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MR Urography in Evaluation of Acute Flank Pain

T2-Weighted Sequences and Gadolinium-Enhanced Three-Dimensional FLASH Compared with Urography

M. Sudah1, R. Vanninen1, K. Partanen1, A. Heino2, P. Vainio1 and M. Ala-Opas2

1 Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland.
2 Department of Urology, Kuopio University Hospital, FIN-70211 Kuopio, Finland.



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  		Fig. 1A. —53-year-old man with acute left-sided flank pain. Half-Fourier acquisition single-shot turbo spin-echo maximum-intensity-projection (MIP) image shows obstruction and perirenal high-intensity signal (arrow).

 


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  		Fig. 1B. —53-year-old man with acute left-sided flank pain. Three-dimensional fast low-angle shot (FLASH) MIP image shows anatomic details of both caliceal systems better than A.

 


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  		Fig. 1C. —53-year-old man with acute left-sided flank pain. Excretory urogram shows obstruction and anatomic details similar to B.

 


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  		Fig. 1D. —53-year-old man with acute left-sided flank pain. Three-dimensional FLASH image reveals small stone (arrow) as filling defect.

 


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  		Fig. 2A. —66-year-old man with acute left-sided flank pain. Excretory urogram shows dilatation of left ureter and collecting system caused by calcific distal ureteral stone (arrow).

 


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  		Fig. 2B. —66-year-old man with acute left-sided flank pain. Three-dimensional fast low-angle shot (FLASH) maximum-intensity-projection image shows same anatomic details as A.

 


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  		Fig. 2C. —66-year-old man with acute left-sided flank pain. Three-dimensional FLASH image reveals small stone (arrow) as intraluminal filling defect.

 


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  		Fig. 3A. —53-year-old man with left-sided acute flank pain. Half-Fourier acquisition single-shot turbo spin-echo maximum-intensity-projection (MIP) image shows obstruction and perirenal high-intensity signal (arrow).

 


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  		Fig. 3B. —53-year-old man with left-sided acute flank pain. Three-dimensional fast low-angle shot MIP image shows obstruction and extravasation of contrast material (arrow).

 


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  		Fig. 4A. —52-year-old man with right-sided flank pain. Half-Fourier acquisition single-shot turbo spin-echo maximum-intensity-projection (MIP) image shows obstruction and substantial perirenal high-intensity signal (solid arrow). Proximal ureteral duplication is also visualized (open arrows). Peripelvic cysts are visible on opposite side (arrowheads).

 


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  		Fig. 4B. —52-year-old man with right-sided flank pain. Excretory urogram shows obstruction and duplication (arrows).

 


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  		Fig. 4C. —52-year-old man with right-sided flank pain. Three-dimensional fast low-angle shot (FLASH) MIP image shows obstruction and duplication (arrows), and fine anatomic details are better visualized than on A and B.

 


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  		Fig. 4D. —52-year-old man with right-sided flank pain. Three-dimensional FLASH MIP source image shows stone (arrow) as partial filling defect in distal ureter.

 


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  		Fig. 5A. —39-year-old man with acute right-sided flank pain. Axial half-Fourier acquisition single-shot turbo spin-echo (HASTE) image at level of urinary bladder. Signal-void line (arrow) starting from left ureteral orifice indicates ureteral jet.

 


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  		Fig. 5B. —39-year-old man with acute right-sided flank pain. Consecutive HASTE image shows ureteral jet starting from right ureteral orifice (arrow). It is another useful sign for excluding obstruction.

 

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