Elsevier

Urology

Volume 79, Issue 6, June 2012, Pages 1252-1255
Urology

Endourology
Half Fourier Single-shot Turbo Spin-echo Magnetic Resonance Urography for the Evaluation of Suspected Renal Colic in Pregnancy

https://doi.org/10.1016/j.urology.2011.12.016Get rights and content

Objective

To report our experience with magnetic resonance urography (MRU) in pregnant women suspected of having obstructing upper tract calculi. The diagnosis of an upper tract calculus in the pregnant woman can be challenging. Recent evidence suggests that MRU can be used to effectively evaluate renal colic.

Methods

From 2008-2011, 9 pregnant women were referred for evaluation of suspected renal colic caused by an obstructing upper tract stone. All patients underwent MRU with a half Fourier single-shot turbo spin-echo (HASTE) protocol. Medical records and imaging studies were reviewed for demographic and clinical data as well as outcome measures.

Results

The mean age of the subjects was 25 years (range 20-34); average gestational age of the fetus was 23 weeks (range 9-36). In all cases, a renal ultrasound was the initial imaging study obtained, with nondiagnostic findings. HASTE MRU detected 4 ureteral stones and 4 cases of physiological hydronephrosis of pregnancy. In one case, interpretation of the MRU was limited as a result of patient motion. Of the patients with obstructing stones, 1 required endourologic management during her pregnancy and 3 were followed conservatively. No adverse events related to MRU occurred.

Conclusion

HASTE MRU is an informative imaging study for pregnant women with suspected upper tract stone disease. Information gathered from this study augments that gained from alternative modalities, and aids in medical decision-making. The lack of ionizing radiation exposure, coupled with the capture of detailed anatomic imaging, makes HASTE MRU a particularly useful study in this setting.

Section snippets

Patients

Pregnant women undergoing HASTE MRU for suspected urinary calculi at Johns Hopkins Hospital (JHH) or Johns Hopkins Bayview Medical Center (JHBMC) were identified retrospectively. In all cases, the indication for HASTE MRU was flank pain consistent with renal colic and the review of a renal ultrasound, which demonstrated hydronephrosis but no obstructing stone. In this way, it was not apparent whether the hydronephrosis represented physiological hydronephrosis of pregnancy or hydronephrosis

Patient Characteristics

Between 2008 and 2011, 9 pregnant women underwent HASTE MRU for suspected renal colic. The mean age of these women was 25 years (range 20-34) and the mean gestational age was 23.4 weeks (range 9-36). Six women were evaluated during their first pregnancy and the remaining women had 1, 2, and 3 prior pregnancies. Three women had a history of nephrolithiasis, but none of their prior pregnancies was complicated by stone disease (Table 1).

In all cases, patients presented to their obstetrician with

Comment

The diagnosis of obstructing ureteral calculi during pregnancy can be a challenging clinical scenario, with serious consequences for the health of both mother and child. The selection of an imaging study to confirm the diagnosis of an obstructing stone can be confusing, because there are significant implications associated with exposure of the developing fetus to ionizing radiation. Although the radiation exposure from a single CT study of the abdomen and pelvis is likely safe for the

Conclusions

Confirming the diagnosis of an obstructing ureteral calculus in pregnant women is a difficult clinical task. Commonly used imaging modalities are either poorly sensitive for ureteral calculi (ie, renal ultrasound) or require exposure of the patient and fetus to ionizing radiation (ie, CT imaging). We report on the application of HASTE MRU as a non–radiation-based imaging modality that can inform the clinician to a greater degree of detail on the presence of ureteral calculi and/or ureteral

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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