Assessment of painful ureterohydronephrosis during pregnancy by MR urography

The purpose of this study was to assess the value of the fast imaging sequence called RARE (rapid acquisition with relaxation enhancement) MR urography (or RMU) in pregnant women with painful ureterohydronephrosis. A total of 17 pregnant women with an acute flank pain were examined with RMU. Results were compared with those of US, X-rays and the evolution of symptoms. The gold standard techniques used to evaluate the results of MR urography were US when it showed the entire dilated urinary tract and the nature of the obstruction (9 cases), limited intravenous urography (IVU) when performed (3 cases) or endoscopic procedure (5 cases). The accuracy of RMU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (sensitivity 100% in our series). The determination of the type of obstruction, intrinsic vs extrinsic, was always exact. The RMU technique alone could not specify the exact nature of the obstruction. The RMU technique is able to differentiate a physiological from a pathological ureterohydronephrosis during pregnancy. It could be considered as the procedure of choice when US failed to establish the differential diagnosis.