The sonographically thickened wall of the upper urinary tract system: correlation with other imaging methods.
BACKGROUND
Sonographically detected, upper urinary tract wall thickening (UUTWT) was reported to occur in urinary tract infection, urinary tract stone disease, rejection after renal transplantation and vesico-ureteral reflux (VUR). A possible association with obstruction can be hypothesized.


OBJECTIVE
The assessment of a potential relationship of UUTWT with VUR or obstruction in patients without one of the above-mentioned conditions.


METHODS
We analyzed 38 patients (74 upper urinary tracts) with at least unilateral UUTWT and concomitant imaging studies such as voiding cystourethrography (VCU), intravenous urography (IVU) and diuretic renography (DR).


RESULTS
At sonography 49 urinary tracts showed UUTWT. In 33, ipsilateral VUR could be demonstrated at VCU, 11 revealed obstruction at IVU and/or DR, and 4 showed non-obstructive pelvicalyceal dilatation at IVU and DR. In one patient, all imaging studies were normal. The positive predictive value of UUTWT for the presence of VUR was 67.4 % and for obstruction it was 22.5 %. Altogether, UUTWT indicated pathology in 98 % of urinary tracts.


CONCLUSIONS
After exclusion of urinary tract infection, urinary stone disease and prior renal transplantation, the most common associated findings in UUTWT are VUR and obstruction. Therefore, VCU seems to be justified in all cases of UUTWT. Nonrefluxing systems should be further evaluated with DR and/or IVU for exclusion of obstruction.
Sorantin
E
E
Department of Radiology, Section of Pediatric Radiology, University Hospital Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
Fotter
R
R
Aigner
R
R
Ring
E
E
Riccabona
M
M
D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000473:pathology; D014551:Urinary Tract / Q000000981:diagnostic imaging* / Q000473:pathology*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000473:pathology