title: An aid to decision-making in therapy of retroperitoneal fibrosis: dynamic enhancement analysis of gadolinium MRI.
abstract: BACKGROUND
  Idiopathic retroperitoneal fibrosis (IRF) as an uncommon cause of obstructive uropathy is often primarily treated medically by the attending urologist. We evaluated dynamic enhancement analysis (DEA) as a possible predictor of response to medical treatment and for treatment monitoring.
  
  
  METHODS
  From 2007, 24 patients with fibrosis were assessed by magnetic resonance imaging (MRI) with DEA. The dynamic enhancement quotient (DEQ) was measured before therapy with prednisone (n = 12) or tamoxifen (n = 12) and in follow-up investigations after 3 and 6 months. Response to medical treatment was recorded by changes in the retroperitoneal mass on MRI and possible relief of ureteral obstruction, which was monitored by intravenous pyelogram and/or MAG3 scan after removal of DJ stents.
  
  
  RESULTS
  Treatment groups did not differ significantly as to age, gender, or laboratory values, and response to medical treatment showed no significant difference between agents. Overall there were no cases of progression, 2 cases of stable disease, 11 cases of mild fibrotic regression, and 11 of significant or complete regression. DJ stents could successfully be removed in 21 of 35 renal units (60.0%). In a total of 61 DEAs the DEQ was significantly higher (P < 0.001) in patients with a good response (DEQ = 4.02) than in those with an average response (3.11) or none (2.14).
  
  
  CONCLUSIONS
  DEA was able to distinguish between patients with different response rates to medical treatment of IRF and may be useful to individualize therapeutic decision-making.
authors: Departments of Urology, Helios Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany.
authors: Alexander Sascha
authors: AS
authors: Brandt
authors: Lars
authors: L
authors: Kamper
authors: Sonja
authors: S
authors: Kukuk
authors: Werner
authors: W
authors: Piroth
authors: Patrick
authors: P
authors: Haage
authors: Stephan
authors: S
authors: Roth
keywords: Ormond’s disease; Retroperitoneal fibrosis
references: Lancet. 2011 Jul 23;378(9788):338-46
references: 21733570
references: Arthritis Rheum. 2009 May 15;61(5):674-9
references: 19404998
references: J Urol. 2011 Feb;185(2):526-31
references: 21168884
references: J Am Coll Cardiol. 2009 May 5;53(18):1621-8
references: 19406336
references: Eur Urol. 2007 Feb;51(2):559-60
references: 17396276
references: Radiology. 2004 Nov;233(2):493-502
references: 15459325
references: Can Assoc Radiol J. 2002 Jun;53(3):168-70
references: 12101539
references: Urologe A. 2000 Mar;39(2):141-8
references: 10768224
references: Am J Med. 2004 Feb 1;116(3):194-7
references: 14749165
references: Eur Urol. 1981;7(4):193-200
references: 7227398
references: J Magn Reson Imaging. 2000 Dec;12(6):965-74
references: 11105038
references: Am J Kidney Dis. 2009 Sep;54(3):546-53
references: 19515472
references: Nephron Clin Pract. 2008;108(3):c213-20
references: 18332635
references: J Urol. 2007 Jul;178(1):140-3; discussion 143-4
references: 17499287
references: Lancet. 2006 Jan 21;367(9506):241-51
references: 16427494
references: Ann Intern Med. 2006 Jan 17;144(2):101-6
references: 16418409
references: Ann Rheum Dis. 2005 Jun;64(6):828-33
references: 15897305
references: Br J Surg. 1988 Jun;75(6):573-7
references: 3293696
references: Am J Kidney Dis. 2007 May;49(5):615-25
references: 17472843
references: Rofo. 2011 Aug;183(8):721-6
references: 21748695
references: J Urol. 1948 Jun;59(6):1072-9
references: 18858051
references: J Clin Pathol. 1970 Nov;23(8):681-9
references: 5488039
references: Neth J Med. 2002 Jul;60(6):231-42
references: 12365466
references: Clin Nephrol. 2008 Apr;69(4):260-8
references: 18397700
references: BJU Int. 2006 Jul;98(1):137-40
references: 16831158
references: Radiology. 1989 Jul;172(1):139-43
references: 2740497
references: Eur J Radiol. 2007 Sep;63(3):335-50
references: 17689907
references: J Urol. 2002 Aug;168(2):550-5
references: 12131307