Early report: comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy.
OBJECTIVE
To compare assessment by MR excretory urography (MREU), Doppler ultrasound and isotope renography of women with symptomatic hydronephrosis in pregnancy and to define its cause.


METHODS
Eleven women at 19-34 weeks of gestation were studied prospectively with gadolinium-enhanced breath-hold gradient echo MREU and transabdominal Doppler ultrasound compared with a 'gold standard' of isotope renography employing frusemide challenge. All studies were performed within 24 h, were reported independently in a blinded fashion and employed clearly defined criteria. Obstetric and infant outcomes were obtained.


RESULTS
There were no adverse reactions to gadolinium administration in pregnancy and no adverse obstetric or infant outcomes. Three of the 11 women were unable to tolerate the complete MREU protocol. Ultrasound indices could not be used to predict ureteric obstruction as shown by isotope renography. MREU agreed with renographic findings in five of the six cases with obstruction and in two without obstruction. MREU directly demonstrated hydronephrosis to result from extrinsic compression of the ureter between the gravid uterus and iliopsoas muscle.


CONCLUSIONS
MR excretory urography is a promising technique which affords equivalent functional and additional anatomical information to isotope renography. It is more accurate than Doppler ultrasound in the assessment of ureteric obstruction in pregnancy.Spencer, J. A. (2000). Clinical Radiology55, 446-453.
Spencer
J A
JA
Department of Clinical Radiology, St. James's University Trust Hospital Leeds, UK.
Tomlinson
A J
AJ
Weston
M J
MJ
Lloyd
S N
SN
D003287:Contrast Media / Q000009:adverse effects; D004232:Diuretics; D005260:Female; D005665:Furosemide; D019786:Gadolinium DTPA / Q000009:adverse effects; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000209:etiology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011866:Radioisotope Renography; D018608:Ultrasonography, Doppler; D014517:Ureteral Obstruction / Q000209:etiology; D014567:Urography
D003287:Contrast Media; D004232:Diuretics; D005665:Furosemide; D019786:Gadolinium DTPA