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Magnetic resonance urography: a pictorial overview

¹ Instituto Radiológico Cántabro, Clínica Mompía, Avenida de los Condes, s/n. 39108 Santa Cruz de Bezana (Cantabria), ² Department of Pathology, Clínica Mompía, Santa Cruz de Bezana (Cantabria), ³ Department of Oncology, Clínica Mompía, Santa Cruz de Bezana (Cantabria), Spain

View larger version (97K): [in a new window]   Figure 1. A 52-year-old woman with an extrinsic ureteral obstruction caused by a metastasis of an ovarian carcinoma. (a) Maximum intensity projection (MIP) image from an unenhanced T2 weighted MR urograph (MRU) shows a left ureteral obstruction (arrow). Note the changes of chronic hydronephrosis and hydroureter. (b) The axial standard T2 weighted turbo spin echo (TSE) image visualizes a soft tissue mass with heterogeneous signal intensity surrounding the ureter (arrowheads).

View larger version (111K): [in a new window]   Figure 2. Staghorn calculus and chronic hydronephrosis in a 32-year-old pregnant patient. (a) Coronal T2 weighted turbo spin echo (TSE) image and (b) urogram from static MR urography show diffuse cortical atrophy, pyelocaliectasis and a voluminous pyelocaliceal filling defect (arrows). Note also the gestational sac (arrowheads) and a left corpus luteum cyst (white arrow).

View larger version (85K): [in a new window]   Figure 3. A 20-year-old man with ureteropelvic junction narrowing (arrow). Coronal maximum intensity projection (MIP) excretory MR urography. The renal pelvis shows typical dilatation and convex inferior border.

View larger version (104K): [in a new window]   Figure 4. Left renal agenesia in a 14-year-old woman with didelphic uterus and a vaginal septum. Maximum intensity projection (MIP) image from (a) excretory MR urography demonstrates a normal right kidney with no evidence of left renal tissue. (b) Axial and (c) coronal T2 weighted turbo spin echo (TSE) images show a bicornuate uterus (arrows) with two cervix (arrowheads).

View larger version (86K): [in a new window]   Figure 5. A 55-year-old man with left-sided ureteral stone. (a) Coronal maximum intensity projection (MIP) excretory MR urograph shows filling defect (arrow) in left distal ureter that is causing mild pyeloureterectasis. (b) Enhanced axial T1 weighted gradient-echo image shows a round dependent filling defect (arrow) in left ureter.

View larger version (266K): [in a new window]   Figure 6. A 52-year-old woman with temporary ureteral obstruction caused by blood clots. (a) Coronal maximum intensity projection (MIP) excretory MR urography and (b) complementary retrograde pyelography show complete proximal ureteral obstruction (arrow) and mild dilatation of the collecting system. (c) Axial gadolinium-enhanced T1 weighted gradient-echo and (d) T2-weighted turbo spin echo (TSE) images demonstrate hypointense tissue filling completely a mildly dilated ureter (arrowhead). (e) After several days, excretory urogram from conventional intravenous pyelography demonstrates patency of previously occluded ureter (arrowheads).

View larger version (121K): [in a new window]   Figure 7. Transitional cell carcinoma of the midureter in a 68-year-old man. (a) Coronal maximum intensity projection (MIP) and (b) source images from excretory MR urography demonstrate a large mass inside the midureter (arrows) with proximal ureteral and pelvocalyceal dilatation. (c) The axial standard T2 weighted turbo spin echo (TSE) sequence confirms the diagnosis by demonstrating a soft-tissue mass (arrowhead) with heterogeneous signal intensity.

View larger version (93K): [in a new window]   Figure 8. A 73-year-old woman with mild narrowing of the midureter (arrow) caused by left common iliac artery. (a) Coronal maximum intensity projection (MIP) image from excretory MR urography and (b) composite coronal MIPs of both urogram an MR angiography.

View larger version (151K): [in a new window]   Figure 9. A 77-year-old man with transitional cell carcinoma of the right ureter. (a) Maximum intensity projection (MIP) image from excretory MR urography (MRU) demonstrates right ureteral obstruction (arrow), hydronephrosis and hydroureter. (b) Original source image from excretory MRU shows a large hypointense filling defect inside distal ureter (arrows). (c) Axial T1 weighted image shows a hypointense soft-tissue mass (arrowhead) in the pelvis. (d) An area of subtle enhancement (arrowhead) is demonstrated on the axial section of a contrast-enhanced T1 weighted sequence.

View larger version (84K): [in a new window]   Figure 10. A 61-year-old man with transitional cell carcinoma of the bladder. (a) Axial T2 weighted turbo spin echo (TSE) image shows an irregular wall thickening at the left-side of the bladder (arrows). (b) Maximum intensity projection (MIP) image from excretory MR urography confirms large irregular filling defect (arrows) on the floor and left-sided wall of the bladder. The tumour does not produce obstruction at the ureterovesical junction.

View larger version (105K): [in a new window]   Figure 11. An excretory MR urograph in a 78-year-old man with benign prostatic hypertrophy. Large, smooth filling defect at the base of the bladder (arrowheads).

View larger version (132K): [in a new window]   Figure 12. A 56-year-old woman with ileal loop urinary diversion. Maximum intensity projection (MIP) image from excretory MR urography shows the post-operative urinary tract anatomy. Both sides are dilated because of stenosis (arrowheads) close to the ureteroenteric implantation site.

View larger version (116K): [in a new window]   Figure 13. Vesicovaginal fistula(arrowheads) formation caused by inadvertent injury to the bladder during surgery in a 48-year-old woman. Sagittal maximum intensity projection (MIP) excretory MR urography.