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Patients with Acute Flank Pain: Comparison of MR Urography with Unenhanced Helical CT¹

¹ From the Departments of Clinical Radiology (M.S., R.L.V., K.P., S.K., A.M.) and Urology (A.H., M.A.O.), Kuopio University Hospital, Finland. Received January 17, 2001; revision requested March 6; final revision received October 9; accepted October 26. Supported by Kuopio University Hospital (EVO funding no. 5063508), the Radiological Society of Finland, and the Pehr Oscar Klingendahl Fund. Address correspondence to M.S., North-Karelian Central Hospital, Department of Radiology, Tikkamäentie 16, 80210 Joensuu, Finland (e-mail: mazen.sudah@pkshp.fi).

View larger version (153K): [in a new window]   Figure 1. Transverse CT image in 57-year-old man with left-sided acute flank pain demonstrates stone (large arrow) at level of ureterovesical junction. The dilated distal ureter (small arrows) is seen behind the stone. Ureterolithiasis and obstruction are easily diagnosed.

View larger version (147K): [in a new window]   Figure 2. Transverse CT image in 50-year-old man with left-sided acute flank pain. Image acquisition at level of bladder base shows pelvic phlebolith (large arrow) and dilated vein (small arrows). Occasionally, a phlebolith can cause diagnostic problems (compare with Fig 1), and the empty bladder makes interpretation more difficult.

View larger version (136K): [in a new window]   Figure 3a. Images obtained in a 76-year-old man with left-sided acute flank pain. (a) Transverse CT image of left kidney demonstrates large pelvic stone (large arrow) causing obstruction at the level of ureteropelvic junction. Perirenal stranding (lower small arrows) and blurring of kidney margins (upper small arrow) are clearly visualized. (b) Transverse half-Fourier RARE image (11.90/95, 150° flip angle) demonstrates signal-void filling defect (large arrow). Perirenal high signal intensity (small arrows) is also clearly visualized, with clear definition of kidney contours. (c) Coronal gadolinium-enhanced 3D FLASH image (4.6/1.8, 30° flip angle) also shows signal-void filling defect (arrow). No enhancement was detected on images obtained with T1-weighted contrast-enhanced sequence (not shown). (d) Radiograph of left kidney shows a large stone (arrow).

View larger version (117K): [in a new window]   Figure 3b. Images obtained in a 76-year-old man with left-sided acute flank pain. (a) Transverse CT image of left kidney demonstrates large pelvic stone (large arrow) causing obstruction at the level of ureteropelvic junction. Perirenal stranding (lower small arrows) and blurring of kidney margins (upper small arrow) are clearly visualized. (b) Transverse half-Fourier RARE image (11.90/95, 150° flip angle) demonstrates signal-void filling defect (large arrow). Perirenal high signal intensity (small arrows) is also clearly visualized, with clear definition of kidney contours. (c) Coronal gadolinium-enhanced 3D FLASH image (4.6/1.8, 30° flip angle) also shows signal-void filling defect (arrow). No enhancement was detected on images obtained with T1-weighted contrast-enhanced sequence (not shown). (d) Radiograph of left kidney shows a large stone (arrow).

View larger version (105K): [in a new window]   Figure 3c. Images obtained in a 76-year-old man with left-sided acute flank pain. (a) Transverse CT image of left kidney demonstrates large pelvic stone (large arrow) causing obstruction at the level of ureteropelvic junction. Perirenal stranding (lower small arrows) and blurring of kidney margins (upper small arrow) are clearly visualized. (b) Transverse half-Fourier RARE image (11.90/95, 150° flip angle) demonstrates signal-void filling defect (large arrow). Perirenal high signal intensity (small arrows) is also clearly visualized, with clear definition of kidney contours. (c) Coronal gadolinium-enhanced 3D FLASH image (4.6/1.8, 30° flip angle) also shows signal-void filling defect (arrow). No enhancement was detected on images obtained with T1-weighted contrast-enhanced sequence (not shown). (d) Radiograph of left kidney shows a large stone (arrow).

View larger version (114K): [in a new window]   Figure 3d. Images obtained in a 76-year-old man with left-sided acute flank pain. (a) Transverse CT image of left kidney demonstrates large pelvic stone (large arrow) causing obstruction at the level of ureteropelvic junction. Perirenal stranding (lower small arrows) and blurring of kidney margins (upper small arrow) are clearly visualized. (b) Transverse half-Fourier RARE image (11.90/95, 150° flip angle) demonstrates signal-void filling defect (large arrow). Perirenal high signal intensity (small arrows) is also clearly visualized, with clear definition of kidney contours. (c) Coronal gadolinium-enhanced 3D FLASH image (4.6/1.8, 30° flip angle) also shows signal-void filling defect (arrow). No enhancement was detected on images obtained with T1-weighted contrast-enhanced sequence (not shown). (d) Radiograph of left kidney shows a large stone (arrow).

View larger version (108K): [in a new window]   Figure 4a. Proximal ureteral obstruction due to ureteral stone in a 42-year-old man. (a) Oblique unenhanced CT multiplanar reconstruction image of right kidney shows an intraluminal ureteral stone (large arrow) and a second caliceal stone (small arrow). (b) Half-Fourier RARE multiplanar reconstruction (11.90/95, 150° flip angle) image also shows obstruction. The ureteral stone is seen as a filling defect (arrow). Caliceal anatomy visualization is better than in a. (c) Gadolinium-enhanced 3D FLASH (4.6/1.8, 30° flip angle) image shows the stone (arrow), also seen as filling defect. Note slight underestimation of stone size on both b and c. Small caliceal stone (small arrow) seen in a was not detected with confidence with either MR urographic sequence.

View larger version (95K): [in a new window]   Figure 4b. Proximal ureteral obstruction due to ureteral stone in a 42-year-old man. (a) Oblique unenhanced CT multiplanar reconstruction image of right kidney shows an intraluminal ureteral stone (large arrow) and a second caliceal stone (small arrow). (b) Half-Fourier RARE multiplanar reconstruction (11.90/95, 150° flip angle) image also shows obstruction. The ureteral stone is seen as a filling defect (arrow). Caliceal anatomy visualization is better than in a. (c) Gadolinium-enhanced 3D FLASH (4.6/1.8, 30° flip angle) image shows the stone (arrow), also seen as filling defect. Note slight underestimation of stone size on both b and c. Small caliceal stone (small arrow) seen in a was not detected with confidence with either MR urographic sequence.

View larger version (94K): [in a new window]   Figure 4c. Proximal ureteral obstruction due to ureteral stone in a 42-year-old man. (a) Oblique unenhanced CT multiplanar reconstruction image of right kidney shows an intraluminal ureteral stone (large arrow) and a second caliceal stone (small arrow). (b) Half-Fourier RARE multiplanar reconstruction (11.90/95, 150° flip angle) image also shows obstruction. The ureteral stone is seen as a filling defect (arrow). Caliceal anatomy visualization is better than in a. (c) Gadolinium-enhanced 3D FLASH (4.6/1.8, 30° flip angle) image shows the stone (arrow), also seen as filling defect. Note slight underestimation of stone size on both b and c. Small caliceal stone (small arrow) seen in a was not detected with confidence with either MR urographic sequence.