MR urography for the preoperative evaluation of living renal donors

The purpose of this study was to assess the image quality and diagnostic value of MR urography in detecting abnormalities of the urinary collecting system relevant for the preoperative evaluation of living renal donors. Study subjects were selected from the existing intravenous urography (IVU) reports: 18 consecutive patients with a duplication or another abnormality of the collecting system and 20 consecutive patients with normal anatomy. They underwent a respiratory-triggered 3D T2-weighted fast spin-echo acquisition after oral administration of furosemide, without and with abdominal compression. The MR images were evaluated by two independent blinded observers. The IVU was used as the standard of reference. Image quality of the MR urograms with compression was overall better than those without compression, and the former were regarded as adequate for the evaluation of small filling defects and deformities of the pelvis and calyces in 76-81% of the kidneys and 74-79% of the patients. Both observers correctly diagnosed all 13 kidneys with a partial or complete duplication. The image quality of MR urography was inadequate to evaluate the calyces and pelvis for small filling defects or deformities in approximately 25% of the patients; however, the technique was accurate in the detection of abnormalities of the urinary collecting system relevant for the preoperative evaluation of living renal donors.     

An evaluation of the post-micturition radiograph following intravenous urography

A prospective study of the post-micturition radiograph in 539 consecutive intravenous urograms was performed. In only 1% of patients was a post-micturition residue demonstrated only on this radiograph and not on the control radiograph. The post-micturition radiograph helped in making a firm diagnosis in two out of six patients with vesico-ureteric junction calculi, which were suspected but could not be confidently diagnosed without it. It was also helpful in two out of 13 bladder patients with carcinoma, enabling a confident diagnosis to be established where the lesion had only been suspected. It would seem pertinent to restrict the post-micturition radiograph to cases of haematuria and possible vesico-ureteric calculi.     

MR泌尿系造影对肾和输尿管移行细胞癌的诊断

目的：评估ＭＲ泌尿系造影（ＭＲＵ）对肾盂、输尿管移行细胞癌的诊断价值。方法用重Ｔ２ＷＩ快速自旋回波（ＦＳＥ）序列和脂肪抑制技术行ＭＲＵ４３５例,诊断肾盂、输尿管移行细胞癌３７例,所有图像均作最大信号强度投影（ＭＩＰ）后处理演算。结果３７例移行细胞癌中,肾盂癌１０例,输尿管癌２２例,多中心癌５例。影像表现共同征象是：充盈缺损,腔内肿块与管壁相连,病变以上的肾盂和集合系统扩张。移行细胞癌具有多发中心的     

Influence of urography on renal function in children. A double blind study with metrizoate and iohexol

Thirty-two children were given either metrizoate or iohexol for urography in a double blind study. Mild to moderate adverse reactions were observed in all patients receiving metrizoate (15/15) and in 4 receiving iohexol (4/17). Alkaline phosphatase in urine was significantly increased 4 hours after the injection of both media, but had returned to pre-injection levels 16 hours later. The excretion of beta 2-microglobulin and albumin was not altered. In 9 children in the metrizoate group and 11 in the iohexol group the glomerular filtration rate (GFR) was determined before urography by the single injection 99Tcm-DTPA-technique and 3 to 4 hours after urography by measuring the plasma disappearance of the contrast medium with the x-ray fluorescence technique. No reduction of GFR was observed.     

An evaluation of orthotopic ileal neobladders by dynamic digital urography

PURPOSE: To report on the diagnostic capabilities of dynamic digital urography in the evaluation of orthotopic ileal neobladders. MATERIAL AND METHODS: Ten male patients (aged 61.3 +/- 14.7 years) with orthotopic ileal neobladder (4 Studer, 4 Camey type II with spiralized ileal segment and 2 classic Camey type II) underwent dynamic digital urography using an angiographic unit (Philips DVI/ARC-A). Eight patients were asymptomatic and two presented mild nycturia. All patients should have undergone follow-up conventional urography, which was replaced, for the purposes of our study, by dynamic digital urography. The intestinal cleansing regimen usual for the double contrast barium enema was used in all the patients. Ninety mL of a nonionic iodinated contrast agent were administered i.v. with an automatic injector. After precontrast mask images, two postcontrast sequences were acquired 15 s and 30 min after the injection (each made of 20 images acquired every 10 seconds). Postprocessing consisted of digital image subtraction and videorecording. RESULTS: Renal pelvis and calyceal systems were well visualized in 18/20 excretory systems. Eighteen of 20 ureters were visualized completely up to the ureteral jet, and two were only partially visualized. Calyceal, pyelic and ureteral enlargement with ureteral kinking were observed in a patient with classic Camey type II. High motility was seen in 11 ureters, moderate in 5 and mild in 4. The orthotopic ileal neobladder was well opacified in 8/10 patients. Effective peristalsis of the afferent ileal segment was seen in all the Studer type neobladders. Ureteral reflux was not observed in any patient. DISCUSSION: After orthotopic ileal neobladder reconstruction, the most frequent complications include urinary leakage, intestinal obstruction, venous thrombosis, stenosis of the neobladder anastomoses, incontinence, cancer recurrence, stone formation. In the follow-up, many diagnostic tools are used: intravenous urography, retrograde cystography, urodynamic studies, transabdominal and transrectal ultrasonography. With dynamic digital urography the nephrographic evaluation was possible in all patients, as well as the evaluation of calyceal, pyelic and ureteral opacification and even ureteral peristalsis. Moreover, this diagnostic tool allows the morphofunctional dynamic study of the ureteral-neobladder anastomoses and of the orthotopic ileal neobladder, even evaluating the residual peristalsis of the detubularized ileal segment. A major drawback of the new method is the relatively high radiation dose given to the patient. A limitation of the study is the selection of a population of completely or nearly asymptomatic patients. CONCLUSIONS: Dynamic digital urography provides useful morphologic and functional information in the follow-up of patients with orthotopic ileal neobladder and could replace conventional urography in symptomatic patients.     

An evaluation of the maximal anaerobic capacity in man

Maximal anaerobic capacity, i.e., the maximal amount of energy released by anaerobic processes (Ean max, J.kg-1), has been evaluated from maximal increase of plasma lactate concentration (Lap) in eight male subjects of different physical fitness submitted to supramaximal runs of various intensity performed until volitional exhaustion (temps-limite, tlim). As previously found (2), the interindividual differences of tlim were reduced when exercise intensity was expressed by the anaerobic component of exercise defined as the difference between the overall energy requirement (E, W.kg-1) and maximal aerobic power Eox max, W.kg-1). Within the range of intensity studied, Lap did not vary significantly as a function of E-Eox max. However, the performances achieved by the less fit subjects (group 1) remained lower than those achieved by the more athletic subjects (group 2). Mean Lap were significantly higher in group 2 (17.2 mmol.l-1 than in group 1 (13.7 mmol.l-1. The rate of increase of Lap, defined by the ratio Lap/tlim, was a linear function of E-Eox max. The energy equivalent of plasma lactate accumulation (beta), given by the reciprocal of the slope of the equation describing the relationship Lap/tlim = f(E-Eox max), amounts 56.8 J.kg-1 when Lap is increased by 1 mmol.l-1. The energy released by anaerobic glycolysis was calculated by multiplying beta by mean Lap measured in the two groups of subjects. Assuming that the energy yielded by the anaerobic alactic processes amounts 260 J.kg-1(1), mean Ean max values in group 1 and 2 were found to be equal to 1040 (range:910-1110) and 1240 J.kg-1 (range: 1100-1330), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

64排螺旋CT尿路成像质量与肾脏功能的相关性研究

目的探讨64排螺旋cT尿路成像（CTU）质量与年龄、图像捕获时间相关性．并依据肾脏功能差异,探讨CTU技术操作规范及成像标准。方法回顾性分析78例患者的CTU质量。结果对照组年龄〈45岁延迟3～5min图像显示好,45～60岁组延迟6-8min显示好,〉60岁组延迟9～10min显示好;肾功能异常组成像质量与对照组基本一致。结论CTU成像质量与肾脏排泄功能无明显相关性,主要与图像捕获时间以及患者年龄有关。     

Magnetic resonance urography vs computed tomography urography in the evaluation of patients with haematuria

Purpose

This study was done to evaluate by direct comparison the image quality of magnetic resonance urography (MRU) and computed tomography urography (CTU) and to assess the diagnostic confidence of the two techniques in detecting urothelial malignancy in patients with haematuria

Materials and methods

Thirty-five patients with haematuria underwent both CTU and MRU. Two different investigators evaluated calyceal, renal pelvis, ureteral and bladder visibility. Their diagnostic confidence in detecting urothelial malignancy with the two procedures was assessed. A Wilcoxon matched-pairs test was performed to compare results. Inter-reader agreement was calculated by weighted kappa (WK) statistic. Patient history (further examinations, cystoscopy and histological specimens) was considered as reference standard to calculate receiver operating characteristic (ROC) curves of diagnostic confidence.

Results

CTU provided better visibility of urothelial structures (p<0.01) and allowed for greater diagnostic confidence (ROC area 0.994 vs. 0.938) than MRU, with a good inter-reader agreement (WK=0.62). Nevertheless, in obstructive patients with impaired excretory function, MRU, thanks to the static-fluid technique, offered better visualisation than CTU.

Conclusions

There is a potential role for MRU in urinary tract imaging, but as diagnostic confidence in detecting urothelial malignancy is poorer than in CTU, it might be stareserved for patients at low risk for malignancy and for evaluating obstructed patients.     

CT renal planimetry: Effectiveness in the evaluation of individual renal function

Computed tomographic (CT) renal planimetry was used to study individual renal function in 32 adult patients with urologic disease. CT results were well-correlated to reference methods (r=0.88,P < 0.001), which were radionuclide studies (N=9) or separate creatinine clearance (N=23). The difference between planimetric data and reference methods did not exceed 14% in any case and was less than 10% in 26 cases.