Comprehensive MR Urography Protocol: Equally Good Diagnostic Performance and Enhanced Visibility of the Upper Urinary Tract Compared to Triple-Phase CT Urography

Mazen Sudah; Amro Masarwah; Sakari Kainulainen; Marja Pitkänen; Hanna Matikka; Vaiva Dabravolskaite; Sirpa Aaltomaa; Ritva Vanninen

doi:10.1371/journal.pone.0158673

Comprehensive MR Urography Protocol: Equally Good Diagnostic Performance and Enhanced Visibility of the Upper Urinary Tract Compared to Triple-Phase CT Urography

PLoS One. 2016 Jul 6;11(7):e0158673. doi: 10.1371/journal.pone.0158673. eCollection 2016.

Authors

Mazen Sudah¹, Amro Masarwah^{1

2}, Sakari Kainulainen¹, Marja Pitkänen¹, Hanna Matikka¹, Vaiva Dabravolskaite², Sirpa Aaltomaa³, Ritva Vanninen^{1

2

4}

Affiliations

¹ Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
² Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
³ Department of Surgery, Urology Unit, Kuopio University Hospital, Kuopio, Finland.
⁴ Biocenter Kuopio and Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.

Abstract

Objectives: To prospectively compare the diagnostic performance and the visualization of the upper urinary tract (UUT) using a comprehensive 3.0T- magnetic resonance urography (MRU) protocol versus triple-phase computed tomography urography (CTU).

Methods: During the study period (January-2014 through December-2015), all consecutive patients in our tertiary university hospital scheduled by a urologist for CTU to exclude UUT malignancy were invited to participate. Diagnostic performance and visualization scores of 3.0T-MRU were compared to CTU using Wilcoxon matched-pairs test.

Results: Twenty patients (39 UUT excreting units) were evaluated. 3.0T-MRU and CTU achieved equal diagnostic performances. The benign etiology of seven UUT obstructions was clarified equally with both methods. Another two urinary tract malignant tumors and one benign extraurinary tumor were detected and confirmed. Diagnostic visualization was slightly better in the intrarenal cavity areas with CTU but worsened towards distal ureter. MRU showed consistently slightly better visualization of the ureter. In the comparison, full 100% visualizations were detected in all areas in 93.6% (with 3.0T-MRU) and 87.2% (with CTU) and >75% visualization in 100% (3.0T-MRU) and 93.6% (CTU). Mean CTU effective radiation dose was 9.2 mSv.

Conclusions: Comprehensive 3.0T-MRU is an accurate imaging modality achieving comparable performance with CTU; since it does not entail exposure to radiation, it has the potential to become the primary investigation technique in selected patients.

Trial registration: ClinicalTrials.gov NCT02606513.

Publication types

Clinical Trial
Comparative Study

MeSH terms

Adult
Aged
Aged, 80 and over
Female
Humans
Image Enhancement / methods
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Tomography, X-Ray Computed / methods*
Urinary Tract / diagnostic imaging*
Urography / methods*
Urologic Neoplasms / diagnosis
Urologic Neoplasms / diagnostic imaging

Associated data

ClinicalTrials.gov/NCT02606513

Grants and funding

This study was supported by Kuopio University Hospital (VTR funding no. 5063534), and in part by grants (MS) from the Radiological Society of Finland, the Instrumentarium Science Foundation and the Finnish Medical Foundation. The funders had no role in study design, data collection or analysis, decision to publish, or preparation of the manuscript.