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Year :2019
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Month :
September-October
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Volume :
8
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Issue :
4
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Page :
RO12 - RO16
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Comparison of Conventional Urogram and Magnetic Resonance Urography in Dilated Ureter
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Correspondence Address :
Prem Kumar Chidambaram, Manibharathi Mayavan, S Vinayagam, Senthil Kumar Aiyappan,
Dr. Prem Kumar Chidambaram,
3, Gurudev Flats, 18, Adigalar Salai, NH1, Maraimalai Nagar, Chennai, Tamil Nadu, India.
E-mail: drcpremkumar@gmail.com
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Introduction: Introduction: Abdominal pain due to urinary tract obstruction is one of the common problems seen in patients seeking medical attention. Diagnosis of hydronephrosis predominantly depends on X-Ray radiography, contrast Intravenous urogram (IVU), ultrasound and Computed Tomographic (CT) examination. However, IVU is inappropriate for pregnant women and young patients, due to radiation effects and ultrasound examination for ureter is difficult in pregnant abdomen. Hence, Magnetic Resonance Imaging (MRI) urogram (MRU), which is safer, can be a better alternative.
Aim: To compare contrast IVU and MRU in patients with dilated ureter to identify the better modality of choice for urinary tract evaluation in situations where radiation has to be avoided.
Materials and Methods: One hundred and twenty patients with 139 dilated ureters due to 125 causes which include renal calculi, extrinsic compression of pelvic mass, stricture etc. underwent both IVU and MRU. IVU was done with 800 mA (Milli Ampere) X-ray machine with the administration of intravenous non-ionic iodinated contrast agent and MRU was performed on a 1.5 Tesla MRI scanner. The presence, level, grade and cause of ureter dilatation on each modality were interpreted and compared using cross-tabulation with the final diagnosis based on other appropriate modalities including imaging, intraoperative and histopathologic diagnosis for each individual.
Results: The sensitivity of IVU and MRU in detecting hydronephrosis were 99.28% and 98.65%, respectively. In detecting the level of obstruction, the sensitivity of IVU and MRU were 87.05% and 96.4%, respectively. The correct diagnosis was made in 64.8% of the cases by IVU and in 80.8% of the cases by MRU.
Conclusion: Static MRU is lacking behind IVU in the grading of dilated ureters with a lower grade of hydronephrosis and in assessing the renal function but have a good agreement with IVU in the grading of hydronephrosis in dilated ureters with higher grades. MRU is superior to IVU in the determination of the level and cause of ureteric obstruction. So, IVU can be the first line of investigation in hydroureteronephrosis due to its easy availability and lesser cost and static MRU can be used in situations when the exact cause as to why the ureter is dilated is not clearly defined by IVU and also in circumstances when IVU is contraindicated in patients, like in those with contrast reactions, pregnant patients and also in evaluation of dilated ureter in patients with non functioning kidneys.
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