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

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