Ioversol for intravenous urography: A comparison study

A new nonionic, low-osmolar iodinated contrast media, ioversol, was compared with another low-osmolar, nonionic contrast media, iohexol, in 80 patients undergoing intravenous urography. There were 40 patients in each contrast group. Patients were assessed for changes in vital signs, patient tolerance (heat and pain), and other adverse effects. Double-blind evaluation was also performed for comparison of the urogram image quality. There were no severe, life-threatening reactions for either contrast group. Ten patients (25%) receiving ioversol and seven (17.5%) receiving iohexol perceived body heat related to the injection of contrast material. Two patients (5%) in each group experienced mild nausea. Two patients (5%) of each group experienced noted unpleasant taste, and two patients (5%) of the iohexol group complained of headache. Vital signs remained stable without significant change in both groups, and image quality was considered equivalent. The results indicate that the two contrast agents are equivalent in image quality, safety, and incidence of adverse effects.     

A double-blind comparison of iopromide and iopamidol in intravenous urography

A randomised double-blind comparative study was performed to assess the imaging properties and side-effects of two non-ionic contrast media, iopromide and iopamidol, in intravenous urography in high risk patients. The results showed the two contrast media to be similar in their imaging efficacy and incidence of side-effects. Using 50 or 100 ml of iopromide or iopamidol (370 mgI/ml), the quality of nephrograms was found to be dose dependent but the quality of pyelograms was not dose dependent.     

Comparison of excretory phase,helical computed tomography with intravenous urography in patients with painless haematuria

AIM: To compare excretory phase, helical computed tomography (CT) with intravenous (IV) urography for evaluation of the urinary tract in patients with painless haematuria. MATERIALS AND METHODS: Ninety-one out-patients had IV urography followed by helical CT limited to the urinary tract. Both IV urograms and CT images were evaluated for abnormalities of the urinary tract in a blinded, prospective manner. The clinical significance of abnormalities was scored subjectively and receiver operator characteristic curve analysis was performed. RESULTS: In 69 of 91 patients (76%), no cause of haematuria was identified. In 22 of 91 patients (24%), the cause of haematuria was identified as follows: transitional cell cancer of the bladder (n=15), urinary tract stones (n=3), cystitis (n=2), haemorrhagic pyelitis (n=1) and benign ureteral stricture (n=1). With IV urography, there were 15 true-positive, seven false-negative and three false-positive interpretations. With CT, there were 18 true-positive, four false-negative and two false-positive interpretations. There was no significant difference between IV and CT urography for the significance of the positive interpretations (n=0.47). CONCLUSION: Excretory phase CT urography was comparable with IV urography for evaluation of the urinary tract in patients with painless haematuria. However, the study population did not include any upper tract cancers.     

输尿管结石在静脉尿路造影术中的表现

目的 :探讨输尿管结石的静脉尿路造影 (IVU)表现。方法 :回顾性分析 65例输尿管结石 (直径 <10mm)患者的临床和IVU表现。结果 :所有病例均经治疗或输尿管镜取石证实。结石 5 .1～ 10mm者 3 4例 ;≤ 5mm者 3 1例 ,结石易停留在输尿管生理狭窄部位 ,多为卵圆形。结石近侧输尿管轻度扩张者 5 9例 ,肾盂肾盏扩张积水者 3 9例。结论 :IVU结合平片能很好地显示尿路的形态 ,具有易于发现结石、定位准确等优点 ,在尿路结石检查中仍占主导地位     

The role of 99mTc DMSA renal scintigraphy in Joubert syndrome

Joubert syndrome is a severe autosomal recessive disorder, which is characterized by hypotonia, impaired psychomotor development, retinal dystrophy with abnormal ocular movements and cerebellar vermis agenesis with dilatation of the fourth ventricle. Joubert syndrome type B is a developmental disorder of the nephronophtisis complex with multiple organ involvement. Although this syndrome is rare, since first described by Joubert et al in 1969, there have been several cases about the components and the chromosomal abnormalities related with it. Here we report 2 patients with Joubert syndrome in whom renal involvement was demonstrated by ultrasonography as renal cystic disorders which represented nephronophtisis. For each patient we performed renal cortical scintigraphy with 99mTc-DMSA ( 99mtechnetium-dimercaptosuccinic acid) which showed bilaterally decreased radiopharmaceutical uptake in kidneys due to tubulointerstitial nephropathy. Scintigraphy may have a great value in the diagnosis and evaluation of the presence and severity of renal involvement in Joubert syndrome since it can evaluate kidney parenchyma and functioning renal tissue.     

静脉尿路造影中立位片的临床应用

在常规静脉尿路造影后加摄尿路立位片，可使扩张的输尿管，特别是扩张远端的病变部位及形态得以清楚显示。从而提高了造影的诊断价值。     

静脉尿路造影检查技术创新

目的通过适当改变体位缩短尿路检查时间,提高静脉尿路造影质量,完善显影。方法对156例静脉尿路造影进行改变体位后,透视下观察点片。结果通过采用改变体位并透视下观察点片,在156例中有67位输尿管显示,效果显著。结论在静脉尿路造影中,通过改变体位适时点片观察,可以补充传统造影检查技术的一些不足,缩短患者检查时间,完善显影,提高诊断质量。     

Impact of micturating cystourethrography and DMSA renal scintigraphy on the investigation scheme in children with urinary tract infection

Objective  The relationships among urinary tract infection (UTI), vesicoureteral reflux (VUR), and permanent renal damage in children are not fully understood. The aim of this study was to evaluate the incidence of renal scarring in children with a history of UTI and to determine the change in the probability of permanent renal damage owing to the presence of VUR documented on micturating cystourethrography (MCU). Methods  We analyzed 201 children (400 renal units, two children with solitary kidney). Seventy-four boys and 127 girls (aged 7 months to 7 years, median 2.5 years) with culture verified UTI were referred for technetium-labeled dimercaptosuccinic (DMSA) renal scintigraphy 4-6 months after acute UTI. MCU was also performed mostly 1 month prior to DMSA. Statistical analysis was performed using χ² test or Fisher’s exact test. Likelihood ratio (LR) positive and negative, diagnostic odds ratio (DOR), and post-test probability of (no) disease were calculated for VUR on MCU versus scarring on DMSA. Results  Vesicoureteral reflux was found in 158 (39.5%) kidneys, and evaluated as grades I, II, III, IV, and V in 3, 70, 43, 25, and 17 refluxing renal units (RRU), respectively. Permanent renal damage according to DMSA was seen in 15.2% (61/400) kidneys. Scarring was shown in 29.7% (47/158) of kidneys with VUR and in 5.8% (14/242) kidneys without VUR (P < 0.0001). LR positive was 2.353 (95% CI 1.889, 2.865), LR negative 0.341 (95% CI 0.209, 0.523), and DOR 6.895 (95% CI 3.533, 14.093). Rate of scarring significantly increased with VUR of grades III, IV, and V. There was no significant difference in the incidence of scarring in kidneys without VUR and RRU with low-grade (I and II) VUR (P = 0.306). The presence of VUR on MCU increased the chance of renal damage on DMSA by about 15%, whereas negative MCU increased the chance of no-renal involvement by 9%. Conclusions  Micturating cystourethrography should not be used as a first-line test to rule out the permanent renal damage owing to UTI. The priority of imaging strategy should be focused on early identification of renal lesions to prevent further deterioration.     

静脉尿路造影术与MR水成像技术在泌尿系统疾病检查中的对比分析

目的:评价静脉尿路造影技术(IVU)与低场强磁共振泌尿系水成像技术(MRU)在泌尿系统疾病检查 中的应用价值。方法:对20例(正常5例,输尿管结石8例,输尿管移行细胞癌1例,输尿管中下段狭窄、扭曲2例, 肾囊肿2例,肾透明细胞癌2例)泌尿系统疾病患者,均行IVU与MRU检查,并进行对比分析。结果:IVU和 MRU检查均能清晰显示输尿管的梗阻部位,定位正确率100%,而定性正确率MRU高于IVU,且对输尿管梗阻的 病变显示较佳,但MRU不能直接观察肾脏的分泌功能。结论:泌尿系统疾病患者应首选IVU检查,以观察其功能 和形态,而对输尿管有梗阻或肾脏有占位性病变的患者应选用MRU,对儿童及不能耐受IVU检查的患者MRU也 可作为首选。     

64层螺旋CT尿路成像与静脉尿路造影对照分析

目的探讨64层螺旋CT尿路成像(CTU)与静脉尿路造影(IVU)对泌尿系病变的应用价值。方法 130例临床疑诊泌尿系病变的患者,先进行IVU,再行64层螺旋CT尿路成像检查,通过工作站进行多种后处理,比较两者结果。结果 IVU诊断正常3例,诊断泌尿系结石95例,其中肾结石50例,输尿管结石44例,膀胱结石1例,输尿管外压病变2例,泌尿系畸形6例,肿瘤7例,感染性病变1例。CTU诊断正常2例,诊断泌尿系结石106例,其中肾结石60例,输尿管结石45例,膀胱结石1例,外压病变4例,泌尿系畸形9例,肿瘤20例,感染性病变17例。对于泌尿系结石、畸形的诊断两种方法无统计学差异(P>0.05),对于泌尿系肿瘤、感染的诊断两者有统计学差异(P<0.05)。结论 64层螺旋CT通过多种后处理方法,既可全景显示泌尿系的形态结构,也可观察局部病变细节,对泌尿系各种疾病的诊断有重要的临床价值;而对于泌尿系单纯结石性梗阻亦可采用IVU。     

尿路肿瘤性血尿的多层螺旋CT尿路造影与静脉尿路造影诊断价值的比较研究

目的 采用Meta分析的方法,比较静脉尿路造影(IVU)和多层螺旋CT尿路造影(MSCTU)在研究肿瘤性血尿的诊断价值.方法 检索Cochrane图书馆、PubMed、OVID、Embase数据库以及中国期刊网1990-2010年公开发表的中英文文献,按照循证医学诊断试验的评价标准筛选文献,提取纳入研究的特征信息.采用权重灵敏度,权重特异度,权重似然比及SROC曲线下面积评价2种扫描方式对尿路肿瘤性血尿的病因诊断价值.统计学分析采用Metadisc 1.40和SPSS13.0软件.结果 按照纳入标准共获取文献26篇,其中有关MSCTU诊断泌尿系肿瘤者17篇,IVU为4篇,二者共同研究者5篇.按照相应的效应模型对纳入文献行汇总分析.结果显示,MSCTU与IVU扫描的汇总灵敏度和特异度分别为93%/97%、55%/94%;汇总的阳性似然比和阴性似然比分别是23.88/0.10、9.92/0.44;二者的SROC曲线下面积分别为:98.02、75.05.结论 MSCTU对肿瘤性血尿具有很好的诊断效能,尤其在上尿路肿瘤的诊断灵敏度明显高于IVU.     

A Japanese multicenter comparison of iotrolan 280 with iopamidol 300 in intravenous urography

A multicenter study was carried out to compare iotrolan 280, a non-ionic, dimeric water-soluble contrast agent, with iopamidol 300 a non-ionic, monomeric agent, to assess visualization, safety and clinical benefit in intravenous urography. Both iotrolan and iopamidol showed a high rate of effective visualization. Iotrolan was significantly better than iopamidol in visualizing the renal pelvis. Adverse reactions did not differ significantly between the two contrast agents, and no severe reactions developed. Both contrast agents were clinically valuable in over 95% of patients. There was no significant difference between the two patient groups in clinical benefit. Iotrolan has been demonstrated to be clinically comparable to iopamidol and is thus very suitable for use in intravenous urography.     

UK audit of relative renal function measurement using DMSA scintigraphy

A variety of software is used to determine quantitative parameters from radionuclide imaging procedures. Knowledge of the variability of parameter values found in different hospitals is an important aspect of clinical audit of these techniques. This study investigated the variation in relative renal function measurement from static DMSA scintigraphy in the UK. Ten studies representing a range of ages and relative function values were distributed in digital form to 100 hospitals with the assistance of the gamma camera computer suppliers and regional audit coordinators. The studies were analysed at each participating hospital and details of the different techniques and computer systems used were documented. The median value of relative percentage function was assessed for each of the studies. Methods varied in terms of the view used for analysis (54% geometric mean, 46% posterior), the type of background subtraction (single region 32%, separate regions 60%, none 8%) and the definition of the renal regions of interest (73% manual, 27% semi-automatic). Eighty-eight percent of results were within two percentage points of the study median and 98% within five percentage points. There were statistically significant differences observed in the results arising from the view used for the analysis and the background subtraction protocol. The results indicate that relative renal function assessment from static DMSA scintigraphy in the UK is essentially a reliable procedure, although improvements could be made by standardizing the technique used.     

CR在静脉肾盂造影中的应用价值

静脉肾盂造影检查应用屏片系统方法,有时存在图像质量欠佳,造成诊断困难。随着计算机技术的发展,医学影像技术也进入数字化时代,计算机X线摄影(computed radiogra-phy,CR)提高了影像质量,应用于静脉肾盂造影(IVP)提高了诊断准确率。本文旨在探讨CR在IVP中的应用价值。1材料与方法本组100例中,男60例,女40例,年龄28~65岁。采用随机抽取普通屏/胶摄影技术的IVP 100例对照组,其中男63例,女37例,年龄30~70岁。设备:日本岛津500mA X线机所使用CR设备为Fujifilm FCR500图像处理系统和FUJI X湿式激光相机。采用泛影葡胺注射液对比剂,静…     

Potential pitfall of DMSA scintigraphy in patients with ureteral duplication

A 5-wk-old male presented with radiographic findings of a duplicated collecting system. A [99mTc]DMSA scan was requested to evaluate cortical function. Images obtained immediately. postinjection showed activity restricted to the upper poles; in contrast, delayed images at 4 hr showed activity in the bladder and throughout both kidneys. Catheterizing the patient drained the activity from the bladder but had little effect on the refluxed renal activity. The early [99mTc]DMSA images were critical in making the proper interpretation. Technetium-99m DMSA is excreted into the urine and this fact needs to be considered when interpreting scans of patients with possible reflux or obstruction. When DMSA scans are obtained in pediatric patients with possible reflux, catheterization prior to the study and early images prior to the appearance of DMSA in the collecting system are recommended.     

The role of Tc-99m (V) DMSA scintigraphy in the evaluation of superscan on bone scintigraphy

PURPOSE: This study evaluated the biodistribution of Tc-99m (V) DMSA in patients with superscans on bone imaging and defined its role in differentiating the underlying cause. METHODS: Nine patients (five with metastatic and four with metabolic bone disease) with classical superscans were entered into the study. All patients had the necessary radiologic and biochemical studies and a final diagnosis was reached accordingly. Tc-99m (V) DMSA scintigraphy was performed 1 week after Tc-99m MDP whole-body bone imaging. RESULTS: In four of five patients with widespread skeletal metastases, Tc-99m (V) DMSA scan showed diffusely increased bone uptake. In the remaining patient, the Tc-99m (V) DMSA scan showed a normal distribution pattern. All patients with metabolic bone disease had increased bone uptake on Tc-99m (V) DMSA scans. CONCLUSION: Tc-99m (V) DMSA shows increased bone uptake in patients having a superscan appearance in metastatic or metabolic bone disease. Tc-99m (V) DMSA imaging may play a role in the evaluation of patients with equivocal bone scan findings for a superscan.