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Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis

  • Magnetic Resonance
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Abstract

Objectives

The diagnosis of acute pyelonephritis (APN) requires demonstration of parenchymal involvement. When no predisposing conditions are found, non-complicated APN is suspected and CT or MRI should be performed. Diffusion-weighted (DW) MRI might be useful, quicker and cheaper than the standard gadolinium-enhanced (GE) MRI. The aim of this study is to compare DW-MRI with GE-MRI to test its diagnostic accuracy in APN.

Methods

Of 318 consecutive patients hospitalised for APN, 279 underwent MRI. Four hundred and fourteen MR studies (first test and follow-up examinations) were gathered and data were processed using Diffusion Analysis software. DW-MRI has been compared with GE-MRI for evaluating diagnostic agreement.

Results

Two hundred and forty-four patients were diagnosed as having APN; 35 were negative. One hundred and sixty-three APN cases were considered non-complicated and selected for the study. Among the 414 MR examinations, comparing DW-MRI with GE-MRI, positive correlation was found in 258 cases, negative in 133. There were 14 false-negatives and 9 false-positives. DW-MRI achieved sensitivity 95.2 %, specificity 94.9 %, positive predictive value 96.9 %, negative predictive value 92.3 % and accuracy 94.6 %.

Conclusions

DW-MRI is reliable for diagnosing non-complicated APN. The high diagnostic agreement between DW-MRI and GE-MRI offers new perspectives in diagnostic management, enabling diagnosis of non-complicated APN without using ionising radiation or contrast media.

Key Points

• The diagnosis of acute pyelonephritis (APN) requires demonstration of renal involvement.

• Hitherto magnetic resonance imaging required gadolinium enhancement (GE-MRI) to establish this diagnosis.

• But diagnostic agreement between diffusion-weighted and GE-MRI offers new diagnostic opportunities.

• Quantification of ADC values can help diagnose and monitor APN.

• DW-MRI avoids ionising radiation and paramagnetic contrast medium administration.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Torino, Italy

    Agostino De Pascale, Sandro Massimo Priola, Daniela Rognone & Laura Rizzo

  2. Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Torino, Italy

    Giorgina Barbara Piccoli & Valentina Consiglio

  3. Department of Oncology, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Torino, Italy

    Irene Garetto & Andrea Veltri

Authors
  1. Agostino De Pascale
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  2. Giorgina Barbara Piccoli
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  3. Sandro Massimo Priola
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  4. Daniela Rognone
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  5. Valentina Consiglio
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  6. Irene Garetto
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  7. Laura Rizzo
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  8. Andrea Veltri
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Correspondence to Andrea Veltri.

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De Pascale, A., Piccoli, G.B., Priola, S.M. et al. Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis. Eur Radiol 23, 3077–3086 (2013). https://doi.org/10.1007/s00330-013-2906-y

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  • DOI: https://doi.org/10.1007/s00330-013-2906-y

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