role of Magnetic resonance urography in the etological diagnosis of upper urinary tract obstruction

We evaluated the role of magnetic resonance urography [MRU] in the diagnosis of the cause and level of. upper urinary tract obstruction as non-invasive technique when the conventional IVU is non conclusive or contraindicated. Our study included 62 patients of them 33 patients with unilateral obstruction, 20 patients with bilateral obstruction and 9 patients with obstructed solitary kidney. Non enhanced T2-weighted MRU was done to diagnose the etiology of uretral obstruction compared to the gold standard of diagnosis of obstruction which was retrograde or antegrade urography, uretroscopy or open surgery. We found that in calcular obstruction the sensitivity specificity and overall accuracy were respectively [70.6%, 97.1% and 83,5%] while for non-caleular obstruction were [95.8%, 97.1% and 96.3%] there was a statistically significant difference between the sensitivity of MRU in diagnosing the cause of obstruction in calcular and non-calcular etiology in favor of non-caleular obstruction [p value = 0.01]. The overall sensitivity of MRU in diagnosis of the cause of obstruction was 85.4%, specificity of 97.1% overall accuracy of 89.2%. In conclusion MRU is a sensitive test for diagnosis of the level and cause of upper tract obstruction when IVU is contraindicated or non-conclusive in non-caleular obstruction, but the sensitivity is lower in detection of calcular obstruction. The addition of KUB and abdominal ultrasonography increase the sensitivity of MRU in diagnosis of calcular upper urinary tract obstruction

Perinatal mortality: clinical value of post - mortem magnetic resonance imaging compared with autopsy in routine obstetric and radiology practice

Goals to compare post mortem magnetic resonance imaging [MRI] with autopsy in perinatal deaths. To determine the acceptance and feasibility of postmortem perinatal MRI Cohort study in Al-Azhar university hospitals. Fetuses and neonates from 16 weeks gestational age until 28 days after birth, still birth as well as intrapartum and neonatal deaths. MRI was performed prior to autopsy in a consecutive cohort of perinatal deaths after full parental consent. Agreement between MRI and autopsy was calculated. The consent rate for both examinations was recorded separately, as well as the time between the perinatal death and the MRI of 58 cases, 26 parents consented to both examinations [45%]. Autopsy showed 18 major malformations, of which 10 were detected with MRI. The positive predictive value of MRI was 80% and the negative predictive value was 65%. Additional consent for MRI was given eight cases [14%]. In 84%, the MRI could be performed within 48 hours. MRI is of value if autopsy is refused, but diagnostic accuracy is insufficient to recommend substitution of full autopsy. The acceptance rate of MRI only is better than that of autopsy

role of unenhanced helical computed tomography scan in the diagnosis of acute renal colic

Patients presenting in the emergency room [ER] with flank pain suggestive of renal or ureteric stones may have alternative underlying conditions mimicking urolithiasis. An early diagnosis and appropriate treatment for urolithiasis and other causes of flank pain is important. The majority of centers around the world are increasingly using un-enhanced helical CT [UHCT] for evaluation of renal colic. This study was conducted to define the importance of UHCT as an alternative to US and IVP in cases of acute renal colic with suspected renal or ureteric stones as a cause of pain and to define the incidence and spectrum of significant incidental diagnosis other than renal or ureteric stones. 43patients presented at ER with acute loin pain were reviewed with UHCT for suspected renal or/ureteral stones. Radiological diagnosis of clinical entities not suspected otherwise was analyzed. All other relevant radiological, biochemical and serological investigations and per-operative findings were also noted. Renal stones were identified in 11 patients [25.6%], ureteral calculi were identified in 16 patients [37.2%], findings of recent passage of calculi in 2 patients [4.7%] and no calculi in 14 patients [32.5%]. Overall the incidental findings [additional or alternative diagnosis] were found in 3 [6.9%] CT scans of all patients; and [21%] of nonurinary calcular patients. Diagnosis was confirmed by peri-operative findings, and other radiological and biochemical investigations or on clinical follow up. UHCT is more beneficial than US and IVP in ER for accurate and rapid management of cases of acute renal colic as a wide spectrum of significant incidental diagnosis - other than stones - can be identified on UHCT performed for suspected renallureteral stones. In the present series of 43 CT examinations, Urolithiasis was appeared in 67.5% of cases. The incidence of incidental diagnosis of pathologies other than urolithiasis was 6.9% of all patients 21% of patients with no calculi

Magnetic resonance imaging for primary fistula in ano

This was a prospective study designed to determine the therapeutic impact of magnetic resonance imaging [MRI] in primary fistula in ano, and to assess its effect on outcome. Thirty patients with suspected primary fistula in ano underwent preoperative MRI, and the findings were revealed during surgery following examination under anaesthesia [EUA]. Any effect on operative approach was noted. Outcome was assessed at a median of 12 months. Two patients had sinuses, one had no sepsis and 27 had fistulas: five superficial, seven intersphincteric, 14 trans-sphincteric and one suprasphincteric. MRI and EUA agreed in 15 patients and MRI findings altered the surgical approach in a further three [10 per cent]; two of the latter patients were believed to have a sinus at EUA, which MRI correctly identified as a fistula, allowing definitive treatment. The therapeutic impact of MRI was therefore 10 per cent. Persisting disagreement between MRI and EUA in 12 patients mostly related to minor discrepancies in classification. Only one patient required further unplanned surgery, which was for skin-bridging rather than any new sepsis. In experience hands, MRI has a therapeutic impact of 10 per cent for primary fistula in ano, precipitating surgery that is likely to reduce recurrence in a small, but important, proportion of patients