Ramos de Campos M, Juan Escudero J U, Navalón Verdejo P, Ordoño Domínguez F, Fabuel Deltoro M, Zaragoza Orts J
Servicio de Urología, Consorcio Hospital General Universitario de Valencia.
Actas Urol Esp. 2007 Mar;31(3):253-61. doi: 10.1016/s0210-4806(07)73631-8.
Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed.
We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract: and a quality study of the urographic images obtained with MR versus IVU.
150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR.
High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%. a positive predictive value of 86.6% and a negative predictive value of 75%.
MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term.
传统尿路造影（IVU）是评估尿路的重要检查方法，但并非没有并发症，如对所用造影剂的不良反应（血管迷走神经反应和过敏反应）、神经毒性、肾毒性，以及患者接受电离辐射造成的损害。因此，已开发出替代成像技术，如磁共振（MR）尿路造影或尿路磁共振成像。
我们展示一项病例研究，评估尿路磁共振成像和IVU作为尿路形态和功能检查的诊断准确性、特异性和敏感性：以及对通过MR与IVU获得的尿路造影图像的质量研究。
150例患者接受了MR检查，其中63例已进行IVU检查，在T2加权像上获得对应于腹部和腹膜后液体的高强度信号，最初使用低剂量速尿，在最终检查中，以0.1mg/kg的速率给予钆剂。该检查适用于有碘造影剂不良反应史、急性或慢性肾衰竭、肾功能丧失、孕妇及儿童患者。研究了两种检查对尿路梗阻的诊断能力及其梗阻病因，以及通过MR尿路造影获得的图像质量。
使用MR获得了所有上尿路的高分辨率图像，尤其是肾盂，没有蠕动或肠道液体干扰造成的伪影。在83.3%的病例中，检查发现了泌尿系统病变。尿路受累病因的诊断准确性为83.3%，敏感性为89.6%，特异性为69.2%，阳性预测值为86.6%，阴性预测值为75%。
MR尿路造影是一种用于研究尿路的高灵敏度技术，尤其在电离辐射禁忌或对造影剂过敏的情况下，以及肾衰竭患者中，可作为传统尿路造影的替代方法，并且提供更广泛的形态和功能研究，具有高图像质量，能够在短期或中期取代传统检查。
