European Radiology

, Volume 23, Issue 12, pp 3501–3508 | Cite as

Diffusion–Weighted Imaging and Apparent Diffusion Coefficient Values Versus Contrast–Enhanced MR Imaging in the Identification and Characterisation of Acute Pyelonephritis

  • Riccardo Faletti
  • Maria Carla Cassinis
  • Paolo Fonio
  • Angela Grasso
  • Giacomo Battisti
  • Laura Bergamasco
  • Giovanni Gandini



To compare contrast-enhanced (CEMR) and diffusion-weighted (DWI) magnetic resonance imaging in diagnosing acute pyelonephritis (APN) and to assess ADC measurement reliability in differentiating among normal renal parenchyma, APN and abscesses.


Eighty-eight patients (80 women, mean age 36.5 years) with clinical suspicion of APN were retrospectively reviewed. An experienced observer quantified lesions with a score ranging from 0 to 3. DWI and CEMR were compared on the basis of the assigned score, total examination number (88) and on presence (36)/absence (52) of abscesses. ADC values, calculated at the healthy parenchyma, APN and abscessed were compared to each other.


Agreement between CEMR and DWI was 94.3 % (83/88 patients; P < 0.05). In the APN group, DWI was awarded the highest visibility score compared to CEMR (P = 0.05), while in the abscess group CEMR had the highest score (P = 0.04). The difference between ADC values of the APN-healthy parenchyma and abscess-APN groups was significant (P < 0.05). The area under the ROC curve of ADC values of the APN-healthy and abscess-APN groups were found to be 0.94 (95 % CI; cutoff value = 2) and 0.78 (95 % CI; cutoff value = 1.2) respectively.


Diffusion-weighted imaging appears reliable in the diagnosis and follow-up of acute pyelonephritis and could provide a reasonable alternative to contrast-enhanced magnetic resonance imaging.

Key Points

• Acute pyelonephritis (APN) is an inflammatory process that preferentially affects young women

• Contrast-enhanced MRI is the reference investigation for the diagnosis and follow-up of APN

• Diffusion-weighted imaging can help differentiate between APN and abscesses

• This is especially useful when administration of contrast agent is contraindicated.


Acute pyelonephritis Dynamic contrast-enhanced magnetic resonance diffusion-weighted imaging apparent diffusion coefficient DWI ADC DCEMR 


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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Riccardo Faletti
    • 1
  • Maria Carla Cassinis
    • 1
  • Paolo Fonio
    • 1
  • Angela Grasso
    • 1
  • Giacomo Battisti
    • 1
  • Laura Bergamasco
    • 1
  • Giovanni Gandini
    • 1
  1. 1.Radiology Institute, Department of Surgical SciencesUniversity of TorinoTorinoItaly

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