MR urography versus retrograde pyelography/ureteroscopy for the exclusion of upper urinary tract malignancy.
OBJECTIVE
To evaluate the diagnostic performance of magnetic resonance urography (MRU) versus retrograde pyelography and/or ureteroscopy (RPU) in the detection of upper urinary tract neoplasms.


METHODS
This retrospective study included 35 patients with suspected upper urinary tract malignancy who underwent MRU and RPU within 6-months in our institution during the study period (February 2002 to January 2007). MRU and RPU reports were reviewed and results recorded. For each patient, the urinary tract was sub-divided into four regions for analysis: left kidney/renal pelvis, left ureter, right kidney/renal pelvis, and right ureter. MRU and RPU results for each patient were compared to a reference standard and the diagnostic performance of both techniques was compared.


RESULTS
A total of 113 regions were analysed on MRU and 90 regions on RPU. Nineteen neoplasms were identified. Sensitivity, specificity, positive predictive value, and negative predictive value for the detection of urinary tract neoplasms were 63, 91, 60, and 92% for MRU, respectively, and 53, 97, 83, and 88% for RPU, respectively. These differences were not statistically significant (p>0.05).


CONCLUSIONS
The high negative predictive value of MRU in the present series supports its use as a non-invasive screening examination for excluding the presence of upper urinary tract malignancy.
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA. kslee@bidmc.harvard.edu
K S
KS
Lee
E
E
Zeikus
W C
WC
DeWolf
N M
NM
Rofsky
I
I
Pedrosa
D000328:Adult; D000368:Aged; D003287:Contrast Media; D003558:Cystoscopy; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007682:Kidney Pelvis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012015:Reference Standards; D012189:Retrospective Studies; D014513:Ureter / Q000473:pathology; D018666:Ureteroscopy; D014567:Urography / Q000379:methods*; D014571:Urologic Neoplasms / Q000175:diagnosis*
D003287:Contrast Media