De Pascale Agostino, Piccoli Giorgina Barbara, Priola Sandro Massimo, Rognone Daniela, Consiglio Valentina, Garetto Irene, Rizzo Laura, Veltri Andrea
Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Torino, Italy.
Eur Radiol. 2013 Nov;23(11):3077-86. doi: 10.1007/s00330-013-2906-y. Epub 2013 Jun 8.
The diagnosis of acute pyelonephritis (APN) requires demonstration of parenchymal involvement. When no predisposing conditions are found, non-complicated APN is suspected and CT or MRI should be performed. Diffusion-weighted (DW) MRI might be useful, quicker and cheaper than the standard gadolinium-enhanced (GE) MRI. The aim of this study is to compare DW-MRI with GE-MRI to test its diagnostic accuracy in APN.
Of 318 consecutive patients hospitalised for APN, 279 underwent MRI. Four hundred and fourteen MR studies (first test and follow-up examinations) were gathered and data were processed using Diffusion Analysis software. DW-MRI has been compared with GE-MRI for evaluating diagnostic agreement.
Two hundred and forty-four patients were diagnosed as having APN; 35 were negative. One hundred and sixty-three APN cases were considered non-complicated and selected for the study. Among the 414 MR examinations, comparing DW-MRI with GE-MRI, positive correlation was found in 258 cases, negative in 133. There were 14 false-negatives and 9 false-positives. DW-MRI achieved sensitivity 95.2 %, specificity 94.9 %, positive predictive value 96.9 %, negative predictive value 92.3 % and accuracy 94.6 %.
DW-MRI is reliable for diagnosing non-complicated APN. The high diagnostic agreement between DW-MRI and GE-MRI offers new perspectives in diagnostic management, enabling diagnosis of non-complicated APN without using ionising radiation or contrast media.
• The diagnosis of acute pyelonephritis (APN) requires demonstration of renal involvement. • Hitherto magnetic resonance imaging required gadolinium enhancement (GE-MRI) to establish this diagnosis. • But diagnostic agreement between diffusion-weighted and GE-MRI offers new diagnostic opportunities. • Quantification of ADC values can help diagnose and monitor APN. • DW-MRI avoids ionising radiation and paramagnetic contrast medium administration.
急性肾盂肾炎（APN）的诊断需要证实肾实质受累。当未发现易感因素时，怀疑为非复杂性APN，应进行CT或MRI检查。扩散加权（DW）MRI可能比标准钆增强（GE）MRI更有用、更快捷且更便宜。本研究的目的是比较DW-MRI与GE-MRI，以测试其在APN中的诊断准确性。
在318例因APN住院的连续患者中，279例接受了MRI检查。收集了414次MR研究（首次检查和随访检查），并使用扩散分析软件处理数据。比较了DW-MRI与GE-MRI以评估诊断一致性。
244例患者被诊断为APN；35例为阴性。163例APN病例被认为是非复杂性的并被选入研究。在414次MR检查中，比较DW-MRI与GE-MRI，258例呈正相关，133例呈负相关。有14例假阴性和9例假阳性。DW-MRI的敏感性为95.2%，特异性为94.9%，阳性预测值为96.9%，阴性预测值为92.3%，准确性为94.6%。
DW-MRI对诊断非复杂性APN可靠。DW-MRI与GE-MRI之间的高诊断一致性为诊断管理提供了新的视角，无需使用电离辐射或造影剂即可诊断非复杂性APN。
•急性肾盂肾炎（APN）的诊断需要证实肾脏受累。•迄今为止，磁共振成像需要钆增强（GE-MRI）来确立该诊断。•但扩散加权和GE-MRI之间的诊断一致性提供了新的诊断机会。•ADC值的量化有助于诊断和监测APN。•DW-MRI避免了电离辐射和顺磁性造影剂的使用。
