Acute Abdominal Pain: Is There a Potential Role for MRI in the Setting of the Emergency Department in a Patient with Renal Calculi?

Emory University School of Medicine, Department of Radiology, Atlanta, Georgia 30322, USA.
Journal of Magnetic Resonance Imaging (Impact Factor: 3.21). 11/2010; 32(5):1012-23. DOI: 10.1002/jmri.22337
Source: PubMed


Acute flank pain is a frequent clinical presentation encountered in emergency departments, and a work-up for obstructive urolithiasis in this setting is a common indication for computed tomography (CT). However, imaging alternatives to CT for the evaluation of renal colic are warranted in some clinical situations, such as younger patients, pregnancy, patients that have undergone multiple prior CT exams and also patients with vague clinical presentations. MRI, although relatively insensitive for the direct detection of urinary calculi, has the ability to detect the secondary effects of obstructive urolithiasis. Using rapid, single shot T2-weighted sequences without and with fat saturation provides an abdominopelvic MR examination that can detect the sequelae of clinically active stone disease, in addition to alternate inflammatory processes that may mimic the symptoms of renal colic. In addition, MR nephro-urography (MRNU) has the ability to provide quantitative analysis of renal function that has the potential to direct clinical management in the setting of obstructing calculi. This review describes the potential utility and limitations of MRI in the emergency setting for diagnosing causes of flank pain and renal colic, particularly in patients with unusual presentations or when an alternative to CT may be warranted.

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    • "The inability of T2-W MRU to fully visualize complete nondilated ureters is cited as a major negative point in many papers [4] [6] [10] [11]. Finally, T2w-MRU has been shown to be a rapid and non-invasive imaging technique which is useful and reliable to reveal hydronephrosis and perirenal high-intensity signals in acute urinary obstruction [12] [13] [14] [15]. "
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    ABSTRACT: Objective: The goal of this prospective study was to compare the efficiency of two types of MRU after diuretic administration to identify the non-dilated ureter. Methods: MR pelvic examinations were performed in 126 patients after receiving furosemide. Each patient underwent in addition to their protocol for context, two types of MRU: 2D T2-weighted FSE (T2w-MRU) and 3D Gd T1-weighted GE (CE-MRU). Four segments were checked for each ureter. For the first part of the analysis, readers evaluated the whole image quality using a four points subjective scale and for the second part, they were asked to score separately each ureteral segment as present or absent. Results: 1008 ureteral segments were checked. For the image quality, readers did not find any significant difference (3.8 ± 0.5 vs 3.6 ± 0.7, p value: 0.13) between MRU methods. The interobserver agreement was excellent with a K correlation coefficient as high as 0.89 for T2w-MRU and 0.92 for CE-MRU, respectively. For the detection of the segments and considering the 9 rotations for the T2W MRU, there were no statistically significant differences between the two groups. Conclusion: T2-weighted MRU with multiple orientations and diuretic is sufficient to identify the non-dilated ureter. It offers information on ureteral peristaltism. It can be suggested that this sequence is able to detect an initial obstruction before hydronephrosis occurs.
    12/2014; 1(1). DOI:10.1016/j.ejro.2014.08.001
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    ABSTRACT: OBJECTIVE: In this article, we review the standard of care for imaging of nephrolithiasis as well as new technology and radiation concerns from the perspective of the urologic surgeon. CONCLUSION: Nephrolithiasis is a common cause of morbidity with a lifetime prevalence of 5-10% worldwide. Increasingly, diagnostic evaluation and planning for medical or surgical intervention have become reliant on imaging.
    American Journal of Roentgenology 06/2011; 196(6):1274-8. DOI:10.2214/AJR.11.6434 · 2.73 Impact Factor
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    ABSTRACT: Cumulative radiation exposure from imaging studies is hazardous. In chronic diseases such as urolithiasis, efforts are made to limit radiation exposure, particularly for routine surveillance. We sought to determine the correlation of ultrasonography (US) compared with noncontrast CT (NCCT) in detecting and determining size of stones. Findings were evaluated in patients who underwent both imaging modalities within a 90-day period between July 2008 and June 2010. Urinary calculi were noted on NCCT in 72 patients. The sensitivity of US to determine the number, size, and location of the stones as described on official radiology reports were compared in reference to NCCT. There were 203 urinary calculi in 90 urinary tracts identified on NCCT imaging. The sensitivity, specificity, and accuracy of detecting specific stones on US were 40%, 84%, and 53%. Correlation between US and NCCT findings decreased with smaller stone size and ureteral location and increased with right-sided laterality. For identified stones, larger stone size discrepancies were noted in up to one-third of stones on US. Despite concern for excessive radiation exposure, urologists should recognize limitations of US in the evaluation of urolithiasis. As the ideal study to image stones, particularly for routine surveillance, remains unclear, tese data also supports the need for low-dose NCCT protocols and/or selective use of alternative modalities, such as magnetic resonance urography.
    Journal of endourology / Endourological Society 03/2012; 26(3):209-13. DOI:10.1089/end.2011.0177 · 1.71 Impact Factor
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