ABSTRACT
PURPOSE: To optimize the MDCT urogram protocol for assessment of the upper tracts. To assess the value of furosemide injection. MATERIALS AND METHODS: Prospective study comparing excretory phase imaging at 450 seconds in 67 patients assigned to 3 groups: a group without furosemide (f=0), a group with 20 mg furosemide (f=20), and a group with 10 mg furosemide (f=10). 3D MIP images were generated. Two experienced radiologists blinded to protocol specifications analyzed the quality of opacification the upper tracts, divided in 8 segments and urine density at the renal pelvis. RESULTS: The injection of 20 mg of furosemide significantly improved the opacification of the upper tracts with complete or near complete opacification in 82.6% of cases compared to 43.5% and 19% for the F=10 and f=0 groups respectively. Density measurements were 5 times less for the f=20 and f=10 groups compared to the f=0 group. CONCLUSION: Furosemide is useful for MDCT urography by improving upper tract opacification and filling: the reduced contrast concentration in the better distended and fully filled upper tracts improves evaluation of ureteral lumen and wall abnormalities.
Subject(s)
Contrast Media , Diuretics , Furosemide , Iohexol , Tomography, X-Ray Computed/methods , Urography/methods , Adolescent , Adult , Aged , Aged, 80 and over , Analysis of Variance , Data Interpretation, Statistical , Diuretics/administration & dosage , Furosemide/administration & dosage , Humans , Injections, Intravenous , Male , Middle Aged , Prospective Studies , Sensitivity and SpecificityABSTRACT
This review analyzes the role of imaging in the diagnosis, follow-up and management of urinary tract infections. Uncomplicated infection of the urinary tract is frequent and usually resolves rapidly with treatment; in such cases imaging is unnecessary except to exclude dilatation or the existence of an obstacle. Progression towards complex infection often occurs in patients with predisposing factors. Imaging helps in evaluating the extent of the disease; it has a role in the selection of therapy and interventional procedures.
Subject(s)
Urinary Tract Infections/diagnosis , Chronic Disease , Diagnostic Imaging , Female , Humans , Male , Urinary Tract Infections/etiologyABSTRACT
Urogenital bilharziasis is a well-known disease that seldom is encountered in western countries. Therefore, bilharziasis usually only is considered after tuberculosis, the main differential diagnosis, has been excluded. Using this case, we will discuss the value of different imaging techniques (especially that of CT combined with transrectal US) for diagnosing bilharziasis and review specific criteria to more easily distinguish both pathologies.
Subject(s)
Cystitis/diagnosis , Male Urogenital Diseases/diagnosis , Schistosomiasis/diagnosis , Adult , Biopsy , Chronic Disease , Cystitis/drug therapy , Cystitis/ethnology , Cystitis/parasitology , Diagnosis, Differential , France , Hematuria/parasitology , Humans , Male , Male Urogenital Diseases/drug therapy , Male Urogenital Diseases/ethnology , Male Urogenital Diseases/parasitology , Mauritania/ethnology , Medical History Taking , Praziquantel/therapeutic use , Rectum , Schistosomiasis/drug therapy , Schistosomiasis/ethnology , Schistosomiasis/parasitology , Schistosomicides/therapeutic use , Sensitivity and Specificity , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/standards , Tuberculosis, Male Genital/diagnosis , Tuberculosis, Urogenital/diagnosis , Ultrasonography/methods , Ultrasonography/standardsABSTRACT
State-of-the-art analysis of non invasive diagnostic imaging techniques to demonstrate upper urinary tract obstruction. Advances in imaging techniques are illustrated (sonography, CT scan, MRI). The imaging features of different presentations of chronic and intermittent obstruction are described with reference to current imaging modalities. New strategies for evaluation of chronic and intermittent upper urinary tract obstruction are proposed using ultrasonography as the first line examination. The role of MRI is illustrated. Causes of obstruction are classified based from the intraluminal, parietal or extrinsic location of the lesion.
Subject(s)
Diagnostic Imaging , Kidney Diseases/diagnosis , Ureteral Obstruction/diagnosis , Adult , Carcinoma, Transitional Cell/diagnosis , Carcinoma, Transitional Cell/diagnostic imaging , Chronic Disease , Contrast Media , Diagnosis, Differential , Diuresis , Humans , Hydronephrosis/diagnosis , Hydronephrosis/diagnostic imaging , Kidney Diseases/diagnostic imaging , Magnetic Resonance Imaging , Syndrome , Tomography, Spiral Computed , Tomography, X-Ray Computed , Ultrasonography , Ureteral Calculi/diagnosis , Ureteral Calculi/diagnostic imaging , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/diagnostic imaging , Ureteral Obstruction/diagnostic imaging , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/diagnostic imaging , UrographyABSTRACT
Urothelial tumors of the upper urinary tract are mainly represented by transitional cell carcinomas. They are usually multifocal, synchronous or metachronous. Patients most often present with hematuria. Histological staging is according to the degree of cellular anaplasia (grade) as well as to the degree of wall invasion (stage). Accurate and differential diagnosis are by excretory urography (EU) and/or by computed tomography (CT) associated with EU. EU and endoscopic investigations assess tumoral extension. The most appropriate treatment is radical nephroureterectomy with a cuff of bladder. Early and high recurrence is common; therefore a regular follow-up is required and depends on the initial treatment and the tumoral aggressiveness. This follow-up is performed by imaging, endoscopic and cytologic investigations.
Subject(s)
Carcinoma, Transitional Cell/diagnosis , Urologic Neoplasms/diagnosis , Aftercare/methods , Angiography/methods , Carcinoma, Transitional Cell/classification , Carcinoma, Transitional Cell/therapy , Cystoscopy/methods , Diagnosis, Differential , Endosonography/methods , Humans , Magnetic Resonance Imaging/methods , Neoplasm Staging/methods , Nephrectomy/methods , Tomography, X-Ray Computed/methods , Urography/methods , Urologic Neoplasms/classification , Urologic Neoplasms/therapyABSTRACT
The purpose of this paper is to present our experience with real-time computed tomography (CT) fluoroscopy guided percutaneous nephrostomy (PNT) and to describe this technique involving puncture under laser guidance. We attempted 30 placements in 25 patients: puncture was directed by laser guidance and placement of the tube was made under real time CT fluoroscopy. 25 procedures were performed in prone position and 5 procedures in the supine position. The time necessary for the procedure ranged from 10 to 45 min (mean 25 min). The average duration of CT fluoroscopy per placement was 49 seconds (range 7-110 s). The PNT placement was successful as a sole procedure including puncture and catheter placement in 24 of 30 cases; in the remainder of cases, puncture was performed under CT guidance but the catheter was definitively positioned in conventional fluoroscopy. The CT fluoroscopy technique allows routine, efficient and safe PNT placement, especially when encountering difficult access to the pelvicaliceal system.
Subject(s)
Fluoroscopy , Lasers , Nephrostomy, Percutaneous/methods , Radiography, Interventional , Tomography, X-Ray Computed , Female , Humans , Male , Middle AgedABSTRACT
In spite of its many advantages: 3D imaging, improved tissue characterization, and lack of ionizing radiation, interventional MRI remains seldom used. Several factors are involved. The purpose of this paper is to analyze the factors preventing or slowing the development of this technique based on a review of data from the literature, work presented at the second symposium on interventional MRI (Düsseldorf, 1997), and our own experimental data. The following elements will be discussed: difficulties related to image quality and open magnets, control of targeted image acquisitions, MR environment and problems related to asepsis, as well as advances of other techniques. Finally, short-term and mid-term perspectives will be presented. These are related to the goals of the technique: open or short bore closed magnets? MR unit installed in a radiology department? MR unit dedicated to interventional procedures only or mixed diagnostic-interventional unit? interventional MR unit placed in a neurosurgery operating room? interventional MR unit installed in a general surgery operating room?
