The Application Value Of 3D-CE-MRU Joint MRU For Diagnosis Of Upper Urinary Tract Disease

Objective:1 To evaluate whether there were differences between images quality of magnetic resonance hydrography(MRU),contrast-enhanced 3-dimensional MRU(3D-CE-MRU)and 3D-CE-MRU after injecting furosemide in obstructive diseases of upper urinary tract.2.The results obtained by using 3D-CE-MRU joint MRU and MRU alone were compared with operative and pathologic findings to evaluate the diagnostic value of imaging examination in obstructive diseases of upper urinary tract by 3D-CE-MRU.Method:1.30 cases who had clinic symptoms of upper urinary tract obstruction as disease group and 30 healthy persons as control group were carried out by conventional MRI scan,MRU,enhanced scan and 3D-CE-MRU scan.All Subjects on each side of the urinary tract(renal parenchyma,renal pelvis and ureter calyceal) were studied as an independent to carry out analysis and evaluation.The disease group were completed MRU scan before intravenous injection of furosemide,one minute later,injected contrast agent.11 cases of control group were injected furosemide by intravenous,another 19 cases were not injected furosemide by intravenous,injected contrast agent directly.MRU images of all the normal upper urinary tract(including the normal side of disease group and control group)were divided into three groups:a.3D-CE-MRU group after furosemide injection;b.3D-CE-MRU group without furosemide injection;c.MRU group.All the data were compared between these groups by using Wilcoxon order test of nonparameter test method,the quality of images were compared.2.Two physicians experienced in MRI studied the images of experimental group independently.A physician diagnosed disease by conventional MRI scan,MRU,and enhanced scan inspection,another physician by conventional MRI scan,MRU, enhanced scan and 3D-CE-MRU inspection.The results of the two types of diagnosis were compared with operative and pathologic findings.Result:1.The images quality of 3D-CE-MRU group after furosemide injection, 3D-CE-MRU group without furosemide injection and MRU group showed significant differences,with x~2=58.701,P＜0.01.Used the graph tools such as the column graph, it can display audio-visually the results of the data's classification and analysis.The images quality of 3D-CE-MRU group after furosemide injection was better than that of 3D-CE-MRU group;The images quality of 3D-CE-MRU group after furosemide injection was superior to that of MRU group;The images quality of 3D-CE-MRU group was superior to that of MRU group.2.Surgical-pathologic findings of the experimental group were:5 cases of upper urinary tract tumors,11 cases of ureteral calculi,3 cases of renal pelvic and ureteral abnormal,2 cases of UPJO(Ureteropelvic Junction Obstruction),4 cases of cicatricial stricture affer operation,4 cases of renal cyst,1 case of Pelvic Lipomatosis.Method 1: the results obtained by combined application of conventional MRI scan,MRU and enhanced scan inspection were compared with the surgical pathologic findings,it was found that 20 cases(66.7%) were diagnosed correctly,which is respectively 3 cases of upper urinary tract tumors,8 cases of ureteral calculi,2 cases of renal pelvic and ureteral abnormal,1 cases of UPJO,2 cases of cicatricial stricture affer operation,3 cases of renal cyst,1 case of Pelvic Lipomatosis.Method 2:the results obtained by combination of 3D-CR-MRU and method 1 were compared with operative and pathologic findings,26 cases(86.6%) were diagnosed correctly,which is respectively 4 cases of upper urinary tract tumors,9 cases of ureteral calculi,3 cases of renal pelvic and ureteral abnormal,2 cases of UPJO,3 cases of cicatricial stricture affer operation, 4 cases of renal cyst,1 case of Pelvic Lipomatosis.The diagnosis rate showed significant differences between two methods,the diagnosis rate of method 1 was lower than that of method 2.The location accuracy rate of the two methods was were similar,it was 30 cases(100%). Conclusion:1.As regards Picture Quality,the images quality of 3D-CE-MRU group after furosemide injection was better than that of without furosemide injection group and MRU group from either well displaying renal collecting system or Ureteral overall,the images quality of without furosemide injection group was better than that of MRU group.The following conclusions can be drawn:Whethert inject furosemide or no,the images quality of 3D-CE-MRU was better than that of MRU,the image quality could be improved greatly by injecting furosemide.Therefore,the patients without seriously impaired renal function should receive 3D-CE-MRU scan and be injected furosemide.2.As for upper urinary tract disease,The diagnosis rate of combination of MRU and 3D-CE-MRU was better than that of MRU alone.