Filling defect artefacts in magnetic resonance urography

The aim of this study was to determine the prevalence of filling defect artefacts (FDA) in magnetic resonance urography (MRU). Retrospectively, we assessed MRU examinations of 45 patients with neurogenic bladder dysfunction (21 men, 24 women; mean age 35 years, age range 18-71 years). The MRU was performed 30 min after intramuscular injection of 20 mg frusemide using heavily T2-weighted fast-spin-echo techniques [axial, thick coronal slab, coronal maximum intensity projection (MIP) images] with fat saturation. The images were reviewed by two observers to determine the presence of filling defects and dilatation of pelvicalyceal system and ureters. The filling defects were classified into central, eccentric and complete. Clinical course and plain films were reviewed to determine significance of the detected filling defects. True filling defects were observed in 5 patients (11%) and all due to stones seen on the plain radiograph of the abdomen. Filling defects artefacts (FDAs) were seen in 23 patients (51%; 17 pelvicalyceal system, 17 upper third of ureters, 7 mid ureters and 1 distal ureter). No stones were seen on the plain radiograph of these patients and they had a favourable clinical course for over 24 months. The true filling defects were large in size, eccentric in position and seen in more than one sequence of the MRU examination (axial, n=5; slab, n=5; and MIP, n=4). Four (80%) of the patients with true defects and 21 (91%) of those with FDAs had dilatation of the pelvicalyceal system and ureters. The FDAs were small in size, centrally placed (74%) and always seen in axial images, rarely in slab images (2 cases) and not seen in MIP images. Artefactual filling defects can be seen in MRU examinations. The cause of the FDAs is not fully explained and could be secondary to turbulent and fast flow of the urine. Some of the FDAs seen in the calyces could be due to the tips of the papillae. Awareness of such defects obviates misinterpretation and prevents unnecessary further investigations or interventions.