Right double inferior vena cava with obstructed retrocaval ureter is an extremely rare anomaly with only a few reported cases in the literature. To the best of our knowledge, this is the first case report describing ureteric repair by use of a single-incision laparoscopic technique. In addition, this report addresses the underlying surgical challenges of this repair and provides a brief review of the embryology of this anomaly. The "Santosh Postgraduate Institute ureteric tacking fixation technique" provides ease of end-to-end uretero-ureteric anastomosis in a single-incision laparoscopic surgery.
Humans ; Intraoperative Care/methods ; Intraoperative Complications/*prevention & control ; Laparoscopy/methods ; Magnetic Resonance Imaging ; Male ; *Retrocaval Ureter/diagnosis/physiopathology/surgery ; Treatment Outcome ; Urography/methods ; Urologic Surgical Procedures/*methods ; *Vena Cava, Inferior/abnormalities/surgery ; Young Adult

OBJECTIVETo retrospectively evaluate the clinical feasibility of high-pitch excretory phase images during dual-source CT urography with Stellar photon detector.

METHODSTotally 100 patients received dual-source CT high-pitch urinary excretory phase scanning with Stellar photon detector [80 kV, ref.92 mAs, CARE Dose 4D and CARE kV, pitch of 3.0, filter back projection reconstruction algorithm (FBP)] (group A). Another 100 patients received dual-source CT high-pitch urinary excretory phase scanning with common detector(100 kV, ref.140 mAs, CARE Dose 4D, pitch of 3.0, FBP) (group B). Quantitative measurement of CT value of urinary segments (Hounsfield units), image noise (Hounsfield units), and effective radiation dose (millisievert) were compared using independent-samples t test between two groups. Urinary system subjective opacification scores were compared using Mann-Whitney U test between two groups.

RESULTSThere was no significant difference in subjective opacification score of intrarenal collecting system and ureters between two groups (all P>0.05). The group A images yielded significantly higher CT values of all urinary segments (all P<0.01). There was no significant difference in image noise (P>0.05). The effective radiation dose of group A (1.1 mSv) was significantly lower than that of group B (3.79 mSv) (P<0.01).

CONCLUSIONHigh-pitch low-tube-voltage during excretory phase dual-source CT urography with Stellar photon detector is feasible, with acceptable image noise and lower radiation dose.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Spiral Computed ; methods ; Urography ; methods ; Young Adult

OBJECTIVETo assess the upper urinary tract opacification and the diagnostic performance of one-bolus dual-source dual-energy CT urography (CTU) for painless hematuria.

METHODSTotally 205 patients who underwent dual-source dual-energy CTU for painless hematuria were enrolled in this study. CTU included true non-enhanced phase, dual-energy mode nephrographic phase, and FLASH mode excretory phase imaging of the urinary tract. Two radiologists independently evaluated the degree of upper urinary tract opacification. Prospective interpretations using true non-enhanced, nephrographic and excretory phase imaging for hematuria were recorded, as well as retrospective diagnosis using virtual non-enhanced, nephrographic and excretory phase imaging. The standard of reference included all available clinical, imaging, laboratory and follow-up data for up to 36 months after CTU exam. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were calculated. Receiver-operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated. The prospective and retrospective diagnostic performance for hematuria and the radiation dose of two CTU protocols were compared.

RESULTSIt was found that 87.8% and 86.8% of segments were at least 50% opacified, respectively. The sensitivity, specificity, PPV, NPV and accuracy for hematuria for prospective interpretation were 95.2%, 91.9%, 98.2%, 81.0% and 94.6%, respectively. Comparable figures for retrospective diagnosis were 98.8%, 91.9%,98.2%, 94.4% and 97.6%. The AUC for prospective and retrospective diagnosis were 0.931±0.027 and 0.940±0.026, respectively (z=1.425, Bonferroni-corrected P>0.05). The radiation dose of the CTU protocol using in retrospective diagnosis[(12.732±3.485)mSv] was significantly lower than that of prospective diagnosis [(17.002±4.013)mSv] (P<0.05), with dose reduction of (32.74±8.92)%.

CONCLUSIONOne-bolus two-phase dual-source dual-energy CT urography provides at least 50% opacification of upper urinary tract segments and has high diagnostic performance for painless hematuria with relatively low radiation dose.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Contrast Media ; administration & dosage ; Female ; Hematuria ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Urography ; methods ; Young Adult

INTRODUCTIONThis study aimed to ascertain whether nonopacified kidney on excretory urography (also known as intravenous urography [IVU]) indicates nonsalvageability.

METHODSWe retrospectively reviewed 45 adult patients with chronic unilateral urinary tract obstruction, in whom IVU revealed nonopacified kidney on one side but normal excretion on the contralateral side. Affected kidneys with split glomerular filtration rate (GFR) < 10 mL/min/1.73 m2 on 99mTc-diethylenetriaminepentaacetic acid diuretic renal scintigraphy were considered nonsalvageable. Non-function was defined based on cutoff points (< 15% and < 20%) to determine the sensitivity and specificity of differential renal function. Differences in IVU and renal scintigraphy findings, with respect to the duration of delayed filming on IVU, were analysed for significance.

RESULTSThe results of IVU and renal scintigraphy findings for 34 (75.6%) nonopacified kidneys matched, representing nonsalvageable kidneys. Sensitivity and specificity of differential renal function were 76% and 100%, respectively, when the cutoff point for non-function was set at < 15%. Sensitivity and specificity were 97% and 82%, respectively, when the cutoff point was < 20%. There was no significant difference between renal scintigraphy findings and IVU with 2-hour and > 2-hour delayed films (p = 0.96).

CONCLUSIONAlthough most nonopacified kidneys on IVU were nonsalvageable, a quarter of them were found to be salvageable on renal scintigraphy. Besides split GFR, differential function at cutoff point < 15% could be used to determine non-function of a chronic obstructed kidney when the contralateral kidney is normal. Delayed filming beyond two hours appears unnecessary in ensuring non-excretion on IVU.

Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Female ; Glomerular Filtration Rate ; Humans ; Kidney ; diagnostic imaging ; Kidney Diseases ; diagnostic imaging ; therapy ; Kidney Function Tests ; Male ; Middle Aged ; Pentetic Acid ; Radioisotope Renography ; methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Technetium ; Treatment Outcome ; Ureteral Obstruction ; diagnostic imaging ; therapy ; Urography ; methods

Renal angiomyolipomas are benign neoplasms composed of varying amounts of adipose tissue, smooth muscles and blood vessels. They typically contain macroscopic fat, which is seen as negative attenuation on computed tomography. Calcification and scarring is rarely seen in renal angiomyolipomas. We report the case of a 40-year-old man who was found to have a renal angiomyolipoma with a central stellate scar and focal calcification. The lesion was initially misdiagnosed as a calyceal calculus.
Adipose Tissue ; diagnostic imaging ; pathology ; Adult ; Angiomyolipoma ; diagnosis ; surgery ; Biopsy, Needle ; Calcinosis ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Kidney Calculi ; diagnosis ; surgery ; Kidney Calices ; diagnostic imaging ; pathology ; Kidney Neoplasms ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Male ; Risk Assessment ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Urography ; methods

BACKGROUNDIntravenous urography (IVU) combined with add-on CT (IVU-CT) can help to provide more diagnostic information for determining the localization and nature of ureteral abnormalities with less irradiation dose. This study aimed to determine the value of IVU-CT for diagnosis of ureteral diseases, where IVU is insufficient to determine the diagnosis.

METHODSTwo hundred and eighty patients underwent IVU for suspected ureteral disorders, which identified a definite diagnosis in 184 cases and was insufficient for definite diagnosis in 96 cases designated as indeterminate diagnosis. Subsequently 90 patients (six patients declined CT) with indeterminate diagnosis consented to undergo immediate or delayed helical CT scan. The CT data were transferred to the workstation for post-processing, and the cost and mean effective dose for each imaging method were calculated and compared indirectly.

RESULTSOf the 90 indeterminate diagnosis cases, diagnosis was determined in 86 cases by IVU-CT with a diagnostic accordance rate of 95.6%, while 184/280 (65.7%) had diagnosis determined by IVU alone. There was a significant difference between IVU and IVU-CT in the determination of the diagnosis of ureteral diseases (c(2) = 36.4, P < 0.05). The cost of IVU equals to 1/8 - 1/9 of that for CT urography (CTU), and the cost of IVU-CT is as much as 1/3 of CTU. CTU results in the highest mean effective dose, approximately nine times that for IVU and three times that for IVU-CT.

CONCLUSIONIVU-CT provides valuable information for the localization and diagnosis of ureteral abnormalities and may be considered as an efficient, cost-effective and low-dose diagnostic technique in this setting.

Adolescent ; Adult ; Aged ; Child ; Cost-Benefit Analysis ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; economics ; methods ; Ureter ; diagnostic imaging ; Ureteral Diseases ; diagnosis ; Urography ; economics ; methods ; Young Adult

Adult ; Humans ; Male ; Neoplasms, Fibroepithelial ; diagnostic imaging ; Polyps ; diagnostic imaging ; Radionuclide Imaging ; Technetium Tc 99m Mertiatide ; Ureteral Neoplasms ; diagnostic imaging ; Urography ; methods

OBJECTIVETo observe the imaging findings of congenital megaureter in order to enhance the understanding of this disease.

METHODSImage data of 5 patients with congenital megaureter and 2 misdiagnosed patients were analyzed, and image findings of congenital megaureter were summarized.Elscint Prestig 2.0T superconductive magnetic resonance urography (MRU) with conventional sequence (spin-echo, T1WI560 ms/16 ms; fast spin-echo, T2WI 9600 ms/96 ms ) was performed. Raw data were acquired with fastspin-echo sequence from heavy T2-weighted image (9600 ms/120 ms). Post-processing method of MRU was the maximum intensity projection with three-dimensional reconstruction in the workstation. Intravenous pyelography (IVP) was conducted, in which X-rayfilms were taken 7 minutes, 15 minutes, and 30 minutes after injecting contrast agent, exceptthat in 2 patients the films were taken delayed at 60 and 90 minutes .X-ray retrograde pyelography was performed on 2 patients, successful in one butfailed in the other.

RESULTSThe dilated ureter showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images in conventional MRI. The mass wall was intact, uniform in thickness, and showing hypointensity on T1-weighted and T2-weighted images. The MRU images showed a retroperitoneal mass appearing as an elongated tubular cystic structure spreading from kidney to bladder. MRU also revealed dilated calices and renal pelvis, pelviureteric obstruction, and renal duplication. The main signs of congenital megaureter in X-urography was significant dilatation of ureter, or normal renal pelvis with ureter dilatation, hydronephrosis, deformity, and displacement.

CONCLUSIONSMRU with X-urography could visualizethe characteristics of congenital megaureter, including the dilation of renal pelvis and ureter, calculi, urinary tract duplication, and stenosis location. The two techniques can complement each other in disease diagnosis and provide more detailed information for preoperative treatment.

Humans ; Magnetic Resonance Imaging ; methods ; Ureter ; abnormalities ; pathology ; Urography

OBJECTIVETo evaluate the clinical feasibility of dual-source computed tomographic urography using dual-energy virtual non-enhanced CT.

METHODSTotally 240 patients received dual-source CT, which included true non-enhanced CT (TNCT) , nephrographic phase scanning with dual-energy mode (100kVp/230mAs and Sn140kVp/178mAs) , and excretory phase scanning. A contrast bolus injection of 100 ml (370 mgI/ml) contrast agent was applied (4.5ml/s) , followed by 100ml normal saline (4.5ml/s) . Virtual non-enhanced CT (VNCT) image sets were reformatted from 'Liver VNC ' software. The mean CT number, noise, signal to noise ratio (SNR) , image quality, and radiation dose were compared between TNCT and VNCT image sets.

RESULTSThere was no significant difference in mean CT numbers of all organs (P>0.05) . However, VNCT images had significantly lower noise and higher SNR than TNCT images (both P<0.05) . Image quality of VNCT was lower than that of TNCT without significant difference (P>0.05) . Radiation dose of nephrographic phase with dual-energy mode was significantly higher than that of TNCT and excretory phase scanning (P<0.05) .

CONCLUSIONDual-energy VNCT requires less radiation dose and therefore has a potential to replace TNCT in the dual-source CT urography.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Radiation Dosage ; Radiography, Dual-Energy Scanned Projection ; methods ; Reproducibility of Results ; Sensitivity and Specificity ; Signal-To-Noise Ratio ; Tomography, X-Ray Computed ; methods ; Urography ; methods ; Young Adult

OBJECTIVE: To explore the diagnostic value of magnetic resonance urography (MRU) in ectopic ureters. METHODS: Seventeen female children with ectopic ureter were examined by sonography, intravenous urography (IVU), computer tomography (CT), MRU and so on. The mean age of the female children was 4.5 years (7 months approximately 12 years). RESULTS: Seventeen patients were examined by sonography, including 3 dysplasia little kidneys, 1 kidney absence, 12 duplex kidneys with hydroureter, 1 normal.Seven patients were examined by IVV, including 3 hydronephrosis and 4 no image or not clear. Fourteen patients were examined by CT, including 3 dysplasia little kidneys, 11 duplex kidneys with hydronephrosis. Five were determined by cystoscope, including 2 ecto-pic urethral orifices which angiography could only display the expansion of ureter. All children were diagnosed by MRU and an accurate anatomical picture of the entire urinary tract was obtained. CONCLUSION To accurately and noninvasively depict the urinary tract and the independence of renal function, MRU may be used for patients with ectopic ureter undiagnosed with sonography and IVU.
Child ; Child, Preschool ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; methods ; Ureter ; abnormalities ; Urography ; methods