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MR Virtual Endoscopy of the Upper Urinary Tract

Emanuele Neri1, Piero Boraschi2, Davide Caramella1, Luigi Battolla1, Roberto Gigoni2, Nicola Armillotta1, Giovanni Braccini2 and Carlo Bartolozzi1

1 Department of Oncology, Transplants and Advanced Technologies in Medicine, Division of Diagnostic and Interventional Radiology, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
2 Second Department of Radiology, Pisa University Hospital, 56100, Pisa, Italy.



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  		Fig. 1. —57-year-old woman who underwent colectomy for colorectal cancer. MR urogram shows dilatation of left renal pelvis and ureter, caused by extrinsic compression of ureter by postoperative fibrosis. Histogram was obtained by tracing on MR urogram circular region of interest (size, 1000 mm2) to include urinary tract (B) and surrounding tissue (A). Among image pixels belonging to urinary tract, virtual endoscopy threshold is identified as cluster of pixels with lower signal intensity.

 


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  		Fig. 2A. —43-year-old man with recurrent infections of urinary tract. MR urogram source image shows dilatation of renal pelvis, suggesting obstruction of pelviureteric junction.

 


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  		Fig. 2B. —43-year-old man with recurrent infections of urinary tract. Maximum-intensity-projection image reveals site of urinary obstruction (arrow). Note three major calices that fuse to form renal pelvis.

 


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  		Fig. 2C. —43-year-old man with recurrent infections of urinary tract. Virtual endoscopic image, created by simulating position of endoscope at level of renal pelvis, shows internal surface of superior (short solid arrows), medium (open arrows), and inferior (long solid arrows) major calices.

 


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  		Fig. 3A. —78-year-old man with hematuria. MR urogram shows filling defect within renal pelvis (arrows).

 


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  		Fig. 3B. —78-year-old man with hematuria. Maximum-intensity-projection image shows extension of lesion to superior major calyx (arrows).

 


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  		Fig. 3C. —78-year-old man with hematuria. Virtual endoscopic image, created from pelviureteric junction to show renal pelvis and calices, reveals well-defined irregularly shaped endoluminal mass.

 


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  		Fig. 3D. —78-year-old man with hematuria. MR urogram shows entire dilatation of ureter (maximum diameter, 15 mm) and site of obstruction (arrow).

 


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  		Fig. 3E. —78-year-old man with hematuria. Virtual endoscopic images, obtained in ureter, show pelviureteric junction (E), abdominal (F and G) and pelvic (H and I) tracts of ureter, and site of occlusion (arrow, J).

 


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  		Fig. 3F. —78-year-old man with hematuria. Virtual endoscopic images, obtained in ureter, show pelviureteric junction (E), abdominal (F and G) and pelvic (H and I) tracts of ureter, and site of occlusion (arrow, J).

 


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  		Fig. 3G. —78-year-old man with hematuria. Virtual endoscopic images, obtained in ureter, show pelviureteric junction (E), abdominal (F and G) and pelvic (H and I) tracts of ureter, and site of occlusion (arrow, J).

 


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  		Fig. 3H. —78-year-old man with hematuria. Virtual endoscopic images, obtained in ureter, show pelviureteric junction (E), abdominal (F and G) and pelvic (H and I) tracts of ureter, and site of occlusion (arrow, J).

 


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  		Fig. 3I. —78-year-old man with hematuria. Virtual endoscopic images, obtained in ureter, show pelviureteric junction (E), abdominal (F and G) and pelvic (H and I) tracts of ureter, and site of occlusion (arrow, J).

 


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  		Fig. 3J. —78-year-old man with hematuria. Virtual endoscopic images, obtained in ureter, show pelviureteric junction (E), abdominal (F and G) and pelvic (H and I) tracts of ureter, and site of occlusion (arrow, J).

 

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