Validity of diffusion-weighted magnetic resonance imaging in the evaluation of acute pyelonephritis in comparison with contrast-enhanced computed tomography

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Abstract

Purpose

Applications of diffusion-weighted magnetic resonance imaging outside the brain have gained increasing importance in recent years, and recent studies have shown the usage of diffusion-weighted (DW) imaging in diagnosing pyelonephritis based on renal cortical and medullary apparent diffusion coefficient (ADC) values. The aim of this study was to assess the validity of DW magnetic resonance (MR) imaging in comparison with contrast-enhanced computed tomography (CECT) in diagnosing pyelonephritis.

Material and methods

A cross-sectional observational study was conducted for a period of six months in a tertiary hospital in Coimbatore. All patients with clinical and laboratory diagnosis of acute pyelonephritis, who were referred for radiological imaging (CECT), were taken into the study. Out of 112 patients with a clinical and laboratorial diagnosis of acute pyelonephritis (APN), who underwent both DW MR and CECT, diagnosis of APN was made in 100 patients based on CECT, while in 12 cases the investigation (CECT) was negative. Finally, these 100 patients were included in the study. The validity of DW MR imaging in diagnosing APN was assessed by deriving sensitivity, specificity, and positive and negative predictive value in comparison with CECT findings.

Results

The validity report of DW MR imaging in the detection of APN showed a very high sensitivity (96-100%) and specificity (86-90%) and very low false positives (6-10%) and negatives (< 5%), and it also showed that in the areas of affected renal parenchyma ADC values were consistently lower compared to unaffected renal parenchyma.

Conclusion

Based on the generated hypothesis, DW MR imaging of the kidneys seems to be highly sensitive and specific for the detection of focal or diffuse infections within the kidney in comparison with CECT.

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Most cited references 21

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Emphysematous infections of the abdomen and pelvis: a pictorial review.

David E Grayson, Robert Abbott, Angela Levy … (2015)

Emphysematous (gas-forming) infections of the abdomen and pelvis represent potentially life-threatening conditions that require aggressive medical and often surgical management. The initial clinical manifestation of these entities may be insidious, but rapid progression to sepsis will occur in the absence of early therapeutic intervention. Conventional radiography and ultrasonography are often the initial imaging modalities used to evaluate patients with abdominopelvic complaints. However, when a differential diagnosis remains, or if further localization or confirmation of tentative findings is needed, computed tomography (CT) should be considered the imaging modality of choice. CT is both highly sensitive and specific in the detection of abnormal gas and well suited to reliable depiction of the anatomic location and extent of the gas. Of equal importance may be the capability of CT to help reliably identify benign sources of gas, because treatment (if any) varies dramatically depending on the source. Knowledge of the pathophysiologic characteristics, common predisposing conditions, and typical imaging features associated with gas-forming infections of the gallbladder, stomach, pancreas, and genitourinary system will help make early diagnosis and successful treatment possible. In addition, such knowledge will aid in further diagnostic work-up, surveillance of potential complications, and evaluation of therapeutic response. Copyright RSNA, 2002

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Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis.

Georg Bongartz, Tilo Niemann, Thilo Kollmann (2008)

The objective of our study was to perform a meta-analysis to evaluate the diagnostic performance of low-dose CT for the diagnosis of urolithiasis (seven studies, 1,061 patients). The medical literature from 1995 to 2007 was searched using PubMed, Medline, and Cochrane Library databases for articles on studies that used low-dose CT (< 3 mSv dose applied for the entire CT examination) as a diagnostic test for the detection of urolithiasis. Prospective and retrospective studies were included if they separately reported the rate of true-positive, true-negative, false-positive, and false-negative diagnoses of urolithiasis from low-dose CT compared with the positive and negative rates of normal-dose CT or a combination of diagnostic tests. Two readers assessed the quality of the studies. The pooled sensitivity and specificity of low-dose CT for the diagnosis of urolithiasis were 0.966 (95% CI, 0.950-0.978) and 0.949 (95% CI, 0.920-0.970), respectively. The results of this meta-analysis suggest that a low-dose CT protocol can be used as the initial imaging technique in the workup of patients with suspected urolithiasis.

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Functional evaluation of transplanted kidneys with diffusion-weighted and BOLD MR imaging: initial experience.

Frederik de Clerck, Chris Boesch, S Zoula … (2006)

To prospectively evaluate feasibility and reproducibility of diffusion-weighted (DW) and blood oxygenation level-dependent (BOLD) magnetic resonance (MR) imaging in patients with renal allografts, as compared with these features in healthy volunteers with native kidneys. The local ethics committee approved the study protocol; patients provided written informed consent. Fifteen patients with a renal allograft and in stable condition (nine men, six women; age range, 20-67 years) and 15 age- and sex-matched healthy volunteers underwent DW and BOLD MR imaging. Seven patients with renal allografts were examined twice to assess reproducibility of results. DW MR imaging yielded a total apparent diffusion coefficient including diffusion and microperfusion (ADC(tot)), as well as an ADC reflecting predominantly pure diffusion (ADC(D)) and the perfusion fraction. R2* of BOLD MR imaging enabled the estimation of renal oxygenation. Statistical analysis was performed, and analysis of variance was used for repeated measurements. Coefficients of variation between and within subjects were calculated to assess reproducibility. In patients, ADC(tot), ADC(D), and perfusion fraction were similar in the cortex and medulla. In volunteers, values in the medulla were similar to those in the cortex and medulla of patients; however, values in the cortex were higher than those in the medulla (P < .05). Medullary R2* was higher than cortical R2* in patients (12.9 sec(-1) +/- 2.1 [standard deviation] vs 11.0 sec(-1) +/- 0.6, P < .007) and volunteers (15.3 sec(-1) +/- 1.1 vs 11.5 sec(-1) +/- 0.5, P < .0001). However, medullary R2* was lower in patients than in volunteers (P < .004). Increased medullary R2* was paralleled by decreased diffusion in patients with allografts. A low coefficient of variation in the cortex and medulla within subjects was obtained for ADC(tot), ADC(D), and R2* (<5.2%), while coefficient of variation within subjects was higher for perfusion fraction (medulla, 15.1%; cortex, 8.6%). Diffusion and perfusion indexes correlated significantly with serum creatinine concentrations. DW and BOLD MR imaging are feasible and reproducible in patients with renal allografts. (c) RSNA, 2006.

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Author and article information

Journal

Journal ID (nlm-ta): Pol J Radiol

Journal ID (iso-abbrev): Pol J Radiol

Journal ID (publisher-id): PJR

Title: Polish Journal of Radiology

Publisher: Termedia Publishing House

ISSN (Print): 1733-134X

ISSN (Electronic): 1899-0967

Publication date (Electronic): 14 March 2020

Publication date Collection: 2020

Volume: 85

Pages: e137-e143

Affiliations

[1 ]Kovai Medical Center and Hospital (KMCH), Coimbatore, India

[2 ]Vinayaka Mission’s Kirupananda Variyar Medical College (VMKVMCH), Salem, India

Author notes

Correspondence address: Dr. R. Shankar, Professor, No. 413, 20 Feet Road, Peramanur, Salem – 636007, India, e-mail: shnkr_radhakrishnan@ 123456yahoo.com

[A]

Study design

[B]

Data collection

[C]

Statistical analysis

[D]

Data interpretation

[E]

Manuscript preparation

[F]

Literature search

[G]

Funds collection

Article

Publisher ID: 40096

DOI: 10.5114/pjr.2020.93669

PMC ID: 7172225

SO-VID: bcb88775-c440-4972-914f-54d28d79710f

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0). License allowing third parties to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

Validity of diffusion-weighted magnetic resonance imaging in the evaluation of acute pyelonephritis in comparison with contrast-enhanced computed tomography

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Abstract

Purpose

Material and methods

Results

Conclusion

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Electron Channelling Contrast Imaging (ECCI)

Most cited references 21

Emphysematous infections of the abdomen and pelvis: a pictorial review.

Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis.

Functional evaluation of transplanted kidneys with diffusion-weighted and BOLD MR imaging: initial experience.

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