Role of Multidetector CT in Assessment of Inflammatory Renal Diseases
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- Category: Vol. 84, June 2016
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Role of Multidetector CT in Assessment of Inflammatory Renal Diseases, TAMER W. KASSEM, MOHAMED F. OSMAN and MAGED A. HAWANA
Abstract
Background: Inflammatory renal diseases are generally well depicted with Multidetector CT. Although Computed Tomography (CT) is not routinely indicated in uncomplicated renal infection, it is of value in establishing the diagnosis in equivocal cases, in evaluating high-risk patients, and in determining the extent of disease. Contrast material enhanced study is essential for complete evaluation of patients with renal inflammatory disease to demonstrate alterations in renal excretion of contrast material that occur as a result of the inflammatory process. Abnormalities in renal perfusion asso-ciated with acute pyelonephritis are best depicted during homogeneous enhancement of the renal parenchyma in the nephrographic phase. Delayed CT scans obtained during the excretory phase are frequently more helpful than early CT scans in defining the extent of the disease process, and iden-tifying its complications such as abscess formation, xan-thogranulomatous pyelonephritis, emphysematous pyelone-phritis, scarring and renal failure, and confirming the presence of urinary obstruction. CT scanning is the diagnostic modality of choice in assessment of perinephric abscess because it is more sensitive, accurate in defining the precise location, size, degree, and extent of the loculation in relation to other retro-peritoneal structures. It may also show renal enlargement; focal parenchymal decreased attenuation; fluid, gas, or both in and around the kidneys; focal thickening of the Gerota fascia; and obliteration of adjacent tissue planes. In assessment of renal corticomedullary abscess, CT scanning is the most useful modality in diagnosing intrarenal abscess and planning operative procedures for treatment.
Objective: Our purpose is to evaluate the sensitivity of Multidetector CT in assessment of renal inflammation, defining the extent of the disease, establishing the diagnosis of equivocal cases and detection of associated complications.
Patients and Methods: Thirty two patients with suspected renal inflammations were examined by Multidetector CT. Non contrast study was performed to 16 patients because of their elevated renal functions using a multidetector CT with recon-struction. Multiphasic CT imaging was performed for 16 patients using a multidetector CT with reconstruction. Results were correlated with severity of clinical presentation, associated risk factors, imaging findings and complications.
Results: MDCT was performed for 32 patients referred to Radiology Department from Various Departments (Urology, Nephrology, and others). Non contrast study shows (31.3%) chronic pyelonephritis, (25%) acute pyelonephritis, (25%) emphysematous pyelonephritis, (12.5%) xanthogranulomatous pyelonephritis, (6.3%) renal abscess. Multiphasic post contrast CT study shows (37.5%) perinephric abscess, (25%) chronic pyelonephritis, (12.5%) acute pyelonephritis, (18.8%) renal abscess and (6.3%) renal tuberculosis.
Conclusion: In cases with suspected renal inflammation, Multidetector CT is the modality of choice for evaluating patients for identifying the extent of the disease and detection of associated complications.