, no significant ADC changes was observed in each anatomic compartment due to saline injection (P > 0.05). Conclusion:As demonstrated by DW-MRI, intravenous iopamidol injection resulted in a successive reduction of intrarenal water diffusion, particularly in IS of kidney. This MR technique may be used as a noninvasive tool to perform a time course study of the pathogenesis associated with contrast-induced nephropathy (CIN).

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Section: Discussionmentioning

confidence: 99%

Time course study on the effects of iodinated contrast medium on intrarenal water transport function using diffusion‐weighted MRI

Wang

Zhang

Yang

et al. 2012

Magnetic Resonance Imaging

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“…From personal experience, we know that kidney stiffness is much less altered compared to the liver during fibrosis, suggesting that elastography in kidneys might not be sensitive enough for assessment of fibrosis. A third approach suggested to measure renal fibrosis is diffusion-weighted MRI (427)(428)(429)(430)(431)(432)(433)(434)(435)(436)(437). Presently it is unclear whether any of these modalities specifically reflects renal fibrosis.…”

Section: Imagingmentioning

confidence: 99%

Renal Allograft Fibrosis: Biology and Therapeutic Targets

Floege

2015

American Journal of Transplantation

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“…Traditionally, antegrade pressure measurements (APMs) of the renal pelvis and the upper ureter are recorded by percutaneous access to the kidney or by the perfusion pressureow test (Whitaker test) [3][4][5], which risk invasive renal bleeding and urinary tract infection. Other methods, such as radionuclide renogram, Doppler vessel resistance and intravenous urography [6][7][8][9], lack sensitivity and speci city. A quantitative, non-invasive and e ective method is needed.…”

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confidence: 99%

A practical pressure measuring method for the upper urinary tract during ureteroscopy

Cai

Li²,

Zhu³

et al. 2012

CIM

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A practical pressure measuring method for the upper urinary tract during ureteroscopy AbstractPurpose: e purpose of this study was to develop and test a method for measuring pressure in the upper urinary tract during ureteroscopic operations and to evaluate its e cacy and clinical signi cance.Methods: A total of 44 patients, each with a ureteral calculus in the proximal ureteral segment, were enrolled in the study group: 21 patients with an acute and 23 with a chronic obstruction. e ureteroscope was passed forward to the upper segment of the obstructed ureter immediately a er the calculus was broken and the intraluminal ureteral pressure was then transmitted along with the irrigant ow (0.9% sodium chloride).Results: e mean ureteral pressures of the acute obstruction subgroup, the chronic obstruction subgroup and the control group were 74.5 mmHg (22-180 mmHg), 32.5 mmHg (9-53 mmHg) and 10.2 mmHg (8-13 mmHg), respectively. A signi cant correlation was found between ureteral pressure and the following indexes: the duration of the obstruction (r=0.985), the diameter of the ureter above the calculus (r=0.878) and the depth of the hydronephrosis of the renal pelvis (r=0.862). No associations were observed between the pressure and the serum creatinine level (r=0.214) or the urinary leukocyte count (r=0.047). e intraluminal pressure correlated with the glomerular ow rate (GFR) of the a ected kidney (r =0.975, P =0.001).Conclusions: is new method is non-invasive, practical and reproducible. Measuring the intraluminal pressure of the ureter can provide a valuable index to quantify the severity of the obstruction of the upper urinary tract, which is helpful for the prediction of the affected renal function prognosis. [3][4][5], which risk invasive renal bleeding and urinary tract infection. Other methods, such as radionuclide renogram, Doppler vessel resistance and intravenous urography [6][7][8][9], lack sensitivity and speci city. A quantitative, non-invasive and e ective method is needed.Recently, ureteroscopy has become a common minimally invasive examination method in the treatment of ureteral calculi [10]. During ureteroscopy, the ureteroscope presses closely to the ureteral wall, and the intraluminal pressure of the ureter can be transmitted along with the owing of the irrigation uid. A er the ureteral calculi are fragmented, the ureteroscope passes the calculus, and the pressure of the ureter is measured by connecting the ureteroscope to a sensitive digital pressure monitor. In this study, we aimed to investigate the feasibility and e cacy of this method in patients with varying severities of calculus obstruction. Materials and Methods Clinical DataFrom July 2010 to July 2011, 44 consecutive patients, including 24 men and 20 women with an average age of 40.2 years (range 18-63 years), were enrolled in the study group. e inclusion criteria were ureteral obstruction caused by ureteral stones, accompanied by hydronephrosis or pyonephrosis. e exclusion criteria were severe de ciency of blood coagulation function and s...

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Noninvasive Assessment of Acute Ureteral Obstruction with Diffusion-weighted MR Imaging: A Prospective Study

Abstract: Diffusion-weighted MR imaging allows noninvasive detection of changes in renal perfusion and diffusion during acute unilateral ureteral obstruction, as exemplified in patients with a ureteral calculus.

Cited by 78 publications

References 30 publications

Time course study on the effects of iodinated contrast medium on intrarenal water transport function using diffusion‐weighted MRI

Time course study on the effects of iodinated contrast medium on intrarenal water transport function using diffusion‐weighted MRI

Renal Allograft Fibrosis: Biology and Therapeutic Targets

A practical pressure measuring method for the upper urinary tract during ureteroscopy

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