Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;44(1):45-50.
doi: 10.5152/tud.2018.08365. Epub 2018 Jan 8.

Dynamic MRI and isotope renogram in the functional evaluation of pelviureteric junction obstruction: A comparative study

Vadivalagia Nambi Sivakumar  1 , Venkatraman Indiran  2 , Babu Peter Sathyanathan  3
Affiliations

Dynamic MRI and isotope renogram in the functional evaluation of pelviureteric junction obstruction: A comparative study

Vadivalagia Nambi Sivakumar et al. Turk J Urol. 2018 Jan.

Abstract

Objective: The aim of this study was to evaluate and compare the diagnostic accuracy of dynamic contrast- enhanced magnetic resonance imaging (dMRI) and isotope renogram in the functional evaluation of pelviureteric junction obstruction (PUJO).

Material and methods: Forty-two patients included in the study were investigated with isotope renogram and subsequently, subjected to dMRI. Time-activity curves were generated for both isotope renogram and dMRI. Out of the 42 cases, 9 cases were conservatively managed. Thirty-three cases were taken up for surgical intervention.

Results: Of 33 patients taken up for surgical intervention, 12 underwent laparoscopic nephrectomy and 21 of them pyeloplasty. The mean glomerular filtration rates (GFRs) as measured by isotope renogram and dMRI were 22.5+4.2 mL/min and 23.8+3.1 mL/min respectively. The calculation of GFR by isotope renogram, showed good correlation with that of dMRI with correlation coefficient of 0.93. The dMRI was able to reveal the functional status of the renal unit accurately. dMRI did not yield false positive results with 20 of 21 patients scheduled for pyeloplasty and 11 of 12 patients scheduled for nephrectomy. Isotope renogram had a false positive result in 3 cases compared with surgical diagnosis.

Conclusion: Analysis of renal function using dMRI yielded results comparable to those of renal scintigraphy, with superior spatial and contrast resolution. It was also better in prompting management decisions with respect to the obstructed systems. dMRI can be used as a "one stop imaging examination" that can replace different imaging methods used for morphological, etiological and functional evaluation of PUJO.

Keywords: MRI; nuclear medicine; obstruction; pelviureteric junction.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1. a, b
Figure 1. a, b
Tc 99m –MAG3 scan in a 14-year-old female. (a, b) Scintigrams showing reduced tracer excretion by the enlarged left kidney. Increased intrarenal transit time (> 20 minutes) and slow clearance from dilated pelvis seen. Right kidney showed normal tracer uptake and excretion. Total GFR was 116 mL/min with right kidney GFR of 72 ml/min (38%) and left kidney GFR of 44 mL/min (62%)
Figure 2
Figure 2
Dynamic contrast-enhanced MRI in a 14-year-old female. MR renogram images showing left PUJO with gross hydronephrosis and significantly thinned renal parenchyma
Figure 3
Figure 3
Dynamic contrast enhanced MRI in a 14-year-old female. Time- intensity curve obtained from the ROI placed over the MR renogram images in patient with normal right kidney and left PUJO with gross hydronephrosis
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Neste MG, du Cret RP, Finlay DE, Sane S, Gonzalez R, Boudreau RJ, et al. Postoperative diuresis renography and ultrasound in patients undergoing pyeloplasty. Predictors of surgical outcome. Clin Nucl Med. 1993;18:872–6. https://doi.org/10.1097/00003072-199310000-00010. - DOI - PubMed
    1. O’Reilly P, Aurell M, Britton K, Kletter K, Rosenthal L, Testa T. Consensus on diuresis renography for investigating the dilated upper urinary tract. Radionuclides in Nephrourology Group. Consensus Committee on Diuresis Renography. J Nucl Med. 1996;37:1872–6. - PubMed
    1. Lawler LP, Jarret TW, Corl FM, Fishman EK. Adult ureteropelvic junction obstruction: insights with three-dimensional multi-detector row CT. Radiographics. 2005;25:121–34. https://doi.org/10.1148/rg.251045510. - DOI - PubMed
    1. MacNeily AE, Maizels M, Conway JJ. Does early Pyeloplasty really avert loss of Renal function? A Retrospective view. J Urol. 1993;150:769–73. https://doi.org/10.1016/S0022-5347(17)35610-0. - DOI - PubMed
    1. Gonzales R, Schimke CM. Pelvic-Ureteric Junction Obstruction in Infants and children. Paediat Clin North AM. 2001;48:1505–17. https://doi.org/10.1016/S0031-3955(05)70388-6. - DOI - PubMed

LinkOut - more resources