European Radiology

, Volume 23, Issue 11, pp 3077–3086 | Cite as

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

  • Agostino De Pascale
  • Giorgina Barbara Piccoli
  • Sandro Massimo Priola
  • Daniela Rognone
  • Valentina Consiglio
  • Irene Garetto
  • Laura Rizzo
  • Andrea VeltriEmail author
Magnetic Resonance



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.


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.


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 %.


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.


Acute pyelonephritis Urinary tract infections Gadolinium-enhanced magnetic resonance imaging Diffusion-weighted magnetic resonance imaging Apparent diffusion coefficient 


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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Agostino De Pascale
    • 1
  • Giorgina Barbara Piccoli
    • 2
  • Sandro Massimo Priola
    • 1
  • Daniela Rognone
    • 1
  • Valentina Consiglio
    • 2
  • Irene Garetto
    • 3
  • Laura Rizzo
    • 1
  • Andrea Veltri
    • 3
    Email author
  1. 1.Department of Diagnostic ImagingSan Luigi Gonzaga Hospital, University of TorinoOrbassanoItaly
  2. 2.Department of Clinical and Biological SciencesSan Luigi Gonzaga Hospital, University of TorinoOrbassanoItaly
  3. 3.Department of OncologySan Luigi Gonzaga Hospital, University of TorinoOrbassanoItaly

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